-
BMC Medical Imaging Dec 2022There are two types of testicular torsion: complete and incomplete. The degree and duration of symptoms of this condition are critical for treatment decision-making, as...
BACKGROUND
There are two types of testicular torsion: complete and incomplete. The degree and duration of symptoms of this condition are critical for treatment decision-making, as the consequences for untimely diagnosis and management can be serious. The preoperative assessment of the degree of acute testicular torsion using ultrasonography is particularly important for determining the appropriate intervention. The purpose of this study was to compare the effectiveness of high-frequency versus contrast-enhanced ultrasonography in determining the degree of acute testicular torsion.
METHODS
Fifteen patients with clinically diagnosed acute testicular torsion underwent both high-frequency and contrast-enhanced ultrasonography. We compared the characteristics of the ultrasonographic images of the testicular parenchyma in both the afflicted and contralateral (healthy) testes to determine the reliability of contrast-enhanced ultrasonography in assessing the degree of acute testicular torsion.
RESULTS
The high-frequency ultrasound and contrast-enhanced ultrasound diagnosis of 4 complete testicular torsion and 11 incomplete testicular torsion were correct before operation. However, 5 patients with incomplete testicular torsion were misdiagnosed as complete testicular torsion because no blood flow was detected by high frequency ultrasound. Finally, low speed blood flow was detected by contrast-enhanced ultrasound and the diagnosis was corrected. The accuracy of diagnosing incomplete testicular torsion was 100% using contrast-enhanced ultrasonography and 66.7% using high-frequency ultrasonography; the difference between the two methods was statistically significant (χ = 2.50, P ≤ 0.05).
CONCLUSION
Contrast-enhanced ultrasonography can diagnose testicular torsion with high accuracy and can detect low-velocity blood flow and show microcirculatory blood perfusion in the testicular parenchyma. This can avoid misdiagnosing incomplete testicular torsion as complete, thus averting unnecessary orchiectomy.
Topics: Male; Humans; Spermatic Cord Torsion; Microcirculation; Reproducibility of Results; Testis; Ultrasonography
PubMed: 36528608
DOI: 10.1186/s12880-022-00953-9 -
BMC Gastroenterology Oct 2021The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study...
BACKGROUND
The clinical features of amoebic colitis resemble those of inflammatory bowel disease (IBD), and therefore the risk of misdiagnosis is very high. The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complication.
METHODS
We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination, no ELISA stool antigen or PCR tests were used.
RESULTS
16 patients were diagnosed with amebic colitis by the colonoscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis (100%), and the caecum and rectum were also involved in many lesions (68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients (100%).The endoscopic findings included multiple irregular shaped ulcers and erosions with surrounding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients (54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients (45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1/HPF to > 50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases (62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case (16.7%). Cryptitis was observed in 12 cases (75%) and its severity was mild or moderate. No crypts abscess was observed in all cases.
CONCLUSIONS
The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the exudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.
Topics: Colonoscopy; Diagnosis, Differential; Dysentery, Amebic; Humans; Inflammatory Bowel Diseases; Retrospective Studies
PubMed: 34627159
DOI: 10.1186/s12876-021-01941-z -
European Heart Journal. Cardiovascular... Sep 2023Traditionally, congestive heart failure (HF) was phenotyped by echocardiography or other imaging techniques according to left ventricular (LV) ejection fraction (LVEF)....
Traditionally, congestive heart failure (HF) was phenotyped by echocardiography or other imaging techniques according to left ventricular (LV) ejection fraction (LVEF). The more recent echocardiographic modality speckle tracking strain is complementary to LVEF, as it is more sensitive to diagnose mild systolic dysfunction. Furthermore, when LV systolic dysfunction is associated with a small, hypertrophic ventricle, EF is often normal or supernormal, whereas LV global longitudinal strain can reveal reduced contractility. In addition, segmental strain patterns may be used to identify specific cardiomyopathies, which in some cases can be treated with patient-specific medicine. In HF with preserved EF (HFpEF), a diagnostic hallmark is elevated LV filling pressure, which can be diagnosed with good accuracy by applying a set of echocardiographic parameters. Patients with HFpEF often have normal filling pressure at rest, and a non-invasive or invasive diastolic stress test may be used to identify abnormal elevation of filling pressure during exercise. The novel parameter LV work index, which incorporates afterload, is a promising tool for quantification of LV contractile function and efficiency. Another novel modality is shear wave imaging for diagnosing stiff ventricles, but clinical utility remains to be determined. In conclusion, echocardiographic imaging of cardiac function should include LV strain as a supplementary method to LVEF. Echocardiographic parameters can identify elevated LV filling pressure with good accuracy and may be applied in the diagnostic workup of patients suspected of HFpEF.
Topics: Humans; Heart Failure; Stroke Volume; Echocardiography; Ventricular Function, Left; Ventricular Dysfunction, Left; Hemodynamics
PubMed: 37542477
DOI: 10.1093/ehjci/jead196 -
Malaria Journal Jul 2022Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and...
Knowledge, attitudes and practices towards malaria diagnostics among healthcare providers and healthcare-seekers in Kondoa district, Tanzania: a multi-methodological situation analysis.
BACKGROUND
Despite the large-scale rollout of malaria rapid diagnostic tests (RDTs) in Tanzania, many healthcare providers (HCPs) continue using blood film microscopy (BFM) and clinical examination to diagnose malaria, which can increase the risk of mal-diagnosis and over-prescribing of anti-malarials. Patients disregarding negative test results and self-treating exacerbate the problem. This study explored the knowledge, attitudes and practices of HCPs and healthcare-seekers regarding RDTs in comparison to BFM testing.
METHODS
A situational analysis was, therefore, conducted in Kondoa District, Dodoma Region, Tanzania. A multi-methodological approach was adopted including (i) a health facility inventory and screening of logbooks from May 2013 to April 2014 with 77,126 patient entries from 33 health facilities; (ii) a survey of 40 HCPs offering malaria services; and iii) a survey of 309 randomly selected household members from the facilities' catchment area. Surveys took place in April and May 2014.
RESULTS
Health facility records revealed that out of 77,126 patient entries, 22% (n = 17,235) obtained a malaria diagnosis. Of those, 45% were made with BFM, 33% with RDT and 22% with clinical diagnosis. A higher rate of positive diagnoses was observed with BFM compared with RDT (71% vs 14%). In the HCP survey, 48% preferred using BFM for malaria testing, while 52% preferred RDT. Faced with a negative RDT result for a patient presenting with symptoms typical for malaria, 25% of HCPs stated they would confirm the result with a microscopy test, 70% would advise or perform a clinical diagnosis and 18% would prescribe anti-malarials. Interviews with household members revealed a preference for microscopy testing (58%) over RDT (23%), if presented with malaria symptoms. For participants familiar with both tests, a second opinion was desired in 45% after a negative microscopy result and in 90% after an RDT.
CONCLUSIONS
Non-adherence to negative diagnostics by HCPs and patients continues to be a concern. Frequent training and supportive supervision for HCPs diagnosing and treating malaria and non-malaria febrile illnesses is essential to offer quality services that can instil confidence in HCPs and patients alike. The introduction of new diagnostic devices should be paired with context-specific behaviour change interventions targeting healthcare-seekers and healthcare providers.
Topics: Antimalarials; Diagnostic Tests, Routine; Health Facilities; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Malaria; Tanzania
PubMed: 35864543
DOI: 10.1186/s12936-022-04244-0 -
Der Pathologe Feb 2020Interstitial lung diseases present clinically with unspecific respiratory symptoms and occur idiopathically or etiologically linked to various causes. The morphology of... (Review)
Review
Interstitial lung diseases present clinically with unspecific respiratory symptoms and occur idiopathically or etiologically linked to various causes. The morphology of interstitial lung diseases (radiology or histopathology) may also be unspecific in the individual case, due to the limited arsenal of reaction patterns of the lungs. Only the combination of all findings assembled during multidisciplinary discussion (MDD) between pulmonologist, radiologist and pathologist, and if required other specialties, enables a highly reliable final diagnosis, permitting improved, personalized patient treatment. The necessity for histological evaluation and the means of tissue acquisition should also be decided on during MDD, considering clinical and radiological differential diagnoses, the risks involved in the procedures and patient-specific characteristics. In the current review, we discuss MDD as the diagnostic gold standard and exemplify its merit presenting a case of interstitial lung disease.
Topics: Diagnosis, Differential; Humans; Lung; Lung Diseases, Interstitial; Radiography
PubMed: 31858183
DOI: 10.1007/s00292-019-00725-3 -
Clinical Oral Investigations Mar 2021Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This...
OBJECTIVES
Chronic rhinosinusitis (CRS) frequently stems from a dental origin, although odontogenic sinusitis (OS) remains underdiagnosed amongst different professionals. This study aimed to explore how often odontogenic causes are considered when diagnosing CRS.
MATERIALS AND METHODS
Patient records from 374 new CRS patients treated at a tertiary-level ear, nose, and throat (ENT) clinic were selected. Entries and radiological reports were assessed exploring how often dentition was mentioned and OS was suspected, how often radiologists reported maxillary teeth, and how commonly typical OS microbial findings and unilateral symptoms occurred.
RESULTS
Although 10.1% of the CRS diagnoses were connected to possible dental issues, teeth were not mentioned for 73.8% of patients. Radiological reports were available from 267 computed or cone beam computed tomographies, of which 25.1% did not mention the maxillary teeth. The reported maxillary teeth pathology was not considered in 31/64 (48.4%) cases. Unilateral symptoms associated with apical periodontitis (OR = 2.49, 95% CI 1.27-4.89, p = 0.008). Microbial samples were available from 88 patients, for whom Staphylococcus aureus was the most common finding (17% of samples).
CONCLUSIONS
Odontogenic causes are often overlooked when diagnosing CRS. To provide adequate treatment, routine assessment of patient's dental history and status, careful radiograph evaluation, and utilization of microbial findings should be performed. Close cooperation with dentists is mandatory.
CLINICAL RELEVANCE
Dental professionals should be aware of difficulties medical professionals encounter when diagnosing possible OS. Thus, sufficient knowledge of OS pathology is essential to both medical and dental professionals.
Topics: Cone-Beam Computed Tomography; Humans; Maxillary Sinusitis; Odontogenesis; Sinusitis; Tomography, X-Ray Computed
PubMed: 32500403
DOI: 10.1007/s00784-020-03384-4 -
Medicine Nov 2023Transverse testicular ectopia (TTE) is a rare congenital malformation with a high rate of misdiagnosis and mistreatment before operation, which cannot be diagnosed even... (Review)
Review
RATIONALE
Transverse testicular ectopia (TTE) is a rare congenital malformation with a high rate of misdiagnosis and mistreatment before operation, which cannot be diagnosed even during operation due to lack of knowledge.
PATIENT CONCERNS
Two patients with ectopic testes who were misdiagnosed as right inguinal hernia for the first time and underwent surgery. The "ovary" and "testicle" like structures was seen in the right inguinal region during the first operation. After being transferred to our hospital for laparoscopic surgery, it was found that the left spermatic cord and testis were transversely transverted to the right, the left testis was fixed at the right inner ring, and agglomerated soft tissue could be seen in the right inguinal canal, which was suspected to be Muller tube.
DIAGNOSES
Based on preoperative images and intraoperative findings, both cases were diagnosed with Transverse testicular ectopia (TTE). The postoperative pathology report for the second patient revealed the presence of an in situ spermatogenic cell tumor in the ectopic testis.
INTERVENTIONS
Preperitoneal tension-free repair of right inguinal hernia and resection of left cryptorchidism were performed on the 2 patients.
OUTCOMES
Postoperative pathology of the first patient confirmed that the resected specimens contained tubal-like and uterine-like structures. The postoperative pathology of the second patient showed that the resected tissue consists of immature testis, epididymis, uterus and seminal vesicle glands, in which an in situ spermatogenic tumor could be seen in the testicular tissue. Postoperative diagnosis: left transversal testicular ectopia and right indirect inguinal hernia.
LESSONS
The clinical misdiagnosis and mistreatment rate of TTE is very high. Once the patients with cryptorchidism complicated with inguinal hernia are found in clinic, the possibility of the disease must be considered. For the patients whose cryptorchidism does not descend into the ipsilateral scrotum and it is difficult to diagnose, laparoscopy can be used for both diagnosis and treatment. If a patient has both inguinal hernia and cryptorchidism, it is crucial to rule out a diagnosis of TTE to prevent misdiagnosis and inappropriate treatment.
Topics: Humans; Male; Cryptorchidism; Diagnostic Errors; Hernia, Inguinal; Neoplasms; Testis
PubMed: 37933018
DOI: 10.1097/MD.0000000000035850 -
Journal of Clinical Immunology Nov 2023Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or...
Missed Opportunities to Diagnose Common Variable Immunodeficiency: a Population-Based Case-Control Study Identifying Indicator Diseases for Common Variable Immunodeficiency.
PURPOSE
Delayed diagnosis of common variable immunodeficiency (CVID) remains a serious problem. We investigated whether some diseases diagnosed during out-patient visits or admission to hospitals could act as indicator conditions for CVID diagnosis.
METHODS
In this nested case-control study, we identified 128 cases diagnosed with CVID in Denmark (1999-2013) and 640 age-, gender-, and region-matched controls. We obtained data on diseases diagnosed at hospitals in the five years before CVID diagnosis from The National Hospital Registry. We grouped hospital diagnoses in 33 major disease categories and 210 subcategories. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (CI) to estimate associations between disease exposure and subsequent CVID.
RESULTS
During the five years preceding a CVID diagnosis, cases had four times as many hospital contacts as the controls (p < 0.001). A diagnosis in 18 major disease categories showed a significant OR for subsequent diagnosis of CVID. The most substantial association with a subsequent CVID diagnosis was a diagnosis of lower respiratory tract infections (OR: 29.9; 95% CI: 14.2-63.2) and lung diseases (35.1; 15.0-82.5). We observed a similar association when we removed the last year before diagnosis from analysis and overall, in the years < 1, ≥ 1-3, and ≥ 3-5 before diagnosis, although the absolute number of exposures was small. Twenty-eight specific diseases displayed an at least 3-fold risk of subsequent CVID diagnosis.
CONCLUSION
Targeted screening for antibody deficiency in patients diagnosed with specific diseases associated with CVID may lead to earlier CVID diagnosis and treatment and thereby potentially reduced morbidity and mortality.
Topics: Humans; Case-Control Studies; Common Variable Immunodeficiency; Early Diagnosis; Odds Ratio; Registries
PubMed: 37770805
DOI: 10.1007/s10875-023-01590-9 -
The British Journal of General Practice... Feb 2020Cellulitis can sometimes be challenging for healthcare professionals to diagnose, with no validated diagnostic criteria available. Supporting healthcare professionals to...
BACKGROUND
Cellulitis can sometimes be challenging for healthcare professionals to diagnose, with no validated diagnostic criteria available. Supporting healthcare professionals to make a more accurate diagnosis of cellulitis in different groups, such as those with lymphoedema, is a cellulitis research priority. However, to the authors knowledge, no previous studies have looked at the involvement of non-healthcare professionals in the diagnostic process.
AIM
To explore the experience of people with lymphoedema and recurrent cellulitis in the diagnosis of lower-limb cellulitis.
DESIGN AND SETTING
Single, semi-structured, qualitative interviews carried out between 29 October and 19 December 2018.
METHOD
Adults with a suspected episode of cellulitis who had been diagnosed in the last 12 months or had a history of recurrent cellulitis were interviewed.
RESULTS
Three key themes emerged: the recurrent nature of cellulitis symptoms, participants' experience of getting a cellulitis diagnosis, and participants' suggestions of how cellulitis diagnosis might be improved. Generally, people with lymphoedema experienced similar clinical features during each of their own recurrent cellulitis episodes and were confident that they could make a self-diagnosis of cellulitis. This is also reflected in the participants' perceived trust from the healthcare professional in being able to make a self-diagnosis. A diagnostic checklist and educational resources were suggested as methods to improve diagnosis.
CONCLUSION
Selected people with lymphoedema who have recurrent cellulitis are confident in self-diagnosing their own recurrent cellulitis episodes. There may be a role for greater involvement of people with lymphoedema in their cellulitis diagnosis.
Topics: Adolescent; Adult; Aged; Cellulitis; Diagnostic Self Evaluation; Female; Humans; Lower Extremity; Lymphedema; Male; Middle Aged; Qualitative Research; Recurrence; Self Concept; Symptom Assessment; Young Adult
PubMed: 31848202
DOI: 10.3399/bjgp19X707909 -
Scientific Reports Jul 2022Computed tomography (CT) has been widely used to diagnose Graves' orbitopathy, and the utility is gradually increasing. To develop a neural network (NN)-based method for...
Computed tomography (CT) has been widely used to diagnose Graves' orbitopathy, and the utility is gradually increasing. To develop a neural network (NN)-based method for diagnosis and severity assessment of Graves' orbitopathy (GO) using orbital CT, a specific type of NN optimized for diagnosing GO was developed and trained using 288 orbital CT scans obtained from patients with mild and moderate-to-severe GO and normal controls. The developed NN was compared with three conventional NNs [GoogleNet Inception v1 (GoogLeNet), 50-layer Deep Residual Learning (ResNet-50), and 16-layer Very Deep Convolutional Network from Visual Geometry group (VGG-16)]. The diagnostic performance was also compared with that of three oculoplastic specialists. The developed NN had an area under receiver operating curve (AUC) of 0.979 for diagnosing patients with moderate-to-severe GO. Receiver operating curve (ROC) analysis yielded AUCs of 0.827 for GoogLeNet, 0.611 for ResNet-50, 0.540 for VGG-16, and 0.975 for the oculoplastic specialists for diagnosing moderate-to-severe GO. For the diagnosis of mild GO, the developed NN yielded an AUC of 0.895, which is better than the performances of the other NNs and oculoplastic specialists. This study may contribute to NN-based interpretation of orbital CTs for diagnosing various orbital diseases.
Topics: Graves Ophthalmopathy; Humans; Neural Networks, Computer; Tomography, X-Ray Computed
PubMed: 35840769
DOI: 10.1038/s41598-022-16217-z