The use of computed tomography in patients with gastrointestinal disease is increasing. However, the triple-phase computed tomographic angiographic appearance of the canine small intestine and the effects that phase of contrast enhancement and plane of reconstruction have on the appearance of the small intestine have not been fully evaluated. The purposes of this study were to investigate these effects on the appearance of the small intestinal wall. The minimal and maximal small intestinal diameter, wall thickness, number of wall layers identified, and degree of mucosal enhancement were recorded. The plane of reconstruction did not have any significant effects on wall thickness, diameter, degree of mucosal enhancement, or number of wall layers identified. There was a positive association between body weight and intestinal diameter. The arterial phase demonstrated the greatest mucosal enhancement and number of wall layers identified. The transverse plane was subjectively the most useful for evaluation of the small intestines.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第24877号 / 医博第5011号 / 新制||医||1068(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 川上 浩司, 教授 森田 智視, 教授 長船 健二 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Bakgrund: Misstanke om angina är vanligt förekommande, och utreds ofta med kranskärlsröntgen. Det är visserligen känns att dessa patienter lider av oro, ovisshet och försämrad livskvalitet men kunskap behövs om varför patienter blir besvikna över ett normalt undersökningsfynd. Syfte: Syftet med studien var att beskriva upplevelser hos patienter som uttrycker en besvikelse över att kranskärlsröntgen visar normala kärl eller inte förklarar patientens symtom samt beskriva vad känslan av besvikelse grundar sig i. Metod: En empirisk studie med beskrivande design och kvalitativ ansats. Sju semistrukturerade intervjuer utfördes med patienter med misstänkt angina. Data har analyserats med kvalitativ innehållsanalys. Huvudresultat: Deltagarna uttryckte en besvikelse över att inte få veta vad deras besvär beror på och över att kranskärlsröntgen inte visade på något som behövde och kunde åtgärdas, vilket hade kunnat bidra till förbättrat välbefinnande och en förbättrad fysisk förmåga. Deltagarna beskrev en förlust och saknad över att inte kunna leva det aktiva liv som de gjort tidigare, vilket tolkas ligga till grund för de förväntningar och reaktioner som deltagarna uttrycker. Upplevda begränsningar, oro och ovisshet leder till psykisk lidande, i form av frustration, nedstämdhet, uppgivenhet, och en känsla av hopplöshet. Detta leder till förväntningar på att få svar och hopp om åtgärd. Slutsats: Sjukvården kanske inte alltid kan minska patienternas grad av begränsningar, men genom relevant och anpassad information, kan vi ge patienterna rimliga förväntningar och till viss del kanske minska graden av besvikelse. Genom tydliga besked, stöd, och uppföljning kan vi förhoppningsvis minska patienternas psykiska lidande och känsla av ovisshet. / Background: Suspicion of angina are common, and often investigated with coronary angiography. Although it´s known that these patients suffer from anxiety, uncertainty and impaired QoL, knowledge is needed as to why patients are disappointed with normal examination findings. Aim: The aim of this study was to describe experiences in patients who express disappointment over the fact that coronary angiography shows normal vessels or don´t explain the patient's symptoms, and to describe what the feeling of disappointment is based on. Method: An empirical study with descriptive design and qualitative approach. Seven semi-structured interviews were conducted with patients with suspected angina. Data have been analyzed with qualitative content analysis. Main results: The participants expressed disappointment of not knowing what causes their problems and that coronary angiography did not reveal something that needed or could be fixed, which could have contributed to improved well-being and improved physical ability. The participants described a loss of not being able to live the active life that they´ve been used to, which interpreted to be the cause of their expressed expectations and reactions. Their experienced limitations, anxiety and uncertainty lead to mental suffering, frustration, depression, despair, and a feeling of hopelessness. This leads to expectations of getting answers and hope of treatment. Conclusion: Healthcare may not always be able to reduce patients' degree of limitation, but through relevant and customized information, we can give patients reasonable expectations and to some extent perhaps reduce the degree of disappointment. Through clear messages, support, and follow-up, we can hopefully reduce patients' mental suffering and feelings of uncertainty.

No description available.

Objectives: To compare early coronary angiography to a delayed or selective approach in out‐of‐hospital cardiac arrest (OHCA) without ST‐segment elevation of possible cardiac cause by means of meta‐analysis of available randomized controlled trials (RCTs). Methods: We searched MEDLINE and the Cochrane Central Register of Controlled Trials for RCTs comparing early with delayed or selective coronary angiography in OHCA patients of possible cardiac origin without ST‐segment elevation. The primary endpoint was all‐cause short‐term mortality (PROSPERO CRD42021271484). Results: The search strategy identified three RCTs enrolling a total of 1167 patients. An early invasive approach was not associated with improved short‐term mortality (odds ratio 1.19, 95% confidence interval 0.94–1.52; p = 0.15). Further, no significant differences were shown with respect to the risk of severe neurological deficit, the composite of all‐cause mortality or severe neurological deficit, need for renal replacement therapy due to acute renal failure, and significant bleeding at short‐term follow‐up. Conclusion: Early coronary angiography in OHCA without ST‐segment elevation is not superior compared to a delayed/selective approach.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23793号 / 医博第4839号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 大森 孝一, 教授 花川 隆, 教授 渡邊 直樹 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23813号 / 医博第4859号 / 新制||医||1059(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中本 裕士, 教授 花川 隆, 教授 大森 孝一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Yes / Digital image processing used in modern cardiac interventional x-ray systems may have the potential to enhance image quality such that it allows for lower radiation doses. The aim of this research was to quantify the reduction in radiation dose facilitated by image processing alone for percutaneous coronary intervention (PCI) patient angiograms, without reducing the perceived image quality required to confidently make a diagnosis. Incremental amounts of image noise were added to five PCI patient angiograms, simulating the angiogram having been acquired at corresponding lower dose levels (by 10-89% dose reduction). Sixteen observers with relevant and experience scored the image quality of these angiograms in three states - with no image processing and with two different modern image processing algorithms applied; these algorithms are used on state-of-the-art and previous generation cardiac interventional x-ray systems. Ordinal regression allowing for random effects and the delta method were used to quantify the dose reduction allowed for by the processing algorithms, for equivalent image quality scores. The dose reductions [with 95% confidence interval] from the state-of-the-art and previous generation image processing relative to no processing were 24.9% [18.8- 31.0%] and 15.6% [9.4-21.9%] respectively. The dose reduction enabled by the state-of-the-art image processing relative to previous generation processing was 10.3% [4.4-16.2%]. This demonstrates that statistically significant dose reduction can be facilitated with no loss in perceived image quality using modern image enhancement; the most recent processing algorithm was more effective in preserving image quality at lower doses. / The study was funded by Philips Healthcare (the Netherlands).

Yes / Cardiologists use x-ray image sequences of the moving heart acquired in real-time to diagnose and treat cardiac patients. The amount of radiation used is proportional to image quality; however, exposure to radiation is damaging to patients and personnel. The amount by which radiation dose can be reduced without compromising patient care was determined. For five patient image sequences, increments of computer-generated quantum noise (white + colored) were added to the images, frame by frame using pixel-to-pixel addition, to simulate corresponding increments of dose reduction. The noise adding software was calibrated for settings used in cardiac procedures, and validated using standard objective and subjective image quality measurements. The degraded images were viewed next to corresponding original (not degraded) images in a two-alternativeforced- choice staircase psychophysics experiment. Seven cardiologists and five radiographers selected their preferred image based on visualization of the coronary arteries. The point of subjective equality, i.e., level of degradation where the observer could not perceive a difference between the original and degraded images, was calculated; for all patients the median was 33% 15% dose reduction. This demonstrates that a 33% 15% increase in image noise is feasible without being perceived, indicating potential for 33% 15% dose reduction without compromising patient care. / Funded in part by Philips Healthcare, the Netherlands. Part of this work has been performed in the project PANORAMA, co-funded by grants from Belgium, Italy, France, the Netherlands, and the United Kingdom, and the ENIAC Joint Undertaking.

Introdução: Pacientes com doença renal crônica terminal (DRCT) apresentam elevada prevalência de doença cardiovascular, sendo esta a principal causa de óbitos na população em diálise e após o transplante renal. Entretanto, a doença arterial coronária (DAC) é frequentemente assintomática em pacientes com DRCT e os exames não invasivos apresentam baixa acurácia diagnóstica nesses pacientes em relação à população geral. Objetivos: Determinar a performance diagnóstica da angiotomografia de artérias coronárias combinada à perfusão miocárdica pela tomografia (TC-AP) em pacientes com DRCT. Métodos: Estudo prospectivo, aberto, unicêntrico. Foram incluídos pacientes com DRCT em terapia de substituição renal, candidatos ao transplante renal com mais um fator de risco cardiovascular: idade >= 50 anos, diabetes ou história de doença cardiovascular. Todos os pacientes foram submetidos à coronariografia invasiva (CI) e à TC-AP. A aquisição das imagens tomográficas foi realizada durante estresse com dipiridamol e em repouso. Os resultados obtidos na TC-AP foram comparados aos da CI, considerada o padrão-ouro para diagnóstico de DAC. Foi realizada medida da reserva de fluxo fracionada (FFR) durante a CI em lesões obstrutivas classificadas visualmente como intermediárias. Baseado nos resultados da TC-AP e da CI (±FFR), os pacientes foram classificados como portadores ou não de DAC significativa e a análise foi feita por paciente. Os investigadores responsáveis pela análise da TC-AP não tiveram acesso aos resultados da CI (±FFR). Resultados: Entre julho de 2015 e janeiro de 2018, 64 pacientes (idade média 56,9 ± 9,2 anos; 67,2% do sexo masculino; 85,9% diabéticos) realizaram CI e TC-AP. A prevalência de DAC significativa na CI foi de 34,4%. Na comparação com a CI, os valores de sensibilidade e especificidade, valor preditivo positivo, valor preditivo negativo e a acurácia da TC-AP foram, respectivamente, 95,5%, 88,1%, 80,8%, 97,4% e 90,6%. As razões de verossimilhança positiva e negativa foram de 8,02 e 0,05, respectivamente. Conclusão: Um único exame baseado na tomografia computadorizada, associando angiografia coronária e perfusão miocárdica, apresentou elevada acurácia no diagnóstico de DAC obstrutiva significativa na população com DRCT candidata ao transplante renal. Essa estratégia poderá ser considerada na avaliação de DAC em pacientes com DRCT / Introduction: Patients with end-stage renal disease (ESRD) have a high prevalence of cardiovascular disease, which is the main cause of death in patients on dialysis or after kidney transplantation. However, coronary artery disease (CAD) is often asymptomatic in patients with ESRD, and noninvasive tests have a lower diagnostic accuracy in this scenario when compared to that in the general population. Objective: To determine the diagnostic performance of computed tomography (CT) angiography combined with myocardial perfusion (CT-AP) in the diagnosis of CAD in patients with ESRD. Methods: This was a prospective, single-center study. Patients with ESRD on renal replacement therapy, candidates for kidney transplantation, with at least one additional risk factor for cardiovascular disease (age >= 50 years, diabetes or previous cardiovascular disease) were included. All patients underwent invasive coronary angiography (ICA) and CT-AP. CT image acquisition was performed during dipyridamole-induced stress and at rest. Results of CT-AP were compared to those obtained on ICA, considered the gold standard for diagnosis of CAD. Fractional flow reserve (FFR) was measured during ICA for obstructive lesions visually graded as intermediate. Based on the results of CT-AP and ICA (±FFR), patients were classified as having significant or nonsignificant obstructive CAD, and analyses were performed at the patient level. Investigators responsible for the analysis of CT-AP were blinded to the findings of ICA (±FFR). Results: Between July 2015 and January 2018, 64 patients (mean age 56.9 ± 9.2 years; 67.2% male; 85.9% with diabetes) underwent ICA and CT-AP. Significant CAD was observed in 34.4% of patients on ICA. Compared to ICA, the sensitivity, specificity, positive and negative predictive values, and accuracy of CT-AP were 95.5%, 88.1%, 80.8%, 97.4%, and 90.6%, respectively. Positive and negative likelihood ratios were 8.02 and 0.05, respectively. Conclusion: A single test based on CT angiography and myocardial perfusion had a high accuracy for the diagnosis of significant obstructive CAD in patients with ESRD being evaluated for kidney transplantation. This strategy may be considered in the assessment of CAD in patients with ESRD