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Comparative accuracies of a finger blood pressure monitor and an oscillometric blood pressure monitor.

A noninvasive blood pressure monitor (Finapres) that uses the methodology of Penaz to continuously display the arterial waveform from the finger has been introduced recently. The Finapres monitor overestimated systolic pressure by 5.8 +/- 11.9 mm Hg, while the Dinamap monitor underestimated systolic pressure by -6.9 +/- 9.2 mm Hg (P = 0.003). Dinamap mean and diastolic pressure biases were less than 2 mm Hg, while the Finapres biases for these variables were significantly greater (7.7 +/- 10.0 and 8.2 +/- 9.8 mm Hg, respectively). There was no difference in systolic or mean pressure precision between the two devices (approximately 10 mm Hg), but the diastolic precision of the Dinamap unit was superior to that of the Finapres. While in most patients the Finapres monitor provided continuous blood pressure data equivalent to the data from the radial artery, marked bias (greater than 15 mm Hg) was exhibited in 2 patients for all three pressure variables. Despite this bias, blood pressure changes were tracked closely in these 2 patients. We conclude that, in its current form, the Finapres monitor cannot be relied upon independently to accurately measure blood pressure in patients undergoing general anesthesia. Since the Dinamap monitor measures mean pressure reliably and accurately, we suggest that mean blood pressure values between the Finapres and Dinamap monitors be compared to guide one in interpreting Finapres data.

Adolescent

Quality monitoring of soft-copy displays for medical radiography.

As presentation of medical radiographic images on soft-copy displays (cathode ray tubes) becomes increasingly prevalent in electronic radiography, methods of quality assurance must be developed to ensure that radiologists can effectively transfer film-based reading skills. Luminance measurements provide the basis for evaluating the state of soft-copy displays. An integrated approach has been implemented at Mallinckrodt Institute of Radiology (MIR, Washington University, St Louis, MO) that facilitates measurement of geographically distributed soft-copy displays with centralized data logging, performance tracking, and calibration. MIR's central radiology image manager exercises the display station that drives the monitor, harvests the measurement data, stores the results, and submits the resulting data for additional processing. The luminance measurements are collected by a small, portable, photometric instrument designed at MIR that includes a serial port that is accessed via local area terminal service supported by the radiology image manager. The design details of the photometric instrument and example luminance characteristics of several soft-copy displays used at MIR are presented in this report.

Computer Peripherals

A simple polymerase chain reaction apparatus based on a computer printer.

We describe a very simple laboratory-made polymerase chain reaction (PCR) apparatus. The reaction tubes are placed in a holder fixed through a mechanical arm to the tape cartridge of a computer printer. A computer controls the horizontal movement of the tube carrier by sending the proper printing commands. The holder is raised or lowered by a frame fixed to the paper-advancing roller of the printer. The system allows the programmed movement of the test tubes within the holder, successively through three thermal baths placed in front of the printer. DNA from single lambda gtll lysis plaques was successfully amplified with this system in our laboratory.

Animals

A versatile dual axis programmable stepping motor controller for a personal computer: a specific application and tutorial for implementing a computer-controlled light microscope.

A simple programmable stepping motor circuit for controlling two independent stepping motors has been designed. The circuit is compatible with the IBM personal computer and needs only slight modification to work with virtually any other microcomputer. The motors can either be programmed by the host personal computer for remote operation, controlled directly by a joystick interface provided in the circuit, or a combination of the two procedures. Independent microprocessors control each stepping motor and can be easily programmed by the host computer via Input/Output ports designed into the circuit. A basic understanding of the circuit demonstrates some commonly used techniques for controlling microcomputer electronics through computer programming. The circuit will likely have many uses, although the implementation of a computerized microscope is explicitly described. The circuit is currently used in a neuroanatomical and neurochemical computer charting system at the University of Iowa.

Computer Peripherals

[Significance of 2 different bone density measurement methods in the assessment of mineral content of the peripheral and axial skeleton].

Between May 1990 and February 1991 we enrolled 212 patients of 410 referred to our clinic for bone mass evaluation according to different diagnosis or therapeutic procedures. These patients were divided into 7 groups. The question had to be answered, which method of measurement and which skeletal site would give better information about the influence of the diseases of therapeutic procedures. We measured the areal mineral density of the lumbar spine with dual x-ray absorptiometry (DEXA) and the mineral content of the total and trabecular bone mass of a cross-sectional slice at the distal radius with peripheral quantitative computed tomography (pQCT). The results were statistically analysed. We calculated the percentage deviation from young normals. Trabecular mineral content showed the greatest difference (18% to 44%), compared to the healthy reference group, corresponding to the known higher turnover of this bone compartment. In contrast, the difference of the areal density of the lumbar spine was found to be lowest (4% to 27%). In order to compare the methods objectively, we additionally calculated a ROC-analysis of two postmenopausal groups (51 healthy, 46 osteoporotic) to demonstrate the diagnostic validity. The validity proved to be substantially better when purely trabecular bone at the distal radius was measured. The ROC-curves showed a sensitivity of 84% for radial trabecular bone on a specificity level of 90%, whereas the lumbar spine values presented with a sensitivity of only 68%.

Absorptiometry, Photon

An analysis of the haemodynamic effects of tolbutamide in conscious dogs.

1. In conscious chronically instrumented dogs, tolbutamide (5-45 mg/kg) induced significant dose-related increases in mean arterial pressure and left ventricular end-diastolic pressure. 2. Cardiac output was decreased while heart rate, d(LVP)/dt, and regional myocardial performance at the left ventricle were not significantly affected. Computed total peripheral resistance was increased. 3. Pretreatment with the alpha-antagonist phentolamine (1-1.5 mg/kg) abolished the pressor response. Furthermore, the pressor response to norepinephrine (0.1 microgram/kg) was enhanced by pretreatment with tolbutamide (45 mg/kg). 4. In an isolated tissue preparation using ring segments of canine femoral arteries, neither tolbutamide nor its major hepatic metabolites (carboxytolbutamide, p-toluene-sulfonamide and p-toluene-sulfonylurea) caused any smooth muscle contraction. However, pretreatment of these tissues with 10(-4), 10(-3), or 10(-2) mol/l tolbutamide potentiated the contractile response to norepinephrine by up to 19% and to phenylephrine by up to 8%. 5. It was concluded that the pressor effect of tolbutamide arises by potentiating the alpha-adrenoceptor mediated vasoconstrictor action of circulating endogenous catecholamines.

Adrenergic alpha-Antagonists

Performance characteristics and image fidelity of gray-scale monitors.

Gray-scale monitors are an essential element of electronic radiology, and their ability to provide images that are perceived to be identical to those available on conventional or laser-printed film is crucial to success of electronic radiology. Image fidelity is measured in physical characteristics (luminance, dynamic range, distortion, resolution, and noise) and with psychophysical techniques, including receiver operator characteristics analysis with clinical images and testing with contrast-detail patterns to determine threshold contrast. Currently, laser-printed images facilitate greater information transfer than does a gray-scale monitor because of their higher absolute luminance (500 ft-L vs 60 ft-L), greater perceived dynamic range, and better spatial resolution. In the near future, the developments of gray-scale monitors with 150-200 ft-L luminance, a display standard based on just noticeable differences, and algorithms to improve similarities between gray-scale display images and laser-printed images will help increase the acceptability of monitors as a means to make primary diagnoses.

Computer Peripherals

Hemodynamics of hemorrhage in the conscious rat and chicken.

Hemodynamic responses to hemorrhage in conscious chicks (n = 10, 233 g) and rats (n = 10, 309 g) were compared. The animals were fitted with miniature pulsed Doppler aortic flow probes 2 days (chickens) or 5 days (rats) before catheterization, and the experiment began 1 (chickens) or 2 (rats) days later. Mean arterial pressure (MAP) and cardiac output (CO) were recorded continuously and simultaneously digitized to compute total peripheral resistance (TPR). MAP, CO, and TPR values were graphed on-line by a microcomputer and stored for later analysis. A 4-ml hemorrhage reduced MAP and CO by 25 and 43% in the rat, and 15 and 4% in the chickens, respectively. The fall in CO in the rat was due to reduction of stroke volume (SV) unlike the birds where SV was well maintained. TPR was elevated 65% in the rats and fell 13% in the chickens. The minimal fall in CO and SV in these conscious birds suggests that anesthetic agents used previously (i.e., urethane, paraldehyde, phenobarbital, and pentobarbital sodium) suppressed cardiac function. However, they do not account for the lack of a peripheral vascular response during hemorrhage. The chicken apparently maintains MAP by a volume regulating mechanism operating independently of peripheral vascular tone inasmuch as circulating fluid volume restitution is rapid and occurs without vasoconstriction. The rat maintains MAP through reflex cardiac and peripheral vascular responses which eventually may contribute to transvascular fluid loss and the ultimate collapse after prolonged hemorrhagic hypotension.

Animals

A method for evaluating head-controlled computer input devices using Fitts' law.

The discrete movement task employed in this study consisted of moving a cursor from the center of a computer display screen to circular targets located 24.4 and 110.9 mm in eight radial directions. The target diameters were 2.7, 8.1, and 24.2 mm. Performance measures included movement time, cursor path distance, and root-mean-square cursor deviation. Ten subjects with no movement disabilities were studied using a conventional mouse and a lightweight ultrasonic head-controlled computer input pointing device. Average movement time was 306 ms greater (63%) for the head-controlled pointer than for the mouse. The effect of direction on movement time for the mouse was relatively small compared with the head-controlled pointer, which was lowest at 90 and 270 deg, corresponding to head extension and head flexion, respectively. Average path distance and root mean square displacement was lowest at off-diagonal directions (0, 90, 180, and 270 deg). This methodology was also shown to be useful for evaluating performance using an alternative head-controlled input device for two subjects having cerebral palsy, and measured subtle performance improvements after providing a disabled subject with lateral torso support.

Adult

User's review of the Canon Colour Copier.

The ability to link the new Canon Colour Laser Copier to a computer opens up new boundaries of data manipulation. A report from the user's point of view, describes a system comprising the copier with computer input, slide scanner and flat copy capacity. Information is given on the types of materials produced, the types of users, the cost of purchase and maintenance, and the potential for generating profit.

Computer Peripherals

[Teleradiography for diagnosis in emergency care. A clinical experience].

This work was aimed at evaluating the role of teleradiology in a diagnostic emergency room. Over a 6-month period (September 1991-February 1992), 2,000 films made in the emergency room were transmitted to a resident radiologist 1 kilometer away: each examination included patient's data (sex, age, site of trauma, etc.) which were sent by the admitting physician. A teleradiology system (Lumiscan 100 AT&T and Philips) was used. Films were digitized on a 1024 x 1024 x 8-bit image matrix and then transmitted over a dedicated standard phone line to the Department of Radiology. The autograph report was sent by fax to the emergency room. Four radiologists, of varying experience, independently reviewed a sample of 179 digitized radiographs and, 30 days later, the original films on a conventional light-box. The results appear to be encouraging because no significant differences were observed in the performance of any of the radiologists. Good video/films agreement was obtained, together with high sensitivity and specificity. A good result was the relatively small number (0.4% of all examined cases) of false negatives diagnosed on faxed films relative to the actual clinical diagnosis.

Computer Peripherals

The need and user requirements for integrating images with radiology reports.

Radiology reports are likely to be more useful if they contain appropriate graphic material. Diagnostic conclusions and recommendations become more convincing and useful when the clinician personally can review the image on which these are based. Modern desk-top publishing techniques make it possible to incorporate radiographic images, appropriately selected and annotated, as part of the radiology report. It is believed that such illustrated reports would be preferred by referring physicians, notwithstanding a significant loss of image detail. A survey of these referring physicians was carried out to determine whether this hypothesis was correct.

Computer Peripherals

Optical mark reader technology and data base development in anesthesiology and critical care medicine at the Johns Hopkins Medical Institutions.

The Department of Anesthesiology and Critical Care Medicine (DACCM) has substantially upgraded its computer resources within the past two years by installing a local area network (LAN) and replacing low-end PC's with PC's utilizing Intel 80286 or 80386 microprocessor technology. Data base development has now become a priority. Data bases are being developed for both clinical and administrative purposes. We are replacing the traditional method of "keypunching" with optical card scanners which results in faster and more accurate data entry directly into the data bases. Previously, such card scanners have been confined to large organizations. We describe a method of data capture and data base development with wide applicability in medicine.

Anesthesiology

Recording vectorcardiographic loops with a microdot thermal printer.

The principle of recording vectorcardiographic loops with a microdot thermal printer is developed using a very small memory area. It is based on two previous achievements: (i) orthogonal electocardiogram derivation from the conventional 12-lead system and (ii) recoding of biomedical signals with a microdot thermal printer, thus permitting the VCG to be just an extension of the standard ECG. The principle consists of decomposing the loop into horizontal sectors each one representing a non-ambigous function. It is implemented in ECG instruments, using the Gotemba microdot thermal printers TLP 480Z and TLP 880Z produced in Japan.

Computer Peripherals