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PubMed1996

Reproducibility of digital testing of the pelvic floor muscles in men.

OBJECTIVE: To validate the digital testing of pelvic floor muscles in men by evaluating its applicability and the reproducibility of test-retest. DESIGN: Prospective survey on volunteer sample. Blinded between investigators. SETTING: University study group with experienced physiotherapists working in a university hospital. PARTICIPANTS: 39 young healthy male volunteers. INTERVENTION: Digital testing of the bulbocavernous muscles, the sphincter ani externus, the puborectal muscles. OUTCOME MEASURES: Each muscle or muscle group was allocated a tripartite valuation score corresponding with muscle strength, endurance, and exhaustion. The muscle testing was repeated by the same investigator with short (10 seconds), medium (2 hours), and long (> 4 hours) intervals. In 9 patients, blinded testing was performed by two independent investigators separately. The results from the different evaluations were statistically compared. RESULTS: Digital testing proved easy to perform and was well tolerated in all patients. Test-retest showed reproducible results with short and long intervals, except for the parameter exhaustion of external anal sphincter and puborectalis muscle as determined with an interval of 2 hours. Between investigators no difference was found between scores except for strength of the bulbocavernous muscle. CONCLUSION: Digital testing of the pelvic floor muscles, when done by an experienced investigator and with full cooperation of the patient, is reliable and useful for clinical practice in male patients. Intracorporal muscle testing is more reliable than evaluation of superficial muscles.

Adult↗
PubMed1991

Intravascular ultrasound assessment of the renal artery.

OBJECTIVE: To determine the feasibility and diagnostic value of catheter-based intravascular ultrasound imaging compared with angiography for visualizing renal artery structure. DESIGN: Renal artery images were obtained in patients with renal artery stenosis having percutaneous balloon angioplasty and in normal subjects by digital angiography and by a 20-MHz, mechanically driven, catheter-based, intravascular ultrasound imaging system. SETTING: A referral-based university hospital. PATIENTS: Four randomly selected normal subjects without known renal disease and four consecutive patients with known renal artery stenosis referred for percutaneous balloon angioplasty. INTERVENTIONS: Digital angiograms and intravascular ultrasound images of nine renal artery segments were obtained. In patients with renal artery stenosis, imaging was done before and after balloon angioplasty. MAIN RESULTS: Digital angiography and ultrasonography correlated closely in the determination of arterial lumen diameter (r = 0.81) and cross-sectional area (r = 0.83). However, ultrasonography provided structural information not shown by angiography. All normal arteries showed discrete intimal, medial, and adventitial wall layers by ultrasonography. In the five stenotic segments, angiography identified the cause of stenosis to be atherosclerosis in four patients and fibromuscular dysplasia in one patient. Ultrasound imaging, however, identified the disease process as atherosclerosis in three patients and as fibromuscular dysplasia in two patients. After renal angioplasty, ultrasonography identified three arterial dissections, only one of which was shown by angiography. CONCLUSIONS: These preliminary data indicate that catheter-based intravascular ultrasound imaging of the renal artery is feasible and correlates well with angiography in assessing renal artery size and also provides potentially important additional structural information that permits a better characterization of arterial pathology.

Aged↗
PubMed1999

High-speed digital imaging of neoglottic vibration after total laryngectomy.

OBJECTIVES: To establish the applicability of digital high-speed imaging in studying neoglottic mucosal vibration after total laryngectomy and to perform a structured evaluation of the recordings using a standardized assessment form to gain insight about the anatomical and morphologic characteristics of the neoglottis. DESIGN: Evaluation of a new clinical tool and description of clinical disorders in a patient survey. SETTING: The Netherlands Cancer Institute, Amsterdam. PATIENTS: Forty-six patients who underwent laryngectomy, 36 who underwent standard total laryngectomy and 10 who underwent a partial or total pharynx reconstruction (ie, myocutaneous pectoralis major flap [n = 4], free radial forearm flap [n = 2], tubed gastric pull-up [n = 3], and full gastric pull-up [n = 1]). INTERVENTION: Digital high-speed imaging, using a 90 degrees rigid laryngoscope, of the neoglottic vibration in prosthetic tracheoesophageal speakers after total laryngectomy. MAIN OUTCOME MEASURES: Digital high-speed imaging might overcome some of the problems of stroboscopy in studying irregular voices and could, therefore, be expected to give more insight into the anatomical and morphologic characteristics of the neoglottis. RESULTS: Digital high-speed recordings could be obtained in 44 of 46 patients. Using a structured evaluation form, a wide variability in anatomical and morphologic features could be established. CONCLUSIONS: Digital high-speed imaging appeared to be a useful tool in studying the irregular vibrations of the neoglottis. Evaluation by the structured evaluation form gives a good idea about the wide variability in anatomical and morphologic features of the neoglottis.

Aged↗
PubMed1999

Face-to-face diagnosis vs telediagnosis of pigmented skin tumors: a teledermoscopic study.

BACKGROUND: Teledermoscopy uses telecommunication technologies to transfer images of pigmented skin lesions, including clinical and anamnestic data, via e-mail to specialized centers for teleconsultation. DESIGN: Sixty-six pigmented skin lesions examined on a face-to-face basis in a skin lesion clinic in L'Aquila, Italy, were sent via e-mail on a standard-resolution color monitor for consultation at a university dermatology department in Graz, Austria. INTERVENTION: Digital photographs of the clinical and dermoscopic images of all pigmented tumors were taken with a stereomicroscope connected to a high-resolution video camera in Truevision advanced graphic array (Targa) format file and converted successively into a Joint Photographic Expert Group (PEG) format file. All lesions were excised surgically and diagnosed histopathologically. MAIN OUTCOME MEASURE: Diagnostic concordance between face-to-face diagnosis and telediagnosis. RESULTS: The diagnostic concordance was 60 (91%) of 66 cases. The number of correct telediagnoses was lower, but the difference was not statistically significant (Wilcoxon test, P = .10). The accuracy of the telediagnoses was not related to the quality of the images, but highly depended on the level of diagnostic difficulty of a given pigmented skin tumor (Spearman correlation, P= .01). CONCLUSION: Teleconsultation of clinical and dermoscopic images of skin tumors via e-mail provides a similar degree of diagnostic accuracy as face-to-face diagnosis.

Adolescent↗
PubMed2004

Comparison of skin biopsy triage decisions in 49 patients with pigmented lesions and skin neoplasms: store-and-forward teledermatology vs face-to-face dermatology.

OBJECTIVE: To determine the relative efficacy of store-and-forward teledermatology vs face-to-face dermatology consultations in triage decisions about the need for a biopsy of neoplastic skin changes. DESIGN: Prospective study of consecutive patients judged by an internist to require dermatologic consultation for a skin growth. SETTING: Private primary care and dermatology practices and an academic dermatology practice. PATIENTS: Patients requiring dermatology consultation for evaluation of skin growths. Patients were seen by a single primary care physician between July 10, 1998, and August 4, 2000. INTERVENTION: Digital photographs of skin growths were obtained by the primary care physician and evaluated by a teledermatologist. The patient was then seen face-to-face by a dermatologist. A biopsy was performed if either dermatologist favored biopsy. MAIN OUTCOME MEASURES: Decisions to perform a biopsy. Agreement between the dermatologists was assessed. RESULTS: Of the 49 patients with evaluable photographs, the face-to-face dermatologist and teledermatologist recommended a biopsy for the same 26 patients, yielding a sensitivity of the teledermatologist of 1.00 (95% confidence interval [CI], 0.87-1.00) and a specificity of 1.00 (95% CI, 0.85-1.00). The agreement between the dermatologists (kappa) was 1.00 (95% CI, 0.72-1.00). CONCLUSION: Store-and-forward teledermatology may provide an accurate and cost-effective method of determining whether skin growths in patients presenting to primary care physicians should undergo biopsy.

Biopsy↗
PubMed2026

Comprehensive molecular profiling of advanced NSCLC in Greek patients:A prospective HeCOG study.

BACKGROUND: We report for the first time the molecular landscape and outcome associations from the prospective CLIMEDIN trial in Greece. METHODS: Two hundred patients with newly diagnosed advanced NSCLC (March 2022-October 2023) were enrolled and randomized to standard-of-care education versus additional automated, adverse-event-targeted digital interventions. Within this study baseline testing (EGFR, ALK, PD-L1) was performed in all; 165 tumors underwent comprehensive NGS (Oncomine Comprehensive Assay v3). Primary endpoint was improvement in AEs/QoL; secondary endpoints included ORR, PFS and OS. Associations between genomic alterations and outcomes were explored. RESULTS: Median age was 68 years; 75% male; 52% current smokers; adenocarcinoma 68.5%. Most received chemo-immunotherapy (66%). At data cut-off (December 2025; reverse-Kaplan-Meier median follow-up 36.3 months), median PFS was 9.6 months and median OS was 15.2 months. Across 200 tumors, 495 pathogenic variants (PVs) were identified in 83 genes. Exploratory outcome analyses showed longer OS in EGFR-mutant disease (preserved under parsimonious multivariable adjustment) and a formal KRAS × smoking interaction for OS (interaction P = 0.011). CONCLUSIONS: In this cohort, the molecular profile mirrors other Caucasian series, with clinically relevant enrichment patterns for EGFR and KRAS. ECOG performance status and first line treatment were the dominant prognostic factors in this cohort. A novel KRAS and smoking interaction for overall survival warrants prospective validation.

Aged↗
PubMed2002

[Low-osmolar gadodiamide as alternative contrast agent for diagnostic angiography and angiographic interventions in patients with renal insufficiency].

PURPOSE: To evaluate the benefit and feasibility of gadolinium contrast agents for intra-arterial use in diagnostic and therapeutic angiography in patients with renal insufficiency. METHODS: In 15 patients with planned peripheral or renal vascular interventions digital subtraction angiography with intra-arterial administration of gadolinium (gadodiamide n = 14, gadolinium-DTPA n = 1) was performed. Gadolinium was used selectively after peripheral catheter placement, mainly as an adjunct to CO2 (n = 12), to assess the distal run-off vessels or to characterize stenotic lesions. RESULTS: In 14 cases gadolinium yielded good or satisfactory results that were superior to those of CO2 angiography in the femoropopliteal region and calf, but also to the aorto-iliac vessels and the renal arteries. A small amount of iodinated contrast media was administered due to insufficient contrast of gadolinium in one patient. Mean serum creatinine level after angiography (295 +/- 167 micromol/l; range 125 - 764 micromol/l) was not significantly different (p >/= 0,37) from the initial level (279 +/- 149 micromol/l; range 143 - 728 micromol/l). CONCLUSION: Gadolinium is a viable alternative contrast agent for digital subtraction angiography and percutaneous transluminal angioplasty in patients with renal insufficiency. It enhances the diagnostic evaluation of stenosis and run-off vessels.

Adult↗
PubMed2006

Is the absence of an ipsilateral fibular fracture predictive of increased radiographic tibial pilon fracture severity?

OBJECTIVE: Despite their frequent occurrence, there is little clinical or biomechanical data associating the status of the fibula with any injury pattern of the tibial plafond. Similarly, the integrity of the fibula is not assessed in the commonly used tibial pilon fracture classification schemes. The purpose of this study was to determine whether there is a difference in the radiographic severity of tibial pilon injuries with fibular fractures compared with those without fibular fractures by using a rank-order method. DESIGN: Case-control, radiographic review. SETTING: Urban level-1, university trauma center. PATIENTS: During a 36-month period, 20 consecutive tibial pilon injuries without associated fibular fractures were retrospectively identified by using a prospectively gathered trauma database (group 1). During the same time period, an additional 197 tibial pilon injuries with fibula fractures were identified and classified according to the AO/OTA System. This included 48 AO/OTA 43B-type (24.4%) and 149 AO/OTA 43C-type (75.6%) fractures. From this larger group of patients, an age- (+/-5 years) and gender- matched cohort of 20 tibial pilon injuries with fibular fractures were randomly selected electronically (group 2). INTERVENTION: Digital concealment of the fibula on the anteroposterior and lateral injury radiographs. MAIN OUTCOME MEASURE: Before definitive fixation, 3 orthopaedic traumatologists independently ranked the digitized anteroposterior and lateral radiographs of all 40 patients according to severity with 40 representing the most severe injury. RESULTS: Interobserver agreement between the 3 evaluators showed a significant positive association (Kendall's concordance coefficient = 0.87; P = 0.0001). The overall mean rank score for tibial pilon injuries with fibula fractures was 24.4, whereas those without fibula fractures was 16.7 (t test = 0.02). When evaluated within the AO/OTA classification system, the mean rank score for C-type tibial pilon fracture patterns was 10.3 in group 1 and 8.7 in group 2 (P = 0.5). AO/OTA C-type tibial pilon fracture patterns were observed more commonly in group 2 than in group 1 (P = 0.006). CONCLUSIONS: This study demonstrates that, overall, tibial pilon injuries with fibular fractures were statistically ranked as more radiographically severe than those without fibular fractures. Fibular fractures are more commonly associated with C-type injuries than B-type injuries. There was no difference in severity in C-type injuries with or without fibular fractures; however, C-type injuries were ranked, as a group, significantly more radiographically severe than B-type injuries.

Adult↗
PubMed1998

Early intraocular pressure after phacoemulsification combined with trabeculectomy.

BACKGROUND AND OBJECTIVE: To determine the efficacy of combined phacoemulsification--trabeculectomy in preventing early postoperative increases in intraocular pressure (IOP). PATIENTS AND METHODS: Eighty patients were enrolled in a prospective cohort study. Thirty-six patients with cataracts and uncontrolled glaucoma underwent combined phacoemulsification--trabeculectomy, and 44 patients with cataracts underwent phacoemulsification alone. The operations were performed in a standardized manner by one surgeon. IOP was measured at 4 hours, 1 day, and 7 days after surgery. The need for intervention (digital massage, medications) and the presence of complications were documented. RESULTS: Four hours after surgery, 5.5% of patients undergoing the combined procedure had IOPs greater than 30 mm Hg, compared with 22.7% of phacoemulsification patients (P < .05). No significant difference in IOP was found between the groups at postoperative day 1 or day 7. CONCLUSION: These results suggest that combined phacoemulsification-trabeculectomy protects against early postoperative elevations in IOP. This finding may influence the surgical management of cataracts in patients with poorly controlled glaucoma and significant compromise of visual field or optic nerve.

Adrenergic beta-Antagonists↗
PubMed1993

Interventional sialography using digital imaging.

We review our results in treating 5 patients with parotid duct pathology (3 stenoses, 2 calculi), using digital subtraction imaging for sialography, and standard interventional techniques using balloon catheters. Good technical results were achieved in all 5 patients. We describe our techniques and how they were modified to overcome various difficulties.

Catheterization↗
PubMed1998

Estimation of effective dose in some digital angiographic and interventional procedures.

In general, effective dose values for similar interventional vascular radiology (IVR) procedures are different. This is due to problems with the classification of radiological procedures, which make comparisons difficult. Patient size, examination technique and clinical condition as well as the skill of the medical radiologists also affect effective dose. Currently, there is a broad agreement on the classification of similar procedures so that effective dose estimates can be made from measurements of the dose area product (DAP). Thus, reference dose values may be established and comparative studies between different services and hospitals can be made. The objective of this study is to provide dose data for some digital angiographic and interventional procedures. Values of measured DAP for 143 patients for five types of procedures are presented. Procedures investigated were abdominal angiography, arteriography of lower limbs, biliary drainage, embolization of spermatic vein and nephrostomy. All the procedures were performed using digital equipment. Values of DAP and effective dose were 30 Gy cm2 and 6.2 mSv for arteriography of lower limbs and 150 Gy cm2 and 38.2 mSv for biliary drainage. In each one of these procedures, effective dose values per minute of fluoroscopy and per radiography film have been calculated. It is possible to use this information for the rapid estimation of effective dose.

Abdomen↗
PubMed2004

Comparison of a conventional and a flat-panel digital system in interventional cardiology procedures.

The purpose of the study was to analyse the technical characteristics of a newly installed flat-panel fluoroscopy (FPF) system in an interventional cardiology (IC) department and compare it with an older conventional system. A patient survey was performed to investigate the radiation doses delivered by the X-ray systems. Finally, methods of technique optimization regarding the new digital system were investigated. Dose rates in all fluoroscopic and cine modes were measured and image quality assessed using a dedicated test tool. 200 patients were investigated, half using the conventional and half using the digital FPF system. Patient data collected were: sex, age, weight, height, dose-area product (DAP), fluoroscopy time (T) and total number of frames (F). Our results are: (1) Digital FPF system: high contrast resolution (HCR) is not affected by fluoroscopic mode, whereas low contrast resolution (LCR) is slightly decreased in the low mode. (2) The digital FPF system has 2.5 times better HCR than the conventional system, with 5 times lower dose in the fluoroscopy mode. (3) Median values of DAP, T and F, respectively, in coronary angiography (CA) are: 27.7 Gycm(2), 4.1 min and 876 for the digital and 39.3 Gycm(2), 5.3 min and 1600 for the conventional system. Median values for percutaneous transluminal coronary angioplasty (PTCA) are: 51.1 Gycm(2), 12.7 min and 1184 for the digital and 44.3 Gycm(2), 7.4 min and 1936 for the conventional system. Digital DAP in CA is reduced by 30%, suggesting that a dose reduction in the FPF system is possible. The results of the study concerning the FPF system lead to the conclusion that the lowest fluoroscopic mode and the lowest frame rate should be used in routine practice.

Angioplasty, Balloon, Coronary↗
PubMed1998

Removal of a Norplant implant located near a major nerve using interventional radiology-digital subtraction fluoroscopy.

Norplant implants can be removed easily, if inserted properly. When they are inserted deeply and can not be palpated, or if they are located close to the neurovascular structures of the upper arm, radiological guidance may be needed to locate and remove the implants without causing injury to the surrounding vital structures. Digital subtraction fluoroscopic guidance is helpful in removing deeply located contraceptive implants and those that are close to the neurovascular structures, where blind removal may result in injury to those structures. We describe a case in which an implant that was located close to a major nerve near the axilla was removed under digital subtraction fluoroscopic guidance.

Adult↗
PubMedDate not supplied

Songwriting and digital video production interventions for pediatric patients undergoing bone marrow transplantation, part I: an analysis of depression and anxiety levels according to phase of treatment.

Purposes of this exploratory case study were: (1) to examine how anxiety and depression levels vary with phase of bone marrow transplantation (BMT) and (2) to examine the effect of the proposed music therapy treatment protocol on anxiety and depression levels. Six pediatric BMT patients participated in the study. Three participants experienced the music condition and three participants experienced the no-music contact condition. Both conditions consisted of six, one-hour sessions that occurred over a three week period. The Children's Depression Inventory (CDI) was administered at the conclusion of each session to examine changes in depression levels across each phase of treatment. The State Trait Anxiety Inventory for Children (STAIC) served as a pre-/post-session measure of state anxiety. Graphic analysis of scores from the CDI and STAIC indicated a consistent trend in depression and anxiety levels according to phase of treatment for all participants. Four participants (3 music; 1 no-music) experienced decreased anxiety following a majority of sessions.

Adolescent↗
PubMedDate not supplied

Songwriting and digital video production interventions for pediatric patients undergoing bone marrow transplantation, part II: an analysis of patient-generated songs and patient perceptions regarding intervention efficacy.

Part I of this exploratory case study examined patient anxiety levels and depressive symptoms according to phase of bone marrow transplantation (BMT). The second part of this study examines more qualitative outcomes of the music therapy intervention. Purposes of this part of the study included: (1) to examine the lyrical content of patient-generated songs and (2) to compare patient perceptions regarding the effectiveness of a 6-week music condition with a no-music contact condition. Six pediatric BMT patients participated in the study. Three participants experienced the music condition and three participants experienced the no-music contact condition. Both conditions consisted of six, 1-hour sessions that occurred over a 3-week period. Content analysis of patient-generated songs revealed expression of issues related to the following themes: hope, positive coping, appreciation, mental status, control, time, bewilderment, treatment, and diagnosis. Examination of patient-generated songs provided insight into each patient's experience with transplantation and the coping strategies used during treatment. Outcomes from a poststudy questionnaire are summarized.

Adaptation, Psychological↗
PubMed2026

Effects of digital health-based exercise interventions on older adults with sarcopenia: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Sarcopenia, the progressive loss of muscle mass and function, impairs independence in older adults. Digital health exercise interventions are scalable solutions for older adults with sarcopenia. This systematic review and meta-analysis aimed to synthesize the evidence on their efficacy in populations with clinically diagnosed sarcopenia and identify influential intervention characteristics associated with treatment outcomes. METHODS: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, CINAHL, CNKI, and Wanfang on May 20, 2026, with no date restrictions. We included randomized controlled trials involving adults aged &#x2265;60 with sarcopenia receiving digital exercise interventions. Two reviewers independently screened studies, extracted data, and assessed risk of bias; analyses were performed using R and Review Manager. RESULTS: Fourteen trials (n&#xa0;=&#xa0;927) were included. Digital interventions showed potential improvements in muscle mass (MD&#xa0;=&#xa0;0.25, 95%CI:0.03-0.46, 95% PI:-0.36 to 0.85), muscle strength (MD&#xa0;=&#xa0;2.14, 95% CI:1.18-3.11, P&#xa0;<&#xa0;0.001), balance ability (SMD&#xa0;=&#xa0;0.31, 95% CI:0.12-0.51, P&#xa0;=&#xa0;0.001), walking performance (SMD&#xa0;=&#xa0;0.55, 95% CI:0.21-0.89, 95% PI:-0.70 to 1.79), and physical function (SMD&#xa0;=&#xa0;0.89, 95% CI:0.08-1.71, 95% PI:-2.33 to 4.12), but not quality of life (SMD&#xa0;=&#xa0;0.08, 95% CI:-0.19 to 0.35, P&#xa0;=&#xa0;0.53). Exploratory subgroup analyses suggested that factors such as supervision, program duration, and measurement tools may influence outcomes; however, formal tests for subgroup differences were generally non-significant, and consistent patterns across all metrics were not observed. CONCLUSION: Digital exercise interventions show potential for managing sarcopenia in older adults, though the very low to moderate certainty of evidence indicates that true effects may differ substantially from observed estimates. This review explores potential roles of intervention design, supervision, and multimodal delivery. Future research should adopt rigorous designs and longer follow-up to validate results and enhance clinical application. TRIAL REGISTRATION: PROSPERO CRD420251135174.

Humans↗
PubMed2002

Gadodiamide as an alternative contrast agent in intravenous digital subtraction angiography and interventional procedures of the upper extremity veins.

PURPOSE: Patients with renal insufficiency or other contraindications to iodine-based contrast agents present a significant management dilemma when angiography or interventional procedures are required. We describe the use of gadolinium as an alternative contrast agent for intravenous digital subtraction angiography (IV-DSA) and interventional procedures of the upper extremity veins. METHODS: Sixteen patients with symptoms of with moderate renal insufficiency underwent digital subtraction angiography for upper extremity and subclavian venography. Angiographic studies were obtained using gadolinium as a contrast agent. In six patients we used stents. RESULTS: Diagnostic images were obtained in all cases. No patient suffered a complication related to the use of gadolinium, and no patient demonstrated worsened renal function after the procedure. CONCLUSION: In the setting of a contraindication to iodine-based contrast agents, gadolinium represents an important alternative contrast material that allows for the visualization of and interventional procedures in the upper extremity veins.

Angiography, Digital Subtraction↗