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  • 1995-1999  (501,379)
  • 1990-1994  (512,697)
  • 1975-1979  (270,112)
  • 1970-1974  (227,045)
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Years
Year
  • 1
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Physics Letters B 294 (1992), S. 466-478 
    ISSN: 0370-2693
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Amsterdam : Elsevier
    Physics Letters B 317 (1993), S. 474-484 
    ISSN: 0370-2693
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
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  • 3
    Keywords: Diagnosis, Computer-Assisted ; Diagnostic Imaging ; Image Processing, Computer-Assisted ; Robotics ; Surgery, Computer-Assisted ; Therapy, Computer-Assisted
    Notes: Latest issue consulted: 7th (Sept. 26-29, 2004).
    Pages: v. : ill.
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  • 4
    Call number: 01-Beschaffungsw:70 ; M230:3/1 ; M230:3/2
    Pages: loose-leaf
    ISBN: 3-8073-0843-1
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    01-Beschaffungsw:70 departmental collection or stack – please contact the library
    M230:3/1 departmental collection or stack – please contact the library
    M230:3/2 departmental collection or stack – please contact the library
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  • 5
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    Unknown
    Totowa, N.J. : Humana Press
    Keywords: Molecular Biology ; Genetic Techniques
    Notes: This is a series title, single volumes see link below.
    ISSN: 1940-6037
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  • 6
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    Unknown
    Berlin : Springer
    Keywords: Biotechnology / methods
    Notes: This is a series title, single volumes see link below.
    ISSN: 1940-607X
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  • 7
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    Unknown
    Totowa, NJ : Humana Press
    Keywords: Molecular Biology / methods
    Notes: This is a series title, single volumes see link below.
    ISSN: 1940-6029
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  • 8
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    Unknown
    New York, NY : Elsevier
    Keywords: Biochemistry ; Enzymes
    Notes: This is a series title, single volumes see link below.
    ISSN: 1557-7988
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  • 9
    Keywords: Leukemia / therapy ; Prognosis
    Notes: Last volumes with varying subtitle and editor.
    ISSN: 0949-7021
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  • 10
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: The content of real-world databases, knowledge bases, database models, and formal specifications is often highly redundant and needs to be aggregated before these representations can be successfully paraphrased into natural language. To generate natural language from these representations, a number of processes must be carried out, one of which is sentence planning where the task of aggregation is carried out. Aggregation, which has been called ellipsis or coordination in Linguistics, is the process that removes redundancies during generation of a natural language discourse, without losing any information.The article describes a set of corpus studies that focus on aggregation, provides a set of aggregation rules, and finally, shows how these rules are implemented in a couple of prototype systems. We develop further the concept of aggregation and discuss it in connection with the growing literature on the subject. This work offers a new tool for the sentence planning phase of natural language generation systems.
    Type of Medium: Electronic Resource
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  • 11
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Type of Medium: Electronic Resource
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  • 12
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: Neural networks whose architecture is determined by genetic algorithms outperform autoregressive integrated moving average forecasting models in six different time series examples. Refinements to the autoregressive integrated moving average model improve forecasting performance over standard ordinary least squares estimation by 8% to 13%. In contrast, neural networks achieve dramatic improvements of 10% to 40%. Additionally, neural networks give evidence of detecting patterns in data which remain hidden to the autoregression and moving average models. The consequent forecasting potential of neural networks makes them a very promising addition to the variety of techniques and methodologies used to anticipate future movements in time series.
    Type of Medium: Electronic Resource
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  • 13
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: We present a method to derive a solution to the combined frame and ramification problems for certain classes of theories of action written in the situation calculus. The theories of action considered include the causal laws of the domain, in the form of a set of effect axioms, as well as a set of ramification state constraints. The causal laws state the direct effects that actions have on the world, and ramification state constraints allow one to derive indirect effects of actions on the domain.To solve the combined frame and ramification problems, the causal laws and ramification state constraints are replaced by a set of successor state axioms. Given a state of the world, these axioms uniquely determine the truth value of dynamic properties after an action is performed. In this article, we extend previous work by formulating an approach for the mechanical generation of these successor state axioms. We make use of the notions of implicate and support that have been developed in the context of propositional theories. The approach works for classes of syntactically restricted sets of ramification state constraints.
    Type of Medium: Electronic Resource
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  • 14
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Type of Medium: Electronic Resource
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  • 15
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: In this paper, we describe a method for automatically retrieving collocations from large text corpora. This method comprises the following stages: (1) extracting strings of characters as units of collocations, and (2) extracting recurrent combinations of strings as collocations. Through this method, various types of domain-specific collocations can be retrieved simultaneously. This method is practical because it uses plain text with no specific-language-dependent information, such as lexical knowledge and parts of speech. Experimental results using English and Japanese text corpora show that the method is equally applicable to both languages.
    Type of Medium: Electronic Resource
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  • 16
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: Nonlinear dynamical systems are notoriously difficult to control. The Acrobot is an under-actuated double pendulum in a gravitational field. Under most driving schemes the Acrobot exhibits chaotic behavior. But with careful applications of energy it is possible to gradually pump the system so as to swing it over its supporting joint. This swing-up task is of current interest to control theory researchers.Conventional notions of AI planning are not easily extended to domains with interacting continuously varying quantities. Such continuous domains are often dynamic; important properties change over time even when no action is taken. Noise and error propagation can preclude accurately characterizing the effects of actions or predicting the trajectory of an undisturbed system through time. A plan must be a conditional action policy or a control strategy that carefully nudges the system as it strays from a desired course. Automatically generating such plans or action strategies is the subject of this research.An AI system successfully learns to perform the swing-up task using an approach called explanation-based control (EBC). The approach combines a plausible qualitative domain theory with empirical observation. Results are in some respects superior to the known control theory strategies. Of particular importance to AI is EBC's notion of a “plan” or “strategy” and its method for automatic synthesis. Experimental evidence confirms EBC's ability and generality.
    Type of Medium: Electronic Resource
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  • 17
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: A critical problem for managers of temporal information is the treatment of assertions and of complex types of queries because in many cases the treatment could involve reasoning on the whole knowledge base of temporal constraints. We propose an efficient approach to this problem. First, we show how different types of queries can be answered (in a complete way) in a time polynomial in the dimension of the query and independently of the dimension of the knowledge base. Second, we provide an efficient (and complete) procedure to deal with sessions of interleaved assertions and queries to the knowledge base. We provide both analytical and experimental evaluations of our approach, and we discuss some application areas.
    Type of Medium: Electronic Resource
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  • 18
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: A natural language collaborative consultation system must take user preferences into account. A model of user preferences allows a system to appropriately evaluate alternatives using criteria of importance to the user. Additionally, decision research suggests both that an accurate model of user preferences could enable the system to improve a user's decision-making by ensuring that all important alternatives are considered, and that such a model of user preferences must be built dynamically by observing the user's actions during the decision-making process. This paper presents two strategies: one for dynamically recognizing user preferences during the course of a collaborative planning dialogue and the other for exploiting the model of user preferences to detect suboptimal solutions and suggest better alternatives. Our recognition strategy utilizes not only the utterances themselves but also characteristics of the dialogue in developing a model of user preferences. Our generation strategy takes into account both the strength of a preference and the closeness of a potential match in evaluating actions in the user's plan and suggesting better alternatives. By modeling and utilizing user preferences, our system is able to fulfill its role as a collaborative agent.
    Type of Medium: Electronic Resource
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  • 19
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: Although case-based reasoning (CBR) was introduced as an alternative to rule-based reasoning (RBR), there is a growing interest in integrating it with other reasoning paradigms, including RBR. New hybrid approaches are being piloted to achieve new synergies and improve problem-solving capabilities. In our approach to integration, CBR is used to satisfy multiple numeric constraints, and RBR allows the performance of “what if” analysis needed for creative design.The domain of our investigation is nutritional menu planning. The task of designing nutritious, yet appetizing, menus is one at which human experts consistently outperform computer systems. Tailoring a menu to the needs of an individual requires satisfaction of multiple numeric nutrition constraints plus personal preference goals and aesthetic criteria.We first constructed and evaluated independent CBR and RBR menu planning systems, then built a hybrid system incorporating the strengths of each system. The hybrid outperforms either single strategy system, designing superior menus, while synergistically providing functionality that neither single strategy system could provide. In this paper, we present our hybrid approach, which has applicability to other design tasks in which both physical constraints and aesthetic criteria must be met.
    Type of Medium: Electronic Resource
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  • 20
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: A multiphase machine translation approach, Generate and Repair Machine Translation (GRMT), is proposed. GRMT is designed to generate accurate translations that focus primarily on retaining the linguistic meaning of the source language sentence. GRMT presently incorporates a limited multilingual translation capability. The central idea behind the GRMT approach is to generate a translationcandidate (TC) by quick and dirty machine translation (QDMT), then investigate the accuracy of that TC by translation candidate evaluation (TCE), and, if necessary, revise the translation in the repair and iterate (RI) phase. To demonstrate the GRMT approach, a translation system that translates from English to Thai has been developed. This paper presents the design characteristics and some experimental results of QDMT and also the initial design, some experiments, and proposed ideas behind TCE and RI.
    Type of Medium: Electronic Resource
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  • 21
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: This paper describes a compound unit (CU) recognizer as a pattern-based approach and its hybridization with rule-based translation. A compound unit is a combined concept including collocations, idioms, and compound nouns. CU recognition reduces part of speech ambiguities by combining several words into a unit and consequently lessening the parsing load. It also provides pretranslated natural equivalents. Our focus in this paper is to obtain flexibility and efficiency from pattern-based machine translation, and high-quality translation by hybridization. A modified trie, our search index structure using “method” strategy is used to manage heterogeneous property of the constituents. Syntactic verification is integrated to obtain precise CU recognition by means of pruning wrongly recognized units that are caused by improper variable hypotheses. The experimental result with verification shows that the precision of CU recognition is increased to 99.69% with 31 CFG rules on the cyclic trie structure for 1,268 Wall Street Journal articles of the Penn Treebank. Another experiment with CU recognition also shows that it raises the understandability of translation for Web documents.
    Type of Medium: Electronic Resource
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  • 22
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: Efficient implementation of type inclusion is an important feature of object oriented programming languages with multiple inheritance. The idea is to associate to each type a subset of a set S={1,...,k} such that type inclusion coincides with subset inclusion. Such an embedding of types into 2S (the lattice of all subsets of S) is called a bit-vector encoding of the type hierarchy. In this paper, we show that most known bit-vector encoding methods can be inserted on a general theoretical framework using graph coloration, namely the notion of a simple encoding. We use the word simple because all these methods are heuristics for the general bit-vector encoding problem, known as the 2-dimension problem. First we provide a correct algorithm for partial orders based on simple encoding, improving the algorithm of Krall, Vitek, and Horspool (1997). Second we show that finding an optimal simple encoding is an NP-hard problem. We end with a discussion on some practical issues.
    Type of Medium: Electronic Resource
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  • 23
    Electronic Resource
    Electronic Resource
    Boston, USA and Oxford, UK : Blackwell Publishers Inc
    Computational intelligence 15 (1999), S. 0 
    ISSN: 1467-8640
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Computer Science
    Notes: In this paper we develop a formalization of semantic relations that facilitates efficient implementations of relations in lexical databases or knowledge representation systems using bases. The formalization of relations is based on a modeling of hierarchical relations in Formal Concept Analysis. Further, relations are analyzed according to Relational Concept Analysis, which allows a representation of semantic relations consisting of relational components and quantificational tags. This representation utilizes mathematical properties of semantic relations. The quantificational tags imply inheritance rules among semantic relations that can be used to check the consistency of relations and to reduce the redundancy in implementations by storing only the basis elements of semantic relations. The research presented in this paper is an example of an application of Relational Concept Analysis to lexical databases and knowledge representation systems (cf. Priss 1996) which is part of a larger framework of research on natural language analysis and formalization.
    Type of Medium: Electronic Resource
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  • 24
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This article describes and analyses the membership and uses of the Teaching-Statistics Mailbase list, based upon a review of all messages since its inception and a recent questionnaire sent to all list members.
    Type of Medium: Electronic Resource
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  • 25
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Type of Medium: Electronic Resource
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  • 26
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This article describes the learning experiences of young children meeting stem-and-leaf plots for the first time.
    Type of Medium: Electronic Resource
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  • 27
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: A game of chance in which players can maximise their expected gain by making appropriate decisions is described. Developing an optimal strategy involves computing probabilities and conditional expected values.
    Type of Medium: Electronic Resource
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  • 28
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Type of Medium: Electronic Resource
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  • 29
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This article describes the use of Microsoft Excel, graphics calculators and a multimedia CBL package by students on an introductory statistics course.
    Type of Medium: Electronic Resource
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  • 30
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: Several measures of “success” for a simple game are discussed. Comparisons between players, and between a player and a simulation, can be made in several ways.
    Type of Medium: Electronic Resource
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  • 31
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This article reports some results of an informal study of very young children's reactions to some visual displays of data.
    Type of Medium: Electronic Resource
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  • 32
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Type of Medium: Electronic Resource
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  • 33
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This is the first of a short series of articles briefly describing the organisations that sponsor Teaching Statistics. The series starts with The Royal Statistical Society.
    Type of Medium: Electronic Resource
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  • 34
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Teaching statistics 21 (1999), S. 0 
    ISSN: 1467-9639
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Mathematics
    Notes: This article shows how simulation can be used to teach sampling distributions to entry level statistics students.
    Type of Medium: Electronic Resource
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  • 35
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Type of Medium: Electronic Resource
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  • 36
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Type of Medium: Electronic Resource
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  • 37
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Type of Medium: Electronic Resource
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  • 38
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Notes: Books reviewed:Emmanuel Agius and Salvino Busuttil, (eds), Germ-Line Intervention and our Responsibilities to Future GenerationsAndrew Edgar, Sam Salek, Darren Shickle and David Cohen, The Ethical QALY: Ethical Issues in Healthcare Resource AllocationsJohn McKie, Jeff Richardson, Peter Singer and Helga Kuhse, The Allocation of Health Care Resources: An Ethical Evaluation of the ‘QALY’ ApproachGregory E. Pence, Who’s Afraid of Human Cloning?Maxwell J. Mehlman and Jeffrey R. Botkin, (eds), Access to the Genome: The Challenge to EqualityUdo Schüklenk, Access to Experimental Drugs in Terminal IllnessPhilip J. Boyle, (ed), Getting Doctors to Listen: Ethics and Outcome Data in ContextEllie Lee, (ed), Abortion Law and Politics Today
    Type of Medium: Electronic Resource
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  • 39
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Notes: Increasing awareness of the importance of the biodiversity of the whole global biosphere has led to further awareness that the problems which arise in connection with preservation and exploitation of our planet’s biodiversity are best tackled from a global perspective. The ‘Biodiversity Convention’ and the ‘Human Genome Project’ are some of the concrete attempts at such globalisation. But, while these efforts are certainly very good at the intentional level and on paper, there is, at the practical level of implementation, the danger that globalisation may simply translate into westernisation, given the Western world’s dominance and will to dominate the rest of the globe. How is ‘global bioethics’ to be possible in a world inhabited by different cultural groups whose material situation, powers, ideas, experiences and attitudes differ rather markedly and who are not, in any case, equally represented in globalisation efforts and fora? One index of the pertinence of this question is that talk about biodiversity, biotechnology, biotrade etc. is being increasingly matched by talk about biopiracy, biorade, biocolonialism etc. In this paper, I attempt to explore and develop these very general concerns.
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  • 40
    Electronic Resource
    Electronic Resource
    Oxford, UK and Boston, USA : Blackwell Publishers Ltd.
    Bioethics 13 (1999), S. 0 
    ISSN: 1467-8519
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Philosophy
    Notes: European biomedical ethics is often contrasted to American autonomy-based approaches, and both are usually distinguished as ‘Western’. But at least three ‘different voices’ within European bioethics can be identified:The deontological codes of southern Europe (and Ireland), in which the patient has a positive duty to maximise his or her own health and to follow the doctor’s instructions, whilst the physician is constrained more by professional norms than by patient rightsThe liberal, rights-based models of Western Europe, in which the patient retains the negative right to override medical opinion, even if his or her mental capacity is in doubtThe social welfarist models of the Nordic countries, which concentrate on positive rights and entitlements to universal healthcare provision and entrust dispute resolution to non-elected administrative officials
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  • 41
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 42
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Research about parity or breastfeeding experience and its relationship with milk production in humans is limited. The purpose of this study was to determine if any difference in milk volume occurred among mothers with and without breastfeeding experience who used either a single or double breast pumping regimen the first 5 weeks postpartum. Methods: A convenience sample of 39 mothers of nonnursing preterm infants participated from two tertiary care centers in the midwestern United States. The sequential single pumping group consisted of 20 mothers, 7 of whom had previous breastfeeding experience; the simultaneous double pumping group consisted of 19 mothers, 2 of whom had previous breastfeeding experience. Income and pumping group regimen were used as blocking variables, and average frequency of kangaroo care per week and average frequency of breast pumping per week were covariants in the repeated measures analysis of variance. Results: Mothers with previous breastfeeding experience had greater milk weights over time, but weights were not significantly different when compared with those mothers with no previous breastfeeding experience. Additional analysis with the covariants of pumping frequency and kangaroo care, and with the independent variables of group, breastfeeding experience, and income resulted in statistically significantly greater milk yield in the women with previous breastfeeding experience. Conclusions: The findings of the two repeated analyses indicated the complexity of the milk production response, and the importance of considerations of environmental as well as physiologic factors.
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  • 43
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This paper defines the needs of women and their newborns, and classifies a number of practices common in postpartum care. It is a summary of the report, Postpartum Care of the Mother and Newborn: A Practical Guide, which was developed by a Technical Working Group of the World Health Organization and published in 1998. The report takes a comprehensive view of maternal and newborn needs during the postpartum period, examining major maternal and neonatal health challenges, nutrition and breastfeeding, birth spacing, immunization, HIV/AIDS, and the essential elements of care and service provision. The document lists recommendations, and classifies common practices in the postpartum period, dividing them into four categories: those which are useful, those which are harmful, those for which insufficient evidence exists, and those which are frequently used inappropriately.
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  • 44
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: American Indian women have one of the lowest cesarean delivery rates among all ethnic groups evaluated in the United States. Our objective was to identify risk factors for cesarean delivery among American Indian women in New Mexico. Methods: Live birth certificate data (1994) from the New Mexico Bureau of Vital Records and Health Statistics were used to compare American Indian women who had a cesarean delivery with those who had a vaginal delivery. We examined demographic, prenatal, and intrapartum factors to determine risk factors for cesarean delivery. Results: In 1994 American Indian women in New Mexico had a cesarean delivery rate of 12 percent. Risk factors for cesarean delivery included age equal to or over 35 years (OR = 1.8, 1.3–2.5) and nulliparity (OR = 1.9, 1.5–2.5). Obstetric risk factors included prematurity (OR = 2.3, 1.5–3.6), low birthweight (OR = 2.6, 1.7–4.2), diabetes (OR = 1.7, 1.1–2.5), pregnancy-induced hypertension (OR = 2.6, 1.8–3.8), and labor and delivery complications (OR = 9.5, 7.5–12.1). Age less than 20 years was negatively associated with cesarean delivery (OR = 0.5, 0.3–0.7). Conclusion: American Indian women have risk factors for cesarean delivery that are similar to those reported in other populations. Future prospective research evaluating intrapartum management may help identify reasons for the low cesarean birth rate.
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  • 45
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 46
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: A worldwide campaign has been initiated to improve the in-hospital care of mothers and babies through increased breastfeeding. The four objectives of the current investigation were to determine the in-hospital breastfeeding rate for Minnesota hospitals, to analyze the relationship between the in-hospital breastfeeding rates and selected hospital demographic characteristics, to determine the rate of adherence to each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps, and to analyze the relationship between the adherence rates for each of the Ten Steps and selected demographic characteristics. Methods: A descriptive survey was conducted and analyzed for the year of 1994 from 79 (83%) Minnesota hospitals. Respondents were directors of nursing, nursing managers, or other staff familiar with their hospital's breastfeeding policies and practices. Results: The average breastfeeding initiation rate was 59 percent. Four of the Ten Steps were implemented with a low adherence rate (0–49%), five were implemented with a moderate rate (50–89%), and none was implemented with a high rate (90–100%). Breastfeeding initiation rates and adherence to the Ten Steps varied with the size of the city and the number of births per year. Conclusions: Improvements in breastfeeding policies, practices, and staff education are needed if Minnesota hospitals are to provide care consistent with the Ten Steps of the BFHI. The results provide baseline information to guide institutional change that could promote successful breastfeeding experiences for postpartum families. This survey instrument could be used easily by researchers in other sites to assess nine of the Ten Steps.
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  • 47
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: Although improving mothers' knowledge about breastfeeding can increase rates and duration of breastfeeding, little is known about the influence of fathers' knowledge. The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving postpartum advice and its relationship to the frequency of breastfeeding. Methods: A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre, Brazil, between July 1994 and March 1995. The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding, an explanatory leaflet, and open discussion after viewing the video. The first 208 couples comprised the control group, the next 197 comprised experimental group 1, and the remaining 196 comprised experimental group 2. Immediately after delivery, mothers and fathers in the three groups answered a test on breastfeeding knowledge; they completed the same test at the end of the first month. All families received home visits at the end of the first, second, fourth, and sixth months, or until breastfeeding ceased. Logistic regression was used to evaluate the association between the mothers' and fathers' knowledge and frequency of breastfeeding. Results: Postpartum advice increased the breastfeeding knowledge of mothers and fathers. The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month, and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers. The fathers' knowledge also significantly influenced breastfeeding rates. The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month, and 1.91 higher chance of receiving maternal milk at the end of the third month. Conclusion: A simple, inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and, consequently, have a positive impact on the frequency of breastfeeding.
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  • 48
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    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Antenatal ascertainment of fetal sex is a common feature of modern pregnancies. Women who opt not to learn fetal sex typically employ a variety of methods to forecast it. This study investigated the validity of prevalent folklore used to identify fetal sex before birth. Method: One hundred four pregnant women, who did not know the sex of the fetus, were administered a questionnaire to explore their perceptions of fetal sex and the basis for these predictions. Results: Fetal sex was not systematically related to the shape of the woman's abdomen, prevalence of morning sickness, or comparisons with previous pregnancies. However, women who had more than twelve years of education correctly predicted fetal sex greater than chance (71% correct), in contrast to less educated women (43% correct). Contrary to expectations, women whose forecasts were based on psychological criteria (i.e., dreams or feelings) were more likely to be correct than those employing prevalent folklore criteria (i.e., the way a woman was carrying the pregnancy). Conclusions: In general, women were not good predictors of fetal sex. The mechanisms that promote maternal accuracy in predicting fetal sex for highly educated women are unknown. It is reasonable to expect that maternal perceptions of fetal sex contribute to the process of fetal attachment.
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  • 49
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Breast stimulation to augment labor has been used for centuries in tribal societies and by midwives. In recent years it has been shown to be effective in ripening the cervix, inducing labor, and as an alternative to oxytocin for the contraction stress test. This study compared the effectiveness of breast stimulation with oxytocin infusion in augmenting labor. Methods: Women admitted to the labor ward were eligible for the study if they had inadequate labor with premature rupture of the membranes and met inclusion criteria. They were assigned to oxytocin augmentation or breast stimulation (manual or pump), and were switched to oxytocin in the event of method failure. Outcomes included time to delivery, intervention to delivery, proportion of spontaneous deliveries, and Apgar scores. One hundred participants were needed in each arm of the study to demonstrate a 2- to 3-hour difference in delivery time, with a power of 80 percent. Results: Analysis was performed on 79 women, of whom 49 were in the breast stimulation group and 30 in the oxytocin group. Sixty-five percent of the participants failed breast stimulation and were switched to oxytocin infusion. Although augmentation start to delivery was shorter for the oxytocin group ( p 〈 0.001), no differences in total labor time occurred between the groups. Nulliparas receiving breast stimulation had more spontaneous (relative risk 1.7, p= 0.04). and fewer instrumental deliveries than those receiving oxytocin (relative risk 0.2, p= 0.02). No significant differences in adverse fetal outcomes occurred between the study groups. Conclusions: The small number of participants and a variety of problems with the conduct of the study prevented the formulation of reliable conclusions from the results. However, the study provided important insights into the feasibility and problems of developing a high-quality randomized trial of augmentation by breast stimulation.
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  • 50
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: This study was a randomized controlled trial of primigravidas in Botswana to determine the effectiveness of the presence of a female relative as a labor companion on labor outcomes. Methods: One hundred and nine primigravidas in uncomplicated spontaneous labor were randomly distributed into a control group who labored without family members present, and an experimental group who had a female relative with them during labor. Results: Significantly more mothers in the experimental group had a spontaneous vaginal delivery (91% vs 71%), less intrapartum analgesia (53% vs 73%), less oxytocin (13% vs 30%), fewer amniotomies to augment labor (30% vs 54%), fewer vacuum extractions (4% vs 16%), and fewer cesarean sections (6% vs 13%) than in the control group. These differences were all significant at p 〈 0.05. Epidural analgesia was not used in the hospital at the time of the study. The only analgesics used were intramuscular pethidine or hyoscine N-butylbromide (Buscopan). Conclusions: The presence in labor of a female relative was shown to be associated with fewer interventions and a higher frequency of normal delivery compared with the outcomes of those without family member support. The presence of a female relative as a labor companion is a low-cost, preventative intervention that is consistent with the traditional cultural practices in Botswana. In the light of this and previous studies, all women giving birth in a hospital should be offered the choice of a female relative as a companion to give support during labor.
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  • 51
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Several countries have developed clinical practice guidelines for the content of prenatal care. This study examines the consistency of recommendations in clinical practice guidelines describing routine prenatal care. Methods: The recommendations for low-risk women in seven guideline documents were examined: two from Australia, two from the United States, two from Canada, and one from Germany. The recommendations were listed into the four areas of “general health screening and health promotion during pregnancy,”“organization of care,”“clinical tests and screening,” and “education specific for pregnancy.”Results: A total of 69 recommendations were identified within the seven documents, most of which fell within the “clinical tests and screening” domain. Notable differences were identified in the number of recommendations made within the same country. Of the 69 recommendations, only four were included in all seven documents. Conclusion: Little consistency was demonstrated within or among countries in terms of the content of their prenatal care guidelines, suggesting a need to reexamine their content and the evidence on which such recommendations are based.
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  • 52
    Electronic Resource
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    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
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  • 53
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    Oxford, UK : Blackwell Science Inc
    Birth 26 (1999), S. 0 
    ISSN: 1523-536X
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Background: Complex interactions occur among women and caregivers throughout labor. Analyzing women's birth stories provides a rich data source on these interactions. The purpose of this qualitative study was to clarify how decisions were made in labor by analyzing women's birth stories. Methods: A convenience sample of 15 primiparous and multiparous Midwestern women contributed a total of 33 birth stories. Qualitative methods were used, including analyses of the content and themes of stories. Results: The primary types of decision making that were identified ranged on a continuum from unilateral to joint (shared), and were associated with various emotions expressed by the women. Conclusions: A model of decision making was derived from the data that may help caregivers change practices in ways that will benefit women. Caregivers can also benefit by understanding women's critiques of the birth care they received, and can use this knowledge to improve women's experiences of birth and therefore their satisfaction with the process.
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  • 54
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    Springer
    European spine journal 8 (1999), S. 1-1 
    ISSN: 1432-0932
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 55
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    European spine journal 8 (1999), S. 27-33 
    ISSN: 1432-0932
    Keywords: Key words Occipito-cervical ; fusion ; Bone thickness ; Spiral CT ; Skull morphology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Arguments concerning the best procedure for occipito-cervical fusion have rarely been based upon occipital bone thickness or only based on in vitro studies. To close this gap and to offer an outlook on preoperative evaluation of the patient, 28 patients were analysed in vivo by means of spiral CT. Ten macerated human skulls were measured by means of CT and directly. Measurements were taken according to a matrix of 66 points following a grid with 1 cm spacing based upon McRae’s line. Maximum thickness in the patient group was met 4 cm above the reference plane in the median slice (11.87 mm; SD 3.41 mm) and 5 cm above it in the skull group (15.85 mm; SD 1.81 mm). Correlation between CT and direct measurements was good (91.79%). Intra-individual discrepancies from one side to the respective point on the other side are common (difference 〉 1 mm in 60%). Judging areas suitable for operative fixation using the 10% percentile value (6.68 mm for the maximum value of 11.87 mm) led to the conclusion that screws should only be inserted along the occipital crest in an area extending from 1.5 cm above the posterior margin of the foramen magnum to the external occipital protuberance (EOP). At the level of the EOP screws may also be inserted up to 1 cm lateral of the midline. A reduction of screw length to 7 mm (9 mm for the EOP) is proposed. Preoperative evaluation of the patient should be carried out by spiral CT with 1 mm slicing and sagittal reconstructions.
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  • 56
    ISSN: 1432-0932
    Keywords: Key words Leg length inequality ; Orthopaedics ; Posture ; Scoliosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A small leg length inequality, either true or functional, can be implicated in the pathogenesis of numerous spinal disorders. The correction of a leg length inequality with the goal of treating a spinal pathology is often achieved with the use of a shoe lift. Little research has focused on the impact of this correction on the three-dimensional (3D) postural organisation. The goal of this study is to quantify in control subjects the 3D postural changes to the pelvis, trunk, scapular belt and head, induced by a shoe lift. The postural geometry of 20 female subjects (x – = 22, σ = 1.2) was evaluated using a motion analysis system for three randomised conditions: control, and right and left shoe lift. Acute postural adaptations were noted for all subjects, principally manifested through the tilt of the pelvis, asymmetric version of the left and right iliac bones, and a lateral shift of the pelvis and scapular belt. The difference in the version of the right and left iliac bones was positively associated with the pelvic tilt. Postural adaptations were noted to vary between subjects for rotation and postero-anterior shift of the pelvis and scapular belt. No notable differences between conditions were noted in the estimation of kyphosis and lordosis. The observed systematic and variable postural adaptations noted in the presence of a shoe lift reflects the unique constraints of the musculoskeletal system. This suggests that the global impact of a shoe lift on a patient’s posture should also be considered during treatment. This study provides a basis for comparison of future research involving pathological populations.
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  • 57
    ISSN: 1432-0932
    Keywords: Key words Thoracolumbar burst fractures ; Recombinant human bone morphogenetic protein-7 ; Transpedicular transplantation ; Clinical results ; Bone graft ; substitute
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The study presented here is a pilot study in five patients with unstable thoracolumbar spine fractures treated with transpedicular OP-1 transplantation, short segment instrumentation and posterolateral fusion. Recombinant bone morphogenetic protein-7 in combination with a collagen carrier, also referred to as OP-1, has demonstrated ability to induce healing in long-bone segmental defects in dogs, rabbits and monkeys and to induce successful posterolateral spinal fusion in dogs without need for autogenous bone graft. Furthermore OP-1 has been demonstrated to be effective as a bone graft substitute when performing the PLIF maneuver in a sheep model. Five patients with single-level unstable burst fracture and no neurological impairment were treated with intracorporal OP-1 transplantation, posterior fixation (USS) and posterolateral fusion. One patient with osteomalacia and an L2 burst fracture had an additional intracorporal transplantation performed proximal to the instrumented segment, i.e. OP-1 into T 12 and autogenous bone into T 11. Follow-up time was 12–18 months. On serial radiographs, Cobb and kyphotic angles, as well as anterior, middle and posterior column heights, were measured. Serial CT scans were performed to determine the bone mineral density at fracture level. In one case, radiographic and CT evaluation after 3 and 6 months showed severe resorption at the site of transplantation, but after 12 months, new bone had started to fill in at the area of resorption. In all cases there was loss of correction with regard to anterior and middle column height and sagittal balance at the latest follow-up. These preliminary results regarding OP-1 as a bone graft substitute and stimulator of new bone formation have been disappointing, as the OP-1 device in this study was not capable of inducing an early sufficient structural bone support. There are indications to suggest that OP-1 application to a fracture site in humans might result in detrimental enhanced bone resorption as a primary event.
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  • 58
    ISSN: 1432-0932
    Keywords: Key words Burst fractures ; Outcome ; Short segment fixation ; Fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract There continues to be controversy surrounding the management of thoracolumbar burst fractures. Numerous methods of fixation have been described for this injury, but to our knowledge, spinal fusion has always been part of the stabilising procedure, whether this involves an anterior or a posterior approach. Apart from an earlier publication from this centre, there have been no reports on the use of internal fixation without fusion for this type of fracture. The aim of the study was to determine the outcome of patients with thoracolumbar burst fractures who were treated with short segment pedicle screw fixation without fusion. This is a retrospective review of 28 consecutive patients who had short segment pedicle screw fixation of thoracolumbar burst fractures without fusion performed between 1990 and 1993. All patients underwent a clinical and radiological assessment by an independent observer. Outcome was measured using the Low Back Outcome Score. The minimum follow-up period was 2 years (mean 3.1 years). Fifty percent of patients achieved an excellent result with the Low Back Outcome Score, while 12% were assessed as good, 20% fair and 16% obtained a poor result. The only significant factor affecting outcome was the influence of a compensation claim (P 〈 0.05). The implant failure rate (14% of patients) and the clinical outcome was similar to that from series where fusion had been performed in addition to pedicle screw fixation. The results of this study support the view that posterolateral bone grafting is not necessary when managing patients with thoracolumbar burst fractures by short segment pedicle screw fixation.
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  • 59
    ISSN: 1432-0932
    Keywords: Key words Thoracic vertebrae ; Fractures ; Paraplegia ; Aortic ; rupture ; Intraoperative ; complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Numerous vertebral fracture patterns have been reported in the literature. We present the case of a patient who sustained severe trauma to the back that resulted in a very unusual and not previously reported rotational injury consisting in complete 180° rotation of the T6 vertebral body along a vertical axis, with only limited anteroposterior and lateral displacement. An unsuspected aortic tear resulted in severe evolution with fatal outcome following surgical attempt. The aetiology of such displacement is unknown. The possibility of late vascular complications should be kept in mind while treating thoracic spine fractures with rotational displacement.
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  • 60
    ISSN: 1432-0932
    Keywords: Key words Cervical osteotomy ; Ankylosing spondylitis ; Internal fixation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Ankylosing spondylitis can produce severe fixed flexion deformity in the cervical spine. This deformity may be so disabling that it interferes with forward vision, chewing, swallowing and skin care under the chin. The only treatment available is an extension osteotomy of the cervical spine. Existing techniques of cervical osteotomy may be associated with risk of neurological injury. We describe a variation on an existing technique, which provides a controlled method of reduction at the osteotomy site, eliminating sagittal translation. The method employs a modular posterior cervical system consisting of lateral mass and thoracic pedicle screws linked to titanium rods. Our technique substitutes the titanium rod with a temporary malleable rod on one side, allowing controlled reduction of the osteotomy as this rod bends and slides through the thoracic clamps. Once reduction is complete definitive contoured rods are inserted to maintain the correction while fusion takes place. This method appears less hazardous by eliminating sagittal translation, and may reduce the risk of neurological injury during surgery. It achieves rigid internal fixation, obviating the need for a halo vest in the postoperative period.
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  • 61
    ISSN: 1432-0932
    Keywords: Key words Lumbar spinal stenosis ; ligamentum flavum ; histology ; Lumbar spinal stenosis ; ligamentum flavum ; calcification ; Lumbar spinal stenosis ; ligamentum flavum ; elastic fibres
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The degree of calcification as well as the structural changes of the elastic fibres in the ligamentum flavum in patients with degenerative lumbar spinal stenosis were evaluated and the results were compared to those of patients without spinal stenosis. In 21 patients (13 male, 8 female) with lumbar spinal stenosis the ligamentum flavum was removed, histologically processed and stained. The calcification, the elastic/collagenous fibre ratio as well as the configuration of the fibres were evaluated with an image analyzing computer. As a control group, 20 ligaments of 10 human corpses were processed in the same way. The results were statistically analysed using the Mann-Whitney-Wilcoxon test (α = 0.05) and the t-test (α = 0.05). Nearly all the ligaments of patients with lumbar spinal stenosis were calcified (average 0.17%, maximum 3.8%) and showed relevant fibrosis with decreased elastic/collagenous fibre ratio. There was a significant correlation between age and histological changes (P 〈 0.05). In the control group we only found minimal calcification in 3 of 20 segments (average 0.015%). No relevant fibrosis was found and the configuration of elastic fibres showed no pathologic changes. The results of this study illustrate the important role of histological changes of the ligamentum flavum for the aetiology of lumbar spinal stenosis.
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  • 62
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    European spine journal 8 (1999), S. 337-337 
    ISSN: 1432-0932
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 63
    ISSN: 1432-0932
    Keywords: Key words Congenital scoliosis ; Cor pulmonale ; Halofemoral ; traction ; Sliding rods
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In severe congenital scoliosis, traction (whether with a halo or instrumental) is known to expose patients to neurologic complications. However, patients with restrictive lung disease may benefit from halo traction during the course of the surgical treatment. The goal of treatment of such deformities is, therefore, twofold: improvement of the respiratory function and avoidance of any neurologic complications. We report our technique to treat a 17-year-old girl with a multi-operated congenital scoliosis of 145 ° and cor pulmonale. Pre-operative halo gravity traction improved her vital capacity from 560 cc to 700 cc, but led to mild neurologic symptoms (clonus in the legs). To avoid further neurologic compromise, her first surgery consisted of posterior osteotomies and the implantation of two sliding rods connected to loose dominoes without any attempt at correction. Correction was then achieved over a 3-week period with a halofemoral traction. This allowed the two rods to slide while the neurologic status of the patient was monitored. Her definitive surgery consisted of locking the dominoes and the application of a contralateral rod. Satisfactory outcome was achieved for both correction of the deformity (without neurologic sequels) and improvement of her pulmonary function (1200 cc at 2 years). This technique using sliding rods in combination with halofemoral traction can be useful in high-risk, very severe congenital scoliosis.
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  • 64
    ISSN: 1432-0932
    Keywords: Key words Internal spinal fixator ; Load measurement ; Body position ; Telemetry ; Spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Telemeterized internal spinal fixation devices were implanted in ten patients. The loads acting on the fixators were compared for different body positions, including standing, sitting, and lying in a supine, prone, and lateral position. Implant loads differed considerably from patient to patient depending, for example, on the indication for surgery and the surgical procedure. They were altered by anterior interbody fusion. Mostly, only small differences in implant loads were found for the various lying positions. Flexion bending moments were significantly higher in upright than in lying body positions. Loads on the fixators were not higher for sitting than for standing. Patients who have undergone mono- or bisegmental spine stabilization should therefore be allowed to sit as soon as they can leave the bed.
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  • 65
    ISSN: 1432-0932
    Keywords: Key words Cervical spine ; Odontoid ; Fracture ; Treatment ; Patient’s age
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Odontoid fractures are frequent in patients over 70 years of age, and in patients over 80 years of age they form the majority of spinal fractures. In a retrospective analysis of 23 geriatric (〉 70 years) patients with a fracture of the odontoid, we compared some of the clinical features to a contemporary series of patients younger than 70 years of age. Whereas in the younger patients high-energy trauma accounted for the majority of the fractures, low-energy falls were the underlying cause in 90% of the odontoid fractures in the elderly. In contrast to the younger age group, in elderly patients predominantly type II fractures (95%) were identified. Anterior and posterior displacement were recorded with equal frequency on the first postinjury radiograph in the younger age group, whereas in geriatric patients displacement was mainly posterior. The number of associated injuries was significantly higher in younger patients. There was no difference in the occurrence of neurological deficits (13%) between the two age groups, and neurological compromise was mainly related to posterior dislocation of the odontoid in both groups. The overall complication rate was significantly higher in elderly patients (52.2% vs 32.7%), with an associated in-hospital mortality of 34.8%. Loss of reduction and non-union after non-operative treatment, a complicated postoperative course and complications due to associated injuries accounted primarily for this high complication rate. Elderly patients with a fracture of the odontoid are a high-risk group with a high morbidity and mortality rate. An aggressive diagnostic approach to detect unstable fractures and application of a halo device or early primary internal stabilisation of these fractures is recommended.
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  • 66
    ISSN: 1432-0932
    Keywords: Key words Atlanto-axial ; instability ; Transoral approach ; Decompression ; Rheumatoid ; arthritis ; C1/C2 fusion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Thirty-six consecutive patients with cervical spine instability due to rheumatoid arthritis (RA) were treated surgically according to a stage-related therapeutic concept. The aim of this study was to investigate the clinical results of these procedures. The initial change in RA of the cervical spine is atlanto-axial instability (AAI) due to incompetence of the cranio-cervical junction ligaments, followed by development of a peridontoid mass of granulation tissue. This results in inflammatory involvement of, and excessive dynamic forces on, the lateral masses of C1 and C2, leading to irreducible atlanto-axial kyphosis (AAK). Finally, cranial settling (CS) accompanied by subaxial subluxation (SAS) occurs. According to these three separate pathological and radiological lesions, the patients were divided into three therapeutic groups. Group I comprised 14 patients with isolated anterior AAI, who were treated by posterior wire fusion. Group II comprised 15 patients with irreducible AAK, who were treated by transoral odontoid resection. The fixation was done using anterior plating according to Harms in combination with posterior wire fusion according to Brooks. Group III comprised seven patients with CS and additional SAS, who were treated with occipito-cervical fusion. Pre- and postoperatively, evaluation was performed using the parameters pain (visual analog scale), range of motion (ROM), subjective improvement and Health Assessment Questionnaire (HAQ). The neurologic deficit was defined according to the classification proposed by Ranawat. Radiographs including lateral flexion and extension views, and MRI scans were obtained. The average clinical and radiographic follow-up of all patients was 50.7 ± 19.3 months (range 21–96 months). No perioperative fatality occurred. Postoperative pain was significantly relieved in all groups (P 〈 0.001). In group II a slight improvement in the HAQ was obtained. In groups I and II the ROM of all patients increased significantly (average gain of motion in group I: 11.3°± 7.8° for rotation; 7.8°± 5.6° for bending; average gain of motion in group II: 21.5°± 14.0° for rotation; 17.2°± 5.5° for bending), while it decreased significantly in group III (10.7°± 18.1° for rotation; 6.7°± 18.5° for bending). Preoperatively 27 patients had a manifest neurologic deficit. At follow-up four patients remained unchanged, all others improved by at least one Ranawat class. All patients, except one, showed solid bony fusion. According to the significantly improved postoperative subjective self-assessment and the clinical and radiological parameters, transoral plate fixation combined with posterior wire fixation after transoral odontoid resection represents an effective reliable and safe procedure for the treatment of irreducible AAK in rheumatoid arthritis.
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  • 67
    ISSN: 1432-0932
    Keywords: Key words MRI ; Disc ; degeneration ; Facet joint ; Osteoarthritis ; Lumbar spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The role of MRI in assessing facet joint osteoarthritis is unclear. By developing a grading system for severity of facet joint osteoarthritis on MRI, the relationship between disc degeneration and facet joint osteoarthritis was determined. The accuracy of MRI in assessing facet joint osteoarthritis against CT was 94%. Under 40 years of age, the degree of disc degeneration varied among individuals. Over the age of 60, most of the discs were markedly degenerated. Under 40 years of age osteoarthritic changes in facet joints were minimal. Over the age of 60, variable degrees of facet joint osteoarthritis were observed but some facets did not show osteoarthritis. No facet joint osteoarthritis was found in the absence of disc degeneration and most facet joint osteoarthritis appeared at the intervertebral levels with advanced disc degeneration. Disc degeneration is more closely associated with aging than with facet joint osteoarthritis. The present study supports the hypothesis that “disc degeneration precedes facet joint osteoarthritis”, and also supports the concept that it may take 20 or more years to develop facet joint osteoarthritis following the onset of disc degeneration.
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  • 68
    ISSN: 1432-0932
    Keywords: Key words Scoliosis ; Brace ; treatment ; Self-image
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the effect of brace treatment on self-image in patients with adolescent idiopathic scoliosis, 54 consecutive patients admitted for brace treatment were interviewed before bracing. A prevalidated questionnaire including the following five aspects of self-image was used: (1) body-image, (2) self-perception of skills and talents, (3) emotional well-being, (4) relations with family, and (5) relations with others. As a control group, the answers of 3465 normal school children were used. Forty-six patients participated in a follow-up interview 1.7 (range 0.8–3.0) years later. In addition, during the first interview, the scoliosis patients answered selected questions about their social circumstances and attitudes towards their forthcoming brace treatment. Grossly, the patient group lived in stable family conditions with a high percentage (40%) of fathers and/or mothers with an academic education or with a high employee status. The patients’ relations with families were generally good. Nearly all believed that the brace would affect their posture, but only a few thought that wearing the brace would influence their growth. Two-thirds believed that it would be difficult to wear the brace, and often reflected on the use of it. There were no statistically significant differences between the scoliosis patients and the age-matched controls at the pre-bracing nor at the follow-up interviews. Neither were there any statistically significant differences between the answers of the scoliosis patients in the pre-bracing and follow-up interviews. This was valid for the total score as well as for each subscale item score. It is concluded that wearing the brace does not affect the self-image of adolescents with idiopathic scoliosis negatively.
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    ISSN: 1432-0940
    Keywords: Key words. Numerical conformal mapping, Quadrilaterals, Conformal modules, Domain decomposition. AMS Classification. 30C30, 65E05, 30E10, 30C35.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mathematics
    Notes: Abstract. We consider the conformal mapping of ``strip-like'' domains and derive a number of asymptotic results for computing the conformal modules of an associated class of quadrilaterals. These results are then used for the following two purposes: (a) to estimate the error of certain engineering formulas for measuring resistance values of integrated circuit networks; and (b) to compute the modules of complicated quadrilaterals of the type that occur frequently in engineering applications.
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  • 70
    Electronic Resource
    Electronic Resource
    Springer
    Constructive approximation 15 (1999), S. 135-151 
    ISSN: 1432-0940
    Keywords: Key words. Orthogonal matrix polynomials, Matrix moment problem. AMS Classification. 42C05, 44A60.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Mathematics
    Notes: Abstract. We describe the image through the Stieltjes transform of the set of solutions V of a matrix moment problem. We extend Riesz's theorem to the matrix setting, proving that those matrices of measures of V for which the matrix polynomials are dense in the corresponding $ {\cal L} $ 2 space are precisely those whose Stieltjes transform is an extremal point (in the sense of convexity) of the image set.
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