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  • 1
    Electronic Resource
    Electronic Resource
    Risk adjusting capitation: Applications in employed and disabled populations (2000)
    Springer
    Health care management science 3 (2000), S. 101-109 
    Details
    ISSN: 1572-9389
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Risk adjustment may be a sensible strategy to reduce selection bias because it links managed care payment directly to the costs of providing services. In this paper we compare risk adjustment models in two populations (public employees and their dependents, and publicly-insured low income individuals with disabilities) in Washington State using two statistical approaches and three health status measures. We conclude that a two-part logistic/GLM statistical model performs better in populations with large numbers of individuals who do not use health services. This model was successfully implemented in the employed population, but the managed care program for the publicly insured population was terminated before risk adjustment could be applied. The choice of the most appropriate health status measure depends on purchasers' principles and desired outcomes.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1019085122553
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  • 2
    Electronic Resource
    Electronic Resource
    MR cholangiopancreatography (1996)
    Springer
    Abdominal imaging 21 (1996), S. 105-116 
    Details
    ISSN: 1432-0509
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900025
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  • 3
    Electronic Resource
    Electronic Resource
    Effect of portal venous flow augmentation on liver enhancement with CT (1997)
    Springer
    Abdominal imaging 22 (1997), S. 277 -280 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Computed tomography (CT)—Contrast media—Liver—Blood supply—Portal vein—Flow dynamics.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Background: The purpose of this study was to evaluate the effect of portal flow augmentation on hepatic computed tomographic (CT) enhancement. Methods: Thirteen patients undergoing follow-up CT of the liver within 6 months of initial study ingested 470 mL of Ensure® 30 min before the second examination. Contrast medium injection and scanning parameters were identical for both studies. Results: The time to peak and the maximum and mean liver enhancements were 68 s, 56 HU, and 46 HU, respectively, for the examinations without Ensure® and 68 s, 53 HU, and 44 HU for the examinations with Ensure®. No significant difference was found between the two groups when mean liver enhancement was calculated over 3-s time intervals. Conclusion: Portal venous flow augmentation induced by a meal had no effect on liver enhancement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900189
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  • 4
    Electronic Resource
    Electronic Resource
    Enhancement patterns of renal masses during multiphase helical CT acquisitions (1998)
    Springer
    Abdominal imaging 23 (1998), S. 431-436 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Kidney—mass—Computed tomography—Helical—Characterization.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Background: To describe the appearance of renal masses during multiphase helical computed tomography (CT) acquisition and evaluate the impact of a cortical nephrographic phase on diagnosis. Methods: The CT examinations of 33 patients with 37 lesions [18 renal cell carcinomas (RCC), nine solid tumors, 10 cystic lesions] were reviewed to characterize renal masses during four phases of CT scanning: plain, cortical nephrographic, tubular nephrographic, and pyelographic. Two reviewers analyzed all lesions on the complete data set, and a third reviewer analyzed three combinations of images separately: (1) plain and tubular nephrographic phases, (2) plain and cortical nephrographic phases, and (3) three phases combined. Receiver operating characteristics (ROC) curves were generated to determine the respective value of each combination in lesion characterization. Results: During the cortical nephrographic phase, hyperdensity of solid renal masses was 100% specific and 22% sensitive for RCC, whereas combining hyperdense and isoattenuating heterogeneous masses was 91% specific and 56% sensitive. ROC curves demonstrated a sensitivity of 85%, 90%, 100% for the three combinations, respectively, with a constant specificity of 88% for diagnosing RCC. Conclusion: The cortical nephrographic phase is useful to characterize renal masses and should be included in the routine helical CT protocol.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900374
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  • 5
    Electronic Resource
    Electronic Resource
    Dynamic enhancement of upper abdominal organs in normal volunteers with MRI and effects of contrast dose reduction (1999)
    Springer
    Abdominal imaging 24 (1999), S. 604-609 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Magnetic resonance (MR)—Contrast enhancement—Contrast media—Experimental studies—Gadolinium.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To quantify enhancement parameters of the upper abdominal organs over time during magnetic resonance (MR) examinations and to evaluate the effect of a dose reduction of contrast medium on these parameters. Methods: Ten volunteers underwent two separate dynamic enhanced MR examinations with 0.1 and 0.075 mmol/kg of contrast medium, respectively. Breath-hold gradient-echo T1-weighted images were acquired every second for 118 s followed by delayed images. The percentages of enhancement, the time to maximum enhancement, and the area under the time-versus-enhancement curve were calculated for each organ. Results: The mean times to maximum percentage of enhancement were less than 25 s for the pancreas, kidneys, and spleen and 50 s for the liver. The mean values of maximum percentage of enhancement for the standard/reduced doses were 72%/62% (pancreas), 165%/155% (kidneys), 114%/87% (spleen), and 67%/53% (liver). This difference was significant when liver enhancement was considered (p= 0.02). In addition, when the areas under the time-versus-enhancement curves were compared, the difference between the standard dose and reduced dose was significant for all organs tested (p 〈 0.05). Conclusions: Dynamic scanning of the upper abdomen should start early after contrast injection. Injection parameters should be standardized to capture arterial and venous enhancements in liver examinations. A 25% dose reduction did not significantly affect peak enhancement (except for the liver) but did significantly reduce overall enhancement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900573
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  • 6
    Electronic Resource
    Electronic Resource
    Hepatic CT enhancement: effect of the rate and volume of contrast medium injection in an animal model (1999)
    Springer
    Abdominal imaging 24 (1999), S. 597-603 
    Details
    ISSN: 1432-0509
    Keywords: Key words: Computed tomography (CT) contrast media—Liver, CT—Liver, blood supply—Portal vein, flow dynamics.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: To evaluate the relative effect of rate of injection and volume of contrast medium on aortic, portal, and hepatic enhancement during computed tomography (CT). Methods: Thirty-eight nonincremental CT examinations were performed in three mini-pigs by using a combination of three different volumes (1.5, 2, and 3 mL/kg) and five different rates (1.5, 3, 4.5, 6, and 7.5 mL/s) of contrast material injection. Time-density enhancement curves of the aorta, portal vein, and liver were plotted over time for each rate of injection, each volume of contrast, and each volume–rate combination. In addition, aortic, portal, and liver peak enhancements, time-to-peak enhancements, optimal scanning intervals, and contrast enhancement indices were calculated for each volume–rate combination. Results: Higher rates of injection increased peak aortic enhancement but had no effect on peak portal or hepatic enhancement. This result may be explained by the dilution of the bolus of contrast medium in the splanchnic circulation. When the results of a 6-mL/s injection of 1.5 mL/kg of contrast material were compared with a 3-mL/s injection of 2 mL/kg, maximum aortic enhancement increased by 32%, whereas maximum liver enhancement decreased by 35%. Conclusion: An increase in the rate of contrast injection results in an increase of peak aortic enhancement even when the total iodine load is decreased. However, an increase of the rate of contrast injection does not increase maximum liver enhancement, which is related to the total iodine dose injected. Therefore, one cannot compensate a decrease in the iodine load by an increase in injection rate in contrast-enhanced CT of the liver.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002619900572
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  • 7
    Electronic Resource
    Electronic Resource
    Syringomyelia Associated with Type I Chiari Malformation A 21-Year Retrospective Study on 75 Cases Treated by Foramen Magnum Decompression with a Special Emphasis on the Value of Tonsils Resection (1998)
    Springer
    Acta neurochirurgica 140 (1998), S. 745-754 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Chiari I malformation; magnetic resonance imaging; syringomyelia.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary  The purpose of the present study is to evaluate retrospectively the effects of several intra-operative manipulations on the results of foramen magnum decompression (FMD) in patients having syringomyelia associated with type I Chiari malformation. Seventy-five patients having syringomyelia associated with Chiari I malformation were operated on between 1975 and 1996. This population was grouped into 4 subgroups according to the surgical protocol: group I=42 patients with FMD alone; group II=16 patients with FMD and third ventricle shunting; group III=9 patients with FMD and syringosubarachnoid shunting (SSS); group IV=8 patients with FMD and cerebellar tonsils resection. Pre- and postsurgical magnetic resonance imaging (MRI) studies were analyzed (and compared). Nine patients were lost to follow-up. The results were evaluated in the 66 remaining patients (mean follow-up: 52 months), using the Bidzinski's outcome scale (ref). Two patients (3%) died postoperatively, 31 (47%) had very good results (after additional surgery in 7), 16 (24,2%) had good results (after additional surgery in 7) and 17 (25,7%) had poor results despite further surgery in 9. A total of 27 reoperations were undertaken after primary FMD in 23 patients (35%). Thirty-nine patients (59%) had both pre- and postsurgical MRI evaluation. In 28 (72%) the syrinx had markedly decreased whereas it had remained stable in 11 (28%). Clinical results were not significantly different between the patients of groups I, II and III. Very good or good results were obtained in 24 patients (64,8%) of group I (after additional surgery in 10), in 8 (61,5%) of group II (after additional surgery in 1) and in 7 (87,5%) of group III (after additional surgery in 3). Results in group IV were as follows: 7 patients (87%) had very good results and one had a good result. With a mean follow-up of 28 months, no patient required additional surgery. Postsurgical MRI syrinx reduction was observed in all 8 patients either in the early postoperative course or on delayed follow-up. It is suggested that tonsils resection might enhance the results of FMD in individuals having Chiari I-related syringomyelia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050175
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  • 8
    Electronic Resource
    Electronic Resource
    Zero rate of shunt infection in the first postoperative year in children – dream or reality? (2000)
    Springer
    Child's nervous system 16 (2000), S. 210-212 
    Details
    ISSN: 1433-0350
    Keywords: Key words Hydrocephalus ; Shunts ; Shunt infection ; Valves
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  The rate of infectious complications following shunt implantations at the Pierre Wertheimer Hospital was 6.4% in 1992–1994. In order to improve this infection rate, new recommendations for surgery were applied and a new type of valve was used. The effects of these measures after a 1-year follow-up were analyzed in 70 patients. The rate of infection was zero, 2.8, and 4.3% at 2, 6, and 12 months, respectively. A case-control study did not reveal any significant risk factor among the patient and surgical factors analyzed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050499
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  • 9
    Electronic Resource
    Electronic Resource
    Cerebral oligodendrogliomas in children: an analysis of 15 cases (1996)
    Springer
    Child's nervous system 12 (1996), S. 527-529 
    Details
    ISSN: 1433-0350
    Keywords: Children ; Oligodendroglioma ; Radiation therapy ; Chemotherapy ; Outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The cases of 15 children operated on for cerebral pure oligodendroglioma were studied. Two groups of children were distinguished. Group 1 children presented with epilepsy (7 cases); their tumor was histologically benign in all cases. These children are all alive after a median follow-up of 72 months; however, 2 of them presented with a local recurrence, which was operated on, and are actually disease-free. Group 2 children presented with intracranial hypertension (8 cases); the tumor was anaplastic in 7 cases. Despite postoperative radiotherapy and chemotherapy 6 children died; their median survival time was 17 months. The present series shows the existence of a clear correlation between clinical presentation, histological grading and survival in childhood cerebral oligodendrogliomas.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00261605
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  • 10
    Electronic Resource
    Electronic Resource
    Diffuse brain stem tumor in an adolescent with multiple enchondromatosis (Ollier's disease) (1999)
    Springer
    Child's nervous system 15 (1999), S. 222-225 
    Details
    ISSN: 1433-0350
    Keywords: Key words Enchondromatosis ; Glioma ; Brain stem
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Among patients with enchondromatosis, those with Ollier's disease are usually considered to be at a lower risk for extra-osseous malignancy than those with Maffucci's disease. However, several reports suggest that Ollier's disease may also be associated with gliomas. We report here the youngest patient in the literature (16 years) to be detected with a brain tumor and Ollier's disease. This is also the first case with diffuse brain stem involvement. Thus, counselling of patients with Ollier's disease may become more difficult than initially thought.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810050377
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