History-taking and the Usefulness Index in the diagnosis of functional dyspepsia.

BACKGROUND: The primary diagnosis of functional dyspepsia (FD) is made on the basis of typical symptoms and by excluding organic gastrointestinal diseases that cause dyspeptic symptoms. However, there is difficulty reaching a diagnosisin FD. OBJECTIVES: To assess the efficiency of the Usefulness Index (UI) test and history-taking in diagnosing FD. METHODS: A study on acute abdominal pain conducted by the World Organization of Gastroenterology Research Committee (OMGE) included 1333 patients presenting with acute abdominal pain. The clinical history-taking variables (n = 23) for each patient were recorded in detail using a preedefined structured data collection sheet, and the collected data were compared with the final diagnoses. RESULTS: The most significant clinical history-taking variables of FD in univariate analysis were risk ratio (RR): location of pain at diagnosis (RR = 5.7), location of initial pain (RR = 6.5), previous similar pain (RR = 4.0), duration of pain (RR = 2.9), previous abdominal surgery (RR = 4.1), previous abdominal diseases (RR = 4.0), and previous indigestion (RR = 3.1). The sensitivity of the physicians' initial decision in detecting FD was 0.44, specificity 0.99 and efficiency 0.98; UI was 0.19 and RR 195.3. In the stepwise multivariate logistic regression analysis, the independent predictors of FD were the physicians' initial decision (RR = 266.4), location of initial pain (RR = 3.4),duration of pain (RR = 3.1), previous abdominal surgery (RR = 3.7), previous indigestion (RR = 2.2) and vomiting (RR = 2.0). CONCLUSIONS: The patients with upper abdominal paininitially and a previous history of abdominal surgery and indigestion tended to be at risk for FD. In these patients the UI test could help the clinician differentiate FD from other diagnoses of acute abdominal pain.

Usefulness index in nonspecific abdominal pain--an aid in the diagnosis?

OBJECTIVE: In 1990, Lavelle and Kanagaratnam introduced Usefulness Index (UI) test for assessment of usefulness of clinical observations. Although, nonspecific abdominal pain (NSAP) is the most common diagnosis among secondary care patients with acute abdominal pain, the efficiency of UI test is rarely considered in NSAP. METHODS: In an extension of the World Organisation of Gastro-Enterology Research Committee (OMGE) acute abdominal pain study, 1333 patients presenting with acute abdominal pain were included in the study. The clinical signs (n = 14) and tests (n = 3) in each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnoses of the patients. RESULTS: The most significant clinical tests and signs of NSAP in univariate analysis were (UI = Usefulness Index and RR = risk ratio): rigidity (UI = 0.36, RR = 32.2), rebound (UI = 0.33, RR = 6.3), guarding (UI = 0.25, RR = 4.9), Murphy's positive (UI = 0.13, 8.9), bowel sounds (UI = 0.12, RR = 3.3), and renal tenderness (UI = 0.12, RR = 2.2). The sensitivity of the doctors' initial decision in detecting NSAP was 0.70 with a specificity of 0.83 and with the UI = 0.37 and RR = 11.4. CONCLUSION: The patients with negative test results in rigidity, rebound, guarding, Murphy's, and bowel sounds tended to be at risk for NSAP and in these patients the UI test could be an aid for clinician to differentiate NSAP from other causes of acute abdominal pain.

[Update on current care guidelines: urinary tract infections]. / Käypä hoito -suosituksen päivitystiivistelmä. Virtsatieinfektiot.

This guideline is focused on the diagnostics and treatment of acute, recurrent and relapsing urinary tract infections in adults and children. Sexually transmitted diseases are not addressed, but must be considered in differential diagnostics. The resistance prevalence of the causative microbes and the ecological adverse effects of antimicrobial agents were considered important factors in selecting optimal therapeutic choices for the guideline. Diagnosis and management of cystitis in otherwise healthy women aged 18-65 years can be based on structured telephone interviews. Primary antimicrobiotic drugs are nitrofurantoin, pivmesillinam and trimetoprim for three days.

Tumour-infiltrating lymphocytes: A prognostic factor of PSA-free survival in patients with local prostate carcinoma treated by radical prostatectomy.

AIM: The aim of the study was to evaluate the prognostic significance of tumour-infiltrating lymphocytes (TILs) in local prostate cancer (PC). MATERIALS AND METHODS: TILs were counted and routine histological variables were assessed from radical prostatectomy specimens in 188 cases of PC. Immunohistochemical (IHC) characterisation of the lymphocytes was done by using CD4 and CD8 antibodies for detection of T lymphocytes and CD20 antibody for B lymphocytes in tissue microarray construction. The results of the lymphocyte analyses were compared to other prognostic factors and PSA recurrence-free survival (RFS). RESULTS: Strong expression of TILs, CD4, CD8 and CD20 lymphocytes were seen in 28%, 33%, 35% and 15% of the cases, respectively. CD4 and CD8, as well as CD4 and CD20, lymphocytes were correlated to each other (p < 0.0001), but not to clinical or histopathological parameters. Weak expression of TILs was correlated with intracapsular carcinoma (p = 0.004), while perineural invasion (p = 0.017) and capsular invasion (p < 0.0001) were related to strong expression of TILs. Shortened PSA RFS was associated with strong expression of TILs (p = 0.005). In Cox regression analysis, independent predictors of shortened PSA RFS were strong expression of TILs (p = 0.012) and high Gleason score (p < 0.001). CONCLUSION: TILs are an independent predictor of short PSA RFS in patients with local PC treated by radical prostatectomy.

The expression and prognostic value of alpha-, beta- and gamma-catenins in renal cell carcinoma.

BACKGROUND: Catenins have prognostic value in several human tumours. The aim of the study was to analyse the prognostic value of catenin expression in a prospectively followed series of renal cell carcinoma. PATIENTS AND METHODS: One hundred and twenty-four renal cell carcinomas were prospectively followed-up for a mean of 3.5 years and the survival data of patients were related to standard prognostic factors and to the results of alpha-, beta- and gamma-catenin immunohistochemistry. The data of catenin immunohistochemistry were also related to the clinical and histopathological characteristics of the tumours. RESULTS: Low cytoplasmic alpha-catenin expression was related to lymphatic tumour growth (p=0.02) and to tumour necrosis (p=0.02). The weak expression intensity of beta-catenin on cell membranes was related to venous growth inside the tumour (p=0.02), extratumoural venous growth (p=0.03) and to perineural growth (p<0.001). Nuclear gamma-catenin expression was strongly associated with clear cell type (p=0.0001) and high WHO grade (p=0.038). Short recurrence-free survival was predicted by weak membranous alpha-catenin (p=0.015) and beta-catenin (p=0.006) expression intensity, while their cytoplasmic expression was of lower significance (p=0.07 and 0.045, respectively). All the conventional prognostic factors predicted short recurrence-free survival: Fuhrman classification (p=0.02), WHO grade (p=0.026), perineural growth (p=0.013), venous invasion (p=0.0024), tumour size (p=0.004) and T-category (p=0.0001). Independent predictors of short recurrence-free survival were weak membranous expression intensity of beta-catenin (RR=0.15, p=0.004), high T-category (RR=2.70, p=0.0001) and high WHO grade (RR=2.24, p=0.025). CONCLUSION: The results show that immunohistochemical analysis of beta-catenin expression may be used as an indicator of aggressiveness in renal cell carcinoma.

Usefulness of history-taking in non-specific abdominal pain: a prospective study of 1333 patients with acute abdominal pain in Finland.

BACKGROUND: Nonspecific abdominal pain is the commonest cause of a patient presenting to a doctor with abdominal pain of less than one week's duration. The differential diagnosis of NSAP is not always easy due to many similarities in the clinical presentation at onset and many cases may be misdiagnosed in the initial situation. To the Authors' knowledge, the diagnostic accuracy of history-taking is rarely considered in NSAP, and therefore the aim of the present study was to investigate the contribution of history-taking to correctly diagnosing NSAP in the clinical situation. PATIENTS AND METHODS: The accuracy of clinical diagnosis of NSAP was studied in connection with the survey of acute abdominal pain by the Research Committee of the World Organization of Gastroenterology (OMGE). In an extension of the OMGE acute abdominal pain study, 1333 patients presenting with acute abdominal pain were included in the study. The clinical symptoms of each patient were recorded in detail, using a predefined structured data collection sheet, and the collected data were compared with the final diagnosis of the patients. RESULTS: The most significant symptoms of NSAP in univariate analysis were: vomiting (Usefulness Index, UI=0.11, Risk Ratio, RR=2.01), progression of pain (UI=0.10, RR=1.90), location of pain at diagnosis (UI=0.05, RR=1.75), intensity of pain (UI=0.05, RR=1.57) and previous indigestion (UI=0.05, RR=1.44). The sensitivity of the doctors' initial decision in detecting NSAP was 0.70, with a specificity of 0.83 and an efficiency of 0.77. CONCLUSION: The results of this study do not support a specific link between any one clinical symptom and NSAP diagnosis. However, patients with midline pain, without any increase in pain and without vomiting, and those with weak or moderate pain tended to be at risk for NSAP.