SEARCH · PubMed Health

Results for “DEXTERITY”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,801 records · Page 100Linked to original sources

PubMedDate not supplied

A warm-up laparoscopic exercise improves the subsequent laparoscopic performance of Ob-Gyn residents: a low-cost laparoscopic trainer.

INTRODUCTION: Residents traditionally acquire surgical skills through on-the-job training. Minimally invasive laparoscopic techniques present additional demands to master complex surgical procedures in a remote 2-dimensional venue. We examined the effectiveness of a brief warm-up laparoscopic simulation toward improving operative proficiency. METHODS: Using a "Poor-Man's Laparoscopy Simulator," 12 Ob/Gyn residents and 12 medical students were allocated 10 minutes to transfer 30 tablets with a 5-mm grasper from point A to point B via laparoscopic visualization in a warm-up exercise. Participants repeated the exercise following a 5-minute pause. Mean scores, expressed in seconds/tablet, and overall improvement (percentage difference between warm-up and follow-up) were analyzed according to postgraduate standing (PGY14), dexterity skills, and pertinent vocational activities. RESULTS: Significant improvements were noted for both residents (+25%) and medical students (+29%), P<0.0001. Scores between the 2 groups, however, were not significant (P=0.677). Proficiency was not influenced by PGY standing. Interestingly, the best (8.73 sec/pill) and the worst (25 sec/pill) scores were attained by a medical student and a chief resident, respectively, suggesting the contribution of individual aptitude. CONCLUSION: A brief warm-up exercise before an actual laparoscopic surgical procedure significantly improves subsequent laparoscopic performance.

Clinical Competence↗

PubMedDate not supplied

Robotic-assisted laparoscopy in gynecological surgery.

BACKGROUND: Laparoscopic surgery has revolutionized the concept of minimally invasive surgery for the last 3 decades. Robotic-assisted surgery is one of the latest innovations in the field of minimally invasive surgery. Already, many procedures have been performed in urology, cardiac surgery, and general surgery. In this article, we attempt to report our preliminary experience with robotic-assisted laparoscopy in a variety of gynecological surgeries. We sought to evaluate the role of robotic-assisted laparoscopy in gynecological surgeries. METHODS: The study was a case series of 15 patients who underwent various gynecologic surgeries for combined laparoscopic and robotic-assisted laparoscopic surgery. The da Vinci robot was used in each case at a tertiary referral center for laparoscopic gynecologic surgery. An umbilicus, suprapubic, and 2 lateral ports were inserted. These surgeries were performed both using laparoscopic and robotic-assisted laparoscopic techniques. The assembly and disassembly time to switch from laparoscopy to robotic-assisted surgery was measured. Subjective advantages and disadvantages of using robotic-assisted laparoscopy in gynecological surgeries were evaluated. RESULTS: Fifteen patients underwent a variety of gynecologic surgeries, such as myomectomies, treatment of endometriosis, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, and Moskowitz procedure. The assembly time to switch from laparoscopy to robotic-assisted surgery was 18.9 minutes (range, 14 to 27), and the disassembly time was 2.1 minutes (range, 1 to 3). Robotic-assisted laparoscopy acts as a bridge between laparoscopy and laparotomy but has the disadvantage of being costly and bulky. CONCLUSION: Robotic-assisted laparoscopic surgeries have advantages in providing a 3-dimensional visualization of the operative field, decreasing fatigue and tension tremor of the surgeon, and added wrist motion for improved dexterity and greater surgical precision. The disadvantages include enormous cost and added operating time for assembly and disassembly and the bulkiness of the equipment.

Colposcopy↗

PubMed2006

[Surgical treatment of cor triatriatum in 15 patients].

OBJECTIVE: To review the clinical data of pathological morphology, diagnosis, surgical treatment of cor triatriatum in 15 patients. METHODS: Fifteen patients with a mean age of (14.6+/-10.3) years (range from 6 months to 40 years) were performed operations under extracorporeal circulation. Fourteen of the patients had cor triatriatum sinister, and 1 had cor triatriatum dexter; 12 of the 15 patients had other cardiac abnormalities. The excision of the fibromuscular membrane was accomplished through a right atrial incision in all of the 14 cases, and the associated abnormalities were corrected at the same time. RESULTS: One patient died after the operation, and the other survivors had good outcome. CONCLUSION: Operation is necessary if the diagnosis is clear. The patients generally have good prognosis. Surgical results of cor triatriatum depend on the complexity of associated defects and the adequacy of the repair.

Adolescent↗

PubMed1991

Human clinical trials of the dilatable pulmonary artery banding prosthesis.

OBJECTIVE: To test the hypothesis that the dilatable pulmonary artery banding prosthesis is as effective and safe to use as conventional fixed fabric bands, and provides an additional nonsurgical option for dilation. DESIGN: Nonrandomized prospective human clinical trial. SETTING: British Columbia's Children's Hospital for tertiary care. PATIENTS: All patients admitted with congenital heart defects who required banding of the pulmonary artery during a 17 month period. The patients who received a dilatable band were selected on the basis of their cardiologist's preference. INTERVENTIONS: Surgical banding was performed using accepted techniques. Intraluminal balloon dilation of the pulmonary artery band was done using techniques accepted for intraluminal balloon dilation in pulmonary valvuloplasty. MAIN RESULTS: Eleven patients received the dilatable bands and eight received fixed bands. There was no evidence of failure of the bands to maintain their function. One patient required intraluminal balloon dilation of the dilatable band. This was successfully accomplished without complication. The dilatable bands were easier to remove than the fixed bands, but required greater surgical dexterity to place and adjust. One of the dilatable bands was applied too distally and one too tightly. One fixed band was applied too tightly and another too loosely, requiring a second banding operation. CONCLUSIONS: The dilatable pulmonary artery banding prosthesis is as effective and safe to use as a fixed fabric band. It is easier to remove and provides a nonsurgical option for dilation.

Blood Vessel Prosthesis↗

PubMed1991

Megakaryocyte maturation in long-term marrow culture.

Evidence has been sought for megakaryocyte maturation in long-term cultures of mouse bone marrow. Cultures up to 14 weeks of age were examined for the presence of megakaryocytes with processes, that is, resembling the morphological appearance seen in vivo prior to platelet liberation. Such cells were found floating just above the adherent stromal layer using low magnification phase contrast microscopy. It was rare to observe as many as 20 of these cells per 25-cm2 flask. At higher magnification, processes were seen to be attenuated with constrictions at intervals along their length. Time-lapse photography was used to follow the development and behavior of the processes. Direct evidence of rupture was very rare; generally the megakaryocytes retracted their processes within 48 h. Careful searching of cultures occasionally revealed the presence of several process fragments, and sometimes individual platelets were found. Ultrastructurally, the processes were seen to contain organelles that are usually associated with platelets. The observations applied to both Dexter and Whitlock-Witte cultures. It is concluded that maturation of megakaryocytes occurs in long-term marrow culture to the point where platelet release appears imminent. Final rupture is rare and may require shearing forces, which in vivo would be provided by blood flow.

Animals↗

PubMed1991

Diving and hypothermia.

Hypothermia is not and should not be a prevalent feature of diving, yet many divers become extremely cold and uncomfortable during their work. It is not difficult to provide adequate insulation to protect the torso but if movement and dexterity are to be maintained, the extremities will inevitably suffer. Free swimming divers are limited by duration in cold (5 degrees C), shallow (10 m) water. Six hours is a typical maximum before both core cooling and extremity pain or dysfunction pose a threat. Habituation to cold may be observed in some divers. Surface supplied or bell supported divers, relying on supplementary hot water, need between 500 and 3500 Watts to preserve comfort over the range 10 to 300 m depth. Deep diving, using oxyhelium gas mixtures, can result in high respiratory convective losses in excess of 300 Watts. Heat exchangers are used to prevent damage to the tract. There have been a number of cases where hypothermia has been implicated in the cause of death in diving accidents, but generally the reason is not lack of physiological knowledge but equipment failure and inadequate contingency. Recent developments in diver protection have focused on electrically heated hand wear to preserve performance and prevent the risk of non freezing injury in a relatively inactive diver.

Acclimatization↗

PubMed1991

[Continuous spinal anesthesia versus continuous epidural anesthesia in surgery of the lower extremities. A prospective randomized study].

Continuous epidural anesthesia (CEA) is generally accepted as a routine method of regional anesthesia while there has been only limited application of continuous spinal anesthesia (CSA), due mainly to a lack of adequate spinal catheters. With the introduction of a new, ultra-thin spinal catheter (32 G) inserted via a thin puncture needle, some of the complications reported after CSA can be eliminated. We studied CSA versus CEA in lower-extremity operations. METHODS. We evaluated 33 patients in a prospective, randomized study. All were comparable with respect to age, anesthetic risk (ASA II-III), and pre-existing diseases. The only exclusion criterium was the presence of a coagulation disturbance. The CSA group consisted of 17 patients (mean age 75.5 +/- 0.1 year); 26 G puncture needle and 32 G catheter were used. The CEA group consisted of 16 patients (mean age 73.8 +/- 11.0 years); an 18 G puncture needle and 22 G epidural catheter with a stylet were inserted with the loss-of-resistance technique. Both catheters were placed with the patient in a sitting position and left in place for 24 h in order to administer local anesthetics (LA) for postoperative analgesia as required. Hemodynamic parameters-mean arterial pressure (MAP) and heart rate (HR)-were compared in each group at 5-min intervals for 30 min after administration of local anesthetic and at 10-min intervals during the operation. Additionally, the ECG, pulse oximetry, respiratory rate, diuresis, and blood gases were monitored. After placement of the catheter, patients in the CSA group received 1.9 ml (+/- 0.2) bupivacaine HCl 0.5%. Patients in the CEA group received 12.6 ml (+/- 2.5) bupivacaine HCl 0.5%. For statistical evaluation of the data we used mean values, standard deviation (+/-), the Kruscal-Wallis procedure, and Student's t-test for unpaired data. P less than 0.05 was considered significant. RESULTS. The mAPs in the CSA group generally remained lower than those of the CEA group. However, over the course of the operation as well as after repeated injections, the difference between the two groups decreased. Only at 5 min after administration of the initial dose was a statistically significant difference in blood pressures between the two groups observed. A clinically relevant, rapid decrease in blood pressure due to relatively high doses of LA was seen in 1 case in each group. The first reinjection of LA after the initial dose was after 1.9 h in the CSA group (bupivacaine HCl 0.5% 1 +/- 0.3 ml) and after 1.8 h in the CEA group (bupivacaine HCl 0.5% 4.5 +/- 1 ml). The total dose of bupivacaine in the CSA group was 0.18 ml/kg per hour versus 0.8 ml/kg in the CEA group. No post-dural puncture headache was observed in the CSA group. DISCUSSION. The catheter designed for CSA is easy to use, although because of its small diameter a certain manual dexterity is required. In addition, CSA resulted in a more rapid onset of action and more pronounced sensorimotor blockade than did CEA. Hemodynamic alterations and side effects were comparably low in both groups.

Aged↗

PubMedDate not supplied

[Dexamethasone therapy in Huntington chorea: preliminary results].

Neuroleptic drugs represent the current therapy for Huntington's chorea (HC). However neuroleptics can improve involuntary movements, but not functional performance and disease progression. Several clinical and experimental data suggest the existence of functional relationship between corticosteroids and extrapyramidal system. We administered dexamethasone to six choreics, all female. Dexamethasone was given i.m. at dose of 4 mg/die for 20 days and 8 mg/die for 20 days more. Dexamethasone at both the doses used, determined significant improvement (p less than 0.05) of dyskinesia, evaluated by AIMS, and manual dexterity, evaluated by Tapping test. Although at present it is not clear which mechanism are responsible for this of dexamethasone favourable effect, it might open new perspectives in HC therapy.

Adult↗

PubMed1991

Granulocyte-macrophage colony-stimulating factor (GM-CSF) in human long-term bone marrow cultures: endogenous production in the adherent layer and effect of exogenous GM-CSF on granulomonopoiesis.

This study was designed to assess the presence of endogenous granulocyte-macrophage colony-stimulating factor (GM-CSF) within adherent layers of human Dexter-type cultures and to investigate the effect on granulomonopoiesis of adding exogenous GM-CSF to the culture medium. The presence of GM-CSF was demonstrated using a bioassay, in which adherent layers from normal bone marrows gave rise to endogenous granulocyte-macrophage colony-forming units (CFU-GM) that were specifically inhibited by increasing amounts of an anti-GM-CSF neutralizing antibody. Using an immunoassay, the estimated amounts of GM-CSF were less than or equal to 40 pg per flask in adherent layers, while remaining undetectable in supernatants. The addition of 10 ng or purified recombinant GM-CSF per milliliter of culture medium increased slightly the CFU-GM output over a 5-week culture period. The addition of 50 ng/mL decreased significantly the CFU-GM output after 5 weeks of culture. This decrease was associated with major modifications of the adherent layer cell composition. Large round or ovoid macrophages were generated at the expense of the interdigitated and elongated stromal cells and the extracellular fibronectin network was no longer observed. These studies suggest that GM-CSF production by accessory cells (stromal cells and/or monocytes) is almost equal to its consumption by hematopoietic cells, a situation similar to that found in long-term cultures of murine marrows. They also show that the maintenance of granulomonopoiesis is decreased by adding more than 10 ng/mL of exogenous GM-CSF to the culture medium, which is related to the induction of adherent macrophages, the disappearance of the major smooth-muscle-like stromal cell component of the adherent layer, and that of the fibronectin extracellular matrix.

Bone Marrow↗

PubMed1991

Neurological consequences of protein and protein-calorie undernutrition.

Malnutrition is a worldwide problem of enormous magnitude. The growth of the central nervous system in human beings is retarded in case of malnutrition in the very early part of life. Likewise, the peripheral nerves in infants and children and young growing animals appear susceptible to nutritional deprivation including protein as well as protein-calorie deficiency. Motor weakness, hypotonia, and hyporeflexia in infants and children are the essential clinical neurological signs in protein-calorie malnutrition (PCM). Motor and sensory nerve conduction are significantly impaired in children with PCM as well as in animals subjected to protein or protein-calorie deficiency. Histological studies have revealed reduced diameter of myelinated nerve fibers, retardation of myelination, segmental demyelination and remyelination, axonal degeneration, and shortened longitudinal growth of internodes. Diffusion barrier by perineurium may be broken. There is reduction in myelin lipids and impaired synthesis of myelin as shown by the biochemical and radioisotope incorporation studies. Presence of cholesterol esters in the biochemical synthesis of nerves suggests degeneration changes. Experimental studies have revealed that most effects of PCM on peripheral nerves can be reversed by nutritional rehabilitation, although complete recovery in the sensory nerve action potential, fiber size of dorsal nerve roots, and myelin-specific lipids does not occur. Skeletal muscle also shows many changes including muscle fiber atrophy, reduction in duration and amplitude of motor unit potentials, and/or fibrillation on electromyography (EMG) and biochemical estimation of muscle enzymes. These changes may be the reflection of a direct effect of PCM on muscles or secondary to the abnormal structural or biochemical changes in the peripheral nerves. PCM affects the central nervous system, especially the neuropsychological functions, in a lasting manner. Learning deficits and impairment of manual dexterity are the most obtrusive features. Neurotransmitter abnormalities and maturation lag in electroencephalogram have been demonstrated in experimental animals. Spinal cord dysfunction sometimes manifests overtly as clinical myelopathy. Degenerative changes in the cerebellum have been noted.

Animals↗

PubMed1991

[Radial keratotomy: analysis of undercorrected patients, based on 200 successive operations].

The authors present the results of a series of 200 radial keratotomies. there were two anatomical complications, neither of which caused any clinical damage. 83% of patients obtained 5/10 distant visual acuity or more without correction. The overcorrection rate was 1.5%. The incidence of induced astigmatism was 3.0%. The real failure of the method lay in an undercorrection rate of 13%. These cases are analysed here. Correction proved easier as patients were older: 0.64 diopters per decade. There was a 0.30 diopter gain in men over women. With corneal curvature of more than 43.5 diopters, the benefit was 0.15 diopters per diopter of keratotomy. Limbus to optical zone incisions provided 1.60 diopters as compared with optical zone to limbus incisions, while redeepening incisions provided only 0.27 diopters. Emphasis is placed upon practical matters, such as quality of measurement, instruments and the dexterity of the surgeon. We limit surgical indications to within the range of -1.50 diopters to -4.50 diopters of myopia. The undercorrection rate within this myopia range was 6.3%, increasing to 39.0% over the range.

Adult↗

PubMed1991

Effect of lipopolysaccharide on the production of colony-stimulating factors by the stromal cells in long-term bone marrow culture.

The production of colony-stimulating factors (CSFs) by murine bone marrow stromal cells was studied with Dexter long-term bone marrow culture (LTBMC). For induction of CSF release, various concentrations (0.5-40.0 microgram/ml) of bacterial lipopolysaccharide (LPS) were added to nonrecharged 3-week-old LTBMCs consisting of an intact or macrophage-depleted adherent cell layer. The depletion of monocytes/macrophages from freshly prepared bone marrow cell suspension was performed by carbonyl-iron incorporation before establishment of LTBMC. The supernatants (Sup) of normal LTBMCs contained a low level of macrophage colony-stimulating factor (M-CSF) that was produced by the adherent cells but not by the nonadherent cell elements. No colony inhibitor was found in the Sup of LTBMCs, whereas a colony-promoting activity (CPA) was detected in medium conditioned by the adherent marrow cells (AC-CM). CPA could enhance the colony formation of myeloid progenitor cells when used in combination with recombinant murine granulocyte-macrophage colony-stimulating factor (GM-CSF). The production of CSFs peaked at about 24 h after refeeding, but it then declined to only half the optimal activity at the end of the week. Addition of LPS to the intact LTBMC invariably increased the production of a GM-CSF-like cytokine. The release of this cytokine was dose dependent and peaked at a dosage of 20 micrograms/ml of LPS at 24 h after treatment. In contrast, macrophage-depleted marrow-adherent cells failed to respond to LPS for CSF secretion. These results suggest that LPS can stimulate marrow macrophages to directly release CSF or to potentiate the production of CSF by other stromal cells.

Animals↗

PubMed1991

Effect of rhCSF-1 on human hemopoiesis in long-term cultures from patients with acute myelogenous leukemia.

Bone marrow and/or peripheral blood cells from seven patients with acute myelogenous leukemia (AML) were maintained for 7 weeks in Dexter-type long-term culture (LTC) in order to study the effect of exogenous recombinant human colony-stimulating factor-1 (rhCSF-1) and to quantitate endogenous levels of CSF-1. rhCSF-1 was added every 2 days during the first 3 weeks of culture at 15 ng/ml. In all but one culture, adding rhCSF-1 inhibited putative leukemic hemopoiesis [i.e. decreased numbers of abnormal (blast) colony-forming cells and blasts] and stimulated putative normal hemopoiesis (increased numbers of CFU-GM and macrophages). Our data, however, do not distinguish direct effects of rhCSF-1 on normal or leukemic cells from indirect effects mediated by accessory cells. In cultures with a poorly formed adherent layer (all derived from patients classified as M5), the endogenous levels of CSF-1 were lower than those in cultures with a good (confluent) adherent layer, indicating that the levels of CSF-1 in LTC from AML patients positively correlate with the formation of the adherent layer. Our data indicate that CSF-1 is an important modulator of human hemopoiesis in LTC established from AML bone marrow or peripheral blood, and that rhCSF-1 might be valuable for purging leukemic cells in LTC established from AML patients' bone marrow or peripheral blood for autologous transplantation.

Hematopoiesis↗

PubMed1991

Colonoscoping the "difficult" colon.

Despite the popularity of colonoscopy, very little has been published on specific technique. There are many factors that make colonoscopy easy or difficult, but the most important one is the endoscopist himself/herself. One must have excellent manual dexterity and technical ability; and, above all, one must perform enough cases to gain the needed experience to understand the procedure and to perform it rapidly, successfully, and safely. There are only so many maneuvers that can be carried out with a colonoscope, such as pushing it in, withdrawing it, turning it to the right, left, up, or down. Therefore, decision making (options), such as changing the position of the patient or applying external pressure points, must be performed rapidly before too many repetitive false moves are made. Options for each anatomical segment of the colon are outlined, based on an experience of ten thousand colonoscopies.

Colon↗

PubMed1991

[Endobronchial drug administration in resuscitation].

The endobronchial application of drugs is recommended during pharmacological reanimation in lack of venous punction possibility. To find out the quantity of the area of resorption after deep endobronchial instillation twelve human corpses had been intubated and methylen-blue was applicated through the tube. A special application kit with a single use ampule was used. The results showed a very good distribution of 100% or 90% in the bronchi principals dexter and sinister. The bronchi lobaris of the right and the left bronchial tree were reached by the injection with an incidence of more than 70%. This proved distribution of the applicated indicator liquid in a patient in horizontal position (no circulation) allows the statement that during reanimation a sufficient pulmonal surface area is reached in both lungs to guarantee a resorption of the drug.

Bronchi↗

PubMedDate not supplied

Relationship between physical impairment, psychological variables and pain in rheumatoid disability. An analysis of their relative impact.

Forty-two consecutive female rheumatoid patients were given the AIMS questionnaire in order to determine their disability. Twenty-one had a second assessment one year later. Factorial analysis showed that the Italian version fully respects the construct of the original test. In fact four main factors (the physical, psychological, social and pain dimensions) arose, explaining 44.8%, 13.6%, 11.4% and 9% of the total variance, respectively. A close relationship was demonstrated between psychological variables, namely depression, and physical impairment, as shown by the correlation coefficient matrix. In order to determine whether depression might influence the ultimate outcome twenty-one patients were separated into two subsets according to their initial depression (greater than 5, less than 5). After one year, dexterity and pain were significantly worse in those with the highest depression score. This study shows that the psychological variables, in addition to physical impairment and pain, are of utmost importance in the outcome of rheumatoid patients.

Adult↗

PubMed1991

[Limbus-plasty in recurrent anterior shoulder dislocation].

We are reporting the results of labrum reconstruction following recurrent dislocations of the shoulder. From 1985 to 1988 35 patients (27 male/eight female) aged 28.4 years on the average (20 to 45 years old) had surgical treatment. 33 of these 35 came in for a follow-up about 40 months later (28 to 60 months). So far, only one patient suffered a re-dislocation from major trauma. In that case, therapy was continued on a conservative basis and the patient has been free of complaints and re-dislocation for three years. No one of the remaining 32 patients had another dislocation. Shoulder mobility is normal in 29 patients. One patient's abduction is impaired by 10 degrees and one has a 10 degrees to 15 degrees impairment of outward rotation. 30 patients have no complaints whatever. 32 patients consider the outcome satisfactory and only one does not. 30 of 33 patients say their dexterity in sports is the same as prior to the accident and only three feel slightly impaired during competitive sports.

Adult↗

PubMed1991

[Modification of in vitro hematopoiesis induced by addition of GM-CSF in long term normal human bone marrow cultures].

We have studied the effects of GM-CSF on cell growth in Dexter's type normal human long-term bone marrow cultures. Non adherent and adherent cells were weekly harvested and studied all over the time of culture up to 10 weeks: number, cytology, hematopoietic granulocyte-macrophage progenitors content (CFU-GM). Control consisted of cultures without growth factor. GM-CSF (100 ng/ml) induced a significant increase in the number of non adherent and adherent cells, mainly increasing the number of cells of the granulocytic lineage. GM-CSF also induced a transient increase in the number of CFU-GM in the non adherent fraction, but as from week 6 of culture, there were no more CFU-GM. At last GM-CSF inhibited completely or partially the adipocyte growth in the adherent stromal cell layers. In conclusion, at this concentration, GM-CSF might be responsible for the accelerated aging, maybe linked to the hematopoietic stem cells exhaustion and to the almost exclusive presence of monocyte-macrophage cell types in the culture supernatant.

Analysis of Variance↗

Refine your search to explore more results.