Diagnostic thoracoscopy

Since the introduction of video-imaging and endoscopic surgical interventions, there is a worldwide renewed interest in thoracoscopy. However, thoracoscopy for diagnosis of pleural and pulmonary disease has been performed for more than 30 years. An overview is presented here of the results and experiences in the past 3 decades of thoracoscopy for diagnosis of pulmonary and pleural disease. Thoracoscopy is a simple and safe method to obtain a diagnosis in case of pleural effusion, pleural mass, or interstitial lung disease. In most cases, it can be performed under local anaesthesia.     

Diagnostic Ultrasound

When ‘Fat Sam’ waddled into Pip Millard's practice, Pip saw only a very fat Jack Russell terrier needing to lose weight, and perhaps a chance for a little local publicity for the practice. Pip rang a local paper to suggest that it run a story on the dangers of overindulging pets, with no inkling that she might end up enjoying more than just 15 minutes of fame…     

Diagnostic laparoscopy

The value of surgical laparoscopy for various therapeutic interventions has been well established. In recent years, the interest of gastroenterologists in this method has revived, since laparoscopy can provide additional information for the staging of oncological and liver diseases. The introduction of miniature lenses may have contributed to this process, and an increasing number of physicians are using minilaparoscopy due to its safety and easy handling. Surgical studies have mainly focused on the evaluation of laparoscopic ultrasound for the detection of liver and lymph-node metastases. In specialized centers, laparoscopic ultrasound is also used for the estimation of locoregional pancreatic tumor spread, but the diagnostic impact of the method, particularly in colorectal carcinoma, still remains to be determined. Remarkably, the number of publications from gastroenterology departments has tended to increase in comparison with last year's review.     

Diagnostic laparoscopy

Diagnostic laparoscopy continues to play an important role in the accurate evaluation of patients with abdominal disorders. Combined with laparoscopic ultrasound, it is highly accurate in the staging of intra-abdominal malignancies, and it is superior to transcutaneous ultrasonography and computed tomography. Other important applications include the evaluation of patients with acute and chronic abdominal pain, acute abdomen, peritonitis, and blunt and penetrating abdominal trauma. Laparoscopy now rests firmly in the hands of surgeons. The majority of last year's papers originated from departments of surgery; papers on laparoscopy in hepatic disorders are sorely missing in this year's review.     

Diagnostic virology

Diagnostic virology services are increasingly available and pertinent as the number of useful antiviral agents grows. In this article, current methods of diagnosis are reviewed with special emphasis on rapid procedures. Guidelines for interpretation of cultures and other tests are provided.     

Diagnostic cholangiopancreatography

As in recent years, the articles on diagnostic endoscopic retrograde cholangiopancreatography (ERCP) published between July 2001 and June 2002 again reflect a defensive attitude and are mainly concerned with magnetic resonance cholangiopancreatography (MRCP) and the complications associated with the new imaging method. Diagnostic ERCP is declining in importance and has held its position mainly due to new advances in tissue sampling, pressure measurement, and the use of echo probes and miniature endoscopes. Problems of training in ERCP have still not yet been resolved, due to the contradictions inherent in low case loads, the desire to offer a wide spectrum of training, and issues of quality assurance.     

Diagnostic testing

The results of cardiac tests must always be interpreted through the lens of pretest probabilities created by the history and the physical examination. Tests should be chosen with a clear diagnostic and prognostic purpose in mind. A clear understanding of the relationship between the history and physical examination and more technologic diagnostic testing improves the primary care physician's ability to evaluate potential cardiac disease in an efficient and cost-effective manner.     

Diagnostic laparoscopy

Each diagnostic procedure needs to be viewed in the context of all the other available diagnostic tools, and therefore has to be reevaluated periodically. This is also true of diagnostic laparoscopy, whether performed by gastroenterologists in patients under sedoanalgesia or by surgeons in patients under general anesthesia. Publications during the previous year have shed light on many important issues. Despite its greater expense, fluorescence laparoscopy may have advantages over white-light laparoscopy in the diagnosis of small tumor seeding. The unchanged superiority of laparoscopy over other imaging modalities for detecting small superficial liver metastases and peritoneal seeding has been clearly demonstrated. Whether cytological investigation of peritoneal washing can add relevant information to laparoscopy remains a matter of debate. Diagnostic laparoscopy before surgery has proved to be effective in many fields, including traumatology. The use of diagnostic laparoscopy in certain clinical circumstances, such as the early postoperative period after major cardiac surgery using extracorporeal circulation, appears promising. A transgastric approach to the peritoneal cavity for diagnostic and therapeutic purposes, the feasibility of which has been demonstrated in a porcine model, is an exciting innovation with as yet unforeseeable implications.     

Diagnostic laparoscopy

Since the early part of the 20th century, diagnostic laparoscopy has become an important tool in the armamentarium of surgeons and gastroenterologists alike. Its indications have expanded from initial attempts at tamponading internal hemorrhage to avoidance of unnecessary laparotomies with accurate staging of malignancies, treatment of a multitude of intra-abdominal pathologies, and even as a resource for evaluating blunt abdominal trauma and chronic abdominal pain. Its accuracy has been demonstrated in the evaluation of chronic liver diseases, in comparison with other diagnostic modalities. Many further technical advances have been introduced in recent years. Gastroenterology training programs should include formal diagnostic laparoscopy training as part of their curriculum.     

Diagnostic laparoscopy

Diagnostic laparoscopy is increasingly being used to aid decision-making in the treatment of serious diseases. The majority of papers on the topic published during the last year have been concerned with preoperative assessment of malignant diseases of the gastrointestinal tract, and have shown that laparoscopy alone--or, even better, in combination with laparoscopic ultrasonography--is able to identify metastatic disease and therefore to reduce significantly the risk of unnecessary laparotomies. New techniques such as the application of fluorescent dyes may improve these results even further. Surgeons are increasingly using diagnostic laparoscopy in patients with acute abdomen and abdominal trauma--a minimally invasive strategy that should also be supported by gastroenterologists. Close cooperation between surgeons and gastroenterologists can also be promoted by using laparoscopy in critically ill patients in intensive-care units when a decision needs to be taken on whether or not laparotomy should be performed. The technique of diagnostic laparoscopy is returning to widespread use after a period of decline.     

Diagnostic Errors

One of the most complex and challenging tasks facing physicians is the need to make a diagnosis. Recent research has focused attention on medical errors alleged to have resulted in increased patient morbidity and mortality. A number of authorities have suggested methods to track and prevent errors. Most have dealt with systems' changes and fail-safe methods to prevent medication errors and commission of errors during treatment. Few have addressed methods to find and prevent diagnostic errors. Unless diagnostic error is either avoided or corrected early, fail-safe methods to prevent medication and treatment errors will ultimately fail to improve patient outcome. American medical literature, particularly postmortem studies, have documented diagnostic error since at least 1912. European literature shows the problem is worldwide. The limits of human memory and errors in both observation and processing of information during problem solving contribute to the commission of errors. The purpose of this article is to examine the thinking patterns and cognitive errors that can result in diagnostic error, and suggest instructional strategies that can be used to alert residents and attending physicians to these potential problems so they can be avoided.     

如何在诊断性试验研究中正确应用有关测量指标

正确使用测量指标有利于科学评价诊断试验的诊断价值。本文阐述了各测量指标的特点及临床应用意义,以助于临床开展诊断试验研究和评价。