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PubMed2003

Active neck muscle training in the treatment of chronic neck pain in women: a randomized controlled trial.

CONTEXT: Active physical training is commonly recommended for patients with chronic neck pain; however, its efficacy has not been demonstrated in randomized studies. OBJECTIVE: To evaluate the efficacy of intensive isometric neck strength training and lighter endurance training of neck muscles on pain and disability in women with chronic, nonspecific neck pain. DESIGN: Examiner-blinded randomized controlled trial conducted between February 2000 and March 2002. SETTING: Participants were recruited from occupational health care systems in southern and eastern Finland. PATIENTS: A total of 180 female office workers between the ages of 25 and 53 years with chronic, nonspecific neck pain. INTERVENTIONS: Patients were randomly assigned to either 2 training groups or to a control group, with 60 patients in each group. The endurance training group performed dynamic neck exercises, which included lifting the head up from the supine and prone positions. The strength training group performed high-intensity isometric neck strengthening and stabilization exercises with an elastic band. Both training groups performed dynamic exercises for the shoulders and upper extremities with dumbbells. All groups were advised to do aerobic and stretching exercises regularly 3 times a week. MAIN OUTCOME MEASURES: Neck pain and disability were assessed by a visual analog scale, the neck and shoulder pain and disability index, and the Vernon neck disability index. Intermediate outcome measures included mood assessed by a short depression inventory and by maximal isometric neck strength and range of motion measures. RESULTS: At the 12-month follow-up visit, both neck pain and disability had decreased in both training groups compared with the control group (P<.001). Maximal isometric neck strength had improved flexion by 110%, rotation by 76%, and extension by 69% in the strength training group. The respective improvements in the endurance training group were 28%, 29%, and 16% and in the control group were 10%, 10%, and 7%. Range of motion had also improved statistically significantly in both training groups compared with the control group in rotation, but only the strength training group had statistically significant improvements in lateral flexion and in flexion and extension. CONCLUSIONS: Both strength and endurance training for 12 months were effective methods for decreasing pain and disability in women with chronic, nonspecific neck pain. Stretching and fitness training are commonly advised for patients with chronic neck pain, but stretching and aerobic exercising alone proved to be a much less effective form of training than strength training.

Adult↗

PubMed2000

Pathogenesis and management of respiratory insufficiency following pulmonary resection.

The underlying principle of the surgical treatment of non-small-cell lung cancer (NSCLC) is complete removal of the local/regional disease within the thorax. Pulmonary resection should be as conservative as possible without compromising the adequacy of tumor removal. A multitude of factors influence the incidence and severity of complications following pulmonary resection including the pre-operative physical and psychological status of the patient, the pathologic process requiring resection, the physiologic impact of the procedure, and the addition of pre-operative or postoperative adjuvant therapy. The insidious onset of interstitial changes on chest X-ray (CXR) 1 to 2 days after pulmonary resection forewarns of respiratory distress; however, the pathophysiology of adult respiratory distress syndrome (ARDS) with progression to respiratory failure requiring mechanical ventilation and advanced critical care often unfolds. Management of patients with severe respiratory failure remains primarily supportive. "Good critical care" is the mainstay of therapy: this includes gentle mechanical ventilation to avoid ventilator-induced barotrauma and over-extension of remaining functional alveoli, diuresis, infection identification and management, and nutritional support. New therapeutic strategies that may impact on outcomes in the adult population include pressure-limited ventilation (permissive hypercapnia), inverse ratio ventilation, high-frequency jet ventilation, high-frequency oscillatory ventilation, intratracheal pulmonary ventilation, and prone position ventilation. In addition, alternative therapies such as partial liquid ventilation, inhaled nitric oxide, and extracorporeal techniques including extracorporeal membrane oxygenation (ECMO), extracorporeal carbon dioxide removal (ECCO(2)R), intravascular oxygenation (IVOX), and arteriovenous carbon dioxide removal (AVCO(2)R), provide additional modalities. A component of some or all of these strategies is finding a role in clinical practice.

Carcinoma, Non-Small-Cell Lung↗

PubMed2000

Free flaps for reconstruction of the lower back and sacral area.

Free flap reconstruction of the lower back and sacrum is complicated by a paucity of recipient vessels and difficulties in postoperative care. From 1983 to 1997, six patients with intractable wounds of the lower back and sacral area were treated with free flaps. The flaps used were latissimus dorsi (three), combined latissimus dorsi and serratus anterior (one), and filleted leg tissue (two). The recipient vessels were the deep femoral vessels, the perforator vessels of the deep femoral system, the inferior epigastric vessels, and the superior gluteal and inferior gluteal vessels. The patients were observed in the intensive care unit for 1 week and kept in prone position for 4 weeks. All flaps survived and wounds healed primarily. For large or multiple defects of the lower back and sacrum, free tissue transfer is effective in achieving primary healing, particularly when local flaps are inadequate or have failed.

Adult↗

PubMed1975

Measures to minimize small intestine injury in the irradiated pelvis.

Small intestine injury causes long-term suffering and high mortality. Five of 187of our patients had developed serious small intestine injury. Four patients had corrective surgery. Three patients died. All were women. Subsequently, all patients who received definitive pelvic irradiation had small intestine roentgenograms to determine itslocation and mobility. Female patients, thin patients, and elderly patients had larger amounts of small intestine in the whole pelvis, a deeper cul de sac, and a greater incidence of relatively immobile small intestine. Patients with relativelyimmobile small intestine in the treatment field may be predisposed to injury. There wasno relationship of the incidence of relatively immobile small intestine to prior pelvicsurgery. We used the findings from the small intestine roentgenograms to modify indiviually the radiotherapy regimen so as to minimize the risk for small intestine injury. Patients were placed in the prone position to displace the small intestineout of the treatment fields used for booster dose irradiation. The treatment field wasmodified to exclude the small intestine. The total tumor dose delivered was determinedby expectations for curve vs. complications. To date, none of the patients in this study group has developed small intestine injury. Cadaver studies showed the feasibility of elective shortening of the pelvic cul de sac. The small intestine can be displacedaway from the bladder, prostate, or cervix.

Age Factors↗

PubMed2001

Urodynamic monitoring during percutaneous sacral nerve neurostimulation in patients with neurogenic detrusor hyperreflexia.

The purpose of this study was to assess urodynamics parameter changes induced by acute sacral neurostimulation (SNS) in spinal cord injury (SCI) patients with neurogenic detrusor hyperreflexia. Fourteen SCI patients with urge incontinence owing to a hyperreflexive bladder were prospectively evaluated. Neurostimulation was performed on the root that obtained the best motor response (10 Hz, 210 microseconds) and amplitude ranges of >0 to 10 V. The urodynamics study was done in the prone position. Four cystometries were recorded before (two), during (one), and 10 minutes after stimulation (one). Maximal bladder capacity (MBC) (volume to first leakage), bladder volume at first uninhibited contraction (BV(1stC)), and maximal detrusor pressure during uninhibited contractions (P(det)max) were compared. Left S3 foramen was the most commonly used (9/14). Mean amplitude of stimulation was 4.5 V (range, 0.5-8.5 V). Statistically significant differences (Mann-Whitney U-test) were found for MBC, BV(1stC), and P(det)max with mean variations of +206.8 mL (+107%, P < 0.001), +151.5 mL (+98%, P < 0.01), and -23.4 cm H2O (-27%, P < 0.05), respectively. Patient gender and SCI level did not reveal any difference. Patients who reached a MBC of up to 400 mL (+278.2 mL, +129%, n = 10) with SNS had statistically significant improvement of BV(1stC) (+210.2 mL, +125%, P < 0.01) and P(det)max (-33.3 cm H2O, -38%, P < 0.01). Acute temporary SNS in SCI patients has a profound effect on key urodynamics parameters. These neurologically impaired patients with detrusor hyperreflexia may be appropriate candidates for implantable SNS.

Adult↗

PubMed2007

Posterior approach technique for accessory-suprascapular nerve transfer: a cadaveric study of the anatomical landmarks and number of myelinated axons.

Accessory-suprascapular nerve transfer by the anterior supraclavicular approach technique was suggested to ensure transferrance of the spinal accessory nerve to healthy recipients. However, a double crush lesion of the suprascapular nerve might not be sufficiently demonstrated. In that case, accessory-suprascapular nerve transfer by the posterior approach would probably solve the problem. The aim of this study was to evaluate the anatomical landmarks and histomorphometry of the spinal accessory and suprascapular nerve in the posterior approach. Dissection of fresh cadaveric shoulder in a prone position identified the spinal accessory and suprascapular nerve by the trapezius muscle splitting technique. After that, nerves were taken for histomorphometric evaluation. The spinal accessory nerve was located approximately halfway between the spinous process and conoid tubercle. The average distance from the conoid tubercle to the suprascapular nerve (medial edge of the suprascapular notch) is 3.3 cm. The mean number of myelinated axons of the spinal accessory and suprascapular nerve was 1,603 and 6,004 axons, respectively. The results of this study supported the brachial plexus reconstructive surgeons, who carry out accessory-suprascapular nerve transfer by using the posterior approach technique. This technique is an alternative for patients who have severe crushed injury of the shoulder or suspected double crush lesion of the suprascapular nerve.

Accessory Nerve↗

PubMed1985

Noninvasive recording of His bundle electrograms using vectorial leads system.

His bundle electrograms were recorded in 8 rats by a signal averaging technique using the Takayasu vectorial lead system. Animals were anesthetized and placed in the prone position. The polarity of three orthogonal leads were: the X axis, from right to left; the Y axis, from top to bottom; the Z axis, from back to front. Potentials from the X, Y, and Z leads were amplified by 20,000 with high-pass 12 dB/octave filtering at 80 Hz, and signal averaging of 2000 beats was performed at a sampling interval of 100 microseconds. The His bundle potential could be clearly defined in all 8 rats. The mean amplitude of the His potential was larger in the X-axis (23.6 +/- 9.2 mu V) or the Y-axis (28.4 +/- 14.5 mu V) than the Z-axis lead (11.5 +/- 8.6 mu V). Directions of the His potential vectors were to the left in 5 of 8 rats (62.5%), to the caudal in 4 of 6 rats (66.7%), and to the dorsal site in 6 of 8 rats (75.0%). This vectorial lead system, devised in accordance with McFee and Johnston's theory on lead field, was useful for recording His bundle electrograms.

Animals↗

PubMed1996

Ultrasonographic determination of ascitic volume.

The purpose of this study was to develop a method by which ascitic volume can be calculated using transcorporeal ultrasonography, and to determine the accuracy of this method by comparison with the volume of distribution of a radiolabeled tracer (indicator dilution technique [IDT]). Subjects with ascites confirmed by ultrasonography were recruited from the San Francisco General Hospital Gastroenterology and Liver Clinics. With subjects in the prone position on their hands and knees, ultrasonographic measurements were obtained along the ventral surface of the abdomen. The greatest vertical depth of ascitic fluid was recorded, and the abdominal circumference was measured from this point. The ascitic fluid volume was modeled as a segment of a sphere. IDT was performed as the reference method by injecting 99mTc-labeled macroalbumin into the peritoneal cavity and determining the volume of distribution of the indicator. Nine patients were evaluated. The median volume of ascites measured by the IDT was 11.2 L (range, 1.5-17.0 L). The median volume calculated by the ultrasonographic method was 10.3 L (range, 1.2-18.0 L). The correlation coefficient between the ultrasonographic and IDT was 0.96 (P < .001). Our technique accurately determines the volume of ascites using simple ultrasonographic measurements.

Ascites↗

PubMed1995

Validation of accuracy and precision of dual energy X-ray absorptiometry for infants.

There is limited information on the validity of bone mineral content measurement by dual energy X-ray absorptiometry (DXA BMC) for use in subjects with low body mass. We evaluated the accuracy and precision of DXA in piglets (body weight 886-5526 g, median 2096 g). Stepwise multiple regression analyses showed that ash weight is the major determinant of DXA BMC (adjusted r2 = 0.98, RMS residual = 3.61 g). The intercept was not significantly different from zero. DXA BMC measurements of other piglets under various clinical situations showed no significant effect from the use of cotton blanket, diaper, or positioning (prone, supine, lateral). In vivo replication of DXA BMC measurements of infants at a postnatal age of from 1-350 days showed a slope of 0.99 and high correlation coefficient (r2 = 0.99, RMS residual = 3.59 g). The intercept was not significantly different from zero, and the average coefficient of variation of duplicate DXA BMC in infants was 2.8%. We conclude that DXA BMC reliably but proportionately underestimates ash weight and is a highly precise method for measuring bone mineral status in young pediatric subjects.

Absorptiometry, Photon↗

PubMed1978

The liquid-filled stomach--an ultrasonic window to the upper abdomen.

An ultrasonic window to the upper abdomen is creasted by (a) filling the fasting stomach with methylcellulose suspension, (b) administering glucagon intravenously, and (c) examining the patient prone. Glucagon relaxes the gastric musculature and the prone position allows the stomach gas to rise to the fundus. This enables assessment of the relationships of the stomach to adjacent structures and permits display of structures forming the stomach bed. The equipment used was a commercially available water-delay system with wide-aperture focused transducers. The system gives good resolution and allows the gastric musculature to be distinguished from the mucosa and its overlying mucus.

Abdomen↗

PubMedDate not supplied

The effect of fluid intake on renal length measurement in adults.

PURPOSE: To evaluate whether oral fluid intake has an effect on renal length as determined with sonography. METHODS: We studied 524 adult patients who were referred to our ultrasound unit with complaints other than urinary tract symptoms. The mean age of the patients was 44 years (range 17-76). All of the measurements were performed with the patient in the prone position. The renal length of each kidney was measured by the same observer before and after oral fluid intake. Student's t-test was applied for the statistical significance of renal length measurements before and after hydration. Analysis of variance was performed for the effect of age and sex on the renal length measurements. RESULTS: The mean renal length on the right side was 106.2 +/- 5.5 mm and 107.5 +/- 5.7 mm on the left side before hydration. There was no statistically significant difference between right and left side renal length measurements. After hydration, the mean renal length was 113.5 +/- 6.1 mm on the right side and 114.6 +/- 6.6 mm on the left side. The mean increase in renal length after hydration was statistically significant (P < 0.001) and was 6.8% on the right side and 6.6% on the left side. Sex and age did not affect the measurements significantly. CONCLUSIONS: Oral fluid intake causes a statistically significant increase in renal length. This observation should be taken into consideration when renal length measurements are clinicallly important.

Administration, Oral↗

PubMed2002

MR-guided percutaneous core biopsy of small breast lesions: first experience with a vertically open 0.5T scanner.

PURPOSE: The growing use of highly sensitive but only moderate specific breast MRI requires the development of both minimal-invasive as well as precise biopsy systems. The aim of the study was to prove the accuracy and feasibility of a biopsy procedure carried out in prone position in a vertically opened MR imager. MATERIALS AND METHODS: The biopsies were carried out in 21 women with lesions visible on MRI alone using an open breast coil with an integrated biopsy device. A 14 G coaxial needle was placed under near real-time MRI-guidance. After the tip of this needle was verified in contact with the lesion, we used a non MR-compatible, but MR-safe biopsy gun with a 16 G canula to take four to eight cores. RESULTS: We found eight malignant and 12 benign lesions. In one patient the procedure was not successful. In case of malignancy, the operation confirmed the diagnosis in all cases. The 12/21 patients with benign lesions have been followed without evidence of lesions growth over eight to 28 months. CONCLUSION: The described procedure allows MRI-guided minimal invasive core biopsy of small breast lesions (five to 17 mm) with a high degree of accuracy.

Adult↗

PubMed2006

Impaired abdominal muscle contractility after high-intensity exhaustive exercise assessed by magnetic stimulation.

High-intensity exercise can induce diaphragm fatigue which can, in turn, limit exercise performance. We investigated whether expiratory muscles fatigue similarly during exhaustive exercise. Eleven healthy male volunteers cycled to exhaustion at 85% maximal power. Before, immediately after exercise, and after 30 and 60 min of recovery, the nerve roots supplying the abdominal muscles were stimulated magnetically at the T10 level in the prone position after full potentiation. Twitch gastric pressure (Pga,tw) was simultaneously recorded. After cycling, Pga,tw was significantly reduced compared to before exercise (40.2 +/- 6.6 vs. 45.3 +/- 7.5 cmH2O; P < 0.001), whereas after 30 and 60 min of recovery differences were no longer significant. The reduction in Pga,tw directly after exercise correlated neither with the fitness level nor with abdominal muscle work, respiratory sensations, or blood lactate concentration during exercise. These results indicate that the ventilatory requirements during intensive exercise can impair abdominal muscle contractility similar to diaphragmatic contractility. Thus, abdominal muscle fatigue may also contribute to exercise limitation, especially when expiratory resistance is increased as in patients with chronic obstructive pulmonary disease.

Abdominal Muscles↗

PubMed1988

Recruitment of intercostal muscle activity during hypercapnia in kittens.

Little is known about the respiratory behavior of the intercostal muscles within a neonatal and developmental context. We, therefore, examined intercostal muscle electromyographic (EMG) activity in kittens (1 month old, n = 8; 2 months old, n = 7) during eupnea and heightened respiratory drive induced by hypercapnia. The kittens were anesthetized with halothane (1.25-1.50%) at comparable minimum alveolar concentrations and were studied in the prone position during an acute exposure to hyperoxic hypercapnia (8% CO2, 50% O2, balance N2) for 7 min. We recorded EMG activities from bipolar electrodes embedded in the intercostal (dorsolateral thorax, 4th-5th interspace) (EMGic) and costal diaphragm (EMGdi) muscles. Peak moving time average EMG measurements served as our index of muscle activity. Phasic inspiratory EMGic activity was present during eupnea in all animals. EMGic and EMGdi increased significantly above baseline levels during hypercapnic exposure with the increase in EMGic (133 +/- 27%) being comparable to that observed in EMGdi (141 +/- 28%) (P = 0.40). No differences in EMGic (P = 0.64) or EMGdi (P = 0.88) recruitment were noted between age groups. These data indicate that hypercapnia augments intercostal muscle EMG activity in kittens and suggest that such activity parallels costal diaphragmatic EMG recruitment. We conclude that EMGic recruitment is a frequent respiratory phenomenon associated with hypercapnically stimulated diaphragmatic muscle activity in kittens. We speculate that intercostal muscle recruitment stabilizes the compliant chest wall of the newborn and helps sustain inspiratory force generation during stimulated breathing.

Animals↗

PubMed2002

Intra-tester reproducibility of pressure biofeedback in measurement of transversus abdominis function.

BACKGROUND AND PURPOSE: Strength, co-ordination and timing of transversus abdominis muscle contraction may be important in stabilizing the low back, and contraction of this particular abdominal muscle may be one factor capable of preventing and reducing low back pain in sport and in activities of daily living. The function and strength of the transversus abdominis muscle is difficult to measure. The pressure biofeedback unit (PBU) is a device designed to teach and measure transversus abdominis muscle function. The purpose of the present study was to evaluate intra-tester reproducibility of the PBU. METHOD: The study used a test-retest design. Fifteen healthy subjects (mean age 22.2 years, range 19-28 years) with no history of low back pain participated in the study. After two sessions of practising transversus abdominis muscle contraction, its function was measured in prone position with the PBU device placed over the transversus abdominis muscle. Subjects were instructed to draw in the abdominal wall (for example, lifting it away from the device) after a standardized procedure. Two tests were conducted on two different days, with a seven-day interval in between. RESULTS: Coefficient of variance (CV) was 21.0% and the standard deviation (SD) of delta was 1.59. CONCLUSION: The use of the PBU should be improved for scientific purposes. However, the device may have a role in providing biofeedback to assist in the instruction of correct transversus abdominis muscle contraction.

Abdominal Muscles↗

PubMed1987

[Local vital reaction following injuries of the neck].

Sixty-one cases of hemorrhaging of the laryngeal muscles are reported among 86 deaths due to compression of the neck (strangulation by ligature and/or with the hands, blunt force); the results of histological examinations of these cases (laryngeal muscles; hemorrhaging of the cervical muscles and tongue in numerous cases) are discussed, as well as 55 comparative cases (natural, violent death) with regard to vital changes from the hemorrhaging aspect. Although sanguineous infiltration of the laryngeal muscles can occur after death (prone position), it differs macroscopically and in some cases also microscopically from the vital type: extensive bleeding on the inside of the larynx or dorsally above the larynx (PCA muscle), possible combined with histologically detectable ruptures of muscle cells, must be viewed as the result of laryngeal compression suffered when still alive. No clear-cut evidence of emigration or infiltration of leukocytes was found in the cases of immediately fatal strangulation, but there was occasional evidence (6 cases) when protracted maltreatment had taken place. Although there was no clear correlation with age, sex, type of impact, cause of death, or amount of laryngeal bleeding, in 25 of the 61 cases leukocytes were sometimes detectable in enormous amounts within the extravasation; the ratio exceeded that to be expected from the composition of the blood. Findings of this nature have also been made in cases of vital bleeding in other violent or natural deaths; they are not a cell reaction in the proper sense but, when distinctly marked, a vital event--at least in the laryngeal region. These findings can support the assumption of the amount of hemorrhaging in deaths in which the survival time was inadequate for a leukocyte emigration. In 20 cases such findings were combined with localized leucocytosis, which is regarded as an early vital reaction.

Asphyxia↗

PubMed1994

Exercise-induced splitting of the inorganic phosphate peak: investigation by time-resolved 31P-nuclear magnetic resonance spectroscopy.

To investigate the splitting of the inorganic phosphate (Pi) peak during exercise and recovery, a time-resolved 31phosphorus nuclear magnetic resonance spectroscopy (31P-MRS) technique was used. Seven healthy young sedentary male subjects performed knee flexion exercise in the prone position inside a 2.1-T magnet, with the surface coil for 31P-MRS being placed on the biceps femoris muscle. After a 1-min warm-up without loading, the exercise intensity was increased by 0.41 W at 15-s intervals until exhaustion, followed by a 5-min recovery period. The 31P-MRS were recorded every 5 s during the rest-exercise-recovery sequence. Computer-aided contour analysis and pixel imaging of the Pi and phosphocreatine peaks were performed. Five of the seven subjects showed two distinct Pi peaks during exercise, suggesting two different pH distributions in exercising muscle (high pH and low pH region). In these five subjects, the high-pH increased rapidly just after the onset of exercise, while the low-pH peak increased gradually approximately 60 s after the onset of exercise. During recovery, the disappearance of the high-pH peak was more rapid than that of the low-pH peak. These findings suggest that our method 31P-MRS provides a simple approach for studying the kinetics of the Pi peak and intramuscular pH during exercise and recovery.

Adult↗

PubMed1980

The oblique approach to the spinal canal for myelography.

The patient is placed in a slightly oblique, prone position, and the spinal needle is directed downward through the interlaminar foramen into the spinal canal under direct fluoroscopic control. This method is superior to the conventional midline interspinous approach as regards ease of positioning the needle tip, removal of contrast, and comfort of the patient.

Humans↗