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Biomedical subjects

P Lander

Publications and source records attributed to P Lander.

At least 19 recordsLinked to original sources
PubMed2004

Minimally invasive dynamic hip screw: prospective randomized trial of two techniques of insertion of a standard dynamic fixation device.

OBJECTIVE: This study evaluates the safety and outcome of a minimally invasive technique for inserting a standard dynamic hip screw for intertrochanteric fractures. HYPOTHESIS: The use of standard plate in a minimally invasive technique is both possible and advantageous to patient outcome. DESIGN AND METHODS: Prospective surgeon-randomized blinded outcome clinical study comparing new technique to conventional technique. MAIN OUTCOME MEASURE: Pain, operative time and mean hemoglobin drop in percutaneous hip fixation. RESULTS: The minimally invasive technique had significantly less blood loss (P < 0.001), operative time (P < 0.001) and a trend to less morphine use. CONCLUSIONS: Minimal invasive technique significantly reduces blood loss and operative time for fixation of intertrochanteric hip fractures without sacrifice of fixation stability or bone healing.

Aged↗
PubMed2001

Paget's disease of the spine and its management.

A review of the literature was conducted to study the pathomechanics by which Paget's Disease of bone (PD) alters the spinal structures that result in distinct spinal pathologic entities such as pagetic spinal arthritis, spinal stenosis, and other pathologies, and to assess the best treatment options and available drugs. The spine is the second most commonly affected site with PD. About one-third of patients with spinal involvement exhibit symptoms of clinical stenosis. In only 12-24% of patients with PD of the spine is back pain attributed solely to PD, while in the majority of patients back pain is either arthritic in nature or a combination of a pagetic process and coexisting arthritis. Neural element dysfunction may be attributed to compressive myelopathy by pagetic bone overgrowth, pagetic intraspinal soft tissue overgrowth, ossification of epidural fat, platybasia, spontaneous bleeding, sarcomatous degeneration and vertebral fracture or subluxation. Neural dysfunction can also result from spinal ischemia, when blood is diverted by the so-called "arterial steal syndrome". Because the effectiveness of pharmacologic treatment for pagetic spinal stenosis has been clearly demonstrated, surgical decompression should only be instituted after failure of antipagetic medical treatment. Surgery is indicated as a primary treatment when neural compression is secondary to pathologic fractures, dislocations, spontaneous epidural hematoma, syringomyelia, platybasia, or sarcomatous transformation. Since, in the majority of cases with pagetic spinal involvement, there are also coexisting osteoarthritic changes, antipagetic medical treatment alone may be disappointing. Therefore, one must be careful before attributing low back pain to PD alone. Five classes of drugs are available for the treatment of PD: bisphosphonates, calcitonins, mithramycin (plicamycin), gallium nitrate, and ipriflavone. Bisphosphonates are the most popular, and several forms have been investigated, but only the following forms have been approved for clinical use: disodium etidronate, clodronate, aledronate, risedronate, neridronate, pamidronate, tiludronate, ibadronate, aminohydroxylbutylidene bisphosphonate, olpadronate, and zoledronate. Several of these forms are still under investigation.

Humans↗
PubMed2001

Imaging of pyogenic infectious spondylodiskitis.

The presence of infectious spondylodiskitis and its complications may present protean clinical and imaging findings. The frequent use of multi-imaging modalities has led to a greater sensitivity and specificity in the diagnosis of this ubiquitous disease.

Bacterial Infections↗
PubMed2000

The efficacy of interconnected porous hydroxyapatite in achieving posterolateral lumbar fusion in sheep.

STUDY DESIGN: An animal study was performed to evaluate lumbar spinal fusion radiologically and mechanically. OBJECTIVES: To assess the efficacy of interconnected porous hydroxyapatite in achieving posterolateral lumbar arthrodesis in sheep. SUMMARY OF BACKGROUND DATA: Posterolateral spinal arthrodesis with autologous bone graft is the gold standard procedure for lumbar fusion. The procedure for harvesting bone from the iliac crest increases morbidity. Interconnected porous hydroxyapatite has been used effectively as an alternative to cancellous bone graft material in metaphyseal bone defects. Little is known about the efficacy of interconnected porous hydroxyapatite in achieving lumbar spinal fusion. METHODS: Four groups of seven sheep underwent bisegmental posterolateral lumbar fusion with instrumentation using different intertransverse graft material. In group 1, no graft material was used. In group 2, autologous bone was used. Group 3 had interconnected porous hydroxyapatite. Group 4 had an equip of interconnected porous hydroxyapatite and autologous bone. The animals were killed at 20 weeks after surgery. Radiographs and computed tomography images were obtained. The fusion masses were graded for bone resorption and trabecular connectivity on the computed tomography images. Mechanical testing of the specimens was performed, and the three-dimensional segmental motion was measured in flexion/extension, axial rotation, and lateral bending. RESULTS: The radiographic images were difficult to interpret because of the radiodense interconnected porous hydroxyapatite granules. According to mechanical stability criteria, the fusion rate for the different groups was as follows: 100% (14/14) for the autologous bone group, 72% (10/14) for the bone/interconnected porous hydroxyapatite group, 50% (7/14) for the pure interconnected porous hydroxyapatite group, and 15% (2/14) for the sham group. CONCLUSIONS: Spinal arthrodesis using interconnected porous hydroxyapatite alone or mixed with bone as graft material reduced segmental motion. It was not, however, as effective as autologous bone graft material in achieving spinal arthrodesis. The sheep model using autologous bone achieved a 100% fusion rate. Because the nonunion rate for a single level in humans may be as high as 40%, the fusion rate with bone/interconnected porous hydroxyapatite in humans may be lower than the 72% found in the sheep model. The little resorption of the radiodense interconnected porous hydroxyapatite granules made the radiologic evaluation of the fusion masses difficult.

Animals↗
PubMed2000

Temporal evolution of traditional versus transformed ECG-based indexes in patients with induced myocardial ischemia.

The time course of changes in the electrocardiogram as a result of myocardial ischemia induced during prolonged coronary angioplasty has been studied. We have analyzed the electrocardiogram evolution during the occlusion in terms of the Ischemic Changes Sensor, which is a parameter that describes the capacity of different indexes to detect induced changes. Traditional indexes at specific time locations (ST level, T wave amplitude and position, and durations of QT interval and QRS complex) and global indexes (based on the Karhunen-Loève transform as applied to the QRS complex, ST-T complex, ST segment and T wave) have been considered. The global indexes better detected ischemic changes than the traditional indexes. The most sensitive were the index for the ST-T complex (89%) in the Karhunen-Loève transform-derived group and for the ST level (61%) in the traditional group. Changes in the ventricular repolarization period usually appeared earlier (77% of patients) than changes in the depolarization period (23% of patients). A similar percentage of patients exhibited the earliest ischemic changes in the T wave (41%) and in the ST segment (36%). The evolution of the Ischemic Changes Sensor parameters showed that the majority (60%) of the total changes occurred during the first minute of occlusion. The results suggest that the use of global electrocardiogram indexes better reflect ischemic changes than do traditional indexes, such as the ST segment deviation.

Angioplasty, Balloon, Coronary↗
PubMed2000

Osteoporosis of the spine: correlation between vertebral deformity and bone mineral density in postmenopausal women.

The purpose of this study is to evaluate the relation of bone mineral density (BMD) or the age-matched z score and osteoporotic vertebral fractures. The radiographs and spinal bone mineral density of 131 consecutive postmenopausal patients were retrospectively reviewed. The vertebral fractures between T4 and L4 were graded. Sixty-two patients had no fractures, and 69 had 1 or more fractures. In the nonfracture group, the mean age was 62.6 years, BMD was 0.88 g/cm2, and the z score was -1.00. In the fracture group, the mean age was 69.6 years, BMD was 0.788 g/cm2, and the z score was -1.26. Patients with 2 and 3 or more fractures had a lower mean BMD than that of the nonfracture group (P < .01). The z score (adjusted for age) was significantly lower only in patients with 3+ fractures (P < .05). Patients with grade 2 and grade 3 of any fracture type had significantly lower BMD (P < .01). The z score was lower only in those with grade 3 fracture (P < .05). Our study indicates that the clinical use of BMD z score adjusted for age is a better predictor of severity of vertebral fractures than is BMD alone.

Adult↗
PubMed1999

Identification of the occluded artery in patients with myocardial ischemia induced by prolonged percutaneous transluminal coronary angioplasty using traditional vs transformed ECG-based indexes.

We have studied the spatial properties of ischemic changes as induced by prolonged angioplasty and how the changes are related to different ECG indexes. Indexes based on measurements at specific points in time (ST level at J + 60 ms point, maximal T wave amplitude and position, QT interval, and QRS duration) and global indexes (based on the Karhunen-Loève transform and applied to the QRS complex, ST-T complex, ST segment, and T wave), considering both repolarization and depolarization information, were analyzed. The changes during the occlusion period of the different indexes were used as variables in a multivariate discriminant analysis to determine which indexes showed the best discrimination of the three major occlusion sites (corresponding to LAD, RCA, and LCX coronary arteries). Occlusions in LCX artery were the most difficult to classify. With three local indexes (ST60 level measured in lead V3, T wave amplitude in I, and ST60 in III) it was possible to correctly classify 76% of patients by the occlusion site, and with three KLT-derived indexes (first-order KLT index for ST-T complex in I and for QRS in leads V3 and I) 83% of correct classification was obtained. Using six indexes for local and KLT-derived indexes the correct classification was increased to 85 and 90% of patients, respectively. The use of different ECG indexes (from different intervals) on quasiorthogonal leads permitted the identification of the occluded artery in patients undergoing PTCA and may be extended to more general use.

Angioplasty, Balloon, Coronary↗
PubMed1998

Comparative study of local and Karhunen-Loève-based ST-T indexes in recordings from human subjects with induced myocardial ischemia.

In this work we studied ST-T complex changes in the ECG as result of induced ischemia. The principal aim was to determine whether global changes in the ST-T complex were more sensitive markers of ischemic alterations than those based on measurements of changes at specific locations on ST segment or T wave. High-resolution ECGs from patients undergoing percutaneous transluminal coronary angioplasty in one of the major coronary arteries were analyzed to give a description of the period from the end of active depolarization (QRS complex) to the end of active repolarization (T wave). During artery occlusion traditional local measurements of the ST-T complex were compared to global measurements based on the Karhunen-Loève transform. An ischemic change sensor parameter was estimated for each of the studied indexes showing that global measurements detected changes better in the repolarization period in a larger number of leads and with higher sensitivity (more than 85%) than was done using local measurements (sensitivity of 64% with ST level, 33% with T-wave maximum position, and 37% with T-wave maximum amplitude). Using these global indexes it was found that most cases of ST-segment changes were accompanied by T-wave changes (72% of patients). With the use of traditional indexes 23% of patients showed no changes in the repolarization period, whereas with global indexes this percentage decreased to 8%. Thus a global representation of the entire ST-T complex appears to be more suitable than local measurements when studying the initial stages of myocardial ischemia.

Algorithms↗
PubMed1998

Electrocardiographic changes during prolonged coronary artery occlusion in man: comparison of standard and high-frequency recordings.

Detection of acute myocardial ischaemia using electrocardiographic methods is generally based on assessment of the ST segments in the standard 12-lead electrocardiogram (ECG). Several studies have also shown changes in high-frequency QRS components during acute ischaemia. The purpose of the present study was to determine the changes in high-frequency QRS components during prolonged percutaneous transluminal coronary angioplasty (PTCA) and to compare these changes with ST-segment deviations in the standard 12-lead ECG. The study population consisted of 19 patients receiving prolonged PTCA. Standard and high-resolution signal-averaged ECGs were recorded before and during balloon inflation. The high-resolution recordings were performed using bipolar X, Y and Z leads. The QRS complexes in the high-resolution signal-averaged ECGs were analysed within a bandwidth of 150-250 Hz. During inflation, significant reductions in high-frequency QRS components were observed (12-72%). Changes in the high-frequency QRS components were seen in four of the patients without ST-segments deviation in the standard ECG. The correlation between the ST-segment deviation and the reduction in high-frequency QRS components was weak (r = 0.27). Acute coronary artery occlusion produces changes in high-frequency QRS components, even in the absence of ST-segment deviation in the standard ECG. Further studies need to be carried out to evaluate whether analysis of high-frequency QRS components could provide a method for detecting myocardial ischaemia and give additional information to that available in the ST segment in the standard ECG.

Adult↗
PubMed1997

Analysis of abnormal intra-QRS potentials. Improved predictive value for arrhythmic events with the signal-averaged electrocardiogram.

BACKGROUND: Using the signal-averaged ECG (SAECG), this study developed a new electrical index for predicting arrhythmic events: abnormal intra-QRS potentials (AIQP). METHODS AND RESULTS: We studied 173 patients followed after myocardial infarction for a mean duration of 14 +/- 7 months. Sixteen arrhythmic events occurred, defined as sudden cardiac death, documented sustained ventricular tachycardia, or non-fatal cardiac arrest. Noninvasive indices of arrhythmia risk were measured, including AIQP, conventional SAECG, Holter, and left ventricular ejection fraction (LVEF). Abnormal intra-QRS potentials were defined as abnormal signals occurring anywhere within the QRS period. They were estimated with a lead-specific, parametric modeling method that removed the smooth, predictable part of the QRS. AIQPs are characterized by the remaining transient, unpredictable component of the QRS and manifest as low-amplitude notches and slurs. A combined XYZ-lead AIQP index exhibited higher specificity (95%) and predictive value (PV) (+PV, 47%; -PV, 94%) than the conventional SAECG in combination with Holter and LVEF (specificity, 89%; +PV, 25%; -PV, 93%). CONCLUSIONS: AIQP improved specificity and predictive value, compared with conventional tests, for prediction of arrhythmic events. AIQP emerged as the best noninvasive univariate predictor of arrhythmic events after myocardial infarction in this study. A review of several other reports shows that AIQP in the present study outperformed the conventional predictive indices reported in those other data sets.

Arrhythmias, Cardiac↗
PubMed1997

Time-frequency plane Wiener filtering of the high-resolution ECG: background and time-frequency representations.

This paper introduces the concept of a posteriori Wiener filtering (APWF), performed in the time-frequency plane. The objective is to improve the signal-to-noise ratio (SNR) of the ensemble-averaged high-resolution electrocardiogram (HRECG). APWF was developed to address the problem of a limited ensemble size for estimating ensemble-averaged evoked potentials. For the HRECG, we identify the major challenge as adapting the time-frequency structure of the filter to that of low-level cardiac signals. Technical limitations and the characteristics of HRECG signals make time-frequency analysis of the ensemble average problematic. Normal and abnormal signal components are difficult to distinguish due to low time-frequency energy concentration and limited spectrotemporal resolution. However, considering the entire ensemble of repetitive ECG records, signal and noise components are separable in the time-frequency plane. This forms the basis of the new time-frequency plane Wiener (TFPW) filter, applicable to any ensemble averaging problem involving repetitive deterministic signals mixed with uncorrelated noise.

Electrocardiography↗
PubMed1997

Time-frequency plane Wiener filtering of the high-resolution ECG: development and application.

The time-frequency plane Wiener (TFPW) filter is a new method, based on a posteriori Wiener filtering principles, to enhance the performance of ensemble averaging. This paper develops the mathematical aspects of the TFPW filter, and assesses its performance with elementary signals, such as sine waves and chirps, and authentic high-resolution electrocardiogram (HRECG) ensembles. The principal feature of the TFPW filter is its use of the time-frequency plane to accommodate signal nonstationarity. Using a posteriori computed statistics of the ensemble, the filter matches itself to the time-frequency structure of the signals to be estimated. The method is sufficiently general to be applicable to any class of repetitive signal with a deterministic time-frequency structure and additive noise in the ensemble. It is concluded that significant improvements in both estimated signal fidelity and noise reduction are possible with the TFPW filter, compared to conventional ensemble averaging.

Electrocardiography↗
PubMed1997

Analysis of abnormal signals within the QRS complex of the high-resolution electrocardiogram.

This paper presents a new, quantitative approach to measuring abnormal intra-QRS signals, using the high-resolution electrocardiogram (HRECG). These signals are conventionally known as QRS "notches and slurs." They are measured qualitatively and form the basis for the ECG identification of myocardial infarction. The HRECG is used for detection of ventricular late potentials (LP), which are linked with the presence of a reentry substrate for ventricular tachycardia (VT) after a myocardial infarction. LP's are defined as signals from areas of delayed conduction which outlast the normal QRS period. Our objective is to quantify very low-level abnormal signals that may not outlast the normal QRS period. In this work, abnormal intra-QRS potentials (AIQP) were characterized by removing the predictable, smooth part of the QRS from the original waveform. This was represented as the impulse response of an ARX parametric model, with model order selected empirically from a training data set. AIQP were estimated using the residual of the modeling procedure. Critical AIQP parameters to separate VT and non-VT subjects were obtained using discriminant functions. Results suggest that AIQP indexes are a new predictive index of the HRECG for VT. The concept of abnormal intra-QRS potentials permits the characterization of pathophysiological signals contained wholly within the normal QRS period, but related to arrhythmogenesis. The new method may have other applications, such as detection of myocardial ischemia and improved ECG identification of the site of myocardial infarction, particularly in the absence of Q waves.

Electrocardiography↗