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Biomedical subjects

V Popescu

Publications and source records attributed to V Popescu.

At least 19 recordsLinked to original sources

Virtual reality-based orthopedic telerehabilitation.

Rehabilitation interventions in remote areas are problematic because of distance and available resources. Orthopedic impairments acquired by individuals in remote areas can then lead to permanent disabilities/loss of function because of lack of appropriate rehabilitation. A system being developed by Rutgers and Stanford Universities provides therapy at the patient's home, with remote monitoring and periodic re-assessment. This telerehabilitation system uses virtual reality and haptic interfaces, and a pair of networked PCs. It is intended for rehabilitation of patients with hand, elbow, knee and ankle impairments. Data from the first patient treated with the telerehabilitation system is encouraging.

Exercise Therapy↗

Orthopedic rehabilitation using the "Rutgers ankle" interface.

A novel ankle rehabilitation device is being developed for home use, allowing remote monitoring by therapists. The system will allow patients to perform a variety of exercises while interacting with a virtual environment (VE). These game-like VEs created with WorldToolKit run on a host PC that controls the movement and output forces of the device via an RS232 connection. Patients will develop strength, flexibility, coordination, and balance as they interact with the VEs. The device will also perform diagnostic functions, measuring the ankle's range of motion, force exertion capabilities and coordination. The host PC transparently records patient progress for remote evaluation by therapists via our existing telerehabilitation system. The "Rutgers Ankle" Orthopedic Rehabilitation Interface uses double-acting pneumatic cylinders, linear potentiometers, and a 6 degree-of-freedom (DOF) force sensor. The controller contains a Pentium single-board computer and pneumatic control valves. Based on the Stewart platform, the device can move and supply forces and torques in 6 DOFs. A proof-of-concept trial conducted at the University of Medicine and Dentistry of New Jersey (UMDNJ) provided therapist and patient feedback. The system measured the range of motion and maximum force output of a group of four patients (male and female). Future medical trials are required to establish clinical efficacy in rehabilitation.

Adult↗

Virtual reality-based training for the diagnosis of prostate cancer.

Prostate malignancies are the second leading cause of cancer deaths among men. The most common method of detecting this disease is digital rectal examination (DRE). Current DRE training is inadequate, since the number of patients that students can practice on is limited. Furthermore, allied care personnel do not train in screening for prostate cancer. Finally, there is no objective way to follow the improvement in DRE skills for medical personnel. This paper presents a virtual reality-based simulator that addresses the above problems. The prototype consists of a PHANToM haptic interface which provides feedback to the trainee's index finger, a motion restricting board, and an SGI workstation, which renders the patient's anatomy. Four types of prostates were modeled--normal, enlarged with no tumor, incipient malignancy (single tumor), and advanced malignancy (tumor cluster). Human factors studies were conducted on both nonmedical students and urology residents in order to quantify the system usefulness. After only five minutes of training, nonmedical students had a 67% correct diagnosis rate of malignant versus nonmalignant cases. This compared with 56% for urology residents in the same trials. Subjective evaluation by the residents pointed out the need to improve the virtual prostate model realism. A control group formed of urology residents performed the same trials on a modified Merck Procar simulator. The control group scored significantly better (96% correct diagnosis of malignancies). We conclude that the virtual prostate palpation simulator, while promising, needs significant improvement in both model realism and haptic interface hardware.

Computer Simulation↗

PC-based telerehabilitation system with force feedback.

A PC-based orthopedic rehabilitation system was developed for use at home, while allowing for remote monitoring from the clinic. The home rehabilitation station has a Pentium II PC with graphics accelerator, Polhemus tracker, and a novel Multipurpose Haptic Control Interface with its own Pentium board. This interface is used to sample patient's hand positions and to provide resistive forces using the Rutgers Master II (RMII) glove. A library of virtual rehabilitation routines was developed using WorldToolKit software. At the present time, it consists of two physical therapy exercises (DigiKey and Ball) and two functional rehabilitation exercises (Peg Board test and Ball game). All VR exercises allow automatic and transparent patient data collection into an Oracle database. A remote Pentium II PC is connected with the home-based PC over the Internet and an additional video-conferencing connection. The remote computer running Oracle server is used to maintain the patient database, monitor progress and change exercise level of difficulty. This allows for timely patient progress monitoring and repeat evaluations over time from the Clinic. The system will soon start clinical trails at Stanford Medical School, with progress being monitored remotely from Rutgers University. Other rehabilitation haptic interfaces under development include devices for elbow, and knee rehabilitation connected to the Multipurpose Haptic Control Interface.

Computer Graphics↗

Computerized hand diagnostic/rehabilitation system using a force feedback glove.

This paper describes recent results of a unified computerized system for hand diagnosis and rehabilitation. Automatic diagnosis data collection and Virtual Reality rehabilitation exercises are the main characteristics of the system. The diagnosis subsystem includes a tactile sensing glove in addition to standard devices such as electronic dynamometer, pinchmeter and goniometer. Three standard rehabilitation exercises were simulated in a Virtual Reality environment, using the WorldToolKit graphics library. The first two exercises (ball squeezing and DigiKey) allow measurement of finger forces exerted during the rehabilitation routine. The third exercise (Peg board) involves the patient's visual-motor coordination. The rehabilitation subsystem uses a VPL DataGlove retrofitted with Rutgers Master (RM-I) and its interface. The exercises involve manipulation of objects with different stiffnesses and geometry. Grasping forces were modeled and fed back using the Rutgers Master worn on patient's hand. Data is gathered in real time from both diagnosis and rehabilitation subsystems. Finger specific forces recorded during rehabilitation exercises allow better diagnosis of the patient impairment. An ORACLE database is used to store and manipulate patients' records. Proof of concept trials were performed in a clinical environment. Some results of patient records analysis are presented in this paper. A new version of the system using an RM II haptic interface is presently under consideration.

Adult↗

AIDS-associated Kaposi's sarcoma in Romanian children.

BACKGROUND: Kaposi's sarcoma (KS) is commonly associated with the acquired immunodeficiency syndrome (AIDS) in adults. Little is known regarding its occurrence in children. OBJECTIVE: Our purpose was to report the clinical and epidemiologic characteristics of KS in three Romanian children with AIDS and to compare them with previously reported AIDS-associated KS in children. METHODS: This was a clinicopathologic study and computer-based literature review. RESULTS: All three Romanian children had skin involvement; two had involvement of lymph nodes and internal organs. All had acquired human immunodeficiency virus (HIV) infection postnatally. Including these children, 33 cases of AIDS-associated KS in children have been reported. Thirteen of 30 evaluable patients had acquired HIV infection postnatally; nine of these children (69%) had cutaneous involvement by KS. A perinatal route of transmission was present in the remaining 17 cases; only two of these children (12%) with KS had cutaneous involvement. No case was noted in which intravenous drug use was the sole parental HIV risk factor. CONCLUSION: The data support the contention that KS is caused by a second infectious agent prevalent only in certain HIV-infected populations. Children of parents in high-risk groups for KS and children who acquire HIV via contaminated blood or blood products are at highest risk for KS. The route of acquisition of HIV infection may also be associated with different clinical manifestations of KS in children.

Acquired Immunodeficiency Syndrome↗

[Infantile spasms (infantile myoclonic encephalopathy with hypsarrhythmia)].

The paper reports on a very important aspect in a pediatric practice, referring to one of the most severe forms of epilepsy of the infant, known in the modern specialty literature as infantile spasms. The paper reviews the etiologic data of the disease in its secondary form, with emphasis on the form of the disease better studied in the last years, i.e. the so-called infantile benign epileptic spasms. The paper also analyzes the clinical and electroencephalographic aspects, discuss the most important aspects of the differential diagnosis that includes some entities recently individualized and appreciates, on the basis of the most topical literature data, the nature of the different treatment means used, and of the evolution and prognosis.

Brain↗

[Pneumocystis carinii pneumonia].

The paper reports on a theme of important pediatric interest, pneumonia with Pneumocystis carinii (PC), a more widespread affection lately, due to the progress in pediatric reanimation, on the one hand (that allowed the survival for a long time of several biologically handicapped infants) and as a consequence of the more and more common use of immunosuppressing therapy, on the other hand (malignant diseases, transplant of organs, etc.); another important role in the increase of the PC pneumonia is played, recently, both in the adult and the child, by the infection with HIV (acquired immunodeficiency syndrome). The authors discuss largely on the pathogenic agent, PC, proved to be a fungus by molecular genetic studies, and on the biological field (small age, dystrophy, prematurity, "debilitating" chronic diseases, long diarrheic diseases, congenital malformations, hospitalization, some infections with long evolution: tuberculosis, Cryptococcus, infection with cytomegalic virus). The paper also deals with epidemiology, pathogeny and pathologic anatomy of the disease (characteristic macroscopic aspect: nonaired lung of high consistency, with whitish infiltrations alternating with congestive zones and the microscopic aspect of alveolo-interstitial pneumonia). The clinical picture includes the common form, met in the biologically handicapped infant and hypoergic hypoimmune form, appearing in all ages in immunodeficient subjects. Radiological examination, pulmonary scintigraphy and a series of laboratory data (with evidence of parasitic cysts) complete the clinical examination, making easier the diagnosis. The techniques of seroimmunological diagnosis offers great hope for the future. The positive diagnosis shows the clinical elements that suggest the presence of the disease, the contribution of the radiologic examination and mainly the presence of the parasite in the bronchitic secretions; the therapeutic response is a retroactive element in the positive diagnosis. The differential diagnosis is presented in detail. The paper concludes with a series of treatment schemes used, prophylaxis, evolution, complications and prognosis of the disease.

Child↗

[Staphylococcal pneumonia].

In spite of the great advances of the antibiotherapy and of the respiratory resuscitation techniques, the staphylococcal pneumonia continues to be one of the most severe bacterial pneumonias of the child, fact which may be explained not only by the poor immunogenic capacity of the infection, but especially by the virulence characteristics of the staphylococcus: necrotizing capacity, toxigenicity (complex), resistance to antibiotics, diffusion capacity of the infection (percontiguum or at distance), resistance to phagocytosis and bacterial lysis etc. The etiology (bacteriology and immunity), the epidemiological data (the disease represents 1/3 of the primitive bacterial pneumonias occurring during the first two years of life), data regarding the pathogenesis and the pathological anatomy are reviewed. The clinical picture, the radiological examination and the laboratory data are extensively analysed, after which the positive diagnosis, based on the correlation of anamnestic, clinical, radiological and bacteriological data, is discussed. Authors point out the contribution of the radiological examination that detects the typical lesions, the aspect of which changes characteristically very rapidly (from day to day), namely: aspect of frank pleurisy (common and very evocative), pyopneumothorax, pneumatocele, excavated staphylomas (abscesses), less frequently mediastinal pneumothorax or emphysema. The clinical differential diagnosis with a number of diseases: suppurative pneumonias, solitary pulmonary cyst, polycystic lung, infected pulmonary sequestration etc., and the radiological differential diagnosis with bilateral diffuse alveolar pulmonary opacities, excavated pulmonary opacities, images under the form of pulmonary "bullae" and "cysts" are discussed. The final part contains a detailed description of the treatment and its basic components: etiological (antibacterial) treatment, treatment by decompression and pleural drainage, resuscitation treatment, as well as of the course, complications and prognosis of staphylococcal pneumonia.

Child↗

Intratumoral ligation in the management of orofacial cavernous haemangiomas.

After a short comment on the essential data concerning the pathology, clinical aspects and treatment of orofacial haemangiomas, the author presents his own method of treatment by intratumoral ligation. He describes the technical details by which interception of the blood supply to the haemangioma is achieved and also breakdown of the angiomatous mass into segments by the occlusion of vascular channels, thus completely interrupting the intratumoral blood flow. Obstruction of vascular lumina, endothelial atrophy, blood clot organization in the small diverticula between them and also subsequent fibrous hyperplasia which take the place of the vascular hyperplasia ensue. The method was used in 31 cases of cavernous haemangioma in different sites; the results, with follow-up periods of 1-8 years prove its efficacy.

Adolescent↗

Bone resection, extra-corporal cryotherapy and immediate re-implantation in the treatment of mandibular tumours.

Two aspects have to be considered in the treatment of mandibular tumours: The eradication of the disease, and the maintenance of mandibular continuity to obtain a good functional and aesthetic result. The authors experimented with a cryo-surgical method which consists of mandibular hemiresection, extra corporal immersion of the specimen in liquid nitrogen at - 180 degrees C, followed by re-implantation of the mandibular body in its bed. In this way we achieved the eradication of the tumour and produced an auto-transplant for immediate bone grafting. The clinical and radiological progress of four patients with various mandibular tumours, followed-up for three years, is presented.

Adolescent↗

The effects of short-term exposure to crowding stress on the pancreatic islets morphology and glycemia in mice.

Behavior, pancreatic islets morphology and plasma glucose levels of male mice exposed for 2, 4, 24 and 48 hours to crowding stress were investigated. The crowding induced an intense turmoil state associated with enhanced irritability and aggressiveness among the specimens of all experimental groups. Violent fights occurred especially in the first 4--6 hours, generally with the death of 1--2 individuals from each group. The changes recorded in the pancreatic islets affected first (2 hours) exclusively the insulin-producing cells, and in subsequent intervals they progressively expanded over all cell types. The changes occurred during the experiment in all islet cell types; however the B-cells showed by far the most pronounced alterations irrespective of the studied time interval. Most changes suggested the stimulation of the entire gland secretory activity, but particularly of B-cells, which was also proved by low glycemia values recorded at 3 of the 4 crowding time intervals. On the other hand, some alterations, occurring first at 24 hours, were regarded as signs of a moderate B-cells secretory hypoactivity; they may partly support the slight hyperglycemia obtained at this time interval. The significance of the above short-term observations in the induction of glycoregulation disturbances, diabetes included, as well as the presumably mediation role of adrenal-cortex and -medulla hormones under stress conditions are discussed and correlated with findings reported in literature.

Animals↗