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PubMed1991

[Diagnostic and interventional radiology in pulmonary embolism].

The clinical picture of pulmonary embolism (PE) ist remarkably unspecific and one has to rely mainly on imaging techniques to obtain a reliable diagnosis. PE is not a primary disease but the complication of deep venous thrombosis (DVT), and thus there is a strong correlation between pulmonary embolism and venous thrombosis. Radiologic screening of these diseases is based on invasive and noninvasive tests. Chest X-ray has a low predictive value of 63% and helps mainly in ruling out other diagnoses such as pneumothorax or pneumonia. Chest computed tomography scanning with contrast may occasionally be useful in detecting large central emboli. Magnetic resonance imaging in PE has not yet been shown to be of great clinical value. Digital subtraction angiography has the potential advantage of allowing injections of smaller contrast volumes and is particularly useful in pulmonary hypertension. Cardiac and respiratory motion blur images and render interpretation difficult. Conventional pulmonary angiography is required for definitive diagnosis in a significant number of patients, especially when V/Q scan is non-diagnostic. Its morbidity and mortality is nowadays negligible. If these facilities are not available, they can often be obviated by venous studies searching for the presence of venous thromboses. Alternative modalities include contrast phlebography and venous ultrasound imaging. This last, newly developed technique combined with compression Doppler is safe and accurate, at least in the femoral and popliteal veins. Contrast phlebography remains the standard imaging method, is widely available, and demonstrates floating clots or thromboses with minor complications using non-ionic contrast media.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography, Digital Subtraction↗

PubMed1987

Proteus syndrome in southern Africa: natural history and clinical manifestations in six individuals.

Six individuals with Proteus syndrome have been investigated; 2 were adults and the others ranged in age from 2 to 11 years. They had a wide spectrum of manifestations and severity together with the hitherto unreported anomalies of penile hypertrophy, macro-orchidism, goiter, and failure of breast development. These findings were associated with normal endocrine function. Bizarre digital overgrowth, hemihypertrophy, thickened palms and soles, exostoses of the skull, and multiple hamartomata were common anomalies. Early overgrowth of limbs and digits occurred in several instances but the ultimate stature of 2 adults was normal. Surgical intervention offers cosmetic and orthopedic benefits, but these must be assessed in the light of potential post-operative complications.

Adult↗

PubMed2003

Fluoroscopic image quality in the film and filmless eras: a standardized comparison performed in coronary interventional facilities.

One hundred and one coronary interventional systems (45 primarily film-based predigital systems, labeled group 1; and 56 filmless digital systems, labeled group 2) were examined over a 5-year period using a standardized imaging phantom. Fluoroscopic image intensifier input dose, high-contrast spatial resolution, low-contrast sensitivity, and static and dynamic low-contrast resolution were assessed under several conditions simulating patient body habitus. The distribution of spatial resolutions in group 2 facilities favored higher line pair resolution over group 1 (P = 0.01). Contrast sensitivity (smallest-diameter hole visualized) was consistently and significantly enhanced with the use of digital imaging under both medium (P = 0.001) and large (P = 0.002) patient habitus simulations. Low-contrast video resolution (number of wires seen) under static (P = 0.007) and dynamic (P = 0.002) conditions was also improved in the digital facilities. However, image intensifer input dose was similar in both groups (group 1 median dose, 23 mR/min; group 2 median dose, 26 mR/min; P = NS). Fluoroscopic spatial resolution in digital filmless laboratories was significantly improved when compared to predigital, film-based laboratories. Low-contrast sensitivity and low- contrast video resolution under both static and dynamic conditions were also significantly improved in the digital laboratories. Notably, the input dose of radiation required to produce these improved fluoroscopic images was similar between groups.

Contrast Sensitivity↗

PubMed1996

Late vascular complication after fracture of the proximal humerus.

A case of late vascular complication after a fracture of the proximal humerus is presented. The main clinical feature was neurological loss of the brachial plexus, while angiography showed no rupture or false aneurysm. The long delay before surgical intervention caused irreversible damage to the nerves. Early diagnosis and surgical intervention are emphasized.

Angiography, Digital Subtraction↗

PubMed2002

[Acral ischemia as a rare paraneoplastic syndrome in the terminal phase of mouth floor carcinoma].

BACKGROUND: The term "paraneoplastic syndrome" describes a clinically apparent disease associated with a malignant neoplasm, which is not a direct consequence of invasive tumor growth. Acral ischemia and digital necrosis of multiple fingertips have been occasionally described as a paraneoplastic syndrome. However, the exact mechanisms of this phenomenon are still not adequately known. CASE REPORT: This paper describes a 72-year-old male patient with severe acral ischemia and multiple necroses on several fingertips. Symptoms evolved under palliative chemotherapy with gemcitabine for inoperable metachronous squamous cell carcinoma of the tonsil following a history of two simultaneous carcinomas of the alveolar crest. Digital ischemia was combined with severe pain, similar to Raynaud's syndrome, which required therapeutic intervention. The treatment objective is to improve perfusion and simultaneously reduce pain. A combination of iloprost, an analog of prostacyclin (50 micrograms intravenous Ilomedin once daily), and a CT-guided thoracic sympathectomy achieved a continuous positive effect on the intensity of acral ischemia and alleviated the pain.

Aged↗

PubMed2004

Perioperative topical nitrate and sphincter function in patients undergoing transanal stapled anastomosis: a randomized, placebo-controlled, double-blinded trial.

PURPOSE: The use of transanal stapling devices may impair continence because of digital dilatation and/or instrumentation. This study assessed the effect of pharmacological dilatation of the sphincter prior to stapler insertion. METHODS: A randomized, placebo-controlled, double-blinded study of 60 patients undergoing transanal stapled anastomosis was undertaken. Consenting patients were randomly assigned to receive a single intraoperative dose of topical 0.2 percent nitroglycerin (glyceryl trinitrate) ointment or nitroglycerin-free placebo. All patients were assessed preoperatively and postoperatively by clinical methods (Wexner incontinence scores and examination), anorectal manometry by a station pull-through technique, and endoanal ultrasonography. RESULTS: Intraoperative mean (+/-SEM) resting pressures (mmHg) were significantly reduced by nitroglycerin compared with prenitroglycerin levels (9.9 +/- 0.9 vs. 50.5 +/- 2.7; P = 0.002) or controls (56.0 +/- 3.2; P = 0.001). Twenty-one of the 28 controls (75 percent) but only 4 of the 32 patients in the nitroglycerin group (12.5 percent) required digital dilatation to insert the stapling instrument ( P = 0.003). Squeeze pressures were unaltered by the intervention but mean resting pressures were higher in the nitroglycerin group postoperatively (52.9 +/- 3.2 - 31.6 +/- 1.3 = 21.3 mmHg; 95 percent confidence interval, 14-27). Incontinence scores were lower in the nitroglycerin group at the 3-month (1.1 +/- 0.2 vs. 4.6 +/- 0.3; P = 0.003) and 12-month (0.9 +/- 0.1 vs. 4.4 +/- 0.3; P = 0.002) clinic visits. CONCLUSION: Preoperative nitroglycerin dilatation protects sphincter function in patients undergoing transanal stapled anastomoses.

Administration, Topical↗

PubMed2005

Sensitivity, specificity, and variability of nerve conduction velocity measurements in carpal tunnel syndrome.

OBJECTIVE: To explore the diagnostic values of 8 commonly used electrodiagnostic techniques for measuring median nerve conduction velocity (NCV) in carpal tunnel syndrome (CTS). DESIGN: Sensitivity and specificity analyses. SETTING: A hospital-based electrodiagnostic laboratory. PARTICIPANTS: Forty-four normal hands and 136 symptomatic hands. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Long-segment studies: antidromic wrist-to-digit sensory NCV without subtraction, (2) short-segment studies: transcarpal palm-to-wrist mixed NCV without subtraction, and (3) 2 segment studies: antidromic transcarpal sensory NCV with subtraction (differential calculation from wrist-to-digit and palm-to-digit segments). Both onset and peak latency values were obtained for calculating the NCV. Sensitivity, specificity, and coefficient of variance were calculated for each NCV study. RESULTS: The short-segment, onset latency-based transcarpal mixed NCV yielded the highest sensitivity (75%). CONCLUSIONS: Results from measurement of a single, short-nerve segment tended to be superior to results obtained by either long-segment studies or differential subtraction between 2 segments of the same nerve in the electrodiagnosis of CTS. Explanations for our results are offered from both electrophysiologic and statistical perspectives.

Adult↗

PubMed2005

Effects of interstitial fallopian tube polyps on isthmic tubal diameter.

OBJECTIVE: To study the apparent association between interstitial fallopian tube polyps and isthmic tubal dilatation. DESIGN: Retrospective clinical study. SETTING: Tertiary academic medical center. PATIENT(S): Sixty-five patients with normal hysterosalpingograms and 40 patients with interstitial tubal polyps (25 unilateral and 15 bilateral). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Proximal, medial, and distal isthmic diameters were measured digitally and normalized according to an internal standard. Polyp volumes were measured and divided into four groups according to increasing volume (<2 mm3, 2-5 mm3, 6-12 mm3, >12 mm3). RESULT(S): There was a significant increase in proximal isthmic tubal diameter in patients with interstitial polyps. Mean diameter increased from 0.6 mm to 0.9 mm. There was no significant change in more distal isthmic diameters. Larger polyps tended to be associated with larger luminal diameters. CONCLUSION(S): Interstitial fallopian tube polyps are associated with a significant increase in proximal isthmic luminal diameter as determined on hysterosalpingography. Although these polyps are nonobstructing and thus thought by most investigators not to affect fertility, their association with altered luminal diameter and perhaps altered function might be of clinical interest.

Fallopian Tube Diseases↗

PubMed2003

The role of low-bandwidth telemedicine in surgical prescreening.

PURPOSE: Low-bandwidth, Internet-based telemedicine is an inexpensive technology that could help deliver heath care in medically underserved areas. The purpose of this study was to evaluate the usefulness of low-bandwidth telemedicine in remote surgical evaluation. METHODS: A group of surgeons and nurses traveled to Mombasa, Kenya to provide surgical assistance at the Coast Province General Hospital (CPGH). Before the visit of the surgical team, surgeons evaluated patients via low-bandwidth telemedicine. Prescreening was performed through use of an Internet-based desktop computer system that was supported technically by the Virginia Commonwealth University (VCU) Medical Informatics and Technology Applications Consortium (MITAC) telemedicine laboratory. Surgical patients were evaluated remotely regarding appropriateness of surgical intervention by reviewing e-mails that included the patient's age, history, physical examination, digital images of the patient, and digital images of pertinent radiographs. RESULTS: Fifty-one patients, including 7 pediatric patients, were prescreened. Thirty-three of the 51 patients (65%) were deemed inappropriate for surgery before this trip because of advanced disease or absence of necessary local medical resources. Of the 18 patients determined to be appropriate candidates for surgery by remote prescreening, 18 (100%) were operated on successfully during the relief effort. Sixty patients including 9 (15%) pediatric patients underwent surgery over the course of 5 days in CPGH. Pediatric cases included various laparoscopic, oncologic, and soft tissue reconstruction. CONCLUSIONS: Low-bandwidth, Internet-based telemedicine is a cost-effective technology that can efficiently and effectively prescreen surgical patients in remote areas.

Adult↗

PubMed2004

Effectiveness of a community-based oral cancer awareness campaign (United States).

OBJECTIVE: The purpose of this study was to provide the first systematic evaluation in the United States of a community-based oral cancer awareness campaign. METHODS: We used a non-equivalent control group design and random-digit-dialing methods to examine billboard effectiveness and pre- and post-billboard impact between intervention and control counties in adult probability samples in Florida, USA. RESULTS: Respondents in the intervention county were more likely than controls to correctly identify the billboard message to get tested for oral cancer, and less likely than controls to report ever having an oral cancer examination, or to have heard of oral cancer. Results of pre-post analyses within each county showed that oral cancer examinations were significantly more frequent in both counties after the campaign. There were no significant differences between counties on the proportion of individuals who reported having seen the campaign or on any other item measuring billboard awareness or impact. CONCLUSIONS: Results suggest the Florida billboard campaign had limited success in increasing public awareness. Future cancer awareness campaigns should incorporate theoretical models, target high-risk groups and the broader community and provide culturally relevant messages as part of a multi-media campaign.

Adolescent↗

PubMed1993

Diagnostic imaging as a measuring device for stereotactic neurosurgery.

A wide range of diagnostic imaging techniques are used as positional measuring devices for the localization stage of stereotactic neurosurgery. Positional mapping from the image system to the surgical reference frame is achieved using a variety of designs of fiduciary systems. Standard projection radiography, computed tomography, digital radiography and fluoroscopy, and magnetic resonance imaging are used to plan and accurately guide interventional neurosurgical procedures. A general summary of the applications of stereotactic techniques is presented. The techniques involved and the design principles of the fiduciary systems used are discussed, along with the scientific limitations and accuracies of the various systems.

Brain↗

PubMed1999

Effect of iron-, iodine-, and beta-carotene-fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial.

BACKGROUND: Deficiencies of iron, iodine, and vitamin A are prevalent worldwide and can affect the mental development and learning ability of schoolchildren. OBJECTIVE: The aim of this study was to determine the effect of micronutrient-fortified biscuits on the micronutrient status of primary school children. DESIGN: Micronutrient status was assessed in 115 children aged 6-11 y before and after consumption of biscuits (fortified with iron, iodine, and beta-carotene) for 43 wk over a 12-mo period and was compared with that in a control group (n = 113) who consumed nonfortified biscuits. Cognitive function, growth, and morbidity were assessed as secondary outcomes. RESULTS: There was a significant between-group treatment effect on serum retinol, serum ferritin, serum iron, transferrin saturation, and urinary iodine (P <0.0001) and in hemoglobin and hematocrit (P <0.05). The prevalence of low serum retinol concentrations (<0.70 micromol/L) decreased from 39.1% to 12.2%, of low serum ferritin concentrations (<20 microg/L) from 27.8% to 13.9%, of anemia (hemoglobin <120 g/L) from 29.6% to 15.6%, and of low urinary iodine concentrations (<100 microg/L) from 97.5% to 5.4%. There was a significant between-group treatment effect (P <0.05) in cognitive function with the digit span forward task (short-term memory). Fewer school days were missed in the intervention than in the control group because of respiratory- (P = 0.097) and diarrhea-related (P = 0.013) illnesses. The intervention had no effect on anthropometric status [corrected]. CONCLUSIONS: Fortified biscuits resulted in a significant improvement in the micronutrient status of primary school children from a poor rural community and also appeared to have a favorable effect on morbidity and cognitive function [corrected].

Anthropometry↗

PubMedDate not supplied

The hemodialysis patient and hand amputation.

The hemodialysis patient requires continued attention once an access surgery has been performed. These procedures lead to an anticipated physiological steal in the involved hand, but rarely lead to hand loss. When the patient has had previous peripheral vascular disease, known diabetes mellitus, multiple interventions on the same extremity, and the use of a synthetic graft, the incidence of digital or hand ischemia is significantly increased. This article represents 3 individuals who required hand amputation for severe ischemia. The pertinent clinical features in each individual will be explained and the literature reviewed for the factors promoting this complication and the all-autogenous access policies which may help to prevent hand ischemia.

Adult↗

PubMed2003

Oximeter's acquisition parameter influences the profile of respiratory disturbances.

STUDY OBJECTIVES: Pulse oximetry (Sp02) is a key parameter monitored during polysomnographic studies, and different acquisition settings can be employed to obtain this data. The purpose of this study was to determine if the use of different settings would significantly influence scoring of respiratory disturbance events (RDE). DESIGN: Prospective study SETTING: Sleep Disorders Center - community PATIENTS: 30 patients had three identical oximeters simultaneously attached to the digits during polysomnography, each placed in a different recording setting: 3, 6 and 12 seconds. INTERVENTIONS: None. MEASUREMENTS: RDEs were identified by changes in snoring and flow then sub-categorized as RDE0, RDE1-2 and/or RDE3 if less than 1%, greater than 1 but less than 3%, and 3% or greater oxyhemoglobin desaturation occurred. Each event was given three labels according to the level of desaturation seen on each oximetry tracing. RESULTS: Significant differences in the mean frequency of RDE types at each recording setting were noted (p < .001). A survey of sleep practitioners revealed changes in clinical behavior when presented examples of such differences. CONCLUSION: These data confirm the impact of different oximetric recording settings on the profile of RDEs and the importance of reporting such acquisition settings in studies of sleep disordered breathing.

Electroencephalography↗

PubMedDate not supplied

Autonomic control of the heart in some vagal maneuvers and normal sleep.

Components of the autonomic control of the heart were studied in 5 young normals subjected to: 1) sustained lung inflation (SLI) in various postures; (2) mental loading by concentration of attention, 3) face immersion in cold water under SLI or snorkel breathing, when sitting; 4) superposition of above experimental interventions. We recorded cardiotachogram (RR interval) and T-amplitude from ECG, ear lobe photoplethysmogram, digital impedance rheogram, thermistor respiration. Cardiac data were explored by means of Fourier spectral analysis on a M 118 B microcomputer. Results caution that allegedly unilateral stimulation by some "vagal" maneuvers triggers in fact amphotropic heart rate control menus involving sympathetic nonreciprocal response. Subsequent bradycardia should be interpreted as an absolute indicator of the parasympathetic function only when a separate measure of the sympathetic counterpart is available. In vigil young adult at physical rest the medullary cardiovascular centers appear as subjected to "sliding capture" by their prominent input signal--as determined by various receptor stimulation or cortical status, the latter preserving a higher priority at competing task demands. In a coupled study 9 normals were polygraphically monitored (EEG, EOG, ear duct temperature and the above variables as well) during 2 nonconsecutive nights and cardiac data were spectrally examined along various sleep stages. Results suggest an increased dual autonomic tone during REM that could be related to reported stage-specific arrhythmias. Reciprocal dynamics of the respiratory versus lower frequency variability of RR interval from NREM to REM sleep points to a useful discriminant for computer sleep stage scoring.

Adult↗

PubMed1995

Arterial pseudoaneurysm as a complication of percutaneous transhepatic biliary drainage: treatment by embolization.

We observed a serious arterial hemorrhage as a complication of percutaneous transhepatic biliary drainage (PTBD). The hemorrhage appeared during catheter placement for implantation of an endobiliary stent as a two-step procedure. It was caused by an arterial pseudoaneurysm and could be successfully treated by superselective embolization. Although there was a preexisting cavernous transformation of the portal vein no signs of liver cell necrosis appeared after embolotherapy. Vascular complications of PTBD will be discussed with regard to their frequency, possible etiology, ways to avoid them and their interventional therapy.

Aged↗

PubMedDate not supplied

Effects of enhanced calling efforts on response rates, estimates of health behavior, and costs in a telephone health survey using random-digit dialing.

Public health researchers frequently rely on random-digit dialing (RDD) telephone surveys in monitoring trends in health behavior and evaluating health promotion interventions. RDD response rates have declined during the past decade, and cost-effective methods to increase response rates are needed. The authors evaluated two levels of enhanced calling efforts in an RDD survey of cancer-related health behavior in the State of Washington. The first level of enhanced calling effort was 1 month after 11 original calling attempts to a household, when the authors attempted up to 11 recalls. The second level was 6 months after the first answered call, when the authors recalled those persons who could not be interviewed. Enhanced calling efforts increased the overall survey response rate by 11 percent. Nine percentage points of the increase were attributable to call backs. There were demographic differences among the participants reached at different levels of calling effort, but no consistent associations of level of calling effort with health behavior related to alcohol use, smoking, diet, or health screening. Marginal costs for interviews completed with enhanced calling efforts were about 50 percent higher than costs for interviews reached in the first 11 calls. The authors concluded that enhanced calling efforts may be justified, because they increase confidence in the generalizability of survey results. However, the authors found very little change in survey results by including interviews from persons who were difficult to reach and to interview.

Adolescent↗

PubMed1998

[Review: the overviews of contrast echocardiography in cardiovascular disorders].

The contrast echocardiography used to be applied for the diagnosis of congenital heart diseases, analysis of right side heart hemodynamics, and the evaluation of peripheral blood flow profiles. Recently, myocardial contrast echocardiography is evoked for estimating regional coronary blood flow as a parallel procedure of interventional therapy for ischemic patients. Advanced technology such as harmonic imaging, rf signal processing and digital storage of the data are extremely supportive for the quantitative evaluation of myocardial blood flow. In addition, new contrast agents which enable interpretation of myocardial contrast could be administered by peripheral injection.

Aged↗