The robot and the satellite for tele-operating echographic examination in Earth isolated sites, or onboard ISS.

UNLABELLED: The objective was to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site. METHOD: The isolated places, defined as areas with reduced medical facilities, could be secondary hospitals 20 to 50 km from the university hospital, or dispensaries in Africa or Amazonia, or a moving structure like a rescue vehicle or the International Space Station (ISS). At the expert center, the ultrasound medical expert moves a fictive probe, connected to a computer (n degrees 1) which sends, the coordinate changes of this probe via an ISDN or satellite line to a second computer (n degrees 2), located at the isolated site, which applies them to the robotic arm holding the real echographic probe. RESULTS: The system was tested at Tours Hospital on 105 patients. A complete investigation (visualization) of all the organs requested for different clinical cases was obtained in 76% of the cases with the robot, and 87% at the reference echography: In 11% of the cases, at least one of the organ visualized at reference echo could not be investigated by the robot, thus the diagnostic was not done. The number of repositioning was higher for the robot (6.5 +/- 2) than for the reference echo (5.1 +/- 2 = or > 24% more with robot). The duration of the examination was higher with the robot (16 +/- 10 min) than for the reference echography (11 +/- 4 min = or > +43% with the robot compare to reference echography. The system was also tested successfully using satellite links in a limited number of cases (approx 30).

Venous stagnation induced by 7 days in HDT, in the cerebral, ophthalmic, renal and splanchnic territories.

The scientific objectives was to quantify the vascular changes in the brain, eye fundus, renal parenchyma, and splanchnic network. Heart, portal, jugular, femoral veins were investigate by Echography. The cerebral mesenteric, renal and ophthalmic arteries were investigated by Doppler. Eye fundus vein an papilla were investigated by optical video eye fundus. The left ventricle volume decreased as usual in HDT. The cerebral and ophthalmic vascular resistances didn't change whereas the eye fundus papilla and vein, and the jugular vein increased. These arterial and venous data confirm the existence of cephalic venous blood stasis without sign of intracranial hypertension. On the other hand the kidney volume increased which is in agreement with blood flow stagnation at this level. At last the mesenteric vascular resistance decreased and the portal vein section increased in HDT which is in favor of an increase in flow and flow volume through the splanchnic area.

3D realtime echography and echography assisted by a robotic arm for investigating astronauts in the ISS from the ground.

As human will stay for long duration in isolated sites like ISS there will be a need to perform quick and reliable diagnosis to evaluate the gravity of the pathology in presence of clinical symptoms. Many pathological situations (abnormal heart rate, pericardic collection, mitral prolaps, cholecystis, renal lithiasis, normal and ectopic pregnancies, ovarian cyst, acute appendicitis, phlebitis ... ) may occur even if all the astronauts are absolutely normal and healthy preflight. Ultrasound echography and Doppler are non invasive methods easy to use in space and very well adapted and used in routine for such diagnosis at the hospital. The objective of the present project was to design a method that guarantee a reliable echographic diagnostic in an isolated site (space station or earth site) by a Medical Doctor located at the expert site that should be the Nasa control center for ISS. It is supposed that there is only a non sonographer person in the isolated site and that the transmission system (audio, video, numeric..) is the only link between the 2 sites. Two options are proposed: (a) A 3D realtime acquisition echograph that can record quickly all the echos of a volume containing the organ suspected to have a lesion, all these echo information being sent to the ground and processed by the ground experts, (b) A robotic arm that hangs the echo probe in the isolated site tele-operated (through sattelite network) from the ground by an expert in clinical ultrasound. (As the expert moves the joystick of his ground computer the robotic arm reproduces the same movements on the probe).

Doppler monitoring of the vascular resistance in the lower limbs during dipyridamole test in preparation for myocardial tomoscintigraphy.

OBJECTIVE: the aim of this work was to quantify the intensity of the vasodilation induced by dipyridamole used to simulate a stress test during a myocardial tomoscintigraphy. METHODS: Doppler measurements of the femoral artery and the thoracic aorta were made on 26 patients (11 men, 15 women), using transducers attached to the skin, measurements being performed every 2 min during the 10 min of the stress test. The following parameters were measured: (a) the vascular resistance index of the lower limbs defined as R(fa)=D/S with S and D, respectively, the maximum amplitude of the systolic wave and the maximum amplitude of the diastolic reflux measured on the Doppler femoral spectrogram; (b) the aortic and femoral blood flows obtained from the mean velocity on the Doppler spectrogram. RESULTS: 14 of the 26 patients (54%) showed a significant vasodilation (i.e. a decrease of R(fa) of more than 10%). Eighty-seven percent of the patients with a positive myocardial scintigraphy showed a vasodilation. Sixty-six percent of patients who had prior vasodilator treatment showed no vasodilation. A slight decrease in blood pressure was observed for vasodilated patients but also for non-vasodilated patients. The aortic flow increased slightly for all patients. CONCLUSIONS: Doppler monitoring of femoral vascular resistance is a useful method for quantifying the dipyridamole-induced vasodilation, and hence the stress level upon which the diagnostic efficiency of myocardial scintigraphy is depending. Our study demonstrates that testing with dipyridamole was inconclusive in 66% of patients who had already vasodilator treatment.

Femoral to cerebral arterial blood flow redistribution and femoral vein distension during orthostatic tests after 4 days in the head-down tilt position or confinement.

The first objective of this study was to confirm that 4 days of head-down tilt (HDT) were sufficient to induce orthostatic intolerance, and to check if 4 days of physical confinement may also induce orthostatic intolerance. Evidence of orthostatic intolerance during tilt-up tests was obtained from blood pressure and clinical criteria. The second objective was to quantify the arterial and venous changes associated with orthostatic intolerance and to check whether abnormal responses to the tilt test and lower body negative pressure (LBNP) may occur in the absence of blood pressure or clinical signs of orthostatic intolerance. The cerebral and lower limb arterial blood flow and vascular resistance, the flow redistribution between these two areas, and the femoral vein distension were assessed during tilt-up and LBNP by ultrasound. Eight subjects were given 4 days of HDT and, 1 month later, 4 days of physical confinement. Tilt and LBNP test were performed pre- and post-HDT and confinement. Orthostatic intolerance was significantly more frequent after HDT (63%) than after confinement (25%, P < 0.001). Cerebral haemodynamic responses to tilt-up and LBNP tests were similar pre- and post-HDT or confinement. Conversely, during both tilt and LBNP tests the femoral vascular resistances increased less (P < 0.002), and the femoral blood flow reduced less (P < 0.001) after HDT than before HDT or after confinement. The cerebral to femoral blood flow ratio increased less after HDT than before (P < 0.002) but remained unchanged before and after confinement. This ratio was significantly more disturbed in the subjects who did not complete the tilt test. The femoral superficial vein was more distended during post-HDT LBNP than pre-HDT or after confinement (P < 0.01). In conclusion, 4 days of HDT were enough to alter the lower limb arterial vasoconstriction and venous distensibility during tilt-up and LBNP, which reduced the flow redistribution in favour of the brain in all HDT subjects. Confinement did not alter significantly the haemodynamic responses to orthostatic tests. The cerebral to femoral blood flow ratio measured during LBNP was the best predictor of orthostatic intolerance.

Monitoring of the cardiac and vascular response to LBNP during the 14 day spaceflight "Cassiopee".

The objective of the present experiment was to monitor in real time the cardiac and the peripheral response to inflight LBNP. The second objective was to detect and quantify hemodynamic signs of orthostatic tolerance inflight by measuring the heart rate, blood pressure, cardiac and regional hemodynamics during LBNP.

[A comparative study of the Doppler methods for evaluation of the degree of carotid artery stenosis. Continuous, pulsed, color Doppler]. / Etude comparative des méthodes Doppler pour l'évaluation du degré des sténoses carotidiennes. Doppler continu, pulsé, couleur.

OBJECTIVE: Compare various Doppler methods for the quantification of the degree of stenosis on 85 patients. METHOD: the following parameters were measured: maximal velocity (Vmax) inside the stenosis (PW), grades of spectral disturbances at the outlet of the stenosis (PW-CW), index of spectral disturbance (STI) at the outlet of the stenosis (PW-CW), ratio of velocities I(IC/CC) in internal and common carotid (PW), ratio of vessel cross section and residual lumen area (% STEN) by color Doppler. The reference method was the Grades of spectral disturbance and the index of stenosis measured post stenosis. (Method validated against angiography and pieces of endarterectomy.) The following comparisons were done; grades and STI by CW against grades and STI by PW, Vmax (PW) against grade and STI, % STEN (color) against grade and STI, % STEN (color) against Vmax (PW), I(IC/CC) (PW) against grade and STI, I(IC/CC) (PW) against Vmax. CONCLUSION: (a) grades or stenosis index : showed the best reproductibility; (b) a high correlation was found between the grades or stenosis index post stenosis measured by CW or PW; (c) Vmax was not proportional to the stenosis degree and showed large fluctuations for the same stenosis degree; (d) the I(IC/CC) showed large fluctuations for the same stenosis degree, the correlation was poor for this velocity ratio. Both Vmax and I(IC/CC) allow to detect only 2 groups of stenosis > 75% or > 90% in area; (e) color doppler over-estimate stenosis degree by approximately 20% but was more accurate and reproducible than Vmax. An appropriate procedure was designed to avoid this over estimation.

Regional blood flow in microgravity: adaptation and deconditioning.

The objectives were to evaluate cardiac and peripheral changes induced by microgravity with and without countermeasures (CM), to assess the peripheral response to orthostatic tests (tilt, LBNP). Inflight or HDT, we used echography and Doppler to assess the left heart function and the peripheral arteries. We studied the cardiovascular system during 1) 21-d and 25-d spaceflights without CM, 2) 14.d spaceflight with "bracelets" CM, 3) 28-d HDT with and without LBNP, and 4) 30-d HDT with and without Exercise+LBNP. Similar peripheral circulation changes were noticed in both astronauts and HDT subjects without CM. There was a decrease in renal, cerebral, and femoral vascular resistances and maintenance of cerebral flow at rest, and a lack of increase in lower limb vascular resistance and abnormal flow redistribution during orthostatic tests. Conversely, with CM at rest, cerebral and renal vascular resistances stayed elevated and femoral resistance decreased, but less than without countermeasures. Lower limb vascular resistance increased normally, peripheral flows were adequately redistributed during orthostatic tests, and no orthostatic intolerance was observed. This confirms the efficiency of countermeasures (LBNP, exercise, cuffs) in preserving the vasomotor tone in most peripheral areas at rest and reducing the development of orthostatic intolerance.

Heart, and peripheral arteries and veins during the 14 month MIR space flight.

NASA: Ultrasound Doppler imaging and electrocardiography were used to study hemodynamic responses to spaceflight onboard the Mir space station. Cardiovascular adaptation was studied at rest and during the use of thigh cuffs or "Bracelets" for weightlessness countermeasures. Specific changes in hemodynamic parameters are presented and discussed, along with an evaluation of the effectiveness of the Bracelet countermeasures.^ieng

Hemodynamic response to LBNP during the 14 month MIR spaceflight (94-95).

NASA: Lower body negative pressure (LBNP) was used during the Mir spaceflight in a study of orthostatic tolerance. Hemodynamic responses were measured including heart rate, blood pressure, cerebral artery blood flow, and lower limb vascular resistance. Results showed that femoral flow volume decreased, which may be due to hypovolemia and reduced cardiac output. Additional changes in femoral vascular response and cerebral to femoral blood flow are discussed.^ieng

Effect of microgravity on renal and femoral flows during LBNP & intravenous saline load.

NASA: Renal and femoral hemodynamics were studied in crew members at rest and during lower body negative pressure before and after the D-2 Spacelab mission and with intravenous saline loading. Specific measurements included renal vascular resistance, femoral arterial flow, and vascular resistance, along with other cardiovascular parameters. Cardiovascular adaptation to microgravity is discussed with a focus on changes observed in femoral and renal vascular resistance.^ieng