Differental diagnosis*

Basing on own experiences we present abilities and limitations of echocardiography in diagnosis and differentation of aortic aneurysms and dissections. Utilization of all ultrasound methods, especially adaptation of different projections for respective aortic segments visualization allows in the majority of cases to establish the proper diagnosis, and in the case of the aortic dissection to determine its extension and localization.

The application of high resolution ultrasound in the prenatal diagnosis enables a detailed differentation of the intracerebral structures in the fetus. In a period of 16 months (Jan. 1990-June 1991) we diagnosed at the "Center for prenatal diagnosis and therapy" at the Charité's Hospital in 14 fetuses among 1800 investigated plexus chorioideus cysts. A rapid karyotyping after cordocentesis was performed in 11 cases. In 3 of them a trisomy 18 could be detected. In one fetus having a normal karyotype we could find besides the cysts multiple structural anomalies...

Digital palpation of the prostate is not suitable for positive differentation between benign and malignant lesions of the prostate. Whenever a conspicuous finding is observed during a physical examination of the prostate a fine needle aspiration cytology is mandatory for eluidation of the disease. This procedure is simple and inexpensive, has a low rate of complications and high diagnostic validity.

This report is concerned with the scope of cytogenetic investigations in the diagnosis of sex abnormalities. In the majority of cases the karyotype leads to correct diagnosis only when the clinical picture and the histology of the gonads are known. It is only rarely possible to identify the phenotype from the chromosome picture, as for instance in the case of XO or XXY karotypes. Cytogenetic investigations can be considered advisable in the diagnosis of sex differentiation disorders in the following cases: a) in the case of ambiguous external sex organs; b) in primary amenorrhoea; c) in secondary amenorrhoea, above all in the case of early menopause; d) in male hypogonadism and in certain cases of gynaecomastia...

Phenobarbital was administered to a patient with extrahepatic biliary obstruction who was initially thought to have cholestatic hepatitis. On two occasions, administration of the drug was associated with a decrease of jaundice, pruritus, and serum bile acid levels. This strongly suggests that phenobarbital may be effective not only in intrahepatic cholestasis, as reported earlier, but also in extrahepatic obstruction, and therefore cannot be used for the differention of these two types of cholestasis.

Aspiration cytology was performed on 2772 breast masses, all of which subsequently had open biopsies. Of the 1745 histologically malignant tumors, 1539 (88%) had a concordant cytologic diagnosis: 54 (0.3%) were diagnosed as probably malignant; 63 (3.6%) were false negatives; and 80 (0.5%) had inadequate smears for diagnosis. Of the histologically benign lesions, 916 (89%) had a concordant cytology: only 3 (0.3%) were false positives; cancer was suggested in 42 (0.4%); and the smears were inadequate in 66 cases (6...

The clinical and pathologic features in 11 cases of histiocytosis were reviewed. The were 6 cases of Hand-Schüller-Christian, disease 4 cases of Letterer-Siwe and 1 case of eosinophilic granuloma. The clinical differences among those diseases are outlined. We agree with other authors that the symptoms are related in great measure to the moment of embryonic differentation in which the proliferation occurred. When proliferation is present at an early stage of development of macrophage (promonocyte), a more malignant disease appears than when it occurs at a later stage (macrophage)...

Diagnostic procedures for the measurement of gastric acid secretion and for the differention between several types of hypergastrinemia have been improved during the last years. An intravenous dose-response curve with increasing doses of pentagastrin resulted in 30% higher MAO compared to subcutaneously administered pentagastrin (6 microgram/kg body weight). Food-stimulated gastric acid secretions can be measured by intragastric titration; this method is used mainly in clinical-physiological studies. The different forms of hypergastrinemia may be differentiated by 3 provocation tests: calciuminfusion, secretintest, glucagontest...

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Retaining an individual on psychiatric dispensary lists long after a single psychotic episode can result in unnecessary restriction of his or her social-vocational rights and responsibilities. This study demonstrates that an early clinical differention can be made between exogenous psychoses and progressive schizophrenia. The validity of the clinical differentiation was enhanced by demonstrating that a computer learning and pattern-recognition program was capable of using signs and symptoms recorded in the first psychotic episode to make a differential diagnosis that coincided closely with diagnoses made at a later date by clinicians aware of the subsequent clinical course...

Non-endocrine tumours are capable of production of ectopic hormones, precursor molecules subunits and hormone-related fragments. The measurement of these may provide biochemical markers of malignancy, allowing presymptomatic diagnosis which may lead ultimately to an improved prognosis for the patient. The study of ectopic humoral syndromes may yield new insights into the nature of cellular differentation and the fundamental process of malignant change.

The spectrum of intrapulmonary findings of Hodgkin's disease is illustrated by 75 pulmonary episodes of 22 patients with Hodgkin's disease (duration of illness up to 14 years). Both the typical and frequent, as well as the rare pulmonary manifestations are discussed. We analysed the time correlation between pulmonary changes and clinical manifestations, and the effect of therapy. This retrospective investigation showed that more than 55% of the observed 75 pulmonary episodes have been diagnosed correctly by the initial radiological examination...