Diagnostic value of 12 leads ECG combined with detection of myocardial enzyme spectrum for atypical myocardial infarction / 中国医学装备

Objective: To explore the diagnostic value of 12 leads electrocardiogram (ECG) combined with detection of myocardial enzyme spectrum for atypical myocardial infarction. Methods: 80 patients with atypical myocardial infarction were enrolled in the observation group, and 80 patients with typical myocardial infarction in the same period were enrolled in the control group. Both of two groups were implemented the routine 12 leads ECG examination using FX-8322 ECG instrument, and the changes of Q wave and ST segment were recorded. And the series of indicators of serum myocardial enzymes (CK, CK-MB and cTnI) were detected by using AU2700 automatic biochemical analyzer. The test results of the first symptoms, ECG characteristics, myocardial enzyme spectrum and diagnostic accuracy of the two groups were compared. Results: In 80 patients of observation group, the painless first symptom was 20%, and the atypical pain was 75%, the typical upper abdominal and back pain accounted for 5%. In 80 patients of control group, all of them were typical upper abdominal and back pain, and the differences of these indicators between the two groups were significant (x2=8.889, x2=48.000, x2=72.381, P<0.05). For characteristics of ECG, the 22.5% of 80 patients of observation group hasn't been changed at ST-T segment, and the 17.5% of them was no pathological Q wave +T wave erect +ST segment elevation, and the percentage of pathological Q wave +T wave erect +ST segment elevation in observation group was 60.0%. On the other hand, the 100.0% of 80 patients of control group was pathological Q wave+T wave inverted +ST segment elevation, the differences of these indicators between the two groups were significant (x2=10.141, x2=7.671, x2=20.000, P<0.05). The results of myocardial enzyme spectrum detection indicated that the levels of serum CK, CK-MB and cTnI in the observation group were significantly lower than those in the control group (t=59.766, t=20.735, t=13.352, P<0.05), respectively. The diagnostic accuracy rate of ECG in observation group was 87.5%, which was significantly lower than 100% in control group (x2=5.333, P<0.05). The accuracy rate of ECG combined with myocardial enzyme spectrum in the observation group was 100%, which was not statistically significant compared with that in control group. Conclusion: 12 leads ECG is effective in diagnosing typical myocardial infarction, but it is necessary to combine myocardial enzyme spectrum detection for atypical myocardial infarction so as to increase the diagnostic accuracy rate.

The accuracy of frozen section of uterine lesions in the practice of gynecologic surgery. A retrospective assessment study in a government tertiary training hospital / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to determine the accuracy, sensitivity and specificity of frozen section (FS) in the diagnosis of uterine neoplasm in a tertiary government training hospital.@*Methodology@#This is a retrospective validation study from 2004-2015 involving cases of uterine lesions from gynecologic surgeries. All histopathologic results of frozen and paraffin sections were retrieved and reviewed. Chi square test with 2x2 Fischer Exact test adjustment was used to check for associations. Accuracy indices of FS tool were estimated such as sensitivity, specificity, likelihood ratios, negative and positive predictive values, and overall accuracy. A p-value of < 0.05 alpha is considered significant.@*Results@#A total of 143 uterine specimens were submitted for frozen section analysis. The utilization rate of FS is 1% per year. The FS results were correlated with the final histopathologic diagnosis with 96% agreement rate. Utilizing a median number of 3 sections per specimen provides an overall accuracy rate of 97%. The accuracy rate of FS is equal between combined benign-premalignant and malignant cases at 96%. The accuracy rate is not statistically affected by the procedure by which the specimen was taken, as well as the source and gross morphology of the specimen. Moreover, a minimum of 11 sections per specimen is needed to obtain an accuracy rate of 99-100%. The accuracy rate particularly for endometrial lesions is between 94 and 100%.@*Conclusion@#Accuracy rates of frozen section on uterine lesions are high regardless of the sampling procedure and source of the specimen. Increasing the number of sections during FS parallels that of the final histopathologic diagnosis. FS for uterine lesions is a vital and cost-effective intraoperative decision tool to maximize care of patients.

Thyroid Lesions: FNAC and Histopathology Correlation in Our Experience.

Background: Fine needle aspiration cytology is considered the gold standard diagnostic test for the diagnosis of thyroid nodules. Fine needle aspiration cytology is a cost effective procedure that provides a specific diagnosis rapidly with minimal complications. Based on the cytology findings, patients can be followed up in cases of benign diagnosis and subjected to surgery in cases of malignant diagnosis thereby decreasing the rate of unnecessary surgery. The purpose of the present study was to correlate the fine needle aspiration cytology findings with histopathology of excised specimens. Methods: This was a prospective study conducted on 310 consecutive patients between June 2012 and May 2015. All patients with clinically diagnosed thyroid nodule were included in the study. Results: In our study sensitivity of the thyroid FNAC ranges from 93.02% to 100% and its specificity from 60.42% to 96.62% respectively. Positive predictive value is 94.44% and negative predictive value is 100%. Commonest benign condition is multinodular goiter and malignancy is papillary carcinoma. Most difficult thyroid lesions to be reported are those in the intermediate category as cytomorphological features are overlapping.Conclusion: Fine needle aspiration cytology is a simple, easy to perform, cost effective, and easily repeated procedure for the diagnosis of thyroid cancer. It is recommended as the first line investigation for the diagnosis of thyroid nodules.

Analysis on long term misdiagnosis of hereditary spherocytosis / 国际检验医学杂志

Objective To increase the recognition of the clinicians and laboratorians to hereditary spherocytosis for reducing the misdiagnosis and missed diagnosis ,and improving the diagnostic level .Methods The data in 4 cases of definitely diagnosed heredi‐tary spherocytosis in our hospital were retrospectively analyzed ,and the misdiagnosis reasons were analyzed and summarized .Results In 4 cases ,2 cases were misdiagnosed as Mediterranean anemia ,1 case was misdiagnosed as hemolytic anemia and 1 case as hemo‐globin disease .Conclusion Correctly mastering the key points of the diagnosis ,strengthening the communication between the labo‐ratorians and clinicians ,paying attention to the red blood cells morphologic examination under microscope and high level diagnosis a‐bility of blood cell morphology are the important means to reduce the misdiagnosis and missed diagnosis and improve the diagnostic accuracy rate .

Analysis of the diagnosis value of B ultrasound for uterine endometrial polyps / 中国医学装备

Objective: To observe the accuracy rate, false negative rate of B ultrasound examination in the diagnosis of endometrial polyps and discuss the diagnosis value. Methods:Selected 80 cases of patients with endometrial polyps treated in the hospital from 2013 January-2013 year in June as the research object and they were confirmed by pathological examination, mean age (43.9±11.2) years old, they were examined by B ultrasound examination before and after menstruation, then analyze sensitivity, specific degrees of B Ultrasound performance combining with pathological examination and the survey of satisfaction for patients. Results:the patients before and after the menstrual endometrium showed different degrees of thickening, ranging from 1.2-2.4 cm, the probe showed ligulate, papillary substance not uniform, single, multiple echo;after analysis 73 cases were diagnosed as endometrial polyp, the correct diagnostic rate was 91.2%and the false negative rate was 8.8%. 76 cases (95%) were satisfactory for the simplicity, low cost, accurate diagnosis. Conclusion:B ultrasound examination in the diagnosis of endometrial polyps has high correct rate and is noninvasive, safe, and is easily accepted by patients, so it has important clinical value.

The accuracy of myocardial infarction diagnosis in medical insurance claims. Korean Research Group for Cardiovascular Disease Prevention and Control

We attempted to assess the accuracy of the International Classification of Diseases (ICD) codes for myocardial infarction (MI) in medical insurance claims, and to investigate the reasons for any inaccuracy. This study was designed as a preliminary study to establish a surveillance system for cardiovascular diseases in Korea. A sample of 258 male patients who were diagnosed with MI from 1993 to 1997 was selected from the Korea Medical Insurance Corporation cohort (KMIC cohort: 183,461 people). The registered medical record administrators were trained in the survey technique, and gathered data by investigating the medical records of the study subjects from March 1999 to May 1999. The definition of MI for this study included symptoms pursuant to the diagnostic criteria of chest pain, electrocardiogram (ECG) findings, cardiac enzyme and results of coronary angiography or nuclear scan. We asked the record administrators for the reasons of incorrectness for cases where the final diagnosis was 'not MI'. The accuracy rate of the ICD codes for MI in medical insurance claims was 76.0% (196 cases) of the study sample, and 3.9% (ten cases) of the medical records were not available due to hospital closures, non-computerization or missing information. Nineteen cases (7.4%) were classified as insufficient due to insufficient records of chest pain, ECG findings, or cardiac enzymes. The major reason of inaccuracy in the disease code for MI in medical insurance claims was 'to meet the review criteria of medical insurance benefits (45.5%)'. The department responsible for the inaccuracy was the department of inspection for medical insurance benefit of the hospitals.

Transrectal ultrasonography in preoperative staging of rectal cancer

A precise knowledge of the depth of invasion of tumor is essential for the planning of treatment of rectal cancer. Transrectal ultrasonography is a new diagnostic modality that has become useful in determining the depth of invasion preoperatively and the presence or absence of metastatic lymph nodes. Transrectal ultrasonography was used in preoperative staging of 36 patients with rectal cancer. Thirty three patients had a radical resection (17 low anterior resection, 15 abdominoperineal resection and 1 pelvic exenteration), one patient had a local excision. Two among these thirty four patients had preoperative radiotherapy. Preoperative transrectal ultrasonographic staging was compared with pathologic findings. In staging depth of invasion, the overall accuracy was 88.8 percent, overstaged in 5.8 percent, understaged in 5.8 percent. Transrectal ultrasonography is the more accurate method than CT in staging of depth of tumor invasion (61.8% vs 88.8%). In staging of lymph nodes, the overall accuracy of transrectal ultrasonography was 85.3 percent, sensitivity was 71.7 percent and specificity was 88.8 percent. Transrectal ultrasonography is a safe, inexpensive and accurate staging method in the assessment of both depth of invasion and nodal status.