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PubMed2002

Moore's Law, disruptive technologies, and the clinician.

The advancement of technical power described by Moore's Law offers great potential for enabling more cost-effective medical devices and systems. However, progress has been slow. Many factors for this failure have been cited, including the anti-rational economic structure of healthcare and the complexity and long time scale of medical development. Christensen et al. suggest that "disruptive technologies" may circumvent some of these difficulties. "Disruptive Technologies" are defined as those that are established in one market, but then penetrate and overwhelm another market. These incursions are accelerated by economic factors, and capitalize on functionality, reliability, and advancements supported by the original market. Christensen has cited many examples from industrial and service businesses, but few examples can be found yet in healthcare. We argue that positive technology impacts in medicine occur most readily when innovators augment the skills of and collaborate with caregivers, rather than seeking to displace them. In the short term, a new approach may improve efficiency or quality. In the longer term, such approaches may obviate human tasks at lower-skill levels, and even permit task automation. One successful example has been the introduction of flexible monitoring for physiologic information. Systems for computer-aided diagnosis, which have failed to impact complex decision making, have succeeded in simpler specialty areas such as the interpretation of EKG's and mammograms, and may do the same with analysis of some pathology images. The next frontier may the operating room, and the adoption of such systemic technologies by caregivers in emergency medicine and general care may then have an even wider "disruptive" effect. Responding to time and cost pressures, and the desire to move care to the patient, other workers, such as radiologists, will drive the trend away from isolated, complex, large-scale devices, and toward integrated, modular, and simpler networked technologies. In summary, technological "push" will continue in the demanding cutting-edge application areas as always, but the "disruption" will occur through wider application of lower-cost technologies, pulled by the users. The capabilities described by Moore's Law will allow the advancements necessary to facilitate this dissemination of capability and its ultimate benefit, so long sought.

Cost-Benefit Analysis↗
PubMed2003

[Significance of anatomic variants of bony surroundings of the internal carotid artery and their significance for lateral surgical approaches to the cavernous sinus].

OBJECTIVE: The central skull base region and the cavernous sinus in particular have traditionally been thought inaccessible to surgical manipulations. Despite significant progress in anatomy, physiology, pathology, imaging and surgical techniques, it is still challenging to explore this part of the skull. The main risk is injury to the internal carotid artery running through the area surrounded by bony structures e.g.: anterior, middle and posterior clinoid processes, optic strut, and petrous bone (Fig. 1, 2). Access to this area requires removal of bony structures but at the same time represents the greatest surgical risk. This microsurgical anatomic study was performed to give surgeons more details on these structures and their relation to the internal carotid artery and venous neighborhood, thus making the operative procedure safer. METHODS: 40 central skull base area specimens were harvested from 20 fresh human cadavers during regular anatomopathologic autopsy. Almost immediately after excision, arterial and venous systems were cannulated and injected with colored acrylic. Microsurgical dissections were performed using a surgical microscope, along with morphometric measurements and photographic documentation of anatomical variants of structures studied. RESULTS: The anterior clinoid process is a structure of complex architecture. In most cases (70%), at least one bony spicula arises from the tip of anterior clinoid and not infrequently passes in a fold of the dura directly under the internal carotid. Bony bridges were observed joining spiculae with similar protrusions of the middle and/or posterior clinoid thought to be especially dangerous during anterior clinoidectomy (Tab. 2, Fig. 2). This observation is in agreement with the literature. 60% of anterior clinoids were pierced by narrow venous canals arising from the anterior cavernous sinus and running through the clinoid space (Fig. 12). They are considered a source of bleeding usually encountered at the very end of anterior clinoid removal. The optic strut seems to be a structure of stable and relatively simple architecture. In 20% of specimens, optic struts were pierced by narrow venous canals arising from the anterior cavernous sinus and running through the clinoid space. The anterior clinoid process and the optic strut happen to be pneumatized. In this case, the pneumatized area is covered with a mucous membrane and opens to the sphenoid sinus or posterior ethmoidal cells (Tab. 2). It was quite surprising that the carotid canal roof was incompletely closed in all samples, although the length of opening was highly variable (Tab. 12, Fig. 1). A relatively thick connective tissue layer covered the opening, usually occupying the area under the Gasserian ganglion i.e. the most medial part of the canal. The greater superficial petrosal nerve was a good landmark for identification of position of the carotid canal in the petrous bone. The canal ran almost directly under the nerve. The hiatus of greater superficial petrosal nerve poorly demarks the area of bone removal lateral to the posterior loop of the internal carotid (Tab. 12). Numerous morphometric measurements of anterior clinoid, optic strut, carotid canal and their anatomical variants give an even greater insight into the area (Tab. 3-13, Fig. 3-11). It is obvious that preoperative CT scanning should be done using thinnest slicing available taking into consideration the scale of measurements presented in this paper. CONCLUSIONS: More details were revealed concerning an area already explored by many researchers. New observations are presented on venous canals passing through the clinoid space. A new insight has been obtained into the area around the roof of the internal carotid canal. The present rich morphometric and photographic documentation should be helpful when dealing with vascular, neoplastic or traumatic lesions of the central skull base. It can also be useful for preoperative planning or training at a neuroanatomy lab.

Cadaver↗
PubMedDate not supplied

[Clinical and electroencephalographic aspects of late infantile neuronal ceroid lipofuscinosis].

AIMS: In this paper we describe the clinical characteristics, and particularly the epileptic seizures and electroencephalographic findings, in 15 patients with a pathology diagnosis of late infantile neuronal ceroid lipofuscinosis (NCL). PATIENTS AND METHODS: Nine female and six male patients were studied and their clinical records covering the period February 1990 to June 2003 were analysed. Neuroimaging, neurometabolic studies, ERG, PE and repeated EEG were carried out in all cases. RESULTS: The mean age on onset of the disease was 3 years (range: 1-5 years). The initial symptom was epilepsy in all cases. Massive myoclonias and myoclonic-atonic seizures were the most frequent kinds of attacks. Focal myoclonias were observed in six patients. Other types of epileptic seizures observed included generalised tonic-clonic, absence, motor focal and complex focal. The epileptic seizures were resistant to therapy. Progressive neurological and visual impairment, pyramidal and cerebellar signs, as well as mental retardation were present in all cases. Intercritical EEG recordings showed diffuse paroxysms with spike and polyspike waves, multifocal spikes and, less often, focal spikes that were predominant in posterior regions. Photostimulation showed high amplitude (300-450) occipital spikes during the application of light stimulation between 1 and 8 Hz. ERG, VEP and SSEP results were pathological. Images showed signs of brain and cerebellar atrophy. Seven of the patients died between 8.5 and 11 years of age. CONCLUSIONS: Late infantile NCL must be considered in the case of a child aged between 1 and 5 years who presents seizures that are predominantly generalised myoclonias and myoclonic-atonic, in association with progressive neurological deterioration including pyramidal, cerebellar and visual signs and an EEG trace showing occipital paroxysms triggered by low frequency photostimulation.

Child↗
PubMed2005

[Uroflowmetry and its influence factors in benign prostate hyperplasia patients].

OBJECTIVE: To determine the relationship between uroflowmetry and age, the course of disease, premicturition volume, transition zone index and proportion of stroma-to-epithelium in benign prostate hyperplasia (BPH) patients. METHODS: Eighty-nine BPH patients in our hospital from 2000 to 2003 were evaluated. With the CMM3 pathology image analysis system, transrectal ultrasound and Dantec 2000 urodynamic instrument, the value of influence factors was determined. A linear regression was applied to analyze all the data by SPSS software. RESULTS: The flow rate was correlated to premicturition volume ( r = 0. 477, P < 0.01) and proportion of stroma-to-epithelium significantly ( r = - 0.437, P < 0.05) , but was not correlated to the age, the course of disease and transition zone index significantly. The parameter of flow rate/premicturition volume had no difference in 3 micturitions in all patients. CONCLUSION: The parameter (flow rate/premicturition volume)could be used to evaluate the micturition status of the BPH patients whose bladder volume is less than 200 ml. We should pay more attention to receptor blockers when we treat BPH patients.

Aged↗
PubMed2005

[Effect of clausenamide on the expression of Bcl-2 protein and apoptosis after focal cerebral ischemia/reperfusion in renovascular hypertensive rats].

OBJECTIVE: To observe the effect and mechanism of clausenamide on the expression of Bcl-2 and apoptosis after focal cerebral ischemia/reperfusion in renovascular hypertensive rats. METHODS: Seventy-five renovascular hypertensive rats were randomly divided into three groups (25 in each group): clausenamide intervention group, single ischemia/reperfusion model group and sham-operated group. Focal cerebral ischemia was reproduced by ligature for 2 hours and loosening of the ligature in the rats. No arterial ligature was applied in sham-operated group. Computerized pathological image analyzer was used to determine the number of cells positive for Bcl-2 by immunohistochemical staining, and also the counts of apoptotic cells after TdT-mediated dUTP nick end labeling (TUNEL) staining respectively in coronal sections of brain after reperfusion (6, 12, 24, 48 and 72 hours). RESULTS: (1) The expression of Bcl-2 protein was detected 6 hours after reperfusion, peaking at 24 hours, then declined gradually. The Bcl-2 protein positive cell counts at every time point in clausenamide intervention group were significantly higher than simple ischemia/reperfusion model group (all P<0.01). (2) The number of apoptotic cells was increased with reperfusion, reaching its peak at 72 hours. The apoptosis counts in clausenamide intervention group were significantly lower than single ischemia/reperfusion model group (all P<0.01). At all time points, except at 48 hours after reperfusion, as there was no significant difference (all P>0.05). No Bcl-2 positive cells and only 0-2 apoptotic cells could be discernible in brain sections from sham-operated animals or in the contralateral side of ischemia in animals of the other groups. CONCLUSION: Expression of Bcl-2 protein is enhanced and apoptosis appears after focal cerebral ischemia/reperfusion in rat brain. Clausenamide can enhance the expression of Bcl-2 protein and inhibit apoptosis remarkably. Clausenamide may coordinate with Bcl-2 in inhibiting apoptosis. This may be the mechanism of protection of brain cells from ischemic damage of clausenamide treatment.

Animals↗
PubMed2004

[Roles of endothelin and nitrogen monoxide in the adenine-induced acute renal failure models].

OBJECTIVE: To determine the roles of endothelin (ET) and nitrogen monoxide (NO) in the adenine-induced acute renal failure (ARF) models. METHODS: ARF models were established by feeding adenine in rats. The activity of NO synthase (NOS) in kidneys of rats was tested by NADPH-diaphorase. Expression of endothelin-1 (ET-1) in kidneys of rats was studied by immunoreactivity method. The area densities for ET-1 and NOS expressions in kidneys were determined by CMM3 pathology image analysis system to calculate the mean light density. RESULTS: Expressions of ET-1 in normal rat kidneys were wide and weak, but they were greatly enhanced in medulla renis of the ARF models while remained unchanged in the cortex. The activities of NOS were stronger in the cortex and the inner medulla than in the outer medulla. The renal functions of the ARF models were improved after they were treated with L-argine, but the expressions of ET-1 and NOS were not improved. After the withdrawal of adenine, the ARF model rats recovered gradually in their renal functions, and the same was true for the expressions of ET-1 and NOS. CONCLUSION: ET-1 and NO both play important roles in the occurrence, development and recovery of ARF. It is supposed that L-Arg can partly protect the renal functions of ARF rats.

Acute Kidney Injury↗
PubMedDate not supplied

[Acquired factor VIII hemophilia in a geriatric patient].

Acquired hemophilia is a rare coagulopathy in adults, associated with bleeding complications. Although the etiology of this disorder remains obscure, an autoimmune mechanism produces the development of autoantibodies against factor VIII. About half of cases are associated with other conditions, mainly post-partum, underlying cancer, autoimmune disease. An 81-year-old male was admitted to the hospital with extensive hematomas (neck, chest, arms and lower limbs). There was no family or personal history of congenital bleeding diathesis. He had chronic bronchitis and cerebrovascular disease; no drugs had been used during the month prior to noted symptoms. Laboratory parameters revealed: hemoglobin 10.9 g%, normal platelet count and white blood cells, prolonged activated partial thromboplastin time (98 s), with normal prothrombin time and fibrinogen concentration. An activated partial thromboplastin time mixing study did not show any correction, suggesting a coagulation inhibitor. Lupus anticoagulant and anticardiolipin antibodies were negative. Biochemical, immunological tests and tumor markers were normal. Thoracic and abdominal computed tomographic scan did not reveal pathological images or hematomas. Analysis of clotting factors revealed decreased factor VIII (< 2%) and elevated factor VIII inhibitor (55 Bethesda units). Idiopathic acquired hemophilia diagnosis was made. Red blood cell transfusion and human factor VIII (2000 U/day for 7 days) infusion were initiated, intravenously with methylprednisolone. A progressive improvement in clinical conditions and laboratory parameters was observed. After 18 days the patient was discharged and treated with prednisone. At follow-up control the clinical conditions and laboratory parameters were normal.

Aged, 80 and over↗
PubMed2005

[Renal angiomyolipoma, histology, diagnostics and therapy].

BACKGROUND: Renal angiomyolipoma is a benign mezenchymal tumour with prevalence of 0.3-3% of all surgically resected renal tumours. Tumour is often associated with tuberous sclerosis complex or with another fakomatosis. Tumour has typical pathological image in computer tomography notation that enables the diagnosis. Symptomatology and possible complications depend on the tumour size. Large or symptomatic tumours are indicated for resection, nephrectomy or local ablation. METHODS AND RESULTS: 612 patients with renal tumour were operated at the Department of Urology faculty hospital in Pilsen. Angiomyolipoma occurred in 7 patients. Average age at the time of operation was 64 years, ratio female and male was 5:2. Clinical symptomatology was expressed in 3 patients. The size of tumour was 2 to 8 cm, in 5 patient the tumors were solitary. Translumbal tumour resection was performed in 3 patients. These tumours were at the same time multifocal. Suspicion from tuberous sclerosis was pronounced in some care. The angiomyolipoma was accidentally found in 2 cases of nephrectomy, which was indicated for other diagnosis. CONCLUSIONS: We define diagnosis by means of CT notation in the most of patients. This notation is not typical by any version of angiomyolipoma and we choose therefore surgical revision.

Aged↗
PubMed2005

Present strategy of lung cancer screening and surgical management.

Previous lung cancer screening trials in the United States (US) employing chest X ray and sputum cytology did not demonstrate reductions in lung cancer mortality. However, recent case control studies in Japan demonstrated a decrease in lung cancer mortality in the computed tomography (CT) screened group. Lung cancer screening using chest CT detected more cancers at an earlier stage than chest X ray. Before CT screening is widely performed, lung cancer mortality reduction should be proved in a scientific manner. The problem of a much higher false positive rate of this method should be solved. The subtypes of adenocarcinoma; bronchioloalveolar carcinoma (BAC) tends to show specific CT findings called ground glass opacity (GGO) and a favorable prognosis can be expected. BAC is usually invisible by chest X ray and detected only by CT. Recent studies have shown the proportion of GGO is strongly related to biological malignancy of small adenocarcinoma. Based on this fact, thoracic surgeons wish to identify the possibility of limited resection for minimally invasive cancers. Lung cancer researchers are interested in evaluating the nature of small adenocarcinoma as well as the carcinogenic process. A comprehensive understanding of screening-detected cancers including the CT images, pathology and genetic analysis is necessary for optimum management of such nodules.

Adenocarcinoma↗
PubMed2006

[Case of multiple thin-walled cavitary pulmonary metastasis from bladder cancer].

A 71-year-old man was admitted to the urological section of our hospital because of hematuria. Cystoscopy revealed a bladder tumor. Transurethral resection of the bladder tumor (TUR-Bt) was performed. This tumor was diagnosed pathologically as bladder cancer (transitional cell carcinoma pT2). His chest computed tomogram showed multiple thin-walled cavitary nodules in both lungs. The pathological images of the specimen that was resected by video assisted thoracic surgery (VATS) showed transitional cell carcinoma. A diagnosis of pulmonary metastasis from bladder cancer was made. This is a rare case.

Aged↗
PubMed1991

[Incidental disclosure of an adrenal tumor. Diagnostic and therapeutic procedure].

Among upper abdominal computed tomography (CT) scans, 0.6 per 1000 fortuitously reveal an adrenal tumour, an "image pathology" now known as "adrenal incidentaloma". Should the clinician avoid useless, iatrogenic surgery or run the risk of failing to identify a malignant adrenocortical tumour? We outline a clinical procedure aimed at distinguishing between solid vs liquid, secreting vs non-secreting and primary vs metastatic tumour. Nevertheless, in the end the diagnosis may be uncertain, in which case tumour size becomes the deciding factor. For tumours of less than 3 cm close surveillance is advocated, whereas surgery is necessary for tumours larger than 3 cm; for tumours in between these sizes only the individual clinician can decide.

Adrenal Gland Neoplasms↗
PubMed1990

[Deficiency syndrome of chronic gastritis].

161 cases of chronic gastritis (including 59 superficial gastritis, 86 atrophic gastritis, 16 superficial gastritis combined with atrophic gastritis) typed in deficiency syndrome (including 64 Spleen-deficiency syndrome, 97 Spleen-Kidney-deficiency syndrome) were studied clinically with modern medicinal multiple-index. The gastroscope image, pathologic changes of gastric mucosa, stomach barium meal examination, gastric acid, serum gastrin, urine pepsinogen, urine 17-ketosteroid, vegetative nerve function, peripheral blood picture, etc. were selected as observation indices. The preliminary findings showed that in Spleen-deficiency patients, the superficial gastritis constituted the majority, the asthenic stomach constituted the minority, the gastric secretion and the serum gastrin were on the high side, the urine pepsinogen, the adrenocortical function and the hemoglobin were on the low side, but the white blood cell was rather normal; otherwise, in Spleen-Kidney deficiency patients, the atrophic gastritis and the asthenic stomach constituted the majority, the gastric secretion decreased, the serum gastrin level was higher, while the urine pepsinogen, the adrenocortical function, white blood cell and the hemoglobin were on the low side. It was also found that in certain same inflammation changes, the gastric secretion of the Spleen-Kidney-deficiency syndrome was markedly than that of Spleen-deficiency syndrome. With the treatment method of invigorating the Spleen and reinforcing the Spleen-Kidney, each index was relatively improved. The degree of seriousness to inflammation changes of gastric mucosa and the disturbance or imbalance of gastric secretion function were reflected from the Spleen-deficiency and the Spleen-Kidney-deficiency syndromes of chronic gastritis. It is suggested that hemopoiesis and hypothalamo-adenohypophysial-adrenal cortical axis be influenced.

Adult↗
PubMed1990

[Echography of pneumothorax].

Ultrasound of 28 radiologically confirmed cases of pneumothorax were compared to 100 controls. Specific ultrasonographic signs were shown in all cases and could be categorised into four groups: isolated pneumothorax (n = 16), hydro-pneumothorax (n = 9), subcutaneous emphysema (n = 1) and post aspiration pneumothorax (n = 2). The isolated pneumothorax was characterised by the disappearance of the lung deflection signal. The effusion of the hydropneumothorax allows in addition a curtain sign which depicts the movement of the air/fluid level, the detachment of the lung being calculated across the liquid window whose echo-structure is analysed. Pneumothoraces appearing during an echo guided thoracic puncture are confirmed by the disappearance of the pathological image. Thus echography appears to be a new method in the diagnosis of pneumothoraces and is complimentary to standard radiology. It should be confirmed as particularly useful during the process of thoracic puncture or juxta-diaphragmatic puncture when following the process of a pneumothorax, for emergency situations and/or those in which no radiological equipment is available.

Aged↗
PubMed1989

Localization of metastases from medullary thyroid carcinoma using different methods.

We analyzed the efficiency of three different noninvasive methods in the localization of recurrent medullary thyroid carcinoma (MTC). Nine patients (six females and three males) with biochemical evidence of disease after primary surgery were subjected to 131I anti-carcinoembryonic antigen (anti-CEA) antibody, 131I meta-iodo-benzylguanidine (MIBG), and computed tomography. Another female patient, in biochemical remission for six years after initial surgery, was also studied using the same methods. Three of the ten patients had negative results with all three methods (including the patient in remission). The other seven patients showed abnormal uptake of labeled anti-CEA antibody in various localizations; only two of these patients had a corresponding pathological image by computed tomography and only one by 131I MIBG. These preliminary results suggest that 131I anti-CEA scanning may be the most sensitive noninvasive method for the localization of MTC recurrences.

3-Iodobenzylguanidine↗
PubMed1989

Malignant bone tumor management. 30 years of achievement.

Malignant bone tumor management has changed drastically over the last three decades. Orthopedic surgery has been in the forefront of these major advances. Amputation is now much less common than other forms of limb reconstruction. Oncologists have come to play a much larger role than do radiotherapists. Indeed, radiotherapy is seldom used now except for its undoubted value in palliation. The development of adjuvant chemotherapy is now prolonging life, assisting the surgeon in local resection, and almost certainly increasing the chances of survival. When one considers the valuable role of thoracic surgery in lung metastectomy and the advances in pathology, imaging, and the staging of bone tumors, it can be seen there has been a revolutionary change in the care of those who suffer from primary malignancy of bone.

Bone Neoplasms↗
PubMed1989

[Radiology of the cervical spine].

The author describes some particularities seen in the abnormal or pathological image of the cervical spine: the osteolysis of the cortical bone in the spinous processes, the "Y" shaped course of the corporeal veins, the notch in interspinous bursitis, and the main forms of constitutional stenosis of the cervical canal.

Bursitis↗
PubMed1979

[The combination mass radiography--blood pressure measurement. Experiences and results in the Canton Bern].

The combination of mass radiophotography and blood pressure measurement was started in the Canton Berne (population approx. 1 million) in 1974. Experience with this method has been highly satisfactory: An average of 80% of personnel attented mass radiophotography on a voluntary basis and 97--i00% participated in the blood pressure measurement. The costs were low because a well-established service could be utilized. In this way, it has been possible to examine 90,000 persons within three years, or 45% of the population (age 30 to 65 years). The results for 1977 were analyzed using a general computer program. A total of 17,112 persons aged 30 years and more and belonging to the working population were examined: 14.6% of the screened population had hypertension of greater than or equal to 160 and/or greater than or equal to 95 mm Hg. Diastolic pressure was found to be greater than or equal to 100 mm Hg in 5.9% and greater than or equal to 110 mm Hg in 1.8%. 54.8% of the detected hypertensions were unknown to the examined persons and 17.8% were under treatment. Correlations with other findings, such as pathologic images of the heart in the X-ray and smoking, have been investigated. An interesting fact was the remarkable difference in the percentage of hypertension between population groups (10.7--20.7%) and occupations such as industry, trades and public utilities (3.0--29.8%). It has been shown that screening for hypertension is not only a propaganda move. A large number of undetected hypertensive subjects can be passed on for treatment.

Adult↗