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PubMed1983

Predicting phenytoin dosages using Bayesian feedback: a comparison with other methods.

A Bayesian feedback technique for predicting phenytoin dosage was compared to other dosing methods. Sixty-nine cases were selected on the basis of apparent reliability from 103 medical charts of epileptic patients with multiple phenytoin levels on different dosage regimens. Two published nomograms and a graphical, or computational, technique were compared to the Bayesian technique. Each method was assessed for absolute predictability using measures of bias and precision, i.e., mean percent error and root mean squared percent error, respectively. For a single previous data pair, the Bayesian method was similar to a published nomogram with regard to bias and precision. For multiple data pairs, the graphical or simultaneous equation technique tended to be less biased, but the Bayesian method had better precision. However, none of these differences was statistically significant (p greater than 0.05). The Bayesian method yielded the lowest percentage of predicted doses that exceeded 110% of the actual dose. The Bayesian method conveniently provides a single method applicable to the use of either single or multiple concentration-dosage data pairs and results in fewer extreme dosing errors.

Adult↗

PubMed2001

A theoretical derivation of the nomograms for permanent prostate brachytherapy.

This study calculates the required minimum radioactivity to deliver a prescribed dose of radiation to a target using radioisotopes in permanent prostate brachytherapy. Assuming the radioactivity to be in a continuous form, an integral equation--Fredholm equation of the first kind, can be formulated with the radioactivity density used as the variable. The density distribution to produce a uniform volume dose rate is determined using a quadrature method and the radial profile behaves smoothly from the zero radius, and peaks sharply approaching the volume boundary. The density for Pd-103 is about 1.5 times that of I-125 due to its higher spatial attenuation. A nomogram is the relationship between the total activity per unit dose (A) and the dimension of the volume (d). Expressing the nomogram as A=c X dn U/Gy, then (c,n)= [(0.0098, 2.09) I-125] and [(0.031, 2.25) Pd-103]. Compared with the Memorial nomogram, (c,n)=[(0.011,2.2) I-125] and [(0.036,2.56) Pd-103], or that quoted by AAPM TG64, (c,n)=[(0.014,2.05) I-125] and [(0.056,2.22) Pd-103], our calculation determined an average 33% and 35% decrease for I-125, and 89% and 77% decrease for Pd-103, respectively. Two reasons for the extra total activity found in the Memorial and AAPM nomograms are: (a) An imperfect clinical situation limited by the restraints of implant techniques (e.g., use of templates) associated with the presence of adjacent normal organs, and (b) source discretization into seeds. When radioactivity is clumped as discrete seeds, higher activity is needed because of "wastage" in two aspects: (a) Dose cold-spots at intersource spaces, (b) hot-spots around the sources. Thus in theory, use of lower activity seeds will require less total activity to deliver a prescribed dose. Based on our study, Pd-103 delivers a higher therapeutic ratio and a lower integral dose to the patient compared to I-125.

Brachytherapy↗

PubMed1980

Comparison of methods of estimating creatinine clearance in children.

The accuracy of seven previously available and two new methods of estimating creatinine clearance (Clcr) from serum creatinine (Scr) and other patient variables was studied in pediatric patients. The medical records of 122 patients, aged 1--18 years, who had one or more 24-hour urine creatinines determined were reviewed; 158 determinations were studied. Equations for estimating Clcr based on patients' Scr, age, height, total body mass (TBM), adjusted body mass (ABM), and body surface area (and derivatives of these variables) were analyzed by correlation and regression analysis. Of the two derived equations, the one based on height and Scr was the simplest and most accurate; a nomogram for this equation is presented. The correlation coefficient for this derived equation (r = 0.802) was equivalent to that found for the best of the seven published methods (Method 7, based on Scr and height). Substitution of ABM for TBM in the published methods reduced the mean differences between predicted and measured Clcr. The derived equation based on Scr and height appears to be clinically useful in predicting Clcr in children but further study is required to ascertain whether it is generally more accurate than Method 7.

Adolescent↗

PubMed1981

The development of a drug dosage adjustment service for patients with renal impairment.

The dosage of nephrotoxic drugs such as gentamicin should ideally be adjusted when they are administered to patients with varying degrees of renal impairment. Such as adjustment of dosage should be estimated with a knowledge of the plasma levels of the drug. Until regular monitoring of drug levels of plasma is routinely available, the use of nomograms which utilize pharmacokinetic data quoted in the literature would provide dosage regimens tailored to suit the individual need of the renal patients. A service for dosage adjustment of nephrotoxic drugs has been provided in the Macclesfield Health District since December 1977 and has been well received by prescribers in the hospitals. The use of flow chart scheme for the adjustment of individual dosage for routine use is described. About 80% of the requests were for dosage adjustments of gentamicin in renal failure. It is advocated that such a service can be provided by hospital pharmacists without difficulty and should be encouraged as part of the patient services.

Creatinine↗

PubMed1966

An attempt to analyse colour reception by electrophysiology.

1. The problem of colour reception is that we do not know the action spectra of the visual pigments involved, the nature of the signals generated nor the interaction between these signals. We only know the incident light and the electric results of interaction.2. In Part 1 we show that S-potentials from red/green (R/G) units saturated with deep red light show this property: added green light pulls down the ceiling of depolarization, but more added red had no power to raise it again. Thus lights that depress the deep red ceiling equally stimulate the green pigment equally. From this the action spectrum of the green pigment can be obtained.3. If we assume that only two visual pigments are involved in the R/G unit, and that lights which do not pull down the deep red ceiling are below the threshold for green cones, then in this range only the red pigment is excited and we may obtain its action spectrum. Its maximum is at 680 nm where no visual pigment so far has been found.4. In Part 2 we consider the following mathematical problem: ;Is it possible that two pigments of given action spectra could combine their outputs in such a way that the resultant would be identical with the output of a third pigment of given action spectrum, for every intensity of every monochromatic light?' The solution shows that this is always mathematically possible, and the necessary interaction function is deduced.5. It is shown further that if the log action spectra are the ;visual parabolas' that resemble Dartnall's nomogram, then the interaction function is simply a linear transform such as Hartline & Ratliff (1957) have found with lateral inhibition in Limulus and Donner & Rushton (1959) with silent substitution in the frog.6. An interaction that matches a single pigment to perfection for all monochromatic lights will not match it for certain mixtures. By this criterion the 680 nm excitability is a pigment and not the resultant of two other pigments, i.e. pigments more excitable in other spectral regions.7. In Part 3 monochromatic lights are matched by red+green mixtures that give identical responses. From this the action spectrum of the red pigment may be obtained without involving nerve organization (except as a null detector). The result, which has one arbitrary constant, is given by the curves of Fig. 10, the continuous curve R or one of the dotted curves. Of these only curve R is acceptable.8. Knowing the action spectra for red and green cones we may consider what signals are generated and how they interact to give the records. Figure 11 suggests a model that will account for the size and sign of S-potentials as function of the quantum catch by the two pigments. It does not embrace the time or space parameters which can be very complex.

Animals↗

PubMed1988

ND: YAG nomogram dosimetry scale for the bladder.

Bowel perforation and damage to surrounding organs is probably the most significant risk with the use of Nd-YAG laser in the bladder. To prevent this unwanted damage, a nomogram dosimetry scale was developed by delivering different settings of laser energy via a cystoscope to 25 female pigs. One week following treatment, exploratory laparotomy and cystectomy were performed. Microscopic analysis of the depth of laser irradiation was accomplished. From this study it was learned that, although the greater the energy delivered, the deeper the tissue damage, this is not uniform. Pulsed energy produced a deeper effect than continuous energy. The use of 30 watts of either pulsed or continuous energy for no longer than 15 seconds (450 joules) or 10 watts of either form of energy for less than 30 seconds (300 joules) did not produce bowel perforation. Other different combinations of high number of watts or pulses translated into transmural necrosis of the bladder with or without perforation and with or without bowel injury. Other factors such as density, thickness, color and temperature of tissue, type and wave length of laser and optimal focusing played a significant role in the final outcome. Useful information for human clinical use may be extrapolated from this experimental model.

Animals↗

PubMed1975

On the theory of base excess curve in the Siggaard-Andersen nomogram.

Two definitions of the base excess (BE) curve are known. The first definition is a geometrical one. We call the second definition the physicochemical one. These definitions are only valid if the water shift between red blood cells and plasma caused by pH alteration is neglected. We show that under this condition the BE curve cannot be calculated according to the mentioned definition. On the contrary we get a well-defined BE curve by calculation only if water shift is taken into account. In that case we must modify the physicochemical definition. The modified equations redefining the BE curve are derived. Furthermore the equivalence of both the geometrical definition and the modified physicochemical definition is shown. Using the modified definition the BE curve is calculated and compared to the curve measured by SIGGARD-ANDERSEN.

Acid-Base Equilibrium↗

PubMed1975

A simple method for computing acid-base state.

Simple methods are described for computing the variables derived from the Siggaard-Andersen nomogram, where the in vitro buffer line is either established by direct measurement or calculated from measurements of pH, Pco2 and haemoglobin. Calculations are performed using the equation of the pH-log Pco2 buffer line, the Henderson-Hasselbalch equation, and the polynomials: BE=-38.402+1.8970 (SB)-0.013342 (SB)-2 m-equiv/litre; SL=-69.046+17.377 (pH40)-1.1121 (pH40)-2; SH=-123.30+31.357 (pH40)-2.0143 (pH40)-2. Then haemoglobin=7.5 (1+(S-SL)/(SH-SL)) G/100 ml, where S is the slope of the buffer line. Results are sufficiently accurate for clinical purposes.

Acid-Base Equilibrium↗

PubMed2003

Is there a difference in outcome after radical prostatectomy between patients with biopsy Gleason sums 4, 5, and 6? Results from the SEARCH database.

PURPOSE: Fewer patients newly diagnosed with prostate cancer today have biopsy Gleason sums <6 compared to several years ago. Several tables and nomograms for predicting disease recurrence after definitive therapy provide little or no discrimination between biopsy Gleason sums 4, 5, and 6. We sought to examine the significance of biopsy Gleason sum for predicting biochemical failure following radical prostatectomy (RP) for men with biopsy Gleason sums of 4, 5, and 6. MATERIALS AND METHODS: We examined data from 988 men treated with RP between 1988 and 2002 who had biopsy Gleason sums of 4-6. Clinical and pathological variables as well as outcome information were compared between men with biopsy Gleason sums of 4-6. The log-rank and Cox proportional hazards analysis were used to determine whether biopsy Gleason sum provided unique prognostic information for men with low biopsy Gleason sums undergoing RP. RESULTS: There was statistically significant, but overall weak correlation between biopsy Gleason sum and Gleason sum of the RP specimen (Spearman's r=0.277, P<0.001). As biopsy Gleason sum increased from 4 to 5 to 6, there was a steady rise (HR=1.31 for each one point increase in Gleason sum, Cox's model) in the risk of PSA failure (P=0.025, log-rank). On multivariate analysis comparing biopsy Gleason sum, preoperative PSA, clinical stage, year of surgery, percent of biopsy cores positive, and age for their ability to predict time to biochemical recurrence, only PSA (HR 2.09, CI 1.56-2.80, P<0.001) and biopsy Gleason sum (HR 1.33, CI 1.05-1.70, P=0.019) were significant independent predictors of PSA failure. CONCLUSIONS: Despite weak correlation between biopsy and pathologic Gleason sum among men with biopsy Gleason sum 4-6 tumors, grade was a significant independent predictor of PSA failure following RP. In the range of 4-6, biopsy Gleason sum acted as a continuous variable for predicting PSA failure. The routine use of Gleason sums 4 and 5 to grade prostate needle biopsy specimens should not be abandoned.

Biopsy, Needle↗

PubMed1988

Equations for the prediction of resting energy expenditure in chronic obstructive lung disease.

Resting energy expenditure can be obtained either by indirect calorimetry or from prediction equations. Several prediction equations were compared to the measured value of REE in a group of COPD patients with moderate to severe disease. Then, using the same group of patients, a new equation was derived by regression analysis and was prospectively tested on patients with similar characteristics. Equations derived from normal populations (Harris-Benedict, Wilmore nomogram) were shown to underestimate REE by 300-400 Kcal. Equations that use body weight as the only variable were found to be easier to use and did not appear to sacrifice accuracy. Quebbeman Ausman body weight, Quebbeman Ausman body surface area and a regression equation derived from COPD patients (males, REE = 11.5 x wt [kg] + 952; females, REE = 14.1 x wt [kg] + 515) performed better than other currently used equations. In both stable COPD and COPD with exacerbation, the mean predicted values fell within a standard deviation (+/- 167 Kcal) of measured values.

Body Surface Area↗

PubMed1992

Noninvasive identification of severe coronary artery disease using exercise tomographic thallium-201 imaging.

The ability of exercise thallium-201 tomographic imaging to predict the presence of left main or 3-vessel coronary artery disease (CAD) was examined in 688 patients who underwent both exercise thallium-201 testing and coronary angiography. Significant differences existed for multiple variables between patients with (n = 196) and without (n = 492) severe left main or 3-vessel CAD. Logistic regression analysis identified 4 variables as independently predictive of left main or 3-vessel CAD. These variables were the magnitude of ST-segment depression with exercise, the number of visually abnormal short-axis thallium-201 segments, the presence or absence of diabetes mellitus, and the change in systolic blood pressure with exercise. Using these variables, patients were classified by nomograms into low-, intermediate- and high-probability groups. Patients at high probability (n = 205) had a 52% prevalence of 3-vessel or left main CAD, whereas those at low probability (n = 170) had only a 12% prevalence. Only 53 patients (29%) with 3-vessel or left main CAD had perfusion abnormalities in all 3 coronary territories. Clinical and exercise parameters provide important independent information in the identification of left main or 3-vessel CAD by exercise thallium-201 tomographic imaging, because thallium scintigraphy alone is suggestive of extensive CAD in few patients.

Aged↗

PubMed1999

Prognostic factors for carcinoma of the prostate.

Prognostic factors for prostatic carcinoma should be significant, independent and clinically important. They should be of practical use, and their determination should be affordable in everyday practice. Prognostic factors may be grouped into patient-related, tumor-related and treatment-related. They should meet certain requirements, such as possession of a clear biological significance, an adequate sample size (possibly more than 150 patients), no patient population bias, an adequate statistical test, such as Cox regression analysis, as well as optimized cut-off values and reproducibility. From a pathologist's view, prognostic factors with established values are grade, margin involvement, capsular penetration, seminal vesical involvement, metastases and invasion of fat in needle biopsies. In contrast to this, factors with little value are, among others, zone location or nuclear shape. If these guidelines for assessment of prognostic factors are not met, the prognostic factors grow exponentially, as an individual patient can only belong to one prognostic group. If one considers all three categories of prognostic factors together, the clinical stage matters most despite all uncertainties. The same holds true for grading; particularly, the well-differentiated grades on biopsy cores have the drawback of being reflected in the specimen only infrequently. The use of biomarkers to give a better prognostic information is also disappointing, as only PSA and PAP have a reliable value among 28 biomarkers. It is of note that new biomarkers are continuously being discovered and examined, such as cyclin A or D. Due to these deficiencies in all three categories of prognostic factors for prostatic carcinoma, prognostic indices in the form of nomograms were constructed. But, if these indices are employed to answer the most important question at the time of diagnosis, i.e., 'is this man a candidate for surveillance?', neoadjuvant treatment plus irradiation, neoadjuvant treatment plus radical prostatectomy, perineal radical prostatectomy, because of a low probability of extracapsular extension or positive lymph nodes, adjuvant therapy after local treatment with curative intent as opposed to progression-based treatment or immediate systemic treatment, let alone intermittent endocrine manipulation, are not reliably possible. The outcomes of the few available studies based on prognostic factors should be studied carefully. If considered, a valuable new way of estimating artificial neural networks is a possibility to come to practical terms.

Biomarkers, Tumor↗

PubMedDate not supplied

[Effect of hospital policies on patient mobility: Siennese experience].

The Italian National Health Service (S.S.N.), adopted in 1978 (Law n 833) and based on Beveridge's model, emphasises the citizens freedom to choose and the equal opportunity in accessing health care structures. Local Health Authorities--L.H.A. (U.S.L.--Unità Sanitarie Locali) become owners of almost all the structures in their territories and directly responsible for the satisfaction of all residents health needs. The former hospitals' network, based on independent first, second and third level public hospitals, in potential competition, was dismantled. Hospitals' financing, the main economic role of the S.S.N., was based on the documented running expenses: therefore the hospital interest to attract patients diminished and expenses increased in a uncontrolled way. In 1992, the Italian Government, (re)introduced (Law n 502) the quasi-market administered competition between Italian hospitals, making the major ones independent (Aziende Ospedaliere--A.O.) from the L.H.A. Hospital income from then is based on DRGs; the L.H.A. (and hospitals) leadership is now entrusted to managers and not politicians. We describe now how these changes were experienced by our hospital (A.O. Senese), placed in Southern Tuscany, Italy. We elaborated hospitalisation data regarding residents in the province of Siena (252,000 inhabitants) and activity data regarding its main hospital (A.O. Senese, 1200 beds, 47,000 admissions/year). Using the Gandy's Nomogram, we show the variation of patients mobility from 1988 to 1999. Our survey demonstrates that the Italian hospital system answers well enough to the legislative regulations: following the Law 833/1978 our hospital diminished its ability to attract patients from other areas; at the same time migrations of hospitals patients from Siena increased. Following the Law 502/1992, the power of attraction of our hospital is increased. Nevertheless the flow of escape continued to increase. It appears that to discourage the attraction power means to promote the loss of perceived quality and that it is difficult to correct such effects.

Data Collection↗

PubMed2004

Fetal ventricular mass determination on three-dimensional echocardiography: studies in normal fetuses and validation experiments.

BACKGROUND: Estimation of ventricular volume and mass is important for baseline and serial evaluation of fetuses with normal or abnormal hearts. Direct measurement of chamber wall volumes and mass can be made without geometric assumptions by 3D fetal echocardiography. Our goals were to determine the feasibility of using fast nongated 3D echocardiography for fetal volumetric and mass assessments, to validate the accuracy of the ultrasound system and the measurement technique, and if satisfactory, to develop normal values for fetal ventricular mass during the second and third trimesters. METHODS AND RESULTS: This was a prospective outpatient study of 90 consecutive normal pregnancies during routine obstetric services at Oregon Health & Science University (Portland). Optimized 3D volumes of the fetal thorax and cardiac chambers were rapidly acquired and later analyzed for right and left ventricular mass by radial summation technique from manual epicardial and endocardial traces. Experiments to validate the ultrasound system and measurement technique were performed with modified small balloon models and in vivo and ex vivo small animal experiments. Our study established the feasibility of fetal ventricular mass measurements with 3D ultrasound technology and developed normal values for right and left ventricular mass from 15 weeks' gestation to term. CONCLUSIONS: Nongated fast 3D fetal echocardiography is an acceptable modality for determination of cardiac chamber wall volume and mass with good accuracy and acceptable interobserver variability. The method should be especially valuable as an objective serial measurement in clinical fetal studies with structurally or functionally abnormal hearts.

Animals↗

PubMed1994

A rapid method for determination of hepatic amino nitrogen to urea nitrogen conversion ('the Functional Hepatic Nitrogen Clearance').

The Functional Hepatic Nitrogen Clearance (FHNC) is a measure of the functional liver mass as to conversion of amino-N to urea-N. FHNC is the slope of the linear regression of multiple samples (10-20) of urea-N synthesis rates (UNSR) on blood alpha-amino-N concentrations (alpha-AN) during infusion of amino acids. UNSR is measured as urinary urea-N excretion rate corrected for accumulation in total body water (TBW) and loss in gut. A simplified method which estimates FHNC from only two samples of UNSR and alpha-AN was developed. Urine was collected in two hourly intervals: before infusion of alanine, and from 2 to 3 h after start of alanine infusion. Blood-urea-N and alpha-amino-N was measured at the beginning and at the end of each urine sampling interval. TBW was estimated from a nomogram, and gut loss of urea was assigned a fixed value (14%). The two-sample FHNC was calculated as delta UNSR (mmol h-1)/delta mean alpha-AN (mmol l-1). Linear regression analysis of the two-sample estimates of FHNC on the 'true' multiple-sample values of FHNC in an independent population of control and cirrhotic subjects showed the two-sample estimates to be closely related with values of the multiple-sample method, the regression equation being: two-sample FHNC = -0.24 + 0.99 x multiple-sample FHNC, r2 = 0.98. A close relationship was also obtained when cirrhotic patients were considered alone: two-sample FHNC = 0.01 + 0.94 x multiple-sample FHNC, r2 = 0.98.(ABSTRACT TRUNCATED AT 250 WORDS)

Amines↗

PubMed1995

Simulation of maximum respiratory venous PCO2 in vitro.

PvCO2 that would result from full O2Hb desaturation at a given O2-CO2 exchange ratio, in the absence of metabolic acid, may be termed maximum respiratory venous PCO2 (PvmrCO2). This theoretical condition of 100% O2 extraction, in the absence of metabolic acid, should simulate maximum aerobic PCO2 in tissue, provided that PCO2 of tissues and large veins is similar. Hence, the value of PvmrCO2 is of interest in identifying critical tissue PCO2. Analysis of the Dill nomogram indicates that PvmrCO2 is 77 torr at RQ = 1.0, PaCO2 = 40 torr in vitro, and that the PvCO2 versus SO2 relation is linear. Since the Dill nomogram is confined to the condition. [Hb] = 15 g.dL-1, [BE] = 0, the goal of the present analysis was to determine variability of PvmrCO2 with [Hb], arterial [base excess] ([BE]), and PaCO2. Venous CO2 titrations for multiple arterial conditions were simulated using published in vitro [BE] and whole blood [total CO2] formulae. In the RQ range of 0.7 to 1.0, the simulation yielded PvCO2 values that were essentially identical to those obtainable from the Dill nomogram. The simulation predicted that PvmrCO2 should decrease in direct proportion to [Hb], and increase non-linearly with decreasing arterial [BE]. The simulation further predicted that venoarterial PCO2 difference should increase linearly with increasing PaCO2. Simulated PvmrCO2-PaCO2 difference varied from 5 torr at arterial [BE] = +10 mmol/L, [Hb] = 6 g.dL-1, PaCO2 = 25 torr, RQ = 0.7 to 67 torr at [BE] = -20 mmol/L, [Hb] = 15 g.dL-1, PaCO2 = 65 torr, RQ = 1.0. It is concluded that the PvCO2 versus SO2 relation is not linear when arterial [Hb] and/or [BE] vary. An equation that predicts in vitro PvmrCO2 as a function of arterial [BE], [Hb], RQ, and PaCO2 is provided. It's accuracy in vivo should be testable.

Acid-Base Imbalance↗

PubMed1977

[Determination of cardiac output by the method of tetrapolar chest rheography and evaluation of its metrological possibilities].

Tetrapolar chest rheography is an up-to-day, convenient and bloodless method of determining the cardiac stroke volume (CSV) and cardiac output (CO) in dynamic observations. The paper presents and analysis of the method and considers the possibilities and limits of its application in determining the stroke volume and cardiac output. Advantages of the Kubicek procedure as modified by the authors by comparison with other rheographic methods are shown, along with methodological procedures employed for dtermining the CSV and CO and a nomogram that significantly facilitates the calculation of the values under study is offered. Results of contrasting the cardiac ejection values in patients with congenital heart diseases and an increased pulmonary circulation as against those in patients with ischemic heart disease, obtained by means of tetrapolar chest rheography and direct Fick's method are cited. The possibility of applying tetrapolar chest rheography in assessing the effect operative treatment in patients with congenital cardiac defects and also when investigating compensatory reactions of the cardio-vascular system in patients with hypertensive disease in the course of the orthostatic and Valsalva tests is demonstrated.

Adult↗

PubMed1991

Estimates of metabolic rate in obese and nonobese adolescents.

To evaluate the validity of equations for the calculation of basal metabolic rate, we compared measured metabolic rates in a population that included obese and nonobese adolescents with metabolic rates calculated from five equations commonly used to estimate metabolic rate. Of the available options, neither the Mayo Clinic nomogram nor the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) equations produced estimates that differed significantly from measured values. In a second cohort of severely obese adolescent girls, the FAO/WHO/UNU equation that included both height and weight provided the most accurate estimate of metabolic rate. Because of their simplicity, we recommend use of the FAO/WHO/UNU equations to estimate metabolic rate in adolescent populations (boys: BMR = 17.5 weight (kg) + 651; girls: BMR = 12.2 weight (kg) + 746). However, when obese cohorts are studied, the FAO/WHO/UNU equation that includes both weight and height predicts metabolic rate most accurately (boys: BMR = 16.6 weight (kg) + 77 height (m) + 572; girls: BMR = 7.4 weight (kg) + 482 height (m) + 217).

Adolescent↗