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Three-dimensional reconstruction of anatomic structures using serial sectional images.

Precise three-dimensional modeling and visualization of human anatomy and pathology are important in medicine. Three-dimensional models have applications in the training of medical students and residents and aid physicians evaluate and determine appropriate clinical management of patients. Three-dimensional reconstructions of radiographic images have been available for some time now. However, electronic reconstruction of these images often requires the utilization of large computer systems or workstations and also requires highly trained and specialized technicians to perform the task. This paper presents a technique for precise three-dimensional reconstruction of the human anatomy and pathology using an 80486 IBM compatible personal computer and commercially available software. We reconstructed the images from computed tomography scans. Implementation of this technique does not require extensive training and shows good results after a short learning curve.

Computer-Assisted Instruction↗

Noninvasive measurement of velocity profiles and blood flow in the common carotid artery by pulsed Doppler ultrasound.

A computer-controlled 14-channel pulsed Doppler ultrasound instrument was used as a noninvasive means to evaluate instantaneous velocity profiles and flow in the comlon carotid arteries of 22 healthy persons and in 22 patients. Of the later, 13 had severe obstructions of the extracranial portion of the carotid artery, four had obstruction of the intracranial portion, and five had severe aortic valve insufficiency (AI), with more than 60% regurgitation in all cases. Measurements could be performed within an accuracy of about +/- 20% under clinical conditions and revealed perfusion values of 5 to 8 ml per second (300 to 480 ml per minute) in healthy persons. Of the patients, values less than 3 ml per second (180 ml per minute) were detected in nine, between 3 and 5 mm per second (180 to 300 ml per minute) in four, and normal values in another four, while significant backflow was observed only in patients with severe AI. Consecutive blood flow profiles were recorded every 4 msec; these demonstratedthat, for a period lasting from 40 msec to 280 msec after the initial systolic peak, blood flow decelerated more rapidly in the central portion of the vessel lumen than near the wall. This situation was present in all healthy persons and in most patients with pathological flow. In patients with AI, flow reinversion from reverse to normal began near the vessel wall, while in the middle third of the vessel lumen, blood was still flowing backward. These phenomena seem to be in agreement with the theoretical and experimental findings of Wormersly, Müller, and others. The AI patients who underwent artificial valve implantation were studied ten days after operation and showed no or little backflow in the common carotid artery at that time.

Adult↗

Cervical lymphangioma in the adult.

Cervical lymphangioma is rare among adults. Thirty-two patients with cervical lymphangioma were treated at the Mayo Clinic between 1950 and 1982. The records of these patients were reviewed to investigate the clinical and pathologic behavior of this lesion in persons more than 16 years of age. The lesions were seen in all decades of adult life and equally in men and women. Most lesions presented as a rapidly enlarging, asymptomatic mass. The anterior triangle of the neck was involved nearly as often as the posterior triangle, and right-sided locations predominated (72%). Histopathologic differentiation of the lesions into simplex, cavernous, and cystic lymphangiomas was not helpful in predicting clinical behavior. Surgical excision is the treatment of choice. The lesions may intimately involve the carotid sheath or adjacent nerves. Recurrence in 21% of the 28 patients on whom follow-up data were available mostly represented incomplete excision. Lymphangioma should be included in the differential diagnosis of a large asymptomatic neck mass of recent origin in the adult.

Adolescent↗

Cerebral atrophy, EEG slowing age, education, and cognitive functioning in suspected dementia.

Seventy-eight hospital patients, 50 years of age or older, were selected for suspected changes in mentation and for the absence of focal or other organic brain disease. They were studied in relation to education, age, cerebral atrophy (by computerized tomography), electroencephalographic (EEG) slowing, and performance in several neuropsychologic tests. Adequate test-retest reliability of the cognitive measures and interjudge reliability of the cerebral atrophy and EEG measures were demonstrated. Stepwise multiple regression analyses suggested the following: (1) EEG slowing is the strongest and most general pathologic influence on cognition in elderly persons without overt brain disease. (2) Cerebral atrophy independently affects primarily the verbal recall of recent and remote information. (3) Age independently affects primarily recent memory for both verbal and nonverbal material. (4) Formal education is a powerful influence that must be accounted for in all studies of the effects of age on cognition.

Age Factors↗

Long-term care of patients with multiple sclerosis: a neurologist's perspective.

Multiple sclerosis is a chronic disease with varying degrees of disability and progression. Because there is no known specific therapy, for best care, patients are individualized, with attempts to deal with each patient and each complication separately, thoughtfully, and with psychological support when required. Efforts are directed toward helping the patient adjust to the realities of the disease and to specific disabilities. Ways and means of gaining patient confidence are discussed--and emphasis is placed on the known pathologic processes involved and how information, personalized professional attention, and support might function to aid the body's defense mechanisms for containment of the disease process. Several clinical cases were summarized (at the symposium) to illustrate the favorable and unfavorable effects of personality and emotional characteristics over a long term of care.

Humans↗

Increasing executive and "self-soothing" capacities in the treatment of addictive disorders.

Freud noted many years ago (1917/1963, 1933/1964) that the talking cure was developed due to the rather primitive nature of neuroscientific knowledge with regard to the brain and hence might eventually be made unnecessary or irrelevant by subsequent discoveries of the neuropsychological causation of neurotic symptoms. The opposite may be true, however. These discoveries may validate the potential effectiveness of therapeutic work with a wide variety of difficult personality disorders and addictive forms of pathology. The recent work of neuroscientists such as Barkley, Davidson, Goldberg, Schore and Volkow and Fowler may allow for empirical demonstrations of benign changes in brain functions following an effective course of treatment.

Behavior, Addictive↗

Mechanism of platelet liberation.

Megakaryocytes from 5 patients and 1 normal person were observed electronmicroscopically. In some pathologic states platelets seemed to be liberated without demarcation membrane system (DMS) and in a normal individual they seemed to be liberated independently of DMS. These findings suggest that DMS is not concerned with platelet liberation and that platelets are liberated through pseudopodia and bleb formation. In mature megakaryocytes vigorous amoeboid movement seems to exist and both pseudopodia and blebs may represent this movement. Structural similarity between surface connected system (SCS) of platelet and DMS of megakaryocyte suggests that the structure called DMS is transported as SCS into platelet.

Adult↗

Sonographic imaging of maternal complications of pregnancy.

OBJECTIVE: To show the role of diagnostic sonography in delineating pathologic conditions occurring during and immediately after pregnancy. METHODS: Cases illustrative of a broad range of pathologic conditions were collected primarily from personal experience in a busy ultrasound clinic serving high-and low-risk pregnancies over the past 15 years, with supplemental cases drawn from departmental teaching files. Sonography was the primary diagnostic tool, with confirmation obtained from other imaging modalities in select instances. RESULTS: Cases were organized on an anatomic and time-of-onset basis. For conditions occurring during pregnancy, the following anatomic areas are considered: the liver and biliary tree, urinary tract, bowel, ovary, and uterus and placenta. For postpartum complications, the following conditions are discussed: subfascial and bladder flap hematomas, retained products of conception, and ovarian vein thrombophlebitis. Although the main imaging modality in these conditions was sonography, correlation with computed tomography and magnetic resonance imaging was also made in several cases. CONCLUSIONS: A broad variety of conditions can affect the pregnant patient, both during and immediately after pregnancy. Sonography can show many of these disease processes, with computed tomography and magnetic resonance imaging useful selectively as supplementary tools.

Biliary Tract Diseases↗

[Pneumooxyhemographic method for the comprehensive study of circulation and respiration].

Over 3000 pneumoxyhaemogrammes were recorded in 1840 persons. Periods, types and criteria of pathology were differentiated in the structure of the pneumoxyhaemogramme. The method permits to reveal early forms of cardiovascular pathology. It is applicable for the examination of both normals and patients for early diagnosis of cardiovascular pathology, for the control of the therapeutic effect, and for a dynamic observation in the course of a dispensary screening.

Blood Circulation↗

[The physiological indices of emotional reactions in the clinical picture of local brain lesions].

The psychophysiological correlates of recognition and reproduction of emotional states were studied in patients with differently localized lesions of the brain cortex. It was shown that the effect of different lesions are anisotropic. The cross and reciprocal interaction between the posteriofrontal and temporal regions of the left and right hemispheres was described. A relation was revealed between the emotion sign and different autonomic indices. A quantitative estimation of physiological reactions of healthy persons and patients with focal brain pathology was carried out.

Adolescent↗

[Dependence of the formation of the addictive personality on the predisposing factors].

During observation of 100 patients with consequences of different types of drug-addictions (heroin, opium, poly-drug, pervitine-ephedrine) a complex of social and biological factors was analyzed: heredity, premorbid personality, somatic diseases, nurture, age of the onset of drug-addiction, duration of drug abuse, a social behavior. Influence of these factors was studied according to the following parameters: alteration of personality; degree of the moral-ethic decline and of the intellectual-mnestic disorders; somatic complications; the presence of the suicidal trends; frequency of self-damages; a professional level; family interrelations; frequency of the delinquencies (including conviction). On the basis of the correlation analysis it was established that the most significant unfavorable prognostic factors, which had determined a rate of the formation of the addictive personality were the following (in order of the decrease of significance): perinatal pathology; family history of alcoholism, drug-addiction and other mental diseases; personality deviations in premorbid period; an early age of the onset of drug addiction; a type of the drug; education; alcoholic abuse before the addiction; duration of the addiction.

Adolescent↗

Aspirin use in relation to risk of prostate cancer.

Experimental studies have shown inhibitory effects of nonsteroidal anti-inflammatory drugs on prostate cancer cell proliferation and reduction of prostate cancer metastasis, suggesting their possible preventive role for prostate cancer. We examined the association between regular aspirin use and the risk of prostate cancer among participants in the Health Professionals Follow-up Study, a prospective cohort of 47,882 United States men who were 40-75 years of age and without a history of prostate cancer in 1986. Biennial self-administered questionnaires were used to assess regular aspirin use from 1986 to 1996. We confirmed and staged incident cases of prostate cancer according to medical records and pathology reports. During 518,072 person-years of follow-up, 2,479 new cases of prostate cancer were ascertained. Of these, 608 were diagnosed as advanced (extraprostatic) prostate cancer and 258 as metastatic prostate cancer. We found no association between aspirin use and total prostate cancer. After accounting for prostate-specific antigen examinations and other potentially confounding variables, the relative risk of total prostate cancer for aspirin users compared with nonusers was 1.05 (95% confidence interval, 0.96-1.14). For metastatic prostate cancer, we observed a suggestive decrease in risk among men reporting greater frequency of aspirin use. The multivariate relative risk of metastatic prostate cancer among men using aspirin 22 or more days/month was 0.73 (95% confidence interval, 0.39-1.38) compared with nonusers. We noted no evidence of a linear dose-response relationship (P for trend = 0.40). The results from this cohort indicate that regular aspirin use is not likely to prevent the incidence of total prostate cancer, but we cannot exclude a possible benefit of frequent aspirin use on risk of developing metastatic prostate cancer.

Adult↗

[Effectiveness of present-day therapy of purulent lesions of the cornea].

The treatment of 313 patients (317 eyes) with purulent injuries of the cornea was studied. The medication therapy was found to be effective in 173 patients (176 eyes), which made up 56.2%. The purulent process in the cornea was arrested after the therapeutic penetrating and lamellar keratoplasty in 62 patients (63 eyes or 20.1%). 74 patients (74 eyes or 23.7%) were cured through the loss of an organ: enucleation was made for 63 patients, evisceroenucleation--for 8 patients and evisceration--for 3 persons. Before the onset of purulent pathology, all removed eyes were blind due to different diseases and traumas. Pathomorphological examinations of 63 enucleated eyes showed, in 76.2% of cases, purulent-and-inflammatory changes only in anterior eye segment, and in 23.8% of cases they showed that the purulent process extended into the posterior segment structures of the eyeball; it is noteworthy that the signs of developing endophthalmitis were found only in 6.3% of cases. The obtained morphological data are indicative of that not all therapeutic possibilities were used to preserve the injured but unpromising (in the optic sense) eyes. We conclude that the absolute indication for removing an eye with purulent pathology of the cornea is the generalizing process, i.e. endophthalmitis or panophthalmitis.

Adolescent↗

[Morphofunctional changes of external male genitalia in alcoholism and substance abuse].

The external male genitals (EMG) of male corpses, who abused alcohol and narcotics at lifetime, were examined. The objects were stained according to the common histological and histochemical methods. The study results are indicative of a high frequency rate of pathologic changes of the EMG in persons, who abused alcohol and narcotics at lifetime. The inflammatory, fibrosing and atrophic changes of the EMG as well as a reduced vascular permeability can be a cause for erection malfunction.

Adolescent↗

[Predictive elements of malignancy of isolated thyroid nodules].

The clinically revealed thyroid nodules are very frequent (3 to 5% of the general population), among them, fewer than 10% are malignant. The objective of this retrospective study type witness-case is to determinate the malignity predictive clinical and paraclinical elements for 45 patients presenting a thyroid malignant nodule and 45 others matched by age and sex presenting a thyroid isolated nodule. These patients were treated at the ORL ward of Charles Nicolle Hospital over a period of 10 years from 1989 to 1999. The average age of advent of malignant nodule is 43.2 + 14.4 years old with a clear female predominance (sex ratio = 4). The elements clearly linked to the hazard of thyroid cancer are loss of weight (p = 0.05; OR = 8.11), hard consistency of nodule (p = 0.002), the presence of cervical adenopathies (p = 0.05; OR = 4.22), vocal cords paralysis (p = 0.04), the presence of anemia (p = 0.01; OR = 5.7), a solid structure at sonography (p = 0.05) and the presence of a flux at doppler-sonography (p = 0.02). Personal antecedents of non malignant thyroid pathology, the nodule location and size and hypoechogenic features have not been clearly associated with the hazards of thyroid cancer.

Adult↗

[Anorexia and malnutrition].

Anorexia is a frequent and complex symptom occurring physiologically in older persons and during acute or chronic pathology. It's an adaptable physiological response to stress. It must be respected as such, as long as it's quickly reversible. The study of anorexia requires evaluation of oral intakes, causal aetiology and nutritional repercussion on body composition, different systems function and quality of life. Early artificial nutrition is recommended for adult patient who severely diminished oral intakes for 7 to 10 days after the beginning of acute pathology. Artificial nutrition is also indicated with chronic pathology associated with a significant weight loss. Faced to the impossibility of treating anorexia and its all causes, we have to treat at least anorexia repercussions and prevent undernutrition with an adequate artificial nutrition.

Aged↗

[A role and a place of ultrasound diagnosis of acute ileus].

The main purpose of the authors is to present their view of a place of present-day ultrasonography in the diagnosis of acute small and large intestinal obstruction. A comparatively sizable material covering 218 verified cases of acute ileus, including 77 patients with large intestinal obstruction and 141 patients with impaired passage of the intestinal contents along the small bowel was used to outline the aspects of ultrasound techniques and the symptomatology of ileus, by differentiating its some types. Along with the general assessment of the methodological and semiotic aspects of ultrasound diagnosis of acute uleus, the authors emphasizes a role of sonography in the detection of large intestinal obstruction by outlining their modified procedure of ultrasound irrigoscopy. For greater objectivization of their positive assessment of the place of ultrasound in the diagnosis of acute ileus and large intestinal obstruction, the authors comparatively studied X-ray and ultrasound studies to reveal this pathology. In addition to their purely personal assessment of a role of ultrasound in the diagnosis of large intestinal obstruction, the lecture also shows its authors' opinion as to the organizational issues associated with the necessity of correcting the existing diagnostic algorithm to detect large intestinal obstruction.

Acute Disease↗

[Glomus tumor of arterio-venous anastomoses].

Collected data of 74 national authors comprising 267 glomus tumors are reported. Based on these data and 49 personal authors' observations the clinic, pathogenesis, pathological anatomy and diagnosis of this rather rare lesion are described. Surgical intervention consisting in total removal of the tumor together with its capsule is the only proper method of treatment for the Barre-Masson disease.

Adolescent↗