Acute abdomen: an unusual presentation of disseminated Penicillium marneffei infection.

PubMed

George, I A; Sudarsanam, T D; Pulimood, A B; Mathews, M S

2008-01-01

Varied clinical presentations of Penicillium marneffei, an opportunistic pathogen in HIV disease has been rarely described in literature. We report a patient with advanced AIDS who presented to us with prolonged fever and had features of an acute abdomen. On radiologic imaging he had features of intestinal obstruction and mesenteric lymphadenitis. A diagnosis was made possible by endoscopic biopsies of the small bowel and bone marrow culture which grew P. Marneffei. He was treated with intravenous amphotericin for 2 weeks followed by oral itraconazole. This case is reported for its rarity and unusual presentation and to sensitise clinicians and microbiologists to consider this as an aetiology in patients with advanced HIV/AIDS who present with acute abdomen, more so in patients from a distinct geographic region--South-East Asia.

Anatomical study of superficial fascia and localized fat deposits of abdomen.

PubMed

Kumar, Pramod; Pandey, Arvind K; Kumar, Brijesh; Aithal, Shrinivas K

2011-09-01

The development of liposuction and abdominoplasty has renewed interest in the anatomy of the localized fat deposits (LFD) areas of the abdomen. This study aims at ascertaining the gross anatomy of superficial fascia and the localized fat deposits of abdomen. Eight adult cadavers (four males and four females) were dissected. Attachments, number of layers of fascia and colour, shape and maximum size of the fat lobules in loin, and upper and lower abdomen were noted. Thickness of deep membranous layer of superficial fascia of upper abdomen and lower abdomen were measured by metal casing electronic digital calipers, with resolution being 10 μm. The independent sample t-test, ANOVA for comparison and Pearson coefficient for correlation were used. Superficial fascia of the abdomen was multilayered in the midline and number of layers reduced laterally. The shape, size, color, and arrangement of fat lobules were different in different locations. The thickness of the fascia of the lower abdomen in males (mean 528.336 ± SE38.48) was significantly (P < 0.041) more than that in females. (Mean 390.822 ± SE36.24). Pearson correlation between thickness of the membranous layer of the upper and lower abdomen revealed moderately positive correlation (r=0.718; P<0.045). The LFD in the central region of the abdomen corresponds to the area of multilayered fascia with smaller fat lobules. The relatively thinner supporting fascia of the lower abdomen in females may be responsible for excessive bulges of the lower abdomen. The fat lobule anatomy at different sites under study was different.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 2-Uncommon Sarcomas.

PubMed

Levy, Angela D; Manning, Maria A; Miettinen, Markku M

2017-01-01

Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis.

Abdomen X-Ray (Radiography)

MedlinePlus

... News Physician Resources Professions Site Index A-Z X-ray (Radiography) - Abdomen Abdominal x-ray uses a ... of an abdominal x-ray? What is abdominal x-ray? An x-ray (radiograph) is a noninvasive ...

Normal sonographic anatomy of the abdomen of coatis (Nasua nasua Linnaeus 1766).

PubMed

Ribeiro, Rejane G; Costa, Ana Paula A; Bragato, Nathália; Fonseca, Angela M; Duque, Juan C M; Prado, Tales D; Silva, Andrea C R; Borges, Naida C

2013-06-23

The use of ultrasound in veterinary medicine is widespread as a diagnostic supplement in the clinical routine of small animals, but there are few reports in wild animals. The objective of this study was to describe the anatomy, topography and abdominal sonographic features of coatis. The urinary bladder wall measured 0.11 ± 0.03 cm. The symmetrical kidneys were in the left and right cranial quadrant of the abdomen and the cortical, medullary and renal pelvis regions were recognized and in all sections. The medullary rim sign was visualized in the left kidney of two coatis. The liver had homogeneous texture and was in the cranial abdomen under the rib cage. The gallbladder, rounded and filled with anechoic content was visualized in all coatis, to the right of the midline. The spleen was identified in the left cranial abdomen following the greater curvature of the stomach. The parenchyma was homogeneous and hyperechogenic compared to the liver and kidney cortex. The stomach was in the cranial abdomen, limited cranially by the liver and caudo-laterally by the spleen. The left adrenal glands of five coatis were seen in the cranial pole of the left kidney showing hypoechogenic parenchyma without distinction of cortex and medulla. The pancreas was visualized in only two coatis. The left ovary (0.92 cm x 0.56 cm) was visualized on a single coati in the caudal pole of the kidney. The uterus, right adrenal, right ovary and intestines were not visualized. Ultrasound examination of the abdomen of coatis may be accomplished by following the recommendations for dogs and cats. It is possible to evaluate the anatomical and topographical relationships of the abdominal organs together with the knowledge of the peculiarities of parenchymal echogenicity and echotexture of the viscera.

An Efficient Pipeline for Abdomen Segmentation in CT Images.

PubMed

Koyuncu, Hasan; Ceylan, Rahime; Sivri, Mesut; Erdogan, Hasan

2018-04-01

Computed tomography (CT) scans usually include some disadvantages due to the nature of the imaging procedure, and these handicaps prevent accurate abdomen segmentation. Discontinuous abdomen edges, bed section of CT, patient information, closeness between the edges of the abdomen and CT, poor contrast, and a narrow histogram can be regarded as the most important handicaps that occur in abdominal CT scans. Currently, one or more handicaps can arise and prevent technicians obtaining abdomen images through simple segmentation techniques. In other words, CT scans can include the bed section of CT, a patient's diagnostic information, low-quality abdomen edges, low-level contrast, and narrow histogram, all in one scan. These phenomena constitute a challenge, and an efficient pipeline that is unaffected by handicaps is required. In addition, analysis such as segmentation, feature selection, and classification has meaning for a real-time diagnosis system in cases where the abdomen section is directly used with a specific size. A statistical pipeline is designed in this study that is unaffected by the handicaps mentioned above. Intensity-based approaches, morphological processes, and histogram-based procedures are utilized to design an efficient structure. Performance evaluation is realized in experiments on 58 CT images (16 training, 16 test, and 26 validation) that include the abdomen and one or more disadvantage(s). The first part of the data (16 training images) is used to detect the pipeline's optimum parameters, while the second and third parts are utilized to evaluate and to confirm the segmentation performance. The segmentation results are presented as the means of six performance metrics. Thus, the proposed method achieves remarkable average rates for training/test/validation of 98.95/99.36/99.57% (jaccard), 99.47/99.67/99.79% (dice), 100/99.91/99.91% (sensitivity), 98.47/99.23/99.85% (specificity), 99.38/99.63/99.87% (classification accuracy), and 98

Milk of calcium in abdomen.

PubMed

Huang, Yu-Sen; Huang, Kuo-How; Chang, Chin-Chen; Liu, Kao-Lang

2011-03-01

A 45-year-old woman had an asymptomatic abnormality on a screening abdominal radiograph. The radiopaque mass in her right upper abdomen was surrounded by numerous "pearls" and resembled an abalone on the supine abdominal radiograph. We advised an additional upright abdominal radiograph, which showed a calcium fluid level. We also clarified the location of the cystic lesion at the right floating kidney, which changed its location between the supine and upright positions. Computed tomography of the abdomen revealed a right renal cyst with a calcium-fluid interface owing to the milk of calcium. The patient was then followed up without additional investigation or the need for intervention. Copyright © 2011 Elsevier Inc. All rights reserved.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 2—Uncommon Sarcomas

PubMed Central

Manning, Maria A.; Miettinen, Markku M.

2017-01-01

Soft-tissue sarcomas occurring in the abdomen and pelvis are an uncommon but important group of malignancies. Recent changes to the World Health Organization classification of soft-tissue tumors include the movement of gastrointestinal stromal tumors (GISTs) into the soft-tissue tumor classification. GIST is the most common intraperitoneal sarcoma. Liposarcoma is the most common retroperitoneal sarcoma, and leiomyosarcoma is the second most common. GIST, liposarcoma, and leiomyosarcoma account for the majority of sarcomas encountered in the abdomen and pelvis and are discussed in part 1 of this article. Undifferentiated pleomorphic sarcoma (previously called malignant fibrous histiocytoma), dermatofibrosarcoma protuberans, solitary fibrous tumor, malignant peripheral nerve sheath tumor, rhabdomyosarcoma, extraskeletal chondro-osseous sarcomas, vascular sarcomas, and sarcomas of uncertain differentiation uncommonly arise in the abdomen and pelvis and the abdominal wall. Although these lesions are rare sarcomas and their imaging features overlap, familiarity with the locations where they occur and their imaging features is important so they can be diagnosed accurately. The anatomic location and clinical history are important factors in the differential diagnosis of these lesions because metastasis, more-common sarcomas, borderline fibroblastic proliferations (such as desmoid tumors), and endometriosis have imaging findings that overlap with those of these uncommon sarcomas. In this article, the clinical, pathologic, and imaging findings of uncommon soft-tissue sarcomas of the abdomen and pelvis and the abdominal wall are reviewed, with an emphasis on their differential diagnosis. PMID:28493803

Electrical burns of the abdomen.

PubMed

Srivastava, Rakesh Kumar; Kumar, Ritesh

2013-09-01

A 35-year-old male farmer came in contact with 11,000 volts high tension electric wire and sustained full thickness burn wounds over scapula, upper limb and anterior abdominal wall along with perforation of the intestine. Patient was initially managed conservatively in general surgery ward and was referred to us after 3 days with necrosis of the burned skin and muscles over the shoulder and abdomen. Patient was initially managed conservatively and then thorough debridement of the necrotic skin over the left shoulder and upper arm was done and the area was split skin grafted. Patient developed enterocutaneous fistula, which healed over a period of 8 weeks. The granulating wound over the abdomen was also skin grafted and patient was discharged after 18 days. About 4 months, after the discharge patient presented with ventral hernia. Repair of ventral hernia by synthetic mesh application and reconstruction of the abdominal wall with a free tensor fascia lata flap was done over the mesh, but the flap failed. Then after debridement two random pattern transposition skin flaps, one from the right upper and another from the left lower abdomen were transposed over the abdominal wound and donor area was skin grafted. Patient was discharged after 17 days.

Ultrasound: Abdomen (For Parents)

MedlinePlus

... the computer screen. A technician (sonographer) trained in ultrasound imaging will spread a clear, warm gel on the skin of the abdomen. This gel helps with the transmission of the sound waves. The ... abdominal ultrasound is painless. Your child may feel a slight ...

Emergency management of acute abdomen in children.

PubMed

Balachandran, Binesh; Singhi, Sunit; Lal, Sadhna

2013-03-01

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle's tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

CT angiography - abdomen and pelvis

MedlinePlus

... this page: //medlineplus.gov/ency/article/007674.htm CT angiography - abdomen and pelvis To use the sharing features on this page, please enable JavaScript. CT angiography combines a CT scan with the injection ...

Ecchymosis and/or haematoma formation after prophylactic administration of subcutaneous enoxaparin in the abdomen or arm of the critically ill patient.

PubMed

Jareño-Collado, R; Sánchez-Sánchez, M M; Fraile-Gamo, M P; García-Crespo, N; Barba-Aragón, S; Bermejo-García, H; Sánchez-Izquierdo, R; Sánchez-Muñoz, E I; López-López, A; Arias-Rivera, S

Ecchymosis and/or haematoma are the most common adverse events after subcutaneous administration of low molecular weight heparin. There is no strong recommendation as to the puncture site. To evaluate the adverse events, ecchymosis and/or haematoma after the administration of prophylactic subcutaneous enoxaparin in the abdomen vs the arm in the critically ill patient. A randomised, two-arm clinical trial (injection in the abdomen vs the arm), performed between July 2014 and January 2017, in an 18-bed, polyvalent intensive care unit. Patients receiving prophylactic enoxaparin, admitted >72h, with no liver or haematological disorders, a body mass index (BMI) >18.5, not pregnant, of legal age and with no skin lesions which would impede assessment were included. We excluded patients who died or who were transferred to another hospital before completing the evaluation. We gathered demographic and clinical variables, and the onset of ecchymosis and/or haematomas at the injection site after 12, 24, 48 and 72hours. A descriptive analysis was undertaken, with group comparison and logistic regression. The study was approved by the ethics committee with the signed consent of patients/families. 301 cases (11 excluded): 149 were injected in the abdomen vs 141 in the arm. There were no significant differences in demographic and clinical variables, BMI, enoxaparin dose or antiplatelet administration [ecchymosis, abdomen vs arm, n(%): 66(44) vs 72(51), P=.25] [haematoma abdomen vs arm, n(%): 9(6) vs 14(10), P=.2]. Statistical significance was found in the size of the haematomas after 72h: [area of haematoma (mm 2 ) abdomen vs arm, median (IQR): 2(1-5.25) vs 20(5.25-156), P=.027]. In our patient cohort, prophylactic subcutaneous enoxaparin administered in the abdomen causes fewer haematomas after 72hours, than when administered in the arm. The incidence rate of ecchymosis and haematoma was lower than the published incidence in critically ill patients, although patients receiving

Laparoscopic anatomy of the equine abdomen.

PubMed

Galuppo, L D; Snyder, J R; Pascoe, J R

1995-04-01

Laparoscopy was performed on 6 horses (2 mares, 2 geldings, 2 stallions) to determine the normal laparoscopic anatomy of the equine abdomen. After withholding feed for 36 hours, horses were examined from the left and right paralumbar fossae, and the visceral anatomic structures were recorded by videotape and photography. One mare developed emphysema located subcutaneously at the primary laparoscopic portal; otherwise, there were no complications. The anatomic structures of diagnostic importance that were observed in the left half of the abdomen were the hepatic duct; left lateral and quadrate lobes of the liver; stomach; spleen; left kidney with the associated nephrosplenic ligament; segments of jejunum, descending colon, and ascending colon; left side of the male and female reproductive tracts; urinary bladder; vaginal ring; and mesorchium. Important structures observed in the right side of the abdomen were portions of the common hepatic duct; left lateral, quadrate, and right lobes of the liver; caudate process of the liver; stomach; duodenum; right dorsal colon, epiploic foramen; omental bursa; right kidney; base of the cecum; segments of jejunum, descending colon, and ascending colon; urinary bladder; right half of the male and female reproductive tracts; and rectum.

MELAS syndrome presenting as an acute surgical abdomen.

PubMed

Dindyal, S; Mistry, K; Angamuthu, N; Smith, G; Hilton, D; Arumugam, P; Mathew, J

2014-01-01

MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate.

Patient-specific dose estimation for pediatric abdomen-pelvis CT

NASA Astrophysics Data System (ADS)

Li, Xiang; Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P.

2009-02-01

The purpose of this study is to develop a method for estimating patient-specific dose from abdomen-pelvis CT examinations and to investigate dose variation across patients in the same weight group. Our study consisted of seven pediatric patients in the same weight/protocol group, for whom full-body computer models were previously created based on the patients' CT data obtained for clinical indications. Organ and effective dose of these patients from an abdomen-pelvis scan protocol (LightSpeed VCT scanner, 120-kVp, 85-90 mA, 0.4-s gantry rotation period, 1.375-pitch, 40-mm beam collimation, and small body scan field-of-view) was calculated using a Monte Carlo program previously developed and validated for the same CT system. The seven patients had effective dose of 2.4-2.8 mSv, corresponding to normalized effective dose of 6.6-8.3 mSv/100mAs (coefficient of variation: 7.6%). Dose variations across the patients were small for large organs in the scan coverage (mean: 6.6%; range: 4.9%-9.2%), larger for small organs in the scan coverage (mean: 10.3%; range: 1.4%-15.6%), and the largest for organs partially or completely outside the scan coverage (mean: 14.8%; range: 5.7%-27.7%). Normalized effective dose correlated strongly with body weight (correlation coefficient: r = -0.94). Normalized dose to the kidney and the adrenal gland correlated strongly with mid-liver equivalent diameter (kidney: r = -0.97; adrenal glands: r = -0.98). Normalized dose to the small intestine correlated strongly with mid-intestine equivalent diameter (r = -0.97). These strong correlations suggest that patient-specific dose may be estimated for any other child in the same size group who undergoes the abdomen-pelvis scan.

Role of computed tomography of abdomen in difficult to diagnose typhoid fever: a case series.

PubMed

Hafeez, Wajid; Rajalakshmi, S; Sripriya, S; Madhu Bashini, M

2018-04-01

Background and Aim Diagnosis of typhoid is challenging when blood cultures fail to isolate Salmonella species. We report our experience with interpreting computed tomography (CT) abdomen findings in a case series of typhoid fever. Methods The case series consisted of patients who had a CT abdomen done as part of their investigations and a final diagnosis of typhoid fever. The CT films were reviewed and findings evaluated for distinctive features. Results During 2011-2017, 11 patients met the inclusion criteria. Indication for CT was pyrexia of unknown origin in the majority of patients. Review of CT films revealed mesenteric lymphadenopathy (100%), terminal ileum thickening (85%), hepatosplenomegaly (45%), retroperitoneal lymphadenopathy (18%) and ascites (9%). Conclusions Enhancing discrete mesenteric lymphadenopathy and terminal ileum thickening are non-specific findings noted in typhoid fever. Absence of matted necrotic nodes and peritoneal thickening rule out tuberculosis and raise suspicion of typhoid fever in endemic regions.

Evaluation of amylase and lipase levels in blunt trauma abdomen patients

PubMed Central

Kumar, Subodh; Sagar, Sushma; Subramanian, Arulselvi; Albert, Venencia; Pandey, Ravindra Mohan; Kapoor, Nitika

2012-01-01

Background: There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). Aim: To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. Materials and Methods: A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal–Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. Results: A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant

Quantification of the thorax-to-abdomen breathing ratio for breathing motion modeling.

PubMed

White, Benjamin M; Zhao, Tianyu; Lamb, James; Bradley, Jeffrey D; Low, Daniel A

2013-06-01

The purpose of this study was to develop a methodology to quantitatively measure the thorax-to-abdomen breathing ratio from a 4DCT dataset for breathing motion modeling and breathing motion studies. The thorax-to-abdomen breathing ratio was quantified by measuring the rate of cross-sectional volume increase throughout the thorax and abdomen as a function of tidal volume. Twenty-six 16-slice 4DCT patient datasets were acquired during quiet respiration using a protocol that acquired 25 ciné scans at each couch position. Fifteen datasets included data from the neck through the pelvis. Tidal volume, measured using a spirometer and abdominal pneumatic bellows, was used as breathing-cycle surrogates. The cross-sectional volume encompassed by the skin contour when compared for each CT slice against the tidal volume exhibited a nearly linear relationship. A robust iteratively reweighted least squares regression analysis was used to determine η(i), defined as the amount of cross-sectional volume expansion at each slice i per unit tidal volume. The sum Ση(i) throughout all slices was predicted to be the ratio of the geometric expansion of the lung and the tidal volume; 1.11. The Xiphoid process was selected as the boundary between the thorax and abdomen. The Xiphoid process slice was identified in a scan acquired at mid-inhalation. The imaging protocol had not originally been designed for purposes of measuring the thorax-to-abdomen breathing ratio so the scans did not extend to the anatomy with η(i) = 0. Extrapolation of η(i)-η(i) = 0 was used to include the entire breathing volume. The thorax and abdomen regions were individually analyzed to determine the thorax-to-abdomen breathing ratios. There were 11 image datasets that had been scanned only through the thorax. For these cases, the abdomen breathing component was equal to 1.11 - Ση(i) where the sum was taken throughout the thorax. The average Ση(i) for thorax and abdomen image datasets was found to be 1.20 �

IROA: International Register of Open Abdomen, preliminary results.

PubMed

Coccolini, Federico; Montori, Giulia; Ceresoli, Marco; Catena, Fausto; Ivatury, Rao; Sugrue, Michael; Sartelli, Massimo; Fugazzola, Paola; Corbella, Davide; Salvetti, Francesco; Negoi, Ionut; Zese, Monica; Occhionorelli, Savino; Maccatrozzo, Stefano; Shlyapnikov, Sergei; Galatioto, Christian; Chiarugi, Massimo; Demetrashvili, Zaza; Dondossola, Daniele; Yovtchev, Yovcho; Ioannidis, Orestis; Novelli, Giuseppe; Nacoti, Mirco; Khor, Desmond; Inaba, Kenji; Demetriades, Demetrios; Kaussen, Torsten; Jusoh, Asri Che; Ghannam, Wagih; Sakakushev, Boris; Guetta, Ohad; Dogjani, Agron; Costa, Stefano; Singh, Sandeep; Damaskos, Dimitrios; Isik, Arda; Yuan, Kuo-Ching; Trotta, Francesco; Rausei, Stefano; Martinez-Perez, Aleix; Bellanova, Giovanni; Fonseca, Vinicius Cordeiro; Hernández, Fernando; Marinis, Athanasios; Fernandes, Wellington; Quiodettis, Martha; Bala, Miklosh; Vereczkei, Andras; Curado, Rafael L; Fraga, Gustavo Pereira; Pereira, Bruno M; Gachabayov, Mahir; Chagerben, Guillermo Perez; Arellano, Miguel Leon; Ozyazici, Sefa; Costa, Gianluca; Tezcaner, Tugan; Ansaloni, Luca

2017-01-01

No definitive data about open abdomen (OA) epidemiology and outcomes exist. The World Society of Emergency Surgery (WSES) and the Panamerican Trauma Society (PTS) promoted the International Register of Open Abdomen (IROA). A prospective observational cohort study including patients with an OA treatment. Data were recorded on a web platform (Clinical Registers®) through a dedicated website: www.clinicalregisters.org. Four hundred two patients enrolled. Adult patients: 369 patients; Mean age: 57.39±18.37; 56% male; Mean BMI: 36±5.6. OA indication: Peritonitis (48.7%), Trauma (20.5%), Vascular Emergencies/Hemorrhage (9.4%), Ischemia (9.1%), Pancreatitis (4.2%),Post-operative abdominal-compartment-syndrome (3.9%), Others (4.2%). The most adopted Temporary-abdominal-closure systems were the commercial negative pressure ones (44.2%). During OA 38% of patients had complications; among them 10.5% had fistula. Definitive closure: 82.8%; Mortality during treatment: 17.2%. Mean duration of OA: 5.39(±4.83) days; Mean number of dressing changes: 0.88(±0.88). After-closure complications: (49.5%) and Mortality: (9%). No significant associations among TACT, indications, mortality, complications and fistula. A linear correlationexists between days of OA and complications (Pearson linear correlation = 0.326 p <0.0001) and with the fistula development (Pearson = 0.146 p = 0.016). Pediatric patients: 33 patients. Mean age: 5.91±(3.68) years; 60% male. Mortality: 3.4%; Complications: 44.8%; Fistula: 3.4%. Mean duration of OA: 3.22(±3.09) days. Temporary abdominal closure is reliable and safe. The different techniques account for different results according to the different indications. In peritonitis commercial negative pressure temporary closure seems to improve results. In trauma skin-closure and Bogotà-bag seem to improve results. ClinicalTrials.gov NCT02382770.

MELAS syndrome presenting as an acute surgical abdomen

PubMed Central

Mistry, K; Angamuthu, N; Smith, G; Hilton, D; P, Arumugam; Mathew, J

2014-01-01

MELAS (mitochondrial cytopathy, encephalomyopathy, lactic acidosis and stroke-like episodes) is a syndrome in which signs and symptoms of gastrointestinal disease are uncommon if not rare. We describe the case of a young woman who presented as an acute surgical emergency, diagnosed as toxic megacolon necessitating an emergency total colectomy. MELAS syndrome was suspected postoperatively owing to persistent lactic acidosis and neurological symptoms. The diagnosis was later confirmed with histological and genetic studies. This case highlights the difficulties in diagnosing MELAS because of its unpredictable presentation and clinical course. We therefore recommend a high index of suspicion in cases of an acute surgical abdomen with additional neurological features or raised lactate. PMID:24417855

[Acute abdomen caused by eosinophilic enteritis: six observations].

PubMed

Martínez-Ubieto, Fernando; Bueno-Delgado, Alvaro; Jiménez-Bernadó, Teresa; Santero Ramírez, María Pilar; Arribas-Del Amo, Dolores; Martínez-Ubieto, Javier

2013-01-01

Eosinophilic enteritis is a rather rare condition characterized by infiltration of the gastrointestinal tract by eosinophils; as a casue of acute abdomen it is really exceptional. The etiology is unclear and its description in the literature is sparse, but associations have been made with collagen vascular disease, inflammatory bowel disease, food allergy and parasitic infections as it was confirmed in one of our pathologic studies. From 1997 to 2011 six cases of eosinophilic enteritis that involved a small bowel segment were diagnosed. A partial resection by an irreversible necrosis was necessary in three of them; in the other three only a biopsy was necessary due to the inflammatory aspect of the affected loop causing the acute abdomen. Eosinophilic enteritis can originate acute abdomen processes where an urgent surgical treatment is necessary. The intraoperative aspect can be from a segment of small bowel with inflammatory signs up to a completely irrecoverable loop, where removing of the affected segment is the correct treatment, which can be done laparoscopically.

A Rare Cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception.

PubMed

Sertkaya, Mehmet; Emre, Arif; Pircanoglu, Eyüp Mehmet; Yazar, Fatih Mehmet; Tepe, Murat; Cengiz, Emrah; Isler, Ali; Vicdan, Halit

2016-01-01

Intussusception in adults is very rarely seen, and this cause acute abdomen. A computed tomography (CT) scan, clinical suspicion, history, and a physical examination are important for the diagnosis. We present two cases of colonic intussusceptions induced by lipoma. The cases had similar locations, diagnoses, and management. Both lipomas were located close to the cecum in the ascending colon, and a right segmental colon resection was performed in both cases. The follow-up of both cases was uneventful. Although benign lesions can cause colonic intussusception, the high incidence of malignancy in colonic lesions should always be considered. Therefore, oncologic surgical procedures should be applied. The definitive diagnosis can be made by histopathology. Sertkaya M, Emre A, Pircanoglu EM, Yazar FM, Tepe M, Cengiz E, Isler A, Vicdan H. A Rare cause of Acute Abdomen: Diagnosis and Management of Adult Colonic Intussusception. Euroasian J Hepato-Gastroenterol 2016;6(2):179-182.

Perforated duodenal ulcer -a rare cause of acute abdomen in pregnancy.

PubMed

Goel, Bharti; Rani, Jyotsna; Huria, Anju; Gupta, Pratiksha; Dalal, Usha

2014-09-01

Acute abdomen during pregnancy is a medico-surgical emergency demanding concerted, synchronized specialties approach of obstetrician, surgeon and gastroenterologist. Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy. Here, we report a case of duodenal perforation with peritonitis in third trimester of pregnancy requiring surgical management. Our aim of reporting this case is to stress the physicians to keep the differential of duodenal perforation also in mind while dealing with cases of acute abdomen in pregnancy and to proceed with multidisciplinary approach for better feto-maternal outcome.

State of the art: dual-energy CT of the abdomen.

PubMed

Marin, Daniele; Boll, Daniel T; Mileto, Achille; Nelson, Rendon C

2014-05-01

Recent technologic advances in computed tomography (CT)--enabling the nearly simultaneous acquisition of clinical images using two different x-ray energy spectra--have sparked renewed interest in dual-energy CT. By interrogating the unique characteristics of different materials at different x-ray energies, dual-energy CT can be used to provide quantitative information about tissue composition, overcoming the limitations of attenuation-based conventional single-energy CT imaging. In the past few years, intensive research efforts have been devoted to exploiting the unique and powerful opportunities of dual-energy CT for a variety of clinical applications. This has led to CT protocol modifications for radiation dose reduction, improved diagnostic performance for detection and characterization of diseases, as well as image quality optimization. In this review, the authors discuss the basic principles, instrumentation and design, examples of current clinical applications in the abdomen and pelvis, and future opportunities of dual-energy CT.

Sonographic findings of localized Castleman disease of the abdomen and pelvis.

PubMed

Zhou, Wei; Zhan, Weiwei; Zhou, Jianqiao; Zhu, Ying; Yao, Jiejie

2015-09-01

The purpose of this study was to sonographically evaluate the diagnosis of localized Castleman disease in the abdomen and pelvis. This was a retrospective analysis of 18 cases of Castleman disease localized in the abdomen and pelvis. The following features of the lesions were assessed on sonography (US): location, size, margin, echogenicity, echotexture, intralesional cystic necrosis, intralesional calcification, posterior acoustic enhancement, and blood supply. Of the 18 tumors, 16 were located in the abdomen and 2 were located in the pelvis close to iliac vessels. The most frequent appearance of localized Castleman disease in the abdomen and pelvis on US was of a single, well-defined, hypoechoic solid mass with no intralesional cystic necrosis. The internal echotexture was homogeneous in 4 cases and heterogeneous in 14 cases, with thin hyperechoic septa (n = 14) or calcifications (n = 3). Posterior acoustic enhancement was seen in 17 of the 18 cases (94%). Ninety-four percent of the lesions (17/18) had marked vascularity on color Doppler US. Localized Castleman disease in the abdomen and pelvis usually appears on US as a heterogeneously hypoechoic lesion containing thin septa, and more commonly than not, demonstrates posterior acoustic enhancement and marked vascularity. © 2014 Wiley Periodicals, Inc.

Irrigation of Abdomen With Imipenem Solution Decreases Surgical Site Infections in Patients With Perforated Appendicitis: A Randomized Clinical Trial

PubMed Central

Hesami, Mohammad Ali; Alipour, Hamid; Nikoupour Daylami, Hamed; Alipour, Bijan; Bazargan-Hejazi, Shahrzad; Ahmadi, Alireza

2014-01-01

Background: Perforated appendicitis is one of the most common causes of acute abdomen requiring emergent surgery for immediate appendectomy and peritoneal cavity irrigation; however, the efficacy of irrigation with antibiotic solutions is controversial. Objectives: The aim of this study was to assess the efficacy of imipenem solution irrigation on post-operative surgical site infections (SSIs), hospital length of stay, and hospital costs. We hypothesized that there would be lower rate of SSIs, a shorter hospital stay, and lower hospital cost in patients with perforated appendicitis who received peritoneal cavity irrigation with imipenem solution in comparison to their counterparts who received irrigation with normal saline. Patients and Methods: In this randomized single-blind parallel-group clinical trial, we enrolled 90 patients with perforated appendicitis with 12-50 years of age and randomly allocated them into experimental group (n = 45) and control group (n = 45). The control group received peritoneal irrigation with normal saline (0.9%) and experimental group underwent peritoneal irrigation with imipenem solution (1 mg/mL). All surgical procedures were performed in Imam Reza Hospital of Kermanshah University of Medical Sciences. The study primary outcome was surgical site infections (including wound infection and abdominal abscess) and the secondary outcomes were length of hospital stay and hospital cost. Chi-squared and t-tests were used to analyze the study data. Results: Imipenem solution irrigation was associated with significant clinical improvement at one-month follow-up. The experimental group presented with significantly lower rate of SSIs and shorter length of hospital stay. The experimental group had lower rate of SSIs compared to the control group (4.4% vs. 22.2%, respectively) (p= 0.013). The duration of hospital stay was nearly one day longer in control group (5.84 ± 2.58 days) vs. experimental group (4.91 ± 1.29 days) (P = 0.034), and

Movement Analysis of Flexion and Extension of Honeybee Abdomen Based on an Adaptive Segmented Structure

PubMed Central

Zhao, Jieliang; Wu, Jianing; Yan, Shaoze

2015-01-01

Honeybees (Apis mellifera) curl their abdomens for daily rhythmic activities. Prior to determining this fact, people have concluded that honeybees could curl their abdomen casually. However, an intriguing but less studied feature is the possible unidirectional abdominal deformation in free-flying honeybees. A high-speed video camera was used to capture the curling and to analyze the changes in the arc length of the honeybee abdomen not only in free-flying mode but also in the fixed sample. Frozen sections and environment scanning electron microscope were used to investigate the microstructure and motion principle of honeybee abdomen and to explore the physical structure restricting its curling. An adaptive segmented structure, especially the folded intersegmental membrane (FIM), plays a dominant role in the flexion and extension of the abdomen. The structural features of FIM were utilized to mimic and exhibit movement restriction on honeybee abdomen. Combining experimental analysis and theoretical demonstration, a unidirectional bending mechanism of honeybee abdomen was revealed. Through this finding, a new perspective for aerospace vehicle design can be imitated. PMID:26223946

[The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management].

PubMed

Grundmann, R T; Petersen, M; Lippert, H; Meyer, F

2010-06-01

This review comments on epidemiology, diagnosis and general principles of surgical management in patients with acute abdomen. DEFINITION AND EPIDEMIOLOGY: The most common cause of acute abdominal pain is non-specific abdominal pain (24 - 44.3 % of the study populations), followed by acute appendicitis (15.9 - 28.1 %), acute biliary disease (2.9 - 9.7 %) and bowel obstruction or diverticulitits in elderly patients. Acute appendicitis represents the cause of surgical intervention in two-thirds of the children with acute abdomen. A standardised physical examination combined with ultrasonography (US) represents the initial investigation in patients with acute abdominal pain. Due to the risk associated with radiation and due to the costs, a selective use of CT imaging is recommended. The work-flow given in this paper restricts the use of CT imaging to less than 50 % of patients with acute abdominal pain. Diagnostic laparoscopy should be considered in patients without a specific diagnosis after appropriate imaging and as an alternative to active clinical observation which is the current practice in patients with non-specific abdominal pain. Acute small bowel obstruction has previously been considered as a relative contraindication for laparoscopic management, but it has been shown in the meantime that laparoscopic treatment is an elegant tool for the management of simple band small bowel obstruction. Bedside diagnostic laparoscopy is recommended in intensive care unit (ICU) patients with acute abdomen or sepsis of unknown origin, in suspicion of acute cholecystitis, diffuse gut hypoperfusion and mesenteric ischaemia or in refractory lactic acidosis, especially after cardiac surgery. Early administration of analgesia to patients with acute abdominal pain in the emergency department will reduce the patient's discomfort without impairing clinically important diagnostic accuracy and is recommended on the basis of some prospective randomised trials. However, the impact on

Experimental pain in the groin may refer into the lower abdomen: Implications to clinical assessments.

PubMed

Drew, M K; Palsson, T S; Hirata, R P; Izumi, M; Lovell, G; Welvaert, M; Chiarelli, P; Osmotherly, P G; Graven-Nielsen, T

2017-10-01

To investigate the effects of experimental adductor pain on the pain referral pattern, mechanical sensitivity and muscle activity during common clinical tests. Repeated-measures design. In two separate sessions, 15 healthy males received a hypertonic (painful) and isotonic (control) saline injection to either the adductor longus (AL) tendon to produce experimental groin pain or into the rectus femoris (RF) tendon as a painful control. Pain intensity was recorded on a visual analogue scale (VAS) with pain distribution indicated on body maps. Pressure pain thresholds (PPT) were assessed bilaterally in the groin area. Electromyography (EMG) of relevant muscles was recorded during six provocation tests. PPT and EMG assessment were measured before, during and after experimental pain. Hypertonic saline induced higher VAS scores than isotonic saline (p<0.001), and a local pain distribution in 80% of participants. A proximal pain referral to the lower abdominal region in 33% (AL) and 7% (RF) of participants. Experimental pain (AL and RF) did not significantly alter PPT values or the EMG amplitude in groin or trunk muscles during provocation tests when forces were matched with baseline. This study demonstrates that AL tendon pain was distributed locally in the majority of participants but may refer to the lower abdomen. Experimental adductor pain did not significantly alter the mechanical sensitivity or muscle activity patterns. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A role of abdomen in butterfly's flapping flight

NASA Astrophysics Data System (ADS)

Jayakumar, Jeeva; Senda, Kei; Yokoyama, Naoto

2017-11-01

Butterfly's forward flight with periodic flapping motion is longitudinally unstable, and control of the thoracic pitching angle is essential to stabilize the flight. This study aims to comprehend roles which the abdominal motion play in the pitching stability of butterfly's flapping flight by using a two-dimensional model. The control of the thoracic pitching angle by the abdominal motion is an underactuated problem because of the limit on the abdominal angle. The control input of the thorax-abdomen joint torque is obtained by the hierarchical sliding mode control in this study. Numerical simulations reveal that the control by the abdominal motion provides short-term pitching stabilization in the butterfly's flight. Moreover, the control input due to a large thorax-abdomen joint torque can counteract a quite large perturbation, and can return the pitching attitude to the periodic trajectory with a short recovery time. These observations are consistent with biologists' view that living butterflies use their abdomens as rudders. On the other hand, the abdominal control mostly fails in long-term pitching stabilization, because it cannot directly alter the aerodynamic forces. The control for the long-term pitching stabilization will also be discussed.

Dual-energy and low-kVp CT in the abdomen.

PubMed

Yeh, Benjamin M; Shepherd, John A; Wang, Zhen J; Teh, Hui Seong; Hartman, Robert P; Prevrhal, Sven

2009-07-01

The purpose of this article is to discuss the influence of tube potential on CT images and explore the potential impact of dual-energy CT on imaging of the abdomen and pelvis. Low peak tube voltage (kVp) settings provide high conspicuity of contrast materials at CT but may result in high image noise, particularly in larger patients. Material decomposition at dual-energy CT can differentiate renal stones by their composition, quantify tissue iron stores, improve the detection of pathologic hyperenhancement, and reduce contrast material and radiation dose compared with conventional CT. Further clinical research and technique refinement will be needed as the usage of these exciting technologies spreads.

Prostheses size dependency of the mechanical response of the herniated human abdomen.

PubMed

Simón-Allué, R; Hernández-Gascón, B; Lèoty, L; Bellón, J M; Peña, E; Calvo, B

2016-12-01

Hernia repairs still exhibit clinical complications, i.e. recurrence, discomfort and pain and mesh features are thought to be highly influent. The aim of this study is to evaluate the impact of the defect size and mesh type in an herniated abdominal wall using numerical models. To do so, we have started from a FE model based on a real human abdomen geometry obtained by MRI, where we have provoked an incisional hernia of three different sizes. The surgical procedure was simulated by covering the hernia with a prostheses, and three surgical meshes with distinct mechanical properties were used for the hernia repair: an isotropic heavy-weight mesh (Surgipro @ ), a slightly anisotropic light-weight mesh (Optilene @ ) and a highly anisotropic medium-weight mesh (Infinit @ ). The mechanical response of the wall to a high intraabdominal pressure (corresponding to a coughing motion) was analyzed here. Our findings suggest that the anisotropy of the mesh becomes more relevant with the increase of the defect size. Additionally, according to our results Optilene @ showed the closest deformation to the natural distensibility of the abdomen while Infinit @ should be carefully used due to its excessive compliance.

Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study.

PubMed

Acosta, Stefan; Seternes, Arne; Venermo, Maarit; Vikatmaa, Leena; Sörelius, Karl; Wanhainen, Anders; Svensson, Mats; Djavani, Khatereh; Björck, Martin

2017-12-01

Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation. This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate. Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N=103), compared with secondary operation (N=88), was associated with less severe initial open abdomen status (p=.006), less intestinal ischaemia (p=.002), shorter duration of open abdomen (p=.007), and less renal replacement therapy (RRT, p<.001). In hospital mortality was 39.3%, and after entero-atmospheric fistula (N=9) was 88.9%. Seven developed graft infection within 6 months, 1 year mortality was 28.6%. Intestinal ischaemia (OR 3.71, 95% CI 1.55-8.91), RRT (OR 3.62, 95% CI 1.72-7.65), and age (OR 1.12, 95% CI 1.06-1.12), were independent factors associated with in hospital mortality, but not open abdomen initiated at primary versus secondary operation. VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was

Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system.

PubMed

Moore, C S; Wood, T J; Avery, G; Balcam, S; Needler, L; Joshi, H; Saunderson, J R; Beavis, A W

2016-11-07

The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQ m ) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQ m and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

Automatic exposure control calibration and optimisation for abdomen, pelvis and lumbar spine imaging with an Agfa computed radiography system

NASA Astrophysics Data System (ADS)

Moore, C. S.; Wood, T. J.; Avery, G.; Balcam, S.; Needler, L.; Joshi, H.; Saunderson, J. R.; Beavis, A. W.

2016-11-01

The use of three physical image quality metrics, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and mean effective noise equivalent quanta (eNEQm) have recently been examined by our group for their appropriateness in the calibration of an automatic exposure control (AEC) device for chest radiography with an Agfa computed radiography (CR) imaging system. This study uses the same methodology but investigates AEC calibration for abdomen, pelvis and spine CR imaging. AEC calibration curves were derived using a simple uniform phantom (equivalent to 20 cm water) to ensure each metric was held constant across the tube voltage range. Each curve was assessed for its clinical appropriateness by generating computer simulated abdomen, pelvis and spine images (created from real patient CT datasets) with appropriate detector air kermas for each tube voltage, and grading these against reference images which were reconstructed at detector air kermas correct for the constant detector dose indicator (DDI) curve currently programmed into the AEC device. All simulated images contained clinically realistic projected anatomy and were scored by experienced image evaluators. Constant DDI and CNR curves did not provide optimized performance but constant eNEQm and SNR did, with the latter being the preferred calibration metric given that it is easier to measure in practice. This result was consistent with the previous investigation for chest imaging with AEC devices. Medical physicists may therefore use a simple and easily accessible uniform water equivalent phantom to measure the SNR image quality metric described here when calibrating AEC devices for abdomen, pelvis and spine imaging with Agfa CR systems, in the confidence that clinical image quality will be sufficient for the required clinical task. However, to ensure appropriate levels of detector air kerma the advice of expert image evaluators must be sought.

Infected Congenital Epicardial Cyst Presenting as Acute Abdomen.

PubMed

Dribin, Timothy; Files, Matthew D; Rudzinski, Erin R; Kaplan, Ron; Stone, Kimberly P

2016-12-01

A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst. Emergency department physicians must maintain a broad differential in patients with symptoms of acute abdomen to prevent complications from serious cardiac or pulmonary diseases that present with symptoms of referred abdominal pain.

HAART toxicity masquerading as a surgical abdomen

PubMed Central

Feghali, Anthony; Wang, Yi; Irizarry, Evelyn; Lueders, Meno

2015-01-01

Introduction Intussusception is a rare disease in adults and poses a challenge to identify and manage. In adults, surgical resection is the preferred treatment since half are due to malignancy. This case reveals an association between highly active antiretroviral therapy (HAART) and intussusception. Presentation of case A 44 year-old female with history of HIV on highly active antiretroviral therapy (HAART) presented with 3 month history of epigastric pain, nausea, emesis, weight loss, and lactic acidosis. CT of abdomen showed two small bowel intussusceptions and pericolic fat infiltration. A diagnosis of mitochondrial toxicity secondary to HAART medication was made. HAART medication was discontinued with resolution of symptoms. Further work-up to exclude a mechanical cause for her symptoms including colonoscopy, small bowel follow through, esophagogastroduodenoscopy, and repeat CT were performed. All established an absence of malignancy and intussusception. Discussion Mitochondrial toxicity (MT) is a well-known complication of HAART. A hallmark of MT is lactic acidosis which when untreated can be fatal. Although MT is known to cause gastrointestinal symptoms, intussusception has not been previously reported. In our patient with MT, prolonged usage of HAART medication resulted in severe gastrointestinal symptoms and intussusception mimicking a surgical abdomen. Laparotomy has been recommended on adult patients with intussusceptions because of the high likelihood of identifying a pathologic lesion. The doctrine of adult intussusception is to operate for concern of malignancy. Conclusion Surgeons, gastroenterologist and internist caring for patients on HAART therapy must be aware of the possibility of MT when evaluating HIV patients for possible surgical abdomen. PMID:26686487

Use of computed tomography abdomen and pelvis for investigation of febrile neutropenia in adult haematology patients.

PubMed

Lim, H Y; Ashby, M; Williams, B; Grigg, A

2016-11-01

We retrospectively evaluated the use of computed tomography abdomen and pelvis (CTAP) in febrile neutropenic autologous stem cell transplant (ASCT) and acute myeloid leukaemia (AML) patients. CTAP was more common in ASCT patients (59%) compared with AML (31%; P  < 0.001). Although abnormal findings were reported in 51%, only 10% resulted in therapy change (addition of anaerobic antibiotic/bowel rest), which would have otherwise been instituted based on clinical grounds. CTAP in these patients rarely provide useful information unsuspected clinically. © 2016 Royal Australasian College of Physicians.

Lymphangioma of the jejunal mesentery and jejunal polyps presenting as an acute abdomen in a teenager.

PubMed

Jayasundara, Jasb; Perera, E; Chandu de Silva, M V; Pathirana, A A

2017-03-01

Cystic lymphangioma of the small bowel mesentery is a rare clinical entity, especially after childhood. Medical literature reveals a limited number of such cases presenting as acute abdomen due to bowel obstruction, small bowel volvulus and bleeding into the tumour. We present the management experience of an 18-year-old woman who presented with rapid onset diffuse peritonism and raised inflammatory markers. Computed tomography showed a mass in the small bowel mesentery with suspicion of segmental bowel ischaemia. Emergency laparotomy revealed a mass in the mid-jejunal mesentery close to the bowel wall with no bowel ischaemia. The patient made an uncomplicated recovery after segmental bowel resection and end-to-end anastomosis. Histology confirmed the mass as a cystic lymphangioma involving the jejunal mesentery and two small jejunal polyps. Lymphangioma could be considered in the differential diagnosis of an acute abdomen in a young adult when the presentation is atypical.

Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis.

PubMed

Osman, Sherif; Moshiri, Mariam; Robinson, Tracy J; Gunn, Martin; Lehnert, Bruce; Sundarkumar, Dinesh; Katz, Douglas S

2015-08-01

The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.

Patient characteristics associated with differences in radiation exposure from pediatric abdomen-pelvis CT scans: a quantile regression analysis.

PubMed

Cooper, Jennifer N; Lodwick, Daniel L; Adler, Brent; Lee, Choonsik; Minneci, Peter C; Deans, Katherine J

2017-06-01

Computed tomography (CT) is a widely used diagnostic tool in pediatric medicine. However, due to concerns regarding radiation exposure, it is essential to identify patient characteristics associated with higher radiation burden from CT imaging, in order to more effectively target efforts towards dose reduction. Our objective was to identify the effects of various demographic and clinical patient characteristics on radiation exposure from single abdomen/pelvis CT scans in children. CT scans performed at our institution between January 2013 and August 2015 in patients under 16 years of age were processed using a software tool that estimates patient-specific organ and effective doses and merges these estimates with data from the electronic health record and billing record. Quantile regression models at the 50th, 75th, and 90th percentiles were used to estimate the effects of patients' demographic and clinical characteristics on effective dose. 2390 abdomen/pelvis CT scans (median effective dose 1.52mSv) were included. Of all characteristics examined, only older age, female gender, higher BMI, and whether the scan was a multiphase exam or an exam that required repeating for movement were significant predictors of higher effective dose at each quantile examined (all p<0.05). The effects of obesity and multiphase or repeat scanning on effective dose were magnified in higher dose scans. Older age, female gender, obesity, and multiphase or repeat scanning are all associated with increased effective dose from abdomen/pelvis CT. Targeted efforts to reduce dose from abdominal CT in these groups should be undertaken. Copyright © 2017 Elsevier Ltd. All rights reserved.

Linking magnetite in the abdomen of honey bees to a magnetoreceptive function

PubMed Central

Lambinet, Veronika; Hayden, Michael E.; Reigl, Katharina; Gomis, Surath

2017-01-01

Previous studies of magnetoreception in honey bees, Apis mellifera, focused on the identification of magnetic material, its formation, the location of the receptor and potential underlying sensory mechanisms, but never directly linked magnetic material to a magnetoreceptive function. In our study, we demonstrate that ferromagnetic material consistent with magnetite plays an integral role in the bees' magnetoreceptor. Subjecting lyophilized and pelletized bee tagmata to analyses by a superconducting quantum interference device generated a distinct hysteresis loop for the abdomen but not for the thorax or the head of bees, indicating the presence of ferromagnetic material in the bee abdomen. Magnetic remanence of abdomen pellets produced from bees that were, or were not, exposed to the 2.2-kOe field of a magnet while alive differed, indicating that magnet exposure altered the magnetization of this magnetite in live bees. In behavioural two-choice field experiments, bees briefly exposed to the same magnet, but not sham-treated control bees, failed to sense a custom-generated magnetic anomaly, indicating that magnet exposure had rendered the bees' magnetoreceptor dysfunctional. Our data support the conclusion that honey bees possess a magnetite-based magnetoreceptor located in the abdomen. PMID:28330921

Linking magnetite in the abdomen of honey bees to a magnetoreceptive function.

PubMed

Lambinet, Veronika; Hayden, Michael E; Reigl, Katharina; Gomis, Surath; Gries, Gerhard

2017-03-29

Previous studies of magnetoreception in honey bees, Apis mellifera , focused on the identification of magnetic material, its formation, the location of the receptor and potential underlying sensory mechanisms, but never directly linked magnetic material to a magnetoreceptive function. In our study, we demonstrate that ferromagnetic material consistent with magnetite plays an integral role in the bees' magnetoreceptor. Subjecting lyophilized and pelletized bee tagmata to analyses by a superconducting quantum interference device generated a distinct hysteresis loop for the abdomen but not for the thorax or the head of bees, indicating the presence of ferromagnetic material in the bee abdomen. Magnetic remanence of abdomen pellets produced from bees that were, or were not, exposed to the 2.2-kOe field of a magnet while alive differed, indicating that magnet exposure altered the magnetization of this magnetite in live bees. In behavioural two-choice field experiments, bees briefly exposed to the same magnet, but not sham-treated control bees, failed to sense a custom-generated magnetic anomaly, indicating that magnet exposure had rendered the bees' magnetoreceptor dysfunctional. Our data support the conclusion that honey bees possess a magnetite-based magnetoreceptor located in the abdomen. © 2017 The Authors.

Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results.

PubMed

Kääriäinen, M; Kuuskeri, M; Helminen, M; Kuokkanen, H

2017-06-01

The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component

FDG-PET/CT Limited to the Thorax and Upper Abdomen for Staging and Management of Lung Cancer.

PubMed

Arens, Anne I J; Postema, Jan W A; Schreurs, Wendy M J; Lafeber, Albert; Hendrickx, Baudewijn W; Oyen, Wim J G; Vogel, Wouter V

2016-01-01

This study evaluates the diagnostic accuracy of [F-18]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) of the chest/upper abdomen compared to the generally performed scan from head to upper thighs, for staging and management of (suspected) lung cancer in patients with no history of malignancy or complaints outside the thorax. FDG-PET/CT scans of 1059 patients with suspected or recently proven lung cancer, with no history of malignancy or complaints outside the thorax, were analysed in a retrospective multi-centre trial. Suspect FDG-avid lesions in the chest and upper abdomen, the head and neck area above the shoulder line and in the abdomen and pelvis below the caudal tip of the liver were noted. The impact of lesions detected in the head and neck area and abdomen and pelvis on additional diagnostic procedures, staging and treatment decisions was evaluated. The head and neck area revealed additional suspect lesions in 7.2%, and the abdomen and pelvis in 15.8% of patients. Imaging of the head and neck area and the abdomen and pelvic area showed additional lesions in 19.5%, inducing additional diagnostic procedures in 7.8%. This resulted in discovery of additional lesions considered malignant in 10.7%, changing patient management for lung cancer in 1.2%. In (suspected) lung cancer, PET/CT limited to the chest and upper abdomen resulted in correct staging in 98.7% of patients, which led to the identical management as full field of view PET in 98.8% of patients. High value of FDG-PET/CT for staging and correct patient management is already achieved with chest and upper abdomen. Findings in head and neck area and abdomen and pelvis generally induce investigations with limited or no impact on staging and treatment of NSCLC, and can be interpreted accordingly.

A Study of Physicochemical Properties of Subcutaneous Fat of the Abdomen and its Implication in Abdominal Obesity

PubMed Central

Kumar, Pramod; Kodavoor, Srinivas Aithal; Kotian, Sushma Rama; Yathdaka, Sudhakar Narahari; Nayak, Dayanand; Souza, Anne D; Souza, Antony Sylvan D

2016-01-01

Introduction The lower abdominal obesity is more resistant to absorption as compared to that of upper abdomen. Differences in the physicochemical properties of the subcutaneous fat of the upper and lower abdomen may be responsible for this variation. There is paucity of the scientific literature on the physicochemical properties of the subcutaneous fat of abdomen. Aim The present study was undertaken to create a database of physicochemical properties of abdominal subcutaneous fat. Materials and Methods The samples of subcutaneous fat from upper and lower abdomen were collected from 40 fresh autopsied bodies (males 33, females 7). The samples were prepared for physicochemical analysis using organic and inorganic solvents. Various physicochemical properties of the fat samples analysed were surface tension, viscosity, specific gravity, specific conductivity, iodine value and thermal properties. Data was analysed by paired and independent sample t-tests. Results There was a statistically significant difference in all the physicochemical parameters between males and females except surface tension (organic) and surface tension (inorganic) of upper abdominal fat, and surface tension (organic) of lower abdominal fat. In males, viscosity of upper abdominal fat was more compared to that of lower abdomen (both organic and inorganic) unlike the specific conductivity that was higher for the lower abdominal fat as compared to that of the upper abdomen. In females there were statistically significant higher values of surface tension (inorganic) and specific gravity (organic) of the upper abdomen fat as compared to that of lower abdomen. The initial and final weight loss of the lower abdominal fat as indicated by Thermo Gravimetric Analysis was significantly more in males than in female Conclusion The difference in the physicochemical properties of subcutaneous fat between upper and lower abdomen and between males and females could be responsible for the variant behaviour of

A Study of Physicochemical Properties of Subcutaneous Fat of the Abdomen and its Implication in Abdominal Obesity.

PubMed

Pandey, Arvind Kumar; Kumar, Pramod; Kodavoor, Srinivas Aithal; Kotian, Sushma Rama; Yathdaka, Sudhakar Narahari; Nayak, Dayanand; Souza, Anne D; Souza, Antony Sylvan D

2016-05-01

The lower abdominal obesity is more resistant to absorption as compared to that of upper abdomen. Differences in the physicochemical properties of the subcutaneous fat of the upper and lower abdomen may be responsible for this variation. There is paucity of the scientific literature on the physicochemical properties of the subcutaneous fat of abdomen. The present study was undertaken to create a database of physicochemical properties of abdominal subcutaneous fat. The samples of subcutaneous fat from upper and lower abdomen were collected from 40 fresh autopsied bodies (males 33, females 7). The samples were prepared for physicochemical analysis using organic and inorganic solvents. Various physicochemical properties of the fat samples analysed were surface tension, viscosity, specific gravity, specific conductivity, iodine value and thermal properties. Data was analysed by paired and independent sample t-tests. There was a statistically significant difference in all the physicochemical parameters between males and females except surface tension (organic) and surface tension (inorganic) of upper abdominal fat, and surface tension (organic) of lower abdominal fat. In males, viscosity of upper abdominal fat was more compared to that of lower abdomen (both organic and inorganic) unlike the specific conductivity that was higher for the lower abdominal fat as compared to that of the upper abdomen. In females there were statistically significant higher values of surface tension (inorganic) and specific gravity (organic) of the upper abdomen fat as compared to that of lower abdomen. The initial and final weight loss of the lower abdominal fat as indicated by Thermo Gravimetric Analysis was significantly more in males than in female. The difference in the physicochemical properties of subcutaneous fat between upper and lower abdomen and between males and females could be responsible for the variant behaviour of subcutaneous abdominal fat towards resorption.

Critical Structure for Telescopic Movement of Honey bee (Insecta: Apidae) Abdomen: Folded Intersegmental Membrane

PubMed Central

Zhao, Jieliang; Yan, Shaoze; Wu, Jianing

2016-01-01

The folded intersegmental membrane is a structure that interconnects two adjacent abdominal segments; this structure is distributed in the segments of the honey bee abdomen. The morphology of the folded intersegmental membrane has already been documented. However, the ultrastructure of the intersegmental membrane and its assistive role in the telescopic movements of the honey bee abdomen are poorly understood. To explore the morphology and ultrastructure of the folded intersegmental membrane in the honey bee abdomen, frozen sections were analyzed under a scanning electron microscope. The intersegmental membrane between two adjacent terga has a Z–S configuration that greatly influences the daily physical activities of the honey bee abdomen. The dorsal intersegmental membrane is 2 times thicker than the ventral one, leading to asymmetric abdominal motion. Honey bee abdominal movements were recorded using a high-speed camera and through phase-contrast computed tomography. These movements conformed to the structural features of the folded intersegmental membrane. PMID:27456912

Lassa fever presenting as acute abdomen: a case series.

PubMed

Dongo, Andrew E; Kesieme, Emeka B; Iyamu, Christopher E; Okokhere, Peter O; Akhuemokhan, Odigie C; Akpede, George O

2013-04-19

Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission.

Lassa fever presenting as acute abdomen: a case series

PubMed Central

2013-01-01

Lassa fever, an endemic zoonotic viral infection in West Africa, presents with varied symptoms including fever, vomiting, retrosternal pain, abdominal pain, sore-throat, mucosal bleeding, seizures and coma. When fever and abdominal pain are the main presenting symptoms, and a diagnosis of acute abdomen is entertained, Lassa fever is rarely considered in the differential diagnosis, even in endemic areas. Rather the diagnosis of Lassa fever is suspected only after surgical intervention. Therefore, such patients often undergo unnecessary surgery with resultant delay in the commencement of ribavirin therapy. This increases morbidity and mortality and the risk of nosocomial transmission to hospital staff. We report 7 patients aged between 17 months and 40 years who had operative intervention for suspected appendicitis, perforated typhoid ileitis, intussuception and ruptured ectopic pregnancy after routine investigations. All seven were post-operatively confirmed as Lassa fever cases. Four patients died postoperatively, most before commencement of ribavirin, while the other three patients eventually recovered with appropriate antibiotic treatment including intravenous ribavirin. Surgeons working in West Africa should include Lassa fever in the differential diagnosis of acute abdomen, especially appendicitis. The presence of high grade fever, proteinuria and thrombocytopenia in patients with acute abdomen should heighten the suspicion of Lassa fever. Prolonged intra-operative bleeding should not only raise suspicion of the disease but also serve to initiate precautions to prevent nosocomial transmission. PMID:23597024

Open abdomen treatment for septic patients with gastrointestinal fistula: from fistula control to definitive closure.

PubMed

Ren, Jianan; Yuan, Yujie; Zhao, Yunzhao; Gu, Guosheng; Wang, Gefei; Chen, Jun; Fan, Chaogang; Wang, Xinbo; Li, Jieshou

2014-04-01

The use of open abdomen in the management of gastrointestinal fistula complicated with severe intra-abdominal infection is uncommon. This study was designed to evaluate outcomes of our staged approach for the infected open abdomen. Patients who had gastrointestinal fistula and underwent open abdomen treatment were retrospectively reviewed. Various materials such as polypropylene mesh and a modified sandwich package were used to achieve temporary abdominal closure followed by skin grafting when the granulation bed matured. A delayed definitive operation was performed for final abdominal closure without implant of prosthetic mesh. Between 1999 and 2009, 56 (68.3%) of 82 patients survived through this treatment. Among them, 42 patients achieved final abdominal closure. Spontaneous fistula closure occurred in 16 patients with secondary fistula recorded in six patients. Besides, wound complications occurred in 13 patients with two cases for pulmonary infection. Within a 12-month follow-up period after definitive closure, no additional fistula was recorded excluding planned ventral hernia repair. Open abdomen treatment was effective for gastrointestinal fistula complicated by severe intra-abdominal infection. A delayed and deliberate operative strategy aiming at fistula excision and fascial closure, with simultaneous abdominal wall reconstruction, was required for the infected open abdomen.

Critical Structure for Telescopic Movement of Honey bee (Insecta: Apidae) Abdomen: Folded Intersegmental Membrane.

PubMed

Zhao, Jieliang; Yan, Shaoze; Wu, Jianing

2016-01-01

The folded intersegmental membrane is a structure that interconnects two adjacent abdominal segments; this structure is distributed in the segments of the honey bee abdomen. The morphology of the folded intersegmental membrane has already been documented. However, the ultrastructure of the intersegmental membrane and its assistive role in the telescopic movements of the honey bee abdomen are poorly understood. To explore the morphology and ultrastructure of the folded intersegmental membrane in the honey bee abdomen, frozen sections were analyzed under a scanning electron microscope. The intersegmental membrane between two adjacent terga has a Z-S configuration that greatly influences the daily physical activities of the honey bee abdomen. The dorsal intersegmental membrane is 2 times thicker than the ventral one, leading to asymmetric abdominal motion. Honey bee abdominal movements were recorded using a high-speed camera and through phase-contrast computed tomography. These movements conformed to the structural features of the folded intersegmental membrane. © The Authors 2016. Published by Oxford University Press on behalf of Entomological Society of America.

Frequency, pattern and management of acute abdomen in dengue fever in Karachi, Pakistan.

PubMed

Shamim, Muhammad

2010-07-01

This study aimed to determine the frequency, pattern and management of acute abdomen in patients with dengue fever. This descriptive case series is a prospective analysis of acute abdomen in dengue fever that was performed at three secondary care hospitals in Karachi, Pakistan from June 1, 2005 to December 31, 2008. The inclusion criterion was all patients with confirmed diagnosis of dengue fever. Patients with incomplete laboratory, ultrasound or histopathology data were excluded. Among 357 patients with dengue fever, 43 (12.04%) had acute abdomen. There were 15 men and 28 women, with a median age of 29 years. These included 26 cases of acute cholecystitis, 7 cases of acute appendicitis, 7 cases of nonspecific peritonitis, and 3 cases of acute pancreatitis. Dengue hemorrhagic fever/shock syndrome was found in acute pancreatitis, and two of these patients died. Emergency surgery was required in eight patients (5 appendectomy and 3 open cholecystectomy). Substantial transfusion of blood and its components was required in eight patients who underwent emergency surgery. Early diagnosis and prompt conservative management of dengue acute abdomen is necessary to avoid mortality and emergency surgery-related morbidity. However, if needed, surgery can be performed with acceptable morbidity. Copyright © 2010 Asian Surgical Association. Published by Elsevier B.V. All rights reserved.

Automatically pairing measured findings across narrative abdomen CT reports.

PubMed

Sevenster, Merlijn; Bozeman, Jeffrey; Cowhy, Andrea; Trost, William

2013-01-01

Radiological measurements are one of the key variables in widely adopted guidelines (WHO, RECIST) that standardize and objectivize response assessment in oncology care. Measurements are typically described in free-text, narrative radiology reports. We present a natural language processing pipeline that extracts measurements from radiology reports and pairs them with extracted measurements from prior reports of the same clinical finding, e.g., lymph node or mass. A ground truth was created by manually pairing measurements in the abdomen CT reports of 50 patients. A Random Forest classifier trained on 15 features achieved superior results in an end-to-end evaluation of the pipeline on the extraction and pairing task: precision 0.910, recall 0.878, F-measure 0.894, AUC 0.988. Representing the narrative content in terms of UMLS concepts did not improve results. Applications of the proposed technology include data mining, advanced search and workflow support for healthcare professionals managing radiological measurements.

Spontaneous rupture of a giant non parasitic hepatic cyst presenting as an acute surgical abdomen.

PubMed

Salemis, Nikolaos S; Georgoulis, Epameinondas; Gourgiotis, Stavros; Tsohataridis, Efstathios

2007-01-01

Spontaneous rupture of a non parasitic hepatic cyst is an extremely rare occurrence. A 50 -year- old male, was admitted with typical clinical manifestations of acute surgical abdomen. At exploratory laparotomy, a giant ruptured non parasitic cyst occupying the entire left liver lobe was found, along with a large amount of free intraperitoneal fluid. The cyst was widely unroofed very close to the liver parenchyma. The patient had an uneventful postoperative course and was discharged six days later. The clinical presentation, diagnostic evaluation and surgical management of this extremely rare clinical entity are discussed, along with a review of the literature. This case, which according to our best knowledge is the fourth reported in the literature, highlights the considerable risk of serious complications associated with the presence of a large symptomatic nonparasitic hepatic cyst. Prophylactic treatment should be considered in all these cases.

Acute abdomen in mentally retarded patients: role of aerophagia. Report of nine cases.

PubMed

van der Kolk, M B; Bender, M H; Goris, R J

1999-05-01

Between 1993 and 1996 nine mentally retarded patients presented because of an acute abdomen. All had the habit of aerophagia, diagnosed previously by a general practitioner. Massive distension of the bowel led to ileus, volvulus, and necrosis. After placement of a percutaneous endoscopic gastrostomy catheter or performing a gastrostomy during laparotomy with the intention to use as a desufflator, no recurrence of the signs and symptoms of an acute abdomen were observed.

Gross anatomy of superficial fascia and future localised fat deposit areas of the abdomen in foetus.

PubMed

Kumar, Pramod; Pandey, Arvind Kumar; Kumar, Brijesh; Aithal, K S; Dsouza, Antony Sylvan

2013-09-01

The development and popularity of body contouring procedures such as liposuction and abdominoplasty has renewed interest in the anatomy of the superficial fascia and subcutaneous fat deposits of the abdomen. The study of anatomy of fascia and fetal adipose tissue was proposed as it may be of value in understanding the possible programing of prevention of obesity. The present study was undertaken to understand the gross anatomy of superficial fascia of abdomen and to study the gross anatomy of future localized fat deposits (LFDs) area of abdomen in fetus. Four fetus (two male & two female) of four month of intrauterine life were dissected. Attachments & layers of superficial fascia and future subcutaneous fat deposit area of upper and lower abdomen were noted. Superficial fascia of the abdomen was multi layered in mid line and number of layers reduced laterally as in adult. The future abdominal LFD (localized fat deposits) area in fetus shows brownish-white blubbary tissue without well-defined adult fat lobules. The attachment and gross anatomy of superficial fascia of the fetus was similar to that in adults. The future LFD areas showed brownish white blubbary tissue with ill-defined fat lobules.

The connection between acute otitis media and the acute abdomen.

PubMed

Masood, Imran; Hendriksz, Tami

2017-06-22

A female aged 9 years with a recent episode of acute otitis media (AOM) presented to her primary care physician with complaints of severe abdominal pain with right lower quadrant rebound tenderness, suggestive of an acute surgical abdomen. Neurological examination was normal on presentation. She was transferred to the local children's hospital for workup of appendicitis, during which she began exhibiting ataxia and slurred speech. Further evaluation revealed mastoiditis, venous sinus thrombosis and subdural empyema. Appendicitis was ruled out. We describe the first documented case of neurological complications of AOM presenting as an acute surgical abdomen without initial neurological findings. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of amylase and lipase levels in blunt trauma abdomen patients.

PubMed

Kumar, Subodh; Sagar, Sushma; Subramanian, Arulselvi; Albert, Venencia; Pandey, Ravindra Mohan; Kapoor, Nitika

2012-04-01

There are studies to prove the role of amylase and lipase estimation as a screening diagnostic tool to detect diseases apart from acute pancreatitis. However, there is sparse literature on the role of serum and urine amylase, lipase levels, etc to help predict the specific intra-abdominal injury after blunt trauma abdomen (BTA). To elucidate the significance of elevation in the levels of amylase and lipase in serum and urine samples as reliable parameters for accurate diagnosis and management of blunt trauma to the abdomen. A prospective analysis was done on the trauma patients admitted in Jai Prakash Narayan Apex Trauma Center, AIIMS, with blunt abdomen trauma injuries over a period of six months. Blood and urine samples were collected on days 1, 3, and 5 of admission for the estimation of amylase and lipase, liver function tests, serum bicarbonates, urine routine microscopy for red blood cells, and complete hemogram. Clinical details such as time elapsed from injury to admission, type of injury, trauma score, and hypotension were noted. Patients were divided into groups according to the single or multiple organs injured and according to their hospital outcome (dead/discharged). Wilcoxon's Rank sum or Kruskal-Wallis tests were used to compare median values in two/three groups. Data analysis was performed using STATA 11.0 statistical software. A total of 55 patients with median age 26 (range, 6-80) years, were enrolled in the study. Of these, 80% were males. Surgery was required for 20% of the patients. Out of 55 patients, 42 had isolated single organ injury [liver or spleen or gastrointestinal tract (GIT) or kidney]. Patients with pancreatic injury were excluded. In patients who suffered liver injuries, urine lipase levels on day 1, urine lipase/amylase ratio along with aspartate aminotransferase (AST), alanine aminotransferase (ALT), and alkaline phosphatase (ALP) on days 1, 3, and 5, were found to be significant. Day 1 serum amylase, AST, ALT, hemoglobin, and

Magnetic Sensing through the Abdomen of the Honey bee.

PubMed

Liang, Chao-Hung; Chuang, Cheng-Long; Jiang, Joe-Air; Yang, En-Cheng

2016-03-23

Honey bees have the ability to detect the Earth's magnetic field, and the suspected magnetoreceptors are the iron granules in the abdomens of the bees. To identify the sensing route of honey bee magnetoreception, we conducted a classical conditioning experiment in which the responses of the proboscis extension reflex (PER) were monitored. Honey bees were successfully trained to associate the magnetic stimulus with a sucrose reward after two days of training. When the neural connection of the ventral nerve cord (VNC) between the abdomen and the thorax was cut, the honey bees no longer associated the magnetic stimulus with the sucrose reward but still responded to an olfactory PER task. The neural responses elicited in response to the change of magnetic field were also recorded at the VNC. Our results suggest that the honey bee is a new model animal for the investigation of magnetite-based magnetoreception.

Synthesis of a posterior indicator protein in normal embryos and double abdomens of Smittia sp. (Chironomidae, Diptera).

PubMed Central

Jäckle, H; Kalthoff, K

1980-01-01

In embryos of the chironomid midge Smittia, synthesis of a posterior indicator protein designated PI1 (Mr approximately 50,000; pI approximately 5.5) forecasts development of an abdomen as opposed to head and thorax. The protein is synthesized several hours before germ anlage formation. In normal embryos at early blastoderm stages, synthesis of PI1 is restricted to posterior embryonic fragments but not to pole cells. In "double-abdomen" embryos, a mirror-image duplication of the abdomen is formed by cells that would otherwise develop into head and thorax. Embryos were programmed for double-abdomen development by UV irradiation of the anterior pole, and half of them were reprogrammed for normal development by subsequent exposure to visible light (photoreversal). Correspondingly, PI1 was synthesized in anterior fragments of UV-irradiated embryos but not after photoreversal. In a control experiment, UV irradiation of the posterior pole caused neither double-abdomen formation nor PI1 synthesis in anterior fragments. The identity of PI1 formed in anterior fragments of prospective double abdomens with the protein found in posterior fragments was revealed by two-dimensional gel electrophoresis and limited proteolysis. Suppression of PI1 synthesis in anterior fragments of normal embryos is ascribed to the activity of cytoplasmic ribonucleoprotein particles thought to act as anterior determinants. Images PMID:6935679

Dose reduction with adaptive statistical iterative reconstruction for paediatric CT: phantom study and clinical experience on chest and abdomen CT.

PubMed

Gay, F; Pavia, Y; Pierrat, N; Lasalle, S; Neuenschwander, S; Brisse, H J

2014-01-01

To assess the benefit and limits of iterative reconstruction of paediatric chest and abdominal computed tomography (CT). The study compared adaptive statistical iterative reconstruction (ASIR) with filtered back projection (FBP) on 64-channel MDCT. A phantom study was first performed using variable tube potential, tube current and ASIR settings. The assessed image quality indices were the signal-to-noise ratio (SNR), the noise power spectrum, low contrast detectability (LCD) and spatial resolution. A clinical retrospective study of 26 children (M:F = 14/12, mean age: 4 years, range: 1-9 years) was secondarily performed allowing comparison of 18 chest and 14 abdominal CT pairs, one with a routine CT dose and FBP reconstruction, and the other with 30 % lower dose and 40 % ASIR reconstruction. Two radiologists independently compared the images for overall image quality, noise, sharpness and artefacts, and measured image noise. The phantom study demonstrated a significant increase in SNR without impairment of the LCD or spatial resolution, except for tube current values below 30-50 mA. On clinical images, no significant difference was observed between FBP and reduced dose ASIR images. Iterative reconstruction allows at least 30 % dose reduction in paediatric chest and abdominal CT, without impairment of image quality. • Iterative reconstruction helps lower radiation exposure levels in children undergoing CT. • Adaptive statistical iterative reconstruction (ASIR) significantly increases SNR without impairing spatial resolution. • For abdomen and chest CT, ASIR allows at least a 30 % dose reduction.

Open abdomen management: A review of its history and a proposed management algorithm

PubMed Central

Kreis, Barbara Elize; de Mol van Otterloo, Johan Coenraad Alexander; Kreis, Robert Walter

2013-01-01

In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic. PMID:23823991

An umbilical venous catheter complication presented as acute abdomen: case report.

PubMed

Oztan, Mustafa O; Ilhan, Ozkan; Abay, Elif; Koyluoglu, Gokhan

2016-12-01

Umbilical venous catheterization has become a widely accepted intravenous route for premature babies. These catheters allow administration of parenteral nutrition and medication and facilitate blood sampling. Besides these benefits, they also have significant potential complications like portal vein thrombosis, infection, vascular or hepatic injury, arrhythmia and sepsis. One of the rare but important complication is extravasation of the fluids due to misplacement of the catheter. The typical symptoms of this condition are sudden deterioration, hepatic enlargement, hematocrit drop, hypotension and abdominal distension. We herein present a premature newborn with unusual acute abdomen findings suggesting a surgical pathology after the extravasation of total parenteral nutrition into the abdomen. Sociedad Argentina de Pediatría.

Sickle Cell Crisis and the Acute Abdomen

PubMed Central

Nazem, Ahmad; Walker, Mark

1986-01-01

Abdominal pain is one of the most common symptoms in sickle cell crisis, and its cause remains controversial. Simple vaso-occlusive crisis may be an explanation. The abdominal pain may also reflect an acute surgical abdomen. A patient presented with sickle cell crisis and abdominal pain; he had a periappendiceal abscess at the site of an appendiceal stump five months after appendectomy. The role of sickle cell anemia in the pathogenesis of this abscess is uncertain. PMID:3531534

["Abdominal dressing" - a new method of treatment for open abdomen following secondary peritonitis].

PubMed

Wild, T; Stremitzer, S; Budzanowski, A; Rinder, H; Tamandl, D; Zeisel, C; Hölzenbein, T; Sautner, T

2004-05-01

Treatment of open abdomen following secondary peritonitis is a challenge for surgery and intensive care units (ICU). The aim of this study was to compare three different concurrent treatment strategies. Patients suffering an open abdomen following surgery for secondary peritonitis at the Department of General Surgery from 01/01 to 12/03 were investigated. Factor studied: duration of open abdomen, incidence of multi-organ failure, need for surgical revisions, length of stay (LOS) in ICU, nursing requirements (change of dressing/day), survival and integrity of abdominal wall after discharge. Treatment strategies included: open packing (OP), classic vacuum assisted (V.A.C.(R))-therapy with silicone net protection for the intestine (CV) and V.A.C.(R)-therapy with "abdominal dressing" a newly developed meshed polyvinyl wrap (AD). 21 patients were studied: 5 patients were treated with OP, 8 patients with CV and 8 patients with AD. Mean LOS was 65 (OP) vs. 53 (CV) vs. 42 (AD) days (NS), peritonitis related death was 3 (OP) vs. 1 (CV) vs. 0 (AD) (p < 0.05 Chisquare test). Median nursing effort was 4 dressings/day (OP), 0.5 (CV) and 0.5 (AD) (p < 0.005 OP vs CV, AD Kruskal-Wallis test). The "abdominal dressing"-therapy seems to be a more efficient treatment option in patients suffering from open abdomen following secondary peritonitis. A trend towards shorter ICU-LOS, lower mortality rates and reduced nursing requirements support our hypothesis.

Using Medical Claims for Policy Effectiveness Surveillance: Reimbursement and Utilization of Abdomen/Pelvis Computed Tomography Scans.

PubMed

Horný, Michal; Morgan, Jake R; Merker, Vanessa L

2015-12-01

To quantify changes in private insurance payments for and utilization of abdominal/pelvic computed tomography scans (CTs) after 2011 changes in CPT coding and Medicare reimbursement rates, which were designed to reduce costs stemming from misvalued procedures. TruvenHealth Analytics MarketScan Commercial Claims and Encounters database. We used difference-in-differences models to compare combined CTs of the abdomen/pelvis to CTs of the abdomen or pelvis only. Our main outcomes were inflation-adjusted log payments per procedure, daily utilization rates, and total annual payments. Claims data were extracted for all abdominal/pelvic CTs performed in 2009-2011 within noncapitated, employer-sponsored private plans. Adjusted payments per combined CTs of the abdomen/pelvis dropped by 23.8 percent (p < .0001), and their adjusted daily utilization rate accelerated by 0.36 percent (p = .034) per month after January 2011. Utilization rate of abdominal-only or pelvic-only CTs dropped by 5.0 percent (p < .0001). Total annual payments for combined CTs of the abdomen/pelvis decreased in 2011 despite the increased utilization. Private insurance payments for combined CTs of the abdomen/pelvis declined and utilization accelerated significantly after 2011 policy changes. While growth in total annual payments was contained in 2011, it may not be sustained if 2011 utilization trends persist. © Health Research and Educational Trust.

Validation of undergraduate medical student script concordance test (SCT) scores on the clinical assessment of the acute abdomen.

PubMed

Goos, Matthias; Schubach, Fabian; Seifert, Gabriel; Boeker, Martin

2016-08-17

Health professionals often manage medical problems in critical situations under time pressure and on the basis of vague information. In recent years, dual process theory has provided a framework of cognitive processes to assist students in developing clinical reasoning skills critical especially in surgery due to the high workload and the elevated stress levels. However, clinical reasoning skills can be observed only indirectly and the corresponding constructs are difficult to measure in order to assess student performance. The script concordance test has been established in this field. A number of studies suggest that the test delivers a valid assessment of clinical reasoning. However, different scoring methods have been suggested. They reflect different interpretations of the underlying construct. In this work we want to shed light on the theoretical framework of script theory and give an idea of script concordance testing. We constructed a script concordance test in the clinical context of "acute abdomen" and compared previously proposed scores with regard to their validity. A test comprising 52 items in 18 clinical scenarios was developed, revised along the guidelines and administered to 56 4(th) and 5(th) year medical students at the end of a blended-learning seminar. We scored the answers using five different scoring methods (distance (2×), aggregate (2×), single best answer) and compared the scoring keys, the resulting final scores and Cronbach's α after normalization of the raw scores. All scores except the single best answers calculation achieved acceptable reliability scores (>= 0.75), as measured by Cronbach's α. Students were clearly distinguishable from the experts, whose results were set to a mean of 80 and SD of 5 by the normalization process. With the two aggregate scoring methods, the students' means values were between 62.5 (AGGPEN) and 63.9 (AGG) equivalent to about three expert SD below the experts' mean value (Cronbach's α : 0.76 (AGGPEN

Abdomen/pelvis computed tomography in staging of pediatric Hodgkin Lymphoma: is it always necessary?

PubMed

Farruggia, Piero; Puccio, Giuseppe; Sala, Alessandra; Todesco, Alessandra; Terenziani, Monica; Mura, Rosamaria; D'Amico, Salvatore; Casini, Tommaso; Mosa, Clara; Pillon, Marta; Boaro, Maria Paola; Bottigliero, Gaetano; Burnelli, Roberta; Consarino, Caterina; Fedeli, Fausto; Mascarin, Maurizio; Perruccio, Katia; Schiavello, Elisabetta; Trizzino, Angela; Ficola, Umberto; Garaventa, Alberto; Rossello, Mario

2016-09-01

The purpose of the study was to determine if abdomen/pelvis computed tomography (CT) can be safety omitted in the initial staging of a subgroup of children affected by Hodgkin Lymphoma (HL). Every participating center of A.I.E.O.P (Associazione Italiana di Ematologia ed Oncologia Pediatrica) sent local staging reports of 18F-fluorodeoxyglucose positron emission tomography (PET) and abdominal ultrasound (US) along with digital images of staging abdomen/pelvis CT to the investigation center where the CT scans were evaluated by an experienced pediatric radiologist. The local radiologist who performed the US was unaware of local CT and PET reports (both carried out after US), and the reviewer radiologist examining the CT images was unaware of local US, PET and CT reports. A new abdominal staging of 123 patients performed on the basis of local US report, local PET report, and centralized CT report was then compared to a simpler staging based on local US and PET. No additional lesion was discovered by CT in patients with abdomen/pelvis negativity in both US and PET or isolated spleen positivity in US (or US and PET), and so it seems that in the initial staging, abdomen/pelvis CT can be safety omitted in about 1/2 to 2/3 of children diagnosed with HL. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Selective non-operative management of stab wounds to the posterior abdomen is safe: the Pietermaritzburg experience.

PubMed

Kong, Victor; Oosthuizen, George; Sartorius, Benn; Clarke, Damian

2015-09-01

The selective non-operative management (SNOM) of stab injuries of the anterior abdomen is well established, but its application to the posterior abdomen remains controversial. A retrospective review of 1013 patients was undertaken at a major trauma service in South Africa over a five-year period. Ninety per cent of patients were males, and the mean age was 25 years. The mean time from injury to presentation was 4h and 73% of all injuries were inflicted by knives. A total of 9% (93) of patients required a laparotomy [Group A] and 82% (833) were successfully observed without the need for operative intervention [Group B]. CT imaging was performed on 52 patients (5%) who had haematuria [Group C], 25 (3%) who had neurological deficits [Group D], and 10 (1%) with retained weapon injuries [Group E]. The accuracy of physical examination for identifying the presence of organ injury was 88%. All observed patients who required laparotomy declared themselves within 24h. There were no mortalities as direct result of our current management protocol. Selective management based on active clinical observation and serial physical examination is safe, and when coupled with the judicious use of advanced imaging, is a prudent and reliable approach in a resource constrained environment. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Appropriateness of the Length of Insulin Needles Based on Determination of Skin and Subcutaneous Fat Thickness in the Abdomen and Upper Arm in Patients with Type 2 Diabetes

PubMed Central

Sim, Kang Hee; Kim, Sun Young; Lee, Hye Mi; Chang, Ji Yeun; Lee, Moon Kyu

2014-01-01

Background Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. Methods First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. Results The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. Conclusion It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes. PMID:24851206

Application of Optical Measurement Techniques During Stages of Pregnancy: Use of Phantom High Speed Cameras for Digital Image Correlation (D.I.C.) During Baby Kicking and Abdomen Movements

NASA Technical Reports Server (NTRS)

Gradl, Paul

2016-01-01

Paired images were collected using a projected pattern instead of standard painting of the speckle pattern on her abdomen. High Speed cameras were post triggered after movements felt. Data was collected at 120 fps -limited due to 60hz frequency of projector. To ensure that kicks and movement data was real a background test was conducted with no baby movement (to correct for breathing and body motion).

Dose to organs at risk in the upper abdomen in patients treated with extended fields by helical tomotherapy: a dosimetric and clinical preliminary study

PubMed Central

2013-01-01

Background The aim of this work was to determine the technical feasibility and safety of extended-field radiotherapy (EF), performed by Helical TomoTherapy, in patients with positive pelvic and/or para-aortic nodes. Dosimetric data were collected and acute and sub-acute toxicities of the upper abdominal organs at risk (OAR) were evaluated. Methods Twenty-nine patients suitable for EF irradiation for local disease and/or nodal disease in the pelvic or para-aortic area were treated. The prescription dose was 50.4/54 Gy (1.7-1.8 Gy/fraction) for prophylactic lymph nodes (N-) and 60–70.5 Gy (2–2.35 Gy/fraction) for clinically evident gross disease (N+). Modulation factor (MF), pitch and field width (FW) were chosen to optimize dose distribution and treatment duration. Dose values of PTVs and OAR were analysed. The length of the treatment field, the N + and N- volumes, and treatment duration were reported. To evaluate the safety of treatment, haematological, hepatic, renal and pancreatic functions were assessed before, during and after treatment. The median follow-up time was 17.6 months (range: 6–22 months). Results The treatment was well tolerated and all patients but one completed treatment without interruption. Four of the 29 patients experienced G3 haematological acute toxicity (13.8%), but no patient experienced sub-acute grade G3 toxicity. Ten patients experienced G1 and three G2 acute gastrointestinal toxicity (nausea). No sub-acute gastrointestinal or renal toxicity was observed. Only one (3.7%) patient had a persistent slight increase of pancreatic enzymes and two (7.4%) patients a slight increase of hepatic enzymes six months after radiotherapy (G1 toxicity). Conclusions With our treatment design and dose regimen, we found that EF treatment by TomoTherapy could be safely and effectively delivered with minimal acute and sub-acute toxicities in the upper abdomen area. PMID:24160769

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1-Common Sarcomas: From the Radiologic Pathology Archives.

PubMed

Levy, Angela D; Manning, Maria A; Al-Refaie, Waddah B; Miettinen, Markku M

2017-01-01

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis.

[Abdomen specific bioelectrical impedance analysis (BIA) methods for evaluation of abdominal fat distribution].

PubMed

Ida, Midori; Hirata, Masakazu; Hosoda, Kiminori; Nakao, Kazuwa

2013-02-01

Two novel bioelectrical impedance analysis (BIA) methods have been developed recently for evaluation of intra-abdominal fat accumulation. Both methods use electrodes that are placed on abdominal wall and allow evaluation of intra-abdominal fat area (IAFA) easily without radiation exposure. Of these, "abdominal BIA" method measures impedance distribution along abdominal anterior-posterior axis, and IAFA by BIA method(BIA-IAFA) is calculated from waist circumference and the voltage occurring at the flank. Dual BIA method measures impedance of trunk and body surface at the abdominal level and calculates BIA-IAFA from transverse and antero-posterior diameters of the abdomen and the impedance of trunk and abdominal surface. BIA-IAFA by these two BIA methods correlated well with IAFA measured by abdominal CT (CT-IAFA) with correlatipn coefficient of 0.88 (n = 91, p < 0.0001) for the former, and 0.861 (n = 469, p < 0.01) for the latter. These new BIA methods are useful for evaluating abdominal adiposity in clinical study and routine clinical practice of metabolic syndrome and obesity.

Soft-Tissue Sarcomas of the Abdomen and Pelvis: Radiologic-Pathologic Features, Part 1—Common Sarcomas: From the Radiologic Pathology Archives

PubMed Central

Manning, Maria A.; Al-Refaie, Waddah B.; Miettinen, Markku M.

2017-01-01

Soft-tissue sarcomas are a diverse group of rare mesenchymal malignancies that can arise at any location in the body and affect all age groups. These sarcomas are most common in the extremities, trunk wall, retroperitoneum, and head and neck. In the adult population, soft-tissue sarcomas arising in the abdomen and pelvis are often large masses at the time of diagnosis because they are usually clinically silent or cause vague or mild symptoms until they invade or compress vital organs. In contrast, soft-tissue sarcomas arising from the abdominal wall come to clinical attention earlier in the course of disease because they cause a palpable mass, abdominal wall deformity, or pain that is more clinically apparent. The imaging features of abdominal and pelvic sarcomas and abdominal wall sarcomas can be nonspecific and overlap with more common pathologic conditions, making diagnosis difficult or, in some cases, delaying diagnosis. Liposarcoma (well-differentiated and dedifferentiated liposarcomas), leiomyosarcoma, and gastrointestinal stromal tumor (GIST) are the most common intra-abdominal primary sarcomas. Any soft-tissue sarcoma can arise in the abdominal wall. Knowledge of the classification and pathologic features of soft-tissue sarcomas, the anatomic locations where they occur, and their cross-sectional imaging features helps the radiologist establish the diagnosis or differential diagnosis so that patients with soft-tissue sarcomas can receive optimal treatment and management. In part 1 of this article, the most common soft-tissue sarcomas (liposarcoma, leiomyosarcoma, and GIST) are reviewed, with a discussion on anatomic locations, classification, clinical considerations, and differential diagnosis. Part 2 will focus on the remainder of the soft-tissue sarcomas occurring in the abdomen and pelvis. PMID:28287938

Analysis of Acoustic Access to the Prostate Through the Abdomen and Perineum for Extracorporeal Ablation

NASA Astrophysics Data System (ADS)

Hall, Timothy L.; Hempel, Christopher R.; Sabb, Brian J.; Roberts, William W.

2010-03-01

As part of the development of a noninvasive treatment for BPH using histotripsy, this study aimed to measure acoustic access for extracorporeal ablation of the prostate. Both transabdominal and transperineal approaches were considered. The objective was to measure the size and shape of a transducer aperture that could target the prostate without obstruction. CT images obtained from 17 subjects >56 years of age were used to create 3D reconstructions of the lower abdomen and pelvis. Target locations on the urethra at the base, mid, and apex in the prostate were marked along with a transrectal imaging probe. Evenly space rays spanning were traced from each target location towards the perineum and separately towards the abdomen with the maximum x-ray density encountered along each path recorded. The overall free aperture through the perineum was found to be a triangular shaped region bounded by the lower bones of the pelvis and the transrectal probe varying significantly in size between subjects. The free aperture through the abdomen was wedge shaped limited by the pubis also with great subject to subject variability. Average unblocked fractions of an f/1 transducer to target base, veru, and apex through the perineum were 77.0%, 94.4%, and 99.6%, respectively. Averages targeting through the abdomen were 86.1%, 52.3%, and 11.0%. Acoustic access to the prostate for through the perineum was judged to be feasible.

Extra-skeletal Ewing's sarcoma resembling acute abdomen. Case report.

PubMed

Valdivia Gómez, Gilberto Guzmán; Soto Guerrero, María Teresa; Cedillo de la Cruz, María Isabel

2010-01-01

Extraosseous Ewing's sarcoma is a rare tumor of neuroectodermal origin. It presents mainly in the soft tissue of the extremities and thorax. Histologically, it is similar to Ewing's sarcoma of the bone. We present the case of a male who arrived at the emergency room with acute abdomen, leucocytosis and imaging techniques (abdominal ultrasound and computed tomography) suggestive of complicated diverticular disease. He was treated with emergency surgery. Intraoperative findings were an unsuspected tumor (20 x 15 x 15 cm). Treatment consisted of extirpation of the tumor, separating it from the adjacent viscera and followed by chemotherapy based on epirubicin, cyclophosphamide and vincristine for six cycles. Because the control abdominal CT demonstrated tumor activity in the retroperitoneum adjacent to the ascending colon and cecum, further resection was decided upon. In a review of the literature, no previous reports of extraosseous Ewing's sarcoma were found presenting as acute abdomen. Due to the rarity of this tumor, only case reports or series have been found in the literature without randomized or comparative studies. Surgery was the cornerstone of treatment, without reports of preoperative chemotherapy. If the patient's condition permits, percutaneous needle biopsy is mandatory to obtain optimum treatment as well as to improve prognosis.

Definitive identification of magnetite nanoparticles in the abdomen of the honeybee Apis mellifera

NASA Astrophysics Data System (ADS)

Desoil, M.; Gillis, P.; Gossuin, Y.; Pankhurst, Q. A.; Hautot, D.

2005-01-01

The biogenic magnetic properties of the honeybee Apis mellifera were investigated with a view to understanding the bee's physiological response to magnetic fields. The magnetisations of bee abdomens on one hand, and heads and thoraxes on the other hand, were measured separately as functions of temperature and field. Both the antiferromagnetic responses of the ferrihydrite cores of the iron storage protein ferritin, and the ferrimagnetic responses of nanoscale magnetite (Fe3O4) particles, were observed. Relatively large magnetite particles (ca. 30 nm or more), capable of retaining a remanent magnetisation at room temperature, were found in the abdomens, but were absent in the heads and thoraxes. In both samples, more than 98% of the iron atoms were due to ferritin.

Current status of laparoscopy for acute abdomen in Italy: a critical appraisal of 2012 clinical guidelines from two consecutive nationwide surveys with analysis of 271,323 cases over 5 years.

PubMed

Agresta, Ferdinando; Campanile, Fabio Cesare; Podda, Mauro; Cillara, Nicola; Pernazza, Graziano; Giaccaglia, Valentina; Ciccoritti, Luigi; Ioia, Giovanna; Mandalà, Stefano; La Barbera, Camillo; Birindelli, Arianna; Sartelli, Massimo; Di Saverio, Salomone

2017-04-01

Several authors have demonstrated the safety and feasibility of laparoscopy in selected cases of abdominal emergencies. The aim of the study was to analyse the current Italian practice on the use of laparoscopy in abdominal emergencies and to evaluate the impact of the 2012 national guidelines on the daily surgical activity. Two surveys (42 closed-ended questions) on the use of laparoscopy in acute abdomen were conducted nationwide with an online questionnaire, respectively, before (2010) and after (2014) the national guidelines publication. Data from two surveys were compared using Chi-square or Fisher's exact test, and data were considered significant when p < 0.05. Two-hundred and one and 234 surgical units answered to the surveys in 2010 and 2014, respectively. Out of 144,310 and 127,013 overall surgical procedures, 23,407 and 20,102, respectively, were abdominal emergency operations. Respectively 24.74 % (in 2010) versus 30.27 % (in 2014) of these emergency procedures were approached laparoscopically, p = 0.42. The adoption of laparoscopy increased in all the considered clinical scenarios, with statistical significance in acute appendicitis (44 vs. 64.7 %; p = 0.004). The percentage of units approaching Hinchey III acute diverticulitis with laparoscopy in 26-75 % of cases (14.0 vs. 29.7 %; p = 0.009), those with >25 % of surgeons confident with laparoscopic approach to acute diverticulitis (29.9 vs. 54 %; p = 0.0009), the units with >50 % of surgeons confident with laparoscopic approach to acute appendicitis, cholecystitis and perforated duodenal ulcer, all significantly increased in the time frame. The majority of respondents declared that the 2012 national guidelines influenced their clinical practice. The surveys showed an increasing use of laparoscopy for patients with abdominal emergencies. The 2012 national guidelines profoundly influenced the Italian surgical practice in the laparoscopic approach to the acute abdomen.

The larval abdomen of the enigmatic Nannochoristidae (Mecoptera, Insecta).

PubMed

Fraulob, Maximilian; Wipfler, Benjamin; Hünefeld, Frank; Pohl, Hans; Beutel, Rolf G

2012-03-01

External and internal structures of the larval abdomen of Nannochorista are described in detail, with emphasis on the posterior segments. The results are compared with conditions found in other groups of Antliophora, especially the mecopteran subgroups Boreidae and Pistillifera. Like the entire postcephalic body, the larval abdomen of Nannochorista is extremely slender and nearly cylindrical. The anterior segments are largely unmodified. The surface is smooth and lacks any protuberances or prolegs. The term "cloaca" for the posterior membranous pouch of Nannochorista sp. is morphologically unjustified. A list of muscles of segments IX and X is presented. The abdominal musculature was partly homologized following Snodgrass. The muscles of segment X are highly modified. They move the membranous pouch, the anal papillae, and the terminal lobes. The presence of these structures is likely an adaptation to the specific aquatic life style of nannochoristid larvae. The anal papillae are possibly homologous to the 4-lobed terminal attachment apparatus of larvae of Caurinus (Boreidae) and Pistillifera (Panorpidae, Bittacidae, Choristidae) but this is uncertain. The specific condition in both groups, i.e. two retractile papillae with tracheae and Malpighian tubules in Nannochoristidae, and a 4-lobed exposed attachment device in Pistillifera + Boreidae (groundplan) are very likely autapomorphic for both groups, respectively. A slender abdomen with smooth surface is very likely plesiomorphic within Antliophora and Mecopterida. This condition is found in Trichoptera (partim), Nannochoristidae, Siphonaptera, and many basal groups of Diptera. An eruciform or scarabaeiform body shape with a soft, largely unsclerotised cuticle is probably a synapomorphy of Boreidae and Pistillifera. The presence of ventral protuberances resembling prolegs on the anterior segments is an autapomorphy of the latter group. The homology of paired or unpaired terminal appendages of segment X is

Small bowel obstruction in the virgin abdomen: time to challenge surgical dogma with evidence.

PubMed

Ng, Yvonne Ying-Ru; Ngu, James Chi-Yong; Wong, Andrew Siang-Yih

2018-01-01

Although adhesions account for more than 70% of small bowel obstruction (SBO), they are thought to be less likely aetiologies in patients without previous abdominal surgery. Expedient surgery has historically been advocated as prudent management in these patients. Emerging evidence appears to challenge such a dogmatic approach. A retrospective analysis was performed in all SBO patients with a virgin abdomen admitted between January 2012 and August 2014. Patients with obstruction secondary to abdominal wall hernias were excluded. Patient demographics, clinical presentation, management strategy and pathology involved were reviewed. A total of 72 patients were included in the study. The majority of patients were males (66.7%), with a median age of 58 years (range: 23-101). Abdominal pain (97%) and vomiting (86%) were the most common presentations while abdominal distention (60%) and constipation (25%) were reported less frequently. Adhesions accounted for the underlying cause in 44 (62%) patients. Other aetiologies included gallstone ileus (n = 5), phytobezoar (n = 5), intussusception (n = 4), internal herniation (n = 4), newly diagnosed small bowel tumour (n = 3), mesenteric volvulus (n = 3), stricture (n = 3) and Meckel's diverticulum (n = 1). Twenty-nine (40%) patients were successfully managed conservatively while the remaining 43 (60%) underwent surgery. The intraoperative findings were in concordance with the preoperative computed tomography scan in 76% of cases. Adhesions remain prevalent despite the absence of previous abdominal surgery. Non-operative management is feasible for SBO in a virgin abdomen. Computed tomography scan can be a useful adjunct in discerning patients who may be treated non-operatively by elucidating the underlying cause of obstruction. © 2016 Royal Australasian College of Surgeons.

[Treatment of enteric fistula in open abdomen].

PubMed

Evenson, R A; Fischer, J E

2006-07-01

Formation of enteric fistulas frequently complicates the open abdomen in patients who have sustained traumatic injury. The post-traumatic subset of patients with enterocutaneous fistula enjoy better than average recovery. To optimize this recovery, a systematic management approach is required. Patients must first be stabilized with nutritional support, control of sepsis, and special wound management systems to prevent further deterioration of the abdominal wall. Investigation of the origin, course, and characteristics of the fistula provides information about its likelihood to close without operation. Definitive operative therapy may be necessary to resolve the fistula and close the abdominal wall. Finally, healing support includes nutritional support and physical and occupational therapies to restore patients to pre-injury states.

[CLINICAL BACKGROUND ANALYSIS ABOUT TRANSURETHRAL ELECTROCOAGULATION].

PubMed

Katsui, Masahiro; Kikuchi, Eiji; Yazawa, Satoshi; Hagiwara, Masayuki; Morita, Shinya; Shinoda, Kazunobu; Kosaka, Takeo; Mizuno, Ryuichi; Shinojima, Toshiaki; Asanuma, Hiroshi; Miyajima, Akira; Oya, Mototsugu

2015-10-01

Transurethral electrocoagulation (TUC) is a rare event but occurs in a constant manner with various causes or disorders and reduces patient quality of life. So far there have been no reports focusing on the details of TUC. We focused on the clinical background and related causes in cases of TUC in our institution. We identified 76 cases (65 patients) who underwent TUC at Keio University Hospital between April 2001 and March 2011. We focused on patient background, especially with respect to the primary disease, treatment modality, use of antiplatelet or anticoagulant agent, timing of TUC, type of electrosurgical device, and the incidence of transfusion. The primary disease for TUC included bladder tumor (BT) in 31 cases, benign prostate hyperplasia (BPH) in 13, prostate cancer (PCa) in 13, idiopathic bladder bleeding in 4, periarteritis nodosa in 3, uterine cervical cancer in 3, and others in 9. TUC after transurethral resection (TUR) was found in 38 cases, including transurethral resection of bladder tumor (TURBT) in 26 of 31 BT cases and transurethral resection of prostate (TURP) in 12 of 13 BPH cases. After TURBT, TUC was performed before removal of a urethral catheter in 7 cases, and after removal of a urethral catheter in 19 cases. With regard to TUC associated with TURP, the average estimated prostate volume in TUC cases before removal of the urethral catheter was 66.2 ml, which was significantly larger than that in TUC cases after removal of the urethral catheter (46.1 ml, p = 0.045). TUC after the radiation therapy was observed in 21 cases, and the average time from the radiation therapy to TUC was 3.4 years (7 months-10 years). TUC was caused by multiple causes or disorders, and 75% of our TUC was associated with BT, BPH or PCa. TUC associated with TURBT frequently occurred within 1 week after TURBT but was still observed after 1 month following the operation. All TUC associated with TURP occurred within 3 weeks after operation. The average period from

Mechanical response of the herniated human abdomen to the placement of different prostheses.

PubMed

Hernández-Gascón, Belén; Peña, Estefanía; Grasa, Jorge; Pascual, Gemma; Bellón, Juan M; Calvo, Begoña

2013-05-01

This paper describes a method designed to model the repaired herniated human abdomen just after surgery and examine its static mechanical response to the maximum intra-abdominal pressure provoked by a physiological movement (standing cough). The model is based on the real geometry of the human abdomen bearing a large incisional hernia with several anatomical structures differentiated by MRI. To analyze the outcome of hernia repair, the surgical procedure was simulated by modeling a prosthesis placed over the hernia. Three surgical meshes with different mechanical properties were considered: an isotropic heavy-weight mesh (Surgipro®), a slightly anisotropic light-weight mesh (Optilene®), and a highly anisotropic medium-weight mesh (Infinit®). Our findings confirm that anisotropic implants need to be positioned such that the most compliant axis of the mesh coincides with the craneo-caudal direction of the body.

Accuracy and precision of flash glucose monitoring sensors inserted into the abdomen and upper thigh compared with the upper arm.

PubMed

Charleer, Sara; Mathieu, Chantal; Nobels, Frank; Gillard, Pieter

2018-06-01

Nowadays, most Belgian patients with type 1 diabetes use flash glucose monitoring (FreeStyle Libre [FSL]; Abbott Diabetes Care, Alameda, California) to check their glucose values, but some patients find the sensor on the upper arm too visible. The aim of the present study was to compare the accuracy and precision of FSL sensors when placed on different sites. A total of 23 adults with type 1 diabetes used three FSL sensors simultaneously for 14 days on the upper arm, abdomen and upper thigh. FSL measurements were compared with capillary blood glucose (BG) measurements obtained with a built-in FSL BG meter. The aggregated mean absolute relative difference was 11.8 ± 12.0%, 18.5 ± 18.4% and 12.3 ± 13.8% for the arm, abdomen (P = .002 vs arm) and thigh (P = .5 vs arm), respectively. Results of Clarke error grid analysis for the arm and thigh were similar (zone A: 84.9% vs 84.5%; P = .6), while less accuracy was seen for the abdomen (zone A: 69.4%; P = .01). Apart from the first day, the accuracy of FSL sensors on the arm and thigh was more stable across the 14-day wear duration than accuracy of sensors on the abdomen, which deteriorated mainly during week 2 (P < .0005). The aggregated precision absolute relative difference was markedly lower for the arm/thigh (10.9 ± 11.9%) compared with the arm/abdomen (20.9 ± 22.8%; P = .002). Our results indicate that the accuracy and precision of FSL sensors placed on the upper thigh are similar to the upper arm, whereas the abdomen performed unacceptably poorly. © 2018 John Wiley & Sons Ltd.

TNP-assisted fascial closure in a patient with acute abdomen and abdominal compartment syndrome.

PubMed

Gourgiotis, S; Villias, C; Benetatos, C; Tsakiris, A; Parisis, C; Aloizos, S; Salemis, N S

2009-02-01

Topical negative pressure was applied to prevent abdominal compartment syndrome in a patient following surgery for an acute abdomen. It delayed fascial closure, protected the underlying bowel and facilitated abdominal re-entry.

Can CT imaging of the chest, abdomen, and pelvis identify all vertebral injuries of the thoracolumbar spine without dedicated reformatting?

PubMed

Imran, Jonathan B; Madni, Tarik D; Pruitt, Jeffrey H; Cornelius, Canon; Subramanian, Madhu; Clark, Audra T; Mokdad, Ali A; Rizk, Paul; Minei, Joseph P; Cripps, Michael W; Eastman, Alexander L

2018-07-01

The main objective of this study was to compare detection rates of clinically significant thoracolumbar spine (TLS) fracture between computed tomography (CT) imaging of the chest, abdomen, and spine (CT CAP) and CT for the thoracolumbar spine (CT TL). We retrospectively identified patients at our institution with a TLS fracture over a two-year period that had both CT CAP and reformatted CT TL imaging. The sensitivity of CT CAP to identify fracture was calculated for each fracture type. A total of 516 TLS fractures were identified in 125 patients using reformatted CT TL spine imaging. Overall, 69 of 512 fractures (13%) were missed on CT CAP that were identified on CT TL. Of those, there were no clinically significant missed fractures. CT CAP could potentially be used as a screening tool for clinically significant TLS injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

SU-E-P-08: Establishment of Local Diagnostic Reference Levels of Routine Abdomen Exam in Computed Tomography According to Body Weight

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, H; Wang, Y; Weng, H

Purpose: The national diagnostic reference levels (NDRLs) is an efficient, concise and powerful standard for optimizing radiation protection of a patient. However, for each hospital the dose-reducing potential of focusing on establishment of local DRLs (LDRLs). A lot of study reported that Computed tomography exam contributed majority radiation dose in different medical modalities, therefore, routine abdomen CT exam was choose in initial pilot study in our study. Besides the mAs of routine abdomen CT exam was decided automatic exposure control by linear attenuation is relate to body shape of patient. In this study we would like to establish the localmore » diagnostic reference levels of routine abdomen exam in computed tomography according to body weight of patient. Methods and Materials: There are two clinical CT scanners (a Toshiba Aquilion and a Siemens Sensation) were performed in this study. For CT examinations the basic recommended dosimetric quantity is the Computed Tomography Dose Index (CTDI). The patient sample involved 82 adult patients of both sexes and divided into three groups by their body weight (50–60 kg, 60–70 kg, 70–80 kg).Carried out the routine abdomen examinations, and all exposure parameters have been collected and the corresponding CTDIv and DLP values have been determined. The average values were compared with the European DRLs. Results: The majority of patients (75%) were between 50–70 Kg of body weight, the numbers of patient in each group of weight were 40–50:7; 50–60:29; 60–70:33; 70–80:13. The LDRLs in each group were 10.81mGy, 14.46mGy, 20.27mGy and 21.04mGy, respectively. The DLP were 477mGy, 630mGy, 887mGy and 959mGy, respectively. No matter which group the LDRLs were lower than European DRLs. Conclusions: We would like to state that this was a pioneer work in local hospital in Chiayi. We hope that this may lead the way to further developments in Taiwan.« less

Role of Definitive Radiation Therapy in Carcinoma of Unknown Primary in the Abdomen and Pelvis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kelly, Patrick; Das, Prajnan; Varadhachary, Gauri R.

2012-04-01

Objectives: Carcinoma of unknown primary (CUP) in the abdomen and pelvis is a heterogeneous group of cancers with no standard treatment. Considered by many to be incurable, these patients are often treated with chemotherapy alone. In this study, we determined the effectiveness of radiation therapy in combination with chemotherapy in patients with CUP in the abdomen and pelvis. Patients and Methods: Medical records were reviewed for 37 patients with CUP treated with radiation therapy for disease located in the soft tissues and/or nodal basins of the abdomen and pelvis at University of Texas M.D. Anderson Cancer between 2002 and 2009.more » All patients underwent chemotherapy, either before or concurrent with radiation therapy. Patients were selected for radiation therapy on the basis of histologic type, disease extent, and prior therapy response. Twenty patients underwent definitive radiation therapy (defined as radiation therapy targeting all known disease sites with at least 45 Gy) and 17 patients underwent palliative radiation therapy. Only 6 patients had surgical resection of their disease. Patient and treatment characteristics were extracted and the endpoints of local disease control, progression-free survival (PFS), overall survival (OS), and treatment-related toxicity incidence were analyzed. Results: The 2-year PFS and OS rates for the entire cohort were 32% and 57%, respectively. However, in patients treated with definitive radiation therapy, the rates were 48% and 76%, and 7 patients lived more than 3 years after treatment with no evidence of disease progression. Nevertheless, radiation-associated toxicity was significant in this cohort, as 40% experienced Grade 2 or higher late toxicities. Conclusions: The use of definitive radiation therapy should be considered in selected patients with CUP in the soft tissues or nodal basins of the abdomen and pelvis.« less

Peritoneal mesothelioma presenting as an acute surgical abdomen due to jejunal perforation.

PubMed

Salemis, Nikolaos S; Tsiambas, Evangelos; Gourgiotis, Stavros; Mela, Ageliki; Karameris, Andreas; Tsohataridis, Efstathios

2007-11-01

Peritoneal mesothelioma is a rare disease associated with poor prognosis. Acute abdomen as the first presentation is an extremely rare occurrence. We report an exceptional case of a patient who was found to have a jejunal perforation due to infiltration of peritoneal mesothelioma. A 62-year-old man was admitted with clinical signs of peritonitis. Computerized tomographic scans showed a mass distal to the ligament of Treitz, thickening of the mesentery and a small amount of ascites. Emergency laparotomy revealed a perforated tumor 15 cm distal to the ligament of Treitz and diffuse peritoneal disease. Segmental small bowel resection and suboptimal cytoreduction were performed. Histopathology and immunohistochemistry showed infiltration of malignant mesothelioma. During the postoperative period pleural mesothelioma was also diagnosed. Despite adjuvant chemotherapy, the patient died of disseminated progressive disease 7 months after surgery. Peritoneal mesothelioma is a rare malignancy with grim prognosis. Small bowel involvement is a poor prognostic indicator. Our case of a small bowel perforation due to direct infiltration by peritoneal mesothelioma appears to be the first reported in the English literature.

Delayed pneumothorax after stab wound to thorax and upper abdomen: Truth or myth?

PubMed

Zehtabchi, Shahriar; Morley, Eric J; Sajed, Dana; Greenberg, Oded; Sinert, Richard

2009-01-01

Stab wounds to the thorax and upper abdomen have the potential to cause pneumothorax (PTX). When a CXR (CXR) obtained during initial resuscitation is negative, a second CXR (CXR-2) is commonly performed with the goal of identifying delayed PTX. To assess the diagnostic yield of the CXR-2 in identifying delayed PTX. Prospective observational study of patients (age >or=13 years) with stab wounds to the thorax (chest/back) and upper abdomen with suspected PTX, in a level 1 trauma centre. Patients were included if they had a negative initial CXR followed by a repeat CXR 3-6h after the initial one. patients who died, were transferred out of the ED, or received chest tubes before the second CXR. The outcome of interest was delayed PTX. All CXR were read by an attending radiologist. To test the inter-observer agreement, another blinded radiologist reviewed 20% of CXR. Continuous data is presented as mean+/-standard deviation and categorical data as percentages with 95% confidence interval (CI). Kappa statistics were used to measure the inter-observer agreement between radiologists. Between January 2003 and December 2006 a total of 185 patients qualified for the enrollment (mean age: 28+/-10 years, age range: 13-65, 94% male). Only 2 patients (1.1%, 95% CI, 0.4- 4.1%) had PTX on the CXR-2. Both patients received chest tubes. The inter-observer agreement for radiology reports was high (kappa: 0.79). Occurrence of delayed PTX in patients with stab wounds to the thorax and upper abdomen and negative triage CXR is rare.

Accuracy of Focused Assessment with Sonography for Trauma (FAST) in Blunt Trauma Abdomen-A Prospective Study.

PubMed

Kumar, Subodh; Bansal, Virinder Kumar; Muduly, Dillip Kumar; Sharma, Pawan; Misra, Mahesh C; Chumber, Sunil; Singh, Saraman; Bhardwaj, D N

2015-12-01

Focused assessment with sonography for trauma (FAST) is a limited ultrasound examination, primarily aimed at the identification of the presence of free intraperitoneal or pericardial fluid. In the context of blunt trauma abdomen (BTA), free fluid is usually due to hemorrhage, bowel contents, or both; contributes towards the timely diagnosis of potentially life-threatening hemorrhage; and is a decision-making tool to help determine the need for further evaluation or operative intervention. Fifty patients with blunt trauma abdomen were evaluated prospectively with FAST. The findings of FAST were compared with contrast-enhanced computed tomography (CECT), laparotomy, and autopsy. Any free fluid in the abdomen was presumed to be hemoperitoneum. Sonographic findings of intra-abdominal free fluid were confirmed by CECT, laparotomy, or autopsy wherever indicated. In comparing with CECT scan, FAST had a sensitivity, specificity, and accuracy of 77.27, 100, and 79.16 %, respectively, in the detection of free fluid. When compared with surgical findings, it had a sensitivity, specificity, and accuracy of 94.44, 50, and 90 %, respectively. The sensitivity of FAST was 75 % in determining free fluid in patients who died when compared with autopsy findings. Overall sensitivity, specificity, and accuracy of FAST were 80.43, 75 and 80 %, respectively, for the detection of free fluid in the abdomen. From this study, we can safely conclude that FAST is a rapid, reliable, and feasible investigation in patients with BTA, and it can be performed easily, safely, and quickly in the emergency room with a reasonable sensitivity, specificity, and accuracy. It helps in the initial triage of patients for assessing the need for urgent surgery.

Utility of screening computed tomography of chest, abdomen and pelvis in patients after heart transplantation.

PubMed

Dasari, Tarun W; Pavlovic-Surjancev, Biljana; Dusek, Linda; Patel, Nilamkumar; Heroux, Alain L

2011-12-01

Malignancy is a late cause of mortality in heart transplant recipients. It is unknown if screening computed tomography scan would lead to early detection of such malignancies or serious vascular anomalies post heart transplantation. This is a single center observational study of patients undergoing surveillance computed tomography of chest, abdomen and pelvis at least 5 years after transplantation. Abnormal findings, included pulmonary nodules, lymphadenopathy and intra-thoracic and intra-abdominal masses and vascular anomalies such as abdominal aortic aneurysm. The clinical follow up of each of these major abnormal findings is summarized. A total of 63 patients underwent computed tomography scan of chest, abdomen and pelvis at least 5 years after transplantation. Of these, 54 (86%) were male and 9 (14%) were female. Mean age was 52±9.2 years. Computed tomography revealed 1 lung cancer (squamous cell) only. Non specific pulmonary nodules were seen in 6 patients (9.5%). The most common incidental finding was abdominal aortic aneurysms (N=6 (9.5%)), which necessitated follow up computed tomography (N=5) or surgery (N=1). Mean time to detection of abdominal aortic aneurysms from transplantation was 14.6±4.2 years. Mean age at the time of detection of abdominal aortic aneurysms was 74.5±3.2 years. Screening computed tomography scan in patients 5 years from transplantation revealed only one malignancy but lead to increased detection of abdominal aortic aneurysms. Thus the utility is low in terms of detection of malignancy. Based on this study we do not recommend routine computed tomography post heart transplantation. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Feature-based respiratory motion tracking in native fluoroscopic sequences for dynamic roadmaps during minimally invasive procedures in the thorax and abdomen

NASA Astrophysics Data System (ADS)

Wagner, Martin G.; Laeseke, Paul F.; Schubert, Tilman; Slagowski, Jordan M.; Speidel, Michael A.; Mistretta, Charles A.

2017-03-01

Fluoroscopic image guidance for minimally invasive procedures in the thorax and abdomen suffers from respiratory and cardiac motion, which can cause severe subtraction artifacts and inaccurate image guidance. This work proposes novel techniques for respiratory motion tracking in native fluoroscopic images as well as a model based estimation of vessel deformation. This would allow compensation for respiratory motion during the procedure and therefore simplify the workflow for minimally invasive procedures such as liver embolization. The method first establishes dynamic motion models for both the contrast-enhanced vasculature and curvilinear background features based on a native (non-contrast) and a contrast-enhanced image sequence acquired prior to device manipulation, under free breathing conditions. The model of vascular motion is generated by applying the diffeomorphic demons algorithm to an automatic segmentation of the subtraction sequence. The model of curvilinear background features is based on feature tracking in the native sequence. The two models establish the relationship between the respiratory state, which is inferred from curvilinear background features, and the vascular morphology during that same respiratory state. During subsequent fluoroscopy, curvilinear feature detection is applied to determine the appropriate vessel mask to display. The result is a dynamic motioncompensated vessel mask superimposed on the fluoroscopic image. Quantitative evaluation of the proposed methods was performed using a digital 4D CT-phantom (XCAT), which provides realistic human anatomy including sophisticated respiratory and cardiac motion models. Four groups of datasets were generated, where different parameters (cycle length, maximum diaphragm motion and maximum chest expansion) were modified within each image sequence. Each group contains 4 datasets consisting of the initial native and contrast enhanced sequences as well as a sequence, where the respiratory motion is

Fulminant ischaemic colitis with atypical clinical features complicating sickle cell disease.

PubMed

Karim, Anita; Ahmed, S; Rossoff, Leonard J; Siddiqui, R; Fuchs, A; Multz, A S

2002-06-01

Clinically significant ischaemic bowel injury is an exceedingly rare complication of sickle cell disease. It manifests as acute surgical abdomen and may respond to conservative treatment. An unusual fatal case of ischaemic colitis with minimal abdominal findings in a young male during a sickle cell vaso-occlusive pain crisis is described. This case demonstrates that an acute surgical abdomen should be considered in such patients who fail to respond to conservative management as untreated this condition may be fatal.

[The historical background and present development of evidence-based healthcare and clinical nursing].

PubMed

Tsai, Jung-Mei

2014-12-01

Evidence-based healthcare (EBHC) emphasizes the integration of the best research evidence with patient values, specialist suggestions, and clinical circumstances during the process of clinical decision-making. EBHC is a recognized core competency in modern healthcare. Nursing is a professional discipline of empirical science that thrives in an environment marked by advances in knowledge and technology in medicine as well as in nursing. Clinical nurses must elevate their skills and professional qualifications, provide efficient and quality health services, and promote their proficiency in EBHC. The Institute of Medicine in the United States indicates that evidence-based research results often fail to disseminate efficiently to clinical decision makers. This problem highlights the importance of better promoting the evidence-based healthcare fundamentals and competencies to frontline clinical nurses. This article describes the historical background and present development of evidence-based healthcare from the perspective of modern clinical nursing in light of the importance of evidence-based healthcare in clinical nursing; describes the factors associated with evidence-based healthcare promotion; and suggests strategies and policies that may improve the promotion and application of EBHC in clinical settings. The authors hope that this paper provides a reference for efforts to improve clinical nursing in the realms of EBHC training, promotion, and application.

Vacuum-assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review.

PubMed

Acosta, Stefan; Björck, Martin; Petersson, Ulf

2017-01-01

The aim of this paper was to review the literature on vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. A high primary fascial closure rate can be achieved with the vacuum-assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-trauma patients, in need of prolonged open abdomen therapy.

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report.

PubMed

Yetişir, Fahri; Salman, A Ebru; Mamedov, Ruslan; Aksoy, Mustafa; Yalcin, Abdussamet; Kayaalp, Cüneyt

2014-01-01

To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS. Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up. Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period. Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Contrast-enhanced MR angiography of the chest and abdomen with use of controlled apnea in children.

PubMed

Saleh, Roya S; Patel, Swati; Lee, Margaret H; Boechat, M Ines; Ratib, Osman; Saraiva, Carla R; Finn, J Paul

2007-06-01

To retrospectively determine if controlled apnea improves the image quality of contrast material--enhanced magnetic resonance (MR) angiography of the chest and abdomen in children. Institutional review board approval and waiver of informed consent were obtained for this HIPAA-compliant study. The authors evaluated contrast-enhanced MR angiographic procedures performed in the chest, abdomen, or both, in 23 children (14 boys, nine girls; age range, 1 month to 8 years) who were under general anesthesia. All patients underwent mechanical ventilation with preoxygenation (100% oxygen) prior to controlled apnea during image acquisition. In control subjects, the authors assessed contrast-enhanced MR angiographic procedures performed in the chest, abdomen, or both, in 23 children (matched for age and type of study with children in the controlled apnea group; 11 boys, 12 girls; age range, 1 month to 8 years) who were under general anesthesia (n=15) or deep sedation (n=8) and were breathing spontaneously during image acquisition. MR angiograms of the chest, abdomen, or both, were assessed for image quality, motion artifacts, and vessel definition by two radiologists working in consensus with a subjective grading scale. Wilcoxon signed rank test was used to assess differences in measurements. Image quality was rated excellent in 97% (30 of 31) of studies with controlled apnea and in 30% (nine of 31) of control studies (P<.001). Motion artifacts were absent in 97% (30 of 31) of studies with controlled apnea and 13% (four of 31) of control studies (P<.001). Vessel sharpness was rated as being significantly better on images obtained with controlled apnea (P<.05). There were no complications caused by anesthesia or sedation in either group. Controlled apnea is highly effective in children for eliminating respiratory motion artifacts with contrast-enhanced MR angiographic studies, resulting in greatly improved image quality and spatial resolution. (c) RSNA, 2007.

SU-F-I-40: Impact of Scan Length On Patient Dose in Abdomen/pelvis CT Diagnosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, I; Song, J; Kim, K

Purpose: To analysis the impact of scan length on patient doses in abdomen/pelvis CT diagnosis of each hospital. Methods: Scan length of 7 hospitals from abdomen/pelvis CT diagnosis was surveyed in Korea. Surveyed scan lengths were additional distance above diaphragm and distance below pubic symphysis except for standard scan range between diaphragm and pubic symphysis. Patient dose was estimated for adult male and female according to scan length of each hospital. CT-Expo was used to estimate the patient dose under identical equipment settings (120 kVp, 100 mAs, 10 mm collimation width, etc.) except scan length. Effective dose was calculated bymore » using tissue weighting factor of ICRP 103 recommendation. Increase rate of effective dose was calculated comparing with effective dose of standard scan range Results: Scan lengths of abdomen/pelvis CT diagnosis of each hospital were different. Also effective dose was increased with increasing the scan length. Generally increasing the distance above diaphragm caused increase of effective dose of male and female, but increasing the distance below pubic symphysis caused increase of effective dose of male. Conclusion: We estimated the patient dose according to scan length of each hospital in abdomen/pelvis CT diagnosis. Effective dose was increased by increasing the scan length because dose of organs with high tissue weighting factor such as lung, breast, testis were increased. Scan length is important factor on patient dose in CT diagnosis. If radiologic technologist interested in patient dose, decreasing the unnecessary scan length will decrease the risk of patients from radiation. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI13C0004).« less

Clinically speaking: A communication skills program for students from non-English speaking backgrounds.

PubMed

Miguel, Caroline San; Rogan, Fran; Kilstoff, Kathleen; Brown, Di

2006-09-01

This paper reports on the design, delivery and evaluation of an innovative oral communication skills program for first year students in a Bachelor of Nursing degree at an Australian university. This program was introduced in 2004 to meet the needs of first year undergraduate students from non-English speaking backgrounds who had experienced difficulties with spoken English while on clinical placement. The program consisted of early identification of students in need of communication development, a series of classes incorporated into the degree program to address students' needs, followed by a clinical placement block. This paper describes the structure of the program, discusses some of the major problems encountered by students in the clinical setting and presents some of the teaching strategies used to address these problems. Evaluations of the program suggest that students' communication skills and confidence improved, resulting in a more positive clinical experience for the majority of students.

[Diagnosis and differential diagnosis for solitary fibrous tumor in the abdomen and pelvis by CT].

PubMed

Liu, Huaping; Li, Wenzheng; Yi, Xiaoping; Pei, Yigang; Liu, Hui; Zhao, Wei; Liu, Wenguang; Hou, Jiale; Ghimire, Obin

2017-04-28

To study the CT features for solitary fibrous tumor (SFT) in the abdomen and pelvis and to improve the diagnostic accuracy.
 Methods: Fourteen patients with SFT were collected in our hospital from January, 2011 to December, 2015. Characteristic of images were analyzed and compared for 10 SFT, which located outside the abdominal organs with extragastrointestinal stromal tumors (EGIST), leiomyosarcoma, and schwannoma.
 Results: Necrosis and cystic formation were frequently present in SFT in the abdomen and pelvis. CE-CT showed serpentine vessels along the periphery, while pattern of enhancement was map-like inhomogeneous progressive. Comparing with the EGIST or schwannoma, the difference of CT value in non-contrast and the arterial phase were statistically significant (P<0.05). The numbers of peritumoral circuity vessel were significantly different between SFT and EGIST (χ²=18.27, P<0.008) or between SFT and schwannoma (χ²=19.25, P<0.008). Comparing with the leiomyosarcoma or schwannoma, SFT located outside the abdominal organs. We found that tumor necrosis rate was significantly different between SFT and leiomyoscarcoma (χ²=8.00, P<0.008).
 Conclusion: SFT in the abdomen and pelvis show certain CT characteristics. The CT value in non-contrast and at the arterial phase, tumor necrosis rate, and serpentine vessels along the periphery were pivotal in differentiating SFT from leiomyosarcoma, EGIST and schwannoma.

Honey bees (Apis mellifera ligustica) swing abdomen to dissipate residual flying energy landing on a wall

NASA Astrophysics Data System (ADS)

Zhao, Jieliang; Huang, He; Yan, Shaoze

2017-03-01

Whether for insects or for aircrafts, landing is one of the indispensable links in the verification of airworthiness safety. The mechanisms by which insects achieve a fast and stable landing remain unclear. An intriguing example is provided by honeybees (Apis mellifera ligustica), which use the swinging motion of their abdomen to dissipate residual flying energy and to achieve a smooth, stable, and quick landing. By using a high-speed camera, we observed that touchdown is initiated by honeybees extending their front legs or antennae and then landing softly on a wall. After touchdown, they swing the rest of their bodies until all flying energy is dissipated. We suggested a simplified model with mass-spring dampers for the body of the honeybee and revealed the mechanism of flying energy transfer and dissipation in detail. Results demonstrate that body translation and abdomen swinging help honeybees dissipate residual flying energy and orchestrate smooth landings. The initial kinetic energy of flying is transformed into the kinetic energy of the abdomen's rotary movement. Then, the kinetic energy of rotary movement is converted into thermal energy during the swinging cycle. This strategy provides more insight into the mechanism of insect flying, which further inspires better design on aerial vehicle with better landing performance.

Aromatherapy massage on the abdomen for alleviating menstrual pain in high school girls: a preliminary controlled clinical study.

PubMed

Hur, Myung-Haeng; Lee, Myeong Soo; Seong, Ka-Yeon; Lee, Mi-Kyoung

2012-01-01

This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.

Aromatherapy Massage on the Abdomen for Alleviating Menstrual Pain in High School Girls: A Preliminary Controlled Clinical Study

PubMed Central

Hur, Myung-Haeng; Lee, Myeong Soo; Seong, Ka-Yeon; Lee, Mi-Kyoung

2012-01-01

This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures. PMID:21949670

"Enteroatmospheric fistulae"--gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique.

PubMed

Marinis, A; Gkiokas, G; Argyra, E; Fragulidis, G; Polymeneas, G; Voros, D

2013-01-01

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.

Genetic, Clinical, and Pathologic Backgrounds of Patients with Autosomal Dominant Alport Syndrome

PubMed Central

Kamiyoshi, Naohiro; Fu, Xue Jun; Morisada, Naoya; Nozu, Yoshimi; Ye, Ming Juan; Imafuku, Aya; Miura, Kenichiro; Yamamura, Tomohiko; Minamikawa, Shogo; Shono, Akemi; Ninchoji, Takeshi; Morioka, Ichiro; Nakanishi, Koichi; Yoshikawa, Norishige; Kaito, Hiroshi; Iijima, Kazumoto

2016-01-01

Background and objectives Alport syndrome comprises a group of inherited heterogeneous disorders involving CKD, hearing loss, and ocular abnormalities. Autosomal dominant Alport syndrome caused by heterozygous mutations in collagen 4A3 and/or collagen 4A4 accounts for <5% of patients. However, the clinical, genetic, and pathologic backgrounds of patients with autosomal dominant Alport syndrome remain unclear. Design, setting, participants, & measurements We conducted a retrospective analysis of 25 patients with genetically proven autosomal dominant Alport syndrome and their family members (a total of 72 patients) from 16 unrelated families. Patients with suspected Alport syndrome after pathologic examination who were referred from anywhere in Japan for genetic analysis from 2006 to 2015 were included in this study. Clinical, laboratory, and pathologic data were collected from medical records at the point of registration for genetic diagnosis. Genetic analysis was performed by targeted resequencing of 27 podocyte-related genes, including Alport–related collagen genes, to make a diagnosis of autosomal dominant Alport syndrome and identify modifier genes or double mutations. Clinical data were obtained from medical records. Results The median renal survival time was 70 years, and the median age at first detection of proteinuria was 17 years old. There was one patient with hearing loss and one patient with ocular lesion. Among 16 patients who underwent kidney biopsy, three showed FSGS, and seven showed thinning without lamellation of the glomerular basement membrane. Five of 13 detected mutations were reported to be causative mutations for autosomal recessive Alport syndrome in previous studies. Two families possessed double mutations in both collagen 4A3 and collagen 4A4, but no modifier genes were detected among the other podocyte–related genes. Conclusions The renal phenotype of autosomal dominant Alport syndrome was much milder than that of autosomal recessive

[Sensibility of the abdomen after high superior tension abdominoplasty].

PubMed

Castus, P; Grandjean, F-X; Tourbach, S; Heymans, O

2009-12-01

Patients who undergo an abdominoplasty frequently complain about the loss of sensibility of the abdominal wall. In this study, we analyze this sensibility after the high tension abdominoplasty. This is a prospective study of 23 females operated between July 2003 and January 2005. The abdominoplasty technique used in our study combines extensive liposuccion, limited undermining centered on the linea alba and traction sutures. The sensibilty tests are carried out preoperatively, as well as at 3 and 6 months postoperatively. The three components of the skin sensibility -tactile, algesic and thermic- are evaluated in four differents areas of the abdomen. In the lateral areas of the abdomen (liposucted only), the thermoalgesic sensibility is diminished at 3 months and completely recovers at 6 months. At 3 months postoperatively, the tactile sensibility is even better than the preoperative one and continues to improve by 6 months. The postoperative hypogastric area is widely undermined during surgery. In this area, the three types of sensibility are heavily altered at 3 months and only partially recover at 6 months. The undermining of the postoperative epigastric area is limited. In this zone, the postoperative thermoalgesic sensibility is diminished at 3 months, but completely recovers at 6 months. At 3 months, the tactile sensibility is less than the preoperative one, but it improves with time to even exceed the preoperative values at 6 months. The high tension abdominoplasty only needs a limited undermining and largely preserves the innervation of the abdominal flap. Only the hypogastric area, largely undermined, presents a sensitivity loss. These results are better than those previously reported in the literature.

Role of Minimally Invasive Surgery in the Reoperative Abdomen or Pelvis

PubMed Central

Feigel, Amanda; Sylla, Patricia

2016-01-01

Laparoscopy has become widely accepted as the preferred surgical approach in the management of benign and malignant colorectal diseases. Once considered a relative contraindication in patients with prior abdominal surgery (PAS), as surgeons have continued to gain expertise in advanced laparoscopy, minimally invasive approaches have been increasingly incorporated in the reoperative abdomen and pelvis. Although earlier studies have described conversion rates, most contemporary series evaluating the impact of PAS in laparoscopic colorectal resection have reported equivalent conversion and morbidity rates between reoperative and non-reoperative cases, and series evaluating the impact of laparoscopy in reoperative cases have demonstrated improved short-term outcomes with laparoscopy. The data overall highlight the importance of case selection, careful preoperative preparation and planning, and the critical role of surgeons' expertise in advanced laparoscopic techniques. Challenges to the widespread adoption of minimally invasive techniques in reoperative colorectal cases include the longer learning curve and longer operative time. However, with the steady increase in adoption of minimally invasive techniques worldwide, minimally invasive surgery (MIS) is likely to continue to be applied in the management of increasingly complex reoperative colorectal cases in an effort to improve patient outcomes. In the hands of experienced MIS surgeons and in carefully selected cases, laparoscopy is both safe and efficacious for reoperative procedures in the abdomen and pelvis, with measurable short-term benefits. PMID:28642675

PMHS impact response in 3 m/s and 8 m/s nearside impacts with abdomen offset.

PubMed

Miller, Carl S; Madura, Nathaniel H; Schneider, Lawrence W; Klinich, Kathleen D; Reed, Matthew P; Rupp, Jonathan D

2013-11-01

Lateral impact tests were performed using seven male post-mortem human subjects (PMHS) to characterize the force-deflection response of contacted body regions, including the lower abdomen. All tests were performed using a dual-sled, side-impact test facility. A segmented impactor was mounted on a sled that was pneumatically accelerated into a second, initially stationary sled on which a subject was seated facing perpendicular to the direction of impact. Positions of impactor segments were adjusted for each subject so that forces applied to different anatomic regions, including thorax, abdomen, greater trochanter, iliac wing, and thigh, could be independently measured on each PMHS. The impactor contact surfaces were located in the same vertical plane, except that the abdomen plate was offset 5.1 cm towards the subject. The masses of the sleds and the force- deflection characteristics of the energy-absorbing interface material between the sleds were set to provide the impactor sled with a velocity profile that matched the average driver door velocity history produced in a series of side NCAP tests. Impactor padding was also selected so that average ATD pelvis and thorax responses from the same series of side NCAP tests were reproduced when the ATD used in these tests was impacted using the average door-velocity history. Each subject was first impacted on one side of the body using an initial impactor speed of 3 m/s. If a post-test CT scan and strain-gage data revealed two or fewer non-displaced rib fractures, then the PMHS was impacted on the contralateral side of the body at a speed of 8 m/s or 10 m/s. The results of tests in the 3 m/s and 8 m/s conditions were used to develop force-deflection response corridors for the abdomen, force history response corridors for the pelvis (iliac wing and greater trochanter), the midthigh, and the thorax. Response corridors for the lateral acceleration of the pelvis were also developed. Future work will compare side impact ATD

An individualized strategy to estimate the effect of deformable registration uncertainty on accumulated dose in the upper abdomen

NASA Astrophysics Data System (ADS)

Wang, Yibing; Petit, Steven F.; Vásquez Osorio, Eliana; Gupta, Vikas; Méndez Romero, Alejandra; Heijmen, Ben

2018-06-01

In the abdomen, it is challenging to assess the accuracy of deformable image registration (DIR) for individual patients, due to the lack of clear anatomical landmarks, which can hamper clinical applications that require high accuracy DIR, such as adaptive radiotherapy. In this study, we propose and evaluate a methodology for estimating the impact of uncertainties in DIR on calculated accumulated dose in the upper abdomen, in order to aid decision making in adaptive treatment approaches. Sixteen liver metastasis patients treated with SBRT were evaluated. Each patient had one planning and three daily treatment CT-scans. Each daily CT scan was deformably registered 132 times to the planning CT-scan, using a wide range of parameter settings for the registration algorithm. A subset of ‘realistic’ registrations was then objectively selected based on distances between mapped and target contours. The underlying 3D transformations of these registrations were used to assess the corresponding uncertainties in voxel positions, and delivered dose, with a focus on accumulated maximum doses in the hollow OARs, i.e. esophagus, stomach, and duodenum. The number of realistic registrations varied from 5 to 109, depending on the patient, emphasizing the need for individualized registration parameters. Considering for all patients the realistic registrations, the 99th percentile of the voxel position uncertainties was 5.6  ±  3.3 mm. This translated into a variation (difference between 1st and 99th percentile) in accumulated D max in hollow OARs of up to 3.3 Gy. For one patient a violation of the accumulated stomach dose outside the uncertainty band was detected. The observed variation in accumulated doses in the OARs related to registration uncertainty, emphasizes the need to investigate the impact of this uncertainty for any DIR algorithm prior to clinical use for dose accumulation. The proposed method for assessing on an individual patient basis the impact of

Abdomen Impact Testing of the Hybrid III Rail Safety (H3-RS) Anthropomorphic Test Device

DOT National Transportation Integrated Search

2017-09-01

The Hybrid III Rail Safety (H3-RS) anthropomorphic test device (ATD) is a crash test dummy that was developed in the UK to evaluate abdomen and lower thorax injuries that occur when passengers impact workstation tables during train accidents. The H3-...

Missile injuries of the abdomen in Zimbabwe-Rhodesia.

PubMed

Dent, R I; Jena, G P

1980-05-01

One hundred and thirteen patients with missile injuries of the abdomen were seen over a 3-year period at one hospital in Zimbabwe-Rhodesia. The details of these injuries and the results of their treatment are presented. Twenty-four patients died (21 per cent). Twenty of these patients had sustained high velocity missile injuries, 18 had damaged colons and 3 died from major vascular injuries before surgery. Excluding these last 3 patients, the mortality rate for high velocity wounds of the colon was 52 per cent and that for all other patients was 6 per cent (P less than 0.01). More than half the postoperative deaths were due to septicaemia. The importance is stressed is stressed of early and effective resuscitation, including appropriate antibiotic therapy and rapid evacuation to facilities for major surgery.

The acutely affected abdomen in paraplegic spinal cord injury patients.

PubMed Central

Neumayer, L A; Bull, D A; Mohr, J D; Putnam, C W

1990-01-01

The records of 145 paraplegic or quadriplegic patients were reviewed to identify those factors useful in the correct diagnosis of the acute abdomen in this population. Twenty-one patients had 22 episodes of acute or subacute abdominal problems. Presenting complaints, physical findings, and laboratory results were useful in various ways. However appropriate radiographic studies led to the correct diagnosis in 77% of patients. Although paraplegic and quadriplegic patients are predisposed to a distinct constellation of medical problems, including urinary tract infection and calculi, they also may present with other abdominal conditions that cause significant morbidity and mortality if not promptly recognized. PMID:2241311

Typhoid fever with severe abdominal pain: diagnosis and clinical findings using abdomen ultrasonogram, hematology-cell analysis and the Widal test.

PubMed

Arjunan, Maripandi; Al-Salamah, Ali A

2010-10-04

A six-year-old boy with high-grade fever and abdominal pain in the epigastric region was examined with ultrasonogram of the abdomen. Hematology-cell analysis, serology (Widal test), urine analysis, and blood cultures were also performed. The ultrasonogram was helpful for the identification of multiple organ involvement with Salmonella typhi. The results revealed mild hepatosplenomegaly, minimal ascitis, and mesenteric lympoadenopathy. Hematological analysis showed a white blood count of 6,300 cells mL-1; a red blood cell count of 4.54 million/cu mm. The erythrocyte sedimentation rate (ESR) was 24 mm/1 hr; hemoglobin level of 11.5 g/dl; and a platelet count of 206,000 cells/mL. The patient's serum was agglutinated with lipopolysaccharide (TO), the titre value was 1:320 dilution, and flagellar antigen (TH) titre was 1:640. The patient was diagnosed with typhoid fever. Ceftriaxone was given intravenously for five days and the patient fully recovered.

Estimation of organ and effective doses from newborn radiography of the chest and abdomen.

PubMed

Ma, Hillgan; Elbakri, Idris A; Reed, Martin

2013-09-01

Neonatal intensive care patients undergo frequent chest and abdomen radiographic imaging. In this study, the organ doses and the effective dose resulting from combined chest-abdomen radiography of the newborn child are determined. These values are calculated using the Monte Carlo simulation software PCXCM 2.0 and compared with direct dose measurements obtained from thermoluminescent detectors (TLDs) in a physical phantom. The effective dose obtained from PCXMC is 21.2 ± 0.7 μSv and that obtained from TLD measurements is 22.0 ± 0.5 μSv. While the two methods are in close agreement with regard to the effective dose, there is a wide range of variation in organ doses, ranging from 85 % difference for the testes to 1.4 % for the lungs. Large organ dose variations are attributed to organs at the edge of the field of view, or organs with large experimental error or simulation uncertainty. This study suggests that PCXMC can be used to estimate organ and effective doses for newborn patients.

A Case Report and Literature Review of Scrub Typhus With Acute Abdomen and Septic Shock in a Child-The Role of Leukocytoclastic Vasculitis and Granulysin.

PubMed

Chang, Po-Hsiung; Cheng, Yu-Pin; Chang, Po-Sheng; Lo, Chiao-Wei; Lin, Lung-Huang; Lu, Chin-Fang; Chung, Wen-Hung

2018-04-24

Scrub typhus is becoming a clinically important cause of acute undifferentiated febrile illness in Taiwan. The incubation period is between 6 and 21 days after exposure. It is transmitted by chiggers (larva of trombiculid mite) in long grasses and in dirt-floor homes, with infection characterized by a flu-like illness of fever, headache, and myalgia lasting approximately 1 week. It has various systemic manifestations, including GI symptoms. In some, the illness progresses to multiorgan dysfunction syndrome and death. We report on a 13-year-old boy who lived in Taipei City and who had initially tentative diagnosis of acute pyrexia of unknown origin with high fever up to 40.3°C for 1 week, but later had thrombocytopenia and diffuse abdominal pain with peritoneal sign suspected acute appendicitis. During the clinical course, septic shock and disseminated intravascular coagulopathy (DIC) were noted. There were skin rash in his trunk and extremities and an eschar with black crust surrounded by a scaling erythematous rim on his right buttock. In addition, we got the information of his travel history in Green Island and Orchid Island for 10 days.With the correct antibiotics, vancomycin, meropenem, and doxycycline, the patient was getting better and corresponding with high level of granulysin and tumor necrosis factor-alpha. The diagnosis of scrub typhus was confirmed by the biopsy of eschar and high quantitative real-time polymerase chain reaction values of Orientia tsutsugamushi (16sRNA and 56 kDa) tested by Centers for Disease Control and Prevention, Taiwan. Histopathological findings of the eschar revealed the leukocytoclastic vasculitis, crust and thrombus formation with many gram-negative microorganisms, O. tsutsugamushi demonstrated by 47 kDa monoclonal antibody immunohistochemical stain and electromicroscopy. After the careful selection of appropriate antibiotics including meropenem, vancomycin, and doxycycline, he recovered and was subsequently discharged 7 days

Simulated Online Adaptive MR-Guided SBRT for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages

PubMed Central

Henke, Lauren; Kashani, Rojano; Yang, Deshan; Zhao, Tianyu; Green, Olga; Olsen, Lindsey; Rodriguez, Vivian; Wooten, H. Omar; Li, H. Harold; Hu, Yanle; Bradley, Jeffrey; Robinson, Clifford; Parikh, Parag; Michalski, Jeff; Mutic, Sasa; Olsen, Jeffrey

2017-01-01

Purpose/Objectives Stereotactic body radiotherapy (SBRT) is increasingly used to treat oligometastatic or unresectable primary malignancy, although proximity of organs-at-risk (OAR) may limit delivery of sufficiently ablative dose. Magnetic resonance (MR)-based online-adaptive radiotherapy (ART) has potential to improve SBRT’s therapeutic ratio. This study characterizes potential advantages of online-adaptive MR-guided SBRT to treat oligometastatic disease of the non-liver abdomen and central thorax. Materials/Methods Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR-IGRT system. SBRT plans were created based on tumor/OAR anatomy at initial CT simulation (PI) and simulated adaptive plans were created based on observed MR-image set tumor/OAR “anatomy-of-the-day” (PA). Each PA was planned under workflow constraints to simulate online-ART. Prescribed dose was 50Gy/5fractions with goal coverage of 95% PTV by 95% of the prescription, subject to hard OAR constraints. PI was applied to each MR dataset and compared to PA to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Results Hard OAR constraints were met for all PI based on anatomy from initial CT simulation, and all PA based on anatomy from each daily MR-image set. Application of the PI to anatomy-of-the-day caused OAR constraint violation in 19/30 cases. Adaptive planning increased PTV coverage in 21/30 cases, including 14 cases where hard OAR constraints were violated by the non-adaptive plan. For 9 PA cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a non-adaptive setting. Conclusions Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared to non-adaptive SBRT. A prospective clinical trial is underway at our institution to evaluate

Zones of Adhesion of the Abdomen: Implications for Abdominoplasty.

PubMed

Taylor, D Alastair

2017-02-01

The elucidation of the superficial fascial system (SFS) by Lockwood in 1991 has been the cornerstone of our understanding of abdominal excisional dynamics for the last 25 years. The SFS can be used for closure and, appropriately mobilized, for tension transmission in abdominoplasty, and lower body lifts. The pattern of SFS adhesion to muscle fascia and the zones of adhesion was also described but there are inconsistencies between the description and clinical experience. This study was performed to better describe the pattern of subcutaneous tissue adhesion to the trunk. Twenty pre-abdominoplasty patients were studied. A series of points were marked around the trunk and the skin moved in four opposing directions. The excursions were measured and the median plotted on a diagram. Two fresh cadavers were also dissected, removing all subcutaneous tissue circumferentially from the trunk muscle fascia and marking the strength of the adhesion with a colored pin. Three grades of adhesion were mapped. In the current study, maximal laxity was shown in the mid-lower abdomen and the anterior and lateral chest. Laxity was limited in the anterior and posterior midlines, over the lower back, and the lateral upper thigh. The cadaver dissection mapped adhesion which correlated with the skin laxity diagram. The detailed skin adhesion map better explains features of surface anatomy. Incorporating this understanding a tension vector of abdominoplasty closure obliquely inwards is proposed to maximally harvest the laxity of the anterior and lateral chest and to create further lowering and narrowing of the waist. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

International consensus conference on open abdomen in trauma.

PubMed

Chiara, Osvaldo; Cimbanassi, Stefania; Biffl, Walter; Leppaniemi, Ari; Henry, Sharon; Scalea, Thomas M; Catena, Fausto; Ansaloni, Luca; Chieregato, Arturo; de Blasio, Elvio; Gambale, Giorgio; Gordini, Giovanni; Nardi, Guiseppe; Paldalino, Pietro; Gossetti, Francesco; Dionigi, Paolo; Noschese, Giuseppe; Tugnoli, Gregorio; Ribaldi, Sergio; Sgardello, Sebastian; Magnone, Stefano; Rausei, Stefano; Mariani, Anna; Mengoli, Francesca; di Saverio, Salomone; Castriconi, Maurizio; Coccolini, Federico; Negreanu, Joseph; Razzi, Salvatore; Coniglio, Carlo; Morelli, Francesco; Buonanno, Maurizio; Lippi, Monica; Trotta, Liliana; Volpi, Annalisa; Fattori, Luca; Zago, Mauro; de Rai, Paolo; Sammartano, Fabrizio; Manfredi, Roberto; Cingolani, Emiliano

2016-01-01

A part of damage-control laparotomy is to leave the fascial edges and the skin open to avoid abdominal compartment syndrome and allow further explorations. This condition, known as open abdomen (OA), although effective, is associated with severe complications. Our aim was to develop evidence-based recommendations to define indications for OA, techniques for temporary abdominal closure, management of enteric fistulas, and methods of definitive wall closure. The literature from 1990 to 2014 was systematically screened according to PRISMA [Preferred Reporting Items for Systematic Reviews and Meta-analyses] protocol. Seventy-six articles were reviewed by a panel of experts to assign grade of recommendations (GoR) and level of evidence (LoE) using the GRADE [Grading of Recommendations Assessment, Development, and Evaluation] system, and an international consensus conference was held. OA in trauma is indicated at the end of damage-control laparotomy, in the presence of visceral swelling, for a second look in vascular injuries or gross contamination, in the case of abdominal wall loss, and if medical treatment of abdominal compartment syndrome has failed (GoR B, LoE II). Negative-pressure wound therapy is the recommended temporary abdominal closure technique to drain peritoneal fluid, improve nursing, and prevent fascial retraction (GoR B, LoE I). Lack of OA closure within 8 days (GoR C, LoE II), bowel injuries, high-volume replacement, and use of polypropylene mesh over the bowel (GoR C, LoE I) are risk factors for frozen abdomen and fistula formation. Negative-pressure wound therapy allows to isolate the fistula and protect the surrounding tissues from spillage until granulation (GoR C, LoE II). Correction of fistula is performed after 6 months to 12 months. Definitive closure of OA has to be obtained early (GoR C, LoE I) with direct suture, traction devices, component separation with or without mesh. Biologic meshes are an option for wall reinforcement if bacterial

Abnormal /sup 67/Ga-citrate scan of the abdomen in tuberculous peritonitis: case report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steinbach, J.J.

1976-04-01

Tuberculous peritonitis in a 34-year-old alcoholic man was associated with an abnormal /sup 67/Ga-citrate scan of the abdomen. Repeated studies after thorough bowel cleansing revealed no change in the site and shape of the abnormality for 2 to 5 days after injection of the tracer. The inflammatory process may have been responsible for the abnormal scan. (auth)

The effect of preparation strategies, qualification and professional background on clinical nurse educator confidence.

PubMed

Nguyen, Van N B; Forbes, Helen; Mohebbi, Mohammadreza; Duke, Maxine

2018-06-12

To describe how clinical nurse educators in Vietnam are prepared for their role; to identify which preparation strategies assist development of confidence in clinical teaching; and to measure the effect of educational qualifications and professional background on perceived confidence levels. The quality of clinical teaching can directly affect the quality of the student learning experience. The role of the clinical educator is complex and dynamic and requires a period of adjustment for successful role transition to occur. Planned orientation and specific preparation programs assist transition and reduce anxiety for new clinical nurse educators. There is, however, a lack of clear evidence to identify the form this preparation should take or which strategies are likely to facilitate the development of role confidence. Descriptive survey study. Cross-sectional surveys were used to collect data from 334 clinical nurse educators during January - March 2015. Eight preparation methods commonly used in Vietnam were identified. There was a small yet significant association between preparation and clinical nurse educators' perceived confidence. Formal preparation methods, as well as postgraduate qualifications and years of clinical teaching experience were linked to increased confidence in clinical teaching. Conversely, informal mentorship was found to hinder confidence development. This study identifies several preparation strategies that significantly enhance clinical educator confidence and readiness for their complex role. These preparation strategies drawn from the Vietnamese context, provide important examples for the wider nursing community to consider. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

CT analysis of fat distribution superficial and deep to the Scarpa's fascial layer in the mid and lower abdomen.

PubMed

Harley, O J H; Pickford, M A

2013-04-01

Mismatches in the thickness of subcutaneous fat at the level of the umbilicus and suprapubic region can result in an unsightly bulge and an unfavourable result following standard abdominoplasty. This problem can be avoided by thinning the abdominoplasty flap. This study was carried out to assess the thickness of the subcutaneous fat layer at the level of the umbilicus and the supra-pubic region. Measurements of full thickness fat and the depth of Scarpa's fascia separating superficial and sub-Scarpa fat layers were taken from the CT scans in 69 women; mean age 52 years (range 30-79). The thickness of the skin and abdominal wall fat was an average of 7 mm thicker (max 22 mm; p < 0.05). The thickness of the fat layer superficial to Scarpa's fascia was an average of 19 mm at mid abdomen and 22 mm in the lower abdomen (p < 0.05). The thickness of the fat layer deep to Scarpa's fascia was 14 mm in the mid abdomen and 5 mm in the lower abdomen (p < 0.05). In 55% of patients the difference in thickness of the mid abdominal and lower abdominal fat was greater than 5 mm, a difference that could lead to a noticeable mismatch and therefore an unfavourable outcome. Results of this study suggest that selectively thinning the fat layer deep to Scarpa's fascia would address potential mismatches and preserve the Scarpa's fascia layer in more than 50% of cases, therefore allowing wounds to be closed with an effective deep tension layer. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Clinics in diagnostic imaging (171). Caecal volvulus with underlying intestinal malrotation.

PubMed

Ooi, Su Kai Gideon; Tan, Tien Jin; Ngu, James Chi Yong

2016-11-01

A 46-year-old Chinese woman with a history of cholecystectomy and appendicectomy presented to the emergency department with symptoms of intestinal obstruction. Physical examination revealed central abdominal tenderness but no clinical features of peritonism. Plain radiography of the abdomen revealed a grossly distended large bowel loop with the long axis extending from the right lower abdomen toward the epigastrium, and an intraluminal air-fluid level. These findings were suspicious for an acute caecal volvulus, which was confirmed on subsequent contrast-enhanced computed tomography (CT) of the abdomen and pelvis. CT demonstrated an abnormal positional relationship between the superior mesenteric vein and artery, indicative of an underlying intestinal malrotation. This case highlights the utility of preoperative imaging in establishing the diagnosis of an uncommon cause of bowel obstruction. It also shows the importance of recognising the characteristic imaging features early, so as to ensure appropriate and expedient management, thus reducing patient morbidity arising from complications. Copyright: © Singapore Medical Association.

Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST Open Abdomen registry.

PubMed

Bradley, Matthew J; Dubose, Joseph J; Scalea, Thomas M; Holcomb, John B; Shrestha, Binod; Okoye, Obi; Inaba, Kenji; Bee, Tiffany K; Fabian, Timothy C; Whelan, James F; Ivatury, Rao R

2013-10-01

Enterocutaneous fistula (ECF), enteroatmospheric fistula (EAF), and intra-abdominal sepsis/abscess (IAS) are major challenges for surgeons caring for patients undergoing damage control laparotomy after trauma. To determine independent predictors of ECF, EAF, or IAS in patients undergoing damage control laparotomy after trauma, using the AAST Open Abdomen Registry. The AAST Open Abdomen registry of patients with an open abdomen following damage control laparotomy was used to identify patients who developed ECF, EAF, or IAS and to compare these patients with those without these complications. Univariate analyses were performed to compare these groups of patients. Variables from univariate analyses differing at P < .20 were entered into a stepwise logistic regression model to identify independent risk factors for ECF, EAF, or IAS. Fourteen level I trauma centers. A total of 517 patients with an open abdomen following damage control laparotomy. Complication of ECF, EAF, or IAS. More patients in the ECF/EAF/IAS group than in the group without these complications underwent bowel resection (63 of 111 patients [57%] vs 133 of 406 patients [33%]; P < .001). Within the first 48 hours after surgery, the ECF/EAF/IAS group received more colloids (P < .03) and total fluids (P < .03) than did the group without these complications. The ECF/EAF/IAS group underwent almost twice as many abdominal reexplorations as did the group without these complications (mean [SD] number, 4.1 [4.1] vs 2.2 [3.4]; P < .001). After multivariate analysis, the independent predictors of ECF/EAF/IAS were a large bowel resection (adjusted odds ratio [AOR], 3.56 [95% CI, 1.88-6.76]; P < .001), a total fluid intake at 48 hours of between 5 and 10 L (AOR, 2.11 [95% CI, 1.15-3.88]; P = .02) or more than 10 L (AOR, 1.93 [95% CI, 1.04-3.57]; P = .04), and an increasing number of reexplorations (AOR, 1.14 [95% CI, 1.06-1.21]; P < .001). Large bowel resection, large-volume fluid

Using fresh tissue dissection to teach human anatomy in the clinical years.

PubMed

Robinson, Alan G; Metten, Shaleen; Guiton, Gretchen; Berek, Jonathan

2004-07-01

Gross anatomy is taught in medical school with textbooks, cadaver dissection, plastic models, and multimedia illustration, but all lack the reality of color and texture that is possible with fresh tissue dissection. The authors studied the use of fresh tissue dissection of the thorax and abdomen of the rat to teach human anatomy. In a half-day exercise, 52 fourth-year medical students paired off and completed an exercise to dissect in less than three hours the thorax and abdomen of a euthanized rat. Observation of organs was augmented by active manipulation such as passing a tube down the esophagus, cannulating the trachea and inflating the lungs, injecting dye in the kidney to trace the ureter and bladder, and pulling the testis through the inguinal canal. Comparison of the rat and human was emphasized to enhance the education. The exercise ended with practice suturing fresh tissue. Students rated the exercise to teach anatomy as 4.9 positive on a 5.0 (high) scale. The significant positive structures (p <.05) for texture were heart, liver, lungs and trachea; for color they were lungs and spleen; for location and size they were adrenal gland and urinary bladder; and for function they were adrenal gland and esophagus. Fresh tissue dissection of the thorax and abdomen of the rat is a valuable tool for human anatomy education. The dissonances in human and rat anatomy enhance abstraction and transfer of knowledge. Active manipulation of organs promotes retention of knowledge, and suturing provides a "clinical" context. Fresh tissue dissection is an efficient innovative method to provide a global review of anatomy of the thorax and abdomen during the busy clinical years of medical education.

Quadruple Inversion-Recovery b-SSFP MRA of the Abdomen: Initial Clinical Validation

PubMed Central

Atanasova, Iliyana P.; Lim, Ruth P.; Chandarana, Hersh; Storey, Pippa; Bruno, Mary T; Kim, Daniel; Lee, Vivian S.

2014-01-01

The purpose of this study is to assess the image quality and diagnostic accuracy of non-contrast quadruple inversion-recovery balanced-SSFP MRA (QIR MRA) for detection of aortoiliac disease in a clinical population. QIR MRA was performed in 26 patients referred for routine clinical gadolinium-enhanced MRA (Gd-MRA) for known or suspected aortoiliac disease. Non-contrast images were independently evaluated for image qualityand degree of stenosisby two radiologists, usingconsensus Gd-MRA as the reference standard. Hemodynamically significant stenosis (≥ 50%) was found in 10% (22/226) of all evaluable segments on Gd-MRA. The sensitivity and specificity for stenosis evaluation by QIR MRA for the two readers were 86%/86% and 95%/93% respectively. Negative predictive value and positive predictive value were 98%/98% and 63%/53% respectively. For stenosis evaluation of the aortoiliac region QIR MRA showed good agreement with the reference standard with high negative predictive value and a tendency to overestimate mild disease presumably due to the flow-dependence of the technique. QIR MRA could be a reasonable alternative to Gd-MRA for ruling out stenosis when contrast is contraindicated due to impaired kidney function or in patients who undergo abdominal MRA for screening purposes. Further work is necessary to improve performance and justify routine clinical use. PMID:24998363

Hematoma of the falciform ligament: a rare cause of acute abdomen.

PubMed

Sari, Serkan; Ersöz, Feyzullah; Güneş, Mehmet Emin; Paşaoğlu, Esra; Arikan, Soykan

2011-01-01

Hematoma or abscess of the liver ligaments is extremely rare, and hematoma of the falciform ligament has been sporadically reported. We report the case of a 70-year-old female who presented with a three-day history of right upper quadrant abdominal pain, fever and nausea. With a preoperative diagnosis of probable perforated acalculous cholecystitis, the patient underwent emergency surgery. Hematoma of the falciform ligament was found. Wide excision of the falciform ligament including the hematoma with abscess was performed. Although pathology of the falciform ligament is rare, it should be included in the differential diagnosis of acute abdomen, especially in the case of antiaggregant drug usage.

Abdomen disease diagnosis in CT images using flexiscale curvelet transform and improved genetic algorithm.

PubMed

Sethi, Gaurav; Saini, B S

2015-12-01

This paper presents an abdomen disease diagnostic system based on the flexi-scale curvelet transform, which uses different optimal scales for extracting features from computed tomography (CT) images. To optimize the scale of the flexi-scale curvelet transform, we propose an improved genetic algorithm. The conventional genetic algorithm assumes that fit parents will likely produce the healthiest offspring that leads to the least fit parents accumulating at the bottom of the population, reducing the fitness of subsequent populations and delaying the optimal solution search. In our improved genetic algorithm, combining the chromosomes of a low-fitness and a high-fitness individual increases the probability of producing high-fitness offspring. Thereby, all of the least fit parent chromosomes are combined with high fit parent to produce offspring for the next population. In this way, the leftover weak chromosomes cannot damage the fitness of subsequent populations. To further facilitate the search for the optimal solution, our improved genetic algorithm adopts modified elitism. The proposed method was applied to 120 CT abdominal images; 30 images each of normal subjects, cysts, tumors and stones. The features extracted by the flexi-scale curvelet transform were more discriminative than conventional methods, demonstrating the potential of our method as a diagnostic tool for abdomen diseases.

Quadruple inversion-recovery b-SSFP MRA of the abdomen: initial clinical validation.

PubMed

Atanasova, Iliyana P; Lim, Ruth P; Chandarana, Hersh; Storey, Pippa; Bruno, Mary T; Kim, Daniel; Lee, Vivian S

2014-09-01

The purpose of this study is to assess the image quality and diagnostic accuracy of non-contrast quadruple inversion-recovery balanced-SSFP MRA (QIR MRA) for detection of aortoiliac disease in a clinical population. QIR MRA was performed in 26 patients referred for routine clinical gadolinium-enhanced MRA (Gd-MRA) for known or suspected aortoiliac disease. Non-contrast images were independently evaluated for image quality and degree of stenosis by two radiologists, using consensus Gd-MRA as the reference standard. Hemodynamically significant stenosis (≥50%) was found in 10% (22/226) of all evaluable segments on Gd-MRA. The sensitivity and specificity for stenosis evaluation by QIR MRA for the two readers were 86%/86% and 95%/93% respectively. Negative predictive value and positive predictive value were 98%/98% and 63%/53% respectively. For stenosis evaluation of the aortoiliac region QIR MRA showed good agreement with the reference standard with high negative predictive value and a tendency to overestimate mild disease presumably due to the flow-dependence of the technique. QIR MRA could be a reasonable alternative to Gd-MRA for ruling out stenosis when contrast is contraindicated due to impaired kidney function or in patients who undergo abdominal MRA for screening purposes. Further work is necessary to improve performance and justify routine clinical use. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Ruptured Hemorrhagic Corpus Luteum Cyst in an Undescended Ovary: A Rare Cause of Acute Abdomen.

PubMed

Suh, Dong Soo; Han, Si Eun; Yun, Ka Yeong; Lee, Nam Kyung; Kim, Ki Hyung; Yoon, Man Soo

2016-02-01

Undescended ovaries are typically detected during infertility evaluations and are frequently associated with uterine malformations. Ruptured hemorrhagic corpus luteum cyst of an undescended ovary is an unusual cause of acute abdomen in an adolescent. A 15-year-old girl presented with right lower quadrant pain, nausea, and vomiting, and transabdominal sonography and magnetic resonance imaging of the pelvis showed a 10 cm × 5 cm sized cystic mass at the level of the pelvic brim, anterior to the psoas muscle suggestive of a retroperitoneal hemorrhagic cyst. At surgery, the uterus and left adnexa appeared normal, but the right ovary was not visible within the pelvic cavity, and the right pelvic retroperitoneum was distended. After opening the retroperitoneum and aspirating blood clots, the undescended ovary with a ruptured cyst was visualized within the retroperitoneum. Right ovarian wedge resection was performed and the right ovary was repositioned in the pelvic cavity. Rupture of a corpus luteum cyst in an undescended ovary should be included in the differential diagnosis of acute abdomen in adolescents. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen.

PubMed

Burlew, Clay Cothren; Moore, Ernest E; Cuschieri, Joseph; Jurkovich, Gregory J; Codner, Panna; Crowell, Kody; Nirula, Ram; Haan, James; Rowell, Susan E; Kato, Catherine M; MacNew, Heather; Ochsner, M Gage; Harrison, Paul B; Fusco, Cynthia; Sauaia, Angela; Kaups, Krista L

2011-02-01

Use of damage control surgery techniques has reduced mortality in critically injured patients but at the cost of the open abdomen. With the option of delayed definitive management of enteric injuries, the question of intestinal repair/anastomosis or definitive stoma creation has been posed with no clear consensus. The purpose of this study was to determine outcomes on the basis of management of enteric injuries in patients relegated to the postinjury open abdomen. Patients requiring an open abdomen after trauma from January 1, 2002 to December 31, 2007 were reviewed. Type of bowel repair was categorized as immediate repair, immediate anastomosis, delayed anastomosis, stoma and a combination. Logistic regression was used to determine independent effect of risk factors on leak development. During the 6-year study period, 204 patients suffered enteric injuries and were managed with an open abdomen. The majority was men (77%) sustaining blunt trauma (66%) with a mean age of 37.1 years±1.2 years and median Injury Severity Score of 27 (interquartile range=20-41). Injury patterns included 81 (40%) small bowel, 37 (18%) colonic, and 86 (42%) combined injuries. Enteric injuries were managed with immediate repair (58), immediate anastomosis (15), delayed anastomosis (96), stoma (10), and a combination (22); three patients died before definitive repair. Sixty-one patients suffered intra-abdominal complications: 35 (17%) abscesses, 15 (7%) leaks, and 11 (5%) enterocutaneous fistulas. The majority of patients with leaks had a delayed anastomosis; one patient had a right colon repair. Leak rate increased as one progresses toward the left colon (small bowel anastomoses, 3% leak rate; right colon, 3%; transverse colon, 20%; left colon, 45%). There were no differences in emergency department physiology, injury severity, transfusions, crystalloids, or demographic characteristics between patients with and without leak. Leak cases had higher 12-hour heart rate (148 vs. 125, p=0

The deceased organ donor with an "open abdomen": proceed with caution.

PubMed

Watkins, A C; Vedula, G V; Horan, J; Dellicarpini, K; Pak, S-W; Daly, T; Samstein, B; Kato, T; Emond, J C; Guarrera, J V

2012-06-01

In solid organ transplantation, the disparity between donor supply and patients awaiting transplant continues to increase. The organ shortage has led to relaxation of historic contraindications to organ donation. A large percentage of deceased organ donors have been subjected to traumatic injuries, which can often result in intervention that leads to abdominal packing and intensive care unit resuscitation. The donor with this "open abdomen" (OA) presents a situation in which the risk of organ utilization is difficult to quantify. There exists a concern for the potential of a higher risk for both bacterial and fungal infections, including multidrug-resistant (MDR) pathogens because of the prevalence of antibiotic use and critical illness in this population. No recommendations have been established for utilization of organs from these OA donors, because data are limited. Herein, we report a case of a 21-year-old donor who had sustained a gunshot wound to his abdomen, resulting in a damage-control laparotomy and abdominal packing. The donor subsequently suffered brain death, and the family consented to organ donation. A multiorgan procurement was performed with respective transplantation of the procured organs (heart, liver, and both kidneys) into 4 separate recipients. Peritoneal swab cultures performed at the time of organ recovery grew out MDR Pseudomonas aeruginosa on the day after procurement, subsequently followed by positive blood and sputum cultures as well. All 4 transplant recipients subsequently developed infections with MDR P. aeruginosa, which appeared to be donor-derived with similar resistance patterns. Appropriate antibiotic coverage was initiated in all of the patients. Although 2 of the recipients died, mortality did not appear to be clearly associated with the donor-derived infections. This case illustrates the potential infectious risk associated with organs from donors with an OA, and suggests that aggressive surveillance for occult infections

The gap gene giant of Rhodnius prolixus is maternally expressed and required for proper head and abdomen formation.

PubMed

Lavore, Andrés; Pagola, Lucía; Esponda-Behrens, Natalia; Rivera-Pomar, Rolando

2012-01-01

The segmentation process in insects depends on a hierarchical cascade of gene activity. The first effectors downstream of the maternal activation are the gap genes, which divide the embryo in broad fields. We discovered a sequence corresponding to the leucine-zipper domain of the orthologue of the gene giant (Rp-gt) in traces from the genome of Rhodnius prolixus, a hemipteran with intermediate germ-band development. We cloned the Rp-gt gene from a normalized cDNA library and characterized its expression and function. Bioinformatic analysis of 12.5 kbp of genomic sequence containing the Rp-gt transcriptional unit shows a cluster of bona fide regulatory binding sites, which is similar in location and structure to the predicted posterior expression domain of the Drosophila orthologue. Rp-gt is expressed in ovaries and maternally supplied in the early embryo. The maternal contribution forms a gradient of scattered patches of mRNA in the preblastoderm embryo. Zygotic Rp-gt is expressed in two domains that after germ band extension are restricted to the head and the posterior growth zone. Parental RNAi shows that Rp-gt is required for proper head and abdomen formation. The head lacks mandibulary and maxillary appendages and shows reduced clypeus-labrum, while the abdomen lacks anterior segments. We conclude that Rp-gt is a gap gene on the head and abdomen and, in addition, has a function in patterning the anterior head capsule suggesting that the function of gt in hemipterans is more similar to dipterans than expected. Copyright © 2011. Published by Elsevier Inc.

Dose to organs at risk in the upper abdomen in patients treated with extended fields by helical tomotherapy: a dosimetric and clinical preliminary study.

PubMed

Bresciani, Sara; Garibaldi, Elisabetta; Cattari, Gabriella; Maggio, Angelo; Di Dia, Amalia; Delmastro, Elena; Gabriele, Domenico; Stasi, Michele; Gabriele, Pietro

2013-10-25

The aim of this work was to determine the technical feasibility and safety of extended-field radiotherapy (EF), performed by Helical TomoTherapy, in patients with positive pelvic and/or para-aortic nodes. Dosimetric data were collected and acute and sub-acute toxicities of the upper abdominal organs at risk (OAR) were evaluated. Twenty-nine patients suitable for EF irradiation for local disease and/or nodal disease in the pelvic or para-aortic area were treated. The prescription dose was 50.4/54 Gy (1.7-1.8 Gy/fraction) for prophylactic lymph nodes (N-) and 60-70.5 Gy (2-2.35 Gy/fraction) for clinically evident gross disease (N+). Modulation factor (MF), pitch and field width (FW) were chosen to optimize dose distribution and treatment duration. Dose values of PTVs and OAR were analysed. The length of the treatment field, the N + and N- volumes, and treatment duration were reported. To evaluate the safety of treatment, haematological, hepatic, renal and pancreatic functions were assessed before, during and after treatment. The median follow-up time was 17.6 months (range: 6-22 months). The treatment was well tolerated and all patients but one completed treatment without interruption. Four of the 29 patients experienced G3 haematological acute toxicity (13.8%), but no patient experienced sub-acute grade G3 toxicity. Ten patients experienced G1 and three G2 acute gastrointestinal toxicity (nausea). No sub-acute gastrointestinal or renal toxicity was observed. Only one (3.7%) patient had a persistent slight increase of pancreatic enzymes and two (7.4%) patients a slight increase of hepatic enzymes six months after radiotherapy (G1 toxicity). With our treatment design and dose regimen, we found that EF treatment by TomoTherapy could be safely and effectively delivered with minimal acute and sub-acute toxicities in the upper abdomen area.

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, Fei, E-mail: feisun@ccmijesususon.com; Crisóstomo, Verónica, E-mail: crisosto@ccmijesususon.com; Báez-Díaz, Claudia, E-mail: cbaez@ccmijesususon.com

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance.more » BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.« less

Prostatic Artery Embolization (PAE) for Symptomatic Benign Prostatic Hyperplasia (BPH): Part 1, Pathological Background and Clinical Implications.

PubMed

Sun, Fei; Crisóstomo, Verónica; Báez-Díaz, Claudia; Sánchez, Francisco M

2016-01-01

Pathological features of benign prostatic hyperplasia (BPH) dictate various responses to prostatic artery embolization (PAE). Typically, BPH originates in the transition zone and periurethral region, where should be considered the primary target area in PAE procedures. Given that histological heterogeneity of components in hyperplasia nodules, epithelial or stromal, identifying the more responsive nodules to PAE will have clinical implications. Since some lower urinary tract symptoms (LUTS) in patients with BPH are usually related to bladder outlet obstruction-induced changes in bladder function rather than to outflow obstruction directly, proper selection of candidate patients prior to PAE is of great clinical importance. BPH is a typical chronic progressive condition, suggesting PAE could aim not only to relieve LUTS but also to delay or prevent the clinical progression. Awareness of the pathological background of BPH is essential for interventional radiologists to improve clinical outcomes and develop new treatment strategies in clinical practice of PAE.

Adaptive iterative dose reduction (AIDR) 3D in low dose CT abdomen-pelvis: Effects on image quality and radiation exposure

NASA Astrophysics Data System (ADS)

Ang, W. C.; Hashim, S.; Karim, M. K. A.; Bahruddin, N. A.; Salehhon, N.; Musa, Y.

2017-05-01

The widespread use of computed tomography (CT) has increased the medical radiation exposure and cancer risk. We aimed to evaluate the impact of AIDR 3D in CT abdomen-pelvic examinations based on image quality and radiation dose in low dose (LD) setting compared to standard dose (STD) with filtered back projection (FBP) reconstruction. We retrospectively reviewed the images of 40 patients who underwent CT abdomen-pelvic using a 80 slice CT scanner. Group 1 patients (n=20, mean age 41 ± 17 years) were performed at LD with AIDR 3D reconstruction and Group 2 patients (n=20, mean age 52 ± 21 years) were scanned with STD using FBP reconstruction. Objective image noise was assessed by region of interest (ROI) measurements in the liver and aorta as standard deviation (SD) of the attenuation value (Hounsfield Unit, HU) while subjective image quality was evaluated by two radiologists. Statistical analysis was used to compare the scan length, CT dose index volume (CTDIvol) and image quality of both patient groups. Although both groups have similar mean scan length, the CTDIvol significantly decreased by 38% in LD CT compared to STD CT (p<0.05). Objective and subjective image quality were statistically improved with AIDR 3D (p<0.05). In conclusion, AIDR 3D enables significant dose reduction of 38% with superior image quality in LD CT abdomen-pelvis.

Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management

PubMed Central

Chabot, Elizabeth; Nirula, Ram

2017-01-01

The term “open abdomen” refers to a surgically created defect in the abdominal wall that exposes abdominal viscera. Leaving an abdominal cavity temporarily open has been well described for several indications, including damage control surgery and abdominal compartment syndrome. Although beneficial in certain patients, the act of keeping an abdominal cavity open has physiologic repercussions that must be recognized and managed during postoperative care. This review article describes these issues and provides guidelines for the critical care physician managing a patient with an open abdomen. PMID:29766080

[Diverticulosis of the colon end its complications under the mask of emergency surgical abdomen--10 years experience].

PubMed

Jaramov, N; Sokolov, M; Angelov, K; Toshev, S; Petrov, B

2009-01-01

estimating the prevalence of colonic diverticulosis and its complications studied at the clinic for 10-years period as well as the approaches for its operative treatment and analysis of the subsequent results. CASES AND APPROACHES: During the period 1998-2008 56 patients were hospitalized (31 women and 25 men) at the Surgical department of the University hospital "Alexandrovska". They had different forms of colonic diverticulosis. The average age of the patients was 66.7. The retrospective analysis divides the patients into three clinical groups: 1st group--peritonitis and pericolic abscess caused by diverticulosis--present in 49 patients. 2nd group--chronic non-specific inflammatory infiltrate and fistula--present in 5 patients. 3rd group--severe haemorrhage and anaemic syndrome--present in 2 patients Mortality-rate is 12.5% (7 patients). 10 patients with complications were registered--5 with suppuration of the surgical wound and 5 with pneumonia and pleural effusion. Colonic diverticulosis is a disease of great surgical interest because of its complicated forms requiring conventional or surgical treatment. Various forms of peritonitis which are part of the emergency surgical abdomen domain are relatively frequent complication of the gastrointestinal (in particular of the colon) diverticulosis. They are difficult to diagnose in the pre-operative period and its not easy to take a decision about the particular operative approach. All that is related with the relatively high morbidity and mortality.

Simulated Online Adaptive Magnetic Resonance–Guided Stereotactic Body Radiation Therapy for the Treatment of Oligometastatic Disease of the Abdomen and Central Thorax: Characterization of Potential Advantages

DOE Office of Scientific and Technical Information (OSTI.GOV)

Henke, Lauren; Kashani, Rojano; Yang, Deshan

Purpose: To characterize potential advantages of online-adaptive magnetic resonance (MR)-guided stereotactic body radiation therapy (SBRT) to treat oligometastatic disease of the non-liver abdomen and central thorax. Methods and Materials: Ten patients treated with RT for unresectable primary or oligometastatic disease of the non-liver abdomen (n=5) or central thorax (n=5) underwent imaging throughout treatment on a clinical MR image guided RT system. The SBRT plans were created on the basis of tumor/organ at risk (OAR) anatomy at initial computed tomography simulation (P{sub I}), and simulated adaptive plans were created on the basis of observed MR image set tumor/OAR “anatomy of the day”more » (P{sub A}). Each P{sub A} was planned under workflow constraints to simulate online-adaptive RT. Prescribed dose was 50 Gy/5 fractions, with goal coverage of 95% planning target volume (PTV) by 95% of the prescription, subject to hard OAR constraints. The P{sub I} was applied to each MR dataset and compared with P{sub A} to evaluate changes in dose delivered to tumor/OARs, with dose escalation when possible. Results: Hard OAR constraints were met for all P{sub Is} based on anatomy from initial computed tomography simulation, and all P{sub As} based on anatomy from each daily MR image set. Application of the P{sub I} to anatomy of the day caused OAR constraint violation in 19 of 30 cases. Adaptive planning increased PTV coverage in 21 of 30 cases, including 14 cases in which hard OAR constraints were violated by the nonadaptive plan. For 9 P{sub A} cases, decreased PTV coverage was required to meet hard OAR constraints that would have been violated in a nonadaptive setting. Conclusions: Online-adaptive MRI-guided SBRT may allow PTV dose escalation and/or simultaneous OAR sparing compared with nonadaptive SBRT. A prospective clinical trial is underway at our institution to evaluate clinical outcomes of this technique.« less

Deflection measurement system for the hybrid iii six-year-old biofidelic abdomen.

PubMed

Gregory, T Stan; Howes, Meghan K; Rouhana, Stephen W; Hardy, Warren N

2012-01-01

Motor vehicle collisions are the leading cause of death for children ages 5 to 14. Enhancement of child occupant protection is partly dependent on the ability to accurately assess the interaction of child-size occupants with restraint systems. Booster seat design and belt fit are evaluated using child anthropomorphic test devices, such as the Hybrid III 6-year-old dummy., A biofidelic abdomen for the Hybrid III 6-year-old dummy is being developed by the Ford Motor Company to enhance the dummy’s ability to assess injury risk and further quantify submarining risk by measuring abdominal deflection. A practical measurement system for the biofidelic abdominal insert has been developed and demonstrated for three dimensional determination of abdominal deflection. Quantification of insert deflection is achieved via differential signal measurement using electrodes mounted within a conductive medium. Signal amplitude is proportional to the distance between the electrodes. A microcontroller is used to calculate distances between ventral electrodes and a dorsal electrode in three dimensions. This system has been calibrated statically, and its performance demonstrated in a series of sled tests. Deflection measurements from the instrumented abdominal insert indicate performance differences between two booster seat designs, yielding an average peak anterior to posterior displacement of the abdomen of 1.0 ± 3.4 mm and 31.2 ± 7.2 mm for the seats, respectively. Implementation of a 6-year-old abdominal insert with the ability to evaluate submarining potential will likely help safety researchers further enhance booster seat design and interaction with vehicle restraint systems , and help to further understand child occupant injury risk in automobile collisions.

Identification of Avian and Hemoparasite DNA in Blood-Engorged Abdomens of Culex pipiens (Diptera; Culicidae) from a West Nile Virus Epidemic region in Suburban Chicago, Illinois.

PubMed

Boothe, Emily; Medeiros, Matthew C I; Kitron, Uriel D; Brawn, Jeffrey D; Ruiz, Marilyn O; Goldberg, Tony L; Walker, Edward D; Hamer, Gabriel L

2015-05-01

Multiple mosquito-borne parasites cocirculate in nature and potentially interact. To understand the community of parasites cocirculating with West Nile virus (WNV), we screened the bloodmeal content of Culex pipiens L. mosquitoes for three common types of hemoparasites. Blood-fed Cx. pipiens were collected from a WNV-epidemic area in suburban Chicago, IL, from May to September 2005 through 2010. DNA was extracted from dissected abdomens and subject to PCR and direct sequencing to identify the vertebrate host. RNA was extracted from the head or thorax and screened for WNV using quantitative reverse transcriptase PCR. Seventy-nine engorged females with avian host origin were screened using PCR and amplicon sequencing for filarioid nematodes, Haemosporida, and trypanosomatids. Filarioid nematodes were identified in 3.8% of the blooded abdomens, Plasmodium sp. in 8.9%, Haemoproteus in 31.6%, and Trypanosoma sp. in 6.3%. The sequences from these hemoparasite lineages were highly similar to sequences from birds in prior studies in suburban Chicago. Overall, 50.6% of blood-fed Culex pipiens contained hemoparasite DNA in their abdomen, presumably from current or prior bloodmeals. Additionally, we detected hemoparasite DNA in the blooded abdomen of three of 10 Cx. pipiens infected with WNV. © The Authors 2015. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications.

PubMed

Willms, A; Muysoms, F; Güsgen, C; Schwab, R; Lock, J; Schaaf, S; Germer, C; Richardsen, I; Dietz, U

2017-04-01

Open abdomen management has become a well-established strategy in the treatment of serious intra-abdominal pathologies. Key objectives are fistula prevention and high fascial closure rates. The current level of evidence on laparostoma is insufficient. This is due to the rareness of laparostomas, the heterogeneity of study cohorts, and broad diversity of techniques. Collecting data in a standardised, multicentre registry is necessary to draw up evidence-based guidelines. In order to improve the level of evidence on laparostomy, CAMIN (surgical working group for military and emergency surgery) of DGAV (German Society for General and Visceral Surgery), initiated the implementation of a laparostomy registry. This registry was established as the Open Abdomen Route by EuraHS (European Registry of Abdominal Wall Hernias). Key objectives include collection of data, quality assurance, standardisation of therapeutic concepts and the development of guidelines. Since 1 May 2015, the registry is available as an online database called Open Abdomen Route of EuraHS (European Registry of Abdominal Wall Hernias). It includes 11 categories for data collection, including three scheduled follow-up examinations. As part of this pilot study, all entries of the first 120 days were analysed, resulting in a review of 82 patients. At 44%, secondary peritonitis was the predominant indication. The mortality rate was 22%. A comparison of methods with and without fascial traction reveals fascial closure rates of 67% and 25%, respectively (intention-to-treat analysis, p < 0.03). Inert visceral protection was used in 67% of patients and achieved a small bowel fistula incidence of only 5.5%. Optimising laparostomy management techniques in order to achieve low incidence of fistulation and high fascial closure rates is possible. The method that ensures the best possible outcome-based on current evidence-would involve fascial traction, visceral protection and negative pressure. The laparostomy

Genetic, Clinical, and Pathologic Backgrounds of Patients with Autosomal Dominant Alport Syndrome.

PubMed

Kamiyoshi, Naohiro; Nozu, Kandai; Fu, Xue Jun; Morisada, Naoya; Nozu, Yoshimi; Ye, Ming Juan; Imafuku, Aya; Miura, Kenichiro; Yamamura, Tomohiko; Minamikawa, Shogo; Shono, Akemi; Ninchoji, Takeshi; Morioka, Ichiro; Nakanishi, Koichi; Yoshikawa, Norishige; Kaito, Hiroshi; Iijima, Kazumoto

2016-08-08

Alport syndrome comprises a group of inherited heterogeneous disorders involving CKD, hearing loss, and ocular abnormalities. Autosomal dominant Alport syndrome caused by heterozygous mutations in collagen 4A3 and/or collagen 4A4 accounts for <5% of patients. However, the clinical, genetic, and pathologic backgrounds of patients with autosomal dominant Alport syndrome remain unclear. We conducted a retrospective analysis of 25 patients with genetically proven autosomal dominant Alport syndrome and their family members (a total of 72 patients) from 16 unrelated families. Patients with suspected Alport syndrome after pathologic examination who were referred from anywhere in Japan for genetic analysis from 2006 to 2015 were included in this study. Clinical, laboratory, and pathologic data were collected from medical records at the point of registration for genetic diagnosis. Genetic analysis was performed by targeted resequencing of 27 podocyte-related genes, including Alport-related collagen genes, to make a diagnosis of autosomal dominant Alport syndrome and identify modifier genes or double mutations. Clinical data were obtained from medical records. The median renal survival time was 70 years, and the median age at first detection of proteinuria was 17 years old. There was one patient with hearing loss and one patient with ocular lesion. Among 16 patients who underwent kidney biopsy, three showed FSGS, and seven showed thinning without lamellation of the glomerular basement membrane. Five of 13 detected mutations were reported to be causative mutations for autosomal recessive Alport syndrome in previous studies. Two families possessed double mutations in both collagen 4A3 and collagen 4A4, but no modifier genes were detected among the other podocyte-related genes. The renal phenotype of autosomal dominant Alport syndrome was much milder than that of autosomal recessive Alport syndrome or X-linked Alport syndrome in men. It may, thus, be difficult to make an

Deflection corridors of abdomen and thorax in oblique side impacts using equal stress equal velocity approach: comparison with other normalization methods.

PubMed

Yoganandan, Narayan; Arun, Mike W J; Humm, John; Pintar, Frank A

2014-10-01

The first objective of the study was to determine the thorax and abdomen deflection time corridors using the equal stress equal velocity approach from oblique side impact sled tests with postmortem human surrogates fitted with chestbands. The second purpose of the study was to generate deflection time corridors using impulse momentum methods and determine which of these methods best suits the data. An anthropometry-specific load wall was used. Individual surrogate responses were normalized to standard midsize male anthropometry. Corridors from the equal stress equal velocity approach were very similar to those from impulse momentum methods, thus either method can be used for this data. Present mean and plus/minus one standard deviation abdomen and thorax deflection time corridors can be used to evaluate dummies and validate complex human body finite element models.

Illness Perception and Clinical Treatment Experiences in Patients with M. Maroteaux-Lamy (Mucopolysaccharidosis Type VI) and a Turkish Migration Background in Germany

PubMed Central

Dilger, Hansjörg; Leissner, Linn; Bosanska, Lenka; Lampe, Christina; Plöckinger, Ursula

2013-01-01

Introduction Mucopolysaccharidosis VI (MPS VI) is an inherited lysosomal storage disease caused by a mutation of the gene for arylsulfatase B (ASB). Of the thirty-one patients registered in Germany, almost fifty percent have a Turkish migration background. MPS VI is treated by enzyme replacement therapy (ERT), which is time-consuming and expensive. Methods This interdisciplinary study explored the illness perceptions and clinical treatment experiences among ten MPS VI patients with a Turkish migration background in two centers for metabolic diseases (Berlin and Mainz, Germany). The clinical treatment situation was observed and semi-structured interviews were conducted with patients and health care personnel, in addition to participatory observation in four patients' everyday environments in Berlin. The data from the interviews, patient records, and personal field notes were encoded, cross-related, and analyzed. Results Patients' acknowledgement of the disease and coping strategies are influenced predominantly by the perception of their individual health status and the handling of the disease within their family. Patients' willingness to cooperate with treatment strategies is further modified by their knowledge of the disease and the relationships with their health care providers. In this analysis, cultural factors turned out to be marginally relevant. Conclusion As with other chronic and debilitating diseases, effective treatment strategies have to reach beyond delivering medication. Health care providers need to strengthen the support for patients with a migration background. In this regard, they should respect the patients' cultural and social background and their personal perception of the disease and the therapy. Yet structural and social aspects (clinical setting, family and educational background) may be more crucial here than “cultural barriers.” PMID:23826140

Cost effectiveness of the addition of a comprehensive CT scan to the abdomen and pelvis for the detection of cancer after unprovoked venous thromboembolism.

PubMed

Coyle, Kathryn; Carrier, Marc; Lazo-Langner, Alejandro; Shivakumar, Sudeep; Zarychanski, Ryan; Tagalakis, Vicky; Solymoss, Susan; Routhier, Nathalie; Douketis, James; Coyle, Douglas

2017-03-01

Unprovoked venous thromboembolism (VTE) can be the first manifestation of cancer. It is unclear if extensive screening for occult cancer including a comprehensive computed tomography (CT) scan of the abdomen/pelvis is cost-effective in this patient population. To assess the health care related costs, number of missed cancer cases and health related utility values of a limited screening strategy with and without the addition of a comprehensive CT scan of the abdomen/pelvis and to identify to what extent testing should be done in these circumstances to allow early detection of occult cancers. Cost effectiveness analysis using data that was collected alongside the SOME randomized controlled trial which compared an extensive occult cancer screening including a CT of the abdomen/pelvis to a more limited screening strategy in patients with a first unprovoked VTE, was used for the current analyses. Analyses were conducted with a one-year time horizon from a Canadian health care perspective. Primary analysis was based on complete cases, with sensitivity analysis using appropriate multiple imputation methods to account for missing data. Data from a total of 854 patients with a first unprovoked VTE were included in these analyses. The addition of a comprehensive CT scan was associated with higher costs ($551 CDN) with no improvement in utility values or number of missed cancers. Results were consistent when adopting multiple imputation methods. The addition of a comprehensive CT scan of the abdomen/pelvis for the screening of occult cancer in patients with unprovoked VTE is not cost effective, as it is both more costly and not more effective in detecting occult cancer. Copyright © 2017 Elsevier Ltd. All rights reserved.

[Successful treatment of hyperthyroidism simulating acute abdomen and psychosis].

PubMed

Kósa, D; Patakfalvi, A; Györi, L

1992-07-19

A 49 years old female patient entered the surgical department because of epigastric and ileocoecal pains with the symptoms of acute abdomen. A surgical intervention was performed because of supposed appendicitis, but it was not verified. During the surgical observation the patient was confused and negativistic so she was transferred to the psychiatric department. Because of loss of 20 kg weight, high blood sedimentation and anaemia she was sent to our department with the suspicion of an organic disease. A moderate exophthalmos, glittering eyes and Graefe's sign was noted, therefore hyperthyroidism was diagnosed, which was proved by Kocher's blood picture, low serum cholesterol, extremely high T3 and T4 level, and iodine storage diagram. The antithyreotic treatment resulted a dramatic improvement in the extremely serious moreover hopeless case and after a long-term treatment the patient became symptom-free without complaints. Later because of regression of hyperthyreoidism and the growing nodular goitre the patient was treated on two occasions with radioactive iodine. At present the patient is in remission.

MO-B-BRB-01: 3D Dosimetry in the Clinic: Background and Motivation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schreiner, L.

Full three-dimensional (3D) dosimetry using volumetric chemical dosimeters probed by 3D imaging systems has long been a promising technique for the radiation therapy clinic, since it provides a unique methodology for dose measurements in the volume irradiated using complex conformal delivery techniques such as IMRT and VMAT. To date true 3D dosimetry is still not widely practiced in the community; it has been confined to centres of specialized expertise especially for quality assurance or commissioning roles where other dosimetry techniques are difficult to implement. The potential for improved clinical applicability has been advanced considerably in the last decade by themore » development of improved 3D dosimeters (e.g., radiochromic plastics, radiochromic gel dosimeters and normoxic polymer gel systems) and by improved readout protocols using optical computed tomography or magnetic resonance imaging. In this session, established users of some current 3D chemical dosimeters will briefly review the current status of 3D dosimetry, describe several dosimeters and their appropriate imaging for dose readout, present workflow procedures required for good dosimetry, and analyze some limitations for applications in select settings. We will review the application of 3D dosimetry to various clinical situations describing how 3D approaches can complement other dose delivery validation approaches already available in the clinic. The applications presented will be selected to inform attendees of the unique features provided by full 3D techniques. Learning Objectives: L. John Schreiner: Background and Motivation Understand recent developments enabling clinically practical 3D dosimetry, Appreciate 3D dosimetry workflow and dosimetry procedures, and Observe select examples from the clinic. Sofie Ceberg: Application to dynamic radiotherapy Observe full dosimetry under dynamic radiotherapy during respiratory motion, and Understand how the measurement of high resolution dose data

Drug-related disorders and the criminal and clinical background of the prison population of São Paulo State, Brazil.

PubMed

Mendes dos Santos, Maíra; Quintana, Maria Ines; Moreira, Fernanda Gonçalves; Taborda, José Geraldo Vernet; Mari, Jair de Jesus; Andreoli, Sérgio Baxter

2014-01-01

To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison populations.

Drug-Related Disorders and the Criminal and Clinical Background of the Prison Population of São Paulo State, Brazil

PubMed Central

dos Santos, Maíra Mendes; Quintana, Maria Ines; Moreira, Fernanda Gonçalves; Taborda, José Geraldo Vernet; Mari, Jair de Jesus; Andreoli, Sérgio Baxter

2014-01-01

Objective To analyze the association between drug (DAD) and alcohol (AAD) abuse and dependency and criminal and clinical background by gender of prisoners in São Paulo, Brazil. Method Cross-sectional study, random sample stratified by administrative district, from which prisons and prisoners were selected via random, multistage sampling. Psychiatric diagnoses were made with the CIDI 2.1. Lifetime prevalence and 95% CI were calculated and adjusted via analysis of complex samples. Multinomial logistic regression analysis was carried out with four categories of dependent variables: presence AAD; presence DAD; presence of another mental disorder; no mental disorders. For female alcohol and drug abuse and dependency (ADAD) were combined into a single category. Results The sample was composed by 1809 interviewed prisoners (1192 men and 617 women). Prevalence of DAD and AAD was 25.2% and 15.6%, respectively, among female prisoners, and 26.5% and 18.5% among males. Male prisoners with DAD were more likely to have a criminal record as an adolescent (OR 2.17), to be a repeat offender (OR 2.85), and to have committed a property crime (OR 2.18). Prisoners with AAD were repeat offenders (OR 2.18). Among female prisoners, ADAD was associated with repeat offenses (OR 3.39), a criminal record as an adolescent (OR 9.24), a clinical or infectious condition (OR 5.09), another health problem (OR 3.04), and violent crime (OR 2.5). Conclusion The study confirmed an association between drug-use disorders and the criminal and clinical background in the study population. Prisoners with such disorders were more likely to be repeat offenders and to have a criminal record as adolescents. Among female prisoners disorders were also associated with violent crime and health problems, while among males they were associated with property crime. These patterns in clinical and criminal backgrounds illustrate the need for social rehabilitation programs and specific medical treatment for prison

Exenatide Once-Weekly Clinical Development: Safety and Efficacy Across a Range of Background Therapies

PubMed Central

Stonehouse, Anthony; Walsh, Brandon

2011-01-01

Abstract In patients with type 2 diabetes mellitus (T2DM), the physiologic glucagon-like peptide-1 (GLP-1) response, which is involved in glucose regulation through several mechanisms, is dysfunctional. GLP-1 receptor agonists can fill an unmet therapeutic need in the treatment of T2DM: improving glycemic control without increasing the risk of hypoglycemia (except with concomitant sulfonylureas) and reducing weight in a substantial proportion of patients. GLP-1 receptor agonists have impacted established disease treatment algorithms for T2DM. For example, in 2009 the American Diabetes Association and European Association for the Study of Diabetes revised their consensus treatment algorithm to incorporate GLP-1 receptor agonists. GLP-1 receptor agonists were originally represented by exenatide BID (ExBID), a short-acting agent requiring twice-daily injections at mealtime. The longer-acting agent liraglutide, requiring once-daily injections, recently received regulatory approval. Several other long-acting agents are in clinical development, one of which is the once-weekly formulation of exenatide (exenatide once weekly [ExQW]). This article reviews the clinical development of ExQW in the DURATION program. Patients in theses clinical trials were receiving various background treatments, ranging from lifestyle therapy to combination oral therapy, although the majority (68%) received metformin monotherapy. Specifically, safety, glycemic control, and weight were compared in patients treated with ExQW versus ExBID, sitagliptin, pioglitazone, or insulin glargine. Moreover, measures of β-cell function, cardiovascular risk, inflammation, and hepatic health were investigated. During ExQW clinical development, consistent clinical efficacy (glycosylated hemoglobin, −1.5% to −1.9%; weight, −2 kg to −4 kg) and safety data were observed in patients with T2DM treated with ExQW. PMID:21732798

Safety and Efficacy of a Non-Invasive 1060 nm Diode Laser for Fat Reduction of the Abdomen.

PubMed

Bass, Lawrence S; Doherty, Sean T

2018-01-01

Changes in temperature are known to produce apoptosis in adipocytes. This study examines the use of a non-invasive treatment that applies 1060 nm laser energy transcutaneously to hyperthermically induce disruption of fat cells in the abdomen. Thirty-five subjects received application of 1060 nm laser on the abdomen for fat reduction. Ultrasound images and high-resolution two-dimensional photography were recorded at baseline, 6 weeks, and 12 weeks post treatment. Subjects maintained a stable diet and exercise routine throughout the course of the study. Weight was recorded at baseline and each follow-up visit. Three board certified dermatologists were trained as blinded evaluators and tasked with identifying before and after photographs from randomized, paired baseline, and 12-week photographs. Ultrasound images were used to measure the fat thickness change from baseline at 6 and 12 weeks. Level of patient satisfaction was graded at 12 weeks using a 6 point Likert scale. 23% of subjects were Fitzpatrick IV-VI. Blinded evaluators correctly identified the post-treatment photograph 95% of the time (88%, 97%, and 100%). Mean reduction in fat layer thickness from baseline was statistically significant (P less than 0.001) at both 6 weeks (1.5 +/-1.23 mm) and 12 weeks (2.65 +/-1.41 mm). Mean weight change was +0.1 lb. Side effects were mild to moderate including edema, tenderness, and induration mostly resolving within 1-3 weeks post treatment. No serious adverse events were reported. 1060 nm based laser treatment can consistently reduce the fat contour in the abdomen with an excellent safety profile in all skin types. The study met all three of its prospectively defined endpoints of success.

J Drugs Dermatol. 2018;17(1):106-112.

THIS ARTICLE HAD BEEN MADE AVAILABLE FREE OF CHARGE.

PLEASE SCROLL DOWN TO ACCESS THE FULL TEXT OF THIS ARTICLE WITHOUT LOGGING IN.

NO PURCHASE NECESSARY.

PLEASE CONTACT THE PUBLISHER WITH ANY QUESTIONS.

Does a Rater's Professional Background Influence Communication Skills Assessment?

PubMed

Artemiou, Elpida; Hecker, Kent G; Adams, Cindy L; Coe, Jason B

2015-01-01

There is increasing pressure in veterinary education to teach and assess communication skills, with the Objective Structured Clinical Examination (OSCE) being the most common assessment method. Previous research reveals that raters are a large source of variance in OSCEs. This study focused on examining the effect of raters' professional background as a source of variance when assessing students' communication skills. Twenty-three raters were categorized according to their professional background: clinical sciences (n=11), basic sciences (n=4), clinical communication (n=5), or hospital administrator/clinical skills technicians (n=3). Raters from each professional background were assigned to the same station and assessed the same students during two four-station OSCEs. Students were in year 2 of their pre-clinical program. Repeated-measures ANOVA results showed that OSCE scores awarded by the rater groups differed significantly: (F(matched_station_1) [2,91]=6.97, p=.002), (F(matched_station_2) [3,90]=13.95, p=.001), (F(matched_station_3) [3,90]=8.76, p=.001), and ((Fmatched_station_4) [2,91]=30.60, p=.001). A significant time effect between the two OSCEs was calculated for matched stations 1, 2, and 4, indicating improved student performances. Raters with a clinical communication skills background assigned scores that were significantly lower compared to the other rater groups. Analysis of written feedback provided by the clinical sciences raters showed that they were influenced by the students' clinical knowledge of the case and that they did not rely solely on the communication checklist items. This study shows that it is important to consider rater background both in recruitment and training programs for communication skills' assessment.

Posterior component separation and transversus abdominis muscle release for complex incisional hernia repair in patients with a history of an open abdomen.

PubMed

Petro, Clayton C; Como, John J; Yee, Sydney; Prabhu, Ajita S; Novitsky, Yuri W; Rosen, Michael J

2015-02-01

The best reconstructive approach for large fascial defects precipitated from a previous open abdomen has not been elucidated to date. We use a posterior component separation with transversus abdominis muscle release (TAR) in this scenario. Patients with a history of an open abdomen who ultimately underwent complex hernia repair with TAR from 2010 to 2013 at Case Medical Center were identified in our prospective database and analyzed. Of 34 patients (mean [SD] age, 54 [11.3] years; mean [SD] body mass index, 32.5 [7.2]) with a history of an open abdomen, the fascia was closed primarily in 11 and skin alone closed primarily in 4 patients after a mean (SD) of 5.9 (6.7) days. Those unable to achieve primary closure either received a skin graft (n = 16) or healed by secondary intention (n = 3). Patients presented to our institution a mean (SD) of 25.1 (26.5) months after their initial operation, eight having already undergone at least one hernia repair, including four anterior component separations. Operations consisted of 21 (61.8%) contaminated cases, including 7 enterocutaneous fistula takedowns, 2 stoma revisions, 2 stoma reversals, and 3 excisions of infected mesh. Wound morbidity consisted of 12 (35%) surgical site occurrences: 1 wound dehiscence, 2 hematomas, 1 seroma, 8 surgical site infections (23.5%; 3 superficial, 3 deep, and 2 organ space), and no enterocutaneous fistulas or chronic mesh infections. One reoperation was necessary for debridement of a hematoma and deep surgical site infection. With a mean follow-up of 18 months (range, 3-42 months), two (5.9%) new parastomal hernias and three (8.8%) midline recurrences have been documented. To our knowledge, this is the first report describing the use of TAR in patients with a history of an open abdomen for definitive abdominal wall reconstruction. We have demonstrated that this approach is associated with low significant perioperative morbidity and recurrence. Therapeutic study, level V.

Acute abdomen due to ovarian congestion: a fallopian tube accompanied by a paratubal cyst, coiling tightly round the ovary.

PubMed

Kaido, Yoshitaka; Kikuchi, Akihiko; Kanasugi, Tomonobu; Fukushima, Akimune; Sugiyama, Toru

2013-01-01

We experienced an unreported rare case with an adnexal mass causing severe acute abdomen during pregnancy. A 30-year-old Japanese pregnant woman was transported to our hospital for her right lower abdominal pain at 30 weeks of gestation. Magnetic resonance imaging and ultrasound demonstrated a cyst measuring 3-4 cm in diameter adjacent to the right ovary, and a parovarian cyst was considered to be the most probable diagnosis. We strongly suspected torsion of the ovarian pedicle or fallopian tube in conjunction with her clinical symptoms. Laparotomy revealed that the elongated right fallopian tube accompanied by a paratubal cyst was coiling tightly 2.5 times round the right ovary, causing apparent congestion and enlargement of the right ovary. Soon after we released the congested right ovary from the coiling of the fallopian tube, the congestion subsided. The postoperative course was favorable, and pregnancy and delivery were uneventful. © 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology.

Do C-reactive protein level, white blood cell count, and pain location guide the selection of patients for computed tomography imaging in non-traumatic acute abdomen?

PubMed

Ozan, E; Atac, G K; Evrin, T; Alisar, K; Sonmez, L O; Alhan, A

2017-02-01

The value of abdominal computed tomography in non-traumatic abdominal pain has been well established. On the other hand, to manage computed tomography, appropriateness has become more of an issue as a result of the concomitant increase in patient radiation exposure with increased computed tomography use. The purpose of this study was to investigate whether C-reactive protein, white blood cell count, and pain location may guide the selection of patients for computed tomography in non-traumatic acute abdomen. Patients presenting with acute abdomen to the emergency department over a 12-month period and who subsequently underwent computed tomography were retrospectively reviewed. Those with serum C-reactive protein and white blood cell count measured on admission or within 24 h of the computed tomography were selected. Computed tomography examinations were retrospectively reviewed, and final diagnoses were designated either positive or negative for pathology relating to presentation with acute abdomen. White blood cell counts, C-reactive protein levels, and pain locations were analyzed to determine whether they increased or decreased the likelihood of producing a diagnostic computed tomography. The likelihood ratio for computed tomography positivity with a C-reactive protein level above 5 mg/L was 1.71, while this increased to 7.71 in patients with combined elevated C-reactive protein level and white blood cell count and right lower quadrant pain. Combined elevated C-reactive protein level and white blood cell count in patients with right lower quadrant pain may represent a potential factor that could guide the decision to perform computed tomography in non-traumatic acute abdomen.

"Surgical" abdomen in a patient with chronic lymphocytic leukemia: a case of acquired angioedema.

PubMed

Jung, Moonjung; Rice, Lawrence

2011-12-01

Acquired angioedema (AAE), an acquired deficiency of C1esterase inhibitor, is a medically treatable condition which can cause severe abdominal pain mimicking an acute surgical abdomen. This disorder is strongly associated with chronic lymphocytic leukemia (CLL) and other indolent lymphoplasmacytic disorders. We describe a patient with known CLL who developed incapacitating, recurrent severe abdominal pains, culminating in partial bowel resection. Signs, symptoms, laboratory and pathologic findings demonstrated AAE. Wider appreciation of the possibility of AAE, particularly in patients with lymphoproliferative disorders, could lead to preventive therapy and spare unnecessary surgery. This is more important now that more effective medical therapies are available.

The appropriateness of the length of insulin needles based on determination of skin and subcutaneous fat thickness in the abdomen and upper arm in patients with type 2 diabetes.

PubMed

Sim, Kang Hee; Hwang, Moon Sook; Kim, Sun Young; Lee, Hye Mi; Chang, Ji Yeun; Lee, Moon Kyu

2014-04-01

Longer needle and complicated insulin injection technique such as injecting at a 45-degree angle and making skinfolds may decrease patient compliance to insulin injection therapy. In this light, shorter insulin needles have been recently developed. However, it is necessary to ascertain that such shorter needles are appropriate for Korean patients with diabetes as well. First, the diverse demographic and diabetic features of 156 Korean adults with diabetes were collected by a questionnaire and a device unit of body fat measurement. The skin and subcutaneous fat thicknesses of each subject were measured by Ultrasound device with a 7- to 12-MHz probe. Data were analyzed using analysis of variance and multiple linear regression. The mean skin thickness was 2.29±0.37 mm in the abdomen and 2.00±0.34 mm in the upper arms, and the mean subcutaneous fat thickness was to 10.15±6.54 mm in the abdomen and 5.50±2.68 mm in the upper arms. Our analysis showed that the factors affecting the skin thickness of the abdomen and upper arms were gender and body mass index (BMI), whereas the factors influencing the subcutaneous fat thickness in the abdomen were gender and BMI, and the factors influencing the subcutaneous fat thickness in the upper arms were gender, BMI, and age. Insulin fluids may not appear to be intradermally injected into the abdomen and upper arms at any needle lengths. The risk of intramuscular injection is likely to increase with longer insulin needles and lower BMI. It is recommended to fully inform the patients about the lengths of needles for insulin injections. As for the recommended needle length, the findings of this study indicate that needles as short as 4 mm are sufficient to deliver insulin for Korean patients with diabetes.

Combing a novel device and negative pressure wound therapy for managing the wound around a colostomy in the open abdomen: A case report.

PubMed

Sun, Xiaofang; Wu, Shaohan; Xie, Ting; Zhang, Jianping

2017-12-01

An open abdomen complicated with small-bowel fistulae becomes a complex wound for local infection, systemic sepsis and persistent soiling irritation by intestinal content. While controlling the fistulae drainage, protecting surrounding skin, healing the wound maybe a challenge. In this paper we described a 68-year-old female was admitted to emergency surgery in general surgery department with severe abdomen pain. Resection part of the injured small bowel, drainage of the intra-abdominal abscess, and fashioning of a colostomy were performed. She failed to improve and ultimately there was tenderness and lot of pus under the skin around the fistulae. The wound started as a 3-cm lesion and progressed to a 6 ×13  (78 cm) around the stoma. In our case we present a novel device for managing colostomy wound combination with negative pressure wound therapy. This tube allows for an effective drainage of small-bowel secretion and a safe build-up of granulation tissue. Also it could be a barrier between the bowel suction point and foam. Management of open abdomen wound involves initial dressing changes, antibiotic use and cutaneous closure. When compared with traditional dressing changes, the NPWT offers several advantages including increased granulation tissue formation, reduction in bacterial colonization, decreased of bowel edema and wound size, and enhanced neovascularization. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament.

PubMed

Kim, Juyoung; Park, Daehyun; Han, Won Bo; Jeong, Hyangjin; Park, Youngse

2014-07-01

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review.

Acute abdomen due to ovarian congestion caused by coiling of the fallopian tube accompanied by paratubal cyst around the utero-ovarian ligament

PubMed Central

Kim, Juyoung; Park, Daehyun; Han, Won Bo; Jeong, Hyangjin

2014-01-01

Torsion of uterine adnexa is an important cause of acute abdominal pain in females. The main organ which can cause torsion is the ovaries, but torsions of the fallopian tube, subserosal myoma, paratubal cyst, and even the uterine body have been reported. The incidence of isolated fallopian tubal torsion is very rare. Even more rarely, it can coil around nearby organs such as the utero-ovarian ligament, showing similar clinical manifestations with those of adnexal torsion. We experienced an extremely rare case of acute abdomen induced by ovarian congestion triggered by the fallopian tube accompanying a paratubal cyst coiling around the utero-ovarian ligament. The right paratubal cyst was misinterpreted as being part of a cystic component of the left ovary on preoperative sonographic examination, and the coiling of the right fallopian tube accompanying the paratubal cyst was misdiagnosed as torsion of the right ovary. We report this rare case with a brief literature review. PMID:25105111

Double intestinal duplication and incidental neuroendocrine tumor of appendix, a rare case of acute abdomen

PubMed Central

Bellanova, G.; Valduga, P.; Costa, A.; Barbareschi, M.; De Carli, N.; Giannelli, G.; Di Sipio, A.; Prezzi, C.; Ciarleglio, F.A.; Beltempo, P.; Marcucci, S.; Giacomin, D.; Depretis, G.; Brolese, A.

2015-01-01

Introduction Intestinal duplication is rarely reported in adulthood and often remains undiagnosed until onset of complications. We describe the case of a 39 year old woman who came to our observation for acute abdomen due to a combination of double intestinal duplication (colon and ileum) and an incidental neuroendocrine tumor of the appendix. Materials and methods A 39 year old woman who was admitted at with upper abdominal pain. Multisliced spiral CT scan showed a cystic lesion suggestive of an inflammed Meckel’s diverticulum.The patient was underwent an urgent explorative laparoscopy. The intraoperative findings revealed a cystic lesion of the anti-mesenteric side of transverse colon, apparently dissectable from the bowel and a second lesion with a strongly adherent and unresectable from the anti-mesenteric aspect of the small bowel. A combined appendectomy was also performed. The histological diagnosis was consistent with a typical intestinal duplication for both intestinal lesionsand an incidental 2 mm carcinoid tumor was also found in the appendix. The postoperative course was uneventful and the patient was discharged on p.o. day 5. At the presenttime she is well and following a regular oncologic follow-up. Discussion The rarity of this case is due to the concomitant presence of an incidental, sincronous, appendiceal NET. The elective treatment is surgical resection. Conclusion Intestinal duplication in the adulthood is extremely rare and may either have an acute presentation as acute abdomen or represents an incidental finding of mass. We suggest that, once the diagnosis is suspected patient must undergo surgery. PMID:26188982

High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis-a retrospective analysis.

PubMed

Mintziras, Ioannis; Miligkos, Michael; Bartsch, Detlef Klaus

2016-08-01

The aim of this study was to evaluate the efficacy of vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis and to identify possible risk factors of fistula formation. The hospital OPS-database (time period 2005-2014) was searched to identify patients treated with an open abdomen due to secondary peritonitis, who underwent vacuum-assisted closure therapy. Medical records were retrospectively analyzed for patients' characteristics, cause of peritonitis, duration of vacuum therapy, number of relaparotomies, fascial closure rates, and risk factors of fistula formation. Forty-three patients (19 male, 24 female) with a median age of 65 years (range 24-90 years) were identified. The major cause of secondary peritonitis was anastomotic leakage after intestinal anastomosis or bowel perforation, the median APACHE II score was 11. Median duration of VAC treatment was 12 days (range 3-88 days). Twenty of 43 (47 %) patients died from septic complications. Delayed fascial closure was obtained by suturing in 20 of 43 patients (47 %). Overall 16 of 43 (37 %) patients developed enteroatmospheric fistulas. Re-explorations after starting VAC treatment and duration of VAC therapy were significantly associated with the occurrence of enteroatmospheric fistulas (p < 0.001). ROC curve analysis determined the optimal duration of VAC therapy to reduce the risk of fistula formation at 13 days. Long-term VAC treatment of patients with an open abdomen due to secondary peritonitis results in a relatively low fascial closure rate and a high risk of fistula formation.

The Effects of Music Intervention on Background Pain and Anxiety in Burn Patients: Randomized Controlled Clinical Trial.

PubMed

Najafi Ghezeljeh, Tahereh; Mohades Ardebili, Fatimah; Rafii, Forough; Haghani, Hamid

2016-01-01

This study aimed to investigate the effect of music on the background pain, anxiety, and relaxation levels in burn patients. In this pretest-posttest randomized controlled clinical trial, 100 hospitalized burn patients were selected through convenience sampling. Subjects randomly assigned to music and control groups. Data related to demographic and clinical characteristics, analgesics, and physiologic measures were collected by researcher-made tools. Visual analog scale was used to determine pain, anxiety, and relaxation levels before and after the intervention in 3 consecutive days. Patients' preferred music was offered once a day for 3 days. The control group only received routine care. Data were analyzed using SPSS-PC (V. 20.0). According to paired t-test, there were significant differences between mean scores of pain (P < .001), anxiety (P < .001), and relaxation (P < .001) levels before and after intervention in music group. Independent t-test indicated a significant difference between the mean scores of changes in pain, anxiety, and relaxation levels before and after intervention in music and control groups (P < .001). No differences were detected in the mean scores of physiologic measures between groups before and after music intervention. Music is an inexpensive, appropriate, and safe intervention for applying to burn patients with background pain and anxiety at rest. To produce more effective comfort for patients, it is necessary to compare different types and time lengths of music intervention to find the best approach.

Type IV-a choledochal cyst--a rare adolescent presentation as acute abdomen.

PubMed

Satya, Ramadass; Vijayakumar, Vani

2006-10-01

A 17-year-old adolescent girl from El Salvador presented to the emergency room (ER) with severe abdominal pain associated with one episode of nausea and vomiting. The pain that started 5 days earlier was sharp in nature and epigastric in location with radiation to back and was relieved by half a tablet of Vicodin. The patient has a history of intermittent epigastric pain for the past 2 years and was treated for Helicobacter pylori for 1 year. In the ER, the serum chemistry demonstrated elevated amylase. Further workup with abdominal ultrasonography (US), computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and hepatobiliary scintigraphy confirmed a type IV-a choledochal cyst with intra- and extrahepatic dilation of bile ducts. We report an unusual acute abdomen presentation of type IV-a choledochal cyst in a 17-year-old young adult from El Salvador.

Implications of respiratory motion for the quantification of 2D MR spectroscopic imaging data in the abdomen

NASA Astrophysics Data System (ADS)

Schwarz, A. J.; Leach, M. O.

2000-08-01

Magnetic resonance spectroscopic imaging (MRSI) studies in the abdomen or breast are acquired in the presence of respiratory motion. This modifies the point spread function (PSF) and hence the reconstructed spectra. We evaluated the quantitative effects of both periodic and aperiodic motion on spectra localized by MRSI. Artefactual signal changes, both the modification of native to a voxel and spurious signals arising elsewhere, depend primarily upon the motion amplitude relative to the voxel dimension. A similar dependence on motion amplitude was observed for simple harmonic motion (SHM), quasi-periodic motion and random displacements. No systematic dependence upon the period or initial phase of SHM or on the array size was found. There was also no significant variation with motion direction relative to the internal and external phase-encoding directions. In measured excursion ranges of 20 breast and abdominal tumours, 70% moved ≤ 5 mm, while 30% moved 6-23 mm. The diaphragm and fatty tissues in the gut typically moved ~ 15-20 mm. While tumour/organ excursions less than half the voxel dimension do not substantially affect native signals, the bleeding in of strong lipid signals will be problematic in 1H studies. MRSI studies in the abdomen, even of relatively well-anchored tumours, are thus likely to benefit from the addition of respiratory triggering or other motion compensation strategies.

Advanced Practice Registered Nurses and Physician Assistants in Sleep Centers and Clinics: A Survey of Current Roles and Educational Background

PubMed Central

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E.; Rogers, Ann E.

2014-01-01

Study Objectives: To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Methods: Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Results: Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through “on the job” training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. Conclusions: APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap. Citation: Colvin L, Cartwright Ann, Collop N, Freedman N, McLeod D, Weaver TE, Rogers AE. Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background. J Clin Sleep Med 2014;10(5):581-587. PMID:24812545

PROPELLER for motion-robust imaging of in vivo mouse abdomen at 9.4 T.

PubMed

Teh, Irvin; Golay, Xavier; Larkman, David J

2010-11-01

In vivo high-field MRI in the abdomen of small animals is technically challenging because of the small voxel sizes, short T(2) and physiological motion. In standard Cartesian sampling, respiratory and gastrointestinal motion can lead to ghosting artefacts. Although respiratory triggering and navigator echoes can either avoid or compensate for motion, they can lead to variable TRs, require invasive intubation and ventilation, or extend TEs. A self-navigated fast spin echo (FSE)-based periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) acquisition was implemented at 9.4 T to enable high-resolution in vivo MRI of mouse abdomen without the use of additional navigators or triggering. T(2)-weighted FSE-PROPELLER data were compared with single-shot FSE and multi-shot FSE data with and without triggering. Single-shot methods, although rapid and robust to motion, demonstrated strong blurring. Multi-shot FSE data showed better resolution, but suffered from marked blurring in the phase-encoding direction and motion in between shots, leading to ghosting artefacts. When respiratory triggering was used, motion artefacts were largely avoided. However, TRs and acquisition times were lengthened by up to approximately 20%. The PROPELLER data showed a 25% and 61% improvement in signal-to-noise ratio and contrast-to-noise ratio, respectively, compared with multi-shot FSE data, together with a 35% reduction in artefact power. A qualitative comparison between acquisition methods using diffusion-weighted imaging was performed. The results were similar, with the exception that respiratory triggering was unable to exclude major motion artefacts as a result of the sensitisation to motion by the diffusion gradients. The PROPELLER data were of consistently higher quality. Considerations specific to the use of PROPELLER at high field are discussed, including the selection of practical blade widths and the effects on contrast, resolution and artefacts.

Efficient organ localization using multi-label convolutional neural networks in thorax-abdomen CT scans

NASA Astrophysics Data System (ADS)

Efrain Humpire-Mamani, Gabriel; Arindra Adiyoso Setio, Arnaud; van Ginneken, Bram; Jacobs, Colin

2018-04-01

Automatic localization of organs and other structures in medical images is an important preprocessing step that can improve and speed up other algorithms such as organ segmentation, lesion detection, and registration. This work presents an efficient method for simultaneous localization of multiple structures in 3D thorax-abdomen CT scans. Our approach predicts the location of multiple structures using a single multi-label convolutional neural network for each orthogonal view. Each network takes extra slices around the current slice as input to provide extra context. A sigmoid layer is used to perform multi-label classification. The output of the three networks is subsequently combined to compute a 3D bounding box for each structure. We used our approach to locate 11 structures of interest. The neural network was trained and evaluated on a large set of 1884 thorax-abdomen CT scans from patients undergoing oncological workup. Reference bounding boxes were annotated by human observers. The performance of our method was evaluated by computing the wall distance to the reference bounding boxes. The bounding boxes annotated by the first human observer were used as the reference standard for the test set. Using the best configuration, we obtained an average wall distance of 3.20~+/-~7.33 mm in the test set. The second human observer achieved 1.23~+/-~3.39 mm. For all structures, the results were better than those reported in previously published studies. In conclusion, we proposed an efficient method for the accurate localization of multiple organs. Our method uses multiple slices as input to provide more context around the slice under analysis, and we have shown that this improves performance. This method can easily be adapted to handle more organs.

Blunt-tip coaxial introducer: a revisited tool for difficult CT-guided biopsy in the chest and abdomen.

PubMed

de Bazelaire, Cedric; Farges, Cecile; Mathieu, Olivier; Zagdanski, Anne-Marie; Bourrier, Pierre; Frija, Jacques; de Kerviler, Eric

2009-08-01

We describe a coaxial introducer provided with an additional blunt-tip stylet that allows safe access to difficult-to-reach lymph nodes in the chest, abdomen, and pelvis under CT control. Once the thoracic, abdominal, or pelvic wall is crossed by the introducer fitted with the sharp-tip stylet, the blunt-tip stylet replaces the sharp stylet for further progression in the fat toward the target. The soft-tip stylet carries a smaller risk of inadvertent perforation displacing vital structures.

'You find yourself.' Perceptions of nursing students from non-English speaking backgrounds of the effect of an intensive language support program on their oral clinical communication skills.

PubMed

Rogan, Fran; San Miguel, Caroline; Brown, Di; Kilstoff, Kathleen

2006-10-01

Nurses of ethnically diverse backgrounds are essential in providing multicultural populations in western societies with culturally and linguistically competent health care. However, many nurses from non-English speaking backgrounds (NESB) are at high risk of failure in university programs particularly during clinical placements. Few studies investigate the clinical experiences of students from NESB and strategies to support their learning. This study describes perceptions of fifteen undergraduate nursing students from NESB about their first clinical placement in an Australian university program and the effect of a language support program on their oral clinical communication skills. Three categories arose: *Wanting to belong but feeling excluded; *Wanting to learn how to...; and *You find yourself. While many students find clinical placement challenging, it appeared difficult for students in this study as language and cultural adjustments required some modification of their usual ways of thinking and communicating, often without coping strategies available to other students.

Aggressive fibromatosis (desmoid tumors): definition, occurrence, pathology, diagnostic problems, clinical behavior, genetic background.

PubMed

Ferenc, Tomasz; Sygut, Jacek; Kopczyński, Janusz; Mayer, Magdalena; Latos-Bieleńska, Anna; Dziki, Adam; Kulig, Andrzej

2006-01-01

Aggressive fibromatosis, usually called desmoid tumor develops from muscle connective tissue, fasciae and aponeuroses. This neoplasm is composed of spindle (fibrocyte-like) cells. As regards the site, aggressive fibromatoses can be divided into: extra-abdominal in the area of the shoulder and pelvic girdle or chest and neck wall; abdominal in abdominal wall muscles; intra-abdominal concerning pelvis, mesentery connective tissue or retroperitoneal space. Desmoid tumor is a neoplasm which rarely turns malignant and is non-metastasizing but demonstrates ability to local infiltration into tissue and is characterized by high risk of recurrence (25-65%) after surgical treatment. Desmoid tumor etiology is uncertain. This neoplasm occurs in sporadic (idiopathic) form and is also associated with some familial neoplastic syndromes. Most sporadic cases of aggressive fibromatosis contain a somatic mutation in either the adenomatous polyposis coli (APC) or beta-catenin genes. Sporadic tumors are more frequent in women than in men from 2 : 1 to 5 : 1. In about 10-15 per cent of patients with familial adenomatous polyposis (FAP), aggressive fibromatosis is a parenteral manifestation of this familial syndrome conditioned by APC gene mutation. Abdomen injury--most frequently due to surgery is said to play an important role in the initiation of fibrous tissue proliferative process in the cases of abdominal and intra abdominal forms. High cells growth potential with relatively high local malignancy is observed in about 10% of cases with sporadic tumors as well as in those FAP-associated.

SU-E-I-29: Care KV: Dose It Influence Radiation Dose in Non-Contrast Examination of CT Abdomen/pelvis?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, J; Ganesh, H; Weir, V

Purpose: CARE kV is a tool that automatically recommends optimal kV setting for individual patient for specific CT examination. The use of CARE kV depends on topogram and the user-selected contrast behavior. CARE kV is expected to reduce radiation dose while improving image quality. However, this may work only for certain groups of patients and/or certain CT examinations. This study is to investigate the effects of CARE kV on radiation dose of non-contrast examination of CT abdomen/pelvis. Methods: Radiation dose (CTDIvol and DLP) from patients who underwent abdomen/pelvis non-contrast examination with and without CARE kV were retrospectively reviewed. All patientsmore » were scanned in the same scanner (Siemens Somatom AS64). To mitigate any possible influences due to technologists’ unfamiliarity with the CARE kV, the data with CARE kV were retrieved 1.5 years after the start of CARE kV usage. T-test was used for significant difference in radiation dose. Results: Volume CTDIs and DLPs from 18 patients before and 24 patients after the use of CARE kV were obtained in a duration of one month. There is a slight increase in both average CTDIvol and average DLP with CARE kV compared to those without CARE kV (25.52 mGy vs. 22.65 mGy for CTDIvol; 1265.81 mGy-cm vs. 1199.19 mGy-cm). Statistically there was no significant difference. Without CARE kV, 140 kV was used in 9 of 18 patients, while with CARE KV, 140 kV was used in 15 of 24 patients. 80kV was not used in either group. Conclusion: The use of CARE kV may save time for protocol optimization and minimize variability among technologists. Radiation dose reduction was not observed in non-contrast examinations of CT abdomen/pelvis. This was partially because our CT protocols were tailored according to patient size before CARE kV and partially because of large size patients.« less

Ultrasound Dopplerography of abdomen pathology using statistical computer programs

NASA Astrophysics Data System (ADS)

Dmitrieva, Irina V.; Arakelian, Sergei M.; Wapota, Alberto R. W.

1998-04-01

The modern ultrasound dopplerography give us the big possibilities in investigation of gemodynamical changes in all stages of abdomen pathology. Many of researches devoted to using of noninvasive methods in practical medicine. Now ultrasound Dopplerography is one of the basic one. We investigated 250 patients from 30 to 77 ages, including 149 men and 101 women. The basic diagnosis of all patients was the Ischaemic Pancreatitis. The Second diagnoses of pathology were the Ischaemic Disease of Heart, Gypertension, Atherosclerosis, Diabet, Vascular Disease of Extremities. We researched the abdominal aorta and her branches: Arteria Mesenterica Superior (AMS), truncus coeliacus (TC), arteria hepatica communis (AHC), arteria lienalis (AL). For investigation we use the following equipment: ACUSON 128 XP/10c, BIOMEDIC, GENERAL ELECTRIC (USA, Japan). We analyzed the following componetns of gemodynamical changes of abdominal vessels: index of pulsation, index of resistance, ratio of systol-dystol, speed of blood circulation. Statistical program included the following one: 'basic statistic's,' 'analytic program.' In conclusion we determined that the all gemodynamical components of abdominal vessels had considerable changes in abdominal ischaemia than in normal situation. Using the computer's program for definition degree of gemodynamical changes, we can recommend the individual plan of diagnostical and treatment program.

[Clinical study of bladder injury].

PubMed

Abe, Kazuhiro; Oishi, Yukihiko; Onodera, Syoichi; Ikemoto, Isao; Kiyota, Hiroshi; Asano, Koji; Ueda, Masataka; Wada, Tetsuro; Tashiro, Kazuya

2002-03-01

Since bladder injury has no specific clinical symptoms, accurate diagnosis at first consultation is relatively difficult. To elucidate the clinical characters type of injury, clinical symptoms, laboratory findings, methods of therapy and diagnosis, we reviewed 15 patients with bladder injury over a 9-year-period 1990-1998 (10 were traumatic injuries and 5 spontaneous injuries). We found no specific clinical symptom of bladder injury. Bladder injury may occur anywhere in the bladder wall, but most commonly occurred at the dome of the bladder (60.0%). Gross hematuria was not seen in 40.0% of the cases. The accuracy of diagnosis at first consultation was relatively low (46.7%) and the tendency to make a misdiagnosis as acute abdomen on digestive organs was found. Of the traumatic injuries 60% were afflicted in the drunken state, so alcohol intoxication was considered as an important enviromental factor of bladder injury. Surgical repair of injury sites was employed in 11 cases (73.3%: 7 were intraperitoneal injuries, 4 were extraperitoneal injuries), 4 cases were managed with indwelling urethral catheter. With appropriate treatment, the prognosis is excellent.

An investigation of human body model morphing for the assessment of abdomen responses to impact against a population of test subjects.

PubMed

Beillas, Philippe; Berthet, Fabien

2017-05-29

Human body models have the potential to better describe the human anatomy and variability than dummies. However, data sets available to verify the human response to impact are typically limited in numbers, and they are not size or gender specific. The objective of this study was to investigate the use of model morphing methodologies within that context. In this study, a simple human model scaling methodology was developed to morph two detailed human models (Global Human Body Model Consortium models 50th male, M50, and 5th female, F05) to the dimensions of post mortem human surrogates (PMHS) used in published literature. The methodology was then successfully applied to 52 PMHS tested in 14 impact conditions loading the abdomen. The corresponding 104 simulations were compared to the responses of the PMHS and to the responses of the baseline models without scaling (28 simulations). The responses were analysed using the CORA method and peak values. The results suggest that model scaling leads to an improvement of the predicted force and deflection but has more marginal effects on the predicted abdominal compressions. M50 and F05 models scaled to the same PMHS were also found to have similar external responses, but large differences were found between the two sets of models for the strain energy densities in the liver and the spleen for mid-abdomen impact simulations. These differences, which were attributed to the anatomical differences in the abdomen of the baseline models, highlight the importance of the selection of the impact condition for simulation studies, especially if the organ location is not known in the test. While the methodology could be further improved, it shows the feasibility of using model scaling methodologies to compare human models of different sizes and to evaluate scaling approaches within the context of human model validation.

Influence of image registration on ADC images computed from free-breathing diffusion MRIs of the abdomen

NASA Astrophysics Data System (ADS)

Guyader, Jean-Marie; Bernardin, Livia; Douglas, Naomi H. M.; Poot, Dirk H. J.; Niessen, Wiro J.; Klein, Stefan

2014-03-01

The apparent diffusion coefficient (ADC) is an imaging biomarker providing quantitative information on the diffusion of water in biological tissues. This measurement could be of relevance in oncology drug development, but it suffers from a lack of reliability. ADC images are computed by applying a voxelwise exponential fitting to multiple diffusion-weighted MR images (DW-MRIs) acquired with different diffusion gradients. In the abdomen, respiratory motion induces misalignments in the datasets, creating visible artefacts and inducing errors in the ADC maps. We propose a multistep post-acquisition motion compensation pipeline based on 3D non-rigid registrations. It corrects for motion within each image and brings all DW-MRIs to a common image space. The method is evaluated on 10 datasets of free-breathing abdominal DW-MRIs acquired from healthy volunteers. Regions of interest (ROIs) are segmented in the right part of the abdomen and measurements are compared in the three following cases: no image processing, Gaussian blurring of the raw DW-MRIs and registration. Results show that both blurring and registration improve the visual quality of ADC images, but compared to blurring, registration yields visually sharper images. Measurement uncertainty is reduced both by registration and blurring. For homogeneous ROIs, blurring and registration result in similar median ADCs, which are lower than without processing. In a ROI at the interface between liver and kidney, registration and blurring yield different median ADCs, suggesting that uncorrected motion introduces a bias. Our work indicates that averaging procedures on the scanner should be avoided, as they remove the opportunity to perform motion correction.

Investigation of the use of thermography for research and clinical applications in pregnant women

NASA Astrophysics Data System (ADS)

Topalidou, Anastasia; Downe, Soo

2016-03-01

Background: The possibility of using thermal imaging, as a non-invasive method, in medicine may provide potential ability of advanced imaging. Objective: The conduction of a preliminary study in healthy non-pregnant females in order to investigate the imaging ability of thermography and its implementation; and to determine hot and cold areas in order to create a "map" of temperature distribution of the abdomen and the torso. Methods: Participants were 18-45 years old non-pregnant women (n = 10), who were measured at 4 different distances. Two thermal imaging cameras and their corresponding software were used to measure abdomen, low back, left and right side of the torso. Results: There were no statistically significant differences in the mean values of the exported temperatures according the distance and the angle between the camera and the subject. The inferior part of the rectus abdominis muscle recorded the coldest zone and the umbilicus appeared as the most prominent hot spot. Conclusions: Thermography shows to be a potential non-invasive technique offering new options in the evaluation of pregnant and laboring women.

MRI artifact reduction and quality improvement in the upper abdomen with PROPELLER and prospective acquisition correction (PACE) technique.

PubMed

Hirokawa, Yuusuke; Isoda, Hiroyoshi; Maetani, Yoji S; Arizono, Shigeki; Shimada, Kotaro; Togashi, Kaori

2008-10-01

The purpose of this study was to evaluate the effectiveness of the periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER [BLADE in the MR systems from Siemens Medical Solutions]) with a respiratory compensation technique for motion correction, image noise reduction, improved sharpness of liver edge, and image quality of the upper abdomen. Twenty healthy adult volunteers with a mean age of 28 years (age range, 23-42 years) underwent upper abdominal MRI with a 1.5-T scanner. For each subject, fat-saturated T2-weighted turbo spin-echo (TSE) sequences with respiratory compensation (prospective acquisition correction [PACE]) were performed with and without the BLADE technique. Ghosting artifact, artifacts except ghosting artifact such as respiratory motion and bowel movement, sharpness of liver edge, image noise, and overall image quality were evaluated visually by three radiologists using a 5-point scale for qualitative analysis. The Wilcoxon's signed rank test was used to determine whether a significant difference existed between images with and without BLADE. A p value less than 0.05 was considered to be statistically significant. In the BLADE images, image artifacts, sharpness of liver edge, image noise, and overall image quality were significantly improved (p < 0.001). With the BLADE technique, T2-weighted TSE images of the upper abdomen could provide reduced image artifacts including ghosting artifact and image noise and provide better image quality.

Fetal demise by umbilical cord around abdomen and stricture.

PubMed

Tan, Shun-Jen; Chen, Chi-Huang; Wu, Gwo-Jang; Chen, Wei-Hwa; Chang, Cheng-Chang

2010-01-01

Umbilical cord abnormalities are accepted as conditions associated with intrauterine fetal demise (IUFD), and umbilical cord stricture is most frequently encountered. In addition, although cord entanglement with multiple loops rarely increases the perinatal mortality, it is associated with a significant increase in variable kind of morbidity such as growth restriction. We describe a 27-year-old woman, with a missed abortion history at about 10 weeks' gestation in her first pregnancy, who presented to our outpatient department at 34 4/7 weeks of gestation due to decreased fetal activity during the preceding week. No fetal heart activity and blood flow had been detected by ultrasonography and pulsed-wave Doppler. A demised fetus with umbilical cord stricture and three loops around abdomen was delivered and was weighted 1,830 g that was below the tenth percentile for the gestational age. Either umbilical cord stricture or entanglement around the body can affect the development of the fetus and even be lethal. The former might play a more important role in this case. Their etiology and the sequence of the events are still undetermined, and additional evaluation such as autopsy and further research may be needed. In addition, counsel and frequent fetal surveillance should be done in patients with previous IUFD attributed to cord stricture during next pregnancy because of undetermined risk of recurrence.

Abdominal intra-compartment syndrome - a non-hydraulic model of abdominal compartment syndrome due to post-hepatectomy hemorrhage in a man with a localized frozen abdomen due to extensive adhesions: a case report.

PubMed

Bressan, Alexsander K; Kirkpatrick, Andrew W; Ball, Chad G

2016-09-15

Postoperative hemorrhage is a significant cause of morbidity and mortality following liver resection. It typically presents early within the postoperative period, and conservative management is possible in the majority of cases. We present a case of late post-hepatectomy hemorrhage associated with overt abdominal compartment syndrome resulting from a localized functional compartment within the abdomen. A 68-year-old white man was readmitted with sudden onset of upper abdominal pain, vomiting, and hemodynamic instability 8 days after an uneventful hepatic resection for metachronous colon cancer metastasis. A frozen abdomen with adhesions due to complicated previous abdominal surgeries was encountered at the first intervention, but the surgery itself and initial recovery were otherwise unremarkable. Prompt response to fluid resuscitation at admission was followed by a computed tomography of his abdomen that revealed active arterial hemorrhage in the liver resection site and hemoperitoneum (estimated volume <2 L). Selective arteriography successfully identified and embolized a small bleeding branch of his right hepatic artery. He remained hemodynamically stable, but eventually developed overt abdominal compartment syndrome. Surgical exploration confirmed a small volume of ascites and blood clots (1.2 L) under significant pressure in his supramesocolic region, restricted by his frozen lower abdomen, which we evacuated. Dramatic improvement in his ventilatory pressure was immediate. His abdomen was left open and a negative pressure device was placed for temporary abdominal closure. The fascia was formally closed after 48 hours. He was discharged home at postoperative day 6. Intra-abdominal pressure and radiologic findings of intra-abdominal hemorrhage should be carefully interpreted in patients with extensive intra-abdominal adhesions. A high index of suspicion and detailed understanding of abdominal compartment mechanics are paramount for the timely diagnosis of

Abdomen and spinal cord segmentation with augmented active shape models.

PubMed

Xu, Zhoubing; Conrad, Benjamin N; Baucom, Rebeccah B; Smith, Seth A; Poulose, Benjamin K; Landman, Bennett A

2016-07-01

Active shape models (ASMs) have been widely used for extracting human anatomies in medical images given their capability for shape regularization of topology preservation. However, sensitivity to model initialization and local correspondence search often undermines their performances, especially around highly variable contexts in computed-tomography (CT) and magnetic resonance (MR) images. In this study, we propose an augmented ASM (AASM) by integrating the multiatlas label fusion (MALF) and level set (LS) techniques into the traditional ASM framework. Using AASM, landmark updates are optimized globally via a region-based LS evolution applied on the probability map generated from MALF. This augmentation effectively extends the searching range of correspondent landmarks while reducing sensitivity to the image contexts and improves the segmentation robustness. We propose the AASM framework as a two-dimensional segmentation technique targeting structures with one axis of regularity. We apply AASM approach to abdomen CT and spinal cord (SC) MR segmentation challenges. On 20 CT scans, the AASM segmentation of the whole abdominal wall enables the subcutaneous/visceral fat measurement, with high correlation to the measurement derived from manual segmentation. On 28 3T MR scans, AASM yields better performances than other state-of-the-art approaches in segmenting white/gray matter in SC.

Abdomen and spinal cord segmentation with augmented active shape models

PubMed Central

Xu, Zhoubing; Conrad, Benjamin N.; Baucom, Rebeccah B.; Smith, Seth A.; Poulose, Benjamin K.; Landman, Bennett A.

2016-01-01

Abstract. Active shape models (ASMs) have been widely used for extracting human anatomies in medical images given their capability for shape regularization of topology preservation. However, sensitivity to model initialization and local correspondence search often undermines their performances, especially around highly variable contexts in computed-tomography (CT) and magnetic resonance (MR) images. In this study, we propose an augmented ASM (AASM) by integrating the multiatlas label fusion (MALF) and level set (LS) techniques into the traditional ASM framework. Using AASM, landmark updates are optimized globally via a region-based LS evolution applied on the probability map generated from MALF. This augmentation effectively extends the searching range of correspondent landmarks while reducing sensitivity to the image contexts and improves the segmentation robustness. We propose the AASM framework as a two-dimensional segmentation technique targeting structures with one axis of regularity. We apply AASM approach to abdomen CT and spinal cord (SC) MR segmentation challenges. On 20 CT scans, the AASM segmentation of the whole abdominal wall enables the subcutaneous/visceral fat measurement, with high correlation to the measurement derived from manual segmentation. On 28 3T MR scans, AASM yields better performances than other state-of-the-art approaches in segmenting white/gray matter in SC. PMID:27610400

The relationship of body mass index and abdominal fat on the radiation dose received during routine computed tomographic imaging of the abdomen and pelvis.

PubMed

Chan, Victoria O; McDermott, Shaunagh; Buckley, Orla; Allen, Sonya; Casey, Michael; O'Laoide, Risteard; Torreggiani, William C

2012-11-01

To determine the relationship of increasing body mass index (BMI) and abdominal fat on the effective dose acquired from computed tomography (CT) abdomen and pelvis scans. Over 6 months, dose-length product and total milliamp-seconds (mAs) from routine CT abdomen and pelvis scans of 100 patients were recorded. The scans were performed on a 64-slice CT scanner by using an automatic exposure control system. Effective dose (mSv) based on dose-length product, BMI, periumbilical fat thickness, and intra-abdominal fat were documented for each patient. BMI, periumbilical fat thickness, and intra-abdominal fat were compared with effective dose. Thirty-nine men and 61 women were included in the study (mean age, 56.3 years). The mean BMI was 26.2 kg/m(2). The mean effective dose was 10.3 mSv. The mean periumbilical fat thickness was 2.4 cm. Sixty-five patients had a small amount of intra-abdominal fat, and 35 had a large amount of intra-abdominal fat. The effective dose increased with increasing BMI (P < .001) and increasing amounts of intra-abdominal fat (P < .001). For every kilogram of weight, there is a 0.13 mSv increase in effective dose, which is equal to 6.5 chest radiographs per CT examination. For an increase in BMI by 5 kg/m(2), there is a 1.95 mSv increase in effective dose, which is equal to 97.5 chest radiographs per CT examination. Increasing BMI and abdominal fat significantly increases the effective dose received from CT abdomen and pelvis scans. Copyright © 2012 Canadian Association of Radiologists. Published by Elsevier Inc. All rights reserved.

A cost-utility analysis of the use of preoperative computed tomographic angiography in abdomen-based perforator flap breast reconstruction.

PubMed

Offodile, Anaeze C; Chatterjee, Abhishek; Vallejo, Sergio; Fisher, Carla S; Tchou, Julia C; Guo, Lifei

2015-04-01

Computed tomographic angiography is a diagnostic tool increasingly used for preoperative vascular mapping in abdomen-based perforator flap breast reconstruction. This study compared the use of computed tomographic angiography and the conventional practice of Doppler ultrasonography only in postmastectomy reconstruction using a cost-utility model. Following a comprehensive literature review, a decision analytic model was created using the three most clinically relevant health outcomes in free autologous breast reconstruction with computed tomographic angiography versus Doppler ultrasonography only. Cost and utility estimates for each health outcome were used to derive the quality-adjusted life-years and incremental cost-utility ratio. One-way sensitivity analysis was performed to scrutinize the robustness of the authors' results. Six studies and 782 patients were identified. Cost-utility analysis revealed a baseline cost savings of $3179, a gain in quality-adjusted life-years of 0.25. This yielded an incremental cost-utility ratio of -$12,716, implying a dominant choice favoring preoperative computed tomographic angiography. Sensitivity analysis revealed that computed tomographic angiography was costlier when the operative time difference between the two techniques was less than 21.3 minutes. However, the clinical advantage of computed tomographic angiography over Doppler ultrasonography only showed that computed tomographic angiography would still remain the cost-effective option even if it offered no additional operating time advantage. The authors' results show that computed tomographic angiography is a cost-effective technology for identifying lower abdominal perforators for autologous breast reconstruction. Although the perfect study would be a randomized controlled trial of the two approaches with true cost accrual, the authors' results represent the best available evidence.

The Qatar Biobank: background and methods.

PubMed

Al Kuwari, Hanan; Al Thani, Asma; Al Marri, Ajayeb; Al Kaabi, Abdulla; Abderrahim, Hadi; Afifi, Nahla; Qafoud, Fatima; Chan, Queenie; Tzoulaki, Ioanna; Downey, Paul; Ward, Heather; Murphy, Neil; Riboli, Elio; Elliott, Paul

2015-12-03

The Qatar Biobank aims to collect extensive lifestyle, clinical, and biological information from up to 60,000 men and women Qatari nationals and long-term residents (individuals living in the country for ≥15 years) aged ≥18 years (approximately one-fifth of all Qatari citizens), to follow up these same individuals over the long term to record any subsequent disease, and hence to study the causes and progression of disease, and disease burden, in the Qatari population. Between the 11(th)-December-2012 and 20(th)-February-2014, 1209 participants were recruited into the pilot study of the Qatar Biobank. At recruitment, extensive phenotype information was collected from each participant, including information/measurements of socio-demographic factors, prevalent health conditions, diet, lifestyle, anthropometry, body composition, bone health, cognitive function, grip strength, retinal imaging, total body dual energy X-ray absorptiometry, and measurements of cardiovascular and respiratory function. Blood, urine, and saliva were collected and stored for future research use. A panel of 66 clinical biomarkers was routinely measured on fresh blood samples in all participants. Rates of recruitment are to be progressively increased in the coming period and the recruitment base widened to achieve a cohort of consented individuals broadly representative of the eligible Qatari population. In addition, it is planned to add additional measures in sub-samples of the cohort, including Magnetic Resonance Imaging (MRI) of the brain, heart and abdomen. The mean time for collection of the extensive phenotypic information and biological samples from each participant at the baseline recruitment visit was 179 min. The 1209 pilot study participants (506 men and 703 women) were aged between 28-80 years (median 39 years); 899 (74.4%) were Qatari nationals and 310 (25.6%) were long-term residents. Approximately two-thirds of pilot participants were educated to graduate level or above. The

[An analysis of clinical characteristics and risk factors for ulceration in ischemic colitis].

PubMed

Liu, Wenhui; Liao, Liang; Shi, Hui; Wu, Benyan; Li, Xiaodong; Liu, Yan

2014-08-01

To investigate the clinical manifestations and risk factors related to ulcer in patients with ischemic colitis (IC). Clinical data of sixty-three IC patients with definite diagnosis from June 2002 to June 2012 in the PLA General Hospital were retrospectively analyzed. All patients were classified into ulcer group (23 cases) and non-ulcer group (40 cases) according to the presence of ulcer or not. Clinical manifestations and risk factors related to ulcer lesions were compared in the two groups. Logistic regression model was used for statistical analysis. There were 50 men and 13 women enrolled, with an average age of 70 years old. The main clinical manifestations included abdominal pain [85.7% (54/63) ], diarrhea [54.0% (34/63)], hematochezia [41.3% (26/63)]. In comparison with non-ulcer group, the ulcer group showed higher incidences of chronic constipation [34.8% (8/23) vs 12.5% (5/40) , P = 0.03], enteric-coated aspirin intake [52.2% (12/23) vs 25.0% (10/40), P = 0.03] and abdomen tenderness [82.6% (19/23) vs 52.5% (21/40), P = 0.02]. Chronic constipation and enteric-coated aspirin intake were independent risk factors related to ulcer lesions (OR = 3.38, P = 0.04; OR = 5.91, P = 0.03). Patients with abdomen tenderness had higher incidence of ulcer lesion (OR = 3.12, P = 0.04). The most common location of IC was left colon [69.8% (44/63)]. No difference of site distribution was found in ulcer and non-ulcer group (P = 0.066). Splanchnic atherosclerosis in the ulcer group was more common than in non-ulcer group [88.2% (15/17) vs 58.3% (14/24), P = 0.038]. The duration of hospitalization was significantly longer in ulcer group [ (14.3 ± 7.1) d vs (6.2 ± 4.1) d, P < 0.01]. Higher white blood cell (WBC) count and lower hemoglobin (Hb) were seen in ulcer group than those in non-ulcer group [(10.17 ± 3.32) ×10(9)/L vs (7.25 ± 3.15)×10(9)/L, P = 0.018; (98 ± 27) g/L vs (126 ± 35) g/L, P = 0.041]. Chronic constipation, enteric-coated aspirin intake and splanchnic

Effect of Listeners' Linguistic Background on Perceptual Judgements of Hypernasality

ERIC Educational Resources Information Center

Lee, Alice; Brown, Susanna; Gibbon, Fiona E.

2008-01-01

Background: Many speech and language therapists work in a multilingual environment, making cross-linguistic studies of speech disorders clinically and theoretically important. Aims: To investigate the effect of listeners' linguistic background on their perceptual ratings of hypernasality and the reliability of the ratings. Methods &…

Feasibility of intra-acquisition motion correction for 4D DSA reconstruction for applications in the thorax and abdomen

NASA Astrophysics Data System (ADS)

Wagner, Martin; Laeseke, Paul; Harari, Colin; Schafer, Sebastian; Speidel, Michael; Mistretta, Charles

2018-03-01

The recently proposed 4D DSA technique enables reconstruction of time resolved 3D volumes from two C-arm CT acquisitions. This provides information on the blood flow in neurovascular applications and can be used for the diagnosis and treatment of vascular diseases. For applications in the thorax and abdomen, respiratory motion can prevent successful 4D DSA reconstruction and cause severe artifacts. The purpose of this work is to propose a novel technique for motion compensated 4D DSA reconstruction to enable applications in the thorax and abdomen. The approach uses deformable 2D registration to align the projection images of a non-contrast and a contrast enhanced scan. A subset of projection images is then selected, which are acquired in a similar respiratory state and an iterative simultaneous multiplicative algebraic reconstruction is applied to determine a 3D constraint volume. A 2D-3D registration step then aligns the remaining projection images with the 3D constraint volume. Finally, a constrained back-projection is performed to create a 3D volume for each projection image. A pig study has been performed, where 4D DSA acquisitions were performed with and without respiratory motion to evaluate the feasibility of the approach. The dice similarity coefficient between the reference 3D constraint volume and the motion compensated reconstruction was 51.12 % compared to 35.99 % without motion compensation. This technique could improve the workflow for procedures in interventional radiology, e.g. liver embolizations, where changes in blood flow have to be monitored carefully.

Whole abdomen radiation for minimal residual epithelial ovarian carcinoma after surgical resection and maximal first-line chemotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cain, J.M.; Russell, A.H.; Greer, B.E.

1988-02-01

Ten patients with Stage III epithelial ovarian received whole abdomen radiation therapy after extensive courses of chemotherapy and second or third laparotomies. All patients had less than 2-mm diameter residual disease. The major side effect was bone marrow suppression which led to decreased dose or field size in four patients. Five patients have recurred and three of these have died. Further treatment after recurrence was compromised by bone marrow suppression. While 40-50% of selected patients may respond to this approach, numerous alternatives are being explored that would not handicap further treatment to the same degree and may have equal responsemore » rates.« less

SU-E-P-11: Comparison of Image Quality and Radiation Dose Between Different Scanner System in Routine Abdomen CT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liao, S; Wang, Y; Weng, H

Purpose To evaluate image quality and radiation dose of routine abdomen computed tomography exam with the automatic current modulation technique (ATCM) performed in two different brand 64-slice CT scanners in our site. Materials and Methods A retrospective review of routine abdomen CT exam performed with two scanners; scanner A and scanner B in our site. To calculate standard deviation of the portal hepatic level with a region of interest of 12.5 mm x 12.5mm represented to the image noise. The radiation dose was obtained from CT DICOM image information. Using Computed tomography dose index volume (CTDIv) to represented CT radiationmore » dose. The patient data in this study were with normal weight (about 65–75 Kg). Results The standard deviation of Scanner A was smaller than scanner B, the scanner A might with better image quality than scanner B. On the other hand, the radiation dose of scanner A was higher than scanner B(about higher 50–60%) with ATCM. Both of them, the radiation dose was under diagnostic reference level. Conclusion The ATCM systems in modern CT scanners can contribute a significant reduction in radiation dose to the patient. But the reduction by ATCM systems from different CT scanner manufacturers has slightly variation. Whatever CT scanner we use, it is necessary to find the acceptable threshold of image quality with the minimum possible radiation exposure to the patient in agreement with the ALARA principle.« less

The Internet and Clinical Trials: Background, Online Resources, Examples and Issues

PubMed Central

Seib, Rachael; Prescott, Todd

2005-01-01

Both the Internet and clinical trials were significant developments in the latter half of the twentieth century: the Internet revolutionized global communications and the randomized controlled trial provided a means to conduct an unbiased comparison of two or more treatments. Large multicenter trials are often burdened with an extensive development time and considerable expense, as well as significant challenges in obtaining, backing up and analyzing large amounts of data. Alongside the increasing complexities of the modern clinical trial has grown the power of the Internet to improve communications, centralize and secure data as well as to distribute information. As more and more clinical trials are required to coordinate multiple trial processes in real time, centers are turning to the Internet for the tools to manage the components of a clinical trial, either in whole or in part, to produce lower costs and faster results. This paper reviews the historical development of the Internet and the randomized controlled trial, describes the Internet resources available that can be used in a clinical trial, reviews some examples of online trials and describes the advantages and disadvantages of using the Internet to conduct a clinical trial. We also extract the characteristics of the 5 largest clinical trials conducted using the Internet to date, which together enrolled over 26000 patients. PMID:15829477

Comparison of virtual unenhanced CT images of the abdomen under different iodine flow rates.

PubMed

Li, Yongrui; Li, Ye; Jackson, Alan; Li, Xiaodong; Huang, Ning; Guo, Chunjie; Zhang, Huimao

2017-01-01

To assess the effect of varying iodine flow rate (IFR) and iodine concentration on the quality of virtual unenhanced (VUE) images of the abdomen obtained with dual-energy CT. 94 subjects underwent unenhanced and triphasic contrast-enhanced CT scan of the abdomen, including arterial phase, portal venous phase, and delayed phase using dual-energy CT. Patients were randomized into 4 groups with different IFRs or iodine concentrations. VUE images were generated at 70 keV. The CT values, image noise, SNR and CNR of aorta, portal vein, liver, liver lesion, pancreatic parenchyma, spleen, erector spinae, and retroperitoneal fat were recorded. Dose-length product and effective dose for an examination with and without plain phase scan were calculated to assess the potential dose savings. Two radiologists independently assessed subjective image quality using a five-point scale. The Kolmogorov-Smirnov test was used first to test for normal distribution. Where data conformed to a normal distribution, analysis of variance was used to compare mean HU values, image noise, SNRs and CNRs for the 4 image sets. Where data distribution was not normal, a nonparametric test (Kruskal-Wallis test followed by stepwise step-down comparisons) was used. The significance level for all tests was 0.01 (two-sided) to allow for type 2 errors due to multiple testing. The CT numbers (HU) of VUE images showed no significant differences between the 4 groups (p > 0.05) or between different phases within the same group (p > 0.05). VUE images had equal or higher SNR and CNR than true unenhanced images. VUE images received equal or lower subjective image quality scores than unenhanced images but were of acceptable quality for diagnostic use. Calculated dose-length product and estimated dose showed that the use of VUE images in place of unenhanced images would be associated with a dose saving of 25%. VUE images can replace conventional unenhanced images. VUE images are not affected by varying iodine

Clinical usefulness of the thickness of preperitoneal and subcutaneous fat layer in the abdomen estimated by ultrasonography for diagnosing abdominal obesity in each type of impaired glucose tolerance in man.

PubMed

Soyama, Akiko; Nishikawa, Tetsuo; Ishizuka, Toshiharu; Ito, Hiroko; Saito, Jun; Yagi, Kazuo; Saito, Yasushi

2005-04-01

For this study we enrolled 1,615 males who were admitted to our hospital for a general health check-up. Plasma glucose (PG) and insulin were measured during 75 g OGTT, and abdominal obesity was assessed by ultrasonography in all subjects. We divided them into several groups: normal glucose tolerance (NGT), high-normal glucose tolerance (h-NGT) who showed >10.0 nmol/l at 1 hr PG among those with NGT, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG + IGT, and DM, according to the results of 75 g OGTT. The aim of the present study was to clarify the clinical characteristics of pre-diabetic disorders relating to metabolic syndrome by comparing various parameters including body mass index (BMI), blood levels of various lipids and abdominal wall fat index (AFI) calculated from the thickness of preperitoneal (Pmax) and subcutaneous (Smin) fat layer in the abdomen estimated by ultrasonography with insulin sensitivity determined by homeostatic model assessment (HOMA-IR) in each type of abnormal glucose regulation as classified by PG changes in 75 g OGTT. We also investigated the relationship between insulin secretion capability and insulin sensitivity to delineate the characteristics of each type of abnormal glucose regulation, and compared the area under the insulin curve (AUCins) and the time axis, and the ability of early insulin secretion by glucose loading (insulinogenic index: I.I.) in each type of abnormal glucose regulation. There was a significant positive correlation between HOMA-IR and Smin or Pmax, suggesting that Smin and Pmax may reflect insulin sensitivity. Abdominal obesity, which was diagnosed from the data of AFI, was present in the h-NGT and IFG + IGT groups, suggesting that those groups belong to the clinical entity of metabolic syndrome. HOMA-IR was higher in IFG than in IGT, although I.I. was reduced and AUCins was increased in IFG as well as in IGT. h-NGT demonstrated a slightly lower I.I. and higher AUCins, compared with IGT

Non-traumatic rhabdomyolysis: Background, laboratory features, and acute clinical management.

PubMed

Cervellin, Gianfranco; Comelli, Ivan; Benatti, Mario; Sanchis-Gomar, Fabian; Bassi, Antonella; Lippi, Giuseppe

2017-08-01

Rhabdomyolysis is a relatively rare condition, but its clinical consequences are frequently dramatic in terms of both morbidity and mortality. Although no consensus has been reached so far about the precise definition of this condition, the term rhabdomyolysis describes a rapid breakdown of striated, or skeletal, muscle. It is hence characterized by the rupture and necrosis of muscle fibers, resulting in release of cell degradation products and intracellular elements within the bloodstream and extracellular space. Notably, the percentage of patients with rhabdomyolysis who develop acute kidney injury, the most dramatic consequence, varies from 13% to over 50% according to both the cause and the clinical and organizational setting where they are diagnosed. Despite direct muscle injury (i.e., traumatic rhabdomyolysis) remains the most common cause, additional causes, frequently overlapping, include hypoxic, physical, chemical or biological factors. The conventional triad of symptoms includes muscle pain, weakness and dark urine. The laboratory diagnosis is essentially based on the measurement of biomarkers of muscle injury, being creatine kinase (CK) the biochemical "gold standard" for diagnosis, and myoglobin the "gold standard" for prognostication, especially in patients with non-traumatic rhabdomyolysis. The essential clinical management in the emergency department is based on a targeted intervention to manage the underlying cause, combined with infusion of fluids and eventually sodium bicarbonate. We will present and discuss in this article the pathophysiological and clinical features of non-traumatic rhabdomyolysis, focusing specifically on Emergency Department (ED) management. Copyright © 2017 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Multiphase whole-body CT angiography before multiorgan retrieval in clinically brain dead patients: Role and influence on clinical practice.

PubMed

Tache, A; Badet, N; Azizi, A; Behr, J; Verdy, S; Delabrousse, E

2016-06-01

To evaluate the contribution of multiphase whole-body CT angiography (CTA) for identifying the contra-indications to multiorgan retrieval (MOR) and improving the preoperative organ harvesting strategy. One hundred and eleven consecutive patients who were clinically brain dead underwent multiphase whole-body CTA to confirm the diagnosis of brain death and for assessment of MOR. The CTA protocol included volumetric acquisitions of the brain and abdominopelvic cavity without IV administration of iodinated contrast material, then images of the thorax-abdomen-pelvis 25s after IV contrast administration, of the brain at 60s and finally an abdominopelvic CT acquisition at 90s. The diagnosis of brain death was based on well-established criteria. The assessment of thorax, abdomen and pelvis was based on a systematic checklist. Post-processing imaging techniques were used in all patients. No organs were retrieved from 21 patients due to patient refusal (19%). Twenty-two potential MOR were denied because of general contra-indications including 12/22 (54%) based on CTA criteria alone. Finally, 68 patients were eligible for MOR and 160 organs were harvested. The exclusion of specific organs was based on CTA alone for 2/16 livers, 4/70 kidneys and 5/55 lungs. Fifty hearts and 58 pancreases were not harvested, none based on CTA results alone. Hepatic abnormalities and vascular anatomical variants were identified in 10% of patients. At least one renal artery variant was found in 28% of patients, 13% presented with a double renal vein and 8% with a hepato-mesenteric artery. Multiphase whole-body CTA for MOR is based on the simultaneous association of cerebral CTA to determine brain death with CTA of the thorax, abdomen and pelvis. This rapid, standardized and easily accessible procedure has no harmful effects on harvested kidneys. It makes it possible to select the donors and the organs to be harvested and allows the retrieving surgeon to identify and anticipate technical

Elderly Japanese emigrants to Brazil before World War II: I. Clinical profiles based on specific historical background.

PubMed

Meguro, M; Meguro, K; Caramelli, P; Ishizaki, J; Ambo, H; Chubaci, R Y; Hamada, G S; Nitrini, R; Yamadori, A

2001-08-01

To research the demographic and clinical profiles of elderly Japanese emigrants, who arrived in Brazil before World War II, in order to give them appropriate psychogeriatric care. Elderly Japanese immigrants aged 65 years and over, belonging to the Miyagi Association in the São Paulo Metropolitan Area, were targeted. They emigrated from Miyagi Prefecture to Brazil and are now living in the area. We were able to interview 166 respondents. All data were gathered using standardized interview methods covering (a) free interview about the immigration history, (b) demographics, and (c) physical status. Through the free interview, we found their immigration histories, which affected their clinical profiles. The mean age and educational level were 77.5 years and 6.3 years, respectively. Sixty per cent of them immigrated when they were younger than 14. Ninety-four per cent of them still keep Japanese nationality. Fifty-seven per cent of them usually use Japanese, while 10% of them use Portuguese. Although their emigration histories were hard, 76% of them perceived their health as being excellent or relatively good. The percentages of subjects with histories of disease were hypertension, 52.5%; cardiac disease, 20.8%; diabetes mellitus, 24.2%; and hyperlipidemia, 25.0%, which were affected by the Brazilian environment. The elderly Japanese who emigrated to Brazil before World War II have a unique historical and demographic background. Their clinical profiles cannot be fully understood without knowing their histories. They definitely need high quality international psychogeriatric care. Copyright 2001 John Wiley & Sons, Ltd.

Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

PubMed

Werhagen, Lars; Borg, Kristian

2016-10-01

Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

Clinical and histopathological study of the TriPollar home-use device for body treatments.

PubMed

Boisnic, Sylvie; Branchet, Marie-Christine; Birnstiel, Oliver; Beilin, Ghislaine

2010-01-01

Professional non invasive treatments for body contouring based on radiofrequency (RF) became popular in aesthetic clinics due to proven efficacy and safety. A new home-use RF device for body treatments has been developed based on TriPollar technology. Our objective was to evaluate the TriPollar home-use device for circumference reduction, cellulite improvement and skin tightening using objective and subjective methods. An ex-vivo human skin model was used for histological and biochemical evaluations of the TriPollar clinical effect. Additionally, twenty four subjects used the new device on the abdomen and thigh areas and the circumference reduction was measured. Ex-vivo models indicated a significant increase of 82% in hypodermal glycerol release. Histology revealed a 34% alteration in adipocyte appearance. Collagen synthesis increased by 31% following TriPollar treatment. A significant average reduction of 2.4 cm was measured on the treated thighs. On the control thighs a lesser, non-significant reduction was found. Average abdominal laxity was reduced from 1.4 at baseline to 0.8 following treatments. A certain reduction was measured in the abdomen circumferences, although it was not significant. The reported results demonstrate the safety and efficacy of the new TriPollar home-use device for body contouring and skin tightening. Treatment may lead to discrete circumference reduction and moderate laxity improvement.

Multidetector CT of blunt traumatic venous injuries in the chest, abdomen, and pelvis.

PubMed

Holly, Brian P; Steenburg, Scott D

2011-01-01

Venous injuries as a result of blunt trauma are rare. Even though current protocols for multidetector computed tomography (CT) of patients with trauma are designed to evaluate primarily the solid organs and arteries, blunt venous injuries may nevertheless be identified, or at least suspected, on the basis of the multidetector CT findings. Venous injuries are associated with high morbidity and mortality rates. Diagnosis of a possible venous injury is crucial because the physical findings of a venous injury are nonspecific and may be absent. This article aims to make the radiologist aware of various venous injuries caused by blunt trauma and to provide helpful hints to aid in the identification of venous injuries. Multidetector CT technology, in combination with interactive manipulation of the raw dataset, can be useful in the creation of multiplanar reconstructed images and in the identification of a venous injury caused by blunt trauma. Familiarity with direct and indirect signs of venous injuries, as well as with examples of blunt traumatic venous injuries in the chest, abdomen, and pelvis, will help in the diagnosis of these injuries.

Role of routine abdominal ultrasonography in intensified tuberculosis case finding algorithms at HIV clinics in high TB burden settings.

PubMed

Spalgais, Sonam; Agarwal, Upasna; Sarin, Rohit; Chauhan, Devesh; Yadav, Anita; Jaiswal, Anand

2017-05-18

High proportion of TB in people living with HIV (PLHIV) is undiagnosed. Due to this active TB case finding is recommended for HIV clinics in high TB burden countries. Presently sputum examination and chest radiography are frontline tests recommended for HIV infected TB presumptives. Abdominal TB which occurs frequently in PLHIV may be missed even by existing programmatic intensified case finding protocols. This study evaluated the routine use of ultrasonography (USG) for active case finding of abdominal TB in HIV clinics. Retrospective analysis of eight years' data from an HIV Clinic in a TB hospital in India. Patients underwent chest x-ray, sputum examination, USG abdomen and routine blood tests at entry to HIV care. Case forms were scrutinized for diagnosis of TB, USG findings and CD4 cell counts. Abdominal TB was classified as probable or possible TB. Probable TB was based on presence of two major USG (abdomen) findings suggestive of active TB, or one major USG finding with at least two minor USG findings or at least two symptoms, or any USG finding with microbiologically confirmed active TB at another site. Possible TB was based on the presence of one major USG finding, or the presence of two minor USG findings with at least two symptoms. Bacteriological confirmation was not obtained. Eight hundred and eighty-nine people PLHIV underwent a baseline USG abdomen. One hundred and thirteen of 340 cases already diagnosed with TB and 87 of the 91 newly diagnosed with TB at time of HIV clinic registration had abdominal TB. Non-abdominal symptoms like weight loss, fever and cough were seen in 53% and 22% cases had no symptoms at all. Enlarged abdominal lymph nodes with central caseation, ascitis, splenic microabsesses, bowel thickening and hepatosplenomegaly were the USG findings in these cases. Abdominal TB is a frequent TB site in PLHIV presenting with non-abdominal symptoms. It can be easily detected on basis of features seen on a simple abdominal ultrasound

A new method to assess the deformations of internal organs of the abdomen during impact.

PubMed

Helfenstein-Didier, Clémentine; Rongiéras, Frédéric; Gennisson, Jean-Luc; Tanter, Mickaël; Beillas, Philippe

2016-11-16

Due to limitations of classic imaging approaches, the internal response of abdominal organs is difficult to observe during an impact. Within the context of impact biomechanics for the protection of the occupant of transports, this could be an issue for human model validation and injury prediction. In the current study, a previously developed technique (ultrafast ultrasound imaging) was used as the basis to develop a protocol to observe the internal response of abdominal organs in situ at high imaging rates. The protocol was applied to 3 postmortem human surrogates to observe the liver and the colon during impacts delivered to the abdomen. The results show the sensitivity of the liver motion to the impact location. Compression of the colon was also quantified and compared to the abdominal compression. These results illustrate the feasibility of the approach. Further tests and comparisons with simulations are under preparation.

Third version of vendor-specific model-based iterativereconstruction (Veo 3.0): evaluation of CT image quality in the abdomen using new noise reduction presets and varied slice optimization.

PubMed

Telesmanich, Morgan E; Jensen, Corey T; Enriquez, Jose L; Wagner-Bartak, Nicolaus A; Liu, Xinming; Le, Ott; Wei, Wei; Chandler, Adam G; Tamm, Eric P

2017-08-01

To qualitatively and quantitatively compare abdominal CT images reconstructed with a newversion of model-based iterative reconstruction (Veo 3.0; GE Healthcare Waukesha, WI) utilizing varied presetsof resolution preference, noise reduction and slice optimization. This retrospective study was approved by our Institutional Review Board and was Health Insurance Portability and Accountability Act compliant. The raw datafrom 30 consecutive patients who had undergone CT abdomen scanning were used to reconstructfour clinical presets of 3.75mm axial images using Veo 3.0: 5% resolution preference (RP05n), 5%noise reduction (NR05) and 40% noise reduction (NR40) with new 3.75mm "sliceoptimization," as well as one set using RP05 with conventional 0.625mm "slice optimization" (RP05c). The images were reviewed by two independent readers in a blinded, randomized manner using a 5-point Likert scale as well as a 5-point comparative scale. Multiple two-dimensional circular regions of interest were defined for noise and contrast-to-noise ratio measurements. Line profiles were drawn across the 7 lp cm -1 bar pattern of the Catphan 600 phantom for evaluation of spatial resolution. The NR05 image set was ranked as the best series in overall image quality (mean difference inrank 0.48, 95% CI [0.081-0.88], p = 0.01) and with specific reference to liver evaluation (meandifference 0.46, 95% CI [0.030-0.89], p = 0.03), when compared with the secondbest series ineach category. RP05n was ranked as the best for bone evaluation. NR40 was ranked assignificantly inferior across all assessed categories. Although the NR05 and RP05c image setshad nearly the same contrast-to-noise ratio and spatial resolution, NR05 was generally preferred. Image noise and spatial resolution increased along a spectrum with RP05n the highest and NR40the lowest. Compared to RP05n, the average noise was 21.01% lower for NR05, 26.88%lower for RP05c and 50.86% lower for NR40. Veo 3.0 clinical presets allow for

Xanthogranulomatous Salpingooophoritis: The Youngest Documented Case Report

PubMed Central

Tanwar, Harshawardhan; Joshi, Avinash; Wagaskar, Vinayak; Kini, Siddharth; Bachhav, Manoj

2015-01-01

Background. Xanthogranulomatous inflammation is an uncommon affection of the female genital tract. The youngest case reported of xanthogranulomatous salpingooophoritis in literature was by Shilpa et al. in 2013 in an eighteen-year-old female. Case Report. We report a case of 2-year-old female child with right-sided xanthogranulomatous salpingooophoritis presented as mass in abdomen. This is a case report of the youngest documented case of xanthogranulomatous salpingooophoritis in literature. As per abdominal examination, there was generalized distention of abdomen and a mass was palpable which was arising out of pelvis more on the right side. The ultrasonography (USG) abdomen and pelvis revealed a thick-walled mass measuring 9.2 cm × 6.0 cm × 7.6 cm in pelvis. We did right salpingooophorectomy of the patient. On histopathology, the diagnosis of xanthogranulomatous salpingooophoritis was confirmed. Conclusion. Clinical presentation, radiological appearance, and gross features of xanthogranulomatous lesions of ovary can mimic neoplastic lesions and lead to misdiagnosis. Though, it is very rare in pediatric age group, xanthogranulomatous salpingooophoritis as one of the differential diagnoses should be kept in mind while dealing with tuboovarian masses in this age group. PMID:26114000

Attenuation-based estimation of patient size for the purpose of size specific dose estimation in CT. Part II. Implementation on abdomen and thorax phantoms using cross sectional CT images and scanned projection radiograph images

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang Jia; Christner, Jodie A.; Duan Xinhui

2012-11-15

Purpose: To estimate attenuation using cross sectional CT images and scanned projection radiograph (SPR) images in a series of thorax and abdomen phantoms. Methods: Attenuation was quantified in terms of a water cylinder with cross sectional area of A{sub w} from both the CT and SPR images of abdomen and thorax phantoms, where A{sub w} is the area of a water cylinder that would absorb the same dose as the specified phantom. SPR and axial CT images were acquired using a dual-source CT scanner operated at 120 kV in single-source mode. To use the SPR image for estimating A{sub w},more » the pixel values of a SPR image were calibrated to physical water attenuation using a series of water phantoms. A{sub w} and the corresponding diameter D{sub w} were calculated using the derived attenuation-based methods (from either CT or SPR image). A{sub w} was also calculated using only geometrical dimensions of the phantoms (anterior-posterior and lateral dimensions or cross sectional area). Results: For abdomen phantoms, the geometry-based and attenuation-based methods gave similar results for D{sub w}. Using only geometric parameters, an overestimation of D{sub w} ranging from 4.3% to 21.5% was found for thorax phantoms. Results for D{sub w} using the CT image and SPR based methods agreed with each other within 4% on average in both thorax and abdomen phantoms. Conclusions: Either the cross sectional CT or SPR images can be used to estimate patient attenuation in CT. Both are more accurate than use of only geometrical information for the task of quantifying patient attenuation. The SPR based method requires calibration of SPR pixel values to physical water attenuation and this calibration would be best performed by the scanner manufacturer.« less

An overview of PET/MR, focused on clinical applications.

PubMed

Catalano, Onofrio Antonio; Masch, William Roger; Catana, Ciprian; Mahmood, Umar; Sahani, Dushyant Vasudeo; Gee, Michael Stanley; Menezes, Leon; Soricelli, Andrea; Salvatore, Marco; Gervais, Debra; Rosen, Bruce Robert

2017-02-01

Hybrid PET/MR scanners are innovative imaging devices that simultaneously or sequentially acquire and fuse anatomical and functional data from magnetic resonance (MR) with metabolic information from positron emission tomography (PET) (Delso et al. in J Nucl Med 52:1914-1922, 2011; Zaidi et al. in Phys Med Biol 56:3091-3106, 2011). Hybrid PET/MR scanners have the potential to greatly impact not only on medical research but also, and more importantly, on patient management. Although their clinical applications are still under investigation, the increased worldwide availability of PET/MR scanners, and the growing published literature are important determinants in their rising utilization for primarily clinical applications. In this manuscript, we provide a summary of the physical features of PET/MR, including its limitations, which are most relevant to clinical PET/MR implementation and to interpretation. Thereafter, we discuss the most important current and emergent clinical applications of such hybrid technology in the abdomen and pelvis, both in the field of oncologic and non-oncologic imaging, and we provide, when possible, a comparison with clinically consolidated imaging techniques, like for example PET/CT.

Accurate diagnosis of acute abdomen in FMF and acute appendicitis patients: how can we use procalcitonin?

PubMed

Kisacik, Bunyamin; Kalyoncu, Umut; Erol, M Fatih; Karadag, Omer; Yildiz, Mustafa; Akdogan, Ali; Kaptanoglu, Bugra; Hayran, Mutlu; Ureten, Kemal; Ertenli, Ihsan; Kiraz, Sedat; Calguneri, Meral

2007-12-01

This study was conducted to define the value of procalcitonin (PCT) levels in the differential diagnosis of abdominal familial Mediterranean fever (FMF) attacks from acute appendicitis. From October 2006 to January 2007, 28 FMF (12 males, 16 females) patients with acute abdominal attacks and 34 patients (18 males) with acute abdomen who underwent operation with the clinical diagnosis of acute appendicitis were consecutively enrolled in this study. FMF patients with concurrent infectious diseases were excluded. PCT values were measured by an immunofluorescent method using the B.R.A.H.M.S. PCT kit (B.R.A.H.M.S. Diagnostica, Berlin, Germany). Erythrocyte sedimentation rate (ESR), C-reactive proteins (CRP) and leucocyte levels were also noted. Mean disease duration in FMF patients was 9.6 +/- 8.1 years (range 2-33 years) and all were on colchicine therapy with a mean colchicine dosage of 1.2 +/- 0.4 mg/day. Among the operated patients, 5 were excluded: 3 patients had normal findings and 2 had intestinal perforation (PCT levels were 2.69 and 4.93 ng/ml, respectively) at operative and pathologic evaluation. There were no significant differences between the two groups with respect to gender and age (p was not significant (NS) for all). Acute phase reactants and PCT levels were increased in patients with FMF compared to patients with acute appendicitis (0.529[0.12 +/- 0.96] vs 0.095 [0.01-0.80] p < 0.001, respectively). PCT levels higher than 0.5 ng/ml were found in 11% (3/28) of FMF patients compared to 62% (18/29) of acute appendicitis patients (p < 0.001). Our results suggest that PCT could be a useful test in the differentiation of abdominal FMF attacks from acute appendicitis, though it should not supplant more conventional investigations.

Comparison of polypropylene mesh and porcine-derived, cross-linked urinary bladder matrix materials implanted in the rabbit vagina and abdomen.

PubMed

Fan, Xuemei; Wang, Yanzhou; Wang, Yu; Xu, Huicheng

2014-05-01

Our aim was to compare histological and biomechanical effects of polypropylene (PP) mesh and porcine-derived, cross-linked urinary bladder matrix (cUBM) graft materials using a rabbit vaginal and abdominal model. Forty rabbits were implanted with PP mesh (n = 20) or cUBM (n = 20) in the vagina and abdomen. Two grafts (PP or cUBM) of the same type were placed into each site, so each rabbit had four grafts. Grafts were harvested 12 weeks later and processed for histologic analysis and biomechanical testing. There were high rates of two types of grafts missing in the vagina. Vaginal PP was associated with erosion reaction (67%), whereas abdominal PP and cUBM showed no sign of erosion. All patches adhered to rectus abdominis or vaginal mucosa and shrank to varying degrees, especially for PP grafts. Compared with vaginal PP, vaginal cUBM induced milder chronic inflammation response, had lower scores (P = 0.000) for inflammation response, and showed higher scores for neovascularization (P = 0.000) and fibroblastic proliferation (P = 0.002). In the abdomen, both histopathological parameters were insignificantly different (P > 0.05) between cUBM and PP. The mechanical properties of UBM did not deteriorate following implantation, whereas the ultimate tensile strength and elastic modulus of vaginal PP increased. PP had higher scores for tensile and break strength than did cUBM (P < 0.05). The cUBM has good biocompatibility, high ability to integrate with the vagina, and maintains mechanical properties in vivo. It may be a promising material for pelvic floor reconstruction.

Advanced practice registered nurses and physician assistants in sleep centers and clinics: a survey of current roles and educational background.

PubMed

Colvin, Loretta; Cartwright, Ann; Collop, Nancy; Freedman, Neil; McLeod, Don; Weaver, Terri E; Rogers, Ann E

2014-05-15

To survey Advanced Practice Registered Nurse (APRN) and Physician Assistant (PA) utilization, roles and educational background within the field of sleep medicine. Electronic surveys distributed to American Academy of Sleep Medicine (AASM) member centers and APRNs and PAs working within sleep centers and clinics. Approximately 40% of responding AASM sleep centers reported utilizing APRNs or PAs in predominantly clinical roles. Of the APRNs and PAs surveyed, 95% reported responsibilities in sleep disordered breathing and more than 50% in insomnia and movement disorders. Most APRNs and PAs were prepared at the graduate level (89%), with sleep-specific education primarily through "on the job" training (86%). All APRNs surveyed were Nurse Practitioners (NPs), with approximately double the number of NPs compared to PAs. APRNs and PAs were reported in sleep centers at proportions similar to national estimates of NPs and PAs in physicians' offices. They report predominantly clinical roles, involving common sleep disorders. Given current predictions that the outpatient healthcare structure will change and the number of APRNs and PAs will increase, understanding the role and utilization of these professionals is necessary to plan for the future care of patients with sleep disorders. Surveyed APRNs and PAs reported a significant deficiency in formal and standardized sleep-specific education. Efforts to provide formal and standardized educational opportunities for APRNs and PAs that focus on their clinical roles within sleep centers could help fill a current educational gap.

The role of follow-up ultrasound and clinical parameters after abdominal MDCT in patients with multiple trauma.

PubMed

Geyer, Lucas L; Körner, M; Linsenmaier, U; Wirth, S; Reiser, M F; Meindl, T

2014-05-01

Beside its value during the initial trauma work-up (focused assessment with sonography for trauma), ultrasound (US) is recommended for early follow-up examinations of the abdomen in multiple injured patients. However, multidetector CT (MDCT) has proven to reliably diagnose traumatic lesions of abdominal organs, to depict their extent, and to assess their clinical relevance. To evaluate the diagnostic impact of follow-up US studies after MDCT of the abdomen and to identify possible clinical parameters indicating the need of a follow-up US. During a 30-month period, patients with suspected multiple trauma were allocated. Patients with admission to the ICU, an initial abdominal MDCT scan, and an US follow-up examination after 6 and 24 h were included. Two patient cohorts were defined: patients with normal abdominal MDCT (group 1), patients with trauma-related pathologic abdominal MDCT (group 2). In all patients, parameters indicating alteration of vital functions or hemorrhage within the first 24 h were obtained by reviewing the medical charts. Forty-four of 193 patients were included: 24 were categorized in group 1 (mean age, 41.1 years; range, 21-90 years), 20 in group 2 (mean age, 36.6 years; range, 16-71 years). In group 1, US did not provide new information compared to emergency MDCT. In group 2, there were no contradictory 6- and 24-h follow-up US findings. In patients with positive MDCT findings and alterations of clinical parameters, US did not detect progression of a previously diagnosed pathology or any late manifestation of such a lesion. In none of the patients with negative abdominal MDCT and pathological clinical parameters US indicated an abdominal injury. Routine US follow-up does not yield additional information after abdominal trauma. In patients with MDCT-proven organ lesions, follow-up MDCT should be considered if indicated by abnormal clinical and/or laboratory findings.

Single-source chest-abdomen-pelvis cancer staging on a third generation dual-source CT system: comparison of automated tube potential selection to second generation dual-source CT.

PubMed

Park, Clara; Gruber-Rouh, Tatjana; Leithner, Doris; Zierden, Amelie; Albrecht, Mortiz H; Wichmann, Julian L; Bodelle, Boris; Elsabaie, Mohamed; Scholtz, Jan-Erik; Kaup, Moritz; Vogl, Thomas J; Beeres, Martin

2016-10-10

Evaluation of latest generation automated attenuation-based tube potential selection (ATPS) impact on image quality and radiation dose in contrast-enhanced chest-abdomen-pelvis computed tomography examinations for gynaecologic cancer staging. This IRB approved single-centre, observer-blinded retrospective study with a waiver for informed consent included a total of 100 patients with contrast-enhanced chest-abdomen-pelvis CT for gynaecologic cancer staging. All patients were examined with activated ATPS for adaption of tube voltage to body habitus. 50 patients were scanned on a third-generation dual-source CT (DSCT), and another 50 patients on a second-generation DSCT. Predefined image quality setting remained stable between both groups at 120 kV and a current of 210 Reference mAs. Subjective image quality assessment was performed by two blinded readers independently. Attenuation and image noise were measured in several anatomic structures. Signal-to-noise ratio (SNR) was calculated. For the evaluation of radiation exposure, CT dose index (CTDI vol ) values were compared. Diagnostic image quality was obtained in all patients. The median CTDI vol (6.1 mGy, range 3.9-22 mGy) was 40 % lower when using the algorithm compared with the previous ATCM protocol (median 10.2 mGy · cm, range 5.8-22.8 mGy). A reduction in potential to 90 kV occurred in 19 cases, a reduction to 100 kV in 23 patients and a reduction to 110 kV in 3 patients of our experimental cohort. These patients received significantly lower radiation exposure compared to the former used protocol. Latest generation automated ATPS on third-generation DSCT provides good diagnostic image quality in chest-abdomen-pelvis CT while average radiation dose is reduced by 40 % compared to former ATPS protocol on second-generation DSCT.

Studying the Physiology of Tadpoles through their Naturally Transparent Abdomen Walls

NASA Astrophysics Data System (ADS)

Naitoh, T.; Yamashita, M.; Wassersug, R.

Because their development is external and they grow rapidly, anurans (frogs and toads) have been important model species in studies of how spaceflight affects vertebrate development. However the long term effects of spaceflight on post embryonic stages have barely been studied in these, or for that matter, any other vertebrate species. Tadpoles of certain species have naturally transparent skin covering a large portion of their ventral abdomen wall. Consequently viscera and visceral movements can be observed through this window without any invasive treatment to the animals. Respiration rate (as measured by buccal floor movements), heart rate, and gut motility are all indices of physiological state that can be observed in unconstrained larvae of these particular anuran species. We are using changes in these physiological variables to study the responses of tadpoles to changes in their external environment. Our study of the physiological responses of these tadpoles to microgravity has been selected as a candidate spaceflight experiment (to be housed in the Canadian Aquatic Research Facility). Ground-based studies with these same larvae are currently underway. Those experiments make use of stepwise changes in temperature as a stimulus to document the effect of temperature on intestinal motility in tadpoles. The scope of our studies on gravitational physiology and key issues in post- embryonic development of anurans are the focus of our presentation. This research is a prelude to raising a vertebrate through a complete life cycle in the space environment.

Necessity and benefits of physician assistants' participation in international clinical experiences.

PubMed

Kibe, Lucy Wachera

2012-01-01

Several consultation stations have been set up in an unfinished stone building. My team is made up of a Kenyan physician assistant (called clinical officer), a Kenyan medical student, and me, a US physician assistant student. We are huddled around a small worn-out square table. A middle-aged woman and her two children, ages 2 and 6, approach the table. They have traveled 2 miles to the medical camp. The children, covered in dust, are emaciated with protruding abdomens, dry skin, and congested noses. The clinical officer (CO) conducts a brief interview in Swahili, the Kenyan national language. The mother explains that they have been coughing up thick yellow sputum for a week and have no appetite. They've also had diarrhea for a couple of weeks. I examine the children, who are obviously scared. Hot, moist skin. They are both running a fever. I listen to the lungs: reduced lung sounds. The protruding abdomens are rock hard. I report the findings to the team. The CO turns to the Kenyan medical student and me and quizzes us on differential diagnoses with rationale for each. We come up with malaria, pneumonia, TB, and worm infestation. Due to limited resources, medical diagnosis in Kenya relies heavily on history and physical exam. The CO explains that comorbid conditions are probable. Luckily, we have malaria-testing kits at the camp. They test negative for malaria. We decide to treat them for pneumonia. We also offer them a free hot meal, toothbrushes, T-shirts, coloring paper, and crayons. The children manage to smile. The mother is so grateful, she cries.

Mechanistic background and clinical applications of indocyanine green fluorescence imaging of hepatocellular carcinoma.

PubMed

Ishizawa, Takeaki; Masuda, Koichi; Urano, Yasuteru; Kawaguchi, Yoshikuni; Satou, Shouichi; Kaneko, Junichi; Hasegawa, Kiyoshi; Shibahara, Junji; Fukayama, Masashi; Tsuji, Shingo; Midorikawa, Yutaka; Aburatani, Hiroyuki; Kokudo, Norihiro

2014-02-01

Although clinical applications of intraoperative fluorescence imaging of liver cancer using indocyanine green (ICG) have begun, the mechanistic background of ICG accumulation in the cancerous tissues remains unclear. In 170 patients with hepatocellular carcinoma cells (HCC), the liver surfaces and resected specimens were intraoperatively examined by using a near-infrared fluorescence imaging system after preoperative administration of ICG (0.5 mg/kg i.v.). Microscopic examinations, gene expression profile analysis, and immunohistochemical staining were performed for HCCs, which showed ICG fluorescence in the cancerous tissues (cancerous-type fluorescence), and HCCs showed fluorescence only in the surrounding non-cancerous liver parenchyma (rim-type fluorescence). ICG fluorescence imaging enabled identification of 273 of 276 (99%) HCCs in the resected specimens. HCCs showed that cancerous-type fluorescence was associated with higher cancer cell differentiation as compared with rim-type HCCs (P < 0.001). Fluorescence microscopy identified the presence of ICG in the canalicular side of the cancer cell cytoplasm, and pseudoglands of the HCCs showed a cancerous-type fluorescence pattern. The ratio of the gene and protein expression levels in the cancerous to non-cancerous tissues for Na(+)/taurocholate cotransporting polypeptide (NTCP) and organic anion-transporting polypeptide 8 (OATP8), which are associated with portal uptake of ICG by hepatocytes that tended to be higher in the HCCs that showed cancerous-type fluorescence than in those that showed rim-type fluorescence. Preserved portal uptake of ICG in differentiated HCC cells by NTCP and OATP8 with concomitant biliary excretion disorders causes accumulation of ICG in the cancerous tissues after preoperative intravenous administration. This enables highly sensitive identification of HCC by intraoperative ICG fluorescence imaging.

[Maintenance treatment in opioid-dependent patients with migration background].

PubMed

Bald, L K; Schouler-Ocak, M; Penka, S; Schoofs, N; Häbel, T; Bermpohl, F; Gutwinski, S

2016-05-01

No regional analyses regarding opioid-dependent patients in maintenance treatment with a migration background have so far been performed in German-speaking countries. This study examined patients with and without a migration background regarding socioeconomic parameters, characteristics of dependency and attitude towards opiate maintenance treatment (OMT). From May to October 2011 patients in OMT from all of the 20 psychiatry clinics and 110 physician practices in Berlin with a licence to provide OMT were included in this analysis. Out of the 986 participating patients, 956 gave information on migration background and of these, 204 (21.3 %) originated from a country other than Germany. Compared to patients without a migration background, their participation in a maintenance program was significantly shorter and they more often expressed a desire to end OMT and wanted a limited duration of OMT. The differences regarding duration of OMT and the wish to end OMT can reflect a stronger desire for abstinence and a different attitude towards maintenance treatment of patients with a migration background.

Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 10. Injuries of the Eye, Ear, Nose, Abdomen, Central Nervous System and Genitalia. Burns and Environmental Injuries. Revised.

ERIC Educational Resources Information Center

Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers injuries of the eyes, ears, nose, abdomen, central nervous system (CNS), and genitalia; burns; and environmental injuries. Objectives stated for the two chapters are for the student to be able to describe procedures…

[Acceptance and Commitment Therapy: Theoretical background and practice].

PubMed

Eisenbeck, Nikolett; Schlosser, Károly Kornél; Szondy, Máté; Szabó-Bartha, Anett

The Acceptance and Commitment Therapy (ACT) is one of the modern, so-called third-wave behavioural therapies. Among them the most successful is ACT, both in the number of therapists and respective scientific research. ACT's theoretical and philosophical background is described explicitly and its therapeutic interventions were developed according to this philosophy. Its psychopathological model is based on the idea that mainly the person's regulatory efforts of their own thoughts and feelings lead to psychological problems. That is, the source of human suffering and various psychological problems is the so called psychological inflexibility: control attempts of private events instead of living a life based on personal values and long-term goals. Therefore, clinical work in ACT focuses on the acceptance and defusion of the unwanted inner experiences and on the development of a meaningful life. The present article aims to provide a comprehensive description of ACT in Hungarian: its theoretical background, clinical techniques, and efficacy. At the end of the article, the state of ACT in Hungary will also be briefly discussed.

Modelling difficulties in abstract thinking in psychosis: the importance of socio-developmental background.

PubMed

Berg, A O; Melle, I; Zuber, V; Simonsen, C; Nerhus, M; Ueland, T; Andreassen, O A; Sundet, K; Vaskinn, A

2017-01-01

Abstract thinking is important in modern understanding of neurocognitive abilities, and a symptom of thought disorder in psychosis. In patients with psychosis, we assessed if socio-developmental background influences abstract thinking, and the association with executive functioning and clinical psychosis symptoms. Participants (n = 174) had a diagnosis of psychotic or bipolar disorder, were 17-65 years, intelligence quotient (IQ) > 70, fluent in a Scandinavian language, and their full primary education in Norway. Immigrants (N = 58) were matched (1:2) with participants without a history of migration (N = 116). All participants completed a neurocognitive and clinical assessment. Socio-developmental background was operationalised as human developmental index (HDI) of country of birth, at year of birth. Structural equation modelling was used to assess the model with best fit. The model with best fit, χ 2  = 96.591, df = 33, p < .001, confirmed a significant indirect effect of HDI scores on abstract thinking through executive functioning, but not through clinical psychosis symptoms. This study found that socio-developmental background influences abstract thinking in psychosis by indirect effect through executive functioning. We should take into account socio-developmental background in the interpretation of neurocognitive performance in patients with psychosis, and prioritise cognitive remediation in treatment of immigrant patients.

The optimization of acoustic fields for ablative therapies of tumours in the upper abdomen

NASA Astrophysics Data System (ADS)

Gélat, P.; ter Haar, G.; Saffari, N.

2012-12-01

High intensity focused ultrasound (HIFU) enables highly localized, non-invasive tissue ablation and its efficacy has been demonstrated in the treatment of a range of cancers, including those of the kidney, prostate and breast. HIFU offers the ability to treat deep-seated tumours locally, and potentially bears fewer side effects than more invasive treatment modalities such as resection, chemotherapy and ionizing radiation. There remains however a number of significant challenges which currently hinder its widespread clinical application. One of these challenges is the need to transmit sufficient energy through the ribcage to ablate tissue at the required foci whilst minimizing the formation of side lobes and sparing healthy tissue. Ribs both absorb and reflect ultrasound strongly. This sometimes results in overheating of bone and overlying tissue during treatment, leading to skin burns. Successful treatment of a patient with tumours in the upper abdomen therefore requires a thorough understanding of the way acoustic and thermal energy is deposited. Previously, a boundary element approach based on a Generalized Minimal Residual (GMRES) implementation of the Burton-Miller formulation was developed to predict the field of a multi-element HIFU array scattered by human ribs, the topology of which was obtained from CT scan data (Gélat et al 2011 Phys. Med. Biol. 56 5553-81). The present paper describes the reformulation of the boundary element equations as a least-squares minimization problem with nonlinear constraints. The methodology has subsequently been tested at an excitation frequency of 1 MHz on a spherical multi-element array in the presence of ribs. A single array-rib geometry was investigated on which a 50% reduction in the maximum acoustic pressure magnitude on the surface of the ribs was achieved with only a 4% reduction in the peak focal pressure compared to the spherical focusing case. This method was then compared with a binarized apodization approach

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery.

PubMed

Binda, Maria Mercedes

2015-11-01

The peritoneum is the serous membrane that covers the abdominal cavity and most of the intra-abdominal organs. It is a very delicate layer highly susceptible to damage and it is not designed to cope with variable conditions such as the dry and cold carbon dioxide (CO2) during laparoscopic surgery. The aim of this review was to evaluate the effects caused by insufflating dry and cold gas into the abdominal cavity after laparoscopic surgery. A literature search using the Pubmed was carried out. Articles identified focused on the key issues of laparoscopy, peritoneum, morphology, pneumoperitoneum, humidity, body temperature, pain, recovery time, post-operative adhesions and lens fogging. Insufflating dry and cold CO2 into the abdomen causes peritoneal damage, post-operative pain, hypothermia and post-operative adhesions. Using humidified and warm gas prevents pain after surgery. With regard to hypothermia due to desiccation, it can be fully prevented using humidified and warm gas. Results relating to the patient recovery are still controversial. The use of humidified and warm insufflation gas offers a significant clinical benefit to the patient, creating a more physiologic peritoneal environment and reducing the post-operative pain and hypothermia. In animal models, although humidified and warm gas reduces post-operative adhesions, humidified gas at 32 °C reduced them even more. It is clear that humidified gas should be used during laparoscopic surgery; however, a question remains unanswered: to achieve even greater clinical benefit to the patient, at what temperature should the humidified gas be when insufflated into the abdomen? More clinical trials should be performed to resolve this query.

Psychiatric emergencies of minors with and without migration background.

PubMed

Akkaya-Kalayci, Türkan; Popow, Christian; Waldhör, Thomas; Winkler, Dietmar; Özlü-Erkilic, Zeliha

2017-03-01

The conditions of children and adolescents with migration background receiving emergency psychiatric care in Europe are not well known. Migrants usually attend regular psychiatric care less frequently than the autochthonous population. We therefore speculated that, being undertreated, they would be overrepresented among psychiatric emergency care patients. We retrospectively analyzed the records of 1093 minors aged 4‑18 years treated during a period of three years at the psychiatric emergency outpatient clinic of the Department of Child and Adolescent Psychiatry at the Medical University of Vienna. More minors with migration background than natives consulted our emergency clinic. Most frequent reasons for referral were suicide attempts by Turkish patients, acute stress disorder in Serbian/Croatian/Bosnian and in Austrian patients. Psychiatric diagnoses like eating and personality disorders were mostly diagnosed in natives. We found gender specific differences between the groups. The reasons for these differences possibly relate to deficits of adequate mental health-care in Austria, to intercultural and intrafamiliar conflicts related to acculturation distress in the migrant population. Prospective longitudinal studies focusing on the utilization of mental health care by the migrant children and the impact of the migration background on their mental health are needed for improving adequate culture-sensitive mental-health care for this population.

Photon migration through fetal head in utero using continuous wave, near infrared spectroscopy: clinical and experimental model studies

NASA Astrophysics Data System (ADS)

Ramanujam, Nirmala; Vishnoi, Gargi; Hielscher, Andreas H.; Rode, Martha; Forouzan, Iraj; Chance, Britton

2000-04-01

Near infrared (NIR) measurements were made from the maternal abdomen (clinical studies) and laboratory tissue phantoms (experimental studies) to gain insight into photon migration through the fetal head in utero. Specifically, a continuous wave spectrometer was modified and employed to make NIR measurements at 760 and 850 nm, at a large (10 cm) and small (2.5/4 cm) source-detector separation, simultaneously, on the maternal abdomen, directly above the fetal head. A total of 19 patients were evaluated, whose average gestational age and fetal head depth, were 37 weeks +/- 3 and 2.25 cm +/- 0.7, respectively. At the large source-detector separation, the photons are expected to migrate through both the underlying maternal and fetal tissues before being detected at the surface, while at the short source-detector separation, the photons are expected to migrate primarily through the superficial maternal tissues before being detected. Second, similar NIR measurements were made on laboratory tissue phantoms, with variable optical properties and physical geometries. The variable optical properties were obtained using different concentrations of India ink and Intralipid in water, while the variable physical geometries were realized by employing glass containers of different shapes and sizes. Third, the NIR measurements, which were made on the laboratory tissue phantoms, were compared to the NIR measurements made on the maternal abdomen to determine which tissue phantom best simulates the photon migration path through the fetal head in utero. The results of the comparison were used to provide insight into the optical properties and physical geometry of the maternal and fetal tissues in the photon migration path.

Arterial phase CT for the detection of splenic injuries in blunt trauma: would it improve clinical outcomes?

PubMed

Corwin, Michael T; Fananapazir, Ghaneh; Lamba, Ramit; Salcedo, Edgardo S; Holmes, James F

2016-01-01

To determine if the addition of an arterial phase abdominal computed tomography (CT) improves clinical outcomes in patients with blunt splenic injuries. Retrospective review of patients who underwent CT of the abdomen revealing splenic injuries. Clinical management in these patients was determined. Fifty-one of three thousand five hundred twenty-five patients had splenic injuries. Twenty-five patients underwent nonsurgical management, and 3 failed. The theoretical additional arterial phase resulted in a 62% increase in mean effective dose compared to the portal venous phase alone. Routine use of arterial phase CT in blunt trauma patients may not be warranted as there is minimal improvement in outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

Insights into the background of autonomic medicine.

PubMed

Laranjo, Sérgio; Geraldes, Vera; Oliveira, Mário; Rocha, Isabel

2017-10-01

Knowledge of the physiology underlying the autonomic nervous system is pivotal for understanding autonomic dysfunction in clinical practice. Autonomic dysfunction may result from primary modifications of the autonomic nervous system or be secondary to a wide range of diseases that cause severe morbidity and mortality. Together with a detailed history and physical examination, laboratory assessment of autonomic function is essential for the analysis of various clinical conditions and the establishment of effective, personalized and precise therapeutic schemes. This review summarizes the main aspects of autonomic medicine that constitute the background of cardiovascular autonomic dysfunction. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Can clinical CT data improve forensic reconstruction?

PubMed

Schuh, P; Scheurer, E; Fritz, K; Pavlic, M; Hassler, E; Rienmüller, R; Yen, K

2013-05-01

In accidents resulting in severe injuries, a clinical forensic examination is generally abandoned in the initial phase due to high-priority clinical needs. However, in many cases, data from clinical computed tomography (CT) examinations are available. The goals of this prospective study were (a) to evaluate clinical CT data as a basis for forensic reconstruction of the sequence of events, (b) to assess if forensic radiological follow-up reading improves the forensic diagnostic benefit compared to the written clinical radiological reports, and (c) to evaluate if full data storage including additional reconstructed 0.6-mm slices enhances forensic analysis. Clinical CT data of 15 living individuals with imaging of at least the head, thorax, and abdomen following polytrauma were examined regarding the forensic evaluation of the sequence of events. Additionally, 0.6-mm slices and 3D images were reconstructed for forensic purposes and used for the evaluation. At the forensic radiological readings, additional traumatic findings were observed in ten of the 15 patients. The main weakness of the clinical reports was that they were not detailed enough, particularly regarding the localization of injuries and description of wound morphology. In seven cases, however, forensic conclusions were possible on the basis of the written clinical reports, whereas in five cases forensic reconstruction required specific follow-up reading. The additional 0.6-mm slices were easily available and with improved 3D image quality and forensic diagnostics. In conclusion, the use of clinical CT data can considerably support forensic expertise regarding reconstruction issues. Forensic follow-up reading as well as the use of additional thin slices for 3D analysis can further improve its benefit for forensic reconstruction purposes.

Clinical profile of dengue among children according to revised WHO classification: analysis of a 2012 outbreak from Southern India.

PubMed

Sahana, K S; Sujatha, R

2015-02-01

To study the clinical profile of dengue fever and its outcome in children with application of revised WHO classification and to identify risk factors for severe dengue. This study was a prospective observational study of children diagnosed with dengue from July 2012 through February 2013 at a tertiary care hospital in Bangalore, Karnataka (South India). Eighty one children including 55(67.9 %) boys and 26(32.1 %) girls were diagnosed with dengue. Mean age of presentation was 8 y. Vomiting (60.5 %), pain abdomen (32 %), headache (30.9 %), myalgia (23.5 %) and bleeding manifestations (16 %) were the common presenting complaints. Facial puffiness (63 %), hepatomegaly (51.9 %), ascites (48.1 %), pleural effusion (39.5 %) and petechiae (14.8 %) were noted during examination. Dengue NS1 antigen, IgM, IgG were positive in 66.7 %, 29.6 % and 18.5 % of cases respectively. Investigations showed hemoconcentration in 72.8 %, leucopenia (34.5 %), thrombocytopenia (82.7 %), abnormal liver function test (LFT) (33.3 %). USG abdomen was suggestive of dengue in 66.7 % and gall bladder edema was noted in 53.1 %. Two patients died out of the total 81 patients with mortality rate of 2.5 %. Number of cases classified as Dengue without warning signs (D), Dengue with warning signs (DW) and Severe Dengue (SD) were 48.1 %, 27.2 % and 24.7 % respectively. Children between 5 and 15 y were most affected by dengue fever. Pain abdomen and vomiting were most common presenting symptoms. Ascites, plerural effusion, hepatomegaly, gall bladder wall thickening and abnormal LFT were found significantly high in severe dengue cases.

Volumetric modulated arc therapy with flattening filter free beams for isolated abdominal/pelvic lymph nodes: report of dosimetric and early clinical results in oligometastatic patients

PubMed Central

2012-01-01

Background SBRT is a safe and efficient strategy to locally control multiple metastatic sites. While research in the physics domain for Flattening Filter Free Beams (FFF) beams is increasing, there are few clinical data of FFF beams in clinical practice. Here we reported dosimentric and early clinical data of SBRT and FFF delivery in isolated lymph node oligometastatic patients. Methods Between October 2010 and March 2012, 34 patients were treated with SBRT for oligometastatic lymph node metastasis on a Varian TrueBeamTM treatment machine using Volumetric Modulated Arc Therapy (RapidArc). We retrospectively evaluated a total of 25 patients for isolated lymph node metastases in abdomen and/or pelvis treated with SBRT and FFF (28 treatments). Acute toxicity was recorded. Local control evaluation was scored by means of CT scan and/or PET scan. Results All dosimetric results are in line with what published for the same type of stereotactic abdominal lymph node metastases treatments and fractionation, using RapidArc. All 25 FFF SBRT patients completed the treatment. Acute gastrointestinal toxicity was minimal: one patient showed Grade 1 gastrointestinal toxicity. Three other patients presented Grade 2 toxicity. No Grade 3 or higher was recorded. All toxicities were recovered within one week. The preliminary clinical results at the median follow up of 195 days are: complete response in 12 cases, partial response in 11, stable disease in 5, with an overall response rate of 82%; no local progression was recorded. Conclusions Data of dosimetrical findings and acute toxicity are excellent for patients treated with SBRT with VMAT using FFF beams. Preliminary clinical results showed a high rate of local control in irradiated lesion. Further data and longer follow up are needed to assess late toxicity and definitive clinical outcomes. PMID:23216821

Amplified fragment length polymorphism of Streptococcus suis strains correlates with their profile of virulence-associated genes and clinical background.

PubMed

Rehm, Thomas; Baums, Christoph G; Strommenger, Birgit; Beyerbach, Martin; Valentin-Weigand, Peter; Goethe, Ralph

2007-01-01

Amplified fragment length polymorphism (AFLP) typing was applied to 116 Streptococcus suis isolates with different clinical backgrounds (invasive/pneumonia/carrier/human) and with known profiles of virulence-associated genes (cps1, -2, -7 and -9, as well as mrp, epf and sly). A dendrogram was generated that allowed identification of two clusters (A and C) with different subclusters (A1, A2, C1 and C2) and two heterogeneous groups of strains (B and D). For comparison, three strains from each AFLP subcluster and group were subjected to multilocus sequence typing (MLST) analysis. The closest relationship and lowest diversity were found for patterns clustering within AFLP subcluster A1, which corresponded with sequence type (ST) complex 1. Strains within subcluster A1 were mainly invasive cps1 and mrp+ epf+ (or epf*) sly+ cps2+ strains of porcine or human origin. A new finding of this study was the clustering of invasive mrp* cps9 isolates within subcluster A2. MLST analysis suggested that A2 correlates with a single ST complex (ST87). In contrast to A1 and A2, subclusters C1 and C2 contained mainly pneumonia isolates of genotype cps7 or cps2 and epf- sly-. In conclusion, this study demonstrates that AFLP allows identification of clusters of S. suis strains with clinical relevance.

The Impacts of Language Background and Language-Related Disorders in Auditory Processing Assessment

ERIC Educational Resources Information Center

Loo, Jenny Hooi Yin; Bamiou, Doris-Eva; Rosen, Stuart

2013-01-01

Purpose: To examine the impact of language background and language-related disorders (LRDs--dyslexia and/or language impairment) on performance in English speech and nonspeech tests of auditory processing (AP) commonly used in the clinic. Method: A clinical database concerning 133 multilingual children (mostly with English as an additional…

Female Mecp2+/− mice display robust behavioral deficits on two different genetic backgrounds providing a framework for pre-clinical studies

PubMed Central

Samaco, Rodney C.; McGraw, Christopher M.; Ward, Christopher S.; Sun, Yaling; Neul, Jeffrey L.; Zoghbi, Huda Y.

2013-01-01

Rett syndrome (RTT) is an X-linked neurological disorder caused by mutations in the gene encoding the transcriptional modulator methyl-CpG-binding protein 2 (MeCP2). Typical RTT primarily affects girls and is characterized by a brief period of apparently normal development followed by the loss of purposeful hand skills and language, the onset of anxiety, hand stereotypies, autistic features, seizures and autonomic dysfunction. Mecp2 mouse models have extensively been studied to demonstrate the functional link between MeCP2 dysfunction and RTT pathogenesis. However, the majority of studies have focused primarily on the molecular and behavioral consequences of the complete absence of MeCP2 in male mice. Studies of female Mecp2+/− mice have been limited because of potential phenotypic variability due to X chromosome inactivation effects. To determine whether reproducible and reliable phenotypes can be detected Mecp2+/− mice, we analyzed Mecp2+/− mice of two different F1 hybrid isogenic backgrounds and at young and old ages using several neurobehavioral and physiological assays. Here, we report a multitude of phenotypes in female Mecp2+/− mice, some presenting as early as 5 weeks of life. We demonstrate that Mecp2+/− mice recapitulate several aspects of typical RTT and show that mosaic expression of MeCP2 does not preclude the use of female mice in behavioral and molecular studies. Importantly, we uncover several behavioral abnormalities that are present in two genetic backgrounds and report on phenotypes that are unique to one background. These findings provide a framework for pre-clinical studies aimed at improving the constellation of phenotypes in a mouse model of RTT. PMID:23026749

Childhood motocross truncal injuries: high-velocity, focal force to the chest and abdomen

PubMed Central

Kennedy, Raelene D; Potter, D Dean; Osborn, John B; Zietlow, Scott; Zarroug, Abdalla E; Moir, Christopher R; Ishitani, Michael B; McIntosh, Amy

2012-01-01

Objectives To review the need for operative intervention and critical care services for motocross truncal injuries in children. Design cohort Retrospective review of patients identified via the hospital trauma registry. Setting Our Level 1 Pediatric Trauma Center serves five motocross tracks. These patients require frequent medical care for injuries. Participants All patients ≤17 years of age with truncal injuries sustained during motocross activities, between 2000 and 2011, were identified through the trauma registry. Primary and secondary outcome measures Operative intervention, intensive care unit (ICU) admission, length of stay, morbidity and demographics were reviewed. Results Motocross injured 162 children. Thirty (18.5%) were thoracic or abdominal injuries. Operative intervention was required in eight (27%) patients. Mean injury severity score (ISS) was 11.8. ICU admission was required in 50% and average hospital length of stay was 4.1 days. The most common injuries include pulmonary contusion, pneumothorax, spleen and liver lacerations. 13% of subjects suffered truncal injury from motocross on more than one occasion. Conclusions Paediatric motocross-related truncal injuries are significant. Surgical intervention is required in 27% of patients. The lower ISS incurred from motocross combined with high surgical and ICU admission rates suggests focal high-impact injuries to the chest and abdomen. Despite significant injury, 13% of motocross patients suffer recurrent injuries. Parents and children need injury prevention education. PMID:23166134

Towards the optimisation of acoustic fields for ablative therapies of tumours in the upper abdomen

NASA Astrophysics Data System (ADS)

Gélat, P.; ter Haar, G.; Saffari, N.

2013-08-01

The efficacy of high intensity focused ultrasound (HIFU) for the non-invasive treatment of cancer has been demonstrated for a range of different cancers including those of the liver, kidney, prostate and breast. As a non-invasive focused therapy, HIFU offers considerable advantages over other techniques such as chemotherapy and surgical resection, in terms of its non-invasiveness and low risk of harmful side effects. There is, however, a number of significant challenges which currently hinder its widespread clinical application. One of these challenges is the need to transmit sufficient energy through the ribcage to induce tissue necrosis at the required foci whilst minimising the formation of side lobes and sparing healthy tissue. Ribs both absorb and reflect ultrasound strongly. As such, a common side effect of focusing ultrasound in regions located behind the rib cage is the overheating of bone and surrounding tissue, which can lead to skin burns. Successful treatment of a patient with tumours in the upper abdomen therefore requires a thorough understanding of the way acoustic and thermal energy are deposited. This is likely to rely on a treatment planning procedure in which optimal source velocity distributions are obtained so as to maximise a dose quantity at the treatment sites, whilst ensuring that this quantity does not exceed a specified threshold at other field locations, particularly on the surface of the ribs. Previously, a boundary element approach based on a Generalised Minimal Residual (GMRES) implementation of the Burton-Miller formulation was developed to predict the field of a multi-element HIFU array scattered by human ribs, the topology of which was obtained from CT scan data [1]. This work describes the reformulation of the boundary element equations as a least-squares minimisation problem with non-linear constraints. The methodology was subsequently tested at an excitation frequency of 100 kHz on a spherical multi-element array in the presence

Background characterization of an ultra-low background liquid scintillation counter

DOE PAGES

Erchinger, J. L.; Orrell, John L.; Aalseth, C. E.; ...

2017-01-26

The Ultra-Low Background Liquid Scintillation Counter developed by Pacific Northwest National Laboratory will expand the application of liquid scintillation counting by enabling lower detection limits and smaller sample volumes. By reducing the overall count rate of the background environment approximately 2 orders of magnitude below that of commercially available systems, backgrounds on the order of tens of counts per day over an energy range of ~3–3600 keV can be realized. Finally, initial test results of the ULB LSC show promising results for ultra-low background detection with liquid scintillation counting.

A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality

PubMed Central

Favazza, Christopher P.; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M.; Bruesewitz, Michael R.; McCollough, Cynthia H.

2015-01-01

Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice’s routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2 ± 0.2 mm using GE’s “Plus” mode reconstruction setting and 5.0 ± 0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24 ± 0.37, 6.20 ± 0.34, and 7.84 ± 0.70 lp/cm, respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5–13.3 HU (noise) and 4.8–13.3 mGy (CTDIvol) for the smallest phantom; 9.1–18.4 HU and 9.3–28.8 mGy for the medium phantom; and 7.8–23.4 HU and 16.0–48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes. PMID:26459751

Clinical education and cultural diversity in physical therapy: clinical performance of minority student physical therapists and the expectations of clinical instructors.

PubMed

Clouten, Norene; Homma, Midori; Shimada, Rie

2006-01-01

Clinical education is an integral part of preparation for the profession of physical therapy and the role of the clinical instructor is critical. The purpose of this study was to investigate clinical instructors' expectations of student physical therapists with different ethnic backgrounds and the clinical performance of the students as assessed using a modification of the Generic Abilities Assessment. For this study, individuals with a Caucasian ethnic background who were raised in the United States were considered as the majority. The remaining individuals (minority) were subdivided into five groups: African American, Hispanic, Asian/Pacific Islander, Caucasian from outside the United States, and Other. Clinical instructors reported their experiences with students from different ethnic backgrounds, their expectation of students' performance, and recollections of specific weaknesses in performance. From the 216 surveys distributed, 192 clinical instructors responded. Fifty-seven percent had supervised a minority student, with a mean of three students each. While 4% reported that they expected a higher standard from majority students, 17% noted a difference in performance between majority and minority students. Results from this study suggest that minority students would benefit from further preparation in communication and interpersonal skills but they are stronger than majority students in stress management and the effective use of time and resources.

Evaluation of dual-source parallel RF excitation for diffusion-weighted whole-body MR imaging with background body signal suppression at 3.0 T.

PubMed

Mürtz, Petra; Kaschner, Marius; Träber, Frank; Kukuk, Guido M; Büdenbender, Sarah M; Skowasch, Dirk; Gieseke, Jürgen; Schild, Hans H; Willinek, Winfried A

2012-11-01

To evaluate the use of dual-source parallel RF excitation (TX) for diffusion-weighted whole-body MRI with background body signal suppression (DWIBS) at 3.0 T. Forty consecutive patients were examined on a clinical 3.0-T MRI system using a diffusion-weighted (DW) spin-echo echo-planar imaging sequence with a combination of short TI inversion recovery and slice-selective gradient reversal fat suppression. DWIBS of the neck (n=5), thorax (n=8), abdomen (n=6) and pelvis (n=21) was performed both with TX (2:56 min) and with standard single-source RF excitation (4:37 min). The quality of DW images and reconstructed inverted maximum intensity projections was visually judged by two readers (blinded to acquisition technique). Signal homogeneity and fat suppression were scored as "improved", "equal", "worse" or "ambiguous". Moreover, the apparent diffusion coefficient (ADC) values were measured in muscles, urinary bladder, lymph nodes and lesions. By the use of TX, signal homogeneity was "improved" in 25/40 and "equal" in 15/40 cases. Fat suppression was "improved" in 17/40 and "equal" in 23/40 cases. These improvements were statistically significant (p<0.001, Wilcoxon signed-rank test). In five patients, fluid-related dielectric shading was present, which improved remarkably. The ADC values did not significantly differ for the two RF excitation methods (p=0.630 over all data, pairwise Student's t-test). Dual-source parallel RF excitation improved image quality of DWIBS at 3.0 T with respect to signal homogeneity and fat suppression, reduced scan time by approximately one-third, and did not influence the measured ADC values. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

[Correlation between vertebral bone marrow fat and abdomen fat: a prospective study].

PubMed

Zhang, Xiao-Dong; Zhao, Yin-Xia; Zhao, Wen-Ji; Zhang, Ling-Yan; Yan, Jie-Wen; Hao, Shuai; Lu, Xiong-Guang; Zhao, Jing; Li, Shao-Lin

2016-02-01

To investigate the correlation between the lumbar bone marrow fat and abdominal fat. A total of 68 individuals (32 men and 36 women, aged 21-74 years with a median of 49.5 years) were included in this study. All the subjects underwent spectroscopic examination of the third lumber vertebra with the single voxel method on a 1.5T MR scanner to measure the fat fraction (FF%). Quantitative CT was also performed for measurement of the abdomen subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT). The measurements were compared between subjects aged ≥50 years and those below 50 years, respectively,in male or female subjects. In male subjects, BMI, FF%, VAT or SAT showed no significant differences between the two age groups (P>0.05), and FF% was not correlated with BMI, VAT or SAT (r=0.109, 0.034, 0.066, respectively; P>0.05). In the female subjects, BMI, FF%, VAT and SAT differed significantly between the two age groups (P<0.05), and in ≥50 years group, FF% showed a positive correlation with VAT (r=0.499, P<0.05) but was not correlated with SAT (r=0.221, P>0.05); in<50 years group, FF% was not correlated with VAT or SAT (r=0.076, -0.067, respectively; P>0.05). FF% is positively correlated with VAT in female subjects aged beyond 50 years, but is not correlated with VAT or SAT in male subjects or in younger female subjects.

The open abdomen and temporary abdominal closure systems--historical evolution and systematic review.

PubMed

Quyn, A J; Johnston, C; Hall, D; Chambers, A; Arapova, N; Ogston, S; Amin, A I

2012-08-01

Several techniques for temporary abdominal closure have been developed. We systematically review the literature on temporary abdominal closure to ascertain whether the method can be tailored to the indication. Medline, Embase, the Cochrane Central Register of Controlled Trials and relevant meeting abstracts until December 2009 were searched using the following headings: open abdomen, laparostomy, VAC (vacuum assisted closure), TNP (topical negative pressure), fascial closure, temporary abdominal closure, fascial dehiscence and deep wound dehiscence. The data were analysed by closure technique and aetiology. The primary end-points included delayed fascial closure and in-hospital mortality. The secondary end-points were intra-abdominal complications. The search identified 106 papers for inclusion. The techniques described were VAC (38 series), mesh/sheet (30 series), packing (15 series), Wittmann patch (eight series), Bogotá bag (six series), dynamic retention sutures (three series), zipper (15 series), skin only and locking device (one series each). The highest facial closure rates were seen with the Wittmann patch (78%), dynamic retention sutures (71%) and VAC (61%). Temporary abdominal closure has evolved from simple packing to VAC based systems. In the absence of sepsis Wittmann patch and VAC offered the best outcome. In its presence VAC had the highest delayed primary closure and the lowest mortality rates. However, due to data heterogeneity only limited conclusions can be drawn from this analysis. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

64-Slice multidetector row CT angiography of the abdomen: comparison of low versus high concentration iodinated contrast media in a porcine model

PubMed Central

Holalkere, N-S; Matthes, K; Kalva, S P; Brugge, W R; Sahani, D V

2011-01-01

Objective In this study we aimed to assess the image quality and degree of vascular enhancement using low-concentration contrast media (LCCM) (300 mg I ml–1) and high-concentration contrast media (HCCM) (370 mg I ml–1) on 64-slice multidetector row CT (MDCT) abdominal CT angiography (CTA). In addition, we aimed to study the feasibility of using HCCM with a reduced total iodine dose. Methods CTA of the abdomen on a 64-slice MDCT was performed on 15 anaesthetised pigs. Study pigs were divided into three groups of five each based on the iodine concentration and dose received: Group A (LCCM; 300 mg I ml–1), Group B (HCCM; 370 mg I ml–1) and Group C HCCM with 20% less iodine dose. The total iodine injected was kept constant (600 mg kg–1) in Groups A and B. Qualitative and quantitative analyses were performed to study and compare each group for image quality, visibility of the branch order of the superior mesenteric artery (SMA), artefacts, degree of enhancement in the aorta and main stem arteries and uniformity of enhancement in the aorta. Groups were compared using the analysis of variance test. Results The image quality of 64-slice MDCT angiography was excellent with a mean score of 4.63 and confident visualisation of the third to fifth order branches of the SMA in all groups. Group B demonstrated superior vascular enhancement, as compared with Groups A and C (p≤0.05). Uniform aortic enhancement was achieved with the use of LCCM and HCCM with 20% less iodine dose. Conclusion 64-slice MDCT angiography of the abdomen was of excellent quality. HCCM improves contrast enhancement and overall CTA image quality and allows the iodine dose to be reduced. PMID:21081582

A cross-platform survey of CT image quality and dose from routine abdomen protocols and a method to systematically standardize image quality.

PubMed

Favazza, Christopher P; Duan, Xinhui; Zhang, Yi; Yu, Lifeng; Leng, Shuai; Kofler, James M; Bruesewitz, Michael R; McCollough, Cynthia H

2015-11-07

Through this investigation we developed a methodology to evaluate and standardize CT image quality from routine abdomen protocols across different manufacturers and models. The influence of manufacturer-specific automated exposure control systems on image quality was directly assessed to standardize performance across a range of patient sizes. We evaluated 16 CT scanners across our health system, including Siemens, GE, and Toshiba models. Using each practice's routine abdomen protocol, we measured spatial resolution, image noise, and scanner radiation output (CTDIvol). Axial and in-plane spatial resolutions were assessed through slice sensitivity profile (SSP) and modulation transfer function (MTF) measurements, respectively. Image noise and CTDIvol values were obtained for three different phantom sizes. SSP measurements demonstrated a bimodal distribution in slice widths: an average of 6.2  ±  0.2 mm using GE's 'Plus' mode reconstruction setting and 5.0  ±  0.1 mm for all other scanners. MTF curves were similar for all scanners. Average spatial frequencies at 50%, 10%, and 2% MTF values were 3.24  ±  0.37, 6.20  ±  0.34, and 7.84  ±  0.70 lp cm(-1), respectively. For all phantom sizes, image noise and CTDIvol varied considerably: 6.5-13.3 HU (noise) and 4.8-13.3 mGy (CTDIvol) for the smallest phantom; 9.1-18.4 HU and 9.3-28.8 mGy for the medium phantom; and 7.8-23.4 HU and 16.0-48.1 mGy for the largest phantom. Using these measurements and benchmark SSP, MTF, and image noise targets, CT image quality can be standardized across a range of patient sizes.

[«Surgical» analysis of the new clinical practice guide on compartmental syndrome].

PubMed

García-Ureña, Miguel Ángel; López-Monclús, Javier; Robín, Álvaro

2014-04-01

The new published guidelines of compartment syndrome are supposed to be a helpful tool in order to make decisions in patients with abdominal hypertension. From a surgical perspective of view, an important effort has been made in order to reach consensus in different phases in which there is no clear answer in evidence-based medicine. It is mandatory the use of a universal classification of open abdomen and there are three main concepts that must be observed: make a decompressive laparotomy when conservative measures have failed, attempt to closure the abdomen as soon as possible and the use of negative-pressure treatments that facilitates the management of an open abdomen. Although most of recommendations that have been delivered are not high grades, the present guide is an important assistant for the management of intra-abdominal hypertension and several lines of investigation are opened in order to answer the doubts that have been addressed. Copyright © 2013 Elsevier España, S.L. and SEMICYUC. All rights reserved.

Predicting performance: relative importance of students' background and past performance.

PubMed

Stegers-Jager, Karen M; Themmen, Axel P N; Cohen-Schotanus, Janke; Steyerberg, Ewout W

2015-09-01

Despite evidence for the predictive value of both pre-admission characteristics and past performance at medical school, their relative contribution to predicting medical school performance has not been thoroughly investigated. This study was designed to determine the relative importance of pre-admission characteristics and past performance in medical school in predicting student performance in pre-clinical and clinical training. This longitudinal prospective study followed six cohorts of students admitted to a Dutch, 6-year, undergraduate medical course during 2002-2007 (n = 2357). Four prediction models were developed using multivariate logistic regression analysis. Main outcome measures were 'Year 1 course completion within 1 year' (models 1a, 1b), 'Pre-clinical course completion within 4 years' (model 2) and 'Achievement of at least three of five clerkship grades of ≥ 8.0' (model 3). Pre-admission characteristics (models 1a, 1b, 2, 3) and past performance at medical school (models 1b, 2, 3) were included as predictor variables. In model 1a - including pre-admission characteristics only - the strongest predictor for Year 1 course completion was pre-university grade point average (GPA). Success factors were 'selected by admission testing' and 'age > 21 years'; risk factors were 'Surinamese/Antillean background', 'foreign pre-university degree', 'doctor parent' and male gender. In model 1b, number of attempts and GPA at 4 months were the strongest predictors for Year 1 course completion, and male gender remained a risk factor. Year 1 GPA was the strongest predictor for pre-clinical course completion, whereas being male or aged 19-21 years were risk factors. Pre-clinical course GPA positively predicted clinical performance, whereas being non-Dutch or a first-generation university student were important risk factors for lower clinical grades. Nagelkerke's R(2) ranged from 0.16 to 0.62. This study not only confirms the importance of past performance as a predictor

Images in clinical medicine: Segmental neurofibromatosis.

PubMed

Ma, Dong-Lai; Hu, Jin

2015-03-05

A 4-year-old girl presented for evaluation of cutaneous nodules that had been present on the left side of her trunk since birth. Physical examination revealed numerous soft, nontender papules and nodules across the left upper abdomen and wrapping around to the back.

Factors Contributing to Background Television Exposure in Low-Income Mexican-American Preschoolers.

PubMed

Thompson, Darcy A; Tschann, Jeanne M

2016-09-01

Objective Background television (TV) exposure is harmful to young children, yet few studies have focused on predictors of exposure. This study's objectives were to elucidate demographic, environmental, and behavioral correlates of background TV exposure in low-income Mexican-American preschoolers and to explore caregiver beliefs about the impact of such exposure. Methods A convenience sample of low-income Mexican-American female primary caregivers of preschoolers (3-5 years old, n = 309), recruited in safety-net clinics, were surveyed by phone. Caregivers reported the frequency of their child's exposure to background TV and responded to questions on the home media environment, TV use, and whether they had thought about background TV exposure and its impact on their child. Results Background TV exposure was common; 43 % reported that their child was often, very often, or always exposed to background TV. More hours of TV viewing by the caregiver and greater frequency of TV viewing during meals were associated with an increased frequency of exposure to background TV. Only 49 % of participants had ever thought about the impact of background TV. Believing that background TV is not harmful was associated with higher levels of background TV exposure. Conclusions Findings suggest that background TV exposure is frequent and caregiver awareness of its potential impact is low in low-income Mexican-American families. Beliefs that background TV is not harmful may predict risk of exposure. Potential targets for interventions focused on reducing background TV exposure in this population include increasing caregiver awareness of the potential negative impact of such TV exposure.

Factors contributing to background television exposure in low-income Mexican American preschoolers

PubMed Central

Thompson, Darcy A.; Tschann, Jeanne M.

2016-01-01

Objective Background television (TV) exposure is harmful to young children, yet few studies have focused on predictors of exposure. This study’s objectives were to elucidate demographic, environmental, and behavioral correlates of background TV exposure in low-income Mexican American preschoolers and to explore caregiver beliefs about the impact of such exposure. Methods A convenience sample of low-income Mexican American female primary caregivers of preschoolers (3–5 years old, n=309), recruited in safety-net clinics, were surveyed by phone. Caregivers reported the frequency of their child’s exposure to background TV and responded to questions on the home media environment, TV use, and whether they had thought about background TV exposure and its impact on their child. Results Background TV exposure was common; 43% reported that their child was often, very often, or always exposed to background TV. More hours of TV viewing by the caregiver and greater frequency of TV viewing during meals were associated with an increased frequency of exposure to background TV. Only 49% of participants had ever thought about the impact of background TV. Believing that background TV is not harmful was associated with higher levels of background TV exposure. Conclusions Findings suggest that background TV exposure is frequent and caregiver awareness of its potential impact is low in low-income Mexican American families. Beliefs that background TV is not harmful may predict risk of exposure. Potential targets for interventions focused on reducing background TV exposure in this population include increasing caregiver awareness of the potential negative impact of such TV exposure. PMID:27007983

Using Mindfulness- and Acceptance-Based Treatments With Clients From Nondominant Cultural and/or Marginalized Backgrounds: Clinical Considerations, Meta-Analysis Findings, and Introduction to the Special Series.

PubMed

Fuchs, Cara; Lee, Jonathan K; Roemer, Lizabeth; Orsillo, Susan M

2013-02-01

A growing body of research suggests that mindfulness- and acceptance-based principles can increase efforts aimed at reducing human suffering and increasing quality of life. A critical step in the development and evaluation of these new approaches to treatment is to determine the acceptability and efficacy of these treatments for clients from nondominant cultural and/or marginalized backgrounds. This special series brings together the wisdom of clinicians and researchers who are currently engaged in clinical practice and treatment research with populations who are historically underrepresented in the treatment literature. As an introduction to the series, this paper presents a theoretical background and research context for the papers in the series, highlights the elements of mindfulness- and acceptance-based treatments that may be congruent with culturally responsive treatment, and briefly outlines the general principles of cultural competence and responsive treatment. Additionally, the results of a meta-analysis of mindfulness- and acceptance-based treatments with clients from nondominant cultural and/or marginalized backgrounds are presented. Our search yielded 32 studies totaling 2,198 clients. Results suggest small (Hedges' g=.38, 95% CI=.11 - .64) to large (Hedges' g=1.32, 95% CI=.61 - 2.02) effect sizes for mindfulness- and acceptance-based treatments, which varied by study design.

Comparison of visual biofeedback system with a guiding waveform and abdomen-chest motion self-control system for respiratory motion management.

PubMed

Nakajima, Yujiro; Kadoya, Noriyuki; Kanai, Takayuki; Ito, Kengo; Sato, Kiyokazu; Dobashi, Suguru; Yamamoto, Takaya; Ishikawa, Yojiro; Matsushita, Haruo; Takeda, Ken; Jingu, Keiichi

2016-07-01

Irregular breathing can influence the outcome of 4D computed tomography imaging and cause artifacts. Visual biofeedback systems associated with a patient-specific guiding waveform are known to reduce respiratory irregularities. In Japan, abdomen and chest motion self-control devices (Abches) (representing simpler visual coaching techniques without a guiding waveform) are used instead; however, no studies have compared these two systems to date. Here, we evaluate the effectiveness of respiratory coaching in reducing respiratory irregularities by comparing two respiratory management systems. We collected data from 11 healthy volunteers. Bar and wave models were used as visual biofeedback systems. Abches consisted of a respiratory indicator indicating the end of each expiration and inspiration motion. Respiratory variations were quantified as root mean squared error (RMSE) of displacement and period of breathing cycles. All coaching techniques improved respiratory variation, compared with free-breathing. Displacement RMSEs were 1.43 ± 0.84, 1.22 ± 1.13, 1.21 ± 0.86 and 0.98 ± 0.47 mm for free-breathing, Abches, bar model and wave model, respectively. Period RMSEs were 0.48 ± 0.42, 0.33 ± 0.31, 0.23 ± 0.18 and 0.17 ± 0.05 s for free-breathing, Abches, bar model and wave model, respectively. The average reduction in displacement and period RMSE compared with the wave model were 27% and 47%, respectively. For variation in both displacement and period, wave model was superior to the other techniques. Our results showed that visual biofeedback combined with a wave model could potentially provide clinical benefits in respiratory management, although all techniques were able to reduce respiratory irregularities. © The Author 2016. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

Abdominal wall integrity after open abdomen: long-term results of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM).

PubMed

Willms, A; Schaaf, S; Schwab, R; Richardsen, I; Bieler, D; Wagner, B; Güsgen, C

2016-12-01

The open abdomen has become a standard technique in the management of critically ill patients undergoing surgery for severe intra-abdominal conditions. Negative pressure and mesh-mediated fascial traction are commonly used and achieve low fistula rates and high fascial closure rates. In this study, long-term results of a standardised treatment approach are presented. Fifty-five patients who underwent OA management for different indications at our institution from 2006 to 2013 were enrolled. All patients were treated under a standardised algorithm that uses a combination of vacuum-assisted wound closure and mesh-mediated fascial traction. Structured follow-up assessments were offered to patients and included a medical history, a clinical examination and abdominal ultrasonography. The data obtained were statistically analysed. The fascial closure rate was 74 % in an intention-to-treat analysis and 89 % in a per-protocol analysis. The fistula rate was 1.8 %. Thirty-four patients attended follow-up. The median follow-up was 46 months (range 12-88 months). Incisional hernias developed in 35 %. Patients with hernias needed more operative procedures (10.3 vs 3.4, p = 0.03) than patients without hernia formation. A Patient Observer Scar Assessment Scale (POSAS) of 31.1 was calculated. Patients with symptomatic hernias (NAS of 2-10) had a significantly lower mean POSAS score (p = 0.04). Vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) seem to result in low complication rates and high fascial closure rates. Abdominal wall reconstruction, which is a challenging and complex procedure and causes considerable patient discomfort, can thus be avoided in the majority of cases. Available results are based on studies involving only a small number of cases. Multi-centre studies and registry-based data are therefore needed to validate these findings.

Technical Note: Partial body irradiation of mice using a customized PMMA apparatus and a clinical 3D planning/LINAC radiotherapy system.

PubMed

Karagounis, Ilias V; Abatzoglou, Ioannis M; Koukourakis, Michael I

2016-05-01

In vivo radiobiology experiments involving partial body irradiation (PBI) of mice are of major importance because they allow for the evaluation of individual organ tolerance; overcoming current limitations of experiments using lower dose, whole body irradiation. In the current study, the authors characterize and validate an effective and efficient apparatus for multiple animal PBI, directed to the head, thorax, or abdomen of mice. The apparatus is made of polymethylmethacrylate and consists of a rectangular parallelepiped prism (40 cm × 16 cm × 8 cm), in which five holes were drilled to accomodate standard 60 ml syringes, each housing an unanesthetized, fully immobilized mouse. Following CT-scanning and radiotherapy treatment planning, radiation fields were designed to irradiate the head, thorax, or abdomen of the animal. Thermoluminescent dosimeters (TLDs) were used to confirm the treatment planning dosimetry for primary beam and scattered radiation. Mice are efficiently placed into 60 ml syringes and immobilized, without the use of anesthetics. Although partial rotational movement around the longitudinal axis and a minor 2 mm forward/backward movement are permitted, this does not compromise the irradiation of the chosen body area. TLDs confirmed the dose values predicted by the treatment planning dosimetry, both for primary beam and scattered radiation. The customized PMMA apparatus described and validated is cost-effective, convenient to use, and efficient in performing PBI without the use of anesthesia. The developed apparatus permits the isolated irradiation of the mouse head, thorax, and abdomen. Importantly, the apparatus allows the delivery of PBI to five mice, simultaneously, representing an efficient way to effectively expose a large number of animals to PBI through multiple daily fractions, simulating clinical radiotherapy treatment schedules.

Fine-needle aspiration of lipoblastoma: Cytological, molecular, and clinical features.

PubMed

Ferreira, Joana; Esteves, Gonçalo; Fonseca, Ricardo; Martins, Carmo; André, Saudade; Lemos, Maria Manuel

2017-12-01

Lipoblastomas are rare, benign adipocytic tumors that present mostly during infancy. In about 70% of cases, these tumors carry abnormalities in chromosome 8, mainly leading to rearrangements of the PLAG1 gene. We report a series of histologically proven lipoblastomas with previous fine-needle aspiration (FNA) cytology from 9 patients (n = 10 samples) and describe their clinical, cytological, and molecular features. Our cohort included 5 boys and 4 girls (median age, 2.5 years [range, 10 months to 13 years]) who presented with soft tissue masses in the thorax (n = 3), abdomen (n = 2), axilla (n = 2), and thigh (n = 2). In 1 patient, the FNA diagnosis was inconclusive due to hypocellularity, and in another patient a diagnosis of benign lipomatous tumor was made. In the remaining 8 samples (one of which confirmed relapse), a correct preoperative FNA diagnosis was rendered. Smears were hypo- to moderately cellular and contained fragments of mature adipose tissue with thin branching vessels admixed with some lipoblasts in a myxoid matrix. Spindle cells and naked oval nuclei with no atypia were observed in the background. Of the 4 patients tested for PLAG1 rearrangement using FISH probes, 3 harbored this alteration (1 was made on a FNA smear and 1 was made in a tumor imprint). All the patients are alive and well, except for 1 patient with a retroperitoneal tumor who, after an initial incomplete excision, died of local disease progression. FNA, especially if used together with molecular biology techniques (eg, PLAG1 FISH analysis), is a reliable and accurate diagnostic tool. Cancer Cytopathol 2017;125:934-9. © 2017 American Cancer Society. © 2017 American Cancer Society.

Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

PubMed

Sánchez-Carrillo, C I

1989-01-01

Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival.

Morbidity following Mexico City's 1985 earthquakes: clinical and epidemiologic findings from hospitals and emergency units.

PubMed Central

Sánchez-Carrillo, C I

1989-01-01

Medical records of 822 inpatients and outpatients cared for by the Department of the Federal District medical services during the 1985 Mexico City earthquakes were reviewed. Record incompleteness varied between 92.8 percent and 14.0 percent for the various study variables. No gender differences were detected among the groups; more than 70.0 percent of the patients were ages 15 to 64 years. Multiple traumatic injuries were frequent for inpatients across age groups, while simple contusions were more frequent among outpatients. Multiple head traumas, thorax-abdomen multiple traumas, and simple fractures of an arm or leg were more frequently recorded for inpatients than for outpatients. Head wounds with contusions; simple contusion of the thorax-abdomen, arms, and legs; and psychological trauma were more frequently recorded for outpatients. Although a great many records were incomplete, the data may reflect what actually happened to these patients, given the similarity of the findings with other reports of disasters. Improved record keeping during emergencies is needed to standardize the quantity and the reliability of the data so that statistical and medical care requirements are soundly based. The use of standard questionnaires for data collection is stressed to facilitate the management of clinical and epidemiologic activities. Longitudinal studies are needed to determine patterns of physical injuries, psychological trauma, and survival. PMID:2508177

The importance of Good Clinical Practice guidelines and its role in clinical trials

PubMed Central

Vijayananthan, A; Nawawi, O

2008-01-01

Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the reasons and the need for doing so. In this paper, we address the historical background and the events that led up to the formation of these guidelines. Today, the ICH-GCP guidelines are used in clinical trials throughout the globe with the main aim of protecting and preserving human rights. PMID:21614316

Correlation between model observers in uniform background and human observers in patient liver background for a low-contrast detection task in CT

NASA Astrophysics Data System (ADS)

Gong, Hao; Yu, Lifeng; Leng, Shuai; Dilger, Samantha; Zhou, Wei; Ren, Liqiang; McCollough, Cynthia H.

2018-03-01

Channelized Hotelling observer (CHO) has demonstrated strong correlation with human observer (HO) in both single-slice viewing mode and multi-slice viewing mode in low-contrast detection tasks with uniform background. However, it remains unknown if the simplest single-slice CHO in uniform background can be used to predict human observer performance in more realistic tasks that involve patient anatomical background and multi-slice viewing mode. In this study, we aim to investigate the correlation between CHO in a uniform water background and human observer performance at a multi-slice viewing mode on patient liver background for a low-contrast lesion detection task. The human observer study was performed on CT images from 7 abdominal CT exams. A noise insertion tool was employed to synthesize CT scans at two additional dose levels. A validated lesion insertion tool was used to numerically insert metastatic liver lesions of various sizes and contrasts into both phantom and patient images. We selected 12 conditions out of 72 possible experimental conditions to evaluate the correlation at various radiation doses, lesion sizes, lesion contrasts and reconstruction algorithms. CHO with both single and multi-slice viewing modes were strongly correlated with HO. The corresponding Pearson's correlation coefficient was 0.982 (with 95% confidence interval (CI) [0.936, 0.995]) and 0.989 (with 95% CI of [0.960, 0.997]) in multi-slice and single-slice viewing modes, respectively. Therefore, this study demonstrated the potential to use the simplest single-slice CHO to assess image quality for more realistic clinically relevant CT detection tasks.

CAN ULTRASOUND ABDOMEN HELP IN EARLY DIAGNOSIS OF DIABETES MELLITUS? AN OBSERVATIONAL STUDY.

PubMed

Anwar, Javed; Aamir, Muhammad Omer; Sanaullah; Imdad, Zeeshan ul Hasnain; Parveen, Ishrat; Yousaf, Nasreen

2015-01-01

Diabetes mellitus is a common disease. Similarly, ultrasound findings of fatty change and renal crystals are commonly seen on ultrasound. In the personal observation of the main author over the past so many years it was noticed that Diabetes Mellitus, Fatty liver and renal crystals all sit well together. This study tries to establish a relationship between diabetes mellitus renal echogenic foci and fatty liver. This study is first of its kind, as nobody has ever before investigated an association between the renal echogenic foci and fatty liver in relation to diabetes mellitus. This cross-sectional, observational study was conducted at Radiology Department Combined Military Hospital, Kohat From 2nd June 2013 to 30th May 2014. Three hundred patients were collected on the basis of having fatty liver and renal echogenic foci on ultrasound and three hundred more patients were collected who had no fatty liver or renal echogenic foci on ultrasound. Their labs were done for diabetes mellitus. The patients having renal echogenic foci together with fatty liver had 83% positive rate of being diabetics, while patients with no fatty liver and no echogenic foci on ultrasonography had only 0.6% Positive rate of being diabetics. Our results provided the first demonstration of an association between renal echogenic foci together with fatty liver with the diabetes mellitus. Thus ultrasound examination of abdomen can be helpful in its early diagnosis if we make a protocol of doing fasting and random blood sugars in all those patients who have positive renal echogenic foci and fatty liver on their ultrasound examination.

What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis.

PubMed

Cirocchi, Roberto; Birindelli, Arianna; Biffl, Walter L; Mutafchiyski, Ventsislav; Popivanov, Georgi; Chiara, Osvaldo; Tugnoli, Gregorio; Di Saverio, Salomone

2016-09-01

The open abdomen technique may be used in critically ill patients to manage abdominal injury, reduce the septic complications, and prevent the abdominal compartment syndrome. Many different techniques have been proposed and multiple studies have been conducted, but the best method of temporary abdominal closure has not been determined yet. Recently, new randomized and nonrandomized controlled trials have been published on this topic. We aimed to perform an up-to-date systematic review on the management of open abdomen, including the most recent published randomized and nonrandomized controlled trials, to compare negative pressure wound therapy (NPWT) with no NPWT and define if one technique has better outcomes than the other with regard to primary fascial closure, postoperative 30-day mortality and morbidity, enteroatmospheric fistulae, abdominal abscess, bleeding, and length of stay. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and the Cochrane Handbook for Systematic Reviews of Interventions, an online literature research (until July 1, 2015) was performed on MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Library databases. The MeSH terms and free words used "vacuum assisted closure" "vac;", "open abdomen", "damage control surgery", and "temporary abdominal closure". No language restriction was made. The initial systematic literature search yielded 452 studies. After a careful assessment of the titles and of the full text was obtained, eight articles fulfilled inclusion criteria. We analyzed 1,225 patients, of whom 723 (59%) underwent NPWT and 502 (41%) did not undergo NPWT, and performed four subgroups: VAC versus Bogota bag technique (two studies, 106 participants), VAC versus mesh-foil laparostomy (two studies, 159 participants), VAC versus laparostomy (adhesive impermeable with midline zip) (one study, 106 participants), and NPWT versus no NPWT techniques (three studies, 854

Optimal background matching camouflage.

PubMed

Michalis, Constantine; Scott-Samuel, Nicholas E; Gibson, David P; Cuthill, Innes C

2017-07-12

Background matching is the most familiar and widespread camouflage strategy: avoiding detection by having a similar colour and pattern to the background. Optimizing background matching is straightforward in a homogeneous environment, or when the habitat has very distinct sub-types and there is divergent selection leading to polymorphism. However, most backgrounds have continuous variation in colour and texture, so what is the best solution? Not all samples of the background are likely to be equally inconspicuous, and laboratory experiments on birds and humans support this view. Theory suggests that the most probable background sample (in the statistical sense), at the size of the prey, would, on average, be the most cryptic. We present an analysis, based on realistic assumptions about low-level vision, that estimates the distribution of background colours and visual textures, and predicts the best camouflage. We present data from a field experiment that tests and supports our predictions, using artificial moth-like targets under bird predation. Additionally, we present analogous data for humans, under tightly controlled viewing conditions, searching for targets on a computer screen. These data show that, in the absence of predator learning, the best single camouflage pattern for heterogeneous backgrounds is the most probable sample. © 2017 The Authors.

Clinical oncologic applications of PET/MRI: a new horizon

PubMed Central

Partovi, Sasan; Kohan, Andres; Rubbert, Christian; Vercher-Conejero, Jose Luis; Gaeta, Chiara; Yuh, Roger; Zipp, Lisa; Herrmann, Karin A; Robbin, Mark R; Lee, Zhenghong; Muzic, Raymond F; Faulhaber, Peter; Ros, Pablo R

2014-01-01

Positron emission tomography/magnetic resonance imaging (PET/MRI) leverages the high soft-tissue contrast and the functional sequences of MR with the molecular information of PET in one single, hybrid imaging technology. This technology, which was recently introduced into the clinical arena in a few medical centers worldwide, provides information about tumor biology and microenvironment. Studies on indirect PET/MRI (use of positron emission tomography/computed tomography (PET/CT) images software fused with MRI images) have already generated interesting preliminary data to pave the ground for potential applications of PET/MRI. These initial data convey that PET/MRI is promising in neuro-oncology and head & neck cancer applications as well as neoplasms in the abdomen and pelvis. The pediatric and young adult oncology population requiring frequent follow-up studies as well as pregnant woman might benefit from PET/MRI due to its lower ionizing radiation dose. The indication and planning of therapeutic interventions and specifically radiation therapy in individual patients could be and to a certain extent are already facilitated by performing PET/MRI. The objective of this article is to discuss potential clinical oncology indications of PET/MRI. PMID:24753986

Supernatural impotence: historical review with anthropological and clinical implications.

PubMed

Margolin, J; Witztum, E

1989-12-01

The historical and cultural background of the belief in supernatural impotence is presented, emphasizing its possible implications for clinical practice. A brief historical survey of the concept in Judaism and Christianity is followed by a short anthropological survey of supernatural impotence in different ethnic subcultures in Israel. A case demonstration exemplifies the connection between understanding the patient's cultural background and beliefs and the clinical competence of the therapist. The relationship between the clinical-therapeutic process in psychiatric practice and knowledge of the patient's cultural background and beliefs is stressed.

[Clinical study on treatment of 405 cases of irregular menstruation by tiaojing zhixue granules].

PubMed

Ma, Kun; Sun, Li-hua; Wang, Qing-hua

2003-01-01

To provide scientific and objective basis for Tiaojing zhixue granules treating irregular menstruation of clinical effect. Choose 405 cases suffering from irregular menstruation and make a systematic study 304 patients were treated with Tiaojing Zhixue granules, 101 patients received Fuxuening treatment. After treatment, the obvious effective rate of Tiaojing Zhixue granules was 78.3% and the total effective rate 97.4%, granule cure rate of Fuxuening was 38.6% and the total effective rate 87.1%. Comparison showed significant difference (P < 0.001). Safety spithetical observation did not discover harmful effects and toxicity and side effects antagonize common symptoms 26 entries of clinical studying, the 7 entry are: weary and tired, short breaths, sore loins, weak knees, insomnia and eccessive dreaming, rapid and thready pulse, colliquative, distending pain in the lower abdomen and hypochondria. Among them, the comparison showed significant difference about treatments(P < 0.01-0.001). Tiaojing Zhixue granules treatment irregular menstruation are scientific and effective.

Doctors in a Southeast Asian country communicate sub-optimally regardless of patients' educational background.

PubMed

Claramita, Mora; Dalen, Jan Van; Van Der Vleuten, Cees Pm

2011-12-01

To explore the relationship between the style of doctor-patient communication and patients' educational background in a Southeast Asian teaching hospital setting using the Roter Interaction Analysis System (RIAS). We analyzed a total of 245 audio-taped consultations involving 30 internal medicine residents with 7-10 patients each in the internal medicine outpatient clinics. The patients were categorized into a group with a high and a group with a low educational level. We ranked the data into 41 RIAS utterances and RIAS-based composite categories in order of observed frequency during consultations. The residents invariantly used a paternalistic style irrespective of patients' educational background. The RIAS utterances and the composite categories show no significant relationship between communication style and patients' educational level. Doctors in a Southeast Asian country use a paternalistic communication style during consultations, regardless of patients' educational background. To approach a more partnership doctor-patient communication, culture and clinical environment concern of Southeast Asian should be further investigated. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Background sources at PEP

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lynch, H.; Schwitters, R.F.; Toner, W.T.

Important sources of background for PEP experiments are studied. Background particles originate from high-energy electrons and positrons which have been lost from stable orbits, ..gamma..-rays emitted by the primary beams through bremsstrahlung in the residual gas, and synchrotron radiation x-rays. The effect of these processes on the beam lifetime are calculated and estimates of background rates at the interaction region are given. Recommendations for the PEP design, aimed at minimizing background are presented. 7 figs., 4 tabs.

Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: A single-center 8-year experience.

PubMed

Tolonen, Matti; Mentula, Panu; Sallinen, Ville; Rasilainen, Suvi; Bäcklund, Minna; Leppäniemi, Ari

2017-06-01

Open abdomen (OA) treatment in patients with peritonitis is increasing worldwide. Various temporary abdominal closure devices are being used. This study included patients with complicated diffuse secondary peritonitis, OA, and vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM). The aim of this study was to describe mortality and major morbidity in terms of delayed primary fascial closure and enteroatmospheric fistula rates. This was a single-academic-center retrospective study of consecutive patients with diffuse peritonitis, OA, and VAWCM between years 2008 and 2016. Descriptive and univariate analyses were performed. Forty-one patients were identified and analyzed. Median age was 59 years, preoperative septic shock was diagnosed in 54% (n = 22), and 59% (n = 24) had a postoperative peritonitis. Mortality was 29% (n = 12), and 76% (n = 31) of patients were admitted in the intensive care unit. The median duration of OA was 7 days with a median of two dressing changes. Delayed primary fascial closure rate among survivors was 92% (n = 33), and enteroatmospheric fistulas developed in 7% (n = 3). In a subgroup analysis, patients with OA in the primary laparotomy for peritonitis (n = 27) were compared with patients with OA in the subsequent laparotomies (n = 14). There were no significant differences between groups. The VAWCM technique in patients with complicated secondary diffuse peritonitis and OA yields excellent results in terms of delayed primary fascial closure rate and a low number of enteroatmospheric fistulas. It seems to be safe to close the abdomen at the index laparotomy, if possible, even if there is a risk of a need of OA later. Therapeutic/care management study, level IV.

The EuroPrevall outpatient clinic study on food allergy: background and methodology.

PubMed

Fernández-Rivas, M; Barreales, L; Mackie, A R; Fritsche, P; Vázquez-Cortés, S; Jedrzejczak-Czechowicz, M; Kowalski, M L; Clausen, M; Gislason, D; Sinaniotis, A; Kompoti, E; Le, T-M; Knulst, A C; Purohit, A; de Blay, F; Kralimarkova, T; Popov, T; Asero, R; Belohlavkova, S; Seneviratne, S L; Dubakiene, R; Lidholm, J; Hoffmann-Sommergruber, K; Burney, P; Crevel, R; Brill, M; Fernández-Pérez, C; Vieths, S; Clare Mills, E N; van Ree, R; Ballmer-Weber, B K

2015-05-01

The EuroPrevall project aimed to develop effective management strategies in food allergy through a suite of interconnected studies and a multidisciplinary integrated approach. To address some of the gaps in food allergy diagnosis, allergen risk management and socio-economic impact and to complement the EuroPrevall population-based surveys, a cross-sectional study in 12 outpatient clinics across Europe was conducted. We describe the study protocol. Patients referred for immediate food adverse reactions underwent a consistent and standardized allergy work-up that comprised collection of medical history; assessment of sensitization to 24 foods, 14 inhalant allergens and 55 allergenic molecules; and confirmation of clinical reactivity and food thresholds by standardized double-blind placebo-controlled food challenges (DBPCFCs) to milk, egg, fish, shrimp, peanut, hazelnut, celeriac, apple and peach. A standardized methodology for a comprehensive evaluation of food allergy was developed and implemented in 12 outpatient clinics across Europe. A total of 2121 patients (22.6% <14 years) reporting 8257 reactions to foods were studied, and 516 DBPCFCs were performed. This is the largest multicentre European case series in food allergy, in which subjects underwent a comprehensive, uniform and standardized evaluation including DBPCFC, by a methodology which is made available for further studies in food allergy. The analysis of this population will provide information on the different phenotypes of food allergy across Europe, will allow to validate novel in vitro diagnostic tests, to establish threshold values for major allergenic foods and to analyse the socio-economic impact of food allergy. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Technical Note: Partial body irradiation of mice using a customized PMMA apparatus and a clinical 3D planning/LINAC radiotherapy system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karagounis, Ilias V.; Koukourakis, Michael I., E-mail: targ@her.forthnet.gr, E-mail: mkoukour@med.duth.gr; Abatzoglou, Ioannis M., E-mail: abadzoglou@yahoo.gr

Purpose: In vivo radiobiology experiments involving partial body irradiation (PBI) of mice are of major importance because they allow for the evaluation of individual organ tolerance; overcoming current limitations of experiments using lower dose, whole body irradiation. In the current study, the authors characterize and validate an effective and efficient apparatus for multiple animal PBI, directed to the head, thorax, or abdomen of mice. Methods: The apparatus is made of polymethylmethacrylate and consists of a rectangular parallelepiped prism (40 cm × 16 cm × 8 cm), in which five holes were drilled to accomodate standard 60 ml syringes, each housingmore » an unanesthetized, fully immobilized mouse. Following CT-scanning and radiotherapy treatment planning, radiation fields were designed to irradiate the head, thorax, or abdomen of the animal. Thermoluminescent dosimeters (TLDs) were used to confirm the treatment planning dosimetry for primary beam and scattered radiation. Results: Mice are efficiently placed into 60 ml syringes and immobilized, without the use of anesthetics. Although partial rotational movement around the longitudinal axis and a minor 2 mm forward/backward movement are permitted, this does not compromise the irradiation of the chosen body area. TLDs confirmed the dose values predicted by the treatment planning dosimetry, both for primary beam and scattered radiation. Conclusions: The customized PMMA apparatus described and validated is cost-effective, convenient to use, and efficient in performing PBI without the use of anesthesia. The developed apparatus permits the isolated irradiation of the mouse head, thorax, and abdomen. Importantly, the apparatus allows the delivery of PBI to five mice, simultaneously, representing an efficient way to effectively expose a large number of animals to PBI through multiple daily fractions, simulating clinical radiotherapy treatment schedules.« less

How well do final year undergraduate medical students master practical clinical skills?

PubMed Central

Störmann, Sylvère; Stankiewicz, Melanie; Raes, Patricia; Berchtold, Christina; Kosanke, Yvonne; Illes, Gabrielle; Loose, Peter; Angstwurm, Matthias W.

2016-01-01

Introduction: The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills. Methods: We conducted a formative 4-station objective structured clinical examination (OSCE) focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray). Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance. Results: 214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n=20) scored insufficiently (<60%). We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%), whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively. Discussion: Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year. PMID:27579358

Relatedness of Streptococcus suis Isolates of Various Serotypes and Clinical Backgrounds as Evaluated by Macrorestriction Analysis and Expression of Potential Virulence Traits

PubMed Central

Allgaier, Achim; Goethe, Ralph; Wisselink, Henk J.; Smith, Hilde E.; Valentin-Weigand, Peter

2001-01-01

We evaluated the genetic diversity of Streptococcus suis isolates of different serotypes by macrorestriction analysis and elucidated possible relationships between the genetic background, expression of potential virulence traits, and source of isolation. Virulence traits included expression of serotype-specific polysaccharides, muramidase-released protein (MRP), extracellular protein factor (EF), hemolysin activity, and adherence to epithelial cells. Macrorestriction analysis of streptococcal DNA digested with restriction enzymes SmaI and ApaI allowed differentiation of single isolates that could be assigned to four major clusters, named A1, A2, B1, and B2. Comparison of the genotypic and phenotypic features of the isolates with their source of isolation showed that (i) the S. suis population examined, which originated mainly from German pigs, exhibited a genetic diversity and phenotypic patterns comparable to those found for isolates from other European countries; (ii) certain phenotypic features, such as the presence of capsular antigens of serotypes 2, 1, and 9, expression of MRP and EF, and hemolysin activity (and in particular, combinations of these features), were strongly associated with the clinical background of meningitis and septicemia; and (iii) isolates from pigs with meningitis and septicemia showed a significantly higher degree of genetic homogeneity compared to that for isolates from pigs with pneumonia and healthy pigs. Since the former isolates are considered highly virulent, this supports the theory of a clonal relationship among highly virulent strains. PMID:11158088

Human abdomen recognition using camera and force sensor in medical robot system for automatic ultrasound scan.

PubMed

Bin Mustafa, Ammar Safwan; Ishii, Takashi; Matsunaga, Yoshiki; Nakadate, Ryu; Ishii, Hiroyuki; Ogawa, Kouji; Saito, Akiko; Sugawara, Motoaki; Niki, Kiyomi; Takanishi, Atsuo

2013-01-01

Physicians use ultrasound scans to obtain real-time images of internal organs, because such scans are safe and inexpensive. However, people in remote areas face difficulties to be scanned due to aging society and physician's shortage. Hence, it is important to develop an autonomous robotic system to perform remote ultrasound scans. Previously, we developed a robotic system for automatic ultrasound scan focusing on human's liver. In order to make it a completely autonomous system, we present in this paper a way to autonomously localize the epigastric region as the starting position for the automatic ultrasound scan. An image processing algorithm marks the umbilicus and mammary papillae on a digital photograph of the patient's abdomen. Then, we made estimation for the location of the epigastric region using the distances between these landmarks. A supporting algorithm distinguishes rib position from epigastrium using the relationship between force and displacement. We implemented these algorithms with the automatic scanning system into an apparatus: a Mitsubishi Electric's MELFA RV-1 six axis manipulator. Tests on 14 healthy male subjects showed the apparatus located the epigastric region with a success rate of 94%. The results suggest that image recognition was effective in localizing a human body part.

Evaluation of clinical, laboratory, imaging findings and outcome in 99 dogs with leptospirosis.

PubMed

Knöpfler, S; Mayer-Scholl, A; Luge, E; Klopfleisch, R; Gruber, A D; Nöckler, K; Kohn, B

2017-10-01

To report clinical, laboratory and diagnostic imaging features and prognostic factors in dogs with leptospirosis from North-East Germany. Medical records of dogs diagnosed with leptospirosis from 2006 to 2013 were evaluated retrospectively. The study included 99 dogs. At initial presentation, the most common clinical signs were lethargy (96%), anorexia (88%), vomiting (85%), painful abdomen (39%), diarrhoea (38%), oliguria (27%) and tachypnoea (26%). Abnormal laboratory findings included anaemia (63%), thrombocytopenia (63%), leucocytosis (57%), increase of plasma urea (84%) and creatinine concentrations (81%), increased liver enzyme activities (80%), hyperbilirubinaemia (69%), hyperphosphataemia (67%), hyponatraemia (64%), hypoalbuminaemia (55%) and hypokalaemia (29%). Radiological pulmonary changes were detected in 57% of the dogs initially or during the course of disease. Severe dyspnoea, oliguria, azotaemia, hyperbilirubinaemia and severe radiological pulmonary changes were more often found in dogs that did not survive. There was renal, hepatic and pulmonary involvement in 95, 92 and 58% of the dogs, respectively, and multi-organ lesions in 98 dogs (98%); 32 dogs died or were euthanased. Several clinical and laboratory abnormalities were associated with a negative outcome; severe lung involvement was specifically associated with high mortality. © 2017 British Small Animal Veterinary Association.

Analysis of the clinical backgrounds of patients who developed respiratory acidosis under high-flow oxygen therapy during emergency transport.

PubMed

Ogino, Hirokazu; Nishimura, Naoki; Yamano, Yasuhiko; Ishikawa, Genta; Tomishima, Yutaka; Jinta, Torahiko; Takahashi, Osamu; Chohnabayashi, Naohiko

2016-01-01

High-flow oxygen is often administered to patients during emergency transport and can sometimes cause respiratory acidosis with disturbed consciousness, thereby necessitating mechanical ventilation. Although oxygen titration in chronic obstructive pulmonary disease patients during emergency transport reduces mortality rates, the clinical risk factors for respiratory acidosis in emergency settings are not fully understood. Therefore, we analyzed the clinical backgrounds of patients who developed respiratory acidosis during pre-hospital transport. This was a retrospective study of patients who arrived at our hospital by emergency transport in 2010 who received high-flow oxygen while in transit. Respiratory acidosis was defined by the following arterial blood gas readings: pH, ≤7.35; PaCO 2 , ≥45 mmHg; and HCO 3 - , ≥24 mmol/L. The risk factors were identified using multivariable logistic regression analysis. In 765 study patients, 66 patients showed respiratory acidosis. The following risk factors for respiratory acidosis were identified: age, ≥65 years (odds ratio [OR] 1.4; 95% confidence interval [CI], 0.7-2.8); transportation time, ≥10 min (OR 2.0; 95% CI, 1.1-3.7); three digits on the Japan Coma Scale (OR 3.1; 95% CI, 1.7-5.8); percutaneous oxygen saturation, ≤90% (OR 1.6; 95% CI, 0.8-3.0); tuberculosis (OR 4.5; 95% CI, 1.4-15.1); asthma (OR 1.8; 95% CI, 0.6-5.3); pneumonia (OR 1.5; 95% CI, 0.7-3.1); and lung cancer (OR 3.9; 95% CI, 1.5-10.1). These underlying diseases as risk factors included both comorbid diseases and past medical conditions. The factors identified may contribute to the development of respiratory acidosis. Further studies on preventing respiratory acidosis will improve the quality of emergency medical care.

Background on Establishing a Working Group to Create Home Clinical Cases for Education.

PubMed

Yoshitake, Taketo

2017-01-01

In Japan there are concerns that there will be a surge in social insurance costs such as medical and nursing care expenses as a result of the baby boom generation reaching the late stages of old age (75 years old and beyond) around 2025 ("The 2025 Problem"). In 2012, the "Outline on Social Insurance and Tax Reform" was approved by the Japanese cabinet and government, including "construction of regional comprehensive care". To promote participation in home medical care by pharmacists, this article presents the roles demanded of pharmacists in regional comprehensive care from the standpoint of physicians, and the discussion of case studies bridging the gap from knowledge learned in lectures to practical applications. In the field of medical education, "The 2023 Problem", regarding standards of education on a global level, caused medical schools across Japan to scramble for curriculum reform, specifically in the demand for increased time spent in clinical training and the expansion of community-based medical education. The current state of community-based medical education will be reviewed. In light of these developments, "the working group to create home clinical cases for education" was developed by clinical pharmacists in the field and university faculty members at Daiichi University of Pharmacy.

[Development of image quality assurance support system using image recognition technology in radiography in lacked images of chest and abdomen].

PubMed

Shibuya, Toru; Kato, Kyouichi; Eshima, Hidekazu; Sumi, Shinichirou; Kubo, Tadashi; Ishida, Hideki; Nakazawa, Yasuo

2012-01-01

In order to provide a precise radiography for diagnosis, it is required that we avoid radiography with defects by having enough evaluation. Conventionally, evaluation was performed only by observation of a radiological technologist (RT). The evaluation support system was developed for providing a high quality assurance without depending on RT observation only. The evaluation support system, called as the Image Quality Assurance Support System (IQASS), is characterized in that "image recognition technology" for the purpose of diagnostic radiography of chest and abdomen areas. The technique of the system used in this study. Of the 259 samples of posterior-anterior (AP) chest, lateral chest, and upright abdominal x-rays, the sensitivity and specificity was 93.1% and 91.8% in the chest AP, 93.3% and 93.6% in the chest lateral, and 95.0% and 93.8% in the upright abdominal x-rays. In the light of these results, it is suggested that AIQAS could be applied to practical usage for the RT.

Backgrounds in Language.

ERIC Educational Resources Information Center

Maxwell, John C.; Long, Barbara K.

"Backgrounds in Language," a field-tested inservice course designed for use by groups of 15 or 25 language arts teachers, provides the subject matter background teachers need to make informed decisions about what curriculum materials to use in what way, at what time, and with which students. The course is comprised of eight 2-hour sessions,…

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Da; Padole, Atul; Li, Xinhua

2014-09-15

Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin dosesmore » were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans

PubMed Central

Zhang, Da; Padole, Atul; Li, Xinhua; Singh, Sarabjeet; Khawaja, Ranish Deedar Ali; Lira, Diego; Liu, Tianyu; Shi, Jim Q.; Otrakji, Alexi; Kalra, Mannudeep K.; Xu, X. George; Liu, Bob

2014-01-01

Purpose: To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Methods: Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. Results: The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8% − 25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2 ± 3.3 and 16.5 ± 2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the

In vitro dose measurements in a human cadaver with abdomen/pelvis CT scans.

PubMed

Zhang, Da; Padole, Atul; Li, Xinhua; Singh, Sarabjeet; Khawaja, Ranish Deedar Ali; Lira, Diego; Liu, Tianyu; Shi, Jim Q; Otrakji, Alexi; Kalra, Mannudeep K; Xu, X George; Liu, Bob

2014-09-01

To present a study of radiation dose measurements with a human cadaver scanned on a clinical CT scanner. Multiple point dose measurements were obtained with high-accuracy Thimble ionization chambers placed inside the stomach, liver, paravertebral gutter, ascending colon, left kidney, and urinary bladder of a human cadaver (183 cm in height and 67.5 kg in weight) whose abdomen/pelvis region was scanned repeatedly with a multidetector row CT. The flat energy response and precision of the dosimeters were verified, and the slight differences in each dosimeter's response were evaluated and corrected to attain high accuracy. In addition, skin doses were measured for radiosensitive organs outside the scanned region with OSL dosimeters: the right eye, thyroid, both nipples, and the right testicle. Three scan protocols were used, which shared most scan parameters but had different kVp and mA settings: 120-kVp automA, 120-kVp 300 mA, and 100-kVp 300 mA. For each protocol three repeated scans were performed. The tube starting angle (TSA) was found to randomly vary around two major conditions, which caused large fluctuations in the repeated point dose measurements: for the 120-kVp 300 mA protocol this angle changed from approximately 110° to 290°, and caused 8%-25% difference in the point dose measured at the stomach, liver, colon, and urinary bladder. When the fluctuations of the TSA were small (within 5°), the maximum coefficient of variance was approximately 3.3%. The soft tissue absorbed doses averaged from four locations near the center of the scanned region were 27.2±3.3 and 16.5±2.7 mGy for the 120 and 100-kVp fixed-mA scans, respectively. These values were consistent with the corresponding size specific dose estimates within 4%. The comparison of the per-100-mAs tissue doses from the three protocols revealed that: (1) dose levels at nonsuperficial locations in the TCM scans could not be accurately deduced by simply scaling the fix-mA doses with local mA values; (2

A rare case of perforated "sub-hepatic appendicitis" - a challenging differential diagnosis of acute abdomen based on the combination of appendicitis and maldescent of the caecum.

PubMed

Chiapponi, Costanza; Jannasch, Olof; Petersen, Manuela; Lessel, Wiebke; Bruns, Christiane; Meyer, Frank

2017-01-01

Unusual locations of the appendix vermiformis can result in delay in appropriate diagnosis and treatment of appendicitis. So an inflamed appendix in a sub-hepatic caecum caused by caecal maldescent for example can mimic cholecystitis, the pain being localized in the right upper quadrant. Here, we present a case of perforated sub-hepatic appendicitis with peritonitis, requiring open ileocaecal resection. Review of the existing literature has demonstrated that this pathology is uncommon, yet not so rare as one might presume. In conclusion, surgeons should be aware of this possibility in the diagnostic and therapeutic management of acute abdomen. Copyright © 2016. Published by Elsevier GmbH.

Deterioration in Distortion Product Otoacoustic Emissions in Auditory Neuropathy Patients With Distinct Clinical and Genetic Backgrounds.

PubMed

Kitao, Kyoko; Mutai, Hideki; Namba, Kazunori; Morimoto, Noriko; Nakano, Atsuko; Arimoto, Yukiko; Sugiuchi, Tomoko; Masuda, Sawako; Okamoto, Yasuhide; Morita, Noriko; Sakamoto, Hirokazu; Shintani, Tomoko; Fukuda, Satoshi; Kaga, Kimitaka; Matsunaga, Tatsuo

2018-04-23

Auditory neuropathy (AN) is a clinical disorder characterized by the absence of auditory brainstem response and presence of otoacoustic emissions. A gradual loss of otoacoustic emissions has been reported for some cases of AN. Such cases could be diagnosed as cochlear hearing loss and lead to misunderstanding of the pathology when patients first visit clinics after the loss of otoacoustic emissions. The purpose of this study was to investigate the time course of changes in distortion product otoacoustic emissions (DPOAEs) in association with patients' genetic and clinical backgrounds, including the use of hearing aids. DPOAE measurements from 31 patients with AN were assessed. Genetic analyses for GJB2, OTOF, and mitochondrial m.1555A> G and m.3243A> G mutations were conducted for all cases, and the analyses for CDH23 and OPA1 were conducted for the selected cases. Patients who were younger than 10 years of age at the time of AN diagnosis were designated as the pediatric AN group (22 cases), and those who were 18 years of age or older were designated as the adult AN group (9 cases). DPOAE was measured at least twice in all patients. The response rate for DPOAEs was defined and analyzed. The pediatric AN group comprised 10 patients with OTOF mutations, 1 with GJB2 mutations, 1 with OPA1 mutation, and 10 with indefinite causes. Twelve ears (27%) showed no change in DPOAE, 20 ears (46%) showed a decrease in DPOAE, and 12 ears (27%) lost DPOAE. Loss of DPOAE occurred in one ear (2%) at 0 years of age and four ears (9%) at 1 year of age. The time courses of DPOAEs in patients with OTOF mutations were divided into those with early loss and those with no change, indicating that the mechanism for deterioration of DPOAEs includes not only the OTOF mutations but also other common modifier factors. Most, but not all, AN patients who used hearing aids showed deterioration of DPOAEs after the start of using hearing aids. A few AN patients also showed deterioration of DPOAEs

Clinical and computed tomography features of adult abdominopelvic desmoplastic small round cell tumor.

PubMed

Shen, Xun-Ze; Zhao, Jian-Guo; Wu, Jian-Jun; Liu, Fang

2014-05-07

To investigate the clinical and computed tomography (CT) features of desmoplastic small round cell tumor (DSRCT), we retrospectively analyzed the clinical presentations, treatment and outcome, as well as CT manifestations of four cases of DSRCT confirmed by surgery and pathology. The CT manifestations of DSRCT were as follows: (1) multiple soft-tissue masses or diffuse peritoneal thickening in the abdomen and pelvis, with the dominant mass usually located in the pelvic cavity; (2) masses without an apparent organ-based primary site; (3) mild to moderate homogeneous or heterogeneous enhancement in solid area on enhanced CT; and (4) secondary manifestations, such as ascites, hepatic metastases, lymphadenopathy, hydronephrosis and hydroureter. The prognosis and overall survival rates were generally poor. Commonly used treatment strategies including aggressive tumor resection, polychemotherapy, and radiotherapy, showed various therapeutic effects. CT of DSRCT shows characteristic features that are helpful in diagnosis. Early discovery and complete resection, coupled with postoperative adjuvant chemotherapy, are important for prognosis of DSRCT. Whole abdominopelvic rather than locoregional radiotherapy is more effective for unresectable DSRCT.

Responsible innovation in human germline gene editing: Background document to the recommendations of ESHG and ESHRE.

PubMed

De Wert, Guido; Heindryckx, Björn; Pennings, Guido; Clarke, Angus; Eichenlaub-Ritter, Ursula; van El, Carla G; Forzano, Francesca; Goddijn, Mariëtte; Howard, Heidi C; Radojkovic, Dragica; Rial-Sebbag, Emmanuelle; Dondorp, Wybo; Tarlatzis, Basil C; Cornel, Martina C

2018-04-01

Technological developments in gene editing raise high expectations for clinical applications, including editing of the germline. The European Society of Human Reproduction and Embryology (ESHRE) and the European Society of Human Genetics (ESHG) together developed a Background document and Recommendations to inform and stimulate ongoing societal debates. This document provides the background to the Recommendations. Germline gene editing is currently not allowed in many countries. This makes clinical applications in these countries impossible now, even if germline gene editing would become safe and effective. What were the arguments behind this legislation, and are they still convincing? If a technique could help to avoid serious genetic disorders, in a safe and effective way, would this be a reason to reconsider earlier standpoints? This Background document summarizes the scientific developments and expectations regarding germline gene editing, legal regulations at the European level, and ethics for three different settings (basic research, preclinical research and clinical applications). In ethical terms, we argue that the deontological objections (e.g., gene editing goes against nature) do not seem convincing while consequentialist objections (e.g., safety for the children thus conceived and following generations) require research, not all of which is allowed in the current legal situation in European countries. Development of this Background document and Recommendations reflects the responsibility to help society understand and debate the full range of possible implications of the new technologies, and to contribute to regulations that are adapted to the dynamics of the field while taking account of ethical considerations and societal concerns.

Influence of background/surrounding area on accuracy of visual color matching.

PubMed

Dudea, Diana; Gasparik, Cristina; Botos, Alexandra; Alb, Florin; Irimie, Ada; Paravina, Rade D

2016-07-01

Visual shade selection is subjective and influenced by factors that might be operator-dependent or not. The objective was to evaluate influence of observer nonrelated factors (background/surrounding area, and light) and observer-related factors (gender and color competence) on shade-matching quality and to identify the most often mismatched shades in correlation with the background. Ten observers with average or superior color discrimination competence according to ISO TR 28642:2011 were asked to match 48 shade tabs of three VITA Classical shade guides, in a viewing booth under two light sources: D65 and D50. Gray, white, black, red, and light blue background/surrounding area simulated various clinical situations. The results were statistically analyzed using Kruskal-Wallis test and Mann-Whitney U test. Post hoc power analyses and sample size calculations were also conducted. The matching scores ranged between 72.7 % (using blue background) and 85.9 % (using white and black backgrounds). There was a statistically significant difference between matching scores on the five backgrounds (χ (2)(4) = 12.67, p = 0.01). When neutral gray was used as reference, Mann-Whitney U value was statistically significant only for the blue background (U = 107.00, Z = -2.52, p = 0.01). The influence of gender and lighting condition was also assessed, no statistically significance being found, but in both cases, the effect size and the achieved power were small. However, color discrimination competence did influence the results (p < 0.01). Background influenced shade matching results for tabs A3, B3, B4, and D4. Within the limitations of this study, it was concluded that 1. When it comes to the influence of the background/surround area on quality of color matching, no difference among achromatic backgrounds was recorded. Significantly worse results were recorded when the blue background was used. 2. Observers with superior color matching competence performed

Marking out the clinical expert/clinical leader/clinical scholar: perspectives from nurses in the clinical arena

PubMed Central

2013-01-01

Background Clinical scholarship has been conceptualised and theorised in the nursing literature for over 30 years but no research has captured nurses’ clinicians’ views on how it differs or is the same as clinical expertise and clinical leadership. The aim of this study was to determine clinical nurses’ understanding of the differences and similarities between the clinical expert, clinical leader and clinical scholar. Methods A descriptive interpretative qualitative approach using semi-structured interviews with 18 practising nurses from Australia, Canada and England. The audio-taped interviews were transcribed and the text coded for emerging themes. The themes were sorted into categories of clinical expert, clinical leader and clinical scholarship as described by the participants. These themes were then compared and contrasted and the essential elements that characterise the nursing roles of the clinical expert, clinical leader and clinical scholar were identified. Results Clinical experts were seen as linking knowledge to practice with some displaying clinical leadership and scholarship. Clinical leadership is seen as a positional construct with a management emphasis. For the clinical scholar they linked theory and practice and encouraged research and dissemination of knowledge. Conclusion There are distinct markers for the roles of clinical expert, clinical leader and clinical scholar. Nurses working in one or more of these roles need to work together to improve patient care. An ‘ideal nurse’ may be a blending of all three constructs. As nursing is a practice discipline its scholarship should be predominantly based on clinical scholarship. Nurses need to be encouraged to go beyond their roles as clinical leaders and experts to use their position to challenge and change through the propagation of knowledge to their community. PMID:23587282

Double abdomen in a short-germ insect: Zygotic control of axis formation revealed in the beetle Tribolium castaneum

PubMed Central

Ansari, Salim; Troelenberg, Nicole; Dao, Van Anh; Richter, Tobias; Klingler, Martin

2018-01-01

The distinction of anterior versus posterior is a crucial first step in animal embryogenesis. In the fly Drosophila, this axis is established by morphogenetic gradients contributed by the mother that regulate zygotic target genes. This principle has been considered to hold true for insects in general but is fundamentally different from vertebrates, where zygotic genes and Wnt signaling are required. We investigated symmetry breaking in the beetle Tribolium castaneum, which among insects represents the more ancestral short-germ embryogenesis. We found that maternal Tc-germ cell-less is required for anterior localization of maternal Tc-axin, which represses Wnt signaling and promotes expression of anterior zygotic genes. Both RNAi targeting Tc-germ cell-less or double RNAi knocking down the zygotic genes Tc-homeobrain and Tc-zen1 led to the formation of a second growth zone at the anterior, which resulted in double-abdomen phenotypes. Conversely, interfering with two posterior factors, Tc-caudal and Wnt, caused double-anterior phenotypes. These findings reveal that maternal and zygotic mechanisms, including Wnt signaling, are required for establishing embryo polarity and induce the segmentation clock in a short-germ insect. PMID:29432152

Visual signal detection in structured backgrounds. II. Effects of contrast gain control, background variations, and white noise

NASA Technical Reports Server (NTRS)

Eckstein, M. P.; Ahumada, A. J. Jr; Watson, A. B.

1997-01-01

Studies of visual detection of a signal superimposed on one of two identical backgrounds show performance degradation when the background has high contrast and is similar in spatial frequency and/or orientation to the signal. To account for this finding, models include a contrast gain control mechanism that pools activity across spatial frequency, orientation and space to inhibit (divisively) the response of the receptor sensitive to the signal. In tasks in which the observer has to detect a known signal added to one of M different backgrounds grounds due to added visual noise, the main sources of degradation are the stochastic noise in the image and the suboptimal visual processing. We investigate how these two sources of degradation (contrast gain control and variations in the background) interact in a task in which the signal is embedded in one of M locations in a complex spatially varying background (structured background). We use backgrounds extracted from patient digital medical images. To isolate effects of the fixed deterministic background (the contrast gain control) from the effects of the background variations, we conduct detection experiments with three different background conditions: (1) uniform background, (2) a repeated sample of structured background, and (3) different samples of structured background. Results show that human visual detection degrades from the uniform background condition to the repeated background condition and degrades even further in the different backgrounds condition. These results suggest that both the contrast gain control mechanism and the background random variations degrade human performance in detection of a signal in a complex, spatially varying background. A filter model and added white noise are used to generate estimates of sampling efficiencies, an equivalent internal noise, an equivalent contrast-gain-control-induced noise, and an equivalent noise due to the variations in the structured background.

Pigs in Toxicology: Breed Differences in Metabolism and Background Findings.

PubMed

Helke, Kristi L; Nelson, Keith N; Sargeant, Aaron M; Jacob, Binod; McKeag, Sean; Haruna, Julius; Vemireddi, Vimala; Greeley, Melanie; Brocksmith, Derek; Navratil, Nicole; Stricker-Krongrad, Alain; Hollinger, Charlotte

2016-06-01

Both a rodent and a nonrodent species are required for evaluation in nonclinical safety studies conducted to support human clinical trials. Historically, dogs and nonhuman primates have been the nonrodent species of choice. Swine, especially the miniature swine or minipigs, are increasingly being used in preclinical safety as an alternate nonrodent species. The pig is an appropriate option for these toxicology studies based on metabolic pathways utilized in xenobiotic biotransformation. Both similarities and differences exist in phase I and phase II biotransformation pathways between humans and pigs. There are numerous breeds of pigs, yet only a few of these breeds are characterized with regard to both xenobiotic-metabolizing enzymes and background pathology findings. Some specific differences in these enzymes based on breed and sex are known. Although swine have been used extensively in biomedical research, there is also a paucity of information in the current literature detailing the incidence of background lesions and differences between commonly used breeds. Here, the xenobiotic-metabolizing enzymes are compared between humans and pigs, and minipig background pathology changes are reviewed with emphasis on breed differences. © The Author(s) 2016.

Reflections on Speech-Language Therapists' Talk: Implications for Clinical Practice and Education. Clinical Forum

ERIC Educational Resources Information Center

Ferguson, Alison; Armstrong, Elizabeth

2004-01-01

Background: Research into the practices of speech-language therapists in clinical sessions is beginning to identify the way communication in clinical interactions both facilitates and potentially impedes the achievement of therapy goals. Aims: This target article aims to raise the issues that arise from critical reflections on the communication of…

Illuminating the Background: Topics in Cosmic Microwave Background Polarization Research

NASA Astrophysics Data System (ADS)

Miller, Nathan J.

The cosmic microwave background provides a wealth of information about the origin and history of the universe. The statistics of the anisotropy and the polarization of the cosmic microwave background, among other things, can tell us about the distribution of matter, the redshift of reionization, and the nature of the primordial uctuations. From the lensing of cosmic microwave background due to intervening matter, we can extract information about neutrinos and the equation of state of dark energy. A measurement of the large angular scale B-mode polarization has been called the "smoking gun" of in ation, a theory that describes a possible early rapid expansion of the universe. The focus of current experiments is to measure this B-mode polarization, while several experiments, such as POLARBEAR, are also looking to measure the lensing of the cosmic microwave background. This dissertation will discuss several different topics in cosmic microwave background polarization research. I will make predictions for future experiments and I will also show analysis for two current experiments, POLARBEAR and BICEP. I will show how beam systematics affect the measurement of cosmological parameters and how well we must limit these systematics in order to get unbiased constraints on cosmological parameters for future experiments. I will discuss a novel way of using the temperature-polarization cross correlation to constrain the amount of inflationary gravitational waves. Through Markov Chain Monte Carlo methods, I will determine how well future experiments will be able to constrain the neutrino masses and their degeneracy parameters. I will show results from current data analysis and calibration being done on the Cedar Flat deployment for the POLARBEAR experiment which is currently being constructed in the Atacama desert in Chile. Finally, I will analyze the claim of detection of cosmological birefringence in the BICEP data and show that there is reason to believe it is due to

Drosophila social clustering is disrupted by anesthetics and in narrow abdomen ion channel mutants.

PubMed

Burg, E D; Langan, S T; Nash, H A

2013-04-01

Members of many species tend to congregate, a behavioral strategy known as local enhancement. Selective advantages of local enhancement range from efficient use of resources to defense from predators. While previous studies have examined many types of social behavior in fruit flies, few have specifically investigated local enhancement. Resource-independent local enhancement (RILE) has recently been described in the fruit fly using a measure called social space index (SSI), although the neural mechanisms remain unknown. Here, we analyze RILE of Drosophila under conditions that allow us to elucidate its neural mechanisms. We have investigated the effects of general volatile anesthetics, compounds that compromise higher order functioning of the type typically required for responding to social cues. We exposed Canton-S flies to non-immobilizing concentrations of halothane and found that flies had a significantly decreased SSI compared with flies tested in air. Narrow abdomen (na) mutants, which display altered responses to anesthetics in numerous behavioral assays, also have a significantly reduced SSI, an effect that was fully reversed by restoring expression of na by driving a UAS-NA rescue construct with NA-GAL4. We found that na expression in cholinergic neurons fully rescued the behavioral defect, whereas expression of na in glutamatergic neurons did so only partially. Our results also suggest a role for na expression in the mushroom bodies (MBs), as suppressing na expression in the MBs of NA-GAL4 rescue flies diminishes SSI. Our data indicate that RILE, a simple behavioral strategy, requires complex neural processing. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Background Underground at WIPP

NASA Astrophysics Data System (ADS)

Esch, Ernst-Ingo; Hime, A.; Bowles, T. J.

2001-04-01

Recent interest to establish a dedicated underground laboratory in the United States prompted an experimental program at to quantify the enviromental backgrounds underground at the Waste Isolation Pilot Plant (WIPP) in Carlsbad, New Mexico. An outline of this program is provided along with recent experimental data on the cosmic ray muon flux at the 650 meter level of WIPP. The implications of the cosmic ray muon and fast neutron background at WIPP will be discussed in the context of new generation, low background experiments envisioned in the future.

Analysis of the clinical backgrounds of patients who developed respiratory acidosis under high‐flow oxygen therapy during emergency transport

PubMed Central

Ogino, Hirokazu; Yamano, Yasuhiko; Ishikawa, Genta; Tomishima, Yutaka; Jinta, Torahiko; Takahashi, Osamu; Chohnabayashi, Naohiko

2015-01-01

Aim High‐flow oxygen is often administered to patients during emergency transport and can sometimes cause respiratory acidosis with disturbed consciousness, thereby necessitating mechanical ventilation. Although oxygen titration in chronic obstructive pulmonary disease patients during emergency transport reduces mortality rates, the clinical risk factors for respiratory acidosis in emergency settings are not fully understood. Therefore, we analyzed the clinical backgrounds of patients who developed respiratory acidosis during pre‐hospital transport. Methods This was a retrospective study of patients who arrived at our hospital by emergency transport in 2010 who received high‐flow oxygen while in transit. Respiratory acidosis was defined by the following arterial blood gas readings: pH, ≤7.35; PaCO 2, ≥45 mmHg; and HCO 3 −, ≥24 mmol/L. The risk factors were identified using multivariable logistic regression analysis. Results In 765 study patients, 66 patients showed respiratory acidosis. The following risk factors for respiratory acidosis were identified: age, ≥65 years (odds ratio [OR] 1.4; 95% confidence interval [CI], 0.7–2.8); transportation time, ≥10 min (OR 2.0; 95% CI, 1.1–3.7); three digits on the Japan Coma Scale (OR 3.1; 95% CI, 1.7–5.8); percutaneous oxygen saturation, ≤90% (OR 1.6; 95% CI, 0.8–3.0); tuberculosis (OR 4.5; 95% CI, 1.4–15.1); asthma (OR 1.8; 95% CI, 0.6–5.3); pneumonia (OR 1.5; 95% CI, 0.7–3.1); and lung cancer (OR 3.9; 95% CI, 1.5–10.1). These underlying diseases as risk factors included both comorbid diseases and past medical conditions. Conclusions The factors identified may contribute to the development of respiratory acidosis. Further studies on preventing respiratory acidosis will improve the quality of emergency medical care. PMID:29123744

Genetic testing in asymptomatic minors Background considerations towards ESHG Recommendations

PubMed Central

Borry, Pascal; Evers-Kiebooms, Gerry; Cornel, Martina C; Clarke, Angus; Dierickx, Kris

2009-01-01

Although various guidelines and position papers have discussed, in the past, the ethical aspects of genetic testing in asymptomatic minors, the European Society of Human Genetics had not earlier endorsed any set of guidelines exclusively focused on this issue. This paper has served as a background document in preparation of the development of the policy recommendations of the Public and Professional Committee of the European Society of Human Genetics. This background paper first discusses some general considerations with regard to the provision of genetic tests to minors. It discusses the concept of best interests, participation of minors in health-care decisions, parents' responsibilities to share genetic information, the role of clinical genetics and the health-care system in communication within the family. Second, it discusses, respectively, the presymptomatic and predictive genetic testing for adult-onset disorders, childhood-onset disorders and carrier testing. PMID:19277061

Percutaneous Removal of Retained Calculi from the Abdomen

DOE Office of Scientific and Technical Information (OSTI.GOV)

O'Shea, S.J.; Martin, D.F.

With rising pressure placed on health service resources minimally invasive techniques requiring only short hospital admissions are increasing in importance. We describe the techniques used to remove calculi from the peritoneal cavity which had been retained after surgery and continued to cause clinical problems. In both cases described the calculi lay within abscess cavities associated with fistulous tracks to the skin. The fistulae were dilated to allow passage of therapeutic radiologic and endoscopic equipment enabling manipulation and subsequent extraction of the stones. In both cases removal of the calculi allowed complete resolution of the fistulae and the patients made amore » full clinical recovery. Removal of gallstones which have escaped into the peritoneum at laparoscopic cholecystectomy leading to sepsis has been described; we describe the novel management of a patient in whom extraction had already been attempted, at another hospital, without success. Removal of an appendicolith, described herein another patient, does not appear to have been reported previously.« less

Dilatonic parallelizable NS-NS backgrounds

NASA Astrophysics Data System (ADS)

Kawano, Teruhiko; Yamaguchi, Satoshi

2003-08-01

We complete the classification of parallelizable NS-NS backgrounds in type II supergravity by adding the dilatonic case to the result of Figueroa-O'Farrill on the non-dilatonic case. We also study the supersymmetry of these parallelizable backgrounds. It is shown that all the dilatonic parallelizable backgrounds have sixteen supersymmetries.

T-wave alternans and beat-to-beat variability of repolarization: pathophysiological backgrounds and clinical relevance.

PubMed

Floré, Vincent; Willems, Rik

2012-12-01

In this review, we focus on temporal variability of cardiac repolarization. This phenomenon has been related to a higher risk for ventricular arrhythmia and is therefore interesting as a marker of sudden cardiac death risk. We review two non-invasive clinical techniques quantifying repolarization variability: T-wave alternans (TWA) and beat-to-beat variability of repolarization (BVR). We discuss their pathophysiological link with ventricular arrhythmia and the current clinical relevance of these techniques.

Mechanosensilla in the adult abdomen of Drosophila: engrailed and slit help to corral the peripheral sensory axons into segmental bundles.

PubMed

Fabre, Caroline C G; Casal, José; Lawrence, Peter A

2010-09-01

The abdomen of adult Drosophila bears mechanosensory bristles with axons that connect directly to the CNS, each hemisegment contributing a separate nerve bundle. Here, we alter the amount of Engrailed protein and manipulate the Hedgehog signalling pathway in clones of cells to study their effects on nerve pathfinding within the peripheral nervous system. We find that high levels of Engrailed make the epidermal cells inhospitable to bristle neurons; sensory axons that are too near these cells are either deflected or fail to extend properly or at all. We then searched for the engrailed-dependent agent responsible for these repellent properties. We found slit to be expressed in the P compartment and, using genetic mosaics, present evidence that Slit is the responsible molecule. Blocking the activity of the three Robo genes (putative receptors for Slit) with RNAi supported this hypothesis. We conclude that, during normal development, gradients of Slit protein repel axons away from compartment boundaries - in consequence, the bristles from each segment send their nerves to the CNS in separated sets.

Clinical Audit of Gastrointestinal Conditions Occurring among Adults with Down Syndrome Attending a Specialist Clinic

ERIC Educational Resources Information Center

Wallace, Robyn A.

2007-01-01

Background: Adults with Down syndrome (DS) are predisposed to syndromic and environmental gastrointestinal conditions. Method: In a hospital-based clinic for adults with DS, a chart audit was conducted to assess the range and frequency of gastrointestinal conditions. Results: From January 2003 to March 2005, 57 patients attended the clinic,…

WE-D-207-01: Background and Clinical Implementation of a Screening Program

DOE Office of Scientific and Technical Information (OSTI.GOV)

Aberle, D.

2015-06-15

In the United States, Lung Cancer is responsible for more cancer deaths than the next four cancers combined. In addition, the 5 year survival rate for lung cancer patients has not improved over the past 40 to 50 years. To combat this deadly disease, in 2002 the National Cancer Institute launched a very large Randomized Control Trial called the National Lung Screening Trial (NLST). This trial would randomize subjects who had substantial risk of lung cancer (due to age and smoking history) into either a Chest X-ray arm or a low dose CT arm. In November 2010, the National Cancermore » Institute announced that the NLST had demonstrated 20% fewer lung cancer deaths among those who were screened with low-dose CT than with chest X-ray. In December 2013, the US Preventive Services Task Force recommended the use of Lung Cancer Screening using low dose CT and a little over a year later (Feb. 2015), CMS announced that Medicare would also cover Lung Cancer Screening using low dose CT. Thus private and public insurers are required to provide Lung Cancer Screening programs using CT to the appropriate population(s). The purpose of this Symposium is to inform medical physicists and prepare them to support the implementation of Lung Screening programs. This Symposium will focus on the clinical aspects of lung cancer screening, requirements of a screening registry for systematically capturing and tracking screening patients and results (such as required Medicare data elements) as well as the role of the medical physicist in screening programs, including the development of low dose CT screening protocols. Learning Objectives: To understand the clinical basis and clinical components of a lung cancer screening program, including eligibility criteria and other requirements. To understand the data collection requirements, workflow, and informatics infrastructure needed to support the tracking and reporting components of a screening program. To understand the role of the medical

SPET/CT image co-registration in the abdomen with a simple and cost-effective tool.

PubMed

Förster, Gregor J; Laumann, Christina; Nickel, Otmar; Kann, Peter; Rieker, Olaf; Bartenstein, Peter

2003-01-01

Fusion of morphology and function has been shown to improve diagnostic accuracy in many clinical circumstances. Taking this into account, a number of instruments combining computed tomography (CT) with positron emission tomography (PET) or single-photon emission tomography (SPET) are appearing on the market. The aim of this study was to evaluate a simple and cost-effective approach to generate fusion images of similar quality. For the evaluation of the proposed approach, patients with neuroendocrine abdominal tumours with liver metastases were chosen, since the exact superimposition in the abdomen is more difficult than in other regions. Five hours following the injection of 110 MBq (111)In-DTPA-octreotide, patients were fixed in a vacuum cushion (MED-TEC, Vac-Loc) and investigated with helical CT in a mid-inspiration position ( n=14). Directly following the CT, a SPET study (SPET1) of the abdominal region was performed without changing the position of the patient. A second SPET study (SPET2), 24 h p.i., was acquired after repositioning the patient in his or her individually moulded vacuum cushion. A total of nine markers suitable for imaging with CT and SPET were fixed on the cushion. Datasets were fused by means of internal landmarks (e.g. metastases or margin of abdominal organs) or by the external markers. Image fusion using external markers was fast and easy to handle compared with the use of internal landmarks. Using this technique, all lesions detectable by SPET ( n=28) appeared exactly superpositioned on the respective CT morphology by visual inspection. Image fusion of CT/SPET1 and CT/SPET2 showed a mean deviation of the external markers that in the former case was smaller than the voxel size of 4.67 mm: 4.17+/-0.61 (CT/SPET1; +/-SD) and 5.52+/-1.56 mm (CT/SPET2), respectively. Using internal landmarks, the mean deviation of the chosen landmarks was 6.47+/-1.37 and 7.78+/-1.21 mm. Vector subtraction of corresponding anatomical points of the CT and the re

Assessing the prevalence and clinical relevance of positive abdominal and pelvic CT findings in senior patients presenting to the emergency department.

PubMed

Alabousi, Abdullah; Patlas, Michael N; Meshki, Malek; Monteiro, Sandra; Katz, Douglas S

2016-04-01

The purpose of our study was to retrospectively evaluate the prevalence and clinical relevance of positive abdominal and pelvic CT findings for patients 65 years of age and older, when compared with all other scanned adult Emergency Department (ED) patients, at a single tertiary care hospital. Our hypothesis was that there is an increased prevalence and clinical relevance of positive abdominal/pelvic CT findings in senior patients. A research ethics board-approved retrospective review of all adult patients who underwent an emergency CT of the abdomen and pelvis for acute nontraumatic abdominal and/or pelvic signs and symptoms was performed. Two thousand one hundred two patients between October 1, 2011, and September 30, 2013, were reviewed. Six hundred thirty-one patients were included in the <65 group (298 men and 333 women; mean age 46, age range 18-64), and 462 were included in the >65 group (209 men and 253 women; mean age 77.6, age range 65-99). Overall, there were more positive CT findings for patients <65 (389 positive cases, 61.6 %) compared with the >65 group (257 positive cases, 55.6 %), which was a statistically significant difference (p < 0.03). Moreover, with the exception of complicated appendicitis cases, which were more common in the >65 group, there were no statistically significant differences in the clinical/surgical relevance of the positive CT findings between the two groups. The findings of our retrospective study therefore refute our hypothesis that there is an increased prevalence of positive abdominal CT findings in patients >65. This may be related to ED physicians at our institution being more hesitant to order CT examinations for the younger population, presumably due to radiation concerns. However, older patients in our series were more likely to present with complicated appendicitis, and a lower threshold for ordering CT examinations of the abdomen and pelvis in this patient population should therefore be considered.

Cushing Syndrome: Diagnostic Workup and Imaging Features, With Clinical and Pathologic Correlation.

PubMed

Wagner-Bartak, Nicolaus A; Baiomy, Ali; Habra, Mouhammed Amir; Mukhi, Shalini V; Morani, Ajaykumar C; Korivi, Brinda R; Waguespack, Steven G; Elsayes, Khaled M

2017-07-01

Cushing syndrome (CS) is a constellation of clinical signs and symptoms resulting from chronic exposure to excess cortisol, either exogenous or endogenous. Exogenous CS is most commonly caused by administration of glucocorticoids. Endogenous CS is subdivided into two types: adrenocorticotropic hormone (ACTH) dependent and ACTH independent. Cushing disease, which is caused by a pituitary adenoma, is the most common cause of ACTH-dependent CS for which pituitary MRI can be diagnostic, with bilateral inferior petrosal sinus sampling useful in equivocal cases. In ectopic ACTH production, which is usually caused by a tumor in the thorax (e.g., small cell lung carcinoma, bronchial and thymic carcinoids, or medullary thyroid carcinoma) or abdomen (e.g., gastroenteropancreatic neuroendocrine tumors or pheochromocytoma), CT, MRI, and nuclear medicine tests are used for localizing the source of ACTH. In ACTH-independent CS, which is caused by various adrenal abnormalities, adrenal protocol CT or MRI is usually diagnostic.

[X-ray diagnostic of partial intestinal obstruction in small intestine diseases: a glance on the problem of radiologist-gastroenterologist].

PubMed

Levchenko, S V; Kotovshchikova, A A; Orlova, N V

2013-01-01

The article is devoted to special features of X-ray examining of patients suffering from acute abdomen pain and X-ray paradigma of some intestine diseases as a cause of partial bowel obstruction. Own clinical data are presented. Long-term experience of our X-ray department is summarized. The possibilities of X-ray examining of abdomen with and without contrast in patients with partial bowel obstruction are described.

Recursive least squares background prediction of univariate syndromic surveillance data

PubMed Central

2009-01-01

Background Surveillance of univariate syndromic data as a means of potential indicator of developing public health conditions has been used extensively. This paper aims to improve the performance of detecting outbreaks by using a background forecasting algorithm based on the adaptive recursive least squares method combined with a novel treatment of the Day of the Week effect. Methods Previous work by the first author has suggested that univariate recursive least squares analysis of syndromic data can be used to characterize the background upon which a prediction and detection component of a biosurvellance system may be built. An adaptive implementation is used to deal with data non-stationarity. In this paper we develop and implement the RLS method for background estimation of univariate data. The distinctly dissimilar distribution of data for different days of the week, however, can affect filter implementations adversely, and so a novel procedure based on linear transformations of the sorted values of the daily counts is introduced. Seven-days ahead daily predicted counts are used as background estimates. A signal injection procedure is used to examine the integrated algorithm's ability to detect synthetic anomalies in real syndromic time series. We compare the method to a baseline CDC forecasting algorithm known as the W2 method. Results We present detection results in the form of Receiver Operating Characteristic curve values for four different injected signal to noise ratios using 16 sets of syndromic data. We find improvements in the false alarm probabilities when compared to the baseline W2 background forecasts. Conclusion The current paper introduces a prediction approach for city-level biosurveillance data streams such as time series of outpatient clinic visits and sales of over-the-counter remedies. This approach uses RLS filters modified by a correction for the weekly patterns often seen in these data series, and a threshold detection algorithm from the

A Rare Case of Splenic Torsion with Sigmoid Volvulus in a 14-Year-Old Girl.

PubMed

Ahmadi, Hamid; Tehrani, Mahdieh Mohammad Khan

2016-01-01

Wandering spleen is an uncommon entity in adults and has been described only rarely with sigmoid volvulus, that rarely affects children and adolescents. It is usually described in adults.Wandering spleen characterized by the abnormal location of the spleen, caused by incomplete fusion of the four primary splenic ligaments, allowing the spleen to be mobile within the abdomen.The wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important. We present a rare clinical case of acute abdomen due to torsion of wandering spleen and volvulus of sigmoid in a 14-year-old girl presented with painful periumbilical mass. Detorsion of sigmoid occurred while undergoing exploratory laparotomy and splenectomy was performed. The possibility of torsion and its complication like gastric, pancreas tail and colon volvulus should be kept in mind in the differential diagnosis of the acute abdomen to avoid serious complications.

Unsupervised background-constrained tank segmentation of infrared images in complex background based on the Otsu method.

PubMed

Zhou, Yulong; Gao, Min; Fang, Dan; Zhang, Baoquan

2016-01-01

In an effort to implement fast and effective tank segmentation from infrared images in complex background, the threshold of the maximum between-class variance method (i.e., the Otsu method) is analyzed and the working mechanism of the Otsu method is discussed. Subsequently, a fast and effective method for tank segmentation from infrared images in complex background is proposed based on the Otsu method via constraining the complex background of the image. Considering the complexity of background, the original image is firstly divided into three classes of target region, middle background and lower background via maximizing the sum of their between-class variances. Then, the unsupervised background constraint is implemented based on the within-class variance of target region and hence the original image can be simplified. Finally, the Otsu method is applied to simplified image for threshold selection. Experimental results on a variety of tank infrared images (880 × 480 pixels) in complex background demonstrate that the proposed method enjoys better segmentation performance and even could be comparative with the manual segmentation in segmented results. In addition, its average running time is only 9.22 ms, implying the new method with good performance in real time processing.

Holistic approach for automated background EEG assessment in asphyxiated full-term infants

NASA Astrophysics Data System (ADS)

Matic, Vladimir; Cherian, Perumpillichira J.; Koolen, Ninah; Naulaers, Gunnar; Swarte, Renate M.; Govaert, Paul; Van Huffel, Sabine; De Vos, Maarten

2014-12-01

Objective. To develop an automated algorithm to quantify background EEG abnormalities in full-term neonates with hypoxic ischemic encephalopathy. Approach. The algorithm classifies 1 h of continuous neonatal EEG (cEEG) into a mild, moderate or severe background abnormality grade. These classes are well established in the literature and a clinical neurophysiologist labeled 272 1 h cEEG epochs selected from 34 neonates. The algorithm is based on adaptive EEG segmentation and mapping of the segments into the so-called segments’ feature space. Three features are suggested and further processing is obtained using a discretized three-dimensional distribution of the segments’ features represented as a 3-way data tensor. Further classification has been achieved using recently developed tensor decomposition/classification methods that reduce the size of the model and extract a significant and discriminative set of features. Main results. Effective parameterization of cEEG data has been achieved resulting in high classification accuracy (89%) to grade background EEG abnormalities. Significance. For the first time, the algorithm for the background EEG assessment has been validated on an extensive dataset which contained major artifacts and epileptic seizures. The demonstrated high robustness, while processing real-case EEGs, suggests that the algorithm can be used as an assistive tool to monitor the severity of hypoxic insults in newborns.

Traumatic diaphragmatic hernia in a clinically normal dog.

PubMed Central

Litman, L M

2001-01-01

A 3.5-year-old border collie was presented for routine ovariohysterectomy. A preoperative physical examination revealed no abnormalities, but, under anesthesia, the patient became dyspneic and cyanotic. Plain radiography indicated the presence of a diaphragmatic hernia. The herniated structures were returned to the abdomen and the diaphragmatic defect was surgically repaired. Images Figure 1. PMID:11467188

Circumference reduction and cellulite treatment with a TriPollar radiofrequency device: a pilot study.

PubMed

Manuskiatti, W; Wachirakaphan, C; Lektrakul, N; Varothai, S

2009-07-01

A wide variety of treatments for circumference reduction and cellulite are available, but most procedures offer suboptimal clinical effect and/or delayed therapeutic outcome. Objective To determine the safety and efficacy of the TriPollar radiofrequency device for cellulite treatment and circumference reduction. Thirty-nine females with cellulite received eight weekly TriPollar treatments. Treatment areas included the abdomen, thighs, buttocks and arms. Subjects were evaluated using standardized photographs and measurements of body weight, circumference, subcutaneous thickness, and skin elasticity of the treatment sites at baseline, immediately after and 4 weeks after the final treatment. Physicians' evaluation of clinical improvement scores using a quartile grading scale was recorded. Thirty-seven patients (95%) completed the treatment protocol. There was significant circumference reduction of 3.5 and 1.7 cm at the abdomen (P = 0.002) and thigh (P = 0.002) regions, respectively. At 4 weeks after the last treatment, the average circumferential reductions of the abdomen and thighs were sustained. No significant circumferential reductions of the buttocks and arms at the last treatment visit compared to baseline were demonstrated (P = 0.138 and 0.152, respectively). Quartile grading scores correlating to approximately 50% improvement in cellulite appearance were noted. Tripollar radiofrequency provided beneficial effects on the reduction of abdomen and thigh circumference and cellulite appearance.

SU-E-I-48: The Behavior of AEC in Scan Regions Outside the Localizer Radiograph FOV: An In Phantom Study of CT Systems From Four Vendors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Supanich, M; Bevins, N

Purpose: This review of scanners from 4 major manufacturers examines the clinical impact of performing CT scans that extend into areas of the body that were not acquired in the CT localizer radiograph. Methods: Anthropomorphic chest and abdomen phantoms were positioned together on the tables of CT scanners from 4 different vendors. All of the scanners offered an Automatic Exposure Control (AEC) option with both lateral and axial tube current modulation. A localizer radiograph was taken covering the entire extent of both phantoms and then the scanner's Chest-Abdomen-Pelvis (CAP) study was performed with the clinical AEC settings employed and themore » scan and reconstruction range extending from the superior portion of the chest phantom through the inferior portion of the abdomen phantom. A new study was then initiated with a localizer radiograph extending the length of the chest phantom (not covering the abdomen phantom). The same CAP protocol and AEC settings were then used to scan and reconstruct the entire length of both phantoms. Scan parameters at specific locations in the abdomen phantom from both studies were investigated using the information contained in the DICOM metadata of the reconstructed images. Results: The AEC systems on all scanners utilized different tube current settings in the abdomen phantom for the scan completed without the full localizer radiograph. The AEC system behavior was also scanner dependent with the default manual tube current, the maximum tube current and the tube current at the last known position observed as outcomes. Conclusion: The behavior of the AEC systems of CT scanners in regions not covered by the localizer radiograph is vendor dependent. To ensure optimal image quality and radiation exposure it is important to include the entire planned scan region in the localizer radiograph.« less

Obstructive sleep apnea and pulmonary function in patients with severe obesity before and after bariatric surgery: a randomized clinical trial

PubMed Central

2014-01-01

Background The increasing prevalence of obesity in both developed and developing countries is one of the most serious public health problems and has led to a global epidemic. Obesity is one of the greatest risk factors of obstructive sleep apnea (OSA), which is found in 60 to 70% of obese patients mainly due to the buildup of fat tissue in the upper portion of the thorax and neck. The aim of the present randomized clinical trial is to assess daytime sleepiness, sleep architecture and pulmonary function in patients with severe obesity before and after bariatric surgery. Methods This randomized, controlled trial, was designed, conducted, and reported in accordance with the standards of The CONSORT (Consolidated Standards of Reporting Trials) Statement. Patients were divided into a bariatric surgery group and control group. The clinical evaluation was performed at the Sleep Laboratory of the Nove de JulhoUniversity (Sao Paulo, Brazil) and consisted of the collection of clinical data, weight, height, body mass index (BMI), measurements of neck and abdomen circumferences, spirometry, maximum ventilatory pressure measurements, standard overnight polysomnography (PSG) and the administration of the Berlin Questionnaire and Epworth Sleepiness Scale. Results Fifty-two patients participated in the present study and performed PSG. Out of these, 16 underwent bariatric surgery. After surgery, mean BMI decreased from 48.15 ± 8.58 to 36.91 ± 6.67 Kg/m2. Significant differences were found between the preoperative and postoperative periods regarding neck (p < 0.001) and waist circumference (p < 0.001), maximum inspiratory pressure (p = 0.002 and p = 0.004) and maximum expiratory pressure (p = 0.001 and p = 0.002) for women and men, respectively, as well as sleep stage N3 (p < 0.001), REM sleep (p = 0.049) and the apnea-hypopnea index (p = 0.008). Conclusions Bariatric surgery effectively reduces neck and waist circumference, increases maximum ventilatory pressures, enhances sleep

Enhancing Adult Learning in Clinical Supervision

ERIC Educational Resources Information Center

Goldman, Stuart

2011-01-01

Objective/Background: For decades, across almost every training site, clinical supervision has been considered "central to the development of skills" in psychiatry. The crucial supervisor/supervisee relationship has been described extensively in the literature, most often framed as a clinical apprenticeship of the novice to the master craftsman.…

Low Background Counting at LBNL

DOE PAGES

Smith, A. R.; Thomas, K. J.; Norman, E. B.; ...

2015-03-24

The Low Background Facility (LBF) at Lawrence Berkeley National Laboratory in Berkeley, California provides low background gamma spectroscopy services to a wide array of experiments and projects. The analysis of samples takes place within two unique facilities; locally within a carefully-constructed, low background cave and remotely at an underground location that historically has operated underground in Oroville, CA, but has recently been relocated to the Sanford Underground Research Facility (SURF) in Lead, SD. These facilities provide a variety of gamma spectroscopy services to low background experiments primarily in the form of passive material screening for primordial radioisotopes (U, Th, K)more » or common cosmogenic/anthropogenic products, as well as active screening via Neutron Activation Analysis for specific applications. The LBF also provides hosting services for general R&D testing in low background environments on the surface or underground for background testing of detector systems or similar prototyping. A general overview of the facilities, services, and sensitivities is presented. Recent activities and upgrades will also be presented, such as the completion of a 3π anticoincidence shield at the surface station and environmental monitoring of Fukushima fallout. The LBF is open to any users for counting services or collaboration on a wide variety of experiments and projects.« less

A Case of Acute Budd-Chiari Syndrome Complicating Primary Antiphospholipid Syndrome Presenting as Acute Abdomen and Responding to Tight Anticoagulant Therapy.

PubMed

Chinen, Naofumi; Koyama, Yasushi; Sato, Shinji; Suzuki, Yasuo

2016-01-01

A 34-year-old woman with primary antiphospholipid syndrome was admitted to the Gastroenterology Department of our hospital with fever, acute abdomen, watery diarrhea, and extremely high levels of inflammatory parameters. She had a history of left lower limb deep vein thrombosis and pulmonary embolism and was taking warfarin potassium. Acute gastroenteritis was suspected and an antibiotic was administered, but symptoms progressed. Abdominal ultrasonography showed occlusion of the left hepatic vein and the middle hepatic vein and her D-dimer level was high. Accordingly, Budd-Chiari syndrome was diagnosed and high-dose intravenous infusion of heparin was initiated. Her abdominal symptoms improved and the levels of inflammatory parameters and D-dimer decreased rapidly. It is known that antiphospholipid syndrome can be complicated by Budd-Chiari syndrome that usually occurs as subacute or chronic onset, but acute onset is rare. It is difficult to diagnose acute Budd-Chiari syndrome complicating antiphospholipid syndrome and this complication generally has a poor outcome. However, the present case can get early diagnosis and successful treatment with tight anticoagulant therapy.

Genetic background effects in Neuroligin-3 mutant mice: Minimal behavioral abnormalities on C57 background.

PubMed

Jaramillo, Thomas C; Escamilla, Christine Ochoa; Liu, Shunan; Peca, Lauren; Birnbaum, Shari G; Powell, Craig M

2018-02-01

Neuroligin-3 (NLGN3) is a postsynaptic cell adhesion protein that interacts with presynaptic ligands including neurexin-1 (NRXN1) [Ichtchenko et al., Journal of Biological Chemistry, 271, 2676-2682, 1996]. Mice harboring a mutation in the NLGN3 gene (NL3R451C) mimicking a mutation found in two brothers with autism spectrum disorder (ASD) were previously generated and behaviorally phenotyped for autism-related behaviors. In these NL3R451C mice generated and tested on a hybrid C57BL6J/129S2/SvPasCrl background, we observed enhanced spatial memory and reduced social interaction [Tabuchi et al., Science, 318, 71-76, 2007]. Curiously, an independently generated second line of mice harboring the same mutation on a C57BL6J background exhibited minimal aberrant behavior, thereby providing apparently discrepant results. To investigate the origin of the discrepancy, we previously replicated the original findings of Tabuchi et al. by studying the same NL3R451C mutation on a pure 129S2/SvPasCrl genetic background. Here we complete the behavioral characterization of the NL3R451C mutation on a pure C57BL6J genetic background to determine if background genetics play a role in the discrepant behavioral outcomes involving NL3R451C mice. NL3R451C mutant mice on a pure C57BL6J background did not display spatial memory enhancements or social interaction deficits. We only observed a decreased startle response and mildly increased locomotor activity in these mice suggesting that background genetics influences behavioral outcomes involving the NL3R451C mutation. Autism Res 2018, 11: 234-244. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Behavioral symptoms of autism can be highly variable, even in cases that involve identical genetic mutations. Previous studies in mice with a mutation of the Neuroligin-3 gene showed enhanced learning and social deficits. We replicated these findings on the same and different genetic backgrounds. In this study, however, the

Unpredicted spontaneous extrusion of a renal calculus in an adult male with spina bifida and paraplegia: report of a misdiagnosis. Measures to be taken to reduce urological errors in spinal cord injury patients

PubMed Central

Vaidyanathan, Subramanian; Hughes, Peter L; Soni, Bhakul M; Singh, Gurpreet; Mansour, Paul; Sett, Pradipkumar

2001-01-01

Background A delay in diagnosis or a misdiagnosis may occur in patients with spinal cord injury (SCI) or spinal bifida as typical symptoms of a clinical condition may be absent because of their neurological impairment. Case presentation A 29-year old male, who was born with spina bifida and hydrocephalus, became unwell and developed a swelling and large red mark in his left loin eighteen months ago. Pyonephrosis or perinephric abscess was suspected. X-ray of the abdomen showed left-sided staghorn calculus. Since ultrasound scan showed no features of pyonephrosis or perinephric abscess, he was prescribed a prolonged course of antibiotics for infection presumed to arise from the site of metal implant in spine. He developed a discharging sinus, following which the loin swelling and red mark subsided. About three months ago, he again developed a red mark and minimal swelling in the left loin. Ultrasound scan detected no abnormality in the renal or perinephric region. Therefore, the red mark and swelling were attributed to pressure from the backrest of his chair. Five weeks later, the swelling in the left loin burst open and a large stone was extruded spontaneously. An X-ray of the abdomen showed that he had extruded the central portion of the staghorn calculus from left kidney. With hindsight, the extruded renal calculus could be seen lying in the subcutaneous tissue of left loin lateral to the 10th rib in the X-ray of abdomen, which was taken when he presented with red mark and minimal swelling. Conclusion This case illustrates how mistakes in diagnosis could occur in spinal cord injury patients, and highlights the need for corrective measures to reduce urological errors in these patients. Voluntary reporting of urological errors is recommended to facilitate learning from our mistakes. In the patients who have marked spinal curvature, ultrasonography of kidneys and perinephric region may not be entirely reliable. As clinical symptoms and signs may be non-specific in

Criterion Validity of the Mood and Feelings Questionnaire for Depressive Episodes in Clinic and Non-Clinic Subjects

ERIC Educational Resources Information Center

Daviss, W. Burleson; Birmaher, Boris; Melhem, Nadine A.; Axelson, David A.; Michaels, Shana M.; Brent, David A.

2006-01-01

Background: Previous measures of pediatric depression have shown inconsistent validity in groups with differing demographics, comorbid diagnoses, and clinic or non-clinic origins. The current study re-examines the criterion validity of child- and parent-versions of the Mood and Feelings Questionnaire (MFQ-C, MFQ-P) in a heterogeneous sample of…

Rewarming affects EEG background in term newborns with hypoxic-ischemic encephalopathy undergoing therapeutic hypothermia.

PubMed

Birca, Ala; Lortie, Anne; Birca, Veronica; Decarie, Jean-Claude; Veilleux, Annie; Gallagher, Anne; Dehaes, Mathieu; Lodygensky, Gregory A; Carmant, Lionel

2016-04-01

To investigate how rewarming impacts the evolution of EEG background in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). We recruited a retrospective cohort of 15 consecutive newborns with moderate (9) and severe (6) HIE monitored with a continuous EEG during TH and at least 12h after its end. EEG background was analyzed using conventional visual and quantitative EEG analysis methods including EEG discontinuity, absolute and relative spectral magnitudes. One patient with seizures on rewarming was excluded from analyses. Visual and quantitative analyses demonstrated significant changes in EEG background from pre- to post-rewarming, characterized by an increased EEG discontinuity, more pronounced in newborns with severe compared to moderate HIE. Neonates with moderate HIE also had an increase in the relative magnitude of slower delta and a decrease in higher frequency theta and alpha waves with rewarming. Rewarming affects EEG background in HIE newborns undergoing TH, which may represent a transient adaptive response or reflect an evolving brain injury. EEG background impairment induced by rewarming may represent a biomarker of evolving encephalopathy in HIE newborns undergoing TH and underscores the importance of continuously monitoring the brain health in critically ill neonates. Copyright © 2015 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

The minimizing of fluorescence background in Raman optical activity and Raman spectra of human blood plasma.

PubMed

Tatarkovič, Michal; Synytsya, Alla; Šťovíčková, Lucie; Bunganič, Bohuš; Miškovičová, Michaela; Petruželka, Luboš; Setnička, Vladimír

2015-02-01

Raman optical activity (ROA) is inherently sensitive to the secondary structure of biomolecules, which makes it a method of interest for finding new approaches to clinical applications based on blood plasma analysis, for instance the diagnostics of several protein-misfolding diseases. Unfortunately, real blood plasma exhibits strong background fluorescence when excited at 532 nm; hence, measuring the ROA spectra appears to be impossible. Therefore, we established a suitable method using a combination of kinetic quenchers, filtering, photobleaching, and a mathematical correction of residual fluorescence. Our method reduced the background fluorescence approximately by 90%, which allowed speedup for each measurement by an average of 50%. In addition, the signal-to-noise ratio was significantly increased, while the baseline distortion remained low. We assume that our method is suitable for the investigation of human blood plasma by ROA and may lead to the development of a new tool for clinical diagnostics.

Body Dysmorphic Disorder and Other Clinically Significant Body Image Concerns in Adolescent Psychiatric Inpatients: Prevalence and Clinical Characteristics

ERIC Educational Resources Information Center

Dyl, Jennifer; Kittler, Jennifer; Phillips, Katharine A.; Hunt, Jeffrey I.

2006-01-01

Background: This study assessed prevalence and clinical correlates of body dysmorphic disorder (BDD), eating disorders (ED), and other clinically significant body image concerns in 208 consecutively admitted adolescent inpatients. It was hypothesized that adolescents with BDD would have higher levels of depression, anxiety, and suicidality.…

[Liberalisation of preoperative fasting guidelines: effects on patient comfort and clinical practicability during elective laparoscopic surgery of the lower abdomen].

PubMed

Meisner, M; Ernhofer, U; Schmidt, J

2008-09-01

In this study, the recently liberalised national guidelines for preoperative fasting were evaluated from the view point of the patients and according to their clinical usability. Patients undergoing elective laparoscopic gynaecological surgery were randomised into two groups. Patients in the long-time NPO-group (LTNPO-group) had nothing per mouth after midnight whereas patients in the short-time NPO-group (STNPO-group) did not receive any oral nutrition after midnight but were allowed an unlimited intake of Pfrimmer Nutricia preOP up to 2 hours before scheduled surgery. Patients were asked to assess the incidence of 12 symptoms of perioperative discomfort prior to and 4-6 hours after surgery using a standardised questionnaire. Gastric fluid volume, vital signs during the induction period of anaesthesia and the actual duration of fasting were registered and compared. 42 patients were included into the study (LTNPO-group: n = 23, STNPO-group: n = 19). The actual duration of fasting for solid nutritition was 11.3 h in the LTNPO-group and 10.9 h in the STNPO-group, respectively. The time of fasting for fluids was in the STNPO-group significantly shorter (4.5 h) compared to the LTNPO-group (11.3 h). The patients of the STNPO-group reported preoperatively a significant lower incidence of "feeling cold" and pre- and postoperatively of "thirst / having a dry mouth". No significant differences were reported between the groups with respect to heart rate, blood pressure, gastric volume, need of vasopressors and infusion requirements. The liberation of the national guidelines for preoperative fluid administration with unlimited intake of a carbohydrate drink offers the benefit of a significantly lower incidence of the preoperative item "feeling cold" and of the pre- and postoperative item "thirst / having a dry mouth". However, in daily clinical practice the length of fasting for fluids was conspicuously longer than that postulated by the new recommendations.

[Clinical analysis of two cases of imported children Zika virus infection in China].

PubMed

Zheng, C G; Xu, Y; Jiang, H Q; Yin, Y X; Zhang, J H; Zhu, W J; Liang, X J; Chen, M X; Ye, J W; Tan, L M; Luo, D; Gong, S T

2016-05-01

To analyze the clinical characteristics, outcome and diagnosis of two cases of imported children Zika virus infection in China. A retrospective analysis was performed on clinical characteristics, treatment and outcome of two cases of imported children with Zika virus infection in February 2016 in Enping People's Hospital of Guangdong. Two cases of children with imported Zika virus infection resided in an affected area of Venezuela, 8-year-old girl and her 6 year-old brother. The main findings on physical examination included the following manifestations: fever, rash, and conjunctivitis. The rash was first limited to the abdomen, but extended to the torso, neck and face, and faded after 3-4 d. The total number of white blood cells was not high and liver function was normal. The diagnosis of two cases of Zika virus infection was confirmed by the expert group of Guangdong Provincial Center for Disease Control and Prevention, according to the epidemiological history, clinical manifestations and Zika virus nucleic acid detection results.Treatment of Zika virus infection involves supportive care. Two Zika virus infection children had a relatively benign outcome. At present, Zika virus infection in children is an imported disease in China. No specific therapy is available for this disease. Information on long-term outcomes among infants and children with Zika virus disease is limited, routine pediatric care is advised for these infants and children.

Background Light Bluer Than Expected

NASA Image and Video Library

2014-11-06

This plot shows data from the Cosmic Infrared Background Experiment, or CIBER, rockets launched in 2010 and 2012. The experiment measures a diffuse glow of infrared light in the sky, known as the cosmic infrared background.

Masticatory Muscle Sleep Background EMG Activity is Elevated in Myofascial TMD Patients

PubMed Central

Raphael, Karen G.; Janal, Malvin N.; Sirois, David A.; Dubrovsky, Boris; Wigren, Pia E.; Klausner, Jack J.; Krieger, Ana C.; Lavigne, Gilles J.

2013-01-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n=124) with a demographically matched control group without TMD (n=46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artifacts were removed. Results indicated that median background EMG during these non SB-event periods was significantly higher (p<.01) for women with myofascial TMD (median=3.31 μV and mean=4.98 μV) than for control women (median=2.83 μV and mean=3.88 μV) with median activity in 72% of cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0–10 numerical scale) on post sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. PMID:24237356

Clinical 3T MR imaging: mastering the challenges.

PubMed

Tanenbaum, Lawrence N

2006-02-01

3T MRI is ready to meet the needs of clinical practice. SAR limitations are minimized by technical advances and surface coils are available for all core applications. With appropriate adjustments to scanning protocols, one can master the challenges of scanning at 3T; studies of the brain, spine, chest, abdomen, pelvis, vasculature, and extremities can be consistently higher in quality than are those obtained at 1.5T. The superior studies that are obtainable at 3T have great appeal to clinicians who are sophisticated about MR technology in areas, such as neurology, orthopedics, vascular surgery, and oncology,and encourage a shift in referrals toward practices that invest in higher field technology. The greater sensitivity to magnetic susceptibility offers unique benefits in functional neuroimaging, and available software/hardware packages enhance clinical setting feasibility, which adds a source of new referrals. The greater overall signal of 3T can be manipulated to make scanning more comfortable and with less motion artifact because scan times could be half as long. Spectacular anatomic delineation that is provided by high-definition scanning at true 1024 resolution can improve preoperative assessment and may improve sensitivity to smaller lesions. 3T provides practices with an advantage that is sought increasingly by high field strength purchasers in a competitive market. Only cost considerations stand in the way of the eventual domination of 3T systems in the high field strength market.

Accuracy of a Fourth-Generation Subcutaneous Continuous Glucose Sensor

PubMed Central

Garg, Satish K.; Brazg, Ronald; Bode, Bruce W.; Bailey, Timothy S.; Slover, Robert H.; Sullivan, Ashley; Huang, Suiying; Shin, John; Lee, Scott W.; Kaufman, Francine R.

2017-01-01

Abstract Background: This study evaluated the accuracy and performance of a fourth-generation subcutaneous glucose sensor (Guardian™ Sensor 3) in the abdomen and arm. Methods: Eighty-eight subjects (14–75 years of age, mean ± standard deviation [SD] of 42.0 ± 19.1 years) with type 1 or type 2 diabetes participated in the study. Subjects wore two sensors in the abdomen that were paired with either a MiniMed™ 640G insulin pump, or an iPhone® or iPod® touch® running a glucose monitoring mobile application (Guardian Connect system) and a third sensor in the arm, which was connected to a glucose sensor recorder (GSR). Subjects were also asked to undergo in-clinic visits of 12–14 h on study days 1, 3, and 7 for frequent blood glucose sample testing using a Yellow Springs Instrument (YSI) reference. Results: The overall mean absolute relative difference (MARD ± SD) between abdomen sensor glucose (SG) and YSI reference values was 9.6% ± 9.0% and 9.4% ± 9.8% for the MiniMed 640G insulin pump and Guardian Connect system, respectively; and 8.7% ± 8.0% between arm SG and YSI reference values. The percentage of SG values within 20% agreement of the YSI reference value (for YSI >80 mg/dL) was 90.7% with the MiniMed 640G insulin pump, 91.8% with the Guardian Connect system, and 93.1% for GSR-connected arm sensors. Mean functional sensor life, when calibrating 3–4 times/day, was 145.9 ± 39.3 h for sensors paired with the MiniMed 640G insulin pump, 146.1 ± 41.6 h for sensors paired with the Guardian Connect system, and 147.6 ± 40.4 h for sensors connected to the GSR. Responses to survey questions regarding sensor comfort and ease of use were favorable. Conclusions: The Guardian Sensor 3 glucose sensor, whether located in abdomen or the arm, provided accurate glucose readings when compared with the YSI reference and demonstrated functional life commensurate with the intended 7-day use. ClinicalTrials.gov: NCT

Recursive least squares background prediction of univariate syndromic surveillance data.

PubMed

Najmi, Amir-Homayoon; Burkom, Howard

2009-01-16

Surveillance of univariate syndromic data as a means of potential indicator of developing public health conditions has been used extensively. This paper aims to improve the performance of detecting outbreaks by using a background forecasting algorithm based on the adaptive recursive least squares method combined with a novel treatment of the Day of the Week effect. Previous work by the first author has suggested that univariate recursive least squares analysis of syndromic data can be used to characterize the background upon which a prediction and detection component of a biosurvellance system may be built. An adaptive implementation is used to deal with data non-stationarity. In this paper we develop and implement the RLS method for background estimation of univariate data. The distinctly dissimilar distribution of data for different days of the week, however, can affect filter implementations adversely, and so a novel procedure based on linear transformations of the sorted values of the daily counts is introduced. Seven-days ahead daily predicted counts are used as background estimates. A signal injection procedure is used to examine the integrated algorithm's ability to detect synthetic anomalies in real syndromic time series. We compare the method to a baseline CDC forecasting algorithm known as the W2 method. We present detection results in the form of Receiver Operating Characteristic curve values for four different injected signal to noise ratios using 16 sets of syndromic data. We find improvements in the false alarm probabilities when compared to the baseline W2 background forecasts. The current paper introduces a prediction approach for city-level biosurveillance data streams such as time series of outpatient clinic visits and sales of over-the-counter remedies. This approach uses RLS filters modified by a correction for the weekly patterns often seen in these data series, and a threshold detection algorithm from the residuals of the RLS forecasts. We

The background in the $$0\

DOE PAGES

Agostini, M.; Allardt, M.; Andreotti, E.; ...

2014-04-04

The GERmanium Detector Array (Gerda) experiment at the Gran Sasso underground laboratory (LNGS) of INFN is searching for neutrinoless double beta (0νββ) decay of 76 Ge. The signature of the signal is a monoenergetic peak at 2039 keV, the Q ββ value of the decay. To avoid bias in the signal search, the present analysis does not consider all those events, that fall in a 40 keV wide region centered around Q ββ. The main parameters needed for the 0νββ analysis are described. A background model was developed to describe the observed energy spectrum. The model contains severalmore » contributions, that are expected on the basis of material screening or that are established by the observation of characteristic structures in the energy spectrum. The model predicts a flat energy spectrum for the blinding window around Qββ with a background index ranging from 17.6 to 23.8 × 10 -3 cts/(keV kg yr). A part of the data not considered before has been used to test if the predictions of the background model are consistent. The observed number of events in this energy region is consistent with the background model. The background at Q ββ is dominated by close sources, mainly due to 42 K, 214 Bi, 228 60 Co and α emitting isotopes from the 226 Ra decay chain. The individual fractions depend on the assumed locations of the contaminants. It is shown, that after removal of the known γ peaks, the energy spectrum can be fitted in an energy range of 200 keV around Q ββ with a constant background. This gives a background index consistent with the full model and uncertainties of the same size.« less

Adolescent gynecomastia is associated with a high incidence of obesity, dysglycemia, and family background of diabetes mellitus

PubMed Central

Kulshreshtha, Bindu; Arpita, Arora; Rajesh, Patnaik T.; Sameek, Bhattacharya; Dutta, Deep; Neera, Sharma; Mohd, Mohsin

2017-01-01

Background: Gynecomastia during adolescence is common though etiology is not clear. We studied the clinical and hormonal profile of adolescent patients with gynecomastia. Methodology: Patients who had onset of breast development between age 10 and 20 years were included in this study. Their clinical profile, biochemical, and hormonal parameters were studied. Results: Of 94 patients with gynecomastia, 4 had hypogonadotropic hypogonadism, 4 had hypergonadotropic hypogonadism, and 1 had fibroadenosis, but in majority (90.4%), no apparent cause for breast enlargement was evident. In the idiopathic group, majority were obese (63%). Fourteen (16%) patients had impaired fasting glucose or impaired glucose tolerance. Another twenty patients had subtle abnormalities (high 1 h glucose or glucose peak at 2 h). Twenty-nine percent of lean and 38% of obese patients had mild abnormalities in glucose profile. Sixty percent of patients had family background of diabetes. Obese patients had lower testosterone as compared to lean patients; however, estradiol, luteinizing hormone, and follicle-stimulating hormone levels were similar in the two groups. Conclusion: Gynecomastia during adolescence is associated with obesity, dysglycemia, and family background of diabetes mellitus. PMID:28217517

A study of abdominal pain in children.

PubMed

Shakya, K N; Dongol, U M S; Khadka, S B

2008-01-01

Pain abdomen is a common pediatric complaint that brings patient to the hospital in Nepal. Knowledge about its etiology and frequency helps in its evaluation and management. The present study was undertaken to find out the causes and their frequency of pain abdomen in Nepali children. Children with pain abdomen presenting at the emergency room and pediatric outpatient department of Kathmandu Medical College, Kathmandu from January, 2006 to December 2007 were clinically evaluated and investigated to find out the causes and frequency of their pain abdomen. The outcomes were tabulated and analyzed for interpretation. Of 444 patients attended, 356 completed investigations and came for follow up. Cause of pain abdomen was apparent in 117 (32.9%) only. 91.5% were medical causes, comprising predominantly of diarrheal diseases (28.3%), infantile colic (9.4%), urinary tract infection (7.7%) and acid peptic disease (6.8%). 8.5% causes were related to surgical conditions, which needed operative management. Secondary or extra-abdominal causes were found in 20 cases (17.1%). Pneumonia (2), functional (5), vulvovaginitis (2) and infantile colic (11) were predominant causes. Our study showed that the causes of pain abdomen in children were predominantly medical. Gastroenteritis was the most frequent cause. Secondary causes, including functional and emotional causes were infrequent. Small percentage needing surgical management formed a diagnostic challenge.

A Flexible Cosmic Ultraviolet Background Model

NASA Astrophysics Data System (ADS)

McQuinn, Matthew

2016-10-01

HST studies of the IGM, of the CGM, and of reionization-era galaxies are all aided by ionizing background models, which are a critical input in modeling the ionization state of diffuse, 10^4 K gas. The ionization state in turn enables the determination of densities and sizes of absorbing clouds and, when applied to the Ly-a forest, the global ionizing emissivity of sources. Unfortunately, studies that use these background models have no way of gauging the amount of uncertainty in the adopted model other than to recompute their results using previous background models with outdated observational inputs. As of yet there has been no systematic study of uncertainties in the background model and there unfortunately is no publicly available ultraviolet background code. A public code would enable users to update the calculation with the latest observational constraints, and it would allow users to experiment with varying the background model's assumptions regarding emissions and absorptions. We propose to develop a publicly available ionizing background code and, as an initial application, quantify the level of uncertainty in the ionizing background spectrum across cosmic time. As the background model improves, so does our understanding of (1) the sources that dominate ionizing emissions across cosmic time and (2) the properties of diffuse gas in the circumgalactic medium, the WHIM, and the Ly-a forest. HST is the primary telescope for studying both the highest redshift galaxies and low-redshift diffuse gas. The proposed program would benefit HST studies of the Universe at z 0 all the way up to z = 10, including of high-z galaxies observed in the HST Frontier Fields.

[Comparison of clinical and laboratory characteristics of viral hepatitis A and E in Montenegro].

PubMed

Terzić, Dragica; Mijović, Gordana; Dupanović, Brankica; Drasković, Nenad; Svirtlih, Neda

2010-01-01

Hepatitis E has many similarities in with hepatitis A concerning clinical picture, route of transmission and nonexistence of chronicity. Comparison of clinical and laboratory parameters of patients with hepatitis A and E to estimate characteristics of these diseases. Total of 54 patients divided into two groups was investigated: 27 had hepatitis A, others had hepatitis E. Detailed history past, clinical examination, liver function tests and ultrasonography of the upper abdomen, were done in all patients. Aetiology of viral hepatitis was investigated serologically by enzyme immunoassay (ELISA) using commercial kits for following viruses: Hepatitis A-E viruses, cytomegalovirus, and Epstein-Barr virus. Asymptomatic infections (29.6%) and clinical forms without jaundice (59.3%) were more frequent in patients with hepatitis E. Splenomegaly was found more frequent in patients with hepatitis A than in hepatitis E (66.7% vs. 33.3%). Patients with hepatitis E had significantly lower activity of aminotransferases than patients with hepatitis A. A significant increase of gamma-glutamyltranspeptidase was found in patients with hepatitis E (mean value: 120 IU/L). Our results are in concordance with other reports that hepatitis E virus infection is more common asymptomatic disease than hepatitis A. In addition, hepatocyte necrosis in hepatitis E is less extensive than in hepatitis A measured by the activity of aminotransferases. Contrary to that the value of gamma-glutamyltranspeptidase is more increased in hepatitis E than in hepatitis A without exact explanation so far: Viral hepatitis E and A have differences in some clinical features and laboratory parameters although both diseases principally have resolved without consequences after 6-8 weeks.

Blood Meal Analysis of Mosquitoes Involved in a Rift Valley fever Outbreak

USDA-ARS?s Scientific Manuscript database

Background: Rift Valley fever (RVF) is a zoonosis of domestic ruminants in Africa. Bloodfed mosquitoes collected during the 2006-2007 RVF outbreak in Kenya were analyzed to determine the virus infection status and animal source of the bloodmeals. Bloodmeals from individual mosquito abdomens were sc...

Tremulatory and abdomen vibration signals enable communication through air in the stink bug Euschistus heros.

PubMed

Kavčič, Andreja; Cokl, Andrej; Laumann, Raúl A; Blassioli-Moraes, Maria Carolina; Borges, Miguel

2013-01-01

Communication by substrate-borne mechanical signals is widespread among animals but remains one of their least understood communication channels. Past studies of vibrational communication in insects have been oriented predominantly to communication during mating, showing that species- and sex-specific vibrational signals enable recognition and localization of potential mates on continuous solid substrates. No special attention has been paid to vibrational signals with less obvious specificity as well as to the possibility of vibrational communication across substrates that are not in physical contact. We aimed to reinvestigate emission of the aforementioned vibrational signals transmitted through a plant in the stink bug Euschistus heros (Pentatomidae: Pentatominae) and to check whether individuals are able to communicate across adjecent, physically separated substrates. We used laser vibrometry for registration of substrate-borne vibrational signals on a bean plant. Using two bean plants separated for 3 to 7 cm between two most adjacent leaves, we investigated the possibility of transmission of these signals through air. Our study showed that males and females of E. heros communicate using tremulatory, percussion and buzzing signals in addition to the previously described signals produced by vibrations of the abdomen. Contrary to the latter, the first three signal types did not differ between sexes or between pentatomid species. Experiments with two physically separated plants showed significant searching behaviour and localization of vibrational signals of an E. heros male or a female, in response to abdominal vibration produced signals of a pair duetting on the neighbouring plant, in comparison to control where no animals were on the neighbouring plant. We also confirmed that transmission through air causes amplitude and frequency decay of vibrational signals, which suggests high-amplitude, low-frequency tremulatory signals of these stink bugs their most

Tremulatory and Abdomen Vibration Signals Enable Communication through Air in the Stink Bug Euschistus heros

PubMed Central

Kavčič, Andreja; Čokl, Andrej; Laumann, Raúl A.; Blassioli-Moraes, Maria Carolina; Borges, Miguel

2013-01-01

Communication by substrate-borne mechanical signals is widespread among animals but remains one of their least understood communication channels. Past studies of vibrational communication in insects have been oriented predominantly to communication during mating, showing that species- and sex-specific vibrational signals enable recognition and localization of potential mates on continuous solid substrates. No special attention has been paid to vibrational signals with less obvious specificity as well as to the possibility of vibrational communication across substrates that are not in physical contact. We aimed to reinvestigate emission of the aforementioned vibrational signals transmitted through a plant in the stink bug Euschistus heros (Pentatomidae: Pentatominae) and to check whether individuals are able to communicate across adjecent, physically separated substrates. We used laser vibrometry for registration of substrate-borne vibrational signals on a bean plant. Using two bean plants separated for 3 to 7 cm between two most adjacent leaves, we investigated the possibility of transmission of these signals through air. Our study showed that males and females of E. heros communicate using tremulatory, percussion and buzzing signals in addition to the previously described signals produced by vibrations of the abdomen. Contrary to the latter, the first three signal types did not differ between sexes or between pentatomid species. Experiments with two physically separated plants showed significant searching behaviour and localization of vibrational signals of an E. heros male or a female, in response to abdominal vibration produced signals of a pair duetting on the neighbouring plant, in comparison to control where no animals were on the neighbouring plant. We also confirmed that transmission through air causes amplitude and frequency decay of vibrational signals, which suggests high-amplitude, low-frequency tremulatory signals of these stink bugs their most

TU-F-BRB-03: Clinical Implementation of MR-Based Motion Management

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glide-Hurst, C.

The current clinical standard of organ respiratory imaging, 4D-CT, is fundamentally limited by poor soft-tissue contrast and imaging dose. These limitations are potential barriers to beneficial “4D” radiotherapy methods which optimize the target and OAR dose-volume considering breathing motion but rely on a robust motion characterization. Conversely, MRI imparts no known radiation risk and has excellent soft-tissue contrast. MRI-based motion management is therefore highly desirable and holds great promise to improve radiotherapy of moving cancers, particularly in the abdomen. Over the past decade, MRI techniques have improved significantly, making MR-based motion management clinically feasible. For example, cine MRI has highmore » temporal resolution up to 10 f/s and has been used to track and/or characterize tumor motion, study correlation between external and internal motions. New MR technologies, such as 4D-MRI and MRI hybrid treatment machines (i.e. MR-linac or MR-Co60), have been recently developed. These technologies can lead to more accurate target volume determination and more precise radiation dose delivery via direct tumor gating or tracking. Despite all these promises, great challenges exist and the achievable clinical benefit of MRI-based tumor motion management has yet to be fully explored, much less realized. In this proposal, we will review novel MR-based motion management methods and technologies, the state-of-the-art concerning MRI development and clinical application and the barriers to more widespread adoption. Learning Objectives: Discuss the need of MR-based motion management for improving patient care in radiotherapy. Understand MR techniques for motion imaging and tumor motion characterization. Understand the current state of the art and future steps for clinical integration. Henry Ford Health System holds research agreements with Philips Healthcare. Research sponsored in part by a Henry Ford Health System Internal Mentored Grant.« less

47 CFR 215.1 - Background.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Background. 215.1 Section 215.1 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL FEDERAL GOVERNMENT FOCAL POINT FOR ELECTROMAGNETIC PULSE (EMP) INFORMATION § 215.1 Background. (a) The nuclear electromagnetic...

47 CFR 215.1 - Background.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Background. 215.1 Section 215.1 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL FEDERAL GOVERNMENT FOCAL POINT FOR ELECTROMAGNETIC PULSE (EMP) INFORMATION § 215.1 Background. (a) The nuclear electromagnetic...

47 CFR 215.1 - Background.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Background. 215.1 Section 215.1 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL FEDERAL GOVERNMENT FOCAL POINT FOR ELECTROMAGNETIC PULSE (EMP) INFORMATION § 215.1 Background. (a) The nuclear electromagnetic...

47 CFR 215.1 - Background.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Background. 215.1 Section 215.1 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL FEDERAL GOVERNMENT FOCAL POINT FOR ELECTROMAGNETIC PULSE (EMP) INFORMATION § 215.1 Background. (a) The nuclear electromagnetic...

47 CFR 215.1 - Background.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Background. 215.1 Section 215.1 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL FEDERAL GOVERNMENT FOCAL POINT FOR ELECTROMAGNETIC PULSE (EMP) INFORMATION § 215.1 Background. (a) The nuclear electromagnetic...

40 CFR 11.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Background. 11.2 Section 11.2 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY GENERAL SECURITY CLASSIFICATION REGULATIONS PURSUANT TO EXECUTIVE ORDER 11652 § 11.2 Background. While the Environmental Protection Agency does not...

Extragalactic background light measurements and applications.

PubMed

Cooray, Asantha

2016-03-01

This review covers the measurements related to the extragalactic background light intensity from γ-rays to radio in the electromagnetic spectrum over 20 decades in wavelength. The cosmic microwave background (CMB) remains the best measured spectrum with an accuracy better than 1%. The measurements related to the cosmic optical background (COB), centred at 1 μm, are impacted by the large zodiacal light associated with interplanetary dust in the inner Solar System. The best measurements of COB come from an indirect technique involving γ-ray spectra of bright blazars with an absorption feature resulting from pair-production off of COB photons. The cosmic infrared background (CIB) peaking at around 100 μm established an energetically important background with an intensity comparable to the optical background. This discovery paved the way for large aperture far-infrared and sub-millimetre observations resulting in the discovery of dusty, starbursting galaxies. Their role in galaxy formation and evolution remains an active area of research in modern-day astrophysics. The extreme UV (EUV) background remains mostly unexplored and will be a challenge to measure due to the high Galactic background and absorption of extragalactic photons by the intergalactic medium at these EUV/soft X-ray energies. We also summarize our understanding of the spatial anisotropies and angular power spectra of intensity fluctuations. We motivate a precise direct measurement of the COB between 0.1 and 5 μm using a small aperture telescope observing either from the outer Solar System, at distances of 5 AU or more, or out of the ecliptic plane. Other future applications include improving our understanding of the background at TeV energies and spectral distortions of CMB and CIB.

Extragalactic background light measurements and applications

PubMed Central

Cooray, Asantha

2016-01-01

This review covers the measurements related to the extragalactic background light intensity from γ-rays to radio in the electromagnetic spectrum over 20 decades in wavelength. The cosmic microwave background (CMB) remains the best measured spectrum with an accuracy better than 1%. The measurements related to the cosmic optical background (COB), centred at 1 μm, are impacted by the large zodiacal light associated with interplanetary dust in the inner Solar System. The best measurements of COB come from an indirect technique involving γ-ray spectra of bright blazars with an absorption feature resulting from pair-production off of COB photons. The cosmic infrared background (CIB) peaking at around 100 μm established an energetically important background with an intensity comparable to the optical background. This discovery paved the way for large aperture far-infrared and sub-millimetre observations resulting in the discovery of dusty, starbursting galaxies. Their role in galaxy formation and evolution remains an active area of research in modern-day astrophysics. The extreme UV (EUV) background remains mostly unexplored and will be a challenge to measure due to the high Galactic background and absorption of extragalactic photons by the intergalactic medium at these EUV/soft X-ray energies. We also summarize our understanding of the spatial anisotropies and angular power spectra of intensity fluctuations. We motivate a precise direct measurement of the COB between 0.1 and 5 μm using a small aperture telescope observing either from the outer Solar System, at distances of 5 AU or more, or out of the ecliptic plane. Other future applications include improving our understanding of the background at TeV energies and spectral distortions of CMB and CIB. PMID:27069645

Association of Radon Background and Total Background Ionizing Radiation with Alzheimer's Disease Deaths in U.S. States.

PubMed

Lehrer, Steven; Rheinstein, Peter H; Rosenzweig, Kenneth E

2017-01-01

Exposure of the brain to ionizing radiation might promote the development of Alzheimer's disease (AD). Analysis of AD death rates versus radon background radiation and total background radiation in U.S. states. Total background, radon background, cosmic and terrestrial background radiation measurements are from Assessment of Variations in Radiation Exposure in the United States and Report No. 160 - Ionizing Radiation Exposure of the Population of the United States. 2013 AD death rates by U.S. state are from the Alzheimer's Association. Radon background ionizing radiation was significantly correlated with AD death rate in 50 states and the District of Columbia (r = 0.467, p = 0.001). Total background ionizing radiation was also significantly correlated with AD death rate in 50 states and the District of Columbia (r = 0.452, p = 0.001). Multivariate linear regression weighted by state population demonstrated that AD death rate was significantly correlated with radon background (β= 0.169, p < 0.001), age (β= 0.231, p < 0.001), hypertension (β= 0.155, p < 0.001), and diabetes (β= 0.353, p < 0.001). Our findings, like other studies, suggest that ionizing radiation is a risk factor for AD. Intranasal inhalation of radon gas could subject the rhinencephalon and hippocampus to damaging radiation that initiates AD. The damage would accumulate over time, causing age to be a powerful risk factor.

Preliminary investigation of the roles of military background and posttraumatic stress symptoms in frequency and recidivism of intimate partner violence perpetration among court-referred men.

PubMed

Hoyt, Tim; Wray, Alisha M; Rielage, Jennifer Klosterman

2014-04-01

Significant rates of intimate partner violence (IPV) perpetration have been identified among men with military backgrounds. Research indicates posttraumatic stress symptoms place military men at increased risk for IPV perpetration, but may be negatively associated with IPV among nonmilitary samples. However, no previous studies have directly compared court-referred IPV offenders with and without military experience, which may have clinical implications if posttraumatic stress symptoms are differentially associated with IPV perpetration across these two samples. Twenty court-referred IPV offenders with military background were demographically matched with 40 court-referred IPV offenders without military background. As anticipated, self- and partner-report of physically assaultive acts and injurious acts during baseline assessment showed significantly greater physical assault and injury perpetrated by offenders with military background. However, 1-year follow-up data on convictions indicated a significantly lower rate of recidivism among offenders with military background than among nonmilitary offenders. As hypothesized, symptoms of posttraumatic stress at intake showed a significant positive correlation with IPV perpetration among offenders with military background; however, this relationship showed a negative correlation among offenders without military background. Clinical implications are discussed including treatment avenues, such as Veterans Courts and other incarceration diversion programs, which may be particularly appropriate for offenders with military backgrounds.

Assessment of the use of disposable skin staplers in bowel anastomoses to reduce laparotomy time in penetrating ballistic injury to the abdomen.

PubMed Central

Howell, G. P.; Ryan, J. M.; Morgans, B. T.; Cooper, G. J.

1991-01-01

Laparotomy and anastomosis of the small bowel after penetrating injury to the abdomen is a lengthy procedure. This paper describes the use of skin staplers for bowel anastomosis and presents the results of a short series of experiments upon dead pigs to compare the staple technique with conventional handsewn anastomosis. The time taken to perform each small bowel anastomosis, the integrity of the anastomosis and the skill required were assessed. The staple technique was considerably faster (mean construction time: 5.4 min, range 4-6 min) than the handsewn technique (mean construction time: 12 min, range 10-14 min), at least halving the anastomosis time (Kolmogorov two-sample test P = 0.05). In addition, the stapled anastomosis had a higher intraluminal failure pressure (mean failure pressure: 65 cmH2O, 6.37 kPa, range 30-70 cmH2O) than the handsewn anastomosis (mean failure pressure: 38.6 cmH2O, 3.78 kPa, range 10-70 cmH2O). Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:2018326

47 CFR 201.0 - Background.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 5 2013-10-01 2013-10-01 false Background. 201.0 Section 201.0 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EXECUTIVE POLICY § 201.0 Background. National policy with respect to the conservation, allocation and use of the Nation's...

47 CFR 201.0 - Background.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 5 2011-10-01 2011-10-01 false Background. 201.0 Section 201.0 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EXECUTIVE POLICY § 201.0 Background. National policy with respect to the conservation, allocation and use of the Nation's...

47 CFR 201.0 - Background.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 5 2010-10-01 2010-10-01 false Background. 201.0 Section 201.0 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EXECUTIVE POLICY § 201.0 Background. National policy with respect to the conservation, allocation and use of the Nation's...

47 CFR 201.0 - Background.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 5 2014-10-01 2014-10-01 false Background. 201.0 Section 201.0 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EXECUTIVE POLICY § 201.0 Background. National policy with respect to the conservation, allocation and use of the Nation's...

47 CFR 201.0 - Background.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 5 2012-10-01 2012-10-01 false Background. 201.0 Section 201.0 Telecommunication OFFICE OF SCIENCE AND TECHNOLOGY POLICY AND NATIONAL SECURITY COUNCIL EXECUTIVE POLICY § 201.0 Background. National policy with respect to the conservation, allocation and use of the Nation's...

28 CFR 23.2 - Background.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 28 Judicial Administration 1 2011-07-01 2011-07-01 false Background. 23.2 Section 23.2 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.2 Background. It is... of intelligence data necessary to support control of serious criminal activity may represent...

28 CFR 23.2 - Background.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 1 2014-07-01 2014-07-01 false Background. 23.2 Section 23.2 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.2 Background. It is... of intelligence data necessary to support control of serious criminal activity may represent...

28 CFR 23.2 - Background.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 28 Judicial Administration 1 2013-07-01 2013-07-01 false Background. 23.2 Section 23.2 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.2 Background. It is... of intelligence data necessary to support control of serious criminal activity may represent...

28 CFR 23.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Background. 23.2 Section 23.2 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.2 Background. It is... of intelligence data necessary to support control of serious criminal activity may represent...

28 CFR 23.2 - Background.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 1 2012-07-01 2012-07-01 false Background. 23.2 Section 23.2 Judicial Administration DEPARTMENT OF JUSTICE CRIMINAL INTELLIGENCE SYSTEMS OPERATING POLICIES § 23.2 Background. It is... of intelligence data necessary to support control of serious criminal activity may represent...

47 CFR 32.1 - Background.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Background. 32.1 Section 32.1 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Preface § 32.1 Background. The revised Uniform System of Accounts (USOA) is a historical...

47 CFR 32.1 - Background.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Background. 32.1 Section 32.1 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Preface § 32.1 Background. The revised Uniform System of Accounts (USOA) is a historical...

47 CFR 32.1 - Background.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Background. 32.1 Section 32.1 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES UNIFORM SYSTEM OF ACCOUNTS FOR TELECOMMUNICATIONS COMPANIES Preface § 32.1 Background. The revised Uniform System of Accounts (USOA) is a historical...

Spectral characterization of natural backgrounds

NASA Astrophysics Data System (ADS)

Winkelmann, Max

2017-10-01

As the distribution and use of hyperspectral sensors is constantly increasing, the exploitation of spectral features is a threat for camouflaged objects. To improve camouflage materials at first the spectral behavior of backgrounds has to be known to adjust and optimize the spectral reflectance of camouflage materials. In an international effort, the NATO CSO working group SCI-295 "Development of Methods for Measurements and Evaluation of Natural Background EO Signatures" is developing a method how this characterization of backgrounds has to be done. It is obvious that the spectral characterization of a background will be quite an effort. To compare and exchange data internationally the measurements will have to be done in a similar way. To test and further improve this method an international field trial has been performed in Storkow, Germany. In the following we present first impressions and lessons learned from this field campaign and describe the data that has been measured.

Two Disciplines of Examiners? The Effect of Professional Background and Level of Experience in Grade-Setting.

ERIC Educational Resources Information Center

Havik, Odd Erik

1980-01-01

Focuses on the influence of examiners' level of experience and professional background on grades given in oral and written undergraduate examinations in psychology. Level of experience was found to have no significant effect. Clinical psychologists gave more laudabilis grades on oral exams and academic psychologists on essay exams. (JD)

32 CFR 1292.3 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Background. 1292.3 Section 1292.3 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS SECURITY OF DLA ACTIVITIES AND RESOURCES § 1292.3 Background. Section 21 of the Internal Security Act of 1950...

14 CFR 1214.302 - Background.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 5 2012-01-01 2012-01-01 false Background. 1214.302 Section 1214.302 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.302 Background. (a) The Space Transportation System (STS) has been...

14 CFR 1214.302 - Background.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 5 2010-01-01 2010-01-01 false Background. 1214.302 Section 1214.302 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.302 Background. (a) The Space Transportation System (STS) has been...

14 CFR 1214.302 - Background.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 5 2011-01-01 2010-01-01 true Background. 1214.302 Section 1214.302 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.302 Background. (a) The Space Transportation System (STS) has been...

14 CFR 1214.302 - Background.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 5 2013-01-01 2013-01-01 false Background. 1214.302 Section 1214.302 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.302 Background. (a) The Space Transportation System (STS) has been...

32 CFR 1292.3 - Background.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 6 2012-07-01 2012-07-01 false Background. 1292.3 Section 1292.3 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS SECURITY OF DLA ACTIVITIES AND RESOURCES § 1292.3 Background. Section 21 of the Internal Security Act of 1950...

32 CFR 1292.3 - Background.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Background. 1292.3 Section 1292.3 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS SECURITY OF DLA ACTIVITIES AND RESOURCES § 1292.3 Background. Section 21 of the Internal Security Act of 1950...

32 CFR 1292.3 - Background.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 6 2013-07-01 2013-07-01 false Background. 1292.3 Section 1292.3 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS SECURITY OF DLA ACTIVITIES AND RESOURCES § 1292.3 Background. Section 21 of the Internal Security Act of 1950...

32 CFR 1292.3 - Background.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 6 2014-07-01 2014-07-01 false Background. 1292.3 Section 1292.3 National Defense Other Regulations Relating to National Defense DEFENSE LOGISTICS AGENCY MISCELLANEOUS SECURITY OF DLA ACTIVITIES AND RESOURCES § 1292.3 Background. Section 21 of the Internal Security Act of 1950...

32 CFR 3.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 1 2010-07-01 2010-07-01 false Background. 3.2 Section 3.2 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE ACQUISITION TRANSACTIONS OTHER THAN CONTRACTS, GRANTS, OR COOPERATIVE AGREEMENTS FOR PROTOTYPE PROJECTS § 3.2 Background. “Other transactions” is the...

32 CFR 763.3 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Background. 763.3 Section 763.3 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY ISLANDS UNDER NAVY JURISDICTION RULES GOVERNING PUBLIC ACCESS Entry Regulations for Kaho'olawe Island, Hawaii § 763.3 Background. (a) Kaho'olawe Island...

32 CFR 735.2 - Background.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Background. 735.2 Section 735.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL REPORTING BIRTHS AND DEATHS IN COOPERATION WITH OTHER AGENCIES § 735.2 Background. For Armed Forces members and their dependents on duty overseas...

32 CFR 735.2 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Background. 735.2 Section 735.2 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL REPORTING BIRTHS AND DEATHS IN COOPERATION WITH OTHER AGENCIES § 735.2 Background. For Armed Forces members and their dependents on duty overseas...

Aircraft and background noise annoyance effects

NASA Technical Reports Server (NTRS)

Willshire, K. F.

1984-01-01

To investigate annoyance of multiple noise sources, two experiments were conducted. The first experiment, which used 48 subjects, was designed to establish annoyance-noise level functions for three community noise sources presented individually: jet aircraft flyovers, air conditioner, and traffic. The second experiment, which used 216 subjects, investigated the effects of background noise on aircraft annoyance as a function of noise level and spectrum shape; and the differences between overall, aircraft, and background noise annoyance. In both experiments, rated annoyance was the dependent measure. Results indicate that the slope of the linear relationship between annoyance and noise level for traffic is significantly different from that of flyover and air conditioner noise and that further research was justified to determine the influence of the two background noises on overall, aircraft, and background noise annoyance (e.g., experiment two). In experiment two, total noise exposure, signal-to-noise ratio, and background source type were found to have effects on all three types of annoyance. Thus, both signal-to-noise ratio, and the background source must be considered when trying to determine community response to combined noise sources.

Traumatic asphyxia.

PubMed

Montes-Tapia, Fernando; Barreto-Arroyo, Itzel; Cura-Esquivel, Idalia; Rodríguez-Taméz, Antonio; de la O-Cavazos, Manuel

2014-02-01

Traumatic asphyxia is a rare condition in children that usually occurs after severe compression to the chest or abdomen. We report 3 cases in patients 18, 20, and 36 months of age who presented signs and symptoms of traumatic asphyxia after car accidents. Two clinical features were consistent in all 3 patients: multiple petechiae on the face and bulbar conjunctival hemorrhage; 2 patients had facial cyanosis, and 1 had facial edema.In children, the number of clinical manifestations that should be evident to diagnose traumatic asphyxia has not been ascertained. However, in any history of trauma with compression of the chest or abdomen and signs of increased intravenous craniocervical pressure, traumatic asphyxia should be suspected.

Rectus sheath haematoma: a rare masquerader for abdominal pain.

PubMed

Changal, Khalid Hamid; Saleem, Saad; Ghous, Ghulam

2017-04-13

Rectus sheath haematoma is a rare cause of abdominal pain. It can be easily confused for other causes of acute abdomen and may even lead to unnecessary laparotomies. Our patient has the rectus sheath haematoma because of violent coughing and on presentation had no obvious clinical sign pointing to the same. Diagnosis was made by a CT scan of the abdomen, and patient was treated conservatively. Rectus sheath haematomas are usually present on the posterior aspect of the rectus muscles and thus may not be clinically appreciable. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Rectus sheath hematoma due to cough in an elderly patient under antiplatelet therapy.

PubMed

Çoşğun, I Güven; Ünal, Yılmaz; Çetin, Mustafa

2015-04-01

Abdominal rectus sheath hematoma (ARSH) is a rare clinical condition that can be confused with other causes of acute abdomen. We report an 83-year-old woman receiving antiplatelet medication who presented with ARSH following a cough episode. The patient was hospitalized with a diagnosis of acute chronic obstructive pulmonary disease exacerbations. During hospital stay, sudden onset abdominal pain was developed following a severe cough episode. Computed tomography of the abdomen revealed ARSH. Rectus sheath hematoma is a rare and often misdiagnosed clinical condition. It is important to be considered for the diagnosis. ARSH should be considered in case of development of acute abdominal pain following cough in receiving anticoagulant or antiplatelet therapy. © 2014 John Wiley & Sons Ltd.

Interrater and Intrarater Reliability of the Tuck Jump Assessment by Health Professionals of Varied Educational Backgrounds

PubMed Central

Dudley, Lisa A.; Smith, Craig A.; Olson, Brandon K.; Chimera, Nicole J.

2013-01-01

Objective. The Tuck Jump Assessment (TJA), a clinical plyometric assessment, identifies 10 jumping and landing technique flaws. The study objective was to investigate TJA interrater and intrarater reliability with raters of different educational and clinical backgrounds. Methods. 40 participants were video recorded performing the TJA using published protocol and instructions. Five raters of varied educational and clinical backgrounds scored the TJA. Each score of the 10 technique flaws was summed for the total TJA score. Approximately one month later, 3 raters scored the videos again. Intraclass correlation coefficients determined interrater (5 and 3 raters for first and second session, resp.) and intrarater (3 raters) reliability. Results. Interrater reliability with 5 raters was poor (ICC = 0.47; 95% confidence intervals (CI) 0.33–0.62). Interrater reliability between 3 raters who completed 2 scoring sessions improved from 0.52 (95% CI 0.35–0.68) for session one to 0.69 (95% CI 0.55–0.81) for session two. Intrarater reliability was poor to moderate, ranging from 0.44 (95% CI 0.22–0.68) to 0.72 (95% CI 0.55–0.84). Conclusion. Published protocol and training of raters were insufficient to allow consistent TJA scoring. There may be a learned effect with the TJA since interrater reliability improved with repetition. TJA instructions and training should be modified and enhanced before clinical implementation. PMID:26464881

Double jeopardy revisited: clinical decision making in unstable patients with, thoraco-abdominal stab wounds and, potential injuries in multiple body cavities.

PubMed

Clarke, Damian L; Gall, Tamara M H; Thomson, Sandie R

2011-05-01

In the setting of the hypovolaemic patient with a thoraco-abdominal stab wound and potential injuries in both the chest and abdomen, deciding which cavity to explore first may be difficult.Opening the incorrect body cavity can delay control of tamponade or haemorrhage and exacerbate hypothermia and fluid shifts. This situation has been described as one of double jeopardy. All stab victims from July 2007 to July 2009 requiring a thoracotomy and laparotomy at the same operation were identified from a database. Demographics, site and nature of injuries, admission observations and investigations as well as operative sequence were recorded. Correct sequencing was defined as first opening the cavity with most lethal injury. Incorrect sequencing was defined as opening a cavity and finding either no injury or an injury of less severity than a simultaneous injury in the unopened cavity. The primary outcome was survival or death. Sixteen stab victims underwent thoracotomy and laparotomy during the same operation. All were male with an age range of 18–40 (mean/median 27). Median systolic blood pressure on presentation was 90 mm Hg. (quartile range 80–90 mm Hg). Median base excess was 6.5 (quartile range 12 to 2.2). All the deaths were the result of cardiac injuries. Incorrect sequencing occurred in four patients (25%). In this group there were four negative abdominal explorations prior to thoracotomy with two deaths. There was one death in the correct sequencing group. Incorrect sequencing in stab victims who require both thoracotomy and laparotomy at the same sitting is associated with a high mortality. This is especially true when the abdomen is incorrectly entered first whilst the life threatening pathology is in the chest. Clinical signs may be confusing, leading to incorrect sequencing of exploration. The common causes for confusion include failure to appreciate that cardiac tamponade does not present with bleeding and difficulty in assessing peritonism in an

Integrated whole-body PET/MR imaging with 18F-FDG, 18F-FDOPA, and 18F-fluorodopamine in paragangliomas, in comparison to PET/CT: NIH first clinical experience with a single-injection, dual-modality imaging protocol

PubMed Central

Blanchet, Elise M.; Millo, Corina; Martucci, Victoria; Maass-Moreno, Roberto; Bluemke, David A.; Pacak, Karel

2017-01-01

Purpose Paragangliomas (PGLs) are tumors that can metastasize and recur; therefore, lifelong imaging follow-up is required. Hybrid positron emission tomography (PET)/computed tomography (/CT) is an essential tool to image PGLs. Novel hybrid PET/magnetic resonance (/MR) scanners are currently being studied in clinical oncology. We studied the feasibility of simultaneous whole-body PET/MR imaging to evaluate patients with PGLs. Methods Fifty-three PGLs or PGL-related lesions from eight patients were evaluated. All patients underwent a single-injection, dual-modality imaging protocol consisting of a PET/CT and subsequent PET/MR scan. Four patients were evaluated with 18F-fluorodeoxyglucose (18F-FDG), two with 18F-fluorodihydroxyphenylalanine (18F-FDOPA), and two with 18F-fluorodopamine (18F-FDA). PET/MR data were acquired using a hybrid whole-body 3-Tesla integrated PET/MR scanner. PET and MR data (DIXON images for attenuation correction and T2-weighted sequences for anatomic allocation) were acquired simultaneously. Imaging workflow and imaging times were documented. PET/MR and PET/CT data were visually assessed (blindly) in regards to image quality, lesion detection, and anatomic allocation and delineation of the PET findings. Results With hybrid PET/MR, we obtained high quality images in an acceptable acquisition time (median: 31 min, range: 25–40 min) with good patient compliance. A total of 53 lesions, located in the head-and-neck area (6), mediastinum (2), abdomen and pelvis (13), lungs (2), liver (4), and bone (26) were evaluated. 51 lesions were detected with PET/MR and confirmed by PET/CT. Two bone lesions (L4 body (8 mm) and sacrum (6 mm)) were not detectable on an 18F-FDA scan PET/MR, likely due to washout of the 18F-FDA. Co-registered MR tended to be superior to co-registered CT for head-and-neck, abdomen, pelvis, and liver lesions for anatomic allocation and delineation. Conclusions Clinical PGL evaluation with hybrid PET/MR is feasible with high image

32 CFR 732.1 - Background.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Background. 732.1 Section 732.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE General § 732.1 Background. When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine Corps member...

32 CFR 732.1 - Background.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Background. 732.1 Section 732.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE General § 732.1 Background. When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine Corps member...

32 CFR 732.1 - Background.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 32 National Defense 5 2014-07-01 2014-07-01 false Background. 732.1 Section 732.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE General § 732.1 Background. When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine Corps member...

32 CFR 732.1 - Background.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Background. 732.1 Section 732.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE General § 732.1 Background. When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine Corps member...

32 CFR 732.1 - Background.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Background. 732.1 Section 732.1 National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL NONNAVAL MEDICAL AND DENTAL CARE General § 732.1 Background. When a U.S. Navy or Marine Corps member or a Canadian Navy or Marine Corps member...

12 CFR 408.1 - Background.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Background. 408.1 Section 408.1 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES PROCEDURES FOR COMPLIANCE WITH THE NATIONAL ENVIRONMENTAL POLICY ACT General § 408.1 Background. (a) The National Environmental Policy Act (NEPA) of 1969 (42 U.S.C...

Critical-thinking ability in respiratory care students and its correlation with age, educational background, and performance on national board examinations.

PubMed

Wettstein, Richard B; Wilkins, Robert L; Gardner, Donna D; Restrepo, Ruben D

2011-03-01

Critical thinking is an important characteristic to develop in respiratory care students. We used the short-form Watson-Glaser Critical Thinking Appraisal instrument to measure critical-thinking ability in 55 senior respiratory care students in a baccalaureate respiratory care program. We calculated the Pearson correlation coefficient to assess the relationships between critical-thinking score, age, and student performance on the clinical-simulation component of the national respiratory care boards examination. We used chi-square analysis to assess the association between critical-thinking score and educational background. There was no significant relationship between critical-thinking score and age, or between critical-thinking score and student performance on the clinical-simulation component. There was a significant (P = .04) positive association between a strong science-course background and critical-thinking score, which might be useful in predicting a student's ability to perform in areas where critical thinking is of paramount importance, such as clinical competencies, and to guide candidate-selection for respiratory care programs.

Universal field matching in craniospinal irradiation by a background-dose gradient-optimized method.

PubMed

Traneus, Erik; Bizzocchi, Nicola; Fellin, Francesco; Rombi, Barbara; Farace, Paolo

2018-01-01

The gradient-optimized methods are overcoming the traditional feathering methods to plan field junctions in craniospinal irradiation. In this note, a new gradient-optimized technique, based on the use of a background dose, is described. Treatment planning was performed by RayStation (RaySearch Laboratories, Stockholm, Sweden) on the CT scans of a pediatric patient. Both proton (by pencil beam scanning) and photon (by volumetric modulated arc therapy) treatments were planned with three isocenters. An 'in silico' ideal background dose was created first to cover the upper-spinal target and to produce a perfect dose gradient along the upper and lower junction regions. Using it as background, the cranial and the lower-spinal beams were planned by inverse optimization to obtain dose coverage of their relevant targets and of the junction volumes. Finally, the upper-spinal beam was inversely planned after removal of the background dose and with the previously optimized beams switched on. In both proton and photon plans, the optimized cranial and the lower-spinal beams produced a perfect linear gradient in the junction regions, complementary to that produced by the optimized upper-spinal beam. The final dose distributions showed a homogeneous coverage of the targets. Our simple technique allowed to obtain high-quality gradients in the junction region. Such technique universally works for photons as well as protons and could be applicable to the TPSs that allow to manage a background dose. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

In Vivo Human Time-Exposure Study of Orally Dosed Commercial Silver Nanoparticles

PubMed Central

Munger, Mark A.; Radwanski, Przemyslaw; Hadlock, Greg C.; Stoddard, Greg; Shaaban, Akram; Falconer, Jonathan; Grainger, David W.; Deering-Rice, Cassandra E.

2013-01-01

Background Human biodistribution, bioprocessing and possible toxicity of nanoscale silver receives increasing health assessment. Methods We prospectively studied commercial 10- and 32-ppm nanoscale silver particle solutions in a single-blind, controlled, cross-over, intent-to-treat, design. Healthy subjects (n=60) underwent metabolic, blood counts, urinalysis, sputum induction, and chest and abdomen magnetic resonance imaging. Silver serum and urine content was determined. Results No clinically important changes in metabolic, hematologic, or urinalysis measures were identified. No morphological changes were detected in the lungs, heart or abdominal organs. No significant changes were noted in pulmonary reactive oxygen species or pro-inflammatory cytokine generation. Conclusion In vivo oral exposure to these commercial nanoscale silver particle solutions does not prompt clinically important changes in human metabolic, hematologic, urine, physical findings or imaging morphology. Further study of increasing time exposure and dosing of silver nanoparticulate silver, and observation of additional organ systems is warranted to assert human toxicity thresholds. PMID:23811290

Negative Pressure Wound Therapy for the Treatment of the Open Abdomen and Incidence of Enteral Fistulas: A Retrospective Bicentre Analysis

PubMed Central

Dold, Stefan; Doberauer, Johannes P.; Mai, Peter

2013-01-01

Introduction. The open abdomen (OA) is often associated with complications. It has been hypothesized that negative pressure wound therapy (NPWT) in the treatment of OA may provoke enteral fistulas. Therefore, we analyzed patients with OA and NPWT with special regard to the occurrence of intestinal fistulas. Methods. The present study included all consecutive patients with OA treated with NWPT from April 2010 to August 2011 in two hospitals. Patients' demographics, indications for OA, risk factors, complications, outcome and incidence of fistulas before, during and after NPWT were recorded. Results. Of 81 patients with OA, 26 had pre-existing fistulas and 55 were free from a fistula at the beginning of NPWT. Nine of the 55 patients developed fistulas during (n = 5) or after NPWT (n = 4). Seventy-five patients received ABThera therapy, 6 patients other temporary abdominal closure devices. Only diverticulitis seemed to be a significant predisposing factor for fistulas. Mortality was slightly lower for patients without fistulas. Conclusion. The present study revealed no correlation between occurrence of fistulas before, during, and after NWPT, with diverticulitis being the only risk factor. Fistula formation during NPWT was comparable to reports from literature. Prospective studies are mandatory to clarify the impact of NPWT on fistula formation. PMID:24285953

Background of SAM atom-fraction profiles

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ernst, Frank

Atom-fraction profiles acquired by SAM (scanning Auger microprobe) have important applications, e.g. in the context of alloy surface engineering by infusion of carbon or nitrogen through the alloy surface. However, such profiles often exhibit an artifact in form of a background with a level that anti-correlates with the local atom fraction. This article presents a theory explaining this phenomenon as a consequence of the way in which random noise in the spectrum propagates into the discretized differentiated spectrum that is used for quantification. The resulting model of “energy channel statistics” leads to a useful semi-quantitative background reduction procedure, which ismore » validated by applying it to simulated data. Subsequently, the procedure is applied to an example of experimental SAM data. The analysis leads to conclusions regarding optimum experimental acquisition conditions. The proposed method of background reduction is based on general principles and should be useful for a broad variety of applications. - Highlights: • Atom-fraction–depth profiles of carbon measured by scanning Auger microprobe • Strong background, varies with local carbon concentration. • Needs correction e.g. for quantitative comparison with simulations • Quantitative theory explains background. • Provides background removal strategy and practical advice for acquisition.« less

Variance analysis of x-ray CT sinograms in the presence of electronic noise background.

PubMed

Ma, Jianhua; Liang, Zhengrong; Fan, Yi; Liu, Yan; Huang, Jing; Chen, Wufan; Lu, Hongbing

2012-07-01

Low-dose x-ray computed tomography (CT) is clinically desired. Accurate noise modeling is a fundamental issue for low-dose CT image reconstruction via statistics-based sinogram restoration or statistical iterative image reconstruction. In this paper, the authors analyzed the statistical moments of low-dose CT data in the presence of electronic noise background. The authors first studied the statistical moment properties of detected signals in CT transmission domain, where the noise of detected signals is considered as quanta fluctuation upon electronic noise background. Then the authors derived, via the Taylor expansion, a new formula for the mean-variance relationship of the detected signals in CT sinogram domain, wherein the image formation becomes a linear operation between the sinogram data and the unknown image, rather than a nonlinear operation in the CT transmission domain. To get insight into the derived new formula by experiments, an anthropomorphic torso phantom was scanned repeatedly by a commercial CT scanner at five different mAs levels from 100 down to 17. The results demonstrated that the electronic noise background is significant when low-mAs (or low-dose) scan is performed. The influence of the electronic noise background should be considered in low-dose CT imaging.

Variance analysis of x-ray CT sinograms in the presence of electronic noise background

PubMed Central

Ma, Jianhua; Liang, Zhengrong; Fan, Yi; Liu, Yan; Huang, Jing; Chen, Wufan; Lu, Hongbing

2012-01-01

Purpose: Low-dose x-ray computed tomography (CT) is clinically desired. Accurate noise modeling is a fundamental issue for low-dose CT image reconstruction via statistics-based sinogram restoration or statistical iterative image reconstruction. In this paper, the authors analyzed the statistical moments of low-dose CT data in the presence of electronic noise background. Methods: The authors first studied the statistical moment properties of detected signals in CT transmission domain, where the noise of detected signals is considered as quanta fluctuation upon electronic noise background. Then the authors derived, via the Taylor expansion, a new formula for the mean–variance relationship of the detected signals in CT sinogram domain, wherein the image formation becomes a linear operation between the sinogram data and the unknown image, rather than a nonlinear operation in the CT transmission domain. To get insight into the derived new formula by experiments, an anthropomorphic torso phantom was scanned repeatedly by a commercial CT scanner at five different mAs levels from 100 down to 17. Results: The results demonstrated that the electronic noise background is significant when low-mAs (or low-dose) scan is performed. Conclusions: The influence of the electronic noise background should be considered in low-dose CT imaging. PMID:22830738

The background in the experiment Gerda

NASA Astrophysics Data System (ADS)

Agostini, M.; Allardt, M.; Andreotti, E.; Bakalyarov, A. M.; Balata, M.; Barabanov, I.; Barnabé Heider, M.; Barros, N.; Baudis, L.; Bauer, C.; Becerici-Schmidt, N.; Bellotti, E.; Belogurov, S.; Belyaev, S. T.; Benato, G.; Bettini, A.; Bezrukov, L.; Bode, T.; Brudanin, V.; Brugnera, R.; Budjáš, D.; Caldwell, A.; Cattadori, C.; Chernogorov, A.; Cossavella, F.; Demidova, E. V.; Domula, A.; Egorov, V.; Falkenstein, R.; Ferella, A.; Freund, K.; Frodyma, N.; Gangapshev, A.; Garfagnini, A.; Gotti, C.; Grabmayr, P.; Gurentsov, V.; Gusev, K.; Guthikonda, K. K.; Hampel, W.; Hegai, A.; Heisel, M.; Hemmer, S.; Heusser, G.; Hofmann, W.; Hult, M.; Inzhechik, L. V.; Ioannucci, L.; Csáthy, J. Janicskó; Jochum, J.; Junker, M.; Kihm, T.; Kirpichnikov, I. V.; Kirsch, A.; Klimenko, A.; Knöpfle, K. T.; Kochetov, O.; Kornoukhov, V. N.; Kuzminov, V. V.; Laubenstein, M.; Lazzaro, A.; Lebedev, V. I.; Lehnert, B.; Liao, H. Y.; Lindner, M.; Lippi, I.; Liu, X.; Lubashevskiy, A.; Lubsandorzhiev, B.; Lutter, G.; Macolino, C.; Machado, A. A.; Majorovits, B.; Maneschg, W.; Nemchenok, I.; Nisi, S.; O'Shaughnessy, C.; Palioselitis, D.; Pandola, L.; Pelczar, K.; Pessina, G.; Pullia, A.; Riboldi, S.; Sada, C.; Salathe, M.; Schmitt, C.; Schreiner, J.; Schulz, O.; Schwingenheuer, B.; Schönert, S.; Shevchik, E.; Shirchenko, M.; Simgen, H.; Smolnikov, A.; Stanco, L.; Strecker, H.; Tarka, M.; Ur, C. A.; Vasenko, A. A.; Volynets, O.; von Sturm, K.; Wagner, V.; Walter, M.; Wegmann, A.; Wester, T.; Wojcik, M.; Yanovich, E.; Zavarise, P.; Zhitnikov, I.; Zhukov, S. V.; Zinatulina, D.; Zuber, K.; Zuzel, G.

2014-04-01

The GERmanium Detector Array ( Gerda) experiment at the Gran Sasso underground laboratory (LNGS) of INFN is searching for neutrinoless double beta () decay of Ge. The signature of the signal is a monoenergetic peak at 2039 keV, the value of the decay. To avoid bias in the signal search, the present analysis does not consider all those events, that fall in a 40 keV wide region centered around . The main parameters needed for the analysis are described. A background model was developed to describe the observed energy spectrum. The model contains several contributions, that are expected on the basis of material screening or that are established by the observation of characteristic structures in the energy spectrum. The model predicts a flat energy spectrum for the blinding window around with a background index ranging from 17.6 to 23.8 cts/(keV kg yr). A part of the data not considered before has been used to test if the predictions of the background model are consistent. The observed number of events in this energy region is consistent with the background model. The background at is dominated by close sources, mainly due to K, Bi, Th, Co and emitting isotopes from the Ra decay chain. The individual fractions depend on the assumed locations of the contaminants. It is shown, that after removal of the known peaks, the energy spectrum can be fitted in an energy range of 200 keV around with a constant background. This gives a background index consistent with the full model and uncertainties of the same size.

Ethnic background and genetic variation in the evaluation of cancer risk: a systematic review.

PubMed

Jing, Lijun; Su, Li; Ring, Brian Z

2014-01-01

The clinical use of genetic variation in the evaluation of cancer risk is expanding, and thus understanding how determinants of cancer susceptibility identified in one population can be applied to another is of growing importance. However there is considerable debate on the relevance of ethnic background in clinical genetics, reflecting both the significance and complexity of genetic heritage. We address this via a systematic review of reported associations with cancer risk for 82 markers in 68 studies across six different cancer types, comparing association results between ethnic groups and examining linkage disequilibrium between risk alleles and nearby genetic loci. We find that the relevance of ethnic background depends on the question. If asked whether the association of variants with disease risk is conserved across ethnic boundaries, we find that the answer is yes, the majority of markers show insignificant variability in association with cancer risk across ethnic groups. However if the question is whether a significant association between a variant and cancer risk is likely to reproduce, the answer is no, most markers do not validate in an ethnic group other than the discovery cohort's ancestry. This lack of reproducibility is not attributable to studies being inadequately populated due to low allele frequency in other ethnic groups. Instead, differences in local genomic structure between ethnic groups are associated with the strength of association with cancer risk and therefore confound interpretation of the implied physiologic association tracked by the disease allele. This suggest that a biological association for cancer risk alleles may be broadly consistent across ethnic boundaries, but reproduction of a clinical study in another ethnic group is uncommon, in part due to confounding genomic architecture. As clinical studies are increasingly performed globally this has important implications for how cancer risk stratifiers should be studied and employed.

Ethnic Background and Genetic Variation in the Evaluation of Cancer Risk: A Systematic Review

PubMed Central

Jing, Lijun; Su, Li; Ring, Brian Z.

2014-01-01

The clinical use of genetic variation in the evaluation of cancer risk is expanding, and thus understanding how determinants of cancer susceptibility identified in one population can be applied to another is of growing importance. However there is considerable debate on the relevance of ethnic background in clinical genetics, reflecting both the significance and complexity of genetic heritage. We address this via a systematic review of reported associations with cancer risk for 82 markers in 68 studies across six different cancer types, comparing association results between ethnic groups and examining linkage disequilibrium between risk alleles and nearby genetic loci. We find that the relevance of ethnic background depends on the question. If asked whether the association of variants with disease risk is conserved across ethnic boundaries, we find that the answer is yes, the majority of markers show insignificant variability in association with cancer risk across ethnic groups. However if the question is whether a significant association between a variant and cancer risk is likely to reproduce, the answer is no, most markers do not validate in an ethnic group other than the discovery cohort’s ancestry. This lack of reproducibility is not attributable to studies being inadequately populated due to low allele frequency in other ethnic groups. Instead, differences in local genomic structure between ethnic groups are associated with the strength of association with cancer risk and therefore confound interpretation of the implied physiologic association tracked by the disease allele. This suggest that a biological association for cancer risk alleles may be broadly consistent across ethnic boundaries, but reproduction of a clinical study in another ethnic group is uncommon, in part due to confounding genomic architecture. As clinical studies are increasingly performed globally this has important implications for how cancer risk stratifiers should be studied and

Towards standardization of 18F-FET PET imaging: do we need a consistent method of background activity assessment?

PubMed

Unterrainer, Marcus; Vettermann, Franziska; Brendel, Matthias; Holzgreve, Adrien; Lifschitz, Michael; Zähringer, Matthias; Suchorska, Bogdana; Wenter, Vera; Illigens, Ben M; Bartenstein, Peter; Albert, Nathalie L

2017-12-01

PET with O-(2- 18 F-fluoroethyl)-L-tyrosine ( 18 F-FET) has reached increasing clinical significance for patients with brain neoplasms. For quantification of standard PET-derived parameters such as the tumor-to-background ratio, the background activity is assessed using a region of interest (ROI) or volume of interest (VOI) in unaffected brain tissue. However, there is no standardized approach regarding the assessment of the background reference. Therefore, we evaluated the intra- and inter-reader variability of commonly applied approaches for clinical 18 F-FET PET reading. The background activity of 20 18 F-FET PET scans was independently evaluated by 6 readers using a (i) simple 2D-ROI, (ii) spherical VOI with 3.0 cm diameter, and (iii) VOI consisting of crescent-shaped ROIs; each in the contralateral, non-affected hemisphere including white and gray matter in line with the European Association of Nuclear Medicine (EANM) and German guidelines. To assess intra-reader variability, each scan was evaluated 10 times by each reader. The coefficient of variation (CoV) was assessed for determination of intra- and inter-reader variability. In a second step, the best method was refined by instructions for a guided background activity assessment and validated by 10 further scans. Compared to the other approaches, the crescent-shaped VOIs revealed most stable results with the lowest intra-reader variabilities (median CoV 1.52%, spherical VOI 4.20%, 2D-ROI 3.69%; p < 0.001) and inter-reader variabilities (median CoV 2.14%, spherical VOI 4.02%, 2D-ROI 3.83%; p = 0.001). Using the guided background assessment, both intra-reader variabilities (median CoV 1.10%) and inter-reader variabilities (median CoV 1.19%) could be reduced even more. The commonly applied methods for background activity assessment show different variability which might hamper 18 F-FET PET quantification and comparability in multicenter settings. The proposed background activity assessment using a

The cosmic microwave background

NASA Technical Reports Server (NTRS)

Silk, Joseph

1991-01-01

Recent limits on spectral distortions and angular anisotropies in the cosmic microwave background are reviewed. The various backgrounds are described, and the theoretical implications are assessed. Constraints on inflationary cosmology dominated by cold dark matter (CDM) and on open cosmological models dominated by baryonic dark matter (BDM), with, respectively, primordial random phase scale-invariant curvature fluctuations or non-gaussian isocurvature fluctuations are described. More exotic theories are addressed, and I conclude with the 'bottom line': what theorists expect experimentalists to be measuring within the next two to three years without having to abandon their most cherished theories.

Characterizing the Background Corona with SDO/AIA

NASA Technical Reports Server (NTRS)

Napier, Kate; Alexander, Caroline; Winebarger, Amy

2014-01-01

Characterizing the nature of the solar coronal background would enable scientists to more accurately determine plasma parameters, and may lead to a better understanding of the coronal heating problem. Because scientists study the 3D structure of the Sun in 2D, any line-of-sight includes both foreground and background material, and thus, the issue of background subtraction arises. By investigating the intensity values in and around an active region, using multiple wavelengths collected from the Atmospheric Imaging Assembly (AIA) on the Solar Dynamics Observatory (SDO) over an eight-hour period, this project aims to characterize the background as smooth or structured. Different methods were employed to measure the true coronal background and create minimum intensity images. These were then investigated for the presence of structure. The background images created were found to contain long-lived structures, including coronal loops, that were still present in all of the wavelengths, 131, 171, 193, 211, and 335 A. The intensity profiles across the active region indicate that the background is much more structured than previously thought.

Rectus sheath hematoma caused by non-contact strenuous exercise mimicking acute appendicitis.

PubMed

Oh, Je Hyeok; Kim, Tae Han; Cha, Sung Jae; Kim, Seung Ho

2010-09-01

A healthy 26-year-old man visited the Emergency Department due to right lower quadrant pain of 2 days' duration that developed after wakeboarding. There was no history of direct trauma to the abdomen. Physical examination revealed tenderness and rebound tenderness on the right lower quadrant area. There was no palpable abdominal mass. Computed tomography (CT) of the abdomen was undertaken to discern the causes of acute abdomen, including acute appendicitis. CT revealed a small-size rectus sheath hematoma beneath the lower end of the right rectus muscle. The patient was admitted for supportive care including pain control and was discharged with improvement after 5 days. Rectus sheath hematoma can be caused by not only a direct blow but also non-contact strenuous exercise, for example, wakeboarding in this case. Although the majority of rectus sheath hematomas are self-limiting, some can cause peritoneal irritation signs, mimicking acute abdomen, and eventually lead to unnecessary laparotomy without clinical suspicion and ancillary tests including CT scan and ultrasonography. Copyright © 2010 Elsevier Inc. All rights reserved.

Cosmic Background Explorer (COBE) press kit

NASA Technical Reports Server (NTRS)

1989-01-01

COBE, the Cosmic Background Explorer spacecraft, and its mission are described. COBE was designed to study the origin and dynamics of the universe including the theory that the universe began with a cataclysmic explosion referred to as the Big Bang. To this end, earth's cosmic background - the infrared radiation that bombards earth from every direction - will be measured by three sophisticated instruments: the Differential Microwave Radiometer (DMR), the Far Infrared Absolute Spectrophotometer (FIRAS), and the Diffuse Infrared Background Experiment (DIRBE).

Systemic Lupus Erythematosus Pancreatitis: An Uncommon Presentation of a Common Disease

PubMed Central

Rodriguez, Eduardo A.; Sussman, Daniel A.; Rodriguez, Vanessa R.

2014-01-01

Patient: Female, 21 Final Diagnosis: Systemic lupus erythematosus pancreatitis Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology Objective: Challenging differential diagnosis Background: Acute pancreatitis is uncommon in systemic lupus erythematosus (SLE). When recognized early and properly treated with IV steroids and hydration, the course may be benign, as exemplified in the following report. Case Report: A 21-year-old woman with history of SLE and stage IV lupus nephritis, was admitted to the Sergio Bernales Hospital ICU (Lima, Peru), complaining of worsening epigastric pain radiating to the back, and nausea and vomiting for 1 week. She denied prior cholelithiasis, alcohol use, or recent medication changes. On examination, she was tachycardic and normotensive, with a slightly distended abdomen and epigastric tenderness on deep palpation, without signs of peritoneal irritation. Laboratory results demonstrated leukocytosis without left shift, creatinine of 2.26 mg/dL, amylase of 750 U/L, and lipase of 1038 U/L. Liver chemistries, calcium, lactic acid, triglycerides, and IgG4 were normal and alcohol level was undetectable. Ultrasound did not show cholelithiasis, biliary sludge, or common bile duct dilation. CT of the abdomen showed pancreas head (parenchyma) stranding with uniform enhancement consistent with interstitial pancreatitis. Despite receiving IV fluids, opiates, anti-emetics, and nothing by mouth, her clinical condition deteriorated, prompting the use of IV methylprednisolone. After completing 1 week of IV steroids, she was transferred to the medical floor clinically improved. The patient was discharged with an oral steroid taper and complete resolution of symptoms. Conclusions: After ruling out common causes, such as hepatobiliary pathology or toxin-related insults like alcohol, hypercalcemia, hypertriglyceridemia or medications, steroids may be used in SLE pancreatitis because they might improve

Characterization and Prediction of the SPI Background

NASA Technical Reports Server (NTRS)

Teegarden, B. J.; Jean, P.; Knodlseder, J.; Skinner, G. K.; Weidenspointer, G.

2003-01-01

The INTEGRAL Spectrometer, like most gamma-ray instruments, is background dominated. Signal-to-background ratios of a few percent are typical. The background is primarily due to interactions of cosmic rays in the instrument and spacecraft. It characteristically varies by +/- 5% on time scales of days. This variation is caused mainly by fluctuations in the interplanetary magnetic field that modulates the cosmic ray intensity. To achieve the maximum performance from SPI it is essential to have a high quality model of this background that can predict its value to a fraction of a percent. In this poster we characterize the background and its variability, explore various models, and evaluate the accuracy of their predictions.

Expected background in the LZ experiment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kudryavtsev, Vitaly A.

2015-08-17

The LZ experiment, featuring a 7-tonne active liquid xenon target, is aimed at achieving unprecedented sensitivity to WIMPs with the background expected to be dominated by astrophysical neutrinos. To reach this goal, extensive simulations are carried out to accurately calculate the electron recoil and nuclear recoil rates in the detector. Both internal (from target material) and external (from detector components and surrounding environment) backgrounds are considered. A very efficient suppression of background rate is achieved with an outer liquid scintillator veto, liquid xenon skin and fiducialisation. Based on the current measurements of radioactivity of different materials, it is shown thatmore » LZ can achieve the reduction of a total background for a WIMP search down to about 2 events in 1000 live days for 5.6 tonne fiducial mass.« less

Expected background in the LZ experiment

NASA Astrophysics Data System (ADS)

Kudryavtsev, Vitaly A.

2015-08-01

The LZ experiment, featuring a 7-tonne active liquid xenon target, is aimed at achieving unprecedented sensitivity to WIMPs with the background expected to be dominated by astrophysical neutrinos. To reach this goal, extensive simulations are carried out to accurately calculate the electron recoil and nuclear recoil rates in the detector. Both internal (from target material) and external (from detector components and surrounding environment) backgrounds are considered. A very efficient suppression of background rate is achieved with an outer liquid scintillator veto, liquid xenon skin and fiducialisation. Based on the current measurements of radioactivity of different materials, it is shown that LZ can achieve the reduction of a total background for a WIMP search down to about 2 events in 1000 live days for 5.6 tonne fiducial mass.

Clinical Profile of Children and Adolescents Attending the Behavioural Paediatrics Unit OPD in a Tertiary Care Set up

ERIC Educational Resources Information Center

Jayaprakash, R.

2012-01-01

Background: There are limited studies on the clinical profile of children attending child guidance clinic under Paediatric background. Aims: To study clinical profile of Children & adolescents attending the Behavioural Paediatrics Unit (BPU) OPD under department of Paediatrics in a tertiary care set up. Methods: Monthly average turnover in the…

Performance of CT scan of abdomen and pelvis in detecting asymptomatic synchronous metastasis in breast cancer.

PubMed

James, Justin; Teo, Melanie; Ramachandran, Vivekananda; Law, Michael; Stoney, David; Cheng, Michael

2017-10-01

In many centres in Australia, CT scan of abdomen and pelvis (CTAP) is a commonly used staging investigation to detect asymptomatic synchronous metastasis (ASM) in newly diagnosed breast cancer. However, its routine use is not supported by strong evidence either on its cost effectiveness or on specificity. Despite contrary recommendations by international guidelines this staging investigation is widely used among new early breast cancers(EBC). This retrospective study aims to assess the cost effectiveness and usefulness of CTAP in new breast cancers. All patients with primary invasive breast cancers who underwent breast cancer treatment through Eastern health breast unit during 50-month period from January 2012 were included in the study. All staging CTAP results were reviewed to evaluate its yield, false positive rate and cost of investigation per single positive result. Odds ratio for positive test results were calculated for five possible risk factors (Age less than 40 years, stage III disease, presence of LVI, HER2 positive disease and presence of metastasis in lymph node). 49% (n = 285) of all breast cancer patient underwent staging CTAP which lead to the detection of 4 ASM. (Over all yield of 1%) Overall false positive rate was 15% because of 42 indeterminate results needing further tests. Based merely on approved billing rates this amounted to $ 40733 per single ASM identified. Presence of lymph node metastasis did not increase the chance of positive test result (OR = 1.3; CI:0.13-12.69). Staging CTAP is associated with high incidence of false positive rates and low yield, especially among EBCs. It is desirable to choose this investigation more selectively than currently practiced. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The Cosmic Background Explorer

NASA Technical Reports Server (NTRS)

Gulkis, Samuel; Lubin, Philip M.; Meyer, Stephan S.; Silverberg, Robert F.

1990-01-01

The Cosmic Background Explorer (CBE), NASA's cosmological satellite which will observe a radiative relic of the big bang, is discussed. The major questions connected to the big bang theory which may be clarified using the CBE are reviewed. The satellite instruments and experiments are described, including the Differential Microwave Radiometer, which measures the difference between microwave radiation emitted from two points on the sky, the Far-Infrared Absolute Spectrophotometer, which compares the spectrum of radiation from the sky at wavelengths from 100 microns to one cm with that from an internal blackbody, and the Diffuse Infrared Background Experiment, which searches for the radiation from the earliest generation of stars.

Exploring accountability of clinical ethics consultants: practice and training implications.

PubMed

Weise, Kathryn L; Daly, Barbara J

2014-01-01

Clinical ethics consultants represent a multidisciplinary group of scholars and practitioners with varied training backgrounds, who are integrated into a medical environment to assist in the provision of ethically supportable care. Little has been written about the degree to which such consultants are accountable for the patient care outcome of the advice given. We propose a model for examining degrees of internally motivated accountability that range from restricted to unbounded accountability, and support balanced accountability as a goal for practice. Finally, we explore implications of this model for training of clinical ethics consultants from diverse academic backgrounds, including those disciplines that do not have a formal code of ethics relating to clinical practice.

Masticatory muscle sleep background electromyographic activity is elevated in myofascial temporomandibular disorder patients.

PubMed

Raphael, K G; Janal, M N; Sirois, D A; Dubrovsky, B; Wigren, P E; Klausner, J J; Krieger, A C; Lavigne, G J

2013-12-01

Despite theoretical speculation and strong clinical belief, recent research using laboratory polysomnographic (PSG) recording has provided new evidence that frequency of sleep bruxism (SB) masseter muscle events, including grinding or clenching of the teeth during sleep, is not increased for women with chronic myofascial temporomandibular disorder (TMD). The current case-control study compares a large sample of women suffering from chronic myofascial TMD (n = 124) with a demographically matched control group without TMD (n = 46) on sleep background electromyography (EMG) during a laboratory PSG study. Background EMG activity was measured as EMG root mean square (RMS) from the right masseter muscle after lights out. Sleep background EMG activity was defined as EMG RMS remaining after activity attributable to SB, other orofacial activity, other oromotor activity and movement artefacts were removed. Results indicated that median background EMG during these non-SB event periods was significantly higher (P < 0·01) for women with myofascial TMD (median = 3·31 μV and mean = 4·98 μV) than for control women (median = 2·83 μV and mean = 3·88 μV) with median activity in 72% of cases exceeding control activity. Moreover, for TMD cases, background EMG was positively associated and SB event-related EMG was negatively associated with pain intensity ratings (0-10 numerical scale) on post-sleep waking. These data provide the foundation for a new focus on small, but persistent, elevations in sleep EMG activity over the course of the night as a mechanism of pain induction or maintenance. © 2013 John Wiley & Sons Ltd.

[Consumer involvement in the Disease Management Guideline for Asthma--a background report].

PubMed

Senger, Sylvia; Lelgemann, Monika; Kopp, Ina

2006-01-01

In the past clinical guidelines were mainly developed by experts and in everyday clinical practice almost exclusively used by clinical experts, while issues that were relevant from the patients' (consumers') point of view tended to be neglected. But then, the majority of patient information has not been perceptibly connected to clinical guidelines. Connecting the development of clinical guidelines with the development of patient information publications would make good sense for both products, though. On the one hand, evidence-based treatment guidelines could be made available to the actual target group of the clinical care process--i.e. the patients or consumers--and on the other hand, patient experiences and competencies (social evidence) might inform the production of guidelines. Such a procedure demands the cooperation of clinical experts and patients. So far there are no generally accepted methods in Germany for the practical implementation of consumer involvement on both the organizational and content level with the aim of involving patients in the development process of guidelines as well as the production of the respective patient information versions. Such a methodology shall be established as part of the National Program for Disease Management Guidelines. For the first time in this program, patient involvement is being exercised within the scope of the National Disease Management Guideline for Asthma (NDM Asthma). Here, patients are involved in the NDM development process by providing the opportunity to comment on the consented guideline draft and to participate in the translation of the NDM Asthma into a patient version. The present paper is a background report describing the current state of work and indicating consequences for some future developments.

Acute abdominal pain in patients with lassa fever: Radiological assessment and diagnostic challenges

PubMed Central

Eze, Kenneth C.; Salami, Taofeek A.; Kpolugbo, James U.

2014-01-01

Background: To highlight the problems of diagnosis and management of acute abdomen in patients with lassa fever. And to also highlight the need for high index of suspicion of lassa fever in patients presenting with acute abdominal pain in order to avoid surgical intervention with unfavourable prognosis and nosocomial transmission of infections, especially in Lassa fever-endemic regions. Materials and Methods: A review of experiences of the authors in the management of lassa fever over a 4-year period (2004-2008). Literature on lassa fever, available in the internet and other local sources, was studied in November 2010 and reviewed. Results: Normal plain chest radiographic picture can change rapidly due to pulmonary oedema, pulmonary haemorrhage and acute respiratory distress syndrome. Plain abdominal radiograph may show dilated bowels with signs of paralytic ileus or dynamic intestinal obstruction due to bowel wall haemorrhage or inflamed and enlarged Peyer's patches. Ultrasound may show free intra-peritoneal fluid due to peritonitis and intra-peritoneal haemorrhage. Bleeding into the gall bladder wall may erroneously suggest infective cholecystitis. Pericardial effusion with or without pericarditis causing abdominal pain may be seen using echocardiography. High index of suspicion, antibody testing for lassa fever and viral isolation in a reference laboratory are critical for accurate diagnosis. Conclusion: Patients from lassa fever-endemic regions may present with features that suggest acute abdomen. Radiological studies may show findings that suggest acute abdomen but these should be interpreted in the light of the general clinical condition of the patient. It is necessary to know that acute abdominal pain and vomiting in lassa fever-endemic areas could be caused by lassa fever, which is a medical condition. Surgical option should be undertaken with restraint as it increases the morbidity, may worsen the prognosis and increase the risk of nosocomial transmission

A review on natural background radiation

PubMed Central

Shahbazi-Gahrouei, Daryoush; Gholami, Mehrdad; Setayandeh, Samaneh

2013-01-01

The world is naturally radioactive and approximately 82% of human-absorbed radiation doses, which are out of control, arise from natural sources such as cosmic, terrestrial, and exposure from inhalation or intake radiation sources. In recent years, several international studies have been carried out, which have reported different values regarding the effect of background radiation on human health. Gamma radiation emitted from natural sources (background radiation) is largely due to primordial radionuclides, mainly 232Th and 238U series, and their decay products, as well as 40K, which exist at trace levels in the earth's crust. Their concentrations in soil, sands, and rocks depend on the local geology of each region in the world. Naturally occurring radioactive materials generally contain terrestrial-origin radionuclides, left over since the creation of the earth. In addition, the existence of some springs and quarries increases the dose rate of background radiation in some regions that are known as high level background radiation regions. The type of building materials used in houses can also affect the dose rate of background radiations. The present review article was carried out to consider all of the natural radiations, including cosmic, terrestrial, and food radiation. PMID:24223380

[METROPLASTY FOR OBSTETRIC PERITONITIS, ARISING IN THE BACKGROUND SUTURE FAILURE OF THE UTERUS].

PubMed

Tussupkaliyev, A; Daribay, Zh; Saduov, M; Dossimbetova, M; Rakhmetullina, G

2016-12-01

Improving treatment outcomes obstetric peritonitis after cesarean section on the basis of organ-preserving treatment and reasonable intensive care in the postpartum period. Fifteen clinical cases in which on the background of peritonitis were made conserving surgery, which included: excision of necrotic areas on the uterus, uterine cavity curettage, metroplasty. Nasointestinal bowel intubation and drainage of the abdominal cavity. It is discussed tactics of postpartum women with obstetric peritonitis on the background of insolvency seams on the uterus, currently existing criteria for evaluation and treatment of patients data. The necessity of using in the algorithm survey postpartum women with obstetric peritonitis diagnostic criteria SIRS, leukocyte index of intoxication, integrated scales organ dysfunctions. Modern approaches to surgical treatment, the starting antibiotic therapy antibiotics ultra wide spectrum of action, combined with early intensive treatment in an intensive care unit avoids removal of the uterus as a primary focus.

What is different about medical students interested in non-clinical careers?

PubMed Central

2013-01-01

Background The proportion of medical school graduates who pursue careers other than full-time clinical practice has increased in some countries as the physician’s role has evolved and diversified with the changing landscape of clinical practice and the advancement of biomedicine. Still, past studies of medical students’ career choices have focused on clinical specialties and little is known about their choice of non-clinical careers. The present study examined backgrounds, motivation and perceptions of medical students who intended non-clinical careers. Methods A questionnaire was administered to students at six Korean medical schools distributed across all provinces in the nation. The questionnaire comprised 40 items on respondents’ backgrounds, their motivation for and interest in the study of medicine, their perceptions of medical professions, and their career intentions. Data was analyzed using various descriptive and inferential statistics. Results In total, 1,388 students returned the questionnaire (60% response rate), 12.3% of whom intended non-clinical careers (i.e., basic sciences, non-clinical medical fields, and non-medical fields). Those who planned non-clinical careers were comparable with their peers in their motivation for studying medicine and in their views of medical professions, but they were less interested in the study of medicine (P < 0.01). The two groups also differed significantly on their perceptions of what was uninteresting about the study of medicine (P < 0.01). The two groups were comparable in gender and entry-level ratios but their distributions across ages and years of study differed significantly (P < 0.01). A majority of respondents agreed with the statements that “it is necessary for medical school graduates to pursue non-clinical careers” and that “medical schools need to offer programs that provide information on such careers.” Still, our finding indicates that medical school curricula do not address

Anatomy and embryology of umbilicus in newborns: a review and clinical correlations.

PubMed

Hegazy, Abdelmonem A

2016-09-01

Umbilicus is considered a mirror of the abdomen in newborns. Despite its importance, the umbilicus has been stated in literature and textbooks as discrete subjects with many body systems, such as the urinary, digestive, and cardiovascular ones. This article aimed to address the basic knowledge of the umbilicus in relation to clinical disorders under one integrated topic to aid physicians and surgeons in assessing newborns and infants. The umbilicus appears as early as the fourth week of fetal life when the folding of the embryonic plate occurs. The umbilicus appears initially as a primitive umbilical ring on the ventral aspect of the body. The primitive umbilicus contains the connecting stalk, umbilical vessels, vitelline duct and vessels, allantois, and loop of the intestine. Changes occur to form the definitive cord, which contains three umbilical vessels, namely, "one vein and two arteries," embedded in Wharton's jelly. After birth, the umbilical vessels inside the body obliterate and gradually form ligaments. Congenital disorders at the umbilicus include herniation, bleeding, and discharge of mucous, urine, or feces. Some of these disorders necessitate emergent surgical interference, whereas others may be managed conservatively. The umbilicus has many embryological remnants. Thus, the umbilicus is prone to various clinical disorders. Detecting these disorders as early as possible is essential to prevent or minimize possible complications.

Clinical learning environment and supervision of international nursing students: A cross-sectional study.

PubMed

Mikkonen, Kristina; Elo, Satu; Miettunen, Jouko; Saarikoski, Mikko; Kääriäinen, Maria

2017-05-01

Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes. To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors. An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016. All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision. International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners. To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rectus sheath hematoma of the abdomen. Case report.

PubMed

Villena-Tovar, José Francisco

2010-01-01

Rectus sheath hematoma in the vast number of cases is due to an inferior epigastric artery tear occasionally due to trauma (not considered serious) or alterations in coagulation or use of anticoagulant therapy. It is an unlikely and difficult to diagnose pathology. We present the case of a 61-year-old female patient. The patient presented in emergency service with sudden abdominal pain caused by coughing as a result of an upper respiratory tract infection. The culmination was a spontaneous rectus sheath hematoma. Rectus sheath hematoma is a diagnosis to consider in a previously asymptomatic patient who presents with clinical features of acute pain and appearance of increase of volume in the abdominal wall involving the rectus muscles.

American Society of Clinical Oncology policy for relationships with companies: background and rationale.

PubMed

2013-06-01

The American Society of Clinical Oncology's (ASCO's) new conflict of interest policy reflects a commitment to transparency and independence in the development and presentation of scientific and educational content. ASCO supports thorough and accessible disclosure of financial relationships with companies at institutional and individual levels and calls for rigorous evaluation of content in light of the information disclosed. For abstracts and articles presenting original research, ASCO holds first, last, and corresponding authors to a clear standard of independence. In imposing restrictions, the new policy focuses on the role of these authors rather than of the principal investigator(s) as in the previous policy. ASCO remains actively engaged with the broader scientific community in seeking and implementing efficient, effective approaches to conflict of interest management.

Compressive Sensing for Background Subtraction

DTIC Science & Technology

2009-12-20

i) reconstructing an image using only a single optical pho- todiode (infrared, hyperspectral, etc.) along with a digital micromirror device (DMD... curves , we use the full images, run the background subtraction algorithm proposed in [19], and obtain baseline background subtracted images. We then...the images to generate the ROC curve . 5.5 Silhouettes vs. Difference Images We have used a multi camera set up for a 3D voxel reconstruction using the

Demonstration of Cosmic Microwave Background Delensing Using the Cosmic Infrared Background.

PubMed

Larsen, Patricia; Challinor, Anthony; Sherwin, Blake D; Mak, Daisy

2016-10-07

Delensing is an increasingly important technique to reverse the gravitational lensing of the cosmic microwave background (CMB) and thus reveal primordial signals the lensing may obscure. We present a first demonstration of delensing on Planck temperature maps using the cosmic infrared background (CIB). Reversing the lensing deflections in Planck CMB temperature maps using a linear combination of the 545 and 857 GHz maps as a lensing tracer, we find that the lensing effects in the temperature power spectrum are reduced in a manner consistent with theoretical expectations. In particular, the characteristic sharpening of the acoustic peaks of the temperature power spectrum resulting from successful delensing is detected at a significance of 16σ, with an amplitude of A_{delens}=1.12±0.07 relative to the expected value of unity. This first demonstration on data of CIB delensing, and of delensing techniques in general, is significant because lensing removal will soon be essential for achieving high-precision constraints on inflationary B-mode polarization.

Gamma-Ray Background Variability in Mobile Detectors

NASA Astrophysics Data System (ADS)

Aucott, Timothy John

Gamma-ray background radiation significantly reduces detection sensitivity when searching for radioactive sources in the field, such as in wide-area searches for homeland security applications. Mobile detector systems in particular must contend with a variable background that is not necessarily known or even measurable a priori. This work will present measurements of the spatial and temporal variability of the background, with the goal of merging gamma-ray detection, spectroscopy, and imaging with contextual information--a "nuclear street view" of the ubiquitous background radiation. The gamma-ray background originates from a variety of sources, both natural and anthropogenic. The dominant sources in the field are the primordial isotopes potassium-40, uranium-238, and thorium-232, as well as their decay daughters. In addition to the natural background, many artificially-created isotopes are used for industrial or medical purposes, and contamination from fission products can be found in many environments. Regardless of origin, these backgrounds will reduce detection sensitivity by adding both statistical as well as systematic uncertainty. In particular, large detector arrays will be limited by the systematic uncertainty in the background and will suffer from a high rate of false alarms. The goal of this work is to provide a comprehensive characterization of the gamma-ray background and its variability in order to improve detection sensitivity and evaluate the performance of mobile detectors in the field. Large quantities of data are measured in order to study their performance at very low false alarm rates. Two different approaches, spectroscopy and imaging, are compared in a controlled study in the presence of this measured background. Furthermore, there is additional information that can be gained by correlating the gamma-ray data with contextual data streams (such as cameras and global positioning systems) in order to reduce the variability in the background

Identification of the subthalamic nucleus in deep brain stimulation surgery with a novel wavelet-derived measure of neural background activity.

PubMed

Snellings, André; Sagher, Oren; Anderson, David J; Aldridge, J Wayne

2009-10-01

The authors developed a wavelet-based measure for quantitative assessment of neural background activity during intraoperative neurophysiological recordings so that the boundaries of the subthalamic nucleus (STN) can be more easily localized for electrode implantation. Neural electrophysiological data were recorded in 14 patients (20 tracks and 275 individual recording sites) with dopamine-sensitive idiopathic Parkinson disease during the target localization portion of deep brain stimulator implantation surgery. During intraoperative recording, the STN was identified based on audio and visual monitoring of neural firing patterns, kinesthetic tests, and comparisons between neural behavior and the known characteristics of the target nucleus. The quantitative wavelet-based measure was applied offline using commercially available software to measure the magnitude of the neural background activity, and the results of this analysis were compared with the intraoperative conclusions. Wavelet-derived estimates were also compared with power spectral density measurements. The wavelet-derived background levels were significantly higher in regions encompassed by the clinically estimated boundaries of the STN than in the surrounding regions (STN, 225 +/- 61 microV; ventral to the STN, 112 +/- 32 microV; and dorsal to the STN, 136 +/- 66 microV). In every track, the absolute maximum magnitude was found within the clinically identified STN. The wavelet-derived background levels provided a more consistent index with less variability than measurements with power spectral density. Wavelet-derived background activity can be calculated quickly, does not require spike sorting, and can be used to identify the STN reliably with very little subjective interpretation required. This method may facilitate the rapid intraoperative identification of STN borders.

Kawasaki Disease Presenting as Acute Intestinal Obstruction

PubMed Central

Lone, Yasir Ahmad; Menon, Jagadeesh; Menon, Prema; Vaiphei, Kim; Narasimha Rao, Katragadda Lakshmi; Thapa, Baburam; Gupta, Kirti

2017-01-01

Kawasaki disease (KD) is an acute febrile illness of childhood associated with vasculitis of medium-sized arteries especially the coronary arteries. Typical clinical features involving the skin, mucous surfaces, etc., occur sequentially over a few days. We report a rare presentation of KD as a surgical abdomen in a 2-year-old boy. Awareness of this presentation is important as it can otherwise lead to a delay in starting potentially life-saving intervention like intravenous immunoglobulins for cardiac complications kept cryptic by the manifest acute abdomen. PMID:28694577

Network Analysis of Associations between Serum Interferon Alpha Activity, Autoantibodies, and Clinical Features in Systemic Lupus Erythematosus

PubMed Central

Weckerle, Corinna E.; Franek, Beverly S.; Kelly, Jennifer A.; Kumabe, Marissa; Mikolaitis, Rachel A.; Green, Stephanie L.; Utset, Tammy O.; Jolly, Meenakshi; James, Judith A.; Harley, John B.; Niewold, Timothy B.

2010-01-01

Background Interferon-alpha (IFN-α) is a primary pathogenic factor in systemic lupus erythematosus (SLE), and high IFN-α levels may be associated with particular clinical manifestations. The prevalence of individual clinical and serologic features differs significantly by ancestry. We used multivariate and network analyses to detect associations between clinical and serologic disease manifestations and serum IFN-α activity in a large diverse SLE cohort. Methods 1089 SLE patients were studied (387 African-American, 186 Hispanic-American, and 516 European-American). Presence or absence of ACR clinical criteria for SLE, autoantibodies, and serum IFN-α activity data were analyzed in univariate and multivariate models. Iterative multivariate logistic regression was performed in each background separately to establish the network of associations between variables that were independently significant following Bonferroni correction. Results In all ancestral backgrounds, high IFN-α activity was associated with anti-Ro and anti-dsDNA antibodies (p-values 4.6×10−18 and 2.9 × 10−16 respectively). Younger age, non-European ancestry, and anti-RNP were also independently associated with increased serum IFN-α activity (p≤6.7×10−4). We found 14 unique associations between variables in network analysis, and only 7 of these associations were shared by more than one ancestral background. Associations between clinical criteria were different in different ancestral backgrounds, while autoantibody-IFN-α relationships were similar across backgrounds. IFN-α activity and autoantibodies were not associated with ACR clinical features in multivariate models. Conclusions Serum IFN-α activity was strongly and consistently associated with autoantibodies, and not independently associated with clinical features in SLE. IFN-α may be more relevant to humoral tolerance and initial pathogenesis than later clinical disease manifestations. PMID:21162028

Evaluation of Shifted Excitation Raman Difference Spectroscopy and Comparison to Computational Background Correction Methods Applied to Biochemical Raman Spectra.

PubMed

Cordero, Eliana; Korinth, Florian; Stiebing, Clara; Krafft, Christoph; Schie, Iwan W; Popp, Jürgen

2017-07-27

Raman spectroscopy provides label-free biochemical information from tissue samples without complicated sample preparation. The clinical capability of Raman spectroscopy has been demonstrated in a wide range of in vitro and in vivo applications. However, a challenge for in vivo applications is the simultaneous excitation of auto-fluorescence in the majority of tissues of interest, such as liver, bladder, brain, and others. Raman bands are then superimposed on a fluorescence background, which can be several orders of magnitude larger than the Raman signal. To eliminate the disturbing fluorescence background, several approaches are available. Among instrumentational methods shifted excitation Raman difference spectroscopy (SERDS) has been widely applied and studied. Similarly, computational techniques, for instance extended multiplicative scatter correction (EMSC), have also been employed to remove undesired background contributions. Here, we present a theoretical and experimental evaluation and comparison of fluorescence background removal approaches for Raman spectra based on SERDS and EMSC.

Studying extragalactic background fluctuations with the Cosmic Infrared Background ExpeRiment 2 (CIBER-2)

NASA Astrophysics Data System (ADS)

Lanz, Alicia; Arai, Toshiaki; Battle, John; Bock, James; Cooray, Asantha; Hristov, Viktor; Korngut, Phillip; Lee, Dae Hee; Mason, Peter; Matsumoto, Toshio; Matsuura, Shuji; Morford, Tracy; Onishi, Yosuke; Shirahata, Mai; Tsumura, Kohji; Wada, Takehiko; Zemcov, Michael

2014-08-01

Fluctuations in the extragalactic background light trace emission from the history of galaxy formation, including the emission from the earliest sources from the epoch of reionization. A number of recent near-infrared measure- ments show excess spatial power at large angular scales inconsistent with models of z < 5 emission from galaxies. These measurements have been interpreted as arising from either redshifted stellar and quasar emission from the epoch of reionization, or the combined intra-halo light from stars thrown out of galaxies during merging activity at lower redshifts. Though astrophysically distinct, both interpretations arise from faint, low surface brightness source populations that are difficult to detect except by statistical approaches using careful observations with suitable instruments. The key to determining the source of these background anisotropies will be wide-field imaging measurements spanning multiple bands from the optical to the near-infrared. The Cosmic Infrared Background ExpeRiment 2 (CIBER-2) will measure spatial anisotropies in the extra- galactic infrared background caused by cosmological structure using six broad spectral bands. The experiment uses three 2048 x 2048 Hawaii-2RG near-infrared arrays in three cameras coupled to a single 28.5 cm telescope housed in a reusable sounding rocket-borne payload. A small portion of each array will also be combined with a linear-variable filter to make absolute measurements of the spectrum of the extragalactic background with high spatial resolution for deep subtraction of Galactic starlight. The large field of view and multiple spectral bands make CIBER-2 unique in its sensitivity to fluctuations predicted by models of lower limits on the luminosity of the first stars and galaxies and in its ability to distinguish between primordial and foreground anisotropies. In this paper the scientific motivation for CIBER-2 and details of its first flight instrumentation will be discussed, including

Enhanced clinical outcome with manual massage following cryolipolysis treatment: a 4-month study of safety and efficacy.

PubMed

Boey, Gerald E; Wasilenchuk, Jennifer L

2014-01-01

Cryolipolysis procedures have been shown to safely and effectively reduce the thickness of fat in a treated region. This study was conducted to determine whether the addition of post-treatment manual massage would improve efficacy while maintaining the safety profile of the original cryolipolysis treatment protocol. The study population consisted of an efficacy group (n = 10) and a safety group (n = 7). Study subjects were treated on each side of the lower abdomen with a Cooling Intensity Factor of 42 (-72.9 mW/cm(2) ) for 60 minutes. One side of the abdomen was massaged post-treatment and the other side served as the control. Immediately post-treatment, the massage side was treated for 1 minute using a vigorous kneading motion followed by 1 minute of circular massage using the pads of the fingers. For the efficacy group, photos and ultrasound measurements were taken at baseline, 2 months, and 4 months post-treatment. For the safety group, histological analysis was completed at 0, 3, 8, 14, 30, 60, and 120 days post-treatment to examine the effects of massage on subcutaneous tissue over time. Post-treatment manual massage resulted in a consistent and discernible increase in efficacy over the non-massaged side. At 2 months post-treatment, mean fat layer reduction was 68% greater in the massage side than in the non-massage side as measured by ultrasound. By 4 months, mean fat layer reduction was 44% greater in the massage side. Histological results showed no evidence of necrosis or fibrosis resulting from the massage. Post-treatment manual massage is a safe and effective technique to enhance the clinical outcome from a cryolipolysis procedure. © 2013 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.

The Cosmic Background Explorer.

ERIC Educational Resources Information Center

Gulkis, Samuel; And Others

1990-01-01

Outlines the Cosmic Background Explorer (COBE) mission to measure celestial radiation. Describes the instruments used and experiments involving differential microwave radiometers, and a far infrared absolute spectrophotometer. (YP)

Non-perturbative background field calculations

NASA Astrophysics Data System (ADS)

Stephens, C. R.

1988-01-01

New methods are developed for calculating one loop functional determinants in quantum field theory. Instead of relying on a calculation of all the eigenvalues of the small fluctuation equation, these techniques exploit the ability of the proper time formalism to reformulate an infinite dimensional field theoretic problem into a finite dimensional covariant quantum mechanical analog, thereby allowing powerful tools such as the method of Jacobi fields to be used advantageously in a field theory setting. More generally the methods developed herein should be extremely valuable when calculating quantum processes in non-constant background fields, offering a utilitarian alternative to the two standard methods of calculation—perturbation theory in the background field or taking the background field into account exactly. The formalism developed also allows for the approximate calculation of covariances of partial differential equations from a knowledge of the solutions of a homogeneous ordinary differential equation.

Celiac Disease in Children with Severe Acute Malnutrition (SAM): A Hospital Based Study.

PubMed

Beniwal, Neetu; Ameta, Gaurav; Chahar, Chandra Kumar

2017-05-01

To evaluate the prevalence and clinical features of Celiac disease among children with severe acute malnutrition (SAM). This prospective observational study was conducted in PBM Children Hospital, Bikaner from July 2012 through December 2013. All consecutively admitted children with SAM were recruited. All subjects were screened for Celiac disease by serological test for IgA-anti tissue Transglutaminase (IgA tTG) antibodies. All seropositive children underwent upper gastrointestinal endoscopy for small bowel biopsy for the confirmation. Clinical features of patients with and without celiac disease were compared. The sero-prevalence (IgA tTg positivity) of Celiac disease was found to be 15.38% while prevalence of biopsy confirmed Celiac disease was 14.42% among SAM children. Abdominal distension, diarrhea, anorexia, constipation, pain in abdomen, vitamin deficiencies, edema, clubbing and mouth ulcers were more common in patients of Celiac disease compared to patients without Celiac disease but the difference was statistically significant only for abdominal distension and pain abdomen. There is a high prevalence of Celiac disease in SAM. Screening for Celiac disease (especially in presence of pain abdomen and abdominal distension) should be an essential part of work-up in all children with SAM.

Early Versus Delayed Source Control in Open Abdomen Management for Severe Intra-abdominal Infections: A Retrospective Analysis on 111 Cases.

PubMed

Rausei, Stefano; Pappalardo, Vincenzo; Ruspi, Laura; Colella, Antonio; Giudici, Simone; Ardita, Vincenzo; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

2018-03-01

Time to source control plays a determinant prognostic role in patients having severe intra-abdominal infections (IAIs). Open abdomen (OA) management became an effective treatment option for peritonitis. Aim of this study was to analyze the correlation between time to source control and outcome in patients presenting with abdominal sepsis and treated by OA. We retrospectively analyzed 111 patients affected by abdominal sepsis and treated with OA from May 2007 to May 2015. Patients were classified according to time interval from first patient evaluation to source control. The end points were intra-hospital mortality and primary fascial closure rate. The in-hospital mortality rate was 21.6% (24/111), and the primary fascial closure rate was 90.9% (101/111). A time to source control ≥6 h resulted significantly associated with a poor prognosis and a lower fascial closure rate (mortality 27.0 vs 9.0%, p = 0.04; primary fascial closure 86 vs 100%, p = 0.02). We observed a direct increase in mortality (and a reduction in closure rate) for each 6-h delay in surgery to source control. Early source control using OA management significantly improves outcome of patients with severe IAIs. This damage control approach well fits to the treatment of time-related conditions, particularly in case of critically ill patients.

Gifted Students from Low-Education Backgrounds

ERIC Educational Resources Information Center

Gibbons, Melinda M.; Pelchar, Taylor K.; Cochran, Jeff L.

2012-01-01

Gifted children from low-education backgrounds often experience barriers to educational and career success. This article reviews the growing body of literature regarding gifted students from low-education backgrounds and the related literature on the challenges and characteristics of first-generation college students. A mother and daughter…

[PATOGENETIC VALUE OF VIOLATIONS FROM GLUTATHIONE SYSTEM AT THE PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS ON A BACKGROUND OF DIABETES MELLITUS TYPE II].

PubMed

Kostev, I V; Teryoshin, V A; Sotckaya, Ya A; Homutyanskay, N I; Dolgopolova, E V; Salamech, K A

2015-01-01

At the patients with nonalcoholic steatohepatitis on a background of diabetes mellitus type 11, after completion of the generally accepted medical treatment there was no normalization of indexes of the glutation system (the level of recovered glutation and activity of enzymes the glutation redox--system was saved decreased), that in a clinical plan was represented in a presence unstable clinical and biochemical remission of disease.

[PATOGENETIC VALUE OF VIOLATIONS FROM GLUTATHIONE SYSTEM AT THE PATIENTS WITH NONALCOHOLIC STEATOHEPATITIS ON A BACKGROUND OF DIABETES MELLITUS TYPE II].

PubMed

Sotskaya, Ya A; Homutyanskaya, N I; Dolgopolova, E V; Salamekh, K A

2015-01-01

At the patients with nonalcoholic steatohepatitis on a background of diabetes mellitus type II, after completion of the generally accepted medical treatment there was no normalization of indexes of the glutation system (the level of recovered glutation and activity of enzymes the glutation redox-system was saved decreased), that in a clinical plan was represented in.a presence unstable clinical and biochemical remission of disease.

Impact of clinical pharmacist intervention in anticoagulation clinic in Sudan.

PubMed

Ahmed, Nahid Osman; Osman, Bashier; Abdelhai, Yassein Mohamed; El-Hadiyah, Tariq Muhammed Hashim

2017-08-01

Background Many trials have compared anticoagulation management provided by a pharmacist led anticoagulation clinic versus usual physician care showing the role for clinical pharmacist in the management of anticoagulant therapy, and demonstrating excellent outcomes. In Sudan, there is no published research evaluating the role of pharmacist in providing pharmaceutical care for patients taking warfarin. Objective The objective of the study is to assess the role of clinical pharmacist intervention in warfarin patients compared to usual medical care. Setting This study was conducted in Ahmed Gasim cardiac surgery and renal transplant center warfarin clinic. Methods One hundred thirty-five patients were randomly selected from adult patients on warfarin therapy The history of INR records, and adverse effects for the past year, were recorded. Then patients' warfarin dose adjustments according to INR, was done by the clinical pharmacist for one year. Patients received continuous verbal education and written information about warfarin. Main outcome measure The primary outcome for this study was the INR control, while the secondary outcomes were the bleeding events and hospitalization due to warfarin. Results After the clinical pharmacist intervention there was significant (P < 0.01) improvement in INR control and a significant (P < 0.05) reduction in incidence of bleeding after clinical pharmacist intervention. Hospitalization due to warfarin related complications (bleeding, high INR, low INR) was also significantly (P < 0.001) reduced. Conclusion Clinical pharmacists intervention in warfarin therapy improve INR control, reduce bleeding and hospitalization due to warfarin complications.

Status of the Simbol-X Background Simulation Activities

NASA Astrophysics Data System (ADS)

Tenzer, C.; Briel, U.; Bulgarelli, A.; Chipaux, R.; Claret, A.; Cusumano, G.; Dell'Orto, E.; Fioretti, V.; Foschini, L.; Hauf, S.; Kendziorra, E.; Kuster, M.; Laurent, P.; Tiengo, A.

2009-05-01

The Simbol-X background simulation group is working towards a simulation based background and mass model which can be used before and during the mission. Using the Geant4 toolkit, a Monte-Carlo code to simulate the detector background of the Simbol-X focal plane instrument has been developed with the aim to optimize the design of the instrument. Achieving an overall low instrument background has direct impact on the sensitivity of Simbol-X and thus will be crucial for the success of the mission. We present results of recent simulation studies concerning the shielding of the detectors with respect to the diffuse cosmic hard X-ray background and to the cosmic-ray proton induced background. Besides estimates of the level and spectral shape of the remaining background expected in the low and high energy detector, also anti-coincidence rates and resulting detector dead time predictions are discussed.

45 CFR 650.16 - Background rights.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 45 Public Welfare 3 2012-10-01 2012-10-01 false Background rights. 650.16 Section 650.16 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PATENTS § 650.16 Background rights. The Foundation will acquire rights to a research performer's pre-existing technology only...

Multi-talker background and semantic priming effect

PubMed Central

Dekerle, Marie; Boulenger, Véronique; Hoen, Michel; Meunier, Fanny

2014-01-01

The reported studies have aimed to investigate whether informational masking in a multi-talker background relies on semantic interference between the background and target using an adapted semantic priming paradigm. In 3 experiments, participants were required to perform a lexical decision task on a target item embedded in backgrounds composed of 1–4 voices. These voices were Semantically Consistent (SC) voices (i.e., pronouncing words sharing semantic features with the target) or Semantically Inconsistent (SI) voices (i.e., pronouncing words semantically unrelated to each other and to the target). In the first experiment, backgrounds consisted of 1 or 2 SC voices. One and 2 SI voices were added in Experiments 2 and 3, respectively. The results showed a semantic priming effect only in the conditions where the number of SC voices was greater than the number of SI voices, suggesting that semantic priming depended on prime intelligibility and strategic processes. However, even if backgrounds were composed of 3 or 4 voices, reducing intelligibility, participants were able to recognize words from these backgrounds, although no semantic priming effect on the targets was observed. Overall this finding suggests that informational masking can occur at a semantic level if intelligibility is sufficient. Based on the Effortfulness Hypothesis, we also suggest that when there is an increased difficulty in extracting target signals (caused by a relatively high number of voices in the background), more cognitive resources were allocated to formal processes (i.e., acoustic and phonological), leading to a decrease in available resources for deeper semantic processing of background words, therefore preventing semantic priming from occurring. PMID:25400572

Perceived Discrimination in Patients With Psychiatric Disorder and Turkish Migration Background in Germany.

PubMed

Müller, Matthias J; Koch, Eckhardt

2016-07-01

Perceived discrimination (PD) has a negative impact on the course of psychiatric disorders. We have investigated PD in inpatients with affective or anxiety disorder and Turkish migration background (TP) or native Germans (GP). Migration-related, clinical, and sociodemographic data of n = 62 TP and n = 62 GP, matched for age, sex, and psychiatric diagnoses, were retrospectively analyzed. PD was assessed as one of 10 questions related to migration and acculturation (yes/no, severity 0-10). PD prevalence rates were compared between TP and GP; relationships of PD with other variables were analyzed using bivariate correlations and multiple regression analyses. A PD prevalence of 26% in TP and 1% in GP was found (odds ratio, 21.2 [2.7-165.8]). Migration background was the strongest predictor of PD in the total group. Within the TP sample, asylum-seeking status and migration-related distress were significantly predictive of PD. In patients with psychiatric disorder in Germany, PD seems to be strongly related to migration-related distress.

Bioterrorism: Implications for the Clinical Microbiologist

PubMed Central

Klietmann, Wolfgang F.; Ruoff, Kathryn L.

2001-01-01

The specter of bioterrorism has captured the attention of government and military officials, scientists, and the general public. Compared to other sectors of the population, clinical microbiologists are more directly impacted by concerns about bioterrorism. This review focuses on the role envisioned for clinical laboratories in response to a bioterrorist event. The microbiology and clinical aspects of the biological agents thought to be the most likely tools of bioterrorists are presented. The historical background of the problem of bioterrorism and an overview of current U.S. preparedness planning, with an emphasis on the roles of health care professionals, are also included. PMID:11292643

Foregrounding the Background.

ERIC Educational Resources Information Center

Robbins, Bruce

1998-01-01

Argues that when introductory activities to the classics begin with background information, it can upstage or confine the life of the story, and shows little faith in the students as readers or in the literature itself. Suggests sometimes letting the literature begin, and then helping students make sense of it. Discusses examples from "To Kill a…

Effects of background stimulation upon eye-movement information.

PubMed

Nakamura, S

1996-04-01

To investigate the effects of background stimulation upon eye-movement information (EMI), the perceived deceleration of the target motion during pursuit eye movement (Aubert-Fleishl paradox) was analyzed. In the experiment, a striped pattern was used as a background stimulus with various brightness contrasts and spatial frequencies for serially manipulating the attributions of the background stimulus. Analysis showed that the retinal-image motion of the background stimulus (optic flow) affected eye-movement information and that the effects of optic flow became stronger when high contrast and low spatial frequency stripes were presented as the background stimulus. In conclusion, optic flow is one source of eye-movement information in determining real object motion, and the effectiveness of optic flow depends on the attributes of the background stimulus.

Background Error Correlation Modeling with Diffusion Operators

DTIC Science & Technology

2013-01-01

RESPONSIBLE PERSON 19b. TELEPHONE NUMBER (Include area code) 07-10-2013 Book Chapter Background Error Correlation Modeling with Diffusion Operators...normalization Unclassified Unclassified Unclassified UU 27 Max Yaremchuk (228) 688-5259 Reset Chapter 8 Background error correlation modeling with diffusion ...field, then a structure like this simulates enhanced diffusive transport of model errors in the regions of strong cur- rents on the background of

Comparison of presbyopic additions determined by the fused cross-cylinder method using alternative target background colours.

PubMed

Wee, Sung-Hyun; Yu, Dong-Sik; Moon, Byeong-Yeon; Cho, Hyun Gug

2010-11-01

To compare and contrast standard and alternative versions of refractor head (phoropter)-based charts used to determine reading addition. Forty one presbyopic subjects aged between 42 and 60 years were tested. Tentative additions were determined using a red-green background letter chart, and 4 cross-grid charts (with white, red, green, or red-green backgrounds) which were used with the fused cross cylinder (FCC) method. The final addition for a 40 cm working distance was determined for each subject by subjectively adjusting the tentative additions. There were significant differences in the tentative additions obtained using the 5 methods (repeated measures ANOVA, p < 0.001). The mean differences between the tentative and final additions were <0.10 D and were not clinically meaningful, with the exception of the red-green letter test, and the red background in the FCC method. There were no significant differences between the tentative and final additions for the green background in the FCC method (p > 0.05). The intervals of the 95% limits of agreement were under ±0.50 D, and the narrowest interval (±0.26 D) was for the red-green background. The 3 FCC methods with a white, green, or red-green background provided a tentative addition close to the final addition. Compared with the other methods, the FCC method with the red-green background had a narrow range of error. Further, since this method combines the functions of both the fused cross-cylinder test and the duochrome test, it can be a useful technique for determining presbyopic additions. © 2010 The Authors. Ophthalmic and Physiological Optics © 2010 The College of Optometrists.

Social Background, Composition and Educational Growth.

ERIC Educational Resources Information Center

Mare, Robert D.

1979-01-01

Studies the impact of changes in family background on grade-level attainment for White males between 1907-1951. Findings show that the effects of social background on grade attainment decrease with increasing levels of attainment. Reprint available from Institute for Research on Poverty, University of Wisconsin-Madison, Madison WI 53706. (AM)

The Radio Background below 100 MHz

NASA Astrophysics Data System (ADS)

Dowell, Jayce; Taylor, Greg B.

2018-05-01

The recent detection of the “cosmic dawn” redshifted 21 cm signal at 78 MHz by the Experiment to Detect the Global EoR Signatures (EDGES) differs significantly from theoretical predictions. In particular, the absorption trough is roughly a factor of two stronger than the most optimistic theoretical models. The early interpretations of the origin of this discrepancy fall into two categories. The first is that there is increased cooling of the gas due to interactions with dark matter, while the second is that the background radiation field includes a contribution from a component in addition to the cosmic microwave background (CMB). In this Letter we examine the feasibility of the second idea using new data from the first station of the Long Wavelength Array. The data span 40–80 MHz and provide important constraints on the present-day background in a frequency range where there are few surveys with absolute temperature calibration suitable for measuring the strength of the radio monopole. We find support for a strong, diffuse radio background that was suggested by the ARCARDE 2 results in the 3–10 GHz range. We find that this background is well modeled by a power law with a spectral index of ‑2.58 ± 0.05 and a temperature at the rest frame 21 cm frequency of {603}-92+102 mK.

Efficient multi-atlas abdominal segmentation on clinically acquired CT with SIMPLE context learning.

PubMed

Xu, Zhoubing; Burke, Ryan P; Lee, Christopher P; Baucom, Rebeccah B; Poulose, Benjamin K; Abramson, Richard G; Landman, Bennett A

2015-08-01

Abdominal segmentation on clinically acquired computed tomography (CT) has been a challenging problem given the inter-subject variance of human abdomens and complex 3-D relationships among organs. Multi-atlas segmentation (MAS) provides a potentially robust solution by leveraging label atlases via image registration and statistical fusion. We posit that the efficiency of atlas selection requires further exploration in the context of substantial registration errors. The selective and iterative method for performance level estimation (SIMPLE) method is a MAS technique integrating atlas selection and label fusion that has proven effective for prostate radiotherapy planning. Herein, we revisit atlas selection and fusion techniques for segmenting 12 abdominal structures using clinically acquired CT. Using a re-derived SIMPLE algorithm, we show that performance on multi-organ classification can be improved by accounting for exogenous information through Bayesian priors (so called context learning). These innovations are integrated with the joint label fusion (JLF) approach to reduce the impact of correlated errors among selected atlases for each organ, and a graph cut technique is used to regularize the combined segmentation. In a study of 100 subjects, the proposed method outperformed other comparable MAS approaches, including majority vote, SIMPLE, JLF, and the Wolz locally weighted vote technique. The proposed technique provides consistent improvement over state-of-the-art approaches (median improvement of 7.0% and 16.2% in DSC over JLF and Wolz, respectively) and moves toward efficient segmentation of large-scale clinically acquired CT data for biomarker screening, surgical navigation, and data mining. Copyright © 2015 Elsevier B.V. All rights reserved.

14 CFR § 1214.302 - Background.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 5 2014-01-01 2014-01-01 false Background. § 1214.302 Section § 1214.302 Aeronautics and Space NATIONAL AERONAUTICS AND SPACE ADMINISTRATION SPACE FLIGHT Payload Specialists for Space Transportation System (STS) Missions § 1214.302 Background. (a) The Space Transportation System (STS) has been...

45 CFR 650.16 - Background rights.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 45 Public Welfare 3 2014-10-01 2014-10-01 false Background rights. 650.16 Section 650.16 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PATENTS § 650.16 Background rights. The Foundation will acquire rights to a research performer's pre-existing technology only in exceptional circumstances where, du...

45 CFR 650.16 - Background rights.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 45 Public Welfare 3 2010-10-01 2010-10-01 false Background rights. 650.16 Section 650.16 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PATENTS § 650.16 Background rights. The Foundation will acquire rights to a research performer's pre-existing technology only in exceptional circumstances where, du...

45 CFR 650.16 - Background rights.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 45 Public Welfare 3 2013-10-01 2013-10-01 false Background rights. 650.16 Section 650.16 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PATENTS § 650.16 Background rights. The Foundation will acquire rights to a research performer's pre-existing technology only in exceptional circumstances where, du...

45 CFR 650.16 - Background rights.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 45 Public Welfare 3 2011-10-01 2011-10-01 false Background rights. 650.16 Section 650.16 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION PATENTS § 650.16 Background rights. The Foundation will acquire rights to a research performer's pre-existing technology only in exceptional circumstances where, du...

Social Background and School Continuation Decisions.

ERIC Educational Resources Information Center

Mare, Robert D.

1980-01-01

Presents a model of the relationship between social background and school continuation decisions among White males born between 1900 and 1950. The model predicts a decline in the effects of social background by the last school transition. Reprint available from Institute for Research on Poverty, University of Wisconsin, Madison, WI 53706. (AM)

Clinical simulation training improves the clinical performance of Chinese medical students

PubMed Central

Zhang, Ming-ya; Cheng, Xin; Xu, An-ding; Luo, Liang-ping; Yang, Xuesong

2015-01-01

Background Modern medical education promotes medical students’ clinical operating capacity rather than the mastery of theoretical knowledge. To accomplish this objective, clinical skill training using various simulations was introduced into medical education to cultivate creativity and develop the practical ability of students. However, quantitative analysis of the efficiency of clinical skill training with simulations is lacking. Methods In the present study, we compared the mean scores of medical students (Jinan University) who graduated in 2013 and 2014 on 16 stations between traditional training (control) and simulative training groups. In addition, in a clinical skill competition, the objective structured clinical examination (OSCE) scores of participating medical students trained using traditional and simulative training were compared. The data were statistically analyzed and qualitatively described. Results The results revealed that simulative training could significantly enhance the graduate score of medical students compared with the control. The OSCE scores of participating medical students in the clinical skill competition, trained using simulations, were dramatically higher than those of students trained through traditional methods, and we also observed that the OSCE marks were significantly increased for the same participant after simulative training for the clinical skill competition. Conclusions Taken together, these data indicate that clinical skill training with a variety of simulations could substantially promote the clinical performance of medical students and optimize the resources used for medical education, although a precise analysis of each specialization is needed in the future. PMID:26478142

Is estimated bullet trajectory a reliable predictor of severe injury? Case report of a thoraco-abdominal gunshot with a protracted trajectory managed nonoperatively

PubMed Central

2013-01-01

Background Operative management of all gunshot’s traumas carries a high rate of unwarranted interventions that are known to cause serious complications. Selective nonoperative management is thus being increasingly practiced which has reduced these avoidable interventions. Physical examination and computed tomography scans are most sensitive in assessing need of laparotomy. Assessment of internal injuries on the basis of an estimated bullet trajectory is often practiced but has seldom been studied. We report a case of conservative management of a thoraco abdominal gun shot patient where an estimated bullet trajectory was indicative of serious injuries. To the best of our knowledge this is the first report of a thoraco abdominal gunshot that, despite of a protracted trajectory, had no sequelae and was thus managed nonoperatively. Case presentation A 30 year old male patient having height of 180 cm and weight of 70 kg (Body Mass Index 21.6) presented with complaint of a penetrating injury at left side of upper torso. The patient had no symptoms or obvious bleeding and was vitally stable. On examination a 1 cm × 1 cm entry wound at the left 3rd intercostal space in the mid clavicular line was identified. The chest and abdomen were otherwise unremarkable on examination. The chest radiograph displayed clear lung fields. The abdominal radiographs displayed a bullet in the upper left quadrant of the abdomen lateral to the spine. The bullets estimated trajectory from 3rd intercostal space and its lodgment in the abdomen lateral to the spine indicated severe visceral injury. The computed tomography scan showed that the bullet was lodged postero-medially to the left kidney. All thoracic, intra peritoneal and retroperitoneal visceral structures were identified to be normal. The patient remained clinically and vitally stable, hence was managed nonoperatively being discharged after 48 h of observation. Conclusion From this case we conclude that decision for managing gun

Evaluation of Shifted Excitation Raman Difference Spectroscopy and Comparison to Computational Background Correction Methods Applied to Biochemical Raman Spectra

PubMed Central

Cordero, Eliana; Korinth, Florian; Stiebing, Clara; Krafft, Christoph; Schie, Iwan W.; Popp, Jürgen

2017-01-01

Raman spectroscopy provides label-free biochemical information from tissue samples without complicated sample preparation. The clinical capability of Raman spectroscopy has been demonstrated in a wide range of in vitro and in vivo applications. However, a challenge for in vivo applications is the simultaneous excitation of auto-fluorescence in the majority of tissues of interest, such as liver, bladder, brain, and others. Raman bands are then superimposed on a fluorescence background, which can be several orders of magnitude larger than the Raman signal. To eliminate the disturbing fluorescence background, several approaches are available. Among instrumentational methods shifted excitation Raman difference spectroscopy (SERDS) has been widely applied and studied. Similarly, computational techniques, for instance extended multiplicative scatter correction (EMSC), have also been employed to remove undesired background contributions. Here, we present a theoretical and experimental evaluation and comparison of fluorescence background removal approaches for Raman spectra based on SERDS and EMSC. PMID:28749450

Caries and background factors in Swedish 4-year-old children with special reference to immigrant status.

PubMed

Stecksén-Blicks, Christina; Hasslöf, Pamela; Kieri, Catarina; Widman, Kjerstin

2014-11-01

This study assesses the prevalence of caries and some background factors in 4-year-old children in the city of Umeå, northern Sweden, and compares this with data from earlier studies to reveal changes over time. Children from the catchment areas of three Public Dental Health Service clinics in Umeå (n = 224) born during the third quarter of 2008 were invited to undergo a clinical dental examination. Decayed surfaces (including both dentine and enamel, except for enamel lesions on buccal and lingual surfaces), missing and filled surfaces (dmfs) were recorded using the same methods and criteria as in a series of earlier studies performed between 1980-2007. Background data were collected in a case-history and a questionnaire. Results. The proportion of children with caries significantly decreased from 2007 (38%) to 2012 (22%) (p < 0.05). In addition, the distribution of dmfs differed significantly between these years (p < 0.05). More immigrant children had caries (42%) than non-immigrant children (15%) (p < 0.05). For children with caries, there were no significant changes in the distribution of dmfs between 1980-2012 (p > 0.05). An immigrant background was associated with a lower frequency of tooth brushing and a higher intake of ice cream, sweets and chocolate drinks (p < 0.05). Although the proportion of children with caries declined between 2007-2012, this decline was limited to non-immigrant children. Since 1980 the distribution of dmfs remained unchanged among children with caries. More research on interventions for changing oral health behaviours is needed, specifically for immigrant children.

Notification: Background Investigation Services

EPA Pesticide Factsheets

Project #OA-FY15-0029, February 26, 2015. The Office of Inspector General (OIG) for the U.S. Environmental Protection Agency (EPA) plans to begin field work for our audit of background investigation services.

Physiologic correlates to background noise acceptance

NASA Astrophysics Data System (ADS)

Tampas, Joanna; Harkrider, Ashley; Nabelek, Anna

2004-05-01

Acceptance of background noise can be evaluated by having listeners indicate the highest background noise level (BNL) they are willing to accept while following the words of a story presented at their most comfortable listening level (MCL). The difference between the selected MCL and BNL is termed the acceptable noise level (ANL). One of the consistent findings in previous studies of ANL is large intersubject variability in acceptance of background noise. This variability is not related to age, gender, hearing sensitivity, personality, type of background noise, or speech perception in noise performance. The purpose of the current experiment was to determine if individual differences in physiological activity measured from the peripheral and central auditory systems of young female adults with normal hearing can account for the variability observed in ANL. Correlations between ANL and various physiological responses, including spontaneous, click-evoked, and distortion-product otoacoustic emissions, auditory brainstem and middle latency evoked potentials, and electroencephalography will be presented. Results may increase understanding of the regions of the auditory system that contribute to individual noise acceptance.

Identification of the subthalamic nucleus in deep brain stimulation surgery with a novel wavelet-derived measure of neural background activity

PubMed Central

Snellings, André; Sagher, Oren; Anderson, David J.; Aldridge, J. Wayne

2016-01-01

Object A wavelet-based measure was developed to quantitatively assess neural background activity taken during surgical neurophysiological recordings to localize the boundaries of the subthalamic nucleus during target localization for deep brain stimulator implant surgery. Methods Neural electrophysiological data was recorded from 14 patients (20 tracks, n = 275 individual recording sites) with dopamine-sensitive idiopathic Parkinson’s disease during the target localization portion of deep brain stimulator implant surgery. During intraoperative recording the STN was identified based upon audio and visual monitoring of neural firing patterns, kinesthetic tests, and comparisons between neural behavior and known characteristics of the target nucleus. The quantitative wavelet-based measure was applied off-line using MATLAB software to measure the magnitude of the neural background activity, and the results of this analysis were compared to the intraoperative conclusions. Wavelet-derived estimates were compared to power spectral density measures. Results The wavelet-derived background levels were significantly higher in regions encompassed by the clinically estimated boundaries of the STN than in surrounding regions (STN: 225 ± 61 μV vs. ventral to STN: 112 ± 32 μV, and dorsal to STN: 136 ± 66 μV). In every track, the absolute maximum magnitude was found within the clinically identified STN. The wavelet-derived background levels provided a more consistent index with less variability than power spectral density. Conclusions The wavelet-derived background activity assessor can be calculated quickly, requires no spike sorting, and can be reliably used to identify the STN with very little subjective interpretation required. This method may facilitate rapid intraoperative identification of subthalamic nucleus borders. PMID:19344225

The cosmic microwave background radiation

NASA Technical Reports Server (NTRS)

Silk, Joseph

1992-01-01

A review the implications of the spectrum and anisotropy of the cosmic microwave background for cosmology. Thermalization and processes generating spectral distortions are discussed. Anisotropy predictions are described and compared with observational constraints. If the evidence for large-scale power in the galaxy distribution in excess of that predicted by the cold dark matter model is vindicated, and the observed structure originated via gravitational instabilities of primordial density fluctuations, the predicted amplitude of microwave background anisotropies on angular scales of a degree and larger must be at least several parts in 10 exp 6.

Urban Background Study Webinar

EPA Pesticide Factsheets

This webinar presented the methodology developed for collecting a city-wide or urban area background data set, general results of southeastern cities data collected to date, and a case study that used this sampling method.

Characterizing the True Background Corona with SDO/AIA

NASA Technical Reports Server (NTRS)

Napier, Kate; Winebarger, Amy; Alexander, Caroline

2014-01-01

Characterizing the nature of the solar coronal background would enable scientists to more accurately determine plasma parameters, and may lead to a better understanding of the coronal heating problem. Because scientists study the 3D structure of the Sun in 2D, any line of sight includes both foreground and background material, and thus, the issue of background subtraction arises. By investigating the intensity values in and around an active region, using multiple wavelengths collected from the Atmospheric Imaging Assembly (AIA) on the Solar Dynamics Observatory (SDO) over an eight-hour period, this project aims to characterize the background as smooth or structured. Different methods were employed to measure the true coronal background and create minimum intensity images. These were then investigated for the presence of structure. The background images created were found to contain long-lived structures, including coronal loops, that were still present in all of the wavelengths, 193 Angstroms,171 Angstroms,131 Angstroms, and 211 Angstroms. The intensity profiles across the active region indicate that the background is much more structured than previously thought.

Using Mobile Health Clinics to Reach College Students: A National Demonstration Project

ERIC Educational Resources Information Center

Fennell, Reginald; Escue, Christopher

2013-01-01

Background: The mobile health unit (MHU) was a grant-funded national initiative to explore the utilization of a mobile clinic to provide health promotion and clinical services for college students in the United States. Purpose: In 2010 and 2011, a 38-foot mobile clinic tested the feasibility of utilizing the clinic to deliver health promotion and…

Background derivation and image flattening: getimages

NASA Astrophysics Data System (ADS)

Men'shchikov, A.

2017-11-01

Modern high-resolution images obtained with space observatories display extremely strong intensity variations across images on all spatial scales. Source extraction in such images with methods based on global thresholding may bring unacceptably large numbers of spurious sources in bright areas while failing to detect sources in low-background or low-noise areas. It would be highly beneficial to subtract background and equalize the levels of small-scale fluctuations in the images before extracting sources or filaments. This paper describes getimages, a new method of background derivation and image flattening. It is based on median filtering with sliding windows that correspond to a range of spatial scales from the observational beam size up to a maximum structure width Xλ. The latter is a single free parameter of getimages that can be evaluated manually from the observed image ℐλ. The median filtering algorithm provides a background image \\tilde{Bλ} for structures of all widths below Xλ. The same median filtering procedure applied to an image of standard deviations 𝓓λ derived from a background-subtracted image \\tilde{Sλ} results in a flattening image \\tilde{Fλ}. Finally, a flattened detection image I{λD} = \\tilde{Sλ}/\\tilde{Fλ} is computed, whose standard deviations are uniform outside sources and filaments. Detecting sources in such greatly simplified images results in much cleaner extractions that are more complete and reliable. As a bonus, getimages reduces various observational and map-making artifacts and equalizes noise levels between independent tiles of mosaicked images.

Modeled summer background concentration nutrients and ...

EPA Pesticide Factsheets

We used regression models to predict background concentration of four water quality indictors: total nitrogen (N), total phosphorus (P), chloride, and total suspended solids (TSS), in the mid-continent (USA) great rivers, the Upper Mississippi, the Lower Missouri, and the Ohio. From best-model linear regressions of water quality indicators with land use and other stressor variables, we determined the concentration of the indicators when the land use and stressor variables were all set to zero the y-intercept. Except for total P on the Upper Mississippi River and chloride on the Ohio River, we were able to predict background concentration from significant regression models. In every model with more than one predictor variable, the model included at least one variable representing agricultural land use and one variable representing development. Predicted background concentration of total N was the same on the Upper Mississippi and Lower Missouri rivers (350 ug l-1), which was much lower than a published eutrophication threshold and percentile-based thresholds (25th percentile of concentration at all sites in the population) but was similar to a threshold derived from the response of sestonic chlorophyll a to great river total N concentration. Background concentration of total P on the Lower Missouri (53 ug l-1) was also lower than published and percentile-based thresholds. Background TSS concentration was higher on the Lower Missouri (30 mg l-1) than the other ri

Mental Subnormality in the Community: A Clinical and Epidemiologic Study.

ERIC Educational Resources Information Center

Birch, Herbert G.; And Others

The book reports a clinical and epidemiologic study of the prevalence, distribution, and antecedents of mental subnormality in 8 to 10 year old children living in Aberdeen, Scotland (population 187,000). Utilizing three types of data (differential clinical diagnoses, biological background information, and social characteristics), the study…

Reflections on Clinical Learning in Novice Speech-Language Therapy Students

ERIC Educational Resources Information Center

Hill, Anne E.; Davidson, Bronwyn J.; Theodoros, Deborah G.

2012-01-01

Background: Reflective practice is reported to enhance clinical reasoning and therefore to maximize client outcomes. The inclusion of targeted reflective practice in academic programmes in speech-language therapy has not been consistent, although providing opportunities for speech-language therapy students to reflect during their clinical practice…

Postgraduate Clinical Psychology Students' Perceptions of an Acceptance and Commitment Therapy Stress Management Intervention and Clinical Training

ERIC Educational Resources Information Center

Pakenham, Kenneth I.; Stafford-Brown, Johanna

2013-01-01

Background: Research into stress management interventions for clinical psychology trainees (CPTs) is limited, despite evidence indicating that these individuals are at risk for elevated stress, which can negatively impact personal and professional functioning. This study explored: (1) CPTs' perceptions of a previously evaluated Acceptance and…

The isotropic radio background revisited

NASA Astrophysics Data System (ADS)

Fornengo, Nicolao; Lineros, Roberto A.; Regis, Marco; Taoso, Marco

2014-04-01

We present an extensive analysis on the determination of the isotropic radio background. We consider six different radio maps, ranging from 22 MHz to 2.3 GHz and covering a large fraction of the sky. The large scale emission is modeled as a linear combination of an isotropic component plus the Galactic synchrotron radiation and thermal bremsstrahlung. Point-like and extended sources are either masked or accounted for by means of a template. We find a robust estimate of the isotropic radio background, with limited scatter among different Galactic models. The level of the isotropic background lies significantly above the contribution obtained by integrating the number counts of observed extragalactic sources. Since the isotropic component dominates at high latitudes, thus making the profile of the total emission flat, a Galactic origin for such excess appears unlikely. We conclude that, unless a systematic offset is present in the maps, and provided that our current understanding of the Galactic synchrotron emission is reasonable, extragalactic sources well below the current experimental threshold seem to account for the majority of the brightness of the extragalactic radio sky.

The EPIC-MOS Particle-Induced Background Spectra

NASA Technical Reports Server (NTRS)

Kuntz, K. D.; Sowden, S. L.

2007-01-01

In order to analyse diffuse emission that fills the field of view, one must accurately characterize the instrumental backgrounds. For the XMM-Newton EPIC instrument these backgrounds include a temporally variable "quiescent" component. as well as the strongly variable soft proton contamination. We have characterized the spectral and spatial response of the EPIC detectors to these background components and have developed tools to remove these backgrounds from observations. The "quiescent" component was characterized using a combination of the filter-wheel-closed data and a database of unexposed-region data. The soft proton contamination was characterized by differencing images and spectra taken during flared and flare-free intervals. After application of our modeled backgrounds, the differences between independent observations of the same region of "blank sky" are consistent with the statistical uncertainties except when there is clear spectral evidence of solar wind charge exchange emission. Using a large sample of blank sky data, we show that strong magnetospheric SWCX emission requires elevated solar wind fluxes; observations through the densest part of the magnetosheath are not necessarily strongly contaminated with SWCX emission.

Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: A prospective interventional study of postoperative handovers.

PubMed

Randmaa, Maria; Swenne, Christine L; Mårtensson, Gunilla; Högberg, Hans; Engström, Maria

2016-03-01

Communication errors cause clinical incidents and adverse events in relation to surgery. To ensure proper postoperative patient care, it is essential that personnel remember and recall information given during the handover from the operating theatre to the postanaesthesia care unit. Formalizing the handover may improve communication and aid memory, but research in this area is lacking. The objective of this study was to evaluate whether implementing the communication tool Situation-Background-Assessment-Recommendation (SBAR) affects receivers' information retention after postoperative handover. A prospective intervention study with an intervention group and comparison nonintervention group, with assessments before and after the intervention. The postanaesthesia care units of two hospitals in Sweden during 2011 and 2012. Staff involved in the handover between the operating theatre and the postanaesthesia care units within each hospital. Implementation of the communication tool SBAR in one hospital. The main outcome was the percentage of recalled information sequences among receivers after the handover. Data were collected using both audio-recordings and observations recorded on a study-specific protocol form. Preintervention, 73 handovers were observed (intervention group, n = 40; comparison group, n = 33) involving 72 personnel (intervention group, n = 40; comparison group, n = 32). Postintervention, 91 handovers were observed (intervention group, n = 44; comparison group, n = 47) involving 57 personnel (intervention group, n = 31; comparison group, n = 26). In the intervention group, the percentage of recalled information sequences by the receivers increased from 43.4% preintervention to 52.6% postintervention (P = 0.004) and the SBAR structure improved significantly (P = 0.028). In the comparison group, the corresponding figures were 51.3 and 52.6% (P = 0.725) with no difference in SBAR structure. When a linear

[Risk factors for the development of pneumonia in multiple injured patients. Results of a prospective clinical trial].

PubMed

Andermahr, J; Hensler, T; Sauerland, S; Greb, A; Helling, H-J; Prokop, A; Neugebauer, E A M; Rehm, K E

2003-05-01

Pneumonia is the most common infectious complication in multiple trauma patients. In a prospective clinical cohort study, 266 multiply injured patients were examined for the development of pneumonia. Various risk factors were tested in uni- and multivariate analyses. Three different definitions of pneumonia were used in order to examine how results depended on definition. The incidence of pneumonia was 41%, but varied with definition (30-50%). Injuries to the thorax, head,and abdomen were associated with a significantly increased risk of pneumonia (adjusted relative risk: 1.77, 1.97,and 1.52, respectively).Furthermore, increasing age led to a higher risk of pneumonia. Although the primary analysis revealed a higher pneumonia risk in male patients (adjusted relative risk: 2.23; 95% CI: 1.43-3.05), this result could not be consistently reproduced when using other definitions of pneumonia. Trunk and head injuries and age are proven risk factors for developing posttraumatic pneumonia. The association between male gender and an increased rate of infectious complications remained questionable.

Towards clinically translatable in vivo nanodiagnostics

NASA Astrophysics Data System (ADS)

Park, Seung-Min; Aalipour, Amin; Vermesh, Ophir; Yu, Jung Ho; Gambhir, Sanjiv S.

2017-05-01

Nanodiagnostics as a field makes use of fundamental advances in nanobiotechnology to diagnose, characterize and manage disease at the molecular scale. As these strategies move closer to routine clinical use, a proper understanding of different imaging modalities, relevant biological systems and physical properties governing nanoscale interactions is necessary to rationally engineer next-generation bionanomaterials. In this Review, we analyse the background physics of several clinically relevant imaging modalities and their associated sensitivity and specificity, provide an overview of the materials currently used for in vivo nanodiagnostics, and assess the progress made towards clinical translation. This work provides a framework for understanding both the impressive progress made thus far in the nanodiagnostics field as well as presenting challenges that must be overcome to obtain widespread clinical adoption.

The EPIC-MOS Particle-Induced Background Spectrum

NASA Technical Reports Server (NTRS)

Kuntz, K. D.; Snowden, S. L.

2006-01-01

We have developed a method for constructing a spectrum of the particle-induced instrumental background of the XMM-Newton EPIC MOS detectors that can be used for observations of the diffuse background and extended sources that fill a significant fraction of the instrument field of view. The strength and spectrum of the particle-induced background, that is, the background due to the interaction of particles with the detector and the detector surroundings, is temporally variable as well as spatially variable over individual chips. Our method uses a combination of the filter-wheel-closed data and a database of unexposed-region data to construct a spectrum of the "quiescent" background. We show that, using this method of background subtraction, the differences between independent observations of the same region of "blank sky" are consistent with the statistical uncertainties except when there is clear evidence of solar wind charge exchange emission. We use the blank sky observations to show that contamination by SWCX emission is a strong function of the solar wind proton flux, and that observations through the flanks of the magnetosheath appear to be contaminated only at much higher solar wind fluxes. We have also developed a spectral model of the residual soft proton flares, which allows their effects to be removed to a substantial degree during spectral fitting.