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European Journal of Heart Failure Nov 2023Diagnosing heart failure is often difficult due to the non-specific nature of symptoms, which can be caused by a range of medical conditions. Natriuretic peptides (NPs)...
Diagnosing heart failure is often difficult due to the non-specific nature of symptoms, which can be caused by a range of medical conditions. Natriuretic peptides (NPs) have been recognized as important biomarkers for diagnosing heart failure. This document from the Heart Failure Association examines the practical uses of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in various clinical scenarios. The concentrations of NT-proBNP vary according to the patient profile and the clinical scenario, therefore values should be interpreted with caution to ensure appropriate diagnosis. Validated cut-points are provided to rule in or rule out acute heart failure in the emergency department and to diagnose de novo heart failure in the outpatient setting. We also coin the concept of 'heart stress' when NT-proBNP levels are elevated in an asymptomatic patient with risk factors for heart failure (i.e. diabetes, hypertension, coronary artery disease), underlying the development of cardiac dysfunction and further increased risk. We propose a simple acronym for healthcare professionals and patients, FIND-HF, which serves as a prompt to consider heart failure: Fatigue, Increased water accumulation, Natriuretic peptide testing, and Dyspnoea. Use of this acronym would enable the early diagnosis of heart failure. Overall, understanding and utilizing NT-proBNP levels will lead to earlier and more accurate diagnoses of heart failure ultimately improving patient outcomes and reducing healthcare costs.
Topics: Humans; Natriuretic Peptide, Brain; Heart Failure; Heart Diseases; Peptide Fragments; Biomarkers; Early Diagnosis
PubMed: 37712339
DOI: 10.1002/ejhf.3036 -
Pathology Oncology Research : POR Apr 2020Hepatocellular carcinoma (HCC) is one of the most malignant cancer with high morbidity and mortality which lead to a serious burden to society. AFP (alpha-fetoprotein)... (Review)
Review
Hepatocellular carcinoma (HCC) is one of the most malignant cancer with high morbidity and mortality which lead to a serious burden to society. AFP (alpha-fetoprotein) is the most widely used serum biomarker to detect HCC worldwide. However, no AFP elevation have been found in many HCC and AFP analysis can't be used to screen HCC in these cases. Currently, many studies have been carried out to find reliable biomarker in diagnosing AFP-negative HCC. Such biomarker would help the diagnosis of AFP-negative HCC, ensuring the timely initiation of treatment. In this review, we highlight the important role of biomarkers that can differentiate AFP-negative HCCs, and discuss their potential clinical applications as biomarkers for the diagnosis of AFP-negative HCC.
Topics: Biomarkers, Tumor; Carcinoma, Hepatocellular; Early Diagnosis; Humans; Liver Neoplasms; alpha-Fetoproteins
PubMed: 30661224
DOI: 10.1007/s12253-019-00585-5 -
Ugeskrift For Laeger Feb 2023Neck masses are common in the paediatric population and can cause diagnostic challenges due to various differential diagnoses as summarised in this review. Neck masses... (Review)
Review
Neck masses are common in the paediatric population and can cause diagnostic challenges due to various differential diagnoses as summarised in this review. Neck masses in children are divided into the following categories: congenital, inflammatory/infectious and neoplastic masses. The neck masses are generally benign, but malignancy should be considered if the child is presenting with certain symptoms and findings. The objective of this review is to increase the knowledge of the common differential diagnoses of neck masses in children and to provide guidance of indications for diagnostics and treatment.
Topics: Child; Humans; Head and Neck Neoplasms; Diagnosis, Differential; Neck
PubMed: 36762376
DOI: No ID Found -
Respiratory Medicine and Research Mar 2020Multiple problems may be encountered during the diagnosis of sarcoidosis: at first diagnose sarcoidosis in an appropriate clinical setting, secondly, identify any... (Review)
Review
Multiple problems may be encountered during the diagnosis of sarcoidosis: at first diagnose sarcoidosis in an appropriate clinical setting, secondly, identify any manifestation to be linked to sarcoidosis at diagnosis work-up and during evolution; thirdly, recognize "danger" in sarcoidosis and parasarcoidosis syndromes, and finally, diagnose sarcoidosis recovery. Diagnosis is often delayed as presentation may be diverse, non-specific, or atypical. Diagnosis of sarcoidosis is based on three criteria: a compatible presentation; evidence of non-caseating granulomas and exclusion of any alternative diagnosis. However, even when all criteria are fulfilled, the probability of sarcoidosis diagnosis varies from definite to only possible depending upon the presence of more or less characteristic radio-clinical and histopathological findings and on the epidemiological context. Bilateral hilar lymphadenopathy and/or diffuse lung micronodules mainly along lymphatics are the most frequent highly suggestive findings. Evidence of granulomas relies on superficial biopsies of clinically suspected lesion when present or most often by bronchial endoscopy. The diagnosis of sarcoidosis may be difficult in absence of thoracic or skin manifestations and may require the benefit of hindsight before being definitive. Differential diagnoses, mainly tuberculosis, must be considered. The diagnosis of events during evolution relies on serial clinical, pulmonary function, radiographic evaluation and on extrapulmonary manifestations work-up, including electrocardiogram and blood biology. Affected organs need to be related to sarcoidosis using an appropriate diagnostic assessment instrument. To declare the recovery of sarcoidosis, all manifestations must have disappeared spontaneously or after 3-5 years post-treatment without relapse.
Topics: Bronchoscopy; Diagnosis, Differential; Diagnostic Techniques, Respiratory System; Humans; Sarcoidosis; Sarcoidosis, Pulmonary
PubMed: 32035337
DOI: 10.1016/j.resmer.2019.09.002 -
The American Journal of Case Reports Sep 2021BACKGROUND Gout is a chronic disease characterized by deposition of monosodium urate crystals, typically manifesting as arthritis. Clinical presentation of gout usually...
BACKGROUND Gout is a chronic disease characterized by deposition of monosodium urate crystals, typically manifesting as arthritis. Clinical presentation of gout usually results from activation of local inflammatory response. Despite being one of the oldest diseases in the world, gout pathophysiology is incompletely understood and clinical features are still surprising. Recent reports describe unusual manifestations including atypical joints involvement, tenosynovitis, panniculitis, and multinodular inguinal swelling. Another atypical feature is the acute polyarticular gout with severe systemic inflammatory response. CASE REPORT We report the case of a 55-year-old man presenting with fever, tachycardia, cauda equina syndrome, left-knee arthritis, and systemic inflammatory manifestations. Lumbar spine magnetic resonance imaging showed a 4.0×1.3×2.2 cm calcified mass inside the vertebral canal at the L4-L5 level, causing stenosis of the dural space and intervertebral foramen. Clinical diagnoses were septic knee arthritis and lumbar spine meningioma. Despite antibiotic therapy and left-knee surgical drainage, fever and increased C-reactive protein persisted, and arthritis developed in the elbows and right knee. As cultures were negatives, we then diagnosed gout flare in the affected joints accompanied by a severe systemic inflammatory reaction. A few days after starting colchicine and anti-inflammatory drugs, symptoms and inflammatory markers subsided. It was such a severe attack that we called it a "gout storm". CONCLUSIONS The report highlights the difficulty in diagnosing acute polyarticular gout affecting atypical joints, particularly when faced with a severe systemic inflammatory reaction.
Topics: Colchicine; Gout; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Symptom Flare Up; Uric Acid
PubMed: 34855717
DOI: 10.12659/AJCR.932683 -
Journal of Medical Ultrasonics (2001) Jul 2020Advances and widespread use of various diagnostic imaging modalities have dramatically improved our ability to visualize and diagnose pancreatic diseases. In particular,... (Review)
Review
INTRODUCTION
Advances and widespread use of various diagnostic imaging modalities have dramatically improved our ability to visualize and diagnose pancreatic diseases. In particular, ultrasonography in pancreatic diseases plays an important role from screening to diagnosis as a simple and safe examination method.
METHODS
The basic scanning method of transabdominal pancreatic ultrasonography, characterization, and differential diagnosis by ultrasonography including contrast-enhanced ultrasonography (CEUS) for solid pancreatic tumors are reviewed with reference to various papers.
RESULTS
In recent years, the ability to visualize and diagnose pancreatic mass lesions has been dramatically improved with advances in ultrasound equipment. In particular, CEUS using an ultrasound contrast agent has made it possible to evaluate hemodynamics in organs or lesions as well as in the flow signal of arterial blood vessels, and it has played an important role not only in diagnosis of the presence of a lesion but also in the qualitative diagnosis. The enhancement behavior and pattern with CEUS of pancreatic solid tumors is shown in text and Fig. 9. Moreover, the flow chart for diagnosing pancreatic solid tumors with CEUS classifying the enhancement behavior and pattern for pancreatic solid tumors on CEUS is shown (Fig. 10). In meta-analyses, the pooled sensitivity in the differential diagnosis of pancreatic adenocarcinomas and other pancreatic focal masses with CEUS was 86-90%, and the pooled specificity was 75-88%.
CONCLUSION
CEUS is a minimally invasive and useful diagnostic method that can be used to make a simple and quick qualitative diagnosis of pancreatic diseases. CEUS provides a lot of information important for diagnosis, and has led to changes in the conventional diagnostic systems in pancreatic diseases.
Topics: Contrast Media; Diagnosis, Differential; Female; Humans; Image Enhancement; Male; Middle Aged; Pancreas; Pancreatic Neoplasms; Sensitivity and Specificity; Ultrasonography
PubMed: 31420821
DOI: 10.1007/s10396-019-00968-w -
Indian Journal of Cancer 2020Cancer therapy is undergoing rapid advancements and many of the conditions that were incurable earlier can now easily be treated. Making a "correct diagnosis" is the...
Cancer therapy is undergoing rapid advancements and many of the conditions that were incurable earlier can now easily be treated. Making a "correct diagnosis" is the first step in the ladder towards treating the disease. However, once diagnosed, "breaking bad news" to the patient and his family that he/she has cancer is still a big challenge as it is a life-changing event not only for the patient but their families as well. The following article narrates an incident dealing with the significance of diagnosing the condition accurately and that of "breaking bad news". It gives an insight into the emotional ordeal that clinicians dealing with terminal-illnesses like cancer go through on a daily basis while trying to diagnose it and communicating it to the patient and his family.
Topics: Diagnosis, Differential; Humans; Male; Neoplasms
PubMed: 32445328
DOI: 10.4103/ijc.IJC_418_19 -
European Journal of Radiology Sep 2020Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis,... (Review)
Review
Acute appendicitis is one of the most common surgical emergencies worldwide. Over the past 30 years, imaging has become central to the diagnosis of appendicitis, reducing both negative appendicectomy rate and healthcare expenses. Appendicitis can be challenging in many ways for radiologists with various clinical presentations, complications and differential diagnoses. The aim of this review is to present a step-by-step reasoning with key findings, tips and tricks leading to the diagnosis of appendicitis and its complications. The first steps are with the use of the appropriate imaging modality (US, CT and MRI) to locate the appendix in abdominal cavity and to identify the features of appendicitis and its complications through specific imaging signs. The next steps are to eliminate an unusual morphology of the appendix that may simulate acute appendicitis and to recognize an unusual imaging presentation of appendicitis. Then, to corroborate the diagnosis of appendicitis, the last step is to rule out any differential diagnoses mainly from the genitourinary and gastrointestinal tracts. Following these steps can help to accurately diagnose appendicitis and its complications.
Topics: Acute Disease; Appendicitis; Appendix; Diagnosis, Differential; Diagnostic Errors; Diagnostic Imaging; Female; Humans; Reproducibility of Results
PubMed: 32663765
DOI: 10.1016/j.ejrad.2020.109165 -
Der Radiologe Apr 2022Multiple sclerosis (MS) is an inflammatory autoimmune disease that leads to the development of demyelination foci in the central nervous system and can affect any... (Review)
Review
Multiple sclerosis (MS) is an inflammatory autoimmune disease that leads to the development of demyelination foci in the central nervous system and can affect any neurological function. In the developed world, it represents the most common chronic neurological (nontraumatic) disease in young and middle-aged patients. Magnetic resonance imaging (MRI) is the first-line imaging modality for the diagnosis and follow-up of MS. The currently valid McDonald criteria, updated in 2017, define the exact morphological imaging criteria for diagnosing MS. In addition to the detection of typical MS plaques, the determination of spatial and temporal dissemination is essential for the initial diagnosis. A standardized MRI protocol consisting of mandatory and optional sequences is recommended for reliable diagnosis and differentiation from a broad spectrum of differential diagnoses.
Topics: Central Nervous System; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Middle Aged; Multiple Sclerosis
PubMed: 35286424
DOI: 10.1007/s00117-022-00981-0 -
Digestion 2024Functional endoscopy signifies a significant advancement in gastrointestinal examination, integrating motor function assessments alongside routine endoscopy findings.... (Review)
Review
BACKGROUND
Functional endoscopy signifies a significant advancement in gastrointestinal examination, integrating motor function assessments alongside routine endoscopy findings. Traditional gastrointestinal endoscopy primarily focuses on the detection of early-stage cancer by identifying morphological changes within the gastrointestinal tract. These alterations include modifications in lumen structure, color tone, and surface patterns, which can be diagnosed using endoscopic images that assess these morphological changes. In contrast, functional endoscopy aims to dynamically evaluate the peristaltic movements of the digestive tract and the presence or movement of reflux of digestive fluids during the endoscopic procedure. It also seeks to identify morphological changes such as hiatal hernias, as observed in conventional endoscopy. Consequently, relying solely on endoscopic images proves inadequate for diagnosis, necessitating continuous observation of these dynamic movements.
SUMMARY
The endoscopic pressure study integrated system (EPSIS) serves as an exemplar of functional endoscopy. It incorporates a stress test to assess the functionality of the lower esophageal sphincter (LES) through intragastric insufflation. A crucial element of EPSIS evaluation is the identification of the scope holding sign (SHS), which signifies LES contraction. EPSIS also encompasses the observation of esophageal peristaltic waves and the auditory detection of burping, providing a comprehensive diagnostic approach while observing the sphincter from a retroflex view on the stomach side. By integrating these dynamic findings, functional endoscopy offers an efficient method for diagnosing functional gastrointestinal diseases, such as gastroesophageal reflux disease (GERD).
KEY MESSAGES
Functional endoscopy combines motor function assessments with traditional endoscopy, enhancing the diagnostic capabilities of gastrointestinal examinations. Traditional endoscopy focuses on identifying morphological changes, while functional endoscopy evaluates dynamic movements, reflux, and sphincter functionality. EPSIS exemplifies functional endoscopy, featuring a stress test and the SHS for LES contraction assessment. EPSIS provides a comprehensive approach to diagnose GERD by integrating dynamic observations.
Topics: Humans; Gastroesophageal Reflux; Endoscopy, Gastrointestinal; Esophageal Sphincter, Lower; Hernia, Hiatal; Manometry
PubMed: 38008079
DOI: 10.1159/000534831