Monitoring Of Edema Research Articles

L’autofluorescence du fond d’œil. A-t-elle une place dans la prise en charge de l’œdème maculaire diabétique ?

Analyze the characteristics of fundus autofluorescence of diabetic macular edema and study the association between these characteristics and visual function. Our study included 18 patients (28 eyes) with clinically significant diabetic macular edema. All patients had a complete eye examination with a fundus autofluorescence imaging and optical coherence tomography. The central macular thickness and central macular volume were measured. The integrity of the inner segment-outer segment junction and the integrity of the external limiting membrane were also evaluated in the same area. Among the 28 eyes studied, 8 had normal autofluorescence. The remaining 20 eyes had abnormal autofluorescence: a hyper-cystoid autofluorescence in 5 eyes (25%), hyper-spot autofluorescence in 8 eyes (40%), and hypo-irregular autofluorescence in 5 eyes (25%). Best corrected visual acuity was significantly better in patients with normal autofluorescence and those with hyper-cystoid autofluorescence. There was no significant difference in central macular thickness (P=0.186) and central macular volume (P=0.191) between the four groups. The autofluorescence is a simple, fast, and non-invasive technique for the study of diabetic macular edema with good correlation to the visual function as well as to the extent of damage to the retina. It is, therefore, a possible alternative to other invasive imaging techniques in particular in the long term monitoring of diabetic macular edema.

Application of Blood-Brain Barrier Permeability Imaging in Global Cerebral Edema

Blood-brain barrier permeability is not routinely evaluated in the clinical setting. Global cerebral edema occurs after SAH and is associated with BBB disruption. Detection of global cerebral edema using current imaging techniques is challenging. Our purpose was to apply blood-brain barrier permeability imaging in patients with global cerebral edema by using extended CT perfusion. Patients with SAH underwent CTP in the early phase after aneurysmal rupture (days 0-3) and were classified as having global cerebral edema or nonglobal cerebral edema using established noncontrast CT criteria. CTP data were postprocessed into blood-brain barrier permeability quantitative maps of PS (permeability surface-area product), K(trans) (volume transfer constant from blood plasma to extravascular extracellular space), Kep (washout rate constant of the contrast agent from extravascular extracellular space to intravascular space), VE (extravascular extracellular space volume per unit of tissue volume), VP (plasmatic volume per unit of tissue volume), and F (plasma flow) by using Olea Sphere software. Mean values were compared using t tests. Twenty-two patients were included in the analysis. Kep (1.32 versus 1.52, P < .0001), K(trans) (0.15 versus 0.19, P < .0001), VP (0.51 versus 0.57, P = .0007), and F (1176 versus 1329, P = .0001) were decreased in global cerebral edema compared with nonglobal cerebral edema while VE (0.81 versus 0.39, P < .0001) was increased. Extended CTP was used to evaluate blood-brain barrier permeability in patients with SAH with and without global cerebral edema. Kep is an important indicator of altered blood-brain barrier permeability in patients with decreased blood flow, as Kep is flow-independent. Further study of blood-brain barrier permeability is needed to improve diagnosis and monitoring of global cerebral edema.

Pulmonary ultrasound guidance of congenital heart disease postoperative ventilator applications

To investigate the pulmonary ultrasound in children with congenital heart disease postoperative invasive ventilator time, non-invasive ventilator use the guide. Using prospective clinical observation research methods, Randomly divide 100 cases ranged from 6 months to 3 years old in cardiopulmonary bypass after congenital heart disease surgery patients into ultrasound group and control group, 50 cases in each group. All postoperative give positive cardiac function maintenance, diuresis, etc. Ultrasound group adopted the pulmonary ultrasound in children with pulmonary interstitial pulmonary edema monitoring and guide to extubation, enable the timing of the noninvasive ventilator support; Control group based on the bedside chest X-ray lung condition. Compare two groups of children with mechanical ventilation time (including the invasive and noninvasive ventilator support), noninvasive ventilator utilization rate and its accuracy, start the noninvasive ventilator time, the incidence of ventilator associated pneumonia (VAP), secondary tracheal intubation cases and ICU stay time, etc. The ultrasound group compared with the control group in Invasive ventilator time [(15.0 ± 11.0) vs (20.0 ± 13.5, P=0.043)], noninvasive ventilation time [(38.5 ± 11.8) vs (48.6 ± 21.9, P=0.032)], the number of cases of the use of noninvasive ventilation (10 cases vs 22 cases, P=0.041), the correct use of the number of cases (10 vs 14, P=0.034) and VAP cases (3 vs 8, P=0.044), there was statistical significance, P< 0.05. The ultrasound group of children with ICU stay time was significantly lower than the control group [(66.0 ± 38.9) vs (82.0 ± 42.4, P=0.038)]; Control group had 2 cases with secondary tracheal intubation, ultrasound group one, comparing the two groups has no statistical significance (P> 0.05). Postoperative children with congenital heart disease using pulmonary ultrasound evaluation of pulmonary interstitial edema,guide the ventilator, it can effectively shorten (invasive and noninvasive mechanical ventilation time and ICU length of hospital stay, lung ultrasound has instant, noninvasive, No radiation, repeatable,pulmonary ultrasound will be important after cardiopulmonary bypass interstitial lung edema diagnosis, evaluation of treatment means and helps to treat critically ill children.

Parametric response map (prm) is a promising tool for the monitoring of post traumatic cerebral oedema

Cerebral edema (CE) is the key factor for the development of secondary brain injuries after severe traumatic brain injury (TBI). This edema may be assessed using the averaged Apparent diffusion coefficient (ADC) measured by diffusion-weighted MRI in specified ROI. However, this approach does not take into account the complexity and the heterogeneity of the post traumatic edema. The parametric response map (PRM), a voxel-based analysis technique, is a promising tool to better investigate spatially dispersed changes of ADC over time (1).

Feasibility of Using Wideband Microwave System for Non-Invasive Detection and Monitoring of Pulmonary Oedema.

Pulmonary oedema is a common manifestation of various fatal diseases that can be caused by cardiac or non-cardiac syndromes. The accumulated fluid has a considerably higher dielectric constant compared to lungs’ tissues, and can thus be detected using microwave techniques. Therefore, a non-invasive microwave system for the early detection of pulmonary oedema is presented. It employs a platform in the form of foam-based bed that contains two linear arrays of wideband antennas covering the band 0.7–1 GHz. The platform is designed such that during the tests, the subject lays on the bed with the back of the torso facing the antenna arrays. The antennas are controlled using a switching network that is connected to a compact network analyzer. A novel frequency-based imaging algorithm is used to process the recorded signals and generate an image of the torso showing any accumulated fluids in the lungs. The system is verified on an artificial torso phantom, and animal organs. As a feasibility study, preclinical tests are conducted on healthy subjects to determinate the type of obtained images, the statistics and threshold levels of their intensity to differentiate between healthy and unhealthy subjects.

Foot edema simulation and monitoring using dielectric electro-active polymer sensors

Edema of the lower extremities, nerve damage and circulatory dysfunction, are common symptoms in diabetes and other chronic diseases. These symptoms must be addressed early in the disease process before permanent nerve damages occur. To provide a better understanding of such symptoms and to avoid unnecessary nerve damages, we aim at developing and testing a wearable edema monitoring system. This study addresses a novel method of foot edema simulation and monitoring. Two prototypes based on an artificial foot covered with latex are developed to simulate edema. Dielectric electro-active polymer (DEAP) stretch sensors are employed for continuous monitoring of edema. National Instruments device and LabVIEW are used for data acquisition and analysis. The experimental results indicate that the DEAP sensors are suitable in this application. The edema simulation system provides an efficient method for testing new sensors or techniques, especially in preclinical studies.

A Novel Color Vision Test for Detection of Diabetic Macular Edema

To determine the sensitivity of the Seoul National University (SNU) computerized color vision test for detecting diabetic macular edema. From May to September 2003, a total of 73 eyes of 73 patients with diabetes mellitus were examined using the SNU computerized color vision test and optical coherence tomography (OCT). Color deficiency was quantified as the total error score on the SNU test and as error scores for each of four color quadrants corresponding to yellows (Q1), greens (Q2), blues (Q3), and reds (Q4). SNU error scores were assessed as a function of OCT foveal thickness and total macular volume (TMV). The error scores in Q1, Q2, Q3, and Q4 measured by the SNU color vision test increased with foveal thickness (P < 0.05), whereas they were not correlated with TMV. Total error scores, the summation of Q1 and Q3, the summation of Q2 and Q4, and blue-yellow (B-Y) error scores were significantly correlated with foveal thickness (P < 0.05), but not with TMV. The observed correlation between SNU color test error scores and foveal thickness indicates that the SNU test may be useful for detection and monitoring of diabetic macular edema.

Novel technology for non-invasive thoracic fluid measurement: an animal model comparative study

Approximately 15 million people worldwide suffer from congestive heart failure (CHF). The most severe symptom of CHF is pulmonary congestion - an acute increase in extravascular lung fluid due to acute decompensation of heart failure. To date, no direct, reliable, simple and non-invasive method is available for assessment of thoracic fluids. Continuous dependable monitoring of pulmonary edema for hospital patients can improve management and reduce duration of hospitalization. KYMA's solution is based on a matchboxsized monitoring device, which monitors thoracic fluid content and trends. The μCor monitor transmits and receives electromagnetic signals that are propagated through tissue layers. Conduction is highly related to the amount of accumulated fluids in tissues. This trial investigated the correlation between KYMA's lung water index (LWI) and directly assessed extravascular lung water (EVLW) in the scenario of acute pulmonary edema induced in seven sheep.

Highly accelerated real-time T2-weighted imaging with through-time radial GRAPPA and low-latency GPU reconstruction

Background T2-weighted cardiac images are commonly used for edema detection [1-4]. However, neither black-blood TSE nor cine images can offer real-time edema monitoring, and are therefore not suitable for the guidance of cardiac ablation procedures. We proposed a radial T2weighted interrupted balanced SSFP (rT2W-iSSFP), a real-time high temporal resolution sequence targeted at monitoring edema.

Serial T2-mapping to quantitatively monitor resorption of myocardial edema following acute myocardial infarction

Background Currently, myocardial edema monitoring after acute myocardial infarction (AMI) is based on visualization of the region with increased signal-intensity on T2-weighted images. T2-mapping is a promising novel cardiac magnetic resonance imaging (CMR) technique to quantitatively assess myocardial edema. The purpose of the study was to quantitatively evaluate resorption of myocardial edema following AMI using T2-mapping. Methods

Measurement of Brain Edema by Noninvasive Cerebral Electrical Impedance in Patients with Massive Hemispheric Cerebral Infarction

Background: Malignant cerebral infarction often occurs in patients with massive cerebral infarction. Monitoring brain edema is therefore helpful to make correct clinical decisions. Our previous studies have confirmed that cerebral electrical impedance (CEI) can sensitively reflect the brain edema after stroke. Methods: The CEI was measured consecutively by a noninvasive brain edema monitor in 69 patients with massive hemispheric cerebral infarction (MHCI). The results of the CEI were converted into the perturbation index (PI). The characteristics of dynamic changes of the CEI after MHCI were analyzed. Receiver-operating characteristics analysis was used to calculate predictive values for PI and other known parameters including NIHSS score and infarct volume. Results: (1) The overall rate of positive CEI was 88.4% (61/69) in all patients with MHCI. (2) The PI on the infarct side increased significantly within 24 h after stroke onset and reached a peak level 3–5 days after stroke onset (p < 0.01). (3) Age, NIHSS score at admission, infarct volume, and the PI at 24 h after stroke onset were significantly different between the malignant and nonmalignant groups. The best predictor of a malignant MHCI was the PI at 24 h after stroke onset with a cut-off value of 10.02 (90.9% sensitivity, 87.2% specificity, 76.9% positive predictive value, 95.3% negative predictive value). Conclusions: The noninvasive CEI can sensitively reflect the brain edema in patients with MHCI. Monitoring the CEI may help to predict malignant MHCI and guide treatment decisions.

Estimation of Extravascular Lung Water During and After Extensive Thoracic Interventions

Background. Postoperative lung injury is a cause of most fatal outcomes after extensive lung resections. Death rates due to postpneumonectomy pulmonary edema have remained unchanged within the past 20 years and are currently tending to 100%. Objective: to make prolonged lung edema monitoring in patients after extensive thoracic interventions. Subjects and methods. The observational study covered 27 patients who had undergone pneumonectomy (PE) (n=16) or lung resection (n=11). Invasive monitoring by the PiCCOplus system was performed to examine the systemic and pulmonary hemodynamics of all the patients during surgery and within 48 postoperative hours. Results. PE rather than lung resection was accompanied by a significant reduction in the extravascular lung water index (EVLWI). Most patients who had undergone PE were found to have a subclinical increase in EVLWI 36-48 hours after termination of the intervention. Conclusion. In this observational clinical study, isolated thermodilution showed an immediate decrease in EVLWI after PE and its increase at 36—48 postoperative hours. Lobar or segmental interventions failed to cause significant changes in EVLWI in the perioperative period. Key words: pneumonectomy, lung resection, lung edema, extravascular lung water, acute lung injury.

Ambulatory Cardiogenic Pulmonary Edema Monitoring as an Essential Ubiquitous Healthcare Service – Development of a Simulation Model

Ambulatory Cardiogenic Pulmonary Edema Monitoring as an Essential Ubiquitous Healthcare Service – Development of a Simulation Model

Automated Analysis of Optic Nerve Images for Detection and Staging of Papilledema

To develop an automated system that analyzes digital fundus images for staging and monitoring of optic disc edema (i.e., papilledema), due to raised intracranial pressure. A total of 294 retrospective, digital photographs of the right and left eyes of 39 subjects with papilledema acquired over the span of 2 years were used. Software tools were developed to analyze three features of papilledema from digital fundus photographs: (1) sharpness of the optic disc border, (2) discontinuity along major vessels overlying the optic nerve, and (3) texture properties of the peripapillary retinal nerve fiber layer (RNFL). A classifier used these features to assign a grade of papilledema according to a standard protocol used by an expert neuro-ophthalmologist (RK). The algorithm showed substantial agreement (κ = 0.71, P < 0.001) with the neuro-ophthalmologist when grading papilledema per patient. Vessel features showed statistical significance (P < 0.05) in differentiating grades 0, 1, and 2 from grades 3 and 4, whereas disc obscuration differentiated grades 0 or 1 from the rest (P < 0.05). These results show that this algorithm can be used to automatically grade papilledema. The algorithm provides objective and quantitative assessment of the stage of papilledema with accuracy that is comparable to grading by a neuro-ophthalmologist. One application is in rapid assessment of digital optic nerve photographs acquired in clinical, intensive care, and emergency response settings by nonophthalmologists to evaluate for the presence and severity of papilledema, due to intracranial hypertension.

Regular Monitoring of Lower Extremity Edema Predicts Cardiac Event-Free Survival in Patients with Heart Failure

Regular Monitoring of Lower Extremity Edema Predicts Cardiac Event-Free Survival in Patients with Heart Failure Kyoung Suk Lee, Terry A. Lennie, Sandra B. Dunbar, Susan J. Pressler, Seongkum Heo, Debra K. Moser; College of Nursing, Univeristy of Kentucky, Lexington, KY; School of Nursing, Emory University, Atlanta, GA; School of Nursing, University of Michigan, Ann Arbor, MI; College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR

Sildenafil prevents the increase of extravascular lung water and pulmonary hypertension after meconium aspiration in newborn piglets

Meconium aspiration syndrome causes respiratory failure after birth and in vivo monitoring of pulmonary edema is difficult. The objective of the present study was to assess hemodynamic changes and edema measured by transcardiopulmonary thermodilution in low weight newborn piglets. Additionally, the effect of early administration of sildenafil (2 mg/kg vo, 30 min after meconium aspiration) on this critical parameter was determined in the meconium aspiration syndrome model. Thirty-eight mechanically ventilated anesthetized male piglets (Sus scrofa domestica) aged 12 to 72 h (1660 ± 192 g) received diluted fresh human meconium in the airway in order to evoke pulmonary hypertension (PHT). Extravascular lung water was measured in vivo with a PiCCO monitor and ex vivo by the gravimetric method, resulting in an overestimate of 3.5 ± 2.3 mL compared to the first measurement. A significant PHT of 15 Torr above basal pressure was observed, similar to that of severely affected humans, leading to an increase in ventilatory support. The vascular permeability index increased 57%, suggesting altered alveolocapillary membrane permeability. Histology revealed tissue vessel congestion and nonspecific chemical pneumonitis. A group of animals received sildenafil, which prevented the development of PHT and lung edema, as evaluated by in vivo monitoring. In summary, the transcardiopulmonary thermodilution method is a reliable tool for monitoring critical newborn changes, offering the opportunity to experimentally explore putative therapeutics in vivo. Sildenafil could be employed to prevent PHT and edema if used in the first stages of development of the disease.

Intraoperative lung edema monitoring by microwave reflectometry☆

Microwave reflectometry might be a suitable tool for the thoracic surgeon to monitor edema formation of the lung during lung surgery. A new setup of microwave reflectometry for lung water measurements was developed and tested for clinical application. Three lung models were used for the microwave reflectometry tests: 1) the model of an ex vivo isolated perfused rat lung to investigate lung edema formation during ischemia-reperfusion (n=6), 2) the in situ lung of a human patient to demonstrate the feasibility of lung water monitoring during a surgical operation, 3) the model of an ex vivo isolated perfused human lung to investigate edema formation during postischemic reperfusion and to investigate the changes in water content in the region of a tumor. During human lung operation, significant changes in water content occurred in different lung areas. During isolated perfusion, a significant increase in lung water was measured in models 1) and 3) (P=0.03). Water content of tumor tissue was higher than in the surrounding healthy lung tissue. Microwave reflectometry offers a non-invasive approach to monitor lung edema formation in experimental models and during thoracic surgery.

Application of non-invasive cerebral electrical impedance measurement on brain edema in patients with cerebral infarction

Objective: To investigate the change of brain edema in patients with cerebral infarction by non-invasive cerebral electrical impedance (CEI) measurements.Methods: An invariable secure current at a frequency of 50 kHz and an intensity of 0.1 mA was given into a person's brain. CEI values of the bilateral hemisphere of 200 healthy volunteers and 107 patients with cerebral infarction were measured by non-invasive brain edema monitor. The results of perturbative index (PI) converted from CEI were compared with the volumes of brain edema, which were calculated by an image analysing system according to magnetic resonance imaging or computed tomography.Results: (1) In the healthy volunteers, PI values in the left and right hemisphere were 7·98 ± 0·95 and 8·02 ± 0·71 respectively, and there was no significant difference between the two sides (p>0·05). Age, gender and different measuring times did not obviously affect PI values (p>0·05). (2) In the cerebral infarction group, CEI measurements were more sensitive to the volumes of lesion, which were more than 20 ml. The positive ratio of PI was higher when the volumes of infarction were >20 ml (80·0%): the ratio of PI was 75·9% when the volumes of infarction were 20–50 ml and it was 83·3% when the volumes of lesion were more than 50 ml. PI was lower when the volumes were less than 20 ml. (3) PI of the infarction side increased obviously 3–5 days after onset; the difference of two sides was the most significant. There was a positive correlation between PI of the infarction side and volume of infarction.Conclusions: PI may be a sensitive parameter for non-invasive monitoring of the change of brain edema in patients with cerebral infarction. CEI is a valuable method for the early detection of brain edema.

Hepatic encephalopathy: current management strategies and treatment, including management and monitoring of cerebral edema and intracranial hypertension in fulminant hepatic failure

Hepatic encephalopathy is a syndrome whose pathophysiology is poorly understood, for which we lack high-quality diagnostic tests and markers, and whose treatment has improved only slightly over the last several decades. Serum ammonia levels remain the diagnostic gold standard. Hepatic encephalopathy can be precipitated by several of the complications of cirrhosis; effective treatment of precipitants is as important as treatment of the encephalopathy itself. Therapy with lactulose and enteral antibiotics is appropriate in any hospitalized patient with more than trivial hepatic encephalopathy. Rifaximin is increasingly important as a therapy for hospitalized patients with hepatic encephalopathy. High-grade encephalopathy continues to carry a high mortality. Current diagnostic tests are imperfect, and modern therapy is nonspecific. No cost-efficient or more effective alternatives to either are likely to enter into clinical practice in the short-term future.

Over-hydration detection in brain by magnetic induction spectroscopy

Detection and continuous monitoring of edema in the brain in early stages is useful for assessment of medical condition and treatment. We have proposed a solution in which the bulk measurements of the tissue electrical properties to detect edema or in general accumulation of fluids are made through measurement of the magnetic induction phase shift between applied and measured currents at different frequencies (Magnetic Induction Spectroscopy; MIS). Magnetic Resonant Imaging (MRI) has been characterized because its capability to detect different levels of brain tissue hydration by differences in diffusion-weighted (DW) sequences and it's involve apparent diffusion coefficient (ADC). The objective of this study was to explore the viability to use measurements of the bulk tissue electrical properties to detect edema or in general accumulation of fluids by MIS. We have induced a transitory and generalized tissue over-hydration condition in ten volunteers ingesting 1.5 to 2 liters of water in ten minutes. Basal and over-hydration conditions were monitored by MIS and MRI. Changes in the inductive phase shift at certain frequencies were consistent with changes in the brain tissue hydration level observed by DW-ADC. The results suggest that MIS has the potential to detect pathologies associated to changes in the content of fluids in brain tissue such as edema and hematomas.