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Biomedical subjects

C Cimino

Publications and source records attributed to C Cimino.

At least 19 recordsLinked to original sources
PubMed1992

Analysis of physician questions in an ambulatory care setting.

We collected 69 questions generated by physicians based on their active patient medical records. Each question was associated with a single term in a specific record (Key Term). These questions were analyzed with respect to word content and concept content. Concepts were matched to the National Library of Medicine's Metathesaurus (Meta-1). Sixty-eight Key Terms were completely matched by Meta-1 terms. Each question matched to an average of 3.7 Meta-1 terms for a total of 255 concepts. Based on word count, these 255 concepts accounted for 43%, stop words accounted for 36%, and numbers and drug trade names accounted for 3% of the words. The remaining 18% of the words could be matched to 143 concepts not in Meta-1. Review of all concepts showed that they could be divided into medical terms (Noun Concepts), modifiers (Modifier Concepts), and concepts that provided context for the questions (Relation Concepts). The majority of Relation Concepts did not match concepts in Meta-1. A vocabulary of Relation Concepts would provide a useful starting point for a computer system designed to aid physicians in answering these questions.

Ambulatory Care Information Systems↗
PubMed1992

Representation of nursing terminology in the UMLS Metathesaurus: a pilot study.

To see whether the National Library of Medicine's Metathesaurus (tm) includes terminology relevant to clinical nursing practice, two widely used nursing vocabularies were matched against the Meta. The two nursing vocabularies are 1) the North American Nursing Diagnosis List of Approved Diagnoses; and 2) the Omaha System, a vocabulary of problems and interventions developed by the Omaha Visiting Nurses Association. First, the terms were scanned against Meta in their "native" form, with phrases and combinations intact. This produced a relatively low percentage of exact matches (12%). Next, the terms were separated into "core concepts" and "modifiers" and the analysis was repeated. The percentage of exact matches to terms in Meta increased to 32%. However, the semantic types of the split terms often were not equivalent to the semantic types of the phrases from which the split terms were derived; also, in some cases, terms returned as exact matches had different meanings in Meta. Automatic scanning for lexical matches is a helpful first step in searching for vocabulary representation in Meta, but term-by-term search for context, semantic type and definition is essential. However, it seems clear that representation of nursing terminology in the Metathesaurus needs to be expanded.

Nursing↗
PubMed1992

Q & A: a query formulation assistant.

Inexperienced users of online medical databases often do not know how to formulate their queries for effective searches. Previous attempts to help them have provided some standard procedures for query formulation, but depend on the user to enter the concepts of a query properly so that the correct search strategy will be formed. Intelligent assistance specific to a particular query often is not given. Several systems do refine the initial strategy based on relevance feedback, but usually do not make an effort to determine how well-formed a query is before actually performing the search. As part of the Interactive Query Workstation (IQW), we have developed an expert system, Questions and Answers (Q&A), that assists in formulating an initial strategy given concepts entered by the user and that determines if the strategy is well-formed, refining it when necessary.

Expert Systems↗
PubMed1992

Interactive query workstation: a demonstration of the practical use of UMLS knowledge sources.

The Interactive Query Workstation (IQW) has been developed to provide clinicians with a uniform program interface for retrieving medical-related information from various computer-based information resources. These resources can vary in content (bibliographic databases, drug information, general medical text databases), function (article retrieval, differential diagnosis, drug interaction detection, or drug dosage and administration information), and media formats (local hard disk, CD-ROM, local area network, or distant telecommunication link). IQW allows modular addition of new resources as well as extension of previously installed resources. The National Library of Medicine's three Unified Medical Language System (UMLS) Knowledge Sources, the Metathesaurus (Meta), the Semantic Network, and the Information Sources Map (ISM) have been incorporated into many aspects of IQW. Meta provides information about medical terminology and aids IQW in isolating the basic concepts from a clinician's question. The Semantic Network provides information about the categorization of concepts and possible relations between concepts. It also assists IQW in determining which queries are appropriate for a set of concepts contained in the clinician's question. The ISM provides information about the content available from a computer-based resources and aids IQW in selecting an appropriate resource from which to collect information. The computer-based resource selection is performed without user intervention. This interactive demonstration shows an environment which increases the accessibility of medical information to clinicians by utilizing the three UMLS Knowledge Sources.

Information Storage and Retrieval↗
PubMed1991

Interactive Query Workstation: standardizing access to computer-based medical resources.

Methods of using multiple computer-based medical resources efficiently have previously required either the user to manage the choice of resource and terms, or specialized programming. Standardized descriptions of what resources can do and how they may be accessed would allow the creation of an interface for multiple resources. This interface would assist a user in formulating queries, accessing the resources and managing the results. This paper describes a working prototype, the Interactive Query Workstation (IQW). The IQW allows users to query multiple resources: a medical knowledge base (DXplain), a clinical database (COSTAR/MQL), a bibliographic database (MEDLINE), a cancer database (PDQ), and a drug interaction database (PDR). Descriptions of each resource were developed to allow IQW to access these resources. The descriptions are composed of information on how data are sent and received from a resource, information on types of query to which a resource can respond, and information on what types of information are needed to execute a query. These components form the basis of a standard description of resources.

Artificial Intelligence↗
PubMed1991

Cryopreserved platelets have decreased adhesive capacity.

The technique of freezing blood platelets has proven very useful in transfusion support of some patients who have become alloimmunized by prior transfusions. Although transfused frozen platelets have an acceptable life span in vivo, functional defects have been found when these cells were tested in vitro. The adhesive properties of frozen platelets were investigated by use of a modified Baumgartner chamber to perform paired perfusion studies of fresh versus frozen platelets or fresh versus 5-day-stored platelets from the same whole blood unit. Platelets were either frozen in liquid nitrogen with dimethyl sulfoxide as the cryopreservative or stored under standard blood bank conditions for 5 days. The freeze-thaw recovery of platelets was 73 +/- 8 percent. Frozen platelets exhibited a significant decrease in platelet adhesion as compared to fresh platelets from the same unit; adhesion of frozen platelets was only 53 percent of that of fresh platelets (p = 0.04). A slight, but insignificant decrease was noted with platelets stored for 5 days (86%, p = 0.197). These findings indicate that frozen-thawed platelets have a significant defect in adhesive capacity as compared to fresh platelets, and that platelets stored under blood bank conditions for 5 days maintain adhesive capacity well.

Blood Platelets↗
PubMed1991

Childhood multiple sclerosis (MS): multimodal evoked potentials (EP) and magnetic resonance imaging (MRI) comparative study.

We compared the diagnostic sensitivity of magnetic resonance imaging (MRI) and evoked potential (EP) studies in a series of 19 children affected by clinically definite (16 cases) and laboratory supported (3 cases) multiple sclerosis (MS). MRI revealed abnormal areas consistent with demyelinating plaques in 18 out of 19 cases: multiple lesions in 16 and an isolated lesion in 2 cases. Abnormal areas were more frequently found in supratentorial regions than in other areas of the central nervous system. In all patients, the distribution, form and topography of the lesions were typical of MS and similar to those found in the adult form of the disease. Multimodal EP were abnormal in 16 out of 19 cases. Visual (VEP) and somatosensory evoked potentials (SEP) abnormalities were frequently asymptomatic and VEPs were particularly sensitive in ascertaining childhood MS. MRI was slightly more sensitive than multimodal EP in confirming the clinical diagnosis of childhood MS. However, in suspected or probable MS with normal MRI, VEPs and SEPs may contribute to the definition of clinical diagnosis because of their capacity to demonstrate asymptomatic involvement in central nervous system (CNS) the optic nerve and central somatosensory pathways).

Adolescent↗
PubMed1991

The hemodynamics of thrombus formation in arteries.

Alterations in arterial blood flow are thought to predispose to thrombus formation, but the exact relationships have not been fully elucidated. The effect of varying blood flows on the accumulation of thrombotic material within arteries was investigated, with use of shear rate as an index of flow across the luminal surface. Partially denuded rabbit aortas were perfused with fresh nonanticoagulated human blood for 3 minutes, with an in vitro recirculating apparatus, Indium 111-labeled platelets, and fibrinogen I 125. Shear rates ranged from zero to 1500 sec-1, correlating with the hemodynamics of various segments of the human arterial tree. A significant correlation was observed between shear rate and platelet deposition, ranging from 5.2 +/- 2.8 x 10(6) platelets/cm2 of vessel surface area at zero shear to a maximum of 64.7 +/- 8.3 x 10(6) platelets/cm2 at a shear rate of 1500 sec-1 (F = 5.01, p less than 0.05). Fibrin deposition paralleled that of platelets, ranging from 28.2 +/- 7.6 micrograms/cm2 at zero shear to 354.1 +/- 62.7 micrograms/cm2 at a shear rate of 1500 sec-1 (F = 5.91, p less than 0.05). These results suggest that shear rate is a most important determinant of platelet and fibrin deposition on altered arterial surfaces.

Animals↗
PubMed1991

Analysis of physician questions in an ambulatory care setting.

We collected 38 questions generated by physicians based on their active patient medical records. Each question was associated with a single term in a specific record (Key Term). These questions were analyzed with respect to word content and concept content. Concepts were matched to the National Library of Medicine's Metathesaurus (Meta-1). Thirty-seven Key Terms matched completely to Meta-1 terms. Each question matched to an average of 4.1 Meta-1 terms for a total of 156 concepts. Based on word count, these 156 concepts accounted for 40 percent, stop words accounted for 39 percent, and numbers and drug trade names accounted for less than 1 percent of the words. The remaining 20 percent of the words could be matched to 69 concepts not in Meta-1. Review of all concepts showed that they could be divided into medical terms (Noun Concepts), modifiers (Modifier Concepts), and concepts that provided context for the questions (Relation Concepts). The majority of Relation Concepts did not match to Meta-1. A vocabulary of Relation Concepts would provide a useful starting point for a computer system designed to aid physicians in answering clinical questions.

Ambulatory Care↗
PubMed1991

The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions.

In patients at risk for acquired immunodeficiency syndrome who present with a mass lesion, a dilemma arises as to whether to treat empirically for toxoplasmosis or perform a brain biopsy. We present data that further define the indications for performing brain biopsy vs empiric treatment. We reviewed charts on 59 patients with acquired immunodeficiency syndrome--related disorders and cerebral mass lesions. Thirty-two patients met diagnostic criteria for toxoplasmosis. Bayesian analysis demonstrated that the prior probability of toxoplasmosis was increased by the presence of contrast enhancement on computed tomographic scans (0.68) and toxoplasmosis titers greater than 1:64 (0.81). Features associated with decreasing probabilities of toxoplasmosis included the absence of contrast enhancement on computed tomographic scans (0.29) and toxoplasmosis titers less than or equal to 1:64 (0.14). Ten percent of patients had complications of brain biopsy. Treatment with pyrimethamine and sulfadiazine produced complications in 29% and serious complications in 8% of treated patients. These data favor empiric therapy for patients with typical features of toxoplasmosis and brain biopsy for defined subsets of patients with atypical features.

Bayes Theorem↗
PubMed1990

Surgical treatment of intracranial dermoid and epidermoid cysts in children.

Between 1956 and 1987 operations were performed on 36 patients below the age of 20 years for epidermoid and dermoid cysts of the central nervous system. Seventeen tumors were intracranial intradural lesions (47%): 12 were located in the supratentorial region (71%) and 5 were located in the infratentorial region (29%). Ten of these tumors (59%) were seated along the midline structures. The clinical presentation was consistent with the location of the tumors. The neuroradiological diagnosis was mostly made with the aid of pneumoencephalography, computed tomography (CT), nonionic contrast medium CT cisternography, and magnetic resonance imaging. Complete removal of the tumor contents was performed in all cases but one, although the completeness of removal of the tumor capsule could not be exactly estimated in some patients. At late follow-up only two tumor recurrences were observed. Radical removal of the tumor capsule of these congenital tumors, even when it is connected to vital neurovascular structures, seems advisable in patients who become symptomatic within the first two decades of life.

Adolescent↗
PubMed1989

Neuromuscular involvement in mild, asymptomatic primary hyperparathyroidism.

PURPOSE: The classic neuromuscular abnormalities of primary hyperparathyroidism are based on observations from an earlier time when the disease presented commonly with signs and symptoms. The purpose of the present study was to test for neuromuscular abnormalities among patients currently seen with primary hyperparathyroidism, in whom the vast majority are asymptomatic. PATIENTS, METHODS, AND RESULTS: Forty-two patients (30 women, 12 men) were studied. Serum calcium level was 11.1 +/- 0.1 mg/dL (normal, 8.7 to 10.7 mg/dL); phosphorus level was 2.8 +/- 0.1 mg/dL (normal, 2.5 to 4.5 mg/dL). Parathyroid hormone levels by radioimmunoassay for N-terminal and for mid-molecule regions were 32.6 +/- 2.4 pg/mL (normal, 8 to 24 pg/mL) and 831 +/- 127 pg/mL (normal, 50 to 330 pg/mL), respectively. Although generalized weakness and easy fatigability were common complaints, they were not seen on neurologic examination. No patient showed typical neuromuscular findings such as muscle weakness or atrophy, hyperreflexia, abnormal gait, tongue fasciculations, or objective changes in mental status. On the other hand, paresthesias and muscle cramps were reported by 22 patients (52%). Neurologic examination in 12 patients (29%) demonstrated findings consisting of either stocking-glove loss of pain sensation or loss of vibratory sensation with diminished reflexes. Creatine phosphokinase levels were normal in all patients. Electromyography and nerve conduction studies were performed in nine patients. None showed myopathy or signs of motor unit denervation. Isolated nerve abnormalities (n = 6) and nonspecific sensory neuropathy (n = 2) were observed. CONCLUSION: We conclude that the classic neuromuscular syndrome of primary hyperparathyroidism is rarely seen among a typical modern-day group of patients with primary hyperparathyroidism. The results suggest that the neurologic component of primary hyperparathyroidism should be included among those features of the disease that have changed along with other aspects of the clinical profile of primary hyperparathyroidism.

Aged↗
PubMed1989

Spinal arteriovenous fistula. A possible cause of paraparesis after epidural anaesthesia.

A 62-year-old male suddenly developed a severe paraparesis after epidural anaesthesia. He recovered gradually over the next few months. He had an acute relapse one year later and a selective spinal angiography showed a dural T8 arteriovenous fistula with large draining veins. Intravascular embolisation of the fistula produced immediate and sustained clinical improvement. The mechanism commonly held responsible for neurological disturbances in spinal dural arteriovenous fistulas is cord hypoxia secondary to venous hypertension. The 20-ml of local anaesthetic solution injected into a narrow spinal canal with osteophytosis may have caused further venous engorgement, cord hypoxia and acute neurological deficit.

Anesthesia, Epidural↗
PubMed1989

Brainstem auditory evoked potential abnormalities and magnetic resonance imaging in posterior fossa lesions.

Brainstem auditory evoked potentials (BAEPs) were evaluated in a series of 15 patients with extra-axial cerebello-pontine angle tumors (3 cases), demyelinating plaques (11 cases), and intra-axial tumor (1 case), verified by magnetic resonance imaging (MRI). A satisfactory correlation between the location of the lesions and the type of BAEP abnormalities was found in 11 cases. In 2 other cases, definite MRI brainstem lesions located outside the acoustic pathways were associated with normal BAEPs. In the opposite situation (2 cases of BAEP abnormalities with normal MRI), the inability of MRI to detect demyelinating lesions may be due to the temporal evolution of the lesions themselves. The results of this BAEP-MRI comparative study confirm that BAEP is a sensitive diagnostic tool in revealing brainstem dysfunction, although its localizing power appears to be debatable. The most satisfactory MRI/BAEP topodiagnostic correlation was found with lesions involving the acoustic nerve in its intracranial tract or the caudal pons and bulbopontine junctions.

Adolescent↗
PubMed1989

Spinal meningiomas: review of 174 operated cases.

The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.

Adolescent↗