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PubMed1975

Diver performance: the effect of cold.

Fifteen divers performed five tasks in water of temperatures 20 degrees C and 5 degrees C, using standard scuba equipment. A significant deterioration of performance occurred under the colder condition in: simple arithmetic 13%; logical reasoning 17%; word recall 37%; word recognition 11%; and manual dexterity 17%. Throughout each dive, rectal and five skin temperatures were monitored. Average fall in rectal temperature was 0.5 degrees C during 20 degrees C dives and 1.1 degrees C during 5 degrees C dives. Average body surface temperature fell by 5 degrees C and 12.5 degrees C respectively. Average heat losses calculated from the data were 95 kcal.m(-2).hr(-1) (20 degrees C dives) and 245 kcal.m(-2).hr(-1) (5 degrees C dives). The impairment in word recognition was significantly correlated with the fall in rectal temperature for the 5 degrees C dives. For other tests, the deterioration did not appear to be correlated with body-temperature changes, but rather, occurred rapidly upon cold water immersion. The significance of these findings is discussed in relation to current understanding of the mechanisms by which cold is thought to influence performance underwater.

Adaptation, Physiological↗

PubMed2005

Predicting academic performance and clinical competency for international dental students: seeking the most efficient and effective measures.

Measures used in the selection of international dental students to a U.S. D.D.S. program were examined to identify the grouping that most effectively and efficiently predicted academic performance and clinical competency. Archival records from the International Dental Program (IDP) at Loma Linda University provided data on 171 students who had trained in countries outside the United States. The students sought admission to the D.D.S. degree program, successful completion of which qualified them to sit for U.S. licensure. As with most dental schools, competition is high for admission to the D.D.S. program. The study's goal was to identify what measures contributed to a fair and accurate selection process for dental school applicants from other nations. Multiple regression analyses identified National Board Part II and dexterity measures as significant predictors of academic performance and clinical competency. National Board Part I, TOEFL, and faculty interviews added no significant additional help in predicting eventual academic performance and clinical competency.

Achievement↗

PubMed2005

Toward in vivo mobility.

Today's laparoscopic tools impose severe ergonomic limitations and are constrained to only four degrees of freedom. These constraints limit the surgeon's ability to orient the tool tips arbitrarily, and can contribute to a variety of complications. Robots external to the patient have been used to aid in the manipulation of the tools and improve dexterity. However, these robots are expensive, bulky, and are used for only select procedures. In vivo robotic assistants have the potential to enhance the capabilities of the surgeon, reduce costs, and reduce patient trauma. The motion of these in vivo robots will not be constrained by the insertion incisions. Such assistants will need to attain optimal viewing angles by traversing the abdominal organs without causing trauma. This paper presents an experimental analysis of miniature in vivo robot wheels.

Humans↗

PubMed2004

Robotic technology applied to meet the requirements of 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

Effectiveness of constraint-induced movement therapy in chronic stroke patients.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of constraint-induced movement therapy (CIMT) in dexterity with Action Research Arm Test (ARA test), hand grip strength, pinch strength of affected upper extremity in chronic stroke patients. MATERIAL AND METHOD: An observer-blinded randomized control trial, 69 chronic stroke patients were allocated either to constraint-induced movement technique (n = 33) or conservative treatment (n = 36). The CIMT group received 6 hours of daily affected-upper-extremity training and restrained unaffected upper extremities for 5 days per week, totally 2 weeks. The control group received bimanual-upper-extremity training by conservative neurodevelopmental technique without restrained unaffected upper extremities for 2 weeks. RESULTS: The CIMT group had ARA scores, pinch strength of affected upper extremities statistically significant higher than the control group at p < 0.05, but the hand grip strength had no statistically significant difference, p > 0.05. CONCLUSIONS: CIMT of unaffected upper extremities has an advantage for chronic stroke patients which may be an efficacious technique of improving motor activity and exhibiting learned nonuse.

Adult↗

PubMed2005

[A case of multiple sclerosis with bilateral useless hand syndrome as a main clinical feature].

A 41-year-old, right-handed man was admitted to our hospital on September 12, 2002, due to progressive clumsiness in both hands. The patient had been diagnosed as having multiple sclerosis three years prior to admission. He noticed difficulty in manipulating objects three months before admission. Cervical T2-weighted MRI showed a high signal intensity at the level of C3-4 which was enhanced on T1-weighted image with gadolinium. On admission, neurological examinations revealed impairment of dexterity, deep sensory disturbance, and astereognosis in both hands. The clumsiness of complex finger movements was predominant on the left side, and was exaggerated with the eyes closed in association with pseudoathetosis. After steroid therapy, his clumsy hands improved gradually. This type of clumsiness in multiple sclerosis had been described as useless hand syndrome by Oppenheim. In accordance with our case, useless hand syndrome has been reported to arise from high cervical (C2-4) lesions, mainly involving the posterior cord ipsilateral to the clumsy hand. Although the majority of reported cases with useless hand syndrome had other neurological complications, such as hemiparesis, tetraparesis, and truncal ataxia, our patient exhibited a pure form of useless hand syndrome. In addition, useless hand syndrome is usually unilateral, and bilateral useless hand syndrome is very rare. Clumsiness of fine finger movements with astereognosis in our patient is similar to numb clumsy hands or limb-kinetic apraxia due to cervical spondylosis or postcentral gyrus lesion, respectively. This indicates an important role of the high cervical posterior cord in conveying a kinesthetic sense necessary to guide fine finger movements. It should be kept in mind that high cervical lesions in multiple sclerosis causes clumsy hands mimicking limb-kinetic apraxia.

Adult↗

PubMed2005

Animal surgery during spaceflight on the Neurolab Shuttle mission.

INTRODUCTION: A surgical procedure has never been required or performed on a human in space. Parabolic microgravity simulations have suggested that surgery would be technically feasible during spaceflight. PROCEDURES: Survival surgery was performed for the first time on rats during the STS-90 Neurolab Shuttle mission. Craniotomy, leg dissection, thoracotomy, laminectomy, and laparotomy were performed as a part of physiological investigations. RESULTS: Surgical techniques successfully demonstrated in rats during spaceflight included general anesthesia, wound closure, wound healing, hemostasis, control of surgical fluids, operator restraint, and control of surgical instruments. No decrement in manual dexterity was noted by the crew, although operative time was longer compared with ground experience due to the need to maintain restraint of surgical supplies and instruments. CONCLUSIONS: The demonstration that technically demanding dissections could be accomplished successfully in space on rats suggests that comparable complex surgical procedures should be feasible on humans, if necessary, on future long-duration missions.

Aerospace Medicine↗

PubMed2005

[Replacement of the urinary bladder by the stomach body].

In the period from 2001 through 2004 plasty of the urinary bladder was performed in 24 patients using a. et v. gastroepyploici dexter. Mean age of the patients (18 men and 6 women) was 58.2 years. Gastrocystoplasty in 18 patients was performed after radical cystectomy for urinary bladder cancer, in 6 patients for neurogenic and small urinary bladder. The authors' original modification with a complete transversal resection of the stomach body taken together with the lesser curvature was used in operations on 10 patients. Early postoperative complications developed in one patient, late ones--in two patients, there were no lethal outcomes. Positive functional results were noted in all patients within the terms of observations from 2 through 22 months. Good quality of life was noted in all of them.

Adult↗

PubMed2005

16-year follow-up study of Vena Cava Filters Group.

AIM: The prevalence of venous thromboembolic disease (VTED) is between 0.05% and 0.1% whereas its incidence is approximately 0.1%. Out of 100 patients with deep vein thrombosis (DVT), 5 will develop clinically serious pulmonary embolism (PE), one of which will be fatal. It is well known from the literature that surgical interventions carried out without antithrombotic prophylaxis have a 30% incidence of DVT, which can be halved with adequate prophylaxis. The aim of this study is to evaluate the immediate, middle- and long-term complications of caval filters by identifying any of the problems connected with or independent of the presence of the filter, also in relation to international literature data. METHODS: In view of the evolution of VTED surgical prevention methods, we have analyzed our case record composed of 821 patients (October 1984-October 2002), treated with different surgical solutions for VTED, with indications for the placement of 634 caval filters. RESULTS: The 30-day follow-up of all the 634 filters placed (100%) shows no mortality from the procedure and any of its immediate complications. The middle-term follow-up (from 1 month to 5 years) of 361 filters (57%) shows 0.55% mortality from PE while the long-term follow-up (5-16 years) of 105 filters (17%) shows a percentage decrease in all complications and no mortality from PE. The results also show a progressive annual decrease in the number of filters placed. CONCLUSIONS: The lower incidence of complications, compared to that reported in the literature, can be attributed to both improved operator dexterity in the placement of the filter and correct management of the complications. The lower number of filters used can be explained by improved therapeutic possibilities with new low molecular weight heparins (LMWH) and by current diagnostic as well as instrumental and biochemical monitoring methodologies.

Adolescent↗

PubMed2005

[The use of first dorsal metacarpal artery flap for thumb reconstruction].

The use of the first dorsal metacarpal artery flap in the reconstruction of soft tissue defects in 6 patients suffered from severe injuries of the thumb is presented. Detailed description of the operative technique is given and results of the treatment of 3 patients who were examined at 1-2 years after operation are evaluated. All flaps healed uneventfully and defects were covered in all patients without terminalization of the thumb. Functional results were satisfactory in 2 patients, but other one considered his hand incompletely dexter, by means of decreased both total grip and pinch strengths. In the other patient a limited range of motion occurred in MCP joint of the index finger from which the flap was harvested. Sensation of light touch was satisfactory in two patients and decreased in one, and 2PD discrimination was of 10 mm in all 3 patients. Presented technique seems to be useful and relatively safe in the reconstruction of severely injured thumbs, and for rearrangement of sensation within the thumb.

Adult↗

PubMed2005

[Subgingival irrigation combined with scaling and root planing. Results of a study with chlorhexidine and sodium hypochlorite].

Scaling and root planning is more and more associated with subgingival irrigation in chronics periodontal treatment. It is unreasonable to expect to control periodontal infections by mechanical treatment alone. Most patients do not achieve the necessary level of manual dexterity or motivation to control their plaque at home. It is rather better to deliver antimicrobial agents directly into the periodontal pocket. The aim of this study is to evaluate the action of subgingival irrigation associated to periodontal scaling on the clinical parameters and to compare the effects of chlorhexidine (Eludril) and sodium hypochlorite (Dakin Cooper) on adult's chronics periodontitis treatment. At the level of Plaque Index, Gingival Index and Bleeding on Probing, the results show that Eludril irrigation associated to scaling is lightly efficacious than Dakin cooper irrigation associated to scaling. And, the last one also is lightly efficacious than scaling alone. However, at the level of pocket depth, scaling alone has been also effective than scaling associated with subgingival irrigation.

Adult↗

PubMed2005

Investigation of anulus fibrosus morphology in human fetus intervertebral discs.

OBJECTIVE: To determine whether the thickness of the anulus fibrosus (AF) structure of the intervertebral disc plays a role in disc herniation etiology, an important pathology. METHODS: We performed this study between February 2000 and May 2001 at Karadeniz Technical University Medical Faculty, Turkey. We used 20 human fetus cadavers with intrauterine ages between 22 and 41 weeks, taking into consideration the highest, lowest, and average frequencies, with 3 each of cervical, thoracal, and lumbar parts of the vertebral column, using a total of 9 intervertebral discs. We measured the thickness of the AF layer in each intervertebral disc in anterior, posterior, postero-dexter, and postero-sinister locations. We performed comparisons among the values obtained at the same level, and of comparative thicknesses at the same location at other levels. RESULTS: It was determined that there was no difference between the thickness of the AF in the same location at the various levels of intervertebral discs, but that at almost all levels, the thickness in posterior and anterior locations was significantly less compared to that in posterolateral locations. CONCLUSION: Anulus fibrosus thickness is not directly related to the incidence of disk hernia at different levels of the vertebral column according to the values obtained from this study.

Cadaver↗

PubMed2005

[Double gloving during orthopaedic procedures--possible discomfort or a right choice].

In the light of the increasing number of infections with hepatitis viruses and HIV, world wide as well as among the health care workers, the prevention of occupationally acquired infections in the operating room environment becomes crucial. Three plausible strategies do not require any knowledge of the exact mechanisms of exposure: vaccination, impenetrable protective barriers and post exposure prophylaxis (PEP). As HIV and HCV vaccine are not currently available, as some of the surgeons avoid the immunisation against hepatitis B as well as PEP in the context of HIV and HBV - appropriate barrier precautions (e.g. gloves, gowns and face shields) remain the last realistic alternative. According to multiple studies the authors present clear arguments for double gloving during surgical procedures. The perforation rates for single gloves or outer gloves are a few times higher than for double-inner gloves. It is concluded that double gloving is an essential element to prevent blood-borne infections at the operating room environment, especially during long-lasting, complex procedures combined with a large amount of blood loss. Possible reduce of sensitivity and manual dexterity may be improved by choosing more suitable combination of inner- and outer-glove size.

Blood-Borne Pathogens↗

PubMedDate not supplied

Prevalence of risk factors predisposing to foot problems in patients on hemodialysis.

A disturbingly high prevalence of single or bilateral lower extremity amputations in our program prompted us to conduct a study to identify the prevalence of risk factors that predispose patients on hemodialysis (HD) to foot problems. The study consisted of a one-time assessment of subjects' risk for and actual prevalence of amputation. The sample consisted of 232 subjects--56% male, 44% female. Ages ranged from 21-91 years, mean age 65.1 and median age 69 years. The most common comorbidities were hypertension (75%), coronary artery disease (50%), diabetes (42.2%), hyperlipidemia (34.9%), and peripheral vascular disease (27.2%), which are all established risk factors for peripheral arterial occlusive disease. Twenty-one percent of subjects were current smokers; 28% were former smokers. Nearly 13.4% of subjects had undergone amputations ranging from single toes to bilateral above knee amputations. Only 31% of subjects had both bilateral palpable pedal pulses present. Neuropathy, as evidenced by the inability to feel the application of monofilaments to 10 sites on each foot or the presence of symptoms, was present in 74.6% of subjects. Only 2.6% of subjects demonstrated comprehensive self-care behaviors (SCBs). With respect to subjects' ability for self-care, 75% of subjects had adequate vision, 60% adequate dexterity, and 55% adequate flexibility to perform self-care. Study findings confirmed impressions that patients are at considerable risk for foot complications. Implications for nursing practice include regular foot assessment, education for self-care, and referral to specialists when required.

Adult↗

PubMed2005

Evaluation of applicants to predoctoral dental education programs: review of the literature.

This review finds that college GPA and DAT scores provide dental schools in the United States and Canada with defensible methods for selecting students. College GPA seems the best predictor of academic performance in dental school. The academic average (AA) of the DAT is a better predictor than is the perceptual ability test (PAT), but dental educators who believe that evidence of manual dexterity or perceptual ability must be a part of the admissions decision can find enough supporting evidence to justify doing so. When added to college GPA and the AA, information from the PAT may in fact enhance predictability. There is also evidence, however, that manual skills can be learned during routine dental curricular experiences. Overall, conventional admissions criteria at best account for about 40 percent of the variance in dental school performance, and most of this variance occurs during the early years of the curriculum. Studies are lacking for evaluating criteria that may predict success in admitting students for preferentially addressing current challenges, including achieving diversity of the workforce, ensuring access to care for all, interprofessional health care, ethics and professionalism, filling faculty positions, and conducting needed research. Schools should periodically validate all of their admissions criteria against expected performances and make corresponding adjustments.

Aptitude Tests↗

PubMed2005

Outcomes in carpal tunnel syndrome: symptom severity, conservative management and progression to surgery.

PURPOSE: This study investigated the relationship between severity of symptoms and success of nonoperative and operative treatment in patients with carpal tunnel syndrome (CTS). METHODS: An observational cohort study regarding the management of CTS was conducted. Thirty patients referred to a tertiary hand centre with a diagnosis of CTS were prospectively followed. Twenty-five of the patients (47 affected hands) were available for long-term follow up to determine management outcomes. Self-report symptoms and physical impairments were assessed and documented at baseline, 6 weeks, and 12 weeks using the CTS Severity Score (SSS), the Disability-Shoulder, Arm and Hand Score (DASH), and the Levine Functional Score. Longer-term follow-up was conducted to identify status on outcome measures and whether patients proceeded to surgery. RESULTS: Those who proceeded to surgery (n = 27/47 hands) had higher initial CTS SSS and DASH scores and also maintained higher scores compared to those who improved with conservative management (p < 0.05). Improvements occurred in the SSS (P < 0.0001), Functional Score (P < 0.001), and DASH score (P < 0.05) following surgery in the patients resistant to conservative management. Recovery of grip and dexterity was less satisfactory. DISCUSSION: This study suggests that the SSS is useful in the triage of patients on surgical wait-lists as patients with high initial scores or failure to change in short-term follow-up are likely to proceed to surgical release. Despite prolonged symptoms and previous treatment, patients with lower SSS scores had moderate success with a second trial of conservative management.

Adult↗

PubMed1992

Coping with embedded mandibular wisdom teeth in developing countries.

Despite low incidence of embedded mandibular wisdom teeth (third molars) among dental patients in developing countries (less than 100/1,000), the unfavourable patients:dentist ratios, the limited resources and low levels of public awareness render them an important problem to operators in these countries. Since the effectiveness with which they are removed largely depends on the age with respect to the stage of root formation, bone resilience and relationship with adjacent anatomical structures, and the dexterity of the operator, whenever possible, early removal is recommended. To minimise occurrence of non-operative complications that are costly to manage, primary health care workers have a vital role to play in raising levels of awareness and early referral for further evaluation. In view of the risks involved in the removal of these teeth and the small number of trained oral surgeons, continuing education to the dental practitioners, could improve their efficiency in the management of this condition.

Developing Countries↗

PubMed2005

Post-traumatic high flow priapism percutaneously treated with transcatheter embolisation.

PURPOSE: The aim of this paper is to present our experience in the percutaneous management of high-flow priapism with transcatheter embolisation and gelfoam. MATERIALS AND METHODS: We present three clinical cases in which an acute trauma caused the development of high-flow priapism. After differing initial management, all cases underwent arteriography, followed by demonstration of the arterial-lacunar fistula and embolisation with gelfoam. RESULTS: Near immediate detumescence after the procedure confirmed the success of embolisation, which was supported by clinical and instrumental follow-up. DISCUSSION: In high-flow priapism, the best therapeutic solution remains transcatheter arterial embolisation, with ultra-selective catheterisation by microcatheter and embolisation of the pudendal artery only, which is responsible for the post-traumatic arterial-lacunar fistula. This manoeuvre is not always technically easy, and requires experience and remarkable dexterity. Technical failure is always possible owing to the spasm of a peripheral arteriole that cannot be resolved with papaverine, and to the possible rehabilitation by the downstream contralateral circulation. Furthermore, the apprehension of the operator carrying out the procedure in this anatomical context may make the immediate result seem satisfactory, even if it is not optimal. All these considerations stress the need for a rigorous clinical and instrumental follow-up to guide later diagnostic and therapeutic choices.

Adult↗