Computer-assisted robotic antireflux surgery

Robotic surgical systems are relatively new technical devices designed to address several of the limitations inherent to standard laparoscopy. Since the 1(st) report of a computer-assisted fundoplication in 1997, numerous authors have reported their experiences with these devices in antireflux surgery. While there are several advantages to robotic when compared to standard laparoscopic antireflux surgery, there are also some distinct drawbacks. Robotic surgical systems allow the surgeon to perform more complex maneuvers with increased precision and accuracy, and without tremor. The image is high-definition and the surgeon operates in a more ergonomic position. These systems are also costly to purchase and maintain, they are large and may limit access to the patient during surgery, they provide a narrower field of view of the operative site, and they provide the surgeon with essentially no tactile feedback. Clinical outcomes of robotic fundoplication seem to be very similar to those of standard laparoscopic fundoplication, although the operating times in many series are increased when using the robot. The role of computer-assisted fundoplication in general practice, at least at the current level of robotic technology, remains to be defined.     

Computer-assisted personalized sedation

The American Society for Gastrointestinal Endoscopy (ASGE) Technology Committee provides reviews of new or emerging endoscopic technologies that have the potential to have an impact on the practice of GI endoscopy. Evidence-based methodology is used, with a MEDLINE literature search to identify pertinent preclinical and clinical studies on the topic, and a MAUDE (Manufacturer and User Facility Device Experience; U.S. Food and Drug Administration Center for Devices and Radiological Health) database search to identify the reported complications of a given technology. Both are supplemented by accessing the "related articles" feature of PubMed and by scrutinizing pertinent references cited by the identified studies. Controlled clinical trials are emphasized but, in many cases, data from randomized, controlled trials are lacking. In such cases, large case series, preliminary clinical studies, and expert opinions are used. Technical data are gathered from traditional and Web-based publications, proprietary publications, and informal communications with pertinent vendors. For this review, the MEDLINE database was searched through January 2010 using the keywords "computer," "computerized," "computer-assisted," "sedation," "propofol." Reports on Emerging Technology are drafted by 1 or 2 members of the ASGE Technology Committee, reviewed and edited by the committee as a whole, and approved by the Governing Board of the ASGE. These reports are scientific reviews provided solely for educational and informational purposes. Reports on Emerging Technology are not rules and should not be construed as establishing a legal standard of care or as encouraging, advocating, requiring, or discouraging any particular treatment or payment for such treatment.     

Computer-assisted evaluation of bicycle ergometry

The pedal ergometry is a reliable method for testing the functional capacity of patients with organic arterial obstructive diseases of the lower extremities. In order to lower the loss of time for evaluation pedal work and performance were calculated by means of a microcomputer KC 85/1 with the help of a basic programme using Hall switch circuits. The connection between working ability of the pedal, type of obstruction and pressure values of the posterior tibial artery is documented in the light of the measuring results of 61 patients with arterial obstructive disease of the lower extremities and of 32 test persons with healthy vessels.     

Computer-assisted critical care information management

A well-designed, reliable, flexible computer system has a place in the modern critical care unit. Such a system may be designed in-house, or a commercial system may be adaptable to specific needs. The features of such a specialized system are outlined, with emphasis on the importance of user-modifiable and expandable software and hardware.     

Computer-assisted diagnosis of rheumatic disorders.

A review of the literature regarding computer-assisted diagnosis of rheumatic diseases is presented. After a general outline of the history and goals of computer programs intended to support physicians in the diagnostic process, 14 systems or projects are described. The scope of seven of these is general internal medicine, and the other seven are intended exclusively for rheumatic problems. The majority of these systems are prototypes. To date, none of them is widely used by physicians. Preliminary evaluation studies and/or independent reviews have been reported for all of the systems. The need for further evaluation studies is recognized, and strategies to carry these out are outlined. Furthermore, the potential usefulness for patient care and education is discussed. It is concluded that a new and interesting field is being developed that deserves more attention among rheumatologists.     

Computer-assisted self-control of diabetes by adolescents

This paper reports an experimental investigation of the microcomputer-based system, Diabetes in Self-Control (DISC), used to facilitate adolescents' self-management of insulin-dependent diabetes mellitus. Twenty 12- to 19-year-old subjects were matched into 10 pairs and randomly assigned to DISC or conventional education (CE). Following a no-treatment phase, information about diabetes and self-monitoring was presented during 7 weeks of phase 2 by means of computer-assisted instruction for the DISC group and printed materials for the CE group. During the 8 weeks of phase 3, DISC subjects received training on monitoring the relationships among variables, diabetes problem solving, and goal setting. Improvement that was both statistically and clinically significant was noted in the DISC group's prelunch and dinner glucose levels. The DISC group showed clinical improvement in frequency of blood glucose testing. Finally, DISC subjects reported more behavioral change as a function of what was learned.     

Computer-assisted diabetes therapy--a challenge for modern medicine

By the use of computers in the therapy of diabetes new diagnostic and therapeutic possibilities are brought about. The computers open the possibility for a comprehensive data seizing, evaluation of the stored material and possibilities of various abilities for demonstration. Moreover, it becomes possible to regulate the therapy more subtly with the help of self-adapting programs and in its consequence to render it more effective than the own management of therapy is able to do it. This manifests itself significantly in badly or only moderately stabilised diabetics. In very well educated and trained diabetics even the superiority of the management of the computer becomes visible. Here this can no more be shown in the improvement of the stabilisation of diabetes which can no more be improved without risks for the patient. In these patients it is the reduction of the frequency of hyperglycaemia, by means of which can be shown that the stabilisation of diabetes in diabetics who were well stabilised already before can still be improved by the computer therapy. In addition to this the computer seems to cause further positive effects on the learning behaviour of the diabetics.     

Computer-assisted ambulatory long-term manometry of tubular esophagus

A two-channel 24-hr digital recording of esophageal pressure generates about 20 times more data than an esophageal pH-metry if an appropriate high sampling rate is used and unreduced data are stored. Because of this large amount of data, manual data evaluation is no longer feasible, and a computer-assisted procedure becomes necessary. The system presented here consists of a combined one-channel pH and two-channel pressure probe, a digital data logger, and a computer program for automated evaluation (CAMA). From the pH channel, standard variables (acid exposure time and number of reflux episodes) are calculated. The analysis of the pressure channels is completed in five distinct steps: (1) recognition of contractory events using dynamically recalculated baseline and threshold values, (2) characterization of contractory events, (3) rejection of artifacts, (4) classification of contractions, and (5) integrated analysis (frequency analysis, hourly patterns of single variables, relation to other external variables). This system has been used successfully more than 150 times in more than 120 patients and volunteers; validation was done for contraction characterization by comparing the system's performance with manual analysis and for contraction detection and classification by comparing its performance with a reference standard established from a questionnaire evaluated by international experts. In addition, the reproducibility of esophageal motility has been tested in a series of repeated measurements, and the system has been used to assess the 24-hr pattern of esophageal motility.Supported by Deutsche Forschungsgemeinschaft grant Em 36/2-1 and by Swiss National Foundation grant 32-26369.89     

Computer-assisted analysis helps detect inner dynein arm abnormalities

The diagnosis of primary ciliary dyskinesia is based on demonstration of ciliary defects, mainly concerning dynein arms. Whereas the absence of outer dynein arms can be easily distinguished, the absence of inner dynein arms is difficult to confirm because of their low contrast on electron microscopy. Ciliary ultrastructure was studied in 40 patients suffering from respiratory tract infections. Conventional transmission electron microscopy showed normal cilia in 6 patients, confirmed a diagnosis of primary ciliary dyskinesia in 26 patients, and was inconclusive in 8 patients. All doubtful cases were related to inner dynein arm determination. Conventional electron microscopic analysis was able to define the ultrastructural phenotype of inner dynein arms in 40.5% of cases (6 presence of inner dynein arms, 13 absence of inner dynein arms). We developed computer-assisted analysis of electron microscopic micrographs to improve inner dynein arm visualization. Computer-assisted analysis consisted of image transformations designed to enhance the signal/noise ratio, based on the symmetry of ciliary axonemes. The sensitivity and specificity of computer-assisted analysis were 100 and 98%, respectively. The efficiency of computer-assisted analysis to visualize inner dynein arms, evaluated in the patients with undetermined phenotype after electron microscopy, was 86% (three normal cilia, seven primary ciliary dyskinesia with absence of outer dynein arms, three primary ciliary dyskinesia with absence of inner dynein arms, five partial absence of inner dynein arms). Computer-assisted analysis of ciliary micrographs improves the characterization of inherited axonemal defects.     

Computer-assisted review of digoxin therapy in the elderly

Current practice with digoxin was assessed in a group of 42 elderly patients by comparing plasma digoxin concentrations attained on previously established maintenance doses with those generated by a computer programme designed to calculate dosage schedules to suit individual patients. Discrepancies between measured and computed plasma levels and between established and computed doses dictated withdrawal of the drug or revision of dosage in 26 patients (62%), with obvious clinical benefit. An important determinant of dosage was renal function; reduction in creatinine clearance provided good evidence for the loss of ability of the elderly kidney to eliminate digoxin. Simple bedside methods are available which permit a reliable estimate of creatinine clearance without a 24-hour urine collection, provoding a rational basis for the choice of digoxin dosage in the elderly.     

Computer-assisted learning in undergraduate and postgraduate rheumatology education

Computers and the Internet form a large part of our professional and personal lives. There are advantages and disadvantages to computer-assisted learning which will be discussed. An Internet and Medline search was performed to assess the educational content of rheumatology websites and also their effect on learning in the undergraduate and postgraduate setting.     

Computer-assisted tomographic findings in a patient with African trypanosomiasis

A 5-year-old boy was diagnosed to have trypanosomiasis and responded to treatment with diminazine. However, 22 months later symptoms recurred, with evidence of cerebral trypanosomiasis. Computer assisted tomography (CAT) scans were subsequently performed on three occasions. He was treated with melarsoprol and to date has made a full recovery. This paper reports on the evolution of the cerebral lesions shown up by the CAT scans.