Comparative Study of Use of Reusable Skin Staples and Vertical Mattress Sutures in the Closure of Midline Laparotomy Wounds.

Background: There is an increasing tendency to close midline abdominal wounds with staples because of the speed of closure. The aim of this study was to compare the use of skin staples and vertical mattress sutures in the closure of midline abdominal wounds. Materials and Methods: Patients who met inclusion criteria and were booked for laparotomy in our teaching hospital were counseled on the two methods of skin closure using vertical mattress sutures or the use of staples (35 W Surustap, Suru International PVT Ltd, India). Alternating post-laparotomy wounds were closed using skin staples and with a vertical mattress, using nylon 2(0) (3 metric) sutures. The parameters assessed were speed of closure, cost of closure using the different methods, wound infection rate, and short-term cosmetic appearance of wounds. Data were analyzed using SPSS version 21 (IBM, SPSS, Chicago, Illinois). Results: Sixty patients met the inclusion criteria and were recruited for the study. The speed of closure of midline laparotomy skin wound was significantly higher in "the staple group" than in "the suture group" (0.14 vs. 0.034 cm/s), P < 0.05, while the cost of use of staples was significantly more than the cost for closure with sutures (184 vs. 26 Naira/cm), P < 0.05. The mean operative time was significantly less in "the staple group" than in "the suture group" (128.9 minutes versus 157.6 min), P < 0.05. There was no significant difference in the infection rates and cosmetic appearance between the two groups (P > 0.05). Conclusion: Midline abdominal wound closure with staples is faster. There was no difference in wound complication rates and scar appearance when compared with skin closures using the vertical mattress technique. Wound closure with staples is, however, more costly.

Rapid learning in a native predator shifts diet preferences towards invasive prey.

Biological invasions often exert negative impacts on native communities and can disrupt a range of biotic interactions such as those between predators and prey. For example, when invasive species alter the foraging landscape, native predators can fail to recognize them as profitable prey because of unfamiliarity. This study therefore investigated whether a native predator (rock lobster Jasus lalandii) can develop a new preference for an invasive prey (mussel Semimytilus patagonicus) following conditioning through a short-term exposure. Conditioned lobsters, exposed to only S. patagonicus for a month, demonstrated a significant change in preference for the novel invasive prey, which was found to contrast with non-conditioned lobsters that continued to show predator preferences toward a native mussel (Choromytilus meridionalis). There is therefore potential for native predators such as J. lalandii to adapt and switch towards feeding on an abundant invasive prey, even if they avoid it at first. This indicates that rapid learning can occur in a species exposed to novel food resources and demonstrates that native species can adapt to biological invasions.

Correlation of Clinical, Endoscopic, and Pathological Findings among Suspected Peptic Ulcer Disease Patients in Abuja, Nigeria.

BACKGROUND: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and has been linked to Helicobacter pylori (H. pylori) infection. This condition may be suspected on clinical grounds, but diagnosis is established using upper gastrointestinal endoscopy. AIMS: To determine the correlation between the endoscopic and pathological findings among suspected PUD patients who have been referred for diagnostic upper gastrointestinal endoscopy in National Hospital Abuja. METHODS: This is a hospital-based prospective study conducted among suspected PUD patients at National Hospital Abuja over a one-year period. Clinical, endoscopic, and histological findings were ascertained and documented. Data obtained were analyzed using SPSS version 21.0. Tests of significance were done using the chi-square test and Student t-test at 95% confidence intervals. RESULTS: One hundred and thirty-two patients were included in the study. The ages ranged from 15 to 87 years, mean age 43.30 ± 11.94 years. Seventy-seven (58.3%) patients had abnormal endoscopic findings, of whom 37 (28.0%) had PUD. Prevalence of H. pylori infection was 42.2% and was found in 81.1% of PUD patients. H. pylori was significantly associated with confirmed PUD (p < 0.001) and abnormal endoscopic findings (p < 0.001). No association was found between normal endoscopic findings and histological findings (p = 0.924). CONCLUSION: There is a poor correlation between clinical and endoscopic diagnoses of PUD. H. pylori was found to be significantly associated with PUD and abnormal endoscopic findings. Endoscopic facilities should therefore be made available and accessible for proper PUD diagnosis. Empirical treatment of H. pylori in patients with diagnosed PUD is strongly recommended.

Out of the pot and into the fire: Explaining the vulnerability of an endangered small headwater stream fish to black-bass Micropterus spp. invasion.

Introduced predatory fishes have had consistently severe consequences for native fishes in stream environments around the world, although the drivers of these effects are often unclear. In the Swartkops River headwaters in South Africa, native Eastern Cape redfin Pseudobarbus afer were always absent from sites occupied by non-native black basses Micropterus salmoides and Micropterus dolomieu, but generally co-occurred with the native predators Anguilla marmorata and Anguilla mossambica. A natural experiment provided by flood-mediated recolonization of black-bass occupied sites by P. afer demonstrated depletion in black-bass invaded sites. Field behavioural observations of P. afer indicated that they foraged among benthic cover during the day, but suspended in open water at night. As the nocturnal A. marmorata and A. mossambica foraged actively within structural cover at night and M. dolomieu and M. salmoides are diurnal or crepuscular predators, P .afer is thus optimized to avoid predation by native anguillid predators and not the functionally unique predatory black basses. The integration of distributional, temporal population dynamics and behavioural data suggests that the severe effects of Micropterus spp. are probably a consequence of prey naïveté and behaviour evolved to evade native predators.

Modelling the effect of a booster vaccination on disease epidemiology.

Despite the effectiveness of vaccines in dramatically decreasing the number of new infectious cases and severity of illnesses, imperfect vaccines may not completely prevent infection. This is because the immunity afforded by these vaccines is not complete and may wane with time, leading to resurgence and epidemic outbreaks notwithstanding high levels of primary vaccination. To prevent an endemic spread of disease, and achieve eradication, several countries have introduced booster vaccination programs. The question of whether this strategy could eventually provide the conditions for global eradication is addressed here by developing a seasonally-forced mathematical model. The analysis of the model provides the threshold condition for disease control in terms of four major parameters: coverage of the primary vaccine; efficacy of the vaccine; waning rate; and the rate of booster administration. The results show that if the vaccine provides only temporary immunity, then the infection typically cannot be eradicated by a single vaccination episode. Furthermore, having a booster program does not necessarily guarantee the control of a disease, though the level of epidemicity may be reduced. In addition, these findings strongly suggest that the high coverage of primary vaccination remains crucial to the success of a booster strategy. Simulations using estimated parameters for measles illustrate model predictions.

Periodicity in an epidemic model with a generalized non-linear incidence.

We develop and analyze a simple SIV epidemic model including susceptible, infected and perfectly vaccinated classes, with a generalized non-linear incidence rate subject only to a few general conditions. These conditions are satisfied by many models appearing in the literature. The detailed dynamics analysis of the model, using the Poincaré index theory, shows that non-linearity of the incidence rate leads to vital dynamics, such as bistability and periodicity, without seasonal forcing or being cyclic. Furthermore, it is shown that the basic reproductive number is independent of the functional form of the non-linear incidence rate. Under certain, well-defined conditions, the model undergoes a Hopf bifurcation. Using the normal form of the model, the first Lyapunov coefficient is computed to determine the various types of Hopf bifurcation the model undergoes. These general results are applied to two examples: unbounded and saturated contact rates; in both cases, forward or backward Hopf bifurcations occur for two distinct values of the contact parameter. It is also shown that the model may undergo a subcritical Hopf bifurcation leading to the appearance of two concentric limit cycles. The results are illustrated by numerical simulations with realistic model parameters estimated for some infectious diseases of childhood.

Problems and prospects of managing thoracic aortic aneurysm at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

The objective of this report is to highlight the problems encountered in managing thoracic aortic aneurysm in a third-generation teaching hospital serving a purely rural community in the heartland of Anambra State, in the southeastern part of Nigeria. This report also proffers solutions aimed at assisting in providing better care for patients afflicted with this condition. From time to time, patients present with vascular diseases, including aneurysm, but the condition is only occasionally suspected and sparingly investigated. This is a report of two cases within the setting of the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi Nigeria. After the death of these two patients, one of whom was a member of the staff of the hospital, post mortem examinations revealed that they had died of ruptured thoracic aortic aneurysm. Their medical records were retrieved from the Medical Records Department and reviewed with the aim of analyzing their clinical features and management in the light of the unexpected post-mortem examination results. The survey of the patient records revealed that the diagnosis of thoracic aortic aneurysm was not suspected in either patient even though both had symptoms pointing to this condition. The staff member was a 55-year old man and the other patient was a 31-year old woman in her 30th week of pregnancy. We conclude by drawing the attention of medical practitioners in our community to the fact that thoracic aortic aneurysms are probably more common than we thought. Only a high index of suspicion will lead to clinical diagnosis and treatment.

Supraventricular arrhythmias in children and young adults with implantable cardioverter defibrillators.

INTRODUCTION: Rapidly conducted supraventricular tachycardias (SVTs) can lead to inappropriate device therapy in implantable cardioverter defibrillator (ICD) patients. We sought to determine the incidence of SVTs and the occurrence of inappropriate ICD therapy due to SVT in a pediatric and young adult population. METHODS AND RESULTS: We undertook a retrospective review of clinical course, Holter monitoring, and ICD interrogations of patients receiving ICD follow-up at our institution between March 1992 and December 1999. Of 81 new ICD implantations, 54 eligible patients (median age 16.5 years, range 1 to 48) were identified. Implantation indications included syncope and/or spontaneous/inducible ventricular arrhythmia with congenital heart disease (30), long QT syndrome (9), structurally normal heart (ventricular tachycardia/ventricular fibrillation [VT/VF]) (7), and cardiomyopathies (7). Sixteen patients (30%) received a dual-chamber ICD. SVT was recognized in 16 patients, with 12 of 16 having inducible or spontaneous atrial tachycardias. Eighteen patients (33%) received > or =1 appropriate shock(s) for VT/VF; 8 patients (15%) received inappropriate therapy for SVT. Therapies were altered after an inappropriate shock by increasing the detection time or rate and/or increasing beta-blocker dosage. No single-chamber ICD was initially programmed with detection enhancements, such as sudden onset, rate stability, or QRS discriminators. Only one dual-chamber defibrillator was programmed with an atrial discrimination algorithm. Appropriate ICD therapy was not withheld due to detection parameters or SVT discrimination programming. CONCLUSION: SVT in children and young adults with ICDs is common. Inappropriate shocks due to SVT can be curtailed even without dual-chamber devices or specific SVT discrimination algorithms.

Electroanatomic mapping of entrained and exit zones in patients with repaired congenital heart disease and intra-atrial reentrant tachycardia.

BACKGROUND: Characterization of reentrant circuits and targeting ablation sites remains difficult for intra-atrial reentrant tachycardias (IART) in congenital heart disease (CHD). METHODS AND RESULTS: Electroanatomic mapping and entrainment pacing were performed before successful ablation of 18 IART circuits in 15 patients with CHD. Principal features of IART circuits were atrial septal defect (4 patients), atriotomy (3 patients), other atrial scar (3 patients), crista terminalis (3 patients), and right atrioventricular valve (5 patients). A median of 176 sites (range, 96 to 317 sites) was mapped for activation and 13 sites (range, 9 to 28 sites) for entrainment response. Postpacing intervals within 20 ms of tachycardia cycle length and stimulus-to-P-wave intervals of 0 to 90 ms (exit zones) were mapped to atrial surfaces generated by electroanatomic mapping. Criteria for entrainment were met over a median of 21 cm2 of atrial surface (range, 2 to 75 cm2), 19% (range, 1% to 81%) of total area tested. Using integrated data, relations between activation sequence and protected corridor of conduction could be inferred for 16 of 17 LARTs. Successful ablation was achieved at a site distant from the putative protected corridor in 9 of 18 (50%) circuits. CONCLUSIONS: The right atrium in CHD supports a variety of IART mechanisms. Fusion of activation and entrainment data provided insight into specific IART mechanisms relevant to ablation.

Minimally invasive cardioverter defibrillator implantation for children: an animal model and pediatric case report.

The smaller venous capacitance in infants and small children may hamper transvenous ICD lead implantation, and epicardial approaches require thoracotomy and have associated complications. The study evaluated the feasibility and performance of subcutaneous arrays and active can ICDs without transvenous shocking coils or epicardial patches. An immature and mature pig were anesthetized and ventilated. A pacing lead was inserted in the right ventricle for fibrillation induction and rate sensing. Subcutaneous arrays were positioned in the right and left chest walls. An ICD emulator was placed in abdominal and prepectoral pockets. Fluoroscopic images were acquired for each electrical vector configuration (array --> can, can --> array, array --> array, array + array --> can). Ventricular fibrillation was induced and DFT testing performed. Defibrillation was achieved in all ten trials in the immature piglet, with DFT < or = 9 J, regardless of vector configuration. Using a single subcutaneous array and active can, the shock impedance ranged from 28-36 ohms. With two arrays, shocking impedance fell to 15-22 ohms. In the adult pig, defibrillation was not accomplished with maximum energy of 40 J, using all vector configurations. Using data garnered from these experiments, this technique was then successfully performed in a 2-year-old child with VT and repaired congenital heart disease, needing an ICD. This study demonstrates the feasibility of leadless ICD implantation in an immature animal and successful implementation in a small child. A single subcutaneous array and active can resulted in excellent implant characteristics and DFTs with a minimally invasive approach. Defibrillation was not possible in a larger animal, possibly due to maximal available energy. This may be of value for small children requiring ICD implantation.

3D image registration using a fast noniterative algorithm.

This note describes the implementation of a three-dimensional (3D) registration algorithm, generalizing a previous 2D version [Alexander, Int J Imaging Systems and Technology 1999;10:242-57]. The algorithm solves an integrated form of linearized image matching equation over a set of 3D rectangular sub-volumes ('patches') in the image domain. This integrated form avoids numerical instabilities due to differentiation of a noisy image over a lattice, and in addition renders the algorithm robustness to noise. Registration is implemented by first convolving the unregistered images with a set of computationally fast [O(N)] filters, providing four bandpass images for each input image, and integrating the image matching equation over the given patch. Each filter and each patch together provide an independent set of constraints on the displacement field derived by solving a set of linear regression equations. Furthermore, the filters are implemented at a variety of spatial scales, enabling registration parameters at one scale to be used as an input approximation for deriving refined values of those parameters at a finer scale of resolution. This hierarchical procedure is necessary to avoid false matches occurring. Both downsampled and oversampled (undecimating) filtering is implemented. Although the former is computationally fast, it lacks the translation invariance of the latter. Oversampling is required for accurate interpolation that is used in intermediate stages of the algorithm to reconstruct the partially registered from the unregistered image. However, downsampling is useful, and computationally efficient, for preliminary stages of registration when large mismatches are present. The 3D registration algorithm was implemented using a 12-parameter affine model for the displacement: u(x) = Ax + b. Linear interpolation was used throughout. Accuracy and timing results for registering various multislice images, obtained by scanning a melon and human volunteers in various stationary positions, is described. The algorithm may be generalized to more general models of the displacement field, and is also well suited to parallel processing.

Estimation of atrial response to entrainment pacing using electrograms recorded from remote sites.

INTRODUCTION: Assessing the entrainment response by measuring postpacing intervals (PPIs) at the pacing site facilitates localization of reentrant circuits, but may be technically difficult. METHODS AND RESULTS: There were 269 right atrial sites entrained in 21 circuits in congenital heart patients left atrial (LA) electrograms were recorded. Entrainment response was measured by two methods: (1) PPI-tachycardia cycle length, and (2) the difference in latencies between the stimulus artifact and the pacing site electrogram, referenced to the LA electrogram. PPI also was measured from the LA as an index of antidromic activation. Among 43 pacing sites with antidromic LA activation, half showed a discrepancy 225 msec between methods 1 and 2. At the other 226 sites, agreement between the two methods was high (mean discrepancy -3+/-8 msec, r = 0.975, 0 sites with discrepancy 225 msec). Correcting all sites by LA antidromicity reduced the mean discrepancy to +1+/-6 msec and improved correlation (r = 0.988). CONCLUSION: LA electrograms can be used to estimate right atrial entrainment response, if antidromic activation of the LA is recognized and taken into account.

Ventricular arrhythmias: when to worry.

Although isolated premature ventricular contractions may be seen in as many as 15% of normal newborns, one third of normal adolescents, and two thirds of adolescents and adults with repaired heart disease, sustained ventricular arrhythmias are relatively rare in young normal hearts. Sudden cardiac health is rare in young normal hearts, although there is an increased incidence in dilated cardiomyopathies and following repair of particular congenital heart lesions. Noninvasive and invasive techniques imperfectly stratify these patients. Patients with cardiomyopathy often have ventricular arrhythmias, although the risk of mortality is more closely linked to ventricular function. There are many infants and pediatric patients with apparently normal hearts who have combinations of asymptomatic nonsustained ventricular tachycardia and potentially serious symptoms. The clinical concern is to identify diagnoses such as long QT syndrome associated with recurrent cardiac syncope and premature mortality so that appropriate choices can be made regarding drug and device therapy. Although this broad range of disease places a premium on careful evaluation, selective therapy, and continued research, serious symptoms, even in the absence of ectopy, are concerning in any patient.

A wavelet-based method for improving signal-to-noise ratio and contrast in MR images.

Magnetic resonance (MR) images acquired with fast measurement often display poor signal-to-noise ratio (SNR) and contrast. With the advent of high temporal resolution imaging, there is a growing need to remove these noise artifacts. The noise in magnitude MR images is signal-dependent (Rician), whereas most de-noising algorithms assume additive Gaussian (white) noise. However, the Rician distribution only looks Gaussian at high SNR. Some recent work by Nowak employs a wavelet-based method for de-noising the square magnitude images, and explicitly takes into account the Rician nature of the noise distribution. In this article, we apply a wavelet de-noising algorithm directly to the complex image obtained as the Fourier transform of the raw k-space two-channel (real and imaginary) data. By retaining the complex image, we are able to de-noise not only magnitude images but also phase images. A multiscale (complex) wavelet-domain Wiener-type filter is derived. The algorithm preserves edges better when the Haar wavelet rather than smoother wavelets, such as those of Daubechies, are used. The algorithm was tested on a simulated image to which various levels of noise were added, on several EPI image sequences, each of different SNR, and on a pair of low SNR MR micro-images acquired using gradient echo and spin echo sequences. For the simulated data, the original image could be well recovered even for high values of noise (SNR approximately 0 dB), suggesting that the present algorithm may provide better recovery of the contrast than Nowak's method. The mean-square error, bias, and variance are computed for the simulated images. Over a range of amounts of added noise, the present method is shown to give smaller bias than when using a soft threshold, and smaller variance than a hard threshold; in general, it provides a better bias-variance balance than either hard or soft threshold methods. For the EPI (MR) images, contrast improvements of up to 8% (for SNR = 33 dB) were found. In general, the improvement in contrast was greater the lower the original SNR, for example, up to 50% contrast improvement for SNR of about 20 dB in micro-imaging. Applications of the algorithm to the segmentation of medical images, to micro-imaging and angiography (where the correct preservation of phase is important for flow encoding to be possible), as well as to de-noising time series of functional MR images, are discussed.

Wavelet domain de-noising of time-courses in MR image sequences.

Magnetic resonance images acquired with high temporal resolution often exhibit large noise artifacts, which arise from physiological sources as well as from the acquisition hardware. These artifacts can be detrimental to the quality and interpretation of the time-course data in functional MRI studies. A class of wavelet-domain de-noising algorithms estimates the underlying, noise-free signal by thresholding (or 'shrinking') the wavelet coefficients, assuming the underlying temporal noise of each pixel is uncorrelated and Gaussian. A Wiener-type shrinkage algorithm is developed in this paper, for de-noising either complex- or magnitude-valued image data sequences. Using the de-correlation properties of the wavelet transform, as elucidated by Johnstone and Silverman, the assumption of i.i.d. Gaussian noise can be abandoned, opening up the possibility of removing colored noise. Both wavelet- and wavelet-packet based algorithms are developed, and the Wiener method is compared to the traditional Hard and Soft wavelet thresholding methods of Donoho and Johnstone. The methods are applied to two types of data sets. In the first, an artificial set of complex-valued images was constructed, in which each pixel has a simulated bimodal time-course. Gaussian noise was added to each of the real and imaginary channels, and the noise removed from the complex image sequence as well as the magnitude image sequence (where the noise is Rician). The bias and variance between the original and restored paradigms was estimated for each method. It was found that the Wiener method gives better balance in bias and variance than either Hard or Soft methods. Furthermore, de-noising magnitude data provides comparable accuracy of the restored images to that obtained from de-noising complex data. In the second data set, an actual in vivo complex image sequence containing unknown physiological and instrumental noise was used. The same bimodal paradigm as in the first data set was added to pixels in a small localized region of interest. For the paradigm investigated here, the smooth Daubechies wavelets provide better de-noising characteristics than the discontinuous Haar wavelets. Also, it was found that wavelet packet de-noising offers no significant improvement over the computationally more efficient wavelet de-noising methods. For the in vivo data, it is desirable that the groups of "activated" time-courses are homogeneous. It was found that the internal homogeneity of the group of time-courses increases when de-noising is applied. This suggests using de-noising as a pre-processing tool for both exploratory and inferential data analysis methods in fMRI.

Preventing sudden death after repair of tetralogy of Fallot: complex therapy for complex patients.

Sudden arrhythmic death in patients with repaired tetralogy of Fallot or its variants has a variety of causes. Consequently, it can serve as a paradigm for management of potentially malignant arrhythmias in all pediatric patients, particularly with regard to the use of nonpharmacologic therapy for management. Five cases are presented as touchpoints for discussion and demonstrate a number of important issues concerning the assessment and reduction of sudden cardiac death risk in these patients. First, there are no clinical parameters that can be used to accurately assess risk. Second, pharmacologic agents alone rarely are adequate therapy. Third, catheter ablation and antitachycardia devices continue to play an ever increasing role in management of these patients, and, finally, additional data are necessary to establish clear management guidelines in patients with congenital heart disease at risk for arrhythmic death.

Value of programmed ventricular stimulation in patients with congenital heart disease.

INTRODUCTION: The role of programmed ventricular stimulation (VSTIM) for risk stratification in congenital heart disease is unclear. We analyzed the results of VSTIM in selected congenital heart disease survivors at a single center to determine whether it improved the ability to predict a serious outcome. METHODS AND RESULTS: Between July 1985 and September 1996, 140 primary VSTIM studies were performed on 130 patients (median age 18.1 years, range 0 to 51). Tetralogy of Fallot (33 %), d-transposition of the great arteries (25 %), and left ventricular outflow tract obstruction (12%) accounted for the majority of patients. Indications included spontaneous ventricular tachycardia (VT) of > or = 3 beats (72%) and/or symptoms (68%). Sustained VT was induced in 25% of the studies, and nonsustained VT in 12%. Atrial flutter or other supraventricular tachycardia was documented in 32% and bradyarrhythmias in 26%. By univariate analysis, mortality was increased in patients with positive VSTIM versus negative VSTIM (18% vs 7%, P = 0.04). Using multivariate analysis, positive VSTIM was associated with a sixfold increased risk of decreased survival and a threefold increased risk of serious arrhythmic events, allowing up to 87% sensitivity in predicting mortality. However, 7 (33%) of 21 patients with documented clinical VT had false-negative studies. CONCLUSION: VSTIM in a large, selected group of congenital heart disease patients identified a subgroup with significantly increased mortality and sudden arrhythmic events. Failure to induce VT was a favorable prognostic sign, but the frequency of false-negative studies was high. Frequent supraventricular tachycardia further complicated risk stratification. Although VSTIM appears to be a reasonable tool for evaluation of this population, a larger, multicenter trial is recommended to clarify its utility.

An improved robust hierarchical registration algorithm.

This note describes an improvement to an accurate, robust, and fast registration algorithm (Alexander, M.E. and Somorjai, R.L., Mag. Reson. Imaging, 14:453-468, 1996). A computationally inexpensive preregistration method is proposed, consisting of simply aligning the image centroids, from which estimates of the translation shifts are derived. The method has low sensitivity to noise, and provides starting values of sufficient accuracy for the iterative registration algorithm to allow accurate registration of images that have significant levels of noise and/or large misalignments. Also, it requires a smaller computational effort than the Fourier Phase Matching (FPM) preregistration method used previously. The FPM method provides accurate preregistration for low-noise images, but fails when significant noise is present. For testing the various methods, a 256 x 256 pixel T2*-weighted image was translated, rotated, and scaled to produce large misalignments and occlusion at the image boundaries. The two situations of no noise being present in the images and in which Gaussian noise is added, were tested. After preregistration, the images were registered by applying one or several passes of the iterative algorithm at different levels of preblurring of the input images. Results of using the old and new preregistration methods, as well as no preregistration, are compared for the final accuracy of recovery of registration parameters. In addition, the performances of three robust estimators: Least Median of Squares, Least Trimmed Squares, and Least Winsorized Mean, are compared with those of the nonrobust Least Squares and Woods' methods, and found to converge to correct solutions in cases where the nonrobust methods do not.