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Soft tissue sarcomas are challenging to oncologists due to their unique character, the infrequency of their occurrence, and the difficulties in predicting outcomes. Advances in imaging, as well as improvements in surgical techniques and adjunctive treatment methods, have improved care for patients with these unusual disorders.The various types of soft tissue tumors are defined, and the statistics for the Orthopaedic Oncology Group in relation to them are reviewed and compared with literature references.The overall survival rate for 1,220 tumors treated at our institute from June 1972 to June of 2001 was 72%, with a wide range. Patients with leiomyosarcomas, clear cell sarcomas, and malignant fibrous histiocytomas had a poorer survival rate, while those with fibrosarcomas, liposarcomas, and neurofibrosarcomas fared better. Outcome was affected by patient age, tumor anatomic site, tumor stage, and a history of recurrence.Competent imaging, predictive immunological and genetic studies, improved surgery, and newer methods of adjunctive and neoadjunctive treatment should result in improvements in outcomes for patients with these tumors.

The 2001 revised criteria for the diagnosis, classification, and staging of idiopathic osteonecrosis of the femoral head were proposed in June 2001, by the working group of the Specific Disease Investigation Committee under the auspices of the Japanese Ministry of Health, Labor and Welfare, to establish criteria for diagnosis and management of idiopathic osteonecrosis of the femoral head. Five criteria that showed high specificity were selected for diagnosis: collapse of the femoral head (including crescent sign) without joint-space narrowing or acetabular abnormality on x-ray images; demarcating sclerosis in the femoral head without joint-space narrowing or acetabular abnormality; "cold in hot" on bone scans; low-intensity band on T1-weighted MRI (bandlike pattern); and trabecular and marrow necrosis on histology. Idiopathic osteonecrosis of the femoral head is diagnosed if the patient fulfills two of these five criteria and does not have bone tumors or dysplasias. Necrotic lesions are classified into four types, based on their location on T1-weighted images or x-ray images. Type A lesions occupy the medial one-third or less of the weight-bearing portion. Type B lesions occupy the medial two-thirds or less of the weight-bearing portion. Type C1 lesions occupy more than the medial two-thirds of the weight-bearing portion but do not extend laterally to the acetabular edge. Type C2 lesions occupy more than the medial two-thirds of the weight-bearing portion and extend laterally to the acetabular edge. Staging is based on anteroposterior and lateral views of the femoral head on x-ray images. Stage 1 is defined as the period when there are no specific findings of osteonecrosis on x-ray images, although specific findings are observed on MRI, bone scintigram, or histology. Stage 2 is the period when demarcating sclerosis is observed without collapse of the femoral head. Stage 3 is the period when collapse of the femoral head, including crescent sign, is observed without joint-space narrowing. Mild osteophyte formation in the femoral head or acetabulum may be observed in stage 3. Stage 3 is divided into two substages. In stage 3A, collapse of the femoral head is less than 3 mm. In stage 3B, collapse of the femoral head is 3 mm or greater. Stage 4 is the period when osteoarthritic changes are observed.

Diabetes mellitus (DM) is a metabolic disorder characterized by the presence of chronic hyperglycemia accompanied by greater or lesser impairment in the metabolism of carbohydrates, lipids and proteins. The origin and etiology of DM can vary greatly but always include defects in either insulin secretion or response or in both at some point in the course of disease. When characteristic symptoms of DM are clearly present and blood glucose levels are high enough, the diagnosis is usually unequivocal. However, it is important to remember that the diagnosis is made in asymptomatic patients in most cases, based on the results of routine tests. The prevalence of DM, its specific complications and the presence of other diseases that often accompany DM make this disease one of today’s main social and public health problems. The great increase in information available on the etiology and pathophysiology of DM and its chronic complications has led necessarily to the revision of diagnostic criteria and reclassification of the processes involved. Revised diagnostic criteria and classifications were agreed upon in 1997 and 1998 by the American Diabetes Association and the World Health Organization, respectively, and new recommendations were published. Thanks to cross-representation on the committees, the conclusions and final recommendations are, in general, very similar, although a few minor differences are present. Clarification of diagnostic criteria and better classification of patients suffering from DM should allow us to make better choices among the various treatment options available and to improve prognosis.

Rare autosomal dominant tubulointerstitial kidney disease is caused by mutations in the genes encoding uromodulin (UMOD), hepatocyte nuclear factor-1β (HNF1B), renin (REN), and mucin-1 (MUC1). Multiple names have been proposed for these disorders, including 'Medullary Cystic Kidney Disease (MCKD) type 2', 'Familial Juvenile Hyperuricemic Nephropathy (FJHN)', or 'Uromodulin-Associated Kidney Disease (UAKD)' for UMOD-related diseases and 'MCKD type 1' for the disease caused by MUC1 mutations. The multiplicity of these terms, and the fact that cysts are not pathognomonic, creates confusion. Kidney Disease: Improving Global Outcomes (KDIGO) proposes adoption of a new terminology for this group of diseases using the term 'Autosomal Dominant Tubulointerstitial Kidney Disease' (ADTKD) appended by a gene-based subclassification, and suggests diagnostic criteria. Implementation of these recommendations is anticipated to facilitate recognition and characterization of these monogenic diseases. A better understanding of these rare disorders may be relevant for the tubulointerstitial fibrosis component in many forms of chronic kidney disease. 88 676 683 Cited By :41

C-shaped canals are mostly found in mandibular second molars. Studies have shown that frequency ranges from 2.7 to 31%. This study was undertaken to provide further knowledge of the distribution of such canal anatomy, by determining the frequency of C-shaped canals in a sample representing the Lebanese population. Ninety-four mandibular second molars with scheduled endodontic treatment were examined over a 1-yr period. Of the 94 treated molars, 18 exhibited C-shaped canals that would represent 19.1% of the sample. The geographical position of Lebanon could represent an explanation for this phenomenon.

Gliomas are the most common form of malignant primary brain tumour. In the past year, substantial progress has been made in the classification and treatment of lower-grade gliomas (WHO grades II and III), and the FDA has approved a new therapy for newly diagnosed glioblastomas.

Currently used diagnostic criteria in different endemic (Balkan) nephropathy (EN) centers involve different combinations of parameters, various cut-off values and many of them are not in agreement with proposed international guidelines. Leaders of EN centers began to address these problems at scientific meetings, and this paper is the outgrowth of those discussions. The main aim is to provide recommendations for clinical work on current knowledge and expertise. This document is developed for use by general physicians, nephrologists, urologist, public health experts and epidemiologist, and it is hoped that it will be adopted by responsible institutions in countries harboring EN. National medical providers should cover costs of screening and diagnostic procedures and treatment of EN patients with or without upper urothelial cancers., JOURNAL ARTICLE, SCOPUS: re.j, info:eu-repo/semantics/published

Background Invasive cervical resorption (ICR) is not well understood by the professional, being misdiagnosed, leading to inappropriate treatment and unnecessary loss of tooth. Introduction ICR is defined as a localized process of resorption, which begins in the cervical area of the tooth, just below the epithelial junction and above the ridge crest in the area of the connective tissue insertion. Possible predisposing factors include external trauma, orthodontic movement, surgical procedures, periodontal disease and its treatments, endogenous bleaching, pressure generated by wind instruments and herpes virus infection. Different approaches have been suggested for the treatment of ICR, depending on the extent of the lesion and its location. However, in some cases due to the severity of the injury, there is no alternative but to tooth extraction, followed by restoration of the edentulous area. Aim and objective Discuss etiology, diagnosis and classification of the ICR, as well as different treatment options. Also is presented a case in which extraction was carried out, installation of the implant and ceramic crown, subsequent to a treatment approach that resulted in failure in the short-term period. Conclusion Early diagnosis of the ICR is critical to proper treatment and favorable prognosis. Interdisciplinary treatment should be instituted as soon as possible, avoiding the loss of the affected tooth. In advanced cases, treatment involving the installation of osseointegrated implants should be considered the first choice of treatment. Clinical significance Early diagnosis of the ICR is critical do prevent unnecessary tooth loss, once the prognosis for advanced cases is doubtful. How to cite this article Discacciati JAC, de Souza EL, Costa SC, Sander HH, Barros VM, Vasconcellos WA. Invasive Cervical Resorption: Etiology, Diagnosis, Classification and Treatment. J Contemp Dent Pract 2012;13(5):723-728.

The psychoflexed hand is a rare clinical condition characterized by fixed finger contractures undetermined by organic etiology, often associated with a psychiatric pathology. We report a series of 20 patients (nine males and 11 females, mean aged 56.2 years). We have introduced a new classification of the various possible patterns of finger deformities: 1) Type 1: prevalent flexion contracture at the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the last two or three fingers; the thumb and the index are not affected; 2) type 2: prevalent flexion contracture at the PIP and distal interphalangeal (DIP) joints of the last two or three fingers; 3) type 3: flexion contracture of all the long fingers; 4) type 4: flexion contracture of all the fingers of the hand, including the thumb (clenched fist syndrome); 5) type 5: isolated flexus-adductus thumb (the long fingers are not affected); 6) type 6: flexion of digits associated with flexion contractures of other joints of the upper extremity. The treatment was conservative in 14 patients with recent deformities and surgical in six patients. Both forms of treatment were followed by a rigorous rehabilitation program, mostly based on home self-rehabilitation. The correction of the deformities was obtained in all cases and maintained over time.

A lo largo de las últimas décadas, la disponibilidad cada vez mayor de grandes cantidades de información biomédica ha potenciado el desarrollo de herramientas que permiten extraer e inferir conocimiento. El aumento de tecnologías biomédicas que asisten a los expertos médicos en sus decisiones ha contribuido a la incorporación de un paradigma de medicina basada en la evidencia centrada en el paciente. Las contribuciones de esta Tesis se centran en el desarrollo de herramientas que asisten al médico en su proceso de toma de decisiones en el diagnóstico de tumores cerebrales (TC) mediante Espectros de Resonancia Magnética (ERM). En esta Tesis se contribuye con el desarrollo de clasificadores basados en Reconocimiento de Patrones (RP) entrenados con ERM de pacientes pediátricos y adultos para establecer el tipo y grado del tumor. Estos clasificadores especializados son capaces de aprovechar las diferencias bioquímicas existentes entre los TC infantiles y de adultos. Una de las principales contribuciones de esta Tesis consiste en el desarrollo de modelos de clasificación enfocados a discriminar los tres tipos de tumores cerebrales pediátricos más prevalentes. El cerebelo suele ser una localización habitual de estos tumores, resultando muy difícil distinguir el tipo mediante el uso de Imagen de Resonancia Magnética. Por lo tanto, obtener un alto acierto en la discriminación de astrocitomas pilocíticos, ependimomas y meduloblastomas mediante ERM resulta crucial para establecer una estrategia de cirugía, ya que cada tipo de tumor requiere de unas acciones diferentes si se quiere obtener un buen pronóstico del paciente. Asimismo, esta Tesis contribuye en la extracción de características para ERM mediante el estudio de la combinación de señales de ERM adquiridas en dos tiempos de eco: tiempo de eco corto y tiempo de eco largo; concluyendo que dicha combinación mejora la clasificación de tumores cerebrales pediátricos frente al hecho de usar únicamente los ERM de un, Vicente Robledo, J. (2012). Clinical Decision Support Systems for Brain Tumour Diagnosis: Classification and Evaluation Approaches [Tesis doctoral]. Editorial Universitat Politècnica de València. doi:10.4995/Thesis/10251/17468., Palancia

Antineutrophil cytoplasmic antibodies (ANCA) are traditionally detected by an indirect immunofluorescence technique. According to the international consensus on ANCA testing, ANCA should also be tested by antigen-specific tests for myeloperoxidase-ANCA and proteinase 3-ANCA. The direct noncompetitive enzyme-linked immunosorbent assay (ELISA) used to be the method of choice. Nowadays, these assays are called "first-generation" assays. Second-generation tests (capture ELISA) or third-generation tests (anchor ELISA) are more sensitive and specific for ANCA testing. We postulate that ANCA as detected by these newer ANCA tests may replace the need to perform indirect immunofluorescence-based assays. For classification of patients, ANCA serotype seems more important than classifying patients according to their clinical subtype, since genetics, clinical manifestations and response to therapy are more related to ANCA serotype than to clinical subtype. Detection of ANCA to monitor disease activity is still a controversial issue. Treatment based on ANCA levels is at present only experimentally performed in those patients who are treated with B-cell depletion therapy with rituximab. Future studies are needed to establish whether this way of monitoring patients is warranted.

Purpose of review : The field of spondyloarthritis (SpA) has evolved enormously over the last few years, starting with the advent of biological therapies at the end of the previous millenium. A lot of work has been done to construct valid outcome measures and treatment guidelines based upon the results of pivotal studies with Tumor necrosis factor (TNF)-blocking agents. Most of these trials were performed in well described populations, such as patients suffering from ankylosing spondylitis (AS) or psoriatic arthritis. Recent findings : Over recent years a reappraisal has been done with regard to considering again the full spectrum of diseases belonging to the SpA concept, especially in early disease stages. This effort culminated in the construction of new classification criteria for axial and peripheral SpA. Around the same time, a number of patient registries were set up, allowing the follow-up of patients in order to study the natural evolution of patients classified early. The first data from these cohorts provide interesting information on peripheral joint manifestations such as arthritis, enthesitis or dactylitis. Recognition and monitoring of these manifestations are essential for clinicians in order to provide comprehensive patient care. Summary : There is a growing interest in the field of SpA to move from rather restricted and longstanding diseases such as AS to a more comprehensive view, encompassing not only inflammatory back pain, but also peripheral arthritis and enthesitis, as well as extra-articular manifestations. The new classification criteria and guidelines for follow-up are applied now in a number of prospective patient registries, and provide us with valuable information on the early disease stages of SpA.

Varying expressions of mood disorders make for difficulties in definition, diagnosis, and classification. DSMIV and ICD10 formal classifications with decision rules (see Chapter 1.9) provide a structure but their underlying models may or may not be valid. This chapter therefore considers how mood disorders can be variably conceptualized and structured—an issue of intrinsic importance but also influencing identification of causes and management. Some definitional and boundary issues are first detailed prior to considering sub-typing and differential diagnostic issues.

This discussion of the diagnosis, classification, and epidemiology of clinical depression includes details of the associated physical morbidity, mortality, and impairment. Treatment approaches to depressive disorders are categorized with an emphasis on medication management, including improved treatment efficacy and progress with respect to side effects and toxicity. Although considerable advances have been made, with 18 antidepressant compounds being available and the impending release of two new antidepressant compounds in 1994, no one agent has demonstrated greater efficacy than another. Currently available studies suggest that only 21-42% of patients entered into treatment reach full recovery, while 20% of patients do not respond to available treatment but remain chronically depressed. Thus, the development of more efficacious agents that will produce complete remissions in patients who now achieve only partial treatment responses is a major challenge for biochemical, pharmacological, and clinical research of the treatment of mood disorders.

Vascular malformations and tumors comprise a wide, heterogeneous spectrum of lesions that often represent a diagnostic and therapeutic challenge. Frequent use of an inaccurate nomenclature has led to considerable confusion. Since the treatment strategy depends on the type of vascular anomaly, correct diagnosis and classification are crucial. Magnetic resonance (MR) imaging is the most valuable modality for classification of vascular anomalies because it accurately demonstrates their extension and their anatomic relationship to adjacent structures. A comprehensive assessment of vascular anomalies requires functional analysis of the involved vessels. Dynamic time-resolved contrast material-enhanced MR angiography provides information about the hemodynamics of vascular anomalies and allows differentiation of high-flow and low-flow vascular malformations. Furthermore, MR imaging is useful in assessment of treatment success and establishment of a long-term management strategy. Radiologists should be familiar with the clinical and MR imaging features that aid in diagnosis of vascular anomalies and their proper classification. Furthermore, they should be familiar with MR imaging protocols optimized for evaluation of vascular anomalies and with their posttreatment appearances. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.315105213/-/DC1.

This column describes the work of the Nursing Diagnosis Extension and Classification (NDEC) research team, which works in a collaborative agreement with NANDA to refine and extend the diagnosis classification.

Objective To describe a classification of microcystic lymphatic malformations of the tongue and to investigate different treatment methods. Design Retrospective review of patients treated for microcystic lymphatic malformations of the tongue. Lymphatic malformations were classified into the following 4 groups according to their extent: isolated superficial microcystic lymphatic malformations of the tongue (stage I); isolated lymphatic malformations of the tongue with muscle involvement (stage II; stage IIA, involving a part of the tongue; stage IIB, involving the entire tongue); microcystic lymphatic malformations of the tongue and the floor of mouth (stage III); and extensive microcystic lymphatic malformations involving the tongue, floor of mouth, and further cervical structures (stage IV). Patients Twenty patients with microcystic lymphatic malformation of the tongue. Main Outcome Measures Medical records were reviewed for demographic data and extent and treatment of the lymphatic malformations. Results Three patients had stage I disease; 5 patients, stage II; 3 patients, stage III; and 9 patients, stage IV. In 6 patients, the lymphatic malformations could be completely removed by carbon dioxide laser surgery; the remaining 13 patients had persistent disease. Conclusions The initial stage seems to predict outcome. Carbon dioxide laser therapy provides good results primarily in stages I and IIA lymphatic malformations. In advanced lymphatic malformations (stages IIB, III, and IV), an interdisciplinary approach is necessary, because complete surgical excision is often impossible owing to the diffuse growth behavior, and therefore recurrence and persistence are common.

This study presents a new machine learning strategy to address the disease diagnosis classification problem that comprises an unknown number of disease classes. This is exemplified by a software called Ellipsoid Clustering Machine (ECM) that identifies conserved regions in mass spectrometry proteomic profiles obtained from control subjects and uses these to estimate classification boundaries based on sample variance. The software can also be used for visual inspection of data reproducibility. ECM was evaluated using mass spectrometry protein profiles obtained from serum of Hodgkin’s disease patients (HD) and control subjects. According to the leave-one-out cross validation, ECM completely separated both groups based only on the information derived from four selected mass spectral peaks. Classification details and a 3D graphical model showing the separation between the control subject cluster and HD patients is also presented. The software is available on the project website together with online interactive models of the dataset and an animation demonstrating the method.

La hipersomnia o somnolencia diurna excesiva es una queja frecuente en la práctica neurológica y puede ser debida a múltiples trastornos. Puede definirse como la sensación subjetiva de sueño a una hora inapropiada. Hay que tener en cuenta que en ocasiones la hipersomnia no viene referida por el paciente como tal sino que lo que aqueja es cansancio o fatiga. Para abordar el diagnóstico de la hipersomnia es necesaria una historia clínica detallada. Un diagnóstico correcto permitirá un correcto abordaje terapéutico lo cual tiene una gran importancia dada la repercusión social y laboral de la hipersomnia. Dentro de los síndromes con somnolencia diurna excesiva podemos encontrar trastornos intrínsecos del sueño como la narcolepsia o hipersomnia secundaria a otras enfermedades o como efecto secundario de diversos fármacos.

Although meibomian gland disease (MGD) is one of the most common disorders encountered in ophthalmic practice, there has been no descriptive system consistently accepted to clinically characterize the anatomical and correlative biochemical alterations that occur in this condition. The purpose of this review is to synthesize a clinical description of meibomian gland disease and to provide a scheme for diagnosis, classification, and quantification that will be of value in the clinical setting and in the conduct of clinical trials.

Fifty canine lymphomas were classified cytomorphologically using the updated Kiel classification scheme. Aspirates of lymph nodes from dogs with lymphoma were stained using 5 canine-specific antibodies and 3 human-specific antibodies that cross-react with canine lymphocytes. The antibody-stained aspirates were analyzed by flow cytometry. A total of 32 (64%) of the 50 lymphomas were characterized as B-cell origin and 18 (36%) were of T-cell origin. B-cell lymphomas were identified in 12 females and 20 males with a mean age of 8.35 years. T-cell lymphomas were identified in 8 females and 10 males with a mean age of 7.9 years. A minority of the lymphomas were low-grade B-cell and T-cell lymphomas (6/50, 12% and 4/50, 8%, respectively). The most common morphologic types were high-grade centroblastic and unclassifiable plasmacytoid for B- and T-cell lymphomas (18/50, 36% and 7/50, 14%, respectively).

The aim of this study was to determine if measurement of the contralateral femora has an effect on osteoporosis diagnosis and treatment classification if the spine is not included in the bone mineral density (BMD) scan. The method used was the T-score discordance from the dual femur BMD scans of 537 women (mean age: 61.2 yr; standard deviation: 10.5; age range: 32-90 yr) who were evaluated to determine if inclusion of the contralateral hip in the BMD study made a difference in clinical diagnosis and treatment classification when the spine was not included in the BMD scan. Clinical diagnosis and treatment classification was based on the lowest T-score at each hip of three femur sites: the neck, the trochanter, and the total femur. The results of the diagnosis classification (i.e., normal, osteopenia, and osteoporosis) differed in the right versus the left femora in 28% of subjects at one or more sites, and in 14%, 15%, and 10% of subjects at the neck, trochanter, and total femur, respectively. Diagnosis discordance increased in subjects who were aged 65 yr and older. Treatment classification (Tor=-1.5; T-1.5; T-2.0) differed in the right versus the left femora in 33% of subjects at one or more sites, and in 18%, 14%, and 12% of subjects at the neck, trochanter, and total femur, respectively. Treatment discordance increased in subjects age 65 yr and older. Using the lowest T-score for clinical diagnosis classification, when the contralateral hip was considered, a clinical difference in diagnosis from normal--osteopenia occurred in 3.9% of subjects, and from osteopenia--osteoporosis in 1.3% of subjects. A clinical difference in treatment category from Tor=-1.5--T-1.5 occurred in 2.7% of subjects, and from Tor=-2--T-2 in 2.7% of subjects. In conclusion, inclusion of the bilateral hip in the BMD study made a clinical difference in diagnosis classification in 5.2% of subjects and in treatment classification in 5.4% of subjects. T-score differences between the contralateral hips increased with age. In the subgroup of subjects age 65 yr and older, a clinical difference in classification to a more severe diagnosis or treatment category occurred in 5.35% and 7.25% of subjects, respectively.

Although ophthalmic involvement in developmental and genetic abnormalities has been recognized for centuries, it is only recently, due to new discoveries in molecular biology, that our classification and pathophysiology of congenital eye diseases have been advanced. In the next few years these advances will increasingly influence aspects of diagnosis classification, and therapy in ophthalmology. Tests for acquired and inherited diseases in opthalmology are being revolutionized by biotechnical innovations. The molecular genetics of ocular diseases is currently undergoing changes in classification due to intense investigations using advanced biotechnology. The potential for new treatment modalities, such as gene therapy, for molecular eye diseases, once thought to be pure fiction, is now a reality. This paper will outline recent changes in classification, organization, and general knowledge regarding inherited eye diseases.

There are several reasons why workers in the field of health care need to register the data from their patients. To facilitate patient-related research a registration system must include patient data on such factors as date of birth, sex, registration number, hospital number, address, and accurate diagnostic data. The collection and analysis of a large quantity of data on many patients requires the help of a computer. Modern computing facilities allow the storage and retrieval of information in a much shorter time. Physicians tend to develop individual registration schemes according to their preferred methods of diagnosis classification. Such a system may be helpful for one’s personal use, but the compatibility with other registration systems may be poor due to the differences in methods of classifying diagnosis. Therefore it seems useful to develop a nationally or internationally accepted method of classification.

The clinical correlates of Rolandic spikes were studied in 47 children to determine the significance of this EEG finding to the diagnosis and classification of epilepsy. The children were classified into 'functional' and 'organic' groups, with and without epilepsy. Children with epilepsy were further subdivided into those with Rulandic and those with non-Rulandic seizures. In children without neurological abnormalities, the EEG finding of Rolandic spikes plays a decisive role in the diagnosis of an epileptic syndrome as benign focal epilepsy of childhood with centro-temporal spikes (BECT), a diagnosis with an excellent prognosis. Neurological and neuroradiological examinations of the 'functional' group revealed that the Rolandic spike may occur as a true 'functional' spike. The frequency of a family history of epilepsy among neurologically normal children with Rolandic spikes suggests, in addition to the inheritance of BECT and the EEG trait, the existence of a hereditary susceptibility to epilepsy.

EDMUS is a minimal descriptive record developed for research purposes to document clinical and laboratory data in patients with multiple sclerosis (MS). It has been designed by a committee of the European Concerted Action for MS, organised under the auspices of the Commission of the European Communities. The software is user-friendly and fast, with a minimal set of obligatory data. Priority has been given to analytical data and the system is capable of automatically generating data, such as diagnosis classification, using appropriate algorithms. This procedure saves time, ensures a uniform approach to individual cases and allows automatic updating of the classification whenever additional information becomes available. It is also compatible with future developments and requirements since new algorithms can be entered in the programme when necessary. This system is flexible and may be adapted to the users needs. It is run on Apple and IBM-PC personal microcomputers. Great care has been taken to preserve confidentiality of the data. It is anticipated that this "common" language will enable the collection of appropriate cases for specific purposes, including population-based studies of MS and will be particularly useful in projects where the collaboration of several centres is needed to recruit a critical number of patients.

The authors classify rupture of echinococcal cysts into three types: contained, communicating, and direct. Contained rupture occurs when only the parasitic endocyst ruptures and the cyst contents are confined within the host-derived pericyst. When cyst contents escape via biliary or bronchial radicles that are incorporated in the pericyst, the rupture is communicating. Direct rupture occurs when both the endocyst and the pericyst tear, spilling cyst contents directly into the peritoneal or pleural cavities or occasionally into other structures. Communicating and direct forms have more serious clinical implications than contained rupture, but even contained rupture should have prompt surgical attention to prevent it from developing into one of the other forms. Untreated communicating rupture of a liver cyst can lead to obstruction of the biliary system with a 50% mortality rate. Direct rupture may cause anaphylaxis, and it should be managed surgically, possibly with adjunctive treatment with antihelminthic drugs to decrease the possibility of metastatic hydatosis.