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PubMedDate not supplied

Interventions in infrainguinal bypass grafts.

The interventional radiologist plays an important role in the detection and prevention of infrainguinal bypass failure. Early detection and evaluation of flow-limiting lesions effectively preserve graft (venous bypass and polyester or expanded polytetrafluoroethylene bypass) patency by identifying stenoses before occlusion occurs. Delay in treatment of the at-risk graft may result in graft failure and a reduced chance of successful revascularization. For this reason, surveillance protocols form an important part of follow-up after infrainguinal bypass surgery. As well as having an understanding of the application of imaging techniques including ultrasound, MR angiography, CT angiography and digital subtraction angiography, the interventional radiologist should have detailed knowledge of the minimally invasive therapeutic options. Percutaneous transluminal angioplasty (PTA), or alternatively cutting balloon angioplasty, is the interventional treatment of choice in prevention of graft failure and occlusion. Further alternatives include metallic stent placement, fibrinolysis, and mechanical thrombectomy. Primary assisted patency rates following PTA can be up to 65% at 5 years. When the endovascular approach is unsuccessful, these therapeutic options are complemented by surgical procedures including vein patch revision, jump grafting, or placement of a new graft.

Angioplasty↗
PubMed1995

Randomized double-blind controlled trial comparing room-temperature and heated lidocaine for digital nerve block.

STUDY OBJECTIVE: To determine whether warming of lidocaine decreases the pain of its injection during digital nerve block. DESIGN: Prospective, randomized, double-blind, controlled trial. INTERVENTIONS: Twenty healthy volunteers received bilateral digital nerve blocks of their middle finger. They were first randomly assigned to receive either room-temperature (21 degrees C) or heated (42 degrees C) 2% lidocaine in their first block. They were then randomly assigned to receive the first block in either the right or left hand. The blocks were performed in a standardized fashion by a single physician, who was blinded to which solution was being used. The volunteers rated the pain of each digital block on a 100-mm visual analog scale (VAS). Efficacy of each digital block was tested at 5 minutes. RESULTS: Heating of the lidocaine was associated with a significantly lower median VAS pain score (31.5 versus 25.0; P < .05). There was no difference in pain score between the two solutions in relation to which hand was used (P = .29) or whether the injection was the first or the second (P = .37). When all factors (temperature, order, and hand) were considered in the ANOVA with respect to VAS pain score, the only significant relation found was that between the temperature of the solution and the VAS pain score (P = .028). CONCLUSION: Heating of lidocaine decreases the pain of injection during digital nerve block.

Adult↗
PubMed2004

[Patient dose measurement with fluorescent glass dosimeter: characteristics evaluation and patient skin dose measurement in abdominal interventional radiology].

In this study, we investigated the usefulness of the fluorescent glass dosimeter for measuring patient dose. The fluorescent glass dosimeter is constructed of a glass element and its holder. One type has a tin (Sn) filter and the other does not. The characteristics of these two types of fluorescent glass dosimeters were studied in the range of diagnostic X-ray energy. The result was excellent for each characteristic. Directional dependency, however, was recognized in the fluorescent glass dosimeter with tin (Sn) filter. Based on these evaluations, patient skin dose was measured for abdominal interventional radiology and diagnostic digital subtraction angiography using the holder without filter, which is less direction-dependent and eliminates obstructive shadows in radiography and fluoroscopy. The average skin dose of 30 patients for abdominal IVR was 1.17+/-0.44 Gy (0.51-1.94 Gy), while those for diagnostic DSA examination was 0.54+/-0.21 Gy (0.15-1.02 Gy). The fluorescent glass dosimeter provides high capability for skin dose measurement. The fluorescent glass dosimeter is also useful for controlling patient dose during IVR procedures.

Fluorescence↗
PubMed2004

An evaluation of information-seeking behaviors of general pediatricians.

OBJECTIVE: Usage of computer resources at the point of care has a positive effect on physician decision making. Pediatricians' information-seeking behaviors are not well characterized. The goal of this study was to characterize quantitatively the information-seeking behaviors of general pediatricians and specifically compare their use of computers, including digital libraries, before and after an educational intervention. METHODS: General pediatric residents and faculty at a US Midwest children's hospital participated. A control (year 1) versus intervention group (year 2) research design was implemented. Eligible pediatrician pools overlapped, such that some participated first in the control group and later as part of the intervention. The intervention group received a 10-minute individual training session and handout on how to use a pediatric digital library to answer professional questions. A general medical digital library was also available. Pediatricians in both the control and the intervention groups were surveyed using the critical incident technique during 2 6-month time periods. Both groups were telephoned for 1- to 2-minute interviews and were asked, "What pediatric question(s) did you have that you needed additional information to answer?" The main outcome measures were the differences between the proportion of pediatricians who use computers and digital libraries and a comparison of the number of times that pediatricians use these resources before and after intervention. RESULTS: A total of 58 pediatricians were eligible, and 52 participated (89.6%). Participant demographics between control (N = 41; 89.1%) and intervention (N = 31; 70.4%) were not statistically different. Twenty pediatricians were in both groups. Pediatricians were slightly less likely to pursue answers after the intervention (94.7% vs 89.2%); the primary reason cited for both groups was a lack of time. The pediatricians were as successful in finding answers in each group (95.7% vs 92.7%), but the intervention group took significantly less time (8.3 minutes vs 19.6 minutes). After the intervention, pediatricians used computers and digital libraries more to answer their questions and spent less time using them. CONCLUSION: This study showed higher rates of physician questions pursued and answered and higher rates of computer use at baseline and after intervention compared with previous studies. Pediatricians who seek answers at the point of care therefore should begin to shift their information-seeking behaviors toward computer resources, as they are as effective but more time-efficient.

Computer User Training↗
PubMed1976

The assessment of hand function: Part III--the final analysis.

Some common surgical procedures, practised to improve the function of the rheumatoid hand, have been subjected to a prospective and objective evaluation. This analysis has been based on the concept of the assessment of hand function by measurement of individual digital forces and the results clearly justify surgical intervention. In addition, function is improved in those digits belonging to the hand operated upon but not themselves undergoing surgery.

Arthritis, Rheumatoid↗
PubMed2003

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey.

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Method for combined FDG-PET and radiographic imaging of primary breast cancers.

The purpose of the study was to demonstrate the feasibility of a hybrid functional/anatomic breast imaging platform with biopsy capability for facilitating lesion detection and diagnosis. This platform consists of an investigative dedicated positron emission mammography (PEM) device mounted on a stereotactic X-ray mammography system, permitting sequential acquisition of mammographic and emission images during a single breast compression. There is automatic coregistration of images from both modalities, and these results can be successfully correlated with histopathologic findings. The potential utility of functional images correlated to anatomic images would include noninvasively detecting clinically and radiographically occult cancers, assessing response to therapy, discriminating between benign and malignant breast masses, and ultimately reducing the number of invasive and costly surgical interventions. A spot-digital mammogram and subsequent PEM image, collected over a 4-minute period, were obtained in a single patient with the breast in compression after intravenous injection of (F-18)-2-deoxy-2-fluoro-D-glucose (FDG) at the time of stereotactic biopsy. The authors conclude that FDG-based lesion localization information may be combined with the lesion X-ray attenuation characteristics using this common imaging platform.

Breast Neoplasms↗
PubMed2000

Primary and metastatic carcinomas in the digits of cats.

In the period 1993-1998, digital carcinomas in 64 cats were examined. In all animals primary complaints were painful digit(s). Eight cats had a primary squamous cell carcinoma which involved one digit or two adjacent digits of one leg. Fifty-six cats had metastases of a pulmonary carcinoma in the digits, and in general multiple digits of different legs were involved. In many of these cats metastases also occurred in other organs, including the skin and muscles. No primary sweat gland carcinomas of the digits were seen. Primary squamous cell carcinomas of the digits were characterized by cornification and the absence of PAS-positive cells, PAS-positive secretory material. Immunohistochemically, these neoplasms stained negative with the monoclonal antibody CAM 5.2 directed against Keratin 8 (K 8). The metastases of pulmonary carcinomas to the digits showed one or more of the following histological features: goblet cells, ciliated epithelial cells, PAS-positive cells or lakes, and/or a PAS-positive lining of luminal membranes and no cornification. Immunohistochemically, they showed positive staining for CAM 5.2 (K8). Thoracic radiographs from three cats with a primary squamous cell carcinoma showed no abnormalities, whereas all cases of metastases from a pulmonary carcinoma to the digits available for follow-up showed evidence of a primary pulmonary carcinoma on radiography and/or postmortem examination (25 out of 56). The conclusion of this study was that most carcinomas in the digits of cats were metastases of a primary pulmonary carcinoma (87.5%). Primary squamous cell carcinomas occurred infrequently. The prognosis of metastases of a pulmonary carcinoma in the digits is poor with an average survival time of 4.9 weeks, in contrast to 29.5 weeks in cats with a squamous cell carcinoma. These data stress the importance of taking thoracic radiographs of cats with digital tumours before surgical intervention.

Animals↗
PubMed1998

Predicting the mechanical outcome of femoral neck fractures fixed with cancellous screws: an in vivo study.

OBJECTIVE: The goal of this project was to determine, by using a retrospective cohort analysis, the relative importance of fracture geometry, bone density, and quality of fracture reduction in predicting redisplacement of femoral neck fractures fixed with multiple cancellous screws in a patient population. DESIGN: A retrospective analysis of quantitative geometric and bone density data from forty-seven patients with femoral neck fractures fixed with cancellous screws was performed. SETTING: Radiographs retrieved after analysis of a statewide hospital database were digitized and analyzed quantitatively. INTERVENTION: Quantitative data from radiographs included estimates of femoral neck bone density, fracture surface orientation and location, degree of comminution, prefixation displacement, initial reduction position of the fractured component, and final displacement of the fracture after fixation. MAIN OUTCOME MEASUREMENTS: Angular rotation and inferior displacement of the fracture component after fixation. RESULTS: Femoral neck bone density can be correlated to femoral cortical thickness and can be used as a measure of bone density from plain x-rays. Significant relative risk of redisplacement of a femoral neck fracture is correlated with initial inferior offset of the fracture component and varus angulation. Relative risks of other variables, including valgus reduction, Garden Stage 3 and 4 position of the femoral head, low bone density, presence of inferior comminution, a more vertical fracture surface angle, and fracture position, were not significant. CONCLUSIONS: When compared with other geometric and mechanical variables, nonanatomic reduction of a femoral neck fracture, with either inferior offset or varus angulation, is the strongest predictor of postfixation redisplacement of the fracture.

Absorptiometry, Photon↗
PubMed1996

Radiographic evaluation of the renal vasculature.

Renal artery stenosis is an important cause of hypertension and progressive renal insufficiency. Additionally, there is increasing concern that renovascular disease is a significant, but previously-unrecognized, cause of end-stage renal disease in certain subsets of patients. Advances in revascularization techniques offer a greater opportunity for blood pressure control and for the restoration or preservation of renal function. Accurate imaging of the renal vasculature, however, is essential for the proper selection of those individuals who might best benefit from such intervention. Although conventional or digital subtraction arteriography remains the gold standard diagnostic test, significant advances in non-invasive imaging techniques now offer the clinician several options for the accurate diagnosis of hemodynamically significant renovascular disease. These techniques include captopril renography, duplex ultrasonography, magnetic resonance angiography, and spiral/fast computed tomography. In this review, the advantages and limitations of these imaging techniques are compared and contrasted with an emphasis on their usefulness in screening for renovascular disease. Also reviewed are recent applications of these techniques for measurement of renal function, predicting outcome of revascularization, and the clinical monitoring of patients with renovascular disease managed either medically or by revascularization.

Diagnostic Imaging↗
PubMed1987

Diagnostic imaging for evaluation of the pediatric chest.

Diagnostic imaging procedures for evaluation of the chest, airways, and sinuses in the infant and child have been reviewed. Procedures include plain radiographs, fluoroscopy, esophagram and UGI, computed tomography, conventional tomography, MRI, digital subtraction angiography, angiography, interventional radiology, ultrasound, bronchography, and pulmonary and esophageal scintigraphy. Knowledge of these imaging procedures aids the physician in ordering the proper examination for the efficient diagnostic workup.

Angiography↗
PubMedDate not supplied

Intraarterial digital subtraction arteriography in the diagnosis and treatment of hepatic tumors.

Intraarterial digital subtraction arteriography (IADSA) was performed in 94 patients with hepatic tumors and evaluated on the following subjects: 1) visualization of small arteries in arterial phase, compared with film study, 2) visualization of faint tumor stains in hepatogram phase, compared with film study, 3) visualization of portal venous branches by intraarterial digital subtraction portography (IADSP). Interventional angiography was performed in 76 patients. Contrast dose and injection rate of IADSA was approximately a third of film study without dilution. The position of the catheter was identical in IADSA and film study. IADSPs were performed with 15-20 ml of 76% Urografin, which was injected into the superior mesenteric artery at the rate of 5 ml/sec after infusion of prostaglandin E1. Comparison in arterial phase of 67 patients showed 24 (36%) IADSAs were equal to film study. Thirty-nine (58%) were inferior but adequate for the diagnosis of hepatic tumors. Comparison in hepatogram phase showed 24 (38%) IADSAs were superior to film study and all were satisfactory for the diagnostic purposes. Ninety-eight percent of 86 IADSPs gave information about the patency of the main portal vein. Fifty-five percent of IADSPs opacified third-order portal vein branches or further. IADSA of hepatic tumors not only save time and contrast dose but was also satisfactory in image quality for interventional angiography.

Adult↗
PubMed2005

Impact of a two-city community cancer prevention intervention on African Americans.

We report the first multisite, multicomponent community intervention trial to focus on cancer prevention in African Americans. The project explored the potential of historically black medical schools to deliver health information to their local communities and used a community-based participatory research approach. The intervention consisted of culturally sensitive messages at appropriate educational levels delivered over an 18-month period and tested in predominantly black census tracts in Nashville, TN and Atlanta, GA. Chattanooga, TN and Decatur, GA served as comparison cities. Results were evaluated by pre- and postintervention random-digit dial telephone surveys. The intervention cities showed an increase in reported contact with or knowledge of the project. There was little or no effect on knowledge or attitudes in the intervention cities. Compared to Chattanooga, Nashville showed an increase in percentage of women receiving Pap smears. Compared to Decatur, Atlanta showed an increase in percentage of age-appropriate populations receiving digital rectal exams, colorectal cancer screenings and mammograms. The results of this community intervention trial demonstrated modest success and are encouraging for future efforts of longer duration.

Adult↗
PubMedDate not supplied

[Complementary echo flow imaging and digital angiography in the supra-aortic area for indication and intervention of carotid revascularization in 1587 subjects in the OPI (Stroke Prevention) program].

The availability of non invasive carotid ultrasound imaging techniques actually allows planning and carrying on of large screening programs for detection of atherosclerotic carotid occlusive disease. The aim of non invasive ultrasound patient selection is to limit the practice of invasive carotid angiography only to patients for whom carotid endarterectomy is likely to be a therapeutic choice. PURPOSE. Testing the efficacy of sequential use of color coded echo flow imaging (echo color Doppler: ECD) and arterial digital angiography (ADA) respectively in the second and third phases of a screening program for detection and treatment of carotid occlusive disease in a resident population (OPI program). METHODS. From January 29th 1990 through March 31st 1992, 1,587 subjects underwent ECD out of 16,379 subjects that participated in the first level investigations. 404 of these (25.5%) were affected with carotid occlusive disease, 271 (17%) had inframural non stenosing carotid lesions and 228 (14.3%) carotid kinkings. At ECD, 71 showed lesions as severe as to be susceptible of surgical operation and underwent ADA. The percentage of carotid stenosis was calculated on the ADA imagins, applying the method suggested by the North American Symptomatic Carotid Endarterectomy Trial. RESULTS. Overall sensitivity and specificity of ECD versus ADA were 94% and 95.2% respectively. Cases in which ECD overestimated the lesion as compared to ADA results were recorded as false positive, while cases in which ECD underestimated the lesion were recorded as false negative. CONCLUSIONS. Both ultrasound imaging and ADA are useful in screening programs for carotid occlusive disease: informations different and complementary to the definition of the lesions can be obtained from each procedures in subsequent phases. Morphologic findings of carotid ECD are essentially consistent with ADA, thus allowing to carry on safely non invasive long-term follow-up programs for operated subjects as well as for people bearing carotid lesions originally not susceptible of surgical treatment.

Aged↗
PubMed1982

Carotid artery surgery based on digital subtraction angiography.

This study shows that digital subtraction angiography provides the morphologic criteria necessary for surgical intervention in most patients with carotid atheroma. Digital subtraction angiography provides a safe means of studying patients, with an overall sensitivity of 96 percent and specificity of 86 percent. Radiopaque casts of the operative specimen have been used as the gold standard, providing a suitable means of comparing the findings on digital subtraction angiography with the operative findings. Failure to obtain visualization of the vessels with biplanar views required conventional angiography to properly evaluate the vessels in 12 percent of patients. This technique represents a major advance in the study of carotid artery disease which may replace many of the current imaging techniques.

Arteriosclerosis↗
PubMed2006

McMaster PLUS: a cluster randomized clinical trial of an intervention to accelerate clinical use of evidence-based information from digital libraries.

BACKGROUND: Physicians have difficulty keeping up with new evidence from medical research. METHODS: We developed the McMaster Premium LiteratUre Service (PLUS), an internet-based addition to an existing digital library, which delivered quality- and relevance-rated medical literature to physicians, matched to their clinical disciplines. We evaluated PLUS in a cluster-randomized trial of 203 participating physicians in Northern Ontario, comparing a Full-Serve version (that included alerts to new articles and a cumulative database of alerts) with a Self-Serve version (that included a passive guide to evidence-based literature). Utilization of the service was the primary trial end-point. RESULTS: Mean logins to the library rose by 0.77 logins/month/user (95% CI 0.43, 1.11) in the Full-Serve group compared with the Self-Serve group. The proportion of Full-Serve participants who utilized the service during each month of the study period showed a sustained increase during the intervention period, with a relative increase of 57% (95% CI 12, 123) compared with the Self-Serve group. There were no differences in these proportions during the baseline period, and following the crossover of the Self-Serve group to Full-Serve, the Self-Serve group's usage became indistinguishable from that of the Full-Serve group (relative difference 4.4 (95% CI -23.7, 43.0). Also during the intervention and crossover periods, measures of self-reported usefulness did not show a difference between the 2 groups. CONCLUSION: A quality- and relevance-rated online literature service increased the utilization of evidence-based information from a digital library by practicing physicians.

Evidence-Based Medicine↗
PubMed2001

Handheld digital equipment for weight composite distress paradigms: new considerations and for rapid documentation and intervention of rodent populations.

Animal care in the third millennium will require a melding of scientific and humane interests to achieve optimal care of genetically engineered mice and to expedite scientific and medical advances by using these mammals. Undoubtedly, rodent patients present certain difficulties for those who wish to assess their daily well-being and to contribute to efficient and successful scientific discovery. High-density housing, large experimental groups, and low-lux room lighting makes the application of large-animal care standards to rodents seem daunting to researchers and veterinary care programs. In addition, great variability in training and experience among those responsible for the direct application of humane care to rodents exists. Most of the direct animal care in small animal facilities occurs in decentralized locales by personnel who have completed obligatory but relatively minimal animal care training. Examples of personnel in this category include postdoctoral fellows, junior-level scientists, summer students, and assistant laboratory animal technologists. Some programs even use the husbandry staff to perform health checks of high-risk populations on a daily basis. For this reason, the extrapolation of performance-based intervention in rodent care is difficult to apply practically. Early efforts to enhance humane outcome in rodents have been published by scientists and veterinarians and are largely directed at singular endpoints, such as weight loss and declining temperatures, in specific models. Scientists often are reluctant to accept such standards because of concern about premature intervention or variability between scorers and to reservations regarding a lack of procedural likeness with their proposed study. This paper highlights a digital method for melding current advanced animal scoring standards using palm pilot user-friendly methods that account for composite weight scoring, behavioral or physiologic attributes, and interventions. Information is rapidly downloaded and results in quick storage of large rodent population monitoring. This minimizes interpretative variability between caregivers and greater standardization of procedures. These considerations facilitate the rapid diagnosis of outliers and make possible intervention that streamlines the delivery of humane care to large experimental populations.

Animal Technicians↗