A disposable patient identification card made of a paper

This paper describes a patient identification system with a disposable paper card. In general, total costs of cards themselves, equipments and personnel are remarkable, not negligible for the hospital management. Therefore, a disposable identification cards made of a paper were issued to out-patients in our hospital. Many order forms were integrated into only one sheet. Patient identification data were printed on this sheet by a computer system when a patient came to the reception desk, and quickly transmitted to physicians. We could save the hospital costs and printing works by physicians, and also shorten the waiting time of patients at reception desks.

Development of an automatic medical summary report system

We developed a medical summary report system. In this system, each department can specify the predetermined conditions for issuing the summary report. The summary is made through a hierarchical database in the integrated hospital information system according to the predetermined conditions. The summary automatically issued after reception of the outpatient, or also issued by on-line summary report program with the patient number if requested by doctors. The report is sent to the proper consulting room from the reception desk using an air-shooter. The report contains the patient information such as a patient name, age, sex, birthday, a clinic name, a chart number, a patient number, diagnoses and examinations. The doctors can refer to the points of the clinical history of the patient in his own and other departments, and make a correct diagnoses and avoid the overlaps of the examinations and medications. This system has contributed to the quality-up of the patient care by availability of patient information even in other departments without the medical chart.

Inverse correlation between expression of multidrug resistance gene and N-myc oncogene in human neuroblastomas

Genomic amplification of N-myc is an important prognostic indicator in neuroblastoma. The tumors with amplified N-myc are initially sensitive to chemotherapy but often acquire resistance to therapy, recur, and ultimately kill the patients. We measured amplification and expression of N-myc and expression of mdr-1 in 35 surgically resected neuroblastomas, before acquisition of drug resistance and in 4 recurrent tumors resistant to chemotherapy. The mdr-1 mRNA expression was found to be inversely correlated with the N-myc expression. The mdr-1 gene expression was at a low level in advanced stage and histologically undifferentiated neuroblastomas, the same group of tumors in which N-myc expression is elevated. A significantly better prognosis was noted in those patients whose tumors had a high level of mdr-1 expression and a low level of N-myc expression. The role, if any, of increased expression of mdr-1 in the acquisition of multidrug resistance in neuroblastoma remains unclear. However, the aggressive clinical behavior associated with N-myc amplification and/or expression appears to be linked to down-regulation of mdr-1 expression.

A method for early detection of abnormal trends in serial clinical examination results over time

In this paper we describe a method for the early detection of changing health conditions which may eventually lead to serious disease. The method makes use of health screening test results accumulated for individuals and can be applied to those who have taken at least four health examinations. The degree of abnormality is calculated using a logistic regression equation. The variables defining the equation are selected by factor analysis and a stepwise variable selection method based on the likelihood ratio criterion. Statistical estimates include linear regression coefficients, isotonic regression probabilities and their standard deviations. These are used to represent trends in health screening results over time. The method is illustrated using a sample of 308 persons with gastric cancer and 3002 healthy persons. Cross-validations were also performed.

[Electrostimulation of ileum and jejunum reservoirs in an acute and chronic experiment]

Voluntary control of the motility of intestinal reservoirs may be used to improve evacuation and continence. In 4 dogs a U-shaped jejunum pouch and in another 4 an ileum pouch was constructed and instrumented with stimulating and EMG electrodes and pressure lines. In the acute experiments jejunum pouch stimulation with 200 microseconds 1.67 kHz 30 mA increased the intrapouch pressure by 38 +/- 4 mm Hg (n = 6) and 500 microseconds 910 Hz 25 mA by 60 +/- 5 mm Hg (n = 3). The pressure increase in the awake animals was consistently lower (200 microseconds 4 +/- 6 mm Hg, n = 9; 500 microseconds 25 +/- 17, n = 11). The ileum pouch responded with a 37 +/- 10 mm Hg pressure increase (n = 9) to 50 ms 6 Hz 20 mA pulse trains. Ileum pouches could not be stimulated in the awake animal due to contraction of the abdominal wall. Electrostimulation may be used to contract and evacuate intestinal reservoirs but additional drug therapy or autonomic nerve stimulation will be necessary to lower the thresholds especially for ileum stimulation in the awake animal.

Developmental retardation in children with refractory epilepsy

It is controversial whether developmental retardation occurs in children with epilepsy and what causes the retardation if it occurs. The present study aims to reveal the factors associated with the retardation. The patients were 126 children who had been developmentally normal before the onset of epilepsy and had been followed for more than five years. Forty-eight of the 126 children showed mental retardation, and the remaining 78 had normal mental development at the follow-up. Developmental retardation was observed in children with onset before one year, known etiology, diffuse slow spike-wave or hypsarrhythmia on EEG, ingestion of six or more drugs and high blood levels of phenobarbital or phenytoin. Late onset of epilepsy, idiopathic or familial etiology, ingestion of five drugs or less and low blood level of phenobarbital or phenytoin were associated with normal development.

Radionuclide assessment of the natural heart ejection fraction before and after LVAD implantation

Complete pressure unloading of the ventricles can preserve ischemically damaged myocardium. Most clinical left heart assist device (LVAD) systems used after ischemic injury of the heart apply atrial cannulation which does not ensure pressure unloading. In order to assess the effect of the implantation of an intracorporeal LVAD on the function of the natural heart, we determined the ejection fraction (EF) in four male Holstein calves (90-105 kg) before and after insertion of a Cleveland Clinic pneumatic LVAD. A gated blood pool scan was obtained with a gamma camera after injection of 40 mCi Tc-labelled albumin. The animals were restrained in a sling to avoid movement artifacts. All animals showed a drop of 65 +/- 12% to 42 +/- 14% EF in the first postoperative (p.o.) week. Left ventricular output did not maintain sufficient blood pressure as assessed by pump-off tests. Systolic blood pressure dropped from 122 +/- 6.5 mm Hg to 81 +/- 6 mm Hg without pump support on the morning of the first p.o. day. Apical coring and possible restrained heart movement by the implanted LVAD may lead to impaired myocardial function that renders the individual LVAD dependent until adaptative corrections take place.

Random exercise stress test in diagnosing effort angina

To improve the performance of exercise stress testing in the diagnosis of effort angina while minimizing risks of serious complications, we evaluated an impulse response of ST changes, which is a transient ST response resulting from a hypothetical, strenuous-impulselike exercise, without actually imposing the strenuous load. To obtain the impulse response, subjects walked intermittently according to a computer-generated random binary sequence on a treadmill for 20 minutes (with a constant speed of 1.7 mph and a slope of 10%). We used Fourier transform for beat-to-beat changes in ST level and the binary sequence of exercise. We then determined the transfer function by taking the ratio of Fourier transformed ST level to exercise over the frequency range of 0.5 through 5.0 cycles/min. Converting the transfer function to the time domain yielded the impulse response of ST change. The subjects consisted of 49 patients (60 +/- 9 years) with effort angina, 13 patients with atypical chest pain (56 +/- 9 years), and 30 healthy, male volunteers (23 +/- 7 years). In 82 subjects (89%), the ST impulse response showed an initial depression followed by a smooth, gradual restoration toward the preexercise ST level (type I response). The average duration of the initial depression was 8 +/- 3 seconds in the healthy volunteers, whereas it was significantly prolonged to 23 +/- 14 seconds in effort angina (p less than 0.05). The depression in patients with atypical chest pain was not significantly different from that in the healthy volunteers.(ABSTRACT TRUNCATED AT 250 WORDS)

Cancer registration using case history database in hospital information system

The World Health Organization (WHO) recommendations for hospital cancer registration, although being effective for combating the disease, need heavy manpower for complete implementation. A computer-based method for cancer registration is in use at Kyushu University Hospital as part of the integrated hospital information system. This method needs no manpower for data gathering, and the database includes almost all the core data and half of optional data recommended for cancer registration by the WHO. This database can, therefore, be regarded as a file for hospital cancer registration, and is used for two applications. The prepared form is automatically completed for the regional cancer register by a computer program without involving any physicians' time. In addition, a decision support system for the protocol used for a patient with a cancer was developed. Trendtables and graphs of clinical examination and medication are displayed, with suggestions and warning for physicians to help them make clinical decisions.

Removal and recovery of cholesterol in thermofiltration

Thermofiltration, a system of membrane plasmapheresis for LDL apheresis, was applied to the treatment of hypercholesterolemic patients to assess its lipid lowering potential, clinical feasibility and post-treatment lipid recovery. Plasma separated by a membrane separator was warmed above physiologic temperature, filtered with a plasma filter and returned to the patient on-line without requiring supplemental plasma product infusion. One calculated plasma volume was treated. Treatment schedules were weekly, biweekly or monthly. Patients treated by thermofiltration in this study were diagnosed as type II hypercholesterolemia. Reductions and sievings of high density lipoprotein (HDL) cholesterol and low density lipoprotein (LDL) cholesterol were evaluated. In addition, post-treatment solute recovery was assessed. The reduction ratios of HDL cholesterol and LDL cholesterol were 0.31 +/- 0.08 and 0.58 +/- 0.08, respectively (mean +/- S.D. of 7 patients). Sieving coefficients of the plasma filter for HDL cholesterol and LDL cholesterol were 0.62 +/- 0.12 and 0.03 +/- 0.02, respectively (mean +/- S.D. of 32 treatments). Cholesterol reduction fitted well to a single pool model. HDL cholesterol recovered significantly faster than LDL cholesterol and LDL cholesterol recovery differed among individuals. For some patients total cholesterol and LDL cholesterol levels were lowered by the biweekly treatment while for others the weekly treatment was required. Significant removal of LDL cholesterol with sparing of HDL cholesterol was achieved without the requirement for plasma products.

Quantitation of myocardial dyssynergy in closed-chest dogs by two-dimensional echocardiography

Myocardial infarction was produced in 29 anaesthetized mongrel dogs by a closed-chest coronary occlusion technique. A two-dimensional echocardiographic examination (2-D echo) was carried out just before occlusion and again 48 h after occlusion. Many cross-sectional images were recorded by a video-tape recorder. The applied site of the probe was fixed in an intercostal space and the direction of the ultrasonic beam was tilted stepwise from the basis to the apex. The animals were sacrificed at 49 hours after occlusion. The hearts were removed, quick frozen, sliced into radiating sections and stained with nitroblue tetrazolium (NBT). The outline of dyssynergy, including dyskinesis, akinesis or extreme hypokinesis, was traced with a tablet digitizer by two specialists. The three-dimensional image of dyssynergy in the left ventricular wall was reconstructed by a computer in spherical co-ordinates and assumed to be made of numerous triangular pyramids. The volume of dyssynergy was calculated quantitatively as the sum of volumes of these numerous triangular pyramids. The volume of dyssynergy seen in 2-D echo correlated well over a wide range with the volume of infarction determined by NBT staining.

Voluntary control of an ileal pouch by coordinated electrical stimulation. A pilot study in the dog

Ileal reservoirs were constructed in four dogs under general anesthesia and stimulated by means of a constant current generator that produced pulse trains at frequencies between 6 Hz and 1.67 kHz. Stimulation at 6 Hz with 50 ms pulses between amplitudes of 15 and 25 mA uniformly produced pouch contraction and reservoir emptying. Stimulation at other frequencies did not cause pouch emptying although pressure increases were sometimes observed. Such electrical stimulation may be useful for voluntary control of intestinal reservoirs when used as replacement for urinary bladder or colon. The mechanism by which the intestinal contraction is produced appears to be different than that produced by slow wave pacing.

[Clinical use of the artificial heart, indications and results]

Clinical experience with the artificial heart now comprises 520 cases. 390 patients had to be supported mechanically when they could not be weaned off cardiopulmonary bypass. 177 (45%) subsequently had their assist devices removed and 100 (25.4%) were discharged. Good functional results were achieved, since 30 of 36 long-term survivors are in NYHA class I or II. 140 underwent two-stage cardiac transplantation. Of 63 patients implanted with a ventricular assist device (VAD) 71% were transplanted and 51% survived. A total artificial heart (TAH) was used in 77 cases, 81% were transplanted and 47% survived. Five patients received TAH implantations as a permanent replacement of the failing heart. Though the clinical courses were complicated by strokes and infections and the patients were tethered to bulky drive units, it was proven that the TAH may sustain human life for up to 622 days, much longer than so far achieved in animal experiments. Improvements of the atrial connectors and valve holding components and of the biocompatibility of the blood contacting surfaces should overcome the complication of thromboembolism. Fully implantable devices which are currently being developed will avoid the problem of drive-line infections and provide fuller mobility to the patient.

Artificial reflex arc: a potential solution for chronic aspiration. II. A canine study based on a laryngeal prosthesis

Long-term and repeated aspiration can result in pneumonia and eventually death. To avoid current techniques which divert or close off the incompetent larynx, the authors have recently described an artificial reflex arc (ARA), in hopes of providing a dynamic solution to this problem. With this concept, a segment of skin surface with intact sensory innervation is implanted into the pharynx in the path of the food bolus. Resulting neural impulses would be detected by a perineural electrode and then channeled to both recurrent laryngeal nerves via an electronic pacemaker to cause vocal fold adduction at the critical time during swallowing. A pilot study using a tubed cervical cutaneous surface has yielded promising results in the canine. In this current study, an alternate means for information pickup based upon use of a miniature strain gage is presented. Mechanical stimulation of the hypopharynx using this "sensory" detector resulted in synchronous laryngeal adduction of the vocal folds, as documented graphically and on videotape.

A Holter-tape analyzer employing circuits for calculation of correlation coefficients

An analyzer for ventricular premature contraction (VPC) arrhythmias was developed. At 60 times real time, the analyzer processes the Holter tape in which the long-term ambulatory electrocardiogram was recorded. Template matching algorithm using Pearson product-moment correlation coefficient is employed. A microprocessor controls the analyzer. Circuits for calculation of correlation coefficients were developed to support insufficient computing speed of the microprocessor. Evaluation study shows that the sensitivity for detecting the normal QRS complexes and the VPCs were 98.9% and 99.4%, and that the specificity for these were 97.5% and 98.4%. Algorithm for high-speed calculation of correlation coefficients is also considered.

Prediction of the prognosis of liver cirrhosis in Japanese using Cox's proportional hazard model

Data on 155 patients with liver cirrhosis were analyzed, using Cox's proportional hazard model. Twenty variables were screened, using a multiple linear regression analysis in a stepwise manner and 6 were considered to reflect the prognosis of cirrhotics. Three of the 6 variables were significantly prognostic, i.e. ascites, atrophy of the right lobe of the liver seen on liver scintigram and the concentration of serum albumin. The prognostic index (PI) for each patient was calculated by adding all the products of scores of these three variables with the corresponding coefficient: PI = 0.895 X ascites (absent = 0, present = 1) + 0.983 X atrophy of right lobe of the liver on the liver scintigram (absent = 0, present = 1) + (-0.561) X serum albumin (g/dl). According to the PI, the subjects were separated into three groups; group 1: PI less than -1.9, group 2: -1.9 less than or equal to PI less than -0.6, group 3: PI greater than or equal to -0.6. The global 5- and 10-year survival rates of each group were 80% and 65% in group 1, 50% and 30% in group 2 and 12% and 0% in group 3, respectively. Four of the 14 deaths in group 1, 8 of 47 in groups 2 and 10 of 24 in group 3 were caused by hepatocellular carcinoma. Our observations suggest that advanced stage cases of cirrhosis are at a high risk concerning development of hepatocellular carcinoma.