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At least 1,531 records · Page 85Linked to original sources

PubMed2001

Use of the Multiple Sclerosis Functional Composite to predict disability in relapsing MS.

OBJECTIVE: To determine whether the MS Functional Composite (MSFC) can predict future disease progression in patients with relapsing remitting MS (RR-MS). BACKGROUND: The MSFC was recommended by the Clinical Outcomes Assessment Task Force of the National MS Society as a new clinical outcome measure for clinical trials. The MSFC, which contains a test of walking speed, arm dexterity, and cognitive function, is expressed as a single score on a continuous scale. It was thought to offer improved reliability and responsiveness compared with traditional clinical MS outcome measures. The predictive value of MSFC scores in RR-MS has not been determined. METHODS: The authors conducted a follow-up study of patients with RR-MS who participated in a phase III study of interferon beta-1a (AVONEX) to determine the predictive value of MSFC scores. MSFC scores were constructed from data obtained during the phase III trial. Patients were evaluated by neurologic and MRI examinations after an average interval of 8.1 years from the start of the clinical trial. The relationships between MSFC scores during the clinical trial and follow-up status were determined. RESULTS: MSFC scores from the phase III clinical trial strongly predicted clinical and MRI status at the follow-up visit. Baseline MSFC scores, and change in MSFC score over 2 years correlated with both disability status and the severity of whole brain atrophy at follow-up. There were also significant correlations between MSFC scores during the clinical trial and patient-reported quality of life at follow-up. The correlation with whole brain atrophy at follow-up was stronger for baseline MSFC than for baseline EDSS. CONCLUSION: MSFC scores in patients with RR-MS predict the level of disability and extent of brain atrophy 6 to 8 years later. MSFC scores may prove useful to assign prognosis, monitor patients during early stages of MS, and to assess treatment effects.

Adult↗

PubMedDate not supplied

Effect of subanesthetic concentration of enflurane and halothane on human behavior.

Ten male volunteers performed 3 tasks before, during, and following administration of 3 levels of alveolar halothane (0.05, 0.1, and 0.2%) for one-half hour each and (on a separate occasion) enflurane (0.15, 0.3, and 0.4%) for one-half hour each. The concentrations of halothane tested representing 7, 13, and 27% of MAC values, respectively; those of enflurane were 9, 18, and 24% of MAC. The tasks were a choice-reaction time test, a digit span test, and a Purdue Pegboard Assembly test. Volunteers also were tested for amnesia with word pairs and a picture. No effects or only slight effects on mental function could be detected at the lowest concentrations of either agent. At higher concentrations both agents impaired function, as indicated by an increase in reaction time, decreased ability to remember numbers, and decreased ability to assemble a simple structural array. Amnesia for word pairs but not pictures occurred at 27% of MAC for halothane and 18% of MAC for enflurane. All test scores reverted to control levels within one-half hour after discontinuing the anesthetic. Our results indicate that subanesthetic but not trace levels of enflurane or halothane can impair mental performance and manual dexterity and produce amnesia. The levels of anesthetic required far exceed those experienced by operating room personnel. However, such levels might be found for several hours in patients following prolonged anesthesia.

Adult↗

PubMed1993

Impairment of anesthesia task performance by laser protection goggles.

This study was designed to determine whether the wearing of colored goggles, commonly used during laser surgery, increased the time needed to perform simple tasks or the likelihood of medication errors. The Stromberg Dexterity Test and the Medication Sorting Task (MST), a test of our own design, were used to measure the speed and accuracy of identifying medications. Thirty anesthesia care providers performed the tests twice, once with colored goggles and once without. Ambient light during the test was controlled to approximate that in the operating room during laser surgery. Times required to complete the tests improved with repetition of the test. When colored goggles were worn, more time was needed to complete the tests. More errors, especially serious errors in medication sorting, occurred when goggles were worn than when they were not. The wearing of colored goggles in combination with low levels of illumination and stress due to time constraints, may increase the potential for medication errors.

Anesthesiology↗

PubMed2004

Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol.

UNLABELLED: Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

Chemical Warfare↗

PubMed2003

Robot-assisted thoracoscopic resection of a benign mediastinal neurogenic tumor: technical note.

OBJECTIVE: Robotic surgery systems were introduced recently with the objective of enhancing the dexterity and view during procedures that use a videoscope. The first case report of robot-assisted thoracoscopic removal of a benign neurogenic tumor in the thorax is presented. METHODS: A 46-year-old woman presented with a history of paravertebral pain. A chest x-ray revealed a left paravertebral mass. A magnetic resonance imaging scan revealed a well-encapsulated mass that was suspected to be a neuroma at the level of T8-T9, separate from vascular structures, without extension in the foramina, and without a spinal canal component. RESULTS: A left robot-assisted thoracoscopic resection of the tumor was performed. After placement of six trocars, the tumor was carefully dissected and removed through one of the trocar openings. The histopathological findings revealed an ancient schwannoma. CONCLUSION: This case report demonstrates the feasibility of robot-assisted thoracoscopic extirpation of a thoracic neurogenic tumor. Robot-assisted surgery may prove to be of additional value in challenging thoracoscopic surgery, such as the delicate surgical removal of benign neurogenic tumors, because of the support in manipulation and visualization during videoscopic interventions.

Female↗

PubMed1991

Expression of a divalent cation-dependent erythroblast adhesion receptor by stromal macrophages from murine bone marrow.

Stromal macrophages in haemopoietic organs express novel surface receptors that are implicated in trophic interactions with developing blood cells. Macrophages isolated from foetal liver bind erythroblasts (Eb) by a divalent cation-dependent receptor (EbR), whereas stromal macrophages in adult bone marrow and lymphoid organs express a lectin-like receptor, sialoadhesin, which interacts with sialylated structures on sheep erythrocytes and murine haemopoietic cells. In order to learn more about the regulation of these haemagglutinins, we examined binding of Eb by stromal macrophages that had been isolated from adult murine tissues or generated in Dexter-type cultures of bone marrow. Macrophages were purified from bone marrow by collagenase digestion, adherence to a substratum and detachment of clustered haemopoietic cells, and tested for their ability to bind Eb from foetal liver or anaemic adult spleen. Freshly isolated bone marrow macrophages bound Eb mainly by a divalent cation-dependent activity that was not inhibited by neuraminidase treatment of Eb or by specific anti-sialoadhesin monoclonal antibodies, although these macrophages express sialoadhesin and Eb bear a potential ligand for this receptor. Macrophages obtained by digestion from other adult lymphoid tissues also bound Eb by a divalent cation-dependent activity, whereas blood monocytes and lavaged peritoneal macrophages failed to do so. Peritoneal macrophages could be induced to express high levels of sialoadhesin by cultivation in homologous mouse serum, but such macrophages did not acquire sialoadhesin-independent EbR activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2001

The morphology of autotomy structures in the sea cucumber Eupentacta quinquesemita before and during evisceration.

Evisceration in the dendrochirotid sea cucumber Eupentacta quinquesemita is a whole-body response involving a predictable series of events including muscle contraction and failure of three autotomy structures: (i) the introvert, the dexterous anterior extensible portion of the body wall, (ii) the tendon linking the pharyngeal retractor muscle to the longitudinal body wall muscle and (iii) the intestine-cloacal junction. The autotomy structures are histologically complex, consisting of muscle, nervous and connective tissue. Autotomy resulted from complete loss in the tensility of the connective tissue ground substance. Separation of the autotomy structures was facilitated by muscle contraction. The cell and tissue changes involved with autotomy were documented by microscopic examination of autotomising tissue. Change in the autotomy structures appears to initiate from the peritoneal side with delamination of the peritoneum followed by a wave of disruption as the connective tissue is infiltrated by coelomic fluid. Evisceration and autotomy in E. quinquesemita are neurally controlled, so particular attention was paid to the fate of neuronal elements. Neurosecretory-like processes containing large dense vesicles and axons were present in the connective tissue layers of the autotomy structures in association with extracellular matrix, muscles and neurons. These neuronal elements remained largely intact during autotomy and did not appear to be a source of factors that effect connective tissue change. They may, however, be involved in muscle activity. Holothuroid autotomy structures are completely or partially bathed in coelomic fluid, so there is potential for hormonal or neurosecretory activity using the coelomic fluid as a conduit. Connective tissue change during evisceration appears to be effected or mediated by an evisceration factor present in coelomic fluid that has a direct transmitter-like or neurosecretory-like mode of operation. The final outcome, expulsion of the viscera, is likely to result from a suite of factors that interact in a manner yet to be determined.

Animals↗

PubMed1997

Simulation of resistance forces acting on surgical needles.

High precision in the manual control of needles and biopsy probes in medical treatment requires high skill and dexterity levels. In anaesthesia, force sensation is an important feedback mechanism, and the practitioner needs to refresh or develop skills to improve on the interpretation of needle progress towards the target site. This paper describes an experimental tactile force simulator for uniaxial needle action for which the force resisting progress of the needle is derived from measured data. As an example, the approach taken to develop the simulation of the insertion of epidural needles is described. Adaptation to other procedures would be possible by adopting new reference models based on appropriate measured force data.

Animals↗

PubMed2000

Stroma-dependent maintenance of cytokine responsive hematopoietic progenitor cells derived from long-term bone marrow culture.

Hematopoietic cells maintained for long periods on primary cultures of bone marrow stromal cells formed cobblestone colonies (Dexter's long-term bone marrow culture, LTBC). These stably maintained hematopoietic cells (for 4 months) were transferred to a coculture on an established spleen stromal cell line (MSS62), and maintained under stromal cell layer, where they retained their invasive ability in the restricted space between the stromal cell layer and culture substratum (DFC culture). DFC contained lineage-negative (Lin-), c-Kit+, Sca-1- cells and spontaneously produced Mac-1+, Gr-1+ cells. DFC could not grow in the absence of MSS62 stromal cells, although, GM-CSF, IL-3, or IL-7 stimulated its growth. Production of granulocyte and monocytic cells was maintained by GM-CSF or IL-3 while it was decreased by IL-7. RT-PCR analysis showed that the IL-7 responsive cell population expressed early lymphoid markers (Ikaros, Pax-5, Oct-2, Rag-1, TdT, IL-7R and Imu), while lacking expression of receptors for G-CSF (G-CSFR) and for M-CSF (M-CSFR), or myeloperoxidase (MPO). These results suggested that DFC simultaneously contained lymphoid-committed progenitors and myeloid-committed progenitors, and that cytokines may expand their responding progenitor cells under the influence of signals provided by the stromal cells. Such a stromal cell-dependent culture system may be useful to analyze the switching mechanism from constitutive to inducible hematopoiesis in vitro.

Animals↗

PubMed1981

Stem cell assays in the evaluation of myelotoxicity.

The concept and characteristics of different types of hematopoietic cells have been described. Hematopoietic stem cells are currently considered to exist in a variety of populations with different degrees of commitment towards a particular cell line. By a combination of animal studies and studies with hematopoietic disorders, the concept of dividing hematopoietic stem cells into uncommitted and committed types has emerged in the past several years. Uncommitted stem cells are capable of differentiation, under the proper stimulus, into either of the cell lines of the hematopoietic system. These cells form a resting population of cells with a low mitoitic rate and a long resting (G(0)) phase. The committed stem cells are partially differentiated and mature only into one type of cell. The committed stem cell population is relatively more active than the population of uncommitted stem cells.A variety of assays both in vivo and in vitro are currently available for the study of different hematopoietic stem cells. These assays are semiquantitative. The number of colonies of mature cells which develop after the infusion or plating of a population of cells containing the stem cells is proportional to the total number of cells infused.A variety of toxic as well as biological substances have been assayed in these systems and a quantitative depression of the number of colonies produced has been noted by a variety of workers. The degree of depression in the number of colonies varies with the agent in use and the type of assay employed. These studies have demonstrated that toxicity of chemicals on the hematopoietic stem cells can be studied with these in vitro and animal studies to give an assessment of their potential toxicity in the intact organism. The recent development of the Dexter two-layer liquid culture system has provided a new impetus to the research on the uncommitted stem cell in a variety of organisms.

Animals↗

PubMed1994

Dietary boron, brain function, and cognitive performance.

Although the trace element boron has yet to be recognized as an essential nutrient for humans, recent data from animal and human studies suggest that boron may be important for mineral metabolism and membrane function. To investigate further the functional role of boron, brain electrophysiology and cognitive performance were assessed in response to dietary manipulation of boron (approximately 0.25 versus approximately 3.25 mg boron/2000 kcal/day) in three studies with healthy older men and women. Within-subject designs were used to assess functional responses in all studies. Spectral analysis of electroencephalographic data showed effects of dietary boron in two of the three studies. When the low boron intake was compared to the high intake, there was a significant (p < 0.05) increase in the proportion of low-frequency activity, and a decrease in the proportion of higher-frequency activity, an effect often observed in response to general malnutrition and heavy metal toxicity. Performance (e.g., response time) on various cognitive and psychomotor tasks also showed an effect of dietary boron. When contrasted with the high boron intake, low dietary boron resulted in significantly poorer performance (p < 0.05) on tasks emphasizing manual dexterity (studies II and III); eye-hand coordination (study II); attention (all studies); perception (study III); encoding and short-term memory (all studies); and long-term memory (study I). Collectively, the data from these three studies indicate that boron may play a role in human brain function and cognitive performance, and provide additional evidence that boron is an essential nutrient for humans.

Aged↗

PubMed1989

Immunocytochemical component of endocrine cells in pancreatic islets of horses.

The endocrine cell components in the pancreatic islets of the following 4 pancreatic regions of the horse were investigated by immunohistochemical methods: lobus pancreatis sinister (left lobe); lobus pancreatis dexter (right lobe); and 2 regions of Corpus pancreatis (body), the duodenal lobe which lies along the cranial duodenal flexure and descending duodenum, and the intermediate lobe which is situated around the portal vein. The islets in the left and intermediate lobes contained a central mass of glucagon cells surrounded by insulin cells, a few somatostatin cells and sporadic pancreatic polypeptide (PP) cells. On the other hand, the islets in the duodenal lobe were small in size compared with the other 3 regions, and were predominant in insulin and pancreatic polypeptide (PP) cells, but almost lacked in glucagon cells. These findings suggested that the duodenal lobe was derived from the ventral pancreatic primordium, and the left and intermediate lobes were originated from the dorsal pancreatic primordium. In the right lobe, the composition and distribution of the islet cells were almost the same as those in the left and intermediate lobes, but there were several lobules containing numerous PP cells as seen in the duodenal lobe.

Animals↗

PubMed2006

Intermittent self-catheterization appliances for disabled patients.

Occasionally, district nurses may be asked to teach a patient intermittent self-catheterization (ISC). However, if the patient has some form of physical disability that reduces their manual dexterity or limits their movement, should this stop the patient undertaking the procedure? This article outlines some of the appliances available to help disabled patients undertake ISC.

Activities of Daily Living↗

PubMedDate not supplied

Indications for and principles of intermittent self-catheterization.

Intermittent self-catheterization (ISC) or carer/nurse assisted intermittent catheterization has developed over the past few years as a means of treating patients with bladder emptying problems. Initially the process was designed for patients with the dexterity to carry out the procedure; today, however, more nurses are trained in the technique and are therefore able to support people with coordination problems in carrying out the procedure. Education programmes on catheterization are becoming increasingly popular and many district nurses have become skilled in its practice. This article describes some of the conditions that may be associated with bladder dysfunction and which warrant ISC. The support required from nurses in the planning, implementing, intervention and evaluation of a package of care are discussed. Simple advice such as avoiding constipation, monitoring urine to identify infection and general measures to improve hygiene all play a role in maintaining good health.

Female↗

PubMedDate not supplied

The Sims Portex Catheter Valve: an alternative to the leg bag.

Any patients who would normally use a catheter and leg bag could benefit from exchanging their leg bag for a catheter valve, as long as they have the manual dexterity to open their valve at regular intervals and remember to do so. The Sims Portex Catheter Valve is a lightweight and compact catheter valve that is discrete and offers more comfort than a leg bag system, especially to the more mobile patient. This article examines this type of catheter valve and assesses its relevance for use in both the community and the acute sector.

Catheters, Indwelling↗

PubMedDate not supplied

Trident T2: a new development in urine bag tap design.

This article looks at Seton Scholl Continence Care's Simpla Trident T2 leg bag with the new advanced lever-action tap which has recently won the Independent Living Design Award. This easy-to-use lever-action tap has a simple, positive action which allows more independence and less intervention from carers. The lever-action tap enables the patient with limited hand coordination or poor finger/thumb dexterity to operate it effectively. The tap is smooth to the touch and the corners have been rounded to reduce any sharpness. The Simpla Trident T1 and T2 bags have the protected sample port to allow safe urine sampling without the need to break the system.

Drainage↗

PubMedDate not supplied

Patients' quality of life and clean intermittent self-catheterization.

This article examines the available literature surrounding the procedure of clean intermittent self-catheterization (CISC) and its impact on patients' quality of life. Many articles have been written about, and much research has been carried out into, the practicalities of performing CISC regarding dexterity, disability, etc, and its advantages and disadvantages related to infection rates and complications. However, there appear to be very few articles addressing the day-to-day problems that having to perform CISC presents to patients. While many articles do acknowledge that CISC improved patients' quality of life, very few go on to identify and discuss the daily life activities that are impacted upon by having to perform the procedure. There is a need for further research from patients' perspectives: to identify the issues that they have in living with this inconvenience and in order for carers to understand fully the implications of CISC on a patient's quality of life. With this insight, carers will be better armed to help patients overcome their fears and be more supportive in the ongoing care of the patient. Non-compliance is the main reason for patients' inability to perform CISC and with a better understanding of the problems, carers will be able to give practical help and support.

Catheterization↗

PubMed2001

Magnification: what is available, and will it aid your clinical practice?

With the development of clinical techniques that require high levels of manual dexterity and involve fine detail, there is increasing interest in the use of magnification for dental procedures. This article considers the potential benefits of magnification, the different methods by which it can be obtained and, finally, presents some caveats to its use.

Dental Equipment↗