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Biomedical subjects

F Philip

Publications and source records attributed to F Philip.

At least 19 recordsLinked to original sources

3D visualization and stereographic techniques for medical research and education.

While computers have been able to work with true 3D models for a long time, the same does not apply to the users in common. Over the years, a number of 3D visualization techniques have been developed to enable a scientist or a student, to see not only a flat representation of an object, but also an approximation of its Z-axis. In addition to the traditional flat image representation of a 3D object, at least four established methodologies exist: Stereo pairs. Using image analysis tools or 3D software, a set of images can be made, each representing the left and the right eye view of an object. Placed next to each other and viewed through a separator, the three dimensionality of an object can be perceived. While this is usually done on still images, tests at Mednet have shown this to work with interactively animated models as well. However, this technique requires some training and experience. Pseudo3D, such as VRML or QuickTime VR, where the interactive manipulation of a 3D model lets the user achieve a sense of the model's true proportions. While this technique works reasonably well, it is not a "true" stereographic visualization technique. Red/Green separation, i.e. "the traditional 3D image" where a red and a green representation of a model is superimposed at an angle corresponding to the viewing angle of the eyes and by using a similar set of eyeglasses, a person can create a mental 3D image. The end result does produce a sense of 3D but the effect is difficult to maintain. Alternating left/right eye systems. These systems (typified by the StereoGraphics CrystalEyes system) let the computer display a "left eye" image followed by a "right eye" image while simultaneously triggering the eyepiece to alternatively make one eye "blind". When run at 60 Hz or higher, the brain will fuse the left/right images together and the user will effectively see a 3D object. Depending on configurations, the alternating systems run at between 50 and 60 Hz, thereby creating a flickering effect, which is strenuous for prolonged use. However, all of the above have one or more drawbacks such as high costs, poor quality and localized use. A fifth system, recently released by Barco Systems, modifies the CrystalEyes system by projecting two superimposed images, using polarized light, with the wave plane of the left image at right angle to that of the right image. By using polarized glasses, each eye will see the appropriate image and true stereographic vision is achieved. While the system requires very expensive hardware, it solves some of the more important problems mentioned above, such as the capacity to use higher frame rates and the ability to display images to a large audience. Mednet has instigated a research project which uses reconstructed models from the central nervous system (human brain and basal ganglia, cortex, dendrites and dendritic spines) and peripheral nervous system (nodes of Ranvier and axoplasmic areas). The aim is to modify the models to fit the different visualization techniques mentioned above and compare a group of users perceived degree of 3D for each technique.

Adult↗

Production of CAL-programs in medicine, odontology and veterinary medicine in Sweden.

At the recommendation of the Swedish Government, the Council for the Renewal of Undergraduate Education was established in 1990. In 1993 the Council was declared a permanent National Agency by Swedish Parliament and became part of the newly established National Agency for Higher Education in 1995. The purpose of the Council for Renewal of Undergraduate Education is to promote and support endeavors to develop quality and renewal of undergraduate education. In particular the council awards grants to development activities. Once a year, teachers at Swedish universities, university colleges and professional schools can apply for funding. Applications are accepted for projects directed towards undergraduate education in all disciplines. The Council selects 15-20 projects and each project is funded for 1-3 years. An advisory group--MEDCAL (Computer Assisted Learning (CAL) in MEDicine, Odontology and Veterinary Medicine)--consisting of representatives from all universities supports the Council with registration and evaluation of programs, offers their opinions on the production of CAL and collaborates with similar organizations in other countries, e.g. Australia, Denmark, Germany, Great Britain and USA. In all, 12 projects within the frame of MEDCAL will be reported.

Computer-Assisted Instruction↗

Influence of food and body weight on the pharmacokinetics of penticainide.

The pharmacokinetics of penticainide, a class Ic antiarrhythmic drug, was studied in 16 healthy adults (eight males and eight females) after a single 300-mg oral dose in fasting conditions and with a standard meal. Penticainide concentrations in plasma and urine were measured by hplc. The pharmacokinetic parameters of penticainide including Cmax, tmax, AUC and t1/2 were not significantly altered in the presence of food. AUC values (mean +/- sd) were 50.68 +/- 10.8 mg.h.l-1 and 49.52 +/- 9.87 mg.h.l-1 in the absence and presence of food, respectively. However, a significant difference was observed between males and females in both fasting and fed conditions with a higher value of the apparent oral clearance in the second group. The values of apparent oral clearance, expressed in weight-normalized units were 1.33 +/- 0.35 ml.mn-1.kg-1 (male) and 1.93 +/- 0.34 ml.mn-1.kg-1 (female) in fast conditions (P < 0.01) and 1.38 +/- 0.28 ml.mn-1.kg-1 (male) and 1.93 +/- 0.49 ml.mn-1.kg-1 (female) in fed conditions (P < 0.02), respectively. The pharmacokinetics of penticainide is not modified by the presence of food, but an influence of body weight may be considered.

Adult↗

[Changes in plasma histamine and catecholamines levels after injection of chymopapain in chemonucleolysis].

Because pruritus, erythema and tachycardia are observed in some patients during chemonucleolysis, a prospective study was designed to investigate the plasma levels of histamine and catecholamines occurring after an injection of chymopapain. Thirteen patients (11 men and 2 women), mean age 38 +/- 11 years, were studied. They all had negative prick skin tests, human basophil degranulation tests (HBDT) and radio-absorbent tests (RAST) to chymopapain. The patients were premedicated with 100 mg hydroxyzine and 3 g tranexamic acid. Sedation was carried out using 0.1 mg.kg-1 droperidol and 0.02 mg.kg-1 phenoperidine. The nucleosus pulposus was visualized with 3 ml of contrast medium (lopamiron 300); 2 ml of chymopapain were then injected. Blood samples were obtained at T1 (after the contrast medium, but before the chymopapain), and then 5, 10, 15, 20 and 30 minutes after the chymopapain. The usual haemodynamic parameters were recorded at the same times. Four patients had clinical signs (group I), whereas the other nine (group II) did not. There was an increase in histamine levels in three patients from group 1, as well as in two in group II (up to 33 nmol.l-1). However, mean histamine and catecholamines levels were comparable in both groups at all times, and between times, of sampling. There therefore was no relationship between clinical signs and the release of histamine or catecholamines. The premedication with an antihistamine may have protected the patients, but the signs reported by four patients may also be due to the chymopapain itself.

Adult↗

Mexiletine in acute myocardial infarction. Simulation of a theoretical protocol and validation in six patients.

A mexiletine (Mexitil, MEX) administration schedule was established by simulation, in order to maintain MEX at therapeutic levels in plasma during the transition from parenteral to slow-release MEX (SR MEX) administration. This protocol was made valid in 6 patients with acute myocardial infarction (AMI) admitted to a coronary care unit, 24 h after the onset of pain. From both the i.v. and oral plasma level data, the pharmacokinetic parameter alterations of MEX and its hydroxymethylmexiletine metabolite (OH MEX) were evaluated over a week's period. The results presented here demonstrate that a twice daily oral SR MEX administration, starting at the end of MEX infusion, maintains the therapeutic concentrations of MEX (750-2000 ng/ml) previously achieved by infusion therapy (at 48 h, end of infusion, mean +/- SD = 1393 +/- 325 ng/ml; at 60 h, mean +/- SD = 1434 +/- 376 ng/ml; at 96 h, mean +/- SD = 1423 +/- 367 ng/ml. No evidence of either clinical side-effects or malignant arrhythmias was observed. MEX and OH MEX pharmacokinetic parameters were estimated by fitting the i.v. infusion data (phase I) and the oral data after the last SR MEX administration (phase II)beta to a linear compartment model. The terminal half-life t1/2 MEX was longer in phase I than in phase II (28.4 +/- 12.1 h (betaI) versus 14.06 +/- 4.47 h (II); p less than 0.01). This prolonged t1/2 MEX was probably due to a decrease of total plasma clearance Cl MEX (3.723 +/- 1.534 ml.kg-1min-1 (I) versus 5.031 +/- 1.28 ml.kg-1min-1 (II).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

[Effects of positive expiratory pressure on cardiac output and estimated hepatic blood flow during controlled ventilation in man].

This study aimed to discover the effects of artificial ventilation with positive end-expiratory pressure (PEEP) on cardiac output and hepatic blood flow in ten patients with chronic stable post-anoxic or post-traumatic coma, without any cerebral oedema or any other visceral pathology. This study was carried out at four levels of end-expiratory pressure (0, 5, 12 and 29 cmH2O) and after 24 h of artificial ventilation with a PEEP arbitrarily fixed at 12 cmH2O. Cardiac output was measured by thermodilution and hepatic blood flow by applying Fick's principle on a continuous infusion of indocyanine green with an analysis of suprahepatic venous samples. Hepatic blood flow is given by the amount of indocyanine green infused (0.5 mg.min-1) divided by the difference between arterial and suprahepatic venous indocyanine green concentration. For all levels of PEEP, mean arterial, right atrial, wedge and suprahepatic pressures and hepatosplanchnic resistances were measured. Artificial ventilation with PEEP induced a fall of cardiac output and hepatic blood flow proportional with the increase in PEEP level. The fall in hepatic blood flow began to be statistically significant for a PEEP level of 5 cmH2O (-17%; p less than 0.01) and was maximum for a PEEP of 20 cmH2O (-49.51%; p less than 0.001). There was no linear correlation between cardiac output and hepatic blood flow: the fall in hepatic blood flow was more important than the fall in cardiac output. These changes in hepatic blood flow were accompanied by a significant increase in hepatosplanchnic resistances (p less than 0.01 for PEEP = 12 cmH2O), without any changes in other haemodynamic parameters or biological signs of hepatic disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Plasma levels and pharmacokinetics of single and multiple dose of tetrazepam in healthy volunteers.

The pharmacokinetics of tetrazepam (Myolastan, Musaril), were studied in 12 healthy volunteers. Tetrazepam was given orally as a single dose of 50 mg and repeated administration for 5 consecutive days of 50 mg at 12-h intervals, in tablet form. Tetrazepam was measured in plasma using a selective and sensitive GLC method. Tetrazepam is rapidly absorbed after oral administration with a peak plasma level of 0.49 +/- 0.10 mg/l at 0.94 +/- 0.47 h. The drug is widely distributed in the organism with an apparent volume of distribution of 6.7 +/- 2.1 l/kg. Tetrazepam is eliminated with a half-life of 22 +/- 4 h and can be classified as a benzodiazepine with medium half-life value. This medium half-life is the result of the high hepatic clearance of the drug in spite of its large distribution volume. Since in this study 6 male and 6 female volunteers were studied it was possible to compare the pharmacokinetic profile in the two groups. No significant differences were observed. No differences were observed between the pharmacokinetic values after a single dose or after repeated administration.

Administration, Oral↗

[High-risk congenital diaphragmatic aplasia and hernia (apropos of 64 cases)].

The prognosis of high risk congenital diaphragmatic hernia and eventration diagnosed in the early neonatal period (before 24 h) is studied based on a series of 64 cases. Eventration has a poor prognosis with 5 deaths out of 7 cases. The replacement of the hemidiaphragm by an abdominal muscular flap seems to be the best surgical procedure (2 recoveries on 4 cases). A high mortality rate remains in the diaphragmatic hernias which are undiagnosed before birth. Out of 54 operated cases with systematic homolateral drainage, there were 35 survivors (65%). Post-operative alveolar-arterial PO2 difference less than 53 kPa appears to be a reliable criterion of good prognosis with a survival rate of 91% in this series. Thus, despite major progresses in post-operative resuscitation, the recovery rate in high risk neonatal congenital diaphragmatic hernia and eventration is only 75%. This seems to be partly related to the existence of lethal forms due to bilateral pulmonary hypoplasia and structural anomalies of the pulmonary arteries.

Blood Gas Analysis↗

[Effects of injectable flunitrazepam on hepatic and cardiac output in man].

The effects of intravenous flunitrazepam (0.03 mg X kg-1) on the estimated hepatic plasma output (DPHE), compared with the cardiac output (Q), were studied before its injection and 1 min afterwards. The question asked was whether the decrease in venous return led to a fall in hepatic perfusion. This study was made on patients in neurological coma without any organic lesion. The DPHE was measured by applying Fick's principle, using a continuous infusion of indocyanine green (ICG). The DPHE was given by the amount of ICG perfused in mg X min-1 divided by the arterial concentration of ICG less the concentration of ICG in the hepatic vein (in mg X 1(-1)). Cardiac output was measured by thermodilution. Flunitrazepam did not significantly modify either DPHE or Q; they fell by 5.6% and 3.4% respectively. None of the seven cardiovascular parameters changed during the time of the study. Thus, in unconscious patients with satisfactory haemodynamic conditions prior to the intravenous injection, flunitrazepam did not significantly modify hepatic perfusion.

Adolescent↗

[Unstable angina and single vessel stenosis of the anterior interventricular artery. Evaluation of the threatened myocardium. Therapeutic implications].

The authors report a special cases of precise evaluation of threatened myocardium during coronaro-ventriculography. Two elements provided this evaluation: 1) spasm in the tight stenosis of the middle part of the anterior interventricular artery with immediate left ventricular dyskinesia (EF: 37%, EDP/EVD: 1.74; EDV: 98 cc/m2). 2) Complete instantaneous recovery after injection of 2 mg of trinitrine into the left ventricle (EF: 69%, EDP/EVD: 4.33; EDV: 28 cc/m2). This loss, in the order of 50%, in the left ventricular function led us to perform an angioplasty (ACT) with success. A further clinical and angiographic stenosis, three months later, in this 72 years old patient with arteritis, led us to perform an aorto-coronary graft, rather than another ACT.

Aged↗

[Course of pulmonary embolism].

One hundred and fifty-five patients with a mean age of 59 years and suffering a recent pulmonary embolism (P.E.) underwent angiopneumography and phlebocavography before and after treatment. The P.E. was minimal in 42 cases (Muller less than 11) and severe in 113 cases (Muller greater than 11). There was an associated venous thrombosis (V.T.) in 134 cases (86%) affecting the iliac veins or vena cava in 44 cases (28%). Several types of treatment were used: heparin 66, SK 24, high dose UK 16, low dose UK + heparin 37, surgery 16. Fifty-two patients underwent a procedure to interrupt the I.V.C. Four patients received two types of treatment in succession. SK resulted in more rapid disappearance of the pulmonary clot than UK at the dose used but the results were comparable on the 15th day (SK = UK = H). With regard to V.T., the Marder index failed to reveal any significant difference between the types of treatment. However, SK resulted in the lowest therapeutic failure rate (19%) and it was the only agent which produced disobliteration of iliac or vena cava thromboses (6 cases out of 13), other types of treatment being ineffective (0 cases out of 28). The mortality rate was high (14%) but 86% of the patients who died had a massive P.E. (greater than 60%). The recurrence rate was less (6%) but recurrences were fatal in 6 cases out of 10. Sixty-four patients were seen again after a mean period of 20.7 months. Pulmonary sequelae were minor (CPC 4.6%, dyspnoea 18%). By contrast, one patient in two suffered from post-phlebitis syndrome. The latter was all the more common when obstruction of the proximal veins persisted after treatment. On the basis of these data, the authors emphasise the gravity of pulmonary thrombo-embolic disease: fatal in the early phase essentially as a result of recurrences, incapacitating in the late phase as a result of post-phlebitis syndrome. They note that proximal V.T. associated with P.E. is responsible for such complications. Such iliocaval disease must therefore be sought routinely by phlebocavography. Their presence justifies aggressive treatment designed to destroy them (SK) or protect against their consequences (I.V.C.I.).

Drug Therapy, Combination↗