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PubMed2003

Prognostic significance of annexin VII expression in glioblastomas multiforme in humans.

OBJECT: Glioblastoma multiforme (GBM) is the most common and lethal primary brain tumor in adults. It is nearly uniformly fatal, with a median survival time of approximately 1 year, despite modem treatment modalities. Nevertheless, a range of survival times exists around this median. Efforts to understand why some patients live longer or shorter than the average may provide insight into the biology of these neoplasms. The annexin VII (ANX7) gene is located on the human chromosome 10q21, a site long hypothesized to harbor tumor suppressor genes associated with prostate and other cancers. To test whether ANX7 expression might be a predictor for GBMs, we examined ANX7 expression, p53 accumulation, and the MIB-1 labeling index in a retrospective series of 99 GBMs. METHODS: In all 99 cases, the patient's age, Karnofsky Performance Scale (KPS) score before surgery, extent of surgery, tumor location, and immunohistochemical features were analyzed using univariate and multivariate analyses to identify whether any significance exists among ANX7 expression, p53 accumulation, the MIB-1 labeling index, and survival time. Kaplan-Meier analyses demonstrated that a higher KPS score before surgery (< 0.0001), total tumor excision (p = 0.0072), young patient age (p = 0.03), and ANX7 expression (p = 0.0006) correlated with longer survival. Multivariate Cox regression analyses demonstrated that ANX7 expression was the strongest predictor of outcome (p < 0.0001), independent of all other variables. In addition, ANX7 expression correlated with higher MIB-1 immunostaining, but did not correlate with p53 accumulation. Moreover, a significant positive correlation was observed between p53 and MIB-1 staining. CONCLUSIONS: These findings indicate that a higher KPS score before surgery, total tumor excision, young patient age, and ANX7 expression correlate with longer survival in patients with GBMs. Multivariate Cox regression analyses demonstrated that ANX7 expression was the strongest predictor of outcome (p < 0.0001) and was independent of all other variables.

Adult↗

PubMed2005

The Mayo brothers and Harvey Cushing: a review of their 39-year friendship through their personal letters.

Mayo Clinic founders, William J. Mayo and Charles H. Mayo, and Harvey W. Cushing were among the most significant pioneers of modem American surgery. A review of their personal correspondence reveals a special relationship among these three individuals, particularly between William Mayo and Cushing. Their interactions within the Society of Clinical Surgery initiated their close personal and professional association, which would endure for 39 years. William Mayo strongly supported Cushing's efforts to develop the specialty of neurological surgery, and Cushing sought Mayo's advice in making important career-related decisions. Their supportive friendship and professional alliance remains an example for future generations of neurological surgeons.

Correspondence as Topic↗

PubMed2005

Safety of intracranial aneurysm surgery performed in a postgraduate training program: implications for training.

OBJECT: Patient care and educational experience have long formed a dichotomy in modem surgical training. In neurosurgery, achieving a delicate balance between these two factors has been challenged by recent trends in the field including increased subspecialization, emerging technologies, and decreased resident work hours. In this study the authors evaluated the experience profiles of neurosurgical trainees at a large Canadian academic center and the safety of their practice on patient care. METHODS: Two hundred ninety-three patients who underwent surgery for intracranial aneurysm clipping between 1993 and 1996 were selected. Prospective data were available in 167 cases, allowing the operating surgeon to be identified. Postoperative data and follow-up data were gathered retrospectively to measure patient outcomes. In 167 cases, a total of 183 aneurysms were clipped, the majority (91%) by neurosurgical trainees. Trainees performed dissections on aneurysms that were predominantly small (< 1.5 cm in diameter; 77% of patients) and ruptured (64% of patients). Overall mortality rates for the patients treated by the trainee group were 4% (two of 52 patients) and 9% (nine of 100 patients) for unruptured and ruptured aneurysm cases, respectively. Patient outcomes were comparable to those reported in historical data. Staff members appeared to be primary surgeons in a select subset of cases. CONCLUSIONS: Neurosurgical trainees at this institution are exposed to a broad spectrum of intracranial aneurysms, although some case selection does occur. With careful supervision, intracranial aneurysm surgery can be safely delegated to trainees without compromising patient outcomes. Current trends in practice patterns in neurosurgery mandate ongoing monitoring of residents' operative experience while ensuring continued excellence in patient care.

Adult↗

PubMed2005

Harvey Cushing and Oskar Hirsch: early forefathers of modern transsphenoidal surgery.

The transnasal transsphenoidal approach is the preferred route for removal of most lesions of the sella turcica. The concept of transnasal surgery traversing the sphenoid sinus to reach the sella has existed for nearly a century. A comprehensive historical overview of the evolution of transsphenoidal surgery has been reported previously. In the present vignette, the authors focus on transsphenoidal surgery in the early 1900s, particularly on the methods advocated by Harvey Cushing and Oskar Hirsch, two prominent pituitary surgeons who pioneered the transsphenoidal technique. Cushing championed the sublabial approach, whereas Hirsch was the master of the endonasal route. Coincidentally, both surgeons independently performed the submucous septal resection for the first time on June 4, 1910. Although Cushing's and Hirsch's approaches were predicated on the work of their predecessors, their transsphenoidal procedures became the two most popular techniques and, for future generations of pituitary surgeons, laid the foundation for modem transsphenoidal surgery. In this comparative analysis, the authors compare the operative nuances of the approaches of Cushing and Hirsch and describe the contributions of these pioneers to modern transsphenoidal surgery.

Austria↗

PubMed2006

Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography--or magnetic resonance imaging-guided electrode implantation.

OBJECT: The purpose of this paper was to define the general efficacy of and morbidity associated with stereoelectroencephalography using modem methods of imaging and to particularize the risks related to specific lobes of the brain. METHODS: All patients admitted to the Montreal Neurological Institute who had undergone either computerized tomography- or magnetic resonance imaging-guided electrode implantation by one surgeon (A.O.) were reviewed. The procedure was considered efficient if the obtained information was sufficient to make a decision either in support of or against surgery. Two hundred seventeen patients underwent 224 implantations with 3022 electrodes. Complications related to each lobe were as follows: temporal lobe, two abscesses (0.54%); frontal lobe, one abscess and three hematomas (1.4%); and occipital lobe, one hypointense lesion found 1 week after electrode explantation (2.6%). Significant risk factors associated with hematomas were implantation in the frontal lobe (p < 0.05) and the use of four or more implanted electrodes (p < 0.025). General complications included the following: 26 patients, psychiatric symptoms during monitoring; one patient, meningitis; four patients, scalp cellulitis; and two patients, hemiparesis during angiography in the early 1980s. One of these latter patients maintained a mild hemiparesis and represents the only case of permanent neurological sequela in the entire series. Data obtained during recordings supported an indication for surgery in 178 patients (79.5%), excluded a surgical option in 37 patients (16.5%), and were unsatisfactory in nine patients (4%). Thus, the overall efficacy as defined previously was 96%. CONCLUSIONS: Stereoelectroencephalography is an efficient procedure with low associated morbidity. Bilateral exploration of the temporal lobes has a morbidity rate of approximately 1%. A higher risk of hematomas occurs with the implantation of four or more electrodes in the frontal lobes.

Adult↗

PubMed1995

Design of an emergency teleradiology system based on progressive transmission.

In clinical surgery, there are frequent needs for communication between the house staff and the attending physician in an emergency situation. To overcome the limitation of voice communication through the telephone line, we have designed an 'emergency teleradiology system' which can be used for emergency surgical and medical decision making. This system can transmit the high quality images of CT, MRI, and other X-ray data using a PC attached to a modem through the conventional telephone line. It is based on the progressive transmission system which enables the successive update of a received image. The iterative residual coding/decoding algorithm efficiently compresses the image to maximally utilize the low bandwidth PSTN channels. This system also satisfies design requirements such as low-cost, ease of operation, fast transmission, and interactive image communication including voice. Test results using several CT, MR, and X-ray images evaluate the compression performance, image quality, transmission time and computational time of the coding and decoding processes, thus demonstrate the usefulness of this system in an emergency situation.

Algorithms↗

PubMed2004

Cemented tibial stems are not requisite in revision.

Tibial stems are necessary in most total knee revisions to share the load and protect the fixation interface of the tibial tray. Successful use of a tibial stem requires independent stability of the stem with or without cement. Some additional geometry on the undersurface of the tibial tray such as peripheral pegs or fins is necessary to provide additional resistance to rotatory stresses if the stem is not cemented. Cementing the tibial stem works. However, with the excellent results of cementless stems, who would want to deal with cement removal in those few cases of loosening or the occasional case with infection or instability? The disadvantages of a press-fit stem are not seen with modem tibial stems, such as with a long conical stem with an offset attachment to the tibial baseplate as used in this series. Cement is not necessary!

Arthroplasty, Replacement, Knee↗

PubMed2004

[Developing a home care nursing information system by utilizing wire-wireless network and mobile computing system].

PURPOSE: The purpose of this study was to develop a home care nursing network system for operating home care effectively and efficiently by utilizing a wire-wireless network and mobile computing in order to record and send patients' data in real time, and by combining the headquarter office and the local offices with home care nurses over the Internet. It complements the preceding research from 1999 by adding home care nursing standard guidelines and upgrading the PDA program. METHOD: Method/1 and Prototyping were adopted to develop the main network system. RESULT: The detailed research process is as follows : 1)home care nursing standard guidelines for Diabetes, cancer and peritoneal-dialysis were added in 12 domains of nursing problem fields with nursing assessment/intervention algorithms. 2) complementing the PDA program was done by omitting and integrating the home care nursing algorithm path which is unnecessary and duplicated. Also, upgrading the PDA system was done by utilizing the machinery and tools where the PDA and the data transmission modem are integrated, CDMX-1X base construction, in order to reduce a transmission error or transmission failure.

Computer Communication Networks↗

PubMed2005

Adenocarcinoma of the prostate: epidemiological trends, screening, diagnosis, and surgical management of localized disease.

Prostate cancer is a leading cause of mortality and morbidity worldwide. Despite years of study and effort, certain key questions remain unanswered, including how prostate cancer is best detected and diagnosed, how it is best treated, and how best to minimize the complications of treatment. The aim of this article is to briefly address these topics to shed light on the current best practices in prostate cancer screening, diagnosis, and surgical treatment of localized disease. We examine current trends in prostate cancer epidemiology and screening, including genetic and dietary risk factors and the newer prostate-specific antigen-derived screening modalities. Methods of diagnosis, including an overview of prostate biopsy technique and indications, and a brief review of relevant pathologic findings are provided. An in-depth analysis of traditional prostate cancer surgical management highlights the relevant advantages and disadvantages of radical retropubic and perineal prostatectomy. Complications of surgery, prognostic factors, and the many risk prediction models currently available are discussed. In all, this article aims to give the reader a broad overview of the basic elements of prostate cancer diagnosis and surgical treatment in the modem era.

Adenocarcinoma↗

PubMed2005

Maximizing the entropy of histogram bar heights to explore neural activity: a simulation study on auditory and tactile fibers.

Neurophysiologists often use histograms to explore patterns of activity in neural spike trains. The bin size selected to construct a histogram is crucial: too large bin widths result in coarse histograms, too small bin widths expand unimportant detail. Peri-stimulus time (PST) histograms of simulated nerve fibers were studied in the current article. This class of histograms gives information about neural activity in the temporal domain and is a density estimate for the spike rate. Scott's rule based on modem statistical theory suggests that the optimal bin size is inversely proportional to the cube root of sample size. However, this estimate requires a priori knowledge about the density function. Moreover, there are no good algorithms for adaptive-mesh histograms, which have variable bin sizes to minimize estimation errors. Therefore, an unconventional technique is proposed here to help experimenters in practice. This novel method maximizes the entropy of histogram-bar heights to find the unique bin size, which generates the highest disorder in a histogram (i.e., the most complex histogram), and is useful as a starting point for neural data mining. Although the proposed method is ad hoc from a density-estimation point of view, it is simple, efficient and more helpful in the experimental setting where no prior statistical information on neural activity is available. The results of simulations based on the entropy method are also discussed in relation to Ellaway's cumulative-sum technique, which can detect subtle changes in neural activity in certain conditions.

Algorithms↗

PubMed1991

Let your computer do the walking.

A personal computer and a modem can be an extremely powerful pair and, used properly, can represent fantastic savings in time and money. Too often, they are underutilized because managers and clinicians do not know how to approach the type of online researching that computers are beautifully designed to perform--the kind of research that can make a daily significant difference.

Computer Peripherals↗

PubMed1991

Quality assessment: from paper shuffle to paperless review.

Even though much of the quality-assurance process had been automated at Kettering Medical Center (KMC) in Dayton, Ohio, reviewers still had to key in data from paper records each day. An extensive paper trail continued until Kettering took the leap to total paperless review using eight laptop computers with internal modems.

Electronic Data Processing↗

PubMed1991

OLIO+: an osteopathic medicine database.

OLIO+ is a bibliographic database designed to meet the information needs of the osteopathic medical community. Produced by the American Osteopathic Association (AOA), OLIO+ is devoted exclusively to the osteopathic literature. The database is available only by subscription through AOA and may be accessed from any data terminal with modem or IBM-compatible personal computer with telecommunications software that can emulate VT100 or VT220. Apple access is also available, but some assistance from OLIO+ support staff may be necessary to modify the Apple keyboard.

Data Display↗

PubMed1997

Networking computers.

This decade the role of the personal computer has shifted dramatically from a desktop device designed to increase individual productivity and efficiency to an instrument of communication linking people and machines in different places with one another. A computer in one city can communicate with another that may be thousands of miles away. Networking is how this is accomplished. Just like the voice network used by the telephone, computer networks transmit data and other information via modems over these same telephone lines. A network can be created over both short and long distances. Networks can be established within a hospital or medical building or over many hospitals or buildings covering many geographic areas. Those confined to one location are called LANs, local area networks. Those that link computers in one building to those at other locations are known as WANs, or wide area networks. The ultimate wide area network is the one we've all been hearing so much about these days--the Internet, and its World Wide Web. Setting up a network is a process that requires careful planning and commitment. To avoid potential pitfalls and to make certain the network you establish meets your needs today and several years down the road, several steps need to be followed. This article reviews the initial steps involved in getting ready to network.

Computer Communication Networks↗

PubMed1997

A new approach to disease management for seniors.

Faced with the challenge of caring for a growing elderly population, case managers at Margaret R. Pardee Memorial Hospital secured a grant to develop a comprehensive data collection system to help them keep track of elderly patients and more effectively share information with other local health care providers. They developed a standardized information system, using a relational database, to collect patient-centered information while eliminating the redundant documentation that had characterized their previous system. Pardee is expanding the program to include local primary care and home health agencies, who will be able to access the patient database by modem.

Aged↗

PubMed1998

Perfusion services national process improvement benchmarking.

The Joint Commission on Accreditation of Health Care Organizations recommends national and regional benchmarking in the quality improvement process. Benchmarking is comparing your organization's patient care process outcomes to the best. This communication describes a national benchmarking process for peer comparison of indicators in perfusion patient services process improvement. A databasing communication aplet was designed to facilitate national benchmarking as part of a larger perfusion service management software application. When patient information is entered in the patient database post precedure, patient-specific numeric data and 'yes'/'no' queries are entered at the clinical site. At any time, the local perfusionist system manager may transmit their own data and receive national database group results by modem and a 1-800 phone number. Local indicator outcomes are compared to national results. Strategies are employed to assure that institution and patient name remain anonymous and institution specific data are stored at the clinical site. Participating institutions employ an e-mail aplet to discuss and decide which indicators to employ as a group. Nine institutions have contributed outcome data for more than 6,425 cardiopulmonary bypass (CPB) procedures to a national database for ten months. National and institutional means for six discrete CPB outcome parameters are compared. The percent 'yes' responses to four procedure-related questions are compared. Joint Commission recommended benchmarking is accomplished while patient care is improved by comparing outcomes.

Benchmarking↗

PubMed1982

Linking personal computers to a hospital laboratory computer.

In the Department of Pathology, Norwood Hospital, a number of individual microcomputers in the home and throughout the laboratory have been connected to a central hospital laboratory computer. The microcomputers are connected to the central computer over standard telephone lines via the autoanswer modem for any telephone. Here, the author describes the system and its benefits, and explains why this type of application is a major potential use of computers in medicine in the future.

Computers↗

PubMed1986

A case for system security.

Mainframe security measures provided by the manufacturer, are adequate for normal security needs. However, a truly competent MIS security and/or hospital administration strategy must try to take advantage of the latest technological advancements as they become available. The integration of intelligent "dial-back" modems that "hang up" and then re-establish their communications link with a CRT terminal is now a requirement. However, finding a terminal with adequate stand-alone security devices is a different matter.

Computers↗