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PubMed1995

Interpretation of nonstress tests by an artificial neural network.

OBJECTIVE: Our purpose was to evaluate an artificial neural network in the interpretation of nonstress tests. STUDY DESIGN: A nonlinear artificial neural network trained by backpropagation was taught to interpret records of nonstress tests by two learning sets. The first set contained nonstress tests that were similarly interpreted by three human experts; the second set contained a subset of nonstress tests that led to interobserver disagreement. Both "raw" fetal heart rate and uterine contraction data and 17 quantified variables obtained by automated computer analysis were introduced to the input layer. After training, the network was tested by presenting it with input patterns to which it had not been exposed. The performance of the system was examined in relation to the human expert. RESULTS: After training the neural network with the first set, a sensitivity of 88.9% and a false-positive rate of 4.3% were obtained at testing. When the learning and test set contained records that led to interobserver disagreement, a sensitivity of 86.7% and a false-positive rate of 19.7% were obtained. Sixty percent of fetal heart rate records interpreted as abnormal by the neural network were interpreted likewise by the human experts. CONCLUSIONS: The results obtained are encouraging in that the neural network could discriminate between normal and abnormal nonstress tests. Further evaluation of this new technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate records.

Algorithms↗
PubMed1979

The pathology of noncirrhotic portal fibrosis: a review of 32 autopsy cases.

A wide spectrum of clinical and morphologic changes in 32 autopsy cases of noncirrhotic portal fibrosis have been described. The disease frequently occurs in younger patients with a long history of splenomegaly, usually with a history of hematemesis. Females are affected almost equally as often as males in contrast to cirrhosis. The patients tolerate the bleeding episodes well. Death is usually due to massive hemorrhage. The diagnosis is achieved through a process of exclusion. A critical analysis of hemodynamic data, a splenoportogram, liver function tests (particularly Bromsulphalein retention) and angiographic data is mandatory. Needle biopsy of the liver appears to have limited value in making the diagnosis. The gross anatomic findings vary from a nearly normal liver to gross nodularity, seen particularly on the posteroinferior surface. In some cases these nodules are seen to physically impede the portal blood flow and contribute to portal hypertension. Phlebosclerosis of the smaller radicles of the portal vein and irregular scarring are the outstanding morphologic features of the disease. These changes are usually associated with irregular dilatation of some of the larger intrahepatic branches of the portal vein as well as fibroelastosis with or without occluding or organizing thrombi in both intra- and extrahepatic branches of the portal vein. The changes in hepatic venous radicles are characterized by irregular sclerosis, which seems to contribute significantly toward postsinusoidal block in advanced cases. The probable mode of evolution is discussed.

Adolescent↗
PubMed2001

De novo hepatitis B after liver transplantation from hepatitis B core antibody-positive donors in an area with high prevalence of anti-HBc positivity in the donor population.

Transmission of hepatitis B virus (HBV) infection from donors who are negative for hepatitis B surface antigen (HBsAg-) but positive for antibody to hepatitis B core antigen (anti-HBc+) has been reported. However, previous studies were generally performed in geographic regions with a low prevalence of anti-HBc positivity in the liver donor population. The aims of this study are (1) to assess the risk for de novo hepatitis B in recipients of livers from anti-HBc+ donors in an area of high prevalence of anti-HBc positivity in the donor population, and (2) to analyze the risk factors for acquisition of HBV infection from anti-HBc+ donors. The transplantation experience of a single center between 1995 and 1998 was reviewed. Thirty-three of 268 liver donors (12%) were HBsAg- and anti-HBc+ during the study period. The proportion of anti-HBc+ donors increased with age; it was lowest (3.6%) in donors aged 1 to 20 years and highest (27.1%) in donors aged older than 60 years. Of the 211 HBsAg- recipients with 3 months or more of HBV serological follow-up, 30 received a liver from an anti-HBc+ donor and 181 received a liver from an anti-HBc- donor. Hepatitis B developed in 15 of 30 recipients (50%) of livers from anti-HBc+ donors but in only 3 of 181 recipients (1.7%) of livers from anti-HBc- donors (P < .0001). None of the 4 recipients who were antibody to HBsAg (anti-HBs)+ at the time of transplantation developed HBV infection after receiving a liver from an anti-HBc+ donor compared with 15 of 26 recipients (58%) who were anti-HBs- (P =.10). None of the 5 anti-HBc+ recipients developed hepatitis B compared with 15 of 25 anti-HBc- recipients (60%; P = 0.04). Child-Pugh score was significantly higher in recipients of livers from anti-HBc+ donors who developed HBV infection than in those who did not (9 +/- 2 v 7 +/- 1; P =.03). In our area, testing liver donors for anti-HBc is mandatory, particularly in older donors. With such information available, anti-HBc+ donors can be safely directed to appropriate recipients, mainly those with anti-HBs and/or anti-HBc at the time of transplantation. In the current era of donor shortage, this policy would allow adequate use of such donors.

Adolescent↗
PubMed2006

[Automated quality control of ultrasonic B-mode scanners by applying an TMM 3D cyst phantom].

Our goal was to apply an advanced and automated process to determine image quality of ultrasonic B-Mode scanner, quantitatively and precisely, with the help of a 3D artificial cylinder cyst phantom. (Artificial cysts are comparable to blood vessels). The detectability of cysts and lesions in defined sizes is an essential indicator of the imaging quality. A periodical test of the ultrasonic scanner in use is mandatory, because slowly-evolving defects of ultrasound probes can cause a continuous deterioration of imaging quality and lead to incorrect diagnosis which is falsely blamed on the apparatus.

Automation↗
PubMed2002

Simulation of hepatitis C based on a mandatory reporting system.

OBJECTIVE: Hepatitis C is a major cause of liver disease in European countries. We aimed to assess the current and future disease burden of hepatitis C. SETTING: A representative data set of hepatitis C was applied to a validated computer model. METHODS: The mandatory reporting of positive hepatitis C virus (HCV) test results by all medical laboratories in Switzerland and the clinical data obtained by questionnaire for each positive test from the treating physicians created a unique, representative epidemiological database allowing the determination of the age distribution of acute (i.e. newly acquired) and chronic HCV infections. Based on these data and a simulation model of the natural history of hepatitis C, we estimated the prevalence of HCV infection, future morbidity/mortality from cirrhosis/hepatocellular carcinoma and costs. RESULTS: Our analysis estimates a prevalence of anti-HCV in Switzerland of 1.25-1.75%, which is slightly higher than prior reports (0.5-1%) derived by extrapolation from selected populations. Although new HCV infections decreased after 1990, our analysis predicts that HCV-related morbidity and mortality will increase by 70-90%, reaching a maximum in 2015-2020, largely from complications in cases already prevalent in 1998. The model predicts that the incidence of cirrhosis will begin to decrease after 2005-2010. Antiviral treatment reduces disease burden by approximately 5%. Undiscounted HCV-related annual direct costs will more than double and reach a maximum of almost US$33 million in 2020. CONCLUSIONS: The incidence of HCV-related cirrhosis is predicted to decrease after 2005-2010, while disease burden and costs due to complications are estimated to continue to increase until 2015-2020.

Adolescent↗
PubMed2005

Dermoscopy for skin cancer detection.

PURPOSE OF REVIEW: The worldwide incidence of melanoma and nonmelanoma skin cancers is increasing alarmingly. The development of new techniques such as dermoscopy leads to a consequent progress in skin cancers screening. The purpose of this review is to highlight recent advances in dermoscopy, reviewing primary research articles published in the last year. RECENT FINDINGS: With the recent standardization of diagnostic procedures obtained by the Consensus Net Meeting on Dermoscopy and the definition of new melanoma-specific criteria, the efficacy in early melanoma diagnosis is improved. Dermoscopy is cost effective, leading to a decreased number of excised benign lesions, and the dermoscopic follow-up allows early detection of melanomas. However, the technique must be performed by experts in order not to miss melanomas. For this reason, instruction in dermoscopy is mandatory. Moreover, computer-aided diagnosis has been tested to be a valid support for physicians. Teledermoscopy is a new tool that allows a second expert opinion to manage atypical lesions. SUMMARY: Dermoscopy opens up a new dimension on clinical morphology of skin lesions. Digital follow-up examinations, computer-aided diagnosis, and teledermoscopy are new facilities that will change the current management of skin cancers in general and melanoma in particular. Dermoscopy in the hands of experienced physicians has higher discriminatory power than naked-eye examination to detect skin cancers.

Dermoscopy↗
PubMed2004

Noninvasive techniques for the measurement of isovolumetric bladder pressure.

PURPOSE: A total of 184,000 prostatectomies were performed in the United States in 2000 for the relief of presumed bladder outlet obstruction. However, it has been reported that prostatectomy using current indications fails to bring about symptomatic improvement in approximately one-fourth of patients. Pressure flow studies are currently recognized as the gold standard for the diagnosis of bladder outlet obstruction. However, these studies are associated with a number of disadvantages. They are time consuming, invasive and expensive, and carry some morbidity for the patient. It has been suggested that the use of pressure flow studies should be mandatory before surgery. The invasive nature of this test limits its application, and a variety of noninvasive methods have been suggested to circumvent the need for conventional urodynamics. MATERIALS AND METHODS: We conducted a MEDLINE search of the published literature on the use of noninvasive techniques to measure bladder pressure. RESULTS: Two promising techniques involve the noninvasive measurement of isovolumetric detrusor pressure. The first of these methods uses an external condom catheter and the second an inflatable cuff around the penis. Both of these methods rely on the interruption of urinary flow and the measurement of the bladder pressure transmitted along the fluid column between bladder and site of urethral occlusion. An alternative strategy analyzes flow patterns following compression and release of the urethra during voiding. CONCLUSIONS: Of the methods reported the penile cuff, which is inflated during voiding, or the penile squeeze technique, which infers bladder pressure from flow patterns, would seem the most likely to be clinically useful. A noninvasive measure of bladder pressure, allied to a free flow rate, would give a useful adjunct to the assessment of men with lower urinary tract symptoms.

Humans↗
PubMed1984

Ethical and social aspects of risk predictions.

This paper reviews past, present and future social and ethical considerations of screening carriers of autosomal disorders and other heterozygotes. A body of ethical and social guidance has evolved in the 1970's and 1980's for screening. The values of voluntaristic participation and informed consent are high. The goal of programs should be to provide couples, families, and individuals with knowledge respecting their reproductive choices. The dangers are coercive strategies, stigmatization, and careless communication of risk information. It is assumed that the number of autosomal carrier states that are screenable will undoubtedly increase as will states of heterozygosity that cause susceptibility to common diseases. Before the end of the century, something approaching a "biopsy of the human genome" will be a practical reality. To balance the potential for harmful psychological and social effects of so much new genetic knowledge, new efforts must be made to find treatments for progeny affected by recessive disorders. Maternal and paternal screening, prenatal diagnosis and treatment will be increasingly linked in the future. This paper will report on a case of fetal therapy for congenital adrenal hyperplasia as a paradigm for the future. The argument will be made that society ought to put a higher priority on prenatal care and prevention of disorders of prematurity than genetic disorders with a low frequency, lest genetic screening be distorted by unfounded concern about eugenics.

Adrenal Hyperplasia, Congenital↗
PubMed2005

Association between erectile dysfunction and coronary artery disease: a case report study.

Evidence is accumulating in favor of classifying erectile dysfunction (ED) as a vascular disorder. There are three main clinical scenarios in which ED and coronary artery disease (CAD) may coexist: the patient with ED who later develops CAD, the patient with overt CAD who is casually found to have ED, and the patient with acute coronary syndrome who has normal sexual function. This study presents three cases and discusses a "putative" pathophysiological mechanism underlying all these clinical presentations. Further studies, coupling functional and structural changes of coronary circulation with those of penile (i.e., dynamic penile test) circulation in each of these situations are mandatory to support this hypothesis.

Aged↗
PubMed1993

[Sporadic case of hemolytic uremic syndrome associated with verotoxin producing Escherichia coli O2:K1:H7].

Cases of enterohaemorrhagic Escherichia coli (EHEC) are being increasingly reported in Japan. Bacteriological isolation of EHEC has been a constant problem because the organism is shed for a short duration after onset on illness and generally during the prodromal stages. In order to ease the diagnosis of EHEC infections in this country, we have developed a LPS-based solid phase enzyme linked immunosorbent assay for serological diagnosis of the infection. Adequate knowledge on the prevalence of EHEC serogroups in Japan is mandatory for the success of such a diagnostic test. O157 is currently the prominent serogroup associated with EHEC infections in Japan followed by O111, O26 and O128 in that order of prevalence. In February 1992, a 1 year-old infant developed hemolytic uremic syndrome (HUS) 15 days later the prodrome of watery diarrhoea. Stool sample obtained on day 15 was cultured for detection of EHEC. Ten colonies of E. coli picked from MacConkey agar plate were examined by the polymerase chain reaction (PCR) using primers specific for both verotoxins (VT1 and VT2). Of the 10 colonies, only one was positive for the VT2 gene. The strain was confirmed to be cytotoxic on cultured Vero cells. The strain agglutinated with antisera of E. coli O2, K1 and with H7 serogroups. As of date, none of such strains of O2:K1:H7 EHEC has been reported in Japan. The patient's sera was found to be positive for antibodies against LPS from the homologous isolate as well as against VT2. The patient recovered uneventfully from HUS 40 days after the onset of the disease and was discharged from the hospital.

Antibodies, Bacterial↗
PubMed2003

The evidence for prosthodontic treatment planning for older, partially dentate patients.

This paper provides a review of the available evidence for traditional prosthodontic need determination and management strategies for older, partially dentate individuals, and compares it to the documented functional benefits of a more limited yet targeted approach to alleviating morphological shortfalls for this group of people, at the population level. The reasons for which the traditional total replacement strategy is not universally applicable or viable are discussed, and research is presented which tests many of the assertions made for the mandatory replacement of posterior teeth. Evidence is presented of the growing prosthodontic challenge posed by an increasing number of middle-aged and older partially dentate individuals in society: many of their remaining teeth are in poor condition, yet few such patients are willing to accept the prospect of becoming edentulous. The shortened dental arch concept is discussed and proposed as an appropriate strategy when complex intervention is to be avoided, inadvisable, or not possible. At the population level, current evidence suggests that prosthodontic strategies aimed at the restoration and/or replacement of all lost molars may be inappropriate in older, partially dentate individuals. A more limited yet targeted strategy is both more effective and more efficient, and should not be seen as compromised care.

Adaptation, Physiological↗
PubMed2005

Pre-ischemic administration of nitric oxide synthase inhibitors reduced germ cell apoptosis after spermatic vessel ligation in the rat testis.

INTRODUCTION: The Fowler-Stephens maneuver, a mode of spermatic vessel ligation, is a method of choice in the management of high testes. The aim of the present study is to investigate the effects of pre-ischemic administration of N(G)-nitro-L-arginine methyl ester (L-NAME), a nitric oxide (NO) synthase (NOS) inhibitor, in preventing testicular ischemic damage and germ cell-specific apoptosis in rats. MATERIALS AND METHODS: 30 min before ligation of the spermatic vessels, L-NAME was administered intraperitoneally to a group of rats and saline was given to another group of rats (controls). Biochemical assessments of NO and germ cell-specific apoptosis were performed. RESULTS: Testicular NO levels in the L-NAME group showed significant decreases in the ipsilateral (p = 0.004) and contralateral (p = 0.015) testes in relation to those of the control group. The apoptotic indices were found in 2.3% of the L-NAME group and 3.1% of the control group. CONCLUSION: Pre-ischemic administrations of the NOS inhibitor, L-NAME, effectively decreased NO production and to some degree caused a reduction in germ cell apoptosis in the rat testes after spermatic vessel ligation. Further studies are mandatory to confirm our preliminary results and to address the potential introduction of NOS inhibitors into clinical practice.

Animals↗
PubMed2003

Application of current guidelines to the management of unstable angina and non-ST-elevation myocardial infarction.

Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) is a common but heterogeneous disorder with patients exhibiting widely varying risks. Early risk stratification is at the center of the management program and can be achieved using clinical criteria and biomarkers, or a combination. In addition to anti-ischemic therapy and aspirin, the thienopyridine clopidogrel is indicated except in patients who are potential candidates for urgent coronary artery bypass grafting (CABG). Platelet glycoprotein (GP) IIb/IIIa antagonists are indicated in high-risk patients likely to undergo percutaneous coronary intervention (PCI) but are not indicated in the management of lower-risk patients who do not undergo PCI. There is a growing body of evidence to support the substitution of the low-molecular-weight heparin (LMWH) enoxaparin for unfractionated heparin (UFH). Three recent trials have demonstrated the benefit of an early invasive strategy with catheterization followed by revascularization in patients at high and intermediate risk. Lower-risk patients should undergo early noninvasive stress testing. An intensive program of secondary prevention is mandatory and should be begun before hospital discharge.

Angina, Unstable↗
PubMed1998

Surgical gowns and drapes into the 21st century.

According to the MDD (Medical Devices Directive) 93/42/EEC of 13 June 1993, medical products including gowns and drapes must provide a high level of protection for patients, users and others. The European Commission CEN/TC 205/WG 14, under the leadership of its convenor, Professor Werner, is developing a mandatory European standard on the basic requirements and test methods for disposable and reusable materials for protection of patients, surgical personnel, and operating room facilities i.e. gowns and drapes. This European standard is intended to clarify the situation with respect to products and their properties, defining basic requirements, for users and manufacturers of medical products. Future use of standard cotton textiles and conventional cotton-polyester mixed textiles is uncertain as they may not meet the requirements of the new standard, i.e. resistance to penetration by microbiological microorganisms, liquids and particle release. However, there are innovative reusable barrier surgical drapes and gowns which meet the basic requirements of the standard made from liquid repellent micro-filament materials, material laminates and perhaps some specific cotton polyester materials which have been chemically modified. In the new standard based on CEN/TC 205/WG 14, quality assurance for reprocessing of surgical gowns and drapes is critical. The manufacturer/distributor must use validated processes to prove that the requirements of this European Standard are met. Quality Assurance Systems will be required to give proof of decontamination, disinfection and sterilisation. Specified processes are to be used to maintain the properties of the materials throughout reprocessing. It is the responsibility of the hospital to assure optimal protection of patients and users. In case of a lawsuit, this could lead to the burden of proof being shifted to the hospital, with related risk of liability because it is always assumed that the work is being done according to the 'state of the art'. Difficult situations arise when it must be proved that one has acted equivalent to or better than the standard procedures and that no mistakes are made. Because of this risk of liability alone, the question of what surgical materials are used in the future should be considered very carefully.

Consumer Product Safety↗
PubMed2004

External cardiac defibrillation does not cause acute histopathological changes typical of thermal injuries in pigs with in situ cerebral stimulation electrodes.

UNLABELLED: Parkinson's disease patients with long-term L-dopa syndrome may benefit from an implanted cerebral stimulation device. When advanced life support demands cardioversion or defibrillation in these patients, undesired effects of monophasic electroshocks might occur in brain tissue adjacent to the stimulation electrodes (e.g., thermal injury), but also in the stimulation device itself. Thus, in this animal study (n = 6 pigs), we investigated the effects of repeated defibrillation (2 x 200 J [n = 1] and 2 x 360 J [n = 5]) at the implantation site of cerebral stimulation electrodes and on stimulation device function. Repeated external cardiac defibrillation did not cause acute histopathologic changes typical of thermal injury to brain tissue adjacent to the cerebral stimulation electrodes. Functionality of the stimulator device after defibrillation, however, ranged from normal to total loss of function. Therefore, when defibrillation is performed, the greatest possible distance between the defibrillation site and the stimulator device implantation site should be considered. Subsequent testing of the stimulator device's function is mandatory. IMPLICATIONS: Repeated cardiac defibrillation did not cause histopathologic changes typical of thermal injury at the implantation site of cerebral stimulation electrodes. The function of the stimulator device after defibrillation, however, ranged from normal to total loss of function.

Adenosine↗
PubMed2003

Supratentorial arachnoid cyst mimicking a Ménière's disease attack.

Arachnoid cysts (AC) often present with symptoms depending on their anatomical location within the skull; while supratentorial cysts grow causing relatively few symptoms, infratentorial ones may impair liquor circulation at the level of the fourth ventricle, giving rise to intracranial hypertension, or may stretch the complex nerve network in the cerebello-pontine angle. We report the singular clinical history of a 54-year-old male, who suddenly began to feel dizzy while sitting at his workplace, complaining of left tinnitus and aural fullness, in a classic clinical picture of Ménière's disease. The anomalous findings at otoneurological examination (markedly the left deviation at the Fukuda test) made a magnetic resonance image (MRI) scan mandatory and a huge AC was found in the left fronto-parietal lobe. The mass provoked an evident clockwise rotation of the brainstem that we suppose to be the cause of acoustico-facial bundle stretching explaining the vestibular symptomatology.

Arachnoid Cysts↗
PubMed1994

Hypothyroidism in head and neck cancer patients: experimental and clinical observations.

Damage to the thyroid gland may occur in patients undergoing treatment for head and neck neoplasms. This injury may result from damage incurred during surgery, from radiation therapy, or a combination of the two. Development of hypothyroidism is often insidious with potential harmful effects. An experimental study was performed to study the effects of hypothyroidism in pigs whose skin closely approximates that of the human. Wound tensile strength and flap necrosis were studied in the hypothyroid animal treated by surgery, radiation, and a combination of the two. The results of this study indicate that hypothyroidism alone has no significant unfavorable impact on wound tensile strengths or flap survival. When combined with preoperative radiation, however, there are statistically significant deleterious effects on both wound tensile strengths and flap survival. Histologically, collagen fibers within the wound appear shorter and thinner, which probably accounts for decreased wound tensile strengths. A clinical review of 62 head and neck cancer patients was also conducted. Within the study group, 10% of patients developed abnormally low thyroxine measurements, whereas 15% developed high thyroid-stimulating hormone levels as the only evidence of early primary hypothyroidism. Hypothyroidism was not statistically related to tumor size, nodal status, clinical staging, or treatment group (surgery alone, radiation alone, or combination surgery and radiation). A previously unreported finding is that patients who develop a second primary tumor are significantly at risk for developing hypothyroidism. All patients diagnosed with a head and neck cancer should undergo baseline thyroid function testing, including measurement of TSH, and have serial repeat testing after treatment. Thyroid function determination should be mandatory in patients undergoing oncologic salvage procedures or treatment of a second primary tumor.

Adult↗
PubMed2002

Predictive genetic testing for conditions that present in childhood.

There is a general consensus in the medical and medical ethics communities against predictive genetic testing of children for late onset conditions, but minimal consideration is given to predictive testing of asymptomatic children for disorders that present later in childhood when presymptomatic treatment cannot influence the course of the disease. In this paper, I examine the question of whether it is ethical to perform predictive testing and screening of newborns and young children for conditions that present later in childhood. I consider the risks and benefits of (1) predictive testing of children from high-risk families; (2) predictive population screening for conditions that are untreatable; and (3) predictive population screening for conditions in which the efficacy of presymptomatic treatment is equivocal. I conclude in favor of parental discretion for predictive genetic testing, but against state-sponsored predictive screening for conditions that do not fulfill public health screening criteria.

Age of Onset↗