Capillary differential diagnosis

Chickenpox in infancy and shingles in adults are caused by the same varicella-zoster virus. Very rarely and almost exclusively in immunosuppressed patients, concomitant hepatitis can occur with pronounced (mainly focal) hepatocellular necrosis, sometimes even with a fatal course. (37) Leucocytic portal and periportal infiltration can spread to the blood vessels and bile capillaries. Intranuclear inclusion bodies are present (s. fig. 23.2). Diagnosis is based on increased GPT, GOT, GDH and y-GT values as well as the presence of varicella IgM antibodies alternatively, pathogens can also be demonstrated in cultures. In children, a differential diagnosis of Reye s syndrome must be considered. As therapy in a severe course, aciclovir is indicated. (38-43)... 

Clark R, Katzmann JA, Kyle R, Fleisher M, Landers JR Differential diagnosis of gammopathies by automated capillary electrophoresis Analysis of serum samples problematic by agarose gel electrophoresis. Electrophoresis 1998 19 2479-84. 

The exact nature of pontine lesions classified as capillary malformations will remain speculative in the vast majority of patients. Beside vascular malformations, the differential diagnosis of an enhancing pontine lesion might include neoplasm, demyelin-ating disease, infection, infarction, or, rarely, central pontine myelinolysis. The absence of mass effect or significant T2 prolongation, however, argues... 

Note that MS/MS is unable to distinguish between isomeric acylcarnitines. Therefore, elevations of C4 can be either from accumulation of butyr-yl or isobutyryl carnitine, C5 can be either isovaleryl or 2-methylbutyryl and so on. Some individual metabolites are characteristic of more that one disease. Propionylcarnitine is markedly elevated in both propionic and methylmalonic acidemia. 3-Hydroxyisovalerylcarnitine (OH-C5) is associated with both 3-MCC deficiency and HMG-CoA-lyase deficiency. Minor elevations in either or both of these metabolites are also consistent with ho-locarboxylase deficiency or with deficiency of the cofactor biotin (or bioti-nidase). The differential diagnosis of each of these conditions is generally made from a careful analysis of urinary organic acids, performed by capillary column GC/MS in a reputable facility. This is especially important in the follow-up of abnormal newborn screening acylcarnitine results. 

Dynamic contrast-enhanced MRI has been used as an additional imaging technique in various clinical applications, such as differentiation of benign from malignant lesions, tissue characterization by narrowing down the differential diagnosis, identification of areas of viable tumour before biopsy and detection of recurrent tumour tissue after therapy. This technique provides information on tissue vascularization, perfusion, capillary permeability and composition of the interstitial space. 

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