RESUMEN
This paper describes a method to register ultrasound images (US) to pre-treatment images. The aim of the work is the information transfer between the pre-treatment imaging modality (MR or CT) and the intra-treatment imaging (US). Ultrasound images are spatially tracked by a stereo-vision system and the prostate boundaries are automatically extracted using a method that combines morphological and adaptive speckle suppression and a priori knowledge. MR/CT images are merged to construct a volume of pelvis using fuzzy logic algorithm and an MPR virtual slice corresponding to the orientation of the US image is generated from the volume. The prostate is segmented from the slice by a model-based method and rigidly registered by ICP algorithm to the US contour. Preliminary experiences gave satisfactory results with short computing time.
RESUMEN
The present study aimed to characterize bone microarchitecture assessed by computed tomography (CT) at the calcaneus in male subjects suffering from osteoporosis. Seventy-nine subjects were assessed (45 with osteoporosis and 34 control subjects matched for age). Osteoporosis was defined according to the World Health Organization classification either at the lumbar spine or at the femoral neck. Thirty-three subjects (73%) had a past history of low-energy fracture mainly represented by vertebral fractures (24/33). Nine axial sections (1 mm in width and 2 mm apart) were selected for each subject. Bone microarchitecture analysis was performed using structural (binary and skeletonized images but also skeletonization from gray levels) and fractal analyses. Bone densitometry by dual-energy X-ray absorptiometry (DXA) at the calcaneus was also performed in 73 cases. Bone mineral density (BMD) was decreased in osteoporotic patients compared with controls both at the lumbar spine and hip and also at the calcaneus (p<0.01). Also 14 microarchitectural features among 25 measured were significantly different between the two groups (p<0.01). The odds ratio for fracture per 1 control group standard deviation decrease were also significant for 13 structural features but also for BMD at the calcaneus. The odds ratios after adjustment for BMD at the calcaneus were significant for the following features (p<0.05): number of valleys, 2.8 (1.2-6.9); trabecular partition, 3.3 (1.3-7.9); apparent trabecular spacing, 1.8 (1.0-3.1); trabecular bone pattern factor, 2.2 (1.1-4.3); Euler number, 3.0 (1.1-8.7); node-to-terminus strut count, 3.3 (1.4-7.8); terminus-to-terminus strut count, 2.9 (1.2-6.9); and fractal dimension, 3.7 (1.5-9.7). Few and weak correlations were found between BMD at the calcaneus measured with DXA and features obtained from CT, suggesting that these two methods give different information about bone status. In conclusion, male osteoporosis is a disease characterized by decreased bone mass but also by microarchitectural deterioration of bone tissue which is partly independent of BMD.
Asunto(s)
Calcáneo/diagnóstico por imagen , Osteoporosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Absorciometría de Fotón , Densidad Ósea , Calcáneo/fisiopatología , Estudios Transversales , Humanos , Procesamiento de Imagen Asistido por Computador , Masculino , Oportunidad Relativa , Osteoporosis/fisiopatología , Estudios ProspectivosRESUMEN
OBJECTIVES: To define key concepts and summarize available guidelines that are important resources to assist nurses to provide culturally competent care. DATA SOURCES: Medline, anthropologic and epidemiologic literature, and National Institutes of Health documents. CONCLUSIONS: Controversy remains about the most appropriate language to use to describe features of diverse populations. IMPLICATIONS FOR NURSING PRACTICE: Becoming culturally competent begins by understanding terms and concepts that are essential in developing cultural awareness, knowledge, and skills. Sensitivity to language and the history of the development of some labels are important.
Asunto(s)
Competencia Clínica , Diversidad Cultural , Enfermería Oncológica/normas , Humanos , Guías de Práctica Clínica como Asunto , Terminología como AsuntoRESUMEN
OBJECTIVES: To describe the benefits of conducting qualitative research with members of diverse cultures. DATA SOURCES: Research studies, articles and books on philosophy of science. CONCLUSIONS: Qualitative research with diverse populations is useful when little research exists on a topic, when there are no reliable and valid instruments for the groups, and when the appropriate language to use or the appropriate concepts and questions to ask are unclear. Participating in research that includes discussing your experiences has also been found to be valuable to those participating. IMPLICATIONS FOR NURSING PRACTICE: Qualitative studies with diverse groups are needed to understand the concepts that are important to members of these groups, and to guide us in asking the correct questions using correct language.
Asunto(s)
Investigación en Enfermería Clínica , Diversidad Cultural , Proyectos de Investigación , Humanos , Enfermería Oncológica , Guías de Práctica Clínica como AsuntoRESUMEN
BACKGROUND: The goals of the current studies were: 1) to determine the pain treatment needs of socioeconomically disadvantaged African-American and Hispanic patients with recurrent or metastatic cancer and 2) to assess the attitudes of health care professionals who treat them. METHODS: In the first study 108 African-American and Hispanic patients with metastatic or recurrent cancer and pain completed a survey about their pain intensity, pain interference, and attitudes toward analgesic medications. Physicians also rated their patients' pain and the adequacy of the patients' current analgesic prescriptions was assessed. In the second study 55 physicians and nurses who treat these patients completed a questionnaire regarding cancer pain and its management in their practice settings. RESULTS: Approximately 28% of the Hispanic and 31% of the African-American patients received analgesics of insufficient strength to manage their pain. Although the majority of patients received appropriate analgesics, 65% reported severe pain. Physicians underestimated pain severity for 64% of the Hispanic and 74% of the African-American patients. Physicians were more likely to underestimate the pain severity of female patients than male patients. Inadequate pain assessment, patient reluctance to report pain, and lack of staff time were perceived as barriers to pain management. CONCLUSIONS: Although the data suggest recent improvements in analgesic prescribing practices for African-American and Hispanic cancer patients, the majority of patients reported high levels of pain and limited pain relief from analgesic medications. Inadequate pain assessment remains a major barrier to optimal cancer pain treatment.
Asunto(s)
Actitud del Personal de Salud , Negro o Afroamericano , Hispánicos o Latinos , Neoplasias/fisiopatología , Manejo del Dolor , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Dolor/etnología , Dolor/psicología , Dimensión del Dolor , Satisfacción del Paciente , Pobreza , Índice de Severidad de la Enfermedad , Factores Sexuales , Clase SocialRESUMEN
Chronic urticaria is a disease of unknown etiology. One type of the disease is accompanied by gastrointestinal complaints. The aim of the present study was to determine the prevalence of Helicobacter pylori (H. pylori) infection in patients with chronic urticaria, and measure the effectiveness of eradication of HP on the skin disease. Patients with chronic urticaria of other origin were excluded from the study. Forty patients out of 95 studied fulfilled the criteria of gastrointestinal urticaria. H. pylori was measured both by measuring H. pylori-specific IgG in the serum and by direct staining of biopsy specimen taken upon endoscopy prior to and after the treatment. Seventeen patients out of 40 with gastrointestinal urticaria were H. pylori positive which incidence (43%) is not higher than that of the age matched healthy population in Hungary. H. pylori positive patients were treated with amoxycillin (4 x 500 mg/die), bismuth subsalicilate (3 x 512 mg/die) and metronidazole (2 x 500 mg/die) for two weeks, respectively, and those remaining positive were treated by omeprazole (2 x 20 mg/die) and amoxycillin for additional two weeks. Eradication of HP infection was successful in all patients. Follow-up was conducted from 6-18 months for urticaria (frequency, duration) and antihistamine drug requirement. Chronic urticaria did not disappeared after the eradication of H. pylori, but there was a significant reduction both in frequency, duration of urticaria and the need for antihistamine therapy after eradication of H. pylori. It was concluded that H. pylorilinfection has no effect on the course of chronic urticaria. Reduction in frequency of urticaria symptoms and reduction of antihistamine requirement is partly due to the natural course of the disease and likely due to the altered bacterial flora of the gut following the combined antibiotic treatment.
Asunto(s)
Enfermedades Gastrointestinales/microbiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori , Urticaria/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Amoxicilina/uso terapéutico , Antiácidos/uso terapéutico , Bismuto/uso terapéutico , Enfermedad Crónica , Femenino , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Humanos , Concentración de Iones de Hidrógeno , Masculino , Metronidazol/uso terapéutico , Persona de Mediana Edad , Penicilinas/uso terapéuticoRESUMEN
In type I (insulin-dependent) diabetic patients, peripheral hyperinsulinemia due to subcutaneous insulin treatment is associated with increased high-density lipoprotein (HDL) cholesterol, and also with an altered surface composition of HDL. Pancreas grafts also release insulin into the systemic rather than into the portal venous system, giving rise to pronounced peripheral hyperinsulinemia. We hypothesized that if peripheral hyperinsulinemia is responsible for high HDL cholesterol and/or altered surface composition of HDL in diabetic subjects, similar changes in the lipid profile should be present in pancreas-kidney transplant recipients (PKT-R). Using zonal ultracentrifugation, we isolated HDL2, HDL3, very-low-density lipoprotein (VLDL), intermediate-density lipoprotein (IDL), and low-density lipoprotein (LDL) from fasting plasma of 14 type I diabetic PKT-R, eight nondiabetic kidney transplant recipients (KT-R), and 14 healthy control subjects and determined the level and composition of the above lipoproteins. HDL2 cholesterol was increased in PKT-R as compared with KT-R and healthy controls (both P < .05), whereas HDL3 cholesterol was unchanged. However, an altered lipoprotein surface composition was evident in PKT-R: HDL2, HDL3, and LDL were enriched in unesterified cholesterol ([UC] PKT-R v KT-R, P=.13, P < .005, and P < .05, respectively; PKT-R v controls, all P < .005); HDL2 was enriched in phospholipids; and LDL was depleted of phospholipid. KT-R, in contrast, showed no changes in lipoprotein surface composition but a substantial triglyceride enrichment of HDL2 as compared with PKT-R and healthy controls (both P < .05). LDL size as determined by gradient gel electrophoresis was increased in PKT-R compared with controls (P < .005). The plasma concentration of cholesteryl ester (CE) transfer protein (CETP), involved also in phospholipid transfer, was increased in both transplant groups compared with healthy controls (both P < .05). Insulin concentrations in fasting plasma were directly related to CETP levels and to the weight-percentage of UC in HDL3, and inversely to the weight-percentage of phospholipids in LDL (all P < .05). We explain the increase in HDL2 cholesterol and LDL size in PKT-R by their high lipoprotein lipase (LPL) activity conferring an excellent capacity to clear chylomicron triglycerides. Effective handling of postprandial triglycerides, high HDL2 cholesterol, and predominance of LDL pattern A, respectively, are established indicators of a low risk of atherosclerosis. However, it is presently unclear what effects the compositional changes on the surface of HDL and LDL may have on cardiovascular risk in clinically stable PKT-R.
Asunto(s)
Diabetes Mellitus Tipo 1/sangre , Diabetes Mellitus Tipo 1/cirugía , Glicoproteínas , Lipoproteínas/sangre , Trasplante de Páncreas/fisiología , Adulto , Arteriosclerosis/etiología , Proteínas Portadoras/sangre , Estudios de Casos y Controles , Colesterol/sangre , Colesterol/química , Proteínas de Transferencia de Ésteres de Colesterol , Ésteres del Colesterol/sangre , HDL-Colesterol/sangre , HDL-Colesterol/química , LDL-Colesterol/sangre , LDL-Colesterol/química , VLDL-Colesterol/sangre , VLDL-Colesterol/química , Diabetes Mellitus Tipo 1/complicaciones , Angiopatías Diabéticas/etiología , Femenino , Humanos , Trasplante de Riñón/fisiología , Lipoproteínas/química , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
Transplantation of pancreatic gland with systemic venous drainage of the graft causes elevated plasma levels of insulin. To examine lipid metabolism triglyceride clearance capacity, lipolytic enzymes, plasma lipids and lipoproteins were quantified in pancreas-kidney transplant recipients and compared them to lipid parameters of healthy controls and those of patients who had received only kidney transplants. Eleven pancreas-kidney transplant recipients with type I diabetes, 9 non-diabetic kidney transplant recipients as controls for the effects of immunosuppressive medication, and 11 healthy controls were studied. In pancreas-kidney transplant recipients fasting cholesterol, non-HDL cholesterol, triglyceride levels were found 5.5 (+/- 1.0), 3.4 (+/- 0.78) and 1.06 (+/- 0.29) respectively and expressed in mmol/L (mean +/- SE). The results were statistically not different from those of healthy controls. In contrast, non-diabetic kidney transplant recipients cholesterol, non-HDL cholesterol and triglyceride levels were increased to 6.1 (+/- 0.81) (p < 0.05), 4.6 (+/- 1.1) (p < 0.05) and 2.34 (+/- 1.53) mmol/L (p < 0.05). HDL cholesterol averaged 2.08 (+/- 0.36) in pancreas-kidney transplant recipients, clearly higher than that of kidney transplant recipients 1.53 (+/- 0.39) mmol/L (p > 0.01), or of controls 1.61 (+/- 0.37) mmol/L (p < 0.05). In pancreas-kidney transplant recipients postprandial lipaemia was the lowest and lipase activity was the highest compared both to kidney transplant recipients (p < 0.001, p < 0.05) and controls (p < 0.01, p < 0.05). This excellent triglyceride clearing capacity appears to be the result of a high activity of lipoprotein lipase, which, can be explained by the peripheral hyperinsulinaemia.
Asunto(s)
Trasplante de Páncreas , Triglicéridos/metabolismo , Endopeptidasas/sangre , Femenino , Humanos , Hiperinsulinismo/sangre , Hiperlipidemias/enzimología , Lipoproteínas/sangre , MasculinoRESUMEN
A telephone survey was conducted among women 35 years old or older in Nueces County, Tex., to assess ethnic differences between Hispanic and non-Hispanic white women in self-reported cancer-screening practices and knowledge, attitudes, and beliefs about cancer and to evaluate the effect of ethnicity as a predictor for screening practices. A total of 233 Hispanic and 332 non-Hispanic white women participated in the survey. Hispanics were younger and had lower educational and income levels. Overall, Hispanics had lower rates than did non-Hispanics of lifetime mammography (65% versus 79%), clinical breast examination (86% versus 96%), monthly performance of breast self-examination (37% versus 49%), and lifetime fecal occult blood testing (36% versus 69%). After control for confounding factors, Hispanics were still less likely to have ever had a clinical breast examination and fecal occult blood test. Our results suggest the need for more culturally sensitive health promotion efforts to improve knowledge about cancer and early detection practices among Hispanic women.
Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Hispánicos o Latinos/psicología , Tamizaje Masivo/estadística & datos numéricos , Neoplasias/psicología , Población Blanca/psicología , Salud de la Mujer , Adulto , Anciano , Autoexamen de Mamas/psicología , Autoexamen de Mamas/estadística & datos numéricos , Femenino , Promoción de la Salud , Encuestas Epidemiológicas , Humanos , Mamografía/psicología , Mamografía/estadística & datos numéricos , Tamizaje Masivo/psicología , Persona de Mediana Edad , Sangre Oculta , Sigmoidoscopía/psicología , Sigmoidoscopía/estadística & datos numéricos , Factores Socioeconómicos , Teléfono , Texas/epidemiología , Frotis Vaginal/psicología , Frotis Vaginal/estadística & datos numéricosRESUMEN
Pancreas transplantation with systemic venous drainage of the graft causes elevated plasma levels of insulin, known to be a potent regulator of plasma lipoprotein metabolism. We studied 11 post-type I diabetic pancreas-kidney transplant recipients, 9 type I diabetic kidney transplant recipients displaying peripheral hyperinsulinemia due to subcutaneous insulin treatment, 11 nondiabetic kidney transplant recipients as controls for the effects of immunosuppressive medication, and 11 healthy control subjects, all matched for age, sex, and body mass index. We determined fasting lipids, lipoproteins and lipolytic enzymes, as well as postprandial lipid metabolism after a standardized oral fat load. High-density lipoprotein (HDL) cholesterol averaged 1.98 (0.40) mmol/L in pancreas-kidney transplant patients, clearly higher than that of kidney transplant recipients (1.52 (0.36) mmol/L, P < 0.05) or of controls (1.50 (0.38) mmol/L, P < 0.05). In pancreas-kidney transplant patients postprandial lipemia was lowest and lipoprotein lipase activity was highest (average 32% and 154%, respectively, of the mean of the controls) compared with nondiabetic kidney transplant recipients (P < 0.005, P < 0.05) and healthy controls (P < 0.001, P < 0.01). In type I diabetic kidney transplant recipients the levels of HDL cholesterol (1.88 (0.63) mmol/L), postprandial lipemia, and lipoprotein lipase activity were intermediate between pancreas-kidney transplant patients and healthy controls. The distinctly elevated HDL cholesterol in pancreas-kidney transplant patients can be readily explained by the low postprandial triglyceride levels resulting from a high activity of lipoprotein lipase. The very favorable lipid profile in post-diabetic pancreas-kidney transplant recipients could be expected to counteract the severe atherosclerotic risk of long-standing diabetes.
Asunto(s)
HDL-Colesterol/sangre , Trasplante de Riñón , Lípidos/sangre , Lipoproteína Lipasa/sangre , Trasplante de Páncreas , Adulto , Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Diabetes Mellitus Tipo 1/cirugía , Femenino , Humanos , Inmunosupresores/uso terapéutico , Masculino , Prednisona/uso terapéutico , Triglicéridos/metabolismoRESUMEN
An individual is influenced by a number of diverse cultural factors, and the interaction of cultural beliefs can create barriers to compliance with recommended prevention, early detection, and screening activities. In order to develop culturally and linguistically appropriate cancer screening and early detection programs, clinicians need to have some background knowledge of culturally diverse populations. In addition, multilevel theoretical models should be used to plan cancer control programs that address the diversity from confluent cultures.
Asunto(s)
Actitud Frente a la Salud/etnología , Características Culturales , Neoplasias/etnología , Neoplasias/prevención & control , Aculturación , Factores de Edad , Anciano , Planificación en Salud , Humanos , Incidencia , Tamizaje Masivo/métodos , Modelos Psicológicos , Cooperación del Paciente , Pobreza , Enfermería TransculturalRESUMEN
We report the long-term metabolic observations made on 37 patients after simultaneous pancreas and kidney transplantation. Plasma C-peptide levels were above the physiological range in all patients and there was no significant difference between patients undergoing delayed duct occlusion (n = 12) or those with drainage of exocrine secretion into the urinary bladder (n = 25). HbA1c was equally at the upper end of the normal range in both subsets of patients. Mean fasting cholesterol (237 mg/dl) and triglycerides (122 mg/dl) were normal, and HDL-cholesterol was above normal with an average concentration of 77 mg/dl. Two patients underwent an oral fat tolerance test and showed extremely low postprandial lipaemia and very high lipoprotein lipase activities. We conclude that patients with a functioning pancreas graft persistently demonstrate normoglycaemia, elevated C-peptide, and a very favourable lipid profile both in the fasting and the postprandial state.
Asunto(s)
Glucemia/metabolismo , Péptido C/sangre , Diabetes Mellitus Tipo 1/cirugía , Nefropatías Diabéticas/cirugía , Fallo Renal Crónico/cirugía , Trasplante de Riñón/fisiología , Trasplante de Páncreas/fisiología , Adulto , Diabetes Mellitus Tipo 1/sangre , Nefropatías Diabéticas/sangre , Femenino , Estudios de Seguimiento , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada/análisis , Humanos , Trasplante de Riñón/métodos , Lípidos/sangre , Trasplante de Páncreas/métodosRESUMEN
We measured serum cholesterol, triglyceride, and lipoprotein Lp(a) concentrations in serum of 37 patients with massive proteinuria of different origin, comparing values with those for age- and sex-matched controls and finding significantly increased Lp(a) concentration in the total group of patients compared with controls. Lp(a) concentration was not correlated with serum cholesterol, triglyceride, serum creatinine, daily urinary protein loss, or selectivity index. Selecting the patients according to their histological diagnosis obtained by renal needle biopsy, we found divergent results in seven patients with minimal change disease (MCD) compared with 11 patients with membranoproliferative glomerulonephritis. Lp(a) in MCD patients did not differ from that controls (101 +/- 102 and 90 +/- 115 mg/L) and correlated positively with total daily urinary protein loss (r = 0.7962, P less than 0.05). In contrast, the patients with membranoproliferative glomerulonephritis had significantly higher Lp(a) values than the controls (219 +/- 222 mg/L), and Lp(a) concentrations correlated negatively with the daily protein loss in urine (r = -0.6545, P less than 0.05). The most surprising results were the marked Lp(a) concentrations in serum of three patients with primary amyloidosis and nephrosis syndrome. Our results indicate a regulatory role of the kidney in the metabolism of Lp(a) and different effects on the serum Lp(a) concentration, depending on the type of damage to renal tissue.