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PubMed1989

Role of the cerebellum in complex human behavior.

Thirty-three outpatient epileptics with normal CT scans (group 1) and 31 patients with cerebellar and brain stem (CBS) atrophy (group 2) were randomly included in this study. There were no significant statistical differences between the groups with regard to age, education, and number of grand mal and other seizures. Statistical analyses showed that group 2 had a longer history of epilepsy with a consequently longer duration of phenytoin (PHT) consumption. Neuropsychological assessment revealed lower performance by this group on the following measures: full I.Q. scale, verbal I.Q. scale, performance I.Q. scale, information, arithmetic, block design, object assembly, digit symbol, Stroop test forms I and II, the B-M dexterity test, and the simple visual and auditory reaction time. No significant differences were observed between the two groups for the remaining 5 subtests from the WAIS scale, for the immediate recall and the delayed recall subtests belonging to Wechsler memory scale as well as for visual and auditory movement time. Analysis of the composite scores of neuropsychological performance showed that the cerebellum interferes with the following complex behavioral functions: (i) visuo-spatial organization for a concrete task, a function related to the cerebello-parietal loops' (ii) planning and programming of daily activities, a function related to the cerebello-frontal loops; and (iii) the speed of information processing, a mainly subcortical function.

Adult↗
PubMed1988

Possible interactions between zolpidem, a new sleep inducer and chlorpromazine, a phenothiazine neuroleptic.

The combined use of a hypnotic and a neuroleptic is a rather frequent situation, encountered especially in the psychiatric sphere. We therefore tested zolpidem and chlorpromazine in six healthy subjects by using a double-blind latin square design. All of them received single doses of 20 mg zolpidem (ZOL), 50 mg chlorpromazine (CPZ) and the combination of ZOL + CPZ. The medication was given as a single dose in the morning and each treatment being separated by a 1-week interval. Zolpidem produced moderate to severe sedation varying according to the subjects. Psychometric performances (manual dexterity, Stroop test), alertness and psychomotricity (visual analogue scales) were reduced up to 3 h after drug intake. Chlorpromazine alone did not have much effect. Combined administration of ZOL and CPZ was rather more effective than ZOL alone. The pharmacokinetics of ZOL or CPZ remained unchanged except for the elimination half-life of CPZ, which increased significantly when administered along with ZOL. No other pharmacodynamic or pharmacokinetic interaction between ZOL and CPZ was evident. The fact that the ZOL and CPZ combination accentuated the pharmacodynamical effects can be explained to result from the summation of each of their own pharmacological effect.

Adult↗
PubMed2003

Comparison of robotically performed and traditional laparoscopic colorectal surgery.

INTRODUCTION: Robotic laparoscopic surgery is postulated to result in better surgical results by allowing improved instrument manipulation and three-dimensional vision. The authors' experience performing robot-assisted laparoscopic colorectal surgery is reported. METHOD: Standard laparoscopic procedures with robot-assisted laparoscopic colon mobilization and vascular ligation were performed. Data relating to the operative procedure, hospital stay, and direct costs were collected. Results were compared with age, gender, and procedure case-matched controls taken from a prospective laparoscopic colorectal surgery database. RESULTS: Six robot-assisted laparoscopic surgeries (2 right hemicolectomies, 3 sigmoid colectomies, and 1 Wells rectopexy) were performed between December 2001 and June 2002. There was no associated morbidity. Operative time was increased from a median time of 108 minutes for standard laparoscopic colorectal surgery to 165 minutes for robot-assisted laparoscopic surgeries (P = 0.0313; Wilcoxon matched-pairs signed-rank test for nonparametric data). This was primarily a result of the time required for robot set-up. Blood loss, length of stay, and hospital cost were not significantly different between groups. Additional direct equipment costs for RAC cases included robotic laparoscopic instruments and sterile drapes (approximately US $350 per case), without including acquisition and maintenance costs for the robot. CONCLUSION: Robot-assisted laparoscopic colectomy is a feasible and safe procedure. Although three-dimensional vision and dexterity are facilitated, operative time is increased and the overall additional expense of robotics is of concern. Robot-assisted laparoscopic colectomy requires further evaluation to establish clinical and financial benefits before introduction to routine practice. Such techniques may, in the future, facilitate complex laparoscopic techniques.

Aged↗
PubMed1994

Use of home automated intermittent peritoneal dialysis in the treatment of end stage renal failure.

We report our retrospective analysis of 16 uraemic patients who were treated with home automated intermittent peritoneal dialysis (IPD) from 1988 to 1993. Six patients were diabetic. The mean age was 58.5 years. The reasons for home automated IPD were: old age, poor eyesight, low intelligence or poor dexterity, family or patient request and old stroke. It took an average of 8.8 sessions to train the helper. The mean frequency of the home IPD was once every 5.8 days with a mean volume of 48 litres of dialysate used during each dialysis. There were 3 peritonitis episodes making the peritonitis rate once every 93 patient months. Four patients were still on home IPD and two were transplanted. Ten patients died of stroke, myocardial infarction, tuberculosis, chronic obstructive lung disease or suicide. A low plasma albumin is the only significant parameter in the early mortality group. Such high mortality can be accounted for by the fact that patients were older and forty per cent were diabetic. We conclude that home automated IPD can be an alternative for some patients in whom other modes of dialysis are difficult.

Adult↗
PubMed1998

The importance of boron nutrition for brain and psychological function.

Boron (B) nutriture has been related to bone, mineral and lipid metabolism, energy utilization, and immune function. As evidence accumulates that B is essential for humans, it is important to consider possible relationships between B nutriture and brain and psychological function. Five studies conducted in our laboratory are reviewed. Assessments of brain electrical activity in both animals and humans found that B deprivation results in decreased brain electrical activity similar to that observed in nonspecific malnutrition. Assessments of cognitive and psychomotor function in humans found that B deprivation results in poorer performance on tasks of motor speed and dexterity, attention, and short-term memory. However, little support was found for anecdotal reports that supplementation with physiologic amounts of B helps alleviate the somatic and psychological symptoms of menopause. Parallels between nutritional and toxicological effects of B on brain and psychological function are presented, and possible biological mechanisms for dietary effects are reviewed. Findings support the hypothesis that B nutriture is important for brain and psychological function in humans.

Animals↗
PubMed1994

Fibreoptic intubation.

Although not widely utilized, fibreoptic techniques represent a dramatic advance in the management of the difficult intubation. Particularly suited to the awake patient in the elective setting, fibreoptic intubation can also be useful in selected emergency situations, and can be done under general anaesthesia. In the awake patient fibreoptic intubation maintains a wide margin of safety while producing minimal patient discomfort, but requires adequate local anaesthesia of the airway. Intimate familiarity with the bronchoscope and the anatomy of the upper airway is essential as is careful attention to various aspects of technique. Intubation mannequins can be readily utilized to develop dexterity in bronchoscopic manipulation and intubation workshops are also effective in improving skills. This CME article provides the clinician with a detailed approach to the technique of fibreoptic intubation based on the author's personal experience supplemented by a limited literature review. Fibreoptic intubation is not a difficult skill to master and should be in the armamentarium of all practising anaesthetists.

Anesthesia, General↗
PubMedDate not supplied

Relations between visceral and behavioral function in men at bedrest.

Multiple physiological measurements as well as a self-assessment of arousal was made in eight men on the first, third, and fifth days of bedrest. On the third day, additional measurements of performance on memory and dexterity tasks were made. Univariate analysis did not reveal any physiological variable to either predict subsequent performance well or to co-vary acutely with it; however, self-rating scores did prove to be useful predictors of subsequent performance. Principal components analysis suggested an "alertness" factor comprised of physiological measures as well as self-ratings which helped in predicting better performance. Although the individual patterns of correlations between variable on each of the three test days was variable, even more variability between subjects was found on the performance testing day. We believe this effect of behavioral activation may be due to the injection of common, slow temporal trends into many of the different data sets.

Aged↗
PubMed2004

Use of a questionnaire to screen for frailty in the elderly: an exploratory study.

BACKGROUND AND AIMS: In a pilot study of community-dwelling geriatric clinic patients (N=48, aged 63-90) we examined the use of a questionnaire to classify frailty status by comparing it with standardized markers of frailty. The questionnaire, developed by Strawbridge et al. in 1998, defines frailty as difficulty in more than one of four domains of functioning: physical, cognitive, sensory, and nutritive. METHODS: Subjects were classified as frail or not frail by questionnaire and assignment was compared with testing of physical and cognitive measures in cross-sectional analysis. Demographic variables, functional inventories, physical activity levels, clinician impression of frailty, and 3-year health outcomes were also examined. RESULTS: Thirty-three percent of subjects were classified as frail. Frailty classification by the Strawbridge questionnaire was correlated to Timed Up and Go and repetitive Sit-to-Stand tests, bimanual dexterity and cognitive tests. A discrepancy was found between assignment of cognitive difficulty, by questionnaire and cognitive performance. When overall Strawbridge frailty scores were modified to account for those with poor cognitive performance who did not report cognitive difficulty, the prevalence of frailty increased to 42%. At 3-year follow-up, the modified Strawbridge frailty classification (p<0.05) and clinician impression of frailty (p<0.01) were both significant predictors of death and institutionalization combined. CONCLUSIONS: This study serves as an initial inquiry into the potential validity and utility of the Strawbridge frailty questionnaire as a simple screening tool to identify patients who may warrant detailed functional testing.

Aged↗
PubMed1997

Weak short-latency spinal projections to the long flexor of the human thumb.

The human thumb is controlled by a muscle, flexor pollicis longus (FPL), that is unique among mammals and contributes to manual dexterity. The present study sought to define whether the spinal reflex circuitry for this muscle differed from that for an adjacent muscle (flexor carpi radialis, FCR). In peri-stimulus time histograms, short-latency, largely monosynaptic excitation produced by median nerve stimulation was significantly less frequent and significantly smaller for FPL motor units than FCR motor units. Thus the motoneurone pools of adjacent muscles differ in their spinal reflex accessibility. The reflex control of FPL may thus be achieved by supraspinal pathways rather than the traditional monosynaptic arc.

Electric Stimulation↗
PubMed1994

[Resuscitation skills of hospital nursing staff].

The hospital nursing staff represents a distinct group of cardiopulmonary resuscitation (CPR) providers. Differences in the success rates of resuscitation attempts inside or outside the hospital seem to be attributable to the skill of the various rescuers. Whereas the definite success rate for prehospital resuscitation is 7%, the corresponding rate for in-hospital settings is 15%. METHODS. During 53 CPR refresher courses offered to nursing staff members, their individual skills and competence in CPR procedures were examined according to the standards and guidelines of the German Medical Association (Bundesärztekammer). The efficacy of cardiac massage and artificial ventilation performed by each nurse was recorded. Quality criteria were defined, grouped and analysed statistically by the Chi-square test. RESULTS. Only 6.6% of the nursing staff were found to have good skills in artificial ventilation. The main faults observed were insufficient tilting of the head (24%) and failure to prevent leakage from the insufflation airway (35%). For 42.8% it proved impossible to insufflate a minimum ventilatory tidal volume of 400 ml. The attempts at resuscitation made by 58.6% were completely inadequate. Although 14.1% of the nurses carried out effective cardiac massage, the majority of the test group (44.7%) failed to do so. For 29.4% the appropriate position of their own upper body to allow adequate chest compression remained elusive. In 41.4% of the compression cycles, the rescuer's hands lost contact with the sternum. The compression period proved too long in relation to the decompression period in 21.4%. Only 4 individuals (0.9%) were able to perform all standard CPR procedures as recommended by the guidelines and 71.8% failed to perform effective CPR manoeuvers. The test results did not differ with respect to the nurses' educational or professional status, clinical CPR experience or work area within the hospital. CONCLUSION. Cardiopulmonary resuscitation skills of hospital nurses are inadequate, mainly because of lack of manual dexterity. Obviously the special skills learned in CPR courses are lost after a relatively short time. These results, however, do not suggest completely inadequate handling of CPR procedures in the hospital setting. Indeed an increasing rate of successful resuscitations inside the hospital (up to 27%) has been reported in the literature. In consequence of our findings, refresher courses in specific CPR techniques must be demanded, which should be made obligatory for nursing staff every 2 years. Qualified nursing personnel routinely trained in CPR and supported by effective hospital logistics is essential if the life-saving benefits of modern CPR are to be provided to our patients.

Humans↗
PubMed2000

[Surgical treatment possibilities of advanced carpal collapse (SNAC/SLAC wrist)].

Longstanding and untreated scaphoid fractures and scapholunate dissociations lead to painful destruction of the wrist with carpal collapse. The severity of degenerative arthrosis is classified in three stages and can be treated adequate operatively. SNAC wrist (scaphoid nonunion advanced collapse) after failed fusion of the scaphoid and SLAC wrist (scapholunate advanced collapse) after scapholunate dissociation should be differentiated. The reconstruction of the scaphoid or scapholunate ligament in stage II and III is no reasonable option. Motion preserving procedures such as proximal row carpectomy or midcarpal arthrodesis are preferable in this situation. Thirty-one male patients (average 41 years) were treated for SNAC or SLAC wrist with midcarpal arthrodesis. All patients were reexamined, the mean follow-up was 15 months. Grip strength was measured with the Dexter-System, pain was evaluated by a visual analogue scale (VAS 0-100). Patients' daily activities and general quality of life were estimated with the DASH-questionnaire. Pain was reduced to 50% compared to the preoperative situation. Grip strength improved to 60% of the opposite side. Active range of motion reached 50% of the contralateral wrist. Total DASH-score reached 39.0. Nonunion at the fusion site necessitated additional surgery in four patients resulting in total wrist arthrodesis. 80% of the patients returned to their original occupation. Midcarpal fusion is a reliable procedure for treating the difficult condition of advanced carpal collapse if proper realignment of the carpus is performed. The DASH-score reflects the subjective impressions of the patients in daily life and justifies the choice of a salvage procedure preserving wrist mobility. Total wrist fusion represents the last line of defense.

Adult↗
PubMed2005

[Apraxias].

Apraxias are deficits in higher motor behaviour that are not primarily caused by elementary deficits of the sensorimotor system, communication problems, or dementia. These patients present with deficits such as imitating meaningful or meaningless gestures and in dexterity or purposeful use of objects. The different forms of apraxia originate from lesions of different levels/structures of the motor system, reflecting its complexity. Apraxias are caused by deficits in motor programmes generated in the frontal motor areas, in modality-specific higher sensorimotor control, or at the highest level of motor planning and motor conception. The types of apraxia differentially affect activities of daily living and hence show marked differences in the prognosis of recovery and the physiotherapeutic treatment required. Therefore, appropriate diagnosis and treatment of the different forms are of foremost clinical importance.

Apraxias↗
PubMed1999

[Rehabilitation treatment after stroke. An assessment of current status].

A standardized postacute inpatient rehabilitation program (Anschlussheilbehandlung) after stroke is well established in Germany. Yet the needs of patients being admitted to an Anschlussheilbehandlung (AHB) are not completely known. Therefore sociodemographic data, handicap, impairment and neuropsychologic deficits in 200 stroke patients were evaluated before admission to an AHB with different scores (Barthel, modified Rankin Score, NIHSS, HAWIE-R, Wilde, etc.). About half of the patients were still working prestroke. Most patients suffered from several vascular risk factors, which were insufficiently treated, and about a third of the patients had cerebrovascular disease prior to this stroke. At admission to the rehabilitation program the group of patients with severe neurological deficits was small. In average the disability was rather moderate (Rankin = 2.6). Mainly gait and finger dexterity were handicapped. Functional impairment was outweighed by neuropsychological deficits.

Adult↗
PubMed2004

Risk-taking, coordination and upper limb fractures in children: a population based case-control study.

The aim of this population based case-control study was to examine the association between risk-taking behaviour, motor coordination and upper limb fractures in children aged 9-16 years. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. The number for different types of upper limb fractures was 91 for hand, 190 for wrist and forearm and 40 for upper arm. Risk-taking behaviour was determined by a 5-item interview-administered questionnaire. Motor coordination was assessed by the 8-point movement ABC that tests manual dexterity, ball skills as well as static and dynamic balance. Bone mass was assessed by dual energy X-ray absorptiometry (DXA) and metacarpal morphometry. In general, there was heterogeneity by fracture site with regard to associations. Risk-taking behaviour was associated with hand fracture risk but not other fracture sites for downhill cycling behaviour (OR: 2.0/category, 95% CI: 1.1-3.7), dare behaviour (OR: 3.3/category, 95% CI: 1.1-10.0) and total risk-taking score (OR: 2.6/category, 95% CI: 1.3-5.7). Conversely, coordination measures were associated with wrist and forearm fractures only: cutting/threading (OR: 1.2/unit, 95% CI: 1.0-1.4); flower trail (OR: 1.2/unit, 95% CI: 1.0-1.4) and dynamic balance score (OR: 1.1/unit, 95% CI: 1.0-1.2). Backward stepwise analysis selected total risk taking score for hand fracture, and dynamic balance score for wrist and forearm fracture. None of the risk-taking or coordination scores were associated with upper arm fractures. These associations were unchanged following adjustment for bone mass. In conclusion, the propensity to take risks is most strongly associated with hand fracture risk while dynamic balance is most strongly associated with wrist and forearm fracture risk in children. These results inform the development of fracture prevention strategies in children.

Adolescent↗
PubMed2005

Effects of the mGluR2/3 agonist LY354740 on computerized tasks of attention and working memory in marmoset monkeys.

RATIONALE: LY354740 is a recently developed metabotropic glutamatergic receptor 2 and 3 (mGluR2/3) agonist. A high density of mGluR2 has been reported in terminal fields of the perforant path in rodents and humans, suggesting its involvement in cognitive functions mediated by the temporal lobe, including memory. A small number of in vivo studies in rodents have assessed the effects of LY354740 on memory tasks, reporting the induction of impaired memory for spatial orientation in a water maze task and for delayed match and non-match to position in an operant version of these tasks. OBJECTIVE: In the present primate study, we used radioautography to describe the distribution and intensity of (3)H-LY354740 binding in the hippocampal formation of the common marmoset monkey (Callithrix jacchus) relative to the rat. In the major, in vivo part of the study, the effects of systemic LY354740 on computerized tasks of attention and memory were investigated. METHODS: Adult common marmosets were trained to perform a five-choice serial reaction time (5-CSRT) task and a concurrent delayed match-to-position (CDMP) task from the Cambridge Neuropsychological Automated test Battery (CANTAB). Filter tests of LY354740 effects on motor dexterity and motivation for reward revealed high inter-individual variation in sensitivity; therefore, on the 5-CSRT, subjects were tested at a dose range of 3--10 mg/kg, and on the CDMP, subjects were tested at 1--3 or 3--10 mg/kg. RESULTS: Radioautography revealed a relatively low level of (3)H-LY354740 binding in the marmoset hippocampal formation compared to the rat. Despite low binding, LY354740 reduced sustained-attention accuracy in the 5-CSRT, and reduced accuracy in two stages of the CDMP. CONCLUSIONS: The current study provides novel evidence for the importance of mGluR2/3 in the regulation of primate cognitive functioning.

Animals↗
PubMed2001

The relative contributions of ecstasy and cannabis to cognitive impairment.

RATIONALE: (+/-)-3,4-methylenedioxymethamphet-amine (MDMA; 'ecstasy'), a commonly used recreational drug, has typically been found to be related to poor cognitive function in humans. However, cannabis consumption may not have been adequately controlled for in these studies. OBJECTIVE: The present study was designed to further elucidate the relation between MDMA and cannabis in cognitive impairment. METHODS: Subjects who had used neither MDMA nor cannabis (controls; n=31), cannabis but not MDMA (cannabis users; n=18) and both MDMA and cannabis (MDMA/cannabis users; n=11) were compared on a battery of neuropsychological tests. RESULTS: The cannabis and MDMA/cannabis groups did not differ on any of the tests, whereas the combined cannabis and MDMA/cannabis groups performed more poorly than controls on tests of memory, learning, word fluency, speed of processing and manual dexterity. Further, apart from speed of processing where higher MDMA consumption predicted slower processing, covariate analysis revealed that the deficits were more closely related to cannabis than MDMA usage. CONCLUSION: The results suggest that cannabis is an important confound in studies of MDMA-related cognitive impairment, and that previously reported cognitive impairment in MDMA users may have been caused by coincident cannabis use.

Adolescent↗
PubMed2003

Transcranial magnetic stimulation reveals asymmetrical efficacy of intracortical circuits in primary motor cortex.

The efficacy of inhibitory and excitatory intracortical circuits acting on the representation of an intrinsic hand muscle in the primary motor cortex of both hemispheres was measured with paired transcranial magnetic stimuli in right-handed subjects. Both intracortical inhibition (measured with an interstimulus interval of 3 ms) and intracortical facilitation (measured with an interstimulus interval of 16 ms) developed more rapidly with increasing conditioning stimulus intensity in the dominant than the non-dominant hand. We conclude that the intracortical circuits in the primary motor cortex are more potent in the dominant than the non-dominant hemisphere, and hypothesize that this difference is a factor in the asymmetrical dexterity associated with hand preference.

Adolescent↗
PubMed2004

Functional modulation of shoulder girdle stability.

We have previously reported that electrical stimulation of the ulnar nerve at group I strength evokes reflex excitation of the trapezius muscle in normal human subjects. In the present study this reflex has been evoked while subjects were performing a number of different tasks. When subjects performed a task involving a high degree of manual dexterity, the reflex was larger. On the other hand, when subjects performed a task that can be achieved with virtually no movement of the hand or wrist musculature, the reflex does not appear to show any task dependency. These results support the view that in delicate tasks of the hand, such compensatory reflexes are more important than in basic mechanisms such as lifting an object. The functional consequences of these findings and their significance in relation to the possibility that these task-related reflex gain changes produce intention tremor is discussed.

Adult↗