Recurrent intravenous leiomyomatosis with extension up the inferior vena cava.
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Cardiovascular Surgical Procedures↗
Biomedical subjects
M Carlton
Publications and source records attributed to M Carlton.
Methods of creating pneumoperitoneum: a review of techniques and complications.
The existence of numerous techniques for the creation of pneumoperitoneum at laparoscopy indicates that none have been proven totally efficacious or complication free. These methods include the standard technique of insufflation after insertion of the Veress needle via the umbilicus or less commonly via the transfundal or transforniceal routes, open laparoscopy involving dissection through the linea alba and opening of the peritoneum under direct vision, and direct trocar insertion as well as variations on these techniques. After reviewing the methods available and surveying the existing data concerning the rates of failure and complications, we conclude that no single technique can claim to be overwhelmingly superior, and that laparoscopists should, therefore, acquaint themselves with at least two of these techniques. Finally, we recommend a large-scale combined survey by the colleges of obstetricians and gynecologists and surgeons on rates of failure and complications of the varied approaches of abdominal entry for laparoscopy.
Humans↗
Skin Closure at Laparoscopy
The choice of wound closure material after laparoscopy is often based more on the preference or familiarity of the surgeon than on scientific facts. This study attempted to discern the best method for wound closure after laparoscopy. Ninety women were randomized to receive interrupted 3-0 nylon sutures, subcuticular 3-0 polyglactin sutures, or Steri-Strips. At the umbilical port site, the rectus sheath was closed with one 0 polyglactin suture and then one of the three materials for skin closure. The lateral ports received a combination of two of the materials, allowing each patient to act as her own control. Each site was covered with a standard adhesive dressing that was removed before discharge. Women recorded pain at each site from days 1 to 5 on a linear analog scale, described wound appearance, and reported their ultimate satisfaction. The operating surgeons also assessed the wound outcome at the 4-week follow-up visit, although they did not know the material used for wound closure.
Journal Article↗
Complications of 174 laparoscopic hysterectomies.
The case records of 174 patients who underwent laparoscopic hysterectomy between September, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 45.4 (range 17.8-68.5) years, mean weight 70.2 (50-121) kg and mean parity 2.3 (0-4). Laparoscopic hysterectomy (i.e. uterine arteries secured laparoscopically) was performed in 98 patients, laparoscopically assisted vaginal hysterectomy in 70, and laparoscopic subtotal hysterectomy in 6. Bilateral or unilateral oophorectomy were performed in 40 cases. The mean operating time was 131 (45-285) minutes and mean hospitalization 2.6 (1-11) days. Endoscopic stapling devices were used in 135 cases, biopolar diathermy in 117, sutures and ties in 84, and the harmonic scalpel in 29. The overall complication rate was 16%. Seven cases (4%) required conversion to laparotomy. These included 2 inadvertent cystotomies (1 after 2 Caesarean sections), 3 cases of dense uterovesical adhesions following previous surgery and 2 instances of excessive uterine size (> 16 weeks). The mean follow-up period was 2.2 (1-18) months. One patient had a shortened vagina requiring dilatation and another had vault granulations requiring diathermy treatment. Overall 98.3% of patients were satisfied with their surgery.
Adolescent↗
A review of results in a series of 113 laparoscopic colposuspensions.
The case records of 113 women having laparoscopic retropubic colposuspensions (Burch procedure) performed for the treatment of genuine urinary stress incontinence between December, 1992 and April, 1995 were retrospectively reviewed. The mean age of the group was 49.4 (30-80) years, mean weight 72.1 (44.5-114) kg, and mean parity 2.7 (0-8). All patients had preoperative urodynamic study to confirm genuine stress incontinence (GSI). Sixteen patients (14%) had dual pathology (GSI and detrusor instability). A transperitoneal approach was used in 93 operations and extraperitoneal in 20. The mean operating time was 108 (30-320) minutes and mean hospitalization 3.3 (1-10) days. In 13 women the operation was converted to laparotomy; 10 due to adhesions and diminished bladder mobility, 1 for inferior epigastric vessel injury, 1 for an ovarian tumour discovered incidentally at the procedure and 1 for equipment problems. Operative complications included 10 cystotomies (5 repaired laparoscopically), 2 extraperitoneal cases converted to transperitoneal, 1 inferior epigastric vessel injury, 1 vaginal tear, 1 suture through the bladder and 1 case of possible enterotomy oversewn at laparoscopy. The mean follow-up period was 8.4 (1-28) months. All patients were reviewed postoperatively and then contact was attempted either by telephone or in consultation. There was an overall 87% subjective success rate. Two patients felt sutures tear out at 4 and 6 months and were deemed failures; 4 felt their incontinence was improved but had ongoing stress incontinence of urine; 9 had symptoms of detrusor instability and one developed an enterocele 9 months after surgery.
Adult↗
Proprioceptive coordination of discrete movement sequences: mechanism and generality.
A "discrete" movement sequence is defined as a movement with a single goal that involves a series of overlapping joint rotations. Reaching-and-grasping and throwing are examples of discrete movement sequences. The central nervous system (CNS) can use reafferent proprioceptive information from one joint rotation in a sequence to coordinate subsequent rotations at other joints. The experiments reported in this paper demonstrate how the human CNS uses proprioceptive information to coordinate discrete movement sequences. We examined the mechanism (at an information processing level) underlying proprioceptive coordination and the generality (i.e., the boundary conditions) of these mechanisms as they apply to everyday movement sequences. Adult human subjects performed a discrete movement sequence that resembles backhand throwing: elbow extension followed by hand opening. The task was to open the hand as the elbow passed through a prescribed "target" angle. We eliminated visual information and made the arrival time at the target angle unpredictable so that the available kinematic information was provided exclusively by proprioception. The subjects were capable of performing this motor task with a high degree of precision, thereby demonstrating that the nervous system can use proprioceptive input to coordinate discrete movement sequences. Our data indicate that precise coordination is achieved by extracting kinematic information related to both the velocity of elbow rotation as well as the elbow position during movement (i.e., "dynamic position"). Dynamic position information appears to be encoded as both absolute joint angle and angular distance, although more precisely as angular distance. Although our experiments were conducted under rather restrictive laboratory conditions, this mechanism of motor coordination might also apply to everyday movement. Our results suggest that this mechanism could be employed for passive as well as active movement sequences, with and without opposing loads; it could exert its influence in discrete movement sequences as brief as 210 ms or as long as 1.5 s; and it does not involve any significant degree of learning (this proprioceptive mechanism appears to be readily available for use on the first attempt of a novel motor task).
Adult↗
Proprioceptive coordination of movement sequences: role of velocity and position information.
1. Recent studies have shown that the CNS uses proprioceptive information to coordinate multijoint movement sequences; proprioceptive input related to the kinematics of one joint rotation in a movement sequence can be used to trigger a subsequent joint rotation. In this paper we adopt a broad definition of "proprioception," which includes all somatosensory information related to joint posture and kinematics. This paper addresses how the CNS uses proprioceptive information related to the velocity and position of joints to coordinate multijoint movement sequences. 2. Normal human subjects sat at an experimental apparatus and performed a movement sequence with the right arm without visual feedback. The apparatus passively rotated the right elbow horizontally in the extension direction with either a constant velocity trajectory or an unpredictable velocity trajectory. The subjects' task was to open briskly the right hand when the elbow passed through a prescribed target position, similar to backhand throwing in the horizontal plane. The randomization of elbow velocities and the absence of visual information was used to discourage subjects from using any information other than proprioceptive input to perform the task. 3. Our results indicate that the CNS is able to extract the necessary kinematic information from proprioceptive input to trigger the hand opening at the correct elbow position. We estimated the minimal sensory conduction and processing delay to be 150 ms, and on the basis of this estimate, we predicted the expected performance with different degrees of reduced proprioceptive information. These predictions were compared with the subjects' actual performances, revealing that the CNS was using proprioceptive input related to joint velocity in this motor task. To determine whether position information was also being used, we examined the subjects' performances with unpredictable velocity trajectories. The results from experiments with unpredictable velocity trajectories indicate that the CNS extracts proprioceptive information related to both the velocity and the angular position of the joint to trigger the hand movement in this movement sequence. 4. To determine the generality of proprioceptive triggering in movement sequences, we estimated the minimal movement duration with which proprioceptive information can be used as well as the amount of learning required to use proprioceptive input to perform the task. The temporal limits for proprioceptive processing in this movement task were established by determining the minimal movement time during which the task could be performed.(ABSTRACT TRUNCATED AT 400 WORDS)
Acceleration↗
Proprioceptive coordination of movement sequences: discrimination of joint angle versus angular distance.
1. The purpose of these experiments was to determine the accuracy with which human subjects could discriminate proprioceptive (nonretinotopic) targets during movement. The targets were located at either a specified angle in joint space, or a specified angular distance from an initial joint angle. 2. In these experiments the right elbows of normal human subjects were passively extended from either predictable or unpredictable starting angles. The subjects were instructed to open the right hand to indicate that the elbow was passing through a target joint angle or a target angular distance. The subjects were not given visual information about the location of the elbow, so they had to rely on proprioceptive input to perform this task. The target (criterion joint angle or angular distance) was learned by the use of proprioception during 8-15 practice trials. 3. Four experiments were conducted. In three experiments the target was located at a constant joint angle, and in the fourth experiment the target was located at a constant angular distance from the starting angle. The starting angle in all four experiments was pseudorandomly varied from trial to trial. 4. On the basis of an analysis of constant errors, subjects were more accurate at discriminating angular distance than joint angle. The slope of the relationship between the starting position and the constant errors was dictated by the task requirement. 5. In the distance discrimination experiment, when the starting angle was more flexed than the intermediate (i.e., central) position, the subjects slightly overshot the target distance. Conversely, when the starting angle was more extended than the intermediate position, the subjects slightly undershot the target distance. 6. In the joint angle discrimination experiments, the opposite results were obtained. Subjects overshot the target when the starting position of the elbow was more extended than the intermediate starting position, and they undershot the target when the starting position was more flexed than the intermediate starting position. The amplitude of these systematic errors increased when the subjects were unaware that the initial angle of their elbow was variable. 7. It is concluded that, in kinesthetic tasks of this type, the discrimination of angular distance is more accurate than the discrimination of joint angle. We hypothesize that the nervous system extracts kinematic information related to both joint angle and angular distance from proprioceptors, and that the encoding and or decoding of angular distance is more accurate than that of absolute joint angle.(ABSTRACT TRUNCATED AT 400 WORDS)
Adult↗
Studies on sperm survival and motility in the presence of cytotoxic sperm antibodies.
The effect of cytotoxic sperm antibodies and native complement in the serum and secretions from 40 fertile and 93 infertile couples on in vitro sperm survival and motion characteristics was studied. Sperm survival in vitro was unaffected by sera from fertile and infertile subjects without cytotoxic sperm antibodies and from infertile men with antibodies to control but not to autologous sperm. Sperm survival was reduced (P less than .001) by sera from infertile men with antibodies to autologous sperm or to antologous and control sperm and from women with cytotoxic antibodies to sperm from both. Sera from fertile couples without sperm antibodies enhanced sperm swimming speed and motility index (P less than .0001). Sera from infertile women with or without cytotoxic sperm antibodies did not affect sperm motility. Sperm survival and motility were reduced by seminal plasma from infertile men with cytotoxic antibodies to autologous and/or control sperm. Seminal plasma from fertile men enhanced sperm survival. Cervical mucus from infertile women with antibodies to autoimmune husbands' sperm or to husbands' and control sperm inhibited sperm motion, whereas cervical mucus from infertile women without sperm antibodies and women with antibodies to control sperm failed to have any effect. It is concluded that cytotoxic sperm antibodies developed through exposure to sperm antigens in autoimmune infertile men decrease in vitro sperm survival and/or motility.
Antibodies↗
Motion characteristics of spermatozoa from men with cytotoxic sperm antibodies.
Semen samples from 55 fertile nonautoimmune and 44 infertile sperm autoimmune men were evaluated by computerized sperm cell motion analysis. Sperm counts (mean +/- SEM, 59.6 +/- 10.3 X 10(6) per ml), motility (39.0 +/- 4.6%), mean swimming speed (micron/sec, 26.5 +/- 0.9), mean linearity (straight line distance of the cell track divided by the actual track length and multiplied by 10, 6.5 +/- 0.2), and motility index (% motility X mean speed, 10.7 +/- 1.4) in 23 men with significant titers of cytotoxic sperm antibodies in their serum and seminal plasma were less (p less than 0.0001) than those in the fertile controls. However, these parameters were comparable in 18 men with sperm antibodies in their seminal plasma but not in their serum, and the control group. Infertile men with serum cytotoxic sperm antibodies had more sperm cells swimming at 11-30 micron/sec, and fewer moving at 31 micron or higher; this was in contrast to results obtained from fertile men (p less than 0.05). The percentages of sperm cells moving at 21-30 micron/sec were increased, while those moving at 51-60 microns/sec were decreased in men with seminal plasma sperm antibodies, versus controls. Spermatozoa with low linearities (less than or equal to 6) were higher (p less than 0.05) in men with serum and seminal plasma cytotoxic sperm antibodies than in the fertile group.(ABSTRACT TRUNCATED AT 250 WORDS)
Autoantibodies↗
A computerized sperm motion analysis [published erraturm appears in Fertil Steril 1986 Nov;46(5):980].
Semen samples from 35 fertile men and husbands of 32 infertile couples were evaluated with the use of a rapid computerized sperm motion analysis (CSA). The counts and percentages of motile sperm measured by routine semen analysis (RSA) and CSA were comparable in both groups. In CSA, mean values of swimming speed (microns per second), linearity, and motility index of sperm in the fertile men were significantly higher than those in the infertile group. At 3 hours, the number of sperm moving at a speed of 21 to 30 microns/second were higher in the infertile group than in the fertile group. In contrast, the number of sperm moving at a speed of 31 to 50 microns/second and higher was increased in the fertile group over the infertile group. Good correlations were obtained between RSA and CSA sperm counts and percentages of progressively motile sperm. Sperm counts, percent motility, indices of motility, and mean sperm speed obtained by two observers with the use of CSA correlated well. It seems that the sperm speed and the motility index remain unaltered in repeat semen analyses of fertile men. It is concluded that a computerized analysis of sperm swimming speed is a reliable and rapid mode for evaluating semen samples and offers more discriminatory sperm motion characteristics than the RSA.
Computers↗
Evidence for differential hemispheric function in children with hemiplegic cerebral palsy.
Eight children with right infantile hemiplegia and eight with left infantile hemiplegia were compared with each other and with 13 sibling controls on a test of manual dexterity, an extended neurological examination and a battery of neuropsychological tests. Right-hemiplegic children performed significantly less well than left-hemiplegic children and the controls on measures of syntactical awareness and the repetition of semantically coherent materials, despite similar verbal IQs. Both hemiplegic groups tended to perform less well than the controls, although not significantly so, on the short-term memory task, repetition of digits, and on a task of confrontation naming. There was also a strong correlation between left-hand impairment and poor arithmetical computation skill in both hemiplegic groups, which conforms with present views as to right-lateralization of certain mathematical functions. The results as a whole support the premise that there is innate hemispheric organization for some language tasks.
Adolescent↗
Transplant: giving a touch of warmth.
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Critical Care↗
Vascular disease risk factors in women with premature menopause.
The vascular disease risk factor profile was studied in 21 women who had experienced a premature menopause due to bilateral oophorectomy. Compared with age-matched menstruating control subjects, oophorectomized women did not differ appreciably with respect to the prevalence of major vascular risk factors other than hyperlipidaemia, nor did they exhibit an excessive prevalence of vascular disease. In oophorectomized women not receiving hormone replacement therapy, the total serum cholesterol and low density lipoprotein (LDL) cholesterol levels were increased, while high density lipoprotein (HDL) cholesterol was not significantly altered. In women receiving replacement with ethinyl oestradiol, the total and LDL cholesterol were significantly decreased while HDL cholesterol was significantly increased, relative to oophorectomized women not receiving hormone replacement. The increased proportion of LDL to HDL in those not receiving hormone replacement suggests that they may be exposed to an increased theoretical long-term vascular risk, and this might justify appropriate hormone replacement in all such women, subject to certain safeguards.
Adult↗
The volume and composition of amniotic fluid in early pregnancy.
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Amniotic Fluid↗
The effect of metoprolol and atenolol on plasma high density lipoprotein levels in man.
1. The effects of two beta-adrenoreceptor blocking drugs, metoprolol and atenolol, on plasma lipoproteins were studied in thirty-four patients using a single-blind cross-over design, with a 10-day placebo washout period between drugs. 2. Compared with placebo values, neither metoprolol nor atenolol influenced total plasma cholesterol levels, while total plasma triglycerides increased slightly. 3. Low density lipoprotein protein level remained unaltered, while high density lipoprotein (HDL) cholesterol and protein were significantly reduced by both beta-adrenoreceptor blockers. 4. The ratio of total cholesterol to HDL cholesterol was increased by both drugs. 5. The data suggest that patients taking these drugs over many years may be exposing themselves to increased vascular risk, despite other anticipated benefits from such therapy.
Atenolol↗