initial work-up

  • 文章类型: Journal Article
    背景:第一次精神病发作(FEP)是一种临床疾病,通常发生在青春期或成年早期,通常是未来精神疾病的征兆。然而,这些症状并不具体,在至少5%的病例中,精神病可能是由身体疾病引起的。及时发现这些疾病,最初的迹象可能出现在童年,特别重要,作为一种可治愈的治疗存在于大多数情况下。然而,学术界没有达成共识,为消除躯体原因的全面医学评估提供建议。
    方法:我们使用双重研究策略进行了系统的文献检索,以:(1)确定可以鉴别诊断为精神病的身体疾病;(2)确定允许我们排除这些病理的临床旁检查。
    结果:我们确定了85篇描述自身免疫,新陈代谢,神经学,传染性,和精神病的遗传差异诊断。描述了临床表现,并提供了识别和确认这些疾病所需的实验室和成像特征的完整列表。
    结论:本系统评价显示,在FEP的情况下,应考虑大多数精神病的鉴别诊断,并且可以通过提供包括氨血症在内的实验室检查的系统检查来确定。抗核和抗NMDA抗体,和HIV检测;应根据临床表现考虑脑磁共振成像和腰椎穿刺。遗传研究可能对表现出与精神病表现相关的身体或发育症状的患者感兴趣。
    BACKGROUND: First episode of psychosis (FEP) is a clinical condition that usually occurs during adolescence or early adulthood and is often a sign of a future psychiatric disease. However, these symptoms are not specific, and psychosis can be caused by a physical disease in at least 5% of cases. Timely detection of these diseases, the first signs of which may appear in childhood, is of particular importance, as a curable treatment exists in most cases. However, there is no consensus in academic societies to offer recommendations for a comprehensive medical assessment to eliminate somatic causes.
    METHODS: We conducted a systematic literature search using a two-fold research strategy to: (1) identify physical diseases that can be differentially diagnosed for psychosis; and (2) determine the paraclinical exams allowing us to exclude these pathologies.
    RESULTS: We identified 85 articles describing the autoimmune, metabolic, neurologic, infectious, and genetic differential diagnoses of psychosis. Clinical presentations are described, and a complete list of laboratory and imaging features required to identify and confirm these diseases is provided.
    CONCLUSIONS: This systematic review shows that most differential diagnoses of psychosis should be considered in the case of a FEP and could be identified by providing a systematic checkup with a laboratory test that includes ammonemia, antinuclear and anti-NMDA antibodies, and HIV testing; brain magnetic resonance imaging and lumbar puncture should be considered according to the clinical presentation. Genetic research could be of interest to patients presenting with physical or developmental symptoms associated with psychiatric manifestations.
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  • 文章类型: Practice Guideline
    SFE-AFCE-SFMN2022共识涉及甲状腺结节的管理,这是内分泌学咨询的常见原因。在90%以上的案例中,患者甲状腺功能正常,良性非进展性结节,不需要特殊治疗。临床医生的目标是检测有复发和死亡风险的恶性甲状腺结节,导致甲状腺功能亢进的毒性结节或压缩性结节需要治疗。甲状腺结节的诊断和治疗需要内分泌学家之间的密切合作,核医学医师和外科医生,但也涉及其他专家。因此,这一共识声明是由3个学会共同建立的:法国内分泌学学会(SFE),法国内分泌外科协会(AFCE)和法国核医学学会(SFMN);各个工作组包括来自其他专业的专家(病理学家,放射科医生,儿科医生,生物学家,等。).本节涉及成人患者甲状腺结节的初步检查,包括临床和生物学评估,用于细针穿刺活检的标准化超声表征和基于EU-TIRADS的结节选择。还提到了甲状腺核心活检或开放性手术活检以及颈部和上胸部横截面成像的适应症。
    The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician\'s objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the initial work-up for thyroid nodules in adult patients, including clinical and biological evaluation, standardized ultrasound characterization and EU-TIRADS-based nodule selection for fine-needle aspiration biopsy. Indications for thyroid core-biopsies or open surgical biopsies and for cross-sectional imaging of the neck and upper chest are also mentioned.
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  • 文章类型: Journal Article
    OBJECTIVE: The aim of this study was to confirm the prognostic value of metabolic tumour volume (MTV) at the primary site on initial work-up FDG PET/CT in patients with squamous cell carcinoma (SCC) of the anal canal.
    METHODS: Patients with a recent diagnosis of SCC of the anal canal without metastases undergoing PET/CT for initial work-up and treated with (chemo)radiotherapy were retrospectively reviewed. Computer-aided MTV and SUVmax were determined. Survival rates were estimated using the Kaplan-Meier method. Cox regression analysis was used to evaluate prognostic variables of progression-free survival and overall survival (OS).
    RESULTS: The study group comprised 75 patients who had an initial work-up PET/CT. Five patients (6.7 %) had stage I disease, 22 (29.3 %) stage II disease, 20 (26.7 %) stage IIIA disease, and 28 (37.3 %) stage IIIB disease. Median follow-up was 51 months (range 10 - 117 months). Global 4-year OS was 82.7 %, ranging from 100 % in patients with stage I disease to 75 % in patients with stage IIIB disease. MTV at the primary site was significantly and independently correlated with OS (p < 0.05), as patients with MTV less than 7 cm3 had a better prognosis. SUVmax was not correlated with survival parameters. Metabolic involvement of the inguinal lymph nodes was also correlated with a poor outcome in the univariate analysis (p < 0.05).
    CONCLUSIONS: MTV at the primary site is a prognostic biomarker in anal canal cancer. Hypermetabolic inguinal lymph nodes also appear to be correlated with survival.
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