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BACKGROUND: Although urinary tract infections (UTIs) are the most common nosocomial infection, active UTI surveillance is often not feasible for infection control departments. METHODS: As part of an ongoing urinary catheter evaluation, we investigated the accuracy and cost-effectiveness of using handheld personal digital assistants (PDA) and computer-based UTI surveillance in comparison with traditional surveillance of UTIs among medical intensive care unit (MICU) patients. From September 22, 2000, to October 22, 2000, an infection control practitioner (ICP) actively surveyed all MICU patients who had a urinary catheter to determine criteria for a nosocomial UTI as defined by the Centers for Disease Control and Prevention (CDC). Research assistants visited the unit each day to determine which patients had urinary catheters, and this information was uploaded to a database designed for laboratory-based UTI surveillance. Patients with a urinary catheter were included if admitted to the MICU for >48 hours and excluded if symptoms developed <48 hours after admission. RESULTS: Both data collection methods identified 8 UTIs within the 1-month period, with 3 UTIs meeting inclusion criteria. Traditional surveillance required 8 hours weekly, whereas the PDA-computer surveillance required 1-and-a-half hours weekly. Traditional surveillance correctly attributed all 3 UTIs to the MICU. The PDA-computer surveillance incorrectly attributed the location of 2 of the UTIs. In both cases, the UTI occurred less than 48 hours after the patient was transferred from the MICU. CONCLUSION: Our data demonstrate that PDA surveillance detects nosocomial UTIs efficiently and is a novel, timesaving technique that realizes a cost savings in the first year. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) pseudoaneurysms are rare clinical entities with an uncertain natural history due to limited follow-up information. This case report describes a 30-year-old woman with two IVC pseudoaneurysms and their associated anatomy. It also details our treatment plan, with follow-up through radiographic resolution of the pseudoaneurysms. To our knowledge, this is the first case report to document a patient with two pseudoaneurysms of the IVC and full resolution treated by nonoperative management., (Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Hypokalemic periodic paralysis (HOPP) is a rare disease associated with attacks of muscle weakness and hypokalemia. In the present study, immunoprecipitation/Western blotting has shown that a HOPP patient was deficient in sarcolemmal K(ATP) channels. Real-time RT-PCR has revealed that HOPP has decreased mRNA levels of Kir6.2, a pore-forming K(ATP) channel subunit, without affecting the expression of other K(ATP) channel-forming proteins. Based on these findings, we conclude that HOPP could be associated with impaired expression of Kir6.2 which leads to deficiency in skeletal muscle K(ATP) channels, which may explain the symptoms and clinical signs of this disease.

A robust, flexible system for tracking the point to point nonrigid motion of the left ventricular (LV) endocardial wall in image sequences has been developed. This system is unique in its ability to model motion trajectories across multiple frames. The foundation of this system is an adaptive transversal filter based on the recursive least-squares algorithm. This filter facilitates the integration of models for periodicity and proximal smoothness as appropriate using a contour-based description of the object's boundaries. A set of correspondences between contours and an associated set of correspondence quality measures comprise the input to the system. Frame-to-frame relationships from two different frames of reference are derived and analyzed using synthetic and actual images. Two multiframe temporal models, both based on a sum of sinusoids, are derived. Illustrative examples of the system's output are presented for quantitative analysis. Validation of the system is performed by comparing computed trajectory estimates with the trajectories of physical markers implanted in the LV wall. Sample case studies of marker trajectory comparisons are presented. Ensemble statistics from comparisons with 15 marker trajectories are acquired and analyzed. A multiframe temporal model without spatial periodicity constraints was determined to provide excellent performance with the least computational cost. A multiframe spatiotemporal model provided the best performance based on statistical standard deviation, although at significant computational expense.

An approach for tracking and quantifying the nonrigid, nonuniform motion of the left ventricular (LV) endocardial wall from two-dimensional (2-D) cardiac image sequences, on a point-by-point basis over the entire cardiac cycle, is presented. Given a set of boundaries, motion computation involves first matching local segments on one contour to segments on the next contour in the sequence using a shape-based strategy. Results from the match process are incorporated with a smoothness term into an optimization functional. The global minimum of this functional is found, resulting in a smooth flow field that is consistent with the match data. The computation is performed for all pairs of frames in the temporal sequence and equally sampled points on one contour are tracked throughout the sequence, resulting in a composite flow field over the entire sequence. Two perspectives on characterizing the optimization functional are presented which result in a tradeoff resolved by the confidence in the initial boundary segmentation. Experimental results for contours derived from diagnostic image sequences of three different imaging modalities are presented. A comparison of trajectory estimates with trajectories of gold-standard markers implanted in the LV wall are presented for validation. The results of this comparison confirm that although cardiac motion is a three-dimensional (3-D) problem, two-dimensional (2-D) analysis provides a rich testing ground for algorithm development.

The repair of intracardiac defects under direct vision by opening the heart to expose the operative field, with the aid of hypothermia or a pump-oxygenator, is now a practical clinical method. Twelve patients were operated upon by this method. In eight patients an atrial septal defect was repaired during total circulatory occlusion under hypothermia. The seven patients in this group who had uncomplicated atrial defects survived the operation and are doing well after a short follow-up period. One patient with an unrecognized, associated ventricular defect died at the time of operation. Four patients were operated upon during total cardiac by-pass with the DeWall bubble-oxygenator. The first three patients survived operation and are continuing to do well after a brief follow-up period. In the fourth patient an atrioventricularis communis was repaired by the reconstruction of an atrial and ventricular septum with a plastic prosthesis. This patient died at the end of operation.