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PubMed1980

Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index.

The pressure-volume index (PVI) technique was used to measure neural axis compliance, cerebrospinal fluid (CSF) formation (If), and CSF absorption (Ro) in 23 children and 7 adults, all free from intracranial masses, who were undergoing diagnostic or therapeutic procedures. Using bolus manipulation of CSF, If was 0.36 +/- 0.08 ml/min and Ro was 2.8 +/- 0.8 mm Hg/ml/min in both adults and children. PVI, as a measure of neural axis compliance or volume buffering capacity, was 25.9 +/- 3.7 ml for the adults. Measured PVI in the children varied from 8.2 to 30.1 ml but correlated well (r = 0.93) with predicted PVI based on estimates of intracranial and spinal volumes obtained from external measurements. This study provides normal reference data in humans for assessing CSF hydrodynamics and neural axis compliance using the PVI technique in pathological settings.

Adolescent↗
PubMed2003

Fetal cardiac function assessed by Doppler myocardial performance index (Tei Index).

OBJECTIVES: The Tei Index (TI) is a useful, non-invasive, Doppler-derived myocardial performance tool which can be used to assess aspects of systolic and diastolic function. The aim of this study was to determine normal values of fetal left ventricular (LV) TI in second- and third- trimester fetuses and to compare these to other values reported in the literature. METHODS: Doppler waveforms of the LV outflow tracts were obtained in 74 second- and early third-trimester fetuses. The LV isovolumic contraction time (ICT), isovolumic relaxation time (IRT) and ejection time (ET) were measured and the TI calculated using the formula (ICT + IRT)/ET. The literature on LV myocardial function in the fetus was also reviewed. RESULTS: The normal TI in second- and early third-trimester fetuses (18-31 weeks' gestation) was 0.53 +/- 0.13. The ICT was 43 +/- 14 ms, the ET was 173 +/- 16 ms and the IRT was 48 +/- 13 ms. CONCLUSION: The TI can be easily obtained in the fetus without the need for precise anatomic imaging. The TI may be a useful tool to explore fetal myocardial function in different clinical situations.

Diastole↗
PubMed1988

The value of estimating pressure-volume index in childhood macrocephaly. The relationship between pressure-volume index and the volumes of intracranial structures.

In this study on cerebrospinal fluid (CSF) dynamics in childhood macrocephaly, we investigated the relationship between the pressure volume index (PVI) and the volume of various brain structures. The most important variables of CSF dynamics are the outflow resistance (Ro) and the PVI. We applied a constant CSF infusion rate to measure the PVI. The volumes of intracranial structures were calculated by means of computed tomography. Our study revealed no significant correlation between PVI and CSF volume or between PVI and the intracranial volume, as suggested by earlier studies. We did, however, find a significant correlation between PVI and ventricle volume. These results indicate that in order to estimate PVI for clinical purposes, the ventricle volume rather than CSF volume or head circumference should be used.

Brain↗
PubMed2002

Doppler sonographic renal resistance index and resistance index ratio in children and adolescents with unilateral hydronephrosis.

The aim of this study was to evaluate Doppler renal resistance index (RI) and RI ratio (RIR) in differentiating between obstructive and nonobstructive hydronephrosis in children and adolescents. The RI and RIR were measured in 32 healthy examinees (control group) and 29 patients with unilateral hydronephrosis. Ten patients had acute obstruction caused by a ureteric stone. Seven had obstructive hydronephrosis due to uretero-pelvic junction (UPJ) obstruction. Twelve patients had nonobstructive hydronephrosis. In controls the mean RI+/-S.D. was 0.615+/-0.04, and RIR 1.045+/-0.033. In children with acute obstruction RI was 0.692+/-0.035 and RIR 1.148+/-0.037. In UPJ obstruction RI was 0.631+/-0.054 and RIR 1.059+/-0.047. In nonobstructive dilatation RI was 0.61+/-0.038 and RIR 1.043+/-0.042. The RI and RIR differences were statistically significant between controls and patients with acute colic ( p<0.01), and between patients with acute obstruction and with nonobstructive hydronephrosis ( p<0.01). In detecting acute obstruction RI>/=0.70 was found to have a 70% sensitivity and a 92% specificity. The RIR>/=1.10 was found optimal to distinguish obstructive from nonobstructive dilatation (sensitivity 90%, specificity 83%). Both RI and RIR are significantly elevated in patients with acute obstruction. Renal Doppler seems to be useful in children and adolescents for the detection of acute renal obstruction, although it cannot differentiate chronic obstruction due to the UPJ obstruction and nonobstructive renal collecting system dilatation.

Adolescent↗
PubMed1994

Application of a transpulmonary double indicator dilution method for postoperative assessment of cardiac index, pulmonary vascular resistance index, and extravascular lung water in children undergoing total cavo-pulmonary anastomosis: preliminary results in six patients.

Total cavo-pulmonary anastomosis (TCPA) is used for the functional correction of an increasing spectrum of congenital heart diseases. The passive pulmonary perfusion after surgical exclusion of the right ventricle has significant implications for the postoperative hemodynamic management of these patients. Because conventional pulmonary artery thermodilution catheters present methodologic problems in patients after TCPA, important cardiovascular variables such as cardiac index (CI) and pulmonary and systemic vascular resistance indices (PVRI, SVRI) usually cannot be assessed directly. In a preliminary series of six patients undergoing TCPA (age 6-22 years), the applicability of a transpulmonary double indicator dilution technique for postoperative determinations of CI, PVRI, SVRI, and extravascular lung water (EVLW) was investigated. After central venous injection of ice-cold indocyanine green (5 mg), thermal and dye dilution curves were recorded in the abdominal aorta using a combined 4F fiberoptic thermistor catheter. Qualitative assessment of the tracer curves did not show major differences in measurements in patients with pulsatile perfusion of the lungs. CI, SVRI, and EVLW could be determined by use of standard algorithms. Pulmonary perfusion pressure for the calculation of PVRI was based on the gradient between central venous and left atrial pressure. The quality of indicator dilution curves allowed determination of flow-related variables in 33 of a total of 34 sets of measurements. No catheter-related problems occurred during or after the period of investigation. Postoperative EVLW was within the range that is commonly accepted as normal for adults. Mean PVRI initially decreased during the postoperative course but showed a significant increase after extubation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1997

Proliferative activity of central neurocytoma: measurement of tumor volume doubling time, MIB-1 staining index and bromodeoxyuridine labeling index.

Central neurocytoma is considered to be a benign intracranial neoplasm, but little is known about the biological behavior of this type of tumor. Proliferative activity of central neurocytoma was measured in 10 cases using MIB-1 staining for Ki-67 antigen. The MIB-1 staining value varied from < 0.1% to 5.6%, to indicating that some of these tumors have proliferative potential similar to that of anaplastic astrocytoma or malignant meningioma. The bromodeoxyuridine labeling index (BUdR LI, BrdU LI) was measured in 2 cases and the results correlated well with those of the MIB-1 analysis. Tumor volume doubling time (Td) measured in one case was 358 days which is similar to that of malignant meningioma. In one case, the MIB-1 value taken before and after 58 Gy of radiation treatment decreased markedly from 5.6% to 0.2%. The other 9 cases were also treated by radiation therapy (50-60 Gy) and no tumor recurrence was observed during follow-up periods ranging from 23 to 160 months. Another two patients with partially removed and 3 with subtotally removed tumors showing relatively high MIB-1 values might also have benefited from radiation therapy.

Adult↗
PubMed1998

Proteinuria selectivity index based upon alpha 2-macroglobulin or IgM is superior to the IgG based index in differentiating glomerular diseases. Technical note.

BACKGROUND: The proteinuria selectivity index (SI) may be used to describe changes of the glomerular permeability for macromolecules in glomerular diseases. Proteins the size of alpha 2-macroglobulin (alpha 2 M) or IgM cannot normally pass the glomerular barrier, whereas IgG can pass through the large pores of glomerular basement membrane. Comparison of the clearance of the three high-molecular-weight proteins to that of albumin may be useful in characterization and diagnosis of different glomerular diseases as well as in understanding of the permeability characteristics of the glomerular filter. METHODS: Three types of SI, each calculated as a ratio of clearance of either IgG, alpha 2M or IgM to that of albumin, were measured in 199 proteinuric patients. The patients were subdivided into eight different biopsy-verified glomerular diseases. RESULTS: Two diagnoses could be clearly distinguished using SI based on alpha 2M (alpha 2 M SI) or IgM (IgM SI). Both alpha 2M SI and IgM SI were significantly lower in minimal change nephropathy and higher in crescentic necrotizing glomerulonephritis than in all the other diagnoses. The SI based on IgG (IgG SI) was less useful in determining specific diagnoses, since patients with minimal change nephropathy could not be distinguished from those with other types of primary glomerulonephritis and patients with crescentic necrotizing glomerulonephritis did not differ from those with diabetic nephropathy. CONCLUSIONS: The findings of this study indicate that alpha 2M SI and IgM SI are superior to IgG SI in characterization of glomerular disorders and might replace the IgG SI for this purpose.

Adolescent↗
PubMed2004

Brief screening indexes for malingering: A confirmation of Vocabulary minus Digit Span from the WAIS-III and the Rarely Missed Index from the WMS-III.

This study investigated the specificity of empirically derived screening measures for the detection of symptom exaggeration in persons with a diagnosis of alcohol abuse (n = 30), polysubstance abuse (n = 43), or head trauma (n = 27). The first measure evaluated was Vocabulary (V) minus Digit Span (DS) (Mittenberg, Theroux-Fichera, Zielinski, & Heilbronner, 1995); the second measure was the Rarely Missed Index (RMI) for the WMS-III Logical Memory subtest (Killgore & Della-Pietra, 2000). V-DS misclassified 0% of individuals in the alcohol abuse group, 2% of those in the polysubstance abuse group, and 0% of head injury cases. RMI misclassification rates were 3%, 5%, and 7% for the alcohol abuse, polysubstance abuse, and head injury groups, respectively. Overall accuracy rates were 99% for V-DS and 95% for RMI.

Adult↗
PubMed2003

Comparison of Alaris AEP index and bispectral index during propofol-remifentanil anaesthesia.

BACKGROUND: The Alaris AEP monitor(TM) (Alaris, UK, version 1.4) is the first commercially available auditory evoked potential (AEP) monitor designed to estimate the depth of anaesthesia. It generates an "Alaris AEP index" (AAI), which is a dimensionless number scaled from 100 (awake) to 0. This study was designed to compare AAI and BIS(TM) (Aspect, USA, version XP) values at different levels of anaesthesia. METHODS: Adult female patients were premedicated with diazepam 0.15 mg kg(-1) orally on the morning of surgery. Electrodes for BIS and Alaris AEP monitoring and a headphone to give auditory stimuli were applied as recommended by the manufacturers. Anaesthesia was induced with remifentanil (0.4 microg kg(-1) min(-1)) and a propofol target-controlled infusion (Diprifusor(TM) TCI, AstraZeneca, Germany) to obtain a predicted concentration of initially 3.5 microg ml(-1). After loss of consciousness the patients were given 0.5 mg kg(-1) of atracurium. After tracheal intubation, remifentanil was given at 0.2 microg kg(-1) min(-1) and the propofol infusion was adjusted to obtain BIS target values of 30, 40, 50, and 60. AAI and BIS values were recorded and matched with the predicted propofol effect-site concentrations. Prediction probability was calculated for consciousness vs unconsciousness. Values are mean (SD). RESULTS: Fifty female patients, 53 (15), range 18-78 yr, ASA I or II were studied. Mean values before induction of anaesthesia were 95 (4), range 99-82 for BIS and 85 (12), range 99-55 for AAI. With loss of eyelash reflex both values were significantly reduced to 64 (13), range 83-39 for BIS (P<0.05) and 61 (22), range 99-15 for AAI (P<0.05). The prediction probability P(K) for consciousness vs unconsciousness (i.e. loss of eyelash reflex) was better for BIS (P(K)=0.99) than for AAI (P(K)=0.79). At a BIS of 30, 40, 50, and 60 the corresponding AAI values were 15 (6), 20 (8), 28 (11), and 40 (16), and these were significantly different. CONCLUSIONS: During propofol-remifentanil anaesthesia a decrease of the depth of anaesthesia as indicated by BIS monitoring is accompanied by corresponding effects shown by the AAI. However, wide variation in the awake values and considerable overlap of AAI values between consciousness and unconsciousness, suggests further improvement of the AAI system is required.

Adolescent↗
PubMed1988

The labelling index is not always reliable. Discrepancies between the labelling index and the mitotic rate in the rat corneal epithelium after intraperitoneal and topical administration of tritiated thymidine and colcemid.

Many cell kinetic studies are based on the assumption that tritiated thymidine injected into an animal is available for incorporation into DNA for only a short time, and that it labels all cells in the S phase. The present study indicates that this is not the fact for the rat corneal epithelium. The labelling index (LI) declines considerably from the limbal area to the central cornea, while the mitotic rate is almost constant all over the corneal epithelium. The LI should therefore not be used as the only criterion in the assessment of proliferation rate.

Administration, Topical↗
PubMed2002

Comparison of the psychometric characteristics of the functional independence measure, 5 item Barthel index, and 10 item Barthel index in patients with stroke.

OBJECTIVES: To compare the reliability, validity, and responsiveness of the motor subscale of the functional independence measure (FIM), the original 10 item Barthel index (BI), and the 5 item short form BI (BI-5) in inpatients with stroke receiving rehabilitation. METHODS: 118 inpatients with stroke at a rehabilitation unit participated in the study. The patients were tested with the FIM motor subscale and original BI at admission to the rehabilitation ward and before discharge from the hospital. The distribution, internal consistency, concurrent validity, and responsiveness of each measure were examined. RESULTS: The BI and FIM motor subscale showed acceptable distribution, high internal consistency (alpha coefficient > or = 0.84), high concurrent validity (Spearman's correlation coefficient, r(s) > or = 0.92, intraclass correlation coefficient (ICC) > or = 0.83), and high responsiveness (standardised response mean > or = 1.2, p < 0.001). The BI-5 exhibited a notable floor effect at admission but this was not found at discharge. The BI-5 showed acceptable internal consistency at admission and discharge (alpha coefficient > or = 0.71). The concurrent validity of the BI-5 was poor to fair at admission (r(s) = 0.74, ICC < or = 0.55) but was good at discharge (r(s) > or = 0.92, ICC > or = 0.74). It is noted that the responsiveness of the BI-5 was as high as that of the BI and the FIM motor subscale. CONCLUSIONS: The results showed that the BI and FIM motor subscale had very acceptable and similar psychometric characteristics. The BI-5 appeared to have limited discriminative ability at admission, particularly for patients with severe disability; otherwise the BI-5 had very adequate psychometric properties. These results may provide information useful in the selection of activities of daily living measures for both clinicians and researchers.

Activities of Daily Living↗
PubMed2004

French version of the addiction severity index (5th Edition): validity and reliability among Swiss opiate-dependent patients. French validation of the Addiction Severity Index.

OBJECTIVE: The aim of the study was to validate a French adaptation of the 5th version of the Addiction Severity Index (ASI) instrument in a Swiss sample of illicit drug users. PARTICIPANTS AND SETTING: The participants in the study were 54 French-speaking dependent patients, most of them with opiates as the drug of first choice. PROCEDURE: Analyses of internal consistency (convergent and discriminant validity) and reliability, including measures of test-retest and inter-observer correlations, were conducted. RESULTS: Besides good applicability of the test, the results on composite scores (CSs) indicate comparable results to those obtained in a sample of American opiate-dependent patients. Across the seven dimensions of the ASI, Cronbach's alpha ranged from 0.42 to 0.76, test-retest correlations coefficients ranged from 0.48 to 0.98, while for CSs, inter-observer correlations ranged from 0.76 to 0.99. CONCLUSIONS: Despite several limitations, the French version of the ASI presents acceptable criteria of applicability, validity and reliability in a sample of drug-dependent patients.

Adult↗
PubMed2004

The effect of different stages of neuromuscular block on the bispectral index and the bispectral index-XP under remifentanil/propofol anesthesia.

Facial electromyographic activity and neuromuscular block could influence bispectral index (BIS) depth of anesthesia monitoring. In this study we examined, in 30 patients undergoing general surgical procedures, the effect of different stages of neuromuscular block on BIS monitoring and compared the conventional A-2000 BIS trade mark (BIS(3.4)) with the new BIS-XP trade mark (BIS(XP)). At deep surgical anesthesia BIS(3.4) of approximately 40, under a propofol 3.61 microg/mL target-controlled infusion and a 0.15-0.3 microg. kg(-1). min(-1) remifentanil infusion, mivacurium 0.15 mg/kg was administered. The onset of neuromuscular block triggered a brief transient odd divergence in response that manifested as a BIS(3.4) increase from 43 +/- 4 to 49 +/- 7 (P = 0.007) and a BIS(XP) decline from 41 +/- 3 to 35 +/- 3 (P = 0.003) at 1 +/- 0.2 min. Then, 2.5 +/- 1 min after mivacurium administration, both monitors returned to baseline values of 43 +/- 5 and 40 +/- 4, respectively. After that, BIS(3.4) and BIS(XP) did not significantly change during complete neuromuscular block or during various levels of neuromuscular recovery. At all phases, BIS(XP) was significantly lower than BIS(3.4). Our study indicated that the BIS(3.4)/BIS(XP) bias and the wide limits of agreement do not allow values given by the two monitors to be used interchangeably.

Adult↗
PubMed2004

Prognostic significance of DNA ploidy and proliferative index (MIB-1 index) in childhood rhabdomyosarcoma.

The prognostic value of DNA ploidy and proliferative index (PI) are well established in many cancers, but their significance in childhood rhabdomyosarcoma (RMS) is unclear. We studied the DNA content and PI of 45 cases of childhood RMS obtained retrospectively. DNA histograms were hyperdiploid in 30 cases (67%), diploid in 6 (13%), tetraploid in 5 (11%), polyploid in 3 (7%), and nonclassifiable in 1 (2%). The 5-year overall survival rate by ploidy was 60% (3/5) in tetraploid, 57% (17/30) in hyperdiploid, and 0% in diploid and polyploid cases (P = .000002). The 5-year overall survival by a PI less than or greater than 19% was 62% (13/21) and 21% (5/24), respectively (P = .006). In multivariate analysis, DNA ploidy (P = .001) was an important independent prognostic factor. DNA content in childhood RMS is an important variable in predicting prognosis. DNA hyperdiploid and tetraploid rhabdomyosarcomas had a favorable prognosis, while DNA diploid and polyploid tumors had a poor prognosis.

Adolescent↗
PubMed2004

Results of blood inflammatory markers are associated more strongly with toe-brachial index than with ankle-brachial index in patients with type 2 diabetes.

OBJECTIVE: Three blood markers of inflammation (high-sensitivity C-reactive protein [hsCRP], interleukin [IL]-6, and fibrinogen) were compared with markers of atherosclerotic cardiovascular disease (CVD) (history of stroke or cardiac ischemia and measured toe-brachial index [TBI]) to determine whether inflammatory markers are associated with atherosclerosis in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Of 103 patients with type 2 diabetes, 26 had CVD. TBI was plethysmographically determined in both great toes. Serum hsCRP was immunonephelometrically determined. Plasma IL-6 was measured by an enzyme immunoassay. RESULTS: Both ABI and TBI were lower in diabetic patients with CVD than in those without CVD (1.05 +/- 0.19 vs. 1.14 +/- 0.09, P < 0.05, and 0.75 +/- 0.20 vs. 0.95 +/- 0.21, P < 0.001, respectively). By linear regression, right TBI but not right ABI showed a significant negative correlation with serum hsCRP (r = -0.372, P < 0.01) and plasma fibrinogen (r = -0.224, P < 0.05). Serum hsCRP was also negatively correlated with lower TBI, but not lower ABI. We found no significant correlation between plasma IL-6 and ABI or TBI. CONCLUSIONS: TBI was strongly associated with CVD, serum hsCRP, and plasma fibrinogen. Of these inflammatory markers, serum hsCRP may be the most promising marker for vascular inflammation.

Aged↗
PubMed2006

Indexation as a novel mechanism of lymphocyte homeostasis: the number of CD4+CD25+ regulatory T cells is indexed to the number of IL-2-producing cells.

To fulfill its mission, the immune system must maintain a complete set of different cellular subpopulations that play specific roles in immune responses. We have investigated the mechanisms regulating CD4+CD25+ regulatory T (Treg) cell homeostasis. We show that the expression of the high-affinity IL-2Ralpha endows these cells with the capacity to explore the IL-2 resource, ensuring their presence while keeping their number tied to the number of CD4+ T cells that produce IL-2. We show that such a homeostatic mechanism allows the increased expansion of T cells without causing disease. The indexing of Treg cells to the number of activated IL-2-producing cells may constitute a feedback mechanism that controls T cell expansion during immune responses, thus preventing autoimmune or lymphoproliferative diseases. The present study highlights that maintenance of proportions between different lymphocyte subsets may also be critical for the immune system and are under strict homeostatic control.

Adoptive Transfer↗
PubMed1991

[The labeling index of parenchymal and stromal tumor cells--an index of radiosensitivity and prognosis of laryngeal cancer].

Biopsy specimens were taken from 130 laryngeal cancer patients and investigated before treatment. Autoradiography with 3H-thymidine was used to determine the labeling index (LI) of parenchymal cells and tumor stroma. Squamous cell carcinoma was diagnosed in all the cases. Altogether 41 patients were irradiated at a total focal dose of 32-40 Gy and underwent surgery. A full course of radiotherapy at a total dose of 52-60 Gy was given to 89 patients, however recurrences were detected in 38. Comparison of the therapeutic results and indices of proliferative activity of tumor cells has shown: 1. interrelationship of Ll of parenchymal cells and LlI of tumor stromal cells; 2. a tendency to correlation was revealed between indices of LI of parenchymal and stromal cells and a stage of disease; 3. correlation between a degree of a decrease in LI of parenchymal cells and completeness of tumor regression in the course of therapy was shown; 4. LI of stromal cells in the patients' tumors with resumption of tumor growth was lower (0.8) than in patients without resumed growth.

Adult↗
PubMed1990

[Index of tumor response by in-vivo 31P-MRS--T1 effect as a new predicting index of therapeutic effects].

We observed the metabolism of the Yoshida sarcoma by in-vivo 31P-MRS, using two varieties of repetition time (TR), i.e., TR2s and TR10s. It was measured before the injection of 5FU and 4, 24, 48 hours after the injection. In the each time, PME/ATP ratio, intracellular pH, and TR10/TR2 ratio of PME which reflects the T1 value of PME, were calculated. TR10/TR2 ratio of PME decreased 4 and 24 hours after the injection of 5FU and recovered 48 hours after the injection to the same level before the injection. However decrease of PME/ATP ratio was not observed until 48 hours after the injection of 5FU, when apparent tumor regression appeared. These results suggested that the T1 value of PME decreased prior to the PME changes and when the PME decreased, the intracellular environment of PME recovered to the same state before the therapy. It was considered that the TR10/TR2 ratio of PME offers significant information different from the PME/ATP ratio. It is possible to use the TR10/TR2 ratio as a predicting index for the therapeutic effects.

Animals↗