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PubMed2005

New quantitative methods for evaluation of dynamic changes in QT interval on 24 hour Holter ECG recordings: QT interval in idiopathic ventricular fibrillation and long QT syndrome.

OBJECTIVES: To introduce a nomogram of the normal QT interval at various heart rates measured from 24 hour Holter ECG recordings in healthy subjects with respect to age and sex and to use the nomogram to characterise dynamic changes in QT interval in patients with idiopathic ventricular fibrillation (IVF) and the long QT syndrome (LQT). METHODS: The study group consisted of 422 subjects: 249 healthy men ranging in age from 21-88 years (mean (SD) 47 (20) years) and 173 healthy women ranging in age from 21-85 years (47 (19) years). In addition, seven men with IVF ranging in age from 33-53 years (43 (9) years) and five women with LQT ranging in age from 20-55 years (37 (14) years) were studied. For each subject, QT interval and heart rate were determined automatically from 24 hour Holter ECG digital data-namely, QT interval was measured from signal averaged ECG waves obtained by averaging consecutive sinus beats during each 15 second period over 24 hours. Data were grouped and averaged at an interval of 5 beats/min for heart rates ranging from 46-120 beats/min. RESULTS: In healthy subjects aged < 50 years and > or = 50 years QT intervals were longer in women than in men. QT intervals were longer in both men and women aged > or = 50 years than in ages < 50 years. From these findings a nomogram of QT interval at varying heart rates adjusted for age (younger group aged < 50 years or older group aged > or = 50 years) and sex was determined. In patients with IVF, QT intervals were significantly shorter at slower heart rates than normal values obtained from the nomogram. In patients with LQT, QT intervals were significantly longer at both faster and slower heart rates than normal values. CONCLUSIONS: The nomogram of QT interval at varying heart rates adjusted for sex and age could be used to assess dynamic changes of QT interval of various pathological conditions. For example, patients with IVF had shorter QT interval at slower heart rates, a finding suggestive of arrhythmogenicity of this specific syndrome at night. Patients with LQT had prolonged QT interval at specific heart rate ranges depending on their genotype.

Adult↗

PubMed2005

Impact of the exercise mode on exercise capacity: bicycle testing revisited.

STUDY OBJECTIVE: To test the performance of a tool designed to estimate functional capacity in order to select a bicycle ramp protocol yielding a test duration from 8 to 12 min in healthy individuals, and to assess differences in exercise responses between bicycle and treadmill tests. PARTICIPANTS AND MEASURES: Forty-one healthy and physically active volunteers (10 women; median age, 37 years; interquartile range [IQR], 29.5 to 41 years) performed an individualized ramp exercise protocol on a bicycle ergometer and a treadmill in random order. Prior to testing, the Veterans Specific Activity Questionnaire (VSAQ) combined with a modified variant of the VSAQ nomogram (metabolic equivalents [METs] derived from VSAQ and age with the modified nomogram, resulting in METs nomogram) was used to estimate exercise capacity and to select the treadmill protocol. The corresponding bicycle work capacity nomogram (in watts) was derived by the following equation: (METs nomogram - 1) x body weight/3.486. RESULTS: Using treadmill tests, all 41 participants (100%) achieved maximal exercise from 8 to 12 min, as compared to 33 participants (80%) for the bicycle tests (p = 0.003). Peak oxygen uptake (V(O2)) [bicycle: median, 49.7 mL/kg/min (IQR, 45.4 to 56.6 mL/kg/min); vs treadmill: median, 53.1 mL/kg/min (IQR, 47.3 to 57.7 mL/kg/min; p < 0.0001)] was lower using the bicycle compared to the treadmill. However, the difference in peak V(O2) values between the two exercise modes was lower (2.6 mL/kg/min; IQR, 1.1 to 4.3 mL/kg/min), corresponding to 4.6% (IQR, 2.4 to 8.5%) of the lower of both values than reported in previous studies, and seven participants (17%) even achieved a higher peak V(O2) using the bicycle. CONCLUSIONS: A modified version of the VSAQ can be effectively used to select appropriate ramp rates for exercise testing using a bicycle ergometer in healthy individuals. Differences in maximal responses are less than those previously reported, suggesting that the bicycle ergometer is an appropriate alternative to the treadmill test in healthy volunteers.

Activities of Daily Living↗

PubMed1981

A graphic approach for prediction of arterial oxygen tension at different concentrations of inspired oxygen.

A rapid, simple method for predicting the arterial oxygen tension (PaO2) at any fractional concentration of inspired oxygen (FIO2) is presented. The method is based on a nomogram interrelating PaO2, arterial carbon dioxide tension (PaCO2) and FIO2, allowing rapid determination of the arterial to alveolar oxygen tension ratio a/A PO2. The applicability of the nomogram and its reliability for predicting the PaO2 at any FIO2 were studied prospectively in nine consecutive patients requiring mechanical ventilation (16 trials). On each occasion, a desired PaO2 was chosen and from the nomogram an FIO2 expected to yield this PaO2 was administered. The PaO2 was then measured. Actual PaO2 differed from desired PaO2 by a mean of 2.6 mm Hg (range 0 to 10 mm Hg, standard deviation (SD) 4.8). Retrospectively, we analyzed the nomogram's ability to predict the PaO2 +/- 9.6 mm Hg (2 SD) at varying FIO2. The overall sensitivity of this method was 85 percent (126 predictions out of 149 trials). We conclude that appropriate levels of supplemental oxygen can be rapidly and reliably chosen using the nomogram in selected patients.

Adult↗

PubMedDate not supplied

[The fetal adrenal gland in risk pregnancy].

INTRODUCTION: The role of the adrenal gland in the metabolism of foetus and its role in maturation of foetal organs are the principal motives for paying more attention to this vital organ, which is still a great enigma for gynaecologists. The control of the gland is important in normal as well as in risk pregnancies. Of the entities that most often imperil the growth of foetus and adrenal glands are diabetes and hypertension in pregnancy. A consequence of the maternal diabetes may be macrosomy of foetus manifested by increase in foetal body mass and enlargement of organs sensitive to increased concentration of insulin in the foetal blood [6], i.e., the liver, fat tissue, lungs, adrenal glands, heart. Brown and Singer (1988) [2] established that adrenal glands of foetus are imperiled in pregnancies complicated by mother's hypertension. Their conclusion was derived from pathologic findings in foetuses from unsuccessful pregnancies of patients with hypertension. The glands were of reduced sizes. The way to perform precise measuring of glands, which are of dilapidated composition during post mortem examination, is not quite acceptable, since during the manipulation the size may, to some degree, be altered. By introduction of the ultrasound method in medical practice the problem of biometry has been overcome. Besides measuring, of great importance for the study of physiology of the gland is also the analysis of the foetal fluid and foetal blood. The first successful measuring of the adrenal gland of foetus by ultrasound was performed in mid 80s of the last century by Jeanty and Romero [3] via transabdominal path. The aim of our study is the comparison of foetal adrenal glands in normal and high-risk pregnancies. MATERIAL AND METHODS: During a prospective follow-up carried out at the Institute of Gynaecology and Obstetrics, Clinical Centre of Serbia, 213 patients, aged from 19 to 44 years were examined. Gestation periods were from the 11th to the 40th week. We divided the patients in 3 groups. The first group consisted of 131 patients with no pathologic changes and whose children were born alive. The second group was formed of 75 pregnant women in whom the course of pregnancy was impaired and disorders in the foetal. From these pregnancies the children were born alive. The third group was composed of 7 patients in whom abortion was indicated. The measured values of foetal adrenal glands diameter in the first group (131 patients), were used for making a nomogram of the glands growth. The measuring was performed with ultrasound apparatus "Toshiba 100 SSA". Transabdominal examination with a probe of 3.75 MHz and transvaginal examination with probes of 5 and 7 MHz were performed. Since the picture of the adrenal gland resembled an ellipse, on the basis of measured diameters and using the formula for circumference of this geometric figure [O = (d1 + d2) x pi/2], we obtained the desired value, which increased with advancement of pregnancy. Patients included in the study were with one-foetus pregnancy, whose last menstruation was precisely dated. Data are presented in a chart. For analysis of the obtained data, in addition to parameter methods, we also used the linear correlation and regression and one-factor analysis of variance. Data base analysis was made in the SPSS for DOS package. RESULTS: In making a nomogram of adrenal glands growth of a foetus old between 11 and 40 weeks, 131 of 213 patients were included, while the other foetuses were excluded as they belonged to high-risk pregnancies. Correlation of the growth of adrenal glands circumference and gestation period of pregnancy are also highly statistically important. The correlation coefficient of the straight line which represents this dependancy, is R = 0.8916, for the significance level of p < 0.01 (GRAPH 1). We observed how the course of pregnancy influenced the growth of foetal adrenal gland in normal pregnancies and in foetuses impaired by a pathological pregnancy course. By the method of one-way variance analysis, we obtained the value of the test, which was F = 2.79; p = 0.07. The graphical presentation of adrenal glands of a foetus in the appropriate week of gestation revealed that dimensions of glands in pregnancies impaired by diabetes were larger than those in normal gestations, and that they were at the top of border value of +2 SD or even over this limit. The statistically obtained value was F = 1.81; p > 0.05 (p = 0.06 and it was close to the border value for the significance level of p < 0.05); however, for glands of pregnancies complicated with hypertension the value was F = 1.61; p = 0.063 and the border value near -2 SD. Data are presented in a chart, regarding nomograms and adrenal glands of risk pregnancies. DISCUSSION: In 1993 Bronstein and colleagues [1] proved that the route of visualization of an adrenal gland was not only transabdominal. They succeeded in detecting the glands by transvaginal ultrasound examination in the 12th week. Jeanty and Romero [3] performed a successful transabdominal visualization in the 23rd week of gestation. By ultrasound prenatal examination we can determine the existence of hyperplasia of adrenal glands (Kelnar 1993) [5]. With ultrasound examination we can also diagnose tumours of the medulla, such as neuroblastoma (Jennings and colleagues 1993) [4]. In our study we reported on the visualization and growth of foetal adrenal glands in the period from the 11th to the 40th week of gestation. We presented the growth of foetal adrenal glands in normal gestations with the growth nomogram. The coefficient of correlation of adrenal glands circumference was R = 0.8916. The level of significance was p < 0.01. In conclusion, we can say that risk factors in pregnancy could impair the growth of adrenal glands. We have found that foetal adrenal glands in pregnancies impaired with maternal diabetes were hypertrophic, while those in pregnancies impaired with hypertension were almost at hypotrophic border. The nomograms of adrenal glands growth were of clinical importance, since they help us to control the state of a foetus in high-risk pregnancies. CONCLUSION: Improvement of the methods used in prenatal diagnosis will contribute to a timely detection of a diseased foetus, and will be the first step in its recovery. Regulating the pathological condition of the mother will surely contribute to decrease the risk of delivering children with an increased risk of morbidity.

Adrenal Glands↗

PubMed2004

Acute acetaminophen intoxication in Taiwan: outcomes and risk factors.

BACKGROUND AND PURPOSE: There is a paucity of information about acetaminophen intoxication from Taiwan. This study investigated the outcome and risk factors for acetaminophen-induced hepatotoxicity and validated the Rumack- Matthew nomogram in Taiwanese patients with acute acetaminophen intoxication. METHODS: A total of 75 patients with acetaminophen intoxication admitted through the emergency department were included in this retrospective analysis. Patients with a serum acetaminophen concentration above the possible risk line on the nomogram were treated with oral N-acetylcysteine. The primary outcome measure was the development of major hepatotoxicity, which was defined as a serum aminotransferase concentration greater than 1000 IU/L. Patient outcomes in the possible risk group and probable risk group were plotted on the modified Rumack-Matthew nomogram for validation. The risk factors for acetaminophen-induced hepatotoxicity were identified by multiple logistic regression analysis. RESULTS: No hepatotoxicity developed in patients with an initial acetaminophen concentration below the possible risk line on the nomogram. One out of 8 patients in the possible risk group developed major hepatotoxicity; 8 out of 22 patients in the probable risk group developed major hepatotoxicity, representing an incidence of 12.5% and 36.4%, respectively. Patients in the major hepatotoxicity group were older (32.5 vs 24.2 years, p = 0.019), and had a longer time to presentation (28.1 vs 6.7 hours, p < 0.01) than those in the non/minor hepatotoxicity group. Multiple logistic regression revealed that age and time to presentation were independent risk factors for hepatotoxicity (p = 0.033 and p = 0.002, respectively). CONCLUSIONS: The results of outcome analysis confirm that the modified Rumack-Matthew nomogram has a high sensitivity for identifying Taiwanese patients at risk for acetaminophen-induced hepatoxicity. Patient age and time to presentation were independent risk factors for acetaminophen-induced hepatotoxicity.

Acetaminophen↗

PubMedDate not supplied

[Utilization of the pharmacokinetic parameters of acetylsalicylic acid for optimizing its use with people of different ages].

Nomograms for application of acetylsalicylic acid in persons of different age are presented. The nomograms are based on pharmacokinetic parameters of acetylsalicylic acid with regard to the age. Proceeding from the known constants of absorption and elimination, the nomograms are made use of to screen the loading and maintenance doses, to determine the time of administering the first maintenance dose and the maximal amount of the drug in the body, which was built up as a result of the use of the accepted treatment schedule. While using the nomograms one should be guided by the known therapeutic dose and the dosage intervals or by the therapeutic or maximal allowable dose. The nomograms are unsophisticated, fairly convenient, and help determine the optimal regimen of the use of acetylsalicylic acid in persons of different age.

Adult↗

PubMed2006

High incidence of prostate cancer detected by saturation biopsy after previous negative biopsy series.

OBJECTIVES: We explored the yield of saturation biopsy and developed a nomogram predicting the probability of prostate cancer (PCa) on the basis of saturation biopsy. MATERIALS AND METHODS: Between 2001 and 2004, saturation biopsies (average of 24 cores) were performed in 161 men with persistently elevated prostate specific antigen (PSA) level (median, 9 ng/ml). All had at least two previously negative, eight-core biopsy sessions. PCa predictors on saturation biopsy were integrated within multivariate nomograms. RESULTS: PCa detection was 41% (n=66 of 161). PSA density and transition zone volume were the most significant predictors of PCa on saturation biopsy. The accuracy of the nomogram with the best performance characteristics was 72%. CONCLUSIONS: Saturation biopsy may be indicated in men with a persistent suspicion of PCa. High-risk individuals can be identified accurately with our nomogram.

Adult↗

PubMed2005

Comparison of the four formulas of adjusting QT interval for the heart rate in the middle-aged healthy Turkish men.

OBJECTIVE: The aim of this study was to evaluate the QT intervals at different rest heart rates in healthy middle-aged Turkish men and to compare the known four QT adjusting methods for heart rate. METHODS AND RESULTS: The QT intervals were measured in electrocardiograms of 210 healthy men (mean age = 35-60 years). A curve relating QT intervals and heart rates from 45 to 135 beats/min was constructed for study population. Based on the formula of Bazett, Fridericia, and Framingham, adjusted QT intervals in these range of heart rates were separately estimated. An adjusting nomogram for different heart rates was created using a reference value, which was the measured QT interval at heart rate of 60 beats/min (QT(No) = QT + correcting number). These four QT correction methods were compared with each other. The reference value of QT interval at heart rate of 60 beats/min was 382 ms. The relationship between QT and RR interval was linear (r = 0.66, P < 0.001). Nomogram method corrected QT interval most accurately for all the heart rates compared with other three adjusting methods. At heart rates of 60-100 beats/min, the equation of linear regression was QT = 237 + 0.158 x RR (P < 0.001). Bazett's formula gave the poorest results at all the heart rates. The formulas of Fridericia and Framingham were superior to Bazett's formula; however, they overestimated QT interval at heart rate of 60-110 beats/min (P < 0.01). At lower rates (<60 beats/min), all methods except nomogram method, underestimated QT interval (P = 0.03). CONCLUSION: Among four QT correction formulas, the nomogram method provides the most accurately adjusted values of QT interval for all the heart rates in healthy men. Bazett's formula fails to adjust the QT interval for all the heart rates.

Adult↗

PubMed2001

Evaluation of artificial neural networks for the prediction of pathologic stage in prostate carcinoma.

BACKGROUND: Currently, the standard for predicting pathologic stage from information available at the time of prostate biopsy is the "Partin nomograms" that were derived using logistic regression analysis. The authors retrospectively reviewed a large series of men with clinically localized prostate carcinoma who underwent staging pelvic lymphadenectomy and radical retropubic prostatectomy. They then utilized pathologic and clinical data at the time of prostate biopsy to develop and test an artificial neural network (ANN) to predict the final pathologic stage for this group of men. They then compared the results of ANN with the previous nomograms. METHODS: Five thousand seven hundred forty-four men were treated at the authors' institution from 1985 to 1998. An ANN was developed using two randomly selected training and validation sets for predicting pathologic stage. Input variables included age, preoperative serum prostate specific antigen level, clinical TNM (tumor, lymph node, and metastasis) classification, and Gleason score from the biopsy specimen. Outcomes included organ confinement and lymph node involvement status. RESULTS: The ANN was slightly superior to the nomograms in predicting pathologic stage, such as organ confinement and lymph node involvement status. CONCLUSIONS: In predicting organ confinement and lymph node involvement status, ANN was more accurate and had a larger area under ROC than the nomograms based on the logistic regression method. Artificial neural network models can be developed and used to better predict final pathologic stage when preoperative pathologic and clinical features are known.

Adult↗

PubMed1985

Overestimation of renal function in glucocorticosteroid treated patients.

Creatinine clearance is commonly used as a parameter for individualization of dosages of drugs primarily excreted by the kidney. Nomograms and equations have been developed for estimating creatinine clearance from serum creatinine concentration, body weight, age and sex. Glucocorticosteroids are said to cause proximal muscle wasting and therefore may be expected to cause a decrease in the creatinine production rate. The purposes of the present investigation were first to evaluate by a computed tomography the effect of long term treatment with prednisone on the mid-thigh muscle area, and second, to establish whether the presumed supposed decrease in muscle mass was associated with a decrease in the urinary creatinine excretion rate, and hence in a systematic error whenever a nomogram is used to predict creatinine clearance in such subjects. Patients taking prednisone had smaller mid-thigh muscle areas than controls. A linear relationship between the mid-thigh muscle area and the observed urinary excretion of creatinine was found, suggesting that the muscle loss could account for the decrease in the urinary excretion rate of creatinine. The ratio of observed to predicted (by nomogram) urinary creatinine excretion was lower in patients than controls, resulting in a corresponding underprediction of creatinine clearance by nomograms in the patients taking prednisone.

Adult↗

PubMed1987

A simple aid to digoxin prescribing.

We have designed a simple nomogram for predicting digoxin dosage and have tested it prospectively in two consecutive studies. These were both conducted in hospital inpatients who were not already taking digoxin but who required drug therapy for atrial tachyarrhythmias and/or cardiac failure. Study I. Sixty-seven patients received digoxin according to the nomogram and 50 completed the ten day course of the study. Forty-one of these patients were eligible for the final analysis. On the tenth day of treatment, 28 patients were within the therapeutic range for plasma digoxin (0.8 to 2.0 ng.ml-1), 12 were subtherapeutic (less than 0.8 ng.ml) and one was potentially toxic (greater than 2.0 ng.ml-1). Study II. Thirty patients completed the second study. Digoxin was prescribed according to the nomogram with the addition of a dosage correction based on the plasma digoxin level on Day 3. On the tenth day of treatment, 24 patients were within the therapeutic range, one in the subtherapeutic and 5 in the potentially toxic. This simple digoxin nomogram, with or without the Day 3 dosage correction, should prove to be a useful aid to prescribing in patients who do not require rapid digitalisation. It is particularly relevant to elderly inpatients with atrial tachyarrhythmias and/or cardiac failure.

Adult↗

PubMed1994

Measurement of body surface area in children with liver disease by a novel three-dimensional body scanning device.

Body surface area (BSA) is used in paediatrics to assess fluid requirement, drug doses, cardiac output and glomerular filtration rate. The aim of this study was to examine, in children with liver disease, the relationship between BSA determined by a traditional nomogram and BSA measured by a novel three-dimensional technique--Loughborough Anthropometric Shadow Scanner (LASS). Subjects were 16 children, mean age 8.1 (range 3.6-14.9) years, with a variety of liver diseases. Twenty-eight controls had a mean age of 7.1 (3.1-10.5) years. All had LASS scans performed as well as 21 anthropometric measurements taken by a single observer. There was a significant relationship between BSA (LASS) and BSA nomogram for liver-diseased children (r = 0.99) and controls (r = 0.96). The BSA nomogram values were significantly greater (P < 0.05) than BSA (LASS) for liver-diseased subjects by 10.1% (-0.35 to +20.6; 95% confidence interval), and for controls by 9.6% (4.1-23.2). Best prediction of BSA (LASS) for liver-disease subjects used height, body weight and gluteal furrow circumference [r2 = 0.997; standard estimated error (SEE) = 0.015 m2] and for controls used body weight alone (r2 = 0.907; SEE = 0.048 m2). BSA nomogram has no additional error in children with liver disease, but may overestimate BSA by 10% compared with a novel three-dimensional body surface scanning technique.

Adolescent↗

PubMed1983

A reweighting of receptor mechanisms in the ground squirrel retina: PIII and B-wave spectral sensitivity functions.

PIII and b-wave spectral sensitivity functions were measured under various adapted conditions in the 13-lined ground squirrel. The PIII was isolated by intravitreal injection of sodium L-aspartate. Under the conditions studied, the PIII spectral sensitivity function always fitted the absorption spectrum of a 518 +/- 3 mm Dartnall nomogram. This suggests that of the three photoreceptors ('rod-like', 'blue' cone and 'green' cone) present in the 13-lined ground squirrel the green cones are the overwhelming majority. The dark-adapted b-wave had two components; a b1-wave with a spectral sensitivity that fitted a 516 +/- 1 nm Dartnall nomogram and a b2-wave with a spectral sensitivity that fitted a 502 +/- 4 nm Dartnall nomogram. The light-adapted b-wave had a spectral sensitivity that fitted a 516 +/- 2 nm Dartnall nomogram.

Animals↗

PubMed1994

Relation between QT intervals and heart rates from 40 to 120 beats/min in rest electrocardiograms of men and a simple method to adjust QT interval values.

OBJECTIVES: The aim of this study was to establish the relation between QT intervals and a wide range of rest heart rates in men. These data provided the basis of a simple method for adjusting the QT interval for heart rate. BACKGROUND: Earlier correction equations give conflicting results, especially at low and high heart rates. METHODS: The QT intervals were measured in 324 electrocardiograms of healthy young men. The sample was weighted for low and high heart rates. A curve relating QT intervals and heart rates from 40 to 120 beats/min was constructed. The QT interval at 60 beats/min was used as the reference value, and an adjusting nomogram for different heart rates was created. The reliabilities of the nomogram and three earlier QT correction equations were tested in the study group and in 396 middle-aged men. RESULTS: The nomogram method presented (QTNc = QT + correcting number) adjusted the QT interval most accurately over the whole range of heart rates on the basis of smallest mean-squared residual values between measured and predicted QT intervals. The Fridericia formula (QTFc = QT/RR1/3) gave the best correction at low, but failed at high, heart rates. The linear regression equation (QTLc = QT + 0.154[1 - RR], Framingham Study) was reliable at normal, but failed at low and high, heart rates. The Bazett formula (QTc = QT/RR1/2) performed poorest at all heart rates. The relation between QT and RR intervals was determined by three linear regressions expressing the slopes 0.116 for heart rates < 60 beats/min, 0.156 for heart rates from 60 to 100 beats/min and 0.384 for heart rates > 100 beats/min. CONCLUSIONS: The QT-RR relation over a wide range of heart rates does not permit the use of one simple adjustment equation. A nomogram providing, for every heart rate, the number of milliseconds that the QT interval must be corrected gives excellent adjustment.

Adolescent↗

PubMed2003

Two-year results of conductive keratoplasty for the correction of low to moderate hyperopia.

PURPOSE: To evaluate the 2-year postoperative safety, efficacy, predictability, and stability results of conductive keratoplasty (CK) to correct low to moderate hyperopia. SETTING: Department of Ophthalmology, Stanford University Medical Center, Stanford, California, USA. METHODS: In a prospective nonrandomized noncontrolled trial, 25 eyes of 14 patients with +0.75 to +3.00 diopters (D) of hyperopia and </=0.75 D of cylinder were treated with CK. Low-energy, radio-frequency current was applied to the peripheral corneal stroma through a probe inserted at 8 to 32 treatment spots. An early nomogram was used in 2 eyes, and a current nomogram was used in 23 eyes; the intended refraction was plano. The 23 eyes treated with the current nomogram were analyzed for efficacy, predictability, and stability. All 25 eyes were included in the safety and patient-satisfaction analyses. RESULTS: Preoperatively, the mean manifest refraction spherical equivalent (MRSE) in the 23 current-nomogram eyes was +1.55 D. At 2 years, the uncorrected visual acuity was 20/20 or better in 64% of eyes and 20/40 or better in 95%. The MRSE was within +/-0.50 D in 64% of eyes, within +/-1.00 D in 91%, and within +/-2.00 D in 100%. No eye lost more than 1 line of best spectacle-corrected visual acuity or had an induced cylinder greater than 0.75 D. The mean MRSE of the cohort with all follow-ups was +0.48 D, which reflected a 29% regression from the intended plano and 43% regression from the 1-month postoperative overcorrection. The rate of regression appeared to be low and decreasing, +0.024 D per month between 12 and 24 months. A patient survey revealed improved quality of vision and a high level of satisfaction. CONCLUSIONS: Conductive keratoplasty appeared to be safe, effective, and predictable for correcting low to moderate hyperopia. Mild hyperopic regression was observed; however, the rate of regression indicated by the mean change in MRSE per month was low and decreased over the 2-year follow-up. Longer follow-up may be necessary to further characterize the refractive stability of CK.

Aged↗

PubMed2006

Comparison of diagnostic criteria for female bladder outlet obstruction.

PURPOSE: There is no universally accepted definition of bladder outlet obstruction in women. We compared 5 contemporary urodynamic definitions and determined how well they correlated with each other and with clinical suspicion of bladder outlet obstruction. MATERIALS AND METHODS: A total of 154 women who underwent videourodynamics were prospectively evaluated. Clinical obstruction was suspected when history, physical examination, symptoms and basic testing before urodynamics raised the suspicion. Women were classified as having obstruction based on 5 contemporary definitions, including 3 pressure flow cutoff point criteria, videourodynamic criteria and the Blaivas-Groutz nomogram. The McNemar Test was used to compare each definition to the others and to suspicion of clinical obstruction. RESULTS: Of the women 91 were evaluable, including 26 (29%) with obstruction by videourodynamic criteria, 28 (31%) with obstruction by 1998 cut point criteria, 18 (20%) with obstruction by 2000 cut point criteria, 13 (14%) with obstruction by 2004 cut point criteria and 38 (42%) with obstruction by the Blaivas-Groutz nomogram. Videourodynamic and 1998 cut point criteria were not significantly different from each other (78.9% concordance) and each agreed with the clinically obstructed category in the comparison. Compared to the other criteria, the Blaivas-Groutz nomogram overestimated obstruction, while 2004 cut point criteria tended to underestimate it. CONCLUSIONS: Each urodynamic definition of female bladder outlet obstruction has merit. Videourodynamic criteria and 1998 cut point criteria have the highest concordance. The Blaivas-Groutz nomogram overestimates obstruction compared to the other criteria. Therefore, it should not be used as the sole or standard definition of obstruction in women.

Adolescent↗

PubMed1993

Prostatic UroLume Wallstent for benign prostatic hyperplasia patients at poor operative risk: clinical, uroflowmetric and ultrasonographic patterns.

The prostatic UroLume Wallstent was positioned in 30 poor operative risk patients with bladder outlet obstruction due to benign prostatic hyperplasia. Preoperatively, 12 patients (40%) could still void spontaneously (group 1), while 18 (60%) had an indwelling catheter (group 2). Preoperative and postoperative assessment included scoring of subjective symptoms, physical examination, uroflowmetry with maximum flow nomogram, transrectal ultrasonography of the prostate, determination of residual urine volume and cystourethroscopy. All but 1 patient could void spontaneously after insertion of the stent. In group 1 preoperative and 1-year followup mean (plus or minus standard error) peak flow rates were 8.0 +/- 0.7 ml. per second and 15.8 +/- 1.8 ml. per second, respectively (p < 0.01), the mean residual urine volumes were 127 +/- 27 ml. and 38 +/- 11 ml. (p < 0.05), respectively, and the mean maximum flow nomograms (plus or minus standard deviation) were -2.6 +/- 0.1 and -1.4 +/- 0.4, respectively. In group 2 the 1-year followup mean peak flow rate, residual urine volume and maximum flow nomogram were 13.2 +/- 0.8 ml. per second (standard error), 32 +/- 14 ml. (standard error) and -1.5 +/- 0.1 (standard deviation), respectively. According to the maximum flow nomogram values all patients were nonobstructed postoperatively. At 1 year the stent was completely covered by prostatic epithelium in 90% of the patients, while in the remainder it was still partially visible at urethroscopy. Transrectal ultrasonography had an essential role in patient followup by accurately assessing the position of the stent. Placement of this prostatic stent is safe and effective for selected benign prostatic hyperplasia patients who cannot undergo surgical treatment due to poor operative risk.

Aged↗

PubMed2003

Biochemical staging of prostate cancer.

PSA continues to be one of the most effective and widely used cancer screening tools available. Its popularity in prostate cancer screening, however, has eroded its usefulness in the staging of this disease. As more men are screened every year on a routine basis with DRE and PSA, the average PSA at diagnosis has drifted down to well below 10 ng/mL in many centers, including ours. This trend is likely to accelerate, as a PSA cut off for prompting biopsy of the prostate of 2.5 ng/mL gains more widespread acceptance. The recent realization that, at these levels, serum PSA is more reflective of the presence of BPH than of the extent of cancer and, therefore, does not provide additional staging information, has renewed the search for new biochemical markers that are capable of predicting prostate cancer stage and prognosis. Because of the heterogeneity of this disease, it is unlikely that a single biochemical marker that is capable of accurately staging all prostate cancer patients will be found. For this reason, nomograms that are capable of integrating various parameters to predict stage and prognosis will remain indispensable. As new biochemical markers that provide independent predictive information about stage or prognosis are identified, they can be incorporated into currently available nomograms. Of the biochemical markers discussed in this article, IL-6sR and TGF-beta1 are the most promising. By incorporating them into a preoperative nomogram designed to predict PSA recurrence, we found that they improved the ability to predict biochemical recurrence by a statistically and clinically significant margin. The ability to stage prostate cancer and predict response to therapy has improved dramatically over the last 3 decades. Nevertheless, there is still a need for new biochemical markers that will improve the ability to predict an individual patient's stage and response to therapy. Incorporating these new markers into nomograms will enhance the ability to provide optimal care for each prostate cancer patient.

Acid Phosphatase↗