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  • 1
    Electronic Resource
    Electronic Resource
    Zur Pathogenese und klinischen Bedeutung der Mönckebergschen Mediaverkalkung (1985)
    Springer
    Journal of molecular medicine 63 (1985), S. 211-216 
    Details
    ISSN: 1432-1440
    Keywords: Mönckeberg's sclerosis ; Lumbar sympathectomy ; Doppler ankle pressures ; Peripheral vessel disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Medial calcinosis of Mönckeberg is frequently observed in peripheral arteries of diabetics with neuropathy. The cause of this vessel alteration is unknown and the clinical significance has been questioned. Six to eight years after uni- or bilateral lumbar sympathectomy 60 patients were investigated radiologically for medial calcinosis of foot arteries. Of 60 patients, 55 had Mönckeberg's sclerosis. In 93% of the patients who had undergone bilateral operation medial calcification was seen in both feet. After unilateral sympathectomy the incidence of medial calcinosis on the operated side was significantly higher than on the non-operated side (88% versus 18%,p〈0.01). There was no significant difference between diabetics and non-diabetics. These findings suggest that medial calcification is related to autonomic neuropathy of peripheral vessels. Fifty-two of 160 patients (32.5%) with severe arterial occlusive disease of the lower limbs showed medial calcification of foot arteries. Mönckeberg's sclerosis was significantly associated with the peripheral type of vascular disease (p〈0.025). Two groups of patients with the same stage of occlusive vascular disease but without (group A) and with (group B) medial calcification were examined by Doppler ultrasound. In group A the mean ankle pressure (pD) was 51 mm Hg lower than the Riva-Rocci pressure (pRR). In spite of the severe ischemia mean pD in group B exceeded pRR by 14 mm Hg. Of the patients of group B 63% had a pD-pRR value ≧0 mm Hg. In group A no positive difference pD-pRR could be shown. Thus medial calcification can cause pseudohypertensive Doppler pressures and mask vessel disease. It might play a role in the development of the peripheral type of arteriosclerosis of the lower limbs.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01731171
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Prospective application of an expert system for the medical history of joint pain (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 466-471 
    Details
    ISSN: 1432-1440
    Keywords: Computer reasoning ; Rheumatology ; Medical history taking ; Computer assisted diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary An expert system with 60 questions about medical history was developed for 32 rheumatologic diseases: 358 outpatients with joint complaints have been examined. The final diagnosis (result of symptoms, signs, and findings) was compared with the computer diagnoses and with the independently assumed diagnoses of the physician. The only source of information available to the physician was the medical history. Misinterpretation of the computer diagnoses occurred in 25.6% of cases compared with 21.5% of the physician. The final clinical diagnosis remained uncertain in 32.6% of cases. The error frequency of the expert system was influenced by the underlying disease, the certainty of the assumed diagnosis by the physician, the user experience in rheumatology, the number of questions asked, and the time of application before or after the doctor-patient contact. Of the errors 44% were produced because of information deficits of the computer using standardized questions. The information of the physician in the diagnostic process is quite different to that of the computer.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01648900
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Stepwise development of a clinical expert system in rheumatology (1993)
    Springer
    Journal of molecular medicine 71 (1993), S. 139-144 
    Details
    ISSN: 1432-1440
    Keywords: Expert systems ; Computer-assisted diagnosis ; Decision support systems ; Evaluation studies ; Rheumatology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The evaluation of computer expert systems, a promising diagnostic tool for future application in clinical medicine, is of great importance. We present here the evaluation of our expert system, “RHEUMA”. It is stressed, that repeated retrospective testing and updating of an expert system and its subsequent repeated assessment in clinical use and surroundings is mandatory. This increases the diagnostic accuracy of the system. For our system this is demonstrated under three separate conditions. In the first study the information available for the computer system (mainframe) came from medical histories only. Here an error rate of about 25% — similar to that of physicians themselves using the same information — was observed in 358 outpatients, compared to the final diagnoses of physicians also relying solely on information from medical histories. In a second step a completely new system on a personal computer was developed with all relevant diagnostic information. The error rate of this system (0.4%) was much too optimistic because the knowledge base was changed during the study, affecting about 30% of the 282 prospectively recruited outpatients. In a third step the efficacy of the expert system was tested in an additional hospital without the diagnostic involvement of the first testing clinic. The error rate of the system without changing the knowledge base reached 11% in 51 outpatients in this rheumatology clinic. This result reflects the diagnostic accuracy of the system today. Its ability to specify the same diagnoses which clinical experts reached approached 90%. Considerable time is needed for such prospective testing, with repeated updating of the knowledge base — in our case for both the two systems and field studies of 2 years each. Further prospective field testing with physicians not specialized in rheumatology and with a larger number of patients is necessary before the system can be used in clinical routine.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00179995
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    Paper (German National Licenses)
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  • 4
    Electronic Resource
    Electronic Resource
    Buchbesprechungen (1987)
    Springer
    Journal of molecular medicine 65 (1987), S. 1112-1112 
    Details
    ISSN: 1432-1440
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01736122
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    Paper (German National Licenses)
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