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PubMed1991

[Roentgen diagnosis of pulmonary complications following allogeneic bone marrow transplantation--application of and experience with digital luminescence radiography].

Pulmonary complications exercise a decisive influence on the prognosis of leukaemia patients after bone marrow transplantation. Very early diagnosis is a mandatory prerequisite to successful therapeutic intervention. Of great importance besides the clinical findings and bronchoalveolar lavage is the analysis of the x-ray morphology of pneumonic infiltrates to narrow down the differential diagnostic spectrum. Since the patients are at high risk of infection, they are under isolated care, so that x-ray examinations can only be performed by means of projection radiography using mobile units. Due to these difficulties in performing relevant radiography the required optimal and constant image quality cannot be achieved by means of conventional x-ray film, so that very early detection of pulmonary complications is not always possible. The use of digital luminescence radiography (DLR) with luminescent storage foils enables a highly constant and hence comparable image quality thanks to increased image dynamics, a larger area of the examined object, and histogram evaluation of the image data for determining the optimal parameters for assessment. In addition, details can be better identified to supply answers to specific questions, because the image can be reprocessed to select relevant image parameters by monitoring. Pulmonary complications in 86 patients were analysed retrospectively. These patients had received an allogeneic bone marrow transplant for acute myeloic leukaemia, after they had been treated with high-dose radio-/chemotherapy. The x-ray morphology, clinical and sometimes autopsy findings were correlated with the occurrence of pulmonary complications subsequent to bone marrow transplant.

Adolescent↗

PubMedDate not supplied

Radiologic diagnosis of hepatocellular carcinoma.

Recent developments in medical imaging technology and their clinical application for the diagnosis and management of hepatocellular carcinoma (HCC) are reviewed. Real-time ultrasound is effective for the screening of HCC in high-risk patients with liver cirrhosis. Information on blood flow is available by color Doppler or power Doppler technique. Dynamic computed tomography (CT) using a fast scanner and the modified contrast administration technique is useful for detection, differential diagnosis, and staging of HCC. Application of magnetic resonance (MR) imaging is increasing with rapid improvements in speed of image acquisition and resolution. Dynamic MR imaging and MR angiography have also been available. Diagnostic and interventional hepatic angiography are now performed less invasively, more safely, and more quickly with modern technologies of digital subtraction angiography (DSA) and catheters. CT during hepatic arteriography (CT arteriography) and arterial portography (CTAP) are used for evaluation of small focal nodules in the cirrhotic liver.

Carcinoma, Hepatocellular↗

PubMed1978

Behavioral treatment of Raynaud's disease.

In order to assess the efficacy of a behavioral intervention in the treatment of idiopathic Raynaud's disease, 30 female patients were trained to control their digital skin temperature using autogenic training or a combination of autogenic training and skin temperature feedback either in the laboratory or at home. All trained subjects demonstrated a significant ability to maintain digital skin temperature in the presence of a cold stress challenge and reported significant reductions in both frequency and intensity of vasospastic attacks. The addition of skin temperature feedback to autogenic training did not provide additional clinical benefit.

Adult↗

PubMed1998

[Teleconference and telesurgery].

Interchange of information has become possible independent of the user's place or time by modern telemedical services and opens up new dimensions for diagnostic and therapeutic procedures. For teleconferences and teleconsultations in surgery, the intraoperative high-quality transmission of live images is essential without disturbing the sterility and operation routine. The clinical specifications require special systems for broadband, stereoscopic online image transmission both intra- and inter-institutionally. Moreover, a telemedical concept integrates the communication equipment suitable for the different diagnostic and functional facilities of a clinic, a digital multimedia patient record and modules for cooperative working. These implementations are a prerequisite for extensive telesurgical interventions using navigational tools, guided instruments or autonomous roboter systems. The realization of such a comprehensive telesurgical concept (OP 2000) is presented.

Computer Communication Networks↗

PubMed2005

Interobserver variability in the diagnosis of minimal and mild endometriosis.

STUDY OBJECTIVE: To evaluate the observer's influence on the diagnosis and classification of endometriosis according to the rASRM classification. DESIGN: : Prospective analysis. SETTING: University hospital. PATIENTS: Digital videotapes of laparoscopies in three patients with typical endometriotic disorders (rASRM I, II and no endometriosis). INTERVENTION: One hundred and eight gynecologic surgeons were asked to indicate the endometriotic lesions on a prepared surgical sketch and to classify the site according to the rASRM classification. MEASUREMENTS AND MAIN RESULTS: Total number, location and morphology of endometriotic lesions, rASRM classification. The interobserver correlation concerning the number of lesions ranged between 18% (rASRM II) and 30%. (rASRM I). There was marginal correlation regarding the location of endometriotic lesions. Kendall W coefficient ranged from 0.14 (rASRM II) to 0.44 (rASRM I) (p < 0.001). Only 13% (rASRM II) to 22% (rASRM I) of observers used the correct endometriotic classification. None of the participants specified the morphological characteristics of endometriotic lesions according to the rASRM classification. CONCLUSION: Visual assessment of an operative situs with minimal and mild endometriosis is subject to a considerable interindividual variability. One and the same lesion is assessed quite differently by different observers. Histopathological verification seems to be necessary to objectify the diagnosis of endometriosis.

Biopsy↗

PubMed2005

Haptoglobin beta chain isoforms in the plasma and peritoneal fluid of women with endometriosis.

OBJECTIVE: To estimate the expression of haptoglobin (Hp) beta chain isoforms in the peritoneal fluid (PF) and plasma (PL) of women with and without endometriosis. DESIGN: Cross-sectional study. SETTING: University hospital. PATIENT(S): Seventy-two patients with endometriosis and 35 controls. INTERVENTION(S): Peritoneal fluid and PL samples were subjected to two-dimensional gel electrophoresis, silver stained, digitally captured, and compared by semiquantitative computerized analysis. MAIN OUTCOME MEASURE(S): Expression of Hp beta chain isoforms. RESULT(S): No significant difference was observed in the frequency of expression of the Hp beta chain isoforms between the two groups. One beta chain isoform (HpbetaE; molecular weight, 38.40 +/- 0.94 kD; and isoelectric point, 5.63 +/- 0.17) had significantly higher expression in both the PF and PL of women with endometriosis than in the PF and PL of controls. No significant difference was observed in HpbetaE expression between women with mild (revised American Fertility Society [rAFS], stage I-II) and severe (rAFS, stage III-IV) endometriosis. In the control group, HpbetaE expression was correlated with the phase of the menstrual cycle. CONCLUSION(S): Women with endometriosis have higher PF and PL levels of HpbetaE. Further investigation should be aimed at producing antibodies against the HpbetaE-specific epitopes to determine whether its measurement may improve the clinical diagnosis of endometriosis.

Adult↗

PubMed2001

Does willingness to pay vary by race/ethnicity? An analysis using mammography among low-income women.

As part of a population-based intervention to improve periodic mammogram screening, we examined WTP for mammography in five ethnic groups. Through random digit dialing, we contacted households in low-income census tracts of Alameda County, California (San Francisco Bay area). Women who met the ethnicity, age and cancer-free eligibility criteria were invited to participate. For the baseline assessment, women were surveyed over the phone in their preferred language. Of the 1465 surveyed women, 499 identified themselves as African-American, 199 were Chinese, 167 were Filipino, 300 were Latina, and 300 were non-Hispanic white. Bivariate and multivariate analysis showed that WTP varied significantly by ethnicity (P<0.05). We also found that when Filipino and Chinese women had a female relative with breast cancer, they were willing to pay less money for a mammogram. African-American, Latino, and non-Hispanic white women, however, were willing to pay more money for a mammogram if a female relative had had breast cancer. This ethnic difference, when there is a familial link to breast cancer, needs further study as it has implication for genetic testing. Nevertheless, WTP studies that do not account for ethnic differences may be overstating net benefits to society.

California↗

PubMedDate not supplied

Comparison of adenosine echocardiography, with and without isometric handgrip, to exercise echocardiography in the detection of ischemia in patients with coronary artery disease.

This study was undertaken to evaluate whether adenosine echocardiography is comparable to exercise echocardiography in the detection of ischemia in patients with suspected coronary artery disease and to assess whether the addition of handgrip exercise to adenosine enhances the induction of ischemia in these patients. Accordingly, 67 patients with suspected or known coronary artery disease referred for exercise testing underwent adenosine, adenosine with handgrip, and post-treadmill exercise echocardiography. A maximal adenosine infusion dose of 170 micrograms/kg/min was used. Images at baseline and during each of the three stress modalities were digitized in a quad-screen format, randomized, and blinded as to the stage and mode of intervention for nonbiased interpretation. An ischemic response was defined as a new or worsening wall motion abnormality. Ischemia was detected by exercise echocardiography (n = 20) more often than by adenosine echocardiography alone (n = 11; p = 0.039) but similarly to adenosine plus handgrip (n = 16; difference not significant). Exact agreement in individual response between exercise adenosine echocardiography was seen in 51 (80%) of 64 patients and increased to 88% between exercise and adenosine plus handgrip. In the patients who underwent angiography (n = 45), the sensitivity for coronary artery disease (n = 33) was 87% for adenosine, 91% for adenosine plus handgrip, and 93% for exercise echocardiography. The respective sensitivities decreased to 64%, 81%, and 89% in patients without previous myocardial infarction. Specificity was 91% for adenosine with or without handgrip and 82% for exercise echocardiography. Image quality during adenosine with and without handgrip was superior to that during exercise (p < 0.01). Thus in patients with coronary artery disease able to exercise, exercise echocardiography induces ischemia more frequently than does adenosine echocardiography alone. The addition of handgrip exercise to adenosine infusion enhances the detection of ischemia without reducing specificity or image quality and is recommended when adenosine echocardiography is used as a pharmacologic stress test.

Adenosine↗

PubMed2000

Simultaneous carotid endarterectomy and coronary artery bypass grafting in 313 patients.

The coincidence of coronary and carotid artery disease (uni- or bilateral, with or without involvement of the supra-aortic branch) is still a problem with regards to surgical strategy. Since the opening of the Heart Centre Duisburg in 1989 the authors have favoured a simultaneous approach to lesions in both arterial systems in order to avoid myocardial infarction or stroke. The aim of this retrospective study was to review the early and late results of the combined procedures for the endpoints of death, myocardial infarction and stroke. During a 7-year period (1990-1997) a total of 18,050 patients underwent cardiac surgery and extracorporeal circulation. Simultaneous intervention in both arterial systems was performed in 313 patients (1.73%). All patients underwent preoperative ultrasonic diagnostics, digital subtraction angiography, neurological examination and cardiac catheterization. The principal indication was the need for myocardial revascularization, and symptomatic or asymptomatic carotid stenosis of 80% diameter reduction or more (with or without contralateral disease). The mean age was 66.4 +/- 6.9 years; 240 patients (76.7%) were male, 73 patients (23.3%) female; 243 patients (77.6%) had triple-vessel disease, 82 patients (26.2%) had left main stenosis and 94 patients (43.5%) had a reduced ejection fraction. A total of 171 patients (54.6%) had a previous myocardial infarction, 54 patients (17.3%) presented with unstable angina and nine patients (2.9%) had prior coronary artery bypass grafts. Eighty-seven patients (27.8%) had an internal carotid artery stenosis on the right side, 75 patients (24%) on the left side and 151 patients (48.2%) lesions in both carotid arteries. Prior carotid endarterectomy was performed in 14 patients (4.5%), and the contralateral carotid was occluded in 24 patients (7.7%). Fifty patients had a previous stroke (16%) and 185 patients (59.1%) were asymptomatic. During surgery, the the carotid artery was first exposed, followed by median sternotomy, systemic heparinization, cannulation and cardiopulmonary bypass. After achieving mild hypothermia (30 degrees C), endarterectomy was performed with a venous patch closure. An occluded contralateral carotid artery was always an indication for shunting. Coronary artery bypass grafting was carried out with intermittent cross-clamping under moderate hypothermia (22-27 degrees C). Ten patients suffered a myocardial infarction (3.2%), seven patients (2.2%) had an apoplectic insult perioperatively ( < 30 days) and one patient (0.3%) had an event during long-term follow-up. Early overall mortality was 28 (8.9%), of which 13 were cardiac related (4.2%). Overall late mortality was eight (2.6%), of which six were cardiac related (1.9%). Mean survival time was 6.18 years. Simultaneous carotid endarterectomy and myocardial revascularization can be justified as a routine surgical management of severe lesions in both arterial systems. The risk of myocardial infarction, apoplectic stroke or mortality was not significantly different than isolated procedures.

Aged↗

PubMed2004

The English national risk-reduction programme for preservation of sight in diabetes.

This paper discusses the new national guidelines for a systematic screening programme to detect sight-threatening diabetic retinopathy in the population of people with diabetes in England. A review of the literature examines the evidence base to support screening interventions and effective management and treatments in diabetic retinopathy. The current evidence supports the establishment of a digital retinal photography system using pupil dilation. A Policy Advisory Group has been formulated by the National Screening Committee to guide the meeting of this target in England. A conclusion is made that with increased effort and organisation, health care professionals can ensure that the screening programme is successfully implemented and rates of visual impairment and blindness caused by diabetic retinopathy can be reduced significantly.

Blindness↗

PubMed2002

Hand strength and fatigue in patients with hereditary motor and sensory neuropathy (types I and II).

OBJECTIVES: To compare maximal isometric hand strength and fatigue between subjects with hereditary motor and sensory neuropathy (HMSN) and healthy controls and to test the reproducibility of handgrip strength (peak force of handgrip [PFgrip]) and fatigue. DESIGN: PFgrip and the decline in PFgrip during 3 sets of 15 contractions were compared. SETTING: University hospital in The Netherlands. PARTICIPANTS: Twenty subjects with HMSN and 20 age- and sex-matched healthy controls; 15 healthy subjects for the reproducibility part of the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: PFgrip and the decline in PFgrip were compared by using a digital handgrip dynamometer. Two-point and lateral pinch measurements of subjects with HMSN were standardized against reference values. Reproducibility measurements were performed on 15 healthy subjects on 2 separate occasions within a 1-week interval. RESULTS: PFgrip was significantly lower in the HMSN subjects compared with controls (P<.05). Pinch measurements also showed a large variance from average normal performance. No significant difference was found in the decline in percentage of PFgrip. Reproducibility was excellent for PFgrip (intraclass correlation coefficient [ICC]=.98; 95% confidence interval [CI],.95-.99) but poor for fatigue (ICC=.62; 95% CI,.20-.85). CONCLUSION: PFgrip and 2-point and lateral pinch in HMSN subjects were significantly reduced compared with healthy controls. Our findings indicated that the rate of decline of PFgrip during effort does not vary between groups.

Adult↗

PubMed2001

The impact of stent-graft development on outcome of AAA repair--a 7-year experience.

OBJECTIVE: to analyse the impact of stent-graft (SG) design and operator skill on the outcome of endovascular AAA repair. DESIGN: prospective non-randomised open. MATERIAL: a total of 158 patients (mean age 71) underwent SG repair. Patients were treated with five different types of SG: first (n =58) and second ( n =17) generation Ivancev-Malmö monoiliac SG (IM I and IM II respectively) combined with femoral-femoral crossover, Chuter bifurcated SG (n =15), Vanguard SG ( n =15) and the Zenith SG ( n =53). METHODS: patients underwent DSA and contrast CT preoperatively and were then followed with CT and digital scans. Recently, one change in AAA diameter and endoleaks (EL) were recorded. Mortality, complications and secondary interventions were recorded and life-table analysis for intervention-free SG survival calculated. RESULTS: immediate and late conversions as well as 30-day mortality were reduced for 2nd (Zenith and Vanguard) compared to 1st generation SG (IM I, Im II and chuter). SG migrations occurred only with the IM I and Chuter SG. Type I EL were significantly more common in 1st generation SG. First generation SG required significantly more secondary interventions than 2nd SG up to 20 months post-operatively. The number of unplanned intraoperative adjunctive manoeuvres was increased with 2nd SG. CONCLUSIONS: enhanced SG design has improved the probability of SG success after endovascular AAA repair. Better technical skills may also have contributed to improved results.

Aged↗

PubMed2000

Effect of discharge letter-linked diagnosis registration on data quality.

OBJECTIVE: Diagnostic data are essential for the assessment of medical practice: they are needed for retrieval of clinical cases and describing co-morbidity and complications. In most Western countries, diagnosis registration in hospital information systems is based mainly on completing forms after patient discharge. As this registration plays no role in patient care, data quality is usually unsatisfactory. To improve data quality, we redesigned the process of diagnosis registration at a paediatric department, and now paediatricians provide diagnoses with codes in a separate registration heading of the discharge letter. We compared the quality of this discharge letter-linked diagnosis registration with the quality of the previous form based registration. DESIGN: Retrospective study with blinded before and after measurement. Re-abstracted diagnosis descriptions of the text of discharge letters were taken as gold standard. SETTING: A paediatric department in an academic medical centre. STUDY PARTICIPANTS: From each registration period, 60 admissions were selected randomly. Mean age of the patients was 4.5 (SD +/- 5.5) and 5.2 (SD +/- 5.2) years for the old and new situation respectively. Mean length of stay was 8.8 (SD +/- 11.0) and 7.2 (SD +/- 12.4) days. INTERVENTION: Discharge letter-linked diagnosis registration. MAIN OUTCOME MEASURES: Completeness and accuracy, both at three-digit level of ICD-9-CM. RESULTS: Completeness of form-based diagnosis registration was 51% (95% CI, 44-58%) and of discharge letter-linked diagnosis registration 54% (95% CI, 47-60%). Accuracy was 65% (95% CI, 58-72%) and 67% (95% CI, 60-74%) respectively. CONCLUSIONS: The discharge letter-linked diagnosis registration does not provide a better basis for assessment of medical practice than the form based diagnosis registration.

Abstracting and Indexing↗

PubMed2005

Capillary hemangioma in the superior sagittal sinus as a rare cause of intracranial hypertension in a child: case report.

OBJECTIVE AND IMPORTANCE: The etiological factors involved in idiopathic intracranial hypertension are not easy to identify. This case of idiopathic intracranial hypertension was associated with a capillary hemangioma growing in the lumen of the superior sagittal sinus. CLINICAL PRESENTATION: A 10-year-old girl had experienced progressive headaches and abdominal pain. Fundoscopic examination disclosed bilateral papilledema and high intrathecal pressure, suggesting idiopathic intracranial hypertension. Magnetic resonance imaging, including magnetic resonance angiography as well as digital angiography, revealed a 3-cm mass protruding into the superior sagittal sinus lumen above the torcular. INTERVENTION: A capillary hemangioma attached to the internal dural wall of the sagittal sinus lumen was microsurgically removed. The symptoms resolved in several days and no additional treatment was required. CONCLUSION: A tumor growing into a venous sinus is a rare cause of venous outflow impairment and may generate the clinical signs of idiopathic intracranial hypertension. This case emphasizes the importance of multiple complementary imaging modalities and the efficacy of a direct surgical approach, which allowed resolution of symptoms.

Child↗

PubMed2001

Dental and skeletal changes associated with long-term mandibular advancement.

STUDY OBJECTIVES: Little is known of the possible dental or skeletal side effects following the use of mandibular advancement in the treatment of obstructive sleep apnea. A study has subsequently been designed to investigate these issues. DESIGN: 100 consecutively treated medically referred patients were reviewed cephalometrically in 6-month intervals (6-30 months) following mandibular advancement therapy. SETTING: Orthodontic Private Practice. PATIENTS: 87 males, 13 females (mean age 49 years, SD 8.5, range 33-74 years). INTERVENTIONS: N/A. MEASUREMENTS AND RESULTS: Reference points and planes in the cranial base, maxilla, and mandible were digitized with a reflex metrograph and their means converted to linear and angular measurements. Significant changes following mandibular advancement were observed in lower face height, vertical condylar position, incisor angulation, overbite, and overjet. Skeletal changes were attributed to a vertical repositioning of the mandibular condyle relative to the cranial base and were present at the first review period (6 months). Dental changes occurred later with treatment with the most significant changes occurring at the final review period (30 months) which resulted in a 4.9 degrees proclination of the mandibular incisors and a reduction in overbite of 1.82mm. CONCLUSION: The data suggests that long-term use of mandibular advancement can cause dental and skeletal changes which may be progressive over time. As many consider mandibular advancement a treatment for life, it is strongly recommended that all patients be fully informed of the potential for such changes prior to treatment and undergo mandatory dental reviews with long-term mandibular advancement.

Adult↗

PubMed2006

Low-technology heart failure care in home health: improving patient outcomes.

This article reports a study that pilot tested the effectiveness of a low-technology structured intervention to standardize home healthcare management of patients with heart failure (HF) within a home health agency (HHA). The purpose of this study was to use low-technology equipment to improve care for patients with HF enrolled in a home health agency. The 9-week intervention was targeted toward the home health nurses and included telephone and home visits, a teaching tool, digital scales, and a log/notebook filled out by the patients in the study. Patient outcomes included decreased rehospitalization, decreased symptoms of HF, and increased quality of life.

Aftercare↗

PubMedDate not supplied

Trabecular bone strain changes associated with subchondral comminution of the distal tibia.

OBJECTIVE: To measure trabecular bone strain changes resulting from three increasing subchondral bone defects in the distal tibia. DESIGN: Cadaveric biomechanical model. SETTING: Contact radiographs were made from sagittal sections of human cadaveric distal tibia under no load and loaded to 400 N. Digital images, made from contact radiographs of unloaded specimens, were compared to corresponding digital images of loaded specimens using custom software that measures trabecular deformation and calculates trabecular bone strain. INTERVENTION: Twelve specimens were initially loaded intact in compression. Testing was repeated after creating three increasing circular subchondral bone defects in the center of a sagittal cross-section of the distal tibia. Defects were 10%, 20%, and 30% of the sagittal diameter of the distal tibia. MAIN OUTCOME MEASURES: Maximum shear strain, maximum principal strain, and minimum principal strain were measured in six discrete regions in the trabecular bone in the distal tibia. RESULTS: Small defects (10%) caused minimal strain elevations. Significant increases in trabecular bone strain were measured with medium (20%) and large (30%) defects. Compressive strain increases as high as 1400 microstrain (10 strain) were measured adjacent to and proximal to the defects with medium and large defects. CONCLUSIONS: Subchondral defects cause size-dependent elevations in trabecular bone strain in the distal tibia. Medium and large defects caused rapidly increasing trabecular bone deformation under load.

Adult↗

PubMed2002

Intravascular graft stent treatment of a ruptured fusiform dissecting aneurysm of the intracranial vertebral artery: technical case report.

OBJECTIVE AND IMPORTANCE: An innovative stenting technique to treat a difficult case of a fusiform aneurysm of the intracranial vertebral artery (VA), with restoration of the vessel lumen, is described. CLINICAL PRESENTATION: A 58-year-old patient experienced sudden pain in the upper cervical spine, followed by a severe headache. He underwent computed tomographic evaluation, which demonstrated subarachnoid hemorrhage in the prepontine cistern. A fusiform aneurysm of the distal right VA and critical stenosis of the left VA were detected in digital subtraction angiograms. The patient experienced a new subarachnoid hemorrhaging episode, and urgent endovascular treatment was planned. INTERVENTION: The patient underwent angioplastic and stenting procedures in the left VA, with good results. Forty-eight hours later, an endovascular procedure was performed to treat the right VA aneurysm. We decided to use a graft stent (Jostent graft stent; Jomed, Conroe, TX) instead of a balloon to preserve the arterial lumen. The complete procedure was well tolerated by the patient, and he was discharged, without symptoms, 48 hours later. CONCLUSION: The patient was discharged, without neurological deficits, 48 hours after completion of the endovascular procedure, with clopidogrel (75 mg/d) and aspirin (325 mg/d) therapy. This treatment was discontinued after 4 weeks. According to our search of the medical literature, this is the first clinical case in which an intracranial fusiform aneurysm was permanently sealed with a graft stent.

Aneurysm, Ruptured↗