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PubMed1999

An approach for access differentiation design in medical distributed applications built on databases.

A formalized "top to bottom" design approach was described in [1] for distributed applications built on databases, which were considered as a medium between virtual and real user environments for a specific medical application. Merging different components within a unified distributed application posits new essential problems for software. Particularly protection tools, which are sufficient separately, become deficient during the integration due to specific additional links and relationships not considered formerly. E.g., it is impossible to protect a shared object in the virtual operating room using only DBMS protection tools, if the object is stored as a record in DB tables. The solution of the problem should be found only within the more general application framework. Appropriate tools are absent or unavailable. The present paper suggests a detailed outline of a design and testing toolset for access differentiation systems (ADS) in distributed medical applications which use databases. The appropriate formal model as well as tools for its mapping to a DMBS are suggested. Remote users connected via global networks are considered too.

Computer Communication Networks↗
PubMedDate not supplied

A giant parietal wall hematoma: unusual complication of laparoscopic appendectomy.

Laparoscopic appendectomy is an established procedure in the treatment of appendicitis. Complications of the procedure are related to the Veress needle and trocar insertions or pertain to actual operative procedures. Trocar-elated major bleeding is rare, and, if it occurs, is detected on the table or during the immediate postoperative period. Delay in recognition may lead to significant morbidity and mortality. We report a case of giant parietal wall hematoma in a 34-year-old female, presenting one week after discharge from the hospital. The hematoma was completely evacuated by exploration through paramedian incision, followed by an uneventful recovery.

Abdominal Muscles↗
PubMed2005

[Laboratory study of effects of yifuning soft capsules on postmenopausal osteoporosis].

OBJECTIVE: To study the effects of Yifuning soft capsules on postmenopausal osteoporosis in ovariectomized female rats. METHOD: 60 female sprague-dawley rats in 3-month were used, 50 of them were ovariectomized and randomly divided into 5 groups: ovariectomy (OVX), OVX with diethylstilbestrol tables (DT), OVX with YFN (high dose, middle dose and low dose), the others were sham-operated group. Began to give the rats drugs in the fifth week after the operation. After 12 weeks killed the rats. The blood,the uterus and bones were collected to inspect. The content of estrogen (E2) in serum was detected by radioimmunoassay method. The contents of Ca, P, ALP in serum were detected using the automic biochemistry-analyse device. The uterus were weight and the length, width, dry weight and net weight of the shoulder bone were measured. The contents of Ca, Mg, Zn, Mn in the bone were measured using the automic absorption spectrophotometer. The right femer and the third lumbar vertebra were detected for BMD using the dual-energy X-ray absorptiometry scanner and compression test using electronic testing device. RESULT: After using the drugs,the content of E2, Ca in serum, the weight of uterus, the contents of Ca, Mg, Zn, Mn in the bone and the BMD of right femer increased significantly, the content of P, ALP in serum decreased significantly. CONCLUSION: Yifuning soft capsules has a good effect on postmenopausal osteoporosis, which provides evidence for clinical use.

Animals↗
PubMed2005

[Effects of Yi-Fu Ning soft gelatin capsules on estrogen receptor expression in bone of postmenopausal osteoporosis rats].

OBJECTIVE: To investigate the effects of Yi-Fu Ning Soft Gelatin Capsules on estrogen receptor expression in bone of postmenopausal osteoporosis rats. METHOD: 60 female Sprague-Dawley rats in 3-month were used, 50 of them were ovariectomized and randomly divided into 5 groups:ovariectomy (OVX), OVX with diethylstilbestrol tables (DT), OVX with YFN (high dose, middle dose and low dose), the others were sham-operated group. The rats were administrated initially in the fifth week after the operation. After 12 weeks the rats were killed. The blood and bones were collected to inspect. The content of Estrogen (E2) in serum was detected by radioimmunoassay method. The expression of estrogen receptor in bones was studied with Western blotting. RESULT: After using the drugs, the content of E2, the estrogen receptor expression in bone increased significantly. CONCLUSION: Yi-Fu Ning Soft Gelatin Capsules has a good effect on postmenopausal osteoporosis by increasing E2 and ER expression in bones.

Animals↗
PubMed2006

[Effects of Yifuning soft gelatin capsules on pathology and biomechanical indexes of ovariectomied rats].

OBJECTIVE: To study the effects of Yifuning soft gelatin capsules (YFN) on pathology and biomechanical indexes of ovariectomied female rats. METHOD: Sixty female Sprague-Dawley rats without pregnancy and delivery were used,50 of them were ovariectomized and randomly divided into 5 groups: ovariectomy(OVX), OVX with diethylstilbestrol tables (DT), OVX with YFN (high dose,middle dose and low dose), the others were sham-operated group. The rats began to take the rats drugs in the fifth week after the operation. After 12 weeks of treat ment the rats were killed, and the bones were collected to inspect. The pathology of bone was observed with the HE stain and the area of trabecular was detected. The electronic testing device was used to detect the biomechanical properties. RESULT: The results indicated that the rat model of postmenopausal osteoporosis (PMO) was a success. Compared with the model group, after application of the drugs, the observation of HE showed different repairing around trabecular. The biomechanical parameters also increased significantly. CONCLUSION: YFN can effectively prevent the loss of bone in OVX rats and strengthen bone quality, and has a good effect on PMO oostmenopausal osteoporosis.

Animals↗
PubMed1991

Percutaneous cerclage wiring and interlocking nailing for treatment of torsional fractures of the tibia.

A new method for treatment of torsional tibial fractures allows full weight bearing two days post-operatively. Percutaneous cerclage wiring (Gotzes method) is done after a manual anatomic reduction on a normal fracture table, followed by static interlocking nailing. Compared to other methods, no extensive exposure is necessary, which helps preserve the periosteal blood supply. These considerations, as well as an early axial pressure load and an almost absolute stability, might explain the roentgenographic and clinical evidence that bone healing with minimal callus formation occurs six to eight weeks postoperatively.

Adult↗
PubMed1990

[Therapy of carotid stenosis in contralateral occlusion of the internal carotid artery].

From January 1985 up to December 1987 sixteen patients with unilateral stenosis of the internal carotid artery (ICA) and concomitant chronic contralateral carotid occlusion underwent surgical correction of the stenosis. 31.2% were asymptomatic, 18.7% had transient ischemic attacks and 50% had suffered a stroke. On the occluded side 31.2% had had a stroke. Angiography showed intracerebral shunting to the occluded side in 43.7%; 56.2% of the patients had concomitant stenoses of intracerebral vessels. Surgical correction consisted of endarterectomy and patch-plasty of the ICA-stenosis in local anesthesia under protection of an intraluminal shunt. There was no mortality and no perioperative stroke. After a mean interval of 32 months life table analysis showed a stroke-free rate of 92% from 6 to 24 months on the operated side and of 84% from 12 to 24 months on the occluded side. We conclude that ICA-endarterectomy in patients with contralateral ICA-occlusion can be done without increased perioperative risk and yields satisfactory long time results.

Arterial Occlusive Diseases↗
PubMed1988

Radial nerve palsy.

The anatomy of the radial nerve, functional loss from nerve damage at various levels, timing of tendon transfers, choices of tendon motors for transfer, and operative and postoperative management have been discussed. My preference of transfers for complete radial nerve palsy is: (table: see text).

Hand↗
PubMed1988

Hip arthroscopy using the lateral approach.

The benefits of hip arthroscopy are apparent. It produces little postoperative morbidity and can be performed on an outpatient basis. The prompt recovery from the operation is also beneficial, particularly for elderly patients. Distraction of the hip by traction on a fracture table is necessary. Suggested indications for this procedure include synovectomy and synovial biopsy; removal of loose bodies; removal of debris after a closed reduction of a fracture-dislocation; evaluation and treatment of osteochondritis dissecans; evaluation for arthroplasty; and unresolved hip pain. Whether the lateral approach is useful in the following situations is yet to be explored: (1) Evaluation of pediatric conditions such as Legg-Perthes disease and congenital dislocated hip; (2) treatment of localized infection; (3) removal of entrapped methylmethacrylate in total hip replacement; and (4) reducing and fixating an acetabular fracture (M. Brennan, oral communication, April 6, 1987). Arthroscopy of the hip joint by the lateral approach is a valuable addition to the evaluation and treatment of hip disorders.

Adolescent↗
PubMed1984

Femorofemoral bypass grafts: ten-year experience.

From August 1972 to September 1982, one of us (F.R.P.) performed 119 femorofemoral bypass grafts on 78 men and 35 women with an average age of 62 years. Axillofemorofemoral grafts were excluded. The 30-day operative mortality rate was 1.7% (2 of 119). The cumulative patency rates determined by the life-table method were 97.4% at 30 days, 95.1% at 1 year, 83.3% at 3 years, 72.2% at 5 years, and 55% from 6 through 10 years. There were no graft failures in the 21 patients followed up for more than 6 years. There were 21 grafts at risk at 7 years, 15 at 8 years, 10 at 9 years, and four at 10 years. Donor iliac arteries were judged to be acceptable by a combination of simple analyses including physical examination, noninvasive laboratory testing, angiography, and intraoperative direct blood pressure measurements. There was no evidence of a vascular steal in any of the postoperative patients. One patient required an inflow procedure 2 years following femorofemoral grafting. Two patients required resection of an abdominal aortic aneurysm 2 and 3 years, respectively, following femorofemoral grafting. There was one early graft failure secondary to infection, and five grafts became infected at 20,29,33,46, and 62 months, respectively, following femorofemoral grafting. False aneurysm formation, diabetes, and trauma were significant factors in these infections. Initially only high-risk patients were selected as candidates for femorofemoral grafting. Because we were encouraged by the early success rate and the apparent durability of the method, the indications were broadened to include good-risk patients who met rigid criteria for femorofemoral grafting.

Adult↗
PubMed1983

[Risk in welding operations. Etiopathogenetic, preventive and legislative considerations].

This work classifies different types of welding procedure, occasional and specific contaminating elements, both of the welding material, and of other possible substances (particularly plastic materials) used in the pre-treating phase. The authors show the risk evaluation factors of the welding operations and, moreover, suggest a diagnostic and prevention program on the exposed subjects. Finally they include a table of references on italian law concerning the contaminating substances produced by welding processes.

Environmental Pollution↗
PubMed1978

Breast reduction.

Large breasts cause problems mainly because of physical discomfort and/or associated emotional problems, and surgery is sought primarily for these rather than for purely cosmetic reasons. Indications for carrying out a breast reduction are given, and important questions are posed and answered to help elucidate many of the factors pertaining to the operation. The overall results that can be expected as well as the possible complications are discussed. A table listing complications in a series of 50 patients is shown. In conclusion, the degree of patient satisfaction that can be expected is briefly discussed.

Breast↗
PubMed1994

[Basic principles of vascular imaging with spiral CT].

Vascular investigations by CT have experienced a decisive advance and found a high acceptance since the introduction of fast volume scanning (spiral CT). We have investigated the underlying physical foundations and optimized the operational aspects of the method now introduced as CT angiography (CTA). Investigations are carried out with a table feed of 1-10 mm/s. Images are reconstructed at 1-2 mm separations by use of algorithms which optimize the layer profile. The parameters must be adapted to the region being investigated. The diagnosis is generally made with interactive cine runs; for this the original images, multiplanar reformations, 3D surface shaded displays (SSD), and maximum intensity projection (MIP) images are used. The 3D representations are discussed in the context of the principle and illustrative examples. Important applications for CTA are the evaluation of aortic aneurysms and dissections, pulmonary vessels, renal arteries, and vessel stents. CTA is characterized by short examination times, low invasiveness, and relatively low cost; in typical cases it is associated with an effective dose of 2-10 mSv. The advantages and disadvantages of the new method are discussed in terms of diagnostic value, image quality, patient dose, contrast medium techniques, and practical aspects in comparison to other angiographic methods.

Algorithms↗
PubMed1997

Combined percutaneous transluminal angioplasty, iliac stent deployment, and femorofemoral bypass for bilateral aortoiliac occlusive disease.

BACKGROUND: We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease. STUDY DESIGN: Retrospective review. RESULTS: During the 5-year period from June 1988 to October 1993, 18 patients with iliac occlusion and a hemodynamically significant contralateral iliac stenosis were treated using a combination of endovascular and open surgical techniques. Patients (13 men and 5 women) ranged in age from 50 to 78 years (mean, 64 years). Thirteen patients (72 percent) were treated for claudication, and 5 patients (28 percent) for rest pain or ulceration. Residual intra-arterial pressure gradients following percutaneous transluminal angioplasty or significant postpercutaneous transluminal angioplasty dissection were the indications for stent deployment in 15 and 3 patients, respectively. No operative deaths occurred, but 3 patients (16 percent) had early complications. Primary patency, as determined by life table analysis, was 100 percent, 79 percent, 62 percent, and 51 percent at 1, 2, 3, and 5 years, respectively. Secondary patency at 1, 2, 3, and 5 years was 100 percent, 93 percent, 75 percent, and 63 percent, respectively, with a mean follow-up of 41 months. CONCLUSIONS: The combination of percutaneous transluminal angioplasty with primary or secondary stent deployment and femorofemoral bypass can be a useful option for treating iliac occlusion and contralateral iliac stenosis of less than 3 cm in length when the severity of the comorbid illnesses, advanced age, or the presence of prohibitive intra-abdominal pathology makes the avoidance of an abdominal incision desirable.

Aged↗
PubMed1997

[Defecation problems: incontinence, constipation and impeded defecation; why and what can be done?].

Defaecation disorders may be subsumed in three categories: Inability to control motions = incontinence. Difficulty of evacuation = constipation [inertia coli, outlet obstruction]. Impeded defaecation: Rectocele, enterocele, intussusception. Etiology, examination and therapy are described in detail. Characteristic complaints of patients are listed and matched with probable diagnoses. Beside routine proctologic examination endosonography, estimation of transit time, endoscopy and defecography are discussed. The role of nutrition is stressed and emphasis layed on fibre and fluid intake. The advice, "take more fluid and fibres" does not help a lot, because no individual help is given. A time consuming nutrition and defaecation history has to be taken to establish nutritional support. This attention gives confidence to the patient and helps a great deal in the treatment. A checklist of the therapy of constipation and summarizing tables on different types of fibres are included. Additional conservative treatments are pelvic exercises and biofeedback training. Operative therapy is directed towards etiology of the disorder. Therefore many different methods exist and their diagnose related indication are discussed.

Anal Canal↗
PubMedDate not supplied

Pharmacological criteria for ventricular assist device insertion following postcardiotomy shock: experience with the Abiomed BVS system.

BACKGROUND/AIM: The traditional approach to postcardiotomy shock includes inotropic support followed by the application of an intra-aortic balloon pump (IABP). Consideration toward insertion of a ventricular assist device (VAD) becomes necessary when these maneuvers fail to restore hemodynamic stability. The definition of maximal inotropic support, however, is lacking such that a standard formula for VAD insertion remains problematic. The purpose of this paper is to define the pharmacological thresholds for VAD implantation in the setting of postcardiotomy cardiogenic shock. METHODS: The medical records of all adult open-heart operations performed at Hahnemann University Hospital, Philadelphia, PA, from 1 July 1996 through 1 July 1999 were reviewed. Specific data were collected on the hemodynamics and inotrope levels upon separation from cardiopulmonary bypass (CPB). The hospital course was reviewed with attention toward documenting hospital mortality. Cardiogenic shock was defined as systolic blood pressure (SBP) < 100 mmHg, mean pulmonary artery blood pressure (mPAP) > 25 mmHg, central venous pressure (CVP) > 15 mmHg, and cardiac index (CI) < 2.0 L/min/per m2. Inotrope dosages were defined as low, moderate, and high according to assigned values. A formula for VAD insertion was established if cardiogenic shock parameters were present in the setting of two or more high dose inotropes. Early VAD insertion was defined as implantation within three hours of the first attempt to wean from CPB. The VAD recipients were divided into two groups. Group A were VADs placed in conjunction with the formula. Group B was VADs placed in violation (excess) of the formula. The results of these two groups were compared. [table: see text] RESULTS: From 1 July 1996 to 1 July 1999, there were 3462 adult open-heart operations performed at Hahnemann University Hospital, Philadelphia, Pa. The hospital mortality for patients successfully separating from CPB on no inotropes, low-dose, moderate-dose, one high-dose, two high-dose, and three high-dose inotropes were approximately 2.0%, 3.0%, 7.5%, 21%, 42%, and 80% respectively. During this time there were 29 patients supported with the Abiomed BVS (Danvers, Mass) system for postcardiotomy cardiogenic shock. For the entire group of VAD recipients, there were 18 (62%) who were successfully weaned and 8 (28%) who were discharged from the hospital. For the 20 VAD recipients in group A, there were 16 (80%) who were successfully weaned and 8 (40%) who were discharged from the hospital. For the nine VAD recipients in group B, there were two (22%) who were successfully weaned and zero (0%) who were discharged from the hospital. Multiple organ system failure occurred in three (15%) in group A versus seven (78%) in group B patients, respectively. Early VAD insertion was accomplished in 17 (85%) group A patients and 2 (22%) group B patients. CONCLUSIONS: Hospital mortality correlates with the number and level of inotropic support necessary to separate from CPB following adult open heart surgery. The application of a standard pharmacological formula together with hemodynamic criteria for VAD insertion after postcardiotomy cardiogenic shock results in earlier insertion, lower incidence of postoperative MOSF, and improved wean and discharge rates.

Algorithms↗
PubMed1986

Limb salvage in octogenarians and nonagenarians.

Although advanced age has often been a relative contraindication to attempts at limb salvage, we have not regarded it as an important deterrent to arterial reconstruction. Our 6-year experience with 168 consecutive patients over 80 years of age who underwent arterial reconstruction or percutaneous transluminal angioplasty represented 18% of all patients treated with limb-threatening ischemia during this period. The average age was 84 years, with 14 patients over 90 years of age. Sixty-eight patients were men (41%) and 100 were women (59%). Indications for treatment in 189 limbs were restricted to limb salvage. One hundred eighty-two operative procedures were performed consisting of 84 femoropopliteal, 72 femorotibial, 12 axillofemoral, 11 femorofemoral, two axillopopliteal and one iliofemoral bypass. Percutaneous transluminal angioplasty was performed in 12 iliac and 14 femoral or popliteal arteries as an alternative (seven) or adjunct (19) to vascular reconstruction. The 30-day procedural mortality rate was 6%. The cumulative life table survival rate of all patients who underwent an attempt at limb salvage was 78% at 1 year, 65% at 2 years, and 54% at 3 years. Cumulative life table limb salvage rates were 84% at 1 year, 74% at 2 years, and 71% at 3 years. Overall graft patency for 182 arterial reconstructive operations was 80% at 1 year and 62% at 3 years. Of patients in whom limb salvage was attempted, 65% lived more than 1 year and 51% more than 2 years with a functional limb. Of patients who died within 5 years of treatment, 76% did so with their previously threatened limb intact. These data support an aggressive approach to arterial reconstruction in elderly patients and indicate that advanced age alone should not be considered a contraindication to attempts at limb salvage.

Actuarial Analysis↗
PubMedDate not supplied

[Acute superficial thrombophlebitis--modern diagnosis and therapy].

Acute superficial thrombophlebitis of the lower extremities is one of the most common vascular diseases affecting the population. Although it is generally considered as a benign disease, it can be extended to the deep venous system and pulmonary embolism. We examined 50 patients (22 males and 28 females), mean age 52.5 years. These patients were surgically treated due to acute superficial thrombophlebitis of the lower limbs that affected great saphenous vein above the knee. The diagnosis was made by palpable subcutaneous cords in the course of great saphenous vein or its tributaries in association with tenderness, erythema and oedema. Of these 50 patients, 26 were examined by duplex ultrasonography before the operation. In 20 patients duplex scanning confirmed that the process was greater than we supposed after clinical examination (77%) and in 6 patients there were no differences (23%) (Figures 1 and 2). The operation included crossectomy, ligation and resection of the proximal part of the great saphenous vein. Intraoperative findings in 38 patients showed that the level of the phlebitic process was higher than the clinical level (76%). There was no difference in 12 patients (24%). Deep vein thrombosis and pulmonary embolism were noted in 14 patients (28%) (Tables 1 and 2). Both complications were found in two patients, and 12 had one of these complications. Generally, there were 12 patients with deep venous thrombosis and 4 patients with pulmonary embolism. Only in one patient deep venous thrombosis appeared postoperatively, while all other complications occurred before surgical intervention (Scheme 1 and Table 3). The most common risk factor was the presence of varicose veins (86%). Obesity, age over 60 years, cigarette smoking are listed in decreasing order of frequency. Patients under 60 years were more likely to have complications while older patients usually followed a benign clinical course (Tables 4 and 5). There was no intrahospital mortality. Average hospitalization was 5.7 days. It was 4 days in patients without complications. After thes urgent operation that practically removed the risk of potentially fatal consequences, the patients were dismissed from hospital. New hospitalization was recommended after two weeks when the second act of surgical treatment was performed. It included stripping of the great saphenous vein and extirpation of varicose veins in the area without acute inflammation. The findings of this study confirm the general opinion that acute superficial thrombophlebitis is a very common vascular disease with usually "benign" clinical course. In its ascending form that affects the great saphenous vein above the knee it can be associated with deep venous thrombosis and pulmonary embolism. The level of phlebitic process is usually much higher than can be palpated clinically. Duplex scanning was a highly reliable, precise, fast non-invasive diagnostic method that is necessary in examining, following and making decision for operative treatment of acute superficial thrombophlebitis. If suspected complications an urgent surgical intervention should be performed. It is short and efficient, contributing to the fast recovery of the patients and their return to normal activities.

Acute Disease↗

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