Analysis of heart-rate variability: a noninvasive predictor of death and poor outcome in patients with severe head injury

BACKGROUND: Analysis of heart-rate variability (HRV) is a promising new technique for noninvasive quantification of autonomic function. We measured HRV in patients with severe head injury to assess its potential as a monitoring tool. METHODS: Analysis of HRV was prospectively done on all intensive care unit patients. Concurrent data on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were collected. Registry data were reviewed to identify patients with severe head injury, defined as Head/Neck Abbreviated Injury Scale score > or = 4. Mortality, likelihood of discharge to home, ICP, and CPP were compared between patients with abnormal HRV and those without. RESULTS: Low HRV was associated with increased mortality and decreased rate of discharge to home. Abnormal HRV was associated with episodes of increased ICP and decreased CPP. CONCLUSION: Assessment of HRV is a noninvasive method that can be widely used. Abnormal HRV was associated with poor outcome and altered cerebral perfusion. Monitoring of HRV may improve outcome by allowing earlier detection and treatment of intracranial pathology.     

Nationwide survey of fluoroscopy: radiation dose and image quality

PURPOSE: To determine the average abdominal entrance air kerma, low-contrast sensitivity, and spatial resolution in upper gastrointestinal tract fluoroscopy in the United States. MATERIALS AND METHODS: A random sample of fluoroscopic facilities was selected to be surveyed for the Nationwide Evaluation of X-ray Trends program. Measurements were performed by using a newly developed fluoroscopic phantom. The surveys were conducted by state radiation control personnel. RESULTS: Average air kerma rates 1 cm above the tabletop, free in air, were 43 mGy/min (n = 340). The rate increased to 64 mGy/min when a 1.6-mm-thick copper filter, which simulated the use of barium contrast medium, was added to increase attenuation. The average entrance air kerma, free in air, for radiographs was 3.4 mGy, and an average of 12 radiographs were obtained per examination. Of 352 facilities surveyed, 306 (87%) were able to resolve wire mesh with 20 or more lines per inch. Of 339 facilities for which percentage contrast could be calculated, 192 (57%) had minimum percentage contrast values of 4% or more. CONCLUSION: Spatial resolution for fluoroscopy is adequate for most of the facilities surveyed, but a substantial proportion of facilities could not visualize low-contrast test objects, which strongly suggests image quality problems.     

Microwave dielectric relaxation and molecular dynamics in binary mixtures of poly(vinyl pyrrolidone)–poly(ethylene glycol)s in non‐polar solvent

Dielectric relaxation study of binary mixtures of poly(vinyl pyrrolidone) (PVP) (M_w = 40 000 g mol^?1) and poly(ethylene glycol)s (PEGs) (M_n = 200, 400 and 600 g mol^?1) with concentration variation was carried out in dilute solutions of benzene at 10.1 GHz and 35 °C. The average relaxation time τ_o, corresponding to segmental motion τ₁ and group rotations τ₂ was determined for PVP–PEGs mixtures. A comparison of these mixtures relaxation times was made with the relaxation times of PEGs in benzene solvent. The evaluated τ_o values of PVP–PEGs mixtures in benzene solution are assigned to the reorientation of PEG molecules. It has been observed that the τ_o value of PVP–PEG200 mixtures increases with increasing concentration of PVP but their values are small in comparison with the τ_o value of PEG200 molecules. In the case of PVP–PEG400 and PVP–PEG600 mixtures, the evaluated values of τ_o are greater than the corresponding τ_o values of PEG400 and PEG600 molecules in benzene solvent. The variation in τ_o values in these systems has been discussed by considering the stretching effect in the PEGs molecular chains in PVP–PEGs mixtures in benzene solutions. The high value of distribution parameter α (≈0.4 to 0.7) suggests that in these mixtures there is a large contribution of segmental motion and group rotations to the relaxation processes. The nature of the formation of hydrogen‐bonded PVP–PEG complex heterogeneous network due to hydrogen bonding between carbonyl groups of PVP monomer units and terminal hydroxyl groups of PEGs is discussed. Furthermore, the elongation behaviour of PVP–PEG complex networks in benzene solvent and the molecular dynamics in the mixture due to breaking and reforming of hydrogen bonds has been explored by comparing the evaluated relaxation times and the Kirkwood correlation factor of pure PEG molecules for their possible use in drug control release systems. The relaxation times of these mixtures are independent of their viscosity, but the elongation of the mixture network is influenced by the PEG chain length and the number of hydroxyl groups in comparison with the number of carbonyl groups in the mixtures. Copyright © 2003 Society of Chemical Industry     

Primary immunodeficiency disorders

The primary immunodeficiency diseases are a relatively rare group of congenital disorders that are linked by the expression of an excessive number, duration, or severity of infections. The clinical features of most of the primary immunodeficiency diseases have been well described by astute physicians over several decades and have provided important clues to our basic understanding of human immunology. In contrast, the genetic basis and potential life-saving therapies for many of these disorders have been established only over the past few years. These recent advances have resulted in the prognosis of many of these disorders being largely dependent on their rapid recognition and treatment. Increased awareness of the differentiating epidemiologic, clinical, laboratory and genetic features of these diseases hold the promise of both furthering our understanding of basic human immunology and providing improved care for this challenging group of patients.     

Hepatic hemangioma. Analysis of 103 cases. Clinical considerations and imaging methods

Hemangiomas are the most common benign vascular tumor found in the liver. In this study, 103 cases of hepatic hemangiomas were analysed in a retrospective manner. Image aspects such as those seen in ultrassonography, computed tomography, nuclear magnetic resonance and arteriography are discussed. The incidence was higher amongst the female sex, between individuals from 40 to 60 years old, which presented predominantly without symptoms (66%) and localized mainly in the right hepatic lobe (74%). The meaning of those aspects, when adopted, permits the clinicians to differentiate benign from malignant nodular lesions in the liver.     

A comparison among different inversion methods for multi-exponential NMR relaxation data

With the object to disclose an association between laryngeal papillomatosis and laryngeal carcinoma, we reviewed 102 patients with laryngeal papillomatosis treated between 1950 and 1979. Seven cases of laryngeal carcinomas were recorded and 1 patient with spread of papilloma to the bronchial tree developed a bronchial carcinoma. The time between onset of papilloma and diagnosis of carcinoma was 4-55 years (mean 24 years). For laryngeal carcinoma the ratio of observed to expected cases was 88. Of the 8 patients developing respiratory tract carcinoma, 2 had received treatment with radiation and 2 had been treated with Bleomycin. Four of these 8 patients were known smokers. This study shows that papillomatosis is more often associated with laryngeal carcinoma than previously reported. It appears, however, that laryngeal papillomas alone seldom induce carcinomas. Apart from irradiation and smoking, Bleomycin could be an important co-factor.