scholarly journals A practical case: features of the autoimmune insulin syndrome diagnosis

2022 ◽  
pp. 100-103
Author(s):  
N. A. Zykova ◽  
E. V. Ignashina ◽  
E. D. Li ◽  
V. V. Kugryshev
Keyword(s):  
Genetic Background ◽  
Laboratory Tests ◽  
Medical Center ◽  
Rare Condition ◽  
Practical Case ◽  
Diagnostic Significance ◽  
Immune Mediated ◽  
Syndrome Diagnosis ◽  
Triggering Factor ◽  
Therapy Department

Autoimmune Insulin syndrome (AIS), also named Hirata disease, is a rare condition characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). AIS is a form of immune-mediated hypoglycemia, which develops when a triggering factor (medication or a viral infection) acts on an underlying predisposing genetic background. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglucemia. The article presents a case of Hirata disease diagnosing of a patient of the therapy department of the Multidisciplinary Medical Center of the Bank of Russia.Purpose: Determining of the features of the diagnosis of Autoimmune Insulin syndrome (Hirata disease)Materials and methods: the article presents a clinical case of the diagnosis of Autoimmune insulin syndrome (Hirata disease), focuses on the diagnostic significance of laboratory tests. The article is intended for general practitioners, endocrinologists, gastroenterologists.

Targeted reduction in neurosurgical laboratory utilization: resident-led effort at a single academic institution

2014 ◽  
Vol 120 (1) ◽  
pp. 173-177 ◽  
Author(s):  
Seunggu J. Han ◽  
Rajiv Saigal ◽  
John D. Rolston ◽  
Jason S. Cheng ◽  
Catherine Y. Lau ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Financial Incentives ◽  
Laboratory Tests ◽  
Medical Center ◽  
Hospital Setting ◽  
Cost Savings ◽  
Fiscal Year ◽  
Incentive Program ◽  
Neurosurgical Patients

Object Given economic limitations and burgeoning health care costs, there is a need to minimize unnecessary diagnostic laboratory tests. Methods The authors studied whether a financial incentive program for trainees could lead to fewer unnecessary laboratory tests in neurosurgical patients in a large, 600-bed academic hospital setting. The authors identified 5 laboratory tests that ranked in the top 13 of the most frequently ordered during the 2010–2011 fiscal year, yet were least likely to be abnormal or influence patient management. Results In a single year of study, there was a 47% reduction in testing of serum total calcium, ionized calcium, chloride, magnesium, and phosphorus. This reduction led to a savings of $1.7 million in billable charges to health care payers and $75,000 of direct costs to the medical center. In addition, there were no significant negative changes in the quality of care delivered, as recorded in a number of metrics, showing that this cost savings did not negatively impact patient care. Conclusions Engaging physician trainees in quality improvement can be successfully achieved by financial incentives. Through the resident-led quality improvement incentive program, neurosurgical trainees successfully reduced unnecessary laboratory tests, resulting in significant cost savings to both the medical center and the health care system. Similar programs that engage trainees could improve the value of care being provided at other academic medical centers.

scholarly journals Abnormally increased iron concentration in basal ganglia in Shy-Drager syndrome MR imaging and autonomic study: RM imagem e estudo autonômico

1991 ◽  
Vol 49 (3) ◽  
pp. 342-347 ◽  
Author(s):  
Jayme A. Maciel Jr. ◽  
Cristiane M. da Rocha ◽  
Sandra Cabelho ◽  
Mario G. Pradal
Keyword(s):  
Basal Ganglia ◽  
Mr Imaging ◽  
Laboratory Tests ◽  
Autonomic Failure ◽  
Iron Concentration ◽  
Pure Autonomic Failure ◽  
Functional Evaluation ◽  
High Field Strength ◽  
Syndrome Diagnosis ◽  
Early Case

Report of an early case of Shy-Drager syndrome in a 67 year-old woman patient. Autonomic failure was diagnosed by functional evaluation as well as laboratory tests. MR imaging disclosed a prominent putamina hypodensity in T2-weighted images at high field strength due to iron increased depositing in this basal ganglia. MR imaging evidences confirm Shy-Drager syndrome diagnosis, and contributes for differential diagnosis of idiopathic hypotension (pure autonomic failure) in special in SDS early cases.

Improving laboratory testing: can we get physicians to focus on outcome?

1995 ◽  
Vol 41 (8) ◽  
pp. 1241-1247 ◽  
Author(s):  
E T Wong
Keyword(s):  
Managed Care ◽  
Laboratory Tests ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Relative Role ◽  
Thyroid Function Tests ◽  
Healthcare Organizations ◽  
Mutual Cooperation ◽  
Laboratory Services ◽  
Beta Human Chorionic Gonadotropin

Abstract Managed care is changing the financing of healthcare and replacing open-ended reimbursement with fixed pricing schemes. Clinical laboratory tests will remain an important part of medical practice because laboratory information is essential for diagnosis and management of patients. The relative role of the hospital-based clinical laboratory, however, remains to be determined because healthcare organizations are reevaluating their services and attempting to drive down costs through reducing unit costs, decreasing utilization of services, and improving patient outcomes. The challenge for the clinical laboratory in managed care is to achieve appropriate utilization of laboratory tests so that clinical outcomes are optimized. The clinical laboratory at this medical center has used a number of approaches to improve utilization of thyroid function tests, isoenzyme tests for myocardial infarction, beta-human chorionic gonadotropin tests, and stat laboratory services for the emergency department. These experiences suggest that the laboratory can contribute to optimizing utilization of laboratory tests. This goal will require mutual cooperation of both the clinician and the clinical laboratory physician and (or) scientist.

scholarly journals Bilateral Sesamoiditis as First Manifestation of Gout

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Daniel de Oliveira Beraldo ◽  
Sasha Duarte ◽  
Gustavo Pacheco ◽  
Rodrigo Barbosa ◽  
Carolina Mendes ◽  
...  
Keyword(s):  
Laboratory Tests ◽  
Case Reports ◽  
Systemic Disease ◽  
Positive Family History ◽  
Rare Condition ◽  
Dual Energy ◽  
Male Athlete ◽  
Important Differential Diagnosis ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Sesamoiditis secondary to gout is an extremely rare condition with few case reports in the literature. It is an important differential diagnosis because the treatment depends on targeted therapy, unlike the main causes of sesamoiditis that often involves immobilization with special orthoses and prescription of anti-inflammatory drugs. We report here a case of a 38-year-old male, athlete, with bipartite medial sesamoid, who had insidious pain in the base of the left hallux. Laboratory tests showed no alterations, and imaging examinations demonstrated sesamoiditis with suspicion of stress fracture. The patient was initially prescribed an immobilization boot and analgesic and anti-inflammatory drugs, but he did not respond to the measures taken. After the onset of the same condition in the contralateral foot and getting the same imaging findings, we began an investigation of systemic disease, focusing on gout, because of a positive family history, which was confirmed by dual-energy computed tomography.

Laryngeal Langerhans Cell Histiocytosis: A Case Report and Literature Review

2020 ◽  
pp. 000348942095488
Author(s):  
Allen S. Zhou ◽  
Lei Li ◽  
Thomas L. Carroll
Keyword(s):  
Literature Review ◽  
Langerhans Cell Histiocytosis ◽  
Medical Center ◽  
Tertiary Care ◽  
Rare Condition ◽  
Surgical Excision ◽  
Langerhans Cell ◽  
Histopathological Analysis ◽  
Current Case ◽  
Tertiary Care Medical Center

Objective: To describe a case of laryngeal Langerhans cell histiocytosis, discuss its characteristic features and management, and provide a review of the available literature. Methods: A patient presenting to a tertiary care medical center with dyspnea and hoarseness is described. A literature review of laryngeal Langerhans cell histiocytosis cases was performed through a search of articles indexed in the National Institutes of Health PubMed system. Results: We report a case of a 69-year old male, who presented with a laryngeal mass highly suspicious for laryngeal squamous cell carcinoma, was treated with laser excision, and was subsequently found to have laryngeal Langerhans cell histiocytosis upon histological analysis. Including our current case, we found six prior reported cases of laryngeal Langerhans cell histiocytosis in the literature. Of the six cases, four were in adults, while two were in children. Dyspnea is a common presenting complaint present in all cases. Smoking may be a potential risk factor. Conclusions: Laryngeal Langerhans cell histiocytosis is a rare condition and an important consideration in the differential diagnosis of patients presenting with a laryngeal mass and symptoms of dyspnea or hoarseness. Biopsy and histopathological analysis are key to the diagnosis. Surgical excision and radiotherapy are successful treatments used in clinical practice.

Clinical Differential Diagnosis of Multifocal Motor Neuropathy

2012 ◽  
Vol 7 (2) ◽  
pp. 124 ◽  
Author(s):  
Jean-Marc Léger ◽  
Eugen Gavriliuc ◽  
◽  
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Rare Condition ◽  
Multifocal Motor Neuropathy ◽  
Motor Neuropathy ◽  
Diagnostic Challenge ◽  
Limb Weakness ◽  
Progressive Muscle Weakness ◽  
Immune Mediated ◽  
Clinical Differential Diagnosis

Multifocal motor neuropathy (MMN) is a rare, clinically well-defined condition within the spectrum of chronic, immune-mediated neuropathies. A typical patient history involves slowly or stepwise progressive, predominantly distal, asymmetrical limb weakness and muscle wasting, most frequently in the arm, that may have developed over a period of years. As a rare condition, MMN may present a diagnostic challenge for non-specialists and some patients may wait years for a correct diagnosis. Timely and accurate diagnosis is essential for patients with MMN. Unlike some motor neuropathies, MMN is treatable with intravenous immunoglobulin and untreated patients are likely to experience progressive muscle weakness that may result in serious functional impairment and impaired quality of life. The aim of this article is therefore to provide a guide for non-specialist neurologists to the clinical recognition and differential diagnosis of MMN.

scholarly journals Characterization of the first symptoms of multiple sclerosis in a Brazilian center: cross-sectional study

2017 ◽  
Vol 135 (3) ◽  
pp. 222-225 ◽  
Author(s):  
Vitor Breseghello Cavenaghi ◽  
Fernanda Martinho Dobrianskyj ◽  
Guilherme Sciascia do Olival ◽  
Rafael Paternò Castello Dias Carneiro ◽  
Charles Peter Tilbery
Keyword(s):  
Multiple Sclerosis ◽  
Medical Center ◽  
Cranial Nerves ◽  
Cross Sectional Study ◽  
Common Symptom ◽  
Cross Sectional ◽  
Immune Mediated ◽  
Initial Symptoms ◽  
Mean Time

ABSTRACT CONTEXT AND OBJECTIVE: Multiple sclerosis (MS) is a chronic, immune-mediated and degenerative central nervous system (CNS) disease with well-established diagnostic criteria. Treatment can modify the course of the disease. The objective of this study was to describe the initial symptoms of multiple sclerosis in a Brazilian medical center. DESIGN AND SETTING: Descriptive study, conducted in a Brazilian reference center for multiple sclerosis treatment. METHODS: Data on 299 patients with confirmed diagnoses of MS were included in the study. Their medical files were evaluated and the data were analyzed. RESULTS: The most common symptom involved the cranial nerves (50.83%) and unifocal manifestation was presented by the majority of this population (73.91%). The mean time between the first symptom and the diagnosis was 2.84 years. Unifocal symptoms correlated with longer time taken to establish the diagnosis, with an average of 3.20 years, while for multifocal symptoms the average time taken for the diagnosis was 1.85 years. Unifocal onset was related to greater diagnostic difficulty. CONCLUSIONS: MS is a heterogeneous disease and its initial clinical manifestation is very variable.

scholarly journals Inborn Errors of Metabolism-Clinical Findings and Laboratory Tests at the Children’s Medical Center, Tehran, Iran

2016 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Farzaneh Abbasi ◽  
Aria Setoodeh ◽  
Fatemeh Sayarifard ◽  
Parastoo Rostami ◽  
Ali Rabbani
Keyword(s):  
Laboratory Tests ◽  
Inborn Errors Of Metabolism ◽  
Medical Center ◽  
Clinical Findings ◽  
Inborn Errors
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