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PubMed2001

Experiences from a collaborative project on the prevention of disability in leprosy patients in Shandong Province, the People's Republic of China.

Shandong Province (present population 89 million) in the People's Republic of China established a leprosy control programme in 1955. Between that year and the end of 1999, allowing for death and migration, the cumulative number of cases registered was 53,618, including 120 cases on multiple drug therapy (MDT) and 18,248 who had completed satisfactory courses of dapsone monotherapy and/or MDT. Of this latter group, 9500 cases (52%) suffered from visible disabilities (grade 2 of the WHO classification). Prevalence and incidence rates of leprosy have decreased dramatically since 1955 and, on average, only 50-70 new cases are now being detected annually in the entire province. Leprosy is thus no longer a public health problem, but the existence of such a large number of patients with grade 2 disabilities is clearly a matter of serious concern. This paper describes a pilot project to investigate the potential of health personnel in the leprosy programme and the dermatology and sexually transmitted diseases services to (a) prevent deterioration of existing disabilities in ex-patients through self-care and (b) prevent new neuritis in patients on MDT through early detection and the use of steroids.

Adult↗

PubMed2004

[Hystero-salpingo-contrast-sonography with 3-d-ultrasound -- a pilot study].

UNLABELLED: Hystero-salpingo-contrast sonography (HyCoSy) is a sensitive method of assessing tubal patency but cannot completely substitute diagnostic laparoscopy with blue dye and hysteroscopy. Three-dimensional sonography has new imaging facilities which could lead to a reduction of invasive diagnostic procedures. AIM: The aim of this pilot study was to analyse the feasibility of HyCoSy by 3D- and 3D-Doppler-sonography. METHODS: In a prospective setting conventional (2D) HyCoSy was performed in 21 patients with an ultrasound device designed for 3D-ultrasound. After the completion of the 2D procedure, 3D-ultrasound was carried out. In five patients an additional 3D-Doppler-HyCoSy was performed. The generated 3D-volumina were then examined. Laparoscopy with blue dye was performed immediately after the ultrasound examination. RESULTS: A total of 42 Fallopian tubes was assessed. On 2D-ultrasound, visibility of the tubes was excellent in 28 and limited in seven tubes. Of the seven tubes not visible on 2D-ultrasound, four were not patent on laparoscopy. On 3D-ultrasound, visibility of the tubes was excellent in 15 and limited in twelve tubes. 15 tubes were not visible on 3D-ultrasound. 3D-Doppler-HyCoSy revealed excellent assessment in eight of ten tubes, even in one of those with limited visibility on 2D- and 3D-HyCoSy. In 19 patients the assessment of the uterine cavity was excellent by 2D- and 3D-HyCoSy, whereas it was limited in two patients. CONCLUSION: It is possible to visualise the full length of the tubes in a very detailed way from the uterine cavity to the fimbrial end in some patients, but the diagnostic power of HyCoSy is not improved by adding 3D-imaging. The accuracy of 3D-ultrasound seemed to be improved by 3D-Doppler-ultrasound.

Fallopian Tubes↗

PubMed1977

Murder will out.

A 1974 showing of more than 200 oils and water colors at the Tate Gallery, London, has led to a revival of interest in the 19th century English painter, Richard Dadd (1817 to 1886). In 1843, Dadd killed his father, cutting his throat, because he believed him to be the devil in human form. On a trip to the Near East, Dadd became deluded that the Egyptian god Osiris was directing him to eliminate the devil's influence. Four months after he returned to London he murdered his father, and was institutionalized for the last 43 years of his life. We advance the hypothesis that one particular painting. 'The Fairy Feller's Master-Stroke,' symbolically re-enacts the murder and makes talion restitution. The painting shows minute attention to detail and altogether occupied the artist for 9 years. He also made a water color copy of it entirely from memory, and wrote a 22-page poem explaining the picture with the title, 'An Elimination.' We suggest that this hints at the same theme of undoing. Some art critics have seen in Dadd's other art works a projection of his inner feelings, especially a series of more than 30 water colors entitled 'Sketches to Illustrate the Passions,' amongthem 'Murder,' 'Anger,' 'Hatred,' 'Grief,' and 'Melancholy.' We construe these to support the thesis of redoing and undoing following the trauma of murder. We also mention Dadd's reminiscing, visible in his art, and its usefulness in reaffirming his self-identity. In the art work of Dadd's last 25 years, violent scenes are remarkably absent. Instead, imaginary landscapes and seascenes--the subject matter of his earliest adolescent art--reflect an inward absorption in and continuity of lifelong interests. We suggest that the long process of painting 'The Fairy Feller's Master-Stroke' recapitulated and made restitution for the murder, encapsulating it so that compulsive expression of violent ideation was largely reduced, allowing other memories and activities to be engaged and expressed.

Art↗

PubMed2005

Effectiveness of photodynamic therapy with topical 5-aminolevulinic acid and intense pulsed light versus intense pulsed light alone in the treatment of acne vulgaris: comparative study.

BACKGROUND: Photodynamic therapy (PDT) involves the activation of a photosensitizing agent by light to produce oxygen intermediates that destroy target tissues. Topical 5-aminolevulinic acid (ALA) is converted to protoporphyrin IX, a very potent photosensitizer, which accumulates in human skin, particularly in the epidermis and its appendages. OBJECTIVE: To study the effect of PDT in acne vulgaris using topical ALA and intense pulsed light (IPL). METHODS: Thirteen individuals with varying degrees of acne were treated after a 3-week washout period. Twenty percent ALA hydrochloride (DUSA Pharmaceuticals, Wilmington, MA, USA) was applied to half of the face, and after 3 hours, the whole face was exposed to intense pulsed light (Quantum SR, Lumenis, Santa Clara, CA, USA) using a 560 nm cutoff filter starting at a fluence of 26 J/cm. The procedure was done twice at 2-week intervals, and the patients were clinically evaluated on the second, fourth, and eighth weeks. RESULTS: All patients had no apparent improvement on the second week on both facial halves. In fact, some of the patients developed acute acneiform eruptions on the side treated with ALA. By the fourth week, however, most of the patients had visible improvement of facial acne that was more significant on the ALA-treated side of the face. This persisted until the eighth week post-treatment. On the other hand, the facial half treated with intense pulsed light only showed a return to baseline of their facial acne. CONCLUSION: ALA-IPL are beneficial in the management of acne vulgaris and may be used in combination with other forms of acne treatment or may be an alternative treatment for patients who do not want to take systemic retinoids.

Acne Vulgaris↗

PubMed1998

Botulinum toxin for the correction of hyperkinetic facial lines.

The present article illustrates the effects of low dose botulinum toxin (BTx) injections for the improvement of hyperkinetic facial lines and presents a grading treatment chart designed to standardize the reporting of the improvement seen. A questionnaire of patient acceptance, the patients' impression of therapy and short-term results and complications are reported. Twelve patients with 26 injected-paired regions were charted and the response to injection was graded. Patients had hyperkinetic facial lines in glabella, periorbital regions or horizontal forehead lines. Diluted BTx type A (1 IU/0.1 mL) was injected and patients were assessed at 10 days. A second follow up injection was offered to patients at this stage if required. Objectively, all patients' hyperkinetic actions and lines improved or diminished. The degree of improvement was similar in all areas injected and a symmetry of results was always observed. In a minority of cases, all movement was lost (7/26) and in others it was weakened but present (19/26). In some injected areas the actual expression line that was visible at rest disappeared entirely (11/26): in the others it was diminished (15/26). Complications were few. Two patients had temporary brow ptosis that spontaneously recovered within the first week. No eyelid ptosis was noted. Bruising and headaches were the most common reported complications. Low dose BTx is an effective and well-tolerated treatment for hyperkinetic facial lines with few significant complications in this small pilot study. The grading chart may allow easier comparisons of results between studies on the effects of BTx therapy.

Botulinum Toxins, Type A↗

PubMed1999

"My crooked vision": the well sib views ataxia-telangiectasia.

The ataxia-telangiectasia gene (designated ATM) has been identified by positional cloning. Retrospective studies in cystic fibrosis (CF) have shown that the illness and death of a sib have far-reaching ramifications on the surviving sib's life. However, there have been no studies on sibs of children and adults with ataxia-telangiectasia (A-T). Thirty-five sibs from 24 families, including 26 adults and 9 adolescents, were drawn from the University of California, Los Angeles; the A-T Clinical Center at the Johns Hopkins University School of Medicine; and the A-T Children's Project Interviews indicated that, unlike CF, the visibility of A-T caused less resentment of time or attention given to the affected, less guilt, and less identification or idealization of the affected, but more embarrassment and shame. It may be said that, unlike CF, the dynamic is one of burden rather than trauma. The specific phenotypic expression of a genetic illness predisposes the way in which the well sib will encounter problems. In A-T affected families, one must help families locate caregiving resources so they will not burden their well children; sibs need help with managing feelings of embarrassment and shame. Geneticists must be alert to understanding characteristic differences of disorders they encounter in order to offer the most appropriate support to affected families.

Adolescent↗

PubMed1983

Applications of rapid-scanning multichannel detectors in chromatography. Plenary lecture.

A review of progress in the field of multichannel detection in column and thin-layer chromatography is presented, together with some novel applications of a computer-based, linear photodiode array UV--visible spectrophotometer for detection in high-performance liquid chromatography (HPLC). Computer-aided methods for simultaneous monitoring of the elution profile at three wavelengths with automatic peak detection and capture of UV spectra are described. The continuous calculation of absorbance ratios during elution is discussed as an index of peak homogeneity. A novel technique for the enhancement of qualitative identification in HPLC, based on transformation of captured spectra to the second derivative or to the decadic logarithm, is proposed. These developments are exemplified by a model system of diacetylmorphine and its principal metabolites and degradation products, morphine and 6-acetylmorphine. The potential utility of three-dimensional projections of (A, lambda, t) data is discussed in the context of pharmaceutical, bioanalytical and forensic applications.

Chromatography, High Pressure Liquid↗

PubMed2000

[Preoperative examination of potential kidney transplantation donors: value of gadolinium-enhanced 3D MR angiography in comparison with DSA and urography].

PURPOSE: To assess a contrast-enhanced standardized MRA protocol for the presurgical evaluation of potential renal transplant donors. METHODS: Twenty-three potential donors for renal transplantations were examined with gadolinium-enhanced, two-phase MR angiograms (1.5 T) and DSA/urography for the number of renal arteries, the presence of aberrant arterial and venous branches, renal artery stenoses and anatomy of the renal collecting system and ureters. The diagnostic value was assessed by evaluating different image processing modalities and interobserver variability. RESULTS: Using maximum intensity projections (MIP) together with multiplanar reformatting (MPR), accessory arteries were detected with a sensitivity/specificity of 100%/98%. Depending on diagnostic experience, exclusive evaluation of MIP yielded a sensitivity/specificity of 67-100%/95-100%. Using MIP/MPR, venous depiction was good in 80%, with MIP solely in 30-40%. At least the proximal third of the ureter was visible in 67%. CONCLUSION: MPR/MIP evaluation of two-phase, contrast-enhanced MRA provides an excellent depiction of renal vessel anatomy for presurgical evaluation of renal transplant donors. Exclusive MIP assessment is less reliable and depends strongly on the examiner's experience. For sufficient visualization of the ureters, either additional measurements or low-dose diuretic injection have to performed.

Adult↗

PubMed2005

Quantitative comparison of open reduction and internal fixation versus the Gillies method in the treatment of orbitozygomatic complex fractures.

BACKGROUND: Precise repair of orbitozygomatic complex fractures is essential for proper re-establishment of facial symmetry, ocular globe position, and infraorbital nerve function. Controversy regarding the optimal treatment method remains. METHODS: To compare uniform study groups, only patients without previous craniofacial injuries or operations who had sustained moderate-energy orbitozygomatic complex fractures, based on preoperative computed tomography scans, and who were treated using the Gillies repair or open reduction and internal fixation were selected. Quantifiable end-points, including orbitozygomatic complex position, ocular globe projection, and infraorbital nerve function, were measured to objectively compare the accuracy of repair produced by the Gillies procedure and open reduction and internal fixation. Negative sequelae resulting from cutaneous access were tabulated. RESULTS: Overall, 12 patients treated using the Gillies repair and 12 treated with open reduction and internal fixation were examined. The results demonstrated that the open reduction and internal fixation technique produces superior realignment of the orbitozygomatic complex, that is, a smaller difference in the position of the orbitozygomatic complex between the injured and noninjured sides of the face. The differences in orbitozygomatic complex projection, height, and lateral position were 1.4 mm, 1.4 mm, and 1.6 mm, respectively, in the open reduction and internal fixation group and 7.5 mm, 5.6 mm, and 4.1 mm in the Gillies group. The p values were 0.0003, 0.01, and 0.06, respectively. Visible cutaneous scarring was present in four patients and lower lid shortening was seen in three patients treated using open reduction and internal fixation. CONCLUSIONS: To the authors' knowledge, this is the first study to objectively show that the open reduction and internal fixation technique results in superior positioning of the orbitozygomatic complex in moderate-energy orbitozygomatic complex fractures compared with the Gillies repair. Although negative sequelae from surgical access were substantial, recently introduced transconjunctival and upper lid blepharoplasty incisions will minimize these drawbacks.

Adult↗

PubMed1997

In vivo monitoring of the degradation process of bioresorbable polymeric implants using magnetic resonance imaging.

The degradation of a bioresorbable poly(L-lactide) osteosynthesis plug after fixation of a transferred coracoid bone block using the Bristow-Latarjet procedure was examined by means of magnetic resonance (MR) imaging. There were 15 patients with a mean follow-up time of 38 months (range 34-42 months). The gross geometry of the biomaterial plug remained unaltered on the MR images. The bone marrow signal reached the implant surfaces in all cases, and no signs of liquid phase around the implant could be discerned. The implants themselves were visible as homogeneous low signal intensity (SI) black linear structures when compared to the surrounding bone, which had a much higher SI. The mean implant SI was 18.2 (s.d. +/- 6.6), that of the scapular bone 48.9 (s.d. +/- 14.3) and that of the background 4.3 (s.d. +/- 1.5). The SI of a newly manufactured intact implant was 5.7. Serial plain radiographs showed no decreased bone density or focal osteolytic lesions around the poly(L-lactide) expansion plug. The implant channel was discernible on most of the radiographs and a sclerotic rim was detected to outline the implant profile in some of the projections of plain radiographs at each follow-up examination. Computer tomography scans on five patients 3 years postoperatively also revealed a discernible implant channel outlined with a sclerotic rim. The radiographic appearance of the radiolucent implant channel did not change over the follow-up period. Summarizing the present findings, MR imaging seems to be able to visualize poly(L-lactide) implants within the bone. Actually, at present it is the only method available to study the degradation process of implants made of this polymer in humans. No signs of degradation of or of an osteolytic foreign-body reaction to poly(L-lactide) at the host tissue-implant interface could be observed within the follow-up times of this study.

Absorption↗

PubMedDate not supplied

Laser modification to an x-ray collimator: an aid in positioning patients for neurosurgical and radiographic procedures.

In high-ambient-light levels such as are found in operating rooms, and at long target-to-patient distances, the cross lines and light field projected from conventional x-ray collimators are not easily visible and proper patient positioning is difficult. The collimators on two mutually perpendicular x-ray units have been modified by replacing the incandescent bulbs with lasers and adjusting the lasers to be coaxial with the x-ray beams. These modifications have been coupled with a third wall-mounted laser to facilitate patient positioning for stereotaxic thermal hypophysectomy. The use of the laser-modified collimators has resulted in considerable saving of time for the operating team and has markedly reduced patient anesthesia time. The laser-modified collimator has also been found useful in positioning patients for other radiographic procedures in the operating room and has virtually eliminated retakes due to malpositioning.

Humans↗

PubMed1999

Professional identification and affiliation of the 1992 graduate class of the colleges of osteopathic medicine.

This survey of the 1992 graduates of colleges of osteopathic medicine included questions regarding their identification with the osteopathic medical profession from application to medical school through residency training and practice. Findings of the study demonstrate that a large majority of graduates regard the profession positively. However, many express concerns about the limited training in advanced osteopathic manipulative skills, with several indicating a low level of confidence in integrating osteopathic techniques into clinical practice. Study respondents also assert that the osteopathic medical profession has yet to effectively project and promote its distinctiveness to the general public. These factors affect the overall identification and affiliation of the respondents to the osteopathic medical profession. Previous anecdotal and research reports suggested that a migration of graduates into nonosteopathic postgraduate training programs and the de-emphasis of osteopathic manipulative medicine in clinical training sites have created an identity crisis within the profession. These reports stimulated the undertaking of this study. Challenges to the profession addressed in this paper include: (1) requiring advanced training in osteopathic manipulative medicine after the second year of medical school; (2) creating an awareness of the need for increased professional visibility; (3) producing effective public relations strategies to portray the osteopathic medical profession accurately; and (4) generating sufficient funds to carry out these strategies.

Adult↗

PubMed2006

Optimizing multicompression approaches to elasticity imaging.

Breast lesion visibility in static strain imaging ultimately is noise limited. When correlation and related techniques are applied to estimate local displacements between two echo frames recorded before and after a small deformation, target contrast increases linearly with the amount of deformation applied. However, above some deformation threshold, decorrelation noise increases more than contrast such that lesion visibility is severely reduced. Multicompression methods avoid this problem by accumulating displacements from many small deformations to provide the same net increase in lesion contrast as one large deformation but with minimal decorrelation noise. Unfortunately, multicompression approaches accumulate echo noise (electronic and sampling) with each deformation step as contrast builds so that lesion visibility can be reduced again if the applied deformation increment is too small. This paper uses signal models and analysis techniques to develop multicompression strategies that minimize strain image noise. The analysis predicts that displacement variance is minimal in elastically homogeneous media when the applied strain increment is 0.0035. Predictions are verified experimentally with gelatin phantoms. For in vivo breast imaging, a strain increment as low as 0.0015 is recommended for minimum noise because of the greater elastic heterogeneity of breast tissue.

Algorithms↗

PubMed2001

Nutrition intervention strategies in chronically malnourished regions: preventing endemic goitre in Togo.

Iodine deficiency disorders (IDDs) are an important problem in the world. Some 760 million people suffer from goitre and 1600 million are at risk. In Togo, a small West African country, the prevalence of visible goitre in 6-12-year-old children was 21.6% and 5.3% in two endemic regions in 1999. Goitre is considered endemic as it affects one adult in five. UNICEF-Togo (United Nations Children's Fund) in co-operation with the Togolese government has implemented different programmes with the aim of improving the survival and development of children and women and to defend and promote children's rights. The aim of this paper is to describe the procedures followed and key results of a school-based nutrition education project implemented in Togo to prevent iodine deficiency disorders, by encouraging use of iodised salt.

Child↗

PubMed2001

[Is alopecia areata a psychosomatic disease?].

INTRODUCTION: Destruction of hair follicles by lymphocytes induces alopecia aerata. Hence, immunological mechanisms are involved in this disease, as for numerous dermatoses. Nonetheless, alopecia aerata appears to be a psychosomatic disease. Is there any contradiction? CURRENT KNOWLEDGE AND KEY POINTS: Alopecia aerata often occurs after stress, particularly during mourning. Psychiatric disorders are more frequent in patients with alopecia than in healthy subjects. But these disorders might be secondary to the visible hair disease. Psychopathological mechanisms need to be clarified but alexithymia seems to be the key for understanding how stress could induce hair loss. In the skin (and the scalp) all functions are narrowly controlled by nerve fibers. Among these functions are hair growth and immunity. Immune cells and hair follicle cells possess receptors for neurotransmitters, which are synthesized by neuronal endings. When activated, these receptors are able to modulate cell properties. The same phenomena are described with stress-induced hormones. In alopecia aerata, like in numerous other diseases, psychosomatics and immunology are not opposed because immune cells are controlled by the nervous system through neurotransmitters. FUTURE PROSPECTS AND PROJECTS: Research needs to be thorough in both the fields of psychology and neurobiology. Psychotherapies or psychotropes appear to be useful in the treatment of alopecia aerata.

Alopecia Areata↗

PubMed1998

A generalized film technique for the verification of vertex fields used in the treatment of brain tumors.

With the availability of commercial three-dimensional (3D)-treatment planning systems, more and more treatment plans call for the use of noncoplanar conformal beams for the treatment of brain tumors. However, techniques for the verification of many noncoplaner beams, such as vertex fields which involve any combination of gantry, collimator, and table angles, do not exist. The purpose of this work is to report on the results of an algorithm and a technique that have been developed for the verification of noncoplanar vertex fields used in the treatment of brain tumors. This technique is applicable to any geometric orientation of the beam, i.e., a beam orientation that consists of any combination of gantry, table, and collimator rotations. The method consists of superimposing a central plane image of a correctly magnified vertex field on a lateral or oblique field port film. To achieve this, the 3D coordinates of the projection of the isocenter onto the film for lateral (or oblique) as well as the vertex fields are determined and then appropriately matched. Coordinate transformation equations have been developed that enable this matching precisely. A film holder has been designed such that a film cassette can be secured rigidly along the side rails of the treatment table. The technique for taking a patient treatment setup verification film consists of two steps. In the first step, the gantry, table, and collimator angles for the lateral (or oblique) field are set and the usual double exposures are made; the first exposure corresponds to that of the treatment portal with the isocenter clearly identified and the second one a larger radiation field so that the peripheral anatomy is visible on the film. In the next step, the gantry, table, and collimator angles are positioned for the vertex field and the table is moved laterally and vertically and the film longitudinally to a position that will enable precise matching of the isocenter on the film. A third exposure is then taken with the vertex portal. What is seen on the film is a superposition of a central plane image of the vertex field onto the image of the lateral or oblique field. This technique has been used on 60 patients treated with noncoplanar fields for brain tumors. In all of these cases, the coincidence of the projection of the isocenter for the lateral (or oblique) and the vertex fields was found to be within 3 mm.

Algorithms↗

PubMed1992

The early development of numerical reasoning.

Children of age 1-4 years were found capable of engaging in numerical reasoning. Children were presented with a task in which they placed a set of objects one by one into an opaque container. An experimenter then visibly performed either an addition, a subtraction, or no transformation on the screened set. Children were then instructed to remove all objects from the container. Across two experiments, children searched for and removed the correct number of objects when set numerosity was small. Knowledge of numerical identity and knowledge of the effects of addition and subtraction transformations on numerosity were present even in children who had not yet begun to count verbally. These findings provide evidence that the emergence of numerical reasoning does not depend upon the prior development of a verbal counting ability or upon cultural experience with numbers.

Child Development↗

PubMed2004

Implanted gold markers for position verification during irradiation of head-and-neck cancers: a feasibility study.

PURPOSE: To assess the toxicity and reliability of the use of implanted gold markers for position verification during irradiation of head-and-neck cancer. METHODS AND MATERIALS: Ten patients with localized head-and-neck tumors received two gold markers in the parapharyngeal region. The acute and late radiation-related toxicity were scored prospectively using the Common Toxicity Criteria. The patients were immobilized during irradiation using a five-point mask. The marker location was detected in portal images taken with an a-Si flat panel imager. The intermarker distance, as well as the interfraction motion of the markers, was determined for all patients. RESULTS: No acute major complications were observed. The acute toxicity grade was not greater than normally detected. The markers were visible in all images. On average, the projected intermarker distance varied 0.8 mm (1 standard deviation). A small time trend was observed in the intermarker distance for 3 patients. For these patients, at least one marker was located in the mucosa or pharyngeal constrictor muscle. Deeper-seated gold markers did not show a time trend in the intermarker distance. The random positioning uncertainty determined using the markers was on average 1.1 and 1.4 mm (1 SD) in the craniocaudal and AP direction, respectively. CONCLUSION: The use of implanted gold markers for position verification during radiotherapy for head-and-neck cancer patients seems safe and feasible. To avoid any chance of migration, markers should be placed in deep muscular compartments.

Feasibility Studies↗