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PubMed1993

Unrecognized left main coronary artery disease in patients undergoing interventional procedures.

Selective, coronary arteriographic, catheter-based, intravascular ultrasound images were obtained to determine the presence and extent of angiographically undetected or underestimated left main (LM) coronary arterial narrowing in patients receiving coronary interventional therapy. Coronary arteriograms were determined to be either normal or abnormal by visual inspection. Abnormal arteriograms were digitized and quantitated using a semiautomated edge-detection algorithm. Thirty-eight patients receiving percutaneous treatment of stenoses in the left coronary artery system were studied. Optimal LM coronary angiograms were obtained in 2 views, and intravascular ultrasound images were obtained after the coronary interventional procedure. Intravascular ultrasound detected plaque in 24 of 27 angiographically normal LM arteries (89%), whereas narrowing was observed in 11 of 11 angiographically abnormal LM arteries (100%). Eight of 38 patients (21%) had > 40% area stenosis by intravascular ultrasound. In patients with angiographic disease, there was no correlation between quantitative angiographic and ultrasound percent area stenosis (r = 0.12; p = 0.72; SEE 19%). The median plaque area was not different between angiographically normal (0.05 cm2; 0.03, 0.08 [25th, 75th percentile]) and abnormal (0.06 cm2; 0.03, 0.1) patients. The median percent area stenosis in arteriographically normal subjects (26%; 14, 32%) was less than that in abnormal ones (37%; 20, 46%) (p = 0.03). Unrecognized LM disease is widespread and often underestimated in patients with normal LM angiograms undergoing interventional procedures. Plaque area is similar for angiographically normal and insignificantly abnormal vessels. This study suggests that intravascular ultrasound overcomes the limitations of silhouette imaging and can be a clinically useful, adjunctive method to evaluate LM coronary artery disease.

Algorithms↗

PubMed2006

Salvage of failed prior endovascular abdominal aortic aneurysm repair with fenestrated endovascular stent grafts.

Three patients with type I proximal endoleak after previous endovascular abdominal aortic aneurysm (AAA) repair were treated with fenestrated endovascular stent grafts. Six renal arteries, three superior mesenteric arteries, and one coeliac axis were targeted for incorporation by graft fenestration. The fenestration-renal ostium interface was secured with balloon-expandable stents and completion angiography demonstrated no endoleaks and antegrade perfusion in all target vessels. All patients made an uncomplicated recovery. Fenestrated endovascular stent grafts can be used to salvage failed prior endovascular AAA repair in patients who are considered unsuitable for other endovascular or open surgical interventions.

Aged↗

PubMed2004

Pelvic floor exercises for treating post-micturition dribble in men with erectile dysfunction: a randomized controlled trial.

PURPOSE: The purpose of this trial was to compare the efficacy of pelvic floor muscle exercises and manometric biofeedback for post-micturition dribble (PMD) in men with erectile dysfunction. METHODS: Fifty-five men with erectile dysfunction (median age 59.2 years; range 22-78) were enrolled from a local urology clinic. Twenty-eight subjects were randomized to an intervention group and received pelvic floor muscle exercises including a strong post-void "squeeze out" pelvic floor muscle contraction, biofeedback, and suggestions for lifestyle changes. Twenty-seven control subjects were solely advised on lifestyle changes. The PMD status, anal manometry, and digital anal muscle grade were assessed at baseline, 3, and 6 months. After 3 months, the control group received the intervention with pelvic floor muscle exercises and biofeedback. Both groups were followed for an additional 3 months of home exercises. An independent assessor who was blinded to the grouping assessed the PMD status of subjects at 3 and 6 months. RESULTS: Thirty-six (65.5%) of the 55 subjects reported PMD at baseline. At 3 months, there was significant reduction in PMD after intervention (p=0.001) compared to the control subjects (p=0.102). In both groups combined after 3 months of pelvic floor muscle exercises and 3 months of home exercises, 27 (75%) subjects became asymptomatic of PMD, 3 (8.3%) improved, 5 (13.9%) dropped out, and 1 (2.8%) subject still reported PMD. PMD was not correlated to age, erectile function, anal manometric pressure, or digital anal muscle grade. CONCLUSION: Pelvic floor muscle exercises including a post-void "squeeze out" pelvic floor muscle contraction are an effective treatment for post-micturition dribble in men with erectile dysfunction.

Adult↗

PubMed1983

Pulmonary circulation time: comparison of mean, median, peak, and onset (appearance) values using indocyanine green and first-transit radionuclide techniques.

To assess the difference between a variety of mathematical methods for assessing pulmonary transit time, we evaluated 11 acutely anesthetized and instrumented mongrel dogs at a control stage and then during infusions of isoproterenol or phenylephrine, or after the induction of ischemia. Green-dye optical density curves were obtained to evaluate a variety of pulmonary circulation times. Mean transit time, median time, peak time, and onset time all correlated well (r greater than or equal to 0.93), with the mean time being the longest, followed by the median time (4% less than the mean time, p less than 0.05), peak time (15% less than the mean time p less than 0.01), and onset or appearance time (49% less than the mean time, p less than 0.001). In the 34 available data points the mean time averaged 4.67 +/- 1.7 seconds, the median time averaged 4.47 +/- 1.74 seconds, the peak time averaged 3.98 +/- 1.7 seconds, and the onset time averaged 2.27 +/- 1.43 seconds. Similar results were obtained from the first-pass radionuclide angiograms from 17 adult male subjects. We conclude that median, peak, and onset times are reasonable though predictably shorter approximates of mean pulmonary transit time. They may be utilized during interventions (particularly when alternative counting methods are planned, as with radionuclide or possibly digital angiographic techniques) as guides to changes in the pulmonary circulation.

Animals↗

PubMed2001

Onset of oscillopsia after visual maturation in patients with congenital nystagmus.

PURPOSE: To describe the clinical and oculographic characteristics of a cohort of five patients with congenital nystagmus (CN) and late-onset oscillopsia caused by a coincidental decline in other visual and/or ocular motor functions. DESIGN: Retrospective, observational, case series. PARTICIPANTS: Five visually mature patients with CN and recent-onset oscillopsia were evaluated clinically and with motility recordings. INTERVENTION: Eye movement analysis was performed off-line by computer analysis of digitized data. Nystagmus was analyzed for null-zone characteristics, waveforms, frequency, amplitudes, and slow-phase drift velocity during foveation. Surgical and medical treatment of associated ocular conditions in four of five patients. MAIN OUTCOME MEASURES: Presence of symptomatic oscillopsia and average time during foveation periods of slow-phase drift velocity less than 10 degrees /second. RESULTS: One of the five patients had associated rod-cone dystrophy, and another had recurrence of childhood head posturing with return of an eccentric null zone. The remaining three patients had decompensated strabismus associated with their oscillopsia. All five patients complained of oscillopsia in primary position that was relieved in the four who received treatment. Treatment included prismatic correction in one patient and surgery in three. Recordings in primary position after treatment showed increased duration during foveation periods of slow-phase drift velocity less than 10 degrees /second and an overall decreased intensity (amplitude/frequency) of the nystagmus. CONCLUSIONS: Symptomatic oscillopsia in patients with CN is unusual. This visually disturbing symptom can be precipitated by new or changing associated visual sensory conditions (e.g., decompensating strabismus, retinal degeneration). If the associated conditions can be treated, then accompanying oscillopsia may be relieved.

Adolescent↗

PubMed1998

Correlation of high-frequency ultrasound backscatter with tumor microstructure in iris melanoma.

OBJECTIVE: This study aimed to correlate histologic characteristics with high-frequency ultrasound backscatter spectra in malignant melanomas of the iris. DESIGN: The study design was a cohort (case series) study of patients diagnosed with iris melanoma in the authors' clinic. PARTICIPANTS: Sixteen patients with iris melanoma participated. INTERVENTION: The patients were scanned with a 50-MHz ultrasound unit equipped for digitization of raw echo data. Spectral parameter images representing the spatial distribution of size and concentration of tissue inhomogeneities were produced. MAIN OUTCOME MEASURES: The variation of spectral properties within and between tumors was determined. In the two tumors in this series for which histologic material was available, the authors compared scatterer concentration and size with histology and mathematically modeled the effect of melanocyte distribution on spectra. RESULTS: Ultrasound scattering characteristics differed considerably among tumors. Where histology was available, acoustic parameters correlated with the size and number of melanocytes present. CONCLUSIONS: Iris melanomas exhibited a wide range in acoustic backscatter properties. Whereas characteristics such as vascularity and necrosis might contribute to this, in the two cases examined here, backscatter characteristics could be largely accounted for by melanocyte distribution. A better understanding of the relationship of histology to noninvasive ultrasound data will enhance the diagnostic utility of this technique.

Adult↗

PubMed1997

Effects of lidoflazine on left ventricular function in patients.

OBJECTIVE: The present study evaluated the effects of the nucleoside transport inhibitor, lidoflazine, at a dose of 1 mg/kg, on left ventricular function. DESIGN: Patients were randomly assigned to receive either lidoflazine or saline in a double-blind manner. SETTING: A university hospital. PARTICIPANTS: The study was performed in 32 patients scheduled for elective coronary artery bypass surgery. INTERVENTIONS: Left ventricular pressures were measured with fluid-filled catheters. Data were digitally recorded during pressure elevation induced by tilt-up of the legs. Transgastric short-axis echocardiographic views of the left ventricle were simultaneously recorded on videotape. Systolic function was evaluated with the slope (Ees, mmHg/mL) of the systolic pressure-volume relationship. Diastolic function was evaluated with the chamber stiffness constant (Kc, mmHg/mL) of the diastolic pressure-volume relationship. Cardiac function was assessed at baseline and after administration of either lidoflazine (group A [n = 16]) or placebo (group B [n = 16]). Data were compared using two-factor analysis of variance. MEASUREMENTS AND MAIN RESULTS: At baseline, diastolic and systolic function were comparable in both groups. Lidoflazine increased Kc from 0.079 +/- 0.015 to 0.125 +/- 0.017 mmHg/mL and decreased Ees from 2.481 +/- 0.213 to 1.217 +/- 0.211 mmHg/mL (p = 0.009 and p = 0.004, respectively). None of these changes occurred when placebo was administered. CONCLUSIONS: Administration of lidoflazine before the start of cardiopulmonary bypass impaired left ventricular systolic function but also increased diastolic stiffness.

Aged↗

PubMed2001

Interaction in the segmentation of medical images: a survey.

Segmentation of the object of interest is a difficult step in the analysis of digital images. Fully automatic methods sometimes fail, producing incorrect results and requiring the intervention of a human operator. This is often true in medical applications, where image segmentation is particularly difficult due to restrictions imposed by image acquisition, pathology and biological variation. In this paper we present an early review of the largely unknown territory of human-computer interaction in image segmentation. The purpose is to identify patterns in the use of interaction and to develop qualitative criteria to evaluate interactive segmentation methods. We discuss existing interactive methods with respect to the following aspects: the type of information provided by the user, how this information affects the computational part, and the purpose of interaction in the segmentation process. The discussion is based on the potential impact of each strategy on the accuracy, repeatability and interaction efficiency. Among others, these are important aspects to characterise and understand the implications of interaction to the results generated by an interactive segmentation method. This survey is focused on medical imaging, however similar patterns are expected to hold for other applications as well.

Algorithms↗

PubMed1998

Pathophysiology of autonomic dysreflexia: long-term treatment with terazosin in adult and paediatric spinal cord injury patients manifesting recurrent dysreflexic episodes.

INTRODUCTION: Spinal cord injury (SCI) results in disruption of synaptic influences on the sympathetic preganglionic neurones. Remodelling of spinal cord circuits takes place in spinal neurones caudal to cord injury. There is an increased vascular alpha-adrenoceptor responsiveness, and peripheral afferent (bladder) stimulation in SCI subjects induces a marked noradrenaline spillover below the level of spinal lesion. These neurophysiological changes possibly contribute to the development of autonomic dysreflexia, a condition of sympathetic hyper-excitability that develops after cervical, or upper dorsal cord injury with resultant paroxysmal rise in arterial pressure, and provide the scientific basis for the use of terazosin, a once-a-day, selective alpha-one adrenergic blocking drug. OBJECTIVES: The use of terazosin, a long-acting, alpha 1-selective blocking agent was investigated in SCI patients who developed recurrent symptoms of autonomic dysreflexia, eg headache, sweating flushing of the face together with an increase in the arterial pressure. DESIGN: An open, prospective study of the efficacy of terazosin in controlling recurrent autonomic dysreflexia in traumatic tetraplegic/paraplegic patients manifesting clinical features of dysreflexia in the absence of an acute precipitating cause such as a blocked catheter. SETTING: The initial assessment and treatment were carried out in the Spinal Injuries Centre. Subsequently, the patients were followed-up in the community. They were monitored by telephonic interviews, follow-up visits by the patients to the hospital, and home-visits by the staff of the spinal unit. SUBJECTS: Eighteen adults with tetraplegia (female: 1; male: 17), three children with ventilator-dependent tetraplegia and three adult male patients with paraplegia who exhibited recurrent features of autonomic dysreflexia in the absence of an acute predisposing factor for dysreflexia eg performance of an invasive procedure such as cystoscopy, digital evacuation of bowels, or acute urinary retention, were enrolled in this study. INTERVENTION: After discussion with the patients and their carers, terazosin was prescribed with a starting dose of 1 mg in an adult and 0.5 mg in a child administered nocte. The patients were observed for (1) drug-induced hypotension; (2) clinical symptoms due to side effects of terazosin; and (3) continued occurrence of dysreflexic symptoms. Step-wise increments of the dose of terazosin (1 mg in case of adults, and 0.5 mg in a child) was carried out at intervals of 3-4 days, if a patient continued to develop dysreflexia but did not manifest any serious side effect. OUTCOME MEASURES: Complete subsidence of dysreflexic symptoms, or development of an adverse event necessitating termination of the terazosin therapy was the clinical end point. RESULTS: The dysreflexic symptoms subsided completely with the terazosin therapy in all the patients. The twenty-one adult patients required a dose varying from 1-10 mg, whereas the paediatric patients required only 1-2 mg of terazosin. The side effects of postural hypotension and drowsiness were transient, and mild. One tetraplegic patient developed persistent dizziness and therefore, the drug therapy was discontinued. CONCLUSION: In 21 adult and three paediatric spinal cord injury patients manifesting recurrent episodes of autonomic dysreflexia in the absence of an acute predisposing cause, the use of terazosin, a once-a-day, specific alpha-one blocker resulted in complete subsidence of the dysreflexic symptoms. However, one tetraplegic patient required termination of terazosin therapy because of persistent dizziness.

Adolescent↗

PubMed1988

Influence of tachycardia and arterial hypertension on infarct size in the pig.

To investigate the clinically important but controversial question of how hypertension during coronary occlusion affects infarct size 24 pigs underwent 1 h occlusion of the mid left anterior descending coronary artery and 24 h reperfusion and were randomised to one of three treatment groups. In group 1 blood pressure was increased during the occlusion period by an infusion of methoxamine; in group 2 tachycardia was induced by atrial pacing; and in group 3 no intervention was performed. The area at risk and infarct size were quantified by digital planimetry of slices of myocardium previously marked with fluorescein and with triphenyl-tetrazolium. Methoxamine maintained mean aortic blood pressure at 117 (SEM8) mmHg during occlusion, whereas the values were 80(6) mmHg in group 2 and 67(9) mmHg in group 3. Pacing increased heart rate to 146(1) beats.min-1 in group 2; it was 103(5) in group 1 and 99(8) in group 3. The pressure-rate product achieved was similar in groups 1 and 2 and significantly higher than in group 3. The pathological studies showed infarct size to be moderately but significantly larger in group 1 (14[3.5]% of the left ventricle) and similar in groups 2 (10.5[3.9]%) and 3 (10.1[2.2]%). The ratio of infarct size to area at risk was also significantly higher (0.743[0.057]) in group 1 with no differences between group 2 (0.604[0.055]) and group 3 (0.613[0.027]). At similar pressure-rate product, infarct size was thus greater with hypertension but not with pacing alone, showing a deleterious effect of increasing blood pressure in this experimental model with negligible collateral blood flow.

Animals↗

PubMedDate not supplied

Emerging technology: remote analysis of traumatic musculoskeletal radiographs transmitted by electronic mail.

OBJECTIVES: To determine whether remote analysis of radiographs via electronic mail (e-mail) had an impact on treatment decision-making. DESIGN: Prospective. SETTING: Level I trauma center. PATIENTS/PARTICIPANTS: Twenty-five cases randomly selected from previous emergency room consultation. INTERVENTION: Textual descriptions obtained from emergency medicine physicians were compared with computer-digitized images of radiographs sent via e-mail and with the actual radiographs. Four board-certified orthopaedic surgeons reviewed all three forms of data to determine fracture diagnosis and treatment plans. MAIN OUTCOME ASSESSMENT: Diagnosis and treatment plans were obtained via written questionnaire after review of each group of data (textual, digitized image, and actual radiograph). Results were then compared across groups to determine whether digitized images were better than textual descriptions and equivalent to actual radiographs. RESULTS: Statistical analysis revealed a significant improvement in the frequency of correct diagnosis and treatment planning when digitized images were used (91 percent) compared with textual descriptions alone (48 percent) (p < 0.001). The difference in correct diagnosis and treatment plans between digitized images and actual radiographs was not statistically significant (p = 0.27). CONCLUSION: Digitized radiographs sent via e-mail can significantly improve accuracy of diagnosis and treatment compared with a simple verbal description.

Computer Communication Networks↗

PubMed1995

Renal vascular disease as a cause of hypertension.

In spite of our comprehensive understanding of renovascular hypertension, diagnostic tests based on the pathophysiology of the disease have been disappointing in their sensitivity and specificity. They are particularly unreliable in the setting of bilateral disease and renal dysfunction. The recent results of vascular surgery and renal angioplasty combined with the use of metallic stents have shown dramatic benefits in revascularization even in the setting of renal artery occlusion, ostial renal artery stenosis, and renal dysfunction. Timely diagnosis and intervention are imperative, and, therefore, we recommend the early use of arteriography using digital subtraction angiographic techniques for the definitive diagnosis.

Angiography↗

PubMedDate not supplied

From wheels to wings with evolutionary spiking circuits.

We give an overview of the EPFL indoor flying project, whose goal is to evolve neural controllers for autonomous, adaptive, indoor micro-flyers. Indoor flight is still a challenge because it requires miniaturization, energy efficiency, and control of nonlinear flight dynamics. This ongoing project consists of developing a flying, vision-based micro-robot, a bio-inspired controller composed of adaptive spiking neurons directly mapped into digital microcontrollers, and a method to evolve such a neural controller without human intervention. This article describes the motivation and methodology used to reach our goal as well as the results of a number of preliminary experiments on vision-based wheeled and flying robots.

Action Potentials↗

PubMed2002

Idiopathic radial artery aneurysm in the anatomical snuff box.

An otherwise fit and well 40-year-old left-handed male computer operator presented with a minimally symptomatic lump of 2 years duration in his non-dominant anatomical snuffbox. There was no history of trauma. This was pulsatile and did not transilluminate despite being referred as a ganglion. MRI scan confirmed the presence of a 1.5 cm radial artery aneurysm fed by the radial artery and draining to the second digital artery. In view of his lack of symptoms the patient declined surgical intervention. Literature review reveals radial artery aneurysms to be very rare and usually traumatic in origin. Iatrogenic pseudoaneurysms are widely reported following cannulation. We are unaware of previous descriptions of an idiopathic, isolated radial artery aneurysm.

Adult↗

PubMed2003

Advances in angiography and their impact on endovascular therapy.

Transvascular therapy has progressed rapidly due to improvements in imaging equipment and endovascular devices. Interventional fluoroscopic equipment and portable machines are able to produce high-resolution digital images in well-lighted procedure rooms. Catheters and guidewires are now available in a variety of shapes, diameters and lengths, allowing entry into distal, small, and tortuous vessels. This in turn permits targeted local therapy of tumors and bleeding sites, as well as endovascular treatment of diseased vessels.

Angiography↗

PubMed2006

Measuring dissimilarity in online health search activities.

There is growing evidence of the use of the Internet to obtain critical health information as well as increased diversity of user groups. While users of web-based information often report their reliance on healthcare providers for validation of information, it has yet to be determined if this is universally true across all types of information or user groups. In some cases consumers may aggregate in places where they trust web information (relative to provider-based information), such as areas of unsettled diagnostic methods or ambiguous treatment protocols. To date little research has been done to identify and differentiate clusters of health consumers and their similarities related to type of information sought. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether clusters of "digitally underserved groups" persist in the US, following national efforts to eliminate barriers to health information access. This exploratory technology assessment study seeks to differentiate and delineate specific information behaviors, across targeted healthcare subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decisionmaking, consumer-centric health information model, critical to the proposed US national health information infrastructure.

Attitude to Computers↗

PubMed1998

Management of cervical disc herniation with upper cervical chiropractic care.

OBJECTIVE: To discuss the chiropractic management of a patient suffering from multiple complaints, including a herniated nucleus pulposus in the cervical spine diagnosed by magnetic resonance imaging (MRI). CLINICAL FEATURES: A 34-yr-old man suffered from severe neck, lower back and radicular pain of 1 yr duration. He had previously received care from multiple medical specialists, with little or no results. An MRI of the cervical spine demonstrated a C6-C7 herniated nucleus pulposus. A needle electromyogram examination confirmed the presence of a C6-C7 radiculopathy with radiculopathic changes from C4-C7. X-ray analysis showed that the atlas and axis were misaligned. These X-rays were read manually (with a template) and with computer-assisted digitization. Computerized analysis also measured misalignments at the levels of L4-L5. INTERVENTION AND OUTCOME: The patient was managed primarily with the Grostic Procedure of upper cervical adjusting by hand. After a period of about 1 month, a series of re-examinations revealed a dramatic improvement in all subjective and objective findings. A follow-up of > 1 yr has shown that surgery was not necessary. CONCLUSION: This single case study suggests that chiropractic care may be a viable treatment option for patients with cervical disc herniation. Further investigation into chiropractic adjustments as a treatment for this condition should be pursued.

Adult↗

PubMed2003

Influence of different types of stressors on the waveform of the peripheral arterial pulse in humans.

BACKGROUND: To characterize further the different reflected waves visible at the peripheral arterial pressure waveform, we recorded changes in the pulse wave contour during different stressful interventions. METHODS: Ten young healthy volunteers underwent two protocols. At the first occasion, the digital arterial pressure waveform was continuously recorded with the Portapres device during 5 min of rest, a mental arithmetic stress test (MAT) and during the cold pressor test (COP). At a second occasion, the pulse waveform was recorded at rest and during bicycle exercise. RESULTS: The reflected pressure peak seen during systole arrived earlier and was increased in amplitude during both MAT and COP compared to rest (p < 0.05). The first reflected pressure peak during diastole arrived earlier and was reduced in amplitude compared to the systolic peak during MAT (p < 0.01), while COP induced smaller effects. Bicycle exercise at 100 and 140 heartbeats/min caused the reflected peak in systole to be undetectable in most subjects and induced a marked reduction in the amplitude of the first diastolic reflected peak (p < 0.01), and time to its appearance was markedly reduced at 140 beats/min. CONCLUSION: Several stressors accounted in daily life, such as mental stress, pain and exercise-induced rapid changes in the arterial pulse waveform. In terms of timing and amplitude, the reflected systolic pressure peak and the first diastolic pressure peak did not always change in the same direction during the interventions, implying different origins of these two reflected waves. Combining the stressors used with pulse wave analysis is a simple method for studying vascular reactivity non-invasively.

Arteries↗