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At least 73 records · Page 4Linked to original sources
PubMed1997

Dynamic ultrasonography of the infant hip with suspected instability. A new technique.

PURPOSE: The combining of clinical examination of the infant hip with dynamic ultrasound (US) into one examination, performed by one examiner, should result in a sensitive test for hip instability. In this study a new method of dynamic US examination of the hip in newborn and very young children, that combined US with stress testing (BARLOW method) was tested. MATERIAL AND METHODS: A specially designed examination table, with a US probe holder, enabled the radiologist to perform a stress test of the hip according to BARLOW (using both hands), and simultaneously monitor it on US. Fifty-seven infants and young children were examined by this method, and compared with the GRAF method and clinical stress test. RESULTS: Our method allowed clear visualisation of the movement of the femoral head during the stress test, and was performed easily in patients under 3-4 months of age. CONCLUSION: The described method is easily adapted for one examiner with experience in US and in the clinical examination of the infant hip.

Hip Dislocation, Congenital↗
PubMed2004

[Orthostatic intolerance--prevalence, diagnostic management and its significance for occupational medicine].

OBJECTIVE: Orthostatic intolerance (OI) is a syndrome which is characterised by headache, concentration difficulties, palpitation of the heart, dizziness associated with postural tachycardia and plasma norepinephrine concentrations that are disportionately high in upright posture. OI hitherto can only be diagnosed by a tilt table examination with high expenditure. In this paper we examine the reliability and validity of a questionnaire as a screening instrument for OI. METHODS: We studied 138 young males (mean age 21.6 years) from the military service. After a medical check and filling in the questionnaire, the participants underwent a tilt table test. The questionnaire consisted of 10 items registering presence and frequency of typical OI-symptoms. RESULTS: 104 probands showed a normal tilt table test. OI was diagnosed in 14 probands, orthostatic hypotension (OH) in 6 and postural orthostatic tachycardia syndrome (POTS) in 14. The participants with OI scored significantly higher in the questionnaire than the normal subjects: The mean score of the OI group was 22.6, the normal participants had a mean score of 3.9. Participants with POTS had a mean score of 13.5 and subjects with OH had a mean score of 17.0. CONCLUSIONS: We were able to establish a short questionnaire as a reliable and valid screening instrument for OI. Usage of this questionnaire can simplify enormously the diagnostic management of patients with suspected OI.

Adult↗
PubMed2002

Diagnostic management of orthostatic intolerance in the workplace.

OBJECTIVE: Orthostatic intolerance (OI) is a syndrome that is characterised by headache, concentration difficulties, palpitation of the heart, dizziness associated with postural tachycardia and plasma norepinephrine concentrations that are disproportionately high when the sufferer is in the upright posture. In contrast to other forms of orthostatic dysregulation - orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS) - OI, hitherto, could be diagnosed only by a tilt table examination, with high expenditure. In this paper we examine the reliability and validity of a questionnaire as a screening instrument for OI. METHODS: We studied 138 young men (mean age 21.6 years) who were undergoing military service. After a medical check and filling in the questionnaire, the participants underwent a tilt table test including monitoring of blood pressure, heart rate and plasma catecholamines, in the supine position and during 30 min of standing. The questionnaire consisted of ten items registering presence and frequency of typical OI symptoms. RESULTS: Probands (104) showed normal tilt table test results. OI was diagnosed in 14 probands, OH in 6 and POTS in 14. The OI participants scored significantly higher in the questionnaire than the healthy subjects did: the mean score of the OI group was 22.6, the healthy participants had a mean score of 3.9. Participants with POTS had a mean score of 13.5 and subjects with OH had a mean score of 17.0. Reliability analysis showed a Cronbach's alpha of 0.888. Validity analysis showed that 93.5% of the probands with any kind of orthostatic dysregulation can be detected. CONCLUSIONS: We were able to establish a short questionnaire as a reliable and valid screening instrument for OI. Usage of this questionnaire can simplify enormously the diagnostic management of patients with suspected OI.

Adolescent↗
PubMed2006

Open magnetic resonance imaging (MRI) scanners.

(1) In most MRI scanners, the patient examination table fits inside a long cylindrical tube. Large patients cannot be accommodated, and some persons experience claustrophobic reactions. Open MRI systems, in which the patient is placed between two plates, overcome these disadvantages. (2) Open MRI scanners are widely used in health care. High-field closed MRI systems are preferred for many examinations. (3) Early versions of open MRI scanners had low magnetic field strength, gave poorer image quality than most closed systems, and required longer examination times. Newer open scanners include machines with higher magnetic field strengths and improved image quality. (4) Closed high magnetic field scanners with short magnets and wide bore tubes offer improved comfort to patients, and may be an alternative to open scanners. (5) There is interest in using open systems for intra-operative and image-guided interventions.

Canada↗
PubMed2001

Being uninsured in 1996 compared to 1987: how has the experience of the uninsured changed over time?

OBJECTIVE: To explore trends in the nonelderly uninsured population between 1987 and 1996 and examine whether the broad disparities in medical care utilization and out-of -pocket spending between the privately insured and uninsured populations that existed in 1987 continued over the following decade. DATA SOURCES/STUDY DESIGN: Data are from the 1996 Medical Expenditure Panel Survey and the 1987 National Medical Expenditure Survey. We used survey data to create descriptive tables examining the characteristics of the uninsured population and the use of medical services, total and out-of -pocket expenditures, and the burden of out-of -pocket spending for the uninsured and the privately insured in 1987 and 1996. Tabulations are presented by demographic and socioeconomic characteristics. PRINCIPAL FINDINGS: The composition of the uninsured population changed somewhat between 1987 and 1996, with adults over age 18 and employed persons making up larger proportions of the uninsured in 1996, and the poor and those in fair or poor health making up smaller proportions. There were few changes in utilization of services by the uninsured over this period and no change in mean expenses, but there was an increase in receipt of at least one preventive service (mammograms) and a decline in the proportion of families with high out-of-pocket burden. Disparities in use and expenses that existed between the uninsured and the privately insured in 1987, however, remained in 1996. CONCLUSIONS: Despite the fundamental changes in the health care system that took place between 1987 and 1996, health care utilization and expenses for the uninsured changed very little. The uninsured are still much less likely to use services than are the privately insured, and they pay for a larger proportion of their medical care expenses out of pocket. There was some improvement in the burden of out-of -pocket spending between 1987 and 1996, but a significant number of the uninsured still have high financial burden.

Adolescent↗
PubMed1997

Assessment of autonomic nervous function in elderly subjects with or without postprandial hypotension.

To examine the role of autonomic nervous dysfunction in postprandial hypotension (PPH) in elderly persons, we non-invasively assessed autonomic nervous function in 50 elderly subjects with or without PPH, defined as a reduction of more than 20 mmHg in systolic blood pressure (SBP) after a meal. The heart rate response to the reduction of SBP during head-up tilt was less and the coefficient of variation of R-R intervals was smaller in subjects with PPH than in those without PPH. The responses to cold pressor test, hyperventilation test, and mental arithmetic test were normal in all subjects. The magnitude of deltaSBP after meal ingestion closely correlated with deltaSBP during tilt-table examination, but did not correlate with the results of the cold pressor test, hyperventilation test, or mental arithmetic test. Stepwise multiple regression analysis revealed that the magnitude of the BP reduction and heart rate increase during the tilt-table test were independent predictors of the magnitude of deltaSBP after meal ingestion. The results indicate that impaired afferent pathways of baroreflexes, including baroreceptors, may play an important role in the pathogenesis of postprandial hypotension in the elderly and that the magnitude of the fall in SBP during tilt-table testing may be related to the degree of the postprandial reduction in BP in elderly persons.

Aged↗
PubMed2005

Whole-body MR imaging of bone marrow.

In clinical routine, multimodality algorithms, including X-ray, computed tomography, scintigraphy and MRI, are used in case of suspected bone marrow malignancy. Skeletal scintigraphy is widely used to asses metastatic disease to the bone, CT is the technique of choice to assess criteria of osseous destruction and bone stability. MRI is the only imaging technique that allows direct visualization of bone marrow and its components with high spatial resolution. The combination of unenhanced T1-weighted-spin echo- and turbo-STIR-sequences have shown to be most useful for the detection of bone marrow abnormalities and are able to discriminate benign from malignant bone marrow changes. Originally, whole-body MRI bone marrow screening was performed in sequential scanning techniques of five body levels with time consuming coil rearrangement and repositioning of the patient. The introduction of a rolling platform mounted on top of a conventional MRI examination table facilitated whole-body MR imaging and, with the use of fast gradient echo, T1-weighted and STIR-imaging techniques, for the first time allowed whole-body imaging within less than one hour. With the development of parallel imaging techniques (PAT) in combination with global matrix coil concepts, acquisition time could be reduced substantially without compromises in spatial resolution, enabling the implementation of more complex and flexible examination protocols. Whole-body MRI represents a new alternative to the stepwise multimodality concept for the detection of metastatic disease, multiple myeloma and lymphoma of the bone with high diagnostic accuracy.

Bone Marrow Neoplasms↗
PubMed1995

Techniques of cutaneous examination for the detection of skin cancer.

Skin cancers are the most common cancers in humans. The American Cancer Society estimates that in the United States more than 700,000 new skin cancers are diagnosed annually. Although the majority of nonmelanoma skin cancers occur on visibly exposed anatomic areas, most malignant melanomas occur on body sites obscured by clothing. The high mortality associated with advanced melanomas emphasizes the importance of performing regular total cutaneous examinations in all patients to detect early, easily curable lesions. A number of techniques aid in these examinations: (1) physical and psychologic preparation of the patient; (2) appropriate lighting and a suitable examination table; (3) when indicated, use of Wood's light, dermoscopy, and photography. In addition, any suspicious lesion should be biopsied promptly either in parte or in toto. Lastly, the patient should be educated about the signs and symptoms of skin cancer, the role of sunlight in causing skin cancer, and the need for sun avoidance and/or protection. By heightening public awareness of the high incidence of cancers of the skin and by emphasizing the need for routine examination of the entire cutaneous surface, most cutaneous malignancies can be diagnosed early when they can be cured by simple surgical procedures.

Biopsy↗
PubMed1994

[A new radiation protection device for cardiologists active in interventional radiology].

The radiation protection system up to now has been in the form of a lead glass pane and a lead curtain on the examination table. As new equipment we used a leaded rubber cover (Pb 0.75 mm) extending from the foot to the rib cage of the patient and a 60-cm high and 70-cm wide stand, reinforced with leaded rubber (Pb 1.0 mm) fixed onto the foot switch. During the period of 2 months the total radiation dose in 156 coronary angioplasties and 71 diagnostic heart catheterizations was measured on the hand, thorax, lower leg and foot of the examiner using ring and placet dosimeters. The dose was measured for a further 2 months, during 152 coronary angioplasty and 66 diagnostic heart catheterizations without the new extra radiation protection equipment. The catheterization procedure was not basically impeded through the lead cover and the lead stand. The radiation dose experienced by the examiner was reduced by 96.8% on the hand, 98.6% on the thorax, 98.8% on the lower leg, and by 99.5% on the foot.

Angioplasty, Balloon, Coronary↗
PubMed1993

Synchronous cystoscopy and cystometry in the management of neurogenic bladder dysfunction.

The physical difficulties associated with cystoscopy and cystometry in the spinal cord injury patient led to a clinical trial of synchronous cystoscopy and cystometry in these individuals. Following a disappointing experience with external transducer methodology, a recently available fiberoptic microtransducer system was used and an effective system was developed. A total of 20 individuals with spinal cord injury underwent a standard water cystometrogram on an examination table followed by synchronous flexible cystoscopy and cystometry using a 5F fiberoptic microtransducer while seated in a chair. The results showed both pressure tracings to be clinically identical. Uninhibited contraction spikes, compliance curves and leak point pressures were essentially the same by both methods and artifact was not a problem. Given the speed, ease and reproducibility of this method, the difficulties with patient transfer for these studies have been virtually eliminated. Two urethral instrumentations have been replaced by 1. Examination room time was decreased from 60 to approximately 10 to 15 minutes with half of the required personnel. Perhaps more importantly, these occasionally problematic individuals clearly prefer this streamlined approach and patient compliance with followup has improved.

Cystoscopes↗
PubMed1987

Frequency of occurrence of Campylobacter pylori and analysis of the systemic and local immune response.

During gastroduodenoscopic examination of 225 patients, bioptic mucosal specimens were taken for bacteriological and histological examination (Table 1). Campylobacter (C.) pylori was isolated from 7 out of 9 patients (78%) with gastric ulcer, from 59 out of 60 (98%) with duodenal ulcer, from 24 out of 31 (77%) with gastric erosions, from 10 out of 10 (100%) with duodenitis, from 14 out of 16 (88%) with chronic active gastritis, from 40 out of 73 (55%) with chronic inactive gastritis and from none out of 26 patients (0%) with normal mucosa (Table 2). To study the immune response an ELISA was developed which proved to give well reproducible and specific test results (Fig. 1). IgA- and IgG-titres were strongly reduced after absorption with C. pylori, but not with other antigens (including C. jejuni and C. coli, Table 3). Some sera gave reactions at higher titres when tested with the patient's own strain than with the standard antigen which is a mixture of 4 strains (Table 4). This indicates differences of the antigen composition within the species C. pylori. Sera from patients with positive culture showed higher IgG- and IgA-titres than sera from patients without isolation of C. pylori. The IgM-titres, however, were comparable in both groups (Fig. 3). Partially, sera from patients without C. pylori also showed high IgG-titres which were positively correlated with the patient's age. About 60% of culturally positive patients had specific IgA in their gastric juice, whereas this was not so with patients without isolation of C. pylori (Fig. 6). Examination of sera from healthy children and blood donors revealed that IgG but not IgA or IgM rose significantly with increasing age (Figs. 7-9). As can be concluded from the results of cultural and serological tests, C. pylori seems to be responsible at least for a part of cases of gastritis and peptic ulcer.

Adult↗
PubMed1991

Internal carotid artery occlusion: diagnostic inaccuracy of the ocular pneumoplethysmography.

The diagnosis of internal carotid artery (ICA) occlusion has serious management and prognostic consequences. The accuracy of noninvasive techniques in this setting remains questionable, with the result that contrast arteriography remains the diagnostic method of choice in patients in whom ICA occlusion is suspected. Ocular pneumoplethysmography-Gee (OPG-Gee) is one of the noninvasive methods that is still utilized extensively in the evaluation of carotid artery disease. In order to determine the real utility of OPG-Gee, the authors conducted a retrospective comparison of the results of OPG-Gee and arteriography in 26 patients (52 internal carotid arteries) who had undergone both examinations. [table: see text] With the angiography results as the standard of comparison, 4 incorrect diagnoses were obtained by OPG-Gee, thus yielding an overall accuracy of 92 for this method. However, duplex ultrasonography, also performed in the same 26 patients, correctly identified the 2 ICA occlusions defined by angiography and further demonstrated patency in the 48 arteries so shown by angiography. The authors conclude from this experience that OPG-Gee is less reliable than duplex ultrasonography in the diagnosis of ICA occlusion. Furthermore, despite the 92% overall accuracy of their results with OPG-Gee, the occurrence of both false-positive and false-negative results renders this examination modality suspect in the diagnosis of ICA occlusion.

Air↗
PubMed2000

Improved US visualization of the pancreatic tail with simethicone, water, and patient rotation.

PURPOSE: To evaluate the effect of degassed water, simethicone, and patient rotation on ultrasonographic (US) visualization of the pancreatic tail. MATERIALS AND METHODS: Seventy patients in whom visualization of the pancreatic tail was poor at US were reevaluated in the upright position after ingesting 2 cups (500 mL) of water with 80 mg of simethicone followed by rotating three times on the examination table. In a few patients, the right posterior oblique position was used. Pancreatic tail visualization and disbursement of gastric gas were evaluated. Seventy patients who received 500 mL of distilled water only served as control subjects. RESULTS: Pancreatic tail visualization in patients versus control subjects was complete in 55 (79%) versus five (7%) of 70 patients and control subjects, partial in 10 (14%) versus 38 (54%), and not improved in five (7%) versus 27 (39%). The effect on diminishing gastric air was closely correlated with the degree of improved visualization in most patients. All patients tolerated the procedure well, with no side effects. The technique added a mean of 8 versus 5 minutes to the examination in patients versus control subjects. The full acoustic window effect of the simethicone-water mixture lasted approximately 10 minutes. CONCLUSION: The simethicone-water-rotation technique is simple, safe, inexpensive, and effective for improving pancreatic tail visualization in ambulatory patients and is superior to the use of water alone.

Adolescent↗
PubMed1990

[Vestibular ataxia caused by meningeal carcinomatosis].

A 74-year-old man developed progressive deafness and unsteady gait two years after gastrectomy for a gastric cancer. Neurological examination revealed an alert and intelligent Japanese male in no acute distress. The optic fundi were normal. The pupils and the extraocular muscles were normal, however, horizontal nystagmus was noted in right and left gaze. He showed marked bilateral deafness, and loss of caloric response bilaterally. No muscle atrophy nor weakness was noted. His gait was wide-based and ataxic. Tandem gait was impossible. Romberg sign was present. No cerebellar ataxia was noted in the finger-to-nose or the heel-to-knee test. No adiadochokinesis was noted. Hyperextensibility was noted in the lower extremities. Deep reflexes were normal in the upper limbs, and diminished in the lower extremities. Sensation was intact. He showed the jumbling phenomenon, and the disturbance of the righting reflex in the tilt-table examination. Neuroradiological as well as laboratory studies were unremarkable except for the high titer of CEA in the CSF. Four months after his admission, malignant tumor cells were found in the CSF. It seemed likely that he had completely lost bilateral vestibular and auditory functions caused by meningeal carcinomatosis. His disturbance of gait and station was apparently similar to cerebellar ataxic gait, however, he did not have limb ataxia. The cranial CT scans failed to show cerebellar atrophy. It was our impression that his motor disturbance was in all likelihood caused by the bilateral loss of vestibular functions, i.e., vestibular ataxia.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Gravity-assisted pivot-shift test for anterior cruciate ligament injury: a new procedure to detect anterolateral rotatory instability of the knee joint.

The denominated gravity-assisted pivot-shift test was introduced as a new procedure to detect anterolateral rotatory instability of the knee joint. The patient lies in the supine position or slightly rotated onto the affected side. The affected knee flexed approximately 60 degrees and the ipsilateral hip flexed, abducted and externally rotated so that the plane of the knee motion runs parallel to the floor. The examiner instructs the patient to raise the affected leg off the examining table and to extend the affected knee gradually. If the lower leg is internally rotated suddenly, with the knee subluxated at an angle of approximately 20 degrees , followed by the reduction in flexion, this test is regarded as positive. This test was investigated on 51 anterior cruciate ligament (ACL) deficient knees, being positive in 30 knees (Group P) and negative in 21 (Group N) with the positive rate of 59%. There was no significant correlation between the result of this test and the clinical features, but Group N included relatively small number of females and recurrent injuries tended to occur more frequently in Group P. Thirty-six knees received ACL reconstruction subsequently. There was no statistically significant difference between the groups in the side-to-side difference in anterior knee laxity at one year postoperatively. However, three patients with the side-to side difference of more than 3 mm belonged to Group P. Relatively low positive rate in ACL deficient knees suggests that it may not be used as a diagnostic procedure for ACL injury. It is possibly used for the prediction of high risk patients for symptomatic giving-way and/or patients with poor prognosis after ACL reconstruction.

Adolescent↗
PubMed1996

Postural vertigo. Quick relief from the postural vertigo component of vestibular diseases.

Patients who had disorders of the vestibular system with a component of benign postural vertigo as a symptom were studied, using an examination table suitable for the canalith (otolith) repositioning maneuver as described by Epply, followed by lack of recumbency for 48 hours. The patients regularly had resolution or decreased intensity of symptoms, as did those described by Epply. A repeated positioning maneuver may be needed in some of the patients. The application of a vibrator, as previously described has not been found to be essential.

Humans↗
PubMed2000

Incorporation of intraoperative computerized tomography in a newly developed spinal navigation technique.

OBJECTIVE: We report on the first successful incorporation of intraoperative computerized tomography in spinal navigation procedures. MATERIALS AND METHODS: All operations were performed with the aid of a Tomoscan M mobile CT system (Philips Medical Systems, Eindhoven, The Netherlands). The system comprises a mobile gantry, a mobile patient examination table, and a mobile workstation. Three different navigation systems were used: the EasyGuide (Philips Medical Systems, Eindhoven, The Netherlands), the Surgical Tool Navigator (Zeiss, Oberkochen, Germany), and a prototype of an ultrasound navigation system developed by ourselves (IVS GbR, Chemnitz, Germany). All surgical operations were performed with the patient positioned on the mobile table of the CT system. Following dorsal preparation of the vertebral region, the surgeon implanted small titanium screws in the vertebrae to serve as fiducial markers. Image data acquisition and image-to-patient registration were performed after implantation of the marker screws. The pedicle screws were inserted using the navigation system, and the position of each implant was confirmed by intraoperative CT scans. RESULTS: To date, 35 patients with various spine disorders have been operated upon using the technique described, and 161 pedicle screws have been inserted. There were no misplacements of pedicle screws. In three (1. 9 %) cases we observed lateral perforation (maximum 2 mm) of the lateral pedicle wall. We achieved a registration error of 0.85 mm (RMSE) +/- 0.42 mm (SD). CONCLUSIONS: The combination of intraoperative computerized tomography and spinal navigation allows easy navigation with a high application accuracy of 0.8 mm +/- 0.4 mm (SD) at the target point (measured in experiments with a plastic spine model). The possibility of performing an intraoperative quality check on demand markedly improves the safety of these procedures.

Adolescent↗
PubMedDate not supplied

Perceived accessibility versus actual physical accessibility of healthcare facilities.

This study addressed how healthcare clinics perceive themselves in regard to accessibility for persons with spinal cord injuries (SCI). All 40 of the clinics surveyed reported that they were wheelchair accessible; however, there was significant variability in the number of sites that actually met the guidelines of the Americans with Disability Act. In general, a person using a wheelchair could enter the building, the examination room, and the bathroom. The majority of sites did not have an examination table that could be lowered to wheelchair level. Most reported limited experience in working with persons with (SCI), yet they claimed to be able to assist with difficult transfers. Only one site knew about autonomic dysreflexia. Problems of accessibility appeared to be seriously compounded by the clinics' perception of how they met physical accessibility guidelines without consideration of the actual needs of persons with SCI. This study addressed the perception of accessibility as reported by clinic managers versus actual accessibility in healthcare clinics in a Midwestern metropolitan area for persons using wheelchairs.

Architectural Accessibility↗