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[Technic for digitalized angiography of the legs by unilateral femoral artery puncture and programmed displacement of the examination table. Apropos of 56 cases].

The authors describe a technique for digital subtraction angiography of vessels of the legs, performed in 56 patients for suspicion or control of peripheral vascular disease. Owing to an unilateral femoral arterial puncture and a programmed moving of the table top, a subtraction arterial mapping of the two legs is obtained with only two injections of contrast medium. On the side of the puncture the arterial opacification is always very satisfactory. On the other side opacified by reflux the popliteotibial region is visualized in 95% of cases. We had no complication with iodine or arterial puncture. Our technique is then characterized by its simplicity and a small trauma owing to the unilateral puncture and the reduction of contrast medium injections.

Adult↗

Multifrequency electrical impedance imaging: preliminary in vivo experience in breast.

We have deployed a recently completed spectroscopic electrical impedance tomography (EITS) imaging system in a small series of women (13 participants accrued to date) in order to investigate the feasibility of delivering EITS breast examinations on a routine basis. Hardware is driven with sinusoidally varying spatial patterns of applied voltage delivered to 16 electrodes over the 10 kHz to 1 MHz spectral range using a radially translating interface which couples the electrodes to the breast through direct contact. Imaging examinations have consisted of the acquisition of multi-channel measurements at ten frequencies on both breasts. Participants lie prone on an examination table with the breast to be imaged pendant in the electrode array that is located below the table. Examinations were comfortable and easy to deliver (about 10 minutes per breast including electrode-positioning time). Although localized near-surface electrode artefacts are evident in the acquired images, several findings have emerged. Permittivity images have generally been more informative than their conductivity counterparts, except in the case of fluid-filled cysts. Specifically, the mammographically normal breast appears to have characteristic absolute EITS permittivity and conductivity images that emerge across subjects. Structural features in the EITS images have correlated with limited clinical information available on participants with benign and malignant abnormality, cysts and scarring from previous lumpectomy and follow-up radiation therapy. Several cases from this preliminary experience are described.

Breast↗

Motor control in patients with incomplete spinal cord injuries and various voluntary movement capabilities.

BACKGROUND: In this study, we attempted to verify the hypothesis that further improvements in volitional movement of patients with a spinal cord injury would diminish and ultimately suppress the segmental responses, while enhancing the supraspinal inhibitory influence. METHODS: Eleven patients with an incomplete spinal cord injury and partial preservation of motor function (ASIS grades C and D) were recruited. Their lower limbs were evaluated using polyelectromyography (PEMG) during voluntary movements, reinforcement maneuvers, tonic vibratory reflex, passive stretch reflex, irradiation of the passive stretch reflex (PSRirrad), and plantar reflex suppression. RESULTS: The reinforcement maneuver response, tonic vibratory response, passive stretch reflex, and PSRirrad were most active in limbs with partially preserved volitional movement, but for which patients were still incapable of lifting their heel off the examination table. In contrast, plantar reflex suppression was strongest in limbs with partially preserved volitional movement, for which patients were capable of lifting the heel off the examination table. CONCLUSIONS: Supraspinal inhibitory effects were most active in those limbs which were capable of lifting the heel off the examination table, compared to limbs with partially preserved volitional activity but without visible movement or which were incapable of lifting the heel off the examination table. The capability for volitional activity paralleled the supraspinal inhibitory effects.

Adult↗

[Quantitative tilt table study with TCD monitoring. A reliable method for the diagnosis of neurocardiogenic syncope (vasovagal syncope)].

The clinical significance of quantitative tilt-table examination with TCD monitoring in the diagnosis of neurocardiogenic syncope is evaluated. A 50-year-old male suffered a neurocardiogenic syncope during tilt-table examination with a strong drop in blood pressure, an increase in cerebrovascular resistance as evidenced by transcranial Doppler monitoring, and a 30-s cardiac asystole, followed by a generalized seizure. No further syncope could be elicited during tilt-table examination after beta-blocker treatment. It was hypothesized that hyperactivity of the left ventricular mechanoreceptors due to increased force of ventricular contraction during a state of reduced venous backstream to the heart was responsible for eliciting the neurocardiogenic syncope. Tilt-table examination with an upright position for at least 45 min enables the diagnosis of a neurocardiogenic syncope to be made with sufficient sensitivity and specificity. Several studies have shown that medication with beta-blockers is successful in the treatment of neurocardiogenic syncope. The implantation of cardiac pacemakers should only be considered if medication is not successful.

Adrenergic beta-Antagonists↗

Sitting up and transferring to a chair: two functional tests for patients with stroke.

OBJECTIVE: The aim of the study was to evaluate the reliability of two clinical tests of mobility for stroke patients. DESIGN: The study took place in a university hospital with a case control design. SUBJECTS: A sample of convenience including 31 subjects: a group of patients with prior stroke (n = 19); a control group (n = 12). METHODS: The time(s) for sitting up from a supine position and transferring from an examination table to a chair were measured and inter- and intra-rater reliability were assessed. The source of variation in the test results as well as intra-class correlations were estimated. RESULTS: The largest source of variation in the supine position was between subjects, and the between-tester variability was very low, with similar results for the transfer from table to chair. The intra-class correlations are all high (range 0.77-0.98). This indicates that it is of little importance which tester is performing the tests. CONCLUSION: Sitting up on an examination table and transferring from an examination table to a chair seem to be reliable timed clinical tests of mobility in stroke research.

Female↗

Only the nose knows: penile hemodynamic study of the perineum-saddle interface in men with erectile dysfunction utilizing bicycle saddles and seats with and without nose extensions.

PURPOSE: To investigate the differential impact of straddles (A(ns) and B(ns)) and noseless two-cheek seats (A(ntcs) and B(ntcs)) on penile hemodynamics and perineal compressive forces in subjects who cycle in a stationary bicycle. MATERIALS AND METHODS: Subjects underwent cavernosal artery peak systolic velocity (CAPSV) measurements after intracavernosal injection of vasoactive agents while supine, sitting upright on an examination table, straddling a saddle, sitting on a seat, and again supine. Mean perineal compression pressures recorded while straddling the saddles were compared with those while sitting upright. RESULTS: No differences were found in right and left CAPSV values while supine, sitting upright on an examination table, sitting on a seat, and supine again. Right/left CAPSV (cm/second) values straddling A(ns) and saddle B(ns) (0.7 +/- 2.9/1.5 +/- 6.2 and 0/0, respectively) were significantly lower than values obtained while sitting on A(ntcs) and B(ntcs) (25.6 +/- 13.4/23.8 +/- 12.0 and 17.3 +/- 6.4/18.3 +/- 6.5, respectively) (P < 0.001). Mean perineal compression pressures (mm Hg) on A(ns) and saddle B(ns) (315.2 +/- 39 and 387.9 +/- 64.3, respectively) were significantly higher than values obtained while sitting upright on an examination table (47.6 +/- 5.2 and 46.0 +/- 8.1, respectively) (P < 0.001). CONCLUSIONS: We have identified an objective test to assess if an individual bicycle rider, sitting on a certain shape of bicycle saddle or seat generates sufficient compressive forces at the perineal-saddle interface to obstruct cavernosal arterial inflow. This study also demonstrated that straddling bicycle saddles with nose extensions is associated with perineum-saddle interface compressive pressures that exceed systolic perfusion pressures, significantly diminishing penile hemodynamics.

Adult↗

Exercise after cryotherapy greatly enhances intramuscular rewarming.

OBJECTIVE: To determine the effect of moderate-intensity walking on rewarming of the triceps surae muscle group after a 20-minute application of a crushed-ice pack. DESIGN AND SETTING: Subjects were randomly assigned to either the ice-rest or the ice-exercise group. All subjects were treated on the left calf for 20 minutes with a 1.8-kg ice pack. The ice-exercise group walked on a treadmill at 5.63 km/h for 10 minutes and then assumed a prone position on an examining table for 20 minutes. The ice-rest group assumed a prone position on an examining table for 30 minutes after the cryotherapy treatment. SUBJECTS: Twenty-eight (19 men and 9 women) college-student volunteers. MEASUREMENTS: Intramuscular temperature was recorded at 10-second intervals for 50 minutes at 1 cm below the subcutaneous fat with a thermocouple implanted via a 21-gauge sterile hypodermic needle. Differences were analyzed within and between groups at pretreatment (T(0)), the end of the ice treatment (T(20)), 11 minutes after the end of ice treatment (T(31)), and 30 minutes posttreatment (T(50)). RESULTS: We found no differences at T(0) and T(20) but significant differences at T(31) and T(50). At T(31), the ice-exercise group was only 0.61 degrees C colder than at pretreatment levels, while the ice-rest group was 8.05 degrees C colder. By T(50), the temperatures were 0.93 degrees C and 6.95 degrees C colder, respectively, than at pretreatment levels. CONCLUSION: Moderate walking significantly enhanced rewarming of the triceps surae.

Journal Article↗