Misdiagnosis in patients with amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) is a progressive neurologic disease that most often begins with weakness in one or more limbs, often first ascribed to ''clumsiness.'' It may also begin with difficulty breathing or speaking, or unexplained weight loss. In time, the patient loses all ability to move, breathe, and talk unaided, although thought and sensation remain unaffected. Most patients die within five years from diagnosis, but approximately one in five has a variant of the disease that progresses more slowly, and some patients live 10 to 20 years and longer. Early diagnosis is important for several reasons. First, the patient and the family have time to talk over and prepare for what is ahead. Second, patients can explore entry into one of the clinical research trials now in progress, as well as clinics or support groups. Third, appropriate treatment can be provided and individualized to the patient's needs. And finally, mismanagement of the condition can be avoided. When patients are incorrectly told that they have a mildly progressive or even a curable disease, they later may become bitter toward the mistaken physician, and depression may result. In this study designed to evaluate the misdiagnosis of ALS patients, 14 out of 33 patients with ALS (43 percent) were initially misdiagnosed, either because of failure to consider the diagnosis of ALS, or because of unfamiliarity with its various forms. Because of these diagnostic errors, three patients underwent spinal laminectomies, or surgery to the vertebrae to relieve compression of the spinal cord. One of these patients went into respiratory arrest under anesthesia, and required mechanical ventilation from then on. Other unnecessary and uncomfortable or even painful procedures included upper gastrointestinal tract and small-bowel X-ray series, gastroscopies (insertion of a tube through the esophagus to view the stomach), sigmoidoscopies (insertion of a tube into the rectum to view the colon), various ultrasound and computerized tomography studies, and lumbar puncture. Five of the 14 misdiagnosed patients had limited electromyographic studies that did not suggest ALS. Other studies have also reported a high rate of failure to diagnose neurological diseases, including multiple sclerosis (for which ALS is often mistaken) and myasthenia gravis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Archives of Internal Medicine
At the frontiers of OCR
The approach to optical character recognition (OCR) research needs to be changed. While the traditional approach that focuses on the correct classification of isolated characters has become obsolete, new classification methods are beyond the means of most researchers because of their large experimental facility and data base requirements. In addition, perfect classification of individual characters is not sufficient for converting complex archival documents to a useful computer-readable form. Since many OCR applications require well-organized typographic and domain-specific knowledge, as well as integrated treatment of entire documents, new OCR systems should implement typographic uniformity of paragraphs or other layout components. They should also take advantage of the interaction with human operators to enhance skills without outright training.
Publication Name: Proceedings of the IEEE
Ken Starr would not be denied
Kenneth Starr's character and personal history has affected the how the investigation into Bill Clinton's alleged misconduct has been handled. Starr was a driven and religious person who had little experience as a prosecutor. He pursued the investigation with the zeal that few others would have.
Publication Name: The New York Times Magazine
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- Abstracts: Pain in the marriage. Harriet Quimby