INTRODUCTION: Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties. MATERIALS AND METHODS: A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected. RESULTS: Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43). CONCLUSION: Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters.

• MeSH
• chybná diagnóza statistika a číselné údaje   MeSH
• elektrokardiografie statistika a číselné údaje   MeSH
• kardiologie MeSH
• klinické kompetence statistika a číselné údaje   MeSH
• lidé MeSH
• odchylka pozorovatele MeSH
• srdeční arytmie diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The article reports results from the largest international dose survey in paediatric computed tomography (CT) in 32 countries and proposes international diagnostic reference levels (DRLs) in terms of computed tomography dose index (CTDI vol) and dose length product (DLP). It also assesses whether mean or median values of individual facilities should be used. A total of 6115 individual patient data were recorded among four age groups: <1 y, >1-5 y, >5-10 y and >10-15 y. CTDIw, CTDI vol and DLP from the CT console were recorded in dedicated forms together with patient data and technical parameters. Statistical analysis was performed, and international DRLs were established at rounded 75th percentile values of distribution of median values from all CT facilities. The study presents evidence in favour of using median rather than mean of patient dose indices as the representative of typical local dose in a facility, and for establishing DRLs as third quartile of median values. International DRLs were established for paediatric CT examinations for routine head, chest and abdomen in the four age groups. DRLs for CTDI vol are similar to the reference values from other published reports, with some differences for chest and abdomen CT. Higher variations were observed between DLP values, based on a survey of whole multi-phase exams. It may be noted that other studies in literature were based on single phase only. DRLs reported in this article can be used in countries without sufficient medical physics support to identify non-optimised practice. Recommendations to improve the accuracy and importance of future surveys are provided.

• MeSH
• dávka záření MeSH
• dítě MeSH
• internacionalita MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• monitorování radiace normy   statistika a číselné údaje   MeSH
• novorozenec MeSH
• pediatrie normy   MeSH
• počítačová rentgenová tomografie normy   statistika a číselné údaje   MeSH
• předškolní dítě MeSH
• průzkumy zdravotní péče MeSH
• radiační expozice normy   statistika a číselné údaje   MeSH
• referenční hodnoty MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Aim: A study on the possibility to use gold nanoparticles in mammography, both for a better image diagnostics and radiotherapy, is presented and discussed. We evaluate quantitatively the increment of dose released to the tumor enriched with Au-NPs with respect to the near healthy tissues, finding that for X-rays the increase can reach two orders of greater intensity. Background: Gold nanoparticles continue to be investigated for their potential to improve existing therapies and to develop novel therapies. They are simple to obtain, can be functionalized with different chemical approaches, are stable, non-toxic, non-immunogenic and have high permeability and retention effects in the tumor cells. The possibility to use these for breast calcified tumors to be better treated by radiotherapy is presented as a possible method to destroy the tumor. Materials and methods: The nanoparticles can be generated in water using the top-down method, should have a size of the order of 10-20 nm and be treated to avoid their coalescence. Under diagnostic X-ray monitoring, the solution containing nanoparticles can be injected locally inside the tumor site avoiding injection in healthy tissues. The concentrations that can be used should be of the order of 10 mg/ml or higher. Results: An enhancement of the computerized tomography diagnostics using 80-150 keV energy is expected, due to the higher mass X-ray coefficient attenuation with respect to other contrast media. Due to the increment of the effective atomic number of the biological tissue containing the gold nanoparticles, also an improvement of the radiotherapy effect using about 30 keV X-ray energy is expected, due to the higher photoelectric cross sections involved. Conclusions: The study carried out represents a feasibility proposal for the use of Au-nanoparticles for mammographic molecular imaging aimed at radiotherapy of tumor nodules but no clinical results are presented.

• Publikační typ
• časopisecké články MeSH

BACKGROUND: Breath detection, i.e. its precise delineation in time is a crucial step in lung function data analysis as obtaining any clinically relevant index is based on the proper localization of breath ends. Current threshold or smoothing algorithms suffer from severe inaccuracy in cases of suboptimal data quality. Especially in infants, the precise analysis is of utmost importance. The key objective of our work is to design an algorithm for accurate breath detection in severely distorted data. METHODS: Flow and gas concentration data from multiple breath washout test were the input information. Based on universal physiological characteristics of the respiratory tract we designed an algorithm for breath detection. Its accuracy was tested on severely distorted data from 19 patients with different types of breathing disorders. Its performance was compared to the performance of currently used algorithms and to the breath counts estimated by human experts. RESULTS: The novel algorithm outperformed the threshold algorithms with respect to their accuracy and had similar performance to human experts. It proved to be a highly robust and efficient approach in severely distorted data. This was demonstrated on patients with different pulmonary disorders. CONCLUSION: Our newly proposed algorithm is highly robust and universal. It works accurately even on severely distorted data, where the other tested algorithms failed. It does not require any pre-set thresholds or other patient-specific inputs. Consequently, it may be used with a broad spectrum of patients. It has the potential to replace current approaches to the breath detection in pulmonary function diagnostics.

• MeSH
• algoritmy * MeSH
• diagnóza počítačová metody   MeSH
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• počítačové zpracování signálu * MeSH
• předškolní dítě MeSH
• respirační funkční testy MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Předkládané sdělení přináší navrhovaný doporučený postup pro diagnostiku a léčbu exogenní alergické alveolitidy. Jelikož celosvětově přijímaný standart chybí, opírá se návrh o literární údaje a vlastní zkušenosti autorů. Diagnóza EAA spočívá především v kvalitně odebrané anamnéze v kontextu s odpovídajícím radiologickým nálezem, ventilačními parametry, rozpočtem buněk v tekutině získané bronchoalvelární laváží, popř. i histologickým obrazem. Po stanovení diagnózy je nemocnému především nutno zdůraznit zamezení další expozice vyvolávajícímu agens. Farmakologická léčba zahrnuje nejčastěji systémovou kortikoterapii, byť její efekt na prognózu nemocných zůstává sporný. Další sledování nemocných se řídí jejich klinických stavem.

The article proposes a guideline for the diagnosis and treatment of extrinsic allergic alveolitis (EAA). Since there are no globally accepted diagnostic criteria, the guideline is based on literature and the authors' experience. The gold standard for EAA diagnosis should comprise precise patient's history data in context with radiological presentation, lung function, bronchoalveolar lavage fluid differential cell count and sometimes also histopathologic findings. After the diagnosis is made, it is crucial to prevent the patient from further exposure to the antigen. Systemic corticoid therapy is used when indicated, even though its effect on patients' prognosis remains dubious. Patients should be followed according to their clinical status.

• Klíčová slova
• HRTC,
• MeSH
• akutní nemoc mortalita   MeSH
• bronchoalveolární laváž MeSH
• chronická nemoc MeSH
• hormony kůry nadledvin terapeutické užití   MeSH
• hypersenzitivní pneumonitida * diagnóza   klasifikace   patologie   terapie   MeSH
• imunoglobulin G krev   MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• prednison terapeutické užití   MeSH
• příznaky a symptomy ústrojí dýchacího MeSH
• progrese nemoci MeSH
• transplantace plic MeSH
• určení vhodnosti pacienta MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

Akantocyty jsou atypické erytrocyty s ostrými výběžky membrány. Jako neuroakantocytózy (NA) jsou označována velmi různorodá onemocnění, u kterých neurologická symptomatika je doprovázena výskytem akantocytů. Záchyt akantocytů však není specifický a nemusí být obligátním příznakem NA. V textu jsou popsány svým výskytem nejčastější i raritní NA, jejich etiologie, klinický a laboratorní obraz. Autoři navrhují vlastní diferenciálně diagnostický postup, založený na výskytu atrofie caput nuclei caudati, který může stanovení diagnózy urychlit a zlevnit.

Acanthocytes are atypical erythrocytes with sharp membrane protrusions. The range of diseases classified as neuroacanthocytosis (NA) includes a variety of disorders characterised by the occurrence of acanthocytes together with neurological symptoms. The detection of acanthocytes is, however, not specific and may not necessarily be a symptom of NA. The text describes both the most frequent and rare forms of NA, their etiology, and clinical and laboratory picture. The authors propose their own differential diagnostic approach based on the incidence of atrophy of the caput nuclei caudati which can make diagnosis faster and cheaper.

• MeSH
• abetalipoproteinemie diagnóza   etiologie   MeSH
• akantocyty patologie   MeSH
• chorea diagnóza   etiologie   MeSH
• choreoakantocytóza diagnóza   etiologie   genetika   MeSH
• diagnostické techniky neurologické využití   MeSH
• diferenciální diagnóza MeSH
• financování organizované MeSH
• hematologické testy metody   využití   MeSH
• Huntingtonova nemoc diagnóza   etiologie   MeSH
• Leschův-Nyhanův syndrom diagnóza   etiologie   MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   využití   MeSH
• neurobehaviorální symptomy MeSH
• nucleus caudatus fyziologie   patologie   MeSH
• odběr vzorku krve metody   využití   MeSH
• počítačová rentgenová tomografie metody   využití   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Although gout is the most common inflammatory arthritis, it is still frequently misdiagnosed. New data on imaging and clinical diagnosis have become available since the first EULAR recommendations for the diagnosis of gout in 2006. This prompted a systematic review and update of the 2006 recommendations. A systematic review of the literature concerning all aspects of gout diagnosis was performed. Recommendations were formulated using a Delphi consensus approach. Eight key recommendations were generated. A search for crystals in synovial fluid or tophus aspirates is recommended in every person with suspected gout, because demonstration of monosodium urate (MSU) crystals allows a definite diagnosis of gout. There was consensus that a number of suggestive clinical features support a clinical diagnosis of gout. These are monoarticular involvement of a foot or ankle joint (especially the first metatarsophalangeal joint); previous episodes of similar acute arthritis; rapid onset of severe pain and swelling; erythema; male gender and associated cardiovascular diseases and hyperuricaemia. When crystal identification is not possible, it is recommended that any atypical presentation should be investigated by imaging, in particular with ultrasound to seek features suggestive of MSU crystal deposition (double contour sign and tophi). There was consensus that a diagnosis of gout should not be based on the presence of hyperuricaemia alone. There was also a strong recommendation that all people with gout should be systematically assessed for presence of associated comorbidities and risk factors for cardiovascular disease, as well as for risk factors for chronic hyperuricaemia. Eight updated, evidence-based, expert consensus recommendations for the diagnosis of gout are proposed.

• MeSH
• dna (nemoc) diagnóza   diagnostické zobrazování   epidemiologie   patologie   MeSH
• hyperurikemie diagnóza   epidemiologie   MeSH
• kyselina močová MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• radiografie MeSH
• rizikové faktory MeSH
• synoviální tekutina MeSH
• ultrasonografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• konsensus - konference MeSH
• směrnice pro lékařskou praxi MeSH

Autoři se v článku zabývají popisem procesu zrání bílé hmoty mozku v různých fázích vývoje CNS (centrálního nervového systému) dítěte, hodnotí limitace jednotlivých zobrazovacích metod v určování stupně a průběhu myelinizace a navrhují protokoly pro zobrazení mozku MR (magnetickou rezonancí) v tomto období. Autoři dále shrnují údaje týkající se MR obrazu v různých obdobích zrání mozku a nabízejí logické časové kategorie pro rutinní hodnocení myelinizace v TI a T2 vážení v souladu s funkčním vývojem dítěte. Na jednotlivých příkladech a obrazové dokumentaci také autoři ukazují dynamiku a variabilitu myelinizace dětského mozku.

The authors describe the process of brain myelination detectable using MRI. The article proposes a protocol for MR imaging of myelination at the different periods of brain development. The authors show logical time categories for routine MR evaluation of white matter myelination and refer to the variability of this above-mentioned proces.

• MeSH
• centrální nervový systém fyziologie   růst a vývoj   MeSH
• diagnostické zobrazování metody   přístrojové vybavení   využití   MeSH
• financování organizované MeSH
• lidé MeSH
• magnetická rezonanční tomografie využití   MeSH
• nervová vlákna myelinizovaná fyziologie   MeSH
• počítačová rentgenová tomografie využití   MeSH
• ultrazvuk MeSH
• vývoj dítěte fyziologie   MeSH
• Check Tag
• lidé MeSH

We report a tumor arising in the middle ear of a 65-year-old female patient that was composed of an ovarian-type stroma (OS) and an epithelial component. The tumor consisted of irregular, polypoid masses containing multiple variably sized cystic spaces, which were invariably surrounded by the OS. The cystic spaces were lined by flat, cuboidal, or columnar epithelial cells, in most parts showing mucinous differentiation. The epithelial lining of the cysts strongly expressed cytokeratins AE1-3, CK7, CK8, CK18, CK19, EMA, and S100 protein. The stroma expressed CD34 and smooth muscle actin. No cytological atypia or mitoses were present, and the proliferative activity was less than 1% in both components. The clonality analysis proved the clonal nature of the neoplasm. We believe that this tumor is a new member in the family of neoplasms containing the OS, and therefore we propose the term mixed epithelial and stromal tumor of the middle ear.

• MeSH
• biopsie MeSH
• buňky stromatu chemie   patologie   MeSH
• diagnostické techniky molekulární MeSH
• epitelové buňky chemie   patologie   MeSH
• imunohistochemie MeSH
• lidé MeSH
• nádorové biomarkery analýza   genetika   MeSH
• nádory komplexní a smíšené chemie   genetika   patologie   chirurgie   MeSH
• nádory ucha chemie   genetika   patologie   chirurgie   MeSH
• počítačová rentgenová tomografie MeSH
• proliferace buněk MeSH
• senioři MeSH
• střední ucho chemie   patologie   chirurgie   MeSH
• terminologie jako téma MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The pilot dose survey on paediatric general radiography, fluoroscopy and CT procedures was performed in four university hospitals. The analysis of data was focused on the radiography and CT imaging of head, chest, abdomen, pelvis and spine and fluoroscopic procedures of gastrointestinal and urinary tracts. The survey was conducted by the National Radiation Protection Institute. Two hospitals exported data from the patient dose management system, while the others collected the data manually. The methodology of diagnostic reference levels assessment was proposed and tested. Local diagnostic reference levels were calculated in terms of air kerma-area product $P_{KA}$, CT air kerma-length product $P_{KL,CT}$ and volumetric CT air kerma index $C_{VOL}$. The lack of procedure standardisation, e.g. in tube voltage setting irrespective of patient's weight, was revealed at one hospital. Dose and exposure parameters distributions with respect to patient's anatomical constitution are presented in this article. In future, this pilot study will be a base for national survey of paediatric diagnostic reference levels.

• MeSH
• dávka záření MeSH
• dítě MeSH
• fluoroskopie metody   MeSH
• gastrointestinální nemoci diagnostické zobrazování   MeSH
• intervenční radiografie metody   MeSH
• kritické orgány účinky záření   MeSH
• lidé MeSH
• pilotní projekty MeSH
• počítačová rentgenová tomografie metody   MeSH
• počítačové zpracování obrazu metody   MeSH
• radiační expozice analýza   MeSH
• radiační ochrana MeSH
• urologické nemoci diagnostické zobrazování   MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH