scholarly journals Diagnostic yield and safety of transbronchial cryobiopsy in sarcoidosis

2019 ◽  
Vol 5 (4) ◽  
pp. 00203-2019 ◽  
Author(s):  
Maria Jacob ◽  
Hélder Novais Bastos ◽  
Patrícia Caetano Mota ◽  
Natália Melo ◽  
Rui Cunha ◽  
...  
Keyword(s):  
Hypersensitivity Pneumonitis ◽  
Diagnostic Yield ◽  
Tertiary Hospital ◽  
Definitive Diagnosis ◽  
Diagnostic Tools ◽  
Histological Features ◽  
Transbronchial Lung Cryobiopsy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

IntroductionTransbronchial lung cryobiopsy (TBLC) is an endoscopic technique proven to be useful in diagnostic approach to interstitial lung disease (ILD), but its role in sarcoidosis is not fully established. The aim of the present study was to assess the diagnostic yield of TBLC in sarcoidosis and its safety profile.MethodsRetrospective analysis of patients, evaluated in a tertiary hospital ILD outpatient clinic, who underwent TBLC in the diagnostic work-up. TBLC was performed in accordance with the 2018 expert statement from the Cryobiopsy Working Group.Results32 patients were included (mean±sd age 47.7±12.6 years, 59.4% male) and divided into three groups: highly likely sarcoidosis (n=21), possible sarcoidosis (n=6) and unlikely sarcoidosis (n=5). A mean of 2.8±0.8 TBLCs were performed. The definitive diagnosis was established by TBLC in 20 out of 27 patients with suspected sarcoidosis. Two patients were diagnosed with sarcoidosis by other methods performed afterwards. TBLC leaded to other diagnosis as well, such as fungal infection (n=1), hypersensitivity pneumonitis (n=1) and silicosis (n=3), making the diagnostic yield for suspected sarcoidosis of TBLC of 92.6%. TBLC was also able to show compatible histological features in five patients whom sarcoidosis was not previously considered. The complications reported overall were pneumothorax in five (15.6%) patients and moderate bleeding in one (3.1%) case.ConclusionIn this cohort, TBLC was a safe, reliable and useful procedure in sarcoidosis diagnosis. These results suggest that TBLC can be used successfully in those cases where a definitive diagnosis could not be reached with the usual and less-invasive diagnostic tools.

Toward Flow Cytometry Based Platelet Function Diagnostics

2018 ◽  
Vol 44 (03) ◽  
pp. 197-205 ◽  
Author(s):  
Ivar van Asten ◽  
Roger Schutgens ◽  
Rolf Urbanus
Keyword(s):  
Flow Cytometry ◽  
Platelet Function ◽  
Platelet Reactivity ◽  
Diagnostic Tools ◽  
Laboratory Diagnostics ◽  
Main Challenge ◽  
Platelet Function Disorders ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

AbstractThe laboratory diagnostics of (inherited) platelet function disorders mainly comprises aggregation and secretion assays, which may be suitable for diagnosing some specific severe platelet function disorders, but are not reliable enough for diagnosing mild platelet function disorders or disorders associated with low platelet count. Flow cytometric assessment of platelet reactivity will expectedly provide additional value during the diagnostic work-up of platelet function disorders because it only requires a small volume of whole blood and allows the measurement of platelet function in thrombocytopenic samples. Flow cytometry has frequently been used to evaluate platelet function in the research setting, and therefore, these assays will require clinical validation before they can be used as routine diagnostic tools. The main challenge in the validation of innovative platelet function diagnostic tests is the lack of a gold standard test for mild platelet function disorders. This review aims to address the many applications of flow cytometry in the current diagnostic work-up of platelet function testing and to discuss the challenges in introducing new tools for diagnosing platelet function disorders.

Small bowel neuroendocrine tumors: A critical analysis of diagnostic work-up and operative approach.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 203-203
Author(s):  
Cecilia Grace Ethun ◽  
Lauren McLendon Postlewait ◽  
Gillian G. Baptiste ◽  
Nina Le ◽  
Mia R. McInnis ◽  
...  
Keyword(s):  
Small Bowel ◽  
Neuroendocrine Tumors ◽  
Capsule Endoscopy ◽  
Diagnostic Yield ◽  
Operative Approach ◽  
Curative Intent ◽  
Primary Tumors ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

203 Background: Small bowel neuroendocrine tumors (SB-NET) are rare, and often small and multifocal. They are difficult to localize preoperatively and can be overlooked during operative exploration. The optimal work-up and operative approach is not known. Methods: Patients who underwent resection of SB-NET at a single institution from 2000-2014 were included. Primary aim was to describe the diagnostic work-up, pathologic characteristics, and compare minimally-invasive (MIS) to open resection. Results: 93pts underwent resection for SB-NET. Median age was 61yrs; 52% were male. On presentation, 71% of pts were symptomatic and underwent an average of 3 diagnostic tests prior to resection: 45% had octreoscans, which identified the region of primary disease in 85%; 11% had small bowel enteroscopy, with a 10% diagnostic yield; 19% had capsule endoscopy, which saw a lesion in 83%, but in only 21% was the correct number of tumors seen. The diagnostic yield of capsule was 28% overall, but 82% in pts presenting with GI bleeding. 79pts (85%) underwent curative-intent resections. Median tumor size was 1.8cm and multiple primary tumors were seen in 34pts(42%), of whom 50% had > 3 tumors. 37% had metastatic and 70% had LN positive disease. 27pts underwent MIS resections vs 66 open. MIS pts were younger (56vs61yrs;p0.035) and less likely to have obstructive symptoms (4vs24%;p = 0.19) and metastatic disease at resection (19vs44%;p = 0.038). Compared to open, the MIS group had smaller (1.7vs2.4cm;p = 0.03) and fewer tumors resected (2vs5;p = 0.049), but similar LN yield (13vs12;p = 0.7). In pts without metastases undergoing curative-intent resection, MIS approach was still associated with fewer tumors removed compared to open (1.5vs4;p = 0.034). Conclusions: Capsule endoscopy appears to be better than small bowel enteroscopy at identifying occult small bowel neuroendocrine tumors, particularly when pts present with bleeding, but still may underestimate tumor burden. While MIS may be appropriate in select patients, recognizing the limitations of preoperative evaluation is critical when selecting the operative approach for these tumors, as heightened operative vigilance is often required.

scholarly journals Perspective Chapter: Recent Advances in Musculo-Skeletal Ultrasound

2021 ◽  
Author(s):  
Felix Okechukwu Erondu
Keyword(s):  
Peripheral Nerve ◽  
Diagnostic Tool ◽  
Diagnostic Yield ◽  
Musculoskeletal Ultrasound ◽  
Therapeutic Interventions ◽  
Ultrasound Images ◽  
Doppler Techniques ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Medical imaging specialists continue to explore better ways of demonstrating pathology and anatomy of the musculo-skeletal system. The continuous quest is fuelled by the desire to improve diagnostic yield, perform procedures more quickly and accurately, reduce risks to patient or operator, achieve better cost efficiency and utilize less complex methodologies. In many instances, musculoskeletal ultrasound acts as a screening, diagnostic tool but also guide and monitor therapeutic interventions. The paper outlines the use of ultrasound in the imaging of peripheral nerve disorders, traumatic and atraumatic joint disorders, Doppler techniques such as super micro vascular Imaging and sono-elastography. Refinements in probe technology and application of digital and novel proprietary software, have continued to improve the resolution of ultrasound images and with finer details on a scale not previously possible. With increasing experience and standardization of protocols, Musculoskeletal ultrasound will continue to play a great role in the diagnostic work-up and treatment of related disorders.

scholarly journals Abdominal ultrasound in the diagnostic work-up of visceral leishmaniasis and for detection of complications of spleen aspiration

2021 ◽  
Vol 15 (2) ◽  
pp. e0009107
Author(s):  
Rezika Mohammed ◽  
Yonathan Gebrewold ◽  
Angela Schuster ◽  
Helina Fikre ◽  
Tigist Mekonnen ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Splenic Injury ◽  
Abdominal Ultrasound ◽  
Diagnostic Value ◽  
Treatment Center ◽  
Diagnostic Tools ◽  
Us Findings ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

Introduction Abdominal ultrasound (US) is increasingly used in the diagnostic work-up of infectious diseases, but studies on its diagnostic value in visceral leishmaniasis (VL) are lacking. US could help to identify complications of spleen aspiration (SA). We aimed to assess the diagnostic value of US and the evolution of findings after VL treatment; the incidence and degree of splenic injury; and the pain perceived during SA. Methodology/result We conducted a cross-sectional prospective study at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia between Oct 2017 and Dec 2018. We enrolled VL suspects undergoing tissue aspiration; US were conducted before and after SA, and at the end of VL treatment. Splenic injury was graded using the American association of surgery trauma injury scale (grade 1–4). The pain perceived during SA was graded using a visual analogue scale. Out of 392 VL suspects, 192 (49%) were confirmed VL cases. The median age was 25 years (IQR 21–30). Massive splenomegaly and hepatomegaly were the most common US findings. Splenic nodules were seen in 3.7% of the 190 VL cases and 1.5% of the 197 non-VL cases. Ascites was more common in VL (16.4%) than in non-VL cases (9.1%). The frequency of US abnormalities decreased with treatment. None of the US findings had sufficient sensitivity and specificity to justify its use as a diagnostic test. US detected splenic injury in four of the 318 patients who had post-SA US. All four patients remained clinically stable. Pain was perceived as moderate or severe in 51% of patients. Conclusion The diagnostic value of abdominal US for VL was low but found useful to detect subclinical splenic injury. SA caries a risk of splenic injury and was perceived painful by most. Further research on less invasive diagnostic tools is needed.

scholarly journals International consensus recommendations on the diagnostic work-up for malformations of cortical development

2020 ◽  
Vol 16 (11) ◽  
pp. 618-635 ◽  
Author(s):  
Renske Oegema ◽  
Tahsin Stefan Barakat ◽  
Martina Wilke ◽  
Katrien Stouffs ◽  
Dina Amrom ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Cortical Development ◽  
Abnormal Development ◽  
Malformations Of Cortical Development ◽  
Feeding Difficulties ◽  
Consensus Recommendations ◽  
Number Of Patients ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

AbstractMalformations of cortical development (MCDs) are neurodevelopmental disorders that result from abnormal development of the cerebral cortex in utero. MCDs place a substantial burden on affected individuals, their families and societies worldwide, as these individuals can experience lifelong drug-resistant epilepsy, cerebral palsy, feeding difficulties, intellectual disability and other neurological and behavioural anomalies. The diagnostic pathway for MCDs is complex owing to wide variations in presentation and aetiology, thereby hampering timely and adequate management. In this article, the international MCD network Neuro-MIG provides consensus recommendations to aid both expert and non-expert clinicians in the diagnostic work-up of MCDs with the aim of improving patient management worldwide. We reviewed the literature on clinical presentation, aetiology and diagnostic approaches for the main MCD subtypes and collected data on current practices and recommendations from clinicians and diagnostic laboratories within Neuro-MIG. We reached consensus by 42 professionals from 20 countries, using expert discussions and a Delphi consensus process. We present a diagnostic workflow that can be applied to any individual with MCD and a comprehensive list of MCD-related genes with their associated phenotypes. The workflow is designed to maximize the diagnostic yield and increase the number of patients receiving personalized care and counselling on prognosis and recurrence risk.

Abstract TP218: Transoesophageal Echocardiography in the Diagnostic Work-up of Patients With Embolic Stroke of Undetermined Source: A Necessary Investigation That Should Not Be Overlooked

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H Katsanos ◽  
Rohini Bhole ◽  
Alexandra Frogoudaki ◽  
Sotirios Giannopoulos ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Tertiary Care ◽  
Previous History ◽  
Transoesophageal Echocardiography ◽  
Atrial Septal Aneurysm ◽  
Diagnostic Work ◽  
Definition Of ◽  
The Impact ◽  
Work Up ◽  
Diagnostic Work Up

Background&Purpose: The currently proposed criteria for the definition of embolic strokes of undetermined source (ESUS) do not include investigation with transesophageal echocardiography (TEE) among the mandatory diagnostic work-up. We sought to evaluate the diagnostic yield of TEE in consecutive patients fulfilling ESUS criteria. Methods: We prospectively evaluated ischemic stroke (IS) patients fulfilling ESUS criteria from three tertiary care stroke centers during a twelve month period. All patients underwent additional diagnostic work-up with TEE to estimate both the diagnostic yield and the impact of TEE findings in the therapeutic management of patients with ESUS. Results: We identified 61 patients with ESUS who underwent investigation with TEE [mean age 44.3±11.5 years; 49.2% males; median NIHSS=5 (IQR, 3-8)]. TEE revealed additional findings in 52.4% (95%CI by the adjusted Wald method: 40.2%-64.5%) of the patients. Patent foramen ovale (PFO) and atrial septal aneurysm (ASA) were reported in 27.8% (95%CI: 18.1%-40.2%) and 13.1% (95%CI: 6.5%-24.1%) of the study population respectively. The concurrence of PFO and ASA was reported in 4 patients (6.5%, 95%CI: 2.1%-16.1%). The presence of valvular vegetations was documented in 2 patients (3.2%; 95%CI: 0%-11.8%), while thrombus was found in the left atrium of one patient (1.6%, 95%CI: 0%-9.5%). Complex aortic arch atheromatosis was reported in 6.5% (95%CI: 2.1%-16.1%) of the patients. Neither myxomas, nor ventricular septal defects were found in TEE examinations. TEE findings changed the management in 16.4% (95%CI: 8.9%-27.8%) of the patients. Anticoagulants were initiated in 5 patients, while the other 2 patients with endocarditis received treatment with intravenous antibiotics. Finally, 3 of the 61 patients underwent a PFO-closure procedure due to the large size of the shunt and the previous history of recurrent cryptogenic IS. Conclusions: Our findings suggest that ESUS patients should undergo investigation with TEE in search of potential cardioembolic or aortogenic sources. TEE findings may have a decisive impact on the selection of the appropriate therapeutic approach for these patients.

scholarly journals Stroke masquerading as cardiac arrest: the artery of Percheron

2021 ◽  
Vol 14 (1) ◽  
pp. e238681
Author(s):  
Megan Quetsch ◽  
Sureshkumar Nagiah ◽  
Stephen Hedger
Keyword(s):  
Cardiac Arrest ◽  
Clinical Assessment ◽  
Altered Consciousness ◽  
Cognitive Changes ◽  
Consciousness Level ◽  
Artery Of Percheron ◽  
Conscious Level ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

scholarly journals Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

2021 ◽  
Author(s):  
Josia Fauser ◽  
Stefan Köck ◽  
Eberhard Gunsilius ◽  
Andreas Chott ◽  
Andreas Peer ◽  
...  
Keyword(s):  
Immune Response ◽  
Case Report ◽  
Macrophage Activation ◽  
Post Mortem ◽  
Life Threatening ◽  
Appropriate Therapy ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up ◽  
Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

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