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[Nutritional status in patients with stroke. Diagnosis, therapy and its monitoring].

Stroke (Ischemic) initiates numerous pathophysiological processes and each of them can be dangerous. When evaluating patient's state and choosing therapeutical strategy, a complexity of the followed-up parameters should be taken into account as well as a complexity of a given therapeutical approach. On the basis of literary data and acquired clinical experience, we developed our own algorithm for diagnosis of the nutritional state and it was implemented into a semi-expert computing system SOFT. Using SOFT program, the group of 23 patients with ischemic CMP was examined within 40 hrs after its origin. These patients were found to show a slight protein catabolism and nutritional stress (aminograms, stress index, nutritional percentage of complications, nitrogen balance, CRP, prealbumin). necessity of an early diagnosis of nutritional deficiency and disorders of protein metabolism in STROKE patients is discussed. The paper reports on means of enteral nutrition prepared in the Hospital in Sternberk which appeared to be highly favorable. The aspects of administration of parenteral nutrition are discussed.

Brain Ischemia↗

Changes in the arteriolar volume pulse of the finger during various degrees of tilt using near infra-red and red photoplethysmography.

1. Photoplethysmography is a widely used non invasive technique for the measurement of peripheral oxygen saturation. A more detailed analysis of the volume pulse (VP) can indicate alterations in peripheral vascular tone, due to sympathetic stimulation, stress, pain and temperature. - 2. In six healthy male volunteers we investigated changes in the VP resulting from vasoconstriction and vasodilatation induced by varies degrees of tilt. Subjects were subjected 0 degrees tilt followed by head down -8 degrees -15 degrees, -30 degrees -15 degrees, -8 degrees, 0 degrees, 15 degrees, 30 degrees , 70 degrees, 30 degrees, 15 degrees and 0 degrees. Each tilt stage was sustained for 15 minutes. Both VP - and haemodynamic changes were continuously recorded 30s before and then for 210 s after the imposition of each tilt step. We used a new computer driven soft and hardware for the analysis of the VP. 3. The VP signal was obtained with a sensor emitting 840 nm (NIR) and 640 nm (RED) light into finger tip with a sample rate of 128 Hz. All data was normalised to the initial mean value obtained at 0 degrees tilt. The signal strength parameters amplitude, and area under the curve and the first derivative of the amplitude (flux) as well as time discrete parameters, time of first maximum (Tmax), dicrote wave (Td), volume pulse decrease (Tdec) and fundamental arterial oscillation Tag = Td - Tmax were measured. 4. HR increased significantly during 30 degrees and 70 degrees tilt, but no change in the other hemodynamic parameters was observed. Amplitude, area under the curve and flux of both the Red and the NIR signal increased following head down tilt. A significant decrease of those parameters was found during foot down tilt. 5. No significant changes were found in the time discrete values, neither within each tilt step nor when compared to the initial mean value at 0 degrees tilt. 6. This study reveals that signal strength related parameters such as area under the curve, amplitude and flux reflect changes in vascular tone. Time discrete parameters however did not depict these changes and appear unsuitable for data analysis when using this specific hardware applied in the current study.

Adult↗

[Personal experience in the diagnosis and monitoring of therapy in metabolic disorders with risk of crystallization in patients with recurrent urolithiasis].

A ten-year experience with diagnosis and therapy of metabolic abnormalities and crystallization risks in patients with recurrent urolithiasis is presented. Since 1985, more than 900 persons with recurrent urolithiasis have been examined at the Metabolic Centre of the Hospital in Sternberk. The patients were examined routinely at ambulance or during hospitalization; the examination consisted of repeated urine and blood collections after the diet with various content of calcium and salt. All initial data (case history, physical finding, biochemistry, radiodiagnostics) were processed by a semi-expert computing program SOFT which was also used for monitoring of the therapy. Then the patients were divided into individual risk groups (Pak). Of all probands, the group of 130 patients (satisfying the strict criteria of the study) was selected and the data obtained was processed statistically. The group of 130 patients with recurrent urolithiasis (all of them were drug-treated) was compared to the group of 50 individuals with urolithiasis treated by diet and regimen measures. The patients given drugs showed a significantly increased crystallization inhibitors concentration in urine and reduced crystallization promotors, or relative saturation of some lithiatic substances. The paper analyzes the effect of the mostly administered drugs on crystallization risks and some less known "metabolic" indications of application of some drugs are recommended. It is concluded that the dietary, drinking and regime measures are basic for a good therapy of patients with urolithiasis, but patients with recurrent urolithiasis should be applied a selective metaphylaxis of drugs after routine metabolic examination. This finding is supported by a low number of recurrent urolithiasis.

Adult↗

Detection of soft-tissue foreign bodies by plain radiography, xerography, computed tomography, and ultrasonography.

Detection of a soft-tissue foreign body is common yet often difficult, particularly when the foreign material is not radiopaque. Various imaging modalities have been advocated for detecting foreign bodies that are not revealed by plain radiography. The abilities of plain radiography, xerography, computed tomography, and ultrasonography to detect glass, wooden, and plastic foreign bodies in an in vitro preparation are compared. While all of these imaging techniques demonstrated a glass foreign body, only ultrasonography clearly identified wooden and plastic foreign bodies.

Evaluation Studies as Topic↗

[Facial soft tissue features analysis of normal Han race adults in Guangdong Province using computer-assisted-photogrammetric-system].

Facial soft tissue profile features of 150 normal native adults of Guangdong Province were analysed using computer-assisted-photogrammetric-system, which contained parameters written by polar coordinate. The results indicated that normal native adults of Guangdong Han race showed sex and region difference in features of facial profile soft tissue, and those parameters written by polar coordinate were helpful in the further study and clinical therapy.

Adult↗

[Computed tomography in the diagnosis of soft tissue neoplasms of the trunk and extremities].

Analysis of CT data on 213 patients with soft tissue and trunk tumors has shown that a majority of malignant and benign tumors have a similar picture (except lipoma). Features of the contours of a tumor and its inner structure do not permit the assessment of its nature. The only significant differential-diagnostic sign of malignant soft tissue tumors is destruction of an adjacent bone, noted in 17.6%. The majority of malignant and benign soft tissue tumors (70.9%) on CT scans look like a single node; recurrent tumors look multinodular (78.2%). Verification of soft tissue tumors, revealed by CT, should be done using morphological methods.

Adult↗

A study of the accuracy of predicted soft tissue changes produced by a computer software package (COG 3.4) in a series of patients treated by the Le Fort I osteotomy.

This study was performed to compare soft tissue movements resulting from a series of Le Fort I osteotomies with those predicted for the same cases by means of a computerised software package (COG 3.4). The source material consisted of serial lateral cephalometric radiographs for 25 consecutive patients that had received similar Le Fort I osteotomies primarily to correct an antero-posterior skeletal discrepancy. Generally it was found that many of the digitised points on the facial profile were surprisingly well predicted. In addition, the chin and profile changes resulting from mandibular auto-rotation also were reasonably well predicted. However, in a number of cases prediction was less consistent and this was particularly true in the region of the nose and lips. In such instances, initial size, thickness and the existing morphology of the soft tissues appeared to be important factors. The tendency of the software occasionally to 'cross-over' the plots for the upper and lower lip profile made the judgement in this area of predicted profile change difficult in some cases.

Adolescent↗

An ROC study of chest radiographs: 2K Versus 4K high-resolution soft-copy images.

Computed radiography of chest with a 4K image array was recently introduced. We performed a multiobserver study to compare the diagnostic accuracy of 2K (standard) and 4K (high quality) chest radiographs displayed on a 5-mega-pixel monitor (2K monitor). One hundred cases of posteroanterior chest radiographs (a total of 200 images) were selected by two chest radiologists. Those radiographs included pneumothorax (n = 14), nodules (n = 15), interstitial disease (n = 10), or neither abnormality (n = 61). These were interpreted by four radiologists in two separate sessions. They recorded their confidence scale for the presence or absence of abnormality. Diagnostic accuracy was determined by receiver operating characteristic (ROC) analysis for each observer. ROC analysis showed no statistically significant difference between the 2K and 4K modes for the detection of any of the different abnormalities by individual readers. Our preliminary study suggests that 2K mode would be sufficient for the detection of abnormality on chest radiograph and there is no considerable validity to incline toward the 4K mode in current picture archiving and communication system environment using 2K monitor. However, we think that additional investigation using more subtle parenchymal or rib lesion should be followed.

Humans↗

CT of soft-tissue neoplasms.

The computed tomographic scans (CT) of 84 patients with untreated soft-tissue neoplasms were studied, 75 with primary and nine with secondary lesions. Each scan was evaluated using several criteria: homogeneity and density, presence and type of calcification, presence of bony destruction, involvement of multiple muscle groups, definition of adjacent fat, border definition, and vessel or nerve involvement. CT demonstrated the lesion in all 84 patients and showed excellent anatomic detail in 64 of the 75 patients with primary neoplasms. CT did not differentiate vessel or nerve entrapment from neurovascular structures that were simply applied to the pseudocapsule of the tumor. Blurring of adjacent fat was an infrequent finding, but when it was present, the tumor was malignant. The CT findings were characteristic enough to suggest the histology of the neoplasm in only 13 lesions (nine lipomas, three hemangiomas, one neurofibroma). No malignant neoplasm had CT characteristics specific enough to differentiate it from any other malignant tumor. However, malignant neoplasms could be differentiated from benign neoplasms in 88% of the cases.

Adipose Tissue↗

The value of computed tomography in the diagnosis of soft-tissue swellings of the hand.

Twenty patients with palpable swellings of the hand were investigated by computed tomography. The results, when compared with the pathological findings, lead us to consider this a technique of considerable value in the assessment of this kind of disease. The importance of angiography and, occasionally of magnetic resonance imaging, are also stressed.

Adolescent↗

[Surgical therapy for impalpable small lung lesion; confirmation method by means of combining computed tomography (CT)-guided marking with soft X-ray radiography].

OBJECTIVE: We examined the usefulness of soft X-ray radiography of the specimen which was obtained by the lung wedge biopsy. PATIENTS AND METHODS: From September 2002 to September 2005, we entered the 10 cases (5 men and 5 women) which were consisted of 15 lesions. We performed lung wedge biopsy after computed tomography (CT)-guided lung marking, and then confirmed the lesion in the specimen by means of soft X-ray radiography. RESULTS: We could confirm impalpable small lung lesions in all cases. CONCLUSION: The confirmation method of impalpable small lung lesion that combined CT-guided lung marking with soft X-ray radiography was very useful.

Adenomatosis, Pulmonary↗

[The development and application of computer assisted photogrammetric-system of facial soft tissue running under multiple facilities for taking image].

The photogrammetric-system was developed by using multimedia computer, colour television camera, SE100 video blaster, Newsketch 1212 HR digitizer and by using Visual Basic language. It ran under Windows 3.1 and Windows 95. The features of this system: 1. It had three kinds of functions: photogrammetric function for frontal and profile facial soft tissue, function for managing file and function for forming dynamic data base. 2. It ran under different facilities for taking image (television camera with video blaster, digitizer, scanner) speedily and specificly, and had very friendly interface, and was of multimedia. The application of this system: 1. assisting diagnosing, making plan for treatment and observing results of treatment in clinic of orthodontics, orthopedics and facial plastics, 2. assisting analysing the features of facial soft tissue about certain people, 3. assisting the multimedia teaching.

Adolescent↗

[Osteomyelitis--imaging methods and their value].

Various imaging modalities are used in diagnosis of acute and chronic infectious endogenous osteomyelitis and exogenous ostitis. The pathophysiological changes of osteomyelitis/ostitis in the bone and surrounding soft tissue are known. Findings in plain film radiography show these changes only in relatively advanced stages of disease. Hence, plain film radiographs are useful as a basic imaging modality by excluding other differentials and as a follow-up modality under therapy. Ultrasound-using advanced technology--offers diagnostic help in acute osteomyelitis, especially in infants. The various techniques of nuclear medicine show much higher sensitivity for detecting osteomyelitis than plain film radiography, but do not permit good separation for bone involvement and infectious changes in the surrounding soft tissue. While computed tomography offers the ability to display bone and soft tissue separately, it has been widely replaced by magnetic resonance imaging using fat-suppressed sequences and paramagnetic contrast media which show the spread of the infectious changes with higher sensitivity and accuracy.

Adolescent↗

[A comparison between echography and computed tomography in assessing neoplastic recurrences in superficial soft tissues].

Thirty-seven superficial soft-tissue recurrences were evaluated with ultrasonography (US) and computed tomography (CT) to assess the correct diagnostic approach. US and CT examinations were performed at the same time. High-frequency US probes and a third-generation CT scanner were employed; all the lesions underwent also histology or cytology. US correctly identified as recurrences or fibrous tissue all the 37 lesions, whereas CT diagnosed 30 lesions only. Seven of the 14 recurrences < 2 cm diameter were not demonstrated. In conclusion, US provides more reliable information than CT relative to small lesions, which suggests that US must be performed just after therapy. Nevertheless, when bone involvement is suspected, CT is required and its use is also suggested to monitor distant metastases.

Biopsy, Needle↗

Cost-effectiveness of staging computed tomography of the chest in patients with T2 soft tissue sarcomas.

BACKGROUND: Published practice guidelines recommend routine chest computed tomography (CT) scanning as part of the staging evaluation for patients with T2 soft tissue sarcomas (STS), although there is no direct evidence to support this practice. The objective of this study was to determine the yield and cost-effectiveness of routine versus selective chest CT scanning for the staging of patients with T2 STS and to identify any subgroups for whom a more selective approach to chest CT scanning could be considered. METHODS: Six hundred consecutive patients with primary, nonthoracic, T2 (> 5 cm) STS underwent both chest X-ray (CXR) and chest CT scanning to evaluate the presence of pulmonary metastatic disease (M1). The authors constructed a decision tree that modeled the outcomes of diagnostic testing for two hypothetical diagnostic strategies: 1) routine chest CT (rCT) or 2) CXR and selective chest CT (sCT). The yield and cost of each strategy were determined; the incremental cost-effectiveness ratio (ICER) was calculated as the cost per additional patient with pulmonary metastases identified by rCT versus sCT. RESULTS: The yield of rCT was higher than that of sCT (M1 disease identified in 19.2% vs. 16.0% of patients, respectively), but rCT was more costly ($1301 vs. $418 per patient, respectively). The ICER of rCT compared with sCT was $27,594 per patient identified with pulmonary metastasis. The expected yields, costs, and ICERs of the diagnostic strategies varied across patient subgroups based on grade, anatomic site, and tumor size. CONCLUSIONS: For patients with T2 STS, rCT was most cost-effective in patients with high-grade lesions or extremity lesions. The findings of this study do not support the routine use of chest CT scanning in all patients with T2 STS.

Adolescent↗

Computed tomography evaluation of fatty tumors of the somatic soft tissues: clinical utility and radiologic-pathologic correlation.

The role of computed tomography (CT) in the evaluation of fatty tumors of the somatic soft tissues was investigated. Six surgically proven cases of fatty tumors were studied preoperatively by CT and standard radiographic means--conventional radiographs, xeroradiography, and angiography. Our case material included a simple lipoma, two infiltrative lipomas, an angiolipoma, and two liposarcomas. The radiologic-pathologic correlation was evaluated with respect to the various imaging modalities. The unique tissue characteristics of fatty tumors makes them particularly adaptable to CT scanning. In addition to its ability to define accurately tissue densities, the facility of CT in depicting depth, size, and extent of the lesion in the axial plane was found to be most useful in the preoperative evaluation of our case material.

Adipose Tissue↗

Use of computed tomographic densitometry to quantify contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal.

OBJECTIVES: To evaluate computed tomography (CT) densitometry as a technique for quantifying contrast enhancement of compressive soft tissues in the canine lumbosacral vertebral canal and to determine whether the degree of contrast enhancement can be used to help predict tissue type or histopathologic characteristics. ANIMALS: 29 large breed dogs with lumbosacral stenosis. PROCEDURE: Contrast-enhanced CT of L5-S3 was performed by use of a previously described protocol. At each disk level, CT densities of a water-filled syringe, epaxial muscles, and 4 vertebral canal locations were measured. Mean tissue enhancement was calculated by vertebral canal location, using water-filled syringe enhancement as a correction factor. Corrected CT enhancement was compared with tissue type, degree of tissue inflammation, and degree of tissue activity. RESULTS: Intravenous contrast administration of contrast medium significantly increased CT densities of water-filled syringes and epaxial muscles. Corrected CT enhancement of vertebral canal soft tissues at stenotic sites was greater than at nonstenotic sites. There was no association between enhancement and tissue type for any vertebral canal location. There was no correlation between enhancement and degree of tissue inflammation. There was a correlation between enhancement and tissue activity in the dorsal vertebral canal only. CONCLUSIONS AND CLINICAL RELEVANCE: A water-filled syringe is a useful calibration tool for CT density measurements. The degree of tissue contrast enhancement, measured by CT densitometry, can be helpful for predicting the location of compressive soft tissues in dogs with lumbosacral stenosis. However, it is of limited value for predicting compressive soft-tissue types or histopathologic characteristics.

Animals↗