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Biomedical subjects

Scott Smith

Publications and source records attributed to Scott Smith.

At least 19 recordsLinked to original sources

CT lower extremity venography in suspected pulmonary embolism in the ED.

The purpose of this study was to evaluate the added benefit of computed tomography lower extremity venography (CTLV)--performed following CT pulmonary angiography (CTPA)--in the emergency department (ED) patient suspected of pulmonary embolism (PE). A retrospective review of 427 consecutive patients having both CTPA and CTLV performed to evaluate patients suspected of PE at two community hospitals was conducted. Three-month follow-up was performed on all patients to ensure that no case of PE or deep venous thrombosis (DVT) was missed. Forty patients were positive for PE, and 11 were positive for DVT. There were 6 CTPA studies read as indeterminate for PE and 11 CTLV studies indeterminate for DVT. Only 1 patient was positive for DVT, who did not have a concurrent PE identified by CTPA. The estimated charges for detecting the single case of isolated DVT was 206,400 US dollars. In our ED setting, the additional benefit of adding CTLV to the standard ED work-up of PE was minimal.

Costs and Cost Analysis↗

High-speed optical coherence tomography of laser iridotomy.

PURPOSE: To describe high-speed (4000 axial scans/s) optical coherence tomography (OCT) findings in a patient with narrow angles. DESIGN: Interventional case report. METHODS: A 56-year-old woman was found to have occludable narrow angles on OCT screening. This was confirmed by gonioscopy. Bilateral iridotomy was performed. Imaging of the angles was performed with a high-speed OCT prototype before and after iridotomy. RESULTS: OCT showed narrow angle bilaterally. Cornea, sclera, scleral spur, trabecula, iris, and iris recess were visualized. After iridotomy, the OCT showed reduction of iris concavity and patent iridotomies. Quantitative measurements of trabecula-iris space area on the OCT images showed widening of the angles to nonoccludable values. CONCLUSIONS: A 1.3-microm wavelength OCT allows noncontact quantitative assessment of the angle and may be useful in the management of narrow-angle glaucoma.

Diagnostic Techniques, Ophthalmological↗

Winning team.

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Cooperative Behavior↗

Safe sedation.

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Analgesics, Opioid↗

Working with cancer.

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Adaptation, Psychological↗

Veterans of quality.

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Hospital Restructuring↗

Development of an animal model of acetabular fractures.

A closed intraarticular fracture is a complex injury that consists of a physical disruption of the subchondral bone and articular surface, and an impaction injury to the articular surface that occurs at the time of the fracture. Few experimental models have been able to incorporate the elements of displaced articular fractures and blunt impaction injury to the articular surface. This work details the initial stages of an attempt to develop such model. Using a model of a dorsal wall fracture of the acetabulum in a goat, we have developed a bench-top method for assessing articular contact stress. Additionally, preliminary in vivo survival data are presented.

Acetabulum↗

Magnetic resonance fluoroscopy allows targeted delivery of mesenchymal stem cells to infarct borders in Swine.

BACKGROUND: The local environment of delivered mesenchymal stem cells (MSCs) may affect their ultimate phenotype. MR fluoroscopy has the potential to guide intramyocardial MSC injection to desirable targets, such as the border between infarcted and normal tissue. We tested the ability to (1) identify infarcts, (2) navigate injection catheters to preselected targets, (3) inject safely even into fresh infarcts, and (4) confirm injection success immediately. METHODS AND RESULTS: A 1.5-T MRI scanner was customized for interventional use, with rapid imaging, independent color highlighting of catheter channels, multiple-slice 3D rendering, catheter-only viewing mode, and infarct-enhanced imaging. MRI receiver coils were incorporated into guiding catheters and injection needles. These devices were tested for heating and used for targeted MSC delivery. In infarcted pigs, myocardium was targeted by MR fluoroscopy. Infarct-enhanced imaging included both saturation preparation MRI after intravenous gadolinium and wall motion. Porcine MSCs were MRI-labeled with iron-fluorescent particles. Catheter navigation and multiple cell injections were performed entirely with MR fluoroscopy at 8 frames/s with 1.7x3.3x8-mm voxels. Infarct-enhanced MR fluoroscopy permitted excellent delineation of infarct borders. All injections were safely and successfully delivered to their preselected targets, including infarct borders. Iron-fluorescent particle-labeled MSCs were readily visible on delivery in vivo and post mortem. CONCLUSIONS: Precise targeted delivery of potentially regenerative cellular treatments to recent myocardial infarction borders is feasible with an MR catheter delivery system. MR fluoroscopy permits visualization of catheter navigation, myocardial function, infarct borders, and labeled cells after injection.

Animals↗

Fryns "Anophthalmia-Plus" syndrome associated with developmental regression.

We report a boy with a nasal deformity, choanal atresia, bifid uvula, severe bilateral microphthalmia and a facial cleft who showed regression of development at the age of 2 years with subsequent improvement. We suggest he represents a further case of the rare Fryns "Anophthalmia-Plus" syndrome.

Abnormalities, Multiple↗

Prospective role for telemedicine as a communication tool for rural rehabilitation practice.

The current trend of cost containment in health care has prompted a search for innovative methods of providing the best quality care at the lowest possible cost. One method that has received much attention is the use of telemedicine to conduct evaluations at rural locations. There has been much research conducted in the area of telemedicine for radiology, and some other medical specialties, however there has been very little research examining the utilization of telemedicine for allied health, vocational rehabilitation, and Assistive Technology evaluations. In addition to providing an overview of telemedicine service delivery history and mechanisms, results of a focus group are discussed, and specific applications for the field of vocational rehabilitation are considered.

Journal Article↗

Logging injuries in Louisiana: nature, trends, and rehabilitation considerations.

Logging is a dangerous occupation, as documented through reported injuries and fatalities. Accidents in the logging industry account for pain, suffering, employee turnover, and high insurance costs. Worker injuries and high insurance costs, in addition to other factors, may be minimized and reduced through safety education and improved logging practices. Furthermore, the injured logger, or logger with a disability may return to logging or other employment through development of viable medical and vocational rehabilitation planing. This article addresses the economic impact of logging, reviews logging injuries, describes a safety program designed to reduce logging injures, discusses rehabilitation considerations for specific injuries, and outlines particular reemployment prospects for loggers with disabilities.

Journal Article↗

Effect of dorsal hip loading, sedation, and general anesthesia on the dorsolateral subluxation score in dogs.

OBJECTIVE: To determine whether dorsal loading of the pelvis and type of chemical restraint affected the dorsolateral subluxation (DLS) score of dog hips. STYDY DESIGN: In vivo testing of diagnostic method. ANIMALS: Labrador retrievers, Greyhounds, and crosses between both breeds (n = 119 dogs). METHODS: Dorsal load was applied to the hips through a strap that was placed over the hips, and the peak vertical and steady-state vertical, ground-reaction forces exerted on the stifles were measured in the DLS position. The DLS score was measured with their hips under dorsal load and compared with the DLS score without load. For 24 dogs, the DLS score was measured both under chemical restraint (medetomidine) and under general anesthesia. Wilcoxon-signed rank test and paired t test was used to compare effects of dorsal load and restraint method on the left and right DLS hip score, and P <.05 was considered significant. RESULTS: Both stifles together accepted median 15% body weight in the vertical plane in the unloaded steady state. Loading the hips increased the steady-state, vertical ground-reaction force to 34% body weight. At 8 months of age, loading significantly decreased the DLS score from 65% +/- 11% (mean +/- SD) to 60% +/- 12% for left hips and 66% +/- 11% to 63% +/- 13% for right hips. The left hip DLS score was affected by load more consistently than the right hip. In general, loading the hips decreased the DLS score in all breeds by 4% to 6% except for the greyhounds, in which the DLS score was unchanged by dorsal loading. When grouped by their DLS scores, load significantly decreased DLS scores in dogs with unloaded scores greater than 55% (nondysplastic), whereas DLS scores of dogs with unloaded scores between 55% and 45% (dysplastic) and less than 45% did not change significantly with load. Unloaded scores did not change significantly when compared under sedation versus general anesthesia. However, load significantly decreased the DLS score under general anesthesia for the left hip but not for the right hip. CONCLUSIONS: Less than half of the vertical ground-reaction force normally exerted by the hindlegs of a standing dog was sufficient to induce hip subluxation in the DLS position. Although dorsal loading approximately doubled the steady-state, vertical ground-reaction force, the decrease in the DLS score under load was never greater than 6%. Furthermore, the DLS scores of dogs most likely to be dysplastic (based on DLS scores <45%) were not affected by load, whereas load slightly decreased DLS cores of dogs with DLS scores greater than 55%. CLINICAL RELEVANCE: External influences can change the DLS score significantly, but the magnitude of change is unlikely to be of clinical importance, making the method useful as a field screening test for both dysplastic and nondysplastic hips in young dogs.

Anesthesia, General↗

S-adenosyl-L-methionine (SAMe) for the treatment of acetaminophen toxicity in a dog.

An 8-month-old, spayed female Shetland sheepdog presented 48 hours after ingesting acetaminophen (1 gm/kg body weight). On presentation, the dog was laterally recumbent and hypovolemic. The dog had brown mucous membranes, severe Heinz-body hemolytic anemia, bleeding tendencies, and a red blood cell (RBC) glutathione (GSH) concentration that was 10% of reference values, despite a regenerative erythroid response. Treatment with s-adenosyl-l-methionine (SAMe) as a GSH donor successfully rescued this dog, despite the animal's late presentation after drug ingestion. A loading dose (40 mg/kg body weight) of a stable SAMe salt per os was followed by a maintenance dose (20 mg/kg body weight) sid for 7 days. Additional therapeutic interventions included an intravenous (i.v.) infusion of one unit of packed RBCs (on admission), i.v. fluid support (3 days), and famotidine (7 days) to reduce gastric acidity. Sequential assessment of RBC GSH concentrations and RBC morphology documented response to antidote administration within 72 hours. This case suggests that SAMe may provide a therapeutic option for treatment of acetaminophen toxicosis in dogs capable of retaining an orally administered antidote and maintaining adequate hepatic function for metabolism of SAMe to its thiol substrates.

Acetaminophen↗