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PubMed1990

Evolution of neuropsychological changes after partial callosotomy in intractable epilepsy.

Early neuropsychological changes following partial anterior callosotomy were evaluated in 15 patients with epilepsy (10 secondary generalized and 5 Lennox-Gastaut syndromes) by comparing their performances 1 month before surgery and then 15-20 and 90-100 days postoperatively without modifying the anticonvulsant treatment. The following neuropsychological and motor functions were tested: memory, attention, visuo-motor ability, posture, motor dexterity, language, praxis and gnosis. Social behaviour was also investigated. The main results are as follows: (i) most cognitive functions showed no significant variation; (ii) motor organization was still slightly impaired at the second check-up after the surgery; (iii) improvements in social behaviour and posture were frequently observed at the final evaluation. The analysis of individual cases highlights the influence of the extent of commissurotomy, lesions related to the surgical procedure and preoperative brain damage in determining the post-surgical profile. On this basis, the short-term neuropsychological cost of partial callosotomy appears to be low and seems to depend mostly on surgical parameters and brain conditions before the operation.

Adolescent↗
PubMed1994

Emerging medical applications of virtual reality: a surgeon's perspective.

Medical applications for virtual reality (VR) technologies are just beginning to emerge. These include VR surgical simulators, telepresence surgery, complex medical database visualization, and rehabilitation. These applications are mediated through the computer interface and embody VR as an integral part of a paradigm shift in the field of medicine. The Green Telepresence Surgery System consists of two components, the surgical workstation and the remote worksite. At the remote site there is a 3-D camera system and responsive manipulators with sensory input. At the workstation there is a 3-D monitor and dexterous handles with force feedback. The VR surgical simulator is a stylized recreation of the human abdomen with several essential organs. Using a head-mounted display and DataGlove, a person can learn anatomy from a new perspective by 'flying' inside and around the organs, or can practice surgical procedures with a scalpel and clamps. Database visualization creates 3-D images of complex medical data for new perspectives in analysis. VR applications in rehabilitation medicine permit impaired individuals to perform tasks not otherwise available to them, allow accurate assessment and therapy for their disabilities, and help architects understand their critical needs in public or personal space. And to support these advanced technologies, the operating room and hospital of the future will be first designed and tested in virtual reality, bringing together the full power of the digital physician.

Computer Graphics↗
PubMed1994

Automatic fracture reduction with a computer-controlled external fixator.

The reduction of fractures by means of an Ilizarov's fixator is obtained by successively shortening or lengthening the rods. This entails that all reduction operations of the fracture stumps be performed with a series of empirical attempts, requiring great experience and manual dexterity in the surgeon. Moreover this process involves a long exposure of both physician and patient to potentially harmful radiation due to the continuous checking of the intermediate positions on the X-ray image intensifier. In order to overcome these limits a new device has been conceived, based on the application of three stepper-motors on three-rods. Its basic principle is functionally very similar to Ilizarov's prototype. The relative motions between the two frames are carried out by controlling the three actuators with a computer, which processes the number of required steps on the basis of an algorithm, starting from a few inputs supplied by the surgeon. This article illustrates the functional kinematic study necessary for the complete automation of the reduction process. Also considered is the complex problem of the reduction trajectory definition, intended as a sequence of configurations of partial correction, obtained by formalizing in geometrical terms the empirical criteria followed by the orthopaedic surgeon in reducing fractures. Such a sequence is intended to be a suggestion for the surgeon who can visualize and possibly interact with the system to determine a trajectory harmless for the soft tissues surrounding the bone.

External Fixators↗
PubMed2005

Normal IQ in a 55-year-old with newly diagnosed rhombencephalosynapsis.

Rhombencephalosynapsis (RS) is a rare congenital disorder characterized principally by agenesis/hypogenesis of the cerebellar vermis and fusion of the dentate nuclei and cerebellar hemispheres. Fusion of the peduncles and colliculi is common, and associated anomalies of the cerebral hemispheres also can be present. Only about 50 cases with RS have been described and the majority of these have been children. While the literature suggests that RS often is associated with behavioral and/or intellectual impairment, no previous report has described overall neuropsychological functioning. This report describes an employed male who was diagnosed with RS by MRI at age 55. The neurological examination revealed only subtle sensory-motor abnormalities and the results of the neuropsychological evaluation were generally within normal limits, with the exception of poor immediate visual memory and motor dexterity. These findings suggest RS is not inevitably associated with substantial cognitive impairment.

Cerebellar Diseases↗
PubMed2006

Standardized assessment of cognitive functioning during development and aging using an automated touchscreen battery.

This study examined the effects of age, gender and education on subjects spanning nine decades on a new cognitive battery of 12 tests. One thousand and seven participants between 6 and 82 completed the battery under standardized conditions using an automated, computerized touchscreen. Sensitive indicators of change were obtained on measures of attention and working memory, learning and memory retrieval, and language, visuospatial function, sensori-motor and executive function. Improvement tended to occur through to the third and fourth decade of life, followed by gradual decrement and/or stabilized performance thereafter. Gender differences were obtained on measures of sustained attention, verbal learning and memory, visuospatial processing and dexterity. Years of education in adults was reflected in performance on measures of verbal function. Overall, the test battery provided sensitive indicators on a range of cognitive functions suitable for the assessment of abnormal cognition, the evaluation of treatment effects and for longitudinal case management.

Adolescent↗
PubMed2005

Long-term results of phototherapeutic keratectomy with 193-nm excimer laser for macular corneal dystrophy.

PURPOSE: To investigate functional and morphologic long-term outcome of phototherapeutic keratectomy (PTK) in macular corneal dystrophy. DESIGN: Retrospective, clinical single-center study. METHODS: Between October 1990 and February 2004, 10 eyes (five oculus dexter, five oculus sinister) of 6 patients (mean age, 23 +/- 8 years [range, 15 to 37 years]) with superficial plaque-like opacities that were caused by macular corneal dystrophy were included. After epithelial debridement and pannus removal, PTK was performed with the 193 nm MEL 60 excimer laser. Intended laser ablation depth varied from 20 to 100 microm; the repetition rate was 20/s or 25/s, and the pulse number was 1774 +/- 502 (range, 976 to 2422). Mean follow-up was 4.5 +/- 3.1 years [maximum, 8.7 years]). Main outcome measures included: uncorrected visual acuity, best corrected visual acuity (BCVA), spherical equivalent, keratometric central power, keratometric astigmatism and regularity (semiquantitative classification of Zeiss keratometry; scale 0 to 3), postoperative "haze," time interval until complete epithelial closure, recurrence rate, and necessity of subsequent penetrating keratoplasty (PK). RESULTS: BCVA increased from 0.3 +/- 0.2 before the operation to 0.6 +/- 0.1 after the operation; the mean spherical equivalent increased from -0.9 +/- 1.1 diopters to -0.4 +/- 1.8 diopters. Mean keratometric central power decreased from 44.5 +/- 0.7 diopters to 42.5 +/- 0.6 diopters. During follow-up, recurrences occurred in nine eyes (90%) after 3.4 +/- 0.4 years. In six eyes, a PK was performed after an average of 5.0 years (range, 3.7 to 6.7 years). None of the transplants had a recurrence during the follow-up period. CONCLUSION: In superficial opacities that are caused by macular corneal dystrophy, PTK can increase BCVA moderately for a limited period of time. Despite possible complications, primary PK still appears to be the definite therapeutic option for patients with macular corneal dystrophy.

Adolescent↗
PubMed2004

Robotic abdominal surgery.

As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills. However, the limitations of laparoscopy-such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field-have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm. This review discusses data obtained from articles indexed in the MEDLINE database written in English and mapped to the following key words: "surgical robotics," "robotic surgery," "robotics," "computer-assisted surgery," "da Vinci," "Zeus," "fundoplication," "morbid obesity," "hepatectomy," "pancreatectomy," "small intestine," "splenectomy," "colectomy," "adrenalectomy," and "pediatric surgery." A limited subset of 387 publications was reviewed to determine article relevance to abdominal robotic surgery. Particular emphasis was placed on reports that limited their discussion to human applications and surgical outcomes. Included are comments about the initial 202 robotic abdominal surgery cases performed at Johns Hopkins University Hospital (Baltimore, MD) from August 2000 to January 2004. Surgical robotic systems are being used to apply laparoscopy to the surgical treatment of diseases in virtually every abdominal organ. Procedures demanding superior visualization or requiring complex reconstruction necessitating extensive suturing obtain the greatest benefit from robotics over conventional laparoscopy. Whereas advanced surgical robotic systems offer the promise of a unique combination of advantages over open and conventional laparoscopic approaches, clinical data demonstrating improved outcomes are lacking for robotic surgical applications within the abdomen. Outcomes data for surgical robotics are essential given the exorbitant costs associated with the use of these tools.

Digestive System Surgical Procedures↗
PubMed2004

Virtual reality and haptics as a training device for movement rehabilitation after stroke: a single-case study.

OBJECTIVE: To investigate whether training in a virtual environment with a haptic device will improve motor function in the left hemiparetic arm of a stroke subject. DESIGN: Single case, A-B-A design. SETTING: University hospital research laboratory. PARTICIPANT: A man in his late fifties (right handed), with a right-hemisphere lesion that caused a deficit in the left upper extremity. INTERVENTION: The subject trained with a 3-dimensional computer game during a 4-week period that consisted of twelve 90-minute sessions. MAIN OUTCOME MEASURES: Three tests (Purdue pegboard test, dynamometer hand-grip strength, upper-extremity test) and a subjective interview were used to evaluate motor performance. RESULTS: Improvements were found in fine manual dexterity, grip force, and motor control of the affected upper extremity. The subject reported that there was a change in his day-to-day use of the upper extremity and that he was able to use it in activities that were previously impossible for him. CONCLUSIONS: Training with virtual reality and haptics can promote motor rehabilitation.

Activities of Daily Living↗
PubMed2005

Application of robotic-assisted techniques to the surgical evaluation and treatment of the anterior mediastinum.

BACKGROUND: We report our initial experience with the application of robotic-assisted technologies to the treatment of diseases of the anterior mediastinum. METHODS: Between October 2001 and December 2003, 18 consecutive patients with anterior mediastinal masses were referred for diagnosis and treatment. Fifteen patients underwent robotic-assisted surgery with the da Vinci robotic system. A single surgical team performed all operations. Resection was accomplished by either median sternotomy or robotic-assisted techniques. RESULTS: Fourteen patients underwent successful robotic-assisted thymectomy. One patient underwent robotic-assisted biopsy of a mass that was later determined to be a poorly differentiated carcinoma, 3 patients underwent complete thymectomy by median sternotomy for biopsy-proven extracapsular thymoma, 7 patients had thymoma, and 3 had myasthenia gravis. There were 2 patients each with benign thymic cysts and thymic hyperplasia. Primary thymic carcinoid, thymolipoma, papillary thyroid cancer, and poorly differentiated carcinoma were present in 1 patient each. No conversions, intraoperative complications, or deaths occurred in the 15 patients who underwent robotic-assisted resection. The mean operative time was 96 minutes (range 62 to 132 minutes). The mean robotic time was 48 minutes (range 22 to 76). The median hospital stay was 2 days. All patients are doing well, with a median follow-up of 1 year. CONCLUSIONS: Robotic-assisted surgery of the anterior mediastinum, and particularly thymectomy, can be performed safely and efficiently. The increased visualization and instrument dexterity afforded by this technology provides an optimal minimally invasive approach to the anterior mediastinum. From this experience we have formulated a comprehensive treatment algorithm for the surgical evaluation and treatment of patients with anterior mediastinal diseases.

Adult↗
PubMed2005

Cardio navigation: planning, simulation, and augmented reality in robotic assisted endoscopic bypass grafting.

BACKGROUND: The aim of this study is to optimize the set-up and port placement in robotic surgery and enhance intraoperative orientation by video overlay of the angiographic coronary tree. METHODS: In three mongrel dogs and two sheep an electrocardiogram-triggered computed tomographic scan and coronary angiography were performed after placing cutaneous fiducials. The regions of interest (ie, heart, ribs, coronaries, internal thoracic artery) were segmented semiautomatically to create a virtual model of the animal. In this model the target regions of the total endoscopic bypass procedure along the internal thoracic artery and anastomotic area were defined. Algorithms for weighing visibility, dexterity, and collision avoidance were calculated after defining nonadmissible areas using a virtual model of the manipulator. Intraoperatively, registration of the animal and the telemanipulator was performed using encoder data of the telemanipulator by pointing to the fiducials. After pericardiotomy, the reconstructed coronary tree was projected into the videoscopic image using a semiautomatic alignment procedure. In dogs, the total endoscopic bypass procedure was completed on the beating heart. The first human case applying preoperative planning, intraoperative registration, and augmented reality was subsequently performed. RESULTS: The rigid transformation linked the patient's preoperative frame and the robot coordinate frame with a root mean square error of 9 to 15 mm. The predicted port placement derived from the model initially varied from the one chosen due to an incomplete formulation of the weighing procedure. After only a few iterations, the algorithm became robust and predicted a collision free triangle. Video overlay of the angiographic coronary tree into the videoscopic image was feasible. CONCLUSIONS: Surgical planning and augmented reality are likely to enhance robotic surgery in the future. A more complete understanding of the surgical decision process is required to better formalize the planning algorithms.

Algorithms↗
PubMed2006

Experience with the "da Vinci" robotic system for thymectomy in patients with myasthenia gravis: report of 33 cases.

BACKGROUND: Our initial experience in applying robotic-assisted technologies for the treatment of myasthenia gravis (MG) in patients without thymoma is reported. METHODS: from April 2002 to October 2004, 33 patients (24 females and 9 males; mean age, 41 years), with clinical nonthymomatous myasthenia gravis, underwent robotic thoracoscopic thymectomy using the "da Vinci" (Intuitive Surgical, Inc, Mountain View, CA) system and adopting a 3 port, left-sided approach. RESULTS: Mean operative time was 120 minutes. No intraoperative complications or surgical mortality is reported and postoperative complications occurred in two patients (6%). Mean hospital stay was 2.6 days (range, 2-14 days). Histologic analysis of surgical specimens revealed 23 hyperplasia, 4 normal thymus, 4 atrophy, and 2 thymomas; in 12 patients (36.3%) ectopic thymic tissue was found. Follow-up evaluation of the first 24 patients (mean, 23.8 months; range, 12-31 months) showed that 4 patients (16.7%) had complete remission and 18 (75%) had significant clinical improvement for a global benefit rate of 91.7%. CONCLUSIONS: In patients with MG, robot-assisted thymectomy can be performed safely and efficiently. The improved visualization and dexterity of this instrument and its advanced technology may facilitate the minimally invasive approach to the thymus. We prefer to use the left-sided approach because it provides an enhanced visualization of the aortic window and it reduces the probability of phrenic nerves injury. A longer follow-up is necessary to verify long-term clinical results.

Adolescent↗
PubMed2005

Rapid serial naming: relations between different stimuli and neuropsychological factors.

We report two studies on rapid serial naming (RSN). Study 1 addressed the relations among RSN tasks comprising different stimuli. Separate components for RSN of alphanumeric and non-alphanumeric stimuli, as well as for tasks in which the stimuli alternated between categories were identified. In Study 2, phonological skills, processing speed, motor dexterity, and verbal fluency were found to explain RSN performance. The studies indicate: (1) that RSN tasks vary in their properties according to the stimuli used and according to the way the tasks are arranged, and (2) that RSN tasks are multi-componented.

Child↗
PubMed2006

Human umbilical cord blood-derived stromal cell, a new resource of feeder layer to expand human umbilical cord blood CD34+ cells in vitro.

Allogeneic transplantation with human umbilical cord blood (hUCB) in adult recipients is mainly limited by a low CD34+ cell dose. To break the limit, hUCB as a novel source of hUCB-derived stromal cells was incorporated in an attempt to expand CD34+ cells from hUCB in vitro. Cord blood CD34 cells were separated by MACS system. HUCB-derived stromal cells were cultured by the Dexter system and characterized by morphologic, immunophenotypical, and functional analysis. We studied the effects of hUCB-derived stromal cells, cytokines, and hUCB-derived stromal cells combined with cytokines on expansion of hUCB CD34 cells. The CD34+ cells were assessed for the degree of expansion and the number of colony-forming units in semisolid culture. Our research found that hUCB-derived stromal cells were mainly composed of three kinds of cell components, with CD106, CD29, CD44, CD45, CD50, CD68, CD31, Fn, Lm, and collagen IV positive, but CD34 negative immunophenotype. Functionally, it was discovered by cell cycle and growth curve analyses that the capability of colony and parietal layer formation of hUCB-derived stromal cells was poorer than that of BM stromal cells, and the doubling time of hUCB-derived stromal cells was longer than that of BM stromal cells. It was indicated by ELISA and RT-PCR that hUCB-derived stromal cells express higher level of TPO and less GM-CSF and SCF than BM stromal cell. Adherent layer of hUCB-derived stromal cells alone or combining with cytokines, increased CD34+ cell expansion. In vitro formation of CFUs by expanded CCD34 cells was significantly higher than that of unexpanded CD34+ cells (P < 0.05). When cocultured with hUCB-derived stromal cells in the presence of cytokines, cell growth was significantly enhanced: CD34 cells by 8.02 +/- 0.96-fold, CFU-GM by 217.60 +/- 6.72-fold, CFU-E by 1940.80 +/- 52.78-fold, and CFU-Mg by 142.60 +/- 4.39-fold. HUCB-derived stromal cells have significant superiority on the expansion of CFU-Mg (P < 0.05). The results indicate that human umbilical cord blood-derived stromal cells may be a suitable feeder layer for expansion of hematopoietic progenitors from hUCB in vitro.

Antigens, CD34↗
PubMed2006

Precision grip function after hand replantation and digital nerve injury.

Understanding how the loss of digital sensibility affects manual dexterity could have important implications for rehabilitation after hand injury. We investigated precision grip function during lifting tasks in seven patients after hand replantation, in five after single digital nerve injury and in four volunteers subjected to digital anaesthesia. Using their affected hand, all participants could successfully lift test objects with parallel and vertical grip surfaces and they all reliably increased the grip force with increasing object weight (0.11-0.55 kg). However, the grip forces used were frequently significantly higher than those applied by the unaffected hand. This was partly due to participants compensating for loss of sensibility with high grip force safety margins against slips, and partly related to misalignments of the fingertips on the grasp surfaces. The latter was most prominent after hand replantation. In a second series of lifting experiments we changed the shape of the grip surfaces in order to investigate the participants' ability to adapt grip forces based on tactile recognition of object shape. An important finding from this series was that in patients with poor clinical outcomes, the contralateral unaffected hand tended to mirror the abnormal grasp patterns of the injured hand. This suggests that control strategies developed for the impaired hand can influence the control of the contralateral uninjured hand.

Adaptation, Physiological↗
PubMed2006

Photophysics of ANS. I. Protein-ANS complexes: Intestinal fatty acid binding protein and single-trp mutants.

We continue investigations into the physical chemistry of intestinal fatty acid binding protein, I-FABP, and its interaction with ANS and other ligands [cf references [Kirk, W., E. Kurian, and F. Prendergast. 1996. Characterization of the sources of protein-ligand affinity: 1-sulfonato-8-anilinonaphthalene binding to intestinal fatty acid binding protein. Biophys. J. 70: 69-83., Kurian, E., W. Kirk, and F. Prendergast. 1996. Affinity of fatty acid for rRat intestinal fatty acid binding protein: Further examination. Biochemistry. 35:3865-74]. The photophysics of the wt protein is compared with that in two mutants which lack respectively one or the other of two trp moieties, one of which, trp 82, is located near the binding region for the polar head group of ligands. These studies afford a look into how the fluorescence of the wt protein is established, that is, as an almost direct sum of the fluorescence of the two individual trp residues, and how this fluorescence is quenched upon binding to ANS. Though we have access to all the relevant spectroscopic and geometric information necessary to specify in detail the Foerster-Dexter energy transfer model, the quenching process is not explicable in terms of very-weak coupling, as is usually assumed in fluorescence studies in protein systems, but in terms of a stronger effect which goes beyond the simple very-weak dipole:dipole formalism. The quenching of trp emission by bound ANS is not as great as that anticipated by ordinary resonance energy transfer, neither is the quenching observed in the reduced lifetimes of the trp emission upon ANS binding as great as that observed in steady-state intensity. However the observed steady-state quenching is explicable in terms derived from the lifetime measurements, together with observed spectral band shifts, by the exciton coupling model we invoke here.

Amino Acid Sequence↗
PubMed2004

Progressive plastic changes in the hand representation of the primary motor cortex parallel incomplete recovery from a unilateral section of the corticospinal tract at cervical level in monkeys.

After a sub-total hemisection of the cervical cord at level C7/C8 in monkeys, a paralysis of the homolateral hand is rapidly followed by an incomplete recovery of manual dexterity, reaching a plateau after about 40-50 days, whose extent appears related to the size of the lesion. During a few days after the lesion, the hand representation in the contralateral motor cortex disappeared, replaced by representations of either face or more proximal body parts. Later, however, following a time course (about 40 days) consistent with the functional recovery, progressive plastic changes in the contralateral motor cortex took place, as demonstrated by a progressive reappearance of digit movements elicited by intracortical microstimulation. These progressive plastic changes, which parallel the functional recovery, correspond to a reinstallation of a hand representation, though substantially diminished in size as compared to pre-lesion. Regarding the functional recovery, the motor cortex (including the reestablished hand area) contralateral to the unilateral cervical cord lesion played a crucial role in reestablishing control on finger movements, as assessed by reversible inactivation experiments. In contrast, the motor cortex ipsilateral to the cervical cord lesion, with largely intact projections to the spinal cord, did not contribute significantly to the recovered movements by the affected hand. These observations indicate that the CS fibers spared by the lesion are not sufficient, at least in their pre-lesion condition, to control the motoneurones innervating the digit muscles and that the pathways conveying signals from the contralateral M1 underwent reorganization.

Animals↗
PubMed2006

Effects of chronic manganese exposure on cognitive and motor functioning in non-human primates.

Acute exposure to manganese is associated with complex behavioral/psychiatric signs that may include Parkinsonian motor features. However, little is known about the behavioral consequences of chronic manganese exposures. In this study, cynomolgus macaque monkeys were exposed to manganese sulfate (10-15 mg/kg/week) over an exposure period lasting 272+/-17 days. Prior to manganese exposure, animals were trained to perform tests of cognitive and motor functioning and overall behavior was assessed by ratings and by videotaped analyses. By the end of the manganese exposure period, animals developed subtle deficits in spatial working memory and had modest decreases in spontaneous activity and manual dexterity. In addition, stereotypic or compulsive-like behaviors such as compulsive grooming increased in frequency by the end of the manganese exposure period. Blood manganese levels measured at the end of the manganese exposure period ranged from 29.4 to 73.7 micro g/l (mean=55.7+/-10.8 (compared to levels of 5.1-14.2 micro g/l at baseline (mean=9.2+/-2.7)), placing them within the upper range of levels reported for human environmental, medical or occupational exposures. These results suggest that chronic exposure to levels of manganese achieved in this study may have detrimental effects on behavior, cognition and motor functioning.

Animals↗
PubMed2005

Quantification of index tapping regularity after stroke with tri-axial accelerometry.

OBJECTIVE: Quantifying intrinsic components of movement may help to better understand the nature of motor deficits after stroke. Here we quantify the ability of stroke patients to finger tap in rhythm with auditory cues given at physiological rate. METHODS: Using tri-axial accelerometry, we measured tapping regularity (Regularity Index) during auditory-cued index-to-thumb tapping at 1.25 Hz in 20 prospectively selected right-handed chronic stroke patients (mean age 61 yrs) and 20 right-handed healthy subjects (7 young and 13 age matched; mean age 24 and 58 yrs, respectively). With the aim to validate our method, two measures of clinical deficit, the European Stroke Scale (ESS) and the maximum number of index-thumb taps in 15s (IT-Max) were recorded on the same day. RESULTS: There was no effect of age or hand used on the Regularity Index in the control subjects. In patients, the Regularity Index of their affected hand was significantly worse compared to their unaffected hand and to age-matched controls (p<0.05 and p<0.01, respectively). The Regularity Index significantly correlated with the ESS and IT-Max in the clinically expected direction (p=0.025 and 0.001, respectively). CONCLUSION: These data indicate that our method has validity to quantify finger-tapping regularity. After stroke, there is a deficit in the ability to keep pace with auditory cues that correlates, but does not equate, with other indices of motor function. Quantifying tapping regularity may provide novel insights into the mechanisms underlying recovery of finger dexterity after stroke.

Acoustic Stimulation↗