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At least 811 records · Page 45Linked to original sources

PubMed2006

Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the "R-scope").

BACKGROUND AND STUDY AIM: Endoscopic submucosal dissection (ESD) allows en bloc resection of lesions > 2 cm in diameter. However the procedure is difficult because of limited visualization of the cutting area. The aim of this study was to evaluate a new endoscope (the "R-scope") for ESD; this provides a second flexible section for improved positioning capability and two instrumentation channels for vertical lifting of the targeted mucosal area and horizontal cutting of the submucosa. METHODS: The R-scope was tested first for ESD of 17 predetermined gastric areas in eight anesthetized pigs. Clinical experience was then prospectively obtained in 10 patients with early gastric neoplasia. In both instances, dye-stained saline solution was used for repeated submucosal injection. Various types of knives were available for circumferential cutting of the mucosa to isolate the targeted lesion. The specimen was then lifted and the submucosal layer was dissected with the appropriate type of knife to achieve en bloc resection. RESULTS: ESD succeeded in 14/17 animal cases (82 %), remained incomplete in two cases and failed in one because of an intractable perforation; a further two small perforations were clipped. In 10 patients (with nine early carcinomas and one adenoma, with a median diameter of 22 mm), lesions were completely resected in six cases. Surgery was necessary in two patients due to early and delayed perforation. Three other patients with small amounts of free air were conservatively managed but elective surgery was performed in two of these patients because of incomplete resection or deep submucosal tumor infiltration. CONCLUSIONS: The R-scope facilitated ESD of large gastric areas in live animal testing and in a small series of patients However the procedure is technically demanding and time-consuming. It was also associated with a high risk of perforation; this may be related to an insufficient volume of solution being injected submucosally, excessively forceful lifting of the specimen, or the short learning period.

Aged↗

PubMed1995

Crucial anatomic lessons for laparoscopic herniorrhaphy.

Laparoscopic herniorrhaphy is generally performed using a transabdominal approach, an approach to hernia repair that is unfamiliar to most general surgeons. There is sufficient published anecdotal experience to indicate that the relationships of structures near the internal ring are not generally known and that this may predispose to their injury. There is considerable variability of nerves that pass through, or deep to, the iliopubic tract lateral to the internal inguinal ring, making it potentially hazardous to place staples or sutures in this region. Medially, the surgeon must be conscious of the possible presence of an aberrant obturator artery or vein and unexpected iliopubic vessels and take appropriate precautions to avoid unexpected sources of hemorrhage. The human cadaver, especially in the unfixed state, can be an ideal model to learn the surgical anatomy for laparoscopic hernia repair and to avoid neurovascular injuries.

Cadaver↗

PubMed1993

Supporting layers of the glenohumeral joint. An anatomic study.

Based on anatomic and surgical dissections, the anatomy of the shoulder region is described in terms of four layers that overlie and support the glenohumeral joint. Each layer envelops the glenohumeral joint on its anterior, lateral, and posterior aspects, and between each layer there is a plane for safe and easy dissection. Layer 1 is composed of the deltoid and pectoralis major muscle bellies with their overlying fascia and enveloping epimysium. Anteriorly, Layer 2 consists of the clavipectoral fascia, the conjoined tendon of the short head of the biceps and coracobrachialis, and the coracoacromial ligament. Posteriorly, Layer 2 is the dense posterior scapular fascia that overlies the infraspinatus and teres minor muscle bellies. It is continuous with the clavipectoral fascia around the lateral aspect of the proximal humerus. Deep to Layer 2, the subdeltoid bursa yields a dissection plane that encompasses the anterior, lateral, superior, and variably the posterior aspects of the glenohumeral joint. Layer 3 consists of the deep layer of the subdeltoid bursa and the underlying musculotendinous units of the rotator cuff, including subscapularis, supraspinatus, infraspinatus, and teres minor. Layer 4 is the capsule of the glenohumeral joint. This includes the glenohumeral ligaments and coracohumeral ligament. These four layers were present and consistent in each shoulder dissected. Significant variations were present only within the deepest layer (shoulder joint capsule). This system can serve as a learning tool and will provide a more organized approach to facilitate surgical dissection in the region.

Cadaver↗

PubMed1998

Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program.

OBJECTIVE: To test whether lesion site patterns in patients with chronic, severe aphasia who have no meaningful spontaneous speech are predictive of outcome following treatment with a nonverbal, icon-based computer-assisted visual communication (C-ViC) program. DESIGN: Retrospective study in which computed tomographic scans performed 3 months after onset of stroke and aphasia test scores obtained before C-ViC therapy were reviewed for patients after receiving C-ViC treatment. SETTING: A neurology department and speech pathology service of a Department of Veterans Affairs medical center and a university aphasia research center. PATIENTS: Seventeen patients with stroke and severe aphasia who began treatment with C-ViC from 3 months to 10 years after onset of stroke. MAIN OUTCOME MEASURE: Level of ability to use C-ViC on a personal computer to communicate. RESULTS: All patients with bilateral lesions failed to learn C-ViC. For patients with unilateral left hemisphere lesion sites, statistical analyses accurately discriminated between those who could initiate communication with C-ViC from those who were only able to answer directed questions. The critical lesion areas involved temporal lobe structures (Wernicke cortical area and the subcortical temporal isthmus), supraventricular frontal lobe structures (supplementary motor area or cingulate gyrus 24), and the subcortical medial subcallosal fasciculus, deep to the Broca area. Specific lesion sites were also identified for appropriate candidacy for C-ViC. CONCLUSIONS: Lesion site patterns on computed tomographic scans are helpful to define candidacy for C-ViC training, and to predict outcome level. A practical method is presented for clinical application of these lesion site results in combination with aphasia test scores.

Adult↗

PubMed1998

Cardiorespiratory effects of breathing and relaxation instruction in myocardial infarction patients.

The effect of individual instruction in relaxation and breathing, additional to an exercise training program, was investigated in 76 post-myocardial infarction patients after rehabilitation and at 3 months follow-up. Respiration rate (RR), heart rate (HR) and respiratory sinus arrhythmia (RSA) were the outcome variables used to compare experimental (exercise plus relaxation) and control (exercise without relaxation) groups. HR and RR decreased slightly during 20-min sessions of supine measurement. This response did not vary between sessions (pre-rehabilitation, post-rehabilitation and after 3-month follow-up). RSA tended to decrease during the sessions. The within-session reduction in RSA became more apparent in the control group after treatment and less so in the experimental group. RR decreased in the experimental group after rehabilitation, but not in the control group. HR decreased for all patients, but the decrease was larger in the experimental group. This effect was associated with the lower RR. RSA did not change in the control group but increased in the experimental group, during both normal and deep breathing. This effect was also associated with a slower RR and became marginally significant when RR was statistically controlled for. We conclude that the relaxation intervention induced a slower breathing pattern which was associated with beneficial effects on resting HR and RSA. Further study is warranted to clarify the degree to which reduced respiration rate is an indicator of lower sympathetic arousal or merely a concomitant of the learned breathing technique.

Adult↗

PubMed1987

Lingual and fusiform gyri in visual processing: a clinico-pathologic study of superior altitudinal hemianopia.

A macular-sparing superior altitudinal hemianopia with no visuo-psychic disturbance, except impaired visual learning, was associated with bilateral ischaemic necrosis of the lingual gyrus and only partial involvement of the fusiform gyrus on the left side. It is suggested that bilateral destruction of the lingual gyrus alone is not sufficient to affect complex visual processing. The fusiform gyrus probably has a critical role in colour integration, visuo-spatial processing, facial recognition and corresponding visual imagery. Involvement of the occipitotemporal projection system deep to the lingual gyri probably explained visual memory dysfunction, by a visuo-limbic disconnection. Impaired verbal memory may have been due to posterior involvement of the parahippocampal gyrus and underlying white matter, which may have disconnected the intact speech areas from the left medial temporal structures.

Aged↗

PubMed2006

In situ hybridisation of a large repertoire of muscle-specific transcripts in fish larvae: the new superficial slow-twitch fibres exhibit characteristics of fast-twitch differentiation.

Much of the present information on muscle differentiation in fish concerns the early embryonic stages. To learn more about the maturation and the diversification of the fish myotomal fibres in later stages of ontogeny, we investigated, by means of in situ hybridisation, the developmental expression of a large repertoire of muscle-specific genes in trout larvae from hatching to yolk resorption. At hatching, transcripts for fast and slow muscle protein isoforms, namely myosins, tropomyosins, troponins and myosin binding protein C were present in the deep fast and the superficial slow areas of the myotome, respectively. During myotome expansion that follows hatching, the expression of fast isoforms became progressively confined to the borders of the fast muscle mass, whereas, in contrast, slow muscle isoform transcripts were uniformly expressed in all the slow fibres. Transcripts for several enzymes involved in oxidative metabolism such as citrate synthase, cytochrome oxidase component IV and succinate dehydrogenase, were present throughout the whole myotome of hatching embryos but in later stages became concentrated in slow fibre as well as in lateral fast fibres. Surprisingly, the slow fibres that are added externally to the single superficial layer of the embryonic (original) slow muscle fibres expressed not only slow twitch muscle isoforms but also, transiently, a subset of fast twitch muscle isoforms including MyLC1, MyLC3, MyHC and myosin binding protein C. Taken together these observations show that the growth of the myotome of the fish larvae is associated with complex patterns of muscular gene expression and demonstrate the unexpected presence of fast muscle isoform-expressing fibres in the most superficial part of the slow muscle.

Animals↗

PubMed1990

[Patients' preferences for nurses' nonverbal expressions of warmth during nursing rounds and administration of oral medication].

Nursing involves deep human interpersonal relationships between nurses and patients. But in modern Korea, the nurse-patient relationship tends to be ritualistic and mechanestic. Patients usually express the hope that nurses be more tender and kind. Patients expect nurses to express their warmth especially through nonverbal behaviour. This study was conducted to identify patients' preferences for nurse's nonverbal expressions of warmth. Through the confirmation of these preferences, nurses may learn how to enhance their interpersonal relationships with patients. Subjects for the study were 73 patients who had been admitted to a university teaching hospital for at least three days and agreed to be interviewed by the investigator. The interactions were studied nonverbal expressions of warmth during nursing rounds and administration of oral medication. The interview schedule was especially designed by the investigator to measure the nurse's posture, the distance between the nurse and the patient, the nurse's eye contact, facial expression, hand motion and head nodding. Data analysis included frequencies, percentages and X2-test. The results of this study may be summerized as follows: 1. Patient's preferences for nurse's nonverbal expressions of warmth during nursing rounds. Preferred nurse's posture was sitting (50.7%) or standing (49.3%) opposite the patient. Preferred distance between the nurse and the patient was close to the bed (93.2%), less than 1m. Preferred eye contact was directed to the patient's eyes or their affected part (41.1%). Preferred facial expression was a smile (97.3%). Preferred hand motions were light gestures (41.1%). Patients preferred head nodding which approved their own opinions (69.9%). 2. Patient's preferences for nurse's nonverbal expressions of warmth during administration of oral medication. Preferred nurse's posture was standing and waiting to confirm that the medication had been taken (58.9%). Preferred distance from the patient was at arm's length, 0.5-1m (64.4%). Patients preferred direct eye contact (58.9%) and a smile (94.5%). Patients preferred that the nurse put the medicine directly the patient's hand (64.4%). Whether the nurse nodded her head or not was not considered important. 3. The relation of general characteristics and patient's preferences for nurse's nonverbal expressions of warmth during nursing rounds and administration of oral medication. During nursing rounds, the age of subjects (p = 0.010) and the standard of education (p = 0.026) related to the distance between the nurse and the patient. The sick hospital ward related to the eye contact (p = 0.017) and facial expression (p = 0.010).(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

PubMed1975

Prefrontal lesions and avoidance reflex differentiation in dogs.

The effects of bilateral partial prefrontal lesions on go-no go differentiation with symmetrical or asymmetrical reinforcement trained by the avoidance procedure were investigated. Moderate impairment of these tasks was observed after large lateral or medial prefrontal lesions, while severe impairment after a deep incision of the fibers in the specific prefrontal region. It is suggested that the mechanism of avoidance differentiation is of a symmetrical type, which is directly related to the "motor act differentiation" but not to the drive-no drive differentiation.

Animals↗

PubMed1999

Stroke rehabilitation. 2. Co-morbidities and complications.

This self-directed learning module highlights new advances in the understanding of co-morbid conditions and medical complications of stroke. It is part of the chapter on stroke rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article covers co-morbid conditions of stroke patients, including cardiovascular disease, diabetes, and sleep apnea. It reviews recent information on complications of stroke, including deep venous thrombosis, dysphagia and aspiration, hospital-acquired infections, depression, falls, spasticity, shoulder pain, and seizures. Treatment advances in diabetes, depression, and spasticity are highlighted. Recent information is presented regarding exercise guidelines for the stroke patient with cardiovascular disease, the relationship between stroke and sleep apnea, prophylaxis of deep venous thrombosis, the changing spectrum of hospital-acquired infections, malnutrition in stroke patients, the problem of falls during rehabilitation, the evaluation and management of poststroke shoulder pain, and the risk of seizures after stroke.

Cardiovascular Diseases↗

PubMed1995

Distribution of calbindin D-28k immunoreactivity in the cochlear nucleus of the young adult chinchilla.

Calbindin is a 28 kD calcium-binding protein found in neural tissue. Although its functional role in nerve cell physiological processing is still uncertain, previous investigations have suggested that because of its intracellular calcium buffering and regulation properties, it could influence temporal precision of neuronal firing to subserve temporal processing in the auditory brainstem, or could mediate monaural versus binaural coding, or be involved in synaptic plasticity (learning). The present study demonstrates differential calbindin immunoreactivity in the cochlear nuclear complex of the chinchilla, a rodent with exceptionally good low-frequency hearing. The most intense labeling in the cochlear cochlear nucleus was in somata of cartwheel and fusiform cells of the fusiform cell layer, and somata and process of the molecular layer of the dorsal cochlear nucleus (DCN). Only a relatively few scattered neurons were stained in the deep layers of DCN. In contrast, moderate labeling of neurons and neuropil throughout the ventral cochlear nucleus was seen. For instance, moderately stained spherical and elongate cells of the anteroventral cochlear nucleus were observed in contact with labeled puncta and amidst stained fibers. In the cochlear nerve root region, stained auditory nerve fibers and global cells were noted. In the posteroventral cochlear nucleus, principal cells of elongate and octopus shape were observed, in contact with labeled swellings and surrounded by labeled neuropil.

Animals↗

PubMed2003

Quality of life philosophy I. Quality of life, happiness, and meaning in life.

In the Danish Quality of Life Survey, we asked 10,000 people about their quality of life with the validated SEQOL questionnaire with more than 300 questions on their quality of life. How did they feel? How content were they with their lives? How happy were they? Did they feel their needs were fulfilled? And many more questions. We asked the questions we believed to be important for their quality of life (QOL). The results were quite surprising and forced us to recontemplate the following philosophical questions: What is quality of life, happiness, and meaning in life? What is a human being? Do we need a new biology? Is the brain the seat of consciousness? How do we seize the meaning of life and by doing so, will we become well again? What are the key concepts of quality of life? The meaning of life is connectedness and development. It is about realizing every opportunity and potential in one"s existence. The opportunities must be found and acknowledged. What do you find when you find yourself deep down? You find your real self and your purpose in life. You realize that you are already a part of a larger totality. Antonovsky called it "coherence". Maslow called it "transcendence". Frankl called it "meaning of life". We call it simply "being". To test if these philosophical questions are actually relevant for medicine, we looked at the consequences for patients being taught the quality of life philosophy. Quite surprisingly we learned from our pilot studies with "quality of life as medicine" that just by assimilating the basic concepts of the quality of life philosophy presented in this series of papers, patients felt better and saw their lives as more meaningful. The improvement of the patient"s personal philosophy of life seems to be the essence of holistic medicine, helping the patient to assume more responsibility for his or her own existence.

Denmark↗

PubMed2000

Comparison of insufflation vs. retractional technique for laparoscopic-assisted intervertebral fusion of the lumbar spine.

Laparoscopic transperitoneal fusion of the L5-S1 spinal interspace has become a common procedure. Retroperitoneal retraction and laparoscopic instrumentation without insufflation also allows visualization of the upper lumbar spaces, but this procedure is much more difficult to accomplish. We review and compare our results using each of these techniques for the treatment of mechanical instability and chronic back pain. A total of 35 selected patients underwent intervertebral fusion between February 1996 and August 1998. Their mean age was 48 years. There were 22 female and 13 male patients. Standard CO2 insufflation was used in 10 patients with L5-S1 fusions. Retractional gasless technique was used in nine patients with fusions at L5-S1, 16 patients at L4-L5, one patient at L3-L4, three patients at L2-3, and one patient at L1-L2. Thus, we performed a total of 40 lumbar fusions in 35 patients. In the 19 patients with the gasless technique, a balloon dissector and retractor facilitated the retroperitoneal exposure. Seven of these 19 patients were converted to open procedures, most commonly due to lacerations of the peritoneal lining that prohibited visualization. None of the L5-S1 patients with insufflation were converted to open. Mean operative time in the insufflated patients was 152 min vs. 181 min for the retractional technique. There were seven complications in the transperitoneal group: one fusion device migration, one postoperative UTI, one intracerebral hemorrhage, one severe postoperative pancreatitis, and three iliac vein lacerations. There were 16 complications in the retroperitoneal group: one deep vein thromboses, one serosal bowel injury, one small tear in the spleen, one cage migration, one postoperative pulmonary atelectasis, one postoperative hydrocele, four postoperative ileus, and six peritoneal tears. The mean postoperative stay was three days for both groups. There were no deaths. The L5-S1 interspace is best approached transperitoneally for anterior fusion. Although the retroperitoneal retractional technique is much more difficult and has a longer and steeper learning curve, it does allow laparoscopic anterior fusion of the upper lumbar spine.

Female↗

PubMed1975

[From anal atresia to continent organ].

In deep anal occlusion complete continence can nearly always be obtained by means of a perineal or sacroperineal operation. On the other hand, the results after reconstruction in case of high recto-anal agenesis are still doubtful. Placing the neorectum inside the junction of the levator ani muscles by the sacro-abdomino-perineal approach has improved the continence function. Manometric studies have shown that the organ of continence has to learn its function first, which may take months or even years. In cases of congenital motor or sensory defects, or iatrogenic lesions, at least partial normalization can be brought about by specific reconstructive operations.

Anus, Imperforate↗

PubMed2003

fMRI of the conscious rabbit during unilateral classical eyeblink conditioning reveals bilateral cerebellar activation.

The relative contributions of the ipsilateral and contralateral cerebellar cortex and deep nuclei to delay eyeblink conditioning have been debated and are difficult to survey entirely using typical electrophysiological and lesion techniques. To address these issues, we used single-event functional magnetic resonance imaging (fMRI) in the conscious rabbit to visualize the entire cerebellum simultaneously during eyeblink conditioning sessions. Examination of the blood oxygenation level-dependent (BOLD) response to a visual conditioning stimulus early in training revealed significant bilateral learning-related increases in the BOLD response in the anterior interpositus nucleus (IPA) and significant bilateral deactivation in hemispheric lobule VI (HVI) of the cerebellar cortex. Later in training, the BOLD response remained bilateral in the cortex and predominantly ipsilateral in the IPA. Conditioning stimulus-alone trials after conditioning revealed that both sides of HVI were affected similarly but that only the ipsilateral interpositus nucleus was activated. These results suggest that both sides of HVI normally influence the side of the IPA being conditioned and illustrate how fMRI can be used to examine multiple brain regions simultaneously in an awake, behaving animal to discover more rapidly the neural substrates of learning and memory.

Animals↗

PubMedDate not supplied

Patient education: a tool in the outpatient management of deep vein thrombosis.

A key to effective outpatient management of thromboembolic disease is patient education. Although highly effective for the treatment of deep vein thrombosis (DVT), antithrombotic treatment may fail as a result of inadequate patient education. The risk of hemorrhage from antithrombotic drugs is related to a number of factors including intensity of anticoagulation achieved, comorbid illness, concurrent drug therapy, and lifestyle. When patients receive inadequate antithrombotic treatment, the risk of recurrent thromboembolic events and long-term complications are substantially increased. A well-organized, structured education program enables patients to learn the necessary skills that permit complex and valuable therapies to be managed on an outpatient basis. Health care professionals who are part of an outpatient DVT treatment program should possess working knowledge of adult learning theory and instructional design. To be effective, education programs should be systematically planned, have an educationally sound structure, and attempt to meet specific objectives. In addition, they should build on patients' existing knowledge, skills, and attitudes. Periodic evaluation of the education program is important to ensure that overall goals are being adequately met and to identify areas of weakness.

Ambulatory Care↗

PubMed2006

Cell biology should be taught as science is practised.

Over the past 20 years, there has been a dramatic transformation in the goals of science teaching at all levels and within all disciplines. The emphasis has moved from students obtaining a base of scientific facts to students developing a deep understanding of important concepts. This transformation requires a significant shift in the approach and attitude of the instructors and students, as well as in the procedures and techniques that are required to teach cell biology.

Biology↗

PubMedDate not supplied

[Conditioned reflex switching-over in the rat after temporary functional decortication].

Conditioned switching-over was elaborated in white rats: in one situation an alimentary instrumental reflex to sound was elaborated, in another one--an electro-defensive avoidance reflex to the same sound, different time of the day and different chamber illumination used as the switching-over factor. One-time influence of spreading depression by means of bilateral application of 10% KCl solution for 1.5 min to dura mater brought to the disturbance of the conditioned switching-over for 2-3 days. Electrolytic destruction of posterior hypothalamus area was produced in some animals. After restoration of functions one-time application of spreading depression elicited deep and long-term disturbance of conditioned switching-over. Apparently more complex conditioned activity suffers greater at short-term elimination of cerebral cortex functions, especially in conditions of compensatory recovery after lesions of the central nervous system.

Animals↗