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Background: Medical decision support systems (CDSSs) are increasingly used in medicine, but their utility in daily medical practice is difficult to evaluate. One variant of CDSS is a generator of differential diagnoses (DDx generator). We performed a feasibility study on three different, publicly available data sets of medical cases in order to identify the frequency in which two different DDx generators provide helpful information (either by providing a list of differential diagnosis or recognizing the expert diagnosis if available) for a given case report.Methods: Used data sets were n = 105 cases from a web-based forum of telemedicine with real life cases from Afghanistan (Afghan data set; AD), n = 124 cases discussed in a web-based medical forum (Coliquio data set; CD). Both websites are restricted for medical professionals only. The third data set consisted 50 special case reports published in the New England Journal of Medicine (NEJM). After keyword extraction, data were entered into two different DDx generators (IsabelHealth (IH), Memem7 (M7)) to examine differences in target diagnosis recognition and physician-rated usefulness between DDx generators.Results: Both DDx generators detected the target diagnosis equally successfully (all cases: M7, 83/170 (49%); IH 90/170 (53%), NEJM: M7, 28/50 (56%); IH, 34/50 (68%); differences n.s.). Differences occurred in AD, where detection of an expert diagnosis was less successful with IH than with M7 (29.7% vs. 54.1%, p = 0.003). In contrast, in CD IH performed significantly better than M7 (73.9% vs. 32.6%, p = 0.021). Congruent identification of target diagnosis occurred in only 46/170 (27.1%) of cases. However, a qualitative analysis of the DDx results revealed useful complements from using the two systems in parallel.Conclusion: Both DDx systems IsabelHealth and Memem7 provided substantial help in finding a helpful list of differential diagnoses or identifying the target diagnosis either in standard cases or complicated and rare cases. Our pilot study highlights the need for different levels of complexity and types of real-world medical test cases, as there are significant differences between DDx generators away from traditional case reports. Combining different results from DDx generators seems to be a possible approach for future review and use of the systems. [ABSTRACT FROM AUTHOR]

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Pathologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We report on a 17-year-old patient with severe bronchiolitis due to Mycoplasma pneumoniae infection. Despite an early 10-day course of clarithromycin, she developed progressive dyspnea, cough, fever, and severe obstructive ventilatory impairment. Sixteen days after onset of the disease a severe hemolytic anemia developed with only cold agglutinins positive at serologic screening. Thoracoscopic lung biopsy revealed diffuse bronchiolitis with suppurative intrabronchiolar inflammation, lymphohistiocytic "cuffing" of the bronchioli, and foam cell aggregates within neighboring alveoli. The infiltrate consisted mainly of CD3+, CD8+ lymphocytes and CD68+ macrophages. The diagnosis of Mycoplasma pneumoniae bronchiolitis was based on repeated complement fixation tests, which turned strongly positive only at day 74 after onset of the disease. Pulmonary function improved slowly under long-term prednisone treatment. [ABSTRACT FROM AUTHOR]

Invasive pulmonary aspergillosis (IPA) is a life-threatening infectious complication in neutropenic patients after high-dose chemotherapy or hematopoietic stem cell transplantation. Its diagnosis is mainly based on clinical symptoms, and radiological signs on thoracic CT scan. The value of bronchoscopy is controversial. We analyzed the diagnostic yield of bronchoscopy in 23 consecutive patients with histologically proven invasive pulmonary aspergillosis. In seven patients (30%) bronchoscopically obtained specimens were diagnostic for pulmonary fungal infection. Typical hyphae were detected by cytology in six patients and fungal cultures were positive in four cases. Patients with a positive bronchoscopic result presented more often with multiple changes on thoracic CT scan (71%; 5/7), but had received a lower median cumulative dose of amphotericine B (300 mg; 168–3010 mg) compared to patients with non-diagnostic bronchoscopy (25% multiple lesions (4/16); amphotericine dose 1100 mg, 260–2860 mg). The diagnostic yield of bronchoscopy was not associated with clinical symptoms or duration of neutropenia. Bronchoscopy allows the diagnosis of IPA in about one third of patients. Fungal cultures and cytological examination of intrabronchial specimens obtained during bronchoscopy have a high specificity, but its sensitivity is low. It is advisable to perform diagnostic bronchoscopy before starting antifungal therapy. Better diagnostic tools are urgently needed. [ABSTRACT FROM AUTHOR]

236 out of 401 predominant female asbestos textile workers of the years 1924 - 1945 at Hamburg could be traced retrospectively: There are 32 deaths (26 female, 6 male) of malignant tumors of all sites among them. In comparison to the general population there is a higher death rate from carcinoma in women (α < 5%). The average age of death from carcinoma was about 10 years below the general population. 25 cases suffered from asbestosis, 10 cases died of it. The X-ray pictures of 123 cases showed irregular shadows as follows: 41 cases s 0/1 or s 1/0, 14 cases s 1/1 or s 1/2. From 50 cases s O/0 were 31 with pleural alterations. There are definite relations between the duration and intensity of exposure (risk-years) and the manifestation of minimal pleural lesions, irregular shadows, asbestosis, death from asbestosis, death from carcinoma. Further investigations are necessary for evaluation of asbestos related risks, especially malignant tumors. Von den von 1924 - 1945 eingetretenen Beschäftigten eines Hamburger Asbest-Textil-Betriebes konnten aus 401 Fällen 236 Probanden (davon 185 Frauen) katamnestisch überprüft werden. 6 Männer und 26 Frauen waren davon an Krebs verschiedener Lokalisationen verstorben; bei Frauen gesichert häufiger als in der Hamburger Bevölkerung, überdies ca. 10 Jahre früher. Bei 25 Fällen wurde Asbestose angenommen, 15 waren daran verstorben. Von 123 Fällen wurden die Röntgenbilder ausgewertet: 41 Fälle hatten intrapulmonal unregelmäßige Herde s 0/1 oder s 1/0, 14 Fälle s 1/1 oder s 1/2. Von 50 Fällen s O/0 hatten 31 pleurale Veränderungen. Die Mittelwerte der 'Gefahrenjahre' als Maß der aufgenommenen Asbeststaubmenge ergeben folgende Zuordnungen: geringe pleurale Veränderungen = 6,27; unregelmäßige Lungenherde s O/1 oder s 1/O = 6,47; Asbestose = 14,84; Tod an Asbestose = 16,8; Tod an Krebs bei Männern = 9,17; dsgl. bei Frauen = 12,85. Weitere Untersuchungen sind erforderlich, um verschiedene asbestbezogene Risiken genauer abschätzen zu können, insbesondere das (allgemeine) Krebsrisiko der Exponierten. [ABSTRACT FROM AUTHOR]

A panel of 14 antibodies (panepithelial antibody Lu-5, anti-keratin-18, anti-keratin-7, Ber-EP4, anti-Leu-M1, HEA-125, anti-carcinoembryonic antigen, anti-blood group-related antigens A, B, H, B72.3, antiplacental alkaline phosphatase, anti-vimentin and BMA-120), which have been evaluated for use in differentiating mesothelioma from lung adenocarcinoma, was applied to a group of 24 suspected mesotheliomas. Using the established qualitative, descriptive criteria derived from monovariate statistical analysis of the tumour control groups (definite mesotheliomas, adenocarcinomas), a definitive allocation was possible in only 25% of suspected cases. We therefore constructed two 'expert systems', based on multivariate discriminant analysis with either the ALLOC 80 program for ordinal data or a newly developed analysis program for binomial data. With these two systems diagnostic allocation of suspected mesotheliomas was improved to 75% and 79%. The use of binomial data ('positive' versus 'negative') in conjunction with the probability-based test system is of particular interest because the primary data are easy to record and the test results have a higher statistical probability. [ABSTRACT FROM AUTHOR]

Specimens of 27 histologically definite mesotheliomas and 34 proven adenocarcinomas were examined with a panel of 14 antibodies: pan-epithelial antibody Lu-5, anti-keratin-18, anti-keratin-7, Ber-EP4, anti-Leu-M1, HEA-125, anti-carcino-embryonic antigen (CEA), anti-blood group-related antigens (anti-BGR A, B, H), B 72.3, anti-placental alkaline phosphatase (PLAP), anti-vimentin and BMA-120 used to determine their value in the differentiation between pleural mesothelioma and lung adenocarcinoma. Lu-5, anti-cytokeratin-7 and -18, B 72.3 and PLAP reacted in a high percentage of cases with both mesothelioma and adenocarcinoma. Anti-CEA and anti-Leu-Ml did not react with any of the 27 mesotheliomas tested but showed a reaction in 75% (anti-CEA) and 66% (anti-Leu-M1) of the lung adenocarcinomas. Seventeen percent of the adenocarcinomas and 96% of the mesotheliomas showed a positive reaction with anti-vimentin. Ber-EP4 was demonstrated in all lung adenocarcinomas, but only in 2 mesotheliomas in a focal manner (7%). HEA-125 and anti-BGR A, B, H reacted with 83% (HEA-125) and 75% (anti-BGR A, B, H) of the lung adenocarcinomas. The statistical parameters, sensitivity and efficiency were estimated and a normogram for judging the diagnostic power of a single antibody for the differential diagnosis of mesothelioma versus adenocarcinoma was developed. According to this, Ber-EP4, HEA-125, anti-BGR A, B, H and anti-CEA were, in descending order, the most powerful discriminatory antibodies. [ABSTRACT FROM AUTHOR]

In patients with suspected sarcoidosis histological confirmation is generally desired. In 40 patients with the ultimate diagnosis of sarcoidosis transbronchial lung biopsy during fiberoptic bronchoscopy revealed in 83% noncaseating granulomas. With 5 biopsies per patient a positive result was obtained in 20 of 25 patients (80%) with radiographic stage I disease, in 6 of 7 (85%) with stage II disease and in 7 of 8 (87%) with stage III disease. The only complications were two small pneumothoraces and two hemorrhages. Transbronchial biopsy with its low morbidity and high diagnostic yield can be recommended as an initial procedure in diagnosing sarcoidosis. [ABSTRACT FROM AUTHOR]

Copyright of Internationales Archiv für Arbeitsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Forty-three consecutive patients with diffuse pulmonary disease who underwent open lung biopsy (OLB) are reviewed. Twenty-two of them had severely impaired respiratory function, pulmonary hypertension or coagulopathy, which in this institution are regarded as contraindications to alternative transbronchial or percutaneous biopsies. The surgical technique and the schedule of histopathological investigations are briefly described. In this series a definitive diagnosis was established by OLB in all cases. The incidence of complications was 7%. In spite of a high percentage of critically ill patients no mortality was related to the operative procedure. OLB, therefore, is recommended as the diagnostic procedure of first choice, particularly in critically ill patients. [ABSTRACT FROM AUTHOR]

We studied at necropsy the bronchi of 49 subjects whose lung function has been measured during life. In each case the glands were examined in three bronchi by measuring the gland/wall ratio (Reid-Index) and by point-counting. The results of the two methods were compared: the data of the gland/wall ratio were normally distributed while those of the volume density established by point-counting were not. Gland/wall ratio and volume density of glands correlated moderately (RSp = 0.524). The function between them was not linear, in contrast with that between gland/wall ratio and gland thickness. The stereological background of these functions is discussed. In 34 subjects without restrictive lung disease FEV1 correlated inversely with the volume density of glands (RSp = -0.396), but not with the gland/wall ratio (Reid-Index)(RSp = -0.243). This discrepancy probably results from the different distribution of the data obtained by the two methods and from the non-linear function between them. These findings indicate that the gland/wall ratio (Reid-Index) is less applicable to clinicopathological correlations than the volume density of glands established by point-counting. [ABSTRACT FROM PUBLISHER]

Inactivation of the p53 gene plays a key role in tumour biology, probably through a disturbed cell cycle control and an increased genetic instability in p53-inactivated tumours. To learn more about the relationship between p53 alterations, proliferation and genetic instability (DNA aneuploidy) in lung cancer patients, specimens of 220 surgically resected lung carcinomas with clinical follow-up information were examined by immunohistochemistry (p53; CM1) and flow cytometry. Nuclear p53 positivity--found in 49.5% of the tumours--was associated with both high S-phase fraction (SPF) and DNA ploidy aberrations. SPF was higher in p53-positive tumours (15.9 +/- 10.2) than in p53-negative tumours (10.3 +/- 8.7; P = 0.03). The rate of p53 positivity was higher in 101 DNA-aneuploid and DNA-multiploid tumours (55%) than in 27 diploid and peridiploid carcinomas (33%; P = 0.0512). These results are consistent with an in vivo role of p53 inactivation for increased proliferative activity and development of genomic instability in lung cancer. There was no association between SPF and prognosis. Although prognosis was worse in DNA-aneuploid and multiploid tumours than in diploid, peridiploid and tetraploid carcinomas (P = 0.029), DNA ploidy was not an independent predictor of poor prognosis in multivariate analysis. These data show that DNA-flow cytometry has little prognostic value for patients with resected non-small-cell lung carcinoma. [ABSTRACT FROM AUTHOR]

Copyright of Beiträge zur Klinik und Erforschung der Tuberkulose und der Lungenkrankheiten is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)