Clinically Undiagnosed Diseases in Autopsies: Frequency and Risk Factors.

CONTEXT.­: Autopsies can reveal clinically undiagnosed diseases. However, the frequency of first diagnoses at autopsy and their association with clinically known risk factors are not well understood because of lack of systematic analyses addressing this topic. OBJECTIVE.­: To perform a large retrospective cohort analysis on the frequency of clinically undiagnosed postmortem findings and correlate these with patients' risk factors. DESIGN.­: Six hundred forty-eight consecutive and complete autopsies of adults (age >18 years), performed in the University Hospital Zurich, Switzerland, during a 3-year time period were retrospectively analyzed. Clinical diagnoses and postmortem findings were compared in order to identify clinically undiagnosed lesions and clarify their correlation with common risk factors. RESULTS.­: In 633 of 648 patients (98%), at least one clinically undiagnosed finding was identified at autopsy. The most common nonneoplastic entities were bronchopneumonia (198; 31%), coronary artery disease (155; 24%) and acute or subacute myocardial infarction (94; 15%), and the most common malignancies were prostate cancer in men (14; 2.2%), followed by kidney cancer (10; 1.5%), gastrointestinal stromal tumor (10; 1.5%), and lung carcinoma (9; 1.4%) in both genders. Clinically undiagnosed cardiac amyloidosis was demonstrated in 8% (52 of 648) of patients and was significantly associated with age, hypertension, chronic kidney disease, coronary artery disease, and hypertensive cardiomyopathy. CONCLUSIONS.­: Autopsy is a useful investigation for the detection of clinically undiagnosed entities. In our cohort, cardiac amyloidosis showed the highest number of underlying risk factors, but was clinically underdiagnosed. Our findings underline the necessity of improved clinical detection of cardiac amyloidosis, especially in light of emerging therapeutic options. Moreover, we characterize the most common entities prone to clinical underdiagnosis.

Episodic Abdominal Pain-An Unexpected Cause for a Common Clinical Problem.

A previously healthy 55-year-old male patient presented repeatedly to the emergency department with severe episodic periumbilical abdominal pain. After an extensive diagnostic work-up and subsequent clinical deterioration, appendiceal diverticulitis was diagnosed. We identified a correlation of white blood cell counts and possibly faecal calprotectin with the clinical presentation. We suggest that appendiceal diverticulitis should be considered in middle-aged patients with recurrent episodes of abdominal pain that correlate with laboratory markers of inflammation.

[The IBD-Control questionnaire: German translation and validation of the standardized questionnaire for Patient Reported Outcome Measurement in inflammatory bowel disease]. / Der IBD-Control-Fragebogen: Deutsche Übertragung und Validierung des standardisierten Fragebogens zur Messung des Outcomes aus Patientensicht bei chronisch entzündlichen Darmerkrankungen.

BACKGROUND: Subjectively perceived results of treatment will be in the center of defining treatment success on the way to value-based and patient-centered health care. Patient-reported outcome measures (PROMs) serve as an instrument to measure treatment success. In inflammatory bowel disease (IBD), measuring treatment success from a patient's point of view is performed with the validated IBD-Control questionnaire. Because the IBD-Control questionnaire has not been published in German yet, the translation and validation of the IBD-Control in the German-speaking part of Switzerland was necessary before use. METHODS: We have translated the English original version of the IBD-Control questionnaire into German in a state-of-the-art procedure of "forward-backward translation" and validated the translated IBD-Control questionnaire with 154 patients with Crohn's disease or with ulcerative colitis. RESULTS: Professional health care and translation experts have contributed to the translation of the IBD-Control into German. The IBD-Control-D is an accepted questionnaire. Spearmans Rho showed high consistency between the IBD-Control-8-Subscore and the IBD-Control-VAS-Score (r=0.632). The disease activity in the past 6 months highly correlated with the IBD-8 subscore (r=0.640) as well as with the IBD-Control-VAS-Score (r=0.622). The IBD-Control-8-Subscore highly correlated with the Harvey Bradshaw Index (r=-0.620) and the partial Mayo Score (r=-0.679), as well as the IBD-Control-VAS-Score with the Harvey Bradshaw Index (r=-0.484) and the Mayo Score (r=-0.435), showing sufficient construct validity. The result is the German version of the IBD-Control, the IBD-Control-D, published here. CONCLUSION: The original English version is a valid instrument, and its use has proven to be a suitable instrument in German-speaking areas to make the subjective feeling of illness and treatment outcome measurable.