Hyperfunctioning parathyroid tumours in patients with thyroid nodules. Sensitivity and positive predictive value of high-resolution ultrasonography and 99mTc-sestamibi scintigraphy.

2003 ◽  
pp. 419-423 ◽  
Author(s):  
F Lumachi ◽  
M C Marzola ◽  
P Zucchetta ◽  
A Tregnaghi ◽  
D Cecchin ◽  
...  
Keyword(s):  
High Resolution ◽  
Primary Hyperparathyroidism ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Frozen Section ◽  
Group A ◽  
Parathyroid Tumours ◽  
Group B ◽  
High Resolution Ultrasonography ◽  
99Mtc Sestamibi

A series of 112 consecutive patients with primary hyperparathyroidism who underwent both high-resolution neck ultrasonography (US) and 99mTc-sestamibi/99mTc-pertechnetate subtraction scintigraphy (SS) prior to successful parathyroidectomy was reviewed. There were 29 (25.9%) men and 83 (74.1%) women, with a median age of 58 years (range 13-78 years). Patients were divided into two groups, according to the preoperative US findings: group A (87 patients, 77.7%) without thyroid diseases, and group B (25 patients, 22.3%) with either multinodular goitre or a solitary nontoxic thyroid nodule. In group B patients partial or total thyroidectomy was also performed, according to the intraoperative findings and frozen-section examination results. Final histopathology showed 99 (88.4%) solitary parathyroid (PT) adenomas and 3 (2.7%) PT carcinomas, while 10 (8.9%) patients had a multiglandular disease. The sensitivity and positive predictive value (PPV) were (group A vs group B) 79.8% vs 70.8% (P=0.25) and 95.7% vs 94.4% (P=0.58) for US, and 83.3% vs 87.0% (P=0.47) and 95.9% vs 90.9% (P=0.32) for SS respectively. Better but similar (P=not significant) results were obtained in patients with solitary PT tumours: 81.5% vs 77.8% (US) and 85.0 vs 94.1% (SS) sensitivity; 97.1% vs 93.3% (US) and 95.8% vs 88.9% (SS) PPV. Overall, the combination of US and SS was 92.9% sensitive (group A=93.1%, group B=92.0%; P=0.55), and the PPV reached 100% in each group. In conclusion, in patients with primary hyperparathyroidism the results of both US and SS are independent of coexistent thyroid disease, especially in patients with solitary PT tumours.

Intraoperative frozen section histopathology for the diagnosis of periprosthetic joint infection in hip revision surgery: the influence of recent dislocation and/or periprosthetic fracture

2020 ◽  
pp. 112070002093399
Author(s):  
Lucas Luyckx ◽  
Jan F A Somers ◽  
Kristof Cokelaere ◽  
Stijn Deloose ◽  
Gaétan Delrue ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Predictive Value ◽  
Periprosthetic Fracture ◽  
Frozen Section ◽  
Joint Infection ◽  
Hip Revision ◽  
Intraoperative Frozen Section ◽  
Hip Revision Surgery ◽  
Group A ◽  
Group B

Aims: To evaluate the accuracy of intraoperative frozen section histopathology for diagnosing periprosthetic joint infection (PJI) during hip revision surgery, both for patients with and without recent trauma to the hip. Patients and methods: The study included all revision total hip replacement procedures where intraoperative frozen section histopathology had been used for the evaluation of infection in a single institution between 2008 and 2015. Musculoskeletal Infection Society criteria were used to define infection. 210 hips were included for evaluation. Prior to revision surgery, 36 hips had a dislocation or a periprosthetic fracture (group A), and 174 did not (group B). Results: The prevalence of infection was 14.3% (5.6% in group A and 16.1% in group B). Using Feldman criteria, the sensitivity of histopathology was 50.0%, specificity 47.1%, positive predictive value 5.3% and negative predictive value 94.1% in group A. The sensitivity of frozen section histopathology was 75.0%, specificity 96.5%, positive predictive value 85% and negative predictive value 95.3% in group B. Conclusions: Intraoperative frozen section histopathology is reliable for the diagnosis of PJI if no dislocation or periprosthetic fracture has occurred prior to hip revision surgery.

scholarly journals DIATHERMY INCISIONS V/S SURGICAL SCALPEL INCISIONS

2015 ◽  
Vol 22 (11) ◽  
pp. 1550-1524
Author(s):  
Khawar Saeed Jamali ◽  
Naveed Ali Khan ◽  
Muhammad Jawed ◽  
Ubedullah Shaikh
Keyword(s):  
Positive Predictive Value ◽  
General Surgery ◽  
Predictive Value ◽  
Surgical Outcome ◽  
Seroma Formation ◽  
P Value ◽  
Cross Sectional ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objectives: The objective of this study was to compare the outcome of diathermyincisions v/s surgical scalpel incisions in general surgery. Study Design: Cross sectional study.Place and Duration of Study: This study was conducted at surgical unit 7, Sindh Govt. LyariGeneral Hospital and Dow University of Health Sciences between January to December 2009.Methodology: 100 consecutive patients for elective general surgery were randomly assignedto either group A incision with cutting diathermy (n=50) or group B cold steel scalpel (n=50).Data including demographic details, hospital stay, infection rate and non-infective complicationslike swelling, bleeding, dehiscence and seroma formation were recorded in both groups tocompare the final surgical outcome compared. Results: A total of 80 patients were included inthe study, placed alternatively into two groups of 40 patients each with majority being male (n =61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients of Group Awas 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared on the basisof Gender for the two groups, the positive predictive value for male patients of Group A and Bwas 90.09% and 89.28% respectively, but for females the positive predictive value of Group Aand B was 100% and 50% respectively. In Diathermy (Group A) total 20% patients developedcomplications and these were seroma formation (n=4, 8%), wound dehiscence (n=3, 6%) andwound infection (n=3, 6%). In Scalpel (Group B) total 26% patients developed complications(P-value=0.370) in which seromas was noted (n=5, 10%) then wound infection (n=4, 8%), thenwound bleeding (n=3, 6%) and lastly seroma formation (n=1, 2%). Hospital stays were alsoalmost similar with mean value 8.24 days in diathermy group and 10.54 days in scalpel group.No remarkable difference in demographics, characteristics and in other variables of patientswas noted. Conclusion: We conclude that no significant difference in surgical outcome ofboth groups (cutting diathermy Vs. steel scalpel). Therefore, use of either technique to createsurgical wound merely depends upon preference of surgeon.

The Role of HE4, a Novel Biomarker, in Predicting Optimal Cytoreduction After Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 696-702 ◽  
Author(s):  
Francesco Plotti ◽  
Giuseppe Scaletta ◽  
Stella Capriglione ◽  
Roberto Montera ◽  
Daniela Luvero ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Advanced Ovarian Cancer ◽  
Debulking Surgery ◽  
Gynecology And Obstetrics ◽  
Group A ◽  
Group B

ObjectivesThis study aimed to evaluate serum human epididymis protein 4 (HE4) changes during neoadjuvant chemotherapy (NACT) to establish HE4 predebulking surgery cutoff values and to demonstrate that CA125, HE4, and computed tomography (CT) taken together are better able to predict complete cytoreduction after NACT in advanced ovarian cancer patients.MethodsFrom January 2006 to November 2015, patients affected by epithelial advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage III–IV), considered not optimally resectable, were included in this prospective study. After 3 cycles of NACT, all patients underwent debulking surgery and were allocated, according to residual tumor (RT), into group A (RT = 0) and group B (RT > 0). Serum CA125, HE4, and CT images were recorded during NACT and compared singularly and with each other in term of accuracy, sensitivity, specificity, and positive and negative predictive value.ResultsA total of 94 and 20 patients were included in group A and group B, respectively. The HE4 values recorded before debulking surgery correlated with RT. The identified HE4 cutoff value of 226 pmol/L after NACT was able to classify patients at high or low risk of suboptimal surgery, with a sensitivity of 75% and a specificity of 85% (positive predictive value, 0.87; negative predictive value, 0.70). The combination of CA125, HE4, and CT imaging resulted in the best combination with a sensitivity of 96% and a specificity of 92% (positive predictive value, 0.96; negative predictive value, 0.94).ConclusionsThe novel biomarker HE4, in addition to CA125 and CT, is better able to predict the RT at debulking surgery and the prognosis of patients.

Estimation of the Prevalence of Pulmonary Artery Hypertension in a Large Group of β-Thalassemia Patients Using Right Heart Catheterization

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3262-3262
Author(s):  
Giorgio Derchi ◽  
Renzo Galanello ◽  
Patrizio Bina ◽  
Maria D Cappellini ◽  
Antonio Piga ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Right Heart Catheterization ◽  
Pulmonary Artery Hypertension ◽  
Heart Catheterization ◽  
Right Heart ◽  
True Prevalence ◽  
Group A ◽  
Group B

Abstract Abstract 3262 Background: Pulmonary artery hypertension (PAH) is a serious complication associated with considerable morbidity and mortality. The prevalence of PAH in patients with β-thalassemia is reported to be high, and is attributed to several pathophysiologic mechanisms including hemolysis, hypercoagulability, and iron overload. However, most available studies relied only on echocardiographic estimation of the prevalence of PAH. Recently, a study in patients with sickle cell disease established that echocardiographic evaluation alone has a low positive predictive value for PAH (Parent F, et al. NEJM 2011). The aim of this study was to establish the true prevalence of PAH in a large group of patients with β-thalassemia major (TM) and intermedia (TI) using right heart catheterization. Methods: This was a multicenter observational study of adult TM and TI patients attending Italian centers participating in the Webthal® project. The study lasted 12 months. Patients were followed, treated, and examined according to the Italian Society for the Study of Hemoglobinopathies (SITE), Thalassemia International Federation (TIF), and Task Force for Diagnosis and Treatment of Pulmonary Hypertension of European Society of Cardiology (ESC) guidelines. Patients were initially screened with transthoracic echocardiography and divided into three groups based on the findings: Group A: pulmonary artery pressure (PAP) <36 mm Hg or a tricuspid regurgitant jet velocity (TRV) <3.0 m/s; Group B: PAP >40 mm Hg or TRV >3.2 m/s; and Group C: PAP 36–40 mm Hg or TRV 3.0–3.2 m/s. Patients in Group B further underwent right heart catheterization to confirm the diagnosis of PAH. Results: A total of 1309 patients were recruited in this study (mean age 36 ± 9 year, 85.1% males) including 977 TM (mean age 34 ± 7, 83.3% males), and 332 TI (mean age 43 ± 1236, 90.8% males) patients. After initial screening, the prevalence of the three groups was as follows: All patients (Group A: n=1234 [94.2%], Group B: 47 [3.6%], Group C: 28 [2.1%]); TM patients (Group A: n=946 [96.8%], Group B: 16 [1.6%], Group C: 15 [1.5%]); TI patients (Group A: n=288 [86.7%], Group B: 31 [9.3%], Group C: 13 [3.9%]). The echocardiographic PAH prevalence estimate was 5.7% (3.2% in TM and 13.3% in TI patients) if Groups B and C are considered to have PAH; and 3.6% (1.6% in TM and 9.3% in TI patients) if only Group B is considered to have PAH. Out of the 47 patients in Group B, 33 (13 TM and 20 TI) underwent right heart catheterization (7 patients declined the procedure, 1 died, 3 were excluded because of low hemoglobin, 2 were excluded due to chronic cardiopulmonary problems, and 1 was excluded due to an erythropoietic extramedullary mass). Out of the 33 patients, 31 (93.9%, representing positive predictive value for the echocardiographic TRV >3.2 m/s threshold) had a confirmed PAH diagnosis on right heart catheterization (12 TM and 19 TI). Accordingly, the prevalence of PAH in the study sample was 2.4% (1.2% in TM and 5.7% in TI). Conclusion: The true prevalence of PAH using right heart catheterization in patients with β-thalassemia is 2.4%, with a higher prevalence noted in TI than TM patients (∼5-fold). Disclosures: No relevant conflicts of interest to declare.

scholarly journals Correlation between iPTH levels on the first postoperative day after total thyroidectomy and permanent hypoparathyroidism: our experience

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 437-442 ◽  
Author(s):  
Gian Luigi Canu ◽  
Fabio Medas ◽  
Alessandro Longheu ◽  
Francesco Boi ◽  
Giovanni Docimo ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Predictive Value ◽  
Strong Predictor ◽  
Detection Threshold ◽  
The Other ◽  
Permanent Hypoparathyroidism ◽  
Patients At Risk ◽  
Group A ◽  
Group B

AbstractPermanent hypoparathyroidism is the most common long-term complication after thyroidectomy. We evaluated whether iPTH concentrations on the first postoperative day may be a good predictor of this complication.Patients undergoing thyroidectomy in our Unit between January 2017 and February 2018 who developed postsurgical hypoparathyroidism were analysed. According to iPTH values on the first postoperative day and on the basis of the detection threshold of the iPTH test used, patients were divided into 2 groups: Group A (iPTH < 6.3 pg/mL, undetectable), Group B (iPTH ≥ 6.3 pg/mL).Seventy-five patients were included in this study: 64 in Group A and 11 in Group B. Permanent hypoparathyroidism occurred in 14 (21.88%) patients in Group A, while none developed this complication in Group B. When iPTH was < 6.3 pg/mL, the sensitivity for the prediction of permanent hypoparathyroidism was 100%, the specificity was 18.03%, the positive predictive value was 21.88% and the negative predictive value was 100%.No patient with iPTH ≥ 6.3 pg/mL on the first postoperative day developed permanent hypoparathyroidism. On the other hand, iPTH concentrations < 6.3 pg/mL have not proved to be a strong predictor of this condition. However, this cut-off value can be useful to identify patients at risk of developing this complication.

scholarly journals ACUTE APPENDICITIS

2015 ◽  
Vol 22 (12) ◽  
pp. 1601-1605
Author(s):  
Khawar Saeed Jamali ◽  
Humaid Ahmed ◽  
Muhammad Jawed ◽  
Ubedullah Shaikh
Keyword(s):  
Acute Appendicitis ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Cross Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Group A ◽  
Male Patients ◽  
The Mean ◽  
Group B

Objectives: The objective of this study was to compare the efficacy of ClinicalEvaluation and modified Alvarado scoring system in diagnosing acute appendicitis. StudyDesign: Cross sectional study. Place and Duration of Study: This study was conducted atSurgical Unit III of Civil Hospital Karachi from May 2010 to October 2010. Methodology: Thisstudy consisted of eighty patients. Patients were divided in two groups. Group A for completeclinical evaluation comprising of 40 patients and Group B for modified Alvarado scoring systemcomprising of 40 patients. Inclusion criteria were all patients presenting with RIF pain, nausea,vomiting, fever and/or anorexia, diagnosed as having acute appendicitis preoperatively andundergoing emergency appendectomy during this period, age >12 years and both gender.Exclusion criteria included not willing for surgery, General anesthesia problem, pregnant femalepatients and those who did not give written consent. Results: A total of 80 patients were includedin the study, placed alternatively into two groups of 40 patients each with majority being male(n = 61, 76.3%). The mean age was 22.46 years. The positive predictive value for patients ofGroup A was 92.5% while for Group B was 77.5%. When diagnostic accuracy was compared onthe basis of Gender for the two groups, the positive predictive value for male patients of GroupA and B was 90.09% and 89.28% respectively, but for females the positive predictive valueof Group A and B was 100% and 50% respectively. Conclusion: We conclude that modifiedAlvarado score can be used safely and effectively in diagnosing acute appendicitis in adultmales especially as the score increases from seven to nine.

Ascitic procalcitonin as a diagnostic and prognostic marker of spontaneous bacterial peritonitis

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Amira Ahmed Salem ◽  
Sarah Abd ElKader ElNakeep ◽  
Ahmed Mohamed ElGhandourl ◽  
Mohamed Ahmed Ahmed Mohamed
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Prognostic Marker ◽  
Ascitic Fluid ◽  
Neutrophil Count ◽  
Predictive Value ◽  
Spontaneous Bacterial Peritonitis ◽  
Bacterial Peritonitis ◽  
Group A ◽  
Group B

Abstract Background SBP is a condition that requires a high index of suspicion, rapid and accurate diagnosis in addition to prompt and effective therapy. It is also characterized by a high recurrence rate within one year of the 1st episode. Objective Evaluation of ascitic fluid procalcitonin as a possible diagnostic and prognostic marker for spontaneous bacterial peritonitis and to study its role in diagnosis of SBP with no increase in the neutrophil count (where neutrophils in the ascitic fluid are less than 250 per ccm while the culture is positive). Patients and Methods Study was conducted at Hepatology and Gastroenterology Department in Ahmed Maher Teaching Hospital and Internal Medicine Department in Ain Shams University from January 2019 till July 2019. Total number of 50 patients with cirrhotic ascites entered this study were divided into three groups: Group A (patient group): 20 patients with SBP as diagnosed by 250 neutrophils or greater per cmm of the ascitic fluid as present in the guidelines. Group B (patient group): 20 patients with criteria suggestive of SBP (abdominal pain, fever, liver function deterioration, leukocytosis in the CBC with no other localization for the infection), but shows neutrophil count in the ascitic fluid less than 250 i.e not diagnostic by itself. Only Patients with positive culture will be included in this group. Group C (control group): 10 patients with ascites,but no evidence of SBP (symptomatic or laboratory) as the control. Results Ascitic fluid procalcitonin level was statistically significant higher in both groups A&B (SBP group) than group C (non-SBP group). As regards Group A VS Group B+ Group C: The cutoff point is 520 (pg). Its sensitivity is 95%. Its specificity is 53.3%. The AUC is 0.633. The positive predictive value is 57.6%. The negative predictive value is 94.1%. Regarding Group B VS Group C: The cut-off point is 300 (pg). Its sensitivity is 85%. Its specificity is 70%. The AUC is 0.823. The positive predictive value is 85%. The negative predictive value is 70%. Conclusion Ascitic fluid procalcitonin had high sensitivity and specificity in diagnosis of SBP. Procalcitonin is valuable in diagnosis and prognosis of SBP. Procalcitonin is more useful as inflammatory marker than in infections

scholarly journals Dynamic Monitoring of sTREM-1 and Other Biomarkers in Acute Cholangitis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Jiahui Jiang ◽  
Xiaolei Wang ◽  
Tongtong Cheng ◽  
Mingyue Han ◽  
Xinxin Wu ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Acute Cholangitis ◽  
Dynamic Monitoring ◽  
Sepsis Group ◽  
Reactive Protein ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background. Sepsis is a common complication of acute cholangitis (AC), which is associated with a high mortality rate. Our study is aimed at exploring the significance of white blood cell (WBC), C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells 1 (sTREM-1), and temperature (T) alone or combined together in early identification and curative effect monitoring of AC with or without sepsis. Methods. 65 consecutive cases with AC and 76 control cases were enrolled. They were divided into three groups: Group A (AC with sepsis), Group B (AC without sepsis), and Group C (inpatients without AC or other infections). The levels of WBC, CRP, PCT, sTREM-1, and temperature were measured dynamically. The study was carried out and reported according to STARD 2015 reporting guidelines. Results. CRP had the highest AUC to identify AC from individuals without AC or other infections (AUC 1.000, sensitivity 100.0%, specificity 100.0%, positive predictive value 100.0%, and negative predictive value 100.0%). Among various single indexes, PCT performed best (AUC 0.785, sensitivity 75.8%, specificity 72.2%, positive predictive value 68.7%, and negative predictive value 78.8%) to distinguish sepsis with AC, while different combinations of indexes did not perform better. From day 1 to day 5 of hospitalization, the levels of sTREM-1 in Group A were the highest, followed by Groups B and C (P<0.05); on day 8, sTREM-1 levels in Groups A and B declined back to normal. However, other index levels among three groups still had a significant difference on day 10. Both in Groups A and B, sTREM-1 levels declined fast between day 1 and day 2 (P<0.05). Conclusions. CRP is the best biomarker to suggest infection here. PCT alone is sufficient enough to diagnose sepsis with AC. sTREM-1 is the best biomarker to monitor patients’ response to antimicrobial therapy and biliary drainage.

scholarly journals ROLE OF USG FINDINGS AS A PREDICTIVE MARKER IN THREATENED ABORTION

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Kamlesh Yadav ◽  
Pragya Ojha
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Predictive Marker ◽  
World Health ◽  
Pregnant Females ◽  
Obstetrics And Gynaecology ◽  
Group A ◽  
Threatened Abortion ◽  
Group B

Background: The Centers for disease control and prevention, and the World Health Organization all define abortion as pregnancy termination before 20 week gestation or with fetus born weighing <500g [1].  Early pregnancy USG parameters: - fetal crown-rump length (CRL), the presence/absence of sub-chorionic hematoma and Fetal Heart Rate (FHR) are good predictors of outcome. Material and Methods: The study was conducted in the Department of Obstetrics and Gynaecology, S.P. Medical College Bikaner& associated Group of Hospital, Bikaner, Rajasthan. This is a hospital based prospective comparative study. The study group comprise of pregnant females attending Obstetrics and Gynaecology OPD. A total of 200 pregnant women are examined in this study. We divided these patients into 2 groups i.e group A and group B. Group A consists of 100 pregnant females with threatened abortion and group B with 100 normal pregnant female. Results: FHR at 115bpm is 76.32% sensitive, 90.32% specific in predicting abortion with 82.86%  positive predictive value and  86.15% negative predictive value.  While CRL at 11 mm is 50% sensitive, 69.35% specific in predicting abortion with 55% positive predictive value and 69.35% negative predictive value.   Conclusion: FHR is best predictive marker followed by presence or absence of sub-chorionic hematoma and CRL  in threatened abortion which results in loss of pregnancy. Keywords: Pregnancy, Abortion, Threatened, USG

Streptococcal Pharyngitis Study

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 808-808
Author(s):  
JENNIFER S. READ ◽  
ROBERT H. BEEKMAN
Keyword(s):  
Positive Predictive Value ◽  
Diagnostic Test ◽  
Rapid Diagnostic Test ◽  
Predictive Value ◽  
Bayes Theorem ◽  
Streptococcal Pharyngitis ◽  
Pediatric Setting ◽  
Group A

Redd and co-workers found the sensitivity of their rapid diagnostic test for group A streptococcal pharyngitis to be 62.8% and its specificity to be 96.9%. Furthermore, the positive predictive value of the test was determined to be 91.5%, sufficiently high to significantly influence the care provided to their patients. We strongly disagree with the authors' conclusion that their findings can be extrapolated to the general pediatric setting. Bayes theorem clearly relates a test's positive predictive value to its sensitivity as well as to the prevalence of true disease in the population.

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