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PubMed1981

Blunt trauma and liver abscess.

Three cases of pyogenic liver abscess following blunt trauma to the torso are described. The association between blunt trauma with liver contusion and the development of bacterial pyogenic liver abscess is explored. Reported series of liver abscess are reviewed. It is suggested that physicians look for the development of liver abscess in patients who have had major blunt trauma to the torso. Physicians should also inquire about blunt trauma in patients with documented pyogenic liver abscesses.

Abdominal Injuries↗
PubMed1980

Skeletal muscle strength during exposure to hypobaric hypoxia.

To assess the effects of acute exposure to hypobaric hypoxia and acute mountain sickness (AMS) on skeletal muscle strength, 10 healthy young men were studied before, during, and after a 48-h sojourn at a simulated altitude of 4,572 m (15,000 feet). Measurements were made of isokinetic (180 degrees, 36 degrees, and 0 degrees/s) knee extensor strength; isometric strength of upper torso, knee, and trunk extensor muscles; and strength endurance of knee extensor and elbow flexor muscles during a bout of repeated isokinetic contractions. There were no significant differences between strength measurements at sea level and after 2 and 24 h of hypoxic exposure. After 48 h of exposure, means of strength measurements were increased relative to sea-level values but the difference was statistically significant in the case of only one test; namely, isometric strength of the upper torso. Strength endurance was unchanged throughout the exposure. Symptoms of AMS were absent after 2 h, most pronounced after 24 h, and although somewhat reduced, still present to a significant extent after 48 h of hypoxia. Thus, despite the occurrence of AMS, muscle strength was unimpaired during acute hypoxic exposure.

Adult↗
PubMed1995

Role of homeodomain protein binding region in the expression of Drosophila proliferating cell nuclear antigen gene: analysis with transgenic flies.

The regulatory region of Drosophila proliferating cell nuclear antigen (PCNA) gene consists of a promoter region (-168 to +24 with respect to the transcription initiation site) and an upstream region containing three homeodomain protein binding sites (HDB) (-357 to -165). The PCNA gene regulatory regions with HDB (-607 to +137) or without HDB (-168 to +137) were fused with the lacZ and transgenic flies were established by P-element-mediated transformation. Male transgenic flies were crossed with wild-type females, and zygotic expression of the lacZ was monitored by quantitative beta-galactosidase assay, at various stages of development. Expression of the lacZ was high in embryos, first and second instar larvae, and adult females, and low at other stages of development. Only a marginal difference in expression was observed between flies carrying the homeodomain protein binding region and those not carrying it. Spatial pattern of the lacZ expression in the embryo visualized by immunostaining with the anti-lacZ antibody was similar to the distribution of the endogenous PCNA protein. Here, too, only a marginal difference was observed between transgenic flies carrying two different constructs of the PCNA lacZ. In genetic crossing experiments of transgenic flies with those carrying mutation in homeobox genes, no significant change in the lacZ expression pattern was observed. However, when male transgenic flies were crossed with female flies homozygous for a torso gain-of-function allele, repression of the lacZ expression was observed in the central region of the embryo. Because these local changes in the lacZ expression depend on the homeodomain protein binding region, unidentified homeodomain proteins are probably involved. Our results suggest that the promoter region is practically sufficient for expression of the PCNA gene and that the homeodomain protein binding region functions as a silencer when torso is activated ectopically.

Animals↗
PubMed1993

Standardization in reduction mammaplasty: a comparison of techniques.

Reduction mammaplasty is enhanced by the use of more than one technique. By comparing the results of my reduction mammaplasties, over the past 20 years, aided by computer imaging and standardization. I set up some guidelines. The following parameters were selected: age, size of breast, weight, torso build, skin tone and texture, skin color, hereditary factors, degree of ptosis, and the patient's size request. The postoperative evaluations are based on volumetric reduction of size, appearance of scar, geometric appearance of the breasts in harmony with the torso build, nipple position, and patient satisfaction. These comparisons enabled me to provide recommendations for a variety of techniques to address the needs of different patients.

Adolescent↗
PubMed1996

Fluid resuscitation of the trauma patient: how much is enough?

Patient management in the prehospital resuscitative phase after trauma is vitally important to the outcome. Early definitive care remains the essential element in improving morbidity and mortality. In Canada, where a large proportion of trauma occurs at sites distant from a trauma centre, the prehospital resuscitative phase is long and has even greater potential to affect outcome. Conventional teaching about the end points of resuscitation has promoted the concept of normalization of hemodynamic parameters with maintenance of end-organ perfusion, as measured by the hourly urine output. Recent work in patients with a closed head injury and in patients with penetrating torso trauma challenge the notion that trauma patients are homogeneous with respect to these end points. In the Canadian setting of blunt injury, where a closed head injury is usually suspected and often present, the evidence from clinical studies suggests that an aggressive approach to maintaining blood pressure is warranted. In penetrating torso injury in an urban setting, there is evidence to suggest that delaying resuscitation until hemorrhage is controlled is beneficial. More Canadian clinical trials are required in this area. In the meantime, the priorities of resuscitation must be carefully assessed for each patient and pattern of injury.

Canada↗
PubMed1996

bowel, an odd-skipped homolog, functions in the terminal pathway during Drosophila embryogenesis.

The terminal genes of Drosophila specify non-segmented regions of the larval body that are derived from the anterior and posterior regions of the early embryo. Terminal class genes include both maternal-effect loci (typified by the receptor tyrosine kinase torso) that encode components of a signal transduction cascade and zygotic genes (e.g. tailless and huckebein) that are transcribed at the poles of the embryo in response to the local activation of the pathway. We have characterized a zygotic gene, bowel, that was identified as a zinc finger homolog of the pair-rule segmentation gene odd-skipped. bowel transcripts are initially expressed at both poles of the blastoderm embryo and in a single cephalic stripe. This pattern depends upon torso and tailless activity, but is not affected in huckebein mutants. We isolated and sequenced five mutations that affect the bowel protein, including a nonsense mutation upstream of the zinc fingers and a missense mutation in a putative zinc-chelating residue. bowel mutants die as late embryos with defects in terminal derivatives including the hindgut and proventriculus. Our results indicate that the developmental roles of odd-skipped and bowel have diverged substantially, and that bowel represents a new member of the terminal hierarchy that acts downstream of tailless and mediates a subset of tailless functions in the posterior of the embryo.

Amino Acid Sequence↗
PubMed1996

Distributed moment histogram: a neurophysiology based method of agonist and antagonist trunk muscle activity prediction.

A neurocortical-based technique of muscle recruitment is presented to solve the muscle indeterminacy problem for lumbar torso modeling. Cortical recordings from behaving primates have established motor cortex cells that respond to a wide range of task directions, but are tuned to a preferred direction. A characteristic activity pattern of these neurons seems to be associated with effort direction. It was hypothesized that a model which recruits muscles based on a similar distribution would predict antagonistic muscle activity with greater realism than a widely referenced optimization formulation. The predictions of the Distributed Moment Histogram (DMH) method were evaluated under common speed (< 30 degrees s-1) sagittal plane lifting conditions using five subjects. The predicted forces showed high correspondence with agonist and antagonist myoelectric patterns. The mean coefficient of determination for the erector spinae was r2 = 0.91, and 0.41 for the latissimus. For the antagonistic muscles, the rectus abdominus was found to be electrically silent (< 3% MVC) and no activity was predicted by the method. The external oblique muscle was observed to be minimally active (< 16% MVC), and the DMH method predicted its mostly constant activity with a mean standard error of 1.6% MVC. The realistic antagonistic predictions supported the hypothesis and justify this cortical based technique as an alternative for muscle tension estimation in biomechanical torso modeling. A primary advantage of this method is its computational simplicity and direct physiologic analog.

Abdominal Muscles↗
PubMed1997

Blunt hepatic injury in adolescents: age makes a difference.

This analysis of mortality from blunt hepatic injury was performed to define outcome in the adolescent age group in relation to that recorded for children and adults. Children (age 0-10 years) were selected from a multi-institutional trauma registry, adults (age > or = 21 years) from the registry of a Level I trauma center, and adolescents (age 11-20 years) from both. Groups were compared by injury frequency, proportion of severe hepatic injuries (code 864.03 or 864.04 in the International Classification of Diseases, Adapted for Use in the United States 9-CM), immediate laparotomy, mortality, and cause of death. Children had the lowest proportion of severe injury and overall mortality. Torso trauma was the primary cause of death in only three children. Adolescent injury patterns were similar to those of adults in the proportion of severe visceral disruption and incidence of fatal torso trauma. Immediate laparotomy was employed almost twice as commonly in adults as in adolescents. The 64 per cent of adolescents who did not undergo laparotomy had a lower mortality than those who did. Conversely, the 36 per cent of adults without exploration had a significantly higher mortality, which usually occurred before laparotomy could be initiated. Increasing hepatic injury severity brought increasing mortality; however, the cause of death differed with age. Although the incidence of severe liver injury did not differ between adolescents and adults, management and outcome did. These data indicate that individualized management based on overall patient status remains the best approach to care of these injuries.

Adolescent↗
PubMed1998

Effect of truncated projections on defect detection in attenuation-compensated fanbeam cardiac SPECT.

UNLABELLED: For some camera systems used in cardiac SPECT, the limited field of view of fanbeam-collimated detectors produces truncation in the projection data. This truncation may generate artifacts and distortions in the transmission CT images and in the attenuation-corrected myocardial SPECT images (that use the transmission CT images as attenuation maps), thus affecting clinical diagnosis. Concern over this problem stimulated us to evaluate the effect of truncation with human observer performance studies. METHODS: A three-dimensional mathematical cardiac-torso phantom that realistically models the attenuation and 201Tl uptake distributions in different organs of the upper torso was used for the investigation. Five degrees of truncation (from 0% to 40% truncation) in the projection data were simulated by the use of five different detector sizes collimated by fanbeam collimators. The attenuation maps were obtained by reconstructing the truncated transmission data generated from these fanbeam geometries. The emission data obtained with the same fanbeam geometries were reconstructed by using the maximum likelihood-expectation maximization algorithm and were corrected for attenuation using the reconstructed attenuation maps. Two observer performance studies were performed. In Study 1, the images were reconstructed without using the body contour as support, whereas in Study 2, the exact body contour was used in reconstructing both the attenuation maps and the attenuation-corrected SPECT images. RESULTS: The results of the receiver operating characteristics analysis indicate that there is very little difference between detection for the various degrees of truncation, and this difference only becomes noticeable for severe truncation of greater than 40%. CONCLUSION: Using the acquisition and processing methods, we found the use of the body contour as support in reconstructing truncated transmission CT and SPECT data reduces the loss of defect detectability in attenuation-compensated myocardial SPECT images due to truncated data.

Algorithms↗
PubMed1997

Knee kinematics in-vivo of kneeling in deep flexion examined by bi-planar radiographs.

Squatting and kneeling are important daily activities for Middle and Far East cultures that require positioning the knee in deep flexion. In these activities, the limb becomes fully flexed with a knee flexion angle reaching between 150 and 160 degrees and the heel reaching the posterior surface of the upper thigh. Existing knee prostheses do not allow a full return to normal activities for this large population since they are limited to achieving knee flexion of about 120 degrees. Also, there is very limited information on knee kinematics and/or forces in the range beyond 120 degrees. The purpose of this study is to describe the kinematics of normal knees in-vivo, assessed in deep flexion, using bi-planar radiographs. A-P and lateral views were obtained from 5 healthy subjects during three sequential positions of kneeling. In the 1st position, the subject knelt with the knees fully flexed (deep flexion between 150 degrees and 160 degrees) and torso upright. In the 2nd position, the subject bowed forward to an intermediate position (about 120 degrees of knee flexion). In the 3rd position, the subject bowed further until his/her head touched the floor, supporting the upper torso with hands and attaining a knee flexion of about 90 degrees. The results show that past 135 degrees of knee flexion, the patella was found to clear the femoral groove and was in contact only with the condyles. The results also show that the classical femoral "roll back" does not appear to occur in deep flexion. It seems that the lateral femoral condyle rolls over the postero medial aspect of the lateral tibial plateau while contact of the medial femoral condyle occurs more anteriorly, but still in the posterior aspect of the medial tibial plateau. This asymmetric rolling motion implies an element of internal tibial rotation. Furthermore, the tibia was found to articulate with the femur at the most proximal points of the condyles in deep flexion. These data on the kinematics and contact characteristics of the tibio-femoral joint must be considered in any approach to design for a Deep Flexion Knee Implant.

Biomechanical Phenomena↗
PubMed1998

Kinematic response of the neck to voluntary and involuntary flexion.

METHODS: The dynamic head-neck responses of human subjects and cadavers undergoing involuntary impact loading conditions have been studied extensively in order to define the kinematics of the neck undergoing rapid movements, but little detailed information is available regarding slower, voluntary motions. In this study, the dynamic kinematics of head/neck complex during subject-controlled, or voluntary head motion have been investigated to compare with the kinematics to involuntary response. Five male human subjects experienced two-types of posterior/anterior neck flexion: flexion initiated under their own volition, and flexion in response to -15Gx acceleration of the torso. Tri-axial photo target mounts were placed on a custom-fit plate at the mouth, on the first thoracic vertebra, and on the sled. High speed movie cameras captured the photo target motion. Linear and angular displacement and velocity of the head and T1 and sled were computed using customized data-processing software. The neck kinematics were represented by a 2-pin linkage which connected the anatomical origins of the head and T1. RESULTS: The results show that maximum neck flexion relative to the torso was not significantly different between the voluntary and involuntary head motions, but that the head motion was significantly greater during the involuntary sled maneuvers. Maximum flexion velocities of 450 and 1236 degrees x s(-1) were sustained during the voluntary and involuntary maneuvers, respectively. CONCLUSION: These findings are important in understanding the kinematics of the human head/neck complex undergoing rapid and slow movements, and will be valuable in future studies determining a realistic physiological performance corridor for the human neck.

Acceleration↗
PubMed1998

Correlation of alcohol intoxication with life-threatening assaults.

The number of violent crimes has increased substantially over the past decade with an associated increase in injury-related mortality. The influence of alcohol intoxication on accidents involving motor vehicles has been investigated extensively, but few studies have examined the influence of alcohol and drug intoxication on life-threatening assaults. This study examined the correlation of alcohol intoxication with life-threatening victimization by penetrating torso trauma. Retrospective evaluation of patients presenting with penetrating nonmissile anterior torso trauma to an urban Level 1 trauma center between January 1988 and December 1991 was performed. Serum ethanol levels and urine toxicology studies were assessed at initial presentation for all patients. Sixty-two patients with anterior abdominal stab wounds were evaluated, of which 51 (82%) were male. Ethnic distribution paralleled that of the surrounding community, with 50 (81%) African-American, 8 (13%) Latino, and 4 (6%) white patients. The mean age was 32 years. Fifty-two (84%) patients tested positive for alcohol, with 39 (63%) having serum levels of ethanol above the legal intoxication limit. Twelve (19%) patients tested positive for cocaine on urine toxicology screen. Polysubstance use was evident in 10 (16%) patients with positive test results for both alcohol and cocaine. These data demonstrate a strong correlation between alcohol use and life-threatening assaults.

Abdominal Injuries↗
PubMed1998

[Nerve cell damages in whiplash injuries. Animal experimental studies].

Mechanical loading of the cervical spine during car accidents often lead to a number of neck injury symptoms with the common term Whiplash Associated Disorders (WAD). Several of these symptoms could possibly be explained by injuries to the cervical spinal nerve root region. It was hypothesised that the changes in the inner volume of the cervical spinal canal during neck extension-flexion motion would cause transient pressure changes in the CNS as a result of hydro-dynamic effects, and thereby mechanically load the nerve roots and cause tissue damage. To test the hypothesis, anaesthetised pigs were exposed to experimental neck trauma in the extension, flexion and lateral flexion modes. The severity of the trauma was kept below the level where cervical fractures occur. Transient pressure pulses in the cervical spinal canal were duly recorded. Signs of cell membrane dysfunction were found in the nerve cell bodies of the cervical spinal ganglia. Ganglion injuries may explain some of the symptoms associated with soft-tissue neck injuries in car accidents. When the pig's head was pulled rearward relative to its torso to resemble a rear-end collision situation, it was found that ganglion injuries occurred very early on in the neck motion, at the stage where the motion changes from retraction to extension motion. Ganglion injuries did not occur when pigs were exposed to similar static loading of the neck. This indicates that these injuries are a result of dynamic phenomena and thereby further supports the pressure hypothesis. A Neck Injury Criterion (NIC) based on a theoretical model of the pressure effects was developed. It indicated that it was the differential horizontal acceleration and velocity between the head and the upper torso at the point of maximum neck retraction that determined the risk of ganglion injuries.

Animals↗
PubMed1989

Congenital smooth muscle hamartoma. A report of six cases and a review of the literature.

Congenital smooth muscle hamartoma (CSMH) represents a proliferation of randomly oriented dermal smooth-muscle bundles. Six patients with CSMH were observed, the largest series to date, and the literature was reviewed. Congenital smooth muscle hamartoma has presented as congenital patches or slightly indurated plaques with prominent overlying hair (88% of cases), or rarely as patches with perifollicular papules without prominent hair (12% of cases). Most lesions (61% of cases) have been somewhat hyperpigmented, but 39% of cases have been flesh colored. Congenital smooth muscle hamartoma has occurred on the torso and proximal extremities, except for one case on the eyebrow and eyelid (present study). A positive pseudo-Darier's sign (temporary induration or piloerection after rubbing) helped to differentiate CSMH from congenital hairy nevo-cellular nevus. Congenital smooth muscle hamartoma is a distinct entity that is at one end of a spectrum that includes Becker's nevus, and should be considered in the differential diagnosis of any congenital hairy lesion.

Biopsy↗
PubMed2004

The safety and efficacy of the 308-nm excimer laser for pigment correction of hypopigmented scars and striae alba.

OBJECTIVE: To assess the safety and efficacy of the 308-nm excimer laser in pigment correction of hypopigmented scars and striae alba. DESIGN: Institutional review board-approved randomized controlled trial. SETTING: Private research center. PATIENTS: Volunteer sample of 31 adult subjects with hypopigmented scars or striae alba distributed on the face, torso, or extremities. INTERVENTIONS: Lesions were randomized to receive treatment or not, with site-matched normal control areas. Treatments were initiated with a minimal erythema dose minus 50 mJ/cm(2) to affected areas. Subsequent treatments were performed biweekly until 50% to 75% pigment correction, then every 2 weeks thereafter until a maximum of 10 treatments, 75% increase in colorimetric measurements, or 100% visual pigment correction. MAIN OUTCOME MEASURES: Pigment correction by visual and colorimetric assessments compared with untreated control lesions and site-matched normal skin before each treatment and at 1-, 2-, 4-, and 6-month follow-up intervals. Occurrence of erythema, blistering, dyspigmentation, or other adverse effects was monitored. RESULTS: The percentage pigment correction by both assessments increased in direct proportion to the number of treatments. The mean percentage pigment correction by visual assessment relative to control of 61% (95% confidence interval [CI], 55%-67%) for scars and 68% (95% CI, 62%-74%) for striae was achieved after 9 treatments. The mean percentage pigmentation by colorimetric measurements relative to control of 101% (95% CI, 99%-103%) for scars and 102% (95% CI, 99%-104%) for striae was achieved after 9 treatments. Both sets of values gradually declined toward baseline levels during the 6-month follow-up. No blistering or dyspigmentation occurred. CONCLUSIONS: Therapy with the 308-nm excimer laser is safe and effective in pigment correction of hypopigmented scars and striae alba. Mean final pigment correction rates relative to control sites of approximately 60% to 70% by visual assessment and 100% by colorimetric analysis were observed after 9 treatments administered biweekly. Maintenance treatment every 1 to 4 months is required to sustain the cosmetic benefit.

Abdomen↗
PubMed1980

Choreic movements induced by the use of methadone.

A 25-year-old man received methadone hydrochloride maintenance therapy for heroin addiction. Choreic movements involving the upper limbs, torso, and speech mechanisms developed. Discontinuation of methadone resulted in complete alleviation of the abnormal movements with no recurrence during the subsequent eight months. To our knowledge, this is the first recorded instance of a movement disorder induced by an opiate. The mechanisms by which drugs may after neurotransmitter relationships in the brain and produce symptoms of this type are discussed.

Adult↗
PubMed1981

Diabetic truncal polyneuropathy.

Diabetic truncal polyneuropathy is a clinical entity characterized by sensory deficit in the distribution of the thoracic intercostal nerves. The sensory loss is relatively symmetric and involves multiple thoracic dermatomes, beginning close to the anterior midline. Diabetic truncal polyneuropathy occurs in patients with advanced distal polyneuropathy involving the limbs. This entity is important because it can be confused with myelopathies that produce sensory levels over the torso. Moreover, recognition of diabetic truncal polyneuropathy is important since this disorder is associated with autonomic neuropathy.

Adult↗
PubMed1980

Amikacin treatment of Pseudomonas-caused corneal ulcer.

A Pseudomonas-caused corneal ulcer developed in a 44-year-old man with severe facial and upper torso thermal burns while in the hospital burn unit. The infecting strain was resistant to most antibiotics, including gentamicin sulfate and tobramycin sulfate. Treatment with topical and parenteral amikacin sulfate resulted in rapid healing. To our knowledge, there have been no reports of the use of amikacin for corneal ulcer. The successful healing in this case suggests that the use of amikacin should be considered in the treatment of corneal ulceration when it is suspected that the pathogen is a Pseudomonas strain resistant to gentamicin and other commonly used antibiotics.

Adolescent↗