8 research outputs found
A systematic review of the literature examining the diagnostic efficacy of measurement of fractionated plasma free metanephrines in the biochemical diagnosis of pheochromocytoma
BACKGROUND: Fractionated plasma metanephrine measurements are commonly used in biochemical testing in search of pheochromocytoma. METHODS: We aimed to critically appraise the diagnostic efficacy of fractionated plasma free metanephrine measurements in detecting pheochromocytoma. Nine electronic databases, meeting abstracts, and the Science Citation Index were searched and supplemented with previously unpublished data. Methodologic and reporting quality was independently assessed by two endocrinologists using a checklist developed by the Standards for Reporting of Diagnostic Studies Accuracy Group and data were independently abstracted. RESULTS: Limitations in methodologic quality were noted in all studies. In all subjects (including those with genetic predisposition): the sensitivities for detection of pheochromocytoma were 96%–100% (95% CI ranged from 82% to 100%), whereas the specificities were 85%–100% (95% CI ranged from 78% to 100%). Statistical heterogeneity was noted upon pooling positive likelihood ratios when those with predisposition to disease were included (p < 0.001). However, upon pooling the positive or negative likelihood ratios for patients with sporadic pheochromocytoma (n = 191) or those at risk for sporadic pheochromocytoma (n = 718), no statistical heterogeneity was noted (p = 0.4). For sporadic subjects, the pooled positive likelihood ratio was 5.77 (95% CI = 4.90, 6.81) and the pooled negative likelihood ratio was 0.02 (95% CI = 0.01, 0.07). CONCLUSION: Negative plasma fractionated free metanephrine measurements are effective in ruling out pheochromocytoma. However, a positive test result only moderately increases suspicion of disease, particularly when screening for sporadic pheochromocytoma
Criopeeling para tratamento de fotodano e ceratoses actĂnicas: comparação entre nitrogĂŞnio lĂquido e sistema portátil Cryopeeling for treatment of photodamage and actinic keratosis: liquid nitrogen versus portable system
FUNDAMENTOS: O criopeeling utiliza a crioterapia difusa nĂŁo somente nas lesões de ceratose actĂnica, mas em toda a pele fotodanificada. OBJETIVOS: Comparar dois mĂ©todos de criopeeling (nitrogĂŞnio lĂquido e sistema portátil de Ă©ter dimetĂlico, propano e isobutano) quanto Ă eficiĂŞncia no tratamento de ceratoses actĂnicas, tolerabilidade do paciente, preferĂŞncia do paciente e do pesquisador e resultado estĂ©tico. MÉTODOS: Dezesseis pacientes (n=16) com mĂşltiplas ceratoses actĂnicas nos antebraços foram submetidos ao criopeeling com nitrogĂŞnio lĂquido em um dos antebraços e com o sistema portátil no outro, randomicamente. RESULTADOS: No tratamento das ceratoses actĂnicas, o nitrogĂŞnio lĂquido obteve 74% de eficiĂŞncia e o sistema portátil, 62% (p=0,019). A mĂ©dia da escala visual analĂłgica (0-10) foi 5,7±1,61 com o nitrogĂŞnio lĂquido e 4,3±1,44 com o sistema portátil (p=0,003). NĂŁo houve diferença estatĂstica entre os mĂ©todos quanto Ă preferĂŞncia do paciente e do pesquisador. Na análise das fotos, observou-se melhora do aspecto da pele nos dois tratamentos (p<0,001). Com o nitrogĂŞnio lĂquido, em 62,5% das vezes houve algum grau de melhora; com o sistema portátil, em 52% (p>0,05). CONCLUSĂ•ES: A tĂ©cnica de criopeeling pode ser uma opção no tratamento de fotodano. O sistema portátil pode ser uma alternativa interessante na prática clĂnica, com boa tolerância e resultados aceitáveis no tratamento de ceratoses actĂnicas<br>BACKGROUND: Cryopelling uses diffuse cryotherapy not only on lesions of actinic keratosis but all over the photodamaged skin. OBJECTIVES: The aim of this study was to compare two cryopeeling methods (liquid nitrogen- LN and portable system - PS) and demonstrate their efficiency in the treatment of actinic keratoses, patient tolerance, researcher and patient preference and aesthetic results. METHODS: Sixteen patients (N = 16) with multiple actinic keratoses on the forearms were subjected to cryopeeling with LN on one of the forearms and PS on the other, randomly. RESULTS: In the treatment of actinic keratoses, LN obtained 74% efficiency and PS, 62% (p = 0.019). The mean visual analogue scale (0-10) was 5.7 ± 1.61 with LN and 4.3 ± 1.44 with PS (p = 0.003). There was no significant statistical difference between the two methods in terms of researcher and patient preference. An analysis of the photos showed improvement of the skin appearance with both treatments (p <0.001). Treatment with LN obtained some degree of improvement in 62.5% of the cases, while treatment with PS obtained some degree of improvement in 52% of the cases (p> 0.05). Discussion: Treatment with the PS showed better tolerance, but was less efficient than LN. Although LN has been the preferred method, there was no statistical difference between the methods. CONCLUSIONS: The cryopeeling technique may be an option in the treatment of photodamage. The PS can be an interesting alternative in clinical practice with good tolerance and acceptable results in the treatment of actinic keratose