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PubMed1991

[Current status of vaginal ultrasound--a worldwide survey].

In the last five years, vaginosonography has become a routine procedure in Obstetrics and Gynaecology. Many obstetricians, gynaecologists, radiologists and ultrasonographers have recognized the advantages of this method. A number of manufacturers of ultrasound equipment offer several types of vaginal probes. Nevertheless, the rapid development of vaginosonography has led to some disadvantages concerning a standardised terminology and image display. In this study we collected data on the current standards of vaginosonography. To gain data on the current use of vaginosonography, we sent out questionnaires to the 1107 departments of Obstetrics/Gynaecology in the FIGO Registry of 1985. In an accompanying letter we asked the chairmen to pass on the questionnaire to the appropriate specialist. The questionnaire was designed to gather information about the personnel performing vaginosonography and such as technique, transducer frequency, position of the patient and image display used. We received 366 responses. Vaginosonographic investigations are performed in 84% of the Obstetrics/Gynaecological University Departments, of which 90% of vaginosonography was performed by an obstetrician or gynaecologist, 5% by a radiologist and 5% by a technician. Predominantly end firing scanners were preferred. The number of electronic and mechanical scanners were nearly identical (55% vs 45%). The preference for a scanner with a narrow (less than 120 degrees) or wide angle (greater than 120 degrees) was very similar (53% vs 47%). More than half of the replies indicated (54%) used a transducer frequency of 5 MHz, 46% preferred scanners with a frequency between 5.5 and 7.5 MHz. In 55%, the gynaecological examination table was considered superior to a flat table.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross-Cultural Comparison↗

PubMed1996

Bioelectrical impedance analysis in body composition measurement: National Institutes of Health Technology Assessment Conference Statement.

The objective of this conference was to provide physicians with a responsible assessment of bioelectrical impedance analysis (BIA) technology for body composition measurement. Participants were a non-Federal, nonadvocate, 13-member panel representing the fields of nutrition, pediatrics, surgery, public health, biomedical engineering, epidemiology, and biostatistics. In addition, 20 experts in nutrition, pediatrics, metabolism, biomedical engineering, physiology, and epidemiology presented data to the panel and a conference audience of 220. The literature was searched through Medline and an extensive bibliography of references was provided to the panel and the conference audience. Experts prepared abstracts with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in open forum and the scientific literature. The panel composed a draft statement that was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The panel concluded that BIA provides a reliable estimate of total body water under most conditions. It can be a useful technique for body composition analysis in healthy individuals and in those with a number of chronic conditions such as mild-to-moderate obesity, diabetes mellitus, and other medical conditions in which major disturbances of water distribution are not prominent. BIA values are affected by numerous variables including body position, hydration status, consumption of food and beverages, ambient air and skin temperature, recent physical activity, and conductance of the examining table. Reliable BIA requires standardization and control of these variables. A specific, well-defined procedure for performing routine BIA measurements is not practiced. Therefore, the panel recommends that a committee of appropriate scientific experts and instrument manufacturers be formed with the goal of setting instrument standards and procedural methods.

Body Composition↗

PubMed1990

Effect of back support and stethoscope head on seated blood pressure determinations.

Seated BP measurements were taken in 48 men with a history of essential hypertension: in a chair with back support v on an examining table with no back support, and with bell v diaphragm stethoscope head in each condition. There were no significant differences between bell and diaphragm in SBP or DBP determinations. SBP was not significantly different between table and chair, but table DBP was 6.5 mm Hg higher (P less than .0001) than chair DBP. We conclude that back support, but not bell v diaphragm stethoscope head, affects seated BP determinations.

Back↗

PubMed1997

Anteroinferior shoulder dislocation: an auto-reduction method without analgesia.

OBJECTIVES: To describe a new reduction method for anteroinferior shoulder dislocations. DESIGN: Retrospective for the first thirty patients; prospective for the remaining seventy patients. SETTING: University hospital. PATIENTS: One hundred patients with anteroinferior shoulder dislocations. INTERVENTIONS: X-rays in two different projections were taken. The patient then was asked to sit on a relatively hard surface. The wrists were protected. The patients's forearms were placed around the homolateral knee, which is flexed at 90 degrees. The head of the examination table was lowered, and the patient was asked to lean backward with his or her neck in hyperextension. The patient had to push his or her shoulders (shrug) anteriorly, thus creating a rational movement of the scapula around a vertical axis. MAIN OUTCOME MEASURES: The authors analyzed initial prereduction x-rays and established a classification system based on the position of the humeral head, then assessed the success rate of the new technique with respect to the radiologic study. RESULTS: When using the reduction method described by Boss-Holzach-Matter, the authors attained an overall success rate of 60 percent, with a mean reduction time of three minutes and a time interval varying from fifteen seconds to nine minutes. CONCLUSION: The Boss-Holzach-Matter method is a reduction technique for anteroinferior shoulder dislocations that can be used without premedication or anesthesia. The authors recommend it for those patients who are not going to be sedated and for whom "quick" reduction and early discharge is desirable.

Adolescent↗

PubMed1997

New 3-dimensional mapping device for cystoscopy.

PURPOSE: The crucial shortcoming of cystoscopy is that it does not measure the size of observed objects, and so we developed a new device that adds measurement capability to the cystoscope. MATERIALS AND METHODS: The device consists of 5 arms linked to each other by freely bending joints. Before use 1 end of the arm is fixed to the examination table and the other end is linked to the eyepiece of the cystoscope. While linked to the arms, the cystoscope can move freely in any direction. Each joint carries an accurate sensor to measure its angle. The angle measurements are calculated collectively to obtain the 3-dimensional coordinates at the tip of the cystoscope. The tip of the cystoscope can be moved to the other side of the objects to be measured, which provides a pair of 3-dimensional coordinates, because the distance between them can be calculated. RESULTS: We could calculate the distance between the bladder neck and each ureteral orifice, and the angle of the bladder neck formed with the left and right orifices in clinical cases. By continuous measurement of the location of the bladder neck and the ureteral orifice, it was clearly demonstrated that the distance between them increased as the bladder filled. CONCLUSIONS: Our computer assisted, 3-dimensional mapping device can replace unreliable cystoscopic assessment with more reliable numerical values. New diagnostic criteria based on the exact numerical values can be established with the use of this device.

Cystoscopes↗

PubMed1991

Effects of subject position on measurements of flexion, extension, and lateral flexion of the spine.

Effects of subject positions on range and repeatability of thoracic and lumbar forward flexion, extension, and lateral flexion were studied. Inclinometric methods were used, and 27 subjects were measured by two trained testers. No great differences in repeatability and range of movements were found between measurements in different positions, but according to the results and convenience of performance, the following positions could be recommended: forward flexion in a sitting position, extension while lying on an examination table with arms braced ahead, and lateral flexion close to a wall and facing it.

Adult↗

PubMed2006

Skin entrance radiation dose in an interventional radiology procedure.

Monitoring of skin entrance radiation exposure in lengthy interventional procedures has been recommended because of the potential for skin injury. Fluoroscopy duration and dose-area product (DAP) are readily available real-time measurements. It would be of interest to study the correlation of these parameters and skin entrance radiation. Twenty neurological interventional procedures performed through the aortic arch were monitored. Two pieces of GafChromic XR Type R film were placed between the patient and the examination table. An observer recorded the fluoroscopy duration and DAP for each phase of the procedure. Each film was scanned post-procedure in RBG mode, and then the image was analyzed for peak skin entrance radiation dose (in air kerma). All DAP values were corrected according to a calibration with an ion chamber. With the DAP values for the respective phases of a procedure, the effective dose in a Reference Man was calculated. For these twenty cases, the means and standard deviations were 17.2+/-6.4 min for x ray on-time, 256+/-65 Gy cm (-2) for DAP, 94+/-34 cGy for peak skin entrance dose in air kerma, and 19.2+/-5.0 mSv for effective dose, respectively. The peak skin entrance dose was correlated to fluoroscopy duration, DAP, and effective dose with the r(2)-values of 0.48, 0.46, and 0.09, respectively. The correlation with DAP or fluoroscopy duration was not sufficiently strong to infer skin entrance dose from either of these parameters. Therefore, skin entrance dose should be determined directly.

Film Dosimetry↗

PubMed1995

Preparatory information for myelogram.

This study identified preparatory information appropriate for patients undergoing myelogram. Twenty-eight patients (16 lumbar and 12 cervical) described the sensations they experienced as they were having a myelogram. Sensations reported by 40% or more of the participants having both kinds of myelograms included hard, cold examining table; wet and cold cleansing of site; stick with injection of local anesthetic; sharp stick with spinal needle insertion; and burning (cervical) or sharp, tingling (lumbar) with contrast medium injection. These sensations, linked with the temporal elements of the procedure, yield a preparatory information intervention appropriate for those scheduled for myelogram. When preparatory information is used for the same myelogram procedure as described in this study, patients should experience reduced anxiety before and during the procedure.

Adult↗

PubMed1998

Apical mural thrombus: technical pitfalls.

A left ventricular thrombus can occur in a variety of clinical settings and, when small, may be difficult to document. Understanding the clinical scenarios of when these thrombi form and how to optimise echocardiographic scanning techniques will increase the sensitivity and specificity of the examination (tables 1 and 2).

Diagnosis, Differential↗

PubMed1997

Impedance ratio as a measure of water shifts.

Total and segmental body compositions (left arm and left leg) were measured by bioelectrical impedance analysis at 5 and 100 kHz and by dual-energy X-ray absorptiometry (DXA) in 14 healthy young males (body mass index, mean +/- SD, 23.5 +/- 2.7 kg/m2) every 20 min for a period of 100 min. During the measurements the subjects remained in the supine position on the examination table, except for the time between the last two measurements, where they got up to walk around. This study focuses on the impact of orthostatic fluid shifts on impedance ratios in body segments and the total body. After 20 min of lying supine lean tissue (DXA) was slightly but significantly lower for the total body and the left leg, but all other consecutive DXA measurements at different times did not differ. Total body impedance and leg impedance increased during the time the subjects were in the recumbent position. Impedance changes in the leg were more pronounced than in the total body, and at 5 kHz the changes were more pronounced compared to 100 kHz. After the subjects got up the impedance values again decreased. Impedance ratios (Z5/Z100) increased for both the leg and to a lesser extent for the total body during the time lying supine, but again decreased after getting up. The results of this study indicate a fluid shift from the legs to the trunk after lying supine and show that this fluid shift is mainly extracellular water. DXA measurements were not able to detect these changes, probably because the magnitude of these changes is below the detection level for lean tissue with DXA methodology. The observations have important implications in the interpretation of impedance measurements in the clinical situation when measurements are made in patients who have been reclining for some time.

Absorptiometry, Photon↗

PubMed2004

Modern concepts of socialisation for dogs: implications for their behaviour, welfare and use in scientific procedures.

The provision of a socialisation and training programme for dogs can lead to an improvement in the quality of the data that are produced from scientific procedures, and also to an improvement in animal welfare. A reduction in the number of animals needed to produce statistically significant data can result from decreasing the variability of the experimental data. The effects of a dog's behaviour can be a major source of random variability. A well socialised, habituated and trained dog should be calm during experimental procedures and, for example, during an ECG measurement, thus providing good quality data. A fearful, poorly socialised dog may also appear to be well-behaved on an examination table, and during an ECG measurement, because of the freezing response. However, there is likely to be a difference in the level of stress that these two individuals experience during the procedures. The stress response can have an impact on vital physiological parameters, such as heart rate. The variability in these parameters and the behaviour exhibited within a group of socialised, habituated and trained dogs that have been well prepared for experimental procedures, should be less than the variability present within a similar group of dogs that have not been prepared for these procedures. This paper describes two socialisation programmes, which were designed in order to compare the heart rates and behaviour of dogs which had received different degrees of socialisation, habituation and training. The behaviour of small groups of dogs from this study was compared with that of dogs on a standard socialisation programme, by using a simple, reproducible behavioural score scheme. The heart rate of the dogs was also measured. The results showed that there was little difference in heart rate between the groups, but that there were significant differences in the scores for key behaviours. There was evidence of a decrease in the variability of the behavioural scores for the groups of dogs that had undergone an intensive socialisation programme. Therefore, a socialisation programme can have a significant effect on behaviour and welfare, and has the potential to improve the quality of the data that are recorded.

Animal Welfare↗

PubMedDate not supplied

Reliability of heel-height measurement for documenting knee extension deficits.

BACKGROUND: Heel-height difference has been used to detect subtle knee flexion contractures, but the effects of thigh circumference differences and patient positioning during testing have not been evaluated. HYPOTHESIS: Differences in thigh circumference measurements and whether the patient's patellae are on or off the examination table during heel-height difference measurement will not affect the accuracy of detecting knee flexion contracture. STUDY DESIGN: Prospective cohort study. METHODS: Bilateral knee range of motion, prone heel-height difference with the patellae on and off the table, and thigh circumference at 5 and 15 cm proximal to the proximal pole of the patella were measured by one investigator on 50 consecutive patients who had undergone unilateral anterior cruciate ligament reconstruction. RESULTS: A high degree of correlation was demonstrated between the heel-height difference and the standard range of motion measurement. Differences in thigh girth and patellar position did not statistically affect the accuracy of the heel-height difference as an indicator of knee flexion contracture. CONCLUSION: Heel-height difference is a valid method of documenting knee flexion contractures. Compared with traditional goniometer assessment, this test is a more meaningful and easier way for detecting subtle knee flexion contractures of less than 10 degrees.

Adolescent↗

PubMed2003

Anesthesia management for spine surgery using spinal navigation in combination with computed tomography.

The development of a spine surgery using neuronavigation with intraoperative computed tomography (CT) is of benefit to the patient. However, the procedure also has a major impact on anesthesia management. During the procedure, the patient remains in the prone position on the CT examination table and is moved extensively during CT scans. Furthermore, there is inadequate separation between operating field and anesthetic area. Problems encountered during the procedure were patient positioning, limited patient access, long tubing, and therefore the need for adequate monitoring. We report our experience using this approach in 35 patients with spinal fracture, spinal degeneration, and tumor and describe a step-by-step anesthetic management protocol that has been developed as a guideline for use in spinal neuronavigation with intraoperative CT at our center.

Adolescent↗

PubMedDate not supplied

[Endothelial trauma in the surgery of cataract].

Cataract surgery is most common in human surgery and comprises 80% of eye surgery programs. Owing to sophisticated technologies, it has become a routine surgery with lowered complications rate; hence, the functional outcome is more conditioned by operative trauma. The aim of this study was to demonstrate the significance of specular microscopy in the evaluation of operative trauma during extracapsular cataract extraction (ECCE) and phacoemulsification (P), in a controlled environment. The study included 100 consecutive patients who met the established criteria, and groups were formed according to the type of surgery by the assignment of successive numbers from a random number table. Examination and photographs of the corneal endothelium, as well as pachymetry were performed on Keeler-Konan Poclington Specular Microscope (KSP). The obtained results revealed significant dissimilarity in endothelial cell reduction (9.17% in group E, and 4.72% in group P), which generated statistically significant correlation of preoperative and post-operative pachymetry in the group E (p=0.0004). On the basis of the results obtained by specular microscopy, it was concluded that under the same conditions phacoemulsification caused reduced operative trauma of the corneal endothelium.

Adult↗

PubMed1975

[A study of the mortality of children with transposition of the great arteries treated at the Institute of Pediatrics, Medical Academy of Cracov, in 1966-1973 (author's transl)].

The mortality of children with transposition of the great arteries treated at the Institute of Pediatrics in 1966-1973 was assessed. The number of deaths among 52 observed children, 5 days to 8 years old, was analysed according to the sex and age of the children treated during 8 subsequent years (Fig. 1). It was shown that this congenital heart malformation occurred three times more frequently among boys than among girls, but mortality was the same in both groups examined (Table I). The period of 8 years was divided into 2 four-year periods because the surgical treatment of that condition was introduced only after 1970. According to the authors' observations all children who were treated conservatively during the first period (1966-1970) have died. During the second period (1970-1973) this malformation of the heart was diagnosed twice as often, in 35 cases, and there were only 21 deaths among these children (Table II). During that period the diagnosis of this malformation greatly improved, because in half of the cases observed the proper diagnosis was made in the first two weeks of life. This is a positive fact, because the possibility of successful septostomy is greater if the surgery is performed on younger infants.

Age Factors↗

PubMed1991

[[A treatise on sex ratio in population by marital status: marriage squeeze and widowhood]].

"This study deals with imbalances of sex ratio in population by marital status, particularly focussing on two important demographic problems in Japan...the first relating to an excess of male population in marriageable ages and the second relating to an excess of [single, widowed, or divorced women] in the middle and old ages.... Population ageing [of] unmarried women, whether never married, widowed or divorced, [is examined]....Tables of [the] family life cycle have been constructed for Japanese couples for the periods 1920 to 1985, particularly specifying lengths of widowhood and widowerhood." (SUMMARY IN ENG)

Age Distribution↗

PubMed2004

Effects of age, gender and holding on pain response during infant immunization.

Determinants of infant pain responses are important when assessing the efficacy of analgesics. In a randomized controlled trial, 106 infants aged 2 to 6 months were positioned either supine (SUP) on the examination table or held (HLD) by a parent during routine immunization in a community pediatric office. There was no difference between the SUP and HLD infants in duration of crying, facial grimacing or visual analogue scale (VAS) pain scores. Similarly gender did not affect pain response. In contrast, 2-month-old infants displayed more pain during immunization than did 4 or 6-month-old infants.

Age Factors↗

PubMed2006

Pseudoaneurysm of inferior epigastric artery complicating ileostomy construction.

Pseudoaneurysm of the inferior epigastric artery complicating ileostomy construction is described in a 25-year-old woman. She underwent total abdominal perineal proctocolectomy with a permanent ileostomy constructed through the right rectus muscle. 15 days later, she abruptly developed significant bleeding through the ileostomy that recurred two more times. Endoscopy performed through the ileostomy stoma revealed a small ulcer 8 cm from the stomal opening. The distal segment of ileum containing the bleeding site was resected, and on-table examination of the lesion revealed an underlying tear in the inferior epigastric artery wall. The patient recovered after the operation.

Adult↗