The production of a copy of an existing object of complex shape is one of the typical applications of the integration between two modern computer-based technologies, reverse engineering (RE) and rapid prototyping (RP). The method is extremely versatile and can be used in various applicative domains (e.g. replacement of anatomical parts with artificial prostheses, replication of skeletal remains). Two different acquisition techniques of images of a skull, by laser and by CT scan, were compared to ascertain which enabled more accurate reproduction of the original specimen. The skull was chosen due to it being the body part most often used in medico-legal investigations (for personal identification, skull-photo superimposition techniques, forensic art, etc). Comparison between the copy and the original yielded satisfactory results for both techniques. However, CT scanning demonstrated some advantages over the laser technique, as it provided a cleaner point cloud, enabling shorter pre-reproduction processing times, as well as data on the internal parts, which resulted in the reproduction of a more faithful copy.

Biomedical Engineering↗

PubMedDate not supplied

Accuracy of magnetic resonance imaging of inguinofemoral lymph nodes in vulval cancer.

Inguinofemoral lymphadenectomy contributes to the high morbidity related to surgical treatment of vulval cancer. The objective of this study was to assess the accuracy of magnetic resonance imaging (MRI) in predicting inguinofemoral lymph nodes metastasis in women with vulval cancer. We reviewed the clinical, MRI, surgical, and pathologic findings of 59 women with vulval cancer who were treated at our institution from January 2000 to June 2004. Histology was available for 39 women who had undergone inguinofemoral lymphadenectomy. Clinical and MRI findings were compared with histology result to assess test accuracy. MRI had a positive likelihood ratio (LR+) of 4.8 (95% confidence interval of 2.7-8.6) and negative likelihood ratio (LR-) of 0.17 (0.06-0.49). It had a sensitivity of 85.7% (63.7-97), specificity of 82.1% (69.6-91.1), positive predictive value (PPV) of 64.3% (44.1-81.4), and negative predictive value (NPV) of 93.9% (83.1-98.7). Clinical examination had an LR+ of 6.1 (1.8-21.6) and LR- of 0.69 (0.5-0.96). It had a sensitivity of 35% (15.3-59.4), specificity of 94.3% (84.3-98.8), PPV of 70% (34.7-93.3), and NPV of 79.4% (67.3-88.5). Kappa statistics for interobserver and intraobserver agreement were 0.9091 and 0.8475, respectively. MRI assessment was accurate in predicting negative nodal status that is clinically useful in identifying women who can be spared inguinofemoral lymphadenectomy. It is noninvasive and is superior to clinical assessment. In clinical practice, this should encourage toward nodal sparing surgery, thus lowering surgical-related patient morbidity.

Aged↗

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Adaptive Wiener filtering for improved acquisition of distortion product otoacoustic emissions.

An innovative acoustic noise canceling method using adaptive Wiener filtering (AWF) was developed for improved acquisition of distortion product otoacoustic emissions (DPOAEs). The system used one microphone placed in the test ear for the primary signal. Noise reference signals were obtained from three different sources: (a) pre-stimulus response from the test ear microphone, (b) post-stimulus response from a microphone placed near the head of the subject and (c) post-stimulus response obtained from a microphone placed in the subject's nontest ear. In order to improve spectral estimation, block averaging of a different number of single sweep responses was used. DPOAE data were obtained from 11 ears of healthy newborns in a well-baby nursery of a hospital under typical noise conditions. Simultaneously obtained recordings from all three microphones were digitized, stored and processed off-line to evaluate the effects of AWF with respect to DPOAE detection and signal-to-noise ratio (SNR) improvement. Results show that compared to standard DPOAE processing, AWF improved signal detection and improved SNR.

Algorithms↗

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Modification of very low density lipoproteins leads to macrophage scavenger receptor uptake and cholesteryl ester deposition.

Chemically modified low density lipoproteins (LDL) are recognized by the macrophage scavenger receptor and can lead to substantial cholesteryl ester accumulation in cultured macrophages. Uptake of modified lipoproteins in vivo could contribute to foam cell formation during generation of the atherosclerotic plaque lesion. In the present study, modification of human pre-beta migrating very low density lipoprotein (VLDL) by acetylation led to recognition by the macrophage scavenger receptor as demonstrated in cross-competition experiments with acetylated LDL (ALDL). Recognition by this alternative binding site was associated with increased cholesterol delivery to human macrophages as assessed by suppression of LDL receptor activity, stimulation of cholesterol esterification rates, and accumulation of intracellular cholesteryl ester. Subfractionation of acetylated very low density lipoprotein (AVLDL) by ultracentrifugation in a discontinuous NaCl gradient demonstrated that AVLDL subfractions were equally effective in competing for 125I-ALDL uptake by macrophages when compared on the basis of particle number. These results suggest that modification of VLDL with subsequent recognition by the macrophage scavenger receptor may be a mechanism by which VLDL particles participate in macrophage cholesteryl ester overload.

Acetylation↗

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[The one-time surgical repair of postintubation esophagotracheal fistulae].

Personal experience in the treatment of the tracheal-esophageal non-neoplastic fistula is reported. In the last years, three cases of FTE, concerning some cannula tracheal-stomachal beare patients from 14, 2, 1 months have been examined. In two cases the patients were in spontaneous ventilation, on the contrary a mechanical ventilation was employed in the third. In two patients the fistular way was located correspondingly of the decubitus point of the tracheal stomachal cannula, on the membranaceous pars, and it was not associated with concomitant tracheal stenosis. The first stage of the treatment was removal of the nasogastric probe, supporting the decubitus phenomenon subtending the establishment and the extension of the FTE, then the preparation of a gastrostomy to assure the drainage of secretions under the fistula and a jejunum anastomosis to allow a suitable feeding and recovery of the patients. In these three cases the restoring operation was accomplished by a cervicotomy with a direct opening of the fistula, a suture of the esophageal wall, a suture of the membranaceous pars on the healthy tissue and then a protection of these sutures by interposition, between trachea and esophagus, of the prethyroid muscles transposed and fixed to the prevertebral band. In two cases the post-operative course did not present complications, while the patients kept in assisted ventilation during the postoperative course showed a relapse of the FTE on the twelfth day and then the progressive establishment of a septic state and the exitus on the twentieth day. It is underlined how the success of the reparation of the fistula is largely conditioned by the respiratory autonomy of the patient that guarantees the recurrence of decubitus and infection phenomena causing the lesion.

Adult↗

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[Lung resection in the elderly: some limits].

INTRODUCTION: A progressive and constant increase of mean life duration in the last century has determined the challenge of the treatment of lung cancer even in the elderly with good functional status. The aim of the present study is to evaluate the results obtained in the elderly, over seventy years old, who underwent pulmonary resection at our Division of Thoracic Surgery of Polyclinic of Bari from 1985 to 1995. PATIENTS AND METHODS: 938 patients with NSCLC have been operated on, from January 1985 to December 1995. 189 were over seventy and 19 were over eighty years old. We have performed the following surgical procedures: 21 pneumonectomies, 108 lobectomies/bi-lobectomies, 44 wedge resections, 16 staging thoracotomies. RESULTS: Post-operative complications were as follows: atelectasis 57, air leak 37, empyema 9, broncho-pleural fistula 3, arrhythmia 103, pulmonary edema 8, cardiac ischemia 3, pulmonary embolisms 1, delirium 2, hemothorax 3, exitus 5. There were 3 deaths caused by acute myocardial ischemia, one by pulmonary embolism, one by main right bronchus broncho-pleural fistula. Two and five-year overall survival were 67.1 and 37.8, respectively. CONCLUSION: Diagnostic and therapeutical procedures for lung cancer should be different in the elderly. In our experience, main post-operative complications were cardiovascular, consequent to the entity and duration of surgical operation and intra-operative blood leaks. The elderly require a more careful post-operative monitoring to prevent this kind of complications.

Aged↗

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[Minimally invasive thoracic surgery versus standard surgery].

Advances in technology, with the availability of optics and minitelevision cameras and improved endoscopic instrumentation (especially endo-stapler devices), have allowed the surgeon to obtain a superior panoramic view of the thoracic cavity and an optimal surgical manuvrability. This has determined the development, besides the traditional thoracotomic approach, of minimally invasive techniques of video-assisted thoracic surgery (VATS). An auxiliary mini-thoracotomic approach and the magnification of the operating theatre, which allows the surgeon to accomplish difficult manoeuvres under diret view, have progressively extended the indications of this procedure: at first used for the treatment of pneumothorax and pleural effusions, it is now employed in biopsy or atypical resection of pulmonary nodules, lung cancer staging and diagnostic-therapeutical procedures of mediastinal diseases, major pulmonary resections (lobectomy and pneumonectomy) and lung volume reduction surgery for emphysema (LVRS). The Authors review minimally invasive techniques of video-assisted thoracic surgery (VATS), compared to the traditional surgical ones, for the treatment of various thoracic diseases.

Hemothorax↗

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[Study of zinc and copper serum levels in dislipemias].

The possible alterations of zinc and copper serum levels in dyslipemies were studied. The population were classified taking into account total cholesterol HDL and triglycerides levels and the serum test at 4 degrees C in 4 groups: 1) Hypercholesterolemia (type II A), 2) Endogenous hyperlipemia (types II B and IV), 3) Mixed hyperlipemia (type V), 4) Exogenous hyperlipemia (Type I), and also the presence of over weight ("15% ideal weight body, according to Bray), that occurred in the 29.5% of the sample. Zinc and copper were determined by AAS (Smith & Butrimovitz method). Total cholesterol, HDL, LDL and triglycerides by enzymatic methods. The main results and conclusions obtained were the following: A significative increase in zinc serum level was observed; Hyperglycemia, present in nearly half of the studied population could be the responsible for it. Obesity was associated with an increase of zinc values, and this could be related to an insulinic dysfunction. A direct correlation between glycemia and triglyceridemia, and between glycemia and zincemia was found. Cardiovascular alterations seemed to decrease zinc serum levels; on the opposite however hypertension increased them. Neither lipidic metabolism alterations, nor obesity did modify copper serum level.

Copper↗

PubMedDate not supplied

[Evolution of facial and dental pain in the treatment of chronic maxillary sinusitis].

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Adolescent↗

PubMedDate not supplied

The distal splenorenal shunt: an update on experience of 106 cases.

This paper analyzes experience with 106 patients treated primarily with DSRS during a ten year period. Operative mortality was 5% of cases. Shunt patency was evaluated by postoperative angiography in 70 patients. A shunt thrombosis and a recanalization of the splenic vein were noted in a patient who had a Britton's operation resulting in a side-to-side shunt. In the other 31 cases, shunt patency was indirectly confirmed by the absence of varices at postoperative or long-term endoscopic examination. At postoperative check, esophageal varices had disappeared in only 19% of patients. However, this rose to 60% at long-term check-up. Ten patients bled from varices in the postoperative period (9%). During the follow-up period, no patient bled from varices, while five patients bled from gastroduodenal lesions (5%). During the postoperative period, 52% of cases had ascites. In the long-term, ascites developed in only 15% of cases and was well controlled by standard medical treatment. Analysis of the actuarial curve showed a 5-year survival rate of 63%. During the follow-up period, 17% of patients experienced at least one episode of acute encephalopathy. Chronic encephalopathy appeared in 14% of cases: ten patients suffered a mild form (10%) and four (4%) a moderate form. No patient had severe chronic encephalopathy. DSRS is effective as treatment of portal hypertension with a low long-term morbidity despite a more troublesome early postoperative period.

Actuarial Analysis↗

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Hypoxemia in attack free asthmatic children: relationship with lung volumes and lung mechanics.

In 113 asthmatic children (mean age +/- SD = 11.0 +/- 2.8 years), the presence of hypoxemia was evaluated during an attack free period. Blood gases were measured in arterialized blood samples. 71% of the patients were hypoxemic. Hypoxemia was defined as partial pressure of O2 (PaO2) below 90% of the mean value for normal children. In a first step, the relationship between hypoxemia and frequency of asthma attacks was examined: frequency of attacks appeared to be a poor predictor of hypoxemia in an attack free period. In a second step, the relationship between hypoxemia and 9 pulmonary function test variables was examined. The static lung volumes considered were: functional residual capacity (FRC: helium dilution technique); thoracic gas volume (TGV: body plethysmography technique) and trapped gases (TG: difference between TGV and FRC). TG was expressed as a percentage of 1) measured FRC (TG/FRCmeas), 2) measured TGV (TG/TGVmeas), 3) predicted FRC (TG/FRCpred). Lung mechanics variables were determined by the oesophageal catheter technique: lung resistance (RL) and dynamic lung compliance (CLdyn). RL and CLdyn were expressed 1) in absolute terms, 2) as a percentage of the index of distension (ID: TGV/FRCpred). All variables are expressed as a percentage of predicted values except for TG/FRCmeas and TG/TGVmeas. Considering lung volumes, hypoxemia was found when TG was present. When lung mechanics were altered, hypoxemia was also present. The relationship between PaO2 and PFT variables was best expressed by the following equation: PaO2 (%) = 85.393 + 0.121 CLdyn/ID--0.151 TG/FRCpred--0.026 RL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

[Primary intestinal lymphangiectasia in children. Report of 3 cases].

It report three cases of Primary Intestinal Lymphangiectasia that presented the common symptoms of diarrhea, oedema and hipoalbuminaemia in which we could observed the clinics variations that can to present this entity. It demonstrated the importance of the intestinal biopsy to get a correct diagnosis just as the essencial of use of the medium chain triglycerides with the restriction of the common fast, to recuperate these patients.

Child↗