PubMed · 14035845
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K KRISTIANSEN. 1963-08-01. [The acute back].. https://pubmed.ncbi.nlm.nih.gov/14035845/
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Oxygen uptake (VO2), heart rate (HR) and myoelectric activity (EMG) were measured while performing a repetitive task in the normal, maximum and extreme workspace reach envelopes. The VO2 and HR increased significantly from the normal to the maximum to the extreme workspace reach envelope. The average increases in VO2 when compared to the normal workspace were 19 and 52%, respectively. The corresponding average increases in HR were 6 and 14%, respectively. The increase in EMG for anterior deltoid, upper trapezious and erector spinae showed a significant increase from normal to maximum and from maximum to extreme workspaces. The average increases in EMG for anterior deltoid, upper trapezious and erector spinae, compared to the normal workspace were 96, 37 and 48% respectively for the maximum workspace and 193, 95 and 106% for the extreme workspace, respectively. The research indicated for the first time that during task performance, worker physiological cost would increase significantly with the increase in workspace reach levels.
A successful sentinel lymph node biopsy (SLNB) in melanoma patients requires an accurate map of the pattern of lymphatic drainage from the primary site. Lymphoscintigraphy (LS) can provide such a map. LS needs an understanding of lymphatic physiology, an appropriate small-particle radiocolloid, high-resolution collimators, and imaging protocols that detect all sentinel nodes (SNs). Patterns of lymphatic drainage from the skin are not clinically predictable. Unexpected drainage has been found from the skin of the back to SNs in the triangular intermuscular space (TIS) and the paraaortic, paravertebral, and retroperitoneal areas. It can also occur from the base of the neck up to nodes in the occipital or upper cervical areas or from the scalp down to nodes at the neck base, bypassing many node groups. Upper limb drainage can be to SNs above the axilla. Interval nodes not uncommonly can be SNs, especially on the trunk. Lymphatic drainage may involve SNs in multiple nodal fields, and drainage across the midline of the body is quite common. Because micrometastatic disease can be present in any SN regardless of its location, all true SNs must be biopsied. LS is an important first step to ensure this goal is achieved.
A review of the imaging features of normal and degenerative anatomy of the spine on medical imaging studies shows features that have been largely overlooked or poorly understood by the imaging community in recent years. The imaging methods reviewed included computed tomography (CT) with multiplanar reconstructions and magnetic resonance imaging (MRI). A routine part of the MRI examination included fat-suppressed T2 weighted fast-spin- or turbo-spin-echo acquisitions. As compared to the normal features in asymptomatic volunteers, alterations in the observed CT/MRI morphology and MR signal characteristics were sought in symptomatic individuals. Findings in symptomatic subjects which departed from the normal anatomic features of the posterior spinal elements in asymptomatic volunteers included: rupture of the interspinous ligament(s), neoarthrosis of the interspinous space with perispinous cyst formation, posterior spinal facet (zygapophyseal joint) arthrosis, related central spinal canal, lateral recess (subarticular zone) and neural foramen stenosis, posterior element alterations associated with various forms of spondylolisthesis, and perispinal muscle rupture/degeneration. These findings indicate that the posterior elements are major locations of degenerative spinal and perispinal disease that may accompany or even precede degenerative disc disease. Although not as yet proven as a reliable source of patient signs and symptoms in all individuals, because these observations may be seen in patients with radicular, referred and/or local low back pain, they should be considered in the evaluation of the symptomatic patient presenting with a clinical lumbosacral syndrome. Imaging recommendations, in addition to the usual close scrutiny of these posterior spinal elements and perispinal soft tissues on CT and MRI, include the acquisition of high-resolution multiplanar CT reconstructions, and fat-suppressed T2 weighted fast-spin- or turbo-spin-echo sequence MRI in at least one plane in every examination of the lumbar spine.