Studies in health technology and informatics
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Stud Health Technol Inform · Jan 2008
Network design for telemedicine--e-health using satellite technology.
Over the last decade various international Information and Communications Technology networks have been created for a global access to high-level medical care. OP 2000 has designed and validated the high-end interactive video communication system WinVicos especially for telemedical applications, training of the physician in a distributed environment, teleconsultation and second opinion. WinVicos is operated on a workstation (WoTeSa) using standard hardware components and offers a superior image quality at a moderate transmission bandwidth of up to 2 Mbps. ⋯ The development of virtual hospitals and digital medicine helps to bridge the digital divide between different regions of the world and enables equal access to high-level medical care. Pre-operative planning, intra-operative navigation and minimally-invasive surgery require a digital and virtual environment supporting the perception of the physician. As data and computing resources in a virtual hospital are distributed over many sites the concept of the Grid should be integrated with other communication networks and platforms.
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Spinal curvatures alter measured stature and may influence the evaluation of skeletal maturity and growth based on stature measurements. ⋯ The findings of the present study indicate that height loss (in mm) occurring with a 10 degrees increase in mean Cobb angle (for two curves) would be 1.1+0.16 times the mean Cobb angle (in degrees). For example, for a Cobb angle change from 30 to 40 degrees, the expected height loss would be 1.1+35*0.16 mm=6.7 mm. This assumes that height loss occurs only as a result of altered curvature, without alteration in disc height associated with an increase in scoliosis.
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Stud Health Technol Inform · Jan 2008
Inclusion and assessment criteria for conservative scoliosis treatment.
The efficacy of brace or conservative treatment in adolescent idiopathic scoliosis is controversial due to variations in inclusion and assessment criteria. This makes the interpretation of brace studies and their comparisons difficult. The Scoliosis Research Society recently introduced new standardized inclusion and assessment criteria for future brace studies. ⋯ The assessment criteria include: percentage of patients with < or = 5 degree curve progression and percentage of patients with > or = 6 degree curve progression at skeletal maturity, percentage of patients who had surgery or recommended before skeletal maturity, percentage of patients with curves exceeding 45 degrees at maturity, and a minimum of 2 years follow-up beyond skeletal maturity for those patients felt to have been successfully treated. All patients treated irregardless of compliance are to be included in the results (intent to treat). The use of these criteria should assist in the determination of the effectiveness of brace treatment, as well as accurate comparison between patient groups and different braces.
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Stud Health Technol Inform · Jan 2008
Concepts on the pathogenesis of adolescent idiopathic scoliosis. Bone growth and mass, vertebral column, spinal cord, brain, skull, extra-spinal left-right skeletal length asymmetries, disproportions and molecular pathogenesis.
There is no generally accepted scientific theory for the causes of adolescent idiopathic scoliosis (AIS). Encouraging advances thought to be related to AIS pathogenesis have recently been made in several fields including anthropometry of bone growth, bone mass, spinal growth modulation, extra-spinal left-right skeletal length asymmetries and disproportions, magnetic resonance imaging of vertebral column, spinal cord, brain, skull, and molecular pathogenesis. These advances are leading to the evaluation of new treatments including attempts at minimally invasive surgery on the spine and peri-apical ribs. ⋯ From these concepts, a collective model for AIS pathogenesis is formulated. The central concept of this model includes the body schema of the neural systems, widely-studied in adults, that control normal posture and coordinated movements with frames of reference in the posterior parietal cortex. The escalator concept has implications for the normal development of upright posture, and the evolution in humans of neural control, the trunk and unique bipedal gait.
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Stud Health Technol Inform · Jan 2008
Risser sign: the value of the lateral spinal radiograph to assess the excursion of the iliac apophysis.
The course of the ossification of the iliac apophysis is considered in adolescent patients with idiopathic scoliosis, under the name of the Risser sign, to determine the remaining spinal growth. Although the iliac crest develops in the three-dimensional space as a complex structure, the iliac apophysis ossification has been assessed only on a one plane frontal spinal radiograph. This study points out the usefulness of the lateral radiograph for the visualization of the whole iliac crest, especially the posterior region which otherwise cannot be observed. ⋯ The regions of the maximal thickness corresponded to the earliest appearance of the apophysis ossification (Risser 1), while the thin part of the iliac bone corresponded to late appearance of the apophysis ossification (Risser 3-4). The ossification of the posterior part of the crest was best visualized with the lateral radiograph, which was exclusive in showing the posterior superior iliac spine region. On the frontal spinal radiograph the end of the course of the apophysis (Risser 3-4) is usually searched at the level of the sacroiliac joint, while in reality this point was found to be situated more caudal, and accessible for observation on the lateral radiograph.