Citations

Surgical removal of gallstones is performed about 500 000 times per year in the United States. Although the usual cost ranges from $5000 to more than $10 000 per patient, the operative mortality is less than 1% for otherwise healthy persons. Nonsurgical dissolution of gallstones is often possible, but many gallstones contain calcium compounds that slow or prevent dissolution using the direct content cholesterol solvent, methyl tertbutyl ether (MTBE). Extracorporeal shock wave lithotripsy (ESL) has potential clinical utility for facilitating dissolution and possibly allowing spontaneous or induced passage of small fragments via the bile ducts and intestines. Obstacles to be overcome include predictable fragmentation of multiple stones up to 3 cm in diameter so that all particles are small enough to be rapidly dissolved or pass safely through the bile ducts (⩽ 3 mm). This must be achieved using biologically tolerable shock wave dosages without requiring general anesthesia within one or two treatment sessions. Acute and chronic safety, patient acceptance, and cost must be competitive with surgical treatment. Initial experience suggests that only solitary noncalcified stones (10% of patients with stones) have a high probability of success using ESL plus oral bile acid dissolution therapy. Improving ESL technology and direct contact fragment dissolution using MTBE should increase the clinical utility of shock wave lithotripsy of gallstones.

A nonlinear model of the human aural system is proposed. Utilizing a homomorphic transformation, the model is implemented in a digital computer and accounts for the Fletcher critical bands in hearing, the nonlinear relationship between input sound intensity and perceived loudness known as recruitment, as well as the thresholds of audibility and the maximum tolerance threshold. The transformed or output signal domain is identified as a perceptual space. It is shown that the model can be used to reproduce the Fletcher Munson equal loudness contours for normal hearing populations. Modification of easily measured parameters results in the generation of equal loudness contours for hearing impaired individuals. Through a combination of the forward homomorphic transformation for normal hearing to the perceptual domain and the inverse mapping utilizing parameters of a hearing impaired individual, it is shown that hearing intelligibility is dramatically improved. It is postulated that signal processing performed in the perceptual domain will produce results more pleasing and intelligible to the listener. Results of auditory testing utilizing the proposed model for both normal and hearing impaired populations are presented. Speech intelligibility scores are shown to increase by more than 40% (i.e., from 40% to over 80%) over preprocessed scores under headphones for hearing impaired subjects used in these tests.

Research suggests that negative affect is an important mediator in the relationship between body dissatisfaction and bulimic symptoms. This study examines the mediational role of specific emotion regulation processes (i.e., negative emotionality, poor awareness of emotion, nonconstructive coping with negative emotion) in bulimic symptoms. In addition to these emotion regulation variables, body dissatisfaction and bulimic symptoms were assessed in 234 girls in Grades 6 to 8 (mean age = 12 years, 11 months). The results indicated that negative affect, poor awareness of emotion, and nonconstructive coping with negative emotion partially mediated the relationship between body dissatisfaction and bulimic behaviors. The findings are discussed in light of previous research that suggests emotion regulation needs to be viewed as a multidimensional construct.

On the basis of many measurements on attenuation, absorption, and speed of ultrasound in biological materials, one can make the following generalizations: (a) Biological tissues have high attenuation coefficients, about two to three orders greater than their major component, water; (b) the amplitude attenuation coefficient increases with frequency near-linearly in soft tissues and near-quadratically in fluids with frequency in the range 1 to 10 MHz, and possibly even up to 100 MHz; (c) speed dispersion is extremely small (∼0.1 to 1 m/s/ MHz); (d) absorption and attenuation coefficients either increase or decrease with an increase in temperature, depending on the nature of the tissue, and the frequency of irradiatiOn; (e) fluids containing proteins show a sharp increase in excess absorption in acidic and basic pH ranges, and finally; (f) at sufficiently high intensity of irradiation the absorption coefficient increases with intensity. Comprehensive models for the propagation of ultrasonic waves through lossy media should explain these experimental findings. We will review some of the current models and critically examine them in light of the definition of absorption in relation to attenuation and scattering. [Work supported by NIH CA 24085, CA 41324, and NSF 8310626.]

The validity of wave equations employed as system models in acoustical diffraction tomography is investigated using simulations and measurements of the scattering of plane ultrasound waves by cylinders. It is demonstrated by simulation and experiment that it can be appropriate to neglect density fluctuations and shear waves, implying that the commonly used form of the wave equation suitably describes scattering by fluctuations of acoustic speed and absorption. Diffraction tomographic reconstructions of simulated data reveal the importance of absorption, the behavior of the real and imaginary parts of the reconstructed refractive index, and the relative advantages and limitations of the Born and Rytov approximate transformations.

Changes in the nonlinear parameter B/A caused by the addition of monohydric alcohols to water have been investigated. The measurements, made by using an aqueous solution of n-propanol, isopropanol, and t-butanol, show that as the alcohol concentration is increased, B/A decreases to a minimum at approximately 10% concentration (by volume). Further increase in alcohol concentration raises B/A rapidly to a maximum at about 80% by volume. This complex variation in B/A is attributed to solute–solvent interaction which is believed to be due to an enhancement of water structure in the water-rich region. These results suggest that the magnitude of B/A may be closely related to the quasilattice structure of water, which to a first approximation can be expressed by relative amounts of bound and unbound water.

A study of the statistics of ultrasound speckle indicates that the noise-to-signal ratio (NSR) of the echo envelope peaks (EEP) in a B scan is monotonically related to the variance of the mean power of the backscattered echoes. If it is assumed that the backscattered echoes all have the same mean power, the NSR of the EEP’s in a B scan will be expected to reach a theoretical minimum value NSR0 (0.40∼0.42). In practical situations, the variance of the mean power of the echoes is increased due to the presence of both attenuation (including beam spreading) and the spatial variation in the backscattering cross section (BCS) of the tissue. Accordingly, the measured value of the NSR of the EEP’s is expected to be greater than the NSR0. In principle, the effects of beam pattern and the attenuation can be compensated for by system calibration and a depth-related gain function, respectively. The attenuation coefficient of the tissue may then be obtained by adjusting the gain function to minimize the NSR of the EEP’s. Due to the random nature of the heterogeneity of diseased tissue, the effect of the variation in the BCS, however, cannot be compensated for by the depth-related gain function. Therefore, the minimum value of the NSR indicates the spatial variation in the BCS and may finally correlate to the disease state of the tissue.

Hearing threshold configuration of the impaired ear was simulated, via two different methods, in the normal ear of each of six subjects with unilateral sensorineural hearing loss. The simulation methods were (1) frequency-specific attenuation (filtering), and (2) masking by shaped masking noise. Identification responses to 20 consonant-vowel nonsense syllables were obtained from the normal ear of each subject in both hearing loss simulation conditions, as well as from the impaired ear. Data were scored both for percent correct syllable recognition and for errors on a set of eight consonant features. Overall performance level and consonant feature error patterns appeared to be relatively independent measures of speech recognition. For three subjects, both masking and filtering successfully simulated the effects of sensorineural hearing loss on consonant feature error patterns. For the remaining subjects, one or both of the simulation schemes was inadequate. [Supported by NINCDS Grant NS-12125.]