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Several laparoscopic techniques of Hartmann reversal have been published. An alternative laparoscopic-assisted procedure, essentially aseptic, which uses the minilaparotomy for colostomy mobilization to apply the Dexterity Pneumo Sleeve device is described. This technique combines the advantages of the minimally-invasive approach with the direct access of the surgeon's hand to the patient's abdomen.
BACKGROUND: Laparoscopic surgery has been successfully applied to several gastrointestinal procedures. Although the totally laparoscopic gastrectomy is feasible, tactile sensation and manipulation of the organ as well as the lesion are decreased when compared to open surgery. The Dexterity Pneumo Sleeve is a new device which allows the surgeon to insert a hand into the abdominal cavity while preserving the pneumoperitoneum. This device was used for patients who underwent laparoscopic gastric surgery. METHODS: The first patient presented with a non-Hodgkin's lymphoma of the stomach. A laparoscopically assisted distal gastrectomy was performed with Roux-en-Y reconstruction. The second patient had a 5-cm leiomyoma involving the greater curve of the stomach, and this device was used for manipulation of the tumor. The last patient suffered from morbid obesity with its associated medical complications and a ventral hernia. The Sleeve was applied at the hernia site and a laparoscopically assisted gastric bypass was performed. RESULTS: The Pneumo Sleeve was useful in these cases for tactile localization of the tumor and for retraction and manipulation of the stomach and surrounding upper abdominal organs. CONCLUSIONS: The utilization of this device resulted in a more easily performed dissection, resection, and anastomosis and was felt to decrease operation time.
Finger tapping, the most widely used test for evaluating motor dysfunction in Parkinson's disease (PD), was found to react sensitively to disease specific factors like disease severity and changes in medication. A possible interference caused by disease unrelated demographic factors--age, gender, education and dexterity--however has not yet been studied systematically. Various components of tapping performance of 187 healthy subjects and 200 PD patients were assessed by means of the BRAIN TEST, a digitalized test battery. The effects of demographic factors--above all education and age--were found to be significant. These influences generally affect different aspects of movement to a different extent, with speed and akinesia being affected more severely than dysmetria and arrhythmokinesis. Our study suggests that whenever precise assement of upper limb motor performance is needed, specific corrections for these demographic factors in both healthy controls and PD patients are necessary.
The relationship between finger skin temperature (FST) and performance was demonstrated with four manual dexterity tasks all of which were performed by black and white, male and female subjects. At air temperatures below 24 degrees C the white subjects tended to have warmer FSTs than the black subjects; white subjects were also able to equal the performance of the black subjects at air temperatures as much as 6 degrees C below that required by the black subjects.
The present review examines studies which have reported on the performance of submerged operators on manual dexterity tasks in the practical arena of the open ocean underwater environment. The previous emphasis on the primacy of the factor situational anxiety, in degrading efficiency, is questioned. The case for environmentally-based factors and performer skill level as potent influences on performance is advanced. In postulating a potential linear relationship between depth of operation and performance decrement for air-breathing divers, the review seeks to stimulate further experimental examination of this important applied issue.
Using a double-blind procedure, 16 out of 32 volunteer subjects (students) each took 2.5 mg of lorazepam (Ativan) orally and the remainder took a placebo. To overcome the problem of wide variation in individual tolerance to the drug, impairment on a task unrelated to memory (a manual dexterity task) was used to divide drug subjects into a group appreciably affected by the drug, subgroup 1, and a group minimally affected, subgroup 2. Only subgroup 1 showed consistent impairment of episodic memory. Both subgroups showed some impairment in a semantic memory task (generation of words from a specified category), but this was confined to the rate at which the task was carried out. The main aim of the experiment was to examine the effect of lorazepam on the rate of forgetting of word lists when drug and control subjects' initial recall levels were equalized. There was no evidence that the drug affected rate of forgetting: this suggests that it does not affect retention. There was also no evidence that it affected retrieval, since there was no impairment in the recall of material presented before administration of the drug. Hence its locus of action is attributed to input, specifically to impaired encoding of contextual information.
Sinus venosus atrial septal defect (SVD) is a rare cardiac abnormality in adults. Particularly, the inferior type is difficult to depict by transthoracic echocardiography because of its infero-posterior location to the fossa ovalis. We describe the case of a 33-year-old woman whose chest X-ray taken during bronchopneumonia revealed a cardiomegaly. Further echocardiographic investigations showed an underlying inferior SVD, an incomplete cor triatriatum dexter and a large patent foramen ovale (PFO). The diagnosis was confirmed by cardiac magnetic resonance imaging (CMR) and during surgical repair.
Given the well established role of the cerebellum in motor control, deficient motor performance during life time appears to be common in cerebellar agenesis. However, behavioural data on motor performance in living subjects with cerebellar agenesis are scarce. Dexterity during object manipulation was comparatively investigated in a 63-year old female with cerebellar agenesis and three healthy age- and gender-matched control subjects. Participants performed a transport task with an instrumented object and caught a weight that was dropped into a hand-held receptacle either expectedly from the opposite hand or unexpectedly from the experimenter's hand. Compared to healthy subjects, the subject with cerebellar agenesis generated greater grasping forces. For the transport task the patient showed a clear impairment of the predictive adjustment of grasping forces to the differential loading requirements of movement direction. For the weight-catching task, the patient established an accurate reactive mode of control when the weight was dropped unexpectedly. In case the weight was dropped expectedly from the opposite hand, predictive control mechanisms were severely disturbed in the subject with cerebellar agenesis. These data highlight the role of the cerebellum for predictive force control and are interpreted within the concept of internal models reflecting the causal relationship between actions and their consequences.
The first objective of this review is to summarize how grip force and load force (holding and transporting forces) are coordinated. Usually, the two forces vary in parallel, thereby resulting in a constant force ratio. Departures from this rule have been observed, however, depending on dynamic task constraints. The second objective is to summarize some of the pathophysiology of grasping in movement disorders. By means of a drawer-pulling task, regulation of grip force was analyzed when pulling was perturbed either by self-induced or externally applied load disturbances. Normal subjects automatically increased grip force in anticipation to the expected load. In the same situation, hemiparetic patients failed to generate proactive grip force and frequent slips were observed. Cerebellar patients were shown to adopt a 'default' strategy in producing high grip force output when the drawer had to be pulled up to its mechanical stop. This differed from the more flexible normal mode of raising grip force in accord with the pulling speed. In patients with Huntington's Chorea, grip/load force coordination differed from that of normal subjects, as expressed in an overscaled grip force. This might be a secondary, less flexible 'default' strategy to overcome the failure in adapting grip force to upcoming disturbances. Writer's cramp patients overscaled grip force in both the dominant and non-dominant hand, and grip force further increased when hand muscles were vibrated, suggesting an abnormal sensorimotor integration. The results illustrate the degrading consequences of cortical and subcortical pathology on manual dexterity, which is sometimes partly compensated for by new, less flexible default strategies.
Cor triatriatum dexter is a malformation resulting from lack of normal regression of the embryonic right valve of the sinus venosus. In this situation, the right atrium is divided by a membrane into two chambers. Two-dimensional echocardiography was used in the antemortem diagnosis of this rare cardiac anomaly in a neonate. Associated cardiac lesions were also documented. The patient died, and findings were verified at autopsy.
The effect of temperature in the range from 25 to 37 degrees C on the population balance of stromal and multiple-lineage hematopoietic cells from murine bone marrow at various stages of differentiation in Dexter's culture was investigated. The length of time required for stromal cells to reach confluence after inoculation of both cell types harvested from murine bone marrow was shorter at higher temperatures. On the other hand, the hematopoietic cell concentration initially decreased more rapidly at higher temperatures until the confluence of stromal cells, which should then support the proliferation of hematopoietic cells. The concentration of hematopoietic cells began to increase after 2 weeks incubation at 33 and 37 degrees C and after 4 weeks at 29 degrees C. However, the growth of hematopoietic cells was not stable at 37 degrees C, and neither stromal nor hematopoietic cells showed significant growth at 25 degrees C. The specific growth rate of hematopoietic cells at 29 degrees C after 4 weeks was comparable or higher than that at 33 degrees C, while the final concentration of hematopoietic cells was maximal at 33 degrees C. Using a cultivation method in which hematopoietic cells were recharged onto a confluent layer of stromal cells prepared at 33 degrees C, the maintenance and growth of hematopoietic cells were better at 29 degrees C than at higher temperatures. The content of progenitor cells among the hematopoietic cells increased prior to the increase in the hematopoietic cell concentration, and the progenitor cell was greater content at the lower temperature. These results suggest that cultivation at 29 degrees C might be superior to 33 degrees C for the maintenance and growth of hematopoietic cells with a prepared confluent layer of stromal cells.
As part of a larger epidemiological survey of a stratified sample of 12-year-old handicapped children in Flanders, Belgium, the present study describes gingival health, gingival hypertrophy, oral cleanliness and the presence of calculus. Statistical analysis was performed with motor skills, brushing help, the use of chemical agents, the use of anti-epileptic drugs, the knowledge of parents and educators (or caregivers) and their opinion of the oral hygiene of their children/ pupils as response variables. From this study, it became clear that mildly mentally retarded and learning-impaired children had significantly better manual dexterity skills than moderately and severely mentally retarded and physically impaired children. However, this was not reflected in improved oral hygiene. The use of chemical plaque controlling agents was found to be extremely low and, with the exception of children with gingival hyperplasia, the users of these agents did not have better oral hygiene. No difference was found between subtypes in the opinion of parents and educators on oral status. There was, however, a difference between their assessment and the clinical picture. It was concluded that there was a need for in-service training programmes in oral health care for educators as well as for parents.
The usable reach of microsurgical instruments employed in eye surgery can be recorded on a TABO diagram. This simple, rapid and versatile method can be used on models and in vivo. Its principal benefit is that it teaches beginners the physical limitations placed on their dexterity, but experienced surgeons will also find it useful when testing new instruments and practicing complicated maneuvers involving two or more hands. Familiarity with the reach of the individual instruments helps prevent complications due to improvisation, and fatigue caused by incorrect posture. The full potential of microsurgical methods can only be exploited if the conditions governing them are observed. One of these conditions is that physical proportions appear different under the microscope and therefore stricter rules apply than for operations carried out with the naked eye.
Cor triatriatum dexter is an unusual cardiac abnormality with division between the sinus and primitive atrial portions of the right atrium. Three-dimensional echocardiography is a novel technique that defines this entity.
Results of neurobehavioral testing in 305 histology technicians were studied by regression analysis with age, years of cigarette smoking, and hours per day of exposure to formaldehyde and to solvents as major independent variables. Increasing age was associated with poorer performance on visual memory, block design, trails, dexterity by pegboard, sharpened-Romberg, finger writing, as well as with longer choice reaction time. Increased daily hours of exposure to formaldehyde were correlated with reduced performance on story memory, visual memory, digit span, pegboard and sharpened-Romberg, as well as with errors on trails. Exposure to solvents was associated only with diminished recall of story.
A book, "On Dexterity and Its Development," written by N. A. Bernstein in the 1940s has recently been published in Moscow. We describe briefly the amazing fate of this miraculously saved book and of its famous author. The book is unique in its reader-friendly handling of the most complicated issues of motor control, motor development, motor skill acquisition, and more general aspects of brain activity. It presents the basis for what is now called motor control and for some of the more fundamental issues of theoretical neuroscience. Bernstein described his views on multilevel control of movements, the role of sensory feedback, preprogramming, feedback and feedforward components in motor control, the role of exercise, and other subjects. Despite the fact that the book was written nearly half a century ago, its deep philosophical content remains beyond any competition.
Chronic myeloid leukemia (CML) is a hematological neoplasia that results from the transformation of a hematopoietic stem cell. It is characterized by the expansion of the myeloid lineage, which results in the accumulation of mature and immature granulocytes in peripheral blood and bone marrow. However, when CML marrow cells are cultured in Dexter-type long-term cultures (LTMC) hematopoiesis is defective and can be sustained for only a few weeks. One possible explanation for the deficient growth of hematopoietic cells in CML LTMC is that some factors that act as key regulators of hematopoiesis are absent in this experimental system. Thus, we tested this hypothesis by adding recombinant cytokines to these cultures. As a first approach, we added recombinant human granulocyte-macrophage colony stimulating factor (rhGM-CSF), rhGranulocyte-CSF (rhG-CSF) and rhErythropoietin (rhEPO); each factor was added individually once a week. Addition of rhGM-CSF and rhG-CSF resulted in a significant increase in the levels of nucleated cells and myeloid progenitors; the highest effects were seen in the presence of rhGM-CSF. Interestingly, such a cytokine also induced a significant decrease in the levels of erythroid progenitors. Recombinant hEPO had no significant effects on nucleated cells or myeloid progenitors, however, it induced a significant, although transient, increase in the levels of erythroid cells. The above results indicate that the hematopoietic regulators used here (rhGM-CSF, rhG-CSF and rhEPO) are capable of stimulating the growth of hematopoietic cells in LTMC from CML patients. Thus, this study demonstrates that it is, indeed, possible to manipulate CML LTMC by the addition of recombinant cytokines; this observation may be of particular relevance, since this in vitro experimental system has already been used as a method for purging of leukemic cells in autologous transplant settings. By using specific recombinant hematopoietic modulators it might be possible to make LTMC a more efficient system for such a clinical purpose.
To study the influence of functional electric stimulation (FES) on grip acquisition and on the change of grip processing speed, 38 hemiplegic patients took part in the rehabilitation program of the Division of Rehabilitation Medicine of the Hospital das Clinicas, School of Medicine, University of Sao Paulo. Half of the patients received FES on their wrist and finger extensor muscles. The patients in this study were evaluated initially, then after 3 months and after 6 months using the Minnesota manual dexterity test. We concluded that the time necessary for use of FES to generate a significant improvement in the grip speed in hemiplegic patients is 6 months, using twice-weekly administration of stimulation.