Biomedical subjects

D Gravel

Publications and source records attributed to D Gravel.

At least 19 recordsLinked to original sources

PubMed1998

Clinical results of a pharmacodynamically-based strategy for higher dosing of gemcitabine in patients with solid tumors.

BACKGROUND: The long intracellular half-life of gemcitabine's active metabolite, difluorodeoxycytidine triphosphate (dFdCTP), suggested that small increases in peak intracellular dFdCTP levels would have a profound effect on its intracellular area under the curve (AUC). Previous studies had shown that a dose rate of 10 mg/m2/min that achieved plasma gemcitabine concentrations of 15-20 mumol/l maximized the intracellular rate of accumulation of dFdCTP. This phase I study was therefore designed to evaluate the clinical feasibility of this pharmacologically-based strategy; assessing the toxic effects and anticancer activity of high weekly doses of gemcitabine administered at a fixed dose rate of 10 mg/m2/min. PATIENTS AND METHODS: Thirty one patients with solid tumor malignancies received 103 courses of gemcitabine. Twenty nine patients had received prior treatment. Weekly doses were escalated from 1200 mg/m2 administered intravenously over 120 minutes to 2800 mg/m2 over 280 minutes for three weeks every four weeks. RESULTS: The first-course MTD was 2250 mg/m2. The dose-limiting toxicity was myelosuppression with thrombocytopenia and granulocytopenia quantitatively more important than anemia. However, cumulative myelosuppression was documented suggesting that a lower MTD of 1800 mg/m2 was more appropriate with a recommended phase II starting dose of 1500 mg/m2. There was no neurologic toxicity. Nonhematologic toxicity was minimal and included fatigue, nausea, and skin rash, but was not dose dependent. Three objective responses were documented. CONCLUSIONS: Escalated doses of gemcitabine designed to maximize intracellular dFdCTP levels can be safely administered using a fixed dose rate. The encouraging anticancer effects documented in patients with refractory malignancies suggests that short gemcitabine infusions based on well-established cellular pharmacologic principles may improve the therapeutic index of this agent. Comparison with standard 30-minute bolus dosing will be evaluated in subsequent randomized phase II trials.

Adult↗

PubMed1998

A static dynamometer measuring simultaneous torques exerted at the upper limb.

The majority of available dynamometers are designed to measure force or torque in one specific direction, one joint at a time. For the quantification of motor incoordination in neurological patient populations, these dynamometers provide limited information about the global behavior of the limb under investigation. This report describes the potential use and function of a static dynamometer measuring torques exerted simultaneously at the shoulder (flexion-extension, abduction-adduction, internal-external rotation), elbow (flexion-extension), and forearm (pronation-supination). Orthogonal forces were measured at the arm and wrist using strain gauge transducers interfaced with a laboratory computer. The lever arms were specified to a software program and the joint torques were calculated in real time according to static equilibrium equations. The use of the dynamometer is illustrated by characterizing for one hemiparetic subject, the joints torques recorded at the shoulder, elbow, and forearm during isolated submaximal grip exertions at different force levels on both sides. The torques generated at the shoulder, elbow and forearm during the hand grip tasks on the affected side were significantly higher than those obtained on the nonaffected side and increased with the grip force level. These differences probably reflect the loss of movement selectivity observed following a lesion in the central nervous system. Further studies are currently being undertaken in neurological patient populations to characterize and quantify motor deficits using this dynamometer. As a long term goal, we hope that the method and technologies described here will contribute to the evaluation and rehabilitation of these populations.

Biofeedback, Psychology↗

PubMed1997

Nutritional factors and colon carcinoma: a case-control study involving French Canadians in Montréal, Quebec, Canada.

BACKGROUND: In a population-based case-control study of colon carcinoma and nutrition involving the francophone community in Greater Montreal, a total of 402 cases (200 males and 202 females) and 668 controls (239 males and 429 females) were interviewed. METHODS: Cases from 1989-1993 were identified through the admission offices of 5 major francophone teaching hospitals in Montreal and were ages 35-79 years. Controls matched by age, place of residence, and language were selected by a modified random digit dialing method. Information on dietary intake was collected with a quantitative food frequency questionnaire. RESULTS: No associations were evident between colon carcinoma and total energy, protein, or carbohydrate consumption, whereas a suggestive inverse association was found with total fat intake, with an odds ratio (OR) of 0.78 (P = 0.0637), and with saturated fat intake as well (OR = 0.71, P = 0.0893). A strongly significant inverse association was found with dietary fiber (OR = 0.50, P = 0.0018). The strongest inverse association concerning fiber was found with fiber from vegetable sources (OR = 0.57, P = 0.0096), and a suggestive (although nonsignificant) inverse association (OR = 0.74, P = 0.0687) was found with fiber from fruits. Calcium was inversely associated with risk (OR = 0.69, P = 0.0411), as was dietary intake of vitamin A (OR = 0.67, P = 0.0162), retinol, (OR = 0.069, P = 0.0409), vitamin E (OR = 0.53, P = 0.0028), and alphatocopherol (OR = 0.63, P = 0.0256). Although there was no association demonstrated between dietary beta-carotene intake and risk, a suggestive (although nonsignificant) inverse association with intake of other types of carotene was observed (OR = 0.76, P = 0.0740). No association was found between intake of other nutrients investigated in this study and risk of colon carcinoma. CONCLUSIONS: There is strong evidence from epidemiologic studies that high intake of fat and meat are risk factors for colorectal carcinoma in humans, whereas high intake of vegetable and fruit are inversely associated with risk of colon carcinoma. The findings from this study are in agreement with this observation.

Adult↗

PubMed1997

Characterization of global synkineses during hand grip in hemiparetic patients.

OBJECTIVE: Global synkineses are defined as nonpurposive associated movements on the involved side of hemiparetic subjects that are triggered during a voluntary movement. The purpose of this study was to characterize the intensity and pattern of upper limb global synkineses in hemiparetic subjects with a static biarticular dynamometer and electromyography during maximal progressive hand grip on the unaffected side. DESIGN: Survey, convenience sample. SETTINGS: University secondary care rehabilitation center. DATA SET: Global synkineses (ie, torques and electromyographic activities) in patients with severe (n = 8) and moderate (n = 7) deficits in motor performance, as evaluated by the Fugl-Meyer assessment, were compared with those obtained in a group of healthy subjects (n = 11). Clinically the subjects from the severe deficit group were more spastic and showed less strength at the elbow than the subjects from the moderate deficit group. RESULTS: Results of analyses of variance showed significant increases of shoulder torque in flexion and internal rotation, and elbow torque in flexion, with increasing force exertion during contralateral hand grip in subjects with severe deficits (p < .05). Furthermore, in these subjects increases of electromyographic activity were also observed in biceps brachii, brachioradialis, and triceps brachii muscles with increasing hand grip force levels. In contrast, no significant torques or electromyographic increases were observed in subjects with moderate deficits and in control subjects during contralateral hand grip exertions. CONCLUSION: These results provide a quantitative assessment of the kinematic and electromyographic patterns of global synkineses and their correlates with clinical observations. Within the limits of the experimental results presented in this study, it is suggested that global synkineses result from contralateral overflow of the voluntary command to hyperexcitable motoneuron pools.

Adult↗

PubMed1997

Relationships between torque, velocity and power output during plantarflexion in healthy subjects.

This study investigated the relationships existing between torque, velocity and power output during plantarflexion. Using a Biodex dynamometric system, 15 healthy subjects performed three maximal dynamic tests, ranging from -12 degrees (-0.209 rad) of dorsiflexion to +47 degrees (+0.818 rad) of plantarflexion and one static test (test 4) at an angle of +10 degrees (+0.174 rad). The dynamic assessment included a 30 degrees s-1 (0.52 rad s-1) concentric isokinetic test (test 1) preceded by a 2-sec maximal pre-loading contraction. The other two dynamic tests were performed using the isotonic mode of testing with a selected torque of 27 N m; one of these tests was executed with pre-loading (test 2) while the other was performed without pre-loading (test 3). The results indicated that the dynamic peak torque, the peak power and the peak velocity were obtained in test 1, test 2 and test 3, respectively. These peak values, as well as the values of torque (test 1 and test 4), power (test 2) and velocity (test 3) obtained at a constant angle +10 degrees (+0.174 rad), were selected for the correlation analyses. The results showed that the torque, velocity and power output during plantarflexion were linearly related to one another with significant correlations (0.71 < r < 0.92; p < 0.01). This finding suggests that a common factor of muscular performance is assessed. Furthermore, these results indicated that the maximal torque produced by a subject can be predictive of his or her maximal velocity and power. Consequently, a stronger subject can generate higher velocity and power than a weaker subject when tested with the same load during maximal effort.

Adult↗

PubMed1997

Dynamometric assessment of the plantarflexors in hemiparetic subjects: relations between muscular, gait and clinical parameters.

The aims of this study were to investigate, in 16 subjects with hemiparesis, the plantarflexor muscle performance of the paretic side and to determine the level of the relationships between muscular parameters, clinical measures and gait performance. A Biodex dynamometric system was used to evaluate static and dynamic torques, power and maximal rate of tension development of the plantarflexor muscles. The clinical measures included the Fugl-Meyer assessment (FMA), the "Up & Go" test and an evaluation of ankle muscle tone. Velocity, cadence, stride length and gait cycle duration were determined for each subject at both comfortable and maximal safe speeds using foot contacts and videographic data. Results indicated that dynamometric values produced by the hemiparetic subjects were reduced in comparison to those reported for healthy subjects. Their torque-angle curves had a curvilinear shape which indicated pronounced decrease of torque for plantarflexion efforts at the beginning of the movement. Torques produced at different velocities of testing did not demonstrate significant differences (MANOVAs: p > 0.05) but power values were significantly different. Results also showed that all the selected muscular parameters (torque, power and maximal rate of tension development) were moderately to highly interrelated (0.65 < r < 0.94; p < 0.01) suggesting that a common factor of muscular performance was assessed. Furthermore, the dynamometric data were significantly associated with some of the clinical measures (sensation and lower limb motor control scores of the FMA) but were not related to the gait variables (Pearson's r < 0.45; p > 0.05). This last finding suggests that the relationship between plantarflexor strength and the level of gait performance in adults with stroke is complex. The relationship may be influenced by other factors such as muscular compensations within and between limbs and motor control impairments.

Adolescent↗

PubMed1996

Knee movement strategies differentiate expert from novice workers in asymmetrical manual materials handling.

One way to generate hypotheses on appropriate handling principles is to compare the strategies of highly skilled workers (experts) with those of novice workers (novices). This study was conducted to determine whether experts differ from novices in their handling strategies and to determine the effects of these differences in joint motions and net reaction moments at the trunk (L5/S1) and knees. Six experts and five novices were compared transferring two loads (12 and 22 kg) from four different initial low positions to a standardized low position on a trolley. The external forces were obtained from two AMTI force platforms, and two 16 mm Locam cameras coupled with two mirrors were used to obtain the three-dimensional kinematic data. An inverse dynamic analysis was performed on each segment and the net reaction moments were evaluated at L5/S1 and the knees; trunk posture, knee flexion angles and feet spacings were also calculated. Results showed that both groups minimized trunk asymmetries of posture and efforts; however, the experts were characterized by reduced knee flexion (31 degrees vs 53 degrees) and total knee excursion (20 degrees vs 38 degrees), increased flexion moments (72 vs 58 Nm) but reduced extension moments (4 vs 26 Nm) and valgus moments (30 vs 54 Nm). The experts' strategies appear safer overall because they reduce trunk asymmetry, asymmetrical efforts on the knee and stress on the femoropatellar joint. Moreover, these strategies present a potential for reduced mechanical energy expenditure due to lower knee excursions and increased knee stability due to reduced knee flexion.

Adult↗

PubMed1996

Preloading and range of motion effect on plantarflexor muscle performance.

OBJECTIVE: To determine the effects of maximal preloading and range of motion (ROM) on the mechanical parameters of the plantarflexor muscles obtained while using the isotonic mode of testing of a Biodex dynamometer. DESIGN: A convenience sample of healthy subjects in the context of a descriptive comparative study. SETTING: Research laboratory in Canada. SUBJECTS: Fifteen volunteered subjects without history of injury or disorder to the right lower extremity. MEASUREMENTS: Four maximal isotonic tests were performed against a selected load of 27Nm. For the first two tests, the movement at the ankle ranged from -12 degrees (dorsiflexion) to +32 degrees (plantarflexion); one of these tests was preceded by a 2-second maximal preloading contraction, while the other was performed without preloading. For the other two tests, the ROM at the ankle was increased by 15 degrees of plantarflexion and thus ranged from -12 degrees to +47 degrees; again one of these tests was executed with preloading and the other without preloading. RESULTS: The four tests showed differences in the mechanical parameters (MANOVA p < .05). At angles of -10 degrees and +5 degrees, subjects produced higher torque and power but lower velocity values for the two tests preceded by a maximal preloading. The effect of ROM was demonstrated at +20 degrees where tests performed in a small amplitude reached a lower velocity than the corresponding tests performed in a larger amplitude. Based on the velocity profiles, the results also revealed that maximal preloading changed the selected isotonic movement of the Biodex dynamometer to an isoaccelerative movement characterized by high torque and power production. CONCLUSIONS: Isotonic assessment using the Biodex dynamometer provides different values of torque, velocity, and power depending on the testing conditions used. In clinical settings, it would be important to control these testing conditions.

Analysis of Variance↗

PubMed1996

Detection of gas embolism by transesophageal echocardiography during laparoscopic cholecystectomy.

Using transesophageal echocardiography (TEE), 16 patients (ASA physical status I-III), undergoing laparoscopic cholecystectomy, were assessed for the occurrence of episodes of gas embolism and cardiovascular changes related to those emboli. The long-axis four-chamber view was monitored continuously, except for predetermined intervals where the transgastric short-axis view was obtained to derive the end-diastolic area (EDA), the end-systolic area (ESA), and the ejection fraction (EF). In one patient, we monitored the longitudinal view of the superior and the inferior vena cava. The monitoring of the patients also included: heart rate (HR), mean arterial pressure (MAP), arterial saturation by pulse oximetry (Spo2), end-tidal CO2 (ETCO2), minute ventilation (VE), and peak inspiratory pressure (PIP). Embolic events were defined as the appearance of gas bubbles in the right cardiac chambers. We observed gas embolism in 11/16 patients (five during peritoneal insufflation and six during gallbladder dissection). Using the longitudinal view of the superior and inferior vena cava (IVC), we found that these emboli were transmitted through the IVC. No episode of cardiorespiratory instability (decrease in MAP > or = 10 mm Hg, Spo2 < 90%) was observed. There was no significant difference in cardiorespiratory variables between patients who presented gas embolism (n = 11) and patients who did not (n = 5) during the studied period. In this small group of patients, we conclude that gas embolism occurs commonly during laparoscopic cholecystectomy but that these gas emboli cause minimal cardiorespiratory instability.

Adult↗

PubMed1996

A mechanical model to study the relationship between gait speed and muscular strength.

This study proposes a mechanical model to investigate the relationship between gait speed and strength of the ankle plantarflexor muscles. The model calculates the muscular utilization ratio (MUR) of the plantarflexor muscles during gait by comparing the plantarflexion moment used while walking to the maximal moment of the plantarflexors estimated from dynamometric measurements. To verify the model, MURs of the plantarflexor muscles were calculated for five healthy subjects and one hemiparetic subject walking at different speeds (slow, self-selected, and fast). Generally, the results of the healthy subjects revealed that MURs increase with an increasing gait speed: average (+/-SD) peak values of MUR reached 58.8% (+/-18.5), 65.6% (+/-17.2) and 71.0% (+/-17.8) for the slow, self-selected, and fast speeds, respectively. The average peak value of MURs at the self-selected speed corresponds to values reported in electromyographic studies of the plantarflexor muscles. At self-selected gait speed, the hemiparetic subject presented a higher peak MUR (80.5%) of the plantarflexors and a lower gait velocity when compared to healthy subjects. For the hemiparetic subject, peak values of MUR of the plantarflexor muscles at maximal walking speed reached 100% suggesting that full activation of the plantarflexors had been reached preventing him from walking faster. From these preliminary results, it appears that MURs calculated by the proposed model are sensitive to the mechanical demands imposed on a group of muscles during a task (eg., increase in gait speed) and to change in the maximal plantarflexor's strength (eg., weakness). The proposed model seems to have the potential to demonstrate whether muscle weakness limits maximal gait speed in hemiparetic subjects. However, considering the complexity of gait speed regulation in hemiparetic patients, the model should be tested on a large number of hemiparetic subjects.

Adolescent↗

PubMed1996

[Comparison of hemodynamic and ventilatory effects of pneumoperitoneum using carbon dioxide or abdominal suspension during laparoscopic cholecystectomy].

This study compares the cardio-respiratory effects of CO2 pneumoperitoneum to those of abdominal suspension (or laparolift) in laparoscopic cholecystectomy. Between september 1993 et may 1995, 31 patients participated in this non-randomized prospective trial. They consisted of 9 males et 22 females, with a mean age of 47.0 +/- 14 years. Sixteen patients were included in the CO2 group and 15 in the laparolift group. Both groups were comparable for age and gender. All patients were submitted to the same anaesthetic protocol. Repeated measurements of the respiratory and cardiovascular function were made during the intervention. End tidal CO2, minute ventilation, peak inspiratory pressure showed superior elevations in the CO2 group. And for the hemodynamic parameters, only the mean arterial pressure and cardiac frequency differed between the two groups, other hemodynamic parameters including left ventricular ejection fraction were comparable. Also, postoperatory hospital stay, OR time, per and postoperatory complications were comparable. With its stable hemodynamic and ventilatory pattern, abdominal suspension can constitute a safe and secure alternative to CO2 pneumoperitoneum in patients with respiratory dysfunction.

Adult↗

PubMed1995

Changes in the electromyographic spectrum power distribution caused by a progressive increase in the force level.

The purpose of the present study was to determine the specific changes occurring in the power spectrum with an increasing force level during isometric contractions. Surface electromyographic signals of the triceps brachii (TB) and the anconeus (AN) of 29 normal subjects were recorded during isometric ramp contractions performed from 0 to 100% of the maximum voluntary contraction (MVC) in a 5-s period. Power spectra were obtained at 10, 20, 30, 40, 50, 60, 70, 80 and 90% MVC. Changes in the shape of these spectra were evaluated visually and with the calculation of several statistical parameters related to the distribution of power along the frequency axis, such as median frequency and mean power frequency, standard deviation, skewness, first and third quartiles and half-power range. For the AN, the behaviour of the spectrum was relatively similar across subjects, presenting a shift toward higher frequencies without any major change in the shape of the spectrum. For the TB, subjects with a thin skinfold thickness presented similar behaviours. In subjects with a thicker skinfold, however, a loss of power in the high frequency region paralleled the increase in the force level. Significant correlations were obtained between the extent of the change in the value of higher order statistical parameters across force and the thickness of the skin. This points out the importance of the skinfold layer when recording with surface electrodes. Furthermore, the use of a combination of several parameters appears to provide a better appreciation of the changes occurring in the spectrum than any single parameter taken alone.

Adult↗

PubMed1995

Effects of symmetry and load absorption of a falling load on 3D trunk muscular moments.

Some epidemiological data have suggested that many physical causes of low back pain such as bending and twisting were, in fact, sudden maximal efforts incidentally carried out at the moment of accident. Sudden loading conditions may be encountered in several circumstances, one of them being the recuperation of a falling load. Such conditions are more likely to occur in conditions of trunk asymmetry. The objective of this study was to determine spinal loadings associated with the reception of a falling box symmetrically and asymmetrically for two mechanisms of load absorption, one limited to the elbows and the other including full absorption with the elbows and lower limbs. It was hypothesized that asymmetrical receptions would be more strenuous for the spine; it was further hypothesized that the full absorption to decelerate the load might be more efficient in reducing the strain in the trunk muscular moments. Nine students in physical education with limited experience in manual materials handling were the subjects of the study. The tasks consisted of receiving a 6.6 kg load falling from a height of 50 cm above the flexed forearms when in a standing position. The subjects were tested with two AMTI force plates and two Locam cameras coupled with two mirrors; dynamic 3D multi-segment models were constructed and the net muscular moments as well as the angular velocities of the trunk relative to pelvis were determined about the three orthogonal axes of the trunk at L5/S1, in twisting, lateral bending, and flexion/extension. The dependent variables included maximal moments, maximal rates of loading for these moments, and the integration of these moments. Statistical analyses were performed to test the main effects of symmetry and absorption and their interaction. The results showed that asymmetrical conditions impose supplementary muscular exertions for trunk muscles, especially the trunk extensors and lateral flexors. Contrary to the proposed hypothesis, full absorption as used in the present study was a condition leading to considerably larger muscular exertions, especially for the loading rates. Thus it was concluded that the process of training for load absorption is essential to effectively decrease the risks of injuries. This factor would merit full consideration in future studies.

Absorption↗

PubMed1995

Comparisons of mechanical and electromyographical muscular utilization ratios.

The physical loading of a muscle during functional activities can be estimated by the muscular utilization ratio. This ratio is defined as the percentage of muscular involvement relative to the maximal capacity. Either mechanical or electromyographical approaches can be used to obtain the muscle utilization ratio. However, the non-linear relationship between electromyographical activity and muscle force, as well as the non-equivalence between agonist muscles, may create differences between the mechanical muscle utilization ratio calculated from joint moments and the electromyographical muscle utilization ratio calculated from electromyographical data. The aim of this study was to compare, during a squat test, the mechanical muscle utilization ratio and the electromyographical muscle utilization ratio estimated by three different methods; direct linear approximation, second order polynomial regression and linear interpolation. The knee extensor moment and electromyographical data of rectus femoris and vastus medialis of 11 subjects were recorded during both knee extension and squat. Both tests were performed with the knee maintained at 90 degrees of flexion. The results showed that: a) the electromyographical muscle utilization ratio, calculated from the average of vastus medialis and rectus femoris, significantly underestimates the mechanical muscle utilization ratio (ANOVA, p < 0.01), b) the differences between the mechanical muscle utilization ratio and the electromyographical muscle utilization ratio are larger for the direct linear approximation method than for the second order polynomial regression (ANOVA, p < 0.01) or the linear interpolation method (ANOVA, p < 0.01), and c) independent of the method utilized, there is no difference between the electromyographical muscle utilization ratio predicted by the vastus medialis as compared with the rectus femoris (ANOVA, p > 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1994

Comparison of the EMG power spectrum of the human soleus and gastrocnemius muscles.

The purpose of this study was to compare the behaviour of electromyographic (EMG) power spectrum statistics, mean power frequency (MPF) and median frequency (MF), across increasing force levels of the soleus (SO), gastrocnemius medialis (GM) and gastrocnemius lateralis (GL) muscles. Surface EMG signals of these three muscles were recorded in 12 men and 10 women during both (1) ramp (single ongoing contractions with the force increasing linearly from 0 to 100% of the maximum voluntary contraction (MVC); and (2) step (steady force levels: 10, 20, 30, 40, 60 and 80% MVC) static (isometric) plantar flexions. Power spectral analysis of these signals was performed on single 256-ms windows at all of the above-mentioned force levels, for both types of contraction. The MF and MPF were calculated from each of the obtained spectra. A less pronounced increase in the MF or MPF was expected for the SO because of its higher type I fibre content. The main results are as follows: (1) similar behaviours were found in the value of MPF and MF across increasing force for the SO and GL muscles, while the GM gave rise to a different behaviour; (2) no difference was found between ramp and step contractions in the behaviour of either MF or MPF across force levels; and (3) different behaviours were observed between the MF and MPF across increasing force levels, for both ramp and step contractions. Our initial expectations were thus not confirmed. It is concluded that the present results support the hypothesis that the EMG power spectrum may be more sensitive to the diameter of the fibres than to the fibre type proportion of the triceps surae muscles. Furthermore, the sensitivity of the power spectrum statistics of a given muscle to the low-pass filter effect of its skin layer was also emphasized.

Adult↗

PubMed1994

Common bile duct exploration: the place of laparoscopic choledochotomy.

Since laparoscopic cholecystectomy was introduced, the treatment of choledocholithiasis has been modified. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) has been performed selectively in elderly patients and in those with a strong suspicion of biliary duct stones (jaundice, demonstrated at ultrasound). Intraoperative discovery of common duct stones at cystic duct cholangiography signifies that they must be removed intraoperatively [or postoperatively by ERPC and endoscopic sphincterotomy (ES)]. As ES has a failure rate of 3-23%, laparoscopic common duct exploration emerges as the treatment of choice. Since November 1990, we have performed 59 laparoscopic common bile duct explorations. In our experience, the transcystic technique (18 patients) with choledochoscopy appears easier to perform than with fluoroscopy without choledochoscopy. Since, during our early experience, we encountered some difficulty with the transcystic technique, we elected to evaluate common duct exploration through a choledochotomy (41 patients). The main advantage of this technique is that it provides complete access to the ductal system without damage to the papilla. This procedure seems more difficult to perform than the transcystic technique and can be used when there are contraindications to the latter.

Adult↗

PubMed1994

[Abdominal rectopexy (Orr-Loygue) in rectal prolapse: celioscopic approach or conventional surgery].

One of the treatment modalities for rectal prolapse is abdominal rectopexy, a comparison of the Orr-Loygue procedure, performed by laparotomy and by laparoscopy was done. From June 1981 and May 1993, 31 females and 3 males, with an average of age of 58.8 were operated. Twelve patients were operated by laparoscopy (group I) and 22 patients by laparotomy (group II). Two patients (16.7%) in group I were converted to a laparotomy due in one to operative hemorrhage and in the other to adhesions. Seven patients in group I and 18 in group II had had previous abdominal surgery. Average operative time was 2.56 hours and 2.25 hours for groups I and II respectively. A reduction in post operative hospital stay (5 vs 8.3 days) as well as in intramuscular analgesic requirements (5.5 vs. 14.1 doses) was observed in group I vs. group II respectively. Time to oral intake and cessation of intravenous fluids were also reduced in group I compared to group II (1.0 vs. 3.9 days and 2 vs. 5.8 days respectively). No mortality and minimal morbidity was observed in both groups. No recurrence of prolapse was noted in either group with an average of 12.6 mouths follow-up (2.8 to 17 months). We concluded that rectopexy by laparoscopy is technically feasible and has undeniable advantages over laparotomy.

Adult↗

PubMed1993

Pivoting with the load. An alternative for protecting the back in asymmetrical lifting.

The purpose of this study was to examine different lifting conditions with combined flexion and twisting of the trunk relative to the pelvis (full twist and half-twist techniques) and to compare them to a situation using feet pivoting with minimization of trunk motions relative to the pelvis. Nine subjects with limited experience were tested with two force platforms and two 16-mm cameras coupled with two mirrors; dynamic three-dimensional multisegment models were constructed and the net muscular moments as well as the angular velocities of the trunk relative to pelvis were determined about the three orthogonal orthopaedic axes of the trunk at L5-S1 in flexion-extension, lateral bending, and twisting. The results showed that pivoting required larger extension moments but considerably smaller twisting moments and that these moments were exerted from a safer trunk posture. Pivoting appears to be a good compromise to avoid or minimize complex trunk postures and loadings.

Adult↗