194,312 results match your criteria difficult diagnose

Direct immunofluorescence analysis of oral Tzanck smears for pemphigus vulgaris: A diagnostic test.

J Oral Pathol Med 2021 Sep 18. Epub 2021 Sep 18.

Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China.

Background: Pemphigus vulgaris (PV) is a rare and potentially fatal autoimmune blistering disease. Direct immunofluorescence (DIF) is an important method for PV diagnosis, but oral tissue biopsy for DIF analysis is difficult to perform because of the fragile characteristics of oral mucosa. However, no well-designed diagnostic studies addressing the validity of DIF analysis of oral Tzanck smears for the diagnosis of PV exist. Read More

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September 2021

Locally advanced anorectal malignant melanoma in septuagenarian patient treated by laparoscopic abdominoperineal resection: A case report.

Int J Surg Case Rep 2021 Sep 6;87:106378. Epub 2021 Sep 6.

University of Tsukuba, Faculty of Medicine, Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, 1-1-1 Tennnodai, Tsukuba-shi, Ibaraki-ken 305-8575, Japan. Electronic address:

Introduction: Anorectal malignant melanoma (ARMM) is a rare disease with a poor prognosis. In cases involving locally advanced disease, the treatment strategy is difficult, especially in octogenarian patients, because the prognosis is poor, despite the corresponding decrease or loss of the anal function.

Presentation Of Case: A 78-year-old woman was admitted to a local hospital with chief complaints of severe anal discomfort due to an egg-sized tumor that was protruding out of the anus and melena. Read More

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September 2021

Volatile organic compounds (VOCs) in exhaled breath as a marker of hypoxia in multiple chemical sensitivity.

Physiol Rep 2021 Sep;9(18):e15034

Department of Neuroscience, Imaging and Clinical Sciences, University "d'Annunzio" Chieti-Pescara, Chieti, Italy.

In the history of diagnostics, breath analysis was one of the first method used until the breakthrough of biochemical testing technology. Today, breath analysis has made a comeback with the development of gas analyzers and e-noses, demonstrating its power in its applicability for diagnosing a wide range of diseases. The physical basis of multiple chemical sensitivity (MCS), an emerging environmental disease, is difficult to understand because it is based on the scenario of chronic hypoxia, with a complex of chemical compounds that trigger the syndrome and result in multiple symptoms. Read More

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September 2021

Assessment of thyroid function in the preterm and/or very low birth weight newborn.

An Pediatr (Engl Ed) 2021 Sep 14. Epub 2021 Sep 14.

Sección de Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, Spain.

The screening program or early detection of congenital hypothyroidism is one of the greatest advances achieved in Pediatrics. Thyroid hormones are essential for brain development and maturation, which continue into the neonatal stage. Alterations in thyroid function in premature and underweight children in the first months of life causes irreversible damage to the central nervous system and is one of the most frequent and avoidable causes of mental retardation. Read More

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September 2021

Application of Ultrasonography in the Diagnosis of Rhabdomyolysis.

Ultrasound Med Biol 2021 Sep 14. Epub 2021 Sep 14.

Department of Ultrasonography, Wuhan Fourth Hospital, Puai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China. Electronic address:

Early diagnosis and treatment of rhabdomyolysis are very important, but difficult to achieve for some atypical cases. Our study was aimed at determining the diagnostic value of ultrasonography in rhabdomyolysis caused by different factors. The study enrolled 50 patients with rhabdomyolysis diagnosed in our hospital. Read More

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September 2021

Detection of Coccidioides posadasii in a patient with meningitis using metagenomic next-generation sequencing: a case report.

BMC Infect Dis 2021 Sep 17;21(1):968. Epub 2021 Sep 17.

Department of Infectious Diseases, Guangzhou Panyu Central Hospital, Guangzhou, China.

Background: Coccidioidomycosis is a systemic infection caused by dimorphic fungi Coccidioides spp. endemic to Southwestern United States and Central and South America. A history of residence and travel in these areas is essential for the diagnostic of coccidioidomycosis, which has highly variable symptoms ranging from asymptomatic to severe, disseminated infection, and even death. Read More

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September 2021

Severe bilateral pleuropneumonia caused by Legionella sainthelensi: a case report.

BMC Infect Dis 2021 Sep 17;21(1):966. Epub 2021 Sep 17.

Laboratoire de Bactériologie, CHU Félix Guyon, Allée des Topazes, 97400, Saint-Denis, La Réunion, France.

Background: Legionella spp. are ubiquitous freshwater bacteria responsible for rare but potentially severe cases of Legionnaires' disease (LD). Legionella sainthelensi is a non-pneumophila Legionella species that was first isolated in 1980 from water near Mt. Read More

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September 2021

SARS-CoV-2 RNA concentrations in wastewater foreshadow dynamics and clinical presentation of new COVID-19 cases.

Sci Total Environ 2021 Sep 4;805:150121. Epub 2021 Sep 4.

Department of Biological Engineering, Massachusetts Institute of Technology, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, USA; Singapore-MIT Alliance for Research and Technology, Antimicrobial Resistance Interdisciplinary Research Group, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Broad Institute of MIT and Harvard, Cambridge, MA, USA. Electronic address:

Current estimates of COVID-19 prevalence are largely based on symptomatic, clinically diagnosed cases. The existence of a large number of undiagnosed infections hampers population-wide investigation of viral circulation. Here, we quantify the SARS-CoV-2 concentration and track its dynamics in wastewater at a major urban wastewater treatment facility in Massachusetts, between early January and May 2020. Read More

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September 2021

Association between bone shape and the presence of a fracture in patients with a clinically suspected scaphoid fracture.

J Biomech 2021 Aug 30;128:110726. Epub 2021 Aug 30.

Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands; NUTRIM School for Nutrition and Translational Research in Metabolism, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, Maastricht, the Netherlands; Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands; Faculty of Medicine and Life Sciences, Hasselt University, Belgium. Electronic address:

Scaphoid fractures are difficult to diagnose with current imaging modalities. It is unknown whether the shape of the scaphoid bone, assessed by statistical shape modeling, can be used to differentiate between fractured and non-fractured bones. Therefore, the aim of this study was to investigate whether the presence of a scaphoid fracture is associated with shape modes of a statistical shape model (SSM). Read More

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The Clinical Implications of Aspergillus Fumigatus Sensitization in Difficult-To-Treat Asthma Patients.

J Allergy Clin Immunol Pract 2021 Sep 14. Epub 2021 Sep 14.

Clinical and Experimental Sciences Department, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK; National Institute for Health Research (NIHR) Southampton Biomedical Research Centre at University Hospital Southampton NHS Foundation Trust, Southampton, UK; Asthma, Allergy and Clinical Immunology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK; The David Hide Asthma & Allergy Research Centre, St Mary's Hospital, Newport, Isle of Wight, UK. Electronic address:

Background: Fungal sensitivity has been associated with severe asthma outcomes. However, the clinical implication of Aspergillus fumigatus (A.fumigatus) sensitization in difficult-to-treat (or difficult) asthma is unclear. Read More

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September 2021

The Spice of Death: Sudden Cardiac Arrest After Novel Psychoactive Substance Exposure.

Pediatr Emerg Care 2021 Sep 15. Epub 2021 Sep 15.

From the Departments of Pediatrics Pharmacology and Toxicology, University of Arkansas for Medical Sciences, College of Medicine, Arkansas Children's Hospital PinPoint Testing, LLC Arkansas State Crime Laboratory, Little Rock, AR.

Abstract: Novel psychoactive substances (NPSs), commonly referred to as "K2" or "spice," are a relatively new toxicology challenge for pediatricians. Adolescents often incorrectly believe that these drugs are safe and can be used without major adverse effects. Although recent legislation attempts to ensure that these drugs are not commercially available, many are able to be purchased online as "not fit for human consumption" or under various misnomers such "incense. Read More

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September 2021

Current emerging MRI tools for radionecrosis and pseudoprogression diagnosis.

Curr Opin Oncol 2021 Sep 16. Epub 2021 Sep 16.

Department of Neuroradiology, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix Sorbonne Université, INSERM, CNRS, Assistance Publique-Hôpitaux de Paris, Institut du Cerveau et de la Moelle épinière, boulevard de l'Hôpital, Paris Department of Research & Innovation, Olea Medical, avenue des Sorbiers, La Ciotat, France.

Purpose Of Review: This review aims to cover current MRI techniques for assessing treatment response in brain tumors, with a focus on radio-induced lesions.

Recent Findings: Pseudoprogression and radionecrosis are common radiological entities after brain tumor irradiation and are difficult to distinguish from real progression, with major consequences on daily patient care. To date, shortcomings of conventional MRI have been largely recognized but morphological sequences are still used in official response assessment criteria. Read More

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September 2021

A case report of fibrolamellar hepatocellular carcinoma, with particular reference to preoperative diagnosis, value of molecular genetic diagnosis, and cell origin.

Surg Case Rep 2021 Sep 17;7(1):208. Epub 2021 Sep 17.

Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Juntendo University Hospital, 3-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.

Background: Fibrolamellar hepatocellular carcinoma (FL-HCC) is a liver tumor that occurs almost exclusively in young adults without underlying liver disease. In spite of its distinct clinical characteristics and specific imaging findings, preoperative diagnosis is often difficult due to the extremely low incidence of the tumor. Although FL-HCC shows particular morphological features on H&E-stained tissue sections, differential diagnosis from ordinary HCC, especially the scirrhous variant of HCC, and intrahepatic cholangiocarcinoma needs additional immunohistochemical (IHC) analyses and/or molecular genetic testing. Read More

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September 2021

Increase in Osteoporotic U-Type Sacral Fractures: Role of the Transiliac-Transsacral Screw Versus Lumbopelvic Fixation.

J Orthop Trauma 2021 Oct;35(Suppl 5):S21-S25

Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY.

Summary: As the population is increasing in age, so increases the number of osteoporotic fractures. U-shaped sacral fractures can be difficult to diagnose and may be a source of disability in patients when left untreated. Many patients with osteoporotic fractures are of advanced age and may experience rapid medical decline when these fractures cause immobility. Read More

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October 2021

Relapsing polychondritis: state-of-the-art review with three case presentations.

Postgrad Med 2021 Sep 17. Epub 2021 Sep 17.

Department of Rheumatology, Rehabilitation and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.

Background: relapsing polychondritis (rpc) is a complex immune-mediated systemic disease affecting cartilaginous tissue and proteoglycan-rich organs. The most common and earliest clinical features are intermittent inflammation involving the auricular and nasal regions, although all cartilage types can be potentially affected. The life-threatening effects of rpc involve the tracheobronchial tree and cardiac connective components. Read More

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September 2021

Detection of hypomimia in patients with Parkinson's disease via smile videos.

Ann Transl Med 2021 Aug;9(16):1307

Technical Department, Hangzhou Healink Technology Corporation Limited, Hangzhou, China.

Background: Parkinson's disease (PD) is a neurodegenerative disease characterized by the impairment of facial expression, known as hypomimia. Hypomimia has serious impacts on patients' ability to communicate, and it is difficult to detect at early stages of the disease. Furthermore, due to bradykinesia or other reasons, it is inconvenient for PD patients to visit the hospital. Read More

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Laparoscopic Sleeve Gastrectomy in a Patient With Situs Inversus Totalis and Kartagener Syndrome.

Cureus 2021 Aug 13;13(8):e17155. Epub 2021 Aug 13.

Department of Surgery, College of Medicine, Najran University, Najran, SAU.

Laparoscopic sleeve gastrectomy (LSG) is a widely accepted and adopted procedure to achieves weight loss in morbid obesity. Situs inversus (SI) is when the body's visceral organs are not in the normal position with reversal of anatomical orientation. Patients with obesity and SI can be challenging to diagnose and manage. Read More

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Quick-Wee versus bladder stimulation to collect midstream urine from precontinent infants under 1 year of age: a study protocol for a randomised controlled trial (ES.Stimquick.U).

BMJ Open 2021 Sep 16;11(9):e046324. Epub 2021 Sep 16.

Service des Urgences Pédiatriques, Hôpitaux Pédiatriques de Nice CHU-LENVAL, Nice, France.

Introduction: Urinary tract infections occur in around 1%-4% of boys and 3%-8% of girls under 2 years old. Diagnosis is difficult because of non-specific symptoms and the risk of urine analysis contamination depending on the sampling method used for precontinent infants. The American Academy of Pediatrics recommend transurethral catheterisation and suprapubic aspiration because of a low contamination rate but these techniques are invasive. Read More

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September 2021

Balloon dilation and rapid maxillary expansion: a novel combination treatment for congenital nasal pyriform aperture stenosis in an infant.

Ital J Pediatr 2021 Sep 16;47(1):189. Epub 2021 Sep 16.

Unit of Dentistry, Bambino Gesù Children's Hospital, 00165, Rome, Italy.

Background: Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition that may occur alone or as part of a multi-formative syndrome. Management remains difficult. There is no specific treatment protocol. Read More

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September 2021

Rare incidence of non-secretory myeloma with talaromycosis: a case report.

BMC Infect Dis 2021 Sep 16;21(1):964. Epub 2021 Sep 16.

Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat Sen University, Shenzhen, 518000, Guangdong, China.

Background: Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Read More

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September 2021

Spine Infections: the role of Fluorodeoxyglucose Positron Emission Tomography (FDG PET) in the context of the actual diagnosis guideline.

Curr Med Imaging 2021 Sep 16. Epub 2021 Sep 16.

Nuclear Medicine Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna. Italy.

Spondylodiscitis is an infectious process which requires numerous health care professionals in order to be clearly diagnosed and eventually, successfully treated. It implies a variety of microbiological agents and condition; during the diagnostic workup it is difficult to correctly identify them, and the clinician has to rapidly choose the most correct treatment, in order to avoid permanent injuries to the patient. In this context it comes our review work: based on current guidelines and literature available we wanted to deeply understand the most proper use of Positron Emission Tomography with 18-Fluoro-deossi-glucose (FDG PET) in a patient with the suspect of spondylodiscitis. Read More

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September 2021

[Definition of tumor rupture in gastrointestinal stromal tumor].

Y B Zhou

Zhonghua Wei Chang Wai Ke Za Zhi 2021 Sep;24(9):762-768

Department of Gastrointestinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao 266003, China.

Tumor rupture is a common clinical event in the process of tumorigenesis, progression, diagnosis and treatment of gastrointestinal stromal tumor, which is closely associated with tumor recurrence, metastasis and poor prognosis. Tumor rupture may be associated with some intrinsic biological aggressiveness qualities, such as large tumor size, high mitotic count, and KIT exon 11 deletion mutations involving codons 557 and 558, and may be relatively more frequent with small intestine GIST and excellent response to imatinib neoadjuvant therapy resulting in tumor tissue rapid liquefacient and necrosis. The triggering factors involve sudden increase in abdominal pressure, external pressure, collision and improper surgical operation, etc. Read More

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September 2021

Trends in diagnostic and therapeutic strategies for extra-abdominal desmoid-type fibromatosis: Japanese musculoskeletal oncology group questionnaire survey.

Jpn J Clin Oncol 2021 Sep 17. Epub 2021 Sep 17.

Department of Orthopaedic Surgery, Kodama Hospital, Takarazuka, Hyogo, Japan.

Objective: The mainstay of treatment modality for extra-abdominal desmoid-type fibromatosis (DF) has shifted from surgery, which often impairs ADL/QOL, to conservative treatment including active surveillance. In the present study, we conducted a longitudinal survey on the diagnosis and treatment of DF at facilities belonging to the Japanese Musculoskeletal Oncology Group, which is a research group of facilities specializing in the treatment of bone and soft tissue tumors in Japan to clarify the transition of medical care for extra-abdominal DF.

Methods: The same questionnaire was administered in 2015 and 2018, and responses were obtained from 46 (69%) of 67 facilities and 42 (53%) of 80 facilities in 2015 and 2018, respectively. Read More

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September 2021

Screening ovarian cancers with Raman spectroscopy of blood plasma coupled with machine learning data processing.

Spectrochim Acta A Mol Biomol Spectrosc 2021 Sep 4;265:120355. Epub 2021 Sep 4.

School of Physics and Astronomy, Shanghai Jiao Tong University, Shanghai 200240, China. Electronic address:

The mortality of ovarian cancer is closely related to its poor rate of early detection. In the search of an efficient diagnosis method, Raman spectroscopy of blood features as a promising technique allowing simple, rapid, minimally-invasive and cost-effective detection of cancers, in particular ovarian cancer. Although Raman spectroscopy has been demonstrated to be effective to detect ovarian cancers with respect to normal controls, a binary classification remains idealized with respect to the real clinical practice. Read More

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September 2021

Translating genetic and functional data into clinical practice: a series of 223 families with myotonia.

Brain 2021 Sep 16. Epub 2021 Sep 16.

MRC International Centre for Genomic Medicine in Neuromuscular Diseases, Department of Neuromuscular disease, UCL Queen Square Institute of Neurology, London, UK.

High throughput DNA sequencing is increasingly employed to diagnose single gene neurological and neuromuscular disorders. Large volumes of data present new challenges in data interpretation and its useful translation into clinical and genetic counselling for families. Even when a plausible gene is identified with confidence, interpretation of the clinical significance and inheritance pattern of variants can be challenging. Read More

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September 2021

Xanthogranulomatous Cholecystitis and Gallbladder Cancer: Two Diseases with Difficult Differential Diagnoses.

Turk J Gastroenterol 2021 Aug;32(8):694-701

Department of General Surgery, Ankara City Hospital, Ankara, Turkey.

Background: Xanthogranulomatous cholecystitis (XGC) etiology has not yet been precisely determined; it is often confused with gallbladder cancer (GBC) in the differential diagnosis.

Methods: This study retrospectively evaluated patients who underwent surgery with the pre-diagnosis of cholelithiasis, cholecystitis, or gallbladder carcinoma at a tertiary center, and were confirmed to have XGC or GBC according to the histological examinations.

Results: In the GBC group, there was a higher number of female patients, patients with magnetic resonance imaging (MRI) and computed tomography (CT) imaging, those that directly underwent open surgery, and those requiring catheters and developed complications; while in the XGC group, there was a higher number of patients with ultrasonography (USG) imaging and those requiring conversion from laparoscopic to open surgery (P < . Read More

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Laparoscopic Surgery for Adult Intussusception: Case Series.

Turk J Gastroenterol 2021 Aug;32(8):611-615

Department of General Surgery, Derince Teaching and Research Hospital, Kocaeli, Turkey.

Background/aims: Intussusception is a rare condition in adults which accounts for 1% of all intestinal obstructions. It usually requires surgical treatment and the classic approach is laparotomy. This article presented six adult patients who underwent laparoscopic surgery for intestinal obstruction due to intussusception. Read More

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Xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma - Analysis of 8 cases.

J Cancer Res Ther 2021 Jul-Sep;17(4):969-975

Department of Pathology, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi, India.

Background/aim: Xanthogranulomatous cholecystitis (XGC) is a rare destructive inflammatory disease of the gallbladder. It is frequently misdiagnosed as gallbladder carcinoma (GBC) as it mimics latter with regard to clinical manifestations, imaging and intraoperative findings, often leading to extended surgical resection in these patients. The aim of this study was to evaluate the diagnostic dilemma of XGC cases clinico-radiologically diagnosed with GBC. Read More

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September 2021

Differentiating renal pelvic cancer from renal cell carcinoma with 18-fluorodeoxyglucose positron emission tomography-computed tomography.

J Cancer Res Ther 2021 Jul-Sep;17(4):901-905

Department of Urology, Okmeydani Training and Research Hospital, Istanbul, Turkey.

Background: The differential diagnosis of pelvis renalis cancer (PRC) from renal cell cancer (RCC) is difficult. Because of that, in this study, we compared the standardized uptake value (SUV) with positron emission tomography-computed tomography (PET-CT) of the RCC and PRC.

Methods: Twenty-one patients (12 males, 9 females; age range: 33-74 years; mean age ± standard deviation [SD]: 57. Read More

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September 2021

Two-stage approach for class II mandibular furcation defect with insufficient keratinized mucosa: a case report with 3 years' follow-up.

J Int Med Res 2021 Sep;49(9):3000605211044595

Oral Diagnosis and General Dentistry, Dental Hospital, 13100Tokyo Medical and Dental University, Tokyo Medical and Dental University, Tokyo, Japan.

Periodontal regenerative treatment is useful for intrabony defects and furcation involvement, but is difficult when there is insufficient keratinized mucosa to cover and maintain the regenerative material, particularly in the mandibular molar region. We report the case of a 27-year-old woman who underwent a two-stage surgical approach for a class II furcation defect with gingival recession and insufficient keratinized mucosal width (KMW) and vestibular depth at the mandibular left first molar. We first improved the KMW and keratinized mucosal thickness using an epithelial embossed connective tissue graft with enamel matrix derivative, and then focused on periodontal regeneration at the furcation defect using an enamel matrix derivative and a bovine-derived xenograft. Read More

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September 2021