Synovial fluid examination for the diagnosis of synovial amyloidosis in patients with chronic renal failure undergoing haemodialysis

The diagnosis of synovial amyloidosis is based upon synovial biopsy. Synovial fluid (SF) in seven patients with amyloid arthropathy associated with chronic renal failure undergoing haemodialysis were studied. The SF and synovial samples of 10 consecutive patients with seronegative mono- or oligoarthritis served as controls. Six of the seven patients with amyloid positive synovial biopsy specimens showed amyloid in their SF. No amyloid was found in the synovial tissue or fluid of the 10 patients in the control group, the sensitivity being 87.7%. The finding of amyloid in SF was highly reproducible, showing its presence in the same joint on several occasions. The deposits were Congophilia resistant to potassium permanganate pretreatment, and the immunohistochemical analysis proved that they contained beta 2 microglobulin. The high sensitivity and good reproducibility of the method shows that the finding of amyloid in SF is sufficient for the diagnosis of synovial amyloidosis. It is possible to perform immunohis

Implications of diagnosis related groups (DRGs) for the management of hospitals.

Although tremendous advances have been made in the diagnosis and treatment of patients, hospital administrative systems have progressed relatively slowly. The types of information available to managers in industrial sectors are not available in the health sector. For this reason, many phenomena, such as the variations of average costs and lengths of stay between different hospitals, have remained poorly explained.The DRG system defines groups of patients that consume relatively homogeneous quantities of hospital resources. On the basis, it is possible to standardize average lengths of stay and average hospital costs in terms of the differences in case mix treated. Thus DRGs can serve as an explanation of variations in these factors between different hospitals, and also (but not only) for prospective reimbursement schems. As in a number of other European countries, a project has been set up in Switzerland to examine the possibilities of using DRGs in hospital management, planning and financing.

Avaliação da universalidade das normas DRIS, M-DRIS e CND

A possibilidade de utilização de normas obtidas em determinado local, para diferentes condições de clima e solo, pode conferir aos métodos de diagnose do estado nutricional um caráter de universalidade. Neste sentido, por meio da aplicação dos métodos: Sistema Integrado de Diagnose e Recomendação (DRIS), DRIS modificado (M-DRIS) e Diagnose da Composição Nutricional (CND) em plantios florestais de Eucalyptus grandis, objetivou-se comparar a diagnose, aplicando-se os métodos, mediante normas específicas ou gerais, em localidades da região Centro-Leste do Estado de Minas Gerais, utilizando diferentes critérios de avaliação. Foram utilizados dados de produtividade e de teores de N, P, K, Ca e Mg nas folhas, referentes a 993 talhões de Eucalyptus grandis plantados no espaçamento 3 x 2 m, com idades variando de 72 a 153 meses, e abrangendo seis localidades da região estudada. A universalidade das normas foi avaliada, comparando-se a freqüência de diagnoses concordantes (FDC) do potencial de resposta à adubação (PRA), obtida mediante normas específicas ou gerais, considerando os seguintes critérios de avaliação: os nutrientes separadamente; desde todos (5) até nenhum nutriente (0); e apenas para o limitante primário por deficiência (p) ou por excesso (n). O grau de universalidade das normas variou de acordo com o critério adotado para sua avaliação. Em virtude da ausência de universalidade das normas, é preferível a utilização de normas específicas em vez de normas gerais.

Expression of E-Selectin and Vascular Cell Adhesion Molecule-1 in So-Called 'Negative' Appendices: First Results to Support the Pathological Diagnosis in Borderline Cases.

Background: Since the rate of histologically 'negative' appendices still ranges between 15 and 20%, appendicitis in 'borderline' cases remains a challenging disease. As previously described, cell adhesion molecule expression correlates with different stages of appendicitis. Therefore, it was of interest to determine whether the 'negative' appendix correlated with the absence of E-selectin or vascular cell adhesion molecule-1 (VCAM-1). Methods: Nineteen grossly normal appendices from a series of 120 appendectomy specimens from patients with suspected appendicitis were analysed in frozen sections for the expression of E-selectin and VCAM-1. As control, 5 normal appendices were stained. Results: This study showed a coexpression of E-selectin and VCAM-1 in endothelial cells in early and recurrent appendicitis. In patients with symptoms for less than 6 h, only E-selectin was detected. Cases with fibrosis and luminal obliteration were only positive for VCAM-1. In cases of early appendicitis with symptoms of less than 6 h duration, a discordance between histological and immunohistochemical results was found. Conclusions: This report indicates that E-selectin and VCAM-1 expression could be useful parameters in the diagnosis of appendicitis in borderline cases.

Consensus 2012 sur le diagnostic et le traitement des patients atteints de démence en Suisse [Consensus 2012--diagnosis and treatment of patients with dementia in Switzerland].

The 2012 Swiss consensus paper on diagnosis and management of patients suffering from dementia resulted from the work of an expert panel who met on March 23d to 25th in Luzem. Based on a literature review, panel members wrote a first draft that was subsequently circulated among multiple dementia experts in Switzerland. After adaptation and revisions according to comments, all consulted dementia specialists and panel members fully endorse the consensus content. The conference was financed by the Swiss Alzheimer Forum.

Clinical role of coronary magnetic resonance angiography in the diagnosis of anomalous coronary arteries.

Though rare, anomalous coronary artery disease is a well-known cause of myocardial ischemia and sudden death among children and young adults. The projectional nature of conventional x-ray angiography often leads to difficulty in the definition of anomalous vessels. Studies have now documented the high accuracy of coronary magnetic resonance angiography (MRA) for the noninvasive detection and definition of anomalous coronary arteries among patients with suspected anomalous coronary arteries of congenital conditions associated with anomalous coronary arteries. With increasing clinical experience, coronary MRA will likely emerge as the gold standard for the diagnosis of this condition.

Pratiques comptables des hôpitaux et faisabilité d'un calcul de coûts basés sur les Diagnosis Related Groups

Travaux effectués dans le cadre de l'étude "Case Mix" menée par l'Institut universitaire de médecine sociale et préventive de Lausanne et le Service de la santé publique et de la planification sanitaire du canton de Vaud, en collaboration avec les cantons de Berne, Fribourg, Genève, Jura, Neuchâtel, Soleure, Tessin et Valais

Biomass and nutrient cycling in pure and mixed stands of native tree species in southeastern Bahia, Brazil

The objective of this paper is to study selected components of the nutrient cycle of pure and mixed stands of native forest species of Atlantic Forest in southeastern Brazil. Tree diameter, height, above-ground biomass, and nutrient content were determined in 22-year-old stands. Litterfall, litter decomposition, and nutrient concentration were evaluated from August 1994 to July 1995. The following species were studied: Peltogyne angustiflora, Centrolobium robustum, Arapatiella psilophylla, Sclerolobium chrysophyllum, Cordia trichotoma, Macrolobium latifolium. The litter of a natural forest and a 40-year-old naturally regenerated second-growth forest was sampled as well. The mixed-species outmatched pure stands in height, stem volume and total biomass (29.4 % more). The greatest amount of forest litter was observed in the natural forest (9.3 Mg ha-1), followed by the mixed-species stand (7.6 Mg ha-1) and secondary forest (7.3 Mg ha-1), and least litterfall was measured in the pure C. robustum stand (5.5 Mg ha-1). Litterfall seasonality varied among species in pure stands (CV from 44.7 to 91.4 %), unlike litterfall in the mixed-tree stand, where the variation was lower (CV 31.2 %). In the natural and second-growth forest, litterfall varied by 57.8 and 34.0 %, respectively. The annual rate of nutrient return via litterfall varied widely among forest ecosystems. Differences were detected between forest ecosystems in both the litter accumulation and quantity of litterlayer nutrients. The highest mean nutrient accumulation in above-ground biomass was observed in mixed-species stands. The total nutrient accumulation (N + P + K+ Ca + Mg) ranged from 0.97 to 1.93 kg tree-1 in pure stands, and from 1.21 to 2.63 kg tree-1 in mixed-species stands. Soil fertility under mixed-species stands (0-10 cm) was intermediate between the primary forest and pure-stand systems. The litterfall rate of native forest species in a mixed-species system is more constant, resulting in a more continuous decomposition rate. Consequently, both nutrient availability and quantity of organic matter in the soil are higher and the production system ecologically more sustainable.

Utility of beta-glucan for the diagnosis of invasive fungal infections

(1,3)-b-D-glucan is a component of the fungal cell wall. New assays have made it possible to detect this molecule in a variety of clinical samples such as blood, cerebrospinal fluid, and bronchioalveolar lavage fluid. Detection of this molecule through several assays has been validated as an adjunct method to diagnose invasive fungal infections. With several decades of data and recent positive meta-analyses, these assays have now been sufficiently studied and are ready to enter the mainstream of diagnosis in medical mycology.

Evaluation of the potential use of trabecular bone score to complement bone mineral density in the diagnosis of osteoporosis: a preliminary spine BMD-matched, case-control study.

The trabecular bone score (TBS) is a new parameter that is determined from gray-level analysis of dual-energy X-ray absorptiometry (DXA) images. It relies on the mean thickness and volume fraction of trabecular bone microarchitecture. This was a preliminary case-control study to evaluate the potential diagnostic value of TBS as a complement to bone mineral density (BMD), by comparing postmenopausal women with and without fractures. The sample consisted of 45 women with osteoporotic fractures (5 hip fractures, 20 vertebral fractures, and 20 other types of fracture) and 155 women without a fracture. Stratification was performed, taking into account each type of fracture (except hip), and women with and without fractures were matched for age and spine BMD. BMD and TBS were measured at the total spine. TBS measured at the total spine revealed a significant difference between the fracture and age- and spine BMD-matched nonfracture group, when considering all types of fractures and vertebral fractures. In these cases, the diagnostic value of the combination of BMD and TBS likely will be higher compared with that of BMD alone. TBS, as evaluated from standard DXA scans directly, potentially complements BMD in the detection of osteoporotic fractures. Prospective studies are necessary to fully evaluate the potential role of TBS as a complementary risk factor for fracture.