Excite and receive solenoid radiofrequency coil for MRI-guided breast interventions.

A radiofrequency coil based on a solenoid design was developed and integrated with a novel device for MR-guided breast interventions using a circumferential approach. The transmit/receive tapered solenoid design conforms to the shape of the pendent breast, and provides open circumferential needle access to breast tissue under rotational symmetry. Phantom and in vivo studies using a healthy volunteer demonstrated a superior uniformity using the tapered solenoid coil compared with a commercial 8-channel diagnostic imaging coil. The solenoid coil design has important advantages due to localized transmit/receive such as B(1) -homogeneity and reduced specific absorption ratio (SAR) especially at high-field strengths. Because it provides open access and a rotationally symmetric local field, the tapered solenoid design can easily be adapted for bilateral imaging and 3D MR-guided breast interventions.

Access to tuberculosis diagnosis in Itaboraí City, Rio de Janeiro, Brazil: the patient's point of view.

SETTING: Itaboraí Municipality in Rio de Janeiro, Brazil. OBJECTIVE: To evaluate access to tuberculosis (TB) diagnosis for users of the Family Health Program (FHP) and Reference Ambulatory Units (RAUs). DESIGN: A cross-sectional study was conducted in Itaboraí City, Rio de Janeiro, Brazil. Between July and October 2007, a sample of 100 TB patients registered consecutively with the TB Control Program was interviewed using the primary care assessment tool. The two highest scores, describing 'almost always' and 'always', or 'good' and 'very good', were used as a cut-off point to define high quality access to diagnosis. RESULTS: FHP patients were older and had less education than RAU interviewees. Sex and overcrowding did not differ in the two groups. Patient groups did not differ with regard to the number of times care was sought at a unit, transport problems, cost of attending units and availability of consultation within 24 h. Adequate access to diagnosis was identified by 62% of the FHP patients and 53% of the RAU patients (P = 0.01). CONCLUSION: In Itaboraí, Rio de Janeiro, TB patients believe that the FHP units provide greater access to TB diagnosis than RAUs. These findings will be used by the Department of Health to improve access to diagnosis in Itaboraí.

Postoperative nausea and vomiting: prevention and therapy.

As we enter the new millennium, the armamentarium available to treat and prevent postoperative nausea and vomiting continues to expand. There remains a finite incidence of postoperative nausea and vomiting, particularly among high-risk populations. This review examines recent studies of drugs, both new and old, and their impact on postoperative nausea and vomiting prophylaxis and treatment.

A comparison of the volume and pH of gastric contents of obese and lean surgical patients.

UNLABELLED: Obese surgical patients are typically considered to be more likely than lean patients to possess high-volume and low-pH (HVLP) gastric contents after a standard preoperative fast, based on a study of a population predominately consisting of patients receiving intramuscular preoperative sedation. We revisited this issue in a study population of 256 fasted surgical patients, of which 232 received no preoperative antacid or gastric prokinetic drug. Immediately after endotracheal intubation, an 18-French sump tube was placed, and gastric contents were withdrawn. Subjects' gastric contents were defined as HVLP if they exhibited a combination of a volume > 25 mL and a pH < 2.5. Obesity was defined as a body mass index > 30. Among nonmedicated obese patients, the proportion with HVLP gastric contents was 20 of 75 (26.6%). The proportion of lean patients with HVLP gastric contents was 66 of 157 (42.0%). The difference between the HVLP proportions for these two groups was found to be significant (P < 0.05) using chi 2 analysis. Obesity seems to be associated with a significantly decreased risk of HVLP gastric contents among surgical patients with no history of gastroesophageal pathology after a normal interval of preoperative fasting. IMPLICATIONS: Previous studies have shown that obese surgical patients have a greater volume of acidic stomach contents than lean patients, despite a routine preoperative fast. We have reexamined this issue and found that among otherwise healthy, fasted, obese surgical patients, there is a lower incidence of combined high-volume, low-pH stomach contents compared with lean patients.

Sleep-disordered breathing and systemic hypertension in the older male.

OBJECTIVE: To investigate the relationship between sleep-disordered breathing (SDB) and essential hypertension in a population of older male hypertensives. PATIENTS: One-hundred forty consecutive older hypertensive males. MEASUREMENTS: Monitoring of sleep-related breathing abnormality with a portable sleep apnea monitor (level III device). Assessment of complaints related to sleep quality using a validated questionnaire. Systemic arterial blood pressure according to WHO standards and biochemical analyses. SDB was defined as more than 10 abnormal respiratory events per hour of sleep. DESIGN: Prospective investigation on a retrospective cohort. SETTING: Veterans Administrations hypertension clinic. MAIN RESULTS: SDB was diagnosed in 80% of this older, hypertensive, male population. Thirty-four percent of all study subjects presented with severe SDB, with more than 30 abnormal respiratory events per hour of sleep. Subjects with SDB were significantly heavier (BMI = 30.0 +/- 5.2 kg/m2) than subjects without SDB (BMI = 26.8 +/- 5.1 kg/m2, P = .004). Furthermore, subjects with SDB slept significantly longer (by a mean of 46 minutes/night, P = .027) and complained significantly more often of daytime sleepiness than subjects without SDB (P = .018). Fifty percent of all 140 subjects snored more than 10% of the total sleep time, and 26% snored for more than one-third of the night. No significant differences in blood pressure values were observed in subjects with compared with subjects without sleep-disordered breathing. However, a considerable number of subjects presenting with hypertensive blood pressure values despite treatment could be identified. Subjects presenting with hypertensive blood pressure values had a significantly higher severity index of SDB than subjects with normotensive blood pressure values (P = .047). CONCLUSIONS: This investigation supports data showing that undiagnosed SDB is a common phenomenon in older male individuals, leading to impaired daytime functioning and impairment of overall quality of life. More importantly, our data suggests that untreated SDB may have an adverse effect on the efficacy of antihypertensive treatment in hypertensive individuals with sleep-disordered breathing.

Determination of the effective charge of a protein in solution by capillary electrophoresis.

This paper describes two methods to estimate the effective charge of a protein in solution by capillary electrophoresis and demonstrates these methods by using representative proteins. In one method, a "charge ladder"--a series of derivatives of a protein differing by known increments of charge but differing only minimally in hydrodynamic drag--is generated by covalent modification of the epsilon-amino groups of lysines with 4-sulfophenyl isothiocyanate or acetic anhydride. In the second method, the equivalent of a charge ladder is produced by noncovalent association of a protein with differently charged ligands. Analysis of the electrophoretic mobilities of the protein and its derivatives as a function of added charge allows the effective charge to be estimated for the unmodified protein. This type of analysis permits estimation of the effective charge of a protein without knowing its composition, structure, or amino acid sequence.

Comparison of inversion restraint provided by ankle prophylactic devices before and after exercise.

The prudence of prophylactic ankle taping continues to be questioned as recent studies have identified other forms of ankle stabilization as more effective means of injury prevention. The purpose of our study was to compare the effectiveness of three ankle prophylaxes (adhesive taping, lace-up brace, and semirigid orthosis) with a control condition (no support) in limiting inversion under dynamic loads imposed by repetitive walking (4 mph) and running (9 mph) on an 8.5 degrees laterally tilted treadmill. Ten subjects participated in four separate testing sessions in which they were videotaped while walking and running on a tilted treadmill before and after 20 minutes of vigorous exercise. Average maximum inversion angle was determined through biomechanical analysis of rearfoot motion for each experimental condition and analyzed with repeated measures ANOVA and Scheffé post hoc tests. There were significant differences in the average maximum inversion angle between the ankle devices at 4 and 9 mph, and between pre-exercise and postexercise measurements at 4 mph, between the semirigid orthosis and the control condition at 4 and 9 mph, and between the lace-up brace and the control condition at 4 mph. Overall, the semirigid orthosis provided the most inversion restraint during dynamic loading, followed by the lace-up brace, tape, and control condition. We concluded that the lace-up brace and semirigid orthosis evaluated were very similar in restricting inversion, and that both devices limited postexercise inversion significantly more than ankle taping.

Isokinetic evaluation of quadriceps and hamstrings symmetry following anterior cruciate ligament reconstruction.

After anterior cruciate ligament (ACL) reconstruction, isokinetic muscle parameters are commonly measured to assess the dynamic status of the knee and to monitor progress in rehabilitation. This study evaluated the symmetry of the quadriceps and hamstrings musculature in postsurgical and contralateral normal limbs of subjects who had undergone one of two types of ACL reconstruction. Subjects were also evaluated for differences on selected isokinetic parameters between types of surgery and lengths of postoperative periods. Postsurgical and normal contralateral limbs of 46 subjects aged 18 to 49 years (mean, 23.7 years) were divided into groups according to type of autogenous intraarticular ACL substitute and length of postoperative period. Results of paired t-tests and analyses of variance indicated significant asymmetries between limbs for all measures of quadriceps and hamstrings musculature strength and endurance (p less than .001) irrespective of the type of reconstruction technique. Average surgical knee deficits in hamstrings endurance were significantly less for the long-term (41 to 101 months) follow-up group (1.9%) than for the intermediate (24 to 40 months) group (12.1%). The results suggest that extended periods of time are required to approximate hamstrings endurance symmetry after ACL reconstruction. Asymmetries between postsurgical and contralateral normal limbs in these subjects may reflect either incomplete rehabilitation or an inability to regain full isokinetic strength and endurance after ACL reconstruction.

Instrumented Lachman tests for the evaluation of anterior laxity after reconstruction of the anterior cruciate ligament.

Using a KT-1000 arthrometer, in fifty subjects were measured the anterior ligamentous laxity in a knee in which the anterior cruciate ligament had been reconstructed and in the normal, contralateral knee. We also determined the anterior tibial displacement and anterior compliance, using the Lachman test. The subjects were divided into groups according to the type of autogenous intra-articular substitute (either the central one-third of the patellar tendon or the semitendinosus tendon) that had been used for the anterior cruciate ligament and according to the duration of follow-up (range, twenty-four to 101 months). Lachman tests were performed, applying sixty-eight and ninety newtons of force, and indices for anterior compliance were calculated. Although significantly more anterior laxity was demonstrated with both sixty-eight and ninety newtons of force in the reconstructed knees than in the contralateral, normal knees (p less than 0.001), thirteen subjects, of whom eight lacked full extension of the reconstructed knee, had more anterior laxity in the normal knee. Analyses of variance showed no significant differences in the results of the Lachman tests as related to either the type of reconstruction or the length of postoperative follow-up. The results suggested that the two types of ligamentous substitute that were used in this study were equally efficient in limiting anterior tibial displacement, as demonstrated by the Lachman test. The study also demonstrated that the substitutes did not elongate significantly during the period of the study.

Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency.

Currently used measures of knee stability and function for ACL reconstructed knees have not gained universal acceptance. Clinical test results often are given more value than the patient's subjective evaluation of the surgical outcome. This study was designed to identify specific knee stability and function variables that were most predictive of the patient's rating of knee function following one of two types of combined (intraarticular and extraarticular) ACL reconstruction procedures. Individual measures of knee stability and function were also evaluated for differences between contralateral operated and nonoperated limbs. Postoperative and healthy contralateral knees of 51 male and female patients aged 18 to 49 years (mean, 23.7 years) were evaluated on a battery of tests at an average of 48.0 months after surgery (range, 24 to 101 months). All subjects possessed a normal contralateral knee for comparative purposes. The results of this retrospective study indicated that the variables selected were not highly correlated with, nor could they effectively predict, the patients' perceptions of postoperative knee status as measured by the Knee Function Rating Form (KFR). Statistically significant differences (P less than 0.001) between operated and nonoperated knees were found for 9 of 11 variables analyzed. The data suggest that patients' perceptions of postoperative knee status were independent of the results of static and dynamic clinical tests commonly used to assess knee stability and function. Postoperative deficits of up to 30% between the surgically reconstructed and normal contralateral knees on specific measures of knee stability and function did not greatly influence the patients' perceptions of knee function. Development of new, more specific dynamic tests may be necessary before stronger relationships between clinical test results and patients' perceptions of knee status in the ACL reconstructed knee can be realized.