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1.
Clin Nucl Med ; 20(5): 391-4, 1995 May.
Artigo em Inglês | MEDLINE | ID: mdl-7628138

RESUMO

An 82-year-old man had his third episode of melanotic stool. Two previous workups had failed to localize the source of bleeding. A Tc-99m labeled RBC scan visualized the gallbladder early in the study. Administration of sincalide visually decreased the activity, confirming gallbladder activity. Three months later, at his second surgery, hepatic metastases were finally identified as the source of bleeding. In retrospect, the hepatic activity is inhomogeneous with at least two cold defects that could have represented hepatic metastases.


Assuntos
Vesícula Biliar/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemobilia/diagnóstico por imagem , Sincalida , Pertecnetato Tc 99m de Sódio , Adenocarcinoma/complicações , Adenocarcinoma/secundário , Idoso , Divertículo/complicações , Eritrócitos , Hemorragia Gastrointestinal/etiologia , Hemobilia/etiologia , Humanos , Doenças do Jejuno/complicações , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/secundário , Masculino , Neoplasias Primárias Desconhecidas , Cintilografia
2.
J Clin Periodontol ; 22(3): 201-7, 1995 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-7790525

RESUMO

The central problem in all previous approaches to clinical assessment of periodontal disease activity is the use of unidimensional measurement, which implies a number of unjustifiable assumptions. In addition, the use of unidimensional probing measurement has established that there are several distinct problems of validity and reliability in currently available techniques. The present paper begins with an analysis of these matters, leading to an approach to accurate clinical measurement of periodontitis in 3 dimensions, with the possibility of future development of a valid system for assessing the nature of disease activity.


Assuntos
Periodontia/instrumentação , Periodontite/diagnóstico , Tecido Conjuntivo/diagnóstico por imagem , Tecido Conjuntivo/patologia , Cemento Dentário/patologia , Esmalte Dentário/patologia , Progressão da Doença , Desenho de Equipamento , Estudos de Viabilidade , Gengiva/patologia , Humanos , Variações Dependentes do Observador , Ligamento Periodontal/diagnóstico por imagem , Ligamento Periodontal/patologia , Bolsa Periodontal/diagnóstico , Bolsa Periodontal/diagnóstico por imagem , Bolsa Periodontal/patologia , Periodontite/diagnóstico por imagem , Periodontite/patologia , Reprodutibilidade dos Testes , Ultrassonografia/instrumentação
3.
Medinfo ; 8 Pt 2: 952, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8591595

RESUMO

In the FRAMEMED system design, the inherent attributes of its concepts are expressed in the hierarchical lists of its 26 Elements (e.g., Agents, Clinical Manifestations, Diseases, Tests, etc.). These concepts, contained in regular structures, are then alphabetized by phrase (and synonym), forming a combined index in which the user may quickly find a concept either alphabetically or hierarchically. Stored in the structures of the index are pointers to four types of knowledge records: 1) Descriptive (definition); 2) Relational (incidental attributes); 3) Conditional (rules); and 4) Procedural (how to). In contrast to the index which is stored in regular structures for rapid access (like relational databases), the knowledge records are stored in free text (variable length) and may include pointers to imaging and audio records. A particular feature of the FRAMEMED system is careful attention to modifiers, an aspect usually not emphasized in other systems. In trying to structure the free text describing a patient encounter, for example, the major concepts such as cough, fever, stiff neck, etc., are relatively easy to code (although a common system has not yet been agreed upon). The devil lies in the modifiers such as 'history of', 'severe,' 'constant,' 'absent,' 'left,' 'abnormal,' etc., particularly when there is concatenation of modifiers modifying modifiers. Our Relational records (in our knowledge base) and our Chronological Medical Records (CMR) in our patient record have the same format, namely, a title, several related items, and a date/author. For example, our disease profile (Relational record) for 'Influenza' might include 'cough,' 'fever,' and 'stiff neck.' The CMR of a particular patient encounter might include the same items. The only differences would be the title (disease name for the disease profile, date for the CMR, and the omission of the redundant date in the date/author line of the CMR). Each related item in either of these records is expressed in a four-part string, namely: 1) Relation; 2) Code; 3) Phrase; and 4) Comment. Modifiers (common ASCII symbols) are structured into each of these parts. For example, if the patient did not have 'cough,' the default '+' in the Relation would be edited to a '-', while 'history of' cough would be '>'. Each Relation can be graded (on a 5-level scale) for both importance and frequency. The Code for a test can carry the result suffix, '+ positive/high,' '-negative/low,' '# abnormal (qualitatively)', or '1 unremarkable/normal.' Topological information, such as '/left,' can be appended to a Code. If the cough is getting worse, its code can have the suffix, '<'. The standardized Phrases associated with the Codes come from the hierarchical lists of the index section described earlier. Phrases are not stored, being rematched to the codes as needed for user display. This practice not only saves memory space but allows a CMR encounter recorded in one language to be displayed in another second language subsequently, requiring only the existence of the hierarchical code/phrase in the second language. A free-text Comment is allowed for any related item in a Relational record or CMR, to allow the doctor to add important nuances such as 'worse on arising' or for a numeric result such as a test result or a thermometer reading. Some structuring can be accommodated in the Comment by introducing symbols such as '> relieved by,' followed by a list containing entries such as 'antacids.' Time can be sturctured through symbol lists such as '@-2 mo' representing '2 months previously.' Because Relational records in the knowledge ase and patient encoutner records in the CMR both display findings in hierarchical order; all similar items (e.g., Agents, Clinical Manifestations, Tests, Procedures, etc.) occur together and in an unique order. (abstract truncated)


Assuntos
Indexação e Redação de Resumos , Inteligência Artificial , Sistemas Computadorizados de Registros Médicos , Descritores , Humanos , Interface Usuário-Computador
4.
Artigo em Inglês | MEDLINE | ID: mdl-7950071

RESUMO

Although knowledge is contained in many systems, moving it from one system to another is not an easy task because each system is tailored in its own unique way and because knowledge configurations are usually copyrighted. To populate our FRAMEMED knowledge base we turned to the NLM Metathesaurus as a readily-available open source of knowledge. We were disappointed by the greatly variable granularity of the concepts and the lack of definitions that could be borrowed. Some reference books in electronic form seem attractive but reformatting will require excessive human intervention and copyright negotiation.


Assuntos
Inteligência Artificial , Unified Medical Language System
5.
MD Comput ; 10(3): 184-92, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8515713

RESUMO

Carefully structured medical knowledge can be used for a variety of purposes, including medical records, drug and test ordering, and differential diagnosis. The Framemed system divides medical information into 26 domains and arranges the items in a hierarchical sequence. The knowledge in the system resides in descriptive, relational, and conditional records created by experts in the various domains, who must sign and date each record as it is developed and are entirely responsible for its contents. Formation of the hierarchies requires careful attention to concepts and yields a logical framework for a standardized terminology that is in the public domain.


Assuntos
Inteligência Artificial , Aplicações da Informática Médica , Bases de Dados Factuais , Arquivamento , Design de Software , Terminologia como Assunto
6.
Br Med J (Clin Res Ed) ; 283(6286): 271-3, 1981 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-6788284

RESUMO

A 20-month-old child was accidentally poisoned after biting through the bottom of a medicine container and ingesting the tablets inside. Consequently a study was carried out to determine the force required to fracture 20 randomly selected 25 and 32 ml polystyrene containers to see whether this exceeded the bite force of a child's jaw. Tests were performed at displacement rates of 0.5 and 10 cm/min. All the containers failed at well below the bite force recorded for children, which is 392 N. All containers must conform to a British Standards test that requires that they withstand a force of only 35 N. Clearly this is not enough to safeguard small children. The use of polystyrene containers should be scrutinised closely, as the case of accidental poisoning reported may not be unique.


Assuntos
Prevenção de Acidentes , Embalagem de Medicamentos/normas , Segurança , Pré-Escolar , Dotiepina/intoxicação , Humanos , Lactente , Poliestirenos , Estresse Mecânico
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