LIMITATIONS OF USING THE PROTEIN PROFILE FOR DIAGNOSTIC GUIDANCE IN INITIAL INTERNAL-MEDICINE CONSULTATIONS - A PERSPECTIVE STUDY OF 76 CASES

Determination of the protein profile of orientation (PPO) is now consi dered by some authors as a means of improving the diagnosis in interna l medicine. The feasibility of systematizing this practice was investi gated in 76 outpatients (79 included three excluded secondarily) seen for pathology of undetermined diagnosis. The 79 patients (mean age: 52 years) underwent the classical biological explorations pills PPO. The physicians were divided into two groups (seniors and assistants). Two complete clinical files were established for each patient, with one d ifference concerning inflammatory and immunologic data: one file inclu ded the minimum number of tests considered necessary by the physician and the other the complete PPO (nine proteins). Each file (with or wit hout PPO) was randomly distributed to one of two physicians in the sam e group. Each physician filled in a diagnostic evaluation sheer indica ting whether there was organic pathology or not, the main diagnosis (i nflammatory, neoplastic, infections or other), the secondary diagnosis and the hypothesis of probability. The relevance of the clinical opin ion was analyzed by an internal medicine specialist from outside the d epartment with 40 years of clinical experience. The duration of sympto ms before the medical visit was from 3 weeks to 5 years (mean 6 months ). A diagnosis of organic pathology was reached for three out of four patients. Sixty-seven patients were seen again after a minimum of 6 mo nths, and nine were lost to follow-up. Diagnostic efficiency was no gr eater for cases with PPO, which appears to be a biological examination of second intention. We suggest that the term ''protein profile of or ientation'' be replaced by ''broad protein profile.''