Oral fluid as a diagnostic tool.

Technological advances over the past decades have enabled oral fluid to expand its usefulness in the diagnosis of disease, prediction of disease progression, monitoring of therapeutic drug levels and detection of illicit drugs. The easy non-invasive nature of collection and the relationship between oral fluid and plasma levels make oral fluid a valuable clinical tool. This review describes advances over the past 5 years in the area of oral fluid as a diagnostic tool, its use in therapeutic and illicit drug monitoring, including proposed guidelines for cut-off values, and methods of collection.     

The T-SCAN technology: electrical impedance as a diagnostic tool for breast cancer detection

In this paper we present the T-SCAN technology and its use as a diagnostic tool for breast cancer detection. We show, using theoretical models with simplified geometries, that displaying planar two-dimensional maps of the currents detected at the breast's surface relate to the electric field distribution within the breast. This distribution is a manifestation of the bulk spatial inhomogeneities in the complex dielectric constant that represent the various tissue types. These differences may be used to discriminate between various pathological states. We furthermore illustrate a useful classifier, based on admittance data measured up to 2 kHz, and we argue that low frequency impedance measurements can be used successfully in breast cancer diagnosis.     

早期宫颈癌患者保留生育功能的研究进展

近年来宫颈癌的发病呈明显的年轻化趋势,未生育的患者显著增加。因而早期宫颈癌患者保留生育功能的手术日益引起人们的关注。本文综述了近年来关于早期宫颈癌保留生育功能手术治疗的相关文献,重点讨论其适应证、具体术式、不同期别的治疗方案以及治疗后的肿瘤结局与妊娠结局。     

Fine-needle aspiration as a diagnostic tool for recurrent tonsillitis

Acute tonsillitis is a common childhood disease, but repeated antibiotic treatment may fail, leading to tonsillectomy. Superficial swab cultures do not sufficiently represent the core bacteria present, but fine-needle aspiration may be a promising diagnostic method. We evaluated 58 patients undergoing tonsillectomy, and took superficial and core swabs, and fine-needle aspirations. Staphylococcus aureus was the most common bacterial pathogen identified, present in 26 out of 50 (52%) positive core cultures, followed by Haemophilus influenza in 13 positive core cultures (26%), and group A beta-haemolytic streptococci in 10 positive core cultures (20%). Fine-needle aspiration detected 33 out of 50 positive core cultures (66%), whereas superficial swab culture detected 18 of 50 (36%); the difference being statistically significant. All pathogens detected by superficial swabs and fine-needle aspiration were detected in core cultures. The sensitivity and specificity of fine-needle aspiration were 66% and 100%, respectively, compared with 36% and 100% for superficial swabs. Fine-needle aspiration is therefore a promising method for detecting core bacteria in patients with recurrent tonsillitis.     

Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices: a reply to a rebuttal

See also Kitchen DP, Kitchen S, Jennings I, Woods TAL, Walker ID. Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices: a rebuttal. This issue, pp 1191–2; Shermock KM, Streiff MB, Pinto BL, Kraus P, Pronovost PJ. Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices. J Thromb Haemost 2011; 9: 1769–75.     

Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review

Summary. Background: The best available test for the diagnosis of upper extremity deep venous thrombosis (UEDVT) is contrast venography. The aim of this systematic review was to assess whether the diagnostic accuracy of other tests for clinically suspected UEDVT is high enough to justify their use in clinical practise and to evaluate if any test can replace venography. Methods: MEDLINE and EMBASE databases were searched from inception to June 2009. Two reviewers independently evaluated study eligibility, extracted data, and assessed study quality. Results: We identified 17 papers, reporting on 793 patients. Overall, the methodological quality was poor, sample sizes were small, and large between‐study differences were observed in spectrum and design. The summary estimates of sensitivity (95% confidence interval) were 97% (90–100%) for compression ultrasonography, 84% (72–97%) for Doppler ultrasonography, 91% (85–97%) for Doppler ultrasonography with compression, and 85% (72–99%) for phleboreography. The corresponding summary estimates of specificity were, respectively, 96% (87–100%), 94% (86–100%), 93% (80–100%), and 87% (71–100%). Clinical findings, a clinical score, D‐dimer, magnetic resonance imaging, rheography and plethysmography were evaluated in one study each, involving a median number of 46 patients (range 21–214). Sensitivity and specificity ranged from 0% to 100% and from 14% to 100%. Conclusions: Methodological limitations, large between‐study differences and small sample sizes limit the evidence of tests for clinically suspected UEDVT. Compression ultrasonography may be an acceptable alternative to venography. The addition of (color) Doppler does not seem to improve the accuracy. Adequately designed studies are warranted to confirm these findings.     

Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices: a reply to a rebuttal

See also Shermock KM, Streiff MB, Pinto BL, Kraus P, Pronovost PJ. Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices. J Thromb Haemost 2011; 9 : 1769–75; and Holland L. Novel analysis of clinically relevant diagnostic errors in point‐of‐care devices: a rebuttal. This issue, pp 321–2.     

Echocardiographic evaluation of fetal hydrothorax: the effusion ratio as a diagnostic tool.

OBJECTIVE: Fetal hydrothorax may lead to hydrops and is associated with mortality as high as 50%. The objective of this study was to define the pathophysiology of fetal hydrothorax and its relation to hydrops. METHODS: Measurements from echocardiograms of 33 fetuses diagnosed with hydrothorax were made, and included diameters of the thorax, heart, inferior vena cava, right ventricle (RV), left ventricle (LV) and aortic and pulmonary valves. Doppler-derived velocities were measured in the aorta and pulmonary artery just above the aortic and pulmonary valves. The ratio of the area of the effusion to the area of the thorax (effusion ratio) was calculated. Variables were converted into Z-scores from regression equations based on normal data. Features of fetuses with and without hydrops were compared. RESULTS: Higher effusion ratios were noted in hydropic versus non-hydropic fetuses. Compared to a normal population, study subjects had smaller dimensions of LV, RV and aortic and pulmonary valves. They also had higher pulmonary artery peak velocities. The comparison between non-hydropic and hydropic fetuses revealed lower values for LV and pulmonary valve dimensions, and peak aortic velocity in hydropic fetuses. The severity of LV compression correlated significantly with effusion ratio. CONCLUSION: Fetal hydrothorax is accompanied by compression of the cardiac structures, resulting in altered cardiac hemodynamics. Echocardiographic assessment, including the measurement of effusion ratio, may be a useful tool in guiding fetal therapy.