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[Automation of the technological medical process in ambulatory polyclinic and hospital establishments].

Now, the creation of automated instruments, apparatus and systems providing complex instrumentation of medical technological processes in ambulant-polyclinical and hospital centers became the main line of the medical technique's development. Primary problems and objects of automation are determined from the proposed models of managing the treatment and diagnostic processes in these establishments.

Ambulatory Care Facilities↗
PubMed1992

Angular deformities and forearm function.

Angular deformities were created in cadaver forearms at proximal, middle, and distal third levels of the radius and ulna separately, and at middle and distal third levels of both bones, to determine the corresponding limitations of pronation and supination. The ranges of pronation and supination were recorded using a rotational motion measurement apparatus instrumented with a 360 degrees goniometer. These experimental results were compared to data obtained from clinical and radiographic examination of 105 patients with similar residual deformities following treatment of fractures by nonsurgical means, to evaluate the accuracy of the experimental model and to determine if loss of rotational motion could be predicted based on radiographic findings. With cadaver forearms, on the average, angulation of 10 degrees of the radius or ulna in coronal or sagittal planes limited pronation and supination by less than 24 degrees, whereas angulation of 10 degrees of both the radius and the ulna limited pronation and supination by less than 18%. Comparison of experimental results with clinical findings showed that, despite the errors involved in measuring forearm deformities in patients using biplanar radiographs, the experimental results predicted the clinical loss of pronation and supination to within 17% for the fractures of the radius, and within 8% accuracy for the fractures of the ulna.

Cadaver↗
PubMed1995

Adenosine pretreatment for prolonged cardiac storage. An evaluation with St. Thomas' Hospital and University of Wisconsin solutions.

Adenosine pretreatment has been shown to be beneficial in several models of ischemia-reperfusion. We wished to evaluate whether adenosine pretreatment is cardioprotective for prolonged cardiac storage and whether the presence of adenosine in the storage media affects the results. Isolated rodent hearts were obtained from Sprague-Dawley rats, mounted on a Langendorff apparatus, instrumented with an intraventricular balloon, and ventricularly paced at 300 beats/min. Four groups of hearts were studied in a 2 x 2 factorial experiment (n = 8 to 12 per group). Hearts were subjected to normal perfusion or to solution supplemented with adenosine 50 mumol/L for 10 minutes followed by adenosine-free perfusion for 10 minutes. Hearts then were stored for 8 hours at 0 degrees C in either University of Wisconsin solution (adenosine 5 mmol/L) or St. Thomas' Hospital II solution (adenosine free). Adenosine pretreatment increased tissue levels of adenosine triphosphate before storage (p = 0.04). Nonfunction was less common after storage (1/19 versus 6/20 hearts, p < 0.05), and diastolic function was better preserved in the adenosine groups in the reperfusion phase (p = 0.01). The beneficial effects of adenosine pretreatment were independent of which storage solution was used. Developed pressure was increased (p < 0.05) and release of creatine kinase and lactate dehydrogenase was reduced (p < 0.0001) in hearts treated with University of Wisconsin solution compared with those treated with St. Thomas' Hospital solution. These studies suggest that adenosine pretreatment improves recovery after prolonged hypothermic storage and that the presence of adenosine in the preservation solution does not alter the results. The experiments provide further evidence that extended myocardial protection is better enhanced with University of Wisconsin solution than with St. Thomas' Hospital II solution.

Adenosine↗
PubMed1997

Load dependence in carpal kinematics during wrist flexion in vivo.

OBJECTIVE: The hypothesis tested was that generation of torque at the wrist affects joint kinematics. DESIGN: An in vivo study of normal wrist kinematics during plantar flexion motion against a constant load was undertaken, using a custom-designed instrumented apparatus to track the motion of the hand during the task. BACKGROUND: Despite clinical observations of a relationship between motion-loading and pain in wrists affected by rheumatoid arthritis, there is little published literature on thein vivo kinematics of the normal human wrist under load. METHODS: Ten volunteers with no wrist pathology were tested while generating torques of zero, 1.1 and 2.2 N m in a planar, unidirectional flexion motion. Hand kinematics were computed using the Planar Rigid Body Method algorithm and an 8 degrees angular step size. The finite radius of motion and the range and standard deviation of the residuals to a fitted second-order curve were used as indices of changes in the kinematics. RESULTS: The magnitude of both the range and standard deviation of the residuals were found to increase significantly with torque at the 95% confidence level. CONCLUSIONS: The wrist does not behave like a smooth mechanism when generating torque. Load affects carpal kinematics. RELEVANCE: We propose that fluctuations in the finite radius of motion are the natural kinematic consequence of intercarpal motion known to occur during wrist flexion. Wrist kinematics may be particularly sensitive to load and joint integrity because orchestrated intercarpal motion depends on the soundness of articular and ligamentous structures, the first to be affected in joint degenerating conditions such as rheumatoid arthritis. Thus, wrist kinematics under load may be a key to characterizing joint integrity. In wrist pathologies, simple planar testing of carpal kinematics under reproducible and controlled joint torque conditions may be a useful way to assess joint involvement before the onset of gross dysfunction, and to evaluate treatment outcomes.

Journal Article↗
PubMed2002

Regulatory initiatives for natural latex allergy: US perspectives.

The US Food and Drug Administration (FDA) has regulatory authority over foods, human drugs, cosmetics, medical devices, radiological products, biologics, and veterinary products. Among these products, FDA believes that the use of medical devices, including medical gloves, condoms, catheters, and breathing bags, represents the greatest source of natural latex proteins to exposed individuals. A medical device is defined in the Federal Food Drug and Cosmetic Act (FFDCA) as an instrument, apparatus, implement, machine, etc., that is intended for use in the diagnosis or treatment of disease or is intended to affect the structure or any function of the body of a human or other animal, and that does not achieve any of its principal intended purposes through chemical action in the body. This article provides some brief, general background about FDA's medical device regulatory process and then addresses the issue of natural latex allergy. Finally we discuss the steps the Agency has taken to evaluate the magnitude and nature of the problem, and FDA's efforts to assist manufacturers, health professionals, and others in minimizing exposure and sensitization to natural latex proteins in medical devices.

Equipment and Supplies↗
PubMed1997

Comparison of the neuronal activity in the SMA and the ventral cingulate cortex during prehension in the monkey.

Two monkeys were trained to use the thumb and forefinger to lift and hold an instrumented apparatus within a narrow position window for 1 s. The device was equipped to measure the position and the grip and lifting forces exerted by the animal. On blocks of trials the weight and surface texture could be varied or a force-pulse perturbation could be systematically delivered 750 ms after the object entered the window. If unopposed, the perturbation would displace the hand from the position window, and in preparation for this perturbation the monkeys either increased their grip force before the perturbation or raised the object higher within the position window. Two clearly separated clusters of cells in the medial wall of the frontal lobe were found to be active in relation to the task. One group of cells (n = 115) was located in the caudal and medial part of area 6, in the supplementary motor area (SMA), and the other (n = 92) was located in the ventral bank of the cingulate sulcus (CMAv), in area 23c. In each area, neurons were characterized by their sensorimotor features clearly related to the hand in addition to their modulated activity in the task. In the SMA, 71% (42 of 59) of the neurons tested for receptive fields responded to peripheral and mainly proprioceptive stimulation, and 71% of them (30 of 42) received inputs from the hand. In the CMAv, 77% (48 of 62) of the neurons responded to peripheral proprioceptive stimulation, and 77% (37 of 48) exhibited receptive fields originating from the hand. Intracortical microstimulation applied to 43 sites in the SMA evoked discrete hand movements at 12 loci, whereas in the CMAv hand movements were observed at 8 of 27 sites tested with an average threshold of > 15 microA. A strong similarity was observed between the SMA and CMAv neurons in their sensorimotor features as well as the modulation of their activity in relation to the prehension task. In both areas the activity was poorly related to grip force and significant correlation with peak grip force was observed for only 9 and 7% of the CMAv and SMA neurons, respectively. In the SMA only five cells exhibited increased activity before the perturbation and in the CMAv no changes in activity were found despite the presence of clear preparatory increases in grip force in anticipation of the perturbation. The perturbation evoked reflexlike excitation of 38% (25 of 65) of the neurons in the CMAv and 28% (20 of 71) of the cells in the SMA; these cells were similar in magnitude and latency (approximately 50 ms) in both areas. In both the SMA and CMAv, most of the neurons increased their firing rate < 200 ms before the grip force onset and the overlap in the distribution of neuronal response times suggests a parallel activation of the SMA and CMAv neurons during the prehension task.

Animals↗
PubMed1991

[The quality standards of patient treatment in hospital departments].

Standards have been compiled on the basis of the clinical picture of the disease as well as objective, laboratory, instrumental-apparatus data. The dynamics of the patient's health were evaluated using concrete indices--normalization or reduction by 10-30% of the initial systolic pressure, absence of painful sensations, increase of range of articular movements, normalization of body temperature, blood indices, urine and oth. Treatment quality values were determined by comparison of results to the preplanned and are evaluated by a three-point rate--good, fair, poor.

Hospital Departments↗
PubMed1998

[Methods of endoluminal treatment of urethral stenosis up to the end of the 19th Century].

Ever since Hippocrates, physicians have managed patients that suffered from urethral stricture. To that end, genius and imagination put to the service of scientific knowledge, have produced numerous apparatus, instruments and methods of a varied nature, with the aim of allowing urine passage through the strictured urethra. Illustrious names such as Andrés Laguna or Francisco Díaz, and other not so well known. Spanish and foreigners, are mentioned in this paper in an intent to contribute a brief view on the evolution of the methods used to treat urethral stricture up to the end of the 19th Century.

Cautery↗
PubMed1987

The clinical relevance of instrumented testing for ACL insufficiency. Experience with the UCLA clinical knee testing apparatus.

An instrumented clinical testing device developed at UCLA records a continuous anteroposterior force versus displacement curve of the tibia with respect to the femur at 20 degrees of flexion. Laxity and stiffness are calculated from the response curve. With this device, 95% of normal knees have an anterior laxity less than 7.5 mm and a side-to-side difference less than 2 mm. In contrast, an anterior cruciate ligament (ACL) absent knee has a mean anterior laxity of 10 mm and a mean side-to-side difference of 5 mm. In a small group of patients with an intraarticular ACL substitution using the medial or lateral one-third of the patellar tendon, laxity and stiffness of the injured knees were returned to within the normal range and remained constant three years after surgery. In a group of 76 patients treated with ACL substitution using the torn meniscus, 51% of the patients still had an anterior laxity outside the normal range 3.5 years after surgery. In a preliminary study of 19 patients receiving a Gore-Tex synthetic ACL substitution, 55% of the patients still had a side-to-side difference greater than 2 mm two years after the procedure. These studies illustrate the advantages of impartial, objective measurements of knee stability. Laxity and stiffness values can supplement, but never replace, a thorough patient examination and patient history. As sports medicine matures as a scientific discipline, improved instrumented test devices may ultimately provide a standardized means for reporting knee stability parameters.

Humans↗