Noninvasive Techniques (noninvasive + techniques)

Distribution by Scientific Domains

Selected Abstracts

Test Characteristics of High-Resolution Ultrasound in the Preoperative Assessment of Margins of Basal Cell and Squamous Cell Carcinoma in Patients Undergoing Mohs Micrographic Surgery

BACKGROUND Noninvasive techniques to assess subclinical spread of nonmelanoma skin cancer (NMSC) may improve surgical precision. High-resolution ultrasound has shown promise in evaluating the extent of NMSC. OBJECTIVES To determine the accuracy of high-resolution ultrasound to assess the margins of basal cell (BCC) and squamous cell carcinomas (SCC) before Mohs micrographic surgery (MMS). METHODS We enrolled 100 patients with invasive SCC or BCC. Before the first stage of MMS, a Mohs surgeon delineated the intended surgical margin. Subsequently, a trained ultrasound technologist independently evaluated disease extent using the EPISCAN I-200 to evaluate tumor extent beyond this margin. The accuracy of high-resolution ultrasound was subsequently tested by comparison with pathology from frozen sections. RESULTS The test characteristics of the high-resolution ultrasound were sensitivity=32%, specificity=88%, positive predictive value=47%, and negative predictive value=79%. Subgroup analyses demonstrated better test characteristics for tumors larger than the median (area>1.74 cm2). Qualitative analyses showed that high-resolution ultrasound was less likely to identify extension from tumors with subtle areas of extension, such as small foci of dermal invasion from infiltrative SCC and micronodular BCC. CONCLUSION High-resolution ultrasound requires additional refinements to improve the preoperative determination of tumor extent before surgical treatment of NMSC. [source]

Assessment of Myocardial Viability with Dobutamine Stress Echocardiography in Patients with Ischemic Left Ventricular Dysfunction

Siu-Sun Yao M.D.
The noninvasive assessment of myocardial viability has proved clinically useful for distinguishing hibernating and/or stunned myocardium from irreversibly injured myocardium in patients with chronic ischemic heart disease or recent myocardial infarction, with marked regional and/or global left ventricular (LV) dysfunction. Noninvasive techniques utilized for the detection of viability in asynergic myocardial regions include positron emission tomographic imaging of residual metabolic activity, single photon emission tomography (SPECT) of radioisotope uptake with thallium-201, low-dose dobutamine echocardiography assessment of inotropic reserve and myocardial contrast echocardiography for evaluation of microvascular integrity. Of these techniques, dobutamine stress echocardiography is a safe, widely available and relatively inexpensive modality for the identification of myocardial viability for risk stratification and prognosis. Low-dose dobutamine response can accurately predict improvement of dysfunctional yet viable myocardial regions, and thus identify a subset of patients whose LV function will improve following successful coronary revascularization. [source]

Single-beat estimation of the left ventricular end-systolic pressure,volume relationship in patients with heart failure

E. A. Ten Brinke
Abstract Aim:, The end-systolic pressure,volume relationship (ESPVR) constructed from multiple pressure,volume (PV) loops acquired during load intervention is an established method to asses left ventricular (LV) contractility. We tested the accuracy of simplified single-beat (SB) ESPVR estimation in patients with severe heart failure. Methods:, Nineteen heart failure patients (NYHA III-IV) scheduled for surgical ventricular restoration and/or restrictive mitral annuloplasty and 12 patients with normal LV function scheduled for coronary artery bypass grafting were included. PV signals were obtained before and after cardiac surgery by pressure-conductance catheters and gradual pre-load reductions by vena cava occlusion (VCO). The SB method was applied to the first beat of the VCO run. Accuracy was quantified by the root-mean-square-error (RMSE) between ESPVRSB and gold-standard ESPVRVCO. In addition, we compared slopes (EES) and intercepts (end-systolic volume at multiple pressure levels (70,100 mmHg: ESV70,ESV100) of ESPVRSB vs. ESPVRVCO by Bland,Altman analyses. Results:, RMSE was 1.7 ± 1.0 mmHg and was not significantly different between groups and not dependent on end-diastolic volume, indicating equal, high accuracy over a wide volume range. SB-predicted EES had a bias of ,0.39 mmHg mL,1 and limits of agreement (LoA) ,2.0 to +1.2 mmHg mL,1. SB-predicted ESVs at each pressure level showed small bias (range: ,10.8 to +9.4 mL) and narrow LoA. Two-way anova indicated that differences between groups were not dependent on the method. Conclusion:, Our findings, obtained in hearts spanning a wide range of sizes and conditions, support the use of the SB method. This method ultimately facilitates less invasive ESPVR estimation, particularly when coupled with emerging noninvasive techniques to measure LV pressures and volumes. [source]

A cranial intercondylar arthroscopic approach to the caudal medial femorotibial joint of the horse

T. Muurlink
Summary Reason for performing study: Current noninvasive techniques for imaging the soft tissue structures of the stifle have limitations. Arthroscopy is commonly used for the investigation and treatment of stifle pain. Cranial and caudal arthroscopic approaches to the femorotibial joints are used. However, complete examination of the axial aspect of the medial femorotibial joint (MFTJ) is not possible currently. Objective: To develop a cranial approach to the caudal pouch of the MFTJ and to assess whether it would allow a more complete examination of the compartment and facilitate the caudomedial approach. Method: The regional anatomy was reviewed and the technique developed on cadavers. A series of nonrecovery surgeries were performed to evaluate the procedure, which was then used in 7 clinical cases. Advantages compared to existing techniques and complications encountered were recorded. Results: Successful entry into the caudal pouch of the MFTJ was achieved in 20 of 22 cadaver legs, 8 of 8 joints of nonrecovery surgery horses and 6 of 7 clinical cases operated. The caudal ligament of the medial meniscus could be visualised, along with other axial structures of the caudal joint pouch. The technique was used to facilitate a caudomedial approach and allowed better triangulation within the joint space. Complications were minor and included puncture of the caudal joint capsule and scoring of the axial medial femoral condyle. Conclusions and potential relevance: It is possible to access the caudal pouch of the MFTJ arthroscopically using a cranial intercondylar approach. The technique has advantages when compared to existing techniques and is associated with few significant complications. A cranial approach to the caudal pouch of the MFTJ could complement existing techniques and be useful clinically. [source]

Changes in Bone Density During Childhood and Adolescence: An Approach Based on Bone's Biological Organization

Frank Rauch
Abstract Bone densitometry has great potential to improve our understanding of bone development. However, densitometric data in children rarely are interpreted in light of the biological processes they reflect. To strengthen the link between bone densitometry and the physiology of bone development, we review the literature on physiological mechanisms and structural changes determining bone mineral density (BMD). BMD (defined as mass of mineral per unit volume) is analyzed in three levels: in bone material (BMDmaterial), in a bone's trabecular and cortical tissue compartments (BMDcompartment), and in the entire bone (BMDtotal). BMDmaterial of the femoral midshaft cortex decreases after birth to a nadir in the first year of life and thereafter increases. In iliac trabecular bone, BMDmaterial also increases from infancy to adulthood, reflecting the decrease in bone turnover. BMDmaterial cannot be determined with current noninvasive techniques because of insufficient spatial resolution. BMDcompartment of the femoral midshaft cortex decreases in the first months after birth followed by a rapid increase during the next 2 years and slower changes thereafter, reflecting changes in both relative bone volume and BMDmaterial. Trabecular BMDcompartment increases in vertebral bodies but not at the distal radius. Quantitative computed tomography (QCT) allows for the determination of both trabecular and cortical BMDcompartment, whereas projectional techniques such as dual-energy X-ray absorptiometry (DXA) can be used only to assess cortical BMDcompartment of long bone diaphyses. BMDtotal of long bones decreases by about 30% in the first months after birth, reflecting a redistribution of bone tissue from the endocortical to the periosteal surface. In children of school age and in adolescents, changes in BMDtotal are site-specific. There is a marked rise in BMDtotal at locations where relative cortical area increases (metacarpal bones, phalanges, and forearm), but little change at the femoral neck and midshaft. BMDtotal can be measured by QCT at any site of the skeleton, regardless of bone shape. DXA allows the estimation of BMDtotal at skeletal sites, which have an approximately circular cross-section. The system presented here may help to interpret densitometric results in growing subjects on a physiological basis. [source]

Noninvasive Assessment of Cardiac Resynchronization Therapy for Congestive Heart Failure Using Myocardial Strain and Left Ventricular Peak Power as Parameters of Myocardial Synchrony and Function

Resynchronization Therapy for Heart Failure.Introduction: Although invasive studies have shown that cardiac resynchronization therapy by biventricular pacing improves left ventricular (LV) function in selected heart failure patients, it is impractical to apply such techniques in the clinical setting. The aim of this study was to assess the acute effects of cardiac resynchronization therapy by noninvasive techniques. Methods and Results: Twenty-two patients enrolled in the InSync trial (age 64 ± 9 years, 18 men and 4 women; all with ejection fraction <35% and QRS >130 msec) were studied 1 to 12 months after pacemaker implantation during pacing, and while ventricular pacing was inhibited. Regional myocardial strains of the interventricular septum, LV free wall, and right ventricular free wall were derived from color Doppler tissue echocardiography. Peak power index was calculated as a product of simultaneously recorded noninvasive blood pressure and pulse-wave (PW) Doppler velocity of the LV outflow tract. The Z ratio (sum of LV ejection and filling times divided by RR interval) and tei index were calculated from PW Doppler data. During pacing, overall regional strain improved (P = 0.01), while the LV strain coefficient of variation decreased from 2.7 ± 2.4 to 1.3 ± 0.7 (P = 0.009). Additionally, peak power index improved from 84 ± 24 to 94 ± 27 cm· mmHg/sec (P = 0.004). The Z ratio increased from 0.71 ± 0.08 to 0.78 ± 0.07 (P = 0.0005), while the tei index decreased from 0.86 ± 0.33 to 0.59 ± 0.16 (P = 0.0002). Conclusion: Using novel noninvasive indices, we demonstrated that cardiac resynchronization therapy improves LV performance. [source]

Long-term asymptomatic biochemical cholestasis after fulminant or subfulminant liver failure is associated with extensive postnecrotic collapse with regeneration of the liver

Michèle Ngassa
Abstract: Fulminant or subfulminant liver failure usually leads to liver failure or to recovery. In rare instances, patients who recover exhibit prolonged asymptomatic biochemical cholestasis which coincides with the development into the parenchyma of large postnecrotic collapse with regeneration. This hitherto poorly recognized form of recovery may now be assessed by noninvasive techniques such as magnetic resonance imaging. We report the case of three patients who recovered from fulminant or subfulminant liver failure and in whom investigation of long-term biochemical cholestasis led to that unusual diagnosis. [source]

Rapid measurement of aortic wave velocity: In vivo evaluation

Kenneth A. Kraft
Abstract A 1D MR sequence has been developed for determining aortic flow wave velocity (WV), a metric of arterial compliance, within a single cardiac cycle. Studies were carried out on the thoracic aortas of 10 normal volunteers. Correlative WV data were also acquired from each subject using a conventional phase-velocity 2D mapping technique. Aortic WV in this cohort was found to range from 411 to 714 cm/s and was highly correlated (R = 0.95) between the two methods. Peak blood velocity was also measured using both methods and found to agree closely. The reproducibility of WV measurements using the rapid 1D method averaged 7.6%, which is comparable or better than that achieved using existing noninvasive techniques. Magn Reson Med 46:95,102, 2001. © 2001 Wiley-Liss, Inc. [source]

Neuroscientific approaches and applications within anthropology

James K. Rilling
Abstract Many of the most distinctive attributes of our species are a product of our brains. To understand the function, development, variability, and evolution of the human brain, we must engage with the field of neuroscience. Neuroscientific methods can be used to investigate research topics that are of special interest to anthropologists, such as the neural bases of primate behavioral diversity, human brain evolution, and human brain development. Traditional neuroscience methods had to rely on investigation of postmortem brains, as well as invasive studies in living nonhuman primates. However, recent neuroimaging methods have made it possible to compare living human and nonhuman primate brains using noninvasive techniques such as structural and functional magnetic resonance imaging, positron emission tomography, and diffusion tensor imaging. These methods are providing an integrated picture of brain structure and function that was not previously available. With a combination of these traditional and modern neuroscience methods, we are beginning to explore and understand the neural bases of some of the most distinctive cognitive and behavioral attributes of the human species, including language, tool use, altruism, and mental self-projection, and we can now begin to propose plausible scenarios by which the neural substrates supporting these human specializations evolved from pre-existing neural circuitry serving related functions in common ancestors we shared with the living nonhuman primates. Consideration of the process of neurodevelopment suggests plausible mechanisms by which the highly encephalized human brain might have evolved. Neurodevelopmental studies also demonstrate that experience can shape both brain structure and function, providing a mechanism by which people of different cultures learn to act and think differently. Finally, not only can anthropologists benefit from neuroscience, neuroscience can benefit from the more sophisticated concept of evolution that anthropology offers, including an appreciation of evolutionary diversity as well as consideration of the process by which the human brain was formed during evolution. Yrbk Phys Anthropol 51:2,32, 2008. © 2008 Wiley-Liss, Inc. [source]

Assessing reproductive profiles in female brown mouse lemurs (Microcebus rufus) from Ranomafana National Park, southeast Madagascar, using fecal hormone analysis

Marina B. Blanco
Abstract Studies on reproductive endocrinology in wild primate populations have greatly increased in the last decades owing to the development of noninvasive techniques that can be applied under field conditions. However, small-bodied nocturnal species are not well represented on the long list of primates surveyed in the wild, and reproductive inferences regarding these animals in their natural habitats have not benefited from direct observations of hormonal changes. We collected fecal samples from female brown mouse lemurs (Microcebus rufus) in a southeastern rainforest of Madagascar in order to determine whether or not fecally excreted steroid levels show a consistent pattern of change during the reproductive season and are a useful complement to reproductive observations in wild-trapped individuals. Initial data show variation in reproductive hormone levels before and after estrus and estimated day of parturition. Elevated levels of excreted estradiol (E2) were observed around the time of estrus, whereas high levels of fecal progesterone (P) were seen during later stages of pregnancy and around parturition. A more complete picture of reproductive profiles in female mouse lemurs, and how they may change over the life span, can be obtained if hormone analyses are used to supplement field observations. Am. J. Primatol. 71:439,446, 2009. © 2009 Wiley-Liss, Inc. [source]

Measurement of urinary and fecal steroid metabolites during the ovarian cycle in captive and wild Japanese macaques, Macaca fuscata

Shiho Fujita
Abstract We measured the concentration of steroid hormones from urine, feces, and blood samples of two captive Japanese macaques, Macaca fuscata, during nonconceptive ovarian cycles to compare the patterns of the excreted steroids with those of circulating steroids. Urine and feces were analyzed for estrone conjugates (E1C) and pregnanediol-3-glucronide (PdG) using enzyme immunoassays (EIAs), while plasma was analyzed for estradiol-17,(E2), progesterone (P), and luteinizing hormone (LH) using radioimmunoassays (RIAs). Urinary and fecal E1C and PdG levels were approximately parallel to plasma E2 and P levels, respectively. The E1C profiles of daily urinary and fecal samples revealed a midcycle peak, followed by a sustained PdG increase lasting up to two weeks from the E1C peak. A fecal E1C peak was one day later than the urinary E1C peak. One of the captive females exhibited a discrete plasma LH peak, one indicator that ovulation has occurred, on the day following the urinary E1C peak, i.e., the same day of fecal E1C peak. We measured excreted steroids in nine wild females and determined the timing of ovulation by comparing fecal steroid profiles to those obtained in captive monkeys. Data from wild females indicated that eight of nine females conceived during their first ovulatory cycle of the sampling period, whereas the remaining female failed to conceive during the sampling period even though she ovulated. In the eight females that conceived, E1C increased again following the detected or estimated E1C peak, with levels comparable to the preovulatory peak levels, and sustained elevations of PdG for over 40 days. These data illustrate that the urinary and fecal profiles of ovarian steroid excretion obtained through the application of these noninvasive techniques provide an accurate approach for monitoring conceptive and nonconceptive ovarian cycle in captive and free-living Japanese macaques. Am. J. Primatol. 53:167,176, 2001. © 2001 Wiley-Liss, Inc. [source]

Brugada Syndrome: Current Clinical Aspects and Risk Stratification

Ph.D., Takanori Ikeda M.D.
Brugada syndrome is a primary electrical disease of the heart that causes sudden cardiac death or life-threatening ventricular arrhythmias, especially in younger men. Genetic analysis supports that this syndrome is a cardiac ion channel disease. A typical electrocardiographic finding consists of a right bundle branch block pattern and ST-segment elevation in the right precordial leads. The higher intercostal space V1 to V3 lead electrocardiogram could be helpful in detecting Brugada patients. Although two types of the ST-segment elevation are present, the coved type is more relevant to the syndrome than the saddle-back type. These patterns can be present permanently or intermittently. Recent data suggest that the Brugada-type electrocardiogram is more prevalent than the manifest Brugada syndrome. Asymptomatic individuals have a much lower incidence of future cardiac events than the symptomatic patients. Although risk stratification for the Brugada syndrome is still incomplete, the inducibility of sustained ventricular arrhythmias has been proposed as a good outcome predictor in this syndrome. In noninvasive techniques, some clinical evidence supports that late potentials detected by signal-averaged electrocardiography are a useful index for identifying patients at risk. The available data recommend prophylactic implantation of an imptantabie cardioverter defibrillator to prevent sudden cardiac death. This review summarizes recent information of the syndrome by reviewing most of new clinical reports and speculates on its risk stratification. A.N.E. 2002;7(3):251,262 [source]