S.E. Mitchell Vascular Anomalies Flow Chart (SEMVAFC): a visual pathway combining clinical and imaging findings for classification of soft-tissue vascular anomalies.

Classification of vascular anomalies (VAs) is challenging due to overlapping clinical symptoms, confusing terminology in the literature and unfamiliarity with this complex entity. It is important to recognize that VAs include two distinct entities, vascular tumours (VTs) and vascular malformations (VaMs). In this article, we describe SE Mitchell Vascular Anomalies Flow Chart (SEMVAFC), which arises from a multidisciplinary approach that incorporates clinical symptoms, physical examination and magnetic resonance imaging (MRI) findings to establish International Society for the Study of Vascular Anomalies (ISSVA)-based classification of the VAs. SEMVAFC provides a clear visual pathway for physicians to accurately diagnose Vas, which is important as treatment, management, and prognosis differ between VTs and VaMs.

Significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, serum albumin and prognostic nutritional index as predictors of morbidity in super-elderly patients operated on for acute appendicitis.

OBJECTIVE: Both life expectancy and the proportion of the population in elderly are increasing. Therefore, the number of cases of acute appendicitis (AA) among the super-elderly population is increasing. In this study, it is aimed to find the correlations between morbidity and the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), albumin and prognostic nutritional index (PNI) in super-elderly patients. PATIENTS AND METHODS: In this retrospective study, we studied super-elderly patients (85 years old and above) who were operated on due to AA between January 2015 and January 2020 at a tertiary health center. After approval by the ethics committee, patients' preoperative, peroperative and postoperative data were collected. Patients were divided into two groups: the morbidity-positive (+) group and the morbidity-negative (-) group. The differences between the two groups regarding the parameters investigated were evaluated. RESULTS: 25 super-elderly patients were operated on for AA. There were 7 patients in the morbidity (+) group and 18 in the morbidity (-) group. The area under the curve (AUC) for NLR was 0.476 ([95% CI: 0.215-0.738]; p = 0.856), and the AUC for PLR was 0.444 ([95% CI: 0.193-0.696]; p = 0.672). However, the AUC for PNI was 0.810 ([95% CI: 0.569-1.000]; p = 0.018), and the AUC for albumin was 0.845 ([95% CI: 0.601-1.000]; p = 0.008). At the cut-off value of 3.35 g/dL, albumin's sensitivity was 88.9% and its specificity was 85.7%. At the cut-off value of 38, PNI's sensitivity was 94.4% and its specificity was 71.4%. CONCLUSIONS: The present study found that PNI and albumin values can be used as prognostic factors and have high sensitivity and specificity. Therefore, this study is a leader study in identifying prognostic factors for AA that can be used in the super-elderly geriatric population. However, the possibility of statistical error should be minimized by conducting studies involving more patients.

Renal Apparent Diffusion Coefficient Values in Patients with Obstructive Uropathy and High Values of Creatinine.

Purpose: Diffusion weighted magnetic resonance imaging (DW-MRI) of the kidneys provides noninvasive information on renal function in healthy volunteers, and it is feasible in severely ill patients. It may provide information on the degree of kidney dysfunction. The purpose of this study is to evaluate apparent diffusion coefficient (ADC) values using DW-MRI in patients with obstructive uropathy and elevated serum creatinine levels. Methods: Fifty patients with high serum creatinine levels and diagnoses of chronic urinary obstruction detected by ultrasonography were included in this study. DW-MRIs were obtained from 50 patients with hydronephrotic kidneys and 26 healthy volunteers using a 1.5T whole-body MR scanner. Results: ADC measurements of renal parenchyma in hydronephrotic kidneys were significantly lower compared to normal kidneys (p < 001). Conclusion: The measurement of ADC values has potential value in the evaluation of the functional status of hydronephrotic kidneys.

Limb deformity in a newborn. Is rifampicin just an innocent bystander?

OBJECTIVE: The first-line antituberculous agents for use during pregnancy have minimal teratogenic effects. The possibility of limb deformity during rifampin use, however, was reported by some researchers. CASE REPORT: A male newborn was born with a hypoplastic right forearm to a mother with tuberculosis who used isoniazid and rifampicin in the first two months of her pregnancy. CONCLUSIONS: The limb anomaly in our case might be attributed to rifampicin usage during the first 2 months of pregnancy. Caution should be given with regard to possible congenital malformations which could be associated with the treatment of pregnant women with antituberculous drugs.

Application of multivariate linear discriminant analysis to lung sounds in some pulmonary diseases.

In the past 15 yrs, a number of investigators have applied spectral analysis to respiratory sounds recorded from the chest wall or the trachea in order to objectively characterize them and to relate them with different pulmonary diseases. In the present study, we have applied multivariate linear discriminant analysis to the spectral features of respiratory sounds. Lung sounds and the airflow velocity were recorded from 15 normal adults and 37 patients falling into three different disease categories: chronic obstructive lung disease, bronchial asthma and bronchiectasis. All patients had prominent adventitious lung sounds (i.e. either wheezes or crackles). Amplitude spectra of five selected inspiratory and expiratory sound segments of each subject were calculated using the Fast Fourier Transform algorithm. Multi-variate linear discriminant analysis was then applied to the normalized and averaged spectral area values calculated for 10 unequal and arbitrarily selected frequency bands for each patient in the frequency range between 80 Hz and 1 kHz. Inspiratory and expiratory sounds were treated separately. Discriminant functions were computed from the spectral area values and plotted on graphs to classify the subjects into one of the disease categories or as normal (training set). While some separation was achieved among the different disease groups, a clearer separation was evident between normals and patients as a whole on the basis both of inspiratory and expiratory sounds. Inspiratory and expiratory sound frequency bands having the largest weights in classification were determined. Admittedly, the specific results of this study are preliminary or even tentative in view of the inadequacies of sound recording and signal conditioning techniques that were available to us at the time of recording. However, we believe that the investigation serves to illustrate the potential of multivariate discriminant analysis in the diagnostic classification of patients on the basis of their lung sound patterns. We suggest that this technique be considered by investigators involved in lung sound research, because it also allows other patient variables to be combined with the selected parameters of lung sounds.

Wavelet transform in the time-frequency analysis of patients with articulation disorders.

Spectral analysis of the human voice is a frequently used digital analysis method in the diagnosis, the planning and follow-up of the treatment of speech disorders. In the classical spectral analysis method, the principals of Joseph Fourier are used. This is called "Fourier Transform" and it accepts that all signals are formed of the synthesis of many sinusoïdal formed signals. In recent years a new transform method called "wavelet transform" accepts the complex signals formed of small signal particles called "wavelets" and it is considered that this transform will solve the documented problems of the "Fourier Transform". By using the appropriate wavelet, this transform can be used as an alternative to the Fourier transform. In this study, the patients with an articulation disorder of the "s" sound were evaluated before and after the phoniatric reeducation by using both the transform methods, and the results obtained are discussed.

Detection of spikes with artificial neural networks using raw EEG.

Artificial neural networks (ANN) using raw electroencephalogram (EEG) data were developed and tested off-line to detect transient epileptiform discharges (spike and spike/wave) and EMG activity in an ongoing EEG. In the present study, a feedforward ANN with a variable number of input and hidden layer units and two output units was used to optimize the detection system. The ANN system was trained and tested with the backpropagation algorithm using a large data set of exemplars. The effects of different EEG time windows and the number of hidden layer neurons were examined using rigorous statistical tests for optimum detection sensitivity and selectivity. The best ANN configuration occurred with an input time window of 150 msec (30 input units) and six hidden layer neurons. This input interval contained information on the wave component of the epileptiform discharge which improved detection. Two-dimensional receiver operating curves were developed to define the optimum threshold parameters for best detection. Comparison with previous networks using raw EEG showed improvement in both sensitivity and selectivity. This study showed that raw EEG can be successfully used to train ANNs to detect epileptogenic discharges with a high success rate without resorting to experimenter-selected parameters which may limit the efficiency of the system.

Median averaging of auditory brain stem responses.

OBJECTIVE: The primary aim of this study is to demonstrate the feasibility of acquiring auditory evoked potentials (AEPs) by median averaging and study its performance under various recording conditions. The auditory brain stem response (ABR) was used as the AEP of choice because it has the poorest signal to noise ratio (SNR) with inherent high susceptibility to extraneous noise. Secondary aim is to evaluate the characteristics of the median ABRs in comparison with the conventional mean averaged ABRs. DESIGN: Single sweep responses to clicks obtained from four subjects at 5 dB steps were saved in hard disk and used for off-line mean and median averaging. The characteristics of the median averaging technique were investigated by manipulating the averaging procedure using the same set of single sweep recordings and comparing them with the mean averaged responses. The effects of analog to digital input resolution (bit size) was simulated computationally by increasing quantization. RESULTS: The results showed that AEPs with low SNRs such as the ABR can be successfully acquired using median averaging with about the same number of sweeps as was required for mean averaging, provided the EEG signal is digitized with a high number of bits. The resulting waveform generally contained more identifiable waves than the corresponding mean average and had a high-frequency noise superimposed on it. This high-frequency noise was successfully filtered out using a digital, running mean smoothing filter. The median average showed an advantage over the mean average when occasional artifacts were recorded. CONCLUSION: The results showed that ABRs can be acquired successfully by median averaging provided EEG is digitized with high bit size. Compared with conventional mean averaging, median averaging is less sensitive to infrequent, externally and internally generated noise that plagues conventional techniques and may help improve wave identification.

Time-frequency distribution of evoked otoacoustic emissions.

Otoacoustic emissions (OAE) are non-stationary signals that vary in time depending on the characteristics of the stimulus. Traditional spectral analysis using Fourier methods ignores the effects of time and can miss important temporal information. Therefore, a better form of spectral analysis requires the use of time-frequency distribution methods. Traditionally, short time Fourier transforms (STFT), commonly known as spectrograms, are used to provide such time-frequency representations. STFT however, suffer from poor resolution and do not provide enough detail about the characteristics of the emissions. In this study, recently developed time-frequency distributions, the Wigner Distribution (WD) and the Choi-Williams Distribution (CWD) are investigated to provide high resolution representations of transient evoked OAEs. Although WD has excellent properties for time-frequency analysis, it suffers from cross-term artefacts generated when multiple sinusoids are present. CWD provides a solution to this problem at the expense of poor time and frequency support. In this study, we use both distributions to estimate the cross-products and provide a relatively artefact-free time-frequency distribution of OAEs. This method is applied to both click and tone burst evoked OAE and shows a more detailed time-frequency representation with as many crests and valleys as different latencies.

An electronic device measuring the frequency of spontaneous swallowing: digital phagometer.

A new and portable electronic device called the "Digital Phagometer" is described for the time based counting of spontaneous swallowing. This device is composed of a piezoelectric sensor and a digital event counter/ recorder which can be downloaded to any IBM-compatible PC. The sensor of Digital Phagometer is placed and fixed on the coniotomy region between the cricoid and thyroid cartilage. In this way, it is capable of sensing each upward and downward movement of the larynx produced by spontaneous movement as a function of time. Spontaneous swallowing was measured 1-4 h after lunch in 21 normal subjects and 21 patients with Parkinson's disease (PD). The mean frequency of spontaneous swallowing was 0.8 counts/min in PD patients and 1.18 counts/ min in normal subjects (p < 0.05). During the intake of 200 ml water, the mean frequency of voluntary swallowing did not differ significantly between the two groups (24.6 counts/min in normals vs. 22.3 counts/min in PD patients), but the time necessary to swallow the same volume of water was longer in the PD group.

Effect of tibial tubercle elevation on patellofemoral compressive force in patellofemoral arthrosis.

In this study, the effect of tibial tubercle elevation on the patellofemoral compressive force (PFCF) was investigated in patients with patellofemoral arthrosis. Fifteen (11 women and 4 men) patients who had undergone tibial tubercle elevation were included in the study. The average follow-up was 4.5 years. The mean age of the patients was 59 years (range 34-71 years). They were able to maintain a normal pain-free daily life. Maximal isometric quadriceps force (Q) was calculated by equating the moment generated by this force to the moment of the force measured at the ankle by a modified hand dynamometer. PFCF was calculated from the quadriceps and patellar tendon forces. Statistical analyses were then applied to the measured and calculated quantities. The mean quadriceps force in the operated knee decreased by 20%. Likewise, the mean PFCF was found to be reduced by 30% in the operated knees as compared with the asymptomatic contralateral knees. The above differences in Q and PFCF between the operated knee and the asymptomatic knee were statistically significant (P < 0.05). Therefore, the results of this study do not agree with the previously held view that Q and PFCF increase due to the removal of pain after the elevation operation. It is our contention that comparison of the forces measured preoperatively in a painful joint with the forces that can be attained postoperatively in the pain-free joint can lead to errors in biomechanical evaluations.