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PubMed1995

Home monitoring of warfarin therapy in children with a whole blood prothrombin time monitor.

We prospectively evaluated a capillary whole blood prothrombin time (PT) monitor (Biotrack, Ciba Corning) in an outpatient pediatric anticoagulation clinic (40 clinic patients) and in age-matched healthy subjects (30 control subjects). Subsequently, 23 children requiring warfarin therapy were placed on a home program (home patients) using the PT monitor; their parents were trained and the results followed by clinic staff. The PT results were reported as internationalized normalized ratios (INRs). The laboratory and PT-monitor INR values were similar for the clinic patients and the control subjects (y = 0.76x + 0.38; r = 0.93; p < 0.001). The accuracy of the PT monitor (the difference between INR values and the laboratory INR) was best at an INR of 2.5 to 3.5; 90% of paired INR values were within 0.8 INR units. The average duration of monitoring for home patients was 13 months (range, 2 to 60 months). They had an average of 3 dose measurements (range, 1 to 11 measurements) and 1.8 dose changes (range, 0.6 to 4.5 changes) per month. Of the 599 measurements, 63% were within the therapeutic range, similar to those for clinic patients; the dose requirements were also similar. There was 1 significant bleeding event, a subdural hematoma in a patient with an INR of 4.1, and 1 catheter-related thrombotic event with an INR of 1.2; both children recovered. Of the 23 families, one discontinued home monitoring because of parental discomfort, 2 children died of their primary disease, 6 completed warfarin therapy, and 14 remain on the home program. We conclude that the whole blood PT/INR monitor is safe and offers practical advantages to children requiring anticoagulation.

Adolescent↗
PubMed1999

Evaluation of a new fibre-optical monitor for respiratory rate monitoring.

OBJECTIVES: To present further development of a fibre-optical respiratory rate monitor and evaluate the function in the final version. METHODS: Respiration was recorded in 18 healthy volunteers of ages 9-83 years by three different methods simultaneously: fibre-optical monitoring, capnography and manually. The recordings were made-breath by breath in four 3-minute periods in each subject. In total there were 54 observations, corresponding to 648 minutes. The recordings were fed simultaneously into a computer. Two subjects were excluded because of pronounced differences between all three methods. One person was later diagnosed as having a nasal septum deviation. Recordings with any kind of technical problem were also excluded. RESULTS: In total 516 minutes were analysed. Students' paired t-test showed a mean of 0.5 and 0.3 more breaths were recorded by fibre-optical monitor compared with the manual method and capnography respectively. The 95% confidence interval of the differences between the fibre-optical monitor and the other two methods was -0.5 to +1.5 when the mean respiratory frequency was 14 breaths per minute. Analysis of variance revealed that the fibre-optical monitor tended to overestimate the mean respiratory rate (p < 0.001). CONCLUSION: The fibre-optical monitor has sufficient accuracy for clinical monitoring. It is easy to use and inexpensive. Combinations with pulse oximetry seem attractive, to use especially for application outside "high tech areas," for example when respiratory depressant drugs are used or in ambulances.

Adolescent↗
PubMed2002

A proposal for a long-term baseline phytobenthos monitoring programme for the Finnish Baltic coastal waters: monitoring submerged rocky shore vegetation.

Several local surveys on the submerged vegetation have been conducted in past decades along the Finnish Baltic coastal areas. Surveys have been carried out by using various methods, which make the temporal comparisons of the results difficult. The need of a joint programme for coastal phytobenthic monitoring is emphasised by the Nordic Council of Ministers and HELCOM. The Finnish coastal phytobenthic monitoring programme complements the Baltic HELCOM monitoring programme (COMBINE). It is primarily designed to reveal the effects of eutrophication. The programme includes general principles for selection of monitoring areas as well as a proposal for monitored habitats, communities and species. The need of evaluated and tested field methods, data collecting, interpretation and data storage are addressed in the Quality Assurance part. The cost-efficiency is secured by integrating the phytobenthos programme with the coastal water monitoring for obtaining the supporting data such like salinity, temperature and nutrients. In the design of the monitoring programme a special interest is paid on areas with high protection values such as Natura 2000 or HELCOM's BSPA (Baltic Sea Protected Areas) or on aspects that would support the implementation of the EU Water Framework Directive.

Baltic States↗
PubMed1995

A consensus view on the technique of ambulatory blood pressure monitoring. The Fourth International Consensus Conference on 24-Hour Ambulatory Blood Pressure Monitoring.

This review, based on the Fourth International Consensus Conference on Ambulatory Blood Pressure Monitoring (Leuven, Belgium, 1994), deals with the technical aspects of ambulatory blood pressure monitoring. Ambulatory blood pressure monitoring by noninvasive intermittent techniques is widely used despite artifacts due to cuff size, movement, body position, short-term blood pressure variability, and interference with sleep. The performance of the currently available monitors under truly ambulatory conditions and during exercise remains a matter of debate, as are the procedures required to validate portable monitors under these circumstances. There is general agreement that whenever a monitor is to be used in special populations, such as older subjects or pregnant women, or in special conditions, such as exercise, a specific demonstration of its accuracy in these defined subgroups or conditions is warranted. Whether the auscultatory or oscillometric method is preferred remains controversial because each technique has specific advantages and disadvantages and because both can provide accurate results. Most experts in the field strongly believe that manufacturers should disclose the algorithms of their devices and that they should specify all changes made to the hardware and software of a previously validated monitor. Finally, the development of the volume-clamp method, which makes continuous noninvasive registration of blood pressure at the finger possible in both stationary and ambulatory conditions, opens new perspectives in research, in particular in relation to short-term blood pressure variability.

Adult↗
PubMed2002

Brain tissue oxygenation monitoring supplementary to somatosensory evoked potential monitoring for aneurysm surgery. Initial clinical experience.

The object of the study was to evaluate brain tissue oxygenation (p(ti)O2) for intra-operative monitoring of critical ischemic events during early cerebral aneurysm surgery of the anterior circulation supplementary to somatosensory evoked potentials (SEPs). P(ti)O2 was continuously evaluated during surgery for an intracranial aneurysm in 28 patients. Standard cortical SEP monitoring was simultaneously performed. The two monitoring methods were compared by evaluating their respective responses to intra-operative events (particularly temporary vessel occlusion), clinical and neuroradiological outcome. P(ti)O2 and SEPs were reliably used for monitoring in 16 patients. Seven patients were excluded due to too high or too low p(ti)O2 readings or initial absence of SEPs (six patients). Of 64 intra-operative events 19 events (eight patients) were associated with a significant decrease in p(ti)O2 (below 10 mmHg), 22 events (13 patients) were associated with a significant change in SEP amplitude (< 50% decrease related to baseline). Temporary vessel occlusion (six SEP andp(ti)O2 changes each in eightpatients) and surgical dissection were most likely to be followed by significant changes in a monitoring method. Intra-operative p(ti)O2 was found to be a safe, rapid method for documenting ischemic events. P(ti)O2 was found to supplement SEP monitoring. The use of p(ti)O2 measurement as a routine monitoring method in aneurysm surgery is limited by its focal spatial resolution. Nevertheless, it might be helpful as an adjunct in situations when SEPs are absent at baseline, in aneurysms when parent vessel anatomy is complex or if temporary vessel occlusion is planned.

Adult↗
PubMed2005

Use of multi-objective air pollution monitoring sites and online air pollution monitoring system for total health risk assessment in Hyderabad, India.

A consensus has been emerging among public health experts in developing countries that air pollution, even at current ambient levels, aggravates respiratory and cardiovascular diseases and leads to premature mortality. Recent studies have also presented well-founded theories concerning the biological mechanisms involved and the groups of people that are probably more susceptible to health effects caused or exacerbated by inhalation of ambient particulate matter (PM.). On the basis of prognostic studies carried out in Center for Environment, JNT University, Hyderabad "it has been estimated that in Hyderabad some 1,700 to 3,000 people per year die prematurely as a result of inhaling PM". These figures reflect only the effects of acute exposure to air pollution. If the long-term effects of chronic exposure are taken into account, 10,000-15,000 people a year could die prematurely in Hyderabad. This estimate of the chronic effects is based on other studies, which are not completely comparable with the Hyderabad situation. While the study designs and analyses in these other studies may indeed be different or irrelevant to Hyderabad, the fact they were carried out in other countries is irrelevant. Taking into account these considerations, a model for total health risk assessment for the city of Hyderabad, and its state of Andhra Pradesh in India has been developed using a multi-objective air pollution monitoring network and online and real time air pollution monitoring stations. For the model studies a number of potential monitoring sites were screened for general and site-specific criteria in a geographic information system (GIS) environment that may, on a local basis, affect the representativeness of the data collected. Local features that may affect either the chemical or meteorological parameters are evaluated to assure a minimum of interference. Finally, for monitoring air pollution, an online and real-time monitoring system was designed using advanced electrochemical sensor systems (sulphur dioxide, oxides of nitrogen, carbon monoxide, hydrocarbons, ozone, mercaptans and hydrogen sulphide) and a particulate matter analyzer (total suspended particulate matter TSPM), PM2.5 and PM10). The sensor and data acquisition systems are programmed to monitor pollution levels at 1/2 hour durations during peak hours and at 1-hour intervals at other times. Presently, extensive statistical and numerical simulations are being carried out at our center to correlate the individuals living in the monitored areas with respiratory infections with air pollution.

Air Pollutants↗
PubMedDate not supplied

[Assessement of home blood pressure with a monitor including MAM technology: comparison with the standard monitor].

OBJECTIVES: To compare two periods of three days of home blood pressure monitoring (HBPM) using two different monitors with one including MAM (microlife average mode) technology. METHODS: In 152 hypertensive subjects referred to hypertension specialists, a self-measurement of blood pressure was performed sequentially with an Omron M6 (arm cuff, A/A, BHS validation) or Microlife BP-3AC1 with the MAM technology. Each patient recorded home blood pressure during two periods of 3 days with 3 measures in the morning and 3 in the evening. Order for use of each monitor was randomised. BP values were reported on a standardized document. RESULTS: In this population, aged 60 +/- 14 years, with 57% of men and a mean blood pressure of 150 +/- 21/84 +/- 21 mmHg, the home blood pressure values were 141.5 +/- 18.7/79.9 +/- 9.6 mmHg with the OMRON monitor and 138.2 +/- 17.1/79.9 +/- 10.1 mmHg with the Microlife monitor. Values between the two monitors differed about 5 mmHg for the mean SBP and about 2.8 mmHg for the mean DBP. The mean HBPM values does not differ between the two methods for more than 2.5 mmHg, 5 mmHg, 10 mmHg and 15 mmHg in 29%, 49%, 80% and 90% for SBP and in 42%, 76%, 94% and 98% for DBP respectively. CONCLUSIONS: For most of patients, mean SBP/DBP obtained with home blood pressure Measurement during three days are comparable when using monitor operated with MAM technology or not.

Blood Pressure Monitoring, Ambulatory↗
PubMed1990

Home monitoring of gonadotropin ovulation induction using the Ovarian Monitor.

The safe use of gonadotropins relies on close hormonal and/or ultrasound monitoring to assess the response to treatment, requiring multiple hospital visits. Home monitoring with the Ovarian Monitor (St. Michael Research Foundation, Macleod, Victoria, Australia) minimizes hospital visits and overcomes many of the logistic difficulties associated with gonadotropin use. It utilizes a system of homogenous enzyme immunoassay using lysozyme conjugates to measure quantitatively either urinary estrone-3 or pregnanediol-3-glucuronide. Results obtained by 24 patients in 57 cycles using the Ovarian Monitor at home correlate closely with results obtained in the laboratory (estrone-3-glucuronide r = 0.955; pregnanediol-3-glucuronide r = 0.958). Cycle outcomes (ovulation, 74%/cycle; clinical pregnancy, 30%/cycle; multiple pregnancy, 13%/pregnancy; hyperstimulation, 11%/cycle) are no different from those achieved in laboratory-monitored patients. Home monitoring can be as safe and effective as laboratory monitoring, offers significant social benefits, and improves access to this form of therapy.

Adult↗
PubMed1996

ST segment monitoring with a derived 12-lead electrocardiogram is superior to routine cardiac care unit monitoring.

BACKGROUND: Prior studies have shown that a derived 12-lead electrocardiogram with a simple electrode configuration is comparable with the standard electrocardiogram for arrhythmia analysis. METHODS: A prospective, comparative, within subjects design was used to compare the value of the derived 12-lead electrocardiogram with that of routine monitoring of leads V1 and II for detection of transient myocardial ischemia in 250 patients treated for unstable angina or myocardial infarction. RESULTS: During 11,532 hours of derived 12-lead ST segment monitoring, 55 (22%) of 250 patients had 176 episodes of ischemia. Of the 55 patients with ischemia, 75% reported no chest pain and 64% had no ischemic ST changes with routine monitoring leads. All five patients who developed angiographically confirmed abrupt reocclusion after percutaneous transluminal coronary angioplasty had ischemic ST changes with the derived electrocardiogram (sensitivity, 100%), compared with only two patients with routine monitoring (sensitivity, 40%). Serious complications occurred in 17% of angina patients with ischemic events compared to 3% of those without ischemia. Length of stay in the cardiac care unit was twice as long in angina patients who had ischemic events. In patients with acute myocardial infarction, ischemic events were not associated with a more complicated hospital course; however, length of stay in the cardiac care unit was longer in patients with recurrent ischemia. CONCLUSIONS: The findings show that derived 12-lead ST monitoring is superior to routine monitoring of leads V1 and II for detecting transient myocardial ischemia. ST monitoring of the derived 12-lead electrocardiogram may identify high-risk patients with unstable angina and provide prognostic information that would not be otherwise available from the usual clinical measures.

Adult↗
PubMed1998

12-lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes.

BACKGROUND: 12-lead ECG monitoring of the ST segment is more sensitive than patients' symptoms for detecting ischemia after thrombolytic therapy or catheter-based interventions, but it is unclear whether monitoring of the single lead showing maximum ST deviation would be as efficacious. OBJECTIVE: To determine whether monitoring all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes. METHODS: Continuous 12-lead ST segment monitoring was performed in 422 patients from the onset of myocardial infarction or during balloon inflation in catheter-based interventions until the patient's discharge from the cardiac care unit. Computer-assisted techniques were used to determine (1) which lead showed the maximum ST deviation at the onset of myocardial infarction or during balloon inflation and (2) what proportion of later ischemic events were associated with ST deviation in this lead. RESULTS: The lead with the maximum ST deviation could be determined in 312 patients (74%). The remaining 110 (26%) had non-Q wave infarction without ST deviation or no ST changes during balloon inflation. During 18,394 hours of 12-lead ST monitoring, 118 (28%) of the 312 patients had a total of 463 ischemic events, 80% of which were silent. Of 377 ischemic events in which a maximum ST lead was detected, 159 (42%) did not show ST deviation in this lead (sensitivity, 58%; 95% CI, 53%-63%). Routine monitoring of leads V1 and II showed ST deviation in only 152 of the 463 events (sensitivity, 33%; 95% CI, 29%-37%). CONCLUSIONS: Monitoring of all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes.

Aged↗
PubMed1991

Comparative accuracies of a finger blood pressure monitor and an oscillometric blood pressure monitor.

A noninvasive blood pressure monitor (Finapres) that uses the methodology of Penaz to continuously display the arterial waveform from the finger has been introduced recently. The Finapres monitor overestimated systolic pressure by 5.8 +/- 11.9 mm Hg, while the Dinamap monitor underestimated systolic pressure by -6.9 +/- 9.2 mm Hg (P = 0.003). Dinamap mean and diastolic pressure biases were less than 2 mm Hg, while the Finapres biases for these variables were significantly greater (7.7 +/- 10.0 and 8.2 +/- 9.8 mm Hg, respectively). There was no difference in systolic or mean pressure precision between the two devices (approximately 10 mm Hg), but the diastolic precision of the Dinamap unit was superior to that of the Finapres. While in most patients the Finapres monitor provided continuous blood pressure data equivalent to the data from the radial artery, marked bias (greater than 15 mm Hg) was exhibited in 2 patients for all three pressure variables. Despite this bias, blood pressure changes were tracked closely in these 2 patients. We conclude that, in its current form, the Finapres monitor cannot be relied upon independently to accurately measure blood pressure in patients undergoing general anesthesia. Since the Dinamap monitor measures mean pressure reliably and accurately, we suggest that mean blood pressure values between the Finapres and Dinamap monitors be compared to guide one in interpreting Finapres data.

Adolescent↗
PubMed1995

Significance and incidence of concordance of drug efficacy predictions by Holter monitoring and electrophysiological study in the ESVEM Trial. Electrophysiologic Study Versus Electrocardiographic Monitoring.

BACKGROUND: Selection of antiarrhythmic therapy may be based on either suppression of spontaneous ventricular arrhythmias assessed by Holter monitoring or by suppression of inducible ventricular arrhythmias during electrophysiological study. This study examines the frequency and significance of concordance of these two approaches in the Electrophysiologic Study Versus Electrocardiographic Monitoring (ESVEM) trial. METHODS AND RESULTS: Twenty-four-hour Holter monitoring was performed in patients randomized to the electrophysiology limb of the ESVEM study at the time of the first drug trial and at the time of an effective drug trial. Holter monitors were available in 65% (146/226) of patients at the time of the first drug trial and in 93% (100/108) of patients at the time of an electrophysiology study predicting drug efficacy. There were no clinical differences between patients who had and those who did not have a Holter monitor. At the time of the first drug trial, concordance of Holter and electrophysiological predictions of drug efficacy was observed in 46% of patients (both techniques predicted efficacy in 23%; neither predicted efficacy in 23%). Discordant results were observed in 54% (Holter suppression without electrophysiological suppression in 44%; electrophysiological suppression without Holter suppression in 10%). At the time of an electrophysiology study predicting drug efficacy, 68 of the 100 patients without inducible ventricular tachyarrhythmias also had suppression of spontaneous ventricular arrhythmias on the Holter recorded at the time of the electrophysiological study. Neither arrhythmia recurrence nor mortality was significantly different in patients with suppression of both inducible and spontaneous ventricular arrhythmias compared with those with only suppression of inducible arrhythmias. Comparison of patients with suppression of both inducible and spontaneous ventricular arrhythmias with the 188 patients in the Holter limb, in whom efficacy was predicted by Holter monitoring only, revealed no difference in outcome. CONCLUSIONS: In this population, (1) there is frequent discordance in prediction of drug efficacy and inefficacy between electrophysiological study and Holter monitoring; (2) a requirement to fulfill both Holter and electrophysiological efficacy criteria reduces the number of patients with an efficacy prediction; and (3) suppression of both spontaneous ventricular ectopy and inducible ventricular tachyarrhythmias does not identify a group with better outcome.

Aged↗
PubMed2004

Introductory experience with the continuous glucose monitoring system (CGMS; Medtronic Minimed) in detecting hyperglycemia by comparing the self-monitoring of blood glucose (SMBG) in non-pregnant women and in pregnant women with impaired glucose tolerance and gestational diabetes.

OBJECTIVE: To assess the detection rate of hyperglycemia with a continuous glucose monitoring system compared to a self-monitoring blood glucose profile in non-pregnant, non-diabetic pregnant women, and patients with impaired glucose tolerance or gestational diabetes.. METHODS: Eight non-pregnant (NP) and 56 pregnant women (17 dietary-treated gestational diabetics (GDM), 15 women with impaired glucose tolerance (IGT), and 24 non-diabetic pregnant women (NDP)) underwent a 72-hour measurement with the CGMS (Medtronic Minimed, Northridge, CA, USA). Self-monitored blood glucose measurements, performed 30 minutes before and 120 minutes after each meal, were compared to the duration of hyperglycemia monitored by the continuous glucose monitoring system. RESULTS: No clinically observable infection was found at the subcutaneous tissue where the electrode was placed. A statistically significant difference was found between the groups in body mass index, HbA1c, and in gestational age, but not in age or parity. Using the self-monitored blood glucose (SMBG), 88 % (7/8) of the NP and 54 % (13/24) of the NDP had no measurement above 6.7 mmol/l. However, 17 % (4/24) of the NDP and 40 % (6/15) of the IGT showed more than two measurements above 6.7 mmol/l compared to 24 % (4/17) of the dietary-treated GDM. The differences between these groups were not significant (p = 0.21). The mean durations (+/- SD) of hyperglycemia above 6.7 mmol/l/24 h were: NP 111 +/- 120 min, NDP 138 +/- 120 min, IGT 381.8 +/- 295 min, and GDM 190 +/- 155 min, p = 0.017; above 7.8 mmol/l/24 h NP 24 +/- 49 min, NDP 38 +/- 47 min, IGT 170.7 +/- 190 min, and GDM 64 +/- 88 min, p = 0.016; and above 8.9 mmol/l/24 h NP 9.3 +/- 25 min, NDP 7.5 +/- 14 min, IGT 59 +/- 77 min, and GDM 14 +/- 21 min, p = 0.026. There was no significant difference in the fetal outcome or rate of birth percentiles using the sensor data. CONCLUSIONS: The use of the sensor in pregnant women is unproblematic. a) The CGMS detected more frequent and longer durations of hyperglycemia in GDM compared to non-diabetic pregnant women than the SMBG. b) Women with an IGT exhibited higher glucose levels than patients with gestational diabetes. c) The clinical importance of these hyperglycemic intervals, e.g. with respect to the risk for macrosomia, must be assessed in larger trials.

Blood Glucose Self-Monitoring↗
PubMed1993

Evaluation of three transportable multigas anesthetic monitors: the Bruel & Kjaer Anesthetic Gas Monitor 1304, the Datex Capnomac Ultima, and the Nellcor N-2500.

We compared the performance of three newly developed anesthetic agent (AA) monitors: the Bruel & Kjaer Anesthetic Agent Monitor 1304 (BK 1304), the Datex Capnomac Ultima (ULTIMA), and the Nellcor N-2500 (N-2500). The following were investigated: the linearity and accuracy in measuring AAs, oxygen, carbon dioxide, and nitrous oxide; the linearity and accuracy during warm-up time; the effect of increasing respiratory rate on the accuracy; the consequences of a difference between monitored and delivered AA and of delivering a mixture of AAs; and, finally, the effect of water vapor and alcohol. For all three monitors we found that the accuracy in determining the respiratory and anesthetic gases was sufficient for clinical use (the N-2500 does not measure oxygen). Because of the calibration mixture supplied with the device, however, the ULTIMA recorded values that were 10 to 12% (relative) less than the AA that was present. The BK 1304 had greater accuracy at higher respiratory rates than did the other two monitors, probably favoring its use in pediatric anesthesia. The N-2500 will detect which agent (isoflurane, enflurane, or halothane) is being used, alone or in a mixture. With the two other monitors the user must define which agent is given. In some situations a difference between this and the one actually delivered can theoretically lead to an overdose of AA, with the ULTIMA up to a 14.9 minimal alveolar concentration (MAC) overdose. No interference from alcohol or water vapor in the expired air was found.(ABSTRACT TRUNCATED AT 250 WORDS)

Anesthesia, Inhalation↗
PubMed1999

Reference values and human biological monitoring values for environmental toxins. Report on the work and recommendations of the Commission on Human Biological Monitoring of the German Federal Environmental Agency.

This article describes the working principles and working procedures of the Commission on Human Biological Monitoring, which was established in 1993 as a joint commission of the Federal Health Office (Bundesgesundheitsamt) and the Federal Environmental Agency (Umweltbundesamt) in Germany. One of the main tasks of the commission is to develop scientifically based criteria for the application of human biological monitoring and for the evaluation of human monitoring data in environmental medicine. In principle, two different kinds of criteria are recommended: (a) reference values and (b) human biological monitoring values (HBM values). Reference values are intended to indicate the upper margin of the current background exposure of the general population to a given environmental toxin at a given time. Reference values can be used to identify subjects with an increased level of exposure (in relation to background exposure) to a given environmental toxin. However, reference values do not represent health-related criteria for the evaluation of human biological monitoring data. HBM values are derived from human toxicology and epidemiology studies and are intended to be used as a basis for a health-related evaluation of human biological monitoring data. Usually the commission recommends two different HBM values: HBM I, the concentration of an environmental toxin in a human biological material (usually blood, serum, plasma, or urine) below which there is--according to the knowledge and judgement of the commission--no risk for adverse health effects in individuals of the general population: and HBM II, the concentration of an environmental toxin in a human biological material (usually blood, serum, plasma, or urine) above which there is--according to the knowledge and judgement of the commission and with regard to the environmental toxin under consideration--an increased risk for adverse health effects in susceptible individuals of the general population. The HBM I value can be considered a kind of alert value (from the toxicological point of view), whereas the HBM II value represents a kind of action level, at which attempts should be undertaken to reduce the level of exposure immediately and to carry out further medical examinations. Values between HBM I and HBM II should be considered a warning signal of the need to control the analytical measurement and to reduce the level of exposure of the concerned individual as reasonably as is achievable. At present, reference and HBM values are available for lead in blood, for cadmium and mercury in blood and urine, and for pentachlorophenol in plasma/serum and urine. Reference values have been established for some polychlorinated biphenyls in blood and plasma as well as for hexachlorocyclohexane and hexacholorobenzene in blood as well as for some organochlorine in human milk.

Adolescent↗
PubMed1992

Intracranial pressure monitoring: fiberoptic monitor compared with the ventricular catheter.

Among the frequently utilized intracranial pressure (ICP) monitoring devices employed in neurosurgical practice is the Camino fiberoptic monitor. Several recent studies have described results with the Camino monitor and compared it with other forms of ICP monitoring with varying results and conclusions. The aim of this study was to compare simultaneous ICP readings from the Camino fiberoptic monitor placed in the brain parenchyma and from a ventricular catheter. ICP values were recorded for up to 118 hours in 10 patients. It was determined that the Camino ICP measurements exceeded those of a ventricular catheter in 66% of total measurements for the 10 patients. The mean ICP difference between the Camino fiberoptic system and the ventricular catheter was 9.2 +/- 7.8 mm Hg. This result suggests that the correlation between intraparenchymal pressure measured by the Camino fiberoptic monitor and the intraventricular pressure is not as close as previously described.

Catheterization↗
PubMed1993

A comparison of electrophysiologic testing with Holter monitoring to predict antiarrhythmic-drug efficacy for ventricular tachyarrhythmias. Electrophysiologic Study versus Electrocardiographic Monitoring Investigators.

BACKGROUND: Invasive electrophysiologic study and noninvasive Holter monitoring (in conjunction with exercise testing) have both been used to evaluate the efficacy of antiarrhythmic drugs in patients with sustained ventricular tachycardia and in survivors of cardiac arrest. We directly compared these two approaches to the prediction of drug efficacy. METHODS: A total of 486 patients who had documented ventricular tachyarrhythmias that were inducible during electrophysiologic study and 10 or more premature ventricular complexes per hour during Holter monitoring were randomly assigned to undergo serial testing of antiarrhythmic-drug efficacy by electrophysiologic study or Holter monitoring. The patients received up to six drugs in random order until one was predicted to be effective either in suppressing inducible arrhythmia (in the electrophysiologic-study group) or in suppressing premature ventricular complexes (in the Holter-monitoring group). The patients were then followed for recurrences of arrhythmia or death. RESULTS: In the electrophysiologic-study group, 108 of 242 patients (45 percent) received a prediction of efficacy, as compared with 188 of 244 patients (77 percent) in the Holter-monitoring group (P < 0.001). Over a six-year follow-up period, there were 150 recurrences of arrhythmia and 46 deaths among the 296 patients receiving drugs predicted to be effective. Thirty-four of the deaths were from arrhythmic causes, and eight were from cardiac causes. There was no significant difference between the two study groups in the actuarial probabilities of these events. The risk of a recurrence of arrhythmia was significantly lower in patients who received sotalol than in those who received other antiarrhythmic drugs, and the risk was lower in those who had not previously failed to respond to antiarrhythmic drugs than in those who had. CONCLUSIONS: Although Holter monitoring led to predictions of antiarrhythmic-drug efficacy more often than did electrophysiologic study in patients with sustained ventricular tachyarrhythmias, there was no significant difference in the success of drug therapy as selected by the two methods.

Actuarial Analysis↗
PubMed1999

Respiratory monitoring during MR imaging. The clinical value of a new fibre-optical monitor.

PURPOSE: To assess the clinical utility of a fibre-optical monitor for respiratory monitoring in patients undergoing MR imaging without general anaesthesia. MATERIAL AND METHODS: One hundred consecutive patients were included at each of 3 MR units (300 patients in total). The technicians estimated the value of monitoring the respiratory rate on a 5-graded scale. Conditions that might complicate the MR examination were noted. RESULTS: The respiratory monitor was well tolerated by 99% of the patients. It was rated as valuable or very valuable in one-third of the total group, but in slightly more than two-thirds of the group of patients with some condition that might have complicated the MR examination. The estimated value of respiratory rate monitoring did not correlate to the age or sex of the patients, the type of examination, or to whether contrast medium was used or not, but it was significantly more often considered valuable in patients placed in the head-first position than in those placed in feet-first. CONCLUSION: Respiratory rate monitoring during MR imaging seems to be valuable in many patients, particularly if some condition that might complicate the MR examination is present.

Adolescent↗