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PubMed1990

[Therapy of juvenile angiofibroma].

We describe 12 juvenile angiofibromas treated predominantly by surgical excision. The course of the disease and therapy are analysed. Four interventions on 3 patients were done after pre-operative embolization. Superselective digital subtraction arteriography allowed detailed analysis of all feeding vessels, and a search for anastomoses between extra- and intracranial arteries and endarterial occlusion of tumour vessels. Intra-operative blood loss was reduced and visibility in the field of operation was improved.

Adolescent↗

PubMedDate not supplied

Gray scale range and the marking of vertebral coordinates on digitized radiographic images.

OBJECTIVE: To determine the relationship between X-ray image quality as reflected by the gray scale range and the reliability of measuring intervertebral angles. DESIGN: Intrarater reliability evaluation. SETTING: Image processing laboratory. PATIENTS: Digitized images of fluoroscopic AP lumbar motion sequences obtained from eight patients. INTERVENTION: Ten consecutive measurements of a single intervertebral angle in each subject related to gray scale range and midpoint gray level. The results were compared to measurements from an osseous lumbar spine calibration model. MAIN OUTCOME MEASURES: Variance of intervertebral angles in relation to gray scale range and midpoint level. RESULTS: No relationship was found between reliability of intervertebral angles and image parameters. CONCLUSION: For radiographs of diagnostic quality the gray scale range and midpoint level over the area of interest does not affect the reliability of coordinate marking.

Adult↗

PubMed2026

From population to individual: advocating personalised digital tools for heat-health early warning in a changing climate.

Escalating heat extremes under climate change are imposing substantial health burdens, with 2023 and 2024 consecutively breaking global temperature records. Mounting evidence suggests that heatwaves elevate the risks of hospitalisation and mortality across multiple disease categories, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and acute kidney injury. Nonetheless, most existing heat-health warning systems remain primarily reliant on population-level predictions, and considering individual differences and disease-specific considerations when defining warning levels would benefit the effectiveness of early prevention for high-risk groups. In this Viewpoint, which is based on the framework of precision public health-delivering the right intervention to the right population at the right time-we propose a framework for personalised digital heat-health early warning tools comprising three dimensions: individualised, risk-stratified prediction models that generate tiered early warnings; personalised health prompts coupled with theory-informed behavioural interventions; and adaptive, equity-oriented alert delivery mechanisms tailored to diverse populations. Such tools have the potential to bridge precision disease prevention and climate adaptation, thereby helping to mitigate heat exposure risks and disease burdens, particularly among high-risk populations. Future implementation research will be essential to address substantial challenges related to feasibility, validation, and equity.

Journal Article↗

PubMed2006

Comparison of infant head shape changes in deformational plagiocephaly following treatment with a cranial remolding orthosis using a noninvasive laser shape digitizer.

Deformational Plagiocephaly (DP) is a multi-planar deformity of the cranium occurring either pre-or postnatally in infants. In the last decade, the incidence of DP has increased substantially due to a number of factors, including supine sleeping positioning to reduce Sudden Infant Death Syndrome and the use of child carriers that increase supine positioning. Clinical questions persist about which children should be treated for DP and how to intervene, questions that are difficult to answer without accurate documentation of three-dimensional (3-D) head shape. This study explored a method for quantifying head shape and used that method to evaluate the success of orthotic treatment. Two hundred twenty-four infants who were diagnosed with DP received either a cranial remolding orthosis or a repositioning program with no orthotic intervention. Data from 25 head shape variables were collected using a noninvasive laser shape digitizer. Only variables attributable to growth showed significant differences in the control population, while the treatment population showed significant differences in pre-and post-treatment values for all variables. The study identified four variables as particularly important in assessing the head shape of infants with plagiocephaly: the cranial vault asymmetry index, radial symmetry index, posterior symmetry ratio, and overall symmetry ratio. Ninety-six percent or more of subjects in the treatment group showed improvement in each variable. These data document the utility of a 3-D scanning device and the effectiveness of treatment with a cranial remolding orthosis.

Analysis of Variance↗

PubMed1996

The results of a five-year early prostate cancer detection intervention. Investigators of the American Cancer Society National Prostate Cancer Detection Project.

BACKGROUND: The American Cancer Society-National Prostate Cancer Detection Project (ACS-NPCDP) is a multidisciplinary evaluation of early prostate cancer detection interventions. This report summarizes the experience of the investigators to date and describes the overall and relative performance of the different detection modalities studied in this project. METHODS: Two thousand nine hundred ninety-nine men aged 55 to 70 years at entry who were not already under evaluation for prostate cancer were recruited to participate in up to 5 annual examinations by prostate specific antigen (PSA), digital rectal examination (DRE), and transrectal ultrasound (TRUS). In the course of 5 years of intervention, ACS-NPCDP investigators have completed 9937 examinations, recommended 1215 biopsies, and detected 203 cancers. RESULTS: Loss to cohort follow-up was greatest in the first year. Overall, TRUS led to twice the number of recommendations for biopsy compared with DRE (8.9% versus 4.4%). Elevated PSA was observed in 13.0% of 9535 measurements performed. The overall cancer detection rate declined significantly during the five years of intervention. Detection was significantly associated with age and symptom status at entry. DRE had lower sensitivity compared with TRUS or PSA, particularly in later years of follow-up. The specificity of TRUS was lower than that for DRE. PSA was elevated in 69.2% of examinations that led to cancer detection, compared with only 10.9% when cancer was not found. PSA level, PSA density, and PSA change were all related to the presence of cancer. Less than 6% of the cancers detected in this study were clinically advanced at the time of diagnosis. CONCLUSIONS: These data quantify the yield of early cancer detection that may be expected when PSA, DRE, and TRUS are used in populations comparable to the men participating in the ACS-NPCDP. Continued follow-up and further research is needed to assess whether men receiving early prostate cancer interventions benefit as a result.

Aged↗

PubMed2005

The digital pen and paper. Evaluation and acceptance of a new data acquisition device in clinical settings.

OBJECTIVES: To evaluate the efficiency and acceptance of digital pen and paper technology for real-time clinical data acquisition. METHODS: A prospective interventional unblinded study involving consecutive patients in two clinical settings during a defined time-frame was proposed. The first trial was designed as a stress test to evaluate acceptance in a workload-intensive environment. Acceptance was assessed using observations and a satisfaction questionnaire. The second trial was intended to determine the reliability of data acquisition in a controlled environment. Reliability was assessed by comparing the performance of the digital pen against scanner analysis and a double human blinded acquisition. RESULTS: Overall, users were satisfied with the use of the digital pen (median 3 on a Likert-scale (-5, 5)). Without any specific user training, successful data acquisition was greater than 80%. Use of this technology required less adaptation than standard computer devices, and was easy to learn and use. Ergonomic problems shaded the perception of the technology by inducing an increased cognitive load. Digitalized data was missing either because of a bug or due to lack of data validation. The reliability obtained with the digital pen was significantly lower to that obtained with the scanner. CONCLUSIONS: Natural technology such as the digital pen proved to be a good tool in stressful clinical environments without interfering with the normal workload or increasing the time for data acquisition. However, in order to improve quality of data acquisition, designing acquisition forms specifically for the use of digital pens is of paramount importance.

Anesthesia, Obstetrical↗

PubMed1990

Role of echocardiography in acute myocardial infarction.

Interventional therapies such as thrombolytic agents, angioplasty and surgery have emerged as important options in the management of patients with myocardial infarction. These therapies are aimed at improving myocardial perfusion with the ultimate improvement or restoration of myocardial function. Two-dimensional echocardiography with digital storage and display is an ideal technique for temporally monitoring regional ventricular function and the effectiveness of interventional therapy. By design, 2-dimensional echocardiography is noninvasive and can be performed conveniently at the bedside. For these reasons, echocardiography is the principal imaging technique at Indiana University Hospital for patients with acute myocardial infarction. Computer retrieval of echocardiograms can be achieved in about 10 seconds at the nurses' station in the coronary care unit. With the availability of such an examination, the physician has a better understanding of the site, size and function of the infarct area. The state of the noninfarcted myocardium is also assessed and may be critical to the patient's prognosis. With the digital recordings, serial studies can be displayed side-by-side, making it easier for the physician to follow the natural history or to judge the effect of therapy. Echocardiography also is useful in identifying many complications that can occur with myocardial infarction. For these reasons, and because echocardiography will also show related cardiac problems, it is indispensable in the management of acute myocardial infarction.

Echocardiography↗

PubMed1983

Intraarterial digital subtraction angiography: a comparative view.

Intraarterial digital subtraction angiography (IA DSA) was performed in 122 patients undergoing a variety of diagnostic and interventional angiographic procedures. Owing to the increased contrast resolution of DSA, diluted contrast material in concentrations of from 12-19% could be employed, thereby significantly reducing contrast material doses compared to doses used with conventional film-screen angiography or intravenous DSA. Patient discomfort was convincingly reduced due to the injection of dilute contrast material. Subtracted digital images could be viewed immediately on a cathode ray tube (CRT) resulting in faster procedures with less catheter time. Savings in film costs relative to conventional angiography were also achieved.

Angiography↗

PubMed1992

Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.

OBJECTIVE: To compare the clinical outcome in patients with preterm premature rupture of membranes (PROM) who had a sterile speculum examination with those having a digital vaginal examination. METHODS: We studied 271 singleton pregnancies complicated by preterm PROM from the Memorial Medical Center of Long Beach Perinatal Outreach program that met the criteria for expectant treatment from January 1986 to April 1990. Patients were not included in the study if they had multiple gestations, cerclage, advanced labor, or any indication for delivery on admission (eg, mature lung profile, chorioamnionitis). All subjects were maternal transports to our tertiary care facility and were managed similarly by our perinatal group. The women were questioned as to whether a digital vaginal examination had been performed before transport. Latency period and other obstetric characteristics were then compared. The latency period, defined as days from rupture of membranes until active intervention was initiated or labor began spontaneously, was also stratified by gestational age. RESULTS: One hundred twenty-seven subjects had a digital vaginal examination and 144 had a sterile speculum examination. A significantly (P less than .0001) shorter mean latency period (2.1 +/- 4.0 versus 11.3 +/- 13.4 days) was found in those who had a digital vaginal examination. In addition, a shorter latency period was noted for each gestational age. No difference in uterine activity or cervical dilatation and effacement was noted between the groups on admission. CONCLUSION: Digital vaginal examinations performed on patients whose pregnancies are complicated by preterm PROM appear to shorten significantly the latency period.

Chorioamnionitis↗

PubMed1997

Evaluation of an on-line patient exposure meter in neuroradiology.

PURPOSE: To assess the clinical performance and usefulness of an on-line patient exposure meter installed on a neuroradiologic biplane imaging system. MATERIALS AND METHODS: A commercial on-line patient exposure meter was installed on each plane of a biplane neuroradiologic imaging system. The meter computed skin exposures on the basis of selected technique factors (tube potential and current) and information about patient location relative to the x-ray tube. Simulations were performed to measure the system accuracy with an angiographic anthropomorphic head phantom with the skin exposures measured with an ionization chamber. Skin doses were computed for 114 consecutive patients who underwent diagnostic and interventional neuroradiologic procedures. RESULTS: Agreement between measured and computed skin exposures in fluoroscopy, plain radiography, and digital imaging was generally within 5% of the true skin dose. For all fluoroscopic and radiographic procedures, total median skin doses were 1.20 and 0.64 Gy for the frontal and lateral planes, respectively. In both planes, patient skin doses resulted primarily from digital subtraction angiographic acquisitions. In 29 (25%) patients, the skin dose exceeded 2.00 Gy, but no radiation-induced deterministic effects were observed. CONCLUSION: An on-line patient exposure meter can provide accurate radiation skin dose data in patients undergoing diagnostic and therapeutic neuroradiologic procedures.

Angiography↗

PubMed1985

Cardiac applications of digital subtraction angiography.

Recent developments in digital computer technology have enabled direct digital acquisition of radiographic images at spatial and temporal resolutions similar to that of cineradiography. Initially intended as a means of performing peripheral angiography, digital subtraction angiography has been increasingly applied to cardiac catheterization procedures. Advantages of cardiac digital subtraction angiography include the capabilities to: immediately replay, magnify and enhance angiographic studies during coronary artery interventions, perform left ventriculography with peripheral contrast injections and direct left ventriculography with substantially reduced contrast doses, perform bypass graft visualization using aortic root contrast injection, assess relative regional coronary blood flow and facilitate the quantification of ventriculographic and coronary stenosis parameters. Clinical comparisons of standard cineradiographic and digital angiographic studies have demonstrated very similar results.

Angiocardiography↗

PubMed2002

[Dystrophic epidermolysis bullosa: surgical treatment of advanced hand deformities].

Dystrophic epidermolysis bullosa (Hallopeau-Siemens, recessive dystrophic epidermolysis bullosa) is a rare inherited disorder of the skin and mucosa, characterized by blistering in response to the slightest mechanical trauma. Healing is associated with scarring and the formation of contractures and milia. Following repetitive trauma (friction), this process leads to severe hand deformities with digits contracted in flexion, the thumb contracted in adduction and pseudo-syndactyly. In advanced cases (as described here), the hands show a mitten-like deformity and digits are encased in an epidermal "cocoon". This results in complete loss of function with major consequences for both the patient's (children's) daily life and their psychosocial development. We demonstrate the advantages of the (simplified) surgical procedure including "de-cocooning"/degloving, syndactyly-release, release of the thumb and the digital joint contractures and Kirschner-wire stabilization. Spontaneous epithelialisation of skin defects proved to be unproblematic and advantageous compared to skin transplantations, flaps, keratinocyte transplantations and other more ambitious procedures. Reviewing the published long-term results of other methods, we favour the procedure described because it simplifies and accelerates the overall treatment. From 1998 to 2001, we treated three children with recessive dystrophic epidermolysis bullosa and five hands were operated. A total number of 23 interventions was necessary (21 x using face masks, 2 x oral intubation). Pseudo-syndactyly (digits II - V, partially or totally) occurred in four hands after six to ten months. Flexion contractures of the digits occurred in two hands after eight to ten months. Limitating adduction contracture of the thumb occurred in two hands after eight to twelve months. Digital function (pinch and grasp) was actually preserved in two hands for 15 to 30 months. An active surgical approach is justified by the gain in functional improvement of the hand - even if only temporary - and, consecutively, by the positive effect on the child's development.

Bone Wires↗

PubMed2001

Duplex scanning allows selective use of arteriography in the management of patients with severe lower leg arterial disease.

PURPOSE: Until April 1997 we routinely performed intra-arterial digital subtraction angiography (iaDSA) in all patients with severe lower leg ischemia requiring intervention. After a comparative study of duplex scanning (DS), pulsegenerated runoff, and iaDSA of the lower leg arteries, we postulated that management could be based on DS/pulse-generated runoff in 59% of patients. We prospectively evaluated the safety of such a noninvasive workup strategy. METHODS: All consecutive patients referred with severe lower leg ischemia between April 1997 and September 1998 were eligible. Management was based on DS with iaDSA being performed only on indication. Complications within 30 days and 12- and 24-month patency, survival, and limb salvage rates were recorded and compared with historical controls. RESULTS: A total of 125 limbs in 114 patients were evaluated (74% rest pain or tissue loss). In 97 (78%) of 125 limbs, management was based on DS. It comprised conservative treatment (n = 33, 0% after iaDSA), percutaneous transluminal angioplasty (n = 25, 16% iaDSA), femoropopliteal bypass graft (n = 29, 17% iaDSA), femorotibial bypass graft (n = 29, 62% iaDSA), and other surgical procedures (n = 8, 4% iaDSA). Overall, the mortality within 30 days was 4% (5/114), and 2-year survival was 83%. Two-year primary and secondary patency and limb salvage rates were 75%, 93%, and 93% after a femoropopliteal bypass operation, respectively. One-year primary and secondary patency and limb salvage rates were 35%, 73%, and 74%, respectively, after a femorocrural bypass operation. There were no differences in patient characteristics, indication for specific treatment, and immediate and intermediate term outcome between the study and reference population. CONCLUSION: In a vascular unit with wide expertise in DS of the lower leg arteries, management of patients with severe lower leg ischemia can be based on DS in most patients without negative effects on clinical outcome within 30 days and at 2-years' follow-up.

Adult↗

PubMed2026

Effectiveness of Embedded Social Media Content on E-cigarette Attitudes and Behaviors: Results from a Randomized Control Trial.

BACKGROUND: This longitudinal randomized controlled trial examined the effects of anti-vaping social media content on e-cigarette attitudes and intentions among U.S. young adults (ages 18-24; n=3,400). METHODS: Targeted content was embedded directly into participants' social media feeds, with varying levels of impressions. RESULTS: Results indicate that increased exposure to anti-vaping messages significantly elevated perceived risk of harm (β=0.11, 95% CI: 0.03-0.20, p < .01) and social unacceptability of e-cigarette use (β=0.10, 95% CI: 0.03-0.18, p < .01), while decreasing intentions to vape (RRR = 0.59, 95% CI: 0.36-0.97, p < .05). Notably, these attitudinal shifts occurred even with relatively low ad exposure and over an extended intervention period, while controlling for the e-cigarette use status (never, former, or current) of participants. Discussion These findings support the effectiveness of digital media campaigns in influencing health-related behaviors and attitudes among young adults. Specifically, embedding anti e-cigarette content directly in the feed of young adults is shown to be effective in shifting attitudes in a space where these young adults are already engaged. Limitations include limited ad impressions and minimal change in ad awareness recall, suggesting future research should explore longer interventions and broader nicotine product messaging.

Humans↗

PubMed2002

Simultaneous real-time visualization of the catheter tip and vascular anatomy for MR-guided PTA of iliac arteries in an animal model.

PURPOSE: To examine the feasibility of simultaneous MR real-time active tip tracking and near real-time depiction of the vascular anatomy for percutaneous angioplasty of iliac arteries under MR guidance. MATERIALS AND METHODS: Nine surgically created stenoses of external iliac arteries in pigs were dilated with MR-compatible balloon catheters (Cordis, Roden, The Netherlands). These catheters were equipped with a microcoil for active tracking of the catheter tip with an in-plane update rate of 10 positions per second. The procedures were performed on an interventional 1.5 T Gyroscan ACS-NT scanner (Philips, Best, The Netherlands). Real-time calculation of images acquired by radial k-space filling was performed on a specially designed backprojector exploiting the sliding window reconstruction technique (Philips Research Laboratories, Hamburg, Germany). The image update rate was 20 frames per second using a radial gradient-echo technique (TR = 12 msec, TE = 3.3 msec, 300 radials). MR angiography and X-ray digital subtraction angiography on the X-ray system positioned in-line next to the interventional MR system served as control for the angioplasty results. RESULTS: Real-time guidance and positioning of the balloon catheters was possible. The actual position of the catheter tip was indicated in the MR images without any time delay for the reconstruction of the anatomical MR images, which were updated with a rate of 20 frames per second. This yielded a combination of a roadmap and fluoroscopy image, in which the catheter position and the anatomical background image both were continuously updated in real time. Six out of nine stenoses were successfully dilated. The effects of the angioplasty could be visualized by the real-time MR technique, as was proven by X-ray digital subtraction angiography. CONCLUSION: Active tip tracking simultaneous with MRI of the vascular anatomy-both in real time-is possible with the applied technique, enabling MR-guided percutaneous dilatation (PTA) of iliac arteries.

Angiography, Digital Subtraction↗

PubMed1996

[Individual archiving of digital angiocardiograms].

CD-R will be introduced internationally as a standardized individual archive and exchange medium allowing individual solutions for long-term archiving in a catheterization laboratory. The concept of digital archiving on two CD-R includes a long-term primary basic archive and a secondary one edited by intelligent (medical) data reduction (IDR). The basic archive is automatically composed by a background process consisting of unprocessed images or image series and is fundamental for further transfers, storage, presentations and additional studies. The digital working archive comprises a set of images and image series edited by IDR, as well as the results of morphometric studies as well as identification and documentation data. IDR is based upon the elimination of useless and redundant images series, documentation of coronary interventions on one single representative image and on the reduction of relevant images series and physiological data into an ECG-controlled representative cardiac cycle. IDR edits a redundancy-free set of 130 images (diagnostic study) or only 85 images of an interventional study. Two cardiologists and two cardiosurgeons independently studied 24 IDR-edited angiograms and the corresponding unedited digital angiograms and found no significant differences in the diagnostically relevant coronary morphology and left ventricular function. This study shows that an edited angiogram may not only serve for digital archiving but also form the basis for further evaluation or copies.

Angiocardiography↗

PubMedDate not supplied

Development of variable dose X-ray fluoroscopic system--aimed at reduction of X-ray exposure during interventional radiologic procedure.

Recent advancement in IVR by the catheterization technique has raised the problem of increased X-ray exposure dose. To minimize this problem, we developed an X-ray fluoroscopy system with which the operator can select the X-ray dose according to the required image quality. The optical system features an optical iris that adjusts the amount of light input to the camera tube (the optical iris is usually fixed). If a rough fluoroscopic image with low S/N is acceptable, the optical iris is opened and the fluoroscopic dose is automatically reduced. This reduces exposure dose to 30-60% of the conventional dose.

Angiography↗

PubMed2001

Gadolinium contrast agents: their role in vascular and nonvascular diagnostic angiography and interventions.

Gadolinium-based contrast agents can be used for diagnostic and interventional angiographic procedures to reduce contrast-related nephrotoxicity or in patients with a history of severe allergic reaction to iodine-containing contrast material. These agents are best used in conjunction with CO(2) to complete nondiagnostic CO(2) angiograms and to monitor the progress of a percutaneous intervention. However, the total volume of gadolinium that can be administered, the reduced quality of gadolinium digital subtraction angiography images, and the increased cost of the gadolinium-based agents can limit their use.

Contrast Media↗