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PubMedDate not supplied

[Levels of oligo-elements and trace elements in patients at the time of admission in intensive care units].

Routinely, the macronutrient contribution is thoroughly studied when a patient is included in a total parenteral nutrition (TPN) program. However, it must be kept in mind that along with macronutrients, micronutrients, oligoelements and vitamins are also administered, and these must be taken into account. At present, for instance, the importance of oligoelements has become evident, and clinical conditions of oligoelement deficiency have been described in many cases even when the minimum daily requirements had been met. This study centers on the importance of evaluating oligoelement and trace element levels when patients are admitted into the ICU and were included into a total parenteral nutrition (TPN) program. An assessment of the serum calcium (Ca), phosphorus (P), magnesium (Mg), zinc (Zn), copper (Cu), iron (Fe) and transferrin (Tfe) levels was done on 55 septic patients who underwent abdominal surgery was done on admission to the ICU. Transferrin was measured of serve as an indicator of metabolic damage. A description of the methods used in analytical assessment, a presentation of normal values, the statistical management of each of the elements under study and the interpretation of the results obtained has been done. The discussion is based on the changes detected in the patients' serum levels on admission to the unit, showing low iron, transferrin, zinc and calcium values and normal magnesium, phosphorus and copper figures. The conclusion arrived at suggests that the daily parenteral supplements of these elements should be higher than those recommended by the American Medical Association (AMA) and by other authors.

Female↗
PubMedDate not supplied

The radiographic diagnosis of the anterior cruciate ligament deficient knee.

Various radiologic procedures are used in the evaluation of the cruciate deficient knee, including routine roentgenography, arthrography, and computed tomography (CT). Routine roentgenograms can document a joint effusion, an avulsion fracture with or without complete anterior cruciate ligament (ACL) description, and other osseous abnormalities, e.g., degenerative joint changes. Double-contrast arthrography can determine the integrity f the ACL. When correctly performed and carefully interpreted, more than 90% accuracy is possible in diagnosing if the ligament is present and intact, torn, or absent. The condition of the medial and lateral menisci, the articular cartilages, and the synovium can be evaluated by the same arthrographic study. In those instances in which the arthrographic diagnosis is equivocal of the ACL has been repaired or can not be examined arthrographically, the CT examination may be useful. Unfortunately, because the CT examination is expensive and correct interpretations are sometimes difficult, its use is accordingly limited.

Humans↗
PubMed1983

[Rubella deafness. Audiometric, ophthalmologic, epidemiological aspects].

Case-reports of 75 children, with deafness due to an embropathy from maternal rubella during the first months of pregnancy, are reviewed. Emphasis is placed on the frequency of interauricular functional asymmetry, of pigmented retinitis alone or associated with a cataract, and of dysmaturity at birth and persistence of overall delayed development. Also stressed are the large proportion of women born outside the French Metropolitan area who contracted rubella during pregnancy, and the very high frequency of errors in interpreting clinical and biological signs in suspected rubella, leading to an impressive number of wrong suggestions with marked effects on the future. Following a detailed description of 15 of the 75 cases studied, the results obtained are analyzed. Nearly half of the cases presented an interauricular auditory functional asymmetry, which is therefore one of the elements of etiological diagnosis and which enables better adaptation of a hearing aid for rubella-induced deafness. The very high frequency of pigmented retinitis alone also constitutes and element of etiological diagnosis, and enabled at least 7 p. cent of overall cases of perception deafness to be assessed as resulting from a rubella cause. The pigmented retinitis is sometimes central and, contrary to classical notions, provokes visual dysfunction. Difficulty in applying a correct diagnosis during the initial episode, and the usual lack of information given to the family in case of rubella during pregnancy, are common features in the vast majority of cases.

Audiometry↗
PubMed1995

[Reference values of laboratory tests: a useful and important epidemiologic contribution of the Centers for health tests].

Since 1969 the Centre for Preventive Medicine in Nancy has been carrying out health examinations of the eastern region of France (Lorraine, Champagne-Ardenne). The clinical chemists at the Centre of Preventive Medicine have made a great contribution to the concept and the description of biochemical reference values for which the transferability to other health centres must be verified. Knowledge of reference values and biological variations facilitates the interpretation of weak modifications of biological constituents which are observed in preventive medicine. Reference values can be used to compare two populations (comparing reference values between to two) or to compare an individual observed value to the reference values obtained in the various population groups. In the long term, these reference values could become a useful education tool for patients coming for health examination. It should be possible for each subject to follow, throughout his life, the evolution of his biological constituents and to detect any deviation towards a pathology.

Diagnostic Tests, Routine↗
PubMed1994

Self-sufficiency--20 years on.

The opening paper of this symposium discusses the theme [European self-sufficiency and haemophilia prophylaxis: achievable goals or idealistic concepts?' from four aspects: (a) the meaning and interpretation of self-sufficiency in the European Community; (b) a summary of the facts, discussions and developments of the last 20 years; (c) a description of future aims and objectives; and (d) a discussion of what this symposium hopes to achieve. The author suggests that one most important point is to find an adequate definition of the term [self-sufficiency' in this context.

Biological Products↗
PubMed1994

[The new international psychiatric classification system, ICD-10. II. New classification systems in psychiatry].

The different interpretations of the concept of "mental disease" and the absence of an etiopathogenetic plane in the area of mental disorders led to the creation of descriptive (phenomenological) classifications of mental disorders. Their main representatives are the American diagnostic and statistical manual of mental disorders, DSM-III, its revised version DSM-III-R and the new international classification of mental disorders iCD-10. Both systems use a common theoretical baseline and are to a considerable extent compatible. Typically they have a high reliability and low validity of diagnostic categories. Subsequent development of psychiatric classifications will be focused in particular on improvement of diagnostic validity. The international psychiatric classification was created in different versions for the purpose of specialized psychiatric care, primary care and for research.

Humans↗
PubMed1997

[Analysis of the diagnostic value of endovascular ultrasound with roc curves. Practical implications].

Intravascular ultrasound enables detection of the components of atherosclerotic plaques. The diagnostic value was assessed by ROC (receiver operating characteristic) curves on images acquired in vitro and correlated with the histological findings in 61 arteries. Five questions were asked of each operator; the reply was represented by a continuous variable in order to express all nuances of judgement. The area under the ROC curve, Az, was the criterion of performance (0.5 : chance response : 1.0 : all replies were accurate). Detection of plaque was satisfactory (Az = 0.89). The three layer appearance of muscular arteries was well recognised (Az = 0.94). The fibrous composition of a plaque was only just satisfactory (Az = 0.88) with 38.7% interindividual variability. The lipid composition of the plaque was poorly recognised (Az = 0.76) with large interindividual variability (52.8%) : hypoechogenicity was too ambiguous a sign from the acoustic point of view. A hypoechogenic zone must not be synonymous with a lipid plaque but a cellular zone. Calcium can almost always be detected (Az = 0.98) with a very low interindividual variability (10.7%), fibrohyaline progression of some plaques can be confusing. The authors present a more objective description of endovascular ultrasonographic images. They conclude that the diagnostic performance of 30 MHz intravascular ultrasound is satisfactory but several limitations are apparent in the interpretation of images, especially hypoechogenic zone and hyper-reflective zones with high attenuation.

Arteries↗
PubMed1998

Investigation of lesions detected by mammography. The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Canadian Association of Radiation Oncologists.

OBJECTIVE: To provide information and recommendations to facilitate decision-making when a mammographic abnormality is detected by screening. EVIDENCE: References identified by use of MEDLINE, AIDSLINE, CANCERLIT and reference lists of review articles to December 1996. Where experimental evidence is lacking, recommendations are based on expert opinion. The evidence is graded accordingly in "levels" (page S2). BENEFITS: Exclusion or confirmation of the presence of cancer with minimum intervention and delay. RECOMMENDATIONS: When an abnormality is detected on screening mammography, clinical evaluation and thorough radiologic work-up are needed to determine its significance. Clinical evaluation should include a history and a thorough examination of the breast, axilla and supraclavicular areas. In the radiologic work-up, diagnostic mammograms should be obtained with additional views, spot compression and magnification views as appropriate. Current mammograms should be compared with previous mammograms whenever possible. The mammographic report should include a precise description of the abnormal features visualized and an estimate of the level of suspicion of cancer they imply. Whenever there is any doubt in the interpretation of mammograms, the interpretation of 2 experienced readers should be obtained. (The following radiologic classification into 4 categories is suggested: 1--benign, not due to cancer; 2--low risk, probability of cancer under 2%; 3--intermediate risk, probability of cancer 2% to 10%; 4--high risk, probability of cancer over 10%.) Ultrasonography can be used to clarify the nature of noncalcified nodular lesions. Management decisions require close communication between the woman and her physicians. Throughout, a clinician in charge should be identified who will coordinate and transmit all decisions. Management will depend on the estimated level of risk Category 1 abnormalities require no further investigation. Category 2 abnormalities may be followed up by periodic mammographic and clinical examinations. Follow-up examination of category 2 abnormalities should be carried out at approximately 6 and 12 months. If the abnormality is stable, examination should be repeated annually for 2 to 3 years thereafter. The rationale of follow-up should be explained, and women should be made aware that it is not possible to provide complete assurance that an abnormality is benign. Category 3 abnormalities usually require image-guided fine-needle or core biopsy. Every image-guided needle biopsy should be accompanied by a full report. Category 4 abnormalities should usually be excised. This may be preceded by image-guided needle biopsy. When surgical biopsy is carried out, the margins of the resected specimen must be free of tumour. The intact pathology specimen should be examined radiographically to confirm that all mammographic abnormalities have been removed. The patient should be kept fully informed as to the reason for each test and the meaning of its results. The process, from initial detection of the mammographic abnormality to the final management decision, should be completed as rapidly as possible. VALIDATION: Guidelines were reviewed and revised by the Writing Committee, expert primary reviewers, secondary reviewers selected from all regions of Canada and by the Steering Committee. The final document reflects a consensus of all these contributors.

Breast Neoplasms↗
PubMed1998

A novel system for the objective classification of iris colour and its correlation with response to 1% tropicamide.

Iris colour can provide an enormous amount of information about an individual. In addition to changes with pathological conditions, the colour of the iris can be a particularly useful indicator of how well a person will respond to a topically applied ocular drug. Until recently, classification of iris colour has been subjective, ranging from a basic description ('light' and 'dark') to more detailed grading systems, such as a comparison with preset photographic standards. However, variability within observers and differences in the interpretation between observers can influence the results. Objective techniques, in this respect, possess several advantages. They are able to detect differences in colour that subjective techniques are incapable of and they provide continuous data rather than discrete categories, thus improving the accuracy of drug response predictions. This study assessed iris colour by objective means. Slit-lamp photographs of various coloured irides were taken under standardised conditions. The slides were then scanned into a computer and the colour analysed using a calibrated software package. To establish the optimum colour parameter to be used for predictions of drug response, several parameters were calculated and compared with the subject response to 1% tropicamide (maximum change in pupil size, time to maximum change and total duration of effect). Many parameters had strong correlations with drug response, but the parameters 'z', 'b' (the proportion of blue in the image) and 'y' (the proportion of yellow in the image) were found to exhibit the highest correlations. They also showed better correlations with drug response than did a current iris colour grading system.

Adult↗
PubMed1991

Interfacial catalysis by phospholipase A2: determination of the interfacial kinetic rate constants.

Hydrolysis of vesicles of 1,2-dimyristoyl-sn-glycero-3-phosphomethanol (DMPM) by pig pancreatic phospholipase A2 (PLA2) occurs in a highly processive "scooting" mode, and the rate is comparable to or exceeds the rates observed with detergent-dispersed mixed micelles under optimal conditions. A complete kinetic description of the steady-state time course of the hydrolysis is developed. The analysis covers the whole Michaelis-Menten space: it emphasizes the key features of interfacial catalysis by a detailed theoretical analysis, describes the experimental protocols to determine the values of the kinetic and equilibrium constants for interfacial catalysis, and provides an interpretation of the effect of calcium, substrate, products, apparent activators, and competitive inhibitors on the reaction progress curve by a single set of rate and equilibrium parameters. In this paper, the integrated reaction progress curve was rigorously interpreted in terms of a minimal model involving the Michaelis-Menten reaction sequence in the interface: E* + S in equilibrium E*S----E*P in equilibrium E* + P, and most of the individual rate and equilibrium constants for the catalytic cycle were determined. This rigorous description of interfacial catalysis was made experimentally possible by examining the action of PLA2 in the scooting mode under conditions of at most one enzyme per vesicle, where it hydrolyzed all of the substrate in the outer monolayer of vesicles without leaving the surface. Other experimentally verified constraints for this analysis include the following: all enzyme was bound to vesicles; the integrity of vesicles was maintained during the course of hydrolysis; and the substrate, enzyme, and products did not exchange between vesicles nor did they exchange across the bilayer. The mechanistic significance of the rate constants is discussed in the accompanying papers.

Animals↗
PubMed1991

Interpretation of intraluminal manometric measurements in terms of swallowing mechanics.

A unified discussion of the mechanics of the swallowing process, and its interpretation through manometric measurements of intraluminal pressure, are presented in this paper. The goals of the discussions are to provide the reader with basic knowledge of pharyngeal, esophageal, and sphincter mechanics; to relate the mechanical processes to intraluminal pressure recordings; and to clarify the relationship between intraluminal pressure and esophageal muscle contractile behavior. The esophageal phase of bolus transport, in particular, is discussed in some detail due to the relatively simple geometry and the straightforward description of peristalsis and muscle mechanics in this region. Several important issues are emphasized in the discussion. For example, pressure variation within a static bolus is fundamentally different from that within a moving bolus. Manometric recordings must be interpreted accordingly. The importance of differentiating between "hydrodynamic pressure," which is pressure measured within a fluid bolus, and "contact pressure," which is the direct squeeze of the luminal wall on the manometric port in a region devoid of bolus fluid, is discussed in some detail. We argue that pressure "amplitude" does not, in principle, give any indication of the forces required to drive the fluid bolus forward. What should be sought is the variation of intrabolus pressure relative to the contact pressure, particularly during periods in which the contractile segment fails to obliterate the esophageal lumen. Examples of intraluminal pressure recording in the esophagus, using manometry and mathematical models, are presented to demonstrate both the possibilities and the difficulties of interpreting manometric recordings in the absence of concurrent radiographic imaging. We discover that in regions of nearly complete luminal closure, the pressure signature and bolus geometry are strongly coupled during peristaltic transport, providing the possibility that in these regions quantitative measures of muscle performance might be developed without the need for radiographic imaging. On the other hand, the ambiguity in the interpretation of manometric recordings that often accompanies dysphagic conditions suggests that as more sophisticated interpretations are sought, manometry concurrent with radiography will play a more prominent role in patient evaluation.

Biophysical Phenomena↗
PubMed2003

Chest radiographs in the emergency department: is the radiologist really necessary?

BACKGROUND: The chest radiograph is considered one of the most complex imaging modalities to interpret. Several studies have evaluated radiograph interpretation in the emergency department, and considerable disagreement among clinical physicians and expert radiologists has been observed in the reading of chest films. The interpretation of chest radiographs by emergency department physicians was compared with senior radiologists in discharged patients, and misinterpretations assessed in relation to the physician's level of training. METHODS: Radiological descriptions of 509 chest radiographs of 507 patients, aged 16-98 years who were discharged from the emergency department, were prospectively reviewed. Missed findings were recorded with regard to the physician's level of training and experience. The effects of misinterpretations on discharge recommendations were also investigated. Statistical assessment was conducted using the chi(2) test. Interobserver agreement was also tested by the kappa coefficient. RESULTS: The sensitivity for detecting different abnormalities in the radiographs ranged from 20% to 64.9% and specificity from 94.9% to 98.7%. Despite the low sensitivities found, there were relatively few clinical implications of the "missed" findings since they were either of a minor nature or appropriate follow up was prescribed. The overall interobserver reliability, assessed by the kappa coefficient, was 0.40 (95% confidence interval 0.35 to 0.46). These findings did not change significantly by emergency department physician's level of training. CONCLUSIONS: Emergency department physicians frequently miss specific radiographic abnormalities and there is considerable discrepancy between their interpretations and those of trained radiologists. These findings highlight the importance of routine evaluation of chest radiographs by a well trained radiologist and emphasise the need for improving interpretive skills among emergency department physicians.

Adolescent↗
PubMed1992

Extendable words in nucleotide sequences.

Previous statistical analyses revealed several peculiarities of nucleotide sequences that preclude their description by existing models and thus allow one to distinguish DNA and RNA sequences from random A,T,G,C-texts. This is a consequence of the unusual distribution of certain words in nucleotide sequences: while the distribution of (most) words is consistent with Markov models of small orders, the distribution of certain words cannot be described by any previous model (anomalies in distribution of homonucleotide/homopurine/homopyrimidine runs, complementary and mirror palindromes, and non-stationary words). In this work we introduce a probabilistic approach that is partly motivated by analogy with linguistics. We also describe another important feature of DNA/RNA sequences: anomalies in distribution of words of poor nucleotide composition. We show that some classes of these words are the major obstacle for the simple Markov description of nucleotide sequences.

Base Sequence↗
PubMed1997

Quantitative analysis of the plain radiographic appearance of Ewing's sarcoma of bone.

RATIONALE AND OBJECTIVES: The authors quantitate the radiographic features that distinguish the plain radiographic appearance of Ewing's sarcoma (ES) from other solitary lesions of bone. METHODS: A total of 709 cases of focal bone lesions, including 44 ES, were analyzed according to demographic, anatomic, and plain radiographic features. Vector analysis of groups of features was performed to determine those that are most sensitive and specific for the appearance of ES in contrast with other lesions in the database. RESULTS: In our sample, Ewing's sarcoma is most consistently a medullary-based (91%) lytic (89%) lesion with at least a partially permeative appearance (82%), poorly defined edges (82%), no margination (91%), and a soft-tissue mass (61%). When these lesions occur in long bones, they most commonly are found in the diaphysis (75%) and are proximal more often than distal. Vector analysis suggests that any primary bone lesion without radiographically visible matrix and with either a soft-tissue mass, an appearance of permeative destruction alone or in combination with other patterns of bone destruction is suspect for the diagnosis. This small subset of common features appears to have a high sensitivity (89%) and prevalence (47%) of ES among the lesions meeting these criteria. Limiting the age of the patients to progressively younger age groups increases the specificity but lowers sensitivity. The vector analysis-generated differential diagnoses includes osteosarcoma, giant-cell tumor, lymphoma, and chondrosarcoma. CONCLUSIONS: A relatively specific set of radiographic features can be defined, which will assist in the radiographic diagnosis of ES and improve upon current textbook descriptions.

Adolescent↗
PubMed1992

Institutional and strategic choice perspectives on board involvement in the strategic decision process.

The level of a board of directors' involvement in strategic decisions can be viewed as an institutional response or as a strategic adaptation to external pressures for greater board involvement. We examined the antecedents and effects of board involvement from both the institutional and strategic choice perspectives. Data obtained from personal interviews with 114 board members and archival records indicated that board size and levels of diversification and insider representation were negatively related to board involvement, and organizational age was positively related to it. Furthermore, we found board involvement to be positively related to financial performance after controlling for industry and size effects. Overall, the results suggest that both theoretical perspectives are necessary for a comprehensive description of the strategic role of boards.

Commerce↗
PubMed1991

A temporal and spatial scaling hypothesis for the behavioral effects of psychostimulants.

A variety of psychoactive substances (amphetamine, nicotine, scopolamine, apomorphine, lisuride, and MDMA) were tested to examine whether a proposed scaling hypothesis is appropriate for the description of the amount and the structure of rat locomotor paths recorded in the Behavioral Pattern Monitor (BPM). The analytical approach was based on the assumption that the scaling behavior of a few collective variables may characterize sufficiently changes in the animal's behavior induced by different drugs. The temporal scaling exponent alpha, describing the ratio of fast to slow responses in the BPM, sensitively reflected the different stimulant properties of the substances. The spatial scaling exponent d, which relates the average path length to the resolution used to measure consecutive responses, was found to discriminate substances that had been separated previously via qualitative descriptions. Several behavioral response categories emerged from comparisons of the locations of different drugs on a two-dimensional d-a plane. Scopolamine, MDMA, lisuride, and high doses of apomorphine increased a while decreasing d, whereas amphetamine, nicotine, and caffeine produced an increased a with no change or an increase in d. Stereotypies could be identified on the opposite ends of the spatial scaling exponent scale and were interpreted as reflecting two kinds of perseveration. These results suggest that scaling approaches can be used to assess quantitatively the state of the animal based on its locomotor behavior and that the exponents can serve as collective variables providing a macroscopic description based on the microscopic elements of behavior.

Animals↗
PubMed2005

Detection and analysis of statistical differences in anatomical shape.

We present a computational framework for image-based analysis and interpretation of statistical differences in anatomical shape between populations. Applications of such analysis include understanding developmental and anatomical aspects of disorders when comparing patients versus normal controls, studying morphological changes caused by aging, or even differences in normal anatomy, for example, differences between genders. Once a quantitative description of organ shape is extracted from input images, the problem of identifying differences between the two groups can be reduced to one of the classical questions in machine learning of constructing a classifier function for assigning new examples to one of the two groups while making as few misclassifications as possible. The resulting classifier must be interpreted in terms of shape differences between the two groups back in the image domain. We demonstrate a novel approach to such interpretation that allows us to argue about the identified shape differences in anatomically meaningful terms of organ deformation. Given a classifier function in the feature space, we derive a deformation that corresponds to the differences between the two classes while ignoring shape variability within each class. Based on this approach, we present a system for statistical shape analysis using distance transforms for shape representation and the support vector machines learning algorithm for the optimal classifier estimation and demonstrate it on artificially generated data sets, as well as real medical studies.

Algorithms↗