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PubMed1987

Limitations of digital subtraction contrast echocardiography in enhancing left ventricular endocardial definition.

The purpose of this study was to evaluate whether the digital subtraction technique, applied to contrast echocardiography of the left ventricle (LV), might improve endocardial edge identification by two-dimensional echocardiography. Injections of the polysaccharide agent SHU-454 were made into the LV of five closed-chest dogs. Data were obtained at different levels of ejection fraction (EF) induced by pharmacologic or mechanical interventions and were documented by left ventriculography (VGRAM) in the right anterior oblique projection. Contrast echocardiography was recorded in the apical four-chamber view. The echocardiographic images were digitized off-line into a 256 X 256 pixel matrix with 256 gray levels/pixel. Two end-diastolic frames prior to contrast appearance were averaged to obtain a mask that was subtracted from end-diastolic contrast frames corresponding to the two beats of peak intensity. The same procedure was repeated for the systolic frames. LV edges from echocardiographic images prior to contrast appearance, from digitally subtracted echo-contrast images, and from VGRAM were traced on two occasions by two different observers. LV volumes were calculated by single-plane Simpson's rule and EF was derived by the classical equation. The intra- and interobserver reproducibility in the measurement of EF was excellent for VGRAM (r = 0.95 and 0.94, respectively), it was good for two-dimensional echocardiography (r = 0.87 and 0.73), and was fair for contrast-echo (r = 0.79 and 0.68).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1994

Age and readiness to quit smoking.

The relationship between planning to quit smoking within the next 3 months and demographic characteristics, smoking history, attitudes and beliefs about smoking cessation, and motivation was analyzed among smokers in three age groups: 18 to 29, 30 to 49, and 50 years or older. Using random-digit dialing, telephone interviews were completed with 2,353 smokers before initiating a self-help, minimal-contact intervention in the Chicago metropolitan area. Multiple logistic regression was used to identify factors that predicted planning to quit within the next 3 months. The two youngest age groups were most likely to have attitudes favorable to being ready to try to quit smoking (they were more concerned about health effects of smoking, perceived a greater reduction in the likelihood of getting lung cancer, were more determined to quit, and were more confident in their ability to quit). Among all three age groups, one-fourth or less planned to quit within the next 3 months, and desire to quit was the strongest predictor in each group. Among smokers who planned to quit someday, the oldest were most likely to plan to quit within the next 3 months. The findings show that there are important age-related differences in readiness to quit smoking that should be considered when planning and evaluating smoking cessation interventions.

Adult↗
PubMed2005

Comprehensive MR angiography of the lower limbs: a hybrid dual-bolus approach including the pedal arteries.

The purpose of this study was to include the pedal vasculature into the coverage of peripheral multistation magnetic resonance angiography (3DceMRA). A total of 216 patients suffering from peripheral vascular disease were examined with a modified hybrid dual-bolus technique. The cruropedal arteries were acquired first with two sagittal slabs and time-resolved 3D sequences. Then the aortofemoral vessels were visualized using the bolus-chase technique and a second contrast injection. Interventional procedures were performed in 104 patients, and in 69 of those, the cruropedal vessels were also examined with digital subtraction angiography (iaDSA). Using 3DceMRA, the cruropedal arteries were displayed with both excellent and good quality in 95% (205/216 cases), and without any venous overlay in 94% (203/216 cases). The aortofemoral vessels were not jeopardized by the first contrast injection. With iaDSA as the standard of reference, observed sensitivity of 3DceMRA was found in ranges from 80% (29%, 99%) to 100% (86%, 100%) for assessing significant stenoses, and observed specificity ranged between 93% [80%, 98%] and 100% (82%, 100%). In conclusion, hybrid dual-bolus 3DceMRA significantly reduces the limitations of standard single-bolus 3DceMRA in anatomic coverage and temporal resolution of the cruropedal arteries, thus providing high-quality images of the entire peripheral vasculature.

Aged↗
PubMed1999

The first polar body does not predict accurately the location of the metaphase II meiotic spindle in mammalian oocytes.

OBJECTIVE: To evaluate how well polar body location predicts spindle localization and to examine spindle morphology. DESIGN: Randomized, controlled animal study. SETTING: University-affiliated research laboratory. ANIMAL(S): Mature, female golden hamsters. INTERVENTION(S): After superovulation with pregnant mare serum gonadotropin and hCG, metaphase II oocytes were obtained and imaged under digital polarization microscopy. MAIN OUTCOME MEASURE(S): Identify the meiotic spindle in living, unfixed hamster oocytes and determine spindle location relative to the polar body. RESULT(S): Spindles were imaged in 30 oocytes and only in 5 of them could the polar body predict the spindle localization. In the remaining oocytes, the spindles presented a random distribution within the cytoplasm. CONCLUSION(S): These data show that the polar body location is not an accurate predictor for meiotic spindle location in mammalian oocytes.

Animals↗
PubMed1999

Diagnostic value of percent free prostate-specific antigen: retrospective analysis of a population-based screening study with emphasis on men with PSA levels less than 3.0 ng/mL.

OBJECTIVES: To retrospectively investigate the use of percent free prostate-specific antigen (PSA) compared with total PSA in serum as predictor of prostate cancer in men selected randomly from the general population who underwent biopsy on the basis of abnormal findings on digital rectal examination (DRE) or transrectal ultrasound (TRUS) and/or serum PSA levels greater than 10 ng/mL. METHODS: A single intervention, population-based screening study was undertaken in 1988 and 1989. Of the 2400 men aged 55 to 70 years invited to participate, 1782 men responded and were examined with DRE, TRUS, and PSA testing (Tandem-Hybritech). In 1995, frozen serum samples from 1748 men were analyzed for percent free PSA (Prostatus, Wallac OY). Five-year follow-up data on new cancers in the screened population were obtained from the Swedish Cancer Registry (SCR). RESULTS: Of the 1748 men, 367 underwent TRUS-guided biopsies because of abnormal findings on either DRE or TRUS or serum PSA levels of greater than 10 ng/mL. This resulted in the diagnosis of 64 cases of prostate cancer (3.7%). PSA levels of 3.0 ng/mL or greater were found in 55 (86%) of 64 cancer cases and in 399 (24%) of the 1684 benign cases. Among the 1294 men with PSA less than 3.0 ng/mL, 9 prostate cancers were diagnosed (14% of all prostate cancers). All 9 patients with cancer and with PSA less than 3.0 ng/mL had a percent free PSA of 18% or less. In the group of 1109 patients with PSA less than 3.0 ng/mL and a percent free PSA greater than 18%, 159 biopsies were performed because of abnormal DRE or TRUS. However, no prostate cancer was diagnosed in this category of patients. Five years after the screening intervention, 7 more cases of prostate cancer were clinically diagnosed in the screened population according to the SCR. CONCLUSIONS: The combination of PSA levels less than 3.0 ng/mL and percent free PSA greater than 18% defines a large part of the population at a very low risk of cancer of the prostate both at the time of screening and during the following 5 years. Men in this group may be spared DRE, and longer screening intervals may be considered. However, the risk of having prostate cancer is not negligible in men with PSA less than 3.0 ng/mL and percent free PSA of 18% or less. The results of this study indicate that biopsy should be recommended to men fulfilling these criteria, although these results should be confirmed in larger prospective studies because of the limited number of patients with prostate cancer in the present series.

Aged↗
PubMed2001

Infantile myofibromatosis: case report of a solitary hand lesion with emphasis on differential diagnosis and management.

Infantile myofibromatosis, both solitary and multicentric types, is discussed with emphasis on the importance of diagnosing this condition correctly. Its distinctive clinical and histological characteristics are described, as are the hazards of overhasty and overly ambitious surgical intervention. Other similarly presenting fibromatous diseases of infancy and childhood are discussed, including aplasia cutis, infantile fibrosarcoma, recurring infantile digital fibromatosis, and juvenile aponeurotic fibromatosis. A case of infantile myofibromatosis, solitary type, is reported, and the two surgical procedures carried out over a 4-year period are described. The importance of histological and immunohistochemical evaluation of lesions present during the neonatal period is stressed.

Biopsy↗
PubMed2002

Trabecular bone strain changes associated with subchondral bone defects of the tibial plateau.

OBJECTIVE: To measure trabecular bone strain changes resulting from three increasing subchondral bone defects in the medial tibial plateau. DESIGN: Cadaveric biomechanical model. SETTING: Contact radiographs were made from coronal sections of human cadaveric proximal tibia under no load and loaded to 400 newtons (N). Digital images made from contact radiographs of unloaded specimens were compared to corresponding digital images of loaded specimens using in-house software that detects trabecular deformation and measure trabecular bone strain. INTERVENTION: Ten specimens were loaded intact and with three increasing circular subchondral bone defects and centered under the subchondral plates in the medial tibial plateau that were 10%, 20%, and 30% of the coronal width of the medial plateau. MAIN OUTCOME MEASURE: Maximum shear strain and minimum principal strain were measured at approximately 2,600 discrete points in the trabecular bone in the medial tibial plateau. RESULTS: Trabecular strain increased most dramatically as defects increased from the medium (20%) to the large (30%) defect. The regions of greatest strain elevation were between the physeal scar and joint line near the medial cortex. Small (10%) and medium (20%) defects resulted in modest strain elevations. CONCLUSIONS: Subchondral defects cause size-dependent elevations in trabecular bone strain in the medial tibial plateau. A size threshold may exist, above which the trabecular bone is subjected to rapidly increasing deformation under load.

Aged↗
PubMed1997

Lost workdays and decreased work effectiveness associated with headache in the workplace.

Little is known about the impact of different types of headache on lost work time and work effectiveness in the United States. Estimation of the distribution and magnitude of the impact of headache in the workplace is necessary before workplace interventions can be developed. During 1993 and 1994 in Baltimore County, Maryland, study subjects were contacted by random-digit dialing and interviewed by telephone about their headaches. Headache diagnoses were assigned using International Headache Society criteria for migraine and episodic tension-type headache. Measures of workplace impact were derived based on self-reports of missing work because of headache and frequency and magnitude of reduced work level because of headache. Of the 13,343 respondents, 9.4% reported missing work more than rarely because of headache, 31% reported that their work level was reduced more than rarely by headache, and 9.2% reported that their work level was reduced more than 50% by headaches during work. In accounting for both actual lost workdays and reduced effectiveness at work, individuals lost the equivalent of 4.2 days per year because of headache. Of the 9922 annual estimated actual lost workdays because of headache, 57% were due to migraine and 43% were due to tension-type and other headache types. Of the 23,287 annual estimated reduced effectiveness workday equivalents, 64% were due to tension-type and other headache types, and 36% were due to migraine. Headache type, headache severity, and education level were each independent predictors of workplace impact of headache. Subjects with migraine headache were much more likely to report actual lost workdays because of headache, whereas tension-type and other headache types accounted for a large proportion of decreased work effectiveness because of headache. The results have implications regarding the control of indirect costs in the workplace because of headache, and on workplace-based treatment and prevention programs.

Adolescent↗
PubMed1992

Embolisation in the management of peripancreatic pseudoaneurysm--a case report.

Peripancreatic pseudoaneurysms are an unusual cause of haemorrhage in patients with chronic pancreatitis and pseudocysts. We describe a 28 year old alcoholic male with documented chronic pancreatic pseudocysts, who presented with melaena and a large pulsatile epigastric mass. Ultrasound and digital subtraction angiography revealed a pseudoaneurysm of the gastroduodenal artery. This was successfully embolised with stainless steel coils. Surgical intervention in such cases is associated with high mortality, and the role of embolisation as an initial therapy is well established. The role of embolisation as definitive therapy is less clear.

Adult↗
PubMed2005

A novel educational strategy to enhance internal medicine residents' familial colorectal cancer knowledge and risk assessment skills.

BACKGROUND: Internal medicine residents are deficient in their knowledge about familial colorectal cancer (CRC) and thus unable to comply with appropriate screening guidelines. The objective of this study was to evaluate the effectiveness of a mixed educational program that incorporates both a didactic lecture (DL) and interactive, case-based seminar (ICBS), plus distribution of a personal digital assistant (PDA)-based risk assessment tool. METHODS: Internal medicine resident continuity care teams were randomly assigned to an intervention (9 teams; 43 residents) or control (11 teams; 39 residents) arm. Both groups participated in a DL addressing the current status of CRC screening for average, moderate, and high-risk groups. Intervention teams also participated in a 1-h pre-clinic ICBS that included vignettes about patients at moderate or high risk of CRC because of family history, following which they received the risk assessment tool by e-mail. Knowledge and clinical risk assessment skills were evaluated using pre/posttests, patient exit interviews, and chart audits. RESULTS: Baseline test scores were similar for both groups (intervention, 51%vs control, 54%; p= 0.35). Immediate post-ICBS scores (intervention group only) significantly increased to 82% (p < 0.001). Six-month post-ICBS scores declined for the intervention group but remained significantly higher than 6-month control group scores (63%vs 56%, p= 0.002), which were unchanged from baseline. No significant differences were observed with respect to family history-taking or documentation skills. CONCLUSION: A mixed educational program that incorporates both a DL and ICBS is more effective that the DL alone for increasing knowledge about familial CRC risk but may have limited influence on clinical risk assessment skills.

Colorectal Neoplasms, Hereditary Nonpolyposis↗
PubMed1997

Use of discount cigarettes by smokers in 20 communities in the United States, 1988-1993.

OBJECTIVE: To examine characteristics of smokers associated with the use of discount and generic cigarettes. DESIGN: Data for this analysis come from two population-based cross-sectional telephone surveys (1988 survey n = 32952; 1993 survey n = 11783) and a cohort tracking survey (n = 11966) of smokers aged 25-64 years conducted in 20 communities in the United States between 1988 and 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. OUTCOME MEASURES: In each survey, current smokers were asked to report the six-digit UPC code displayed on the side of the pack of their current cigarettes. Respondents who did not have a pack available or who could not locate the UPC code number were asked to report their usual brand of cigarettes smoked. A master list of UPC code numbers was developed so that reported UPC codes could be associated with specific cigarette brand names. Brand name cigarettes were categorised as either premium or discount brands using information from the Maxwell consumer report. Respondents who reported smoking "no name" generic cigarettes were classified as smoking a discount cigarette. RESULTS: The reported use of discount/generic cigarettes increased from 6.2% in 1988 to 23.4% in 1993. The trend toward increased use of lower priced cigarettes was evident in all 20 communities studied. The use of low priced cigarettes was associated with lower household income, higher daily cigarette consumption, and residence in an area with higher average cigarette prices. Respondents using discount/generic cigarettes were less likely to stop smoking or to reduce cigarette consumption between 1988 and 1993 compared with those using premium brand cigarettes. CONCLUSIONS: The availability of discount/generic cigarettes has made smoking more affordable, which most likely has helped the cigarette industry retain customers sensitive to price, who might have otherwise reduced consumption or stop smoking altogether.

Adolescent↗
PubMed2006

Health and digital gaming: the benefits of a community of practice.

Psychologists have a tendency to focus on the negative side of life. Our discipline has become preoccupied with illness rather than health. Where the media are concerned we explore the consequences of unhealthy messages for the population in general or young people in particular. This commentary breaks with tradition by outlining ways in which digital games can enhance health. Positive health consequences of gaming are explored in relation to surgical training and therapeutic interventions, physical exercise, health education and community participation.

Behavioral Medicine↗
PubMed2006

Energy expenditure of sedentary screen time compared with active screen time for children.

OBJECTIVE: We examined the effect of activity-enhancing screen devices on children's energy expenditure compared with performing the same activities while seated. Our hypothesis was that energy expenditure would be significantly greater when children played activity-promoting video games, compared with sedentary video games. METHODS: Energy expenditure was measured for 25 children aged 8 to 12 years, 15 of whom were lean, while they were watching television seated, playing a traditional video game seated, watching television while walking on a treadmill at 1.5 miles per hour, and playing activity-promoting video games. RESULTS: Watching television and playing video games while seated increased energy expenditure by 20 +/- 13% and 22 +/- 12% above resting values, respectively. When subjects were walking on the treadmill and watching television, energy expenditure increased by 138 +/- 40% over resting values. For the activity-promoting video games, energy expenditure increased by 108 +/- 40% with the EyeToy (Sony Computer Entertainment) and by 172 +/- 68% with Dance Dance Revolution Ultramix 2 (Konami Digital Entertainment). CONCLUSIONS: Energy expenditure more than doubles when sedentary screen time is converted to active screen time. Such interventions might be considered for obesity prevention and treatment.

Child↗
PubMedDate not supplied

Digital chondroma.

Digital or extraskeletal chondromas are rare tumors. Slow growing in nature, they rarely exceed 3 cm. in diameter. Surgical intervention is necessary for diagnosis and elimination of the problem.

Adult↗
PubMed1998

Therapeutic approach to arteriovenous malformations of the tongue.

Arteriovenous malformations (AVM) are developmental errors with a high complication rate because they are hemodynamically active. The aim of our study is to evaluate management of the rare subgroup of tongue AVM. From 1982 to 1994, 25 patients with AVM of the tongue presented to our department. All patients were discussed in our multidisciplinary staff consultation and were treated by embolization, surgery, or were followed-up clinically with no intervention. Thirteen patients were asymptomatic in a hemodynamically quiescent phase and did not require any kind of intervention. The 12 others underwent embolization procedures following which 6 became stable, 2 had complementary surgery, 1 was lost to follow-up, 1 had two minor bleeding episodes without the need for hospitalization, and 2 were improved. Arteriovenous malformations of the tongue must be followed clinically and treated only if they become active. Permanent embolization with a polymerizing liquid administered through supra-selective catheterization or by direct puncture of the malformation is recommended.

Adolescent↗
PubMed2003

Midaortic syndrome and subarachnoid hemorrhage associated with ruptured middle cerebral artery aneurysm: case report and review of the literature.

OBJECTIVE AND IMPORTANCE: We describe the presentation, screening, management, and clinical outcome of a 21-year-old man who sought care for a ruptured middle cerebral artery (MCA) aneurysm and midaortic syndrome (MAS). Only three cases of MAS and intracranial aneurysm rupture have previously been described in the literature. CLINICAL PRESENTATION: Cranial computed tomographic (CT) scanning, cerebral and abdominal angiography, and multislice three-dimensional CT angiography were used to evaluate intracerebral hemorrhage and to assess medically intractable hypertension in the patient. Digital subtraction angiography revealed a right MCA aneurysm, and multislice three-dimensional CT angiography revealed narrowing of the abdominal aorta. INTERVENTION: The patient's right MCA aneurysm was successfully clipped via a right pterional craniotomy. A narrowed abdominal aorta was confirmed by an abdominal aortic angiogram (performed at Day 5 after surgery) and then dilated by using percutaneous transcatheter angioplasty during the same session. The patient was normotensive even without antihypertensive medications. Neurological examination and postoperative cranial CT findings were within normal limits at the last follow-up examination, performed 4 months after the operation. CONCLUSION: Our patient is the first reported case of ruptured MCA aneurysm with MAS in an adult. The most important problem in the management of MAS associated with ruptured intracranial aneurysm is medically intractable hypertension, which may markedly increase the incidence of rebleeding. It is hard to achieve normotension unless the narrowed aorta and its branches are dilated. For these reasons, MAS should be considered in patients with medically intractable hypertension associated with ruptured intracranial aneurysm.

Adult↗
PubMed2006

Vertebral artery injury after blunt cervical trauma: an update.

BACKGROUND: Vertebral artery injury (VAI) after blunt cervical trauma has been considered to be rare. The incidence of VAI has increased dramatically within the last decade after a heightened awareness of this entity on the part of spine surgeons. Diagnostic or therapeutic guidelines for VAI have not been established fully, however. METHODS: A review of the literature published between 1990 and 2004 was conducted. RESULTS: The incidence of VAI among total blunt trauma admissions ranged from 0.20% to 0.77%. Most VAI patients remained asymptomatic, but sudden unexpected deterioration was often reported. Distraction/extension, distraction/flexion, and lateral flexion injuries were the major mechanisms of injury. Dissection and occlusion were the frequent vascular injury patterns. Facet joint dislocations and the fractures extending into the transverse foramen were the spine injury patterns closely associated with VAI. Digital subtraction angiography was the most sensitive imaging study, but because of invasiveness, its role as a screening study remained questionable. Neuroradiological intervention was used successfully to treat hemorrhagic VAI and progressing vertebrobasilar stroke. Systemic anticoagulation with heparin was the preferred treatment for mild ischemia. Treatment of asymptomatic patients has been controversial because the natural history of VAI has not been elucidated. Prophylactic anticoagulation with heparin or the use of antiplatelet agents was advocated in recent studies. CONCLUSIONS: Preemptive treatment may be reasonable in selected patients considering the devastating potentials of VAI. The potential risks of heparin or antiplatelet agents in relation to early cervical spine surgery have not been addressed fully, however, and spine surgeons have to weigh the risk and benefit of such treatment cautiously.

Angiography, Digital Subtraction↗