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At least 343 records · Page 19Linked to original sources
PubMed2003

[Rotational angiography of the femoropopliteal arteries after percutaneous transluminal angioplasty: technical aspects and preliminary results].

PURPOSE: The angiographic evaluation of the results of femoropopliteal balloon angioplasty (PTA) is fundamental for monitoring long term success, but, often, the examination is performed only with one or two orthogonal projections. The aim of this study is to report our experience with a new digital angiography system able to perform "rotational" acquisitions to assess the results after femoro-popliteal PTA. MATERIALS AND METHODS: Twenty-eight patients underwent femoro-popliteal PTA due to steno-obstructive lesions varying in length between 1 and 10 cm. All examinations were performed on a Philips Integris Allura system able to perform "rotational angiography"(RA). The two frames showing the greatest degree of stenosis and the presence of subintimal "flaps" induced by PTA were compared with the frame obtained in the AP projection. RESULTS: RA after PTA was possible in all cases. In 12/28 (42.4%) cases there was no difference between the static AP projection and RA, whereas in 13/28 (46.5%) the static acquisition, compared with RA, underestimated the extent of residual stenosis by 10-30%. In 6 out of these 13 cases a discordance on the presence and extent of subintimal flap between static and rotational acquisition was identified. In three other cases (10.7%) there was substantial agreement on the residual stenosis but not on the PTA-induced dissection which was always better visible on RA. CONCLUSIONS: RA allowed optimal analyses of all cases improving the information of the conventional technique based on one projection only. It also proved very useful in demonstrating residual stenosis and PTA-induced dissections. In our experience this information modified our therapeutic approach leading to repeated balloon angioplasty or stenting in about 50% of cases.

Aged↗
PubMed1997

[Optics with natural appearing added illumination].

Today's endoscopes use a central frontal illumination which creates huge contrast, no visible shadows, and gives an unnaturally flat impression. In the SIMIC project, a new type of optics has been developed that uses additional illumination fibres ending 3 mm behind the front lens. This gives a more natural and spatial impression of the body cavity, causes shadows that are an improvement when approaching tissue with an instrument, reduces blooming in the foreground, and improves detail reproduction in the background.

Endoscopes↗
PubMed2003

Novel human vaccine strategies and the 5th Framework Programme: pushing the envelope.

Mucosal vaccines could result in a great scientific and practical achievement. More than three decades of research in experimental models have shown promising results in stimulating mucosal immune responses, thus, it was expected that within a short time mucosal vaccines for human use could be achieved. Indeed this is not being the case. In the last few years, the most important oral vaccine, the anti-polio developed by Sabin in the fifties, has been progressively abandoned in developed countries to avoid the few cases of disease caused by the vaccine. Furthermore, two recently developed mucosal vaccines for human use against rotavirus diarrhoea and influenza were withdrawn after a short period in the market because of adverse reactions among the vaccinees. This controversial situation has created a difficult future for research on mucosal vaccine at the industrial level. A great help and encouragement for believers in mucosal vaccines has been given by the EU Commission through the 5th Framework Programme (5FP). At the end of the first projects of the 5FP, it is quite clear that mucosal vaccines are experiencing a real renaissance. The Euroconference/Workshop "Novel Strategies of Mucosal Immunisation through Exploitation of Mechanisms of Innate Immunity in Pathogen-Host Interaction", organised under the sponsorship of the EU Commission and reported in this special issue of Vaccine, witnesses a very creative moment of European groups involved in mucosal immunology. This conclusive paper of the issue is intended to describe a positive experience of some European scientists that have been working together in organised fashion within two EU projects. The first, defined by the acronym MUCIMM, was aimed to pave the way to tackle mucosal vaccines with different approaches, mainly that of new delivery systems and adjuvants, that of dissecting the fine mechanisms of basic mucosal responses and that of obtaining meaningful assays to measure human immune responses to mucosal vaccines. The second, the MUCADJ project, was aimed to prove that an intranasally delivered influenza vaccine induces protective levels of immunity in human adult volunteers. The results obtained demonstrate that mucosal vaccines for humans are feasible. It is interesting to note how this model of making biomedical research is flourishing, becoming an example for work organisation. At the same time it is important to underline some of the limits of this cooperative approach and it is also mandatory to spend a word of consciousness regarding the impact that the new European regulations could exert on mucosal vaccines, particularly for those based on live delivery systems. In a world where the damages caused by syringe needles are still largely visible, mucosal vaccines could represent an extremely important tool to fight infections, particularly in the large population of the most impoverished. The EU Commission will still encourage and support mucosal vaccines in the 6FP. The scientific community must decide in which direction has to proceed to avoid regulatory problems that could halt a promising tool to improve human health. The envelope has been pushed, the trip begins.

Europe↗
PubMed2004

Severe calcification in left main stem coronary artery stenosis visible on routine chest radiograph.

Coronary calcification is a strong predictor of significant coronary stenosis in symptomatic patients. While discrete calcification within coronary arteries is only detected by sensitive methods such as computed tomography, severe calcification can already be seen on the plain chest radiograph. In this article, we describe a patient with a high grade left main stem coronary artery stenosis who presented with a severe focal calcification on the plain chest radiograph in projection of the offspring of the left coronary artery.

Aged↗
PubMed1998

Developing a nursing research culture in the university and health sectors in Western Sydney, Australia.

The context for the development of a research culture in both the health and education sectors in Australia is similar to that in other developed countries. Contextual factors, especially those resulting from increasing fiscal constraint, militate against improved research productivity for nurses in both university and health sectors. Despite this, however, an impressive range of initiatives have been designed and introduced, both unisectorally and intersectorally, in the last 14 months to expedite the development of a nursing research culture in Western Sydney. The former include, in the University of Western Sydney (UWS), reward systems for research productivity and development, the funding of Designated Research Groups and Faculty Research Support Units. In the health service they include the funding of a Clinical Development Unit (Nursing)--CDU(N)--leadership program and the provision in 1997-98 of seed funds for research projects to be undertaken in the CDU(N)s. Intersectoral initiatives include the joint funding of four 'clinical' nursing Chairs, other sub-professorial positions and a 'flagship' series of nursing research seminars. All these initiatives will be described, together with an assessment of their impact to date, in terms of (1) research productivity, (2) improved intersectoral relationships and (3) heightened visibility and appreciation of nursing and nursing research.

Academic Medical Centers↗
PubMed1989

[The supinator fat pad in fractures of the elbow joint].

The position of the supinator fat pad is regarded as a valuable sign in fractures of the elbow. In our patients the pad was visible in 277 out of 337 cases (82%). The sign was positive in only 27 out of 55 proximal fractures of the radius (sensitivity 0.49). There was no correlation between the severity of the fracture and the sign. There was marked variation in the distance between the pad and the radius, depending on age, build and projection. Our results indicate that the sign is not suitable for the diagnosis of fracture of the elbow.

Adipose Tissue↗
PubMed2001

[Application of a computer-aided detection (CAD) system to digitalized mammograms for identifying microcalcifications].

PURPOSE: It is estimated that during mammographic screening programs radiologists fail to detect approximately 25% of breast cancers visible on retrospective review; this percentage rises to 50% if minimal signs are considered. Independent double reading is now strongly recommended as it allows to reduce the rate of false negative examinations by 5-15%. Recent technological progress has allowed to develop a number of computer-aided detection (CAD) systems. The aim of CAD is to help radiologists interpret lesions by serving as a second reader. In this study the authors developed and applied a CAD system to measure its ability to microcalcifications detect and compare its performance with that of a human observer. MATERIAL AND METHODS: The study was performed as part of the CALMA (computer-aided library for mammography) project of the Pisa section of the National Institute of Nuclear Physics. The aim of this project is to set up a large database of digital mammograms and to develop a CAD system. Our study series consisted of 802 mammograms - corresponding to 213 patients - digitalized between March and June 2000. We performed traditional mammography and then digitalized the mammograms using a CCD linear scanner (pixel size of 85 x 85 microm2, 12 bits). The images were evaluated by two radiologists with similar experience and then by the CAD system. This CAD system searches for microcalcifications by using ad hoc algorithms and an artificial neural network (Sanger type). RESULTS: The number of clusters in our database was 141 corresponding to 140 images; 692 images were non pathological. The CAD system identified a variable number of clusters depending on the threshold values. The threshold value is a number over which the probability of finding a lesion is highest. With thresholds of 0.13 and 0.14 the CAD system identified 140/141 clusters (99.3%); with a threshold of 0.15 it identified 139/141 clusters (98.6%); with a threshold of 0.16, 137/141 (97.2%); with a threshold of 0.18, 133/141 (94.3%); with thresholds of 0.18 and 0.20, 130/141 (92.2%). With threshold values of 0.13, 0.14, 0.15, 0.16 and 0.17 the system's sensitivity was greater than 82%, whereas with values of 0.18 and 0.20 it was greater than 80%. The number of false positive region of interest (ROI) / image was greater with low threshold values: in particular, thresholds of 0.13 and 0.14 yielded 16 false positives /image, thresholds of 0.15 and 0.16 yielded 9 and 7 false positives/image, and both 0.18 and 0.20 only 5/image. DISCUSSION: ROC curve shows how the use of high threshold values determined a very high specificity despite very low sensitivity rates. Conversely, low threshold values allowed to have a high sensitivity and a very low specificity. The best performance of our CAD system was obtained with threshold values at 0.15 and 0.16. In fact these thresholds resulted in a high sensitivity (greater than 82%) with an acceptable number of false positives/image, 9 and 7/image, respectively. It is not yet known how radiologists can deal with large numbers of false positives in screening programmes but in our opinion the most important feature of a good CAD system is a high sensitivity. CONCLUSIONS: In the near future the use of CAD systems will be widespread and easier to apply to everyday practice above all in centers where digital mammography is performed. Mammograms could be directly shown to radiologists after the CAD system has selected the ROI and analysed the images. Thanks to its high sensitivity and despite its low specificity CAD represents a concrete aid for radiologists.

Breast Diseases↗
PubMed2001

Metallic clip deployment during stereotactic breast biopsy: retrospective analysis.

PURPOSE: To determine the visibility of presumably excised lesions on screen-film mammograms obtained after biopsy and to determine the accuracy of clip deployment on the basis of measurements obtained on routine pre- and postbiopsy mammograms. MATERIALS AND METHODS: One hundred eleven cases of core-needle biopsy with clip deployment were reviewed. In each, the type of lesion, lesion location, and biopsy approach were recorded. Pre- and postbiopsy images were reviewed, and the distance between the clip and biopsy site was measured. Postbiopsy images were reviewed to determine whether the targeted lesion remained visible. RESULTS: In 62 (56%) cases, the clip was located within 5 mm of the target on postbiopsy images (craniocaudal and mediolateral), while in 18 (16%), the clip was within 6-10 mm on one projection. However, 31 (28%) clips were more than 1 cm from the target on at least one postbiopsy image. Of the 111 cases, 39 (35%) were malignant or atypical and required excision. Of these, 18 (46%) had clips at least 1 cm from the targeted lesion on at least one projection. CONCLUSION: Metallic clips placed during core-needle breast biopsy are intended to mark the biopsy site when the visible lesion is excised, in case additional biopsy is required. The data suggest that the position of metallic clips placed during stereotactic core-needle biopsy may differ substantially from the location of the biopsy site. Postbiopsy mammography should be performed in two orthogonal planes to document clip position relative to the biopsy site.

Biopsy, Needle↗
PubMed2001

Under one roof: the Miami Project to Cure Paralysis model for spinal cord injury research.

Concentrating a wide range of spinal cord injury (SCI) research laboratories in a single location to accelerate progress and draw attention to the promise of SCI research has made The Miami Project to Cure Paralysis one of the most publicly recognized and often controversial research groups in the neurosciences. A "Center of Excellence" at the University of Miami School of Medicine, the Miami Project also serves as a model for SCI research programs being developed nationally and internationally. Founded in 1985, the Miami Project set out on an unprecedented path-to develop a research center dedicated to improving treatments for SCI by bridging basic and clinical science. In doing so, neurosurgeon Barth Green, M.D., enlisted not only a multidisciplinary team of scientists but also a devoted following of financial donors and volunteer research subjects, and support from the University of Miami and Florida legislature. Highly visible spokespersons, including cofounder ex-Miami Dolphin Nick Buoniconti and his son Marc, brought the issue of SCI paralysis and the promise of research before the public, the media, and sports communities. As progress in the neurosciences has raced ahead, public attention to medical research, and SCI research in particular, has grown exponentially. This review will assess the Miami Project as a model for disease-based research that unites academic, philanthropic, and patient communities in a common cause.

Academic Medical Centers↗
PubMed2004

3 dimensional modelling of early human brain development using optical projection tomography.

BACKGROUND: As development proceeds the human embryo attains an ever more complex three dimensional (3D) structure. Analyzing the gene expression patterns that underlie these changes and interpreting their significance depends on identifying the anatomical structures to which they map and following these patterns in developing 3D structures over time. The difficulty of this task greatly increases as more gene expression patterns are added, particularly in organs with complex 3D structures such as the brain. Optical Projection Tomography (OPT) is a new technology which has been developed for rapidly generating digital 3D models of intact specimens. We have assessed the resolution of unstained neuronal structures within a Carnegie Stage (CS)17 OPT model and tested its use as a framework onto which anatomical structures can be defined and gene expression data mapped. RESULTS: Resolution of the OPT models was assessed by comparison of digital sections with physical sections stained, either with haematoxylin and eosin (H&E) or by immunocytochemistry for GAP43 or PAX6, to identify specific anatomical features. Despite the 3D models being of unstained tissue, peripheral nervous system structures from the trigeminal ganglion (approximately 300 microm by approximately 150 microm) to the rootlets of cranial nerve XII (approximately 20 microm in diameter) were clearly identifiable, as were structures in the developing neural tube such as the zona limitans intrathalamica (core is approximately 30 microm thick). Fourteen anatomical domains have been identified and visualised within the CS17 model. Two 3D gene expression domains, known to be defined by Pax6 expression in the mouse, were clearly visible when PAX6 data from 2D sections were mapped to the CS17 model. The feasibility of applying the OPT technology to all stages from CS12 to CS23, which encompasses the major period of organogenesis for the human developing central nervous system, was successfully demonstrated. CONCLUSION: In the CS17 model considerable detail is visible within the developing nervous system at a minimum resolution of approximately 20 microm and 3D anatomical and gene expression domains can be defined and visualised successfully. The OPT models and accompanying technologies for manipulating them provide a powerful approach to visualising and analysing gene expression and morphology during early human brain development.

Brain↗
PubMed1999

Distribution of cathepsin D in human eyes with or without age-related maculopathy.

Cathepsin D is a ubiquitous enzyme which plays an important role in the catabolism of proteins. Enzymatic studies showed that cathepsin D is the most important lysosomal enzyme in the proteolysis of opsin. The importance of cathepsin D in the lysosomal digestion of phagocytosed photoreceptor outer segments by the retinal pigment epithelium suggests that a decrease in cathepsin D activity might contribute to the development of hyalinized drusen and to the development of age-related maculopathy. The aim of this project was to study the immunohistochemical localization of cathepsin D in human eyes and particularly to compare the immunoreactivity of cathepsin D normal retinal pigment epithelial cells and in cells surrounding hyalinized drusen or lesions of age-related maculopathy. Following clinicopathological examinations the eyes were fixed, paraffin embedded and individual sections were subjected to Picro-Mallory staining for histopathological examination. Bleaching was performed then immunohistochemistry was carried out using a monoclonal mouse anti-human cathepsin D antibody. On the basis of the appearance of basal laminar deposit the eyes were divided into five groups corresponding to levels of progression in age-related maculopathy development. Following optimization of bleaching cathepsin D immunostaining was clearly visible in the iris epithelium, ciliary body and the retinal pigment epithelial layer of all eyes with the highest immunoreactivity present in the RPE cells. Within the neural retina the ganglion cells demonstrated a weak signal. Retinal pigment epithelial cathepsin D immunoreactivity was not impaired by age, geographical location or by age-related maculopathy status. There was a small increase in cathepsin D immunoreactivity around hyalinized drusen. The maintenance of cathepsin D immunoreactivity in eyes with hyalinized drusen or in samples with age-related maculopathy suggest that down-regulation of cathepsin D expression in the affected locations does not precede the development of these conditions. However, further studies are required to establish if the immunoreactive cathepsin D represents the fully processed biologically active enzyme.

Adolescent↗
PubMed1995

The use of color Doppler imaging for the assessment of sacroiliac joint stiffness: a study on embalmed human pelvises.

PURPOSE: The validity and reproducibility of an instrumented dynamic examination method to measure sacroiliac (SI) joint stiffness was tested in vitro. METHODS: Four embalmed human female pelvises were excitated by a pelvic vibrator. A color Doppler imaging (CDI) scanner was used to image the amplitude of vibrations at different sites of the pelvis. Vibrations were applied to the anterior superior iliac spines unilaterally and were received by CDI all over the ipsilateral SI region. Three different stability conditions were created in the SI joints: no intervention, screwed and ligaments cut. Test results were quantified by taking the minimum threshold levels of the bones. The relative difference of vibration intensity between ipsilateral ilium and sacrum at each stability condition is accepted as the stiffness level for the SI joint. RESULTS: Statistics showed high reproducibility and significant differences between the stability conditions. Dynamic testing based on the use of vibrations provides visible and quantifiable intra- and inter-individual differences between SI joint stiffnesses. CONCLUSIONS: This new method is objective and reproducible. Future in vivo application is promising since there are no technical and safety restrictions.

Aged↗
PubMed2001

Outcome of stroke patients without angiographically revealed arterial occlusion within four hours of symptom onset.

BACKGROUND AND PURPOSE: Follow-up imaging data from stroke patients without angiographically apparent arterial occlusions at symptom onset are lacking. We reviewed our Emergency Management of Stroke (EMS) trial experience to determine the clinical and imaging outcomes of patients with ischemic stroke who showed no arterial occlusion on angiograms obtained within 4 hours of symptom onset. METHODS: All patients in this report were participants in the EMS trial that was designed to address the safety and potential efficacy of combined IV and intraarterial thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) in patients with acute ischemic stroke. RESULTS: Thirty-five patients were randomized to receive either IV rt-PA (n = 17) or placebo (n = 18), followed by cerebral angiography. No symptomatic arterial occlusion was evident in 10 (29%) of the 34 patients. Eight (80%) of 10 patients without angiographically apparent clot within 4 hours of symptom onset had a new cerebral infarction confirmed on follow-up brain imaging. The median 72-hour infarction volume was 2.4 cc (range, 1-30 cc). Four of the 10 "no-clot" patients had a favorable 3-month outcome as assessed by Barthel Index (score, 95 or 100) and modified Rankin Scale (score, 0 or 1). The six remaining patients had 3-month Rankin Scale scores of 1 (Barthel of 90), 2, 3, 4, or 5. CONCLUSION: Acute ischemic stroke patients with a neurologic deficit but a negative angiogram during the first 4 hours after symptom onset usually develop image-documented cerebral infarction, and approximately half suffer from long-term functional disability. The two most likely explanations for negative angiograms are very early irreversible ischemic damage despite recanalization or ongoing ischemia secondary to clot in non-visible penetrating arterioles or in the microvasculature.

Aged↗
PubMed2004

Unique partnership makes a solid case for on-site DM.

Don't discount such factors as high visibility and easy access when putting together your DM program. These advantages figured strongly into the development of a unique diabetes program in Massachusetts that is actually making a profit for the provider group that funds the program. In fact, the effort has gotten so much positive attention that other practices are now referring patients to the program.

Boston↗
PubMed2006

A pilot case control study on the efficacy of acetic acid wash and chemiluminescent illumination (ViziLite) in the visualisation of oral mucosal white lesions.

Conventional screening practice for oral lesions involves visual scrutiny of the oral tissues with the naked eye under projected incandescent or halogen illumination. Visualisation is the principal strategy used to assess patients' lesions at risk for malignant transformation; hence, any procedure which highlights such lesions should aid the clinician. The aim of this pilot study was to examine the efficacy of acetic acid wash and chemiluminescent light (ViziLite) in enhancing visualisation of oral mucosal white lesions, and its ability to highlight malignant and potentially malignant lesions. Fifty five patients referred for assessment of an oral white lesion, were prospectively screened with ViziLite, and an incisional scalpel biopsy performed for a definitive diagnosis. The size, location, ease of visibility, border distinctness, and presence of satellite lesions were recorded. The ViziLite tool enhanced intra-oral visualisation of 26 white lesions. Indeed, all lesions appeared "aceto-white", regardless of the definitive diagnosis. Examination of the oral tissues with ViziLite illumination did not change the provisional diagnosis, nor alter the biopsy site. ViziLite illumination does not discriminate between keratotic, inflammatory, malignant or potentially malignant oral mucosal white lesions and thus, a high index of suspicion, expert clinical judgment, and scalpel biopsy are still essential for proper patient care.

Acetic Acid↗
PubMed2004

Detailed anatomy of the abdomen and pelvis of the visible human female.

We report on a virtual anatomical preparation of the abdomen and pelvis of the Visible Human Female (VHF) for laparoscopic surgery training. The detailed cross-sectional image data set from the U.S. National Library of Medicine was used as the basis to build an exemplary model of the female abdomen and pelvis. Segmentation software was developed to delineate organ outlines and more than 300 structures of interest, including organs, blood vessels, bones, muscles, and ligaments, have been segmented and three-dimensionally reconstructed. Analyzing the normal anatomy we found several variations and pathologies of the VHF, such as missing muscles (gemellus superior, psoas minor), additional veins as well as spondylophytes (vertebral column, pubic bone), and colon diverticula. The complete data set may be viewed on the home page of the project (http://www.vision.ee.ethz.ch/projects/Lasso/start.html).

Abdomen↗
PubMed2001

Early and late morphological effects of experimental HPNS--animal model of psychosis?

The high pressure neurological syndrome (HPNS), a neurological condition during elevated pressure especially in deep diving, has been simulated with experimental animals. Rats were subjected to 61 bars with slow pressure increase and one or two hours constant high pressure; subsequently the pressure was released to sea level within 20 seconds--leading to immediate oxygen depletion and death of animals--or with slow decompression rates allowing survival. In all animals, brains and partly other organs were investigated morphologically. In animals sacrificed immediately, subtle changes in different brain regions were found: symmetrical occurrence of dark neurons in the hippocampus formation, cortex and brain stem, reduced expression of tyrosin hydroxylase in the substantia nigra and enhanced expression of Bax protein in some of these regions. The dark neurons were only observed after aldehyde fixation, otherwise the brains were unaltered despite ultrarapid decrease of highly elevated pressure. In animals that were allowed to survive for different time periods, some of these subtle changes were equally noted by light and electron microscopy. Furthermore, the ventricles were enlarged, the astrocytic reaction in the hippocampus increased and some signs of the destruction of the adrenal gland were visible. We conclude, that HPNS leads to minimal changes within the nervous system. The behaviour of animals during pressure was slightly altered, the weights after the experiments reduced, but no lasting sequelae were noted. Since both in human and experimental deep diving conditions signs of psychosis were reported, this HPNS model must be considered as a tentative animal model of human psychosis.

Adrenal Glands↗
PubMed2002

Oblique radiograph for the detection of bone spurs in anterior ankle impingement.

OBJECTIVE: The aim of this study was to develop a radiographic view to detect anteromedial talotibial osteophytes that remain undetected on standard radiographs. DESIGN AND PATIENTS: In 10 cadaver specimens the maximal size was measured of anteromedial tibial osteophytes that remain undetected on a standard lateral radiograph projection, due to the presence of the anteromedial tibial rim. The average projection of the most prominent anterolateral tibial rim over the anteromedial rim was found to be 7.3 mm. A 7 mm barium-clay osteophyte was attached to this anteromedial rim of the distal tibia. Anteromedial osteophytes become most prominent on an oblique view, in which the radiographic beam is tilted into a 45 degrees craniocaudal direction with the leg in 30 degrees external rotation. This oblique view was compared with the findings of arthroscopic surgery in 25 consecutive patients with anterior ankle impingement syndrome. RESULTS: Medially located tibial and talar osteophytes remained undetected on a standard lateral projection and became visible on the oblique anteromedial impingement (AMI) radiograph. Anterolateral tibial and talar osteophytes were well detected on a standard lateral radiograph projection but were invisible on the AMI view. There was a high correlation between the location of the osteophyte and the location of symptoms and the findings at arthroscopy. CONCLUSION: A combination of lateral and oblique radiographs can be used to differentiate between anteromedial and anterolateral bony ankle impingement.

Adult↗