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At least 1,009 records · Page 56Linked to original sources

PubMed1999

Robotic-assisted laparoscopic pyeloplasty: a pilot study.

OBJECTIVES: Robotic technology has been employed to manipulate the laparoscope during urologic procedures. However, to our knowledge, robotic technology has not been previously applied to actually perform the urologic laparoscopic procedure. The objective of this study was to determine the feasibility and efficacy of performing robotic-assisted laparoscopic pyeloplasty and compare it with conventional laparoscopic pyeloplasty in an acute porcine model. METHODS: Five female swine (10 kidneys) were prospectively randomized to undergo unstented robotic-assisted laparoscopic pyeloplasty (6 kidneys) or conventional laparoscopic pyeloplasty (4 kidneys). Robotic pyeloplasty was performed with the Zeus robotic system, which incorporates three remote-controlled interactive arms: one voice-activated arm to control the laparoscope and two robotic arms to manipulate purpose-designed instruments. Tissue dissection and transection of ureteropelvic junction area were performed manually by conventional laparoscopy. The pyeloureteric anastomosis during the robotic-assisted pyeloplasty was performed completely robotically from a remote workstation using running 5-0 absorbable sutures. Conventional laparoscopic pyeloplasty was performed manually by laparoscopic intracorporeal suturing and knot-tying techniques. Immediate patency and anastomotic integrity were evaluated by intravenous indigo carmine and ex vivo retrograde ureteropyelogram. RESULTS: In comparing robotic and conventional laparoscopic pyeloplasty, the following data were obtained: total surgical time (115.2 versus 94.5 minutes, P = 0.2), anastomosis time (75.7 versus 64.3 minutes, P = 0.3), and total number of suture-bites per ureter (13.0 versus 12.5, P = 0.8). Anastomoses were immediately watertight in 5 of 6 robotic and 3 of 4 conventional pyeloplasties. CONCLUSIONS: Robotic-assisted laparoscopic pyeloplasty is a feasible and effective procedure that may enhance surgical dexterity and precision. This has implications for clinical applications of laparoscopic telesurgery in the future.

Animals↗

PubMed1990

The effect of albuterol aerosol on fine-motor performance in children with chronic asthma.

A double-blind, crossover trial was conducted to examine the effect of albuterol aerosol on the fine-motor performance of children with chronic asthma. Twenty subjects, 4 1/2 to 14 1/2 years of age, were each tested after both the administration of albuterol aerosol and a placebo. The fine-motor composite of the Bruininks-Oseretsky Test of Motor Proficiency was used to evaluate abilities in response speed, visual-motor control, and speed and dexterity. The degree of tremor was tested with a "steadiness" tester, and postural adjustment was recorded on a clinical rating scale. No significant differences were found in fine-motor skills after albuterol or placebo administration, but a significant increase in tremor as well as in postural adjustment occurred after albuterol. The effect of test order and several other patient characteristics on test scores may be related to these findings. Major educational adjustments to compensate for the increase in tremor are unnecessary.

Administration, Inhalation↗

PubMed1998

Links in the left/right axial pathway.

We now have a sketch of the vertebrate L/R pathway from egg to organ. There is a lot to learn and a lot to explain, but the beauty of the pathway is already evident. We also have an inkling of its fragility. Set against the complex laterality disorders seen in humans, efforts to understand this pathway should continue to challenge our intellectual and experimental dexterity.

Animals↗

PubMed1976

Bromocriptine and levodopa (with or without carbidopa) in parkinsonism.

Bromocriptine, a dopamine receptor agonist, was administered to 20 patients with idiopathic parkinsonism taking levodopa (L-dopa) or "Sinemet" (levodopa combined with carbidopa in a 10/1 ratio) at optimum doses. In a double-blind randomised cross-over study lasting 6 months, the addition of bromocriptine (mean daily dose 79 mg) led to a significant (P less than 0.01) 74% reduction in the dose of sinemet and levodopa. "Total disability score" showed a significant (P less than 0.01) improvement at both low and high doses of bromocriptine. Tremor improved 50% (P less than 0.01), with significant improvements in gait, posture, writing, balance, rigidity, finger dexterity, and drooling. Adverse reactions were similar to those observed with sinemet and levodopa. Although both the cause and the cure of idiopathic parkinsonism remain elusive, bromocriptine appears to represent a therapeutic advance.

Aged↗

PubMed1994

Three-dimensional video-endoscopy: clinical use in gynaecological laparoscopy.

We describe a system that displays the abdominal organs in three dimensions during laparoscopy. The system consists of a single-rod-lens endoscope and two integrated microchip cameras. The surgeon has to wear active-liquid-crystal shutter-glasses to obtain a three-dimensional impression during the operation. Improved orientation in the abdominal cavity allows exact handling of surgical instruments. The three-dimensional system permits surgery with more accuracy, speed, dexterity, and safety than conventional two-dimensional systems.

Female↗

PubMed1994

Physiological maturation of muscles in childhood.

Little is known about the motor muscle physiology of growing children and it has been assumed that increasing motor dexterity and speed correspond solely to brain maturation, although there is evidence that muscles mature from studies of other mammalian species. Such a finding in children would throw light on the possible mechanics of motor delays in speech, hand function, athletic, and musical skills as well as helping towards a better understanding of pathological motor disorders such as the cerebral palsies. Our non-invasive observations of soleus-muscle relaxation times in healthy children suggest that a child's muscles are initially slow to relax but relaxation doubles in speed up to adult rates by early adolescence. Half-relaxation times halved from about 90 ms at age 3 to about 40 ms at age 10. On the basis of these studies, we suggest that muscle maturation rate-limits motor tasks; which should be borne in mind when considering motor development in muscles and when attempting to determine the effects of early brain or spinal cord damage. Such methods of measuring the dynamics of muscle open up new areas of research and offer the possibility of developing operationally-defined in-vivo measurements for use in motor assessment and for following up the effects on muscle or treatments such as physiotherapy, orthotics, surgery, and drugs.

Adolescent↗

PubMed2001

In vitro characterization of the hematopoietic system in pediatric patients with acute lymphoblastic leukemia.

Acute lymphoblastic leukemia (ALL) has been recognized as a hematologic neoplasia that originates at the level of a primitive lymphoid stem/progenitor cell. To date, however, the biology of the hematopoietic system in this disorder is still not fully understood. In the present study, we have determined the progenitor cell content (including myeloid, erythroid and multipotent progenitors) in 14 children with ALL and followed the proliferation kinetics of these cells in Dexter-type long-term marrow cultures. We have also characterized some aspects related to the composition and function of the hematopoietic microenvironment developed in vitro. All patients included in this study showed extremely reduced levels of progenitor cells (median of 6.2% of the levels found in normal marrow). Proliferation of these cells in long-term cultures was markedly deficient, since they showed very low numbers - compared to normal cultures - and reached undetectable levels after only a few weeks. Regarding the microenvironment developed in vitro, whereas normal marrow samples contained a median of 8 fibroblastic progenitors/10(5) marrow cells and the stromal cell layers developed in culture contained a median of 341000 adherent cells per well, ALL marrow samples showed no fibroblastic progenitors and the numbers of adherent cells were 21% of those in normal cultures. Interestingly, the levels of TNFalpha and IL-6 in ALL culture supernatants were significantly increased, compared to normal cultures. Bone marrow samples from all 14 children were also analyzed once they reached a complete clinical and hematological remission. Myeloid, erythroid and multipotent progenitor cell levels were significantly increased, compared to patients at diagnosis, and proliferation of myeloid progenitors in long-term cultures was also improved. In contrast, proliferation of erythroid progenitors showed no difference to that in cultures from patients at diagnosis. The numbers of fibroblastic progenitors and adherent cells were significantly increased, compared to patients at diagnosis, and TNFalpha and IL-6 levels returned to normal. In summary, in the present study, we have demonstrated significant in vitro alterations of the hematopoietic system, both in terms of its composition and function, in pediatric patients with ALL. Importantly, most of these alterations are corrected, at least partially, after chemotherapy.

Adolescent↗

PubMed2002

Correlates of human handedness in primary motor cortex: a review and hypothesis.

A review of the research on anatomical and functional asymmetries in human primary motor cortex suggests that the area of hand representation is greater in the dominant than in the non-dominant hemisphere and that there is a greater dispersion of elementary movement representations with more profuse horizontal connections between them. The more profuse interconnections in motor cortex (M1) of the dominant hemisphere might form a neural substrate which favors the formation of experience-dependent excitatory and inhibitory interactions between elementary movement representations. Motor practice might lead to more precise spatiotemporal coordination of the activity of the elementary movement representations in M1 of the dominant than that of the non-dominant hemisphere, thus leading to more dexterous behavior of the dominant than that of the non-dominant hand.

Functional Laterality↗

PubMed2002

Carbon monoxide and the nervous system.

Carbon monoxide (CO) is a colorless, tasteless, odorless, and non-irritating gas formed when carbon in fuel is not burned completely. It enters the bloodstream through the lungs and attaches to hemoglobin (Hb), the body's oxygen carrier, forming carboxyhemoglobin (COHb) and thereby reducing oxygen (O(2)) delivery to the body's organs and tissues. High COHb concentrations are poisonous. Central nervous system (CNS) effects in individuals suffering acute CO poisoning cover a wide range, depending on severity of exposure: headache, dizziness, weakness, nausea, vomiting, disorientation, confusion, collapse, and coma. At lower concentrations, CNS effects include reduction in visual perception, manual dexterity, learning, driving performance, and attention level. Earlier work is frequently cited to justify the statement that CO exposure sufficient to produce COHb levels of ca. 5% would be sufficient to produce visual sensitivity reduction and various neurobehavioral performance deficits. In a recent literature re-evaluation, however, the best estimate was that [COHb] would have to rise to 15-20% before a 10% reduction in any behavioral or visual measurement could be observed. This conclusion was based on (1) critical review of the literature on behavioral and sensory effects, (2) review and interpretation of the physiological effects of COHb on the CNS, (3) extrapolation from the effects of hypoxic hypoxia to the effects of CO hypoxia, and (4) extrapolation from rat behavioral effects of CO to humans. Also covered in this review article are effects of chronic CO exposure, the discovery of neuroglobin, a summary of the relatively new role for endogenous CO in neurotransmission and vascular homeostasis, groups which might be especially sensitive to CO, and recommendations on further research. The interested reader is directed to other published reviews of the literature on CO and historically seminal references that form our understanding of this ubiquitous gas.

Animals↗

PubMed2003

Pictures of Dorothy Hodgkin.

There are no established conventions for portraying scientific women. At the Royal Society, the first image of a female scientist was Henry Moore's drawing of Dorothy Hodgkin's hands, cruelly twisted by agonising arthritis. In her famous oil portrait, Maggi Hambling also focuses on Hodgkin's hands, thus symbolising the Nobel-prize winner's dedication to research and the importance of manual dexterity. Although Hambling's picture features a model of insulin, it is very different from photographs celebrating the discovery of DNA.

Academies and Institutes↗

PubMed1979

Complications associated with aphakic contact lenses.

Complications associated with rigid contact lenses are more frequent in aphakia. The limited dexterity of older patients not only may prove an insurmountable barrier to the mastery of daily contact lens insertion and removal, but also may produce significant direct eye trauma, its seriousness determined by the integrity of the cataract wound. Since prolonged wear of aphakic contact lenses is the rule rather than the exception, the risk of irreversible corneal changes such as vascularization and erosions is greater. A poorly fitted aphakic contact lens that does not permit adequate oxygenation of all corneal areas makes such complications even more likely to occur. Decreased corneal sensitivity associated with cataract surgery permits continued wear of a poorly fitted lens, which does not allow the cornea to recover between wearing periods. Detection of keratoconjunctivitis sicca, more prevalent in the older age group, may prevent the associated complications of corneal erosion, iritis, and infection. Complications of aphakic contact lenses can be controlled by patient instruction, appropriate contact lens adjustments, and regularly scheduled follow-up examinations.

Aged↗

PubMed1997

Factors controlling haemopoiesis in ovine long-term bone marrow cultures.

We describe an adaptation of the Dexter technique for obtaining ovine long-term bone marrow cultures able to sustain haemopoiesis in vitro for long periods. Two inocula of bone marrow cells collected at three-five weeks interval, in IMDM supplemented with fetal calf serum (10%), horse serum (10%) and hydrocortisone (5 x 10(-7) M), gave rise to the growth of an adherent cell layer which supported, in most cases, active haemopoiesis for up to 15 weeks. The cell layer was composed of macrophages, fibroblasts and adipocytes. Haemopoietic cells formed large foci of "cobblestone" areas. Haemopoietic progenitors were also released into the supernatant medium and were detectable by clonogenic assay. Granulocytes and monocyte-macrophages differentiated in the cultures in constant proportion until week five, when the monocytic lineage superseded the myelocytic one. These cultures, between weeks five and twelve, produced colony forming cells in a constant pattern, indicating the presence and self renewing of early haemopoietic progenitor cells.

Animals↗

PubMed2002

Impairment of pronation, supination, and body co-ordination in reach-to-grasp tasks in human Parkinson's disease (PD) reveals homology to deficits in animal models.

Animal (monkey, rat, mouse) models are widely used to investigate degenerative processes and potential therapeutic treatments for human Parkinson's disease (PD). One task that has proved useful in these investigations is a reach-to-grasp task (skilled reaching) in which an animal reaches for a piece of food that it then consumes. Rats with extensive unilateral Dopamine depletions are impaired in using the contralateral limb. The qualitative features of posture, lifting and advancing the limb, pronating the paw to grasp food, and in withdrawing and supinating the paw to place the food in the mouth are impaired, as is reaching success. Humans with PD are often described as having poor manual dexterity that worsens as the disease progresses. As there have been no detailed comparisons of reaching movements in the animal models and in PD subjects, the following descriptive analysis was performed. Ten subjects with PD, eight age matched controls and 14 young normal subjects were studied as they used a natural movement of reaching for a small piece of food that they then placed in the mouth to eat. The reaching movements were described using Eshkol-Wachman Movement Notation (EWMN), supplemented with kinematic analyses. From this description, a 21-point rating scale was devised to describe the component movements of the reach. Movements included: orienting the head and eyes to the target, adjusting posture, lifting the hand, shaping and aiming the digits to the target, pronating the hand to grasping the food with a pincer grip, lifting and supinating the hand to transporting the food to the mouth, and further supinating the hand and opening the digits to place food in the mouth, and finally returning the hand to the starting position. Analysis indicated that most aspects of the reaching movements of the PD subjects were significantly different relative to both young control subjects and old control subjects. As compared to the control groups, postural and reaching components of the movements were fragmented, movements were achieved using more proximal segments of the body, and rotatory movements of the hand were limited. The PD subjects did use a pincer grasp to obtain the food, but the grasp was less independent of other digit movements than was observed in the control subjects. These results are discussed in terms of a homology to impairments displayed animal models of PD.

Adult↗

PubMed2001

Changes in the dynamics of tremor during goal-directed pointing.

For successful performance of activities requiring a fine level of manipulative control and dexterity, precise control over the intrinsic oscillations (tremor) in each segment is essential. However, the question of how individuals control (minimize) their tremor during precise postural movements remains unresolved. The aim of this study was to investigate the changes observed in limb tremor during goal-directed postural pointing tasks. Seven subjects attempted to minimize limb tremor during a pointing task whereby progressively greater levels of accuracy were required. Subjects held a small lightweight laser pointer in their extended hand during all tasks, the goal being to maintain the laser emission within a specified target area. Frequency analysis showed that the tremor profile for the hand and index finger was characterized by two prominent frequency peaks, located between 2-4 and 8-12 Hz. When the accuracy requirement of the task increased, there was a significant increase in the amplitude of the 8-12 Hz peak for all segments. Analysis of the time series component of tremor revealed a similar trend with the root mean square (RMS) and approximate entropy (ApEn) of the finger tremor increasing as the accuracy requirement increased. This same pattern was not seen for hand tremor where a small but systematic decrease in both the tremor RMS and ApEn was observed. Overall, it would appear that subjects attempted to reduce tremor at the finger by exerting greater control over the hand (as evidenced by decreased tremor output and increased regularity in the tremor signal). Unfortunately, the consequence of this strategy was that the tremor in the distal effector actually increased. Changes in the tremor output observed as a result of defining an explicit external goal probably resulted from the enhanced visual information provided by the laser emission. However, it would appear that subjects were not able to utilize this feedback effectively to reduce their tremor during the targeting tasks.

Adult↗

PubMed1992

A comparison of observed and self-reported compliance with universal precautions among emergency department personnel at a Minnesota public teaching hospital: implications for assessing infection control programs.

STUDY OBJECTIVES: To determine the level of universal precautions compliance in a hospital emergency department by two methods (direct observation of subjects versus self-reporting by questionnaire). SETTING: A Level II trauma center located within a university-affiliated medical center in Minneapolis/St Paul, Minnesota. Glove and needle disposal containers were available in each treatment room; gowns, masks, and goggles were readily available. PARTICIPANTS: ED physicians (12 staff plus rotating residents), medical students, nursing staff, and ancillary personnel. METHODS: Ten observers documented six specific behaviors among ED personnel: needle recap frequency, needle recap techniques, and use of gowns, gloves, masks, and goggles. After the observations, surveys were distributed to ED personnel by intrahospital mail in Fall 1989. RESULTS: During 270 observation hours, 1,018 patient-worker interactions were recorded. Gloves were the barrier worn most frequently when appropriate (74%), followed by goggles (13%), gowns (12%), and masks (1%). Needles were recapped 51% of the time, and most needles that were recapped (79%) were recapped by the two-hand technique; 5% of all needles used were left uncapped at bedside or in the trash. Physicians were observed to use gloves more frequently than registered nurses and nursing assistants; nurses were observed to recap more frequently than physicians. From the survey, the three most common reasons for noncompliance involved time (71%), dexterity (61%), and patient appearance (50%). CONCLUSION: Universal precautions are not consistently used by ED personnel, and ED personnel significantly overestimate their compliance with universal precautions.

Data Collection↗

PubMed1999

Glove resistance to permeation by a 7.5% hydrogen peroxide sterilizing and disinfecting solution.

BACKGROUND: This study evaluated 6 types of glove materials for resistance to permeation by a 7.5% hydrogen peroxide liquid chemical germicide. METHODS: Based on American Society for Testing and Materials Method F739-96, a small piece of glove material was placed in the center of a dual chamber test cell. The challenge and collection chambers of the test cell were filled with the hydrogen peroxide test chemical and the collecting medium (deionized water), respectively. Chemical permeation was determined by measuring the concentration of hydrogen peroxide in the collection medium at various time intervals. RESULTS: Both the polyvinylchloride and disposable latex examination gloves at 4.5 mil thickness provided less than 30 minutes of protection from hydrogen peroxide. The natural rubber latex glove at 16.5 mil lasted for 8 hours without any detectable penetration. Neoprene (15 mil) and nitrile butyl rubber (18 mil) both provided excellent protection throughout the 8-hour test period. CONCLUSION: Disposable latex examination gloves should be used for short-term exposure to hydrogen peroxide solutions. Thicker rubber latex gloves provided adequate protection and necessary dexterity for conducting intricate tasks. The level of protection depends largely on the thickness and quality of the glove material.

Anti-Infective Agents, Local↗

PubMedDate not supplied

Clinical evaluation of the efficacy and safety of an ultrasonic toothbrush system in an elderly patient population.

Twelve dentulous patients, age 65 or older, with no medical or pharmacologic predisposition to gingival hyperplasia were enrolled in a controlled clinical trial to evaluate the effect of the unaided use of an ultrasonic toothbrush on supragingival plaque and gingival bleeding. Subjects used the ultrasonic toothbrush in lieu of their conventional toothbrushes for a 30-day period. Clinical measurements of the plaque index and bleeding index were made at baseline and at 15 and 30 days. At the end of the 30-day test period, the use of the ultrasonic toothbrush resulted in significant reductions in plaque score, proportion of high plaque surfaces, and bleeding index. The reduction of the bleeding index indicates significant improvement in oral health. In this study, the use of an ultrasonic toothbrush effectively improved oral hygiene and health in a population that often exhibits decreased manual dexterity. Strategies for oral health care assessment and education for guidance of effective interventions are included in checklist form; level of care classification, cost in both time involved and equipment, and purchase instructions also are discussed. Further study is warranted to evaluate this instrument for cognitively impaired elders, who often rely on caregivers for oral hygiene procedures.

Aged↗

PubMed2006

[Use of a virtual immersion computer simulator as a model for basic training in laparoscopic urology].

BACKGROUND: to date, it has not been defined the best method for teaching urologic laparoscopy, however it is well recognized that it involves a steep learning curve. METHODS: A course of Laparoscopic Urology was done in our Institute. The program included skill practices in a virtual immersion simulator which evaluated, the score and time to complete each activity. This was done in a group of residents with previous experience with this virtual simulator (group 1) and another group of residents with no experience (group 2). Four different basic tasks were performed in the virtual simulator, which included: coordination, cutting, clip application and performing a simple suture. RESULTS: When we compared the scores between both groups the mean scores for each task were superior in group 1 compared to the group 2, with no statistically significant difference, however when we compared the time to complete each task, it was shorter in group 1 compared to group 2 with a statistically significant difference. CONCLUSIONS: The performance of residents without experience in a virtual simulator was similar to that of previously trained residents, however it takes less time to complete each task as the resident gains experience in these simulators. The use of virtual simulators for laparoscopy training are useful when learning basic techniques allowing the surgeon to improve hand dexterity and coordination in laparoscopic surgery.

Computer Simulation↗