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At least 253 records · Page 14Linked to original sources

Use of a combined right ventricular ejection fraction-oximetry catheter system for coronary bypass surgery.

OBJECTIVE: To evaluate the reproducibility and accuracy of a new pulmonary artery catheter system that provides both right ventricular ejection fraction and continuous venous oxygen saturation monitoring. DESIGN: Criterion standard study. SETTING: University medical center. PATIENTS: A consecutive sample of ten patients undergoing elective coronary artery bypass surgery provided informed consent for the study. Exclusion criteria included emergency surgery or clinically important preoperative tricuspid regurgitation as assessed by echocardiography. None of the patient sample was excluded. MEASUREMENTS: Catheter-derived mixed venous and arterial oximetry data were compared with simultaneous values obtained using conventional laboratory cooximetry methods. Measurements were performed before cardiopulmonary bypass and intermittently up to 48 hrs after cardiopulmonary bypass. The variability of cardiac output and computed right ventricular ejection fraction was also assessed concurrently with the oximetry analysis. RESULTS: A significant correlation was observed for mixed venous oxygen saturation between catheter-derived and laboratory cooximetry data (r2 = .81, p < .01). Similarly, arterial oxygen saturation values obtained from pulse oximetry and laboratory values were significantly related (r2 = .81, p < .01). The coefficient of variation for each set of five repeated measurements for cardiac output was 8%, and for computed right ventricular ejection fraction, it was 16%. CONCLUSIONS: The combined catheter system provides the means to monitor both mixed venous oxygen saturation and right ventricular ejection fraction. These data provide a reliable and detailed assessment of cardiopulmonary function that should prove beneficial in the critical care setting.

Aged↗

Significance of gated equilibrium radionuclide ventriculography in quantification and follow up of valvular regurgitation.

In order to evaluate the significance of gated equilibrium radionuclide ventriculography (RNV) for non invasive quantification of valvular regurgitation and follow up, various approaches were tested concerning accuracy and reproducibility. By using in vitro labeling of red blood cells and extending the acquisition time, a clear reduction of dispersion was obtained in patients without valvular insufficiency. Quantification of regurgitation directly from functional images (ventricular amplitude or stroke volume image) was clearly superior compared to the variable region of interest method. Employing functional images, reproducibility between two observers and between two independent measurements was excellent. Correlation to regurgitation values determined by cardiac catheterization was only moderate with all RNV approaches tested. RNV is limited in the absolute quantification of valvular regurgitation due to the variable overlap of right atrium and right ventricle. However, because of its high reproducibility, RNV is a non invasive technique suitable for intraindividual follow up of patients with valvular insufficiency.

Adult↗

[Verbal memory disorders in local lesions of the right and left hemispheres].

Disturbances of verbal memory were examined in patients with local cerebral affections. The patients were asked to reproduce triads of words selected with regard to their semantic (situation or synonymic associations) or sensor (phonetic association) similarity. The ability to reproduce the triads was found to be different depending on the kind of the triads and the pathological focus localization. Patients with the pathological focus in the posterior divisions of the left hemisphere could hardly reproduce the triads of the semantically-similar words, while those with the pathological focus in the posterior divisions of the right hemisphere had difficulties in reproducing the triads of the phonetically-similar words. There were no differences as regards the triad type in patients with the pathological focus localization in the frontal divisions of the left hemisphere. A problem of multi-channel coding of the information for its processing and storage is discussed.

Brain Diseases↗

Validation of noninvasive assessment of coronary flow velocity reserve in the right coronary artery. A comparison of transthoracic echocardiographic results with intracoronary Doppler flow wire measurements.

AIMS: Assessment of coronary flow velocity reserve (CFR) noninvasively using transthoracic Doppler echocardiography (TDE) is validated for the left anterior descending artery only. We evaluated the feasibility and reproducibility to assess CFR using TDE in the right coronary artery, and compared the results with intracoronary Doppler flow wire (DFW) measurements. METHODS AND RESULTS: Introduction of a modified apical 2-chamber view allows visualization of the posterior descending branch of the right coronary artery (RPD). 42 consecutive patients (31 men, mean age 61+/-10) with suspected coronary artery disease scheduled for coronary angiography underwent CFR assessment using TDE in fundamental imaging mode; the results were compared with DFW measurements. CFR could be taken noninvasively in 81% (34/42); in case of right dominant- or balanced coronary circulation type success rate was significantly higher (87%; 33/38) than in case of left dominant coronary circulation (25%; 1/4). Correlation between echocardiographically and intracoronary derived CFR results was significant (r=0.85, P<0.0001), as well as reproducibility (r=0.94, P<0.0001) and interobserver variability (r=0.78, P<0.0001). CONCLUSION: Coronary flow reserve assessed in the peripheral RCA by TDE concurs very closely with intracoronary Doppler flow wire CFR results. This new approach allows feasible, accurate and reproducible measurement of CFR in the RCA.

Adult↗

Geometry and reproducibility in 360 degrees fundoplication.

BACKGROUND: In this study, we set out to precisely define two symmetrical points-a on the anterior fundic wall and b on the posterior fundic wall. These points, when advanced around a 60-Fr bougie-filled esophagus, will meet on the right side, to the right of the anterior vagus nerve, to create a reliable, reproducible, loose (i.e., or "floppy") 360 degrees fundoplication (FP). METHODS: For the terms of this study, circumference = c; diameter = d; c/d = pi; pi = 3.14; and d(cm) = Fr/30. Using a flexible plastic ruler, we measured, in cadavers (n = 5) and intraoperatively (n = 16), esophageal c at the gastroesophageal junction (GEJ) with a 60-Fr bougie in place; d was calculated from c. RESULTS: The smallest measured value for c was 7.5 cm (d = 2.39 cm); the largest value for c was 10.0 cm (d = 3.18 cm). The mean value was 8.35 cm (d = 2.66 cm). Points a and b are established by measuring laterally from a point where the greater curve meets the GEJ in the bougie-filled esophagus. Point a is 6.0 cm laterally and 6.0 cm below the short gastric vessels on the anterior fundus; point b is 6.0 cm laterally in a symmetrical position on the posterior fundus. Connecting these three points as a line defines the inner c of the completed FP and measures 12.0 cm. This gives an internal d of 3.82 cm for the FP. This is >1 cm larger than d for the mean measured external esophageal c of 8.35 cm where d = 2.66 cm. This technique creates a correctly oriented, symmetrical, "floppy," true fundoplication. It avoids wrapping or twisting the fundus around the GEJ. The technique is easily taught and reproducible. CONCLUSIONS: Two points, measured a horizontal distance of 6.0 cm from the GEJ, symmetrically placed on the anterior (point a) and posterior (point b) fundus can be brought anterior (a) and posterior (b) to the esophagus and sutured to the right of the anterior vagus nerve to reliably and reproducibly create a "floppy" 360 degrees fundoplication.

Esophagus↗

Cortical modulation of whole body movements in brain-damaged patients.

The aim of the present study was to assess whether the consistent bias in reproducing distances and lengths on visual tasks that characterizes hemispatial neglect is also present when whole body displacements have to be calculated and reproduced. Two different experiments were proposed to participants with right brain lesions and neglect syndrome (RN+), right (RN-) and left brain lesions (LN-) without neglect and to participants without brain damage (C). In Experiment 1, participants actively reproduced passive linear displacements in the same or in a different direction. This task could be performed using only vestibular and somatosensory input, since no relevant visual input was available. In Experiment 2, relevant visual information had to be integrated with vestibular and somatosensory information in order to make the active reproduction. In Experiment 1, all brain-damaged groups reproduced the horizontal displacements similarly to the control group and without any spatial asymmetry. In Experiment 2, when vestibular, somatosensory and visually remembered information was required to produce an integrated mental representation, RN+ processed contralesional displacements differently from ipsilesional ones. Rectilinear displacements of the whole body in space were not affected by focal left and right brain lesions, suggesting that the computation of nonvisual information can be accomplished by brain structures different from those involved in spatial visual processes. However, when body displacements in space required a mental representation based on visual and nonvisual sensory information, a significant asymmetry appeared only in patients with hemispatial neglect. Some attempts are made to identify the neural substrates involved in this integration.

Aged↗

The effectiveness of immobilization during prostate irradiation.

PURPOSE: To evaluate the effect of a hemibody foam cradle on the reproducibility of patient setup during external beam radiation treatment of prostate cancer. METHODS AND MATERIALS: Between January 1992 and April 1993, 74 patients received external beam radiation treatment to the prostate +/- nodes, generally with a four-field box technique. Forty-four of the 74 patients had a custom-made hemibody foam cast used in an attempt to improve setup accuracy. A review of the routine weekly port films was performed following the completion of therapy to determine the reproducibility of patient setup in all 74 patients. The physician's request of an isocenter shift was used as an indicator of reproducibility. Neither the treating technologists nor the physicians knew at the time the films were taken that the port films would be reviewed for setup reproducibility at a later date. The results were compared between the patients treated with (44) and without (30) an immobilization device. RESULTS: In the 44 immobilized patients, 213 routine checks of the isocenter were performed during the 7-week course of radiation therapy. In 17.4% of these instances (37 out of 213), an isocenter shift was requested. This rate is compared to 23.1% (30 out of 130) in the 30 patients who did not have the immobilization device (p < 0.2). There was a statistically significant reduction in isocenter shifts requested in the anterior to posterior direction in the patients who were immobilized, 5.1% (9 out of 175) vs. 12.6% (13 out of 103) (p < 0.05, two tailed chi-square test). There was no significant improvement in the reproducibility of isocenter placement in the cephalad to caudal or right to left directions. CONCLUSIONS: This custom-made hemibody foam cradle appears to improve the reproducibility of patient setup during the 7-week course of fractionated external beam irradiation for patients with adenocarcinoma of the prostate. This type of immobilization device is now routinely used in our clinic and is recommended for all patients receiving pelvic radiotherapy. These devices are likely to be particularly useful when contemplating dose escalation to minimize the volume of bladder and rectum included in the treatment fields.

Adenocarcinoma↗

A three-site programmed electrical stimulation protocol in patients with and without ventricular tachyarrhythmias.

Programmed electrical stimulation (PES) of the ventricle plays an important role in diagnosis and in testing the effect of pharmacological and non-pharmacological therapy of ventricular tachyarrhythmias. A stimulation protocol should reliably reproduce clinical ventricular tachyarrhythmia. The authors compared the results of the standard one-site protocol to those of a new test delivering extrastimuli alternately into the right and left ventricle. In group I (control group, n = 37), clinically without ventricular tachycardia, tachycardia could not be induced in any of the patients. In group II (n = 30), with clinical ventricular tachycardia, inducibility was in 22 patients using the standard test, and in 23 patients using the new test. The authors conclude that this modification of the PES protocol with alternate extrastimulus delivery into the right and left ventricle does not seem to contribute significantly to PES sensitivity compared to the standard one-site stimulation protocol. It is not clear whether or not another stimulation protocol with alternate stimulus delivery to both ventricles or to different sites in the right ventricle will raise the sensitivity, specificity and reproducibility of the PES test.

Amiodarone↗

Planar imaging versus gated blood-pool SPECT for the assessment of ventricular performance: a multicenter study.

UNLABELLED: Gated blood-pool SPECT (GBPS), inherently 3-dimensional (3D), has the potential to replace planar equilibrium radionuclide angiography (ERNA) for computation of left ventricular ejection fraction (LVEF), analysis of regional wall motion (RWM), and analysis of right heart function. The purpose of this study was to compare GBPS and ERNA for the assessment of ventricular function in a large, multicenter cohort of patients. METHODS: One hundred seventy-eight patients referred in the usual manner for nuclear medicine studies underwent ERNA followed by GBPS. Each clinical site followed a GBPS acquisition protocol that included 180 degrees rotation, a 64 by 64 matrix, and 64 or 32 views using single- or double-head cameras. Transverse GBPS images were reconstructed with a Butterworth filter (cutoff frequency, 0.45-0.55 Nyquist; order, 7), and short-axis images were created. All GBPS studies were processed with a new GBPS program, and LVEF was computed from the isolated left ventricular chamber and compared with standard ERNA LVEF. Reproducibility of GBPS LVEF was evaluated, and right ventricular ejection fraction (RVEF) was computed in a subset of patients (n = 33). Using GBPS, RWM and image quality from 3D surface-shaded and volume-rendered cine displays were evaluated qualitatively in a subset of patients (n = 30). RESULTS: The correlation between GBPS LVEF and planar LVEF was excellent (r = 0.92). Mean LVEF was 62.2% for GBPS and 54.1% for ERNA. The line of linear regression was GBPS LVEF = (1.04 x ERNA LVEF) + 6.1. Bland-Altman plotting revealed an increasing bias in GBPS LVEF with increasing LVEF (Y = 0.13x + 0.61; r = 0.30; mean difference = 8.1% +/- 7.0%). Interoperator reproducibility of GBPS LVEF was good (r = 0.92). RVEF values averaged 59.8%. RWM assessment using 3D cine display was enhanced in 27% of the studies, equivalent in 67%, and inferior in 7%. CONCLUSION: GBPS LVEF was reproducible and correlated well with planar ERNA. GBPS LVEF values were somewhat higher than planar ERNA, likely because of the exclusion of the left atrium.

Gated Blood-Pool Imaging↗

Assessment of lung area in normal fetuses at 12-32 weeks.

OBJECTIVE: To establish reference intervals with gestation for the right and left lung areas and lung area to head circumference ratio (LHR). METHODS: This was a cross-sectional study of 650 normal singleton pregnancies at 12-32 weeks of gestation. We measured the left and right lung areas on the cross-sectional plane of the thorax, used for examination of the four-chamber view of the heart, by three different techniques: firstly, manual tracing of the limits of the lungs; secondly, multiplication of the longest diameter of the lung by its longest perpendicular diameter; thirdly, multiplication of the anteroposterior diameter of the lung at the mid-clavicular line by the perpendicular diameter at the midpoint of the anteroposterior diameter. RESULTS: The respective mean left and right lung areas (manual tracing) increased with gestational age, from 36 and 58 mm(2) at 12 weeks to 220 and 325 mm(2) at 20 weeks and 594 and 885 mm(2) at 32 weeks. This 16-fold increase in lung area was accompanied by a four-fold increase in head circumference. Consequently, the left and right LHR increased with gestational age. The most reproducible way of measuring the lung area was by manual tracing of the limits of the lungs and the least reproducible was by multiplying the longest diameter of the lungs by their longest perpendicular diameter. Furthermore, the method employing the longest diameter, compared with the tracing method, overestimated both the left and the right lung areas by about 45% and the method employing the anteroposterior diameter overestimated the area of the right lung by about 35%, but not that of the left lung. CONCLUSIONS: In the antenatal prediction of pulmonary hypoplasia by the assessment of lung area it is important to take gestational age into account. Dividing the lung area by the head circumference does not correct for the gestation-related increase in lung area. Reproducible measurement of the lung area is provided by manual tracing of the limits of the lungs, rather than by multiplication of lung diameters.

Anthropometry↗

Visually induced gait deviations during different locomotion speeds.

Optic flow is essential for the perception of self motion and the control of path integration during locomotion. Inverting prisms oriented 15 degrees off vertical in the roll plane were used to experimentally distort optic flow during locomotion. Depending on the direction in which the prisms were rotated, optic flow was diagonally upward to the right or upward to the left. A reproducible deviation of gait toward the direction of perceived optic flow was found in ten healthy subjects. This deviation is explained to be a gait deviation that compensates for misleading perceived self motion induced by optic flow. The amount of deviation was dependent on locomotion speed. When walking slowly (about 1 m/s), mean deviation was 0.22+/-0.08 m/s to the right and -0.18+/-0.08 m/s to the left for right and left, respectively, diagonal prism orientation. Deviation was significantly less when running (about 3 m/s) with mean deviations of 0.05+/-0.03 m/s and -0.06+/-0.03 m/s, respectively (ANOVA, P<0.01). It is assumed that path integration during running is largely achieved by highly automated spinal programs operating independently of sensory control. In contrast, walking is more dependent on afferent and reafferent visual control. Thus, the experiments show that visual control of locomotion is direction specific and dependent on optic-flow-induced vection. It becomes less influential with increasing speed of locomotion, e.g., when walking in contrast to running.

Adult↗

Anatomical variability in the cortical representation of first and second language.

Functional magnetic resonance imaging was used to assess inter-subject variability in the cortical representation of language comprehension processes. Moderately fluent French-English bilinguals were scanned while they listened to stories in their first language (L1 = French) or in a second language (L2 = English) acquired at school after the age of seven. In all subjects, listening to L1 always activated a similar set of areas in the left temporal lobe, clustered along the left superior temporal sulcus. Listening to L2, however, activated a highly variable network of left and right temporal and frontal areas, sometimes restricted only to right-hemispheric regions. These results support the hypothesis that first language acquisition relies on a dedicated left-hemispheric cerebral network, while late second language acquisition is not necessarily associated with a reproducible biological substrate. The postulated contribution of the right hemisphere to L2 comprehension is found to hold only on average, individual subjects varying from complete right lateralization to standard left lateralization for L2.

Adult↗

[Analysis of left unilateral spatial neglect with a non-visual sensory-motor task].

An experiment was conducted to analyze the space-movement processes which unilateral spatial neglect (USN) patients manifested. Three kinds of movement features were tested which were reported in previous studies; (a) general coarse response tendency, (b) hypokinesia in the disordered space-side, and (c) more frequent response toward the normal space-side. Five left USN patients with right brain damage were compared with five non-USN right brain damaged patients, and five normal controls. As an experimental movement task, a non-visual movement reproduction with regard to kinesthetic sensory modality was adopted. Subjects were blindfolded and asked to reproduce the criterion-movement (length of 10 cm) toward right hand side in space. Three different experimental spaces were used in relation to the subject's body positions; 'left space (range from left shoulder to median line)', 'right space (from median line to right shoulder)', and 'right-outside space (outside of right shoulder)'. The criterion-movement was presented to the subjects, and then they reproduced the movement in either one of these three spaces. Generally, the left USN patients reproduced movements with more errors and less accuracy when the execution side was in the 'left space'. The results confirmed the observation that left USN patients showed more frequent response toward the right hand side direction in the 'left space'. The left USN patients with lesions in frontal and/or basal ganglia regions showed larger errors in this task compared to the left USN patient whose lesion is localized in the parietal region in the right hemisphere.

Aged↗

How we got this way: the sciences of homosexuality and the Christian right.

The discourse of the new sciences of homosexuality interacts with, reproduces, and sometimes challenges other discourses that inform and intersect it--popular discussions of scientific discoveries, legal discourse, debates about gay and lesbian identity, and religious discourse. Despite their different intentions and vocabularies, what links the discourse of the Christian right to that of contemporary sexology research and its popularized versions is its reproduction of a binary gender system, in which women are figured as both within and outside of "nature." Researchers in gay, lesbian, and bisexual sexuality can make a significant contribution by exposing the ways their research contends with discursive practices that have a context and a history (in connections between Aquinas's theology and Aristotle's science, for example). The narrative, rooted in traditional Christian theology and early Western science, that produces gender as binary and heterosexuality as normative can be rewritten to reveal the constructedness of both gender and sexuality.

Christianity↗

Reproducibility of two in vivo tests of platelet function.

We correlated repeat determinations of platelet aggregate ratios (PAR) and plasma beta-thromboglobulin (BTG) in the right and left arms of thirty-four subjects in order to measure test reproducibility and to evaluate the effects of venipuncture. The reproducibility of PAR on the same blood samples was relatively low but similar to that obtained when the right arm and left arm values were compared, thus indicating little variation secondary to venipuncture. For BTG, the reproducibility on identical blood samples was quite high, but fell significantly when plasma samples from the two sides were correlated. This finding and increased BTG values when obvious blood collection problems occurred, indicated that plasma BTG levels are quite sensitive to venipuncture technique.

Humans↗

[Value of tomoscintigraphy with Fourier analysis in the diagnosis of arrhythmogenic right ventricular cardiomyopathy].

ECG gated blood pool tomography has been performed in sixteen patients with right ventricular arrhythmias in whom the diagnosis of arrhythmogenic right ventricular cardiomyopathy was made based on the finding of abnormalities on contrast angiography. They were compared both to control subjects and to patients with primary dilated cardiomyopathy. Thick slices of ventricles were obtained throughout the cardiac cycle in three orthogonal planes: horizontal long axis and short axis thick slices for analysis of right and left ventricular regional wall motion abnormalities and analysis of the spread of the contraction by means of Fourier phase imaging, vertical long axis slices (one for each ventricle) for ejection fractions, because of easy and reproducible determination of valvular planes and analysis of all right ventricular segments, especially the pulmonary infundibulum. Five typical right ventricular abnormalities were seen: decreased ejection fraction (32 +/- 15% vs 55 +/- 3% in control; p < 0.001), increased diameter (ratio of right to left diameters = 1.2 +/- 0.3 vs 0.9 +/- 0.1; p < 0.01), global delayed contraction versus that of the left ventricle (22 +/- 20 degrees vs -2 +/- 6%; p < 0.01), increased dispersion of contraction (32 +/- 16 degrees vs 13 +/- 4 degrees; p < 0.01) and presence of segments with decreased and/or delayed contraction. Right ventricular disease was observed in all the patients: localized form (56%), diffused form (44%). This method provides accurate functional data for diagnosis and follow-up of patients. In future, this wall motion evaluation method may replace planar nuclear angiography as myocardial SPECT have replaced myocardial planar scintigraphy.

Adolescent↗

Reproducibility of repeat bitewing radiographs determined by measurement of the distance between the amelocemental junction and the alveolar crest: an ex vivo study using human skulls.

OBJECTIVE: To assess the reproducibility of repeat bitewing radiographs. METHODS: Five right and left pairs of posterior bitewing radiographs were taken without the use of beam-aiming or film-holding devices in five dry skulls with complete dentitions. The amelocemental junction (ACJ) and alveolar crest (AC) of every interdental site was traced on projected radiographs and the linear distance between the ACF and AC determined. RESULTS: There was close concordance between the ability to read the ACJ on the approximal tooth surface and the AC. The overall readability of interdental sites was 71% although sites at the extremities of radiographs were often unreadable. Kappa analysis of the readability of alveolar bone height from repeat radiographs was 0.52. There were significant differences in the reproducibility of ACJ and AC measurements from repeated radiographs (p<0.001). Intra-examiner variability was significantly less (p<0.001) than that due to repeat radiography with no significant differences between sites. The standard deviation for all surfaces from repeat readings of the same radiographs was 0.12 mm compared with 0.51 mm from repeat radiography. CONCLUSIONS: In this study a freehand technique produced a degree of imprecision in readings of alveolar bone height from successive films of the same site. In clinical terms, a difference of more than 1.4 mm between pairs of serial measurements from the same site would have to occur in order to be certain that the difference was not measurement error but real bone loss.

Alveolar Bone Loss↗

Reproducibility of regional brain metabolic responses to lorazepam.

UNLABELLED: Changes in regional brain glucose metabolism in response to benzodiazepine agonists have been used as indicators of benzodiazepine-GABA receptor function. The purpose of this study was to assess the reproducibility of these responses. METHODS: Sixteen healthy right-handed men underwent scanning with PET and [18F]fluorodeoxyglucose (FDG) twice: before placebo and before lorazepam (30 micrograms/kg). The same double FDG procedure was repeated 6-8 wk later on the men to assess test-retest reproducibility. RESULTS: The regional absolute brain metabolic values obtained during the second evaluation were significantly lower than those obtained from the first evaluation regardless of condition (p < or = 0.001). Lorazepam significantly and consistently decreased both whole-brain metabolism and the magnitude. The regional pattern of the changes were comparable for both studies (12.3% +/- 6.9% and 13.7% +/- 7.4%). Lorazepam effects were the largest in the thalamus (22.2% +/- 8.6% and 22.4% +/- 6.9%) and occipital cortex (19% +/- 8.9% and 21.8% +/- 8.9%). Relative metabolic measures were highly reproducible both for pharmacologic and replication condition. CONCLUSION: This study measured the test-retest reproducibility in regional brain metabolic responses, and although the global and regional metabolic values were significantly lower for the repeated evaluation, the response to lorazepam was highly reproducible.

Adult↗