Non-invasive measurement of brain temperature using radiometric thermometry: experimental validation and clinical observations in asphyxiated newborns.

BACKGROUND: Therapeutic hypothermia (HT) has been shown to decrease death and severe disability in infants with hypoxic-ischemic encephalopathy (HIE). Rectal temperature (RT) is used to determine the temperature set-points for treatment with HT, however experimental studies have shown significant differences between RT and brain temperature during HT. Knowledge of actual brain temperature during HT might allow better determination of optimal degree of cooling and improve outcomes. OBJECTIVES: To compare measurements of brain temperature obtained by non-invasive radiometric thermometry (RadT) to direct tissue measurements in an experimental model of HT, and to use RadT in newborn infants with HIE undergoing HT. STUDY DESIGN: RadT measurements of brain temperature were compared to fiber optic (Luxtron) thermometry measurements placed at a depth of 1.5 centimeters into the brain of cooled miniswine. Following validation studies, brain RadT and RT measurements were continuously recorded in thirty infants with HIE during HT and rewarming. RESULTS: RadT and Luxtron probe temperatures were comparable in miniswine throughout a temperature range similar to therapeutic HT. RadT measurements of brain temperature were higher than RT in 60% of infants with HIE undergoing HT. Higher RadT measurements compared to RT were associated with cerebral white matter abnormalities (p = 0.01). CONCLUSIONS: RadT provides a safe, passive and non-invasive way to measure brain temperature that can be used in the clinical setting. RadT may be helpful in determining the optimal degree of cooling and identifying infants at highest risk of brain injury.

Effects of cross-modal selective attention on the sensory periphery: cochlear sensitivity is altered by selective attention.

There is increasing evidence that alterations in the focus of attention result in changes in neural responding at the most peripheral levels of the auditory system. To date, however, those studies have not ruled out differences in task demands or overall arousal in explaining differences in responding across intermodal attentional conditions. The present study sought to compare changes in the response of cochlear outer hair cells, employing distortion product otoacoustic emissions (DPOAEs), under different, balanced conditions of intermodal attention. DPOAEs were measured while the participants counted infrequent, brief exemplars of the DPOAE primary tones (auditory attending), and while counting visual targets, which were instances of Gabor gradient phase shifts (visual attending). Corroborating an earlier study from our laboratory, the results show that DPOAEs recorded in the auditory-ignoring condition were significantly higher in overall amplitude, compared with DPOAEs recorded while participants attended to the eliciting primaries; a finding in apparent contradiction with more central measures of intermodal attention. Also consistent with our previous findings, DPOAE rapid adaptation, believed to be mediated by the medial olivocochlear efferents (MOC), was unaffected by changes in intermodal attention. The present findings indicate that manipulations in the conditions of attention, through the corticofugal pathway, and its last relay to cochlear outer hair cells (OHCs), the MOC, alter cochlear sensitivity to sound. These data also suggest that the MOC influence on OHC sensitivity is composed of two independent processes, one of which is under attentional control.

Microwave applications in clinical medicine.

Over the last fifty years, energy has been applied to various human tissues for both the diagnosis and therapy of numerous diseases. However, in general, the medical community remains uninformed about the many potential applications of this energy source. We review the many areas in which microwave energy has shown clinical utility.

New connection method for isolating and disinfecting intraluminal path during peritoneal dialysis solution-exchange procedures.

Microbiological data have been collected on the performance of a new method of isolating and disinfecting the intraluminal path at the connect/disconnect site of a peritoneal dialysis (PD)-exchange pathway. High-temperature moist-heat (HTMH) disinfection is accomplished by a new device that uses microwave energy to heat the solution contained in the pressure-tight inner lumen of PD connector pairs between the transfer-set connector-clamp and the bag-connector break-away seal. An 85 degrees C (S.D. = 2.4 degrees C, n = 10) rise in solution temperature is seen in 12 seconds, thus yielding temperatures under pressure well over 100 degrees C with starting temperatures of 25 degrees C. Connector pairs were prepared by inoculation of a solution suspension containing at least 10(6) colony-forming units (CFU) of a test micro-organism. Approximately 0.4 mL of solution was contained within the mated connector pair. Using standard D-value determination methods, data were obtained for surviving organisms versus five exposure times and a positive control to obtain a population reduction curve. Four micro-organisms (S. epidermidis, P. aeruginosa, C. albicans, and A. niger) recognized to be among the most prevalent or problematic in causing peritonitis were tested. After microwave heating, the treated solution was aseptically withdrawn from the connector pair using a needle and syringe, plated in growth media, and incubated. Population counts of CFUs after incubation were used to establish survival curves. Results showed a tenfold population reduction in less than 3 seconds for all organisms tested. A 30-second cycle time safely achieves a > 10(8) population-reduction for bacteria and yeast organisms, and a > 10(7) population reduction for fungi. One potential benefit of using this new intraluminal disinfection method is that it may help reduce peritonitis resulting from the even more problematic pathogens such as the gram-negative bacteria and fungal organisms.

Detection of air emboli in radiographic contrast media by microwave radiometry.

To evaluate the efficacy of a microwave radiometry system in detecting in-line air emboli in radiographic contrast media, air emboli ranging in volume from 0.1 to 0.005 ml were introduced into ionic (ioxaglate) and nonionic (iohexol) contrast media at 22 or 37 degrees pumped at flow rates of 16.7, 180 or 300 ml/min through polyvinlychloride tubing with an inner diameter of 0.100 inches (2.54 mm) over which was fitted a radiometer antenna connected to a Microwave Medical System F+ radiometer and a computerized data acquisition system. A total of 400 determinations were run, with 10 replicate determinations for each unique set of experimental conditions. The success of air emboli detection was not significantly related to contrast media (p = 0.73) or contrast temperature (p = 0.68). Embolus volume (p < 0.0001) and pump speed (p < 0.0001) were significant factors affecting system performance. The system could reliably detect small (0.005 ml) emboli in both ionic and nonionic low-osmolar contrast media.

The effects of postnatal caffeine exposure on growth, activity and learning in rats.

Caffeine is both ingested by pregnant women in their third trimesters and administered therapeutically to premature infants to stimulate respiration. This experiment attempted to delineate any persistent effects of low dose caffeine exposure during the first week of life in rats, since this time period provides an animal model equivalent to the human third trimester or premature infant exposure. Rat pups who had received either 1 or 9 mg/kg of caffeine during the first week of life grew more slowly, were hypoactive at two weeks of age, and were impaired on an operant spatial learning task as adults. Adding visual cues to the operant task did not improve their performance. The timing of the appearance of developmental landmarks, adult body weight and adult brain weight, however, were not affected by postnatal caffeine exposure. The persistent behavioral deficits noted after postnatal caffeine exposure were all opposite in direction to the acute effects of caffeine, and similar to the effects of adenosine. Thus the behavioral deficits reported here may reflect an upregulation of developing adenosine receptors that persists into adulthood subsequent to early chronic postnatal caffeine exposure.

Rapid in-line blood warming using microwave energy: preliminary studies.

The management of massive blood loss resulting from trauma or surgery necessitates rapid transfusion capability. Hypothermia secondary to shock, transfusion, and prolonged surgical procedures significantly increases morbidity and mortality in these patients. Transfusion at high flow rates frequently exceeds the warming capacity of conventional blood-warming devices, whose inherent resistance also limits the maximal flow rates. Microwave ovens are capable of blood warming, but have been associated with unacceptable hemolysis. We have investigated the possibility of using microwave energy to provide rapid in-line blood warming. Fresh blood from 10 human subjects was warmed from an average of 18 degrees C to temperatures ranging from 37 to 39 degrees C at flow rates from 250 to 500 mL/min. Laboratory analysis of free plasma hemoglobin, haptoglobin, hematocrit, hemoglobin, and electrolytes showed no difference between heated and control samples. LDH was elevated in those samples warmed repeatedly, but remained within the normal range. These data indicate the potential for further investigation utilizing properly controlled microwave energy for in-line blood and fluid warming.

Spatial resolution measurements for passive microwave radiometry using a tissue-equivalent phantom.

A tissue-equivalent "hot" line source phantom is described for assessing spatial resolution in passive microwave radiometry systems. LSFs were measured for two rectangular waveguide antennas connected to a 4.7-GHz radiometer. The normalized LSFs and corresponding modulation transfer functions were found to be independent of line source temperature, but dependent upon antenna size, orientation, and line source depth.

Performance characteristics of a helical microwave interstitial antenna for local hyperthermia.

A helical microwave antenna has been designed to improve heat deposition by interstitial applicators used for clinical hyperthermia. Iso-specific-absorption-rate (SAR) curves of the helical antenna as well as a conventional monopole antenna were measured and compared in both muscle and brain tissue phantoms. The heating pattern of the helical antenna is more uniform along the length of the antenna which has important implications for multiarray implant configurations.

Detection of extravasation of antineoplastic drugs by microwave radiometry.

Microwave radiometry may be used as a non-invasive technique for subcutaneous thermal sensing. This technique was capable of demonstrating extravasation of small volumes of fluids, including the antineoplastic agent adriamycin, when these fluids were administered at room temperature in dogs. The rate of temperature drop upon extravasation was proportional to the flow rate. It is feasible that microwave radiometry may be useful as an alarm system to reduce serious complications which often accompany the extravasation of antineoplastic drugs.

Cancer detection studies using a 4.7 Gigahertz radiometer.

Our laboratory has begun to evaluate the cancer detection capabilities of a microwave thermographic unit that employs a 4.7 GHz radiometer. The technique is passive and noninvasive. The temperature sensitivity of the unit is less than 0.1 degrees C. Malignant tumors are often about 1 degree C warmer than normal tissues. Microwave radiometry can provide information related to subsurface temperatures, whereas infrared thermography is limited to surface temperatures. Positive results were obtained in four of six biopsy-proved primary carcinomas of the breast, in four of four patients with lymphoma, and in nine of ten women with recurrent breast cancer. Negative results were obtained in patients with deeply seated tumors such as in lung, liver, esophagus, femur, and humerus. Microwave thermography is a promising new method of noninvasive cancer detection, and the choice of a 4.7 GHz frequency may represent an improvement over units operated at other frequencies.