Biomedical subjects

R Acosta

Publications and source records attributed to R Acosta.

At least 19 recordsLinked to original sources

PubMed2006

Reading aids for adults with low vision.

BACKGROUND: The purpose of low vision rehabilitation is to allow people to resume or to continue to perform daily living tasks, reading being one of the most important. This is achieved by providing appropriate optical devices and special training in the use of residual vision and low vision aids, which range from simple optical magnifiers to high power video magnifiers. OBJECTIVES: The objective of this review was to assess the effects of reading aids for adults with low vision. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Group Trials Register) in The Cochrane Library, MEDLINE, EMBASE, SIGLE, LILACS, IndMed to July 2006 and the reference lists of relevant articles. We used the Science Citation Index to find articles that cited the included studies and contacted investigators and manufacturers of low vision aids. We handsearched the British Journal of Visual Impairment from 1983 to 1999 and the Journal of Visual Impairment and Blindness from 1976 to 1991. SELECTION CRITERIA: This review included randomised and quasi-randomised trials in which any device or aid used for reading had been compared to another device or aid in people aged 16 or over with low vision as defined by the study investigators. DATA COLLECTION AND ANALYSIS: Each author independently assessed trial quality and extracted data. MAIN RESULTS: Eight small studies with a cross-over design (221 people overall) and one three parallel-arm study (243 participants) were included in the review. The cross-over studies evaluated various types of aids. The quality of the studies was unclear in most cases, especially concerning carry-over or period effects. In one study on 20 participants head-mounted electronic devices (four types) were worse than optical devices. We could not find any differences in comparisons among electronic devices when pooling 23 participants of two small studies. One study on 10 people found that overlay coloured filters were no better than a clear filter. A parallel-arm study including 243 patients with age-related macular degeneration found that custom or standard prism spectacles are not different from conventional near spectacles, but the estimated difference was not precise. AUTHORS' CONCLUSIONS: Further research is needed on the comparison of different types of low vision aids. It will be also necessary to delineate patient's characteristics that predict performance with costly electronic devices as well as their sustained use in the long term compared to simpler and cheaper optical devices.

Adult↗

PubMed2006

Stage-dependent fetal umbilical blood flow changes induced by laser therapy and amniodrainage in twin-to-twin transfusion syndrome.

OBJECTIVE: To estimate changes in umbilical blood flow (UBF) and Doppler indices in pregnancies complicated by twin-to-twin transfusion syndrome (TTS) treated with either laser therapy or amniodrainage, and to evaluate the influence of the presence of hemodynamic deterioration prior to therapy, as determined by the Quintero stages of severity. METHODS: Forty-eight cases of TTS were included, and further classified into severity Stages I or II (absence of critically abnormal Dopplers (CAD), n = 22) and Stages III or IV (presence of CAD or hydrops fetalis, n = 26). In Stages I-II, 14 cases were treated with laser and eight with amniodrainage, and in Stages III-IV, 17 were treated with laser and nine with amniodrainage. Differences in the UBF, umbilical artery pulstility index (UA-PI) and ductus venosus pulsatility index (DV-PI) were estimated for both groups of severity before and after both treatments. Eleven normal monochorionic pregnancies were evaluated as controls. RESULTS: In recipients, UBF was significantly higher with respect to controls regardless of the stage, while donors had a significant decrease in UBF, but only in Stages III-IV. After laser treatment no changes were observed in fetuses in Stages I-II. In Stages III-IV, recipients showed a significant reduction in the DV-PI (mean DV-PI 1.31 +/- 0.18 vs. 1.05 +/- 0.22; P = 0.005) whereas donors showed a significant increase in the UBF (mean UBF 134 +/- 36 mL/min vs. 195 +/- 25 mL/min; P < 0.001) and in the DV-PI (mean DV-PI 0.99 +/- 0.26 vs. 1.36 +/- 0.42; P = 0.002), and a reduction in the UA-PI (mean UA-PI 1.86 +/- 0.41 vs. 1.58 +/- 0.30; P = 0.01). After amniodrainage only donor fetuses in Stages III-IV showed an increase in UA-PI (mean UA-PI 1.54 +/- 0.35 vs. 1.72 +/- 0.40; P = 0.015). No other changes were observed in any of the parameters studied. CONCLUSION: Laser therapy induces consistent hemodynamic variations in TTS mainly manifested in Stages III-IV.

Amniocentesis↗

PubMed2006

[Systematic review of population-based studies of the prevalence of cataracts].

OBJECTIVE: The prevalence of cataracts has increased due to the progressive ageing of the population and the fact that cataracts affect a wide and increasing proportion of the population. The goal of the present study was to describe the prevalence of cataracts through a systematic and exhaustive review of population-based studies. METHODS: A systematic review of population-based studies of the prevalence and incidence of cataracts was performed. Inclusion criteria were: a healthy non- institutionalised population, older than 40 years of age, of white race, with a sample size of greater than 1,000 and published between 1980 and 2002. RESULTS: Ten studies met the inclusion criteria (3 European, 5 from the United States and 2 from Australia), and were performed between 1984 and 2001. The cataract prevalence, according to lens opacity criteria, ranged between 15% and 19%. When the cataract was defined as a lens opacity combined with a decreased visual acuity, the prevalence ranged from 15% to 30%. The overall prevalence increased with age, reaching 40% and more than 60% in populations older than 70 and 75 years respectively. The prevalence among women was higher than that among men, with a more marked increase being evident at older ages than for men. CONCLUSIONS: There were variations among the criteria used to measure the prevalence of cataract, which made it difficult to compare all the studies. Overall the prevalence was higher in the older population, especially among women. The increasing prevalence associated with age predicts an increasing burden of cataract to health services, this being particularly related to the ageing of the population.

Adult↗

PubMed2003

Ontogeny of cholinergic regulation of fetal upper gastrointestinal motility.

OBJECTIVE: In the fetal rabbit immediately prior to birth (day 30; 0.97 gestation), intragastric atropine suppresses upper gastrointestinal (GI) motility, indicating that cholinergic receptors are expressed and functional at birth. To explore the developmental timing of upper GI cholinergic receptor function, we assessed the effect of intragastric atropine administration in rabbit fetuses during the last 10% of gestation. METHODS: Pregnant rabbits were studied at day 27, day 28 and day 29 of their normal 31-day gestation. In each litter, two fetuses were selected as study fetuses and two as control fetuses. Under ultrasound guidance, fluorescein and either atropine (0.04 microg/g fetal body weight) or normal saline were injected into the fetal stomach. Two hours after injection, fetuses were delivered and the small intestine was harvested. The per cent motility was calculated as the fluorescein travel distance, which was measured by ultraviolet light optical density, divided by the total small intestinal length. RESULTS: Fetal body weight, small intestinal length and per cent motility increased from day 27 to day 29 (p < 0.01). There were no differences in fetal body weight and small intestinal length between atropine and control groups. Atropine significantly decreased per cent motility (versus control values) in fetuses at day 29 and day 28 (56.1 +/- 13.5 vs. 66.1 +/- 11.7% and 59.7 +/- 15.6 vs. 68.3 +/- 11.7%, respectively; p < 0.05), but not at day 27 (52.4 +/- 12.9 vs. 52.8 +/- 11.2%). CONCLUSIONS: These results indicate that upper GI functional cholinergic receptors develop between 0.87 and 0.90 of rabbit gestation. Extrapolation to human development suggests that reduced GI motility in preterm human infants results, in part, from immature GI cholinergic receptors.

Animals↗

PubMed2002

Clinical experience with non-penetrating vascular clips in free-flap reconstructions.

To date, the gold standard for performing a microvascular anastomosis has been the penetrating suture with attached needle. During the last two decades, non-penetrating techniques have been introduced, including the Unilink system for end-to-end anastomoses, and the VCS clip-applier system for both end-to-end and end-to-side anastomoses. The aim of this study was to compare the results of different techniques used to create microvascular anastomoses in free-flap reconstructions. Between January 1995 and October 1999, we performed 474 microvascular anastomoses in 216 consecutive free-tissue transfers. The anastomosis techniques included manual sutures (42%), Unilink rings (34%) and VCS clips (24%). Seven combined sutured-clipped anastomoses were excluded from further analysis. The mean anastomotic time when rings were applied was significantly shorter than when using clips (P 0.0001) or sutures (P 0.0001). Venous anastomoses using clips took less time than those using sutures (P 0.05). There were 19 anastomotic failures, all of which lead to early flap failure. Ten flaps were salvaged by early reoperation; nine flaps were lost. Three more flaps were lost as a result of other causes, bringing the flap survival rate down to 94.4%. Early flap failure was caused by failure of the arterial anastomosis in eight cases; all of them were sutured (these represented 5% of all arterial anastomoses with sutures). None of the clipped arterial anastomoses failed. Early flap failure was caused by failure of the venous anastomosis in 11 patients. Three of these anastomoses were sutured (representing 6% of all venous anastomoses with sutures), seven were anastomosed with rings (representing 5% of all venous anastomoses with rings) and one was clipped (representing 2% of all venous anastomoses with clips). Both the VCS clip-applier system and the Unilink system are easy to handle and allow fast microvascular anastomoses without intraluminal penetration. The patency rate of clipped vessels is at least as good as the patency rates of vessels anastomosed using sutures or rings.

Adolescent↗

PubMed2002

Anticholinergic suppression of fetal rabbit upper gastrointestinal motility.

OBJECTIVE: At birth the newborn digestive tract must assume the responsibility of assimilating nutrients for survival. Immature gastrointestinal motility in the neonate may result in impaired feeding and nutrition. Newborn gastrointestinal motility development requires the expression and functional maturation of gastrointestinal receptors. To explore the timing of fetal responses to gastrointestinal cholinergic motility agents, we assessed the effect of the anticholinergic agent atropine in the late-gestation rabbit fetus. METHODS: Seven pregnant New Zealand White rabbits were studied at day 30 of their normal 31-day gestation. In each litter, two fetuses were selected as study (n = 14) and two as control (n = 14). Under ultrasound guidance, a spinal needle was percutaneously inserted through the maternal uterus into the fetal stomach and 0.5 ml of gastric content was aspirated. Fluorescein, labelled with colored microspheres, and either atropine (0.04 microg/g fetal body weight) or normal saline were injected in a total volume of 0.5 ml. Two hours after injection, fetuses were delivered, the small intestine harvested, and the total small intestinal length and the distance the gastrointestinal fluorescein travelled were measured by ultraviolet light optical density. The fluorescein travelled distance and the per cent motility, defined as the length of fluorescein travelled divided by the total length of the small intestine, were calculated. RESULTS: All fetuses survived the intragastric injection. Mean fetal body weight at delivery was 44.2 +/- 6.7 and 46.8 +/- 7.2 g in atropine and control fetuses, respectively. The fluorescein travelled distance (15.4 +/- 4.2 vs. 19.0 +/- 4.3 cm;. p < 0.01) and per cent motility (51.0 +/- 8.9 vs. 63.8 +/- 11.7%; p < 0.01) of atropine-treated fetuses were significantly lower than those of control fetuses. CONCLUSION: Fetal upper gastrointestinal motility is suppressed in response to intragastric atropine. These results indicate that fetal gastrointestinal cholinergic receptors are expressed and functional in the term (0.97 gestation) rabbit fetus. In utero administration of cholinergic agonists/antagonists may potentially modulate fetal gastrointestinal motility and absorption of amniotic fluid water and solutes.

Animals↗

PubMed2001

[A case report. Hypotensive reaction caused by albumin infusion].

Hypotensive reactions during surgical procedures cause diagnostic problems in establishing whether the hypotension is due to blood loss or pharmaceuticals or other causes. A case of hypotension probably due to an albumin infusion is described. Bradykinin effects are probably the cause of many hypotensive reactions. Angiotensin-converting enzyme (ACE) inhibitors reduce degradation of bradykinin and thus increase the risk of hypotensive reactions. When possible, doctors should consider withholding ACE inhibitors 24 hours before surgical procedures likely to require albumin transfusions.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2000

High-resolution gas-chromatographic analysis of the secondary metabolites obtained by subcritical-fluid extraction from Colombian rue (Ruta graveolens L.).

Subcritical (CO(2)) extraction, carried out in a J&W Scientific High Pressure Soxhlet Extractor, was used to isolate secondary metabolites from leaves, flowers, stems and roots of Colombian rue (Ruta graveolens L.). The various extracts were analyzed by capillary chromatography, on an HP-5 (30 m) column, using nitrogen-phosphorus, flame ionization, and mass selective detection systems. Kováts indexes and mass spectra (electron impact, 70 eV) were employed for compound identification. The extracts from the various parts of rue studied had different compositions. The number of compounds detected at concentrations above 0.01% (w/w) in the extracts from leaves, flowers, stems and roots, was 78, 45, 25 and 24, respectively. 2-Nonanone (8.9%), 2-undecanone (13.4%), chalepensin (13.0%), and geijerene (19.3%) were the main constituents found in the extracts from rue leaves, flowers, stems and roots, respectively. Furanocoumarins, furoquinolines, hydrocarbons and benzodioxol derivatives were the main compound families found in all extracts, at total concentrations between 3.7 and 33.9%, depending on the part of the plant. The extraction method used has low environmental impact and produced solvent-free extracts in good yield with no pigments, waxes, resins, or high-molecular weight compounds which may interfere with the isolation and analysis of the alkaloids responsible for rue's biological activity, which were extracted in relatively high yield.

Alkaloids↗

PubMed2000

The results of a primary and staged pantalar arthrodesis and tibiotalocalcaneal arthrodesis in adult patients.

Twenty-three patients (twenty-seven feet) with either a primary or staged pantalar arthrodesis or a tibiotalocalcaneal arthrodesis were evaluated to determine their clinical status. The main indication for the operation was the presence of severe pain unresponsive to non-operative treatment. Fourteen feet (twelve patients) had a pantalar arthrodesis; a fusion of the ankle, subtalar, talonavicular and calcaneocuboid joints. Half the feet in this group had either a triple arthrodesis or an ankle fusion performed at an earlier time. The remaining seven feet had all joints fused during the same operation. Thirteen feet (eleven patients) had a tibiotalocalcaneal arthrodesis. Two of these feet had an ankle arthrodesis performed four and six years previously. The other eleven had the ankle and subtalar joints fused during the same operation. All patients were followed for a mean of fifty-five months (14 to 159 months) from the time of their final arthrodesis procedure. Overall, twenty-three of the twenty-seven feet achieved a solid arthrodesis of all joints operated upon. Four feet had a failure of fusion of only a single joint and all were in the pantalar group. The mean time to radiographic fusion was twenty-three weeks and resulted in a plantigrade foot with an average tibia-floor angle of 87 degrees. Complications occurred in ten feet (37%); of which there were three deep infections; two ankles and one subtalar joint. These arthrodeses procedures resulted in marked relief of the patients' preoperative pain, the main indication for performing the surgery. Postoperatively there was no pain in eleven feet, mild occasional pain in thirteen feet, and moderate pain in only three feet. However, when all parameters of our clinical rating scale were evaluated, only five patients had an excellent clinical result, nine were rated good, three were rated fair and six patients had a poor result. These operations must be considered to be salvage procedures. They are technically difficult to perform and major complications may occur. Pain relief appears to be the main indication for performing these operations, and may account for whatever improvement occurs in the patient's function.

Adult↗

PubMed1999

Prognostic role of serum prostatic acid phosphatase for 103Pd-based radiation for prostatic carcinoma.

PURPOSE: To establish the prognostic role of serum enzymatic prostatic acid phosphatase (PAP) in patients treated with palladium (103Pd) and supplemental external beam irradiation (EBRT) for clinically localized, high-risk prostate carcinoma. METHODS AND MATERIALS: One hundred twenty-four consecutive patients with Stage T2a-T3 prostatic carcinoma were treated from 1992 through 1995. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (100 patients), Gleason score 7-10 (40 patients), pretreatment prostate specific antigen (PSA) >15 ng/ml (32 patients), or elevated serum PAP (25 patients). Patients received 41 Gy conformal EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose 80 Gy). Biochemical failure was defined as a PSA greater than 1 ng/ml (normal <4 ng/ml). RESULTS: The overall, actuarial freedom from biochemical failure at 4 years after treatment was 79%. In Cox-proportional hazard multivariate analysis, the strongest predictor of failure was elevated pretreatment acid phosphatase (p = 0.02), followed by Gleason score (p = 0.1), and PSA (p = 0.14). CONCLUSION: PAP was the strongest predictor of long-term biochemical failure. It may be a more accurate indicator of micrometastatic disease than PSA, and as such, we suggest that it be reconsidered for general use in radiation-treated patients.

Acid Phosphatase↗

PubMed1996

103Pd brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma.

PURPOSE: To summarize biochemical failure rates and morbidity of external beam irradiation (EBRT) combined with palladium (103Pd) boost for clinically localized high-risk prostate carcinoma. METHODS AND MATERIALS: Seventy-three consecutive patients with stage T2a-T3 prostatic carcinoma were treated from 1991 through 1994. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (71 patients), Gleason score 7-10 (40 patients), prostate specific antigen (PSA) > 15 (32 patients), or elevated prostatic acid phosphatase (PAP) (17 patients). Patients received 41 Gy EBRT to a limited pelvic field, followed 4 weeks later by a 103Pd boost (prescription dose: 80 Gy). Biochemical failure was defined as a PSA greater than 1.0 ng/ml (normal < 4.0 ng/ml). Patients whose PSA was still decreasing at the last follow-up were censored at that time. Patients whose PSA plateaued at a value greater than 1.0 were scored as failures at the time the PSA first plateaued. RESULTS: The overall, actuarial freedom from biochemical failure at 3 years after treatment was 79%. In Cox proportional hazard multivariate analysis, the strongest predictor of failure was elevated acid phosphatase (p = 0.04), followed by PSA (p = 0.17), Stage (p = 0.23), and Gleason score (p = 0.6). Treatment-related morbidity was usually limited to temporary, RTOG Grade 1-2 urinary symptoms. One patient, who had both a transurethral incision of the prostate (TUIP) and a transurethral resection of the prostate (TURP), developed low-volume urinary incontinence. The actuarial potency rate at 3 years after implantation was 77% for 46 patients who were sexually potent prior to implant. CONCLUSION: Biochemical freedom from failure rates following combined EBRT and 103Pd brachytherapy for clinically localized, high-risk prostate cancer compare favorably with that reported after conventional dose EBRT alone. Morbidity has been acceptable.

Aged↗

PubMed1996

Dihydroxyprogesterone acetophenide 150 mg + estradiol enantate 10 mg as monthly injectable contraceptives.

A survey among users and health personnel participating in the Salvadorian Social Security Institute (ISSS) Family Planning Program revealed interest in including a monthly preparation for injection as a contraceptive method offered by this Institution. The formulation containing dihydroxyprogesterone acetophenide (DHPA) 150 mg + estradiol enantate (E2EN) 10 mg was chosen for conducting an open and prospective study of efficacy and tolerability. Between January 1992 and March 1994, 7054 women were treated with this product for a total of 60010 months. A sample composed of 4505 women treated at this Institution confirmed that average users are young, have one or two children, do not show a particular geographical distribution and choose the monthly injection instead of oral contraceptives as the first contraceptive method or for the puerperium. The study formulation showed a high efficacy (Pearl Index: 0.018) and tolerability (general withdrawal rate throughout the study: 27.09%). The most frequent adverse events included bleeding disorders, headache and mastalgia; their incidence decreased spontaneously from the sixth month (3.9%), reaching 0% after two years. Treatment was discontinued due to adverse events in 3.47% of women. No significant bodyweight or systolic and diastolic blood pressure alterations were observed. Based on these results, the monthly injectable contraceptive was included in the basic product list at ISSS.

Adolescent↗

PubMed1996

Spinal endothelin content is elevated after moderate local trauma in the rat to levels associated with locomotor dysfunction after intrathecal injection.

The role of endothelin (ET) in the pathophysiology of secondary neural damage after experimental spinal cord injury (SCI) was examined in a rat model of weight-drop contusion injury. Initial studies demonstrated a significant increase in spinal ET concentrations in a 7.5-mm segment of tissue (centered at the impact site) at 30 min, 4 h, and 24 h after a moderate (50 g-cm) contusion injury. Subsequent experiments were aimed at reproducing these elevations by the intrathecal (i.t.) administration of ET and observing the effect on locomotor function. These studies showed that i.t. dosage of 9.6 ng produced spinal cord elevations of ET similar to those seen 30 min after moderate SCI as well as mild locomotor deficits. A 48 ng dose of ET resulted in moderate to severe locomotor deficits that were associated with spinal ET elevations much greater than those seen after injury. The mild deficits attributable to the lower dose of ET could contribute to the pathophysiological actions of other purported secondary injury mediators. The more pronounced locomotor deficits associated with the higher dose could be of relevance for severe SCI.

Animals↗

PubMed1996

Recovery of sensation in the radial forearm free flap in oral reconstruction.

The purpose of this study was to find out to what extent sensory function recovers in a free radial forearm flap used for intraoral reconstruction after surgery for oral cancer. In 40 free radial forearm flaps we investigated the perception of light touch, two-point discrimination, pain, directional sensation, and temperature between 6 months and 11 years after flap transfer to the oral cavity. Four flaps (10 percent) were anesthetic, 21 flaps (52.5 percent) recovered partly, and 15 flaps (37.5 percent) had perception of all sensory modalities tested in at least two-thirds of the flap area. All patients with positive sensation in the surrounding area subsequently had good sensory recovery in the flap. This suggests that recovery of sensation in a nonreinnervated free flap is due to nerve ingrowth from the surrounding mucosa. The present results suggest that sensory function in intraoral free radial forearm flaps returns again. Further study is necessary to define the use of neurofasciocutaneous radial forearm flaps in reconstruction of the oral cavity.

Carcinoma, Squamous Cell↗

PubMed1995

Low oxygen enhances sickle and normal erythropoiesis and fetal hemoglobin synthesis in vitro.

Erythropoiesis is increased in cultures of human blood progenitors when oxygen tension is reduced from 20% (room air) to 5% (low oxygen, closer to physiological bone marrow levels). The effects of low oxygen on gamma-globin synthesis and colony growth in methyl cellulose cultures of blood mononuclear cells from normal individuals and patients with sickle cell diseases were examined. Low oxygen increased colony numbers by 1.5- to 2-fold and erythropoietin sensitivity by almost 2-fold. The interval required for maximal colony growth in cultures from patients with sickle cell disease (sickle colonies) was reduced from 17 days in 20% oxygen to 13 days in 5% oxygen. Relative synthesis of gamma-globin was examined by labeling with 3H-leucine and electrophoresis on Triton acid urea polyacrylamide gels. The % gamma was 1.7-fold higher in normal and 1.4-fold higher in sickle cultures on day 13 in low oxygen. On day 16 the expected temporal decline was not seen in low oxygen, and the % gamma was 2-fold higher in normal and 1.8-fold higher in the sickle studies. Hemin increased colony growth and gamma-globin synthesis in normal cultures in air, and the effects of hemin and low oxygen were additive. In sickle cultures, hemin and low oxygen had additive effects on colony growth, but only low oxygen increased gamma-globin synthesis. Interleukin-3 increased colony numbers on day 13, primarily by acceleration of peak growth. Interleukin-3 also increased gamma-globin synthesis in low oxygen in normal but not sickle cultures. Thus, low oxygen increases in vitro sensitivity to erythropoietin, colony numbers, and relative gamma-globin synthesis in normal and sickle cultures.

Cell Hypoxia↗

PubMed1994

Detrusor-myoplasty, innervated rectus muscle transposition study, and functional effect on the spinal cord injury rat model.

The purpose of this investigation was to determine the feasibility of striated muscular augmentation of the urinary bladder (detrusor-myoplasty, DMP). Initial studies, transposition, and bladder wrap using several distinct muscle groups was attempted in laboratory rats, goats, and fresh human cadavers. The rectus abdominus muscle was found to be best suited to completely encompass the bladder with an intact neural and vascular supply. The technique was then applied in a rat model of spinal cord injury (SCI). Modified Tarlov ratings were employed to assess neurologic function 30 days after SCI. The median final neurological score of SCI rats with and without DMP was 4 and 5, respectively. Sham-operated SCI (control) rats, with and without DMP, both had normal final Tarlov scores of 12 (P < 0.05). Muscle blood flow values for the flap and the contralateral undissected rectus muscles were not significantly different (97 +/- 34 and 105 +/- 40 ml/100 g tissue/min, respectively, P = 0.47). Postoperatively, no bowel or abdominal wall functional deficits were apparent. The rotated muscular flap remained innervated and vascularized. Analysis of 24 hr micturition patterns demonstrated no differences in oral fluid intake/24hr, voided volume/24hr, and ratio of number of micturitions during the night vs. day among the four groups: (1) control (neither SCI nor DMP), (2) DMP only, (3) SCI only, and (4) SCI with DMP. Spinal cord injured rats with and without detrusor-myoplasty demonstrated a significant decrease in the number of micturitions/24hr, an increased volume per micturition, and greater largest and smallest micturition volumes (P < 0.05) when compared to controls. The micturition patterns among SCI rats with and without DMP were similar, as were non-SCI animals with and without DMP. This is the first report of the principle and technique of detrusor-myoplasty. Dissection of rats, goats, and human cadavers revealed that a vascularized and innervated rectus muscle flap can be rotated into the pelvis and wrapped around the bladder without tension. Significant loss of bladder capacity did not occur with skeletal muscle adaptation. Detrusor-myoplasty may be applicable for patients with an areflexic detrusor and non-intact sacral motor roots who are not candidates for sacral anterior root neurostimulation.

Abdominal Muscles↗

PubMed1994

Reconstruction of the dorsal ligament of the triangular fibrocartilage complex.

The distal radio-ulnar ligaments (DRUL) are key components of the triangular fibrocartilage complex (TFCC). The dorsal DRUL tightens during pronation of the forearm and helps to stabilize this motion. 12 women and three men at our clinic have been treated for DRUJ instability secondary to dorsal DRUL rupture or attenuation. Their chief complaint was pain. The dorsal DRUL was reconstructed using a tendon graft, the ends of which were anchored in the bone of the radius and ulna. This technique has been shown to correct dynamic DRUJ instability in carefully selected patients, decreasing or eliminating pain and restoring normal function.

Adolescent↗

PubMed1994

Chronic mountain sickness and chronic lower respiratory tract disorders.

To determine whether chronic lower respiratory tract disorders contributed to the development of chronic mountain sickness (CMS), we compared hemoglobin (Hb), oxygen saturation (SaO2), peak expiratory flow rate (PEFR), and CMS scores (CMSsco) in 97 normal men at high altitude with those of men at high altitude with acute (ARD; n = 12), chronic upper (CURD; n = 33), and chronic lower (CLRD; n = 34) respiratory diseases. The clinical diagnosis of the different types of respiratory disorders was based on the results of a questionnaire and physical examination performed during an epidemiologic study. The CLRD group had higher CMSsco and Hb concentrations, and lower SaO2 and PEFR values when compared with the other groups. The frequency of low PEFR and SaO2 and high Hb and CMSsco was substantially higher in men with CLRD when compared with normal subjects. The results support the hypothesis that there is an association between signs and symptoms of CMS, as measured by the CMSsco, and CLRD. The chronic hypoxemia, product of chronic lung diseases, would cause excessive erythrocytosis and increase the signs and symptoms of CMS. Studies of Hb, PEFR, pulse oximetry, and CMSsco are recommended for early detection of high-altitude natives at risk of developing CMS.

Adult↗