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Nailfold computed videomicroscopy in morpho-functional assessment of diabetic microangiopathy.

Although careful measurement of the size of capillary loops is mandatory in the evaluation of diabetic microangiopathy, no current technique allows rapid and careful morphometric analysis of capillaroscopic findings. In an attempt to solve this problem, assembling readily available instruments, the authors have set up an original apparatus for computed videomicroscopy. The apparatus ensures detailed morphological assessment of single loops at high magnification. Each single frame stored on videocassettes can be digitalized for morphometric analysis, saved on floppy disk or printed by means of a graphic printer.

Aged↗

Lexical word formation in children with grammatical SLI: a grammar-specific versus an input-processing deficit?

An ongoing controversy is whether an input-processing deficit or a grammar-specific deficit causes specific language impairment (SLI) in children. Previous studies have focussed on SLI childrens' omission of inflectional morphemes or impaired performance on language tasks, but such data can be accounted for by either theory. To distinguish between these theories we study compound formation in a subgroup of SLI children with 'grammatical (G)-SLI'. An input-processing account (e.g. Leonard, L. (1998). Children with specific language impairment. Cambridge, MA: MIT Press), in which perception and production of inflections requires extra processing resources, would predict that G-SLI children will omit the regular plural -s in compounds (e.g. rat-eater). A grammar-specific deficit account (e.g. Ullman, M. & Gopnik, M. (1994) The production of inflectional morphology in hereditary specific language impairment. The McGill Working Papers in Linguistics, 10, 81-118; van der Lely, H. K. J. & Ullman, M. (1996). The computation and representation of past-tense morphology in normally developing and specifically language impaired children. In A. Stringfellow, D. Cahana-Amitay, E. Hughes & A. Zukowski, Proceedings of the 20th Annual Boston University Conference on Language Development (pp. 816-827). Somerville, MA: Cascadilla Press), in which G-SLI children are impaired in regular inflectional morphology, would predict that G-SLI children will produce regular plural -s forms inside compounds (e.g. *rats-eater). We compared the responses of 16 G-SLI subjects (aged 10 years 4 months to 18 years) with those of 36 normally developing control children (24 matched on language ability and 12 matched on age and cognitive ability). All the groups produced irregular plural nouns in compounds (mice-eater). The normally developing children and teenagers rarely, if ever. produced regular plural nouns inside compounds (*rats-eater), whereas the G-SLI subjects did so often. This pattern of results conflicts with the predictions ofthe input-processing deficit account. The findings support the grammar-specific deficit hypothesis. The data rovide further evidence that specialized grammatical abilities may be differentially impaired within the language system.

Adolescent↗

Technegas ventilation SPECT for evaluating silicosis in comparison with computed tomography.

To compare the subtle pulmonary parenchymal morphologic changes with ventilation function in patients with silicosis, the conventional CT, high resolution CT and technegas ventilation SPECT were performed. In 25 silicotic patients and six controls, the pulmonary ventilation state was evaluated by an index called the coefficient of variation (CV), which expresses the subliminal heterogeneous distribution of technegas in the lungs. The results showed that with silicosis the CV value is significantly higher than that without silicosis. The CV value was proved by multifactorial analysis to independently reflect the extent of the appearance of small scattered interstitial findings such as nodules, septal thickening and bulla, which were typical findings for silicosis. The CV value calculated from the technegas SPECT correlated well with the severity of silicosis. It is considered that the CV value can also express the functional state of the silicotic lung.

Adult↗

Assessment of the efficacy of Sephadex G-15 filtration of bovine spermatozoa for cryopreservation.

Semen from five dairy AI bulls was split-filtered through a Sephadex G-15 filter and frozen in a Tris-citric acid buffer egg yolk-based extender. The effect of filtration was studied morphologically for individual sperm abnormalities. Computer-assisted sperm analysis (CASA) was used for motility and sperm motion assessment. Flow cytometry was used to disclose sperm viability (SYBR-14/PI), mitochondrial membrane potential (Mitotracker Deep Red/SYBR 14), acrosome integrity (SYBR 14/PE-PNA/PI), plasma membrane stability (Merocyanine 540/YO-PRO 1/Hoechst 333342), and chromatin stability (acridine orange staining). Filtration significantly reduced the concentration of recovered spermatozoa (P < 0.01), but improved semen quality, reducing the number of spermatozoa with various forms of morphological defects. Filtration also affected percentages of sperm motility after equilibration and after freezing/thawing. Sperm motion characteristics were, however, not significantly affected by filtration at any stage of the cryopreservation protocol, including post-extension, equilibration, or freezing/thawing. Filtration enhanced sperm viability after thawing (P < 0.05), but had no significant effect (P > 0.05) on recovery of spermatozoa with high mitochondrial potential, intact acrosomes, or preserved sperm chromatin structure. Sperm plasma membrane stability was also not affected by the filtration method used (P > 0.05). It can be concluded that filtration effectively separates weaken or abnormal spermatozoa in pre-freezing semen samples and therefore the procedure could be recommended to improve post-thaw sperm viability of selected, fertile sires.

Acrosome↗

Anatomic approach to the parametrium: value of computed tomographic in vitro study compared to dissection.

The aim of this study is to describe the morphology of the normal parametrium by correlating the slices obtained with computed tomography of 12 female cadavers studies after intravascular injection of latex with the dissection findings in 6 of the these patients. the upper limit, represented by the isthmus was defined by the uterine a. and/or a superficial uterine v. and/or the coronary v. (Charpy). The lower limit corresponded to the insertion of the levator ani mm. at the junction of the middle and inferior thirds of the vagina. The paracervical and paravaginal tissues above the levator ani m. and medial to the pelvic fascia covering these muscles were perfectly visualized. The posterior limit, formed by the lateral ligament of the rectum and/or the sacrouterine ligaments, and the anterior limit determined by the umbilico-vesical fascia were more difficult to demonstrate. In this study the parametrium appeared as a highly vascular and essentially venous connective structure with a variable morphology dependent on the uterine position.

Aged↗

Magnetic resonance imaging in distinguishing malignant from benign pleural disease.

OBJECTIVE: To explore the role of magnetic resonance imaging (MRI) in distinguishing malignant from benign pleural disease. METHODS: All 64 patients were examined with both computed tomography (CT) and MRI. The morphologic features of pleural lesions and MR signal intensity on T1-weighted, T2-weighted and contrast-enhanced T1-weighted images were evaluated. RESULTS: Mediastinal pleural involvement, circumferential pleural thickening, nodularity, irregularity of pleural contour, and infiltration of the chest wall and/or diaphragm were most suggestive of a malignant cause on CT and MR images. Contrary to what has been reported in the literature, pleural thickness greater than 1 cm either on CT or on MRI did not reveal a significant difference between malignant and benign pleural disease (P > 0.05, chi-square test). Using morphologic features in combination with signal intensity features, MRI had a sensitivity of 98% and a specificity of 92% in the detection of pleural malignancy. CONCLUSIONS: Compared with those on CT, the morphologic features on MRI allowed a mostly equal and in some cases superior detection and evaluation of the spread of pleural disease. In combination with signal intensity and morphologic features, MRI is very useful in distinguishing malignant from benign pleural disease.

Adult↗

Sperm morphology: assessing the agreement between the manual method (strict criteria) and the sperm morphology analyzer IVOS.

OBJECTIVES: To correlate the percentage normal morphology reported by different observers and a computerized method (IVOS; Hamilton-Thorne Research, Beverly, MA) on a slide-by-slide basis using strict criteria: [1] Experienced observer (T.F.K.) versus experienced observer (R.M.), [2] experienced observer (T.F.K.) versus sperm morphology analyzer (IVOS), and [3] repeatability of normal and abnormal cells (IVOS). DESIGN SETTING, PATIENTS: Slides from 30 different patients from the Tygerberg IVF program were selected randomly. Microscopic fields and sperm cells were chosen randomly and percent normal morphology was recorded (objectives 1 and 2). The same slides were used and a cell-by-cell repeatability was done as outlined (objective 3). RESULTS: Experiment 1 (objective 1): there was no significant bias between T.F.K. and R.M. The limits of agreement were 8.6% and -7.3%. The SDs were not significantly different (P = 0.1283). The Spearman correlation coefficient between readers was 0.83. Experiment 2 (objective 2): the same findings were reported but the limits of agreement were 12.1% and -15.5%. The Spearman correlation coefficient was 0.85. The limits of agreement was tighter below 20% normal forms (+8.4 and -6.6). Experiment 3 (objective 3) (repeatability): 255 cells were analyzed three times in succession. Estimating pairwise agreement, the kappa statistic for the pairs are 0.85, 0.80, and 0.85, respectively, which compares favorably with the second canonical moment of 0.8329 (kappa = 0.83). DISCUSSION: The computer's ability to classify normal morphology per slide is promising. Below 20% normal forms, the limit of agreement is tight. Because of the 6% higher reading compared with the manual method, different thresholds possibly will be developed to identify subfertile from fertile patients. The computer gives excellent repeatability of normal and abnormal cells. Based on results obtained, this system can be of clinical value both in IVF units and andrology laboratories but more clinical data is required in this field.

Cytological Techniques↗

Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection.

OBJECTIVE: Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. DESIGN AND PATIENTS: CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (+/-15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 degrees to +30 degrees at 15 degrees increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. RESULTS: Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation. CONCLUSION: Angulation of the reconstruction plane considerably affects the appearance of the sacroiliac joints. By shortening joint depth, an inferiorly directed approach to SI joint injection may make fluoroscopic guidance easier, although associated bony interposition can prevent access to the synovial compartment. A superiorly directed approach is more likely to have adverse effects.

Anesthetics, Local↗

Characteristics of skin surface morphology and transepidermal water loss in clinically normal-appearing skin of patients with atopic dermatitis: a video-microscopy study.

In patients with atopic dermatitis (AD), it is debatable whether clinically normal-appearing skin is equal to non-atopic normal skin. The aim of this study was to quantitatively evaluate the characteristics of normal-appearing skin of AD. We examined the value of skin surface morphological changes using a new, simple, computer-assisted method with a video microscope. We also investigated the physiological function as represented by transepidermal water loss (TEWL) levels in 44 patients with AD and 15 normal controls. The morphological changes were represented by a variation coefficient score that reflected the irregularity of skin ridges, named the surface irregularity index (SII). There were significant differences between the normal-appearing skin of AD and non-atopic normal skin in both SII (P<0.001) and in TEWL (P<0.01). Especially for the SII, there were significant differences between AD subgroups subdivided by peripheral blood eosinophil count (Eo), serum lactate dehydrogenase level, and clinical score. TEWL values were significantly higher in the high-Eo AD group (n=15) than in the low-Eo AD group (n=29) (P<0.05). These findings indicate that clinically normal-appearing skin of AD patients with high disease activity differs from non-atopic normal skin in both surface morphology and physiology and that these changes reflect the current disease activity.

Adolescent↗

Importance of morphological findings in the progress and treatment of chest wall deformities with special reference to the value of computed tomography, echocardiography and stereophotogrammetry.

Patients with chest wall deformities have many particular anatomical, physiological, genetic, biomechanical and psychological characteristics. It is generally recognized that surgical correction of funnel chest and pigeon breast may be done for psychosocial reasons alone. Morphological and dynamic investigations are done to identify the function of the deformed chest wall and to permit objective assessment of the cosmetic and functional outcomes of the operation. There is no universally agreed standard for the diagnosis of funnel chest and pigeon breast. Non-invasive investigations, such as computed tomography (CT), echocardiography (ECG) and stereophotogrammetry (SP), improve the quality of the diagnostic assessment, including evaluation of its functional aspects, without directly influencing the decision to operate, which is still made mainly on subjective grounds. The value of these techniques in the diagnosis of chest wall deformities is assessed and the results of our personal experience are presented.

Adolescent↗

Time-domain analysis of beat-to-beat variability of repolarization morphology in patients with ischemic cardiomyopathy.

There is growing evidence that beat-to-beat changes in ventricular repolarization contribute to increased vulnerability to ventricular arrhythmias. Beat-to-beat repolarization variability is usually measured in the electrocardiogram (ECG) by tracking consecutive QT or RT intervals. However, these measurements strongly depend on the accurate identification of T-wave endpoints, and they do not reflect changes in repolarization morphology. In this article, we propose a new computerized time-domain method to measure beat-to-beat variability of repolarization morphology without the need to identify T-wave endpoints. The repolarization correlation index (RCI) is computed for each beat to determine the difference between the morphology of repolarization within a heart-rate dependent repolarization window compared to a template (median) repolarization morphology. The repolarization variability index (RVI) describes the mean value of repolarization correlation in a studied ECG recording. To validate our method, we analyzed repolarization variability in 128-beat segments from Holter ECG recordings of 42 ischemic cardiomyopathy (ICM) patients compared to 36 healthy subjects. The ICM patients had significantly higher values of RVI than healthy subjects (in lead X: 0.045 +/- 0.035 vs. 0.024 +/- 0.010, respectively; P < .001); 18 (43%) ICM patients had RVI values above the 97.5th percentile of healthy subjects (>0.044). No significant correlation was found between the RVI values and the magnitude of heart rate, heart rate variability, QTc interval duration, or ejection fraction in studied ICM patients. In conclusion, our time-domain method, based on computation of repolarization correlation indices for consecutive beats, provides a new approach to quantify beat-to-beat variability of repolarization morphology without the need to identify T-wave endpoints.

Electrocardiography, Ambulatory↗

A study of root canal morphology of human primary molars using computerised tomography: an in vitro study.

Knowledge of the size, morphology and variation of the root canals of primary teeth are useful in visualizing the pulp cavity during treatment. This study was carried out to investigate the applicability of Computed Tomography in studying the root canal morphology of the primary molars. A total of 60 primary molars.without any macroscopic root resorption were collected and divided into four groups. The samples were arranged in wax block and then scanned for evaluation in the CT Scanner both in axial and coronal plane. The results obtained from the scanned images were statistically analyzed to know the frequency, mean and standard deviation for all the groups. The images showed the complexity of the root canals of the primary molars and also several capabilities of the CT Scan in advance Endodontic research in primary teeth were observed.

Dental Pulp Cavity↗

Indications for posthepatectomy hepatic vein reconstruction from functional and morphological studies: clamping test and hepatic vein branch distribution determined by three-dimensional computed tomography.

BACKGROUND/AIMS: Indications for hepatic vein reconstruction for preserving remnant liver function after hepatectomy were assessed using the clamping test and the findings of preoperative 3D-CT (3-dimensional computed tomography). METHODOLOGY: Fifteen patients who underwent hepatectomy for malignant tumors in segment VII or VIII, or both, were examined with preoperative 3D-CT and an intraoperative clamping test. RESULTS: On the basis of changes in right hepatic venous pressure during clamping, we classified all patients into 3 types: the persistent elevation type (P-type, 8 patients), the no elevation type (N-type, 3 patients) and the transitory elevation type (T-type, 4 patients). Hepatic venous hemoglobin oxygen saturation (ShvO2) decreased significantly in the P type but hardly changed in the T and N types during the clamping test. Both the inferior right hepatic vein (IRV6) and the tributary of the middle hepatic vein draining segment V (MV5) were detected by preoperative 3D-CT in the T and N types. CONCLUSIONS: Assessments of hepatic vein branch distribution using preoperative 3D-CT served to predict the results of the hepatic vein clamping test. The results of preoperative 3D-CT were useful as indications for hepatic vein reconstruction.

Adult↗

[Construction and use of a virtual anthropomorphic phantom of the bronchial tree].

MOTIVATION: Usually, phantoms are used to quantify properties of computer algorithms working on spiral CT data. The high complexity of the human bronchial tree, however, complicates the construction of a physical phantom enormously; hence, a virtual phantom must be employed. METHODS: Because the human bronchial tree is fractal, Lindenmayer systems were utilized to generate its structure. Applying the correct diameter and length ratios and branching angles, a virtual anthropomorphic phantom could be generated by a three-dimensional turtle graphic. The simulation of a spiral CT measurement on the virtual phantom delivered synthetic spiral CT data. RESULTS: The computer-controlled growing process supplies exact morphologic and morphometric data. The spiral CT simulation saves the time-consuming and complicated generation of a physical phantom. PERSPECTIVE: The virtual phantom can be completed by the introduction of blood vessels and lung parenchyma partitioned into lobes and segments. The field of application can thus be extended.

Anthropometry↗

Stereo morphology of temporal bone and ear.

BACKGROUND: The temporal bone has the most complicated anatomic feature among the whole human body, which always challenges otolaryngologists. This study was to study three-dimensional (3D) morphology of the temporal bone and the ear by means of a computer image processing technique, for the purpose of providing a 3D image to help in pathological, diagnostic and surgical procedures. METHODS: Forty sets of temporal bone celloidin serial sections with reference points were prepared and the contours of selected structures and reference points were entered into a graphics programme. The technique of computer-aided 3D reconstruction was applied to obtain 3D images and parameters of the temporal bones and the ears. Stereo views of the ossicles (n = 5), the facial nerves (n = 11), the posterior tympanic sinuses (n = 11), the posterior ampullary nerves (n = 4), the endolymphatic ducts and sacs (n = 5), and the bony and membranous labyrinth (n = 1) were reconstructed. RESULTS: Three-dimensional images, including the cochlea, the ossicles, the nerves, the tendons and the endolymphatic fluid system in the temporal bone, were obtained. Stereo picture pairs and 3D parameters of spatial dimensions, angle and volume for these reconstructed structures were calculated. The arrangement of the ossicles, spatial relationship of the bony and membranous labyrinth, the whole course of the facial nerves, the endolymphatic sac and posterior tympanic cavity were clearly observable. Stereo picture pairs made the spatial relationships among the above-mentioned structures much clearer. The operation of the posterior ampullary nerve transection was designed and simulated on the graphic computer based on 3D anatomic investigations. CONCLUSION: The technique of computer-aided 3D reconstruction provides a new tool to observe the morphology of the temporal bone and thus may allow design and study of new surgical approaches.

Ear↗

Computer diagnosis of skin disease.

A transferable computer program for the differential diagnosis of diseases of the skin, CLINDERM, has been produced for use by physicians on standard IBM and compatible personal microcomputers. This program lists the differential diagnosis and definitive diagnosis of any presented disease of the skin, except single tumors. The physician operator indicates the distribution and detailed description of lesions, which the interactive system integrates with a comprehensive knowledge base. The computer diagnosis in 129 cases was compared with independent interpretation of the same information by an academic dermatologist. Results were synonymous in 66.7% of all diseases and similar in an additional 4.7%. A common differential diagnosis was obtained in 24%, for a 95.3% rate of synonymous, similar, or common differential diagnoses. Diagnosis was different in 3.9% and description was inadequate for diagnosis in 0.8%. The variation in diagnosis showed that some descriptive terms are prejudicial of certain diagnoses; that diagnostic terms are not all completely standardized; that some diagnoses are variants of another disease; and that drug-induced eruptions simulate many other diseases. A skin disease can usually be diagnosed by specific description. Most lesions that are not diagnostic from inspection are nodular. A computer can be programmed to list diagnoses according to morphologic description.

Dermatology↗

[The value of computerized tomography for the diagnosis of diabetic osteoarthropathy].

The diagnostic possibilities of computed tomography as compared to conventional radiology are presented. Morphological changes, which can be identified by normal x-rays, can be shown by computed tomography without any disturbing overshadowing. The computed tomography is showing especially well necrotic lesions, pathological fractures, and joint changes. The high resolution of computed tomography reveals good visibility of the adjacent soft tissues and para-articular structures. As computed tomography gives additional and important informations, it should be used for solution of diagnostic problems in diabetic osteoarthropathy.

Adult↗

Segmentation of brain tissue from magnetic resonance images.

Segmentation of medical imagery is a challenging problem due to the complexity of the images, as well as to the absence of models of the anatomy that fully capture the possible deformations in each structure. The brain is a particularly complex structure, and its segmentation is an important step for many problems, including studies in temporal change detection of morphology, and 3-D visualizations for surgical planning. We present a method for segmentation of brain tissue from magnetic resonance images that is a combination of three existing techniques from the computer vision literature: expectation/maximization segmentation, binary mathematical morphology, and active contour models. Each of these techniques has been customized for the problem of brain tissue segmentation such that the resultant method is more robust than its components. Finally, we present the results of a parallel implementation of this method on IBM's supercomputer Power Visualization System for a database of 20 brain scans each with 256 x 256 x 124 voxels and validate those results against segmentations generated by neuroanatomy experts.

Algorithms↗