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PubMed1991

Manganese exposure in steel smelters a health hazard to the nervous system.

In a study of the effects of low-level exposure to manganese (0.19-1.39 mg/m3 for 1-45 years) 30 men (aged 20-64 years) from two steel smelting works and 60 unexposed referents (aged 22-65 years) were examined with the use of a general health inquiry, electroencephalography, event-related auditory evoked potentials, brain-stem auditory evoked potentials, diadochokinesometry, simple and complex reaction time, finger tapping, digit span, mental arithmetic, vocabulary, a coding task, manual dexterity, symptoms, and mood scales, the diagnostic interview scheme, a dynamic rating scale for neurasthenic syndrome, and a comprehensive psychopathological rating scale. No group differences were found in the electroencephalography or the psychiatric examinations. However, there were increased frequencies of some symptoms, the diadochokinesis was slower, the P-300 latency and reaction time were increased, and finger-tapping and digit-span performance were impaired in the exposed group. These effects were interpreted as early (subclinical) signs of disturbances of the same type as parkinsonism.

Adult↗

PubMed1990

Moderate cold exposure in the Faroe fishing industry.

Differences in female workers' finger temperatures, manual dexterity, ratings on thermal comfort, and local cooling exposure were studied in three factories in the Faroe Island fishing industry. Environmental temperatures in the factories varied from 5 to 19 degrees C with vertical gradients of 7 degrees C/m, and the mean temperatures of the flushing water varied from 2 to 15 degrees C. Finger temperature varied from 12 to 24 degrees C when measured 2 min after work was stopped, and about one-third of the women experienced thermal discomfort in the fingers during work. The fish temperature increased, on the average, less than 1 degrees C during passage through the production room, notwithstanding the thermal differences among the factories. These findings should be used in attempts to reduce the cold exposure of the workers; but also improved control should be recommended for both environmental and water temperatures in the factories.

Adult↗

PubMed1987

Peripheral neurological assessment methods for workers exposed to hand-arm vibration. An appraisal.

Peripheral neurological assessment methods for workers exposed to hand-arm vibration have included vibration perception and esthesiometric threshold testing, electroneurography, handgrip force, and manipulative dexterity. For epidemiologic investigations with the purpose of detecting vibration effects anticipated as moderate to large in size in occupational populations, these methods have demonstrated their usefulness. Concerning their value in the assessment of individual workers, there is little quantitative information, as there have been no studies which have conducted rigorous "gold standard" neurological evaluation with which the results of independently performed diagnostic tests can be compared. However, results from four papers which used depth-sense (or ridge) and two-point discrimination esthesiometry were available for an analysis of the sensitivity of these tests in the detection of Taylor-Pelmear stages 2 and 3 of the hand-arm vibration syndrome. With specificity set at 90%, sensitivity ranged from 45 to 96% for depth-sense esthesiometry and from 19 to 75% for two-point discrimination. In addition, likelihood ratios were determined, as a measure of the capacity of the tests to alter pretest probability of disease. Because of their direct clinical interpretation and application, the use of likelihood ratios is suggested for future research on diagnostic methods used for vibration-exposed workers.

Arm↗

PubMed1987

Sensorineural stages of the hand-arm vibration syndrome.

Recent work has shown that the vascular signs and neurological symptoms commonly associated with exposure of the hand to vibration may develop independently. A classification for the neurological component of the hand-arm vibration syndrome has been developed for those symptoms dominated by sensory afferent involvement, based on the results of objective tests on 634 hands. The first symptomatic stage (1SN) consists essentially of episodic finger numbness with or without tingling, the second involves, in addition, reduced sensory perception (2SN), while the most severe stage (3SN) focuses on reduced tactile discrimination and/or manipulative dexterity. Consistent implementation of this classification by means of objective tests requires one, or more, precise, quantitative measure of peripheral somatosensory dysfunction, in addition to the traditional neurological tests (fine touch, pain, and temperature). Measurements of tactile function by means of esthesiometry or vibrotactile perception appear suited to this purpose. A procedure for staging individual hands may then be based on combining numerical scores assigned to the results of the traditional neurological tests and, additionally, esthesiometer and/or vibrotactile perception thresholds.

Hand↗

PubMed1985

Response of solvent-exposed printers and unexposed controls to six-hour toluene exposure.

The acute effects of toluene were studied in 43 male printers and 43 control subjects matched according to sex, age, educational level, and smoking habits. The mean age of the subjects was 36 (range 29-50) years. The printers had been exposed to solvents for 9 to 25 years during employment at flexo and rotogravure printing plants, while the controls had no history of solvent exposure. Each subject was exposed once in a climate chamber to either 100 ppm of toluene or clean air for 6.5 h preceded by a 1-h acclimatization period. The effects of toluene were measured from subjective votes with linear analogue rating scales on 16 items, and on the performance of 10 different tests measuring psychomotor skills, perceptual skills, and vigilance. Exposure to 100 ppm of toluene compared with exposure to clean air caused discomfort with complaints of low air quality, strong odor, fatigue, sleepiness, a feeling of intoxication, and irritation of the eyes, nose and throat. Furthermore, the subjects exposed to toluene showed decreased manual dexterity, decreased color discrimination, and decreased accuracy in visual perception. There was no significant difference in the effects of toluene on printers compared to those of toluene on controls, but tendencies toward a greater sensitivity were seen for the printers in two tests.

Adult↗

PubMed1980

Exposure to organic solvents. A cross-sectional epidemiologic investigation on occupationally exposed care and industrial spray painters with special reference to the nervous system.

In the present epidemiologic study 80 car or industrial spray painters with long-term low level exposure to organic solvents were examined and compared with two matched reference groups of nonexposed industrial workers (80 persons in each group). The aim of the study was to investigate the possible effects of the solvent exposure on health. The investigation included psychiatric interviews, psychometric tests, neurological, neurophysiological and ophthalmologic examinations, and computed tomography of the brain. The painters' previous and present exposure was carefully assessed by interviews and on-the-job measurements both at modern places of work and in a reconstructed model of a workshop from 1955. On the basis of the psychiatric interviews the psychiatric symptoms were rated according to a specially designed scale of 46 different items, graded in seven steps of increasing severity. The psychological performance was assessed by a battery of 18 tests. The neurological and neurophysiological examinations comprised visual evoked responses (VER), electroencephalography (EEG), and computerized EEG analysis (SPA) for the central nervous system and electroneurography (ENeG), the estimation of vibration sense thresholds, and a quantified neurological examination for the peripheral nervous system. The ophthamologic examination concentrated on the condition of the lens. Statistically significant differences between the exposed individuals and referents were found for psychiatric items indicative of a slight cerebral lesion (ie, a neurasthenic syndrome). The psychometric tests revealed statistically significant differences between the groups with respect to reaction time, manual dexterity, perceptual speed, and short-term memory. No differences were found with respect to performance on verbal, spatial, and reasoning tests. Significant differences between the groups were also found for the majority of the neurophysiological parameters measuring peripheral nerve functions, the most pronounced occurring in the long, sensory fibers. Moreover EEG and VER showed some differences between the groups, as did the results of the ophthalmologic examination and the computed tomography. Finally, it should be emphasized that the exposure levels, as measured at modern places of work and in the reconstructed workshop from 1955, were found to be considerably lower than the valid threshold limit values in Sweden.

Brain↗

PubMed1975

Exposure to white spirit. II. Psychological functions.

The effect of the solvent white spirit on psychological functions, such as perceptual speed, reaction time, short-term memory, numerical ability, and manual dexterity, was studied in two separate series of experiments employing 14 and 8 healthy male students, respectively. Each subject was tested repeatedly in each series in exposure to 625, 1,250, 1,875 and 2,500 mg/m3 of white spirit in inspiratory air and under control conditions with exposure to pure air. In another experimental series each subject was tested during exposure to 4,000 mg/m3 of white spirit and under control conditions. Alveolar air samples were taken every fifth minute. No effect on examined functions was observed in the first experimental series. However, a prolonged reaction time and a probably impaired short-term memory was observed in subjects exposed to 4,000 mg/m3. At this concentration of white spirit in inspiratory air an alveolar air concentration was obtaine which corresponded to values obtained in exposure to 2,500 mg/m3 during light exercise.

Adolescent↗

PubMed1992

Epidermal inclusion cysts following minimal incision surgery.

One of the most frequent causes of epidermal inclusion cysts is trauma involving the epidermis with subsequent implantation of epidermal cells into the dermis or subcutis. Minimal incision surgery is capable of achieving this because it is performed by using small incisions and rapidly rotating power instruments. The technique requires that the surgeon master a high degree of dexterity and knowledge of the anatomy without the aid of direct visualization. Van Enoo and Cane suggest the use of fresh, sharp skin blades to protect against invagination of skin edges which could lead to epidermal inclusion cysts. They also state that an improper position or an incision that is too small will cause tension, which can lead to heat buildup with subsequent sloughing and dehiscence. It may also drive some epidermal cells underneath the dermis and foster an epidermal cyst. Other surgeons using small incisions suggest thorough and copious irrigation to flush away debris and to avoid potential foreign body reactions. The periosteum should be reflected away from the point where the drill bit exits the bone to prevent bone chips from being forced subperiosteally and potentially causing a foreign body reaction. By virtue of the technique, minimal incision surgery lends itself to a greater risk of causing epidermal inclusion cysts. Surgeons who use these techniques must be aware of this potential complication.

Adult↗

PubMedDate not supplied

Self-administration of medicines.

In the fourth of this six-part series on nurse prescribing, Susan Davis assesses the advantages and disadvantages of patient self-administration of medicines in hospital. The former, she asserts, considerably outweigh the latter; a controlled self-administration programme can hasten a patient's progress towards full independence and ease the often difficult transition period following discharge. The problems experienced by specific groups of patients such as those with visual or manual dexterity deficits are considered and guidelines for practice offered.

Drug Therapy↗

PubMedDate not supplied

A telescopic crown concept for the restoration of the partially edentulous arch: the Marburg double crown system.

PURPOSE: This article describes the concept of the Marburg double crown system (MDC system) in the treatment of partially edentulous patients. Long-term success is assessed by a review of patient records. MATERIALS AND METHODS: Double crowns with clearance fit are used to retain tooth-, mucosa-, and implant-supported removable partial dentures (RPD). To achieve retention, an additional attachment, the TC-SNAP system, is used. All metal components are fabricated in a single cobalt-chromium-molybdenum alloy; the framework (including outer crowns) is cast in one piece. Because of the framework's rigidity, the RPD can be constructed without major and minor connectors. The denture base adjacent to the abutments is fabricated using a perioprotective design that is similar to fixed partial dentures. One hundred eleven dentures, of which 49 (44%) were fabricated for patients with intraoral defects, were evaluated by reviewing patient records. RESULTS: The mean age of the patients at the time of insertion was 57.5 years (+/- 12.3). The mean number of double crowns per denture was 3.5 +/- 2.1 (range, 1 to 9). The probability that a patient will have lost all abutment teeth 10 years after insertion of the denture is 4%. The probability that a patient will have kept all teeth that abut the denture 5 years after insertion is 87%; 10 years after insertion the probability is 80%. CONCLUSION: The Marburg double crown system is a versatile and successful means of achieving the long-term restoration of the partially edentulous jaw. Insertion and removal of the denture and routine oral hygiene are easy to perform, even for patients with limited manual dexterity. As a full-arch reconstruction, the MDC system enables easy adjustment, modification, and relining with low follow-up costs.

Adolescent↗

PubMed1998

Adaptive Morse code recognition using variable degree variable step size LMS for persons with disabilities.

In this paper, we applied variable degree, variable step size LMS algorithm to adaptive Morse code recognition for persons with impaired hand coordination and dexterity. The automatic recognition of Morse code by the disabled is difficult because they cannot maintain a stable typing rate. Therefore, a suitable adaptive automatic recognition method is needed. In this adaptive Morse code recognition method, three processes are involved: character separation, character recognition, and adaptive processing. Statistical analyses demonstrated that the proposed method resulted in a better recognition rate compared to alternative methods from the literature.

Adolescent↗

PubMed1997

Basic technology of simulation system for laparoscopic surgery in virtual environment with force display.

A basic simulation system for laparoscopic surgery was constructed. The system consists of force display in a virtual environment construction system. Recently, laparoscopic surgery has become popular around the world. However, this operation strategy requires very high dexterity, so that only some medical doctors can use it. Doctors can see the human organs in a three-dimensional environment in the case of ordinary operations. On the other hand, in the case of laparoscopic surgery, doctors can only see a narrow space in a two-dimensional environment on a CRT monitor and tactile information is decreased during operation procedures. We therefore developed a basic technology of surgical simulator for laparoscopic surgery. The focus of our research is the presentation of resistance from virtual organs.

Computer Simulation↗

PubMed1997

Virtual reality in endonasal surgery.

Virtual environments provide a new dimension of graphic simulation. The interaction between the human and the computer is now intuitive for the user. The use of virtual reality (VR) gives the user the feeling of participating in a (computer generated) scenario very much like reality. This feeling is an essential requirement for simulation of surgical interventions using digital data. Especially in the fields of sinus and skull-base surgery, computer assisted simulation could present a valuable and effective alternative method for honing endoscopic skills. Traditionally, surgeons gain experience through anatomic preparation and education by more experienced colleagues. Landmarks like skull base, carotid arteria or optical nerve have to be identified intraoperatively in order to orientate in this critical region. Highly sensitive structures can be damaged most easily. The quality of surgical skills can be characterized as the sum of knowledge, individual experience and manual dexterity. It is conceivable that a surgeon's level of training and experience could be significantly increased by use of VR. With this in mind, a VR-based simulator for procedures in sinus surgery will improve most of these parts. To provide the virtual environment, a realistic representation of the region of interest with all relevant anatomical structures is required. Based on data from tomographic imaging studies, a three-dimensional representation of the paranasal sinuses is semiautomatically reconstructed. Textures derived from endoscopic images are superimposed on the virtual anatomic structures and provide better realism. Two main components of the VR interface can be distinguished: the 3-D interaction to guide the surgical instruments and the 2-D graphical user interface for visual feedback and control of the session. Moreover, the 3-D interaction has to be realized by means of Virtual Reality techniques providing a simulation of an endoscope and an intuitive handling of other surgical instruments.

Computer Simulation↗

PubMed1998

Review of orthopaedic manipulator arms.

Trajectory planning and implementation forms a substantial part of current and future orthopaedic practice. This type of surgery is governed by a basic orthopaedic principle [1] which involves the placement of a surgical tool at a specific site within a region, via a trajectory which is planned from X-ray based 2D images and governed by 3D anatomical constraints. The accuracy and safety of procedures utilising the basic orthopaedic principle depends on the surgeon's judgement, experience, ability to integrate images, utilisation of intra-operative X-ray, knowledge of anatomical-biomechanical constraints and eye hand dexterity. The surgeon must remain as the responsible medical expert in charge of the overall system. At the same time the surgeon covets the accuracy offered by Computer Assisted Surgery including a manipulator. A summary of current inadequacies of manipulators indicates that the main drivers for future work are that accuracy is critical in close contact with the environment, safety concerns dictate manipulator geometry and technological limitations are many. In any effort to develop an optimal manipulator to guide surgical instruments and tools it is an obvious first step to review and categorise current manipulators. The aim of this paper is to review all aspects of manipulator design against the five main criteria of ergonomics; safety; accuracy; sterility and measurable benefits such as reduced operative time, reduced surgical trauma and improved clinical results.

Equipment Design↗

PubMed1999

Amyotrophic lateral sclerosis: Lou Gehrig's disease.

Amyotrophic lateral sclerosis (ALS), commonly called Lou Gehrig's disease, is a progressive neuromuscular condition characterized by weakness, muscle wasting, fasciculations and increased reflexes. Approximately 30,000 Americans currently have the disease. The annual incidence rate is one to two cases per 100,000. The disease is most commonly diagnosed in middle age and affects more men than women. It usually presents with problems in dexterity or gait resulting from muscle weakness. Difficulty in speaking or swallowing is the initial symptom in the bulbar form of the disease. Over a period of months or years, patients with ALS develop severe, progressive muscular weakness and other symptoms caused by loss of function in both upper and lower motor neurons. Sphincter control, sensory function, intellectual abilities and skin integrity are preserved. Patients become completely disabled, often requiring ventilatory support and gastrostomy. Death usually occurs within five years of diagnosis and is attributed to respiratory failure or cachexia. The etiology of the disease is unknown. Current research is focused on abnormalities of neuronal cell metabolism involving glutamate and the role of potential neurotoxins and neurotrophic factors. New drugs are being developed based on these theories. Current management involves aggressive, individualized alleviation of symptoms and complications.

Amyotrophic Lateral Sclerosis↗

PubMedDate not supplied

Undersea psychophysiologic reactions of human organism.

The determinations carried out on 12 divers during the immersion into the sea to a depth between 7 and 29 m, as well as on controls in immersions at 4 m revealed a significant prolongation of the visual reaction time and a marked tachycardia. The changes were more marked at great depths and if exercise was superimposed over hyperbaric stress. A rise in the urinary excretion of 17-HOCS and vanillylmandelic acid and an impairment of the manual dexterity were also found during immersions. The results stress the importance of divers' monitoring during their underwater activity and the necessity of improving their physical training.

17-Hydroxycorticosteroids↗

PubMed1999

Cognitive effects of Lyme disease in children: a 4 year followup study.

OBJECTIVE: To measure cognitive effects of Lyme disease (LD) in a pediatric population 4 years after disease onset. METHODS: Prospective, blinded, multivariable controlled study of cognitive skills in children who have been treated for LD. The setting was a children's hospital in an area endemic for LD. Twenty-five children with strictly defined LD were compared with 17 control children (6 disease-control and 11 sibling-control). OUTCOME MEASURES: An extensive set of neuropsychological measures was administered. These included assessment of the cognitive areas of IQ, information processing speed, fine-motor dexterity, novel problem solving and executive functioning, short term and intermediate memory, and acquisition of new learning. Parents' ratings were also obtained concerning disease impact upon everyday activities. RESULTS: Seventeen of the 18 neuropsychological test measures showed the LD and control groups similar at time of 4 year followup. There were no differences between the groups regarding parents' impressions of disease impact. CONCLUSION: In contrast to studies of adults with LD, the results of longterm followup of the pediatric population continue to strongly support the finding that children treated appropriately for LD have an excellent prognosis for normal cognitive functioning.

Analysis of Variance↗

PubMedDate not supplied

The current role of laparoscopic surgery in the treatment of benign gastroduodenal diseases.

BACKGROUND/AIMS: The impressive breakthrough in laparoscopic surgery has urged several authors to adopt such an approach in the treatment of both benign and malignant gastric diseases, even though laparoscopic gastric resection has not yet met with widespread enthusiasm. The current work is aimed at illustrating the feasibility and assessing the efficacy of laparoscopic (LGRs) and laparoscopic-assisted (LAGRs) gastric resections in the treatment of non-malignant gastric conditions. METHODOLOGY: As of April 1997, we performed LGRs or LAGRs on a total of 24 patients (M:F = 15:9; mean age: 43 years; range: 19-65 years), among whom 8 presented with chronic gastric ulcer, 4 had benign pyloric stenosis, 8 were affected with recurrent duodenal ulcers no longer amenable to treatment, and 4 with persistent symptomatic biliary reflux. Pre-operatively, all patients underwent blood tests, upper GI endoscopy coupled with biopsy, and barium swallow. Post-operatively, all patients were administered saline solution and water dextrane for the first 5 days; antibiotics (cefuroxim 4 g i.v. daily) and analgesics (paracetamol 6 g i.v. daily) for the first 48 hours. A hydrosoluble swallow was scheduled for the 5th post-operative day. RESULTS: The surgical procedure consisted of a Billroth II distal gastrectomy in 13 cases and total duodenal diversion with Roux-en-Y gastrojejunostomy in 11. Among such patients, 18 underwent a totally laparoscopic procedure, whereas 6 had laparoscopic-assisted gastrectomy, with the use of a Dexterity device in 1 case. The mean duration of the procedure was 150 min (range: 120-200), and blood losses were not remarkable. No intra-operative complication ever occurred. Post-operatively, we observed one case of retrogastric collection and incisional hernia in 1 patient who underwent a laparoscopic-assisted procedure. The abscess was drained percutaneously and hernia conventionally repaired 5 months post-gastrectomy. Post-operative hospital stay was 7 days on the average (range: 5-25). One patient was lost to follow-up. In the remaining cases, no major functional sequelae were observed at a mean follow-up of 19 months (range: 2-41), apart from 2 cases of transient diarrhea. CONCLUSIONS: Laparoscopic surgery appears to be an invaluable tool for the treatment of gastric diseases and LGRs are a valid option in experienced hands and in selected centers, allowing patients to benefit from a less cumbersome hospital stay and fewer functional sequelae. The economic impact of such a practice, however, needs better clarification.

Adult↗