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The clinical applications of computed x ray tomography (CT in tumour identification are reviewed. The advantages and limitations of the technique are highlighted in the context of tumour presentation, staging and subsequent management. Particular emphasis is laid on the ability of CT guided biopsy techniques to overcome the lack of soft tissue specificity inherent in CT scanning.
A model of experimental hepatointestinal transplant in pigs, with clinical applications is presented. Ten animals received a graft composed by the liver and the full length of the small bowel. Two pigs died during the transplant and in eight the surgical procedure was well tolerated with a good revascularization of the grafts. The coagulation parameters were normal after the transplant and only minor biochemical disturbances were found. The main difficulties of the surgical technique are related with the poor tolerance of the pig to the portal and caval clamping, and the close relationships of the duodenum, pancreas and distal colon, produced by the 360 degrees anti-clockwise bowel rotation around the mesenteric vessels. Clamping the supraceliac aorta during the implant of the graft keeps the animal hemodynamically stable and makes unnecessary the use of the more complicated veno venous shunt.
Positron emission tomography (PET) provides metabolic information that has been documented to be useful in patient care. The properties of positron decay permit accurate imaging of the distribution of positron-emitting radiopharmaceuticals. The wide array of positron-emitting radiopharmaceuticals has been used to characterize multiple physiologic and pathologic states. PET is used for characterizing brain disorders such as Alzheimer disease and epilepsy and cardiac disorders such as coronary artery disease and myocardial viability. The neurologic and cardiac applications of PET are not covered in this review. The major utilization of PET clinically is in oncology and consists of imaging the distribution of fluorine 18 fluorodeoxyglucose (FDG). FDG, an analogue of glucose, accumulates in most tumors in a greater amount than it does in normal tissue. FDG PET is being used in diagnosis and follow-up of several malignancies, and the list of articles supporting its use continues to grow. In this review, the physics and instrumentation aspects of PET are described. Many of the clinical applications in oncology are mature and readily covered by third-party payers. Other applications are being used clinically but have not been as carefully evaluated in the literature, and these applications may not be covered by third-party payers. The developing applications of PET are included in this review.
Investigators are currently using techniques of DNA flow cytometry to measure ploidy status (DNA content) and proliferative potential (S phase fraction) in a wide variety of solid tumors. These measurements have shown relevance for diagnosis, prognosis, and treatment for patients with cancer. National cooperative group studies are beginning to evaluate these measurements in controlled clinical trials to further define their clinical utility as well as limitations. The purpose of this report is to discuss both practical aspects of DNA flow cytometry and clinical applications of these measurements in a variety of solid tumors. We describe in detail our methods for sample handling, processing, and interpretation of DNA histograms. Although there are multiple ways of processing samples and interpreting histograms, we present methodology and interpretations that have proven efficient and reproducible. The review of clinical applications of flow cytometry to solid tumors focuses on breast cancer, but includes a discussion of other solid tumors.
BACKGROUND AND PURPOSE: Until now the assessment of intracranial pressure (ICP) requires invasive methods. A previously introduced mathematical model allowed the non-invasive estimation of ICP (nICP) from arterial blood pressure (ABP) and blood flow velocity (FV). In various studies we have investigated the accuracy of this method and possible clinical applications. METHODS AND RESULTS: Selected hemodynamic parameters, calculated from the cerebral blood FV and the ABP curves, were used to express the relationship between ABP input and ICP output by linear transformation rules. In several clinical studies the accuracy and possible benefits of this method of non-invasive ICP (nICP) assessment were investigated. ASSESSMENT OF ICP PLATEAU WAVES: In 17 severely head injured patients we verified this model by comparison of nICP and measured ICP during generation of plateau waves, recorded in seven of these patients. In all simulations plateau elevations of ICP were well replicated. The correlation coefficient between increase of nICP and real ICP was R=0.98; P<0.001. LUMBAR INFUSION TESTS: Twenty one hydrocephalic patients were studied. Parallel increases in real ICP and nICP during lumbar infusion tests were evidently visible. Resistance of cerebrospinal fluid outflow (Rcsf) was computed using nICP and compared with Rcsf computed from real ICP. The mean error between real and non-invasive Rcsf was 4.1+/-2.2 mmHg min/ml. CEREBRAL AUTOREGULATION: One hundred and forty five patients were studied after severe head injuries. The state of autoregulation was assessed by moving correlation of cerebral perfusion pressure (CPP=ABP-ICP) and FV (Mx index). nICP instead of ICP was used to continuously estimate the state of autoregulation and to dynamically adapt the nICP procedure to this state. A median error between ICP and nICP of 6.0 mmHg was observed. Directly and non-invasively assessed Mx indices correlated highly significantly (R=0.9; P<0.001). CONCLUSIONS: The results demonstrate that the nICP assessment model constitutes a reliable method to monitor ICP and may therefore provide various useful clinical applications.
Intermountain Healthcare (Intermountain) has developed a referential free-text interdisciplinary document collection to define standards for patient care. In order to improve access and use in bedside clinician workflow, Intermountain converted the document collection into a ubiquitous web-compatible format. The content has been structured using XML so it can be utilized by Intermountain's existing clinical applications, as well as positioning it for use in future deployed applications. It has become evident the strategy of structuring the content in this web-compatible format will support its use to drive current and future system functionality. As Intermountain moves forward in creating and deploying clinical applications, it is important to maintain and improve the current collection structure, sustaining the efficient integration and use of the content necessary to support clinician workflow and to meet information needs.
OBJECTIVE: To monitor the microcirculation of lateral groin skin flaps. METHODS: The microcirculation in 12 lateral groin skin flaps was monitored continuously by laser doppler flowmetry (LDF). RESULTS: The microcirculatory changes in lateral groin skin flaps were divided into two phases: rapid rising (2-6 days after operation) and plateau (6-11 days after operation). PU values were 2.83 +/- 0.46, 3.21 +/- 0.41, 3.66 +/- 0.43, 4.77 +/- 0.71, 7.08 +/- 0.37; 7.53 +/- 0.41, 7.57 +/- 0.62, 7.70 +/- 0.44, 7.60 +/- 0.26, 7.58 +/- 0.17. CONCLUSION: In clinical application, division of the lateral groin skin flaps within the plateau, and the values (PU) returned to or exceeded 50% of that values (PU) determined before application of the tourniquet, causes flaps survival (100%). The time of division was decreased to 8-11 postoperative days in our clinical application.
OBJECTIVE: The aim of this study was to examine the wound healing of soft tissue after the application of a diode laser (980 nm) in oral surgical procedures. SUMMARY BACKGROUND DATA: Like the CO2 laser, the diode laser can be used for soft tissue surgery without extensive experience in the field of oral surgical. METHODS: A diode laser was used to treat a variety of oral soft tissue lesions in 22 patients. The oral surgical procedures included removal of soft tissue tumors, frenectomies, excision of gingival hyperplasias, vestibuloplasties, hemangioma removal, and periimplant soft tissue surgery. The laser was used in both pulsed and continuous modes, with and without contact to the tissue. Intraoperative and postoperative clinical observations are reported. RESULTS: Our preliminary clinical findings include sufficient hemostasis and precise incision margin with all of the surgical procedures. The coagulation properties, associated with the use of a diode laser, were particularly beneficial during removal of vascular lesions. The postoperative advantages, i.e., lack of swelling, bleeding, pain or, scar tissue formation, and the good wound healing were observed in all of the clinical applications and were dependent only on the laser physical parameters used. CONCLUSIONS: The clinical application of the diode (980 nm) laser in oral and maxillofacial surgical procedures seems to be of beneficial effect for daily practice.
Ischemic coronary syndrome is still the most frequent cause of mortality in the United States. Despite extensive investigation into the diagnosis of acute myocardial infarction (MI), this process remains quite complex because the majority of patients with chest pain have atypical symptoms and nonspecific electrocardiogram (ECG) changes and fall in the low or medium risk category. The biochemical cardiac markers play an important role in helping physicians make the diagnosis of acute MI and stratify patients for risk modifications. The use of cardiac markers in the diagnosis of acute MI is discussed extensively on pages 36-44 of this issue. This article focuses on reviewing other clinical applications. This field is large and rapidly expanding, making it impossible to cover every single clinical application of cardiac markers. Several research efforts are underway to find better cardiac markers and develop new applications for them. We review the literature on the use of cardiac markers, particularly troponin, with the risk stratification of acute coronary syndromes, the detection of reperfusion, perioperative MI, periprocedural MI, myocarditis, cardiac contusion, and MI associated with sepsis.
The clinical applicability of molecular cardiology has been questioned at length and by many clinical investigators. The congenital long QT syndrome (LQTS) provides an excellent example of how tight the relationship can be between molecular biology and clinical cardiology. The advent of molecular diagnosis has demonstrated how low the penetrance can be in LQTS; this implies that there are many gene carriers who do not show the clinical phenotype and may have a normal QT interval despite being at risk. There is also a gene-specific predisposition to be at risk for cardiac arrest under different circumstances, and this provides additional basis for a gene-specific approach to therapy.
SUBJECT: Several authors used musculocutaneous free flaps of serratus anterior. However, the localization and dimensions of its skin paddle are not clearly defined in the literature. Thus, we realized an anatomical study trying to prove the reality of this skin paddle and its localisation, before considering clinical applications. PATIENT AND METHODS: Twenty-six dissections on 13 fresh anatomical subjects were realized. The protocol consisted in catheterization the thoracic branch of the thoracodorsal artery to inject a mixture of iodized product and methylene blue. The results were obtained by direct measurement of the blue cutaneous area and by radiographic evaluation of the radiopaque area, compared to reproducible anatomical reference marks. RESULTS: Twenty-five dissections were interpretable with superposable results. The skin paddle was always located compared to the 5th, 6th and 7th ribs between the anterior axillary line and the mamelonnary line. The area of the skin paddle was 11,75 cm of length (10-14), 10,75 cm of width (9-12) and 125 cm(2) from surface (110-140). Then, we realized between January and December 2003 several clinical applications of this anatomical study. We report 12 cases of free flaps of serratus anterior with skin paddle for the monitoring of the flap (4 musculocutaneous, 5 osteo-musculo-cutaneous, 3 of fascia with skin paddle). CONCLUSION: This study comes to the support from the anatomical observations from Salmon, the per-operational observations of several authors and our own clinical experiment. It certifies the autonomy of cutaneous vascularization by branches resulting from the surface fascia of the muscle. It specifies the localization and dimensions of the skin paddle of the serratus anterior flap in its muscular, osteo-muscular or fascial form, which still increases its versatility of use.
OBJECTIVE: To study the clinical application of GnRHa prior to uterine myomectomy and its effect on the clinical outcome of pregnancy. METHODS: A retrospective review of the medical records in 20 cases of uterine myomectomy over a period of 6 years was performed. The changes of uterus and myoma volumes in response to preoperative GnRHa was observed, and the rate of relapse in the follow-up, time of impregnation, spontaneous abortion after the impregnation, time of delivery after the operation and the aura threatening uterine rupture, and uterine rupture during the delivery were assessed. RESULTS: Application of GnRHa produced significant improvement in the clinical symptoms and resulted in obviously reduced volumes of the uterus and myoma. The myoma volume reduction was close to 50% in these cases, and relapse occurred in only 1 case. No spontaneous abortion was found after GnRHa application. The average time of pregnancy was 34+/-3.5 weeks, and aura for uterine rupture was found in 1 case at 33 weeks of pregnancy after GnRHa application. CONCLUSION: Application of GnRHa can correct anemia, decrease the relapse rate of myoma, reduce uterus and myoma volumes, to make possible smaller incision for uterine myomectomy that leaves smaller scar in the uterus and decrease intraoperative bleeding, also relieving endometrial injuries to promote the conditions for impregnation and minimize the risks of uterine rupture and total hysterectomy for the benefit of normal delivery.
OBJECTIVE: To review and evaluate the extensive and further research and the application of the collagen-based biomaterials in the field of clinical medicine. METHODS: The clinical research and application of collagen-based biomaterials were comprehensively reviewed and evaluated on the basis of the up-to-date publications and our practical experiences in their studies and manufacturing. RESULTS: The following five aspects concerned with the collagen-based biomaterials were evaluated: biological property, quality control, formulation of substrate and clinical application, immunogenicity and clinical side effect, and potential of the market development. CONCLUSION: Collagen-based biomaterials have a great potential and market space in their clinical application.
The goal of this study was to validate the quantitative accuracy of a system for 3-dimensional (3D) echocardiographic reconstruction of the left ventricle to assess its volume and function in human beings by using 3 apical views as a simplified technique to promote practical clinical application. End-diastolic and end-systolic volumes (EDV, ESV) and ejection fraction (EF) were obtained by 3D echocardiography in 50 patients with dilated or geometrically distorted left ventricles and compared with values from magnetic resonance imaging (20 consecutive patients), angiography (22 consecutive patients), and radionuclide imaging (8 consecutive patients). Three-dimensional results were also compared with 2-dimensional (2D) echocardiographic estimates. Three-dimensional left ventricular reconstruction provided values that correlated and agreed well with pooled data from the other techniques for EDV (y = 0.93x + 9.1, r = 0.95, standard error of the estimate [SEE] = 15.2 mL, mean difference = -0.5 +/- 15.4 mL), ESV (y = 0.94x + 4.3, r = 0. 96, SEE = 11.4 mL, mean difference = 0.4 +/- 11.5 mL), and EF (y = 0. 90x + 4.1, r = 0.92, SEE = 6.2%, mean difference = -0.9 +/- 6.4%) (all mean differences not significant versus 0), with greater errors by 2D echocardiography. Intraobserver and interobserver variabilities of 3D echocardiography were less than 6% for EDV, ESV, and EF. The overall time for image acquisition and 3D reconstruction was 5 to 8 minutes. Although this 3D method uses only a small number of apical views, it accurately calculates EDV, ESV, and EF in patients with dilated and asymmetric left ventricles and is more accurate than 2D echocardiography. The flexible surface fit used to combine the 3 views provides a convenient visual output as well as quantitation. This simple and rapid 3D method has the potential to facilitate routine clinical applications that assess left ventricular function and changes that occur with remodeling.
A 2-year experience with laboratory and clinical applications of fibrin glue is presented. An autologous technique, which eliminates the danger of multidonor preparations, has been developed in our blood bank. While one can obtain different fibrinogen concentrations from the same amount of a patient's blood, in vitro mechanical testing demonstrated that at higher fibrinogen concentrations there is an increase in shear adhesive strength. Evaluation of skin-graft take in 16 Sprague-Dawley rats did not demonstrate significant differences in healing when adhesive use was compared with suture technique. In a clinical study, four different groups of patients (facial burns, hand burns, difficult graft sites, and miscellaneous surgical applications) benefited from autologous or single-donor fibrin glue for a total of 82 cases. There are several distinct advantages to the use of fibrin adhesive: The autologous technique eliminates the risk of transmissible viral diseases (AIDS, hepatitis); it can be used as a sealant in the treatment of seromas, dural leaks, and lymphoceles; and it improves hemostasis and early graft adherence. Face and hands are resurfaced with sheet grafts in a single procedure, obtaining a better aesthetic result with complete graft take and immediate start of physical therapy. Neither sutures nor pressure dressings are required. The minimal postoperative care associated with early return to normal activities seems to increase the satisfaction of patients and nurse personnel.
A deterministic reliability analysis of the Mehrfachwahl-Wortschatz-Intelligenztest, Lehrl (MWT-A, MWT-B), a very economical device for the assessment of crystallized intelligence and the most frequently administered intelligence test by physicians in Germany, was performed on the test data of n = 300 in- and outpatients (University Clinic for Psychiatry, Vienna). Numerical outcomes showed a substantial lack of satisfying test properties, which are further also discussed under non-numerical aspects. For the clinical application of the MWT in Eastern Austria three alternative versions of the MWT (each consisting of 37 items and having better scale characteristics in the analysed sample than the original scales) were developed from the original item pool and presented as MWT-PIRIT, MWT-RIT, and MWT-PI. All five MWT scales were standardized for the present with the patient sample for clinical application. Correlational analyses with a measure for fluid intelligence (Standard Progressive Matrices) suggested only moderate associations between crystallized and fluid intelligence, as well as a differential validity for the MWT in our sample.
Since 1970, when the concept of continuous passive motion (CPM) was originated by one of the authors (R.B.S.), he and a succession of his research fellows have investigated its biological effects on the healing and regeneration of articular tissues in a wide variety of experimental models in rabbits. From this basic research he concluded that CPM is well tolerated, seems to be painless, stimulates the healing and regeneration of articular tissues, prevents joint stiffness, and permits the normal healing of arthrotomy incisions. Beginning in 1975, one of the authors (H.W.H.), and in 1978, the remaining authors, (from two additional Canadian cities) applied the knowledge from the basic research on CPM to the orthopaedic care of human patients. The CPM devices for humans (CPM Mobilimbs), which have been designed in collaboration with University of Toronto engineers, include, to date, devices for the ankle-knee-hip, the elbow, and the finger. Indications for CPM in patients have been the immediate postoperative management following such operative procedures as open reduction and internal fixation of fractures, arthrotomy and arthrolysis for post-traumatic arthritis, synovectomy, surgical drainage for septic arthritis, release of extraarticular contractures, metaphyseal osteotomies, total joint replacement, and ligamentous reconstruction. The case reports of nine selected patients are presented as examples of the clinical application of CPM. These patients have been relatively free of pain, have maintained the increased motion gained at operation, and have accepted the application of CPM well. There have been no complications of CPM; the operative wounds have healed well and the period of hospitalization has not been prolonged. The authors believe that the clinical application of CPM is feasible and that the clinical and radiographic results of CPM in these patients are encouraging. Long-term, prospective clinical investigations (including control patients in whom CPM is not used) will be required to assess the efficacy of CPM in relation to the various stated indications.
Indirect calorimetry is the method by which metabolic rate and substrate utilization are estimated in human beings starting from respiratory gas exchange measurements and urinary nitrogen excretion. This method is based on some models and assumptions that must be known and taken into consideration to correctly interpret the results obtained. Recent advances in technology and the availability of precise and portable metabolic carts have made this technique practical at the beside even in critically ill patients. It must be considered that, particularly in the ICU, there may be several sources of error and many technical difficulties in applying this methodology. Taking into account the relevant clinical studies related to the outcomes of critically ill patient, this article defines when the assessment of energy expenditure by indirect calorimetry may provide useful and valid information. Review of the literature suggests that the clinical application of indirect calorimetry in critically ill patients, although promising, requires further evaluation. Currently, the potential useful clinical applications of indirect calorimetry in this category of patients can be summarized as follows: (1) assessment of energy expenditure in patients who fail to adequately respond to the estimated nutritional needs; (2) assessment of energy expenditure in patients with single- or multiple-organ dysfunction who need prolonged ICU care and artificial nutritional support; (3) assessment of the effects induced by artificial nutrition on the cardiocirculatory and respiratory systems in mechanically ventilated patients with acute respiratory failure; and (4) monitoring of VO2 during weaning from mechanical ventilation.