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PubMed2004

Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery.

BACKGROUND: The radiofrequency (RF) maze procedure can effectively restore sinus rhythm and atrial transport function in the majority of patients with permanent atrial fibrillation (AF) and mitral valve disease. No previous study has described a cutoff value of preoperative atrial size determined by the discriminant analysis in predicting the success of sinus conversion by the RF maze procedure for permanent AF in patients with mitral valve disease. METHODS AND RESULTS: This study included 81 patients with permanent AF and mitral valve disease who underwent the RF maze IV procedure while undergoing concomitant valvular operations. There was one surgical death (1.2%). Another patient died of acute necrotizing pancreatitis 13 months later. Two patients (2.5%) developed sick sinus syndrome and received transvenous permanent pacemaker implantation. In the remaining 77 patients, there were 38 men and 39 women, with a mean (+/- SD) age of 51 +/- 11 years. At a mean follow-up time of 38 months, 65 patients (84.4%) had persistent sinus conversion that had been accomplished by the RF maze procedure (group 1), and 12 patients (15.6%) did not regain sinus rhythm (group 2). We evaluated the preoperative variables between the two groups. Univariate analysis demonstrated that the preoperative left atrial area and the left atrial diameter of group 1 patients were significantly smaller than those of group 2 patients. Group 1 had significantly fewer patients associated with tricuspid valve disease than did group 2. By multiple stepwise logistic regression analysis, only the preoperative left atrial area was an independent determinant of sinus conversion by the RF maze procedure (odds ratio, 0.961; 95% confidence interval, 0.935 to 0.988; p < 0.005). Linear discriminant analysis demonstrated that the sensitivity and specificity of the cutoff value of 56.25 cm(2) of the preoperative left atrial area in predicting the sinus conversion by the RF maze procedure were 50.0% and 86.2%, respectively, and the positive and negative predictive values were 40.0% and 90.3%, respectively. CONCLUSION: The preoperative left atrial area is an independent determinant of sinus conversion by the RF maze procedure for patients with permanent AF and mitral valve disease.

Adult↗
PubMed2006

The Magenstrasse and Mill procedure can be combined with a Roux-en-Y gastric bypass to produce greater and sustained weight loss.

BACKGROUND: The Magenstrasse and Mill operation (M&M) is effective in producing sustained weight loss and reducing obesity-related co-morbidity. It avoids the implantation of foreign material and is a more physiological procedure by maintaining normal gastric emptying. Side-effects are minimal and operative mortality is low. Satisfactory weight loss is seen at 1 year with 60% of excess weight lost. The present study compared weight loss produced by the combination of a Roux-en-Y gastric bypass (RYGBP) with the standard M&M procedure. METHODS: Between 1993 and 2001, 118 patients underwent surgery for the treatment of morbid obesity. 70 patients between 1993 and 1998 underwent only a M&M vertical gastric stapling, and 48 patients from 1998 underwent the M&M combined with a RYGBP. RESULTS: Median follow-up for the M&M procedure was 36 months (range 1 to 72) and for the combined M & M and RYGBP was 30 months (range 1 to 48). At all time points following surgery, patients having a RYGBP performed in addition to the standard M&M procedure demonstrated a significantly greater amount of weight lost (P<0.0001, Mann-Whitney U-test) and overall percentage of excess weight lost (P<0.0001, Mann-Whitney U-test). Both groups had a significant reduction in BMI, although this was greater in the group that underwent the combined procedure at 3 years (P<0.001, sample t-test). CONCLUSIONS: A more rapid and prolonged weight loss was found when the M&M procedure was performed in combination with a RYGBP. This suggests that this combined procedure may be more beneficial when greater amounts of weight loss are needed in the super-obese.

Adult↗
PubMed2001

Dental clinical attire and infection-control procedures. Patients' attitudes.

BACKGROUND: The authors surveyed adults in military and civilian dental practices about infection-control procedures and clinical attire to see if patients' attitudes had changed with the alteration of infection-control procedures over the last two decades. METHODS: The authors surveyed 1,500 adults, using a written questionnaire at two military hospital dental practices and at four civilian dental offices, which included two general practices, one periodontal practice and one orthodontic practice. RESULTS: The authors found that the use of name tags and patient safety glasses during treatment were preferred by 52.0 percent and 53.4 percent, respectively, of respondents in military facilities. Respondents had no preference about dentists' clothing, use of protective glasses for examinations or head cover use. A majority of respondents preferred that dentists wear glasses when performing treatment (54.1 percent), and 77.4 percent of respondents preferred that dentists wear masks when providing their care. Respondents preferred the use of plastic barriers, and 63.0 percent said it made them feel confident that proper infection-control procedures were followed. A majority of respondents (52.3 percent) said they would be concerned if barriers were not used. CONCLUSIONS: Military and civilian respondents had similar perceptions of infection-control procedures. Respondents said they preferred that dentists wear name tags in group practices and use masks and protective glasses when performing treatment. The use of plastic barriers made respondents feel confident that proper infection-control procedures were being followed. PRACTICE IMPLICATIONS: This study can be used by dental practices to review their infection-control procedures and how patients perceive them. Dentists may decide to implement some of these procedures, especially those that are not required, and that improve customer satisfaction.

Adolescent↗
PubMed1984

A new procedure for discriminating between two patient populations using multivariate decision limits: application in the detection and exclusion of alcoholism based on clinical laboratory findings.

A simple, nonparametric discrimination procedure was developed and tested for use in discriminating between two populations, especially in those cases where the properties of the distributions lead to unsatisfactory results by classical discrimination procedures. The procedure is based on transferring the conventional concept of a decision limit from one to several variables, with combinations (in set theory terms: unions and intersections) of multidimensional intervals serving as the discriminant regions (referred to here as simple discriminant regions). The procedure was applied to two groups of patients, alcoholics and non-alcoholics. A level of efficiency 20% higher than that attainable with conventional procedures was obtained using only six clinical chemical parameters. In addition, the procedure is more flexible than conventional procedures. It enables the solution of optimization problems for each of the three common discrimination criteria (sensitivity, specificity and efficiency) with no fundamental difficulties, and it is still possible to select at will the range(s) for the decision point and for the order of the discriminant regions. For all of the clinical chemical parameters studied the distributions of the results for the two patient samples overlapped very markedly. If, for example, a sensitivity of 100% was specified, the best specificity attainable using the six parameters that discriminated best was only about 53%, and if a specificity of 100% was required, the best sensitivity was about 56%. The analogy between the discrimination principle and the principle of a statistical test (the relationship between detection and exclusion of alcoholism) is also discussed.

Alcoholism↗
PubMed2006

Partitioning reference values of several Gaussian subpopulations with unequal prevalence--a procedure with computer program support.

BACKGROUND: To be able to interpret laboratory values, it is essential to develop population-based reference intervals. A crucial consideration is whether a reference interval should be divided into subpopulations or not, so-called partitioning. There are established methods for deciding whether partitioning should be done or not. However, these methods are only applicable when partitioning into two subpopulations is considered. The primary aim of this study was to suggest a procedure that was also valid for several subpopulations. The method assumes that these subpopulations are Gaussian. Furthermore, a secondary aim was to provide a tailor-made computer program to support calculations. METHODS: The fundamental idea is to partition reference intervals if the proportions of the distributions of the subpopulations outside the combined reference limit deviate from the nominal value of 0.025. This is made possible by finding the combined reference interval using an equation solver algorithm. RESULTS: It was found that an equation solver algorithm could easily identify the combined reference interval when combining two or more subpopulations, even if these subpopulations had unequal prevalences. It was also found that this could be done even if the ratio between samples does not reflect the ratio between prevalences. Using this algorithm, it was possible to study whether the proportion outside the combined reference limits in any of several subpopulations deviated from the nominal 0.025 by such a magnitude that partitioning was recommended. When similar figures to those found in earlier studies with other methods were tested, the procedure showed consistent results with these methods. The procedure was also found to be applicable when several subpopulations were considered. As a practical result of the study, a tailor-made computer program was developed and is now provided over the Internet. CONCLUSIONS: The suggested procedure could serve as an alternative or complement to existing methods. The procedure provides calculations of the combined reference interval, even if sample fractions do not reflect prevalence fractions. The important advantage with the suggested procedure is the generalisation to the situation when several Gaussian subpopulations, possibly with unequal prevalences, are considered. Finally, since a tailor-made computer program is provided, the procedure is simple to use.

Algorithms↗
PubMed2005

Bispectral index as a guide for titration of propofol during procedural sedation among children.

OBJECTIVE: To determine whether the bispectral index (BIS) monitor could be used to guide physicians in titrating propofol to an effective safe level of deep sedation for children undergoing painful medical procedures. DESIGN: Multiphase clinical trial. SETTING: Outpatient treatment center of a university children's hospital. PATIENTS: Pediatric outpatients undergoing painful medical procedures. INTERVENTIONS: Patients were sedated with propofol for the procedures. Patients were monitored with a BIS monitor, and the BIS score was correlated with the patient's clinical level of sedation. The BIS score was then used as a guide to titrate propofol in the last phase of the study. MEASUREMENTS AND MAIN RESULTS: The study consisted of 3 phases. In a chart review of data for 154 children who underwent 212 procedures, propofol was found to be safe and effective, with consistent dosing among the intensivists administering the medication. The children received a mean bolus dose of propofol of 1.56 mg/kg, with a mean total dose of propofol of 0.33 mg/kg per minute for the duration of the procedure. In the second phase, 21 patients ranging in age from 27 weeks to 18 years, with normal neurologic function, were sedated with propofol. An observer who was blinded to the BIS scores recorded clinical levels of sedation and reactivity (with a modified Ramsay scale and reactivity score) every 1 to 3 minutes. Another observer recorded the BIS scores at the same times. A total of 275 data points were collected and evaluated. All data points from the times at which patients were considered to be sedated adequately were used to construct a normal distribution of BIS scores. The mean BIS score was 62. This distribution was used to predict that a maximal BIS score of 47 was needed to ensure adequate sedation for 90% of the population. In the third phase of the study, an algorithm was devised to determine the target BIS score necessary for adequate sedation of 95% of the patients. We chose an initial BIS score of 50 (at which 85% of the patients in phase 2 were sedated) because of the possibility of data from phase 2 being skewed toward oversedation. Propofol was administered by an intensivist in an attempt to maintain the target BIS score. A blinded observer noted the patient's clinical level of sedation. In this group, there were 2 failures, ie, patients were clinically uncomfortable despite a BIS score of < or =50, representing only 90% success. Therefore, with the algorithm, propofol was titrated to sedate the next patients to a BIS score of 45. These patients required a mean bolus dose of 1.47 mg/kg and a mean total dose of 0.51 mg/kg per minute to maintain a BIS score of 45. They awakened in 12.75 minutes. All patients were sedated adequately, all procedures were successful, and no patients experienced complications from the sedation. To eliminate variability in the way propofol was dosed, the next 10 patients were given propofol according to a standardized protocol. These 10 children received an initial bolus of 1 mg/kg, with incremental bolus doses of 0.5 mg/kg per dose (maximum: 20 mg) to achieve and to maintain a BIS score of 45. With this protocol, all patients were sedated adequately and none experienced complications from the sedation. The patients required a mean bolus dose of 2.23 mg/kg and a mean dose of 0.52 mg/kg per minute to maintain a BIS score of 45. The mean time until awakening was 14.9 minutes. Regarding the total dose over time and the time until awakening, there was no statistical significance between this group and the group sedated to a BIS score of 45 without the dosing protocol. CONCLUSION: The BIS monitor can be a useful monitoring guide for the titration of propofol by physicians who are competent in airway and hemodynamic management, to achieve deep sedation for children undergoing painful procedures.

Adolescent↗
PubMed1992

Acquisition of lever-press responding in rats with delayed reinforcement: A comparison of three procedures.

The present study examined the acquisition of lever pressing in rats under three procedures in which food delivery was delayed by 4, 8, and 16 seconds relative to the response. Under the nonresetting delay procedure, food followed the response selected for reinforcement after a specified interval elapsed; responses during this interval had no programmed effect. Under the resetting procedure, the response selected for reinforcement initiated an interval to food delivery that was reset by each subsequent response. Under the stacked delay procedure, every response programmed delivery of food t seconds after its occurrence. Two control groups were studied, one that received food immediately after each lever press and another that never received food. With the exception of the group that did not receive food, responding was established with every procedure at every delay value without autoshaping or shaping. Although responding was established under the resetting delay procedure, response rates were generally not as high as under the other two procedures. These findings support the results of other recent investigations in demonstrating that a response not previously reinforced can be brought to strength by delayed reinforcement in the absence of explicit training.

Journal Article↗
PubMed2006

Feasibility and influence of the microgap of two implants placed in a non-submerged procedure: a five-year follow-up clinical trial.

BACKGROUND: The aim of this study was to evaluate the feasibility of using a two-piece implant system in a non-submerged procedure and to study the impact of the microgap between the implant and abutment. METHODS: Sixty edentulous patients (Cawood Class V-VI) participated in this study. After randomization, 20 patients received two two-piece implants placed in a non-submerged procedure, 20 patients received two two-piece implants placed in the traditional submerged procedure, and 20 patients were treated with two one-piece dental implants placed in the traditional non-submerged procedure. The implants were placed in the mandible for overdenture treatment. A standardized clinical evaluation was performed and radiographs were taken immediately after denture insertion and yearly up to 5 years. Peri-implant samples were collected 12, 36, and 60 months after loading with sterile paper points and analyzed for the presence of putative periodontal pathogens using culture techniques. RESULTS: One two-piece implant of the non-submerged group and one two-piece implant of the submerged group were lost after 6 and 12 months, respectively. After 5 years of functioning, no significant clinical, radiological, or microbiological differences were found between the three groups. No association was found between the level of the microgap and the amount of bone loss. CONCLUSIONS: The results of this study indicate that dental implants designed for a submerged implantation procedure can also be used in a non-submerged procedure and may be as predictable as when used in a submerged procedure or as one-piece implants. The microgap at the crestal level in two-piece implants does not appear to have an adverse effect on the amount of peri-implant bone loss.

Alveolar Bone Loss↗
PubMed1992

Trends in obstetric operative procedures, 1980 to 1987.

OBJECTIVES: Increasing rates of cesarean deliveries have received widespread attention in recent years, as concern in the United States about unnecessary surgical procedures has increased. However, little information has been published on the national trends of other operative obstetric procedures occurring during deliveries. METHODS: We analyzed data from the National Hospital Discharge Survey to examine trends in the use of forceps, vacuum extraction, and cesarean section from 1980 through 1987. RESULTS: The rate of cesarean sections increased by 48%, while the rate of forceps procedures declined by 43%. Although the risk of cesarean section was significantly increased for older women, the risk of forceps and vacuum extraction procedures did not vary by age. Women with private insurance were significantly more likely to receive a cesarean section (rate ratio [RR] = 1.2), forceps procedure (RR = 1.7), and vacuum extraction procedure (RR = 1.8) than were women without private insurance. CONCLUSIONS: As pressure mounts to decrease the national cesarean section rate from 24% to 15% by the year 2000, attention should also be given to surveillance of other operative delivery procedures.

Adolescent↗
PubMed1995

Racial and ethnic differences in the use of invasive cardiac procedures among cardiac patients in Los Angeles County, 1986 through 1988.

OBJECTIVES: The purpose of the study was to compare use of invasive cardiovascular procedures among Latino, Asian, African-American, and White patients. METHODS: In a cross-sectional study of hospital discharge data, multiple logistic regression was used to model use of coronary artery angiography, bypass graft surgery, and angioplasty among adult Los Angeles County residents discharged from California hospitals between 1986 and 1988 with primary diagnoses consistent with possible ischemic heart disease. RESULTS: After potential demographic, socioeconomic, and clinical confounders, including hospital procedure volume, were controlled, Latinos were less likely than Whites to undergo angiography (odds ratio [OR] = 0.90) and bypass graft surgery (OR = 0.87). African Americans were less likely to receive bypass graft surgery (OR = 0.62) and angioplasty (OR = 0.80). Asians were as likely as Whites to receive each procedure. The impact of adjustment for hospital procedure volume was greater for Latinos and Asians than for African Americans. CONCLUSIONS: Administrative data suggest that disparities in use of invasive cardiovascular procedures are not limited to African Americans. Hospital procedure volume appears to be an important factor related to such disparities. The causes of racial/ethnic differences in reported procedure rates remain unclear.

Adult↗
PubMed2000

Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder.

BACKGROUND: Neer and Foster previously described the inferior capsular shift procedure for treating multidirectional instability of the shoulder and reported preliminary results that were quite satisfactory. The purpose of our study was to perform a longer-term follow-up evaluation of the efficacy of the inferior capsular shift procedure for treating multidirectional instability of the shoulder. METHODS: An inferior capsular shift procedure was used to treat multidirectional instability of the shoulder in forty-nine patients (fifty-two shoulders). All patients had failed to respond to an exercise program. In this series, the operative approach (anterior or posterior) was based on the major direction of the instability, as determined by the preoperative history and physical examination and as verified by examination with the patient under anesthesia. In all of the patients, the inferior capsular shift was the primary attempt at operative stabilization. The repair consisted of a lateral-side (or humeral-side) shift of the capsule to reduce capsular redundancy and, when necessary, a reattachment of the avulsed labrum to the anteroinferior aspect of the glenoid. RESULTS: A redundant capsular pouch was seen in all of the shoulders in this series. In addition, detachment of the anteroinferior aspect of the labrum was found in ten shoulders and an anterior fracture of the glenoid rim was seen in two shoulders. At an average of sixty-one months (range, twenty-four to 132 months), results were available for forty-nine shoulders (forty-six patients). Thirty shoulders (61 percent) had an excellent overall result, sixteen (33 percent) had a good result, one (2 percent) had a fair result, and two (4 percent) had a poor result. Forty-seven (96 percent) of the forty-nine shoulders remained stable at the time of follow-up. Two of the thirty-four shoulders that had been repaired through an anterior approach began to subluxate anteroinferiorly again. None of the fifteen shoulders that had been repaired through a posterior approach had recurrent instability. Full function, including the ability to perform strenuous manual tasks, was restored to forty-five shoulders (92 percent). A return to sports was possible after thirty-one (86 percent) of the thirty-six procedures done in athletes; however, a return to the premorbid level of participation was possible after only twenty-five (69 percent) of the thirty-six procedures. CONCLUSIONS: The results in this series demonstrate the efficacy and the durability of the results of the inferior capsular shift procedure for the treatment of shoulders with multidirectional instability. The procedure directly addresses the major pathological feature - a redundant joint capsule. Similar results were seen with either an anterior or a posterior approach, and we continue to approach shoulders with multidirectional instability on the side of greatest instability. A postoperative brace was reserved for patients in whom a posterior approach had been used or in whom an anterior approach had involved extensive posterior capsular dissection (ten of the thirty-four shoulders treated with the anterior approach).

Adolescent↗
PubMed2004

Association between hospital and surgeon procedure volume and the outcomes of total knee replacement.

BACKGROUND: The annual volume of major cardiovascular and oncologic procedures performed in hospitals and by surgeons has been inversely associated with the rates of perioperative mortality and complications. The relationship between hospital and surgeon volume and perioperative outcomes following total knee replacement has received little study. METHODS: We analyzed claims data for Medicare patients who had elective primary total knee replacement between January 1 and August 31, 2000. Hospital and surgeon volumes were defined as the number of primary and revision total knee replacements performed in the hospital or by the surgeon in Medicare recipients in 2000. We examined the associations between the annual volumes of total knee replacement performed in the hospitals and by the surgeons and the rates of mortality and complications (infection, pulmonary embolus, myocardial infarction, or pneumonia) in the first ninety days postoperatively. The analyses were adjusted for age, gender, comorbid conditions, Medicaid eligibility (a marker of low income), and arthritis diagnosis. Analyses of hospital volume were adjusted for surgeon volume and vice versa. RESULTS: Twenty-five percent of the primary total knee replacements were done by surgeons who performed twelve of these procedures or fewer in the Medicare population annually, and 11% were done in hospitals with an annual volume of twenty-five of these procedures or fewer. Compared with the patients who had a primary total knee replacement in hospitals with an annual volume of twenty-five procedures or fewer, those managed in hospitals with an annual volume exceeding 200 procedures had a lower risk of pneumonia (odds ratio, 0.65; 99% confidence interval, 0.47 to 0.90) and any of the adverse outcomes examined (death, pneumonia, pulmonary embolus, acute myocardial infarction, or deep infection) (odds ratio, 0.74; 99% confidence interval, 0.60 to 0.90). Similarly, patients who had a primary total knee replacement done by surgeons who performed more than fifty such procedures in Medicare recipients annually had a lower risk of pneumonia (odds ratio, 0.72; 99% confidence interval, 0.54 to 0.95) and any adverse outcome (odds ratio, 0.81; 99% confidence interval, 0.68 to 0.98) compared with patients of surgeons with an annual volume of twelve procedures or fewer. CONCLUSIONS: Patients managed at hospitals and by surgeons with greater volumes of total knee replacement have lower risks of perioperative adverse events following primary total knee replacement. Patients and clinicians should incorporate these findings into discussions about selecting a surgeon and a hospital for total knee replacement. These data should also be integrated into the policy debate about the advantages and drawbacks of regionalizing total joint replacement to high-volume centers.

Aged↗
PubMedDate not supplied

An improved filter elution and cell culture assay procedure for evaluating public groundwater systems for culturable enteroviruses.

Large-scale virus studies of groundwater systems require practical and sensitive procedures for both sample processing and viral assay. Filter adsorption-elution procedures have traditionally been used to process large-volume water samples for viruses. In this study, five filter elution procedures using cartridge filters were evaluated for their effectiveness in processing samples. Of the five procedures tested, the third method, which incorporated two separate beef extract elutions (one being an overnight filter immersion in beef extract), recovered 95% of seeded poliovirus compared with recoveries of 36 to 70% for the other methods. For viral enumeration, an expanded roller bottle quantal assay was evaluated using seeded poliovirus. This cytopathic-based method was considerably more sensitive than the standard plaque assay method. The roller bottle system was more economical than the plaque assay for the evaluation of comparable samples. Using roller bottles required less time and manipulation than the plaque procedure and greatly facilitated the examination of large numbers of samples. The combination of the improved filter elution procedure and the roller bottle assay for viral analysis makes large-scale virus studies of groundwater systems practical. This procedure was subsequently field tested during a groundwater study in which large-volume samples (exceeding 800 L) were processed through the filters.

Biological Assay↗
PubMed1999

Image-guided procedures in brain biopsy.

Image-guided procedures, such as computed tomography (CT)-guided stereotactic and ultrasound-guided methods, can assist neurosurgeons in localizing the relevant pathology. The characteristics of image-guided procedures are important for their appropriate use, especially in brain biopsy. This study reviewed the results of various image-guided brain biopsies to ascertain the advantages and disadvantages. Brain biopsies assisted by CT-guided stereotactic, ultrasound-guided, Neuronavigator-guided, and the combination of ultrasound and Neuronavigator-guided procedures were carried out in seven, eight, one, and three patients, respectively. Four patients underwent open biopsy without a guiding system. Twenty of 23 patients had a satisfactory diagnosis after the initial biopsy. Three patients failed to have a definitive diagnosis after the initial procedure, one due to insufficient volume sampling after CT-guided procedure, and two due to localization failure by ultrasound because the lesions were nonechogenic. All patients who underwent biopsy using the combination of ultrasound and Neuronavigator-guided methods had a satisfactory result. The CT-guided procedure provided an efficient method of approaching any intracranial target and was appropriate for the diagnosis of hypodense lesions, but tissue sampling was sometimes not sufficient to achieve a satisfactory diagnosis. The ultrasound-guided procedure was suitable for the investigation of hyperdense lesions, but was difficult to localize nonechogenic lesions. The combination of ultrasound and Neuronavigator methods improved the diagnostic accuracy even in nonechogenic lesions such as malignant lymphoma. Therefore, it is essential to choose the most appropriate guiding method for brain biopsy according to the radiological nature of the lesions.

Aged↗
PubMed1997

MR arthrography of the shoulder: rethinking traditional imaging procedures to meet the technical requirements of MR imaging guidance.

OBJECTIVE: The purpose of this study was to determine the feasibility of and the appropriate technique for performance of MR imaging-guided arthrography of the shoulder. SUBJECTS AND METHODS: Thirty-eight MR imaging-guided glenohumeral joint punctures were performed using an open C-arm scanner with a vertically oriented magnetic field, adapted for interventional procedures. Two different approaches to the shoulder were used: a modification of the traditional anterior approach (seven procedures), and an anterosuperior approach (31 procedures) mimicking the anterior arthroscopy portal. The average procedure duration was determined. A retrospective review of needle mediolateral and anterioposterior position was determined for the anterosuperior approaches. RESULTS: Average procedure duration was 21 min for the anterior approach and 12 min for the anterosuperior approach. Subjectively, needle conspicuity was minimal with the anterior approach, contributing to prolonged imaging times. Needle visualization was much improved with the anterosuperior approach. Nine of the 31 anterosuperior procedures involved inadvertent injection of the subacromial or subdeltoid bursa. At the time of retrospective review, the needle was too laterally or too anteriorly positioned in six of these nine patients. CONCLUSION: With consideration of the technical demands of MR imaging guidance for interventional procedures, MR imaging-guided arthrography of the shoulder is feasible. The traditional radiologic approach to the shoulder must be modified to provide adequate visualization of the needle. The anterosuperior approach meets this needs.

Adult↗
PubMed2003

Renal allograft implantation in respect of atypical vascular procedures.

In minority of renal transplants it is unevitable to perform atypical vascular procedures of renal allograft implantation, which increases the risk of vascular complications, graft loss and lethality. In the presenting study, we retrospectively evaluated kinds of atypical vascular procedures in renal allograft implantation by donor type and the transplants outcome related to these procedures. From 1980 to 1998, a total of 463 patients (mean age 36.2+/-10.3), underwent renal transplantation (319 from living donor and 144 from cadaveric donor) at the Institute of Urology & Nephrology in Belgrade. Atypical vascular procedures of renal allograft implantation were representative for the some of the following cohorts: bypass grafting, endarterectomy, end to side both arterial and venous anastomotic site. A total of 45 patients (9.72%) underwent some of atypical vascular procedures (41 from living donor and 4 from cadaveric donor) (p<0.01). Among analyzed procedures, bypass grafting was performed in majority of cases (n=38). A total of 101 patients underwent endarterectomy. End to side both arterial and venous anastomotic site was done in two patients. Severe direct postoperative vascular complications following by lethal outcome appeared in 2 patients. Related to standardized, atypical vascular procedures had been of increased risk for appearance of severe vascular complication.

Adolescent↗
PubMed2004

Effects of a mock ultrasonographic procedure on cortisol concentrations during low-dose dexamethasone suppression testing in clinically normal adult dogs.

OBJECTIVE: To determine whether the stress of an ultrasonographic procedure would interfere with the suppressive effect of dexamethasone during a low-dose dexamethasone suppression test (LDDST) in healthy dogs. ANIMALS: 6 clinically normal adult dogs. PROCEDURE: In phase 1, an LDDST was performed 5 times at weekly intervals in each dog. Serum samples were obtained 0, 2, 4, 6, and 8 hours after dexamethasone injection. A mock 20-minute abdominal ultrasonographic examination was performed on all dogs at each time point during the LDDST on weeks 2 through 5. In phase 2, serum cortisol concentrations were measured before and immediately after a 20-minute mock abdominal ultrasonographic examination, as described for phase 1. RESULTS: We did not detect significant differences after dexamethasone injection when comparing median cortisol concentrations for weeks 2 to 5 (mock ultrasonographic procedure) with median concentration for week 1 (no mock ultrasonographic procedure). For 5 of the 6 dogs, cortisol concentrations after dexamethasone injection decreased to < 35.9 nmol/L after each mock ultrasonographic procedure and remained low for the duration of the LDDST. In phase 2, all dogs had significant increases in cortisol concentrations immediately after the mock ultrasonographic procedure. CONCLUSIONS AND CLINICAL RELEVANCE: A 20-minute mock abdominal ultrasonographic examination performed during LDDST did not alter results of the LDDST in most dogs. Cortisol concentrations measured immediately after a mock ultrasonographic examination were significantly increased. Ultrasonographic procedures should be performed a minimum of 2 hours before collection of samples that will be used to measure cortisol concentrations.

Abdomen↗
PubMed1998

Preservation of cognitive procedural memory in a case of Korsakoff's syndrome: methodological and theoretical insights.

Using the Tower of Hanoï puzzle, Butters, et al. in 1985 illustrated the difficulties in learning the procedure and questioned the suitability of this task for assessment of the cognitive procedural memory in Korsakoff's syndrome. Our objective, in the light of these criticisms, was to show preservation of cognitive procedure capacities with the Tower of Hanoï for a man (P.F.) who was suffering from alcoholic Korsakoff's syndrome. For this procedural task, some aids helped to compensate in part for the difficulties with declarative memory and with working memory. In this condition, P.F. was able to learn the cognitive procedure. This study suggests that cognitive procedure memory may be preserved in some patients suffering from Korsakoff's syndrome and that this may be shown when a suitable task is used. The result makes it possible to discuss the interaction between declarative and procedural knowledge in the solving of the Tower of Hanoï.

Alcohol Amnestic Disorder↗