Akathisia diagnosis: an objective test

In summary, we have attempted, in planning the Diploma Nursing Program at Okanagan College, to retain the positive aspects of existent hospital and college programs, while at the same time developing some unique features: a health promotion focus, a comprehensive curriculum framework and a cooperative education design. As yet, in this first year the program, it is too early to predict outcomes, but we anticipate that our students will be better equipped to deal with the reality of a work situation.     

激光辅助冷喷涂技术应用进展

激光辅助冷喷涂技术是基于冷喷涂的原理,综合冷喷涂和激光熔覆的优点为一体的复合涂层沉积技术,可以沉积致密匀称、孔隙率可控的功能涂层,而且沉积速度快、涂层废品率低。本文主要介绍了该技术的原理及其最新应用范围,阐述了采用该技术在制备Stellite-6合金涂层、Ti涂层、Al-12 wt.%Si涂层、Ni60基金刚石复合涂层、Ti-HAP复合生物涂层等不同领域的应用优势。激光辅助冷喷涂技术的应用是激光用于工程部件表面修饰、涂层制备,提升部件性能的一个新趋势。     

Assessment of visual field impairment by objective technique

An objective psychophysical technique for investigating visual fields by averaged scalp potentials evoked by pattern gratings of alternating contrast and by sinusoidally modulated flicerking light is applied to a child with a right homonomous hemianopsia. This technique illustrates a value, in obtaining clinical data on visual fields in situations were subjective perimetry is difficult to administer or where conservating diagnostic methods do not yield evidence of pathology.     

Input-output function of the acoustic reflex and objective hearing aid evaluation

Hearing aid evaluation procedures should mainly consider hearing properties in the most comfortable loudness intensity range. This applies to both subjective and objective methods. With regard to this aspect, input-output characteristics of the acoustic reflex were investigated for speech noise and narrow-band noise (0.5, 1, 2 and 4 kHz) stimulation. In these terms, hearing aid evaluation can be understood as an approximation of pathological input-output functions to the normal range by suitable hearing aids. After normal input-output characteristics have been established, we report on first experiences with this fitting procedure. Frequency-specific elicitation of the stapedial reflex with and without hearing aid enables a compensation for hearing impairment in accordance with frequency-dependent dynamic properties.     

Feasibility and short-term results of the "plug" technique in inguinal hernia. A prospective evaluation

The aim of this prospective study was to assess the feasibility and postoperative outcome of the "plug" technique in inguinal hernia. One hundred and forty-six consecutive patients were operated for 151 hernias. A plug was applied in 131 cases (86.8%). The Lichtenstein technique was used in 20 cases (13.2%) because of a wide weakness of the posterior wall. Eleven (7.3%) postoperative benign complications occurred. No severe complications were observed and no patient was reoperated. The mean duration of oral analgesia was 2.7 (0-10) days. Mean durations of postoperative hospital stay, time off work and cessation of normal activities were 1.2 (0-4) days, 18.1 (1-37) days and 5.8 (1-18) days, respectively. In conclusion, the "plug" technique is feasible in a wide range of hernias and allows a short hospital stay and an early return to normal activity.     

Inguinal microsurgical varicocelectomy in the adolescent: technique and preliminary results

PURPOSE: In large series of adults microsurgical varicocelectomy has been associated with extremely high success rates, combined with minimal incidence of postoperative hydrocele. We report our initial experience of inguinal varicocelectomy using an intraoperative microscope in adolescents. MATERIALS AND METHODS: From 1994 to 1996, 32 adolescents (mean age 15.3 years) underwent inguinal microsurgical varicocelectomy. An operative microscope and Doppler probe were used during spermatic cord dissection to identify and preserve the testicular artery and lymphatics. RESULTS: All patients were available for followup, which ranged from 2 to 35 months (mean 20). There were no intraoperative complications. A temporary reactive hydrocele, which subsequently completely resolved, was observed in 1 patient. There were no palpable recurrent varicoceles. CONCLUSIONS: The operative microscope permits reliable identification of the testicular artery and lymphatics, as well as venous channels in adolescents. As a result, the postoperative development of hydrocele or recurrence of the varicocele may be prevented.     

A vision-based technique for objective assessment of burn scars

In this paper a method for the objective assessment of burn scars is proposed. The quantitative measures developed in this research provide an objective way to calculate elastic properties of burn scars relative to the surrounding areas. The approach combines range data and the mechanics and motion dynamics of human tissues. Active contours are employed to locate regions of interest and to find displacements of feature points using automatically established correspondences. Changes in strain distribution over time are evaluated. Given images at two time instances and their corresponding features, the finite element method is used to synthesize strain distributions of the underlying tissues. This results in a physically based framework for motion and strain analysis. Relative elasticity of the burn scar is then recovered using iterative descent search for the best nonlinear finite element model that approximates stretching behavior of the region containing the burn scar. The results from the skin elasticity experiments illustrate the ability to objectively detect differences in elasticity between normal and abnormal tissue. These estimated differences in elasticity are correlated against the subjective judgments of physicians that are presently the practice.     

MR cholangiopancreatography: technique, indications and clinical results

INTRODUCTION: MR cholangiopancreatography (MRCP) is a new noninvasive imaging technique for the study of biliopancreatic disorders, providing projectional images of the biliary tree and pancreatic duct without any contrast agent. MATERIAL AND METHODS: We used different sequences, with both breath-hold and nonbreath-hold techniques, to acquire MRCP images, first based on GE and then on FSE sequences. FSE images provide higher SNR and are less susceptible to artifacts (metal objects, motion and blood flow artifacts). At the Department of Radiology of the University of Rome La Sapienza, we acquired MRCP images with non breath-hold, 3D fat-suppressed TSE sequences (TR = 3000-2000, TE 700, turbo factor 128) optimized on a .5T magnet with 15 mT/m gradients. No patient preparation or sedation was required, although antiperistaltic drugs and oral administration of tap water were preferred. Four hundred and thirty patients were examined, all of them with an indication to conventional cholangiography. RESULTS: MRCP depicted the whole common bile duct and the first-order intrahepatic branches in all the normal cases. Its accuracy in identifying biliary obstruction level and site was 100%, versus 94.6% in characterizing its cause. MRCP had 96.3% diagnostic accuracy in choledocholithiasis, with some false positives and false negatives caused by: 1) small stones missed on MIP reconstructions; 2) signal loss due to complete CBD obstruction by stones; 3) pneumobilia; 4) differential diagnosis between small stones and air bubbles. The main role of MRCP in benign strictures is to provide a detailed map of the biliary tract for better treatment planning. In particular, MRCP is extremely useful in hepaticojejunostomy patients, where ERC is not indicated because of postoperative anatomical changes. Both conventional MRI and MRCP are important in malignant strictures to identify the lesion and to characterize and stage it. Finally, MR pancreatography is very useful to follow up chronic pancreatitis patients because it shows Wirsung duct strictures and dilatations, intraductal filling defects and, in some cases, the communication between the pseudocyst and the pancreatic duct. CONCLUSIONS: MRCP combined with conventional MRI can completely replace CT and ERCP in bilio-pancreatic disorders.     

Endoscopic endonasal dacryocystorhinostomy: indications, technique and results

To understand the changes of urinary endothelin-1 (ET-1) concentrations in acute renal failure (ARF) and to investigate the origin of human urinary ET-1, we studied urinary ET-1 excretion in 70 normal children and 12 children with ARF caused by tubular dysfunction. Urinary ET-1 excretion was expressed as a ratio of urinary ET-1 to urinary creatinine (ET-1/Cr). Among healthy children, the highest urinary ET-1/Cr values were found during infancy. In patients with ARF, there was a positive correlation between urinary ET-1/Cr values and daily total urinary ET-1 (r = 0.42, n = 26, p < 0.05). Plasma ET-1 concentrations were elevated in children with ARF during the period of peak serum creatinine concentration. During the course of ARF, the lowest urinary ET-1/Cr value occurred during the period of peak serum creatinine, whereas the plasma ET-1 concentration declined after the peak. These results provide insight into the developmental changes of urinary ET-1 values in normal children, and illustrate the pattern of changes in plasma and urinary ET-1 concentrations during the course of ARF in children. The results suggest that renal production, rather than clearance from the circulation by glomerular filtration, may be the source of urinary ET-1.     

A wall-incorporated valve for preserving continence: an experimental evaluation of a new technique

The purpose of the present study was to analyse whether sex, age, skin test reactivity, cigarette smoking and occupational exposure were related to the total serum immunoglobulin (Ig)E concentrations (kU x L[-1]), in a general population sample. We studied 1,905 subjects (915 males, 990 females) of a general population sample (n=2,841, 8-73 yrs) participating in the second cross-sectional respiratory epidemiological survey in the rural Po Delta area (near Venice, North Italy). Distribution of total serum IgE concentrations was skewed, thus a log-transformation was performed to obtain a Gaussian shape. Significantly higher values of IgE were found in males compared to females. In general, a peak of IgE concentration was found at 8-14 yrs. IgE values tended to be lower in older than younger adults. Significantly higher serum IgE levels were shown in subjects with a positive skin-prick test index (ST+) than in those with a negative skin-prick test index (ST-). There was a significant relationship of total IgE levels with skin reactivity to pollens and house-dust mites. In both sexes higher values of IgE were found in current smokers than in ex-nonsmokers, regardless of skin-test reactivity. There was no significant difference in IgE values between ex- and nonsmokers. Passive smoking and occupational exposure were significantly related to increased IgE values. Our results confirm that in a general population sample immunoglobulin E concentrations are related not only to skin-prick test reactivity to common aeroallergens, but also to other risk factors for chronic obstructive lung diseases, such as sex, active/ passive smoking and occupational exposure.     

Diode Laser Assisted Surface Nitriding of Ti-6Al-4V: Properties of the Nitrided Surface

In the present study, a detailed investigation of mechanical and electrochemical properties of laser-surface-nitrided Ti-6Al-4V has been carried out. Laser treatment is carried out by melting the surface of Ti-6Al-4V substrate using a high power CW diode laser with nitrogen as shrouding environment. The effect of laser parameters (applied power and gas flow rate) on the properties of the nitrided surface was evaluated. The microhardness of the nitrided surface was improved to a maximum of 1175 VHN in the present set of laser processing conditions as compared to 280 VHN of as-received substrate. Surface nitriding increased the potential for pit formation (E _pit) significantly as compared to as-received Ti-6Al-4V. Immersion in Hank’s solution showed calcium phosphate deposition from the solution. The optimum process parameters for laser surface nitriding were derived.     

A modified technique of the triple pelvic osteotomy: early results

A modification of the triple pelvic osteotomy for children over 8 years and the young adult is described. The results of the first 32 cases are reviewed. These show that the indications for the operation can be widened so that not only primary dysplasias but also subluxated or dislocated hips with secondary dysplasia can be operated on successfully. The operation is done in two stages. At first the patient is lying prone. The osteotomy of the ischial ramus is done dorsally by cutting the connection between the sciatic notch and obturator foramen immediately behind and below the acetabulum. In the second stage, with the patient lying supine, the pubic and the iliac osteotomy are performed rather circular and parallel to the hip joint. These modifications have several advantages: (a) the operator has a direct field of view at all times; (b) the osteotomy is performed close to the acetabulum, thus allowing a great amount of lateral rotation and medial displacement of the acetabulum, thereby providing good coverage of the femoral head by hyaline cartilage; and (c) the ischial ramus and its ligaments to the sacrum are left intact, leading to greater stability of the pelvis and spine.     

COFFEE: an objective function for multiple sequence alignments

MOTIVATION: In order to increase the accuracy of multiple sequence alignments, we designed a new strategy for optimizing multiple sequence alignments by genetic algorithm. We named it COFFEE (Consistency based Objective Function For alignmEnt Evaluation). The COFFEE score reflects the level of consistency between a multiple sequence alignment and a library containing pairwise alignments of the same sequences. RESULTS: We show that multiple sequence alignments can be optimized for their COFFEE score with the genetic algorithm package SAGA. The COFFEE function is tested on 11 test cases made of structural alignments extracted from 3D_ali. These alignments are compared to those produced using five alternative methods. Results indicate that COFFEE outperforms the other methods when the level of identity between the sequences is low. Accuracy is evaluated by comparison with the structural alignments used as references. We also show that the COFFEE score can be used as a reliability index on multiple sequence alignments. Finally, we show that given a library of structure-based pairwise sequence alignments extracted from FSSP, SAGA can produce high-quality multiple sequence alignments. The main advantage of COFFEE is its flexibility. With COFFEE, any method suitable for making pairwise alignments can be extended to making multiple alignments. AVAILABILITY: The package is available along with the test cases through the WWW: http://www. ebi.ac.uk/cedric CONTACT: cedric.notredame@ebi.ac.uk     

Subjective and objective evaluation of the outcome of rhinoplasty. A retrospective study

Between 1983 and 1988, 206 patients underwent a septorhinoplasty in the ENT Department of the University Hospital Benjamin Franklin in Berlin. The results of the operation were analysed by an "objective" evaluation form including measurements of cephalometric angles and a "subjective" questionnaire reflecting the patient's view. Ninety-nine patients responded to our questionnaire. About one third of our patients were foreigners (mostly Turks). Seventy-five percent of the results were good in objective as well as subjective terms. Comparison of results between the two sexes did not show a significant difference. A relevant discrepancy between the objective and the subjective results was seen in the foreign patients. The low average age and therefore unrealistically high expectations are a possible explanation for this phenomenon. Patients with small preoperative deformities also turned out to be less satisfied with the outcome even though the objective result was better. While obtaining the objective results, we also realized that the nasofrontal angle seems to be of minor importance for the facial profile. The nasofacial and the nasolabial angle actually seem to be more important for the rhinoplasty and reflect the aesthetic correction of the nose better than the nasofrontal angle. It was much more often possible to correct the nasofacial and the nasolabial angle, while the nasofrontal angle remained uncorrected in many cases. Our retrospective study was able to answer the question whether the aesthetic outcome after rhinoplasty can be rated objectively.     

Osseous extensor tendon rupture of the finger joint: surgical technique and results

Mostly mallet finger can be treated conservatively. In cases of fracture of the distal phalanx open reduction and fixation is recommended. We favour the well-established cerclage, yet perform it in a more comfortable way with the use of cannulated drilling. This technique was applied on 13 patients even with lesions several weeks old. The evaluation 5-16 months postoperatively based on radiological, clinical and subjective criteria. We present the technique and the results followed by the discussion of the advantages over conservative and other operative managements.     

Pulsus paradoxus: an objective measure of severity in croup

We used a noninvasive monitor of arterial pressure to determine the utility of pulsus paradoxus (PP) as an objective severity measure in croup. We performed a prospective, blinded comparison of PP in children with croup versus healthy control subjects, analyzed the relationship between PP and Westley croup score (WCS), and observed the effect of racemic epinephrine (RE) on PP and WCS in a subgroup of patients with severe croup. The PP and WCS were measured at presentation and in severe patients after treatment with RE. Mean PP was 6.1 +/- 1.8 (SD) mm Hg (n = 29) in control subjects compared with a mean of 17.8 +/- 11.2 (SD) mm Hg (n = 28) in patients with croup (p < 0.00001). There was significant concordance between baseline WCS and PP (Spearman's rho: 0.68; p = 0.0001). The mean decrease in PP after RE was 7.5 +/- 11.8 (SD) mm Hg (p = 0.05; n = 12). The magnitude of decrease in PP after RE has significant concordance with the concurrent decrease in WCS (Spearman's rho: 0.73; p < 0.007). PP is elevated in children with croup, and the magnitude of elevation correlates with severity as measured by the WCS. PP may have utility as a research tool to objectively measure the severity of upper airway obstruction in croup.     

Rotational atherectomy: technique, indications, results

Immunoperoxidase staining was performed for estrogen and progesterone receptors in 93 cases of primary breast carcinoma. Breast tumor samples were fixed in formalin and embedded in paraffin. Antigen retrieval was performed by microwave heating in citrate buffer, pH 6.0, using precisely defined and reproducible conditions. The cases studied included material from the current year and from paraffin blocks retrieved from archival storage dating back to 1981. In all cases, estrogen and progesterone receptor values determined by biochemical assay were available for comparison with the immunohistochemical results. We found 94% agreement of results between the two methods.     

Eradication of Helicobacter pylori: an objective assessment of current therapies

The purpose of the present review was to determine objectively the optimal treatment for the eradication of H. pylori amongst the currently used regimens. A comprehensive literature search provided a data-base relating to the following treatments: dual therapy with an anti-secretory drug plus either amoxycillin or clarithromycin; standard triple therapy, with or without additional anti-secretory drugs; proton pump inhibitor triple therapy; and H2-receptor antagonist triple therapy. Emphasis was placed on intention-to-treat analyses of eradication rates using all of the available evidence. The criteria used to select the optimal treatment were efficacy (eradication rates), frequency of side-effects, simplicity of the regimen (number of tablets per day and duration of treatment) and cost. The analysis showed that proton pump inhibitor triple therapy (that is, a proton pump inhibitor plus any two of amoxycillin, clarithromycin or a nitroimidazole) was the preferred treatment for the eradication of H. pylori. In particular, the 1-week, low-dose regimen with omeprazole plus clarithromycin plus tinidazole produced the highest eradication rates (> 90%) with the lowest frequency of side-effects and at only modest cost.     

SMAS rhytidectomy versus deep plane rhytidectomy: an objective comparison

Although there are a multitude of techniques currently used for performing face lifts, there is no general agreement as to which, if any, of these techniques is most effective. There may never be a definitive answer to this issue because of the highly subjective nature of aesthetics, variability among surgeons, differences in patient anatomy, and specific patient desires. In an attempt to evaluate face lift techniques objectively, this study compares the rate of patients undergoing a tuck procedure after traditional SMAS (superficial musculoaponeurotic system) rhytidectomy to that of patients after deep plane rhytidectomy. A retrospective chart review was performed on all patients who underwent a tuck procedure following a face lift by the senior author (Kamer) between July of 1990 and January of 1997. There were 634 patients who electively underwent either a SMAS or deep plane type of rhytidectomy during the 6.5-year period; 48 patients subsequently underwent tuck operations, and adequate information was available on 44 patients. Of these, 43 were women and the average age was 57 years. The overall tuck rate from July of 1990 to January of 1997 was 7.5 percent. The tuck rate following SMAS rhytidectomy was 11.4 percent, and that following deep plane rhytidectomy was 3.3 percent. Therefore, a tuck was required 71 percent less frequently after a deep plane lift than after a SMAS lift. This was found to be a statistically significant difference with a p value of .0001 (Fisher's exact test, 2-tail). If the assumption is made that the need for a tuck procedure implies a less than optimal face lift, then the data of this study suggest that the deep plane technique is more effective than the SMAS technique.