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At least 487 records · Page 27Linked to original sources

[Clinical application of distal base sural island flap].

OBJECTIVE: To sum up the experience of clinical application of distal base sural island flap. METHODS: From January 1997 to April 1999, the posterior island flap of leg pedicled with sural nerve and its nutrient vessels was applied to repair heel or dorsum of foot in 6 cases, chronic ulcer of heel in 2 cases, chronic osteomyelitis in 2 cases, scar contracture of bone defect accompanying fistulation in 1 case. The range of flap was 5 cm x 8 cm to 8 cm x 12 cm. RESULTS: All the flaps survived completely without vascular crisis. All the wounds healed by first intention. Followed up 3 to 12 months, no ulcer, osteomyelitis, fistulation were recurrence, and the sensation of flap was recovered slightly. CONCLUSION: The flap do not damage critical blood vessels and nerves, the donating region is hidden. The manual of operation is simple and blood supply of flap is sufficient. It can repair the defect of soft tissue on heel and dorsum with high survival rate.

Adolescent↗

Clinical applications of bone density testing for osteoporosis.

Bone mineral density (BMD) testing is a clinical tool to diagnose osteoporosis or low bone density, predict fracture risk, and monitor changes in bone density over time. Non-invasive measurement of BMD is done with a variety of technologies for many different skeletal sites. Dual-energy X-ray absorptiometry (DXA) is the gold-standard for diagnosing osteoporosis and monitoring changes in BMD over time. Optimal use of DXA requires staff training and standard operating procedures that include quality controls for instrument maintenance, patient education, indications and contraindications for testing, precision assessment, scan acquisition, analysis, interpretation, and reporting. Other technologies, as well as DXA, are used to estimate the risk of fracture. BMD is commonly expressed as a T-score, the standard deviation variance of the patient's BMD compared to a young-normal reference population. In untreated postmenopausal women, there is a strong correlation between T-score and fracture risk, with fracture risk increasing about two-fold for every standard deviation decrease in bone density. BMD in postmenopausal women is classified as normal, osteopenia, or osteoporosis according to criteria established by the World Health Organization. BMD testing, combined with assessment of clinical risk factors for fracture, allows healthcare providers to identify patients who may benefit from pharmacologic therapy to reduce the risk of future fractures. Clinical applications of BMD testing are presented in this review.

Absorptiometry, Photon↗

[Synthesis of zinc chlorophyllin a and its preliminary clinical application].

A method for synthesis of zinc chlorophyllin a (I), a promising drug for clinical application, is presented. Taking silkworm faeces as a raw material. Chlorophyll was extracted with ethyl alcohol. After concentration the solid formed was dissolved in petroleum ether and the solution was subjected to column chromatography to separate pheophytin a and chlorophyll a. The products were dissolved in ethyl ether and the Mg in the products was stripped off with concentrated hydrochloric acid. The excess hydrochloric acid in the solution was neutralized with ammonia solution and the mixture was hydrolyzed with diluted hydrochloric acid to obtain pheophorbide a, then (I) was synthesized with pheophorbide a and zinc salt. The characteristics of (I) and pheophorbide a were checked by IR, UV and elemental analyses. All results of pheophorbide a coincided with those values reported in literature. The acute toxicity of (I) was tested in mice and the LD50 of (I) was 324 +/- 40 mg/kg. (I) has been applied in several hospitals for several months. It has been found that (I) has outstanding effects on burns and oral sepsis and that it increases the growth of granulation tissue and epithelium remarkably.

Animals↗

[Clinical application of echocardiokymography for detection of global and sectorial dyskinesias (author's transl)].

The clinical application of a new ultrasonic technique, echocardiokymography (ECKG), has been showed particularly useful in the detection of myocardial and pericardial dyskinesias. In patients with congestive cardiomyopathy, the global hypokynesia was confirmed by the ECKG; regional impairment of parietal wall motion after myocardial infarction is clearly demonstrated by the technique; acute and chronic pericarditis show peculiar kymographic patterns. The ECKG is a kind of two-dimensional examination, that keeps some of the advantages of the time-motion, in the comparative study of cardiac walls dynamics.

Acute Disease↗

[Clinical application of lateral lag screw in fixing intracapsular sagittal condylar fracture].

OBJECTIVE: To introduce the clinical application and curative effect of lateral lag screw technique in fixing condylar intracapsular sagittal fractures. METHODS: Thirteen condyles with intracapsular sagittal fracture of 11 cases were fixed using lateral lag screw technique. Curative effects were observed by clinical and radiological follow-up for 6 approximately 30 months (mean 12 months) postoperatively. RESULTS: The favorable results were obtained in all cases. All patients were satisfied with the clinical results. slight malocclusion existed in 2 cases. Radiological abnormalities were seen in 3 cases by CT scanning, but without any obvious function disturbances. CONCLUSIONS: Lateral lag screw technique is a simple and effective treatment in fixing intracapsular sagittal condylar fractures.

Adolescent↗

Recombinant Factor VIIa: clinical applications for an intravenous hemostatic agent with broad-spectrum potential.

Recombinant Factor VIIa (NovoSeven, Novo Nordisk) is a unique hemostatic agent with potential for broad-spectrum applications in bleeding patients with congenital and acquired bleeding abnormalities. At present, recombinant Factor VIIa is only approved for the treatment of hemophilia A and B patients who have acquired antibodies to Factors VIII and IX. However, the literature is rapidly expanding indicating that rFVIIa could benefit patients with bleeding due to a variety of etiologies. Unfortunately, the vast majority of these reports are case studies or small-series summaries, and are neither prospective nor controlled. Controlled trials are currently underway in several potential areas of application. While the possibility of thrombotic complications has been a clinical concern, safety data on patients treated to date have not revealed a significant problem. Expansion of the clinical applications for this interesting and important hemostatic agent are hampered by its expense, the limited scope of the US Food and Drug Administration approval for its use, and the absence of an appropriate laboratory monitoring assay.

Consumer Product Safety↗

[Clinical application of high dose rate interstitial radiation therapy].

High dose rate interstitial radiation (HDR-ISRT) with afterloading method is newly introduced radiotherapeutic modality which can be performed in short time and can lower the radiation exposure to the medical personnel. Afterloading Buchler IR was used in this study which obtains dose distribution by continuous oscillation of small high intensity iridium-192 source in 2.2 mm diameter applicator. The dose calculation programme for HDR-ISRT developed by us proved to be satisfactorily reliable except in the close proximity of less than 5 mm from the applicator. By using the developed programme, optimal applicator insertion interval was calculated which attain the dose homogeneity of 11% in a given plane. It was shown that this oscillating iridium source can give satisfactory dose distribution even if the applicators are inserted with interval greater than 1.5 cm. The clinical application of the HDR-ISRT with evaluable lesions has been performed in 23 sites in 21 patients. In 13 sites local control was obtained in spite of the advanced stage of the tumors. Radiation injury was shown in 5 sites, of which 3 needed to be treated surgically. The analysis of 23 sites which underwent HDR-ISRT showed that external radiation less than 50 Gy, HDR-ISRT dose between 15 to 20 Gy and total dose between 60 to 70 Gy in 40 to 100 days seemed necessary to obtain local control without radiation injury.

Aged↗

Enzyme immunoassay for plasma renin activity: II. Clinical application.

The application of an enzyme immunoassay for plasma renin activity in clinical diagnosis was studied and the following findings were obtained: 1. In patients with primary aldosteronism, very low renin activities were found. On the other hand, increased renin levels were observed in patients with secondary aldosteronism (renal artery stenosis, malignant hypertension, Bartter's syndrome). 2. Plasma renin activity was found to be considerably increased in Addison's disease. Measurements of Plasma renin were a guide-line for appropriate mineralocorticoid substitution in those patients. In 6 patients with salt-losing congenital adrenal hyperplasia due to 21-hydroxylase deficiency, the renin activity was also elevated and normalized after corticoid treatment. 3. During pregnancy, the renin levels showed an increasing tendency from the first to third trimester. Women with pre-eclampsia showed higher values than normal pregnant women. 4. An age-dependent change of renin activity was observed in newborns and children, especially markedly increased values during the first 5 days of life. 5. During the normal menstrual cycle the renin levels increased to a maximum in the mid-luteal phase. A significant increase of renin activity was found in women taking oral contraceptives. Previously, we reported on the determination of renin activity by an enzyme immunoassay (EIA) (Hubl et al., 1980). In this study, we examined the clinical application of this EIA.

Addison Disease↗

Clinical applications of hypnosis for brief and efficient pain management psychotherapy.

This paper describes four specific clinical applications of hypnosis that can make psychotherapy for pain management briefer, more goal-oriented, and more efficient: (1) the assessment of hypnotizability; (2) the induction of hypnotic analgesia and development of individualized pain coping strategies; (3) direct suggestion, cognitive reframing, hypnotic metaphors, and pain relief imagery; and (4) brief psychodynamic reprocessing during the trance state of emotional factors in the patient's experience of chronic pain. Important theoretical and clinical issues regarding the relationship of hypnotizability to the induction of hypnotic analgesia are presented, and attempts to individualize pain treatment strategies on the basis of assessed differences in hypnotizability and patients' preferred coping strategies are described. Some ways are also presented of integrating direct hypnotic suggestion, cognitive reframing, hypnotic metaphors and imagery for alleviating the sensory and affective components of pain with an exploratory, insight-oriented, and brief psychodynamic reprocessing approach during trance for resolving unconscious sources of resistance to treatment and reducing the emotional overlay associated with chronic pain. Some basic assumptions underlying the use of this approach are discussed, and a brief step-by-step protocol is outlined.

Chronic Disease↗

Recombinant adeno-associated virus (rAAV) vectors for somatic gene therapy: recent advances and potential clinical applications.

Adeno-associated virus (AAV) is a single-stranded DNA dependovirus of the family of Parvoviridae that has promising features as a vector for somatic gene therapy. Different recombinant (r) AAV vectors have been generated that seem to have some advantages compared with other vector systems, such as the transduction of terminally differentiated and non-dividing cells, the lack of any apparent pathogenicity, low immunogenicity, relatively high stability of transgene expression, and the potential of targeted integration. Recent improvements in rAAV packaging should allow the generation of sufficient quantities of rAAV for clinical trials. Preclinical studies with rAAV are currently being performed for the treatment of a variety of inherited monogenic defects, such as beta-thalassemia, sickle cell anemia. Fanconi anemia, chronic granulomatous disease, Gaucher disease, metachromatic leukodystrophy and cystic fibrosis, and of acquired diseases, such as HIV infection and non-Hodgkin lymphoma. The diversity of these studies indicates that rAAV might have a broad range of clinical applications. A first clinical trial with rAAV vectors has been started for cystic fibrosis. While several important issues, including safety, tissue tropism and methods to achieve site-specific integration, need further clarification, rAAV seems to have a sufficient number of advantages to be seriously considered as a future gene therapy vector.

Anemia↗

Three-dimensional dose verification of the clinical application of gamma knife stereotactic radiosurgery using polymer gel and MRI.

This work seeks to verify multi-shot clinical applications of stereotactic radiosurgery with a Leksell Gamma Knife model C unit employing a polymer gel-MRI based experimental procedure, which has already been shown to be capable of verifying the precision and accuracy of dose delivery in single-shot gamma knife applications. The treatment plan studied in the present work resembles a clinical treatment case of pituitary adenoma using four 8 mm and one 14 mm collimator helmet shots to deliver a prescription dose of 15 Gy to the 50% isodose line (30 Gy maximum dose). For the experimental dose verification of the treatment plan, the same criteria as those used in the clinical treatment planning evaluation were employed. These included comparison of measured and GammaPlan calculated data, in terms of percentage isodose contours on axial, coronal and sagittal planes, as well as 3D plan evaluation criteria such as dose-volume histograms for the target volume, target coverage and conformity indices. Measured percentage isodose contours compared favourably with calculated ones despite individual point fluctuations at low dose contours (e.g., 20%) mainly due to the effect of T2 measurement uncertainty on dose resolution. Dose-volume histogram data were also found in a good agreement while the experimental results for the percentage target coverage and conformity index were 94% and 1.17 relative to corresponding GammaPlan calculations of 96% and 1.12, respectively. Overall, polymer gel results verified the planned dose distribution within experimental uncertainties and uncertainty related to the digitization process of selected GammaPlan output data.

Acrylic Resins↗

Clinical applications of antiviral agents for chemophrophylaxis and therapy of respiratory viral infections.

Table III summarizes clinical applications of antiviral agents in respiratory viral infections. (table: see text) For influenza A virus infections, both oral amantadine and rimantadine are effective when used for seasonal prophylaxis and for prophylaxis in institutional populations. Both of these drugs, as well as aerosolized ribavirin, have antiviral and therapeutic effects in uncomplicated influenza. It remains to be determined whether any of these modalities or possibly their combined use [44] will be useful in treating severe influenza hospitalized patients or whether they can prevent the development of complications in high risk patients. Unfortunately, there is no parenteral formulation of amantadine or rimantadine for use in critically ill patients. Aerosolized ribavirin has also been shown to have modest therapeutic effects in influenza B virus infection. However, a major need exists for an antiviral which is active against influenza B virus and which can be used on an outpatient basis. Controlled clinical trials have shown that aerosolized ribavirin therapy improves arterial oxygenation and modifies the severity of respiratory syncytial virus bronchiolitis and pneumonia [3,5]. Its role in treating life-threatening disease or in modifying the long-term sequelae of RSV infections are unknown at the present time. Again, a specific antiviral agent is needed for outpatient use in preventing or treating RSV infections. Finally, after over a decade of work since the original observation that intranasal interferon could prevent experimental rhinovirus infection [11], recent studies have established that intranasal rIFN-a2 is effective in the postexposure prophylaxis of rhinovirus colds in families [42]. This strategy needs to be studied with regard to the prevention of infection and its complications in high risk patients and it remains to be determined whether intranasal interferon will have therapeutic activity in established colds.

Adult↗

[The effects of clinical application of a nursing diagnosis protocol].

This study was conducted to measure the effects of clinical application of a Nursing Diagnosis Protocol. The dependent variables were the degree of patient's satisfaction and the degree of nurse's satisfaction with the nursing activity. Analysis of the effect of the use of the nursing diagnosis protocol was based on the nursing record. The subjects for this study were 61 nurses (experimental group 31, control group 30) and 155 patients (experimental group 55, control group 100) on four internal medicine wards in K University Hospital in Seoul.

Clinical Protocols↗

3T MR imaging of the musculoskeletal system (Part II): clinical applications.

The gain in SNR that is afforded by 3T MR imaging systems has tremendous clinical applications in the musculoskeletal system. The potential for demonstrating and enhancing the visibility of normal osseous, tendinous, cartilaginous, and ligamentous structures is exciting. Furthermore, harnessing this added signal to increase spatial resolution may improve our diagnostic abilities in various joints dramatically. Radiologists have enjoyed great success in assessing joint disease with current MR imaging field strengths; however, many intrinsic joint structures remain poorly evaluated, which leads to a golden opportunity for 3T MR imaging. The articular cartilage of the knee, the glenoid labrum of the shoulder, the intrinsic ligaments and TFC of the wrist, the collateral ligaments of the elbow, the labrum and articular cartilage of the hip, and the collateral ligaments of the ankle have been evaluated suboptimally on 1 .5T systems using routine nonarthrographic MR images. Because of the enhanced SNR, the higher spatial resolution, and the greater CNR of intrinsic joint structures at higher field strengths, 3T MR imaging has the potential to improve diagnostic abilities in the musculoskeletal system vastly, which translates into better patient care and management. The author's 2 years of clinical experience with musculoskeletal MR imaging on 3T systems has met and exceeded his expectations, and has bolstered the confidence of his orthopedic surgeons in his diagnoses. As coil technology advances and as the use of parallel imaging becomes more available in the extremities, the author expects to see even more dramatic improvements in image quality.

Humans↗

Reducing mortality from sudden cardiac death in the community: lessons from epidemiology and clinical applications research.

The reduction of mortality from sudden cardiac death (SCD) in the community remains a challenge. Clinical-epidemiologic studies have identified a range of factors that are associated with an increased risk of SCD. While of potential etiologic and prognostic importance, these factors have limited sensitivity and a low positive predictive value for SCD. On the other hand, clinical trials have suggested that a variety of interventions, including risk factor reduction, nutritional interventions, drug therapies, cardiac procedures, and new technologies, have the potential to reduce mortality from SCD. In this review, we examine what is known about the epidemiology and clinical application of interventions to reduce mortality from SCD; and, we consider the impact of both prevention and clinical interventions on mortality from SCD from a community perspective. There is mounting evidence that supports both public health and clinical efforts to prevent the occurrence of SCD. There also is evidence suggesting that new technologies, such as automated external defibrillators, have the potential to reduce case-fatality from SCD. Further progress will depend on improved methods to identify persons-at-risk, reduction of risk factors, and application of techniques -- both simple and advanced -- to improve survival in victims of SCD.

Cardiopulmonary Resuscitation↗

[Clinical application of new cytokines].

Recent progress of molecular biology and gene technology has developed a novel approach of clinical treatment. Several recombinant cytokines are already applied to clinical field. In this symposium, I introduced clinical application of some cytokines including GM-CSF, interleukin (IL)-1 and IL-3. The clinical benefits of IL-1 are; 1) IL-1 has an anti-tumor effect especially on cutaneous lymphoma and brain tumors, and 2) IL-1 has a function as hematopoietic growth factor for very immature hematopoietic stem cells. In the clinical Phase I/II study, IL-1 has been shown to have anti-tumor effect on cutaneous T-lymphoma via immune mechanisms. The side effects of IL-1 were variable including fever, fatigue, skin redness and so on, but they were all tolerable. The clinical phase studies of GM-CSF and IL-3 are now on going. The preliminary studies show that GM-CSF has granulo-poietic activity but not thrombo-poietic activity, and that IL-3 has multi-hematopoietic activity. These cytokines may be useful for treatment of disorders of hematopoietic stem cells such as aplastic anemia and myelodysplastic syndrome. The side effects of both cytokines are resemble, but all are tolerable.

Anemia, Aplastic↗

Clinical application of flow cytometry: a review.

A survey of the use of flow cytometry for clinical purposes is given. In the last decade the main clinical application of this technique has been measurements of cellular DNA content for estimation of cell cycle distribution and ploidy studies. A large body of data is now available on the presence of aneuploidy in different malignant diseases. By measurements with high resolution, the demonstration of abnormal cellular DNA content in several types of tumors can be of definite diagnostic value when combined with conventional diagnostic procedures. The prognostic significance of different types of DNA aberrations is so far not established. Attempts to monitor cancer treatment by studying altered cell cycle distribution have not been successful, although some applications are of potential value. The main reasons for this are the complexity of tumor tissue as well as difficulties with interpretation of altered cell cycle distribution caused by drug combinations. For further progress in this field more emphasis on other cell constituents than DNA measured by flow cytometry is desirable, either as single or as multiparameter measurements.

Blood Cells↗