Circumcaval ureter: a new classification.
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Adult↗
Biomedical subjects
D Atkinson
Publications and source records attributed to D Atkinson.
Radiological changes in the urinary tract in S haemoglobinopathy. A review of 80 patients presenting with haematuria.
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Adult↗
Assessment of coronary artery patency after stent placement using magnetic resonance angiography.
The ability to noninvasively assess the patency of coronary stents would represent a significant advance. We evaluated the safety and ability of two-dimensional coronary MR angiography in imaging stents and suggesting patency. Coronary MR angiography of 26 coronary stents (Palmaz-Schatz) was performed in 16 patients 39 to 73 years of age. Studies were performed between 2 and 4 months after stent placement. All patients were symptom free at the time of imaging. Coronary MR angiography was performed with a commercial 1.5-T MR imager using an electrocardiographically gated pulse sequence with breath-holding. Images were obtained in mid-diastole with and without fat suppression. Image artifacts caused by the metal in the stents were clearly visualized in all 26 stents (100% sensitivity for stent detection). Arterial flow signal was seen in the coronary artery or graft distal to the stent in 25 of 26 cases (96%). All patients, except for the one in which distal flow could not be seen, remained symptom free for >2 years. The distribution of stent locations was as follows: 10 in the right coronary artery (RCA), 10 in the left anterior descending coronary artery (LAD), 2 in the left circumflex coronary artery, and 4 in saphenous vein grafts (SVGs) to RCA. One patient had 2 RCA and 2 LAD stents, one had 3 RCA and 1 LAD stents, one had 3 SVG stents, and two had double RCA stents. Coronary MR angiography is safe for noninvasive imaging of coronary stents, and in the proper clinical setting, it can be used to help suggest patency.
Adult↗
Determination of gradient magnetic field-induced acoustic noise associated with the use of echo planar and three-dimensional, fast spin echo techniques.
The purpose of this study was to assess gradient magnetic-field-induced acoustic noise levels associated with the use of echo planar imaging (EPI) and three-dimensional fast spin echo (3D-FSE) pulse sequences. Acoustic noise measurements were obtained from two different high field-strength MR systems (1.5 T, Siemens and General Electric Co.) under ambient noise conditions and the use of EPI and 3D-FSE pulse sequences. Parameters were selected to produce "worst case" acoustic noise levels. Acoustic noise recordings were made at the entrance, the center, and at the exit of the magnet bores with a specially designed microphone that was unperturbed by electromagnetic fields. The highest ambient noise levels (A-weighted scale) were 67 dB (Siemens: the same values were recorded at the center and at the exit) and 78 dB (General Electric Co.; recorded at the exit). The highest acoustic noise levels recorded during activation of the gradient magnetic fields were 114 dB (Siemens) and 115 dB (General Electric Co.) and those occurred at the centers of the MR systems with the use of the EPI technique. Gradient magnetic fields associated with the use of EPI and 3D-FSE techniques produced acoustic noise levels that were within permissible levels recommended by federal guidelines.
Echo-Planar Imaging↗
Cryosurgery of liver cancer.
Cryosurgery, the in situ destruction of tissue using subzero temperatures, has been used to treat hepatic metastases. Because it is a focal treatment, cryosurgery can be used in patients with unresectable lesions due to location (next to major blood vessels) or multiplicity. In this study, 57 patients with unresectable hepatic metastases were treated with cryosurgery (with at least a 6-month follow-up). The number of lesions treated ranged from 1-16 with a mean of 4.6. Forty-three patients (73%) had bilobar disease, while 25 patients (42%) were treated with a combination of resection and cryosurgery. The disease-free survival rate (patients with normal computed tomography [CT] scans and carcinoembryonic antigen [CEA] levels) was 27% with a mean follow-up of 21 months. This is comparable to other hepatic cryosurgery studies that have found survival rates of 25-37.5%. Although the results are still short-term, this study indicates that hepatic cryosurgery offers the hope of long-term survival in patients with unresectable hepatic metastases.
Colonic Neoplasms↗
Smoking among male teenagers in Dhaka, Bangladesh.
BACKGROUND: Smoking is now recognized as a major public health problem in the developing world. Despite this, there is a dearth of relevant data on smoking prevalence and on the characteristics and attitudes of smokers: in particular, studies are lacking among teenagers and young adults, the group in which the habit frequently begins. The present study addresses this issue by examining the smoking patterns of a sample of teenagers in Dhaka, Bangladesh, during 1991. METHODS: The study investigated smoking behavior and attitudes among two groups of male teenagers: the first consisted of 555 students, age 12-20 years, selected from two metropolitan high schools; the second, chosen to provide a broad comparison group from a different socioeconomic stratum, contained 112 males of similar age residing in an urban slum. Data were collected largely by interview supplemented by some direct observation and relevant secondary data. RESULTS: The results showed that 29% of the students and 68% of the slum dwellers said they were regular smokers. In addition, the slum youths smoked substantially more and had smoked for longer than the students. While the study suggests both groups of smokers had been influenced to take up smoking by the smoking behavior of peers and parents, peers were more important for the students. Advertising may also have been a important influence on students since smokers in this group could better identify tobacco advertisements compared with their nonsmoking peers. No significant association was found between respondents' knowledge of the health risks of smoking and their actual smoking behavior. CONCLUSIONS: This study demonstrates that in Bangladesh, smoking is very common among middle-class male teenagers and even more prevalent among youths from nearby slums. Clearly, local and national programs that draw on relevant knowledge from other countries, but are appropriate to Bangladesh, need to be developed to tackle a major epidemic.
Adolescent↗
Digital arthrography in the evaluation of painful joint prostheses.
Digital arthrography was accomplished in 16 patients who had painful prostheses. In each instance, resulting arthrographic abnormalities were compared with those apparent on subsequent overhead radiographs. Results indicate the potential value of the digital technique in this clinical setting. The examination is easy to perform and rapid, and allows the examiner to view the changing images in the subtraction mode. Image manipulation and enhancement are also possible.
Aged↗
MR-guided procedures using contemporaneous imaging frameless stereotaxis in an open-configuration system.
Frameless MR-guided procedures have had limited application using conventional closed magnets, due largely to the technical difficulties involved. As a result of in-room MR image-monitoring capabilities, new open-design magnets now allow frameless stereotaxis using contemporaneous imaging to guide more invasive procedures. We evaluate our clinical experience with this new technique. An open-design 0.2 T magnet (Siemens OPEN) combined with an in-room monitor was used for 33 frameless MR-guided procedures (aspiration cytology, biopsy, and/or treatment) in a variety of locations in the head, neck, spine, brain, pelvis, and abdomen. Success of the procedure was based on the ability to accurately position the instrument in the target region to allow biopsy and/or treatment. The open-design magnet allowed the physician to directly access the patient for frameless stereotaxis as the procedure was performed. The in-room monitor provided contemporaneous imaging feedback during the procedure for successful placement of the instrument in the target region. Twenty-eight biopsy and five treatment procedures were performed. In all cases the technique resulted in successful placement of the instrument within the target tissue to complete the procedure. MR-guided procedures using contemporaneous imaging frameless stereotaxis are possible in an open-design magnet with in-room image monitoring and offer exciting possibilities for further development.
Adolescent↗
Tetracycline and its effect on teeth.
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Adult↗
Design of a survey to inform state health decision making: a collaborative effort.
BACKGROUND: The North Carolina Health Profile (NCHP), a statewide telephone survey, was introduced as part of the state's Health Policy Information Project aimed at enhancing the use of health data for state policy decision making and program management. A key factor in the creation of the NCHP was a collaboration between the State Center for Health Statistics and the Survey Research Unit at the University of North Carolina at Chapel Hill. The purpose of this article is to describe our partnership, the development of the survey design, and the dissemination of survey results. METHODS: Three designs were considered during the planning and development of the survey. The final design consisted of a random digit dialing sample of 2,400 households in the state's noninstitutionalized population. The questionnaire was comprised of an adult module (addressing adult health care use and insurance coverage), a child module (addressing health care use and insurance coverage of children ages 0-17 years), and a young child module (addressing child development and safety for children ages 0-5 years). RESULTS: Several statistical briefs, a report, a public dataset, and accompanying public use documentation were prepared for a variety of audiences, including state legislative committees and commissions, state agencies, and advocacy groups. DISCUSSION: We learned several lessons in our research and practice partnership including the need for collaboration between data creators and users, for addressing obstacles in soliciting policy information needs, and for prioritization in meeting information needs.
Cooperative Behavior↗