Journal articles on the topic 'Diagnosis – Examinations – Study guides'

Benign Prostatic Hyperplasia (BPH) is a medical condition that is often found in men and its incidence is influenced by age. In autopsy studies, the histologic prevalence of BPH was 8% in the fourth decade of life, 50% in the sixth decade of life, and 80% in the ninth decade of life. In addition, Benign Prostatic Hyperplasia (BPH) is a disease that is progressive and causes a decrease in the quality of life in men. Therefore, knowledge about the diagnosis and good management of BPH needs to be understood by every clinician. The writing of this article focuses on discussing the diagnosis and management of BPH. The method used in writing this article is literature review relevant sources from various references include scientific journals, the latest clinical guides from IAUI, websites, and the latest and most trusted textbooks on the topic of Benign prostatic hyperplasia (BPH). Based on the literature search, the diagnosis of BPH was established based on anamnesis, physical examination, and appropriate supporting examinations. In the history it is important to explore the various complaints that are typical of BPH patients. BPH is a medical condition that is often found in men and its incidence is influenced by age. This disease is progressive and causes a significant reduction in quality of life. The diagnosis of BPH is based on anamnesis, physical examination, and appropriate investigations. Treatment options or management in BPH patients consist of conservative therapy (watchful waiting), medication, and surgery.

Abstract This article continues a discussion of the results of a nationwide study that reviewed 2100 impairment ratings and found a large number of errors (see the May/June issue of The Guides Newsletter). Spinal impairment ratings, for example, often are erroneous. Although the AMA Guides to the Evaluation of Permanent Impairment, (AMA Guides) clearly specifies use of the Diagnosis related estimates (DRE) method, evaluators sometimes incorrectly use the range-of-motion (ROM) method, which is fraught with potential error and typically results in higher impairment ratings. The most common problem associated with rating the lower extremities is combining multiple duplicative impairments. Multiple impairments typically are combined rather than added because the latter usually results in overrating impairments. A sidebar highlights red flags to erroneous AMA Guides ratings, and evaluators can take a number of steps to ensure accurate ratings. The first of these is to ensure an unbiased rating, preferably by a board-certified physician who, ideally, also has certification in the performance of independent medical and impairment examinations. The client requesting the evaluation should provide a cover letter describing the specifics of the evaluation, and the evaluator's report should comply with standards defined in the AMA Guides. All submitted reports should be reviewed by a physician experienced in the use of the AMA Guides; this cannot be accomplished by a nonphysician reviewer.

Introduction: Frozen section is a rapid intraoperative method of tissue sectioning with the help of cryostat to arrive at a diagnosis and guide the operative procedure. It is an important diagnostic tool in the intraoperative management of ovarian neoplasms. Aims and Objectives: 1) To evaluate clinically suspected ovarian neoplastic lesions by frozen section. 2) To analyze the factors associated with difficulty in diagnoses of borderline ovarian neoplasms. Materials and Methods: This is a cross-sectional study conducted in the Department of Pathology for a period of 2 years. 60 cases of ovarian neoplasms undergoing Frozen section and subsequent histopathological examination are included in the study. Results: The mean age of patient is 39.49 years (21-72). Of the 60 cases, 73.33% are benign, 8.33% borderline and 18.3% are malignant on histopathological diagnosis. The concordance rate of frozen section with histopathological diagnosis is 91.67%. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Frozen section in the diagnosis of Benign, Borderline and Malignant ovarian neoplasms are 95.45%, 92.73%, 97.67%, 88.24% and 88.64%; 100%, 92.16%, 55.56%, 100% and 55.56%; 72.73%, 100%, 100%, 94.23% and 72.73% respectively. Conclusion: Frozen section of ovarian neoplasms helps to arrive at a diagnosis of whether they are benign or malignant with a high level of accuracy. Diagnosis of a benign lesion in a young patient guides the surgeon to a fertility conserving surgery. Likewise, diagnosis of a malignant lesion on table guides the surgeon to execute an extensive surgery in a single setting, saving the patient of the physical, emotional, psychological and financial strain of a second look operation.

Aims The aims of this study were to determine the diagnostic yield of image-guided biopsy in providing a final diagnosis in patients with suspected infectious spondylodiscitis, to report the diagnostic accuracy of various microbiological tests and histological examinations in these patients, and to report the epidemiology of infectious spondylodiscitis from a country where tuberculosis (TB) is endemic, including the incidence of drug-resistant TB. Methods A total of 284 patients with clinically and radiologically suspected infectious spondylodiscitis were prospectively recruited into the study. Image-guided biopsy of the vertebral lesion was performed and specimens were sent for various microbiological tests and histological examinations. The final diagnosis was determined using a composite reference standard based on clinical, radiological, serological, microbiological, and histological findings. The overall diagnostic yield of the biopsy, and that for each test, was calculated in light of the final diagnosis. Results The final diagnosis was tuberculous spondylodiscitis in 250 patients (88%) and pyogenic spondylodiscitis in 22 (7.8%). Six (2.1%) had a noninfectious condition-mimicking infectious spondylodiscitis, and six (2.1%) had no definite diagnosis and improved without specific treatment. The diagnosis was made by image-guided biopsy in 152 patients (56%) with infectious spondylodiscitis. Biopsy was contributory in identifying 132/250 patients (53%) with tuberculous spondylodiscitis, and 20/22 patients (91%) with pyogenic spondylodiscitis. Histological examination was the most sensitive diagnostic modality, followed by Xpert MTB/RIF assay. Conclusion Image-guided biopsy has a reasonably high diagnostic yield in patients with suspected infectious spondylodiscitis. A combination of histological examination, Xpert MTB/RIF assay, bacterial culture, and sensitivity provides high diagnostic accuracy in a country in which TB is endemic. Cite this article: Bone Joint J 2022;104-B(1):120–126.

Background: This study was initiated to compare the diagnostic hypotheses of doctors in the emergency department, ultrasound results and operative reports of patients seen for acute abdominal and/or pelvic pain. Patients and method: This is a prospective descriptive study of 12 months from January to December 2022, involving 55 consenting patients, hospitalized at the Fertilia medical clinic in Bamako and having benefited from at least one imaging examination to abdominal and pelvic emergency. Ultrasounds were performed using General Electric Voluson E8, Logic9 and Vivid3 devices. The x-rays were taken by an Italian Mecall machine. Result: Our study involved a sample of 55 consenting patients with acute abdominal and/or pelvic pain. The average age was 25.5 years. The male sex was the most represented with a sex ratio of 1.5. The most common etiology mentioned was appendicitis, i.e. 38%. The diagnostic hypotheses formulated by the host doctors were confirmed by imaging in 87.2% of cases and those of imaging confirmed by surgery in 60% of cases. Conclusion: Abdominal emergencies are frequent in consultations and mainly affect young people. The approach to the management of emergency patients requires a well-performed clinical examination which guides the choice of the imaging examination which remains most often necessary not only to make the diagnosis but also to guide the therapeutic actions. Imaging helps to correct the clinical suspicion. Despite these good results, progress remains to be made, especially in terms of the prescription of radiological examinations, in this case that concerning information.

Introduction and Aim: Coronavirus disease (COVID-19) is a viral infection that can lead to severe respiratory disease. Radiological examinations mainly computed tomography (CT) and Chest x-ray (CXR) play a role in diagnosis, follow-up, and management of COVID-19 infection. The purpose of this study was to look into the extent of using chest imaging in COVID-19 infection, as well to see if chest imaging in COVID-19 infections is justified and guided by clinical recommendation in Mosul, Iraq. Materials and Methods: This cross-sectional study involved 245 people (93 males and 152 females), infected previously with COVID-19 infection in Mosul, Iraq. The participants were asked to self-complete an anonymous questionnaire. Data obtained was subjected to statistical analysis. Results: The 245 participants had an average age of 25.7 ±8.44 years. The study sample included 57 (23.2%) with low education and 188 (76.7%) with moderate to high education. Among the radiological examinations undergone by these participants, chest X-ray (CXR) was the most common followed by chest computed tomography scan (CT scan). The CXR and the CT scan were done during the patient's illness either for diagnosis or follow-up of the disease. Non-clinically recommended examinations were reported by 64% and 20% of patients who undertook CXR and CT scan respectively, during COVID-19 illness. Higher education status was associated with a tendency to do non-recommended CXR examination during COVID-19 infection. Conclusion: CXR and CT imaging are the most commonly used radiological examinations in the diagnosis and follow-up in COVID-19 infection. However, a non-clinically recommended utilization of these examinations was noted in Mosul, Iraq during the pandemic. Therefore, educating people of this region about the limitation of non-justified uses of imaging is essential for healthy maintenance of individuals, environment, and resources.

e15680 Background: Radiological examinations including computed tomography (CT) and endoscopic ultrasound sonography (EUS) are important for the diagnosis of pancreatic neuroendocrine tumors (PNETs). Pathological diagnosis is not needed with functional PNETs because the diagnosis is made by biochemical testing. Therefore, pathological diagnosis is essential for the non-functional PNETs (nf-PNETs). In this study, we examined the diagnostic yield of radiological examinations and endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) for nf-PNETs. Methods: From January 1997 to December 2007, consecutive 38 cases were pathologically diagnosed from as nf-PNETs at Aichi Cancer Center Hospital. Of these 33 patients was diagnosed with surgical specimen, 5 patients with EUS-FNA specimen. Of 33 patients, 16 patients underwent EUS-FNA preoperatively, and were examined further: their EUS-FNA specimens were submitted for additional immunohistochemical examination for CD 56, chromogranin A, synaptophysin, somatostatin receptor 2A (SSTR2A) and Ki-67 using cell block method. Staging of PNETs was performed according to WHO classification. Results: 16 patients (10 men and 6 women) who ranged in age from 23 to 81 years. The mean of tumor size was 2.2 cm and ranged from 0.7 to 4.4 cm. Diagnosis by CT and EUS was 12 (75.0%) PNETs, two pancreatic cancer, one solid papillary tumors and one malignant lymphoma. Accurate diagnosis by cytology and immunohistochemistry was 75.0% and 93.8%, respectively. The Ki-67 in specimens of malignancy tended to be higher than those of benign or uncertain behavior. If we assumed that a tumor with Ki-67 of more than 2% was malignancy, the diagnostic accuracy was 75.0%. Positive reaction to SSTR2A was up to 14 out of 16 nf-PNETs. Conclusions: The EUS-FNA is a useful tool for diagnosing nf-PNETs with immunohistochemical staining compared to cytology and radiological examinations. Ki-67 may be also effective to predict the degree of malignancy. No significant financial relationships to disclose.

Percutaneous ultrasound-guided cholecystocentesis was performed on 13 healthy beagle dogs to determine whether percutaneous ultrasound-guided cholecystocentesis in the dog was a feasible and safe procedure. Clinical, laboratory and ultrasonographic examinations were done at 0 and 10 minutes, in the 2nd and 16th hour, and on the 7th day. They included a detailed physical examination of the mucous membranes, cardiorespiratory system and abdominal organs. Laboratory examinations of the blood consisted of a complete blood count, determination of packed cell volume (PCV), haemoglobin (Hb), total plasma protein (TPP), parameters of haemostasis including prothrombin time (PT), activated partial thromboplastin time (APTT), and enzyme activities reflecting hepatobiliary function, i.e. aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT). Ultrasonographic findings of the gallbladder (size, shape, wall, content) and appearance of the biliary tract and the surrounding cranial intraabdominal organs were also evaluated. Percutaneous ultrasound-guided cholecystocentesis was performed easily during the study, and dogs tolerated well the procedure performed without anaesthesia. All laboratory parameters of the blood remained within normal limits throughout the study. However, some follow-up values, i.e. PCV, TPP, APTT and ALT, demonstrated statistically significant differences when compared to baseline measurements, which might reflect the effect of 24-hour fasting before the experiment, as well as day-to-day metabolic fluctuations due to feeding and water supply during the study. There were no visible signs of bleeding from the liver, bile leakage from the gallbladder or accumulation of free peritoneal fluid during repeated ultrasonographic examinations. Percutaneous ultrasound-guided cholecystocentesis seems to be an important diagnostic procedure in canine gallbladder diseases and can be used safely and easily to gain gallbladder bile for diagnosis of bacterial cholecystitis or for investigating hepatobiliary function in the dog.

AbstractA multitude of musculoskeletal disorders of the knee are commonly encountered in clinical practice. Ensuring an accurate diagnosis can be challenging. It is critical to establish a thoughtful and systematic approach to assessing the patient using history and physical exam followed by appropriate imaging studies. The physical exam may be complicated due to various test maneuvers designed to help make the diagnosis. It is also important to understand the limitations of each physical exam maneuver. When appropriate, imaging is obtained to help make the diagnosis and guide treatment. There are various imaging examinations to choose from when evaluating the knee, including X-rays, computed tomography, magnetic resonance imaging, and ultrasound. An algorithmic approach to choosing the best imaging study is often helpful to avoid unnecessary costs and burden to the patients. The combination of a thorough clinical assessment and appropriate imaging examinations will result in accurate diagnosis, which directs proper treatment.

Background: Rural general practitioners (GPs) have insufficient diagnostic information to deal with complex clinical scenarios due to the inequality in medical imaging resources in rural and remote communities. The objective of this study is to explore the value of a tele-mentored handheld ultrasound (tele-HHUS) system, allowing GPs to provide ultrasound (US) services in rural and remote communities. Methods: Overall, 708 patients underwent tele-HHUS examination between March and October 2021 and March and April 2022 across thirteen primary hospitals and two tertiary-care general hospitals. All US examinations were guided and supervised remotely in real time by US experts more than 300 km away using the tele-HHUS system. The following details were recorded: location of tele-HHUS scanning, primary complaints, clinical diagnosis, and US findings. The recommendations (referral or follow-up) based on clinical experience alone were compared with those based on clinical experience with tele-HHUS information. Results: Tele-HHUS examinations were performed both in hospital settings (90.6%, 642/708) and out of hospital settings (9.4%, 66/708). Leaving aside routine physical examinations, flank pain (14.2%, 91/642) was the most common complaint in inpatients, while chest distress (12.1%, 8/66) and flank discomfort (12.1%, 8/66) were the most common complaints in out-of-hospital settings. Additionally, the referral rate increased from 5.9% to 8.3% (kappa = 0.202; p = 0.000). Conclusions: The tele-HHUS system can help rural GPs perform HHUS successfully in remote and rural communities. This novel mobile telemedicine model is valuable in resource-limited areas.

Disease affecting Lymph nodes form wide range of spectrum from simple to malignant pathology. Such cases are an important element to rule out malignancy in early stages. However Generalised Lymphedenopathy diagnosis become huge challenge. Hence, an insight into clinocohistopathological correlation with help of IHC markers becomes highly important to decide morphologic differential diagnosis.: To study lymph node lesions with clinicohistopathological correlation with the help of IHC study. This is a combined observational and prospective study held in District hospital Vijayapur during August 2022 to September 2023. Patient details were taken with the questionnaires. During his first visit clinical examinations and investigations, CBC, PS study, FNAC of left lower cervical region, Urine routine, chest X-ray & USG of abdomen performed and patient was analyzed & diagnosed as Chronic appendicitis and treated. During patient’s second visit, clinical examinations and investigations CBC, PS study, FNAC of left Axillary swelling, Urine routine, chest X-ray, USG of neck & abdomen, CT Neck & abdomen, USG guided FNAC of Liver, Bone marrow aspiration study, Biopsy of left lower Cervical lymph node for Histopathology study & IHC study performed. Case was studied using routine H&E, PAP stain slides of Biopsy material were evaluated by light microscopy. And for IHC, patient biopsy material referred to higher center, using specific monoclonal or polyclonal antibodies, paraffin sections were stained immunohistochemically (IHC) using a Peroxidase antiperoxidase (PAP) technique in referred higher center. Patient was diagnosed as B-cell Lymphoma as per WHO guidelines with the help of IHC markers.: From this study, concluded that IHC plays a significant role clinicopathology and helped in the definitive diagnosis and typing of tumours and appropriate treatment can be planned.

Fiberoptic bronchoscopy (FOB) is one of the important modalities in helping to uphold the diagnosis and stadium of bronchogenic carcinoma. However, FOB has some limitations, namely invasive, time-consuming, requiring sedation, intolerable in patients who are critically ill, and difficult to evaluate distal airway side of severe stenosis. To identify the imaging capability of virtual bronchoscopy (VB) examinations in evaluating abnormalities in the tracheobronchial in bronchogenic carcinoma. Observational study with total sampling. Data was obtained from the histopathologic with diagnosis of bronchogenic carcinoma in 1 year. Retrospectively, the data were obtained from the archives of thoracic CT examinations in Radiology and FOB examination in Lung Operating Room. The variables assessed were the finding of mass of endobronchial based on its location, the main bronchi constriction, lobar bronchi constriction, segmental bronchi constriction, and compression/tracheal deformity. The results of VB were examined by three radiologists independently and were then compared with the results of FOB. The observation results of VB and FOB were used to analyse the degree of conformity. There is a low level of agreement on the finding of endobronchial mass, lobar bronchi and segmental bronchi constriction, sufficient level of agreement on the main bronchial constriction finding. VB has a limited capacity to evaluate abnormalities of the tracheobronchial compared with FOB, but VB has an advantage in evaluating the patency of the distal airway of severe obstruction.

Objective Nonalcoholic Wernicke’s encephalopathy (WE) is a devastating neuropsychiatric syndrome caused by thiamine deficiency. Although many case reports on WE have been published, more studies are required to guide the diagnosis and treatment of nonalcoholic WE. Methods We retrospectively studied patients who were diagnosed with WE in our hospital. Data on demographics, possible causes, phenomenology, and diagnostic and treatment delays were abstracted from medical records by chart reviews. Results Seventeen patients were diagnosed with nonalcoholic WE. Nonalcoholic WE had many causes, such as gastrointestinal surgery, gastrointestinal tract diseases, vomiting, and psychiatric diseases. Most patients presented with abnormal mental symptoms, including those in a coma. Conclusion In summary, we recommend using operational criteria to diagnose and treat nonalcoholic WE as early as possible to avoid misdiagnosis and treatment delays. Nonalcoholic WE remains a clinical diagnosis, and certain examinations are helpful for this diagnosis, such as measuring serum thiamine concentrations. We should focus on patients who present with abnormal mental symptoms, even those in a coma, and administer parenteral thiamine before any carbohydrate to reduce the high frequency of residual morbidity.

Abstract Background and study aims A newly developed peroral cholangioscopy (POCS) system, SpyGlassDS has high maneuverability. This study aimed to evaluate acceptability of the accuracy of SpyGlassDS accompanied by simultaneous POCS-guided biopsy compared with that of a traditional POCS scope, CHF-B260, to diagnose the lateral extent of extrahepatic cholangiocarcinoma (LEC). Patients and methods Patients who underwent surgical resection after preoperative examinations to diagnose LEC were evaluated. POCS by CHF-B260 was performed if there was discrepancy between preceding fluoroscopy-guided biopsy findings and other examinations between January 2004 and September 2015 (group A, n = 56); and POCS plus POCS-guided mapping biopsy by SpyGlassDS was performed in all surgical candidates between October 2015 and December 2017 (group B, n = 20). The main outcome measure was the accuracy of overall preoperative diagnosis (OPD) of LEC defined based on all examinations, including POCS. Results Accuracy of OPD for the liver side and the ampullary side was 93 % and 100 %, respectively, in group A, and 84 % and 100 %, respectively, in group B (P = 0.37 for the liver side; P, not available for the ampullary side). Diagnostic accuracy of simple optical evaluation by POCS for the liver side and the ampullary side was 83 % and 100 %, respectively, in group A, and 58 % and 88 %, respectively, in group B (P = 0.29 for the liver side; P = 0.40 for the ampullary side). Conclusions POCS by SpyGlassDS was found to be acceptable and could be a standard approach for diagnosis of LEC.

In order to explore the pathological examination and differential diagnosis of pulmonary ground-glass opacities (GGO) with CT-guided percutaneous needle biopsy (CTPNB), this study retrospectively analyzed the medical records of 120 cases of patients who were diagnosed with pulmonary GGO and underwent CTPNB in a hospital designated by this study from December 2014 to December 2018. The results showed that all the 120 cases of patients were successfully punctured at one time and obtained sufficient tissue specimens with the puncture success rate and diagnostic accuracy both of 100%, being able to make a clear qualitative diagnosis. Among them, 30 cases were malignant lesions including 14 cases of bronchioloalveolar carcinoma and 16 cases of metastatic carcinoma; 90 cases were benign lesions including 52 cases of hematogenous pulmonary tuberculosis, 14 cases of sarcoidosis, 12 cases of silicosis and coal workers’ pneumoconiosis, 6 cases of interstitial pneumonia, 4 cases of alveolar proteinosis, and 2 case of allergic pneumonia. The complications of the 120 patients during the treatment included 8 cases of pneumothorax with an incidence of 6.67% (8/120), in which 2 case had the pulmonary tissue compression rate of about 25% and the other cases had no obvious perceived symptoms and required no special treatment, and 10 cases of hemoptysis with an incidence of 8.33% (10/120), whose symptoms disappeared after the treatment with batroxobin, and had no serious symptoms such as air embolism complication. The sensitivity, specificity, and accuracy of CTPNB in the diagnosis of malignant pulmonary GGO were 83.67% (82/98), 100% (22/22), and 86.67% (104/120), respectively, without statistically significant differences in diagnostic efficacy (P > 0.05). In summary, the CTPNB for the diagnosis of malignant pulmonary GGO has high sensitivity, specificity, and accuracy, and the CTPNB is also the simplest and most important approach to obtain effective pathological examinations and differential diagnoses of pulmonary GGO, which has simple operation, high accuracy and few complications, and has high application value for the qualitative diagnosis of pulmonary GGO.

This study aimed to investigate the diagnostic utility of percutaneous ultrasound-guided needle biopsy conjunction with GeneXpert MTB/RIF for epididymal tuberculosis. A retrospective analysis was conducted on the pathological and laboratory examinations of 20 patients with epididymal lesions undergoing ultrasound guided biopsy at Shandong Public Health Clinical Center. Laboratory examination included acid-fast staining, Mycobacterium tuberculosis culture by BACTEC MGIT 960, and GeneXpert MTB/RIF test. Diagnosis and complications were comprehensively analyzed. Among the 20 patients, 15 had epididymal tuberculosis and 5 had non-epididymal tuberculosis. Ten patients had granulomatous inflammation and necrotic tissues. The sensitivity and specificity of acid-fast staining, Mycobacterium tuberculosis culture, and GeneXpert MTB/RIF for the diagnosis of epididymis tuberculosis were 26.67% and 100.00%, 33.33% and 100.00%, and 86.67% and 100.00%, respectively. The diagnostic value analysis of the 3 detection techniques indicated that the GeneXpert MTB/RIF technique (Kappa = 0.765, Area under the curve (AUC) = 0.933) was superior to Mycobacterium tuberculosis culture (Kappa = 0.200, AUC = 0.667) and acid-fast staining (Kappa = 0.154, AUC = 0.633). Ultrasound-guided percutaneous biopsy is a safe procedure. The GeneXpert MTB/RIF test has high sensitivity, specificity, and superior AUC value, which are of great value in the diagnosis of epididymal tuberculosis and rifampicin resistance detection.

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banding cytogenetic analysis.Patients and Methods: This cross sectional study was conducted in Department of Haematology, Pakistan Institute of Medical Sciences, and Islamabad and Department of Genetics, Children Hospital, Lahore from June 2015 to July 2017. Sample size was calculated using WHO sample size calculator. A total of sixty cases of peripheral blood pancytopenia having clinical suspicion of acquired aplastic anemia and diagnosed on bone marrow examination with aplastic anemia were included in the study. Bone marrow or peripheral blood samples were also processed for cytogenetics by G-banding and karyotyping according to International System for Human Cytogenetic Nomenclature (ISCN) to determine frequency of chromosomal abnormalities in the patients of acquired aplastic anaemia.Results: Sixty cases diagnosed to have acquired aplastic anaemia using bone marrow examination as gold standard were included in the study based on inclusion criteria. Forty-five out of 60 patients (75%) had successful karyotyping whereas 15 out of 60 patients (25%) had inconclusive cytogenetics due to culture failure, inadequate metaphase cells and contamination. G-banding revealed normal karyotyping in 40 out of 45 patients (88.9%) while 5 out of 45 patients (11.1%) were found to have abnormal karyotyping. Chromosomal abnormalities revealed by abnormal karyotyping included three numerical abnormalities i.e. monosomy 7, trisomy 8, trisomy 14 and two structural abnormalities i.e. deletion of 11q, deletion of 13q. 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Objectives Intermuscular venous malformations are common vascular malformation, do not have typical symptoms, and are difficult to diagnose. This article is a retrospective analysis of the diagnostic and therapeutic measures of intermuscular venous malformations. Methods From January 2013 to June 2018, 21 patients were included in this study. The clinical presentations, managements, and follow-up results were retrospectively analyzed. The indications and potential risks of different treatments were summarized. Results The complaints of patients with intermuscular venous malformations included local pain, swelling, discomfort, or aggravation after activity. Ultrasound, phlebography, magnetic resonance imaging, percutaneous sinus angiography, and three-dimensional computed tomography imaging were performed. The patients received surgical excision, sclerotherapy, or the combinational therapy of intralesional copper wires retention and ethanol injection and were followed for six months to five years. All patients’ symptoms were relieved largely. The lesions evaluated by magnetic resonance imaging decreased apparently or disappeared. Conclusions Imaging examinations are necessary in the diagnosis of intermuscular venous malformations and can guide the choice of treatment. Individualized treatment for intermuscular venous malformations should be made to achieve good effect and avoid adverse effects.

Background: Ectopic pregnancy is the implantation of a fertilized egg outside the endometrial cavity of the uterus. Ectopic pregnancy is the leading cause of pregnancy-related death in the first trimester, accounting for 75% of maternal deaths in the first trimester and 9% to 13% of all pregnancy-related deaths. In the diagnosis of ectopic pregnancy, elevated serum levels of human chorionic gonadotropin (Beta-HCG) and uterine changes at early sonography are early indications for diagnostics. Magnetic resonance imaging (MRI) plays an important role in diagnosing and managing cases where ultrasound is inconclusive or when more accurate information is needed to make a proper diagnosis or to guide clinical management. Case Description: There was a 30-year-old female patient with a diagnosis of G1P1A0 at 10-11 weeks gestation who came with complaints of bleeding from the vagina. In these patients, physical examination and laboratory were examined, followed by radiological examinations with transvaginal ultrasound (TVUS) and MRI, and confirmed by histopathology study. Conclusion: MRI is not used conventionally in the diagnosis of ectopic pregnancy but can be an additional imaging modality for ultrasound. MRI is an effective diagnostic imaging alternative in cases where sonography is inconclusive or when more precise information is needed to diagnose properly or guide clinical and surgical management.

(1) Background: The accurate diagnosis of esophageal strictures is quite critical for optimizing medical intervention. However, the diagnosis of suspicious malignant esophageal strictures with intact mucosa appearance and negative biopsy results is challenging. This study aimed to evaluate the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) in the diagnosis of suspicious esophageal strictures. (2) Methods: We retrospectively analyzed the cases with suspicious malignant esophageal strictures that underwent EUS-FNA, with or without rapid on-site evaluation (ROSE), in our hospital from April 2017 to September 2022. Their clinical manifestations, imaging examinations, gastroscopic examinations, EUS-FNA results, and therapeutic strategies were retrospectively recorded and analyzed. (3) Results: A total of 23 patients (15 male and 8 female) were enrolled in this study. Based on EUS-FNA results, 18 patients were diagnosed with malignancies, including 16 cases of primary esophageal cancer (13 squamous carcinomas and 3 adenocarcinomas), 1 case of mediastinal cancer, and 1 case of metastatic esophageal cancer; 1 case of tuberculosis was also confirmed by EUS-FNA. Among 4 cases of ambiguous diagnosis with EUS-FNA, 1 was diagnosed with an esophageal glomus tumor after surgical removal, and 2 patients survived for several years without medical intervention, which hinted at the possibility of benign esophageal strictures. No major complications, including bleeding or perforation, were observed. (4) Conclusions: EUS-FNA may serve as a safe and effective diagnostic tool in suspicious malignant esophageal strictures with accurate specimen acquisition, especially for biopsy-negative cases.

Early diagnosis of pancreatic ductal adenocarcinoma (PDAC) is challenging but essential for improving its poor prognosis. We established a multicenter study to clarify the clinicopathological features, and to propose new algorithm for early diagnosis of PDAC. Ninety-six patients with stage 0 and IA PDAC were enrolled from 13 high-volume centers. Overall, 70% of the patients were asymptomatic. The serum pancreatic enzyme levels were abnormal in half of the patients. The sensitivity of endoscopic ultrasonography (EUS) for detecting small PDAC was superior to computed tomography and magnetic resonance imaging (MRI) (82%, 58%, and 38%, respectively). Indirect imaging findings were useful to detect early-stage PDAC; especially, main pancreatic duct stenosis on MRI had the highest positive rate of 86% in stage 0 patients. For preoperative pathological diagnosis, the sensitivity of endoscopic retrograde cholangiopancreatography (ERCP)-associated pancreatic juice cytology was 84%. Among the stage IA patients, EUS-guided fine-needle aspiration revealed adenocarcinoma in 93% patients. For early diagnosis of PDAC, it is essential to identify asymptomatic patients and ensure close examinations of indirect imaging findings and standardization of preoperative pathological diagnosis. Therefore, a new diagnostic algorithm based on tumor size and imaging findings should be developed.

Background: The diagnosis of prostate carcinoma (PCa) requires time- and material-consuming histopathological examinations. Ex vivo fluorescence confocal microscopy (FCM) can detect carcinoma foci in diagnostic biopsies intraoperatively. Methods: MRI-guided and systematic biopsies were identified in a dataset of our previously published study cohort. Detection rates of clinically relevant tumors were determined in both groups. A retrospective blinded trial was performed to determine how many tumors requiring intervention were detectable via FCM analysis of MRI-guided targeted biopsies alone. Results: MRI-guided targeted biopsies revealed tumors more frequently than systematic biopsies. Carcinomas in need of intervention were reliably represented in the MRI-guided biopsies and were identified in intraoperative FCM microscopy. Combined with serum PSA levels and clinical presentation, 91% of the carcinomas in need of intervention were identified. Conclusions: Intraoperative FCM analysis of MRI-guided biopsies is a promising approach for the efficient diagnosis of PCa. The method allows a timely assessment of whether a tumor disease requiring intervention is present and can reduce the psychological stress of the patient in the waiting period of the histological finding. Furthermore, this technique can lead to reduction of the total number of biopsies needed for the diagnosis of PCa.

Abstract The aim of this study was to evaluate the main nonconformities that result in cytopathological samples inappropriate for diagnosis in veterinary medicine. All cytopathological samples, obtained from different canine and feline tissues/lesions, included in the study were received and classified as inconclusive by a single public laboratory of veterinary pathology, located in Pernambuco State, Brazil, between 2012 and 2016. Nonconformities regarding the smear quality, cellularity, presence or absence of hemorrhage, cellular overlapping, desiccation, and presence or absence of necrotic debris and/or artifacts were evaluated. Data were tabulated using Microsoft Excel 2007; absolute and relative frequencies were calculated using EPIINFO 3.5.2. From the 3268 cases received between 2012 and 2016, 190 cases were selected and comprised 514 inconclusive slides. The most frequent nonconformities detected were insufficient/absence of cellularity in 100% (514/514), inadequate submacroscopic presentation in 87% (446/514), and hemorrhage in 69% (356/514) of samples. Other features identified were cellular overlapping in 34% (175/514), inadequate staining in 31% (175/514), artifacts in 30% (154/514), desiccation in 28% (145/514), and necrotic debris in 26% (133/514) of samples. The implementation of laboratory standard operational procedures aimed at maintaining quality is essential. It is necessary to initially identify the main errors occurring in the processing stages as a way to guide and design strategies to avoid them.

Background: Ultrasonography is a useful modality to diagnose stones and to confirm the occurrence of complications of other renal pathology, so it is important to understand these characteristic findings and other diseases that mimic them. In addition, other imaging modalities such as computed tomography (CT) can be recommended if the clinical or radiological diagnosis is ambiguous.Methods: A group of 325 patients with clinical suspicion of renal calculi were included in this study. Out of these 325 patients 179 (55.0%) were male and 146 (44.9%) were female. All these patients underwent ultrasonography (USG) examination. Final diagnosis was based on CT findings which was done subsequently.Results: The total number of patients comprising the study were 325 who underwent ultrasound examination. After USG and CT scan was done to confirm the diagnosis. Out of 325 patients, 201 patients were confirmed having renal calculi on USG analysis and remaining 103 patients were true negative.Conclusions: The study proves that USG is highly accurate in diagnosing and characterizing renal calculi. USG also guides in defining exact location as well as aids in deciding the medical or surgical approach to be used.

Abstract: The incidence of endometriosis, including atypical forms of the disease, has been continuously growing, thus increasingly challenging for the imaging specialists as well. We conducted a retrospective study to analyze the results of ultrasound-guided interventions between 2016 and 2018. All interventions were performed in female patients due to uncertain abdominal wall lesions at the University of Szeged, Hungary. The abdominal wall lesions were incidentally detected, one by CT, the others by ultrasound examinations. We identified 12 cases during the study period. The average age of the patients was 59 years (29–79), 8 of them had abdominal surgery in their medical history. The mean diameter of the masses was 34.4 mm (20–49 mm). Since the indication of imaging examinations was the evaluation of a known or suspected malignancy, four patients had undergone an MRI prior to the biopsy. In addition, ultrasound-guided biopsy was not performed in another two patients, and the diagnosis was established by histological examination of the surgically removed specimens. The histological examination revealed malignant primary serous epithelial tumor in one case, metastases in six cases, endometriosis in six patients and abdominal wall abscess was found in one patient. Endometriosis was more frequent in the younger patients. The likelihood of endometriosis as a cause of abdominal wall lesions of younger, premenopausal female patients is rather high, especially with obstetrical or gynaecological operations in the medical history. Ultrasound plays a primary role in the detection and therapy planning of these lesions. Orv Hetil. 2019; 160(35): 1395–1403.

Background:Pyogenic spondylodiscitis (SPD) is a serious infection of an intervertebral disc and/or adjacent vertebrae, that remains a topical problem in rheumatological practice. Early diagnosis and treatment are the only guarantees of a favorable outcome. Clinicians must strive to isolate the responsible bacteria in order to adapt the treatment, and thus reduce the risk of resistance and complications due to SPD itself, but also to the multiplication of probabilistic treatments.Objectives:Our aim was to study the contribution of the different microbiological and anatomopathological examinations in the diagnosis of pyogenic SPD.Methods:It was a descriptive study in a single rheumatology department. Data were collected retrospectively from observations of patients hospitalized in the past 20 years who have been diagnosed with pyogenic SPD. We excluded cases of tuberculous and brucellar SPD from our study because of their completely different histological and microbiological profiles.Results:Twenty-two cases of pyogenic SPD were collected (14M/ 8F). The mean age of the population was 55.9 years [29,80]. A bacteriological survey including at least one cytobacteriological examination of the urine (CBEU), chest X-rays and blood cultures allowed the identification of the bacteria in 16 cases (73%). The most common site were bacteria was identified was blood culture in 7 cases, skin sample and urine collection in 2 cases each. Disco-vertebral puncture and biopsy (DVPB) was performed in 19 patients when there was no bacteria identification and/or when diagnosis of infectious SPD persisted doubtful. On histopathological examination, were described: an infiltrate and/or inflammatory changes without specificity signs in 7 patients and an appearance of chronic pyogenic SPD very likely in 12 patients. Bacteriological study of DVPB fluid or paravertebral abscesses sample helped to isolate bacteria in 4 patients. DVPB or abscesses puncture were contributing by histological and/or bacteriological examination in 12 patients (63%).Infecting bacteria was identified in 14 patients (64%). Gram-negative bacilli (GNB) and staphylococcus aureus were the most frequent germs (7 cases each) including 2 cases of co-infection. GNBs were represented by: Escherichia Coli and Enterobacter Cloacae in 2 cases each, Proteus Mirabilis, Serratia Marcescens and Klebsiella oxytoca in 1 case each. Clostridium clostridioforme and Lactococcus cremoris were isolated in 1 case each. For patients whose etiological investigation remained negative, SPD diagnosis was retained based on imaging (MRI) guided by anamnestic, clinico-biological and histopathological arguments.Conclusion:SPD is a rare condition that needs to be treated rapidly. Once the diagnosis is suspected, bacteria must be isolated before starting any antibiotic therapy. Simple and non-invasive exams as blood cultures, CBUE and chest rays, should be undertaken first. In fact, these simple exams allowed a germ identification in 73% cases in our study. If doubt persist, DVPB could be contributive to the diagnosis.References:NoneDisclosure of Interests:None declared

Purpose: The purpose of this retrospective study was to evaluate our combinatorytreatment using ultrasonography, minimally invasive pit-picking, and Nd:YAG lasertherapy against pilonidal disease in adolescent patients.Methods: From June 2017 to December 2020, 147 patients were treated. Thetreatment cycle lasted 6-12 months. In this time, patients underwent pit-pickingprocedures and 6 to 10 Nd:YAG treatments. The remnants of the cyst were removedby laser therapy, which provided easy epilation. Each patient underwent multipleultrasound examinations during the therapy to discover any possible newly formedasymptomatic sinuses. When those sinuses were located, the pit-picking procedurewas repeated. The mean follow-up time for the program was 6 months.Results: Of the total 147 patients who were treated, the first 52 were included in thisstudy with a one-year follow-up post procedure. There were 49 symptom-free patients(96%). One patient underwent surgery in another hospital because of a recurrence andone had a pilonidal disease relapse (4%). Asymptomatic cysts were found in two otherpatients by ultrasound examination. They were all treated in the outpatient departmentwith pit-picking method with good results.Conclusions: Performing sequentially repeated pit-picking procedures combined withthe Nd:YAG laser therapy is an effective treatment method for adolescent pilonidaldisease. Repeatable ultrasonography examinations allow for early diagnosis ofpilonidal sinus relapse. Simultaneous Nd:YAG laser therapy enables efficaciousepilation of the intergluteal cleft and prevents recurrences.Level of evidence - IV

Abstract Introduction Ultrasonography (US) has become an invaluable tool in the management of critically ill patients. Objectives This study aimed to evaluate the role of US in the diagnosis and treatment of pleural diseases in patients in the respiratory intensive care unit. Patients and methods This study recruited 55 patients who presented with suspected clinical and/or radiological evidence of pleural disease in whom US and chest radiography were performed. In addition, US-guided interventions were carried out whenever needed and computed tomography scans of the chest where obtained whenever possible. Results Pleural effusion was the most common pleural disease encountered (54.5%). US correctly predicted the nature of most pleural effusions, whether transudative or exudative (84%). US was significantly more sensitive than chest radiography in the diagnosis of pleural effusion and pleural thickening (P = 0.00 and 0.004, respectively) and had significantly better sensitivity for unilateral effusions and for septations compared with computed tomography (P = 0.004). There was almost perfect agreement between US results and the final diagnosis in all pleural diseases, with κ values ranging from 0.9 to 0.98. A total of 67 US-guided interventions were carried out, with a success rate of 94%, and only one (1.5%) complication was encountered in the form of partial pneumothorax. US affected the diagnosis and altered the treatment policy, with recorded favorable outcomes. Short-term training programs enable pulmonologists to acquire US examination skills after 30 examinations. Conclusion US is an efficient and suitable method for evaluating pleural disease in the respiratory intensive care unit, especially pleural effusion. US-guided pleural interventions have been successful and have shown favorable outcomes and minimal complications. Short-term training could enable mastering of US use.

Abstract Background Meningitis is infection of the central nervous system with high mortality and morbidity in adults. Markers for diagnostic purposes can therefore be useful guides in differential diagnosis. Procalcitonin (PCT), platelet distribution width (PDW) and red blood cell distribution width (RDW) can be easily calculated with automated blood systems, and have been regarded as biomarkers showing inflammation in infection-related diseases. The purpose of this study was to determine the diagnostic significance of these biomarkers in adult meningitis. Methods This study was a retrospective investigation. Diagnosis of meningitis was based on clinical findings and microbiological and biochemical investigations of CSF specimens. Patients’ white blood cell count (WBC), C-reactive protein (CRP), PDW, RDW and PCT levels at time of presentation were compared. P < 0.05 was regarded as statistically significant. Results 137 patients were assessed. Ninety-five patients had acute bacterial meningitis (ABM), 17 had aseptic meningitis (AM) and 25 had chronic meningitis (CM). When patients were evaluated by age, AMB was more common in the elderly and AM in the young (P < 0.05). CRP and PCT levels at presentation were significantly higher in AM than in AM and CM (P < 0.05). WBC levels differed statistically significantly between ABM and CM (P < 0.05). PDW levels were significantly higher in AM then in CM (P < 0.05). RDW was statistically significantly higher in CM than in ABM and AM (P < 0.05). When ROC analysis was performed to differentiate ABM from the other forms (table). Correlation analysis between CSF biochemistry and biomarkers revealed that PCT was positively correlated with CRP, PDW and CSF protein and negatively correlated with CSF glucose. Conclusion Our results suggest that PCT and CRP have diagnostic characteristics in favor of ABM at differential diagnosis in cases in which LP is contraindicated and/or CSF examination cannot be performed immediately or the agent cannot be identified. WBC and RDW can be useful guides in differentiating ABM from CM, and PDW and RDW in differentiating CM from ABM and AM. Disclosures All authors: No reported disclosures.

IntroductionBronchoscopy is the main method in the diagnosis of various lung diseases. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is the most modern bronchoscopic technique useful in diagnosis and staging of lung cancer (LC).ObjectiveThe aim of the study was to assess the yield of bronchoscopy in patients with suspected various respiratory diseases including LC. In particular, we examined the efficiency of different biopsy techniques in the diagnosis of LC in correlation with its localisation and pathomorphological type.Patients and methodsThe results of pathomorphological examinations from 5279 bronchoscopies performed in 2016–2018 were analysed. The material was collected with EBUS-TBNA, endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endobronchial forceps biopsy. Clinical and demographic factors were analysed using the Fisher χ2 test.Results5279 patients were diagnosed due to various respiratory symptoms. LC was confirmed in 36.42% of patients. 40.81% of patients had no definitive pathomorphological diagnosis. Among patients with LC, the most frequent diagnosis was non-small cell LC: squamous cell lung cancer (SCC)—32.07% and adenocarcinoma (AC)—30.61%, then small cell LC—25.83% and not otherwise specified non-small cell lung cancer (NSCLC-NOS)—11.49%. Diagnosis of SCC was obtained significantly more often (χ2=43.143, p<0.000001) by forceps biopsy (41.09%) than by EBUS-TBNA/EUS-FNA (26.62%). On the contrary, diagnosis of AC or NSCLC-NOS was significantly more often (χ2=20.394, p<0.000007, and χ2=3.902, p<0.05, respectively) observed in EBUS-TBNA/EUS-FNA (34.31% and 12.6%) than in endobronchial biopsies (24.52% and 9.64%).ConclusionsThe use of bronchoscopy in the diagnosis of various lung diseases is vital but also has many limitations. Effectiveness of EBUS-TBNA and endobronchial forceps biopsy in the diagnosis of lung cancer is strongly affected by tumour localisation and type of cancer.

According to the WHO, neoplastic processes of the uterus remain one of the important and relevant areas of modern gynecology. Uterine leiomyoma is one of the most common tumors of the female reproductive system. According to the latest data, every 4–5th woman in the world is diagnosed with leiomyoma, the incidence of which under the age of 35 reaches 50%, and according to autopsy data reaches 80%.The article provides a review of the scientific publications in recent years devoted to the study of the problem of uterine fibroids – relevance, causes and mechanisms of development, provides a classification, clinical manifestations, modern diagnostics and management tactics.The etiological factors of leiomyoma are numerous, there is no a single theory of the disease. Among the pathogenetic factors of leiomyoma are hormonal disorders, genetic components, infections, injuries. There are several classifications of leiomyoma, the most common classification was proposed by the International Federation of Gynecology and Obstetrics, which reflects the types of leiomatous nodes depending on their location and relationship to the uterine cavity and myometrium.Clinical manifestations of uterine fibroids range from asymptomatic to painful sighns and hemorrhagic syndromes, symptoms of compression of adjacent organs, the development of uterine bleeding, which lead to severe anemia. The nature of clinical features significantly depend on the localization of the leiomyoma nodes in the uterine body and their relationship to the uterine cavity (submucosal, intramural, subserous), as well as their number, size and blood supply.Modern diagnosis of leiomyoma is based on anamnesis, bimanual gynecological examination, ultrasound examination, and in some cases – magnetic resonance imaging and computed tomography examinations, hysteroscopy and laparoscopy. Today, the main methods of treatment of leiomyoma are conservative, surgical and radiological methods (uterine artery embolization, magnetic resonance-guided focused ultrasound).In addition to the listed modern aspects of the clinic, diagnosis and treatment of uterine leiomyoma, the article emphasizes the importance of preventive measures to reduce the incidence of this gynecological pathology.

This study aimed to develop a high-performance deep learning algorithm to differentiate Stafne’s bone cavity (SBC) from cysts and tumors of the jaw based on images acquired from various panoramic radiographic systems. Data sets included 176 Stafne’s bone cavities and 282 odontogenic cysts and tumors of the mandible (98 dentigerous cysts, 91 odontogenic keratocysts, and 93 ameloblastomas) that required surgical removal. Panoramic radiographs were obtained using three different imaging systems. The trained model showed 99.25% accuracy, 98.08% sensitivity, and 100% specificity for SBC classification and resulted in one misclassified SBC case. The algorithm was approved to recognize the typical imaging features of SBC in panoramic radiography regardless of the imaging system when traced back with Grad-Cam and Guided Grad-Cam methods. The deep learning model for SBC differentiating from odontogenic cysts and tumors showed high performance with images obtained from multiple panoramic systems. The present algorithm is expected to be a useful tool for clinicians, as it diagnoses SBCs in panoramic radiography to prevent unnecessary examinations for patients. Additionally, it would provide support for clinicians to determine further examinations or referrals to surgeons for cases where even experts are unsure of diagnosis using panoramic radiography alone.

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), does not provide a Diagnosis-based estimate of impairment due to syringomyelia, a disorder in which a cyst (syrinx), develops within the central spinal cord and destroys neural tissue as it expands. The AMA Guides, however, does provide an approach to rating a syringomyelia based on objective findings of neurological deficits identified during a neurological examination and demonstrated by standard diagnostic techniques. Syringomelia may occur after spinal cord trauma, including a contusion of the cord. A case study illustrates the rating process: The case patient is a 46-year-old male who fell backwards, landing on his upper back and head; over a five-year period he received a T5-6 laminectomy and later partial corpectomies of C5, C6, and C7, cervical discectomy C5-6 and C6-7; iliac crest strut graft fusion of C5-6 and C6-7; and anterior cervical plating of C5 to C7 for treatment of myelopathy; postoperatively, the patient developed dysphagia. The evaluating physician should determine which conditions are ratable, rate each of these components, and combine the resulting whole person impairments without omission or duplication of a ratable impairment. The article includes a pain disability questionnaire that can be used in conjunction with evaluations conducted according to Chapter 3, Pain, and Chapter 17, The Spine.

Enamel fractures are often caused by trauma. Can be seen as visible irregularities that require early intervention to prevent aesthetic issues. Dentin fractures are marked by increased sensitivity. Require tailored interventions such as desensitizing agents or restorations to address symptoms and maintain tooth integrity. Root fractures present with localized pain and swelling, posing challenges that require a management approach. Vertical fractures affecting both the crown and root need assessment using imaging techniques to guide treatment decisions. Cracked tooth syndrome involves fractures that may be managed holistically through measures or endodontic therapy in severe cases. This comprehensive review explores the world of fractures, examining their various types, symptoms and treatment strategies. It covers fractures in enamel, dentin, roots, and vertical ones that affect both the crown and root as cracked tooth syndrome. The study emphasizes the importance of diagnosis and effective treatment for the presentation of fractures. The study also highlights the integration of expertise with advanced tools like cone beam computed tomography (CBCT) for more precise dental diagnostics. Adhesive dentistry is recognized as an aspect of invasive restorations that aim to preserve natural tooth structure. This review underscores the significance of intervention and patient education while recognizing the interplay between traditional practices and modern modalities in managing dental fractures. Each type of fracture requires an approach addressing anything from cosmetic concerns like enamel fractures to more complex issues like root fractures. It is crucial to intervene relying on clinical examinations and advanced diagnostic tools for guidance.

Background: Recurrent colorectal cancer may be amenable to curative treatment. As the debate on the ideal set of investigations and frequency of follow-up continues, it is important to review the pattern of recurrence in the real-world setting, which could help tailor future follow-up strategies. Objectives: Our primary objective was to study the varying clinical presentations and patterns of recurrence of colorectal cancer. The secondary objectives were to study the site of recurrence, method of diagnosis of recurrence, incidence of second primary colorectal cancer, and salvage rates after recurrence of colorectal cancer. Material and Methods: We reviewed the data of patients who were treated from January 2010 to December 2016 at the Malabar Cancer Center, a tertiary cancer center in Kerala, India. We recorded the clinicopathologic details of patients who were treated with curative intent and had serologic (carcinoembryonic antigen [CEA] elevation), clinical, or radiological evidence of disease recurrence. We also studied the timing and anatomical location of recurrence, symptoms, and the method by which the recurrence was diagnosed. Results: We included 675 patients in the study. There were 324 (48%) female patients; the median age was 55 years (interquartile range [IQR], 47.2-65). The primary diagnosis was colon cancer in 326 (48.3%) and rectal in 349 (51.7%) patients. Multimodality therapy was administered to 393 (58.2%) patients in the form of surgery with or adjuvant neoadjuvant chemoradiation adjuvant radiation, or neoadjuvant short-course radiation with neoadjuvant and adjuvant chemotherapy. Recurrences occurred in 109 (16.1%) patients, only 50 (45.9%) of whom were symptomatic. Recurrences were diagnosed by CEA elevation in 65 (59.6%), imaging in 12 (11%), clinical examination in 4 (3.7%), and colonoscopy in 1 (0.9%) patient. The median time to recurrence was 17 months (95% CI, 14-22). Local and distant recurrences occurred in 29 (4.2%) and 80 (11.9%) patients, respectively; 22 (27.5%) patients developed multisite distant recurrences. Recurrences occurred within the first 5 years of completion of therapy in 96 (88.1%) cases. Twelve (11%) patients received salvage therapy with curative intent. Six patients (0.9%) had a metachronous colorectal primary tumors. Conclusions: Colorectal cancer recurs most commonly in the first 5 years after therapy. Multisite distant recurrence and isolated liver metastases predominate. Recurrences are often asymptomatic and most commonly manifest as elevated CEA. Regular clinical evaluation, CEA testing, colonoscopy, and symptom-based cross-sectional imaging detect up to three-quarters of patients with recurrences, but the overall salvageability remains low.

ObjectiveTelehealth has been established as a viable option for improved access and timeliness of care. Physician-guided patient self-evaluation may improve the viability of telehealth evaluation; however, there are little data evaluating the efficacy of self-administered examination (SAE). This study aims to compare the diagnostic accuracy of a patient SAE to a traditional standardised clinical examination (SCE) for evaluation of femoroacetabular impingement syndrome (FAIS).Methods75 patients seeking care for hip-related pain were included for participation. All patients underwent both SAE and SCE and were randomised to the order of the examinations. Diagnostic accuracy statistics were calculated for both examination group for a final diagnosis of FAIS. Mean diagnostic accuracy results for each group were then compared using Mann-Whitney U non-parametric tests.ResultsThe diagnostic accuracy of individual SAE and SCE manoeuvres varied widely. Both SAE and SCE demonstrated no to moderate change in post-test probability for the diagnosis of FAIS. Although low, SAE demonstrated a statistically greater mean diagnostic accuracy compared with the SCE (53.6% vs 45.5%, p=0.02).ConclusionDiagnostic accuracy was statistically significantly higher for the self-exam than for the traditional clinical exam although the difference may not be clinically relevant. Although the mean accuracy remains relatively low for both exams, these values are consistent with hip exam for FAIS reported in the literature. Having established the validity of an SAE, future investigations will need to evaluate implementation in a telehealth setting.

Objective: Thyroid nodules, a clinical disease with high incidence, include benign and malignant types. This study aims to evaluate the diagnostic value of ultrasound-guided fine-needle aspiration cytology (US-FNAC) in determining the pathological nature of thyroid nodules and to conduct an in-depth analysis of its diagnostic efficacy across nodules of varying sizes. Material and Methods: This retrospective study identified 116 patients undergoing thyroidectomy in Zibo Central hospital from January 2022 to March 2023, with 98 meeting the study’s inclusion criteria. All patients received ultrasound and US-FNAC examinations before surgery to analyze the ultrasonic features of thyroid nodules. The diagnosis results of pathological natures obtained by US-FNAC were analyzed with the result of post-operative pathological examination as the gold standard. The patients were divided into four groups according to the median and quartile of nodular diameters to explore the diagnostic efficacy of US-FNAC for the pathological natures of thyroid nodules with various diameters and comprehensively evaluate its application value. The evaluation tool of diagnostic efficacy was the receiver operator characteristic (ROC) curve. Results: A total of 98 puncture nodules were evaluated, with a diameter of 0.8–5.2 cm. Post-operative pathological examination showed 10 (10.20%) benign and 88 (89.80%) malignant lesions. The ultrasound examination showed 14 (14.29%) benign and 84 (85.71%) suspected malignant lesions. The US-FNAC results showed 2 cases (2.04%) of type I, 9 cases (9.18%) of type II, 3 cases (3.06%) of type III, 29 cases (29.59%) of type IV, 39 cases (39.80%) of type V, and 16 cases (16.33%) of type VI, including 9 (9.18%) benign and 84 (85.72%) malignant lesions and 5 (5.10%) uncertain pathological natures. According to the median and quartile of nodular diameters, specifically, 1.90 (1.60, 2.30) cm, 93 nodules with decided pathological natures were divided into groups Q1 (n = 24, ≤1.6 cm), Q2 (n = 26, 1.7–1.9 cm), Q3 (n = 24, 2.0–2.3 cm), and Q4 (n = 19, >2.3 cm). The results of ROC analysis showed that the area under the curve (AUC), sensitivity, and specificity of US-FNAC diagnosis were 0.894, 98.80%, and 80.00%, respectively. The AUCs of US-FNAC in groups Q1, Q2, Q3, and Q4 were 0.978, 1.000, 0.977, and 0.971. The AUCs of Q1 group, Q2 group, Q3 group and Q4 group were all > 0.9, and US-FNAC had high diagnostic efficiency for the pathological properties of thyroid nodules with different diameters. Conclusion: US-FNAC has a high diagnostic efficiency for the pathological properties of thyroid nodules. Whether the nodule diameter has an effect on the accuracy of this method requires more clinical evidence.

Background: The breast imaging-reporting and data system (BI-RADS) grading has a great advantage in diagnosing breast diseases, but with some limitations. Aims: The study analyzed the value of ultrasound-guided core needle biopsy (CNB) in diagnosing BI-RADS grades 3, 4, and 5 breast cancer. Methods: Breast cancer patients at BI-RADS grades 3 to 5 received breast ultrasonography, ultrasound-guided CNB and immunohistochemical examination. Receiver operating characteristic (ROC) curve was made to test diagnostic efficiency of regression model. Results: Calcification was positively correlated with expression of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (HER)-2. The areas of 4 ROC curves were 0.752, 0.805, 0.758, and 0.847, and the 95%CI was 0.660 to 0.844, 0.723 to 0.887, 0.667 to 0.849, and 0.776 to 0.918, respectively. BI-RADS grades 3 to 5 were positively correlated with expression of ER, PR and human epidermal growth factor receptor-2 (HER-2). Statistical significance existed between grade 5 and expression of ER, PR and HER-2, and between grade 4 and expression of HER-2. Conclusions: The study demonstrates that BI-RADS can be used as an effective evaluation method in the diagnosis of breast diseases before invasive operation, and it has higher diagnostic accuracy if combined with pathological examinations.

Objectives: Telemedicine has become a critical component in the evaluation and management of patients with shoulder pathology. However, the reliability and accuracy of findings on a virtual physical exam relative to in-person evaluation is unclear. The purpose of this study is to determine the reliability and accuracy of a recorded telemedicine physical exam for diagnosis of shoulder pathology compared to the traditional in-person physical exam performed in an outpatient shoulder clinic. Methods: This study is a randomized controlled trial. New patients presenting with unilateral shoulder pain to a singlesurgeon shoulder clinic were recruited between July and November 2020. In a single visit, patients were evaluated with standardized in-person and telemedicine physical exams, and the order was randomized. The telemedicine exam was recorded and consisted of a pre-recorded video guide displaying self-directed shoulder exam maneuvers that patients performed under remote coaching by an independent observer. The in-person physical exam was performed by the treating physician and results were used as the gold standard. The telemedicine videos were evaluated by two independent observers for inter-observer reliability. The treating physician subsequently evaluated the telemedicine videos after a minimum 2-month washout period for intra-observer reliability. Inter- and intra-observer reliability analyses were conducted using the Kuder-Richardson 20 (KR-20) formula. Results: Thirty-two patients (17 male, 15 female; average age 50.2 ±16.2 years) were enrolled and included in the analysis. Overall KR-20 reliability across all 40 physical exam maneuvers was 0.391±0.332 (76.4% ± 15.4% agreement) between the in-person and telemedicine exams. Maneuvers conducted via telemedicine that examined range of motion (ROM) limitations had the highest degree of reliability, sensitivity, specificity, and likelihood of also producing a positive finding on the in-person exam (0.700±0.114, 66.5%, 81.0%, and 6.06, respectively). Exam maneuvers conducted via telemedicine that relied on identifying apprehension associated with glenohumeral instability were found to have the lowest reliability, sensitivity, and likelihood of producing a positive finding on the in-person exam (0.176±0.440, 23.5% and 0.518, respectively). All included patients were satisfied with their telemedicine experience. Conclusions: Overall reliability of telemedicine physical examination maneuvers was poor. ROM limitations identified on the telemedicine exams were found to be the most reliable and accurate, while techniques used to evaluate instability were found to be the least reliable and accurate. While the telemedicine exam can be reliable as a screening tool in certain pathologic conditions, providers should use the in-person exam and imaging results to confirm any suspected diagnoses. [Table: see text][Table: see text][Table: see text]

Introduction. Oral candidiasis is a complication of dry mouth witch is not present in all cases, but its prevalence remains high. Material and method. 29 patients aged 45 to 82 years suffering from dry mouth caused by various general conditions were selected for this study. Clinical examinations were performed and all the lesions of oral mucosa were counted. The accurate diagnosis of oral candidiasis was established by the mycological exam. Results. 66% of patients involved in this study presented oral candidiasis confirmed by the laboratory. The atrophic and hyperplasic oral candidiasis were the most common clinical types found in this study. Conclusions. The prevalence of oral candidiasis remains relatively high among patients suffering from dry mouth; therefore dentists should treat or guide them to a specialist.

This cross sectional study was done to assess the diagnostic accuracy of Computed Tomography (CT) in the evaluation of hilar and mediastinal involvement in bronchogenic carcinoma. A total of 104 patients with bronchial mass lesion were included in the study. Thorough history, clinical examinations, X-ray chest, CT chest and CT guided fine needle aspiration cytology (FNAC) were done. This study was carried out in the department of Radiology and Imaging of Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) from July 2009 to June 2010. Diagnosis of hilar and mediastinal involvement in bronchogenic carcinoma by CT scan was highly sensitive and specific. CT findings of the present study correlated well in most of the cases with the CT guided FNAC results. It can therefore be concluded that CT scan is a useful modality in the evaluation of hilar and mediastinal involvement in bronchogenic carcinoma.Bangladesh J. Nuclear Med. 19(1): 32-37, January 2016

Abstract Our purpose was to develop recommendations for contouring the computed tomography (CT)-based high-risk clinical target volume (CTVHR) for 3D image-guided brachytherapy (3D-IGBT) for cervical cancer. A 15-member Japanese Radiation Oncology Study Group (JROSG) committee with expertise in gynecological radiation oncology initiated guideline development for CT-based CTVHR (based on a comprehensive literature review as well as clinical experience) in July 2014. Extensive discussions occurred during four face-to-face meetings and frequent email communication until a consensus was reached. The CT-based CTVHR boundaries were defined by each anatomical plane (cranial–caudal, lateral, or anterior–posterior) with or without tumor progression beyond the uterine cervix at diagnosis. Since the availability of magnetic resonance imaging (MRI) with applicator insertion for 3D planning is currently limited, T2-weighted MRI obtained at diagnosis and just before brachytherapy without applicator insertion was used as a reference for accurately estimating the tumor size and topography. Furthermore, utilizing information from clinical examinations performed both at diagnosis and brachytherapy is strongly recommended. In conclusion, these recommendations will serve as a brachytherapy protocol to be used at institutions with limited availability of MRI for 3D treatment planning.

Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is considered to have high value in the staging of mediastinal lymph nodes in lung cancer. The current study was conducted to investigate the diagnostic value of EBUS-TBNA in intrapulmonary lesions located near the central airway. Methods From September 2009 to March 2013, 66 patients with pulmonary masses located close to the central airways suspected to be lung cancer were accessed by EBUS-TBNA. Conventional bronchoscopic biopsy before EBUS-TBNA was nondiagnostic in all cases. If EBUS-TBNA did not result in a formal pathological diagnosis of malignancy, patients were subsequently referred for a surgical procedure. Results Among the 66 cases, 59 were confirmed as pulmonary malignancies by EBUS-TBNA, of which 48 cases were non-small cell lung cancer, nine were small cell lung cancer, and two were metastatic lung tumors. No evidence of malignancy was found by biopsy and histopathological examination in the other seven cases. Thoracoscopy or thoracotomy was subsequently undergone for them. Postoperative pathological examinations confirmed three cases of squamous cell carcinoma of the lung, one case of lymphoma, two cases of sclerosing hemangioma, and one case of pulmonary tuberculoma. The definitive diagnosis rate of EBUS-TBNA for intrapulmonary lesions near the central airway was 89.4%. The sensitivity, specificity, and accuracy of EBUS-TBNA in distinguishing benign from malignant intrapulmonary lesions were 93.7%, 100.0%, and 93.9%, respectively. The positive and negative predictive values were 100.0% and 42.9%, respectively. The EBUS-TBNA procedures were well-tolerated by all patients. No associated complications were observed. Conclusions For intrapulmonary lesions near the central airway highly suspected of cancer, EBUS-TBNA has satisfactory diagnostic value. However, the negative predictive value of this technique is low, so negative results obtained by EBUS-TBNA should be confirmed by other methods.

Introduction. Hypertrophic pyloric stenosis (HPS) is the most common abdominal surgical condition in newborns and infants, while intussusceptions is the most frequent problem in children between the ages of 6 months and 2 years. The aim of this study was to show the advantages of ultrasonography in diagnosis of hypertrophic pyloric stenosis and intussusception and also to point out the efficiency of ultrasound guided hydrostatic reduction of childhood intussusception, as a nonoperative therapeutic option. Material and Methods. This study had a prospective design and included 208 patients in a 2-year period (2004-2005). Both US examinations were done using a linear 7.5 MHz probe, and the main ultrasound criteria for HPS were increased pyloric muscle thickness of 3mm and over, as well as pyloric length over 15mm, typical ultrasonic findings of intussusception included a target sign or a pseudokidney sign. Sonographically guided hydrostatic reduction of intussusceptions was also performed. Results HPS was predominant in male infants, and the mean age was 40 days. The mean pyloric muscle thickness was 4.95mm in infants with HPS, and the average length of the antropyloric canal was 19.26mm. In patients with intussusception, male predominance was also observed and the mean age was 1 year and 79 days. The intussusceptum was most often located in the cecoascending (53.6%) and transverse colon (21.4%). US- guided hydrostatic reduction of intussusception was successful in 82.14% of all cases. Discussion. Our findings are in absolute agreement with literature data regarding the average age of patients, both with HPS and intussusception, thickness of the muscular layer, length of the antropyloric canal, and extremely successful US-guided hydrostatic reduction of intussusceptions. Conclusion. Ultrasonography has proved to be a remarkably precise diagnostic modality in diagnosing HPS and intussusception, but also makes nonoperative treatment of intussusceptions possible in extremely high percentage. .

Interventional examinations are associated with high levels of patient exposure per examination, which makes it particularly important to monitor individual patient doses and to assess radiation risks. The aim of this study was the assessment of effective doses for fluoroscopy-guided balloon dilatation of benign esophageal strictures, whichwasperformedonpediatricpatientsaged 1 to 2 yearsatthe Departmentof Radiosurgical Methodsof Diagnosis and Treatment of St. Petersburg State Pediatric Medical University. Patient exposure patterns were basedonourowndatacollection. Thecalculationofeffectiveandorgandosesofpatientsnormalizedbythevalue of the dose area product measured during the study was carried out using PCXMC 2.0 software. The conversion coefficients from the dose area product to the effective dose were calculated using tissue weighting coefficients from the ICRP Publications 60 and 103 their values were 10.7 and 11.7 µSv/cGy cm2, respectively. The results of verification of the method indicated that the use of inappropriate conversion coefficients leads to an almost double underestimation of children’s effective doses. Differences in the values of conversion coefficients are significant and are explained by differences in voltage, source to image distance, and irradiation field size. A simplified model of patient exposure was proposed, which is described by a single irradiation field. The assessment of effective doses using multi-field and single-field irradiation model shows comparable results, which allows using the differentiated approach to the assessment of radiation doses of patients.

Hemangiomas are rare benign vascular tumors; there are several types including the capillary hemangiomas, we present the case of an exceptional localization of capillary hemangioma in the middle ear. We report the case of a 60-year-old female which consults for episodes of pulsatile tinnitus, otorragies, and hearing loss of the left ear. The clinical examination revealed a reddish polypoid mass in the left external auditory canal, the radiological tests showed a vascular mass in the middle left ear. The tumor was surgically removed, the histological study revealed a capillary hemangioma. The incidence of hemangiomas in the temporal bone, especially in the middle ear, is exceptional. Medical imaging guides to the vascular nature of these tumors that make confusion with other vascular tumors such as tympanic paragangliomas. The management is often surgical and the final diagnosis is histological.

Autism spectrum disorder is a neurodevelopmental disorder with a heterogeneous presentation, the etiology of which is not clearly elucidated. In recent years, comorbidity has become more evident with the increase in the frequency of autism and diagnostic possibilities of inborn errors of metabolism. One hundred and seventy-nine patients with diagnosis of autism spectrum disorder who presented to the Pediatric Metabolism outpatient clinic between 01/September/2018-29/February/2020 constituted the study population. The personal information, routine and specific metabolic tests of the patients were analyzed retrospectively. Out of the 3261 patients who presented to our outpatient clinic, 179 (5.48%) were diagnosed with autism spectrum disorder and were included in the study. As a result of specific metabolic examinations performed, 6 (3.3%) patients were diagnosed with inborn errors of metabolism. Two of our patients were diagnosed with classical phenylketonuria, two with classical homocystinuria, one with mucopolysaccharidosis type 3D (Sanfilippo syndrome) and one with 3-methylchrotonyl Co-A carboxylase deficiency. Inborn errors of metabolism may rarely present with autism spectrum disorder symptoms. Careful evaluation of the history, physical examination and additional findings in patients diagnosed with autism spectrum disorder will guide the clinician in the decision-making process and chose the appropriate specific metabolic investigation. An underlying inborn errors of metabolism may be a treatable cause of autism.

Ultrasound-guided needle biopsy based on artificial neural network, as a safe, effective, and simple preoperative pathological diagnosis technique, has been widely used in clinical practice. Ultrasound-guided needle biopsy based on artificial neural networks for suspicious breast lesions found in conventional ultrasound examinations is an effective method for preoperative diagnosis. The purpose of this article is to study the value of artificial neural network ultrasound in improving breast cancer diagnosis. This article summarizes the neuron model of PCNN by observing and studying its impulse synchronization phenomenon. Aiming at gray-scale images disturbed by mixed noise (impulse noise and the Gaussian noise), a comprehensive filtering algorithm based on the simplified PCNN model is proposed. In this paper, the benign and malignant breast masses were evaluated based on the two-dimensional and three-dimensional ultrasound imaging signs of the mass, and compared with the postoperative pathological results, a logistic regression model was established to analyze the shape, boundary, microcalcification, and posterior echo attenuation of the mass, values for keratinization or burrs, convergent signs, and blood flow classification in the differential diagnosis of benign and malignant. In this paper, a color ultrasound diagnostic device is used, Sonobi is used as a contrast medium, and the injection volume is 2.4 ml/dose. During the imaging process, the sound image performance of the lesion is dynamically observed, the original dynamic data are stored throughout the whole process, and the playback analysis is performed after the imaging is completed. Studies have shown that CDUS elastography (UE) combined with MRI can increase the sensitivity of breast cancer diagnosis, with a diagnostic accuracy rate of 92.4%.

Syndesmotic instability is a fundamental question that guides treatment; despite the currently available diagnostic imaging tests, its determination is still challenging. Knowledge of the instability degree assists the physician in the decision-making process regarding surgical or nonsurgical treatments. The authors are currently conducting a prospective diagnostic accuracy study by consecutively selecting individuals aged 18 years and older with an orthopaedic clinical examination indicating suspected acute syndesmotic injury. Magnetic resonance imaging is the reference standard used for evaluating the diagnostic accuracy of 3 computed tomography index tests. These tests include the neutral position and 2 ankle stress maneuvers: external rotation and dorsiflexion. Comparative measurements between the injured syndesmosis and the uninjured contralateral side of the same individual evaluate the tibiofibular relationship and investigate syndesmotic instability. This study aims to describe a summarized research protocol for a new technique using computed tomography with stress maneuvers and to show a didactic example of syndesmotic instability diagnosis. Level of Evidence V; Diagnostic Studies; Expert Opinion.