scholarly journals Dermoscopy of difficult-to-diagnose Melanomas

2016 ◽  
Vol 8 (3) ◽  
pp. 121-127
Author(s):  
Chrysoula Papageorgiou ◽  
Demetrios Ioannides ◽  
Zoe Apalla ◽  
Efstratios Vakirlis ◽  
Elisabeth Lazaridou ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Invasive Procedure ◽  
Cutaneous Lesions ◽  
Non Invasive ◽  
Melanoma Detection ◽  
Melanocytic Lesions ◽  
Melanoma Subtypes ◽  
Digital Dermoscopy ◽  
Excision Rate

Abstract Dermoscopy is a non-invasive procedure that allows the evaluation of cutaneous lesions, and is considered to be a useful tool that improves the diagnostic accuracy of melanoma. Many dermoscopic criteria of melanoma have been established and several algorithms have been created for melanoma detection. However, the recognition of some melanomas remains challenging. Melanomas on specific body sites, melanomas in patients with multiple atypical moles, and nodular melanomas represent the most difficult-to-recognize melanoma subtypes, since they typically lack the “classic” melanoma-specific criteria. This paper provides an update on dermoscopy of difficult-to-diagnose melanomas by summarizing the newest data. Lastly, we highlight the importance of digital dermoscopy in the follow-up of melanocytic lesions for the detection of incipient melanomas while maintaining a low excision rate.

scholarly journals The applicability of non-invasive methods for assessing liver fibrosis in hemodialysis patients with chronic hepatitis C

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242601
Author(s):  
Jia-Jung Lee ◽  
Yu-Ju Wei ◽  
Ming-Yen Lin ◽  
Sheng-Wen Niu ◽  
Po-Yao Hsu ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Hepatitis C ◽  
Transient Elastography ◽  
Hemodialysis Patients ◽  
Accurate Assessment ◽  
Non Invasive

Background The accurate assessment of liver fibrosis among hemodialysis patients with chronic hepatitis C (CHC) is important for both treatment and for follow up strategies. Applying the non-invasive methods in general population with viral hepatitis have been successful but the applicability of the aminotransferase/platelet ratio index (APRI) or the fibrosis-4 index (FIB-4) in hemodialysis patients need further evaluation. Materials and methods We conducted a prospective, multi-center, uremic cohort to verify the applicability of APRI and FIB-4 in identifying liver fibrosis by reference with the standard transient elastography (TE) measures. Results There were 116 CHC cases with valid TE were enrolled in our analysis. 46 cases (39.6%) were classified as F1, 35 cases (30.2%) as F2, 11 cases (9.5%) as F3, and 24 cases (20.7%) as F4, respectively. The traditional APRI and FIB-4 criteria did not correctly identify liver fibrosis. The optimal cut-off value of APRI was 0.28 and of FIB-4 was 1.91 to best excluding liver cirrhosis with AUC of 76% and 77%, respectively. The subgroup analysis showed that female CHC hemodialysis patients had better diagnostic accuracy with 74.1% by APRI. And CHC hemodialysis patients without hypertension had better diagnostic accuracy with 78.6% by FIB-4. Conclusions This study confirmed the traditional category level of APRI and FIB-4 were unable to identify liver fibrosis of CHC hemodialysis patients. With the adjusted cut-off value, APRI and FIB-4 still showed suboptimal diagnostic accuracy. Our results suggest the necessary of TE measures for liver fibrosis in the CHC uremic population.

scholarly journals THU0530 HIGHLY-SENSITIVE CARDIAC TROPONIN I AND BETA-2-GLYCOPROTEIN-I IGA ANTIBODIES INFORM THE UTILITY OF SCREENING AND FOLLOW-UP NON-INVASIVE CORONARY ATHEROSCLEROSIS EVALUATION AND OPTIMIZE CARDIOVASCULAR RISK ASSESSMENT IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 504.2-505
Author(s):  
G. Karpouzas ◽  
S. Ormseth ◽  
E. Hernandez ◽  
M. Budoff
Keyword(s):  
Diagnostic Accuracy ◽  
Cardiac Troponin ◽  
Coronary Atherosclerosis ◽  
Troponin I ◽  
Coronary Plaque ◽  
Non Invasive ◽  
Obstructive Disease ◽  
Highly Sensitive ◽  
Iga Antibodies

Background:Occult coronary atherosclerosis burden predicts mid-term cardiovascular disease (CVD) events in rheumatoid arthritis (RA) above and beyond Framingham D’Agostino cardiac risk score (FRS-DA). Highly-sensitive cardiac troponin I (hs-cTnI) levels in blood associate with coronary plaque burden and event risk in RA. Moreover, IgA antibodies against beta2-glycoprotein-1 (a-b2GPI-IgA)- an atherosclerotic plaque antigen- in RA promote coronary plaque progression and moderate the effect of inflammation on CVD events. It is currently unclear when to recommend a screening, non-invasive coronary atherosclerosis evaluation in asymptomatic RA patients and whether such an assessment should be repeated.Objectives:To explore whether either biomarker alone or their combination improved prediction of plaque presence on an initial coronary CT angiogram (CCTA) beyond FRS-DA score; to evaluate whether either biomarker predicted progression to extensive or obstructive plaque on a follow-up evaluation.Methods:One hundred fifty RA patients underwent a baseline CCTA; 101 had repeat evaluation within 6.9±0.3 years. Hs-cTnI and a-b2GPI-IgA were assessed at baseline; the latter were confirmed 12 weeks later, if positive. Lesions rendering greater than 50% luminal stenosis were considered obstructive. Extensive plaque was defined as >5 coronary segments with plaque, or stenosis score>5, or coronary artery calcium score (CAC)>100. The diagnostic accuracy of FRS-DA alone vs. with hs-cTnI or a-b2GPI-IgA individually or combined for plaque or CAC at baseline was evaluated as area under the curve (AUC). Improvement in prediction accuracy between constructs was further assessed as integrated discrimination improvement (IDI). Similar AUC and IDI constructs evaluated the transition to obstructive or extensive atherosclerosis at follow-up in patients with baseline non-extensive or non-obstructive disease.Results:High hs-cTnI (>1.5pg/ml) added to FRS-DA increased AUC from 0.717 to 0.731 (Figure 1A) and improved prediction accuracy for baseline plaque [IDI=0.041 (SE)=0.017, p=0.015]. In contrast, a-b2GPI-IgA did not [IDI=0.005 (0.006), p=0.47] and the combination offered no added benefit to the hs-cTnI model alone. Similar observations were made for CAC. Presence of a-b2GPI-IgA independently associated with coronary plaque progression (IRR=1.67 [95%CI 1.04-2.67]), whereas hs-cTnI did not. Likewise, a-b2GPI-IgA associated with transition to extensive or obstructive disease independently of FRS-DA (OR=13.48 [95%CI 2.09-86.99]). Notably, 71.4% of a-b2GPI-IgA positive patients with high hs-cTnI progressed to extensive or obstructive disease compared to 7.7% of a-b2GPI-IgA negative subjects with high hs-cTnI (p=0.008). Addition of a-b2GPI-IgA to FRS-DA in patients with prevalent non-extensive non-obstructive plaque increased AUC from 0.785 to 0.900 (Figure 1B) and significantly improved the prediction for development of obstructive or extensive atherosclerosis at follow-up [0.387, (0.13), p=0.003].Figure 1.(A) Diagnostic accuracy for prediction of occult coronary atherosclerosis at baseline. FRS-DA alone is the base model followed by addition of hs-cTnI or a-b2GPI-IgA individually or combined.(B) Diagnostic accuracy for progression from non-obstructive and non-extensive plaque at baseline to obstructive or extensive atherosclerosis at follow-up.Conclusion:High hs-cTnI improved the risk of baseline plaque presence beyond clinical risk score and may trigger an initial non-invasive coronary atherosclerosis evaluation. A-b2GPI-IgA presence may justify a follow-up evaluation in patients with non-extensive, non-obstructive plaque at baseline.Disclosure of Interests:George Karpouzas Grant/research support from: Pfizer, Consultant of: Sanofi-Genzyme-Regeneron, Janssen, Speakers bureau: Sanofi-Genzyme-Regeneron, BMS, Sarah Ormseth: None declared, Elizabeth Hernandez: None declared, Matthew Budoff: None declared

scholarly journals AN OBSERVATIONAL STUDY OF DERMOSCOPIC FINDINGS IN CASES OF LICHEN PLANUS IN INDIAN SKIN

2020 ◽  
pp. 1-2
Author(s):  
Mayuri Ranpariya ◽  
Brijesh Parmar
Keyword(s):  
Observational Study ◽  
Lichen Planus ◽  
Tertiary Care ◽  
Invasive Procedure ◽  
Vascular Pattern ◽  
Background Color ◽  
Non Invasive ◽  
Care Institute ◽  
Almost All

INTRODUCTION: Dermoscopy is non-invasive procedure used for diagnosis of various dermatoses. As there are very few dermoscopic studies available on LP in India, this study was undertaken to explore its role. AIM: To study dermoscopic features in LP cases. METHOD: Dermoscopic examination was done in 65 cases of LP over the study period of 3 months at a tertiary care institute. RESULTS: Total 155 lesions of 29 classical LP(CLP), 13 hypertrophic LP(HLP), 9 eruptive LP(ELP), 6 lichen planus pigmentosus(LPP), 4 lichen plano pilaris(LPPI), 2 linear LP(LLP), 2 follicular LP(FLP) cases were examined. Lesions of CLP, ELP and LLP were examined in which: Active lesions (94 lesions) - Wickham’s striae (WS): commonest pattern was radial streaming (40% lesions) and Color was white (91.48% lesions). Pigment pattern (PP): absent in almost all lesions. Commonest vascular pattern (VP): radial linear in 68.08% lesions. Commonest background Color (BC): violet Regressed lesions (20 lesions) - WS: absent in 95% lesions. Commonest PP: diffuse dots/globules (80% lesions). VP: absent. BC: brown (100% lesions) HLP (26 lesions)-Keratin Plugs (KP) in 84.61% lesions, VP: absent. FLP (2 lesions) -follicular KP in all lesions. LPP (9 lesions)-Reticular & granular Pattern was seen in all lesions, commonest pigment was dark brown, different intensity of pigmentation was present in 4 lesions. LPPI (4 lesions)-Follicular atrophy, peripilar cast and interfollicular reticular brownish pigmentation was seen in all lesions. CONCLUSION: Dermoscopic findings of LP and its variants can be useful for diagnosis and follow up.

scholarly journals Melanocytic lesions ≤ 6mm: Prospective series of 481 melanocytic trunk and limb lesions in Brazil

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252162
Author(s):  
Gabriella Campos-do-Carmo ◽  
Aretha Brito Nobre ◽  
Tullia Cuzzi ◽  
Giuseppe Argenziano ◽  
Carlos Gil Ferreira ◽  
...  
Keyword(s):  
Excisional Biopsy ◽  
Benign Lesions ◽  
Cutaneous Lesions ◽  
Predictive Values ◽  
Mortality And Morbidity ◽  
Melanocytic Lesions ◽  
Sensitivity Specificity ◽  
Breslow Index

Early diagnosis when melanoma is still small and thin is essential for improving mortality and morbidity. However, the diagnosis of small size melanoma might be particularly difficult, not only clinically but also dermoscopically. This study aimed to define clinical and dermatoscopic parameters in the diagnosis of suspicious pigmented cutaneous lesions with a diameter of ≤ 6mm and determine the sensitivity, specificity, positive and negative predictive values as well as the accuracy of each clinical and dermatoscopic criterion. This is a transversal, descriptive and analytical study of dermatoscopic analysis with the gold standard being the pathologic examination obtained from the excisional biopsy of suspicious melanocytic lesions with a diameter of ≤ 6mm. Trunk and limb lesion data from a public health service and a private clinic were prospectively collected from 2011 to 2017 by a unique observer. In total, 481 melanocytic lesions were included, with 73.8% being ≤ 4mm in diameter. Overall, 123 were diagnosed as melanoma, 56.0% in situ and 22.0% as thin melanomas (Breslow index 0.1 to 1.0mm). Melanoma presented symmetry in 53.7% of cases, regular borders in 54.5% and a single color in 60.2%. Regarding evolution, 13.8% of melanomas versus 10.9% of benign lesions (p = 0.116) were new by comparing photos from baseline with photos from the follow-up. The majority of melanomas (65%) were found on the limbs compared to 37.2% of the benign lesions at this location (p<0.001). A multiple logistic regression model adjusted for age, gender and location was created. The independent variables associated with the diagnosis of melanoma ≤ 6mm, adjusted for age, gender and location, were: streaks (adjusted Odds Ratio [aOR] 2.5; 95% CI 1.3–4.7; p = 0.006), and the presence of a structureless area (aOR 2.2, 95% CI 1.2–4.0, p = 0.011). Conversely, a symmetric typical pigment network was a protection variable (aOR 0.4, 95% 0.7–0.9, p = 0.040). In conclusion, dermatoscopic criteria have been identified which help to diagnose cases of small size melanoma. These include streaks and structureless areas that can be taken, particularly in consideration for the diagnosis of this subset of small difficult melanomas.

scholarly journals Membranous Glomerulonephritis: Overview of the Role of Serum and Urine Biomarkers in the Management

2019 ◽  
Author(s):  
Sadiq Mu'azu Maifata ◽  
Rafidah Hod ◽  
Nor Fadhina Zakaria ◽  
Fauzah Abd Ghani
Keyword(s):  
Membranous Glomerulonephritis ◽  
Invasive Procedure ◽  
Treatment Decision ◽  
Retinol Binding Protein ◽  
Non Invasive ◽  
Urine Biomarkers ◽  
Beta 2 Microglobulin ◽  
Serum And Urine

Detection of PLA2R and THSD7A among primary membranous glomerulonephritis (MGN) patients transformed the diagnosis, treatment monitoring and prognosis. Anti-PLA2R can be detected in 70-90% of primary MGN patients while anti-THSD7A in 2-3% of anti-PLA2R negative primary MGN patients depending on the technique used. Serum and urine samples are less invasive and non-invasive respectively and can detect the presence of anti-PLA2R and anti-THSD7A with higher sensitivity and specificity, significant in patients&rsquo; monitoring and prognosis better than exposing patients to frequent biopsy which is an invasive procedure. Different techniques of detection of PLA2R and THSD7A in patients&rsquo; urine and sera were reviewed with the aim of providing newer and alternative techniques. We proposed the use of biomarkers (PLA2R and THSD7A) in making the diagnosis, treatment decision and follow up of patients with primary MGN. We also reviewed other prognostic renal biomarkers like retinol binding protein (RBP) and beta-2 microglobulin in order to detect progression of renal damage for early intervention.

MR guided high intensity focused ultrasound (MRgFUS) for the treatment of oligometastatic prostate cancer bone metastasis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17600-e17600
Author(s):  
Alessandro Napoli ◽  
Luca Marchetti ◽  
Enrico Cortesi ◽  
Paolo Marchetti
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Focused Ultrasound ◽  
Treatment Time ◽  
Invasive Procedure ◽  
High Intensity Focused Ultrasound ◽  
Bone Lesions ◽  
Non Invasive ◽  
Oligometastatic Prostate Cancer

e17600 Background: With improvements in diagnostic modalities such as functional imaging, oligometastatic prostate cancer is being diagnosed with greater frequency than ever before. Our aim was to determine MRgFUS ability to downstage patients with oligometastatic bone disease with single session of non-invasive metastasis-directed therapy. Methods: The study was designed with intention-to-treat metastatic bone lesions. Patients were enrolled if they had accessible bone metastasis and could safely undergo MRgFUS (InSightec, Israel). Baseline measurable characteristics included dynamic contrast enhanced MRI study (DCE; Gd-BOPTA, Bracco; GE 750 3T magnet) with semiquantitative perfusion analysis, PSA level (ng/ml) and choline PET (SUV). Measurable variables were obtained at treatment time, 3 months, 12 months and 24 months follow-up. Results: 18 patients fulfilled the inclusion criteria and safely underwent MRgFUS procedure of metastatic bone ablations. Lesions were located in the pelvis (11), scapula (3) and long bones (4). At baseline all lesions showed a significant DCE perfusion (highly vascular) with mean perfusion reduction of 88% at 3 months follow-up (CI: 100-50; p < 0.001) stable at subsequent follow-up scans. Similarly PSA levels decreased from a mean baseline of 19 (ng/ml) to 7.1, 2.9 and 2.1, at 3-12 and 24 moths respectively. SUV values showed similar trend with reduction from baseline (mean 8.9 to 3.0, 2.3 and 1.7: p < 0.001). In all patients single MRgFUS session was appropriate without any major or minor adverse events reported. Conclusions: MRgFUS is a totally non-invasive procedure that can obtain complete bone ablation in patients with oligometastatic prostate disease. The technique features a radiation-free approach that can be of incremental value in long-survivor subset on oncological patients, significantly reducing risk of toxic effects. Concurrent chemo regimen is not a contraindication.

scholarly journals The Impact of COVID-19 Outbreak on Syncope Units Activities in Italy: A Report from the Italian Multidisciplinary Working Group on Syncope (GIMSI)

2021 ◽  
Vol 18 (17) ◽  
pp. 9194
Author(s):  
Vincenzo Russo ◽  
Giulio Boggian ◽  
Maria Giulia Bolognesi ◽  
Domenico Maria Carretta ◽  
Simone Cencetti ◽  
...  
Keyword(s):  
Working Group ◽  
Invasive Procedure ◽  
Cardiac Pacing ◽  
Time Frame ◽  
Non Invasive ◽  
Cardiac Implantable Electronic Devices ◽  
Multidisciplinary Working ◽  
The Impact ◽  
Remarkable Reduction

The aim of our study was to evaluate the impact of the COVID-19 outbreak on Syncope Units (SUs) Activities in Italy. Methods: Data about types of SU activities and admissions were obtained from 10 SUs throughout Italy, certified by the Italian Multidisciplinary Working Group on Syncope (GIMSI), from 10 March 2020 to 31 December 2020 and compared with the same time frame in 2019. Results: A remarkable reduction in overall non-invasive diagnostic tests (−67%; p < 0.001) and cardiac invasive procedure. Elective cardiac pacing procedures disclosed a significant decrease (−62.7%; p < 0.001); conversely, the decrease of urgent procedures was not significant (−50%; p = 0.08). There was a significantly increased rate of patients who underwent both telemedicine follow-up visits (+225%, p < 0.001) and cardiac implantable electronic devices (CIEDs) remote monitoring follow-up visits (+100%; p < 0.001). Conclusion: The COVID-19 outbreak was associated with a remarkable decrease in all clinical activities of Syncope Units in Italy, including both non-invasive tests and cardiac invasive procedures; conversely, a significant increase in telehealth activities was shown.

Sign in / Sign up

Export Citation Format

Share Document