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At least 379 records · Page 21Linked to original sources
PubMed2005

Pediatric patient surface doses in neuroangiography.

BACKGROUND: Neuroangiographic techniques (diagnostic and interventional) can be lengthy and complex and can be associated with high radiation entrance skin doses from fluoroscopy and digital subtraction angiography (DSA). OBJECTIVE: To measure entrance surface doses received by pediatric patients undergoing neuroangiographic procedures and to (1) compare these doses with thresholds for deterministic effects, (2) compare these doses with those reported in adults, and (3) to understand the dose relationships among diagnostic and interventional procedures, DSA and fluoroscopy. MATERIALS AND METHODS: A neurobiplane unit with fluoroscopic and DSA capabilities was used for all neuroangiographic procedures. An automated patient dosimeter, installed on both planes of the unit, calculated maximum surface dose. The dosimeter also recorded the number of angiographic frames and the length of fluoroscopy time for each procedure. RESULTS: This retrospective study analyzed entrance surface doses to 100 pediatric patients, 76 of whom underwent neuroangiographic diagnostic procedures and 24 of whom underwent neuroangiographic interventional procedures. The DSA acquisitions ranged from 44 frames to 1,428 frames per procedure and fluoroscopy times ranged from 1.1 to 85.6 min per procedure. The mean surface dose from fluoroscopy was 68.1 mGy (max: 397.1 mGy) in the frontal (PA) plane; in the lateral (LAT) plane, the mean surface dose was 40.9 mGy (max: 418.5 mGy). The mean surface doses from DSA were 263.1 and 126.9 mGy in the frontal and lateral planes, with maximum doses of 924.4 and 410.1 mGy, respectively. Mean fluoroscopy dose rates were 5.4 mGy/min in the PA plane and 4.7 mGy/min in the LAT plane. The DSA largely contributed to the overall procedural surface dose, accounting for 82% of the combined surface dose in the each of the imaging planes. CONCLUSION: The surface dose for each procedure measured in this study was found to be below thresholds for deterministic effects. Interventional procedures consistently yield the highest doses.

Adolescent↗
PubMed2000

A case report of low intensity laser therapy (LILT) in the management of venous ulceration: potential effects of wound debridement upon efficacy.

OBJECTIVE: This single case report (ABA design) was undertaken as a preliminary investigation into the clinical effects of low intensity laser upon venous ulceration, applied to wound margins only, and the potential relevance of wound debridement and wound measurement techniques to any effects observed. METHODS: Ethical approval was granted by the University of Ulster's Research Ethical Committee and the patient recruited was required to attend 3 times per week for a total of 8 weeks. Treatments were carried out using single source irradiation (830 nm; 9 J/cm2, CB Medico, Copenhagen, Denmark) in conjunction with dry dressings during each visit. Assessment of wound surface area, wound appearance, and current pain were completed by an independent investigator. Planimetry and digitizing were completed for wound tracings and for photographs to quantify surface areas. Video image analysis was also performed on photographs of wounds. RESULTS: The primary findings were changes in wound appearance, and a decrease in wound surface area (range 33.3-46.3%), dependent on the choice of measurement method. Video image analysis was used, but rejected as an accurate method of wound measurement. Treatment intervention produced a statistically significant reduction in wound area using the C statistic on digitizing data for photographs (at Phase one only; Z = 2.412; p < 0.05). Wound debridement emerged as an important procedure to be carried out prior to measuring wounds. Despite fluctuating pain levels recorded throughout the duration of the study, VAS scores showed a decrease of 15% at the end of the study. This hypoalgesic effect was, however, statistically significant (using the C statistic) at Phase one only (Z = 2.554; p < 0.05). CONCLUSIONS: Low intensity laser therapy at this dosage, and using single source irradiation would seem to be an effective treatment for patients suffering venous ulceration. Further group studies are indicated to establish the most effective therapeutic dosage for this and other types of ulceration.

Bandages↗
PubMed2003

[Carotid stenosis: diagnosis, patient selection, therapy].

Atheromatosis frequently develops in the carotid bifurcation, leading to significant stenoses of the internal carotid artery. The associated risk of stroke reaches 20-25% during the first three years for a high-grade symptomatic stenosis and 2-3% per year for a high-grade asymptomatic stenosis. The diagnosis of carotid stenosis is made after occurrence of a cerebral ischemic event or during an angiologic examination, mainly using Doppler/Duplex-sonography. Ultrasonography also enables an accurate determination of the grade of stenosis and accordingly the risk of stroke. Non-invasive MR- or CT-angiography is presently preferred to digital subtraction angiography to confirm the sonographic findings and prepare for an intervention. The intervention has to be decided individually for each patient. It is mandatory that the estimated risks of operation + best medical therapy be significantly lower than the risks of medical therapy alone; otherwise, the benefit of the intervention is lost for the patient. Only the mortality and major morbidity are taken into consideration to estimate the risks of an intervention. Local and systemic complications are transitory and do not influence the final outcome. A high-grade symptomatic stenosis (70-99%) should be operated upon whenever possible. A middle-grade symptomatic stenosis (50-69%) is treated operatively only if the associated risk of stroke is estimated to be high. A high-grade asymptomatic stenosis is operated upon only if the estimated perioperative risks are very low (< 3%). A middle-grade asymptomatic stenosis as well as low-grade stenoses (< 50%) should not be operated, but treated with the best medical therapy available. Carotid endarterectomy is established as method of first choice to treat a carotid artery stenosis. A major complication rate as low as 1% can be expected in experienced centres. The long-term results of carotid endarterectomy are well documented and the incidence of restenosis is very low. Endovascular angioplasty with stenting is increasingly performed as an alternative to the open operation. Presently, the scientific evidence is still lacking to recommend this method as primary therapy; however, progress in the field is constant and we expect new technical improvements which should increase the safety and efficacy of the procedure in the near future.

Aged↗
PubMedDate not supplied

Interventional uroradiologic procedures performed using gadodiamide as an alternative to iodinated contrast material.

Three patients with either a history of severe allergic reactions to iodinated contrast or marked renal insufficiency underwent interventional uroradiologic procedures using full-strength gadodiamide (Gd) as a contrast agent in place of iodinated contrast material. The procedures were percutaneous access for nephrostolithotomy, antegrade pyelography with placement of a nephroureteral stent, and a diagnostic nephrostogram with exchange of a nephroureteral stent. Gd was visualized fluoroscopically and produced satisfactory digital radiographs without allergic reaction or worsening renal function. Gd can be useful in guiding interventional uroradiologic procedures when iodinated contrast material is contraindicated.

Contrast Media↗
PubMed2006

Clinical presentation, quantitative sensory testing, and therapy of 2 patients with fourth thoracic syndrome.

OBJECTIVE: The aim of the study was to describe 2 representative cases of patients presenting to an osteopathic pain practice with signs and symptoms consistent with the fourth thoracic (T4) syndrome. In addition, this article reports the application of quantitative thermosensory testing and dynamometer strength testing to confirm associated sensory and motor strength changes. Nonmanipulative therapeutic interventions are reported for the first time. CLINICAL FEATURES: Two patients experienced paresthesias in all digits of the hands, glove-like numbness of the hands and forearm, weakness (unable to open jars), hand clumsiness, upper extremity coldness, fullness or tightness, deep aching pain, and other signs and symptoms consistent with T4 syndrome. The patients were evaluated using quantitative thermosensory testing and handgrip dynamometry before and after treatment. INTERVENTION AND OUTCOME: Relief of bilateral arm pain, numbness, and paresthesias occurred after intramuscular injections of 1 to 2 mL of 0.5% bupivacaine at the fourth thoracic paraspinal level. Additional therapy for associated signs and symptoms was provided using an anticonvulsant (gabapentin). CONCLUSION: The clinical presentation of the patients reported in this article provides a description and additional information regarding T4 syndrome.

Adult↗
PubMedDate not supplied

A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar.

Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention.

Acculturation↗
PubMed1993

The status of prostate cancer early detection.

Prostate cancer represents an increasing public health burden that may be controlled by early detection interventions. Several studies using transrectal ultrasound (TRUS), prostate-specific antigen (PSA), and digital rectal examination (DRE) in men without known prostate disease have been reported. Recent studies are reviewed, and recent preliminary results of the American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) are presented. Results show that the rate of early prostate cancer detection can be increased by coordinated use of TRUS, PSA, and DRE. The ACS-NPCDP data indicate that the positive predictive value of recommendations to biopsy is improved when based on a combination of studies. Examination by TRUS alone is least specific and least cost-effective, whereas the combination of PSA and DRE is less costly and more specific with equal sensitivity to cancer. Additional data are needed to determine if prostate cancer death rates will be altered by early detection interventions. Physicians and patients need to be informed of the possible risks and benefits of early detection interventions.

American Cancer Society↗
PubMed1997

The future of arteriography and vascular interventional radiology.

Non-invasive vascular imaging techniques threaten to diminish the catheter skills which radiology trainees currently acquire during diagnostic angiography. This, coupled with the desire of some vascular surgeons to perform minimally invasive "endovascular surgery", may threaten the future of this radiological subspecialty, or perhaps it will help to create a new discipline incorporating surgical, medical and radiological skills.

Angiography↗
PubMed2000

New look at endometrial echogenicity: objective computer-assisted measurements predict endometrial receptivity in in vitro fertilization-embryo transfer.

OBJECTIVE: To determine whether endometrial echogenicity, assessed objectively by a computer-assisted system on the day of hCG administration, predicts endometrial receptivity in controlled ovarian hyperstimulation (COH) cycles for IVF-ET. DESIGN: Prospective analysis. SETTING: Assisted reproduction unit, Clamart, France. PATIENT(S): Two hundred twenty-one women (aged <38 years with a normal uterus and >/=2 grade A or B embryos transferred) undergoing 228 GnRH agonist and FSH/hCG cycles for IVF-ET. INTERVENTION(S): On the day of hCG administration, uterine ultrasound scans were digitized with an image analysis system. Endometrial echogenicity was assessed as the ratio of the extent of the hyperechogenic transformation over the whole endometrial thickness. According to this, cycles were sorted arbitrarily into six groups: <30% (n = 34), 31%-40% (n = 37), 41%-50% (n = 37), 51%-60% (n = 55), 61%-70% (n = 37), and >70% (n = 28). MAIN OUTCOME MEASURE(S): Pregnancy and implantation rates. RESULT(S): The groups were similar in regard to population characteristics, ovarian response to COH, and embryology data. Pregnancy rates (59%, 57%, 35%, 20%, 16%, and 11%, respectively) and implantation rates (35%, 23%, 17%, 6%, 7%, and 3%, respectively) fell progressively and significantly from the low-echogenicity group to the high-echogenicity group. CONCLUSION(S): The present results confirm and extend previous observations that advanced hyperechogenic transformation of the endometrium is associated with poor IVF-ET outcome.

Adult↗
PubMed1998

Prostate cancer in the post-transplant population. Urologic Society for Transplantation and Vascular Surgery.

OBJECTIVES: We conducted a multicenter retrospective study to determine the results of treatment for prostate cancer in solid organ transplant recipients. METHODS: A retrospective analysis of all patients diagnosed with prostate cancer after organ transplantation at five centers was conducted. Data were obtained by chart review and a multipoint data sheet was used to abstract the data from the patient charts. RESULTS: Eighteen cases of prostate cancer were identified from six institutions. Most (84%) of the cancers were clinically localized at the time of diagnosis. Nine (50%) of 18 patients underwent radical prostatectomy, which was the predominant mode of treatment. Overall survival at a mean follow-up of 32 months was 66%, with a cancer specific mortality of 16%. Mortality was 13% for the 15 patients with localized disease and 33% for the 3 patients with metastatic disease at the time of diagnosis. CONCLUSIONS: Most of the patients with prostate cancer being detected after solid organ transplantation were diagnosed with localized disease. Aggressive therapeutic intervention as in the general (nontransplant) population yields good results and should be pursued. Diligent surveillance for prostate cancer in this population using periodic digital rectal examination, serum prostate-specific antigen, and prostate needle biopsy as needed will ensure earlier cancer detection and allow for definitive therapeutic intervention.

Aged↗
PubMed1991

Fetal echocardiography in multiple gestations.

We reviewed fetal echocardiograms from 36 multiple gestations from 20 weeks gestation to term. Seven sets of twins plus one set of triplets were referred because of a suspect cardiac anomaly in one fetus; heart disease was confirmed in one fetus of six sets of twins and in one triplet. Six sets were referred because of extracardiac malformations and heart disease was confirmed in two sets (including both twins in one set). The remaining case was detected in a patient sent for evaluation of karyotypic abnormality. Thus 11 fetal cardiac defects were detected in ten pregnancies. Chromosomes were abnormal in three of the anomalous fetuses. Two sets discordant for heart disease were monochorionic. Intervention, including a change in the planned location of delivery, or maternal digitalization for fetal congestive failure, occurred in six. We conclude that fetal echocardiography is feasible and useful in appropriate multiple gestations. Although often ethically complex, the information gained can be applied to patient management.

Journal Article↗
PubMed2005

Posterior communicating artery: from microsurgical, endoscopic and radiological perspective.

OBJECTIVE: The main objective of this study was to display the morphological characteristics of the posterior communicating artery and its perforating branches in various configurations of the circle of Willis and their relationship with neighbouring anatomic structures by microscopic examination of the brain hemispheres and endoscopic examination of cadaver specimens. A secondary aim was to investigate the possibility of detecting the posterior communicating artery and its variations in cerebral MR angiographies performed for various reasons. METHODS: The posterior communicating artery was examined under the microscope in 24 cerebral hemisphere specimens, by endoscopy in 5 cadavers and by 3D TOF MRI in 62 patients. RESULTS: The posterior communicating artery had a hypoplastic configuration in 28 %, whereas it was transitional in 14 %, fetal in 28 % and adult in 30 % of cerebral hemisphere specimens. While no posterior communicating artery and transitional configuration could be detected in 11 % of the MR angiography examinations, 34 % had a hypoplastic configuration, 10 % a fetal configuration and 45 % an adult configuration. The percentage of infundibular dilatation was 22 % and the pre-mamillary artery was the thickest perforating branch. The diameter of the posterior communicating artery varied between 0.5 and 3.03 mm. DISCUSSION: A detailed knowledge on the variations of the posterior communicating artery and the morphological characteristics of the perforators arising from this artery in various configurations of the circle of Willis is an important factor affecting the results of surgical interventions.

Angiography, Digital Subtraction↗
PubMed2006

Improvement patterns among survivors of brain injury: three case examples documenting the effectiveness of memory compensation strategies.

Three case examples illustrate possible patterns of improved functioning that may emerge as survivors of traumatic brain injury (TBI) attempt compensation for persistent memory deficits impeding independent living. The task selected for report was independence in remembering to take regularly-prescribed medications. Strategies applied to promote learning included use of written reminders and use of two assistive technology (AT) devices-a wristwatch alarm (WatchMinder) and a digital voice recorder and alarm system (Voice Craft ). With participation in the intervention programme, two of the three individuals demonstrated increased independence in remembering to take medications; the third did not. The case examples illustrate varying responses of people with TBI to intervention using compensatory strategies and AT devices. Professionals and caretakers working with survivors must recognize the uniqueness of each survivor, must adjust intervention programmes accordingly and must be willing to persist in trying to increase functional independence repeatedly for many years post-injury.

Adult↗
PubMed1994

Race- and ethnicity-specific characteristics of participants lost to follow-up in a telephone cohort.

The purpose of this study was to describe race- and ethnicity-specific characteristics of subjects lost to follow-up. For a study of community-based health interventions, adult subjects from 11 US communities were initially recruited by random digit dialing and interviewed by telephone in 1988; 2 years later, they were recontacted, and the same survey was administered a second time. Associations with loss to follow-up were assessed in separate models for whites, African Americans, Hispanic Americans, and Asian Americans. After 2 years, 40.8% of the 5,851 participants were lost to follow-up; cohort attrition was highest among African Americans (51.3%) and lowest among whites (37.5%). Age, aspects of employment, education, marital status, and income were significant independent predictors of loss to follow-up for one or more of the four racial and ethnic groups. Characteristics of subjects lost to follow-up in this telephone cohort differed among various racial and ethnic groups. After adjustment for demographic, socioeconomic, and health status variables, the important behavioral predictors of loss to follow-up were current smoking for whites (p < 0.05), having a high fat diet for African Americans (p < 0.10), consuming one or more alcoholic drinks per day for Hispanic Americans (p < 0.10), and high levels of physical activity for Asian Americans (p < 0.05).

Adolescent↗
PubMedDate not supplied

The meaning of computers to a group of men who are homeless.

The purpose of this pilot study was to explore the experience with computers and the meaning of computers to a group of homeless men living in a long-term shelter. This descriptive exploratory study used semistructured interviews with seven men who had been given access to computers and had participated in individually tailored occupation based interventions through a Work Readiness Program. Three themes emerged from analyzing the interviews: access to computers, computers as a bridge to life-skill development, and changed self-perceptions as a result of connecting to technology. Because they lacked computer knowledge and feared failure, the majority of study participants had not sought out computers available through public access. The need for access to computers, the potential use of computers as a medium for intervention, and the meaning of computers to these men who represent the digital divide are described in this study.

Adult↗
PubMedDate not supplied

[Methods of digital processing of pulse and motor signals].

The paper outlines the authors' developed and practically applied procedure for digital processing of pulsomotorograms obtained by monitoring hemomotorodynamic parameters during abdominal surgical interventions whose purposes are to diminish the influence of interference, to eliminate systematic distortions, to standardize and identify motor and pulse waves from the baseline interferential wave.

Abdomen↗
PubMed1992

[Prevention of postoperative ischemic colitis in aorto-iliac vascular reconstruction].

In consecutive series with 1740 aorto-iliac reconstructions (1970-1989) 32 patients (1.8%) with postoperative ischemic colitis have been registered. In a retrospective follow-up (1970-1983, group I, n = 1121) the incidence of this postoperative complication (ischemic colitis grade C) reached to 0.7%. In a further prospective follow-up (group II, 1984-1989, n = 619) the operative procedure was influenced by: 1) intraoperative stump pressure in the inferior mesenteric artery, 2) by the penile brachial index (PBI), 3) pre- and postoperative rectoscopy, and 4) measurement of perfusion in branches in the inferior mesenteric artery. The frequency of ischemic colitis could not be reduced. Grade C colitis reached to 1.3%. Rectosigmoidoscopy as a routine method before and after operation caused an remarkable decrease of the time interval between operation and diagnosis of ischemic colitis in group II (from 11 days to 24/48 h). As a result the mortality rate of transmural colon necrosis (grade C) could be reduced from 50% (group I) to 13.6% (group II). The IMA stump pressure alone (limit of 40 mm Hg) doesn't help to decide if reimplantation of the IMA necessary. The stump pressure with Doppler ultrasound flow registration in the branches of the IMA gains a greater sensitivity by a "two vessel clamping" (infrarenal aorta and digital compression of the SMA) (sensitivity 100%). During the last 230 surgical interventions the incidence of ischemic colitis ranged 0.9%.

Anastomosis, Surgical↗