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Biomedical subjects

M Kutner

Publications and source records attributed to M Kutner.

46 records · Page 3Linked to original sources
PubMed1979

Normative data on low back mobility and activity levels. Implications for neuromuscular reeducation.

Low back mobility and electromyographic movements were performed in 121 normal subjects, grouped by age and sex. Women tended to show greater ranges of motion for straight leg raising, trunk rotation and lateral bending while vertebral separation (forward flexion) was greater in men. A sex-age interaction was observed only in lateral bending, thus implying that for other mobility measurements, data within the age groupings employed in this study can be combined for men and women. Electromyographic data were integrated and quantified using EMG biofeedback equipment for unilateral or bilateral recordings made primarily from the erector spinae muscle between lumbar 3-4 and lumbar 4-5 levels, three centimeters lateral to the spinous processes. Dynamic (trunk flexion-extension, lateral rotation-standing, stooping) and static (quiet sitting, rotation-sitting) movements were performed over a ten second interval. Data analyses verified previous electromyographic studies by demonstrating the trunk extensor function of the erector spinae and the relatively greater unilateral activity when turning to the opposite direction in the erect posture. EMG silence was seen during full trunk flexion. Noticeable sex-age interaction were observed for all dynamic movements but not for static activities. Therefore, it is suggested that EMG data during dynamic movements in a normal population cannot be grouped for men and women within a specified age distribution. These data represent one series of baselines to which mobility and movement patterns in a back pain patient group can be compared. Suggestions are offered for the use of EMG biofeedback during dynamic lower back movements as a possible method of alleviating the pain state, perhaps by altering the patient's posture.

Adolescent↗
PubMed1979

Tyrosine metabolism in cirrhosis.

The aim of this study was to define the enzyme defect responsible for tyrosinemia in cirrhotic patients. The principal hepatic degradation pathway for tyrosine, tyrosine leads to p-hydroxyphenylpyruvic acid equilibrium homogentisic acid leads to CO2 was studied in 18 cirrhotic patients and eight controls. The classic method employed in elucidation of hereditary tyrosinosis was sued. Metabolic intermediates on the pathway were measured in the basal state, and following oral loading doses (50 mg/kg BW) of tyrosine, PHPA, and homogentisic acid. Cirrhotic patients showed a significant increase (p = 0.005) in fasting plasma tyrosine and in basal PHPA excretion and impaired tolerance to all three metabolites when compared to normals. Fifteen of the 18 cirrhotic patients showed tyrosine intolerance which was not accompanied by change in distal metabolites compared to their basal levels. Nevertheless 13 of the 18 did exhibit intolerance of either PHPA or homogentisic acid. We conclude that in contrast to the single complete defect in hereditary disorders of tyrosine metabolism, cirrhotic patients have partial defects at tyrosine transaminase, PHPA oxidase, and homogentisic acid oxidase, the initial step being rate-limiting.

Adult↗
PubMed1978

Relationship of selected clinical variables to current delivered during transcutaneous electrical nerve stimulation.

Nineteen normal subjects were given transcutaneous electrical nerve stimulation to the hypothenar eminence, back, or legs, using a selected constant-current device. Stimulation characteristics from this unit were measured. Stimulation, at 20- microsec or 80- microsec pulse widths, was provided at increasing strengths until subject tolerance or muscle contraction was reached. The current delivered at each stimulus setting for single or repeated intrasubject trials was reliable at each anatomical landmark. For intersubject single trials, current levels proved reliable in the hand and back but not at any of the three interelectrode distances evaluated in the leg. Possible explanations for this latter finding are offered. This study showed that, for those stimulation settings evaluated, at least one constant-current transcutaneous electrical nerve stimulation unit reliably delivers current of specific stimulus strengths to the hypothenar eminence or back.

Adolescent↗
PubMed1978

A randomized, controlled trial of the distal splenorenal shunt.

In 1971 a prospective, randomized trial was initiated to determine efficacy of the distal splenorenal shunt in the management of cirrhotic patients who had previously bled from esophageal varices. When entry into the trial was terminated in 1976, 26 patients had received the distal splenorenal shunt (selective) and 29 had undergone a nonselective shunting procedure (18 interposition mesorenal, six interposition mesocaval, and five other nonselective shunts). Three operative deaths occurred in each group. Early postoperative angiography revealed preservation of hepatic portal perfusion in 14 of 16 selective patients (88%), but in only one of 20 nonselective patients (5%; p < .001). Quantitative measures of hepatic function (maximal rate of urea synthesis or MRUS and Child's score) were similar to preoperative values in the selective group but were significantly decreased in nonselective patients on the first postoperative evaluation (p < .001 for MRUS; p < .05 for Child's score). Eighty-seven per cent of selective and 81% of nonselective patients have now been followed for three to six years since surgery. Late postoperative evaluation of 29 survivors (12 selective, 17 nonselective) still shows an advantage to the selective group with respect to MRUS, Child's score, and incidence of hepatopetal portal blood flow, but differences are no longer statistically significant. However, if the seven patients with portal flow (five selective; two nonselective) are compared to the 20 with absent portal flow (seven selective; 13 nonselective), the former group has significantly higher values for MRUS (p < .05) and Child's score (p < .025). No patient with continuing portal perfusion has developed encephalopathy as compared to a 45% incidence of this complication in individuals without portal flow (p < .05). No significant differences between selective and nonselective groups have appeared with respect to total cumulative mortality (ten selective; 38%; eight nonselective, 28%), shunt occlusion (two selective, 10%; five nonselective, 18%), or recurrent variceal hemorrhage (one selective, 4%; two nonselective, 8%). Overall, significantly fewer selective patients have developed postoperative encephalopathy (three selective, 12%; 15 nonselective, 52%; p < .001). Therefore, we conclude that the distal splenorenal shunt, especially when its objective of maintaining hepatic portal perfusion is achieved, results in significantly less morbidity than nonselective shunting procedures.

Alcoholism↗
PubMed1977

Objective determinations of sensibility in the upper extremity. Part I. Median nerve sensory conduction velocities.

Distal sensory conduction velocities were determined in 109 normal median nerves. A significant decrease in sensory conduction velocity was noted with increasing age. Latencies increased with age but this relationship was not significant in men. Variables which contribute to the wide range of normal conduction velocities are discussed, and the need for each clinician to establish his own testing procedure is stressed. An additional method for assessing sensory function is suggested.

Adult↗
PubMed1977

Objective determinations of sensibility in the upper extremity. Part II. Application of cutaneous stimuli in control subjects.

Sensitization statements were read to two groups of normal subjects to determine whether quantifiable thresholds for pressure, electrical, or tactile stimuli could be altered. Significant reductions in perception thresholds were observed for pressure and digital pulsed stimulation, but not for stimulation to the discomfort threshold, or two point discrimination. These data seem to suggest that increased sensitization is related to the ease of stimulus applications and the comparative simplicity of sensory processing.

Adult↗
PubMed1977

Objective determinations of sensibility in the upper extremity. Part III. Application of cutaneous stimuli in patients with peripheral nerve lesions.

Quantitative values for pressure, electrical, and two-point touch stimulation were examined in five patients with peripheral nerve injuries of the ulnar or median nerves. Analyses of profiles generated for each stimulus application in each patient participating in this preliminary study suggest that, following the reading of a sensitization statement, pressure and electrical shock threshold values are clearly reduced compared to similar measurements in the unaffected limb. Values obtained prior to the statement indicated progressively reduced thresholds, however. Changes in sensation appear to precede significant improvements in sensory nerve conduction velocity. Limitations in the sensory testing techniques as well as suggestions for improving its validity are discussed.

Adult↗