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Fracture risk during pedicle screw insertion in osteoporotic spine.

Although using a larger screw can enhance the stability of screw-bone interface in pedicular screw instrumentation, it may cause pedicle fracture during screw insertion in osteoporotic spine. We investigated structural changes of the pedicle with the advance of osteoporosis and its implication for the risk of pedicle fracture. Bone mineral density of trabecular, subcortical, and cortical bone of pedicle in an osteoporotic group, assessed by peripheral quantitative computed tomography, was significantly lower than that of those in the normal group. Cortical thickness also declined. There were no pedicle fractures in normal vertebrae, but seven (41.2%) fractures were observed among 17 pedicles in osteoporotic vertebrae in which bone mineral density measured with dual-energy x-ray absorptiometry was <0.7 g/cm2 and screw diameter >70% of the outer diameter of the pedicle. Our results suggest that screw diameter should not exceed 70% of the outer diameter of the pedicle in the case of osteoporosis in which vertebral bone mineral density is <0.7 g/cm2.

Aged↗

Mobile workers in healthcare and their information needs: are 2-way pagers the answer?

The ability to have access to information relevant to patient care is essential within the healthcare environment. To meet the information needs of its workers, healthcare information systems must fulfill a variety of functional requirements. One of these requirements is to define how workers will interact with the system to gain the information they need. Currently, most healthcare information systems rely on users querying the system via a fixed terminal for the information they desire; a method that is inefficient because there is no guarantee the information will be available at the time of their query and it interrupts their work flow. In general, clinical event monitors--systems whose efficacy relies on the delivery of time-critical information--have used e-mail and numeric pagers as their methods to deliver information. Each of these methods, however, still requires the user to perform additional steps, i.e., log into an information system in order to attain the information about which the system is alerting them. In this paper we describe the integration and use of 2-way alphanumeric pagers in CLEM, the UPMC Health System's Clinical Event Monitor, and how the use of these pagers addresses the information needs of mobile workers in healthcare.

Attitude of Health Personnel↗

The impact of degenerative spinal changes on the correlation of peripheral and axial bone density.

Results of bone density measurements by quantitative computed tomography of the peripheral skeleton (pQCT) were compared with those of measurements at the axial skeleton with a view to study the effects of degenerative spinal changes on the validity of bone densitometry of the lumbar spine. 556 consecutive patients were examined by dual-energy x-ray absorptiometry (DXA) of the spine and by peripheral quantitative computed tomography (pQCT) of the distal radius. There were significant differences between the bone mineral values at the distal radius and those at the spine, depending on the degree of spinal degeneration. As expected, spinal degenerations showed a highly significant age dependence. With increasing degeneration the correlations between the radius total bone mineral concentration and the bone density of the lumbar spine decreased from r = 0.45 to 0.23 in women and from r = 0.64 to 0.28 in men. We conclude that the value of spinal DXA is reduced in patients with degenerative spinal disease, compared to the pQCT at the peripheral skeleton.

Absorptiometry, Photon↗

[Three-dimensional computed tomography for the evaluation of peripheral small lung cancers].

To facilitate the accurate diagnosis of small peripheral lung cancers (less than 30 mm in diameter), we evaluated the use of three-dimensional computed tomography (3D-CT). Conventional CT images (10 mm thick), thin-slice CT images (2 mm thick) and 3-D-CT images were prospectively studied in 29 patients with peripheral lung cancer (23 adenocarcinoma, 3 squamous cell carcinoma, 1 large cell carcinoma, 1 adeno-squamous cell carcinoma, 1 small cell carcinoma) who underwent thoracotomy. Patients were 20 males and nine females with a median age of 65 (range 38-75) years. Conventional CT and thin-slice CT images were examined with an extended scale (window level: -600, window width: 1900) using high resolution images. 3D-CT images were made using TCT-900S (Toshiba, Tokyo) software. In resected cases, surgical specimens were sliced transversely to correlate with the CT images. Comparison of diagnoses based on CT findings and on pathological findings showed that 3D-CT was 96% accurate for detecting involved vessels, while conventional CT was 47% and thin-slice CT was 87% accurate. Thus 3D-CT was superior to conventional CT for detecting involved vessel (p < 0.01). 3D-CT images also showed specific features of the lesions, including the appearance of the margin and pleural indentations, as seen in thin-slice CT images. These results suggest that 3D-CT images may have an important role in diagnosing small peripheral lung cancers by demonstrating involved vessels and the morphology of the lesions.

Adenocarcinoma↗

Imaging of peripheral arteries by 16-row multidetector computed tomography angiography: a feasible tool?

OBJECTIVE: To evaluate the efficacy of multidetector (16-row) computed tomography (MDCT) in imaging the upper and lower limb arterial tree in trauma and peripheral arterial occlusive disease (PAOD). METHODS: Thirty-three patients underwent MDCT angiography (MDCTA) of the upper or the lower limb on 16-row MDCT scanner between November, 2004 and July, 2005. The findings were compared with the surgical outcome in cases with trauma and suspected arterial injuries or color Doppler correlation was obtained for patients of PAOD. RESULTS: MDCTA allowed a comprehensive diagnostic work-up in all trauma cases with suspected arterial injuries. In the 23 cases of PAOD, MDCT adequately demonstrated the presence of stenosis or occlusion, its degree and extent, the presence of collaterals and plaques. CONCLUSION: Our experience of CT angiography (CTA) with 16-row MDCT scanner has clearly demonstrated its efficacy as a promising, new, fast, accurate, safe and non-invasive imaging modality of choice in cases of trauma with suspected arterial injuries and as a useful screening modality in cases of PAOD for diagnosis and for grading.

Adult↗

Discrimination of position and contrast in amblyopic and peripheral vision.

Many computational models of normal vernier acuity make predictions based on the just-noticeable contrast difference. Recently, Hu, Klein and Carney [(1993) Vision Research, 33, 1241-1258] compared vernier acuity and contrast discrimination (jnd) in normal foveal viewing using cosine gratings. In the jnd stimulus the test grating was added in-phase to the (sinusoidal) pedestal, whereas in the vernier stimulus the same test grating was added with an approx. 90 deg phase shift to the pedestal. In the present experiments, we measured thresholds for discriminating changes in relative position and changes in relative contrast for abutting, horizontal cosine gratings in a group of amblyopes using the Hu et al., test-pedestal approach. The approach here is to ask whether the reduced vernier acuity of amblyopes can be understood on the basis of reduced contrast sensitivity or contrast discrimination. Our results show that (i) abutting cosine vernier acuity is strongly dependent on stimulus contrast. (ii) In both anisometropic and strabismic amblyopes, abutting cosine vernier discrimination thresholds are elevated at all contrast levels, even after accounting for reduced target visibility, or contrast discrimination. (iii) For both strabismic and anisometropic amblyopes, the vernier Weber fraction is markedly degraded, while the contrast Weber fraction is normal or nearly so. (iv) In anisometropic amblyopes the elevated vernier thresholds are consistent with the observers' reduced cutoff spatial frequency, i.e. the loss can be accounted for on the basis of a shift in spatial scale. (v) In strabismic amblyopes and in the normal periphery, there appears to be an extra loss, which can not be accounted for by either reduced contrast sensitivity and contrast discrimination or by a shift in spatial scale. (vi) This extra loss cannot be quantitatively mimicked by "undersampling" the stimulus. (vii) Surprisingly, in some strabismics, and in the periphery, at relatively high spatial frequencies, vernier thresholds appear to lose their contrast dependence, suggesting the possibility that there may be qualitative differences between the normal fovea and these degraded visual systems. (viii) This contrast saturation can be mimicked by "undersampling" the target, or by introducing strips of mean luminance between the two vernier gratings, thus mimicking a "scotoma". Taken together with the preceding paper, our results suggest that the extra loss in position acuity of strabismic amblyopes and the normal periphery may be a consequence of noise at a second stage of processing, which selectively degrades position but not contrast discrimination.

Amblyopia↗

Fractal analysis of internal and peripheral textures of small peripheral bronchogenic carcinomas in thin-section computed tomography: comparison of bronchioloalveolar cell carcinomas with nonbronchioloalveolar cell carcinomas.

PURPOSE: To analyze the internal and peripheral textures of small peripheral bronchogenic carcinomas (<2 cm) in thin-section computed tomography (HRCT) images with fractal analysis. METHOD: Thin-section computed tomography images from 70 patients with bronchogenic carcinomas (61 adenocarcinomas and 9 squamous cell carcinomas) were used. Regions of interest (ROIs) with a matrix size of 32 x 32 (0.326 mm per pixel) were selected manually on the lung-nodule interfaces and within the nodules on HRCT images. Three-dimensional density surfaces based on CT values of ROIs were characterized by fractal dimensions (FDs). RESULTS: When all the bronchogenic carcinomas were divided into bronchioloalveolar cell carcinomas (BACs) and other bronchogenic carcinomas (nonBACs), there were significant differences between BACs and nonBACs in the FDs obtained from the internal textures (mean: 2.38 +/- 0.05 versus 2.19 +/- 0.05; P< 0.0001) and in the FDs obtained from the peripheral textures (mean: 2.16 +/- 0.01 versus 2.06 +/- 0.01; P< 0.0001). CONCLUSION: The textures of BACs that reveal ground-glass opacities are more complicated than those of nonBACs. The FDs can differentiate between small localized BACs, which have a good prognosis, and nonBACs, which have a poor prognosis. Fractal analysis is promising for characterization of small peripheral pulmonary bronchogenic carcinomas based on radiographic features of HRCT images.

Adenocarcinoma↗

CT angiography of peripheral arterial disease.

Lower-extremity computed tomographic (CT) angiography (ie, peripheral CT angiography) is increasingly used to evaluate patients with peripheral arterial disease. It is therefore increasingly important for all vascular specialists to become familiar with the strengths and limitations of this new technique. The aims of this review are to explain the principles of scanning and injection technique for a wide range of CT scanners, to explain and illustrate the properties of current image postprocessing tools for effective visualization and treatment planning, and to provide an overview of current clinical applications of peripheral CT angiography.

Angiography↗

Teaching the clinical interpretation of peripheral blood smears to a second-year medical school class using the PeripheralBlood-Tutor computer program.

The interpretation of peripheral blood smears has an important role in the diagnosis of hematologic diseases and is, therefore, part of the education of physicians and technologists. We describe a computer program, PeripheralBlood-Tutor (Lippincott-Raven, Philadelphia, Pa), that teaches the morphologic features of normal and abnormal peripheral blood smears; we also describe the evaluation of the effectiveness of the program in 133 second-year medical students who were required to use the program in their hematology course. The version of the PeripheralBlood-Tutor used in the study had 2 distinct but equivalent 20-question examinations; one examination, the pretest, was taken before the students viewed the contents of the program, and the other examination, the posttest, was taken after completing the program. The mean score on the pretest was 61% (SD, 14%), the mean on the posttest was 91% (SD, 10%), and the improvement was significant. In addition, 4 questions about peripheral blood smears, which were based on printed images, were administered at the end of the hematology course. The students scored an average of 2.75 (SD, 0.86), and a positive correlation was found between these scores and the scores on the Tutor posttest. The results of the study suggest that PeripheralBlood-Tutor is feasible to implement, and it helps students learn to interpret peripheral blood smears. The use of PeripheralBlood-Tutor is now a requirement in the medical school curriculum, the medical technology program, and the pathology residency at the University of Washington, Seattle.

Blood Cell Count↗

[Clinical features of resected patients with lung cancers revealed by computed tomography].

Seven cases of peripheral lung cancers revealed only by computed tomography (CT) were examined in order to study the clinical features and the roentgeno-pathological correlation. There were four male and three female cases with a median age of 68 (range 32-79) years. Conventional X-ray films were negative, but the primary tumors were found by CT. The reasons why the primary tumors were overlooked on conventional X-ray films were that two cases had lesions situated in the para-mediastinal area and five cases had vague lesions. CT findings were classified into two groups; infiltrative type with obscure margin and solid type with clear margin. Histologically, the former were revealed to be well differentiated adenocarcinoma and the latter included poorly differentiated adenocarcinoma and large cell carcinoma. Pathological evaluation showed stage I in six of the seven cases. Our study cannot prove whether CT screening will prevent any number of participants from deaths due to lung cancer. However, it is suggested that CT may be superior for early detection of lung cancer as opposed to conventional X-ray. In the future, a more applicable CT system will be required for early detection of lung cancer.

Adenocarcinoma↗

"Early" peripheral lung cancer: prognostic significance of ground glass opacity on thin-section computed tomographic scan.

BACKGROUND: The number of peripherally located lung cancers with an excellent prognosis has been increasing, possibly due to the introduction of computed tomography for lung cancer screening in Japan. The concept of peripherally located "early lung cancer" remains controversial. METHODS: A retrospective study was conducted on 1,540 lung cancers resected at our institute between May 1992 and December 2000. The sizes of solid attenuation and ground glass opacity were evaluated radiologically and the relationships between radiologic findings and clinicopathologic features were investigated to define peripheral early lung cancer. RESULTS: Sixty-nine (4.4%) lung cancers showed a large ground glass opacity component on thin-section computed tomographic scan. The maximum tumor dimension ranged from 6 to 41 mm, and all tumors were clinical stage I. Forty-seven patients were diagnosed as having bronchioloalveolar carcinoma pathologically. None of the tumors showed lymph node involvement or lymphatic invasion. Only two showed vascular invasion, but all were pathologic stage I disease. Most of the lung cancers that showed pure ground glass opacity were bronchioloalveolar carcinoma. CONCLUSIONS: Peripheral lung nodules with a large ground glass opacity component on thin-section computed tomographic scan, which do not disappear during follow-up, tend to be bronchioloalveolar carcinomas or minimally invasive adenocarcinomas of the lung. These findings warrant a feasibility study of limited surgical resection for such lung tumors.

Adenocarcinoma↗

A quantitative computer-assisted morphometric analysis of stimulation-induced injury to myelinated fibers in a peripheral nerve.

We describe a computer-assisted morphometric procedure for quantifying acute axonal injury induced in peripheral nerves by prolonged electrical stimulation. The procedure is a two-phase process, with the image analysis implemented via a commercial image analysis program, followed by an automated editing of the morphometric parameters of each object identified by the image analysis software. Both phases are implemented on IBM-compatible personal computers. The custom software counts the number of fibers undergoing early axonal degeneration, using a two-category classification scheme based on the range of myelin cross-sectional area and axonal cross-sectional areas of normal (unstimulated) nerves. When the damaged fibers are counted using this procedure, the correlation between the normalized amplitude of the electric stimulus and the number of degenerating fibers is the same as when the analysis is performed by an experienced histopathologist (R = 0.87) and carries the advantage of being entirely objective. The correlation was higher with a two-category classification (damage/no damage) than when the severity of the damage to each axon was weighted according to the amount of axonal shrinkage. We determined that axons 3.5-9 microm in diameter are the most vulnerable to injury from the electrical stimulation. This has certain implications regarding the mechanism underlying this type of injury.

Animals↗

[The value of multislice spiral computed tomography in demonstrating the relationship between bronchus and peripheral lung cancer].

OBJECTIVE: To investigate the value of multislice spiral computed tomography (MSCT) in demonstrating the relationship between bronchus and peripheral lung cancer. METHODS: We prospectively performed volumetric targeted scans of 0.5 mm collimation with MSCT and reconstructed images of multiplanar reconstruction (MPR), curved multiplanar reformations (CMPR) and surface shaded display (SSD) in 53 peripheral lung cancers. The results were compared with macroscopic and microscopic specimens. RESULTS: (1) The third- to seventh-order branches of the bronchi were clearly shown in all patients by the designed protocol. CT demonstrated the tumor-bronchus relationship in 29 (96.7%) adenocarcinomas and 13 (76.5%) squamous-cell carcinomas. Statistic analysis showed that there was no significant difference between the two groups (chi(2) = 2.8, P > 0.05). (2) The tumor-bronchus relationship was identified as four types with MSCT. Type I: bronchus was obstructed abruptly by the tumor, type II: bronchus penetrated into the tumor with tapered narrowing and interruption, type III: bronchus lumen shown within tumor was patent and intact, type IV: bronchus ran at the periphery of the tumor with intact or narrowed lumen. (3) Type I was shown in 31 of 53 (58.5%) tumors with squamous-cell carcinoma slightly more common than adenocarcinoma. Type II and type III were seen equally in 8 of 53 (15.1%) tumors which occurred only in adenocarcinomas. Type IV was seen in 15 of 53 (28.3%) tumors with adenocarcinoma being slightly more frequent than squamous cell carcinoma. (4) The tumor at the fourth-order bronchus was more common in squamous cell carcinoma, whereas that at the fixth-order bronchus was more likely in adenocarcinoma. CONCLUSION: Volumetric targeted scan of ultra-thin section with MSCT and followed by MPR, CMPR and SSD reconstruction can greatly improve the manifestation of the bronchioles and accurately demonstrate the patterns of tumor-bronchus relationship, thereby reflecting pathologic changes to some extent.

Aged↗

A telemedicine system for enabling teaching activities.

In order to improve the distance teaching of minimally invasive surgery techniques, an integrated system has been developed. It comprises a telecommunications system, a server, a workstation, some medical peripherals and several computer applications developed in the Minimally Invasive Surgery Centre. The latest peripherals, such as robotized teleoperating systems for telesurgery and virtual reality peripherals, have been added. The visualization of the zone to be treated, along with the teacher's explanations, enables the student to understand the procedures of the operation much better.

Computer Communication Networks↗