Adjunctive testing

Pirog, E. C., Chen, Y.-T., and Isacson, C. 2000. MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum. Am. J. Surg. Pathol. 24 1393-1399. Pizzolo, G., Vincenzi, C., Nadali, G., Veneri, D., Vinante, F., Chilosi, M., Basano, G., Connelly, M. 

Measurement of blood tHcy is usually performed for one of three reasons (1) to screen for inborn errors of methionine metabolism (2) as an adjunctive test for cobalamin deficiency (3) to aid in the prediction of cardiovascular risk. Hyperhomocysteinemia, defined as an elevated level of tHcy in blood, can be caused by dietary factors such as a deficiency of B vitamins, genetic abnormalities of enzymes involved in homocysteine metabolism, or kidney disease. All of the major metabolic pathways involved in homocysteine metabolism (the methionine cycle, the transsulfuration pathway, and the folate cycle) are active in the kidney. It is not known, however, whether elevation of plasma tHcy in patients with kidney disease is caused by decreased elimination of homocysteine in the kidneys or by an effect of kidney disease on homocysteine metabolism in other tissues. Additional factors that also influence plasma levels of tHcy include diabetes, age, sex, lifestyle, and thyroid disease (Table 21-1). 

Total T4 and FT4E measurements are not ideal indicators of thyroid status, in part because of the effects of variations in serum binding protein concentrations, but also because T3 is the biologically active and most potent form of thyroid hormone and because the relationships between these hormones (T4 and T3) are not always predictable. In patients with hyperthyroidism, T3 is usually elevated to a greater extent than T4 because it is derived from two sources increased thyroidal secretion of T3 and increased peripheral conversion of T4 to T3. The measurement of total T3 is sometimes a useful adjunct test in patients suspected of hyperthyroidism. However, because T3 concentrations fluctuate rapidly in response to stress and other nonthyroidal factors, T3 concentrations are low not only in hypothyroidism, but also in many other conditions. Thus the routine measurement of total T3 is not a good screening test of thyroid status. 

Pirog EC, Chen YT, Isacson C. MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum. Am J Surg Pathol. 2000 24 1393-1399. 

Bibbo M, DeCecco J, Kovatich AJ. P16INK4A as an adjunct test in liquid-based cytology. Anal Quant Cytol Histol. 2003 25 8-11. 

O Donnell J, et al. Role of the Thrombelastograph as an adjunctive test in thrombophiha screening. Blood Coagul Fibrinolysis 2004 15 207-11. 

Two additional tests, the red blood cell phototoxicity test (RBC PT) (Pape et al., 1994) and the Human 3-D Skin Model In Vitro phototoxicity test (H3D PT) (Roguet et al., 1994 Bernard et al, 1999 Liebsch et al, 1999 Jones et al, 2003), are regarded useful and important adjunct tests to overcome some limitations of the 3T3-NRU-PT, like the fairly low UVB tolerance of 3T3 fibroblasts. Moreover, the RBC PT enables evaluation of the phototoxic mechanisms involved (Okamoto et al, 1999) and the H3D PT model is qualified as an adjunct test to further investigate chemicals with (probably false) positive outcomes in the 3T3 NRU PT. 

D-dimer this test may be a helpful adjunct to either a venous ultrasound or V/Q scan... 

As a psychotherapist, I have recommended both of these books to depressed clients, and I found them useful adjuncts to treatment, but the real basis of my recommendation is the research that has been published testing their effectiveness as stand-alone... 

Ferrari HF, Luvizottob MCR, Rahald P, et al. Detection of bovine Flerpesvirus type 5 in formalin-fixed, paraffin-embedded bovine brain by PCR a useful adjunct to conventional tissue-based diagnostic test of bovine encephalitis. J. Virol. Methods 2007 146 335-340. 

The starting and recommended dose of tolcapone is 100 mg three times daily as an adjunct to carbidopa/L-dopa. Its use is limited by the potential for fatal liver toxicity. Strict monitoring of liver function is required, and tolcapone should be discontinued if liver function tests are above the upper limit of normal or any signs or symptoms suggestive of hepatic failure exist. It should be reserved for patients with fluctuations that have not responded to other therapies. 

In screening studies of standard design, the tendency has been to concentrate mainly on hypothesis testing. However, presentation of the results in the form of estimates with confidence intervals can be a useful adjunct for some analyses and is very important in studies aimed specifically at quantifying the size of an effect. 

Alternative pharmacological approaches Clonidine, an o2 adrenergic agonist, has been employed as adjunctive therapy to assist in smoking cessation. However, results have been mixed or the effects small (Gourlay et al. 1994 Hilleman et al. 1993 Franks et al. 1989). Buspirone (BuSpar) is a 5-HTlA partial agonist with anxiolytic effects. It has been tested as a treatment for smoking cessation because anxiety is a prominent feature of nicotine withdrawal (Farid and Abate 1998). To date, results have been mixed and more controlled research is needed. 

Miscellaneous. In recent years, other medication classes have been tested in the treatment of specihc anxiety syndromes. For example, atypical antipsychotics have been used as adjunctive treatments for OCD and GAD, and mood stabilizers have been used to treat PTSD. These syndrome-specific regimens will be discussed in the following sections. 

This method is of sufficient practicality to make it useful for routine screening of animals used in toxicology testing as an adjunct to the standard Salmonella plate test. There are several refwrts in literature of the detection of mutagens in animal urine that could not be detected in the standard plate test. (21,22)... 

Intracavernosal alprostadil may be a useful adjunct to other diagnostic tests in the diagnosis of erectile dysfunction (Cave/yecf only). 

Neuron-specific enolase (NSE). NSE is useful for monitoring the outcome of treatment and the course of disease in patients with neuroendocrine tumors, in particular small cell lung cancer and neuroblastoma. The test is not suitable as a screening or adjunct to diagnosis because of low clinical sensitivity and specificity. Elevated serum NSE concentrations are found in patients with ... 

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