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At least 253 records · Page 14Linked to original sources

PubMed2003

Clinical experience using the computerized digital stapling system in open gastric bypass surgery for morbid obesity.

BACKGROUND: Roux-en-Y gastric bypass is currently the preferred method of surgical treatment for morbid obesity. Complications associated with this technique include anastomotic leaks and anastomotic strictures. Our technique employs a computerized digital stapling system (SurgASSIST). This stapling system has been utilized in affecting both the end-to-end gastrojejunostomy and end-to-side enteroenterostomy anastomoses. METHODS: SurgASSIST is a computerized stapling system consisting of a power console and a 2.13-meter flexshaft. Using a remote control, various stapling cartridges can be opened and closed, and the tip of the flexshaft can be steered in four directions prior to firing. Because the firing mechanism and force are generated away from the surgical field, torque applied to the anastomotic site is minimized. The system is designed to approximate tissue to the correct staple height, based on tissue thickness, which precludes excessive compression of the tissues. RESULTS: We have employed the SurgASSIST computerized digital stapling system in a series of 403 cases with 558 applications. We have experienced no anastomotic leaks. There were 7 strictures (1.7%) requiring balloon dilatation. There were no strictures requiring surgical intervention. CONCLUSION: Our extensive clinical experience using the SurgASSIST computerized digital stapling system has shown it to be a safe and effective method for performing stapled anastomoses.

Anastomosis, Roux-en-Y↗

PubMed1983

Prolonged animal observation by use of digitized videodisplays.

Quantitative assessment of animal behavior requires not only much time and good training, but is always dependent upon the interpretation of the observer. Therefore we employed a commonly-used microcomputer to analyze, without intervention of a human observer, the picture obtained via videocamera, a digitizer and disk-drive. The program, written in BASIC and listed in Appendix I, generates pictures of the monitored animal in the graphics of the computer. These pictures can be analyzed immediately or stored on disk for further analysis.

Analog-Digital Conversion↗

PubMed1993

Impact of a breast cancer screening community intervention.

BACKGROUND: Efforts to detect breast cancer in its early stages are necessary to reduce breast cancer-associated mortality. This study evaluated the impact of a multicomponent intervention implemented between 1987 and 1990 to increase a community's utilization of breast cancer screening by women over 50 years of age. METHODS: The study used a pretest/post-test two-community design, with one community assigned as the intervention community and the other as the comparison. The intervention consisted of a comprehensive physician involvement component and a community education effort. To assess the overall impact of the interventions, we measured women's participation in screening via random digit dial telephone surveys at three time points, each approximately 18 months apart. RESULTS: Over the course of the study, there were dramatic improvements in breast cancer screening participation in both communities. However, the intervention city showed more improvement in selected variables than did the comparison community in the early phases of the project between baseline and midpoint. These included increased advice by physicians to have mammograms, increased awareness that screening is necessary in the absence of symptoms, increased awareness that many women over 50 have mammograms, decreased perception of barriers to clinical breast exam, and an increase in the proportion of women having a clinical breast exam. In addition, significantly fewer women in the intervention city than in the comparison city reported never having had a mammogram at midpoint. CONCLUSIONS: The findings demonstrate limited impact of a community intervention during a period of increasing adoption of mammography screening, in part, due to this rapidly rising secular trend. Additionally, increased activities in the comparison community were documented. Therefore, as incidence of screening increases, targeted activities aimed at population subgroups are warranted, and evaluation designs need to include multiple comparison groups or broader geographic random samples.

Aged↗

PubMed2000

Haemodynamic evaluation of cerebral arteriovenous malformations by quantification of transit time using high speed digital subtraction angiography: basic considerations.

It is important to evaluate the haemodynamics of cerebral arteriovenous malformations (AVMs) in order to predict and avoid complications following surgical intervention. This study measured the transit time of each component of AVMs by high-speed digital subtraction angiography (DSA) to understand the haemodynamics and to evaluate which parameter is an appropriate indicator for the monitoring. Eleven cases of cerebral AVMs were studied. Haemodynamics were evaluated by analysis of tracer transit using DSA. Tracer transit parameters including transit time and peak time were calculated by application of gamma fitting to time density curve, and measured in the following compartments; feeding artery, nidus and draining vein. Significant correlations of tracer transit parameters were present among compartments. Although there was no significant correlation of nidus volume and tracer transit parameters, the peak time was shorter in haemorrhage cases than in non-haemorrhage cases. Measurements of tracer transit parameters by high-speed DSA may be a useful tool for characterising and monitoring the haemodynamics of AVMs following surgical intervention.

Adolescent↗

PubMed2005

Bilateral symmetry of the human metacarpal: implications for sample size calculations.

OBJECTIVE: The aim of this study was to assess the three-dimensional mechanical symmetry of the human second metacarpal and provide sample size estimates for future mechanical intervention studies of the metacarpal. DESIGN: Bone densitometry and digital image analysis were used to assess the morphometric, geometric and densitometric symmetry of the second human metacarpal. BACKGROUND: An assessment of the left-right mechanical symmetry of the human metacarpal is important in considering the suitability of using the contralateral metacarpal as a control and in providing sample size calculations for future studies involving a mechanical intervention to the metacarpal such as implantation of a metacarpophalangeal prosthesis. METHODS: Metaphyseal sectional areas, diaphyseal cortical sectional areas, second moments of area, average periosteal and medullary radii and bone densities were measured at nine transverse levels for each of seven pairs of index metacarpals using computed tomography and bone densitometry. Polar Fourier regression was used to assess the morphometry of sectional periosteal and endosteal boundaries. Differences between clinically important left-right parameters were assessed. RESULTS: Mean differences between clinically important left-right parameters were small (<3%) and similar to the degree of experimental precision. There were strong significant left-right correlations for the morphometric, geometric and densitometric parameters considered, indicating a high degree of bilateral mechanical symmetry. CONCLUSIONS: The contralateral bone is a suitable control for mechanical intervention studies of the human metacarpal, and the use of bilateral pairing results in an important reduction in sample size. RELEVANCE: Responses to mechanical interventions on the human metacarpal, such as implantation of a metacarpophalangeal prosthesis, are generally unknown. The degree of left-right mechanical symmetry in the human metacarpal provides a measure of the advantage of using paired design studies to address these questions.

Anatomy, Cross-Sectional↗

PubMed2002

Teledermatology's impact on time to intervention among referrals to a dermatology consult service.

The aim of this study was to determine if a teledermatology consult system, using store-and-forward digital imaging technology, results in patients achieving a shorter time from referral date to date of initial definitive intervention when compared to a traditional referral process. Patients being referred to the dermatology consult service from the primary care clinics at the Durham VA Medical Center were randomized to either a teledermatology consultation or usual care. A usual care consultation consisted of a text-based electronic consult request. A teledermatology consultation included digital images and a standardized history, in addition to the text-based electronic consult. Time to initial definitive intervention was defined as the time between referral date and the date the patient was scheduled for a clinic visit for those patients that the consultant requested a clinic-based evaluation, or the time between referral date and the date the consult was answered by the consultant if a clinic visit was not required. Patients in the teledermatology arm of the study reached a time to initial definitive intervention significantly sooner than did those patients randomized to usual care (median 41 days versus 127 days, p = 0.0001, log-rank test). Additionally, 18.5% of patients in the teledermatology arm avoided the need for a dermatology clinic-based visit compared to zero patients avoiding a dermatology clinic visit in the usual care arm of the study (p < 0.001, z-test). Teledermatology consult systems can result in significantly shorter times to initial definitive intervention for patients compared to traditional consult modalities, and, in some cases, the need for a clinic-based visit can be avoided.

Aged↗

PubMed1999

[Digital subtraction angiography with carbon dioxide--basic principles, technique and clinical application].

Carbon dioxide digital subtraction angiography Carbon dioxide (CO2) digital subtraction angiography offers the possibility for diagnostic and interventional angiographic procedures in high risk patients for ionidated contrast material. As a gaseous contrast agent its physicochemical properties have special requirements concerning the radiologists knowledge, the X-ray equipment, the injector and the catheters. This article reviews the current literature concerning the history, physics and physiology, indications and contraindications, clinical use, adverse effects and possible complications of carbon dioxide digital subtraction angiography.

Angiography, Digital Subtraction↗

PubMed2005

Detection of foreign bodies of the head with digital volume tomography.

OBJECTIVES: Foreign bodies occur as a sequela of trauma or therapeutic interventions. If the risks are not too high, therapy of choice is the removal of the foreign body. This is only possible if the existence of a foreign body is detected and it is localized accurately. METHODS: The suitability of digital volume tomography (DVT) for the detection and localization of foreign bodies was investigated. Samples of various materials that are typically found as foreign bodies in the head and neck region were used. RESULTS: All materials investigated are principally detectable with DVT. Highly radiopaque material was detectable down to small sizes. The detectability of less radiopaque substances like wood and resins was poor when located in soft tissue. CONCLUSION: DVT is an appropriate tool for the detection of radiopaque foreign bodies. However, foreign bodies made of wood and resin, although detectable by DVT, can be missed when located in muscular tissue. The detectability decreases further when the foreign body is located adjacent to a highly radiopaque tissue like bone. This has to be taken into consideration when using DVT for foreign body detection.

Contrast Media↗

PubMed2026

User Engagement and Feature Preferences in an AI-Powered mHealth Intervention for Diabetes Prevention: Secondary Analysis of a Randomized Controlled Trial.

BACKGROUND: Prediabetes is highly prevalent and increasing globally, yet lifestyle interventions remain underused. AI-driven mobile health (mHealth) tools can help scale diabetes prevention efforts, but the key factors driving their success are not well understood. OBJECTIVE: This post hoc secondary analysis of a randomized controlled trial (RCT) aimed to characterize the most valued features and the role of user engagement in outcomes of a fully automated mHealth intervention for diabetes prevention. METHODS: Data from 151 participants with prediabetes and overweight or obesity who were assigned to an AI-based diabetes prevention program (Sweetch) in a parent RCT (NCT05056376) were analyzed. Engagement (defined as the total number of days the app was used) was categorized into tertiles (low, medium, and high). Baseline characteristics were compared across engagement groups using ANOVA, Kruskal-Wallis, and chi-square tests, and regression models assessed the association between engagement and achievement of diabetes risk reduction outcomes (≥5% weight loss, ≥4% weight loss with ≥150 min/week of physical activity, or ≥0.2 percentage point reduction in hemoglobin A1c [HbA1c] at 12 months). Perceived usefulness of intervention features was surveyed at 12 months. RESULTS: Median engagement was 98 (IQR 34-232) days. Older age (P<.001) and lower baseline BMI (P=.04) were significantly associated with higher engagement. Compared with low engagement, high engagement was associated with greater odds of achieving the composite diabetes risk reduction outcome (odds ratio [OR] 2.59, 95% CI 1.11-6.01; P=.03), ≥5% weight loss (OR 3.31, 95% CI 1.16-9.42; P=.03), and ≥0.2 percentage point reduction in HbA1c (OR 3.57, 95% CI 1.19-10.75; P=.02). Participants most frequently rated weight tracking, physical activity tracking, and the digital body weight scale as the features that were most helpful for achieving their health goals. CONCLUSIONS: Higher engagement with an AI-driven intervention requiring no human intervention was associated with improved diabetes risk reduction. Contrary to concerns about lower digital literacy, older adults engaged with the intervention more than younger adults. Features related to weight and physical activity tracking were most valued by patients in the program. TRIAL REGISTRATION: ClinicalTrials.gov NCT05056376; https://clinicaltrials.gov/study/NCT05056376.

Humans↗

PubMed1991

Technical and therapeutic aspects of dynamic stereotactic radiosurgery.

A treatment procedure that results in a uniform dose in a single fraction over the entire treatment volume while minimizing the dose to other tissues has been developed to treat intracranial lesions such as arteriovenous malformations (AVMs). This technique is called dynamic stereotactic radiosurgery. Its main characteristic is simultaneous and continuous gantry and couch motion during the treatment procedure. It employs an isocentrically mounted linear accelerator as the source of radiation. Target localization is determined by digital subtraction angiography and CT. From results obtained in other centres, this technique has shown that an AVM less than 2.5 cm in diameter has an 85% chance of being completely obliterated within two years after a single treatment of stereotactic radiosurgery. This technique is suitable for those patients with inoperable, surgically inaccessible lesions, or whose current medical profile shows them to be high-risk candidates for surgical intervention.

Angiography, Digital Subtraction↗

PubMed1990

Classification and treatment of postburn metacarpophalangeal joint extension contractures in children.

Two hundred and seventy-eight surgically treated postburn metacarpophalangeal joint extension contractures in children were reviewed. A classification system based on the limitation of passive metacarpophalangeal flexion was devised to direct surgical intervention and assess postoperative results. Type I (47%) digits demonstrated greater than 30 degrees of metacarpophalangeal flexion with the wrist fully extended, and scarring was generally limited to the dorsal skin. Type II (34%) digits demonstrated less than 30 degrees of metacarpophalangeal flexion with the wrist maximally extended, and scarring typically involved skin, dorsal apparatus, and metacarpophalangeal capsule. Type III (19%) digits were fixed in greater than 30 degrees of metacarpophalangeal hyperextension and often demonstrated incongruity or dorsal subluxation of the metacarpophalangeal joint. Improvement after reconstruction was seen in 95% of type I digits, 73% of type II digits, and 47% of type III digits. Failure to improve usually resulted from inadequate scar release/excision or from failure to release deep soft tissues (dorsal apparatus or metacarpophalangeal capsule). Thirty secondary procedures were done to improve an unsatisfactory result after the initial reconstruction. These included deep releases, metacarpophalangeal joint arthrodeses, and amputations. The ring and small fingers accounted for 65% of the digits in this study, 68% of the failures, and all seven amputations.

Adolescent↗

PubMed2006

Intraoperative brain ultrasound: a new approach to study flow dynamics in intracranial aneurysms.

The aim was to evaluate the potential of contrast-enhanced ultrasound to visualize the hemodynamics in intracranial aneurysms during neurosurgical intervention and to quantify the ultrasound data using digital particle image velocimetry (DPIV) technique. Aneurysms were scanned through the intact dura mater, preclipping and again postclipping after closure of the dura. After intravenous injection of Optison, angio-like views of the vascular tree surrounding the aneurysm, including the aneurysm sac, were obtained. Single ultrasound contrast agent microbubbles could be visualized in the aneurysm sac and the flow dynamics could be assessed in vivo. Spatial and temporal distributions of the velocity in the aneurysm and in the parent vessels were measured with DPIV using the backscattered signals from the microbubbles. Subsequently, the fluid stresses, vorticity, circulation, etc., were calculated from the velocity fields. We demonstrate in this paper that intraoperative contrast-enhanced ultrasound can be used to quantify the flow dynamics within an aneurysm.

Albumins↗

PubMed1995

Validation testing of the spacelabs PC2 ST-segment analyzer.

OBJECTIVES: Recent studies have demonstrated that perioperative myocardial ischemia, detected by electrocardiography, is a risk factor for myocardial infarction. ST-segment analyzers and hemodynamic monitors may be useful for on-line detection in perioperative and critical care environments. However, independent performance and accuracy standards for these devices have not been established. Therefore, a testing protocol was developed using an electrocardiogram (ECG) simulator that allowed selectively altered ST-segment displacement, in a calibrated fashion over a wide range. DESIGN: Laboratory bench study. SETTING: Not applicable. PARTICIPANTS: Not applicable. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: Custom digital ECG waveform templates were programmed for use with a commercially available ECG simulator (M311 ECG simulator; Fogg Systems, Inc., Aurora, CO). For each template, ST-segment morphology (horizontal elevation or depression, downsloping depression), QRS duration, and the presence or absence of a P wave were manipulated, resulting in seven different QRS shapes. Within each shape, the degree of ST-segment deviation was altered over a wide range. A PC2 Bedside Monitor (SpaceLabs Inc., Redmond, WA) was tested. One hundred forty-eight measurements of ST-segment deviation input from the simulator were made at each of two testing sessions. The first ST-segment value displayed by the analyzer was recorded, and the two measurements averaged for comparison. Placement of the J-point, J + 60 msec, and isoelectric reference points by the analyzer were evaluated. Simulator output was validated for accuracy and stability. Subtle errors in placement of the J-point marker were observed in all seven QRS shapes. These errors usually did not alter placement of the isoelectric marker before, but not exactly at the beginning of, the R-wave upstroke. Thus, ST-segment values returned by the monitor (J + 60 msec - isoelectric reference value) were unaffected. However, in two QRS shapes, the isoelectric point was displaced onto the upstroke of the R wave, resulting in erroneous ST-segment values. In one, the error may have been caused by the difference in QRS duration of that template (120 msec) relative to the fixed 115-msec interval from the J point used by the analyzer and was present in all points tested. In the second (normal QRS duration), the error was present in some, but not all points tested (4/21, 24%). All QRS shapes with proper placement of the isoelectric point returned ST-segment values within +/- 0.5 mm of expected, and 98% were within +/- 0.25 mm of expected. The mean difference between observed and expected ST-segment values for 100 measurements with normal QRS duration and proper isoelectric point placement was 0.08 mm +/- 0.07 mm (SD). CONCLUSIONS: The bench results suggest that visual confirmation of ST-segment analyzer values may be advisable in the clinical setting. Although most complexes with normal conduction and a P wave are likely to be accurately analyzed, those with prolonged QRS duration were problematic. The simulator protocol may be helpful in ensuring accuracy of ST-segment analyzers, especially in their early development stages.

Calibration↗

PubMed2001

Truly hybrid interventional MR/X-ray system: investigation of in vivo applications.

RATIONALE AND OBJECTIVES: The purpose of this study was to provide in vivo demonstrations of the functionality of a truly hybrid interventional x-ray/magnetic resonance (MR) system. MATERIALS AND METHODS: A digital flat-panel x-ray system (1,024(2) array of 200 microm pixels, 30 frames per second) was integrated into an interventional 0.5-T magnet. The hybrid system is capable of MR and x-ray imaging of the same field of view without patient movement. Two intravascular procedures were performed in a 22-kg porcine model: placement of a transjugular intrahepatic portosystemic shunt (TIPS) (x-ray-guided catheterization of the hepatic vein, MR fluoroscopy-guided portal puncture, and x-ray-guided stent placement) and mock chemoembolization (x-ray-guided subselective catheterization of a renal artery branch and MR evaluation of perfused volume). RESULTS: The resolution and frame rate of the x-ray fluoroscopy images were sufficient to visualize and place devices, including nitinol guidewires (0.016-0.035-inch diameter) and stents and a 2.3-F catheter. Fifth-order branches of the renal artery could be seen. The quality of both real-time (3.5 frames per second) and standard MR images was not affected by the x-ray system. During MR-guided TIPS placement, the trocar and the portal vein could be easily visualized, allowing successful puncture from hepatic to portal vein. CONCLUSION: Switching back and forth between x-ray and MR imaging modalities without requiring movement of the patient was demonstrated. The integrated nature of the system could be especially beneficial when x-ray and MR image guidance are used iteratively.

Animals↗

PubMed2003

Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer's disease.

OBJECTIVES: To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD). DESIGN: Cross-sectional intervention study with subjects serving as their own controls. SETTING: Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center. PARTICIPANTS: Twenty-eight patients diagnosed with probable AD. INTERVENTION: Performance of a cognitive task (repeating random digits) while walking. MEASUREMENTS: Neuropsychological measures including clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini-Mental State Examination, the measures of dementia severity. Gait speed and stride-to-stride variability of gait rhythm were measured, once during normal walking and once during dual-task walking. RESULTS: During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual-task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single-task walking measures of gait. CONCLUSION: Divided attention markedly impairs the ability of patients with AD to regulate the stride-to-stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.

Aged↗

PubMed2002

Sensory motor retuning: a behavioral treatment for focal hand dystonia of pianists and guitarists.

OBJECTIVE: To evaluate the long-term effectiveness of sensory motor retuning (SMR), a new treatment for focal hand dystonia in musicians. DESIGN: Prospective case series with an (adventitious) comparison group with 3- to 25-month follow-up in piano and guitar and 0- to 4-month follow-up in flute and oboe players. SETTING: General community in Germany. PARTICIPANTS: Eleven professional musicians. INTERVENTION: Immobilization by splints of 1 or more digits other than the focal dystonic finger. This finger carried out repetitive exercises in coordination with 1 or more of the other digits for 1(1/2) to 2(1/2) hours a day for 8 consecutive days under therapist supervision. The subjects then were instructed to continue practice for 1 hour daily for 1 year. MAIN OUTCOME MEASURES: Spectral analysis of the output of a dexterity-displacement device that continuously recorded digital displacement during finger movements and a dystonia evaluation scale on which patients rated how well they had just performed dystonic movement sequences and repertoire passages. RESULTS: The 3 wind players (adventitious placebo controls) did not improve substantially. However, each pianist and guitarist showed marked and significant improvement in spontaneous repertoire performance without the splint. The first subject is now 25 months posttreatment. CONCLUSIONS: Results suggest that SMR is of value for the treatment of focal hand dystonia in pianists and guitarists.

Adult↗

PubMed1986

Early surgical intervention in Apert's syndactyly.

The hand deformities in Apert's syndrome are among the most complex congenital hand problems to reconstruct due to the skeletal malalignment, symphalangism, and progressive functional deficits with growth. Ten children with Apert's syndactyly underwent early surgical intervention (mean age 8.4 months) as part of a staged program of digital separation leading to completion of both hands by the age of 2 years. The incidence of major complications was low, rate of revision (18 percent) acceptable, and the aesthetic result very satisfactory. Long-term functional results tend to reflect the effect of progressive intrinsic disease despite preservation of skeletal alignment and digital form with growth. However, the aesthetic improvement and potential for greater functional gains at a young age support the concept of early surgical intervention in this syndrome.

Acrocephalosyndactylia↗

PubMed2004

Vestibular schwannoma growth rates in neurofibromatosis type 2 natural history consortium subjects.

OBJECTIVE: To determine the amount of growth in vestibular schwannomas in Neurofibromatosis type 2 (NF2) patients from diagnosis through short-term (up to 2 yr) and long-term (up to 4 yr) follow-up. STUDY DESIGN: Retrospective magnetic resonance imaging (MRI) films were obtained on subjects enrolled in the NF2 Natural History study and examined for changes in vestibular schwannoma size over time. SETTING: Data were collected from nine foreign and domestic NF2 centers, including hospital-based, academic, and tertiary care centers. SUBJECTS: NF2 patients with MRI data and at least one follow-up examination within 9 months to 2 years of diagnosis were included; n=56 patients with 84 lesions for evaluation of growth. INTERVENTION: Routine, clinically obtained, magnetic resonance images were digitized and measured using image management software. Short-term follow-up was defined as up to 2 years (n=84 lesions), and long-term follow-up was defined as 3 to 4 years (n=29 lesions). OUTCOME MEASURES: Vestibular schwannoma size was assessed using anterior-posterior, medial-lateral, and greatest diameter linear measurements. RESULTS: Vestibular schwannomas increased in size (at least 5 mm) in 8% of the vestibular schwannomas across short-term follow-up. At long-term follow-up, 13% of the tumors had increased in size. On average, schwannomas increased in greatest diameter 1.3 mm per year across short-term follow-up. CONCLUSION: Slightly greater than 1 in 10 diagnosed NF2-related vestibular schwannomas increased in size by at least 5 mm by 4 years of follow-up, if still untreated at that time.

Adult↗