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| 4. |
- Babic, Ankica, 1960-, et al.
(författare)
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Case Based Reasoning in a Web Based Decision Support System for Thoracic Surgery
- 2013
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Ingår i: IFMBE Proceedings 41. - Cham : Springer. - 9783319008455 - 9783319008462 ; , s. 1413-1416
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Konferensbidrag (refereegranskat)abstract
- Case Based Reasoning (CBR) methodology provides means of collecting patients cases and retrieving them following the clinical criteria. By studying previously treated patients with similar backgrounds, the physician can get a better base for deciding on treatment for a current patient and be better prepared for complications that might occur during and after surgery. This could be taken advantage of when there is not enough data for a statistical analysis, but electronic patient records that provide all the relevant information to assure a timely and accurate clinical insight into a patient particular situation.We have developed and implemented a CBR engine using the Nearest Neighbor algorithm. A patient case is represented as a combination of perioperative variable values and operation reports. Physicians could review a selected number of cases by browsing through the electronic patient record and operational narratives which provides an exhaustive insight into the previously treated cases. An evaluation of the search algorithm suggests a very good functionality.
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| 7. |
- Dahlström, Örjan, et al.
(författare)
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Clustering as a data mining method in a Web-based system for thoracic surgery
- 2001
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Ingår i: Journal of the Medical Informatics Association. Symposium Supplement. - Washington : Hanley&Belfus. - 1560535369 ; , s. 888-
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Konferensbidrag (refereegranskat)abstract
- Cluster analysis is one way of data mining from large amounts of information. Being able to perform series of analyses, varying clinical criteria and requests, expected results of the clustering might be truly rewarding. Instead of having a few hypotheses prepared and tested, medical experts can be surprised by obtaining a set of hypotheses to further validate and work on.Internet technologies enable a substantial flexibility that can be taken advantage of when implementing a Web-based tool. Division of Medical Informatics together with Linkoping Heart Center of the Linkoping University is developing procedures for multivariate clustering within the Web-based AssistMe1 system.
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| 8. |
- Delle, M., et al.
(författare)
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Preserved pelvic circulation after stent-graft treatment of complex aortoiliac artery aneurysms: a new approach
- 2005
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Ingår i: Journal of endovascular therapy. - 1526-6028. ; 12:2, s. 189-95
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To describe an endovascular technique that allows stent-graft treatment of aortoiliac aneurysmal disease affecting both common iliac arteries (CIA), with maintenance of pelvic circulation on one side. TECHNIQUE: For patients with aortoiliac aneurysms, both common femoral arteries (CFA) were surgically exposed. One internal iliac artery (IIA) was initially embolized with coils. A bifurcated stent-graft main body was deployed with the proximal end just below the renal arteries. On the ipsilateral side, the stent-graft limb was extended 3 cm beyond the orifice of the embolized IIA into the external iliac artery (EIA) using stent-graft limb extenders. On the contralateral side, the stent-graft limb was deployed so that the distal end was 10 to 15 mm proximal to the patent IIA orifice. Via a left brachial artery access, the IIA was catheterized, and stent-grafts were deployed from the distal end of the contralateral AAA stent-graft limb into the IIA. A femorofemoral crossover graft provided circulation to the leg ipsilateral to the IIA stent-graft, and the EIA on the same side was ligated. The technique can also be modified to treat isolated bilateral CIA aneurysms. CONCLUSIONS: By extending the distal aspect of the stent-graft into an IIA, bilateral CIA aneurysms can be excluded while preserving pelvic circulation on one side.
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| 9. |
- Granfeldt, Hans, et al.
(författare)
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Risk Factor Analysis of Swedish Left Ventricular Assist Device (LVAD) Patients
- 2003
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Ingår i: Annals of Thoracic Surgery. - : Elsevier. - 0003-4975 .- 1552-6259. ; 76:6, s. 1993-1998
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Tidskriftsartikel (refereegranskat)abstract
- Background. The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. Methods. All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. Results. Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. Conclusions. The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers. © 2003 by The Society of Thoracic Surgeons.
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| 10. |
- Granfeldt, Hans, et al.
(författare)
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The Linkoping-Lund surgical experience with the HeartMate left ventricular assist system
- 1995
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Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 59:Suppl. 1, s. 52-55
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Tidskriftsartikel (refereegranskat)abstract
- Four transplant candidates fulfilling the Food and Drug Administration criteria for a permanent left ventricular assist device received a pneumatic HeartMate system as a bridge to heart transplantation. All patients survived and were fully rehabilitated at the time of transplantation, which was carried out 2 to 6 months after the initial operation. There were no major complications associated with the procedures. We are impressed by the effectiveness and safety of the device.
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| 11. |
- Gunnarsson, Urban, et al.
(författare)
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Local-scale genetic structure in the peatmoss Sphagnum fuscum
- 2007
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Ingår i: Molecular Ecology. - 0962-1083 .- 1365-294X. ; 16:2, s. 305-312
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Tidskriftsartikel (refereegranskat)abstract
- Sphagnum (peatmoss) dominates huge areas of the Northern Hemisphere and acts as a significant carbon sink on a global scale, yet little is known about the genetic structure of Sphagnum populations. We investigated genetic structure within a population of the common peatmoss Sphagnum fuscum, to assess local patterns of genetic diversity and the spatial extent of clones. One hundred seventeen shoots were sampled from five transects in Fuglmyra, central Norway, and sequenced for three anonymous DNA regions. Five neighbourhood patches were marked along each transect, and from each patch, five stems were sampled for molecular analyses. Seventeen haplotypes could be distinguished and two major groups of haplotypes differed by 12 mutational steps. The two major haplotype groups differed significantly in microhabitat association along the distance to groundwater table and the pH gradients, indicating microhabitat differentiation. The haplotypes within these groups were all genetically similar, differing by one or two mutations. The most common haplotype occurred in four transects separated by 250-m distance. Most of the molecular variation in the population was found among transects, and within patches. Large dominating clones within each transect resulted in low variation explained by the among-patch-within-transect component of spatial structure. Mutation appears to account for a larger proportion of the population variation than recombination. Within the population, vegetative growth and asexual reproduction from gametophyte fragments dominate as the main reproductive mode.
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| 15. |
- Hübbert, Laila, et al.
(författare)
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Echocardiography and myocardial Doppler indices in the anesthetized calf : A closed and open chest study
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: the aim of this study was to provide baseline central hemodynamic and echocardiographic values in an anaesthetized calf model before and after sternotomy, and to include tissue Doppler imaging (TDI) modalities so that they may be applied to future anaesthetized calf models in cardiovascular research. Method and results: twenty-one healthy anaesthetized calves were catheterized and invasively and echocardiographic monitored before and after sternotomy using a pulmonary artery catheter, left atrial and carotid artery catheters, and transthoracic or pericardial echocardiography. The following data were registered: heart rate, mean arterial pulmonary and systemic pressures, central venous pressure and saturation, cardiac output, left and right ventricular dimensions and their myocardial regional basal peak velocity and strain rate during systole, early diastolic and atrial filling and systolic peak strain and systolic displacement. After sternotomy, the heart rate, systemic arterial pressure and left ventricular size increased, but other cardiovascular parameters, including echocardiographic myocardial velocities, strain and displacement did not change. Conclusion: transthoracic and pericardial echocardiography including TDI, is feasible and applicable to the anaesthetized calf model. The normal ranges for baseline hemodynamic and echocardiographic variables derived from this study demonstrate that, as in humans, sternotomy influences basic hemodynamic variables such as heart rate, blood pressure and heart volumes but does not significantly affect TDI. The data collected may be useful in the future development of cardiovascular research using the anaesthetized calf model.
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| 16. |
- Karlsson, Daniel M G, 1974-, et al.
(författare)
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Analysis and processing of laser Doppler perfusion monitoring signals recorded from the beating heart
- 2003
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Ingår i: Medical and Biological Engineering and Computing. - : Springer. - 0140-0118 .- 1741-0444. ; 41:3, s. 255-262
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Tidskriftsartikel (refereegranskat)abstract
- Laser Doppler perfusion monitoring (LDPM) can be used for monitoring myocardial perfusion in the non-beating heart. However, the movement of the beating heart generates large artifacts. Therefore the aim of the study was to develop an LDPM system capable of correlating the laser Doppler signals to the cardiac cycle and to process the signals to reduce the movement artifacts. Measurements were performed on three calves, both on the normal beating heart and during occlusion of the left anterior descending coronary artery (LAD). The recorded LDPM signals were digitally processed and correlated to the sampled ECG. Large variations in the output (perfusion) and DC signals during the cardiac cycle were found, with average coefficients of variation of 0.36 and 0.14 (n-14), respectively. However, sections with a relatively low, stable output signal were found in late diastole, where the movement of the heart is at a minimum. Occlusion of the LAD showed the importance of recording the laser Doppler signals at an appropriate point in the cardiac cycle, in this case late systole, to minimise movement artifacts. It is possible to further reduce movement artifacts by increasing the lower cutoff frequency when calculating the output signal.
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| 18. |
- Karlsson, M G Daniel, 1974-, et al.
(författare)
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Myocardial tissue motion influence on laser Doppler perfusion monitoring using tissue Doppler imaging
- 2004
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Ingår i: Medical and Biological Engineering and Computing. - : Springer. - 0140-0118 .- 1741-0444. ; 42:6, s. 770-776
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Tidskriftsartikel (refereegranskat)abstract
- Tissue motion of the beating heart generates large movement artifacts in the laser Doppler perfusion monitoring (LDPM) signal. The aim of the study was to use tissue Doppler imaging (TDI) to localise intervals during the cardiac cycle where the influence of movement artifacts on the LDPM signal is minimum. TDI velocities and LDPM signals were investigated on three calves, for normal heartbeat and during occlusion of the left anterior descending coronary artery. Intervals of low tissue velocity (TDIint<1 cm s−1) during the cardiac cycle were identified. During occlusion, these intervals were compared with low LDPM signal intervals (LDPMint<50% compared with baseline). Low-velocity intervals were found in late systole (normal and occlusion) and late diastole (normal). Systolic intervals were longer and less sensitive to heart rate variation compared with diastolic ones. The overlap between LDPMint and TDIint in relation to TDIint length was 84±27% (n=14). The LDPM signal was significantly (p<0.001, n=14) lower during occlusion if calculated during minimum tissue motion inside TDIint), compared with averaging over the entire cardiac cycle without taking tissue motion into consideration. In conclusion, movement artifacts are reduced if the LDPM signal is correlated to the ECG and investigated during minimum wall motion. The optimum interval depends on the application; late systole and late diastole can be used.
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| 19. |
- Kircher, Albert, et al.
(författare)
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Knowledge representation forms for data mining methodologies as applied in thoracic surgery
- 2000
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Ingår i: AMIA,2000. - Philadelphia : Hanley & Belfus Inc. - 156053480X ; , s. 428-432
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Konferensbidrag (refereegranskat)abstract
- Typical ways of disseminating and using results of clinical research are scientific journals and reports. Presentation forms are condensed and comprehensible mainly to the experts following the specific topics. A vast amount of information remains unutilized due to the complex form of presenting the knowledge. Subject of this research is to explore possibilities of representation and also visualization of the results obtained using data mining methodologies. The intention is to formulate more than scientific ways to communicate facts that are of interest for the clinicians, medical students and even patients. Internet technologies as already widely established media support knowledge representation forms such as hypertext documents and structured knowledge components. The "Assist Me" decision support system for surgical treatment of cardiac patients integrates several forms of data mining and representation methodologies. We are showing a feasibility study in which scientific outcomes were forwarded to a broad group of potential users.
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| 21. |
- Lindmark, Stina, et al.
(författare)
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Dysregulation of the autonomic nervous system can be a link between visceral adiposity and insulin resistance
- 2005
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Ingår i: Obesity Research. - : Wiley. - 1071-7323 .- 1550-8528. ; 13:4, s. 717-728
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the interplay among abdominal adipose tissue distribution, the cortisol axis, the autonomic nervous system, and insulin resistance. RESEARCH METHODS AND PROCEDURES: Two age-, sex-, and BMI-matched groups were studied. Fifteen subjects were first-degree relatives of patients with type 2 diabetes (R), and 15 had no family history of diabetes (controls, C). A hyperinsulinemic euglycemic clamp, cortisol measurements, and analysis of heart rate variability (HRV) were performed. Computed tomography was performed in a subgroup (n = 9 + 9) to determine abdominal adipose tissue distribution. RESULTS: R tended to be less insulin-sensitive than C (M value 9.2 +/- 1.0 vs 10.3 +/- 0.7 mg/kg per minute, not significant). Stimulation with tetracosactin or corticotropin releasing hormone yielded lower peak serum cortisol levels in R (p = 0.03 and p = 0.06, respectively). The amount of visceral abdominal fat (VAT) tended to be greater in R. In all subjects, VAT was negatively correlated to insulin sensitivity (r = -0.93, p < 0.001). There was a positive association between VAT and resting heart rate (r = 0.70, p = 0.003) and sympathetic/parasympathetic ratio in HRV assessment after tilt (r = 0.53, p = 0.03). Subcutaneous abdominal tissue was not associated with insulin sensitivity or any of the hormonal or HRV assessments. DISCUSSION: Subjects genetically predisposed for type 2 diabetes had a tendency toward a larger amount of VAT and to lower insulin sensitivity compared with control subjects. The amount of visceral fat was strongly associated with insulin resistance and signs of a high ratio of sympathetic vs. parasympathetic reactivity. A large amount of visceral fat may act in concert with sympathetic/parasympathetic imbalance to promote the development of insulin resistance, and this may be partly independent of genetic background.
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| 22. |
- Lönn, Urban
(författare)
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A minimally invasive axial blood flow pump : an experimental and clinical study
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The first aim of this thesis was to evaluate a new minimally invasive axial blood flow pump for treatment of patients needing circulatory support after open heart surgery. This system, the Hemopump temporary cardiac assist device, is a very small catheter mounted intracorporeal pump, which is introduced transvalvularly into the left ventricle. The pump can be inserted either through the femoral artery or directly through a graft sutured to the ascending aorta. In an experimental model, the flow capacity of three different designs of the system was investigated. Flow capacity varied between 2.0 and 4.5 liters per minute, depending on the working conditions for the different pump models. Twenty,four patients were treated for post,cardiotomy heart failure. Fourteen patients (58 %) were weaned from the device and later discharged from the hospital. In a subgroup of these patients (54%) where early intervention was instituted, the survival rate was 85%. The pump proved to be an effective tool for unloading a failing left ventricle with preservation of multi-organ perfusion. A clinical protocol was established for postoperative management. The Hemopump was easy to adapt to the clinical setting, and device~ related complications were few.The second aim was to develop a new less invasive procedure for CABG, avoiding the need for cardio~pulmonary bypass during these procedures. First an animal trial was performed as a feasibility study. In combination with the administration of a short~acting ~~blocker, esmolol, this method enabled precise coronary bypass surgery. When results became consistent a small pilot study was done on five patients showing that this was a reproducible technique. Finally a prospective randomized trial comparing this technique with conventional bypass surgery was carried out. The Hemopump supported bypass surgery did not prolong the procedure, did not require a longer time on circulatory support and bleeding was less. Postoperative enzyme levels indicated that ischemic insult to the myocardium was less than with conventional surgery.In summary, this minimally invasive axial blood flow pump proved to be a powerful left ventricular assist system enabling a less invasive approach during conditions where circulatory support is needed.
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| 26. |
- Peterzén, Bengt, et al.
(författare)
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Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting beta-blocker
- 1999
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Ingår i: Journal of cardiothoracic and vascular anesthesia. - 1053-0770. ; 13:4, s. 431-436
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting β-blocker. Design: A retrospective study. Setting: A university hospital. Participants: Seventeen patients scheduled for elective CABG. Interventions: Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting β-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe. Measurements and main results: Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and β-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital. Conclusion: The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting β-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.
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| 28. |
- Peterzén, Bengt, et al.
(författare)
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Management of patients with end-stage heart disease treated with an implantable left ventricular assist device in a nontransplanting center
- 2000
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Ingår i: Journal of cardiothoracic and vascular anesthesia. - : Elsevier BV. - 1053-0770. ; 14:4, s. 438-443
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the setup of a left ventricular assist device (LVAD) program in a nontransplanting center. Design: A prospective study from February 1993 to June 1999. Setting: A university hospital. Participants: Ten patients, 6 men, with a mean age of 44 years (range 16 to 63 years) and with end-stage heart failure resulting from dilated cardiomyopathy (n = 7) or ischemic heart disease (n = 3). Interventions: The patients received the TCI (Thermo Cardiosystems Inc, Woburn, MA) Heart Mate implantable assist device. Five patients had a pneumatic device, and 5 had an electric device. All except 1 patient with an electric device had the pump for an extended period. Measurements and Main Results: Median time on the ventilator was 6.2 days, and median time in the ICU was 14 days. Significant hemodynamic improvement was observed by echocardiography and invasive monitoring. Milrinone and epinephrine supplemented by prostaglandin E1 were the most commonly used drugs to avoid right-sided heart failure. Nine patients were transplanted after pump therapy of 241 days (median) (range, 56 to 873 days). One patient died because of endovascular infection and septicemia. Infectious complications were frequent, especially when the pump time was extended. Conclusions: The introduction of an LVAD program in a nontransplanting center can be achieved with good results. Intense collaboration with a transplant center is mandatory. The complication rate increased when treatment times were extended.
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| 29. |
- Peterzén, Bengt, et al.
(författare)
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Postoperative management of patients with Hemopump support after coronary artery bypass grafting
- 1996
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Ingår i: The Annals of thoracic surgery. - 0003-4975. ; 62:2, s. 378-385
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Tidskriftsartikel (refereegranskat)abstract
- Background In this study, we describe postoperative monitoring, pharmacologic therapy, and hemodynamic responses in patients receiving Hemopump support after postcardiotomy heart failure. Methods The Hemopump was used in 24 patients with severe left ventricular dysfunction after coronary artery bypass grafting. Results Fourteen patients (58%) were weaned from the Hemopump. Low to moderate doses of a combination of catecholamines, phosphodiesterase inhibitors, vasodilators, and vasoconstrictors were required to optimize Hemopump function and left ventricular unloading. Mean arterial blood pressure, mixed venous oxygen saturation, and urinary output were the most important therapy guidelines. Conclusions Together with our clinical protocol, the Hemopump effectively unloaded the failing ventricle while maintaining vital-organ perfusion. Doses of vasoactive drugs could be kept low. This approach to treatment provides good conditions for recovery of the stunned myocardium.
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| 30. |
- Voznuka, Natalja, et al.
(författare)
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Report generation and data mining in the domain of thoracic surgery
- 2004
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Ingår i: Journal of medical systems. - 0148-5598 .- 1573-689X. ; 28:5, s. 497-509
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Tidskriftsartikel (refereegranskat)abstract
- As a part of AssistMe system, the reporting system has been developed for the thoracic surgery domain. Reporting System is defined as software for dynamic report generation purpose and based on the data-mining techniques. The target users of the future reporting system - physicians, administrative staff, and patients - have been identified. Two major types of clinical reports have been found: predefined and customized. The decision of splitting reports into groups has been taken mainly because users were heterogeneous and had different access rights to the sensitive information. Data-mining process in the reporting system is based on descriptive statistics. It allows dynamically mined AssistMe databases and generates statistical reports about patient's morbidity, mortality, and comorbidity. Information is visualized in the chart way and can be also observed in tabular form. User interaction is also supported by the system.
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| 31. |
- Wulff, John, et al.
(författare)
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Flow characteristics of the Hemopump : an experimental in vitro study.
- 1997
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 63:1, s. 162-166
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Hemopump (DLP/Medtronic) has been in clinical use for about 7 years. There is still no adequate way of determining actual output from the three available pump systems in the clinical situation. If the pump is completely stopped during weaning from the device, there is a possibility of back-leakage through the pump, endangering the patient from regurgitation into the left ventricle. It can also make it more difficult to judge the recovery of heart function because of a volume load of the left ventricle. The aim of this study was to evaluate in a standardized, experimental in vitro model the output from three different-sized Hemopump catheters at various pressure levels and to quantify the back-flow through the pumps.METHODS: The Hemopump models were tested in an in vitro study regarding total outflow at various speeds at three pressure levels. The back-flow through the pumps was also measured with the pumps at a complete stop.RESULTS: The outflow from the Hemopumps ranged from 0.4 to 4.5 L/min, depending on which pump and speed were used. Variations in total output, depending on speed and various pressure settings, could be up to 0.4 L/min. Back-flow through the pump into the left ventricle may be as great as 1.6 L/min.CONCLUSIONS: The flow outputs from the different Hemopump models were reproducible over time and were closely related to the resistance of the model. The Hemopump, if not running, can induce substantial regurgitation through the pump into the left ventricle.
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| 32. |
- Wårdell, Karin, 1959-, et al.
(författare)
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Circulatory response of cardiac assist treatment
- 2000
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Ingår i: European Conference on Microcirculation,2000. - Bologna, Italy : Monduzzi Editore, International Proceedings Division. - 9783805571227 - 9783318006209
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Konferensbidrag (refereegranskat)
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