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At least 1,711 records · Page 95Linked to original sources
PubMed1996

Lack of effects of recombinant growth hormone on muscle function in patients requiring prolonged mechanical ventilation: a prospective, randomized, controlled study.

OBJECTIVE: To evaluate the benefit of recombinant human growth hormone administration on muscle strength and duration of weaning in critically ill patients undergoing prolonged mechanical ventilation. DESIGN: Prospective, randomized, controlled, single-blind study. SETTING: Intensive care unit. PATIENTS: Twenty patients requiring > or = 7 days of mechanical ventilation for acute respiratory failure. INTERVENTION: Random assignment to receive either 0.43 IU (approximately 0.14 mg) recombinant growth hormone/kg body weight/day (treated group), or saline (nontreated group) for 12 days. MEASUREMENTS AND MAIN RESULTS: Nutritional support was guided by indirect calorimetry. Cumulative nitrogen balance was positive throughout the study period in the treated group 17.3 (44.9 +/- 17.3[SEM] g/12 days) vs. the nontreated group (-65.8 +/- 11.8 g/12 days) (p<.0001). Despite similar initial plasma concentrations, recombinant growth hormone supplementation resulted in marked increases in growth hormone, insulin like growth factor-1, and insulin concentrations (p<.05, .02, and .0001, respectively, vs. nontreated group). Body impedance determined net fat-free mass increased in the treated group (0.8 +/- 0.6 kg) vs. the nontreated group (-1.1 +/- O.5 kg) (p<.03). Initial peripheral muscle function, assessed by computer-controlled electrical stimulation of the adductor pollicis, was similarly lower in treated and nontreated groups than sex and age-matched normal controls, and decreased further during the study period. Arterial blood gases, cumulative total mechanical ventilation time, and number of hrs/day of mechanical ventilation during weaning were similar in both patient groups. Only three of the ten patients in each group were weaned from mechanical ventilation by day 12. CONCLUSIONS: Daily administration of recombinant growth hormone in mechanically ventilated patients with acute respiratory failure promotes a marked nitrogen retention. However, this reaction is accompanied neither by an improvement in muscle strength nor by a shorter duration of ventilatory supports.

Acute Disease↗
PubMed2000

Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report.

OBJECTIVE AND IMPORTANCE: Gouty arthritis and gouty tophi of the spine are very rare. We present a patient with the clinical manifestations of an intradural tumor and histologically proven gouty deposits in the filum terminale. CLINICAL PRESENTATION: The patient presented with typical symptoms of lumbar radiculopathy and neurogenic claudication. There was no evidence of peripheral gout. INTERVENTION: Imaging studies, including computed tomography and magnetic resonance imaging, demonstrated a 1-cm, round, intradural, calcified lesion at the L3 vertebral level, causing moderate spinal stenosis. The patient underwent a two-level laminectomy and removal of the mass. A pathological examination of the specimen revealed gouty deposits in the region of the filum terminale. CONCLUSION: Spinal involvement in gout is very rare, and intradural gouty deposits have not been previously described. Intradural gout should be considered in the differential diagnosis of intradural masses.

Diagnosis, Differential↗
PubMed2001

A method for diagnosing multiple diseases in MUNIN.

A new method for diagnosing multiple diseases in large medical decision support systems based on causal probabilistic networks is proposed. The method is based on characteristics of the diagnostic process that we believe to be present in many diagnostic tasks, both inside and outside medicine. The diagnosis must often be made under uncertainty, choosing between diagnoses that each have small prior probabilities, but not so small that the possibility of two or more simultaneous diseases can be ignored. Often a symptom can be caused by several diseases and the presence of several diseases tend to aggravate the symptoms. For diagnostic problems that share these characteristic, we have proposed a method that operates in a number of phases: in the first phase only single diseases are considered and this helps to focus the attention on a smaller number of plausible diseases. In the second phase, pairs of diseases are considered, which make it possible to narrow down the field of plausible diagnoses further. In the following phases, larger subsets of diseases are considered. The method was applied to the diagnosis of neuromuscular disorders, using previous experience with the so-called MUNIN system as a starting point. The results showed that the method gave large reductions in computation time without compromising the computational accuracy in any substantial way. It is concluded that the method enables practical inference in large medical expert systems based on causal probabilistic networks.

Decision Trees↗
PubMed2005

Non-invasive pulsatile arterial pressure and stroke volume changes from the human finger.

In this paper we review recent developments in the methodology of non-invasive finger arterial pressure measurement and the information about arterial flow that can be obtained from it. Continuous measurement of finger pressure based on the volume-clamp method was introduced in the early 1980s both for research purposes and for clinical medicine. Finger pressure tracks intra-arterial pressure but the pressure waves may differ systematically both in shape and magnitude. Such bias can, at least partly, be circumvented by reconstruction of brachial pressure from finger pressure by using a general inverse anti-resonance model correcting for the difference in pressure waveforms and an individual forearm cuff calibration. The Modelflow method as implemented in the Finometer computes an aortic flow waveform from peripheral arterial pressure by simulating a non-linear three-element model of the aortic input impedance. The methodology tracks fast changes in stroke volume (SV) during various experimental protocols including postural stress and exercise. If absolute values are required, calibration against a gold standard is needed. Otherwise, Modelflow-measured SV is expressed as change from control with the same precision in tracking. Beat-to-beat information on arterial flow offers important and clinically relevant information on the circulation beyond what can be detected by arterial pressure.

Arteries↗
PubMed2005

Local and global geometric influence on steady flow in distal anastomoses of peripheral bypass grafts.

We consider the effect of geometrical configuration on the steady flow field of representative geometries from an in vivo anatomical data set of end-to-side distal anastomoses constructed as part of a peripheral bypass graft. Using a geometrical classification technique, we select the anastomoses of three representative patients according to the angle between the graft and proximal host vessels (GPA) and the planarity of the anastomotic configuration. The geometries considered include two surgically tunneled grafts with shallow GPAs which are relatively planar but have different lumen characteristics, one case exhibiting a local restriction at the perianastomotic graft and proximal host whilst the other case has a relatively uniform cross section. The third case is nonplanar and characterized by a wide GPA resulting from the graft being constructed superficially from an in situ vein. In all three models the same peripheral resistance was imposed at the computational outflows of the distal and proximal host vessels and this condition, combined with the effect of the anastomotic geometry, has been observed to reasonably reproduce the in vivo flow split. By analyzing the flow fields we demonstrate how the local and global geometric characteristics influences the distribution of wall shear stress and the steady transport of fluid particles. Specifically, in vessels that have a global geometric characteristic we observe that the wall shear stress depends on large scale geometrical factors, e.g., the curvature and planarity of blood vessels. In contrast, the wall shear stress distribution and local mixing is significantly influenced by morphology and location of restrictions, particular when there is a shallow GPA. A combination of local and global effects are also possible as demonstrated in our third study of an anastomosis with a larger GPA. These relatively simple observations highlight the need to distinguish between local and global geometric influences for a given reconstruction. We further present the geometrical evolution of the anastomoses over a series of follow-up studies and observe how the lumen progresses towards the faster bulk flow of the velocity in the original geometry. This mechanism is consistent with the luminal changes in recirculation regions that experience low wall shear stress. In the shallow GPA anastomoses the proximal part of the native host vessel occludes or stenoses earlier than in the case with wide GPA. A potential contribution to this behavior is suggested by the stronger mixing that characterizes anastomoses with large GPA.

Anastomosis, Surgical↗
PubMed1990

Atrial natriuretic peptide augments forearm capillary filtration in humans.

Low-dose infusions of atrial natriuretic peptide (ANP) into humans reduce cardiac filling pressures without enhancing renal excretion or producing vasodilation. The present human study was undertaken to seek an effect of ANP on capillary filtration in humans and to determine its relationship to reductions in cardiac filling pressures. Heart rate (electrocardiogram), blood pressure (cuff method), and renal excretion of salt and water were determined, and central venous pressure (jugular vein cannulation, strain-gauge transducer) and forearm venous compliance and capillary filtration coefficient (strain-gauge plethysmography) were derived by computer. Forearm girth and venous pressure (peripheral vein catheter) measurements were obtained while the arm was elevated above heart level, and an upper arm blood pressure cuff was intermittently inflated to venous occluding pressures of 20, 30, and 40 mmHg. Forearm measurements, hematocrit, plasma proteins, albumin and plasma levels of ANP were determined from euvolemic volunteers before and during 60 min intravenous infusions of ANP (5 ng.kg-1.min-1, n = 9) or placebo (isotonic saline, n = 7). ANP infusions produced physiological increases (4- to 5-fold) in plasma ANP (from a base line 35 +/- 6 pg/ml) (P less than 0.05). Hemodynamic responses to ANP consisted of a reduction in central venous pressure (P less than 0.05) and no change in heart rate, mean arterial pressure, or renal excretory parameters. ANP increased forearm capillary filtration between 37 and 63% (P less than 0.05) from base line but did not significantly alter forearm compliance measurements.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Traumatic pseudoaneurysm of the intracavernous ICA presenting with massive epistaxis: imaging diagnosis and endovascular treatment.

Traumatic pseudoaneurysm of the intracavernous internal carotid artery (ICA) is a very rare cause of epistaxis but is a life-threatening clinical situation when left untreated. The authors have experienced four cases of traumatic pseudoaneurysm involving the intracavernous ICA. Delayed massive epistaxes developed 1 to 8 months after trauma and initial transient epistaxis in all four patients. Three of the cases were successfully managed by the detachable balloon occlusion (DBO) of the ICA along with the aneurysm openings. In one case, a large pseudoaneurysm destroying a large area of the central skull base with peripheral blood clot was demonstrated on computed tomography, magnetic resonance imaging, and angiography; this patient died due to massive epistaxis before the trial of DBO. Imaging findings of pseudoaneurysms involving the intracavernous ICA in the four cases are described, and the role of endovascular treatment is discussed.

Accidental Falls↗
PubMed1984

CT identification of bronchopulmonary segments: 50 normal subjects.

A systematic evaluation of the fissures, segmental bronchi and arteries, bronchopulmonary segments, and peripheral pulmonary parenchyma was made from computed tomographic (CT) scans of 50 patients with normal chest radiographs. Seventy percent of the segmental bronchi and 76% of the segmental arteries were identified. Arteries could be traced to their sixth- and seventh-order branches; their orientation to the plane of the CT section allowed gross identification and localization of bronchopulmonary segments.

Adolescent↗
PubMed2006

Obstructive jaundice caused by secondary pancreatic tumor from malignant solitary fibrous tumor of pleura: a case report.

A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of alpha-smooth muscle actin (alpha-SMA) or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.

Aged↗
PubMed2002

Professional monitoring and critical incident reporting using personal digital assistants.

OBJECTIVE: To assess the practicality of using personal digital assistants (PDAs) for the collection of logbook data, procedural performance data and critical incident reports in anaesthetic trainees. DESIGN: Pilot study. SETTING: Two tertiary referral centres (in Victoria and New Zealand) and a large district hospital in Queensland. PARTICIPANTS: Six accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their ANZCA training supervisors. INTERVENTIONS: Registrars and supervisors underwent initial training for one hour, and supervisors were provided with ongoing support. MAIN OUTCOME MEASURES: Reliable use of the program, average time for data entry and number of procedures logged. RESULTS: ANZCA trainees reliably enter data into PDAs. The data can be transferred to a central database, where they can be remotely analysed before results are fed back to trainees. CONCLUSIONS: This technology can be used to monitor professional performance in ANZCA trainees.

Anesthesia↗
PubMed1999

Transaortic gradient is pressure-dependent in a pulsatile model of the circulation.

BACKGROUND AND AIM OF THE STUDY: Although the transvalvular gradient is described as flow-dependent, pressure-dependence of the gradient, irrespective of flow, has not been demonstrated. METHODS: The Sheffield pulse duplicator equipped with a X-Cell 21 porcine valve mounted in the aortic position was used. Transaortic gradient was measured at a constant rate of 80 beats/min, while flow was kept at 2, 5 or 8 l/min, and systemic pressure was increased up to 200 mmHg by adjusting peripheral resistance manually. Valve area was computed with the Gorlin formula. A total of 87 measurements was carried out. RESULTS: For each flow, transvalvular gradient increased linearly with pressure, and computed area decreased. The slope of the pressure-gradient relationship was independent of flow. CONCLUSION: Transaortic gradient depends not only on flow, but also shows pressure-dependency that should be taken into account when evaluating aortic stenosis, especially in hypertensive and hypotensive states.

Aortic Valve↗
PubMed2000

[Two cases of intravascular lymphomatosis diagnosed antemortem by transbronchial lung biopsy].

Patient 1 was a 71-year-old man who had been admitted to our hospital with high-grade fever. Chest computed tomographic (CT) images revealed clear peripheral and high-density central areas. Abnormal laboratory findings included elevated LDH and hypoxemia. Interstitial pneumonia was suspected, and transbronchial lung biopsy (TBLB) confirmed the diagnosis of intravascular lymphomatosis (IVL). The patient succumbed before completion of chemotherapy. Patient 2 was a 65-year-old man admitted with high-grade fever. Abnormal laboratory findings included pancytopenia, hypoxemia, and elevated levels of LDH and soluble interleukin-2 receptor. Chest CT images revealed diffuse, mildly dense areas in the upper fields of both lungs. TBLB specimens yielded a diagnosis of IVL. Complete clinical remission was obtained with CHOP multiagent chemotherapy. Although IVL is usually diagnosed at autopsy, in these 2 cases an antemortem diagnosis was made on the basis of TBLB findings. Also, multiagent chemotherapy achieved a complete clinical remission in Patient 2.

Aged↗
PubMed2001

[Controversy over the UICC-TNM classification].

The new UICC-TNM classification is accepted by most thoracic surgeons and medical oncologists because the prognosis of lung cancer patients is well distinguished by stage based on the TNM classification. However, there are several controversies over improving the classification. The number of small-sized peripheral lung cancers detected by helical computed tomography screening is rapidly increasing in Japan. The prognosis for patients with these tiny lung cancers is extremely good. Therefore, these lung cancers should be separated from T1 lung cancers detected by conventional chest X-ray. T2 includes a wide range of tumor sizes. The prognosis of T3 disease is different depending on the organs invaded. T4 disease is a contraindication for surgery, although some T4 cases could undergo complete resection and be cured. T4 disease should therefore be divided into operable T4 and inoperable T4. The most important controversy over the N factor is the boundary between N1 and N2 because of the lack of a universally common map of lymph node stations. Classification of satellite nodules is another controversy. Most proposals by Japanese surgeons are based on postoperative pathological TNM classification and staging. Pathological classification indicates postoperative prognosis well. Prognostic analysis based on clinical classification indicates postoperative prognosis well. Prognostic analysis based on clinical classification is needed to determine the strategy for each patient.

Humans↗
PubMed2002

[Pleomorphic adenoma of the lung; report of a case].

A 67-year-old woman was admitted because of an abnormal shadow on the chest X-ray film. Chest computed tomography (CT) film revealed a peripheral mass in the middle lower lobe of the lung. We performed open lung biopsy and diagnosed as a benign epithelial adenoma but not ruled out adenocarcinoma completely by intraoperative examination of frozen sections. We operated right middle lobectomy and mediastinal lymph nodes dissections. Histological examination confirmed pleomorphic adenoma. We examined salivary glands, but didn't find the focus of that. The patient had been well for three years postoperatively.

Adenoma, Pleomorphic↗
PubMed2005

[Case of autosomal dominant polycystic kidney disease presenting hepatic encephalopathy].

We report a 71-year-old woman with autosomal dominant polycystic kidney disease (ADPKD), who presented with hepatic encephalopathy. She was diagnosed as having ADPKD at 61 years of age. Thereafter, her renal function gradually worsened and she was admitted to our hospital because of encephalopathy and end-stage renal failure. The main laboratory findings were as follows: BUN 77 mg/dl; creatinine 9.0 mg/d; ammonia 573 microg/dl. Hepatic encephalopathy was improved after hemodialysis and administration of lactulose. The liver demonstrated multiple cysts on computed tomography. Angiography demonstrated that the peripheral branch of the portal vein was stenotic and a spleno-renal shunt was detected. We considered that portal hypertension was caused by multiple liver cysts, and that hepatic encephalopathy was caused by the spleno-renal shunt. It is generally considered that severe hepatic complications are rare in ADPKD, but this case suggested the need to screen for the development of hepatic lesions in ADPKD.

Aged↗
PubMed1990

A fully robotic assay for human hormone analysis.

To create a more convenient analytical system for the determination of hormones in human serum, we attempted to make a robotic system by combining robotic equipment and the DELFIA system (time-resolved fluoroimmunoassay; Pharmacia Co.). To combine the two systems, we constructed various peripheral instruments, created software for the computer, and introduced these to the robot at our laboratory. We developed this system to operate more exactly and smoothly than manual procedures during analytical movement steps such as taking samples, adding reagents, mixing samples in kit strips, and measuring the results of the fluoroimmunoassay. With this system the robot can measure in random sequence eight hormones--thyrotropin, triiodothyronine, thyroxin, prolactin, lutropin, follitropin, choriogonadotropin, and cortisol--according to physicians' orders placed through the computer. Consequently, this robotic system can operate fully automatically, from delivering the samples into the robotic system to printing out graph reports for physicians. The technologist merely puts the sample rack on the conveyor belt.

Fluoroimmunoassay↗