Repair with a surveyed cast clasp while patient retains the partial denture

A technique is described that allows a removable partial denture with a broken clasp or a removable partial denture in which an abutment has been extracted to be restored by the reattachment of a new cast clasp component or a complete surveyed clasp assembly. The technique is applicable to most clasp designs and can include attachment to the acrylic denture base or the metal major connector. The technique is distinguished from other repair techniques by (1) providing a cast clasp replacement, (2) allowing the patient to retain the prosthesis during the repair, (3) generating a precisely formed surveyed clasp assembly by the laboratory, and (4) including an efficient transfer mechanism for the precision clasp created in the laboratory to be attached to the removable partial denture in the dental office. A two-step impression procedure is used to ensure proper relation of the partial denture to the abutments.     

The effect of parenteral testosterone replacement on prostate specific antigen in hypogonadal men with erectile dysfunction

PURPOSE: Parenteral testosterone supplementation is a common treatment for erectile dysfunction in hypogonadal men. Despite its frequent use, the effect of testosterone on prostate specific antigen (PSA) in these patients has not been documented previously. In this study we determined the effect of parenteral testosterone replacement on PSA and PSA velocity in a group of men being treated for erectile dysfunction. MATERIALS AND METHODS: A retrospective analysis of 48 patients (mean age 65.9) was performed and 2 study groups were identified. Group 1 consisted of 27 patients with a serum PSA level before and after initiating testosterone replacement therapy, and group 2 consisted of 27 men with a minimum of 3 PSA measurements (intervals of 6 months or greater) while on testosterone replacement. Each man had erectile dysfunction, a normal digital rectal examination and a low or low-normal total serum testosterone level before initiating therapy. Testosterone replacement was discontinued if no subjective improvement in erectile function was obtained, or if prostate adenocarcinoma was suggested by digital rectal examination or PSA. RESULTS: The mean increase in PSA after initiating testosterone replacement was 0.29 ng./ml. representing a mean change of 37% from baseline (mean interval 12.8 months). The mean PSA velocity was 0.05 ng./ml. per year. Pretreatment testosterone level, age and testosterone dose did not independently alter the PSA during testosterone replacement. Eleven men required prostate biopsies during treatment. Biopsies were indicated for abnormal digital rectal examination in 10 men and an elevated PSA in 1. All biopsies were benign. CONCLUSIONS: Parenteral testosterone replacement in hypogonadal men with normal pretreatment digital rectal examination and serum PSA levels does not alter PSA or PSA velocity beyond established nontreatment norms. Thus, any significant increase in PSA or PSA velocity should not be attributed to testosterone replacement therapy and should be evaluated.     

Building a pediatric cardiac catheterization laboratory and conference room: design considerations and filmless imaging

Building or upgrading a dedicated pediatric cardiac catheterization laboratory is an expensive and elaborate undertaking complicated by long-standing biases based on adult laboratory requirements. Optimal design for the needs of pediatric cardiologists and their patients has never been published. This communication discusses these design issues in the context of pediatric needs and offers potential solutions. It also attempts to educate the reader on the basics of digital imaging and its advantages over cine film technology; and it explains how to achieve optimal filmless data acquisition and subsequent display for pediatric cardiac management.     

Digital imagery/telecytology. International Academy of Cytology Task Force summary. Diagnostic Cytology Towards the 21st Century: An International Expert Conference and Tutorial

ISSUES: Optical digital imaging and its related technologies have applications in cytopathology that encompass training and education, image analysis, diagnosis, report documentation and archiving, and telecommunications. Telecytology involves the use of telecommunications to transmit cytology images for the purposes of diagnosis, consultation or education. This working paper provides a mainly informational overview of optical digital imaging and summarizes current technologic resources and applications and some of the ethical and legal implications of the use of these new technologies in cytopathology. CONSENSUS POSITION: Computer hardware standards for optical digital imagery will continue to be driven mainly by commercial interests and nonmedical imperatives, but professional organizations can play a valuable role in developing recommendations or standards for digital image sampling, documentation, archiving, authenticity safeguards and teleconsultation protocols; in addressing patient confidentiality and ethical, legal and informed consent issues; and in providing support for quality assurance and standardization of digital image-based testing. There is some evidence that high levels of accuracy for telepathology diagnosis can be achieved using existing dynamic systems, which may also be applicable to telecytology consultation. Static systems for both telepathology and telecytology, which have the advantage of considerably lower cost, appear to have lower levels of accuracy. Laboratories that maintain digital image databases should adopt practices and protocols that ensure patient confidentiality. Individuals participating in telecommunication of digital images for diagnosis should be properly qualified, meet licensing requirements and use procedures that protect patient confidentiality. Such individuals should be cognizant of the limitations of the technology and employ quality assurance practices that ensure the validity and accuracy of each consultation. Even in an informal teleconsultation setting one should define the extent of participation and be mindful of potential malpractice liability. ONGOING ISSUES: Digital imagery applications will continue to present new opportunities and challenges. Position papers such as this are directed toward assisting the profession to stay informed and in control of these applications in the laboratory. Telecytology is an area in particular need of studies of good quality to provide data on factors affecting accuracy. New technologic approaches to addressing the issue of selective sampling in static image consultation are needed. The use of artificial intelligence software as an adjunct to enhance the accuracy and reproducibility of cytologic diagnosis of digital images in routine and consultation settings deserves to be pursued. Other telecytology-related issues that require clarification and the adoption of workable guidelines include interstate licensure and protocols to define malpractice liability.     

Theoretical and philosophical issues in industrial/organizational psychology.

In preparing to address the question posed to the various divisions regarding the extent and character of theoretical and philosophical concerns in the various areas of psychology, I informally solicited input from about 20 Division 14 members. Almost without exception I received the same response: the observation that philosophical issues are not central to the daily activities of most I/O psychologists. After a bit more thought, most were able to identify areas or issues within I/O psychology to which philosophical issues are relevant. In the comments which follow, I will make no attempt to be systematic or complete in presenting the philosophical/theoretical issues facing I/O psychology. I will present examples of different types of issues facing the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Detection of main renal artery stenosis using phase-contrast cine MR angiography

OBJECTIVE: The purpose of our study was to assess the ability of phase-contrast cine MR angiography to detect the presence of main renal artery stenosis. SUBJECTS AND METHODS: We prospectively evaluated 75 hypertensive patients form main renal artery stenosis using phase-contrast cine MR angiography. Each main renal artery was evaluated as normal or abnormal. Thirty-seven of the 75 patients underwent conventional arteriography or intraarterial digital subtraction arteriography; these results were compared with the MR angiographic interpretations. Only those patients who had confirmatory arteriography were included in the statistical analysis. RESULTS: Thirty-six main renal arteries interpreted as normal by MR angiography were found to be without a focal stenosis on invasive arteriography. MR angiography suggested 32 main renal artery stenoses; invasive arteriography showed 29 of these as stenoses. Three main renal arteries that were interpreted as having focal stenoses by MR angiography were shown to be not stenotic by invasive arteriography. Three other patients had diffusely narrowed main renal arteries bilaterally without a focal stenosis on MR angiography; bilateral proximal renal artery stenoses were seen at arteriography in two of these patients, and diffusely narrowed main renal arteries were seen in the third patient. Thus, the sensitivity of phase-contrast cine MR angiography for detecting a focal stenosis or abnormal main renal artery was 100% (95% confidence interval, 88-100%) and the specificity was 93% (95% confidence interval, 80-99%). The kappa coefficient was 0.85 with a standard error of 0.08. CONCLUSION: Phase-contrast cine MR angiography had a high degree of accuracy and a high negative predictive value in detecting the presence of main renal artery stenoses and may be a good screening technique for renovascular hypertension.     

Contrast mapping and evaluation for electronic X-ray images on CRT display monitor

Simple chest X rays on film are the most common type of image in medical diagnosis. However, amongst the various types of medical X-ray images, they require the highest level of display quality due to the fact that the body structures they capture on film have varying degrees of permeability to X rays. Conventional high-definition digital display technology has not always been able to match the quality of such film images. This has been a major impediment against progress toward the complete digitization of simple chest X rays. The intent of this paper is to examine that, when applied to medical diagnosis of chest X rays, super-high-definition (SHD) images (digital images with resolution exceeding that of HDTV) are capable of producing a level of quality of diagnostic accuracy on a par with conventional film images. We will start out by seeking out the overall transmission characteristics of a system that uses digital radiography and a film digitizer to digitize images. We will then derive gray-scale transform characteristics based on the luminance linear method for approximating, as closely as possible on a CRT, film images on a light box that have wide dynamic range and high luminance. Finally, we will present the results of image evaluation experiments using high-definition CRT monitors. These results indicate that conventional film images and those on super-high-definition CRT monitors have nearly the same quality. They will also show that the contrast mapping selected by radiologists and theoretical luminance linear characteristics were almost the same except in low-luminance regions. We will also discuss radiologists' comments on CRT monitors after they participated in the evaluation experiment.     

X-ray digital subtraction angiography to magnetic resonance-digital subtraction angiography using three-dimensional TRICKS. Historical perspective and computer simulations: a review

Seventeen years after the introduction of x-ray digital subtraction angiography (DSA), gadolinium-enhanced magnetic resonance (MR) angiography techniques have become available for the performance of MR-DSA. For the purposes of this article, we will consider this to include two-dimensional and three-dimensional approaches using time-resolved and non-time-resolved applications. Magnetic resonance-DSA is one in a historical progression of techniques which have aimed to produce less invasive forms of angiography. After outlining some historical milestones, several current issues regarding current methods for MR-DSA are discussed.     

A technique for developing a master cast with previously made dies

This article describes a technique for preparing final working casts to be used in the laboratory phase of restorative treatment. The goal is to produce accurate working casts that have stable dies which are easily removed from the base and reliably replaced. Most casts with removable dies are made from a single master impression. However, individual dies are sometimes made previously from individual tooth (preparation) impressions. In such cases, transfer copings are required to relate the dies and produce the final working cast. Hollow plastic casting sprues are used as temporary dowels in this technique until a transfer coping pickup impression has been made. After the dies are seated and secured in the transfer coping pickup impression, the plastic casting sprues are replaced with conventional brass dowel pins. This technique ensures well-placed dowel pins that will facilitate easy and accurate withdrawal and replacement of the dies.     

Classification of hemodynamic changes in renal artery stenosis using cine magnetic resonance phase contrast flow measurements

PURPOSE: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). MATERIAL AND METHODS: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. RESULTS: By means of the MR blood flow parameters high-grade stenoses (> 50%, n = 23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n = 37) and non-stenosed vessels (n = 19) revealed a sensitivity of 87% and a specificity of 100%. CONCLUSION: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis.     

Regional myocardial function

Methods for noninvasive tissue tracking and quantification of myocardial shortening with magnetic resonance imaging have been developed using presaturation tagging and velocity encoded phase maps. The concurrent development of rapid scanning techniques, such that a complete cine loop of a slice can be obtained in a breath-hold, has made the measurement of myocardial wall motion in patients a simple and reproducible examination. These methods make it possible to quantify the severity and extent of regional heart wall motion abnormalities both at rest and during stress.     

Titanium alloys in total joint replacement--a materials science perspective

Increased use of titanium alloys as biomaterials is occurring due to their lower modulus, superior biocompatibility and enhanced corrosion resistance when compared to more conventional stainless steels and cobalt-based alloys. These attractive properties were a driving force for the early introduction of alpha (cpTi) and alpha + beta (Ti-6A1-4V) alloys as well as for the more recent development of new Ti-alloy compositions and orthopaedic metastable beta titanium alloys. The later possess enhanced biocompatibility, reduced elastic modulus, and superior strain-controlled and notch fatigue resistance. However, the poor shear strength and wear resistance of titanium alloys have nevertheless limited their biomedical use. Although the wear resistance of beta-Ti alloys has shown some improvement when compared to alpha + beta alloys, the ultimate utility of orthopaedic titanium alloys as wear components will require a more complete fundamental understanding of the wear mechanisms involved. This review examines current information on the physical and mechanical characteristics of titanium alloys used in artifical joint replacement prostheses, with a special focus on those issues associated with the long-term prosthetic requirements, e.g., fatigue and wear.     

Surfactant replacement therapy. An update on applications

Surfactant replacement therapy has been shown to be an effective and often life-saving treatment for newborn infants with respiratory distress syndrome (RDS). This article provides the clinician with an update regarding the various other applications of surfactant replacement therapy, as well as issues related to surfactant administration for the preparations approved for use in pediatric patients.     

Cine magnetic resonance imaging of pulsatile cerebrospinal fluid flow using CSPAMM

Spatial modulation of magnetization (SPAMM) is a well established imaging technique which superimposes a tagging pattern on conventional magnetic resonance (MR) images, allowing movement to be visualized. A modification to the SPAMM technique, called complementary spatial modulation of magnetization (CSPAMM), which improves the contrast of the tagging pattern is explained. The application of CSPAMM to the visualization of pulsatile cerebrospinal fluid flow (CSF) using an 8 frame cardiac-gated cine sequence is described. Various combinations of binomial pulses, up to the fifth order, were investigated to see which produces the optimum tagging pattern in the CSPAMM images. The flip angles of the imaging RF pulses were studied to see which would give equal maximum CSF signal intensity in all the cine images. The optimized cine CSPAMM technique was compared in vivo with SPAMM and CSF motion was found to be more easily visualized in the CSPAMM images.     

Feasibility of a large area x-ray sensitive vidicon for medical fluoroscopy: signal and noise factors

A large area x-ray-sensitive vidicon utilizing amorphous selenium (a-Se) is being investigated as an alternative to the x-ray image intensifier and television camera combination (XRII/TV) for medical fluoroscopy. The x-ray vidicon is, to a first approximation, a scaled up version of the 1" (2.54 cm) light-sensitive vidicon. The modulation transfer function (MTF) of an x-ray vidicon is mainly determined by the number of lines used, the beam spot profile, and the electronic bandwidth. The x-ray vidicon is expected to have roughly the same MTF as the 1" vidicon from a XRII/TV system referenced to the x-ray input and as such will be superior to the MTF of the complete XRII/TV system especially in high resolution applications such as cardiac cine. Beam discharge lag is expected to be approximately the same as in the 1" vidicon since they have comparable photoconductor layer capacitance. Photoconductive lag is also expected to be low since a-Se is known to have a low trap density.     

Studying electric field effects on embryonic myocytes

OBJECTIVE: Little attention has been paid to the occurrence of aortic regurgitation after complete repair in patients with pulmonary atresia and ventricular septal defect or tetralogy of Fallot. To highlight the development of aortic regurgitation or aortic root dilation severe enough to necessitate aortic valve replacement with or without aortic aneurysmorrhaphy or aortic root replacement, we retrospectively reviewed the records of patients who underwent aortic valve operation at our institution subsequent to repair of pulmonary atresia and ventricular septal defect or tetralogy of Fallot. METHODS: We searched the Mayo Clinic database for patients with pulmonary atresia and ventricular septal defect or tetralogy of Fallot who subsequently had aortic valve or aortic root operations. The degree of aortic regurgitation before operation was noted. Aortic sinus and root dimensions were measured. RESULTS: Sixteen patients underwent complete repair at a median age of 17 years, followed by an aortic operation a median of 13.5 years later. All 16 patients had dilated aortic sinuses at the time of the aortic valve operation. These 16 patients had aortic valve replacement: 11 with mechanical prostheses and 5 with bioprostheses. Five of the 16 also had reduction of aortic dilation by lateral aneurysmorrhaphy, and 1 had graft replacement of the ascending aorta. Five patients had associated conditions (evidence of valvular damage, recurrent ventricular septal defect, or history of endocarditis) discovered at the aortic valve operation that have been reported to be related to the development of aortic regurgitation. The remaining 11 patients had progressive aortic regurgitation despite complete, uncomplicated repair. CONCLUSIONS: Progressive aortic regurgitation and aortic root dilation can occur despite complete repair of pulmonary atresia and ventricular septal defect or tetralogy of Fallot.     

Retinoic acid receptor expression abnormalities in lung cancer: important clues or major obstacles?

We have developed a cine display of postprocessed 3D MR images of the thoracic aorta. Maximum intensity projection (MIP) images of the thoracic aorta in each phase were reconstructed from consecutive 2D-cine MR data sets, and displayed in a cine loop. The postprocessed 3D MR images clearly showed the relationship between major cervical branches and aortic pathologies such as aneurysms, and cine display presented the flow pattern in the aorta. 3D-cine MR angiography seems to be useful for follow-up studies of thoracic aortic diseases especially in patients with renal dysfunction.     

Synthesis and structure-activity relationships of novel naphthalenic and bioisosteric related amidic derivatives as melatonin receptor ligands

A previous paper reported the synthesis of melatonin receptor ligands. In order to complete the structure-activity relationships and to obtain antagonists to the melatonin receptor, a new series of naphthalenic analogues of melatonin have been synthesized. Modifications include deletion of the 7-methoxy group, replacement of the ethylene moiety, replacement of the amidic function by bioisosteres, and replacement of the naphthalenic nucleus by other bicyclic rings. Almost all the structural modifications lead to decreased affinity for the melatonin receptor. However, the N-n propyl urea derivative (27) is a very potent ligand at this receptor (pKi = 14.3). Most interestingly deletion of the methoxy group resulted in the first antagonist in this series. This molecule, compound 12, or N-[2-(1-naphthyl)-ethyl]cyclobutyl carboxamide has been selected for preclinical development.     

Laboratory Experiments on Frazil-Size Characteristics in a Counterrotating Flume

In an attempt to increase the fundamental understanding of the formation and evolution of frazil ice, laboratory experiments have been conducted in a counterrotating flume at the Hydraulics Research and Testing Facility, University of Manitoba. A high-precision thermometer and recently improved digital image processing system were used to acquire data from these experiments, which will hopefully aid in the development of numerical models. The image processing system is described, and results from a series of experiments are presented. The effects of air temperature, water velocity, and bottom roughness on the formation of frazil ice are discussed. A lognormal distribution appears to provide a reasonable fit to the observed frazil particle size distributions.     

Docosahexaenoic acid concentrations in retinal phospholipids of piglets fed an infant formula enriched with long-chain polyunsaturated fatty acids: effects of egg phospholipids and fish oils with different ratios of eicosapentaenoic acid to docosahexaenoic acid

The purpose of our study was the assessment of the diagnostic value of vacuum core biopsy, which promises high accuracy by minimally invasive percutaneous excision of 1-2 cm3 of tissue. The materials used were a digital stereotaxic biopsy table (Fischer Imaging) and a Mammotome-gun (Biopsys). A total of 236 patients with 261 predominantly indeterminate lesions (indeterminate: 230; suspicious: 26; malignant: 5) underwent vacuum core biopsy (VCB). Verification was as follows: (a) demonstration of complete or partial removal of the lesion or replacement of the lesion by a small hematoma by comparison of the pre- and post-VCB mammogram; (b) reexcision of 45 malignant and 6 borderline lesions; (c) radiologic-histologic correlation; and (d) 6-month-follow-up mammograms in 129 cases. Two VCBs were not possible because very fine microcalcifications could not be visualized. Two puncture errors occurred which, however, were immediately recognized and VCB was repeated. Based on the above verification a 100 % accuracy was achieved. No relevant side effects occurred. Except for 2 cases mammographically hardly any scarring was visible. Based on the excellent accuracy and excellent tolerance of the procedure VCB appears to be the future method of choice for the workup of those indeterminate mammographically detected lesions that up to now have still required surgical biopsy.