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At least 1,747 records · Page 97Linked to original sources

PubMed2003

Thoracoscopic lobectomy using robotic technology.

BACKGROUND: While robotic technology is gaining popularity in cardiac surgery, it also is being used to facilitate thoracoscopic procedures, such as insertion of phrenic pacemakers and resection of mediastinal masses. This report describes the use of robotic technology in performing thoracoscopic lobectomy. METHODS: One patient underwent a left lower lobectomy with the da Vinci robotic surgical system (Intuitive Surgical, Mountain View, CA, USA). With 3 1-cm port incisions and a 4-cm minithoracotomy in the left chest, visualization of the pertinent anatomy was excellent. Standard lymph node dissection was performed. The specimen was removed through the 4-cm minithoracotomy incision. RESULTS: Pathologic examination revealed mucinous adenocarcinoma. The margins of the specimen were negative, and there was no vascular or bronchial invasion. The patient's postoperative course was uneventful, and he was discharged to home on postoperative day 5. CONCLUSION: Robotic technology enhances visualization and instrument dexterity during thoracoscopic intrathoracic procedures. This technology can be used to facilitate development of minimally invasive thoracic approaches.

Adenocarcinoma, Mucinous↗

PubMed2003

Cortical remapping in amputees and dysmelic patients: a functional MRI study.

OBJECTIVES: To investigate motor cortex function in upper and lower limb amputees and dysmelic patients using fMRI. MATERIAL AND METHODS: Five amputees and two dysmelic patients were examined. Motor and imagery tasks were defined according to each patient limb deficiency. Cortical activation patterns were analysed for each patient and compared between groups, integrating patients clinical data. RESULTS: There is a consistent pattern of cortical reorganization in all amputees: predominance of activation in the ipsilateral motor cortex and extension to premotor and sensory areas of the contralateral cortex. On the contrary, cortical maps of dysmelic patients were similar to those of healthy volunteers, predominantly with activation of contralateral primary motor cortex areas. CONCLUSIONS: fMRI discloses specific patterns of cortical reorganization on amputees and dysmelic patients, suggesting influence by prosthesis adaptation or stump use with dexterity. These findings could be further applied in influencing neurorehabilitation and development of prosthetic devices.

Aged↗

PubMed1992

Mechanical aids in the prevention of dental diseases in the elderly.

Dental practitioners, who are often unaccustomed to treating geriatric patients, should be taught to accept that old people do not necessarily respond to optimal dental treatment as younger patients do. There is an evident need for continuing education in this respect. The many plaque removing mechanical aids available, such as toothbrushes, toothpicks, and dental flosses, have not been studied in the elderly. Since manual dexterity decreases with increasing age, the use of electric tooth cleaning devices and other aids for improving oral hygiene should be encouraged among the elderly. This is particularly so in patients with physical or mental handicaps. Future studies should investigate the benefits of preventive dental procedures in the elderly and to survey their knowledge, attitudes and behaviour related to oral health. Maintaining proper oral hygiene among the institutionalised elderly has been neglected in many cases. Nurses and other staff in institutions need more information about the role of optimal oral health in the patient's general health and well-being. Staff also need to know more specifically how to help the patients in their daily oral hygiene and how to take care of the patient's dentures. The recently discovered association of poor oral health with life-threatening vascular diseases and other medical catastrophes further emphasizes the importance of maintaining good oral hygiene. Diseases of the mouth and the teeth must be diagnosed and treated in the elderly, who are just as entitled to receive individually designed preventive dental care as are the younger generations.

Aged↗

PubMed2002

[Shelter in Konczyce Male as an example of a rehabilitation centre].

Polish society towards the end of the 20th century has passed the point of demographic senility. 16% of the population is older than 60 and 14% are registered disabled. A good proportion of the above groups is unable to function normally in their everyday lives and to some extent have to rely on shelters. Based on the existing demographic data a prediction can be made of continuous growth of the population of the disabled and elderly which necessitates further development of social care and rehabilitation institutions. In the paper shelters for mentally retarded are discussed. There are two objectives: to demonstrate the methods of work of such shelter, to find out if these methods contribute to the better functioning of the resident women. The basic technique for gathering data employed was the analysis of shelter residents' documents while additional technique was observation of the residents. Based on collected data we concluded that the residents participating in occupational therapy appeared to have better developed social skills, manual dexterity and physical fitness and are therefore more independent.

Activities of Daily Living↗

PubMed2004

Examining the effect of cerebral perfusion abnormality magnitude on cognitive performance in recently abstinent chronic cocaine abusers.

BACKGROUND AND PURPOSE: Cerebral perfusion abnormalities and neuropsychological impairment are common sequelae of chronic cocaine abuse. While perfusion abnormalities have been shown to relate to cognitive deficits in this substance abuse population, the relationship between cognitive performance and the magnitude of perfusion abnormality has yet to be fully determined. METHODS: Thirty-seven abstinent cocaine abusers and 13 normal controls were administered resting 99m-Tc-HMPAO single photon emission computed tomography (SPECT) scans followed by a neuropsychological assessment battery tapping executive skills, attention, memory, and motor performance. Statistical parametric mapping (SPM99) techniques were used to analyze the SPECT data to detect significant regional perfusion abnormalities in the cocaine group relative to normal controls, and resulting abnormal SPECT counts were employed for comparison with the assessment measures to examine the relationship between cocaine-induced perfusion abnormalities and cognitive performance. RESULTS: SPECT data analysis revealed significant regional perfusion abnormalities in the cocaine abuse sample relative to controls and significant differences in neuropsychological functioning on measures of executive functioning, complex attention, memory, and manual dexterity. For chronic cocaine abusers, however, within-group comparisons of the magnitude of abnormal perfusion and neuropsychological performance were largely nonsignificant, with the exception of complex attention and motor speed. CONCLUSIONS: Perfusion abnormalities and neuropsychological impairments readily distinguished cocaine abusers from normal controls. However, when the magnitude of cocaine-induced perfusion abnormalities is examined in relation to cognitive performance, motor speed and complex attention appear to be the best behaviorial indicants of the severity of perfusion dysfunction within this substance abuse population.

Adolescent↗

PubMedDate not supplied

Training and assessment of laparoscopic skills.

Laparoscopic surgery is gaining popularity among the surgical community. While its prevalence expands, the need for reliable training and assessment tools is becoming increasingly important. Laparoscopic skills are not an innate behavior, nor can they be easily mimicked, and can only be acquired through hands-on training. A consensus exists among physicians that establishment and evaluation of technical skill in surgical training programs are inadequate and in need of improvement. A validated, reliable bench model that could train and assess could be standardized and provide numerous benefits including determination of which medical students should consider a career in surgery, valuable feedback to residents, a tracking mechanism of resident performance, a possible certification and recertification tool, and to allow for interinstitutional comparison. To this end, several potentially successful bench models testing dexterity, hand-eye coordination, and depth perception have been developed. A few models have been proven to be both valid and reliable indicators of technical skill. Although the future remains uncertain, enough groundwork has been laid to begin incorporating technical skill training and assessment into surgical training programs.

Clinical Competence↗

PubMed2004

An evaluation of anesthesia patient satisfaction instruments.

The purpose of this study was to systematically review the instruments used to obtain anesthesia-specific patient satisfaction data and to determine the degree to which each instrument controlled for measurement error bias, such as poor survey design. By using an assessment and evaluation tool developed for the present study that held proven internal reliability and construct validity, we analyzed and scored each instrument according to the presence or absence of measurement error in survey design. We found that a paucity of anesthesia-specific patient satisfaction studies exists and that patient satisfaction studies dealing with anesthesia care were erratically defined, nonstandardized, and imprecise regarding intent and method. Moreover, the simple rating forms used in most of the reviewed studies were inadequate to achieve the goal of measuring the quality of anesthesia care. One instrument, the Iowa Satisfaction With Anesthesia Scale (ISAS), developed by Dexter et al (1997), was the first found to inculcate scientifically accepted psychometric item construction algorithms, an indicator of measurement reliability. Although the ISAS holds substantial potential for future application in this realm, we recommend that it be refined further and that the search for a superlative instrument to obtain anesthesia-specific patient satisfaction continue.

Evaluation Studies as Topic↗

PubMed2004

The potential of robotic technology applied to meet requirements for tools to support microsurgery and cellular surgery.

Microsurgery and processes involving cell manipulation or cell surgery are clinical practices where the operator works at or beyond the threshold of human dexterity. Current tools available are conventional in their design, and this limits consistency and the level of reliability and achievement. Surgical robotic devices have been explored to improve precision in minimal access surgical procedures to augment control of tool points in tissues, and have enabled feedback of sensory data from which the operator is able to deduce information on the tool at the working site. In this paper, relevant technologies are described that can be harnessed to improve perception of tool point interaction with tissues at the working site and to improve tool control at the small scale required in clinical practice for microsurgery and for cell surgery.

Humans↗

PubMed2004

[A child with traumatic hemobilia].

A 4-year-old boy was hit by a car travelling at 40 km/h and was admitted 3.5 h later to the department of paediatric surgery. Because he was haemodynamically unstable and needed blood transfusion, the patient underwent an emergency operation. The liver was ruptured in the right lobe. A large haematoma was found in the serosa of the duodenum, along with a Meckel's diverticle, which was left in place. The liver rupture was covered and sealed. One month after the accident the patient was re-admitted, because of abdominal pain and gastrointestinal bleeding. The cause was thought to be the Meckel's diverticle, which was removed later. Two months after the trauma the patient was re-admitted with abdominal pain, again with haematemesis and melaena. The diagnosis of hemobilia was obtained with MRI and angiography, which revealed a ruptured pseudoaneurysm of the ramus dexter of the proper hepatic artery. The patient was successfully treated with embolization. The diagnostic delay was two months, which illustrates the importance of considering the possibility of the diagnosis hemobilia in case of gastrointestinal haemorrhage combined with biliary symptoms.

Accidents, Traffic↗

PubMed1992

Detection and quantitation of long-term culture-initiating cells in normal human peripheral blood.

The objective of this study was to utilize the Dexter long-term culture system to characterize and quantitate early hematopoietic cells in normal human blood. Peripheral blood mononuclear cells were depleted of T cells. B cells, and monocytes, yielding a population (null cells) highly enriched for hematopoietic precursors. One to 2 x 10(7) null cells containing an average of 5.4 x 10(4) granulocyte-macrophage progenitors (granulocyte-macrophage colony-forming units, CFU-GM) were cultured on irradiated allogeneic marrow stromal layers in T-25 flasks. Nonadherent progenitors were detected for an average of 6.8 +/- 0.7 (standard error of the mean) weeks and exceeded 1 x 10(4) per flask for 4 weeks. Null cells were treated with 5-fluorouracil (5-FU) to determine whether long-term growth was due to survival of CFU-GM or to maturation of more primitive precursors. When 5-FU treatment killed greater than 99% of CFU-GM, an increase in progenitors was observed after 12 days of cultivation with stroma. CFU-GM cloning efficiency of 5-FU-treated cells peaked after 24 days of incubation, whereas controls peaked after 7 days. The total number of nonadherent CFU-CM in 5-FU-treated and control cultures converged during the 5-8 weeks of incubation. The frequency of long-term culture-initiating cells (LTCIC) in peripheral blood was determined by limiting dilution analysis in micro-stromal cultures. In two donors, the frequencies of LTCIC were 6.3 and 19.6 per 1 x 10(5) null cells. The CFU-GM:LTCIC ratios were 12.6:1 and 12.8:1. We conclude that normal peripheral blood contains primitive hematopoietic precursors demonstrable as 5-FU-resistant precursors of CFU-GM or as LTCIC. The frequency of the latter is 13-fold lower than day-14 CFU-GM.

B-Lymphocytes↗

PubMed2002

Dextrous and shared interaction with medical data: stereoscopic vision is more important than hand-image collocation.

The current experiment was carried out to extend our knowledge about the relative importance of stereoscopic display and hand-image collocation for dextrous interaction. We devised a new task, the Volumetric Dexterity Test (VDT), which quite accurately duplicates the way professional personnel such as surgeons and radiologists interact with detailed medical data in a VR environment. Our results were surprising. Stereo vision was very important to both accuracy and speed of task completion, as we found previously. But the presence of hand-image collocation did not improve accuracy, despite the fact that this was a truly three-dimensional task. If this finding is borne out it has important implications for the volumetric presentation of medical data to individual practitioners and in group settings.

Attention↗

PubMed2004

Understanding the pattern of functional recovery after stroke: facts and theories.

Longitudinal studies show that almost all stroke patients experience at least some predictable degree of functional recovery in the first six months post stroke. However, the non-linear pattern as a function of time is not well understood. Several mechanisms are presumed to be involved, such as recovery of penumbral tissues, neural plasticity, resolution of diaschisis and behavioural compensation strategies. Rehabilitation is believed to modulate this logistic pattern of recovery, probably by interacting with these underlying processes. However, prediction models that are adjusted for the effects of time after stroke onset suggest that outcome is largely defined within the first weeks post stroke, although functional improvement has been found to extend beyond six months post stroke. In addition, kinematic studies show that functional improvement is more than recovery from impairments alone, suggesting that patients are able to improve in terms of gait or dexterity deficits using behavioural compensation strategies. Therefore, understanding the impact of task-dependent cortical activation patterns in non-invasive methods requires not only information derived from longitudinal studies pertaining to functional outcomes, but also a better understanding of what is kinematically learned during the acquisition of new skills.

Clinical Trials as Topic↗

PubMed2004

Impairment-oriented training (IOT)--scientific concept and evidence-based treatment strategies.

Everyday activities can be affected by many different body dysfunctions (impairments). A multi-modal analysis of electric brain activity revealed that movement-related brain activity is differentially altered in patients with different impairments, i.e. paresis, somatosensory deficits, and apraxia. Each body dysfunction has its own characteristics in terms of the resulting sensorimotor control deficits. The Impairment-oriented Training concept intends to characterise the resulting sensorimotor control deficits for each impairment. Based on such analyses two specific training techniques have been developed for stroke patients with mild and severe arm paresis: (1.) The Arm Ability training for mild arm paresis trains different sensorimotor abilities such as dexterity, speed of isolated hand and finger movements, steadiness, aiming, or tracking under visual guidance. Improvement of these motor abilities leads to improved motor performance in every day life circumstances. (2.) The Arm BASI S training for severe arm paresis intends to restore more basic motor control, i.e. the full range of active non-segmented motion of all limb segments, both postural activities and dynamic motion control, interjoint-coordination, and adequate motor control when external forces are applied. Clinical trials with representative study populations supported both techniques' clinical efficacy.

Arm↗

PubMed2001

[Measuring outcome in spasticity rehabilitation].

Spasticity is a frequent consequence of upper motor neuron lesion and is associated with a variety of symptoms such as pain, muscle stiffness and reflex patterns that interfere with activities of daily living, dexterity and gait. As therapy strategies in managing spasticity-associated problems have been evolving there is an increasing need for a practicable documentation system which describes spasticity and related symptoms on different levels in order to evaluate especially the level of functioning. In daily routine the single-case-design reflects a useful technique to evaluate the status in terms of technical, functional and individual goals for treatment. However, there is no single tool to measure the different types of changes due to treatment, therefore a variety of selecting tests, based on the functional changes expected from the selected treatment, is recommended. The sensitivity of the selected tests should match the range of expected improvements related to the specific treatment. Technical goals should be evaluated by validated spasticity rating scales. As changes in technical measures of spasticity such as muscle tone, muscle length, range of motion or repetitive voluntary movements may not correlate with clinical improvements, individual functional goals should be defined. Those functional goals should reflect the patients' and care-givers' individual perception of the actual problem. A treatment diary is a useful tool to document subjective perception of changes over time. Some practical issues are adressed below. Reliable outcome measures enable patients and doctors to select further treatment strategies and gives health care providers information on treatment expectations in return for their investments.

Activities of Daily Living↗

PubMed2002

[Nd: YAG laser therapy for persistent pupillary membranes].

PURPOSE: To evaluate the clinical effects and surgical techniques of Neodymium-yttrium, aluminum, garnet(Nd: YAG) laser therapy for persistent pupillary membranes. METHODS: Twenty-five patients (26 eyes) with persistent pupillary membranes were suffered to resection membranes. The energy of laser was adjusted according to the thickness and density of the membranes. The laser with the best cutting effects and lowest energy was selected to resection. All patients were followed up for 3 - 6 months after the operation. RESULTS: All patients were cured after one laser therapy. The corrected visual acuities were improved in different degrees. Three eyes were 0.6 - 0.7 (11.5%), 5 eyes were 0.8-0.9 (19.2%) and 18 eyes were > or = 1. 0 (69.2%). No complication was observed. CONCLUSION: The laser therapy for persistent pupillary membrane is an easy, safe and effective method only if the laser energy is appropriately selected, the focus is accurate and the operation is dexterity.

Child↗

PubMed2004

THUMP: an immersive haptic console for surgical simulation and training.

Telerobotic systems are revolutionizing minimally invasive surgery (MIS), giving the surgeon complete control over precise dexterous movements of tiny robotic instruments. Such 'surgery-by-wire' approaches also create unique opportunities for simulation and training, as the surgeon operates at a computer-mediated haptic console. Possible extensions include offline training in simulated environments and advanced guidance and mentoring during actual operations. To explore these options and further improve telerobotic interfaces, we have constructed a two-handed, fully articulating haptic console that provides force and torque feedback as well as a stereoscopic display.

Computer Simulation↗

PubMed1992

Intraorgan differences of blood flow, oxygen supply and glycogen content in the multilobular liver of normal and hemorrhagic rats.

In order to characterize intraorgan differences in blood supply of the rat liver, hepatic blood flow (HBF), surface oxygen tension (sPO2) and glycogen content of the largest and smallest lobi have been determined for normal and hemorrhagic rats (N = 68) in ketamin-xylazine anesthesia. 1. Mean HBF +/- SD of lobus sinister measured 1.07 +/- 0.23 ml/g min (n = 119 determinations, N = 9 rats); HBF of lob. caudatus dexter showed a left-shifted histogram (mean value = 0.77 ml/g.min, median = 0.72 ml/g.min, modul = 0.63 ml/g.min, p less than 0.005). 2. Mean sPO2 +/- SD of lob. sin. measured 23 +/- 6.8 mm Hg (n = 168, N = 16). The histograms of lob. caudat. dext. and sin. were left-shifted (mean value of l.c.d. = 9 mm Hg, median = 4 mm Hg, modul = 0 mm Hg, mean value of l.c.s. = 16 mm Hg, median = 17 mm Hg, modul = 0 mm Hg). Under hemorrhage sPO2 became almost zero in 91% of the measurements. 3. In response to an arterial bolus of fluorescence stained gamma-globulins, spreading of the dye showed a pronounced front and marked periportal area within lob. sin., while an irregular convective front and a much smaller area were detected within both of the lobi caudati. Under hemorrhage, intersinusoidal staining and undefined, irregular contours were observed within all lobes. 4. Compared with lob. sin. preferential glycogen depletion and partial centrilobular necrosis were detected within both of the lob. caudati while under hemorrhage the glycogen stores were empty and severe group necroses have been observed especially within the small lobi. From the data it is concluded that in comparison to lob. sin. an insufficient supply and pronounced vulnerability against hepatic ischemia exists within the small lobi caudati.

Acid-Base Equilibrium↗

PubMed2004

Prospective functional analysis of trapeziectomy combined with intermetacarpal tendon stabilisation in trapeziometacarpal arthritis.

We conducted a prospective study to evaluate the functional status of patients surgically treated by trapeziectomy with intermetacarpal tendon stabilisation. Pain relief, the height of the trapezial cavity, hand impairment, and manual ability were measured in a group of 18 patients at a mean of 2.3 years after surgery. Complete relief of pain was achieved in 89% of our patients. The height of the trapezial cavity was significantly reduced. Hand strength and digital dexterity were not impaired after the operation. Manual ability was significantly improved by the trapeziectomy as demonstrated by the median VAS values of 53.5 before and 95.5 after surgery. The ABILHAND questionnaire revealed that most of the patients were satisfied with the functional results of the trapeziectomy. Based on our findings in this prospective study, it appears that trapeziectomy with intermetacarpal tendon stabilisation relieved pain in almost 90% of patients suffering from trapeziometacarpal osteoarthritis, at no functional cost.

Arthroplasty↗