Novel biomarkers in heart failure: usefulness in clinical practice

Biomarkers have become an increasingly important tool in clinical practice, helping to improve patient care. In heart failure (HF), brain natriuretic peptide and N-terminal prohormone of the brain natriuretic peptide have been widely applied in prognosis, clinical diagnosis and treatment. Recently, several novel biomarkers have been examined on their efficacy to improve diagnosis, determine the pathophysiologic state of HF, improve clinical decision making, clinical outcome, guide treatment and assess prognosis of HF patients. In this special report, the authors summarize the usefulness and significance of the most promising novel biomarkers in patients with HF.     

Disappointing specificity of the leucocyte-esterase test for the diagnosis of urinary tract infection in general practice

Objectives: To determine the sensitivity and specificity of the leucocyte-esterase test (LE test) as a diagnostic tool in general practice.

Methods: In 249 women consulting their general practitioners for dysuria, both the LE test (Nephur testR + leuco/Boehringer Mannheim) and a culture (UricultRdipslide) were performed on freshly voided urine. The sensitivity and specificity of the LE test were determined with urine culture as standard.

Results: Sensitivity was 96%, specificity only 15.5% (criterion for positivity of the stick: each colour change; positivity for culture: $100,000 colony-forming units (cfu)/ml or every pure culture of Staphylococcus saprophyticus. By lowering the criterion for culture from $100,000 cfu/ml to $10,000 cfu/ml, the specificity increased by only 0.3%. An increase in the specificity to 36% was possible by classifying ‘lightly positive’ dipsticks (10-20 white blood cells/Ml) as negative; the sensitivity then dropped to 87%. Interpretation after one minute also gave a slightly higher specificity and lower sensitivity. Conclusions: In contrast with earlier hospital-based studies, we observed a disappointing specificity of the LE test in daily practice conditions, with the risk of a significant overdiagnosis of urinary tract infection. Earlier diagnostic studies in general practice have shown very diverging results. Our study confirms the most negative ones, questioning the value of the LE test in general practice.     

Angiogenesis in salivary gland tumors: from clinical significance to treatment

Introduction: Salivary gland tumors (SGTs) represent a rare cancer entity, consisting of various morphological features that complicate diagnosis. Their diversity in terms of morphology and clinical course makes defining risk factors difficult, while the molecular steps responsible for SGT development remain unclear. Angiogenesis, a hallmark of cancer development, is considered as an attractive target.

Areas covered: This review aims to summarize the available research regarding angiogenesis in SGTs from clinical significance to treatment options.

Expert opinion: The available data suggest that microvessel density (MVD) evaluation may be capable of discriminating between benign and malignant SGTs, while the use of CD105 antibody seems to be the most suitable. Substantial evidence also suggests that MVD and VEGF expression could be used as prognostic factors in malignant SGTs. Although several agents have shown antiangiogenic activities in adenoid cystic carcinoma cells and xenograft tumors, limited effectiveness in the existing clinical trials was noted. Further studies are strongly recommended for the validation of already well-known and the identification of novel prognostic and predictive angiogenic markers. There is also a strong demand for relatively larger cohorts, homogenous samples referring to same histological SGT subtypes and including an equivalent number of low- and high-grade SGTs.     

Role of MRI in screening,diagnosis and management of breast cancer

Screening and early diagnosis has an important role in reducing the morbidity and mortality associated with breast cancer. Mammography has an established role and has been approved for routine screening. MRI is an emerging tool and has the highest sensitivity of current breast imaging techniques. Although low specificity and high cost of MRI restricted its use in routine screening, it has been increasingly used in the screening of high-risk individuals, diagnosing occult cases, staging and assessing the response to chemotherapy. MRI-guided techniques, including needle-localization biopsy and vacuum-assisted breast biopsy, have a special role in diagnosis and management. This article focuses on the role of MRI in diagnosis, screening and management of breast cancer, and reviews the current indications for breast MRI.     

Current Trends and Investigative Developments in Wheat Allergy

The prevalence of gluten-related diseases is increasing in an alarming rate. The studies regarding wheat allergy in the Southeastern and Central Europe are few. The aim of our study was to discuss the effectiveness of serological tests in detecting the prevalence of specific allergens.     

Histology,Histochemistry, and Pathology of Mesothelioma

Abstract

Mesotheliomas, rare tumors arising from flat mesothelial cells lining serous cavities, are often difficult to distinguish from carcinomas. The diagnosis is made after examining all the data from clinical findings, radiology, and biopsy. An algorithmic approach to histologic, histochemical, and electron microscopic study of the biopsy is offered. (The J Histotechnol 10:269, 1987)     

First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature

A case of ectopia cordis (EC) with gastroschisis in a 27-year-old primigravida was diagnosed at 10^3/7 weeks of gestation. The pregnancy was terminated by suction dilatation and curettage. With the increasing use of first trimester ultrasonography, early detection of fetal abnormalities is becoming more frequent. We review other published cases of EC detected in the first trimester and discuss the possible advantages of early diagnosis including options of termination at earlier gestational ages which might decrease the physical and psychological trauma on some patients.