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PubMed1987

Common arterial trunk arising exclusively from the right ventricle with hypoplastic left ventricle and intact ventricular septum.

A common arterial trunk is a rare congenital anomaly usually accompanied by other intracardiac malformations. The association with hearts with a univentricular atrioventricular connexion is particularly uncommon. We report a case of a common arterial trunk occurring in a heart with absent left atrioventricular connexion. The trunk arose exclusively from the right ventricle, the left ventricle was incomplete and the ventricular septum was intact. Other associated malformations were an interrupted aortic arch and an atrial septal defect.

Aorta, Thoracic↗

PubMed1991

Morphogenetic considerations on congenital malformations of the outflow tract. Part 1: Common arterial trunk and tetralogy of Fallot.

On the basis of our recent embryologic work concerning the separation process of the outflow tract, together with our study of the morphology of specimens from the Leiden Collection of malformed hearts, we have reconsidered, in conjunction with the pertinent literature, the morphogenesis of common arterial trunk and tetralogy of Fallot. The constant characteristics of common arterial trunk, namely a common trunk, a common arterial orifice and a ventricular septal defect, can be explained simply by absence of the aorto-pulmonary septum, or its complete failure to contribute to the process of separation. The nature of the variable morphologic features, however, is not always clear. Presence of such variation is not contradictory to the explanation of the main characteristics in this malformation. Tetralogy of Fallot, in contrast, can be considered to result from anterior displacement of the columns of the aorto-pulmonary septum relative to the outlet segment and its proximal boundary, the primary fold. Our findings, and suggestions, diverge considerably from conventional theories concerning the morphogenesis of these malformations.

Heart Septal Defects, Ventricular↗

PubMed1995

A cineradiographic study on the lumbar disc deformation during flexion and extension of the trunk.

To reveal deformation behaviour of normal lumbar discs (L((3/4)), L((4/5)) andL(5)/S(1), the lumbar spines of eight asymptomatic volunteers were examined cineradiographically during flexion and extension of the trunk. Disc deformation could be evaluated by displacement of the superior corners of the disc, which were measured with respect to the upper surface of the adjacent lower vertebra. Furthermore the in-vivo strain distribution of each lumbar disc was analysed by the finite element method and in-vivo measurement of the disc deformation. During flexion, deformation of the lumbar disc increased rapidly after a certain delay from the start of trunk motion and reached maximum value before the finish of trunk motion. It was also confirmed that time lags were present between the onsets of disc deformation. Namely, each disc deformed not simultaneously but stepwise from the upper to the lower level with time lags during flexion. When the lower disc deformation started, the strain at the adjacent upper discs had already reached more than half of the value at full flexion. RELEVANCE: The present study revealed one of the phenomena of lumbar spinal kinematics, which will provide helpful information to clinical problems such as evaluation of spinal instability.

Journal Article↗

PubMed1987

Influence of head or trunk oscillations on visually induced self-motion perception in humans.

The influence of concurrent head or trunk movements on optokinetically induced self-motion perception has been investigated by measuring circularvection (CV) latencies. Active head as well as passive trunk oscillation cause an increase in circularvection latency of about 50% as compared to latencies with the head and trunk stationary during full field optokinetic stimulation. The results point towards an intersensory inhibition of self-motion perception.

Adolescent↗

PubMed1995

Time-dependent changes in electrical resistance of the intact trunk, thorax and abdomen of rats during the first 21 days post mortem.

Electrical resistance of the intact trunk, thorax and abdomen was determined sequentially in each of eight rat cadavers maintained at constant temperature. All electrodes applied to each cadaver were left in situ for the duration of the 21-day postmortem period. Trunk, thoracic and abdominal resistances increased (on average) from 337 +/- 31, 174 +/- 27 and 163 +/- 22 omega 1 h after death, to peak values of 567 +/- 46, 333 +/- 36 and 254 +/- 33 omega at 2, 3 and 1 days post mortem, respectively. Thereafter, all resistances decreased progressively with increasing time since death, reaching values of 294 +/- 39 omega (trunk), 173 +/- 33 omega (thorax) and 121 +/- 19 omega (abdomen) at 21 days post mortem. These changes are believed to reflect progressive postmortem decreases in the resistivities of the body segments studied.

Animals↗

PubMed2005

A rare variation of the coeliac trunk.

The hepatic, splenic and Left gastric arteries are considered as the "main classic branches" of the coeliac trunk. During the routine dissections in the laboratory of the Anatomy Department in a 62-year-old male cadaver, a rare variation, a coeliacomesenteric trunk was observed. This trunk gave rise to the left gastric, the common hepatic, the splenic, the left gastro-epiploic, the right and left inferior phrenic arteries. The developmental and clinical significance of this anomalous vessel is discussed.

Arteries↗

PubMed2005

Trunk muscle responses to demands of an exercise progression to improve dynamic spinal stability.

OBJECTIVES: To compare relative activation amplitudes among abdominal and trunk extensor muscle sites of healthy people performing a leg-loading exercise protocol aimed at progressively challenging spinal stability. DESIGN: A prospective, comparative, repeated-measures design. SETTING: Motion analysis research laboratory. PARTICIPANTS: Eighteen healthy male and female volunteers (mean age +/- standard deviation, 23.8+/-3.4y). INTERVENTIONS: Subjects performed 5 progression levels in random order, while surface electromyograms were recorded from 5 abdominal and 2 back extensor muscle sites. Levels 2 through 5 were of interest because they included a leg-extension phase. The root mean square (RMS) amplitude during the leg-extension phase was calculated and normalized to maximal voluntary isometric contractions (MVICs) for each muscle. A 2-factor repeated-measures analysis of variance tested the muscle-by-level interactions and the 2 main effects for the abdominal and trunk extensor sites separately. Bonferroni adjustments were performed on significant results. MAIN OUTCOME MEASURE: Normalized RMS (NRMS) amplitude for each muscle during the leg-extension phase. RESULTS: There were statistically significant muscle-by-level interactions (P<.05) for both abdominal and trunk extensor sites. The relative amplitudes increased for the abdominal muscles and erector spinae muscles among levels, except between levels 3 and 4. Significant differences were found among the abdominal muscle sites for the lower-level exercises (levels 2-4), but not for level 5. The highest NRMS amplitude was at level 5, that is, 40% of MVIC. CONCLUSIONS: The patterns of activation amplitudes differed among levels; therefore, this was not a simple progressive loading protocol because muscles responded in a nonuniform manner to the demands associated with the various levels of progression. Based on the results, the protocol met some of the objectives of dynamic stability protocols.

Adult↗

PubMed2006

The elephant trunk technique for staged repair of complex aneurysms of the entire thoracic aorta.

BACKGROUND: Extensive thoracic aortic aneurysms that involve the ascending, arch, and descending segments require challenging repairs associated with substantial morbidity and mortality. The purpose of this report is to evaluate contemporary outcomes after surgical repair of extensive thoracic aortic aneurysms using a two-stage approach with the elephant trunk technique. METHODS: During a 15 1/2-year period, 148 consecutive patients underwent total aortic arch replacement using the elephant trunk technique. Seventy-six of these patients (51%, 76/148) returned for second-stage repair of the descending thoracic or thoracoabdominal aorta 4.9 +/- 7.5 months after the first stage. RESULTS: Operative mortality after the proximal aortic stage was 12% (18/148). Seven patients (5%) had strokes. Among the patients who subsequently underwent distal aortic repair, operative mortality was 4% (3/76). Two patients (3%) developed paraplegia. Long-term survival after completing the second stage of repair was 70 +/- 6% at 5 years and 59 +/- 7% at 8 years. CONCLUSIONS: Contemporary management of extensive thoracic aortic aneurysms using the two-stage elephant trunk technique yields acceptable short-term and long-term outcomes. This technique remains an important component of the surgical armamentarium.

Acute Kidney Injury↗

PubMed2005

Thoracic cross-over pathways of the rat vagal trunks.

It is very difficult to study the independent contributions of the afferent and efferent pathways of the subdiaphragmatic vagus to physiology and behavior. Total subdiaphragmatic vagotomy can confound the interpretation of experimental results because it destroys both afferent and efferent vagal fibers. One approach to address this problem involves producing a total ablation of afferent (or efferent) vagal fibers while retaining half of the efferent (or afferent) vagal fibers by making a unilateral rhizotomy plus contralateral subdiaphragmatic vagotomy. However, the completeness of this afferent (or efferent) lesion is based on the assumption that there are no cross-over pathways within the thoracic cavity between the vagal trunks of the rat. To directly test for the presence of vagal cross-over pathways in the rat, we recorded the compound action potentials from the ventral and dorsal trunks of the subdiaphragmatic vagus following electrical stimulation of the left or right cervical vagi. C-fiber cross-over pathways comprised an average of 9% of the total nerve responses (range was 0 to 29%, n = 20). Direct application of the anesthetic bupivacaine to the vagus completely blocked the recorded signals. The vagal cross-over pathways were also demonstrated using capsaicin as a stimulus. These results indicate the presence of thoracic cross-over pathways between vagal trunks in the rat and demonstrate that for most animals it is not possible to produce a "complete" ablation of afferent (or efferent) components of the subdiaphragmatic vagus using unilateral rhizotomy combined with contralateral subdiaphragmatic vagotomy.

Action Potentials↗

PubMed2005

Trunk muscle recruitment patterns in specific chronic low back pain populations.

BACKGROUND: It is hypothesized that injury or degeneration of osteoligamentous spinal structures would require compensation by trunk musculature and alterations in motor control to maintain spine stability. While, biomechanical modeling has supported this hypothesis, studies of muscle recruitment patterns in chronic low back pain patients both with and without significant osteoligamentous damage have been limited. This study utilized a non-randomized case-control design to investigate trunk muscle recruitment patterns around the neutral spine position between subgroups of patients with chronic mechanical low back pain and asymptomatic controls. METHODS: Twenty subjects with chronic low back pain attributed to clinical lumbar instability were matched to 20 asymptomatic controls. In addition 12 patients with non-specific chronic low back pain were studied. Surface EMG from five trunk muscles was analyzed to determine activation levels and patterns of recruitment during a standing reach under two different loading conditions. FINDINGS: The chronic low back pain group with symptoms attributed to clinical instability demonstrated significantly higher activation levels of the external oblique and rectus abdominus muscles and lower abdominal synergist ratios than the control group. No significant differences were found between patient subgroups. INTERPRETATION: While these data demonstrate altered muscle recruitment patterns in patients with chronic low back pain, the changes are not consistent with Panjabi's theory suggesting that these alterations are driven by passive subsystem damage. However, the higher activation of global abdominal musculature and altered synergist patterns may represent a motor control pattern that has consequences for continued dysfunction and chronic pain.

Abdominal Muscles↗

PubMed2005

Kinematic and electromyographic response to whiplash-type impacts. Effects of head rotation and trunk flexion: summary of research.

Despite the fact that whiplash patients often report they had their head rotated or were in a twisted posture at the time of impact, the effect of these postures on the cervical muscle response to impact remains uninvestigated in impact studies. Prior impact studies have positioned the volunteers in the recommended driving position, for example, with head and trunk in a neutral posture. Using an approach of sled impacts with volunteers in very-low velocity impacts to describe the head kinematics and cervical muscle electromyography in response has provided a wealth of data. From this approach, the effect of varying impact direction and level of impact awareness can be discerned without subjecting the volunteers to injury. In part 1 of this review, a further series of results of impacts from eight directions is presented, revealing that the cervical electromyography response to whiplash-type impacts varies according to the presence and direction of head rotation. In part 2, additional data is summarised concerning whiplash-type impacts from 8 directions in the presence of trunk flexion. Contrary to a popular notion, head rotation or trunk flexion at the time of impact are factors that probably reduce injury risk. This data adds to attempts to approach an understanding of the human response to more complex scenarios of low-velocity road collisions.

Acceleration↗

PubMed2006

Wrapping of trunk thoracic extensor muscles influences muscle forces and spinal loads in lifting tasks.

BACKGROUND: An improved assessment of risk of spinal injury during lifting activities depends on an accurate estimation of trunk muscle forces, spinal loads and stability margin which in turn requires, amongst others, an accurate description of trunk muscle geometries. The lines of action of erector spinae muscles are often assumed to be linear despite the curved paths of these muscles in forward flexion postures. METHODS: A novel approach was introduced that allowed for the proper simulation of curved paths for global extensor muscles in our Kinematics-driven finite element model. The lever arms of global muscles at different levels were restrained either to remain the same or decrease only by 10% relative to their respective values in upright posture. Based on our earlier measurements, static lifting tasks at two trunk flexions (40 degrees and 65 degrees ) and three lumbar postures (free style, lordotic and kyphotic) with 180 N in hands were analyzed. FINDINGS: Muscle forces and spinal compression at all levels substantially decreased as the global extensor muscles took curved paths. In contrast, the shear force at lower levels increased. Allowing for a 10% reduction in these lever arms during flexion increased muscle forces and compression forces at all levels. Despite smaller muscle forces, wrapping of global muscles slightly improved the spinal stability. INTERPRETATION: Consideration of global extensor muscles with curved paths and realistic lever arms is important in biomechanical analysis of lifting tasks. Reduction in the erector spinae lever arms during flexion tasks could vary depending on the lumbar posture. Results advocate small flattening of the lumbar curvature in isometric lifts yielding smaller compression and shear forces at the critical L5-S1 level.

Abdominal Muscles↗

PubMed2004

Postural and respiratory activation of the trunk muscles changes with mode and speed of locomotion.

Despite the importance of the deep intrinsic spinal muscles for trunk control, few studies have investigated their activity during human locomotion or how this may change with speed and mode of locomotion. Furthermore, it has not been determined whether the postural and respiratory functions, of which these muscles take part, can be coordinated when locomotor demands are increased. EMG recordings of abdominal and paraspinal muscles were made in seven healthy subjects using fine-wire and surface electrodes. Measurements were also made of respiration and gait parameters. Recordings were made for 10s as subjects walked on a treadmill at 1 and 2 ms(-1) and ran at 2, 3, 4 and 5 ms(-1). Unlike the superficial muscles, transversus abdominis was active tonically throughout the gait cycle with all tasks, except running at speeds of 3 ms(-1) and greater. All other muscles were recruited in a phasic manner. The relative duration of these bursts of activity was influenced by speed and/or mode of locomotion. Activity of all abdominal muscles, except rectus abdominis (RA), was modulated both for respiration and locomotor-related functions but this activity was affected by the speed and mode of locomotion. This study provides evidence that the deep abdominal muscles are controlled independently of the other trunk muscles. Furthermore, the pattern of recruitment of the trunk muscles and their respiratory and postural coordination is dependent on the speed and mode of locomotion.

Abdominal Muscles↗

PubMed2005

Trunk sway measurements during stance and gait tasks in Parkinson's disease.

To achieve a unified assessment of postural instability in Parkinson's disease (PD) over a range of clinical stance and gait tasks, which may provide an insight into a tendency to fall, we measured trunk sway in the anterior-posterior and medial-lateral directions in freely moving PD patients and age-matched controls. We also measured task duration as time to complete the task or time to loss of balance. Patients had larger amplitudes of trunk sway velocities for stance tasks (e.g. mean pitch velocity when standing on two-legs eyes closed equalled 19.1 +/- 6.4 for PD patients on medication versus 4.8 +/- 0.3 degrees/s for controls, p = 0.0003) and for an expected (following prior warning) retropulsion test (mean roll angle equalled 4.3 +/- 0.5 degrees for PD patients versus 2.2 +/- 0.6 degrees for controls, p = 0.0003) than controls. Patients were more likely to fall earlier for stance tasks, and took longer to complete gait tasks (e.g. walking 3 m eyes closed, mean time 6.8 +/- 0.6 sees versus 4.9 +/- 0.1 sees, p = 0.0001). These differences between patients and controls were, in most cases, independent of medication. Based on these results we defined a simple test battery of stance and gait tasks that could discriminate between PD patients who had recent falls and controls. These results indicate that trunk sway measures recorded during stance and gait tasks provide useful information on balance deficits leading to falls in PD patients.

Aged↗

PubMed2005

Coordination of pelvis-HAT (head, arms and trunk) in anterior-posterior and medio-lateral directions during treadmill gait in preadolescents with/without Down syndrome.

In human biped gait, movements in the frontal plane such as side-to-side rocking, are as essential as the alternating movement of the legs in the sagittal plane. In addition, the top-heavy structure of human body necessitates control of the trunk during walking. In this study, we evaluated the pelvis and HAT (head, arms and trunk) movements and their coordination during treadmill walking in the anterior-posterior and medio-lateral directions in children with typical development (TD) and those with Down syndrome (DS). Participants were 12 children with DS aged 8-10 years and 10 age-matched children with TD. They walked on a treadmill at 40%, 75% and 110% of their preferred overground walking speeds. Kinematic data were collected using a 3D-motion-capture system; movements of the mid-point of hip joints (OPELVIS) and the center of mass of HAT (COMHAT) were reduced. Children with DS showed larger and speed dependent amplitude responses compared to their TD peers. Coordination patterns for children with DS were less stable, especially in medio-lateral direction at slow speed. Differences in amplitude response may be the result of poorer trunk control in children with DS or, alternatively, part of a necessary and sufficient propulsion/stabilization mechanism for this population with reduced tone and muscle strength. Response differences observed between the anterior-posterior and medio-lateral directions for both groups may reflect relative differences in the involvement of active neuromuscular control.

Arm↗

PubMed2004

Reliability of EMG measurements for trunk muscles during maximal and sub-maximal voluntary isometric contractions in healthy controls and CLBP patients.

The purpose of this study was to compare the reliability of trunk muscle activity measured by means of surface electromyography (EMG) during maximal and sub-maximal voluntary isometric contractions (MVC/sub-MVC) over repeated trials within-day and between-days in healthy controls and patients with chronic low back pain (CLBP). Eleven volunteers (six controls and five CLBP patients) were assessed twice with a 1-week interval. Surface EMG signals were recorded bilaterally from six trunk muscles. Intra-class correlation coefficients (ICC) and standard error of measurement as a percentage of the grand mean (%SEM) were calculated. MVC and sub-MVC showed excellent within-day reliability in both healthy controls and CLBP patients (ICC mean 0.91; range 0.75-0.98; %SEM mean 4%; range 1-12%). Sub-MVC for both groups between-days showed excellent reliability (ICC mean 0.88; range 0.78-0.97; %SEM mean 7%; range 3-11%). The between-days MVC for both groups showed trends towards lower levels of reliability (ICC mean 0.70; range 0.19-0.99; %SEM mean 17%; range 4-36%) when compared to sub-MVC. Findings of the study provide evidence that sub-MVC are preferable for amplitude normalisation when assessing EMG signals of trunk muscles between-days.

Abdomen↗

PubMed2004

Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management.

OBJECTIVE: We report a ruptured aneurysm of the pancreaticoduodenal arteries without acute or chronic pancreatitis but associated with a median arcuate ligament division that compressed the celiac trunk, an exceptional event, thus far described in only 11 patients. We also conducted a targeted review to seek information about clinical presentation, to hasten diagnosis and assist in therapeutic management. METHODS: A 54-year-old man with retroperitoneal hemorrhage associated with an arcuate ligament division, documented on computed tomographic scans, underwent diagnostic arteriography and embolization to treat the bleeding aneurysm. In a second elective operation the causative arcuate ligament was sectioned to decompress the celiac artery, to prevent aneurysm recurrence. RESULTS: Embolization stopped the aneurysmal bleeding, and arteriograms showed that surgical sectioning resolved the celiac trunk stenosis. At 1-year follow-up the patient had no signs of complications or recurrence of disease. CONCLUSION: Ruptured aneurysm of the pancreaticoduodenal arteries associated with stenosis of the celiac trunk is a surgical emergency. Although a literature review disclosed no significant difference between outcomes after open surgery and radiologic arterial embolization, our experience in this case suggests immediate embolization during arteriography as the most effective treatment. Later, to prevent recurrence, the arcuate ligament should be surgically sectioned and the celiac artery stenosis treated.

Aneurysm, Ruptured↗

PubMed2005

Hedgehog and retinoid signalling confines nkx2.2b expression to the lateral floor plate of the zebrafish trunk.

The ventral neural tube of vertebrates consists of distinct neural progenitor domains positioned along the dorsoventral (DV) axis that develop different types of moto- and interneurons. Several signalling molecules, most notably Sonic Hedgehog (Shh), retinoic acid (RA) and fibroblast growth factor (FGF) have been implicated in the generation of these domains. Shh is secreted from the floor plate, the ventral most neural tube structure that consists of the medial (MFP) and the lateral floor plate (LFP). While the MFP is well characterized, organization and function of the LFP remains unclear. Here, we describe the novel homeobox gene nkx2.2b that is strongly expressed in the trunk LFP of zebrafish and thus represents a unique marker for the characterization of LFP formation and the identification of LFP deficient mutants. nkx2.2b and its paralog nkx2.2a (formerly known as nk2.2 and nkx2.2) arose by gene duplication in zebrafish. Both duplicates show significant differences in their expression patterns. For example, while prominent nkx2.2a expression has been described in the ventral brain [Barth, K.A., Wilson, S.W., 1995. Expression of zebrafish nk2.2 is influenced by sonic hedgehog/vertebrate hedgehog-1 and demarcates a zone of neuronal differentiation in the embryonic forebrain. Development 121, 1755-1768], hardly any expression can be found in the trunk LFP, which is in contrast to nkx2.2b. Overexpression, mutant and inhibitor analyses show that nkx2.2b expression in the LFP is up-regulated by Shh, but repressed by retinoids and ectopic islet-1 (isl1) expression. In contrast to previously described zebrafish trunk LFP markers, like e.g. tal2 or foxa2, nkx2.2b is exclusively expressed in the LFP. Thus, it represents a unique tool to analyse the mechanisms of ventral neural tube patterning in zebrafish.

Amino Acid Sequence↗