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At least 217 records · Page 12
All sourcesNASA NTRSDOE OSTI
NASA NTRS1993

Neurogenic orthostatic hypotension: a double-blind, placebo-controlled study with midodrine

PURPOSE: To investigate the efficacy and safety of midodrine for treatment of patients with orthostatic hypotension due to autonomic failure. PATIENTS: Ninety-seven patients with orthostatic hypotension were randomized in a 4-week, double-blinded, placebo-controlled study with a 1-week placebo run-in period. Patients ranged in age from 22 to 86 years (mean: 61 years). METHODS: After a 1-week run-in phase, either placebo or midodrine at a dose of 2.5 mg, 5 mg, or 10 mg was administered three times a day for 4 weeks. Both the placebo group and the 2.5-mg midodrine group received constant doses throughout the double-blind phase. The patients receiving 5 mg or 10 mg of midodrine were given doses that were increased at weekly intervals by 2.5-mg increments until the designated dose was reached. Efficacy evaluations were based on an improvement at 1-hour postdose in standing systolic blood pressure and in symptoms of orthostatic hypotension (syncope, dizziness/lightheadedness, weakness/fatigue, and low energy level). RESULTS: Midodrine (10 mg) increased standing systolic blood pressure by 22 mm Hg (28%, p < 0.001 versus placebo). Midodrine improved (p < 0.05) the following symptoms of orthostatic hypotension compared to placebo: dizziness/lightheadedness, weakness/fatigue, syncope, low energy level, impaired ability to stand, and feelings of depression. The overall side effects were mainly mild to moderate. One or more side effects were reported by 22% of the placebo group compared with 27% of the midodrine-treated group. Scalp pruritus/tingling, which was reported by 10 of 74 (13.5%) of the midodrine-treated patients, was most frequent. Other reported side effects included supine hypertension (8%) and feelings of urinary urgency (4%). CONCLUSION: We conclude that midodrine is an effective and well-tolerated treatment for moderate-to-severe orthostatic hypotension associated with autonomic failure.

NASA Discipline Number 14-10↗
NASA NTRS2004

Non-invasive method of determining diastolic intracranial pressure

A method is presented for determining diastolic intracranial pressure (ICP) in a patient. A first change in the length of a path across the skull of the patient caused by a known change in ICP is measured and used to determine an elasticity constant for the patient. Next, a second change in the length of the path across the patient's skull occurring between systolic and diastolic portions of the patient's heartbeat is measured. The patient's diastolic ICP is a function of the elasticity constant and the second change.

Yost, William T.↗
NASA NTRS2006

Automated objective characterization of visual field defects in 3D

A method and apparatus for electronically performing a visual field test for a patient. A visual field test pattern is displayed to the patient on an electronic display device and the patient's responses to the visual field test pattern are recorded. A visual field representation is generated from the patient's responses. The visual field representation is then used as an input into a variety of automated diagnostic processes. In one process, the visual field representation is used to generate a statistical description of the rapidity of change of a patient's visual field at the boundary of a visual field defect. In another process, the area of a visual field defect is calculated using the visual field representation. In another process, the visual field representation is used to generate a statistical description of the volume of a patient's visual field defect.

Fink, Wolfgang↗
NASA NTRS1996

Patent Foramen Ovale: Association between the Degree of Shunt by Contrast Transesophageal Echocardiography and the Risk of Future Ischemic Neurologic Events

This study investigated whether there is an association between the degree of interatrial shunting across a patent foramen ovale, as determined by saline contrast transesophageal echocardiography, and the risk of subsequent systemic embolic events, including stroke. Thirty-four patients found to have patent foramen ovale during transesophageal echocardiography were divided into two groups on the basis of the maximum number of microbubbles in the left heart in any single frame after intravenous saline contrast injection: group 1 (n = 16) with a "large" degree of shunt (220 microbubbles) and group 2 (n = 18) with a "small" degree of shunt (23 but <20 microbubbles). Patients were followed up over a mean period of 21 months for subsequent systemic embolic events, including transient ischemic attack and stroke. Five (31%) of the patients with large shunts had subsequent ischemic neurologic events, whereas none of the patients with small shunts had embolic events (p= 0.03). These events occurred in spite of antiplatelet or anticoagulant therapy. We conclude that patients with a large degree of shunt across a patent foramen ovale, as determined by contrast transesophageal echocardiography, are at a significantly higher risk for subsequent adverse neurologic events compared with patients with a small degree of shunt.

Stone, David A.↗
NASA NTRS1987

Surgical evaluation of candidates for cochlear implants

The customary presentation of surgical procedures to patients in the United States consists of discussions on alternative treatment methods, risks of the procedure(s) under consideration, and potential benefits for the patient. Because the contents of the normal speech signal have not been defined in a way that permits a surgeon systematically to provide alternative auditory signals to a deaf patient, the burden is placed on the surgeon to make an arbitrary selection of candidates and available devices for cochlear prosthetic implantation. In an attempt to obtain some information regarding the ability of a deaf patient to use electrical signals to detect and understand speech, the Good Samaritan Hospital and Neurological Sciences Institute cochlear implant team has routinely performed tympanotomies using local anesthesia and has positioned temporary electrodes onto the round windows of implant candidates. The purpose of this paper is to review our experience with this procedure and to provide some observations that may be useful in a comprehensive preoperative evaluation for totally deaf patients who are being considered for cochlear implantation.

Non-NASA Center↗
NASA NTRS1974

An improved method for echographic detection of left atrial enlargement

Echographic dimensions of the aortic root and left atrium were compared in 170 patients in order to assess dilation of the left atrium with reference to the relatively nondistensible fibrous aortic root. In 50 patients without cause for left atrial or aortic enlargement, the ratio of left atrial/aortic root dimensions was 0.87 to 1.11. In 80 patients with known cause for left atrial enlargement, the left atrial/aortic root ratio was greater than or equal to 1.17. In 40 patients with isolated valve disease, dilation of both the aortic root and the left atrium resulted in a left atrial/aortic root dimension ratio less than 1.17 in some patients. Despite this consideration, the comparison of left atrial and aortic root dimension appears to be as specific as, and more sensitive than, previously proposed methods for the evaluation of left atrial enlargement.

Brown, O. R.↗
NASA NTRS1974

The use of objective measurements in the evaluation of therapy programs

The importance of objective measurements is discussed as a means of assessing the efficacy of physical and occupational therapy programs applied to patients recovering from neurological diseases. Considered are three primary categories of neurologically injured patients: patients with hemiplegia, patients with spinal cord injuries, and the heterogeneous group of cerebral palsy patients.

Chaplin, H.↗
NASA NTRS1975

Proposed application of lower body negative pressure to cardiology

Potential medical applications are presented of lower body negative pressure to the evaluation and treatment of cardiac patients. The essential features of an LBNP unit and the basic cardiovascular physiology of lower body negative pressure (LBNP) testing are described. Some of the results of previous spaceflight experiences and bedrest studies are summarized. The deconditioning effects of weightlessness experienced by orbiting astronauts are compared with the effects of bedrest restrictions prescribed for convalescing cardiac patients. The potential of LBNP for evaluating both pharmacological and physical activity regimens was examined, particularly in relation to post-myocardial infarction and coronary artery bypass patients. Applications of LBNP to the cardiac catheterization laboratory and the out-patient follow-up of cardiac patients are proposed.

E. V. Schmidt↗
NASA NTRS1980

Rheoencephalography in Meniere's disease

Rheoencephalography (REG) was used on 35 patients with Meniere's disease to determine tonus and perfusion of cerebral vessels. The analysis took account of age, duration of the disease and presence or absence of cervical osteochondrosis. Hypertensive symptoms in the vertebro-basilar system predominated in the under 45 age group, while for the over 45 patients and those suffering for more than 5 years, hypertensive symptoms were likewise noted in the internal carotid arterial system. Signs of angiospasm were revealed both for patients with cervical osteochondrosis and without it. Hypertensive signs were noted in 88.5% of patients with Meniere's disease and as a rule they were noted in the entire vertebro-basilar system without respect to the presence or absence of concurrent cervical osteochondrosis and uni- or bilateral affection of the labyrinth; in patients over 45 who had suffered more than 5 years this also applied to the internal carotid arterial system. Identification of the condition of cerebral circulation and the planning of more effective therapy that influences vascular tone is made possible by REG.

Nikolayev, M. P.↗
NASA NTRS1991

Application and use of spinal immobilization devices in zero-gravity flight

A KC-135 parabolic flight was performed for the purpose of evaluation of spinal immobilization techniques in microgravity. The flight followed the standard 40 parabola profile with four NASA/KRUG experimenters involved. One performed as coordinator/recorder, one as test subject, and two as the Crew Medical Officers (CMO). The flight was to evaluate the application of spinal immobilization devices and techniques in microgravity as are performed during initial stabilization or patient transport scenarios. The sequence of detail for examination of the following objectives included: attempted cervical spine immobilization with all free floating, the patient restrained to the floor, various hand positioning techniques; c-collar placement; Kendrick Extrication Device (KED) application with various restraints for patient and CMO; patient immobilization and transport using the KED; patient transported on KED and spine board. Observations for each task are included. Major conclusions and issues are also included.

Krupa, Debra T.↗
NASA NTRS1994

Selectively lockable knee brace

A knee brace for aiding in rehabilitation of damaged leg muscles includes upper and lower housings, normally pivotable, one relative to the other about the knee joint axis of a patient. The upper housing is attachable to the thigh of the patient above the knee joint, while the lower housing is secured to a stirrup which extends downwardly along the patient's leg and is attached to the patient's shoe. An actuation rod is carried within the lower housing and is coupled to a cable. The upper and lower housings carry cooperative clutch/brake elements which normally are disengaged to permit relative movement between the upper and lower housings. When the cable is extended, the clutch/brake elements engage and lock the housings together. A heel strike mechanism fastened to the stirrup and the heel of the shoe is connected to the cable to selectively extend the cable and lock the brace in substantially any position when the patient places weight on the heel.

Myers, Neill↗
NASA NTRS1994

Non-invasive method and apparatus for monitoring intracranial pressure and pressure volume index in humans

Non-invasive measuring devices responsive to changes in a patient's intracranial pressure (ICP) can be accurately calibrated for monitoring purposes by providing known changes in ICP by non-invasive methods, such as placing the patient on a tilting bed and calculating a change in ICP from the tilt angle and the length of the patient's cerebrospinal column, or by placing a pressurized skull cap on the patient and measuring the inflation pressure. Absolute values for the patient's pressure-volume index (PVI) and the steady state ICP can then be determined by inducing two known changes in the volume of cerebrospinal fluid while recording the corresponding changes in ICP by means of the calibrated measuring device. The two pairs of data for pressure change and volume change are entered into an equation developed from an equation describing the relationship between ICP and cerebrospinal fluid volume. PVI and steady state ICP are then determined by solving the equation. Methods for inducing known changes in cerebrospinal fluid volume are described.

Cantrell, John H.↗
NASA NTRS1996

Selectively Lockable Knee Brace

A knee brace for aiding in rehabilitation of damaged leg muscles includes upper and lower housings normally pivotable one relative to the other about the knee joint axis of a patient. The upper housing is attachable to the thigh of the patient above the knee joint while the lower housing is secured to a stirrup which extends downwardly along the patient's leg and is attached to the patient's shoe. An actuation rod is carried within the lower housing and is coupled to a cable. The upper and lower housings carry cooperative clutch/brake elements which normally are disengaged to permit relative movement between the upper and lower housings. When the cable is extended the clutch/brake elements engage and lock the housings together. A heel strike mechanism fastened to the stirrup and the heel of the shoe is connected to the cable to selectively extend the cable and lock the brace in substantially any position when the patient places weight on the heel.

Myers, W. Neill↗
NASA NTRS2003

Monitoring Outpatient Care

Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

Source record↗
NASA NTRS2002

Association between simian virus 40 and non-Hodgkin lymphoma

BACKGROUND: Non-Hodgkin lymphoma has increased in frequency over the past 30 years, and is a common cancer in HIV-1-infected patients. Although no definite risk factors have emerged, a viral cause has been postulated. Polyomaviruses are known to infect human beings and to induce tumours in laboratory animals. We aimed to identify which one of the three polyomaviruses able to infect human beings (simian virus 40 [SV40], JC virus, and BK virus) was associated with non-Hodgkin lymphoma. METHODS: We analysed systemic non-Hodgkin lymphoma from 76 HIV-1-infected and 78 HIV-1-uninfected patients, and non-malignant lymphoid samples from 79 HIV-1-positive and 107 HIV-1-negative patients without tumours; 54 colon and breast carcinoma samples served as cancer controls. We used PCR followed by Southern blot hybridisation and DNA sequence analysis to detect DNAs of polyomaviruses and herpesviruses. FINDINGS: Polyomavirus T antigen sequences, all of which were SV40-specific, were detected in 64 (42%) of 154 non-Hodgkin lymphomas, none of 186 non-malignant lymphoid samples, and none of 54 control cancers. This difference was similar for HIV-1-infected patients and HIV-1-uninfected patients alike. Few tumours were positive for both SV40 and Epstein-Barr virus. Human herpesvirus type 8 was not detected. SV40 sequences were found most frequently in diffuse large B-cell and follicular-type lymphomas. INTERPRETATION: SV40 is significantly associated with some types of non-Hodgkin lymphoma. These results add lymphomas to the types of human cancers associated with SV40.

Non-NASA Center↗
NASA NTRS2002

Mutations in the dopamine beta-hydroxylase gene are associated with human norepinephrine deficiency

Norepinephrine (NE), a key neurotransmitter of the central and peripheral nervous systems, is synthesized by dopamine beta-hydroxylase (DBH) that catalyzes oxidation of dopamine (DA) to NE. NE deficiency is a congenital disorder of unknown etiology, in which affected patients suffer profound autonomic failure. Biochemical features of the syndrome include undetectable tissue and circulating levels of NE and epinephrine, elevated levels of DA, and undetectable levels of DBH. Here, we report identification of seven novel variants including four potentially pathogenic mutations in the human DBH gene (OMIM 223360) from analysis of two unrelated patients and their families. Both patients are compound heterozygotes for variants affecting expression of DBH protein. Each carries one copy of a T-->C transversion in the splice donor site of DBH intron 1, creating a premature stop codon. In patient 1, there is a missense mutation in DBH exon 2. Patient 2 carries missense mutations in exons 1 and 6 residing in cis. We propose that NE deficiency is an autosomal recessive disorder resulting from heterogeneous molecular lesions at DBH. Copyright 2002 Wiley-Liss, Inc.

Case Reports↗
NASA NTRS1990

Functional disorders of the stomach

Gastroenterologists frequently encounter patients who report vague epigastric discomforts or sensations of fullness, bloating, and distention in the upper abdomen. The discomfort is neither burning in character nor severe in intensity; there is no nocturnal pain. The epigastric location of discomfort and lack of radiation may help to exclude biliary tract and pancreatic diseases. Nausea may be present, but there is little or no vomiting. After these patients ingest liquids or solid foods, the symptoms of easy filling or early satiety and increasing discomfort and nausea are almost always present. The patient may only report "indigestion," but a specific chief complaint, such as pain, discomfort, nausea, or bloating may be elicited with further inquiries. Solid foods usually provoke more symptoms than do liquids. Symptoms of early satiety, nausea, bloating, and abdominal discomfort may culminate in the vomiting of undigested food. These vague upper gastrointestinal (GI) symptoms have been termed "dyspepsia." When peptic diseases of the stomach are excluded, the symptom complex has been called "nonulcer" dyspepsia, a vague syndrome with symptoms attributed to stomach dysfunction. Nonulcer dyspepsia has been reviewed recently. Such symptoms, commonly attributed to a "functional" disorder, are very common in clinical practice, with an incidence of 30% of patients. In this review, we will discuss an approach to the evaluation and treatment of patients with symptoms of nausea, early satiety, bloating, and vague epigastric discomfort--dyspeptic symptoms associated with functional stomach disorders. We will review the anatomy and motility of the stomach and suggest potential neuromuscular malfunctions of the stomach that may result in epigastric symptoms. The potential role of stress and other brain-gut interactions, which may underlie these symptoms, will also be reviewed.

Non-NASA Center↗
NASA NTRS2000

Prediction of thrombus-related mechanical prosthetic valve dysfunction using transesophageal echocardiography

Identification of thrombus-related mechanical prosthetic valve dysfunction (MPVD) has important therapeutic implications. We sought to develop an algorithm, combining clinical and echocardiographic parameters, for prediction of thrombus-related MPVD in a series of 53 patients (24 men, age 52 +/- 16 years) who had intraoperative diagnosis of thrombus or pannus from 1992 to 1997. Clinical and echocardiographic parameters were analyzed to identify predictors of thrombus and pannus. Prevalence of thrombus and diagnostic yields relative to the number of predictors were determined. There were 22 patients with thrombus, 19 patients with pannus, and 12 patients with both. Forty-two of 53 masses were visualized using transesophageal echocardiography (TEE), including 29 of 34 thrombi or both thrombi and panni and 13 of 19 isolated panni. Predictors of thrombus or mixed presentation include mobile mass (p = 0.009), attachment to occluder (p = 0.02), elevated gradients (p = 0.04), and an international normalized ratio of < or = 2.5 (p = 0.03). All 34 patients with thrombus or mixed presentation had > or = 1 predictor. The prevalence of thrombus in the presence of < or = 1, 2, and > or = 3 predictors is 14%, 69%, and 91%, respectively. Thus, TEE is sensitive in the identification of abnormal mass in the setting of MPVD. An algorithm based on clinical and transesophageal echocardiographic predictors may be useful to estimate the likelihood of thrombus in the setting of MPVD. In the presence of > or = 3 predictors, the probability of thrombus is high.

NASA Discipline Cardiopulmonary↗