Social Relations for Human Development

In spite of the exceptional development of the human community in the last few decades the present state of development manifests not only increasing differences between parts of human society but also a serious threat to man s survival Numerous problems as a result of the development to date as well as of the existing present day problems are an indication of the need to change the approach and ways of developing life and work in the human community The influential factors impacting development include man science and education technology and technical sciences natural resources and socio-political systems Human development is considered the best alternative in regard to which corresponding goals criteria and standards are proposed as well as man becoming both the subject and object of development New development should be pursued in an integral and coordinated manner in all segments of life and work in society Regional development and local self-government sustainable development and environmental protection as well asthe education and professional training of people represent the three main determinants namely areas on which it is necessary and possible to place emphasis in future developmen

Untersuchungstechniken und Stellenwert der CT bei der Diagnostik von Herzklappenerkrankungen

Zusammenfassung: Klinisches/methodisches Problem: Die Herz-CT wird in erster Linie anlässlich einer Koronarabklärung durchgeführt. Sie ist aber auch in der Lage, wichtige Informationen über die Morphologie und teilweise auch Herzklappenfunktion zu liefern. Radiologische Standardverfahren: Die primäre Modalität zur Evaluation der Herzklappen ist die Echokardiographie, gefolgt von der Magnetresonanztomographie. Methodische Innovationen: Durch die kontinuierliche technische Weiterentwicklung der CT-Geräte erfolgte eine markante Verbesserung der räumlichen und zeitlichen Auflösung, welche für die artefaktfreie Darstellung schnell bewegender und kleiner Strukturen, wie etwa der Koronargefäße und Herzklappen, entscheidend sind. Leistungsfähigkeit: Die CT liefert eine ausgezeichnete Bildqualität der Aorten- und Mitralklappe und erlaubt somit eine präzise Beurteilung ihrer Morphologie. Zudem ermöglicht die CT eine gute Beurteilung der Aortenklappenfunktion mit einer Graduierung von Stenose und Insuffizienz. Bewertung: Die CT ist nicht die primäre Modalität zur Beurteilung der Herzklappen. Sie kann aber wichtige Informationen über ihre Morphologie und Funktion liefern. Empfehlung für die Praxis: Sind die Echokardiographie und/oder die Herzmagnetresonanztomographie eingeschränkt beurteilbar, inkonklusiv oder nicht durchführbar, ist die Herz-CT eine gute Alternative zur Bildgebung der Herzklappe

Language attitudes towards Serbian Sign Language and experiences with deaf education in Serbia

In this paper, we report on data obtained from interviews with 28 deaf signers and three hearing teachers of deaf pupils regarding their experiences with and attitudes towards deaf education and Serbian Sign Language (SZJ). Following transcription of the data, we conducted thematic analyses of the deaf informants’ and teachers’ comments. Data, which indicate that a change in language attitudes among deaf people has taken place compared to the oralist ideology still prevalent among teachers, are considered within a broader historical context by giving the first account of SZJ, its place in education and its history. In the light of the results, we highlight the importance of teacher training for promoting a cultural-linguistic minority perspective in deaf education in Serbia that would allow for deafness to be viewed as human diversity rather than disability

Computed tomography for planning and postoperative imaging of transvenous mitral annuloplasty: first experience in an animal model

To investigate the use of computed tomography (CT) to measure the mitral valve annulus size before implantation of a percutaneous mitral valve annuloplasty device in an animal trial. Seven domestic pigs underwent CT before and after implantation of a Cardioband™ (a percutaneously implantable mitral valve annuloplasty device) with a second-generation 128-section dual-source CT machine. Implantation of the Cardioband™ was performed in a standard fashion according to a protocol. Animals were sacrificed afterwards and the hearts explanted. The Cardioband™ was found to be adequately implanted in all animals, with no anchor dehiscence and no damage of the circumflex artery (CX) or the coronary sinus (CS). The correct length of the band as chosen according to the length of the posterior mitral annulus measured in CT before implantation was confirmed in gross examination in all animals. The device did not result in a metal artifact-related degradation of image quality. The closest distance from the closest anchor to the CX was 2.1 ± 0.7 mm in diastole and 1.6 ± 0.5 mm systole. Mitral annulus distance to the CS was 6.4 ± 1.3 mm in diastole and 7.7 ± 1.1 mm in systole. CT visualization and measurement of the mitral valve annulus dimensions is feasible and can become the imaging method of choice for procedure planning of Cardioband™ implantations or other transcatheter mitral annuloplasty devices

Characterization of indeterminate spleen lesions in primary CT after blunt abdominal trauma: potential role of MR imaging

The purpose of this study was to determine the value of magnetic resonance imaging (MRI) for characterization of indeterminate spleen lesions in primary computed tomography (CT) of patients with blunt abdominal trauma. Twenty-five consecutive patients (8 female, 17 male, mean age 51.6 ± 22.4years) with an indeterminate spleen lesion diagnosed at CT after blunt abdominal trauma underwent MRI with T2- and T1-weighted images pre- and post-contrast material administration. MRI studies were reviewed by two radiologists. Age, gender, injury mechanism, injury severity score (ISS), management of patients, time interval between CT and MRI, and length of hospital stay were included into the analysis. Patient history, clinical history, imaging, and 2-month clinical outcome including review of medical records and telephone interviews served as reference standard. From the 25 indeterminate spleen lesions in CT, 11 (44%) were traumatic; nine (36%) were non-traumatic (pseudocysts, n = 5; hemangioma, n = 4) and five proven to represent artifacts in CT. The ISS (P  0.05). The MRI features ill-defined lesion borders, variable signal intensity on T1- and T2-weighted images depending on the age of the hematoma, focal contrast enhancement indicating traumatic pseudoaneurysm, perilesional contrast enhancement, and edema were most indicative for traumatic spleen lesions. As compared with CT (2/25), MRI (5/25) better depicted thin subcapsular hematomas as indicator of traumatic spleen injury. In conclusion, MRI shows value for characterizing indeterminate spleen lesions in primary CT after blunt abdominal trauma

High-pitch coronary CT angiography with third generation dual-source CT: limits of heart rate

To determine the average heart rate (HR) and heart rate variability (HRV) required for diagnostic imaging of the coronary arteries in patients undergoing high-pitch CT-angiography (CTA) with third-generation dual-source CT. Fifty consecutive patients underwent CTA of the thoracic (n=8) and thoracoabdominal (n=42) aorta with third-generation dual-source 192-slice CT with prospective electrocardiography (ECG)-gating at a pitch of 3.2. No β-blockers were administered. Motion artifacts of coronary arteries were graded on a 4-point scale. Average HR and HRV were noted. The average HR was 66±11beats per minute (bpm) (range 45-96bpm); the HRV was 7.3±4.4bpm (range 3-20bpm). Interobserver agreement on grade of image quality for the 642 coronary segments evaluated by both observers was good (κ=0.71). Diagnostic image quality was found for 608 of the 642 segments (95%) in 43 of 50 patients (86%). In 14% of the patients, image quality was nondiagnostic for at least one segment. HR (p=0.001) was significantly higher in patients with at least one non-diagnostic segment compared to those without. There was no significant difference (p>0.05) in HRV between patients with nondiagnostic segments and those with diagnostic images of all segments. All patients with a HR<70bpm had diagnostic image quality in all coronary segments. The effective radiation dose and scan time for the heart were 0.4±0.1mSv and 0.17±0.02s, respectively. Third-generation dual-source 192-slice CT allows for coronary angiography in the prospectively ECG-gated high-pitch mode with diagnostic image quality at HR up to 70bpm. HRV is not significantly related to image quality of coronary CTA

Sizing the mitral annulus in healthy subjects and patients with mitral regurgitation: 2D versus 3D measurements from cardiac CT

The purpose of our study was (1) to assess retrospectively, in healthy subjects and in patients with moderate and severe functional mitral regurgitation (FMR), the normal mitral annular dimensions, (2) to determine differences in mitral annular geometry between healthy subjects and patients with FMR, and (3) to evaluate potential errors in 2-dimensional (2D) measurements given the 3D nature of the mitral annulus. 15 patients with no cardiac abnormalities (referred to as normals), 13 with moderate and 15 with severe FMR as determined by echocardiography underwent contrast-enhanced cardiac 64-slice Computed tomography (CT) with prospective electrocardiography-gating for excluding coronary artery disease. With an advanced visualization, segmentation, and image analysis software, the area, intercommissural distance (CC), septolateral distance (SLD), and the anterior and posterior circumference of the MA were measured in diastole. We found significant (P.05). Measurements in 3D differed significantly from those with 2D for all circumference measurements and groups (P<.01), with a systematic underestimation of the posterior circumference of 2.1±1.5mm in normals, 1.8±1.3mm in patients with moderate FMR, and 1.9±1.9mm in patients with severe FMR for 2D. Our study provides in vivo human CT data on MA dimensions in normals and patients with FMR, indicating differences in patients for the area, posterior circumference and SLD but not for the anterior circumference and CC. Systematic differences exist between 2D and 3D measurements for all circumferential measurements

Performance of turbo high-pitch dual-source CT for coronary CT angiography: first ex vivo and patient experience

Objectives: To evaluate image quality, maximal heart rate allowing for diagnostic imaging, and radiation dose of turbo high-pitch dual-source coronary computed tomographic angiography (CCTA). Methods: First, a cardiac motion phantom simulating heart rates (HRs) from 60-90bpm in 5-bpm steps was examined on a third-generation dual-source 192-slice CT (prospective ECG-triggering, pitch 3.2; rotation time, 250ms). Subjective image quality regarding the presence of motion artefacts was interpreted by two readers on a four-point scale (1, excellent; 4, non-diagnostic). Objective image quality was assessed by calculating distortion vectors. Thereafter, 20 consecutive patients (median, 50years) undergoing clinically indicated CCTA were included. Results: In the phantom study, image quality was rated diagnostic up to the HR75 bpm, with object distortion being 1mm or less. Distortion increased above 1mm at HR of 80-90bpm. Patients had a mean HR of 66bpm (47-78bpm). Coronary segments were of diagnostic image quality for all patients with HR up to 73bpm. Average effective radiation dose in patients was 0.6 ± 0.3mSv. Conclusions: Our combined phantom and patient study indicates that CCTA with turbo high-pitch third-generation dual-source 192-slice CT can be performed at HR up to 75bpm while maintaining diagnostic image quality, being associated with an average radiation dose of 0.6mSv. Key points : • CCTA is feasible with the turbo high-pitch mode. • Turbo high-pitch CCTA provides diagnostic image quality up to 73bpm. • The radiation dose of high-pitch CCTA is 0.6mSv on average

Perfusion CT best predicts outcome after radioembolization of liver metastases: a comparison of radionuclide and CT imaging techniques

Objective: To determine the best predictor for the response to and survival with transarterial radioembolisation (RE) with 90yttrium microspheres in patients with liver metastases. Methods: Forty consecutive patients with liver metastases undergoing RE were evaluated with multiphase CT, perfusion CT and 99mTc-MAA SPECT. Arterial perfusion (AP) from perfusion CT, HU values from the arterial (aHU) and portal venous phase (pvHU) CT, and 99mTc-MAA uptake ratio of metastases were determined. Morphologic response was evaluated after 4months and available in 30 patients. One-year survival was calculated with Kaplan-Meier curves. Results: We found significant differences between responders and non-responders for AP (P 20ml/100ml/min had a significantly (P = 0.01) higher 1-year survival, whereas an aHU value >55 HU did not discriminate survival (P = 0.12). The Cox proportional hazard model revealed AP as the only significant (P = 0.02) independent predictor of survival. Conclusion: Compared to arterial and portal venous enhancement and the 99mTc-MAA uptake ratio of liver metastases, the AP from perfusion CT is the best predictor of morphologic response to and 1-year survival with RE. Key Points : • Perfusion CT allows for calculation of the liver arterial perfusion. • Arterial perfusion of liver metastases differs between responders and non-responders to RE. • Arterial perfusion can be used to select patients responding to RE