PubMed · 10275909
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J Christen. 1986. Problem-solving teams improve productivity, reduce costs.. https://pubmed.ncbi.nlm.nih.gov/10275909/
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There is controversy as to whether the double-balloon or the Inoue technique of percutaneous mitral balloon valvuloplasty (PMBV) provides superior immediate and long-term results. This study was undertaken to analyze the effect of the learning curve of the Inoue technique of PMBV in the immediate and long-term outcome of PMBV. The learning curve of Inoue PMBV was analyzed in 233 Inoue PMBVs divided into 2 groups: "early experience" (n = 100) and "late experience" (n = 133). The results of the overall Inoue technique were compared with those of 659 PMBVs performed with the double-balloon technique. Baseline clinical and morphologic characteristics between early and late experience Inoue groups were similar. Post-PMBV mitral valve area (1.89 +/- 0.56 vs 1.69 +/- 0.57 cm(2); p = 0.008) and success rate (60% vs 75.9%; p = 0.009) were significantly higher in the late experience Inoue group. Furthermore, there was a trend for less incidence of severe post-PMBV mitral regurgitation > or = 3+ in the late experience group (6.8% vs 12%; p = 0.16). Although the post-PMBV mitral valve area was larger with the double-balloon technique (1.94 +/- 0.72 vs 1.81 +/- 0.58 cm(2); p = 0.01), the success rate (71.3% vs 69.1%; p = NS), incidence of > or = 3+ mitral regurgitation (9% vs 9%), in-hospital complications, and long-term and event-free survival were similar with both techniques. In conclusion, there is a significant learning curve of the Inoue technique of PMBV. Both the Inoue and the double-balloon techniques are equally effective techniques of PMBV because they resulted in similar immediate success, in-hospital adverse events, and long-term and event-free survival.
With the development of the concept of the motor unit and new recording instruments, single motor unit action potentials (MUAPs) were recorded in 1929 in man by Adrian and Bronk and in the experimental animal by Denny-Brown. Studies of MUAPs in patients with neuromuscular disease followed, and in 1938, Denny-Brown and Pennybacker laid the foundation for clinical electromyography (EMG). Action potentials of single contracting or spontaneously firing motor units, termed fasciculations, were recorded and separated from the action potentials of single denervated muscle fibers, termed fibrillations. Thus, it was possible to interpret muscle twitching and cramping by EMG and separate neurogenic from myopathic diseases. Since then, EMG and neuromuscular disease have expanded greatly providing greater diagnostic capability and therapeutic success.