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PubMed1991

T-plasty modification of the Bankart procedure for multidirectional instability of the anterior and inferior types.

Forty patients who had a diagnosis of multidirectional instability of forty-two shoulders had a modified Bankart operation in which a T-shaped incision was made in the anterior portion of the capsule, with advancement of the inferior flap superiorly and of the superior flap medially. All of the patients had been injured during athletic activities. Some degree of anterior labral injury was present in thirty-eight of the forty-two shoulders. Half of the patients had generalized ligamentous laxity. The patients were followed for an average of three years (range, two to seven years). Four patients had episodes of instability after the operation. Three had a single episode of posterior subluxation during throwing, one had recurrent posterior subluxation that subsequently was treated by posterior stabilization, and one had anterior subluxation while he was diving from a high board. The average loss of external rotation after the operation was 5 degrees with the arm at the side and 4 degrees with the arm abducted 90 degrees. Satisfaction of the patient was rated excellent for forty (95 per cent) of the shoulders, good for one shoulder, and fair for one shoulder. However, throwing athletes found that they were unable to throw a ball with as much speed as before the operation.

Adolescent↗
PubMed1986

The biomechanical effects of tight suture closure upon fascia.

The biomechanical effect of tight suture closure of fascial incisions in male rats was evaluated. The incision of rats in group 1 was closed with maximum tension on the first throw of the approximating knot. The incision of rats in group 2 was closed in a similar manner, however a 3.14 squared millimeter rod was placed in the suture loop before securing the first throw. The rod was removed after the knot was formed and fascial edges were observed to be loosely approximated. All rats were sacrificed after seven days. The abdominal fascial and muscle unit was dissected and a 1 by 6 centimeter strip containing two suture loops was excised. Scanning electron microscopic examination of tissue specimens, tensile strength measurements and energy-to-failure under tensile loading studies were performed. Specimens for hydroxyproline assay were obtained from the tissue immediately surrounding the incision and between two suture loops. The scanning electron microphotographs of group 1 showed tissue overlap from the excessive force on the initial knot throws. Wounds loosely approximated had proper alignment of the wound edges and had greater proliferative activity in the clefts of the wounds. The tensile strength and energy-to-failure studies showed loosely approximated wounds to be far stronger (p less than 0.001). No statistically significant difference (p greater than 0.05) was found between hydroxyproline assays of the two groups.

Animals↗
PubMed1987

A modified Bristow-Helfet-May procedure for recurrent dislocation and subluxation of the shoulder. Report of two hundred and twelve cases.

A modified Bristow-Helfet-May procedure was performed for recurrent dislocation or subluxation of the glenohumeral joint in 207 patients (212 shoulders), whose average age at the time of surgery was 20.3 years (range, fourteen to forty-seven years). The procedure was modified by directing the coracoid segment and conjoined tendon over the superior border rather than through the substance of the subscapularis tendon and muscle. The indications were either documented recurrent anterior dislocation of the glenohumeral joint or subluxation with instability as demonstrated on examination with the patient under anesthesia. The procedure was evaluated on the basis of the rate of recurrence of dislocation and subluxation, postoperative complications, the patients' subjective evaluation, and the effect of the procedure on the motion of the glenohumeral joint and the strength of the muscles of the shoulder as related to overhead throwing. Eight (3.8 per cent) of the shoulders redislocated and ten (4.7 per cent) had one or more subjective episodes of subluxation after the procedure. Complications included postoperative infection in two patients and problems with the screw that required its removal in ten. One hundred and thirty-one (62 per cent) of the patients responded to a questionnaire regarding their subjective evaluation of the results of surgery. Eleven (8 per cent) were unable to perform daily activities that involved overhead work, and forty-five (34 per cent) stated that they still had some degree of discomfort or pain in the shoulder. One hundred and twenty-six patients (96.2 per cent) stated that they were happy with the results of the surgery and would have the procedure again. Thirty patients had Cybex testing of the muscles of the shoulder. Only three (16 per cent) of the nineteen athletes whose dominant arm had been operated on returned to their pre-injury level of throwing. Data obtained with regard to changes in the range of motion and strength of the glenohumeral joint indicate that this loss of throwing ability was not due solely to a loss of glenohumeral motion. It appeared to be also related to a concomitant loss of strength at the extreme of external rotation of the humerus and the initiation of internal rotation of the humerus.

Adolescent↗
PubMed1983

[Hygiene problems in inland and sea navigation].

Both waste and sewage disposal are ubiquitous problems which have also affected navigation. Shipping is a very important transport carrier on a worldwide basis which together with the fishing industry employs roughly two million people. The problems associated with waste and sewage disposal obviously present a severe hazard to the coastal areas, narrow sea basins and, in particular, to inland and open-sea waterways. These problems are particularly alarming in large sea-ports, docks without outfall etc. The reduction of the crews aboard the ships operated by the industialised countries has helped to quantitatively ease the problem of waste and sewage disposal caused by the crews. However, passenger steamers with high waste and sewage volumes cause considerable nuisance in small harbours and the same holds for the disposal of technical waste products from ships such as dunnage packing material, ropes, plastic material, oil, etc. The quantity of waste water aboard a sea-going vessel including that from the toilets, washrooms, galley, and cleaning is rather considerable and is estimated at 300 litres per person and day under tropical climates. The volume of waste varies greatly and depends mainly on the type of material used aboard as mentioned above. Passenger liners with a very high volume of kitchen refuse and other solid waste give rise to specially insidious problems. In the past, sea-going vessels as well as ships employed in inland navigation used to throw overboard any type of refuse and sewage. However, during the last few decades the port authorities and also governments have introduced local and national regulations ruling that waste may no longer be thrown into harbour basins, but must be collected and disposed of on shore. Most ships have complied with these provisions, but some of them kept the collected refuse aboard and disposed of it on the open sea outside the harbours. International agreements on the prohibition of emptying oil and oil-containing waste into the sea were reached as early as 1954. The first rigorous provisions on the strict prohibition of discharging sewage and throwing spoilage overboard on the sea were promulgated around 1960 for the Great Lakes (USA and Canada) as well as for some Baltic Sea and Black Sea harbours (USSR). This legislation has been increasingly tightened. The international agreement on the prevention of sea pollution by ships, submitted by the International Maritime Consultative Organization (IMCO) in 1973 and 1978, strictly bans the throwing overboard or discharging of oil, plastic material, stowing and packing materials etc. as well as unperishable substances.(ABSTRACT TRUNCATED AT 400 WORDS)

Fresh Water↗
PubMed1982

[Unusual way of regenerating intestinal epithelium during seasonal intestinal transformation in Stichopus japonicus holothurians (possibility of an "external cambium")].

In Stichopus japonicus during summer months a profound morphofunctional rearrangement of the digestive tract resulting in its renovation is noted. It includes certain destructive-atrophic changes in the wall of the intestinal tube and some reparative processes accompanying them. In some species a spontaneous throwing out of the intestine with its subsequent restoration takes place. The mechanisms of the intestinal tube regeneration after its partial atrophy and after its spontaneous throwing out have much in common between them and with those previously described after an experimental throwing out. It is possible that under natural conditions (as well as under experimental ones) certain forms of wandering cells, migrating from the sublayers and/or from the surrounding structures (mesenterium and others), participate in the regenerative histogenesis of the intestinal epithelium. A suggestion is made that these cells are of coelomesodermal origin and play the role of the external cambium at sharp seasonal rearrangements of the holothurian intestinal tract.

Aging↗
PubMed2004

An education theory-based method to teach a procedural skill.

OBJECTIVE: To determine the effectiveness of an education theory-based method to teach students to place and tie a simple interrupted stitch. DESIGN: A teaching intervention before-after trial. SETTING: Dermatology department, academic university. PARTICIPANTS: Fourth-year medical students and dermatology residents. MAIN OUTCOME MEASURES: Scores on a 12-criterion grading instrument before and after instruction. RESULTS: The scores for medical students and residents in each class showed significant improvement. The mean score for all participants (N = 23) rose by 24% after instruction (P< .001). Scores in 9 of the 12 graded performance areas improved significantly after instruction, including scores in tissue damage/teeth marks (P<.001), needle dulled/bent (P< .001), needle loaded properly and knots square (P = .01), throws done correctly (P = .01), stitch tension and needle entry/exit angle (P = .02), amount of suture used (P = .03), and correct number of throws (P = .04). In addition, participants' confidence increased significantly after instruction (P<.001). No difference was noted between men and women in preinstruction vs postinstruction score improvement. CONCLUSIONS: This teaching method can be effectively used to teach students to place and tie a simple interrupted stitch. Once validated and expanded, it may prove useful in shortening and standardizing procedural skill training and in objectively documenting competency.

Education, Medical↗
PubMed1986

Technique for trouble-free removal of pars plana infusion cannulas.

We describe a simple procedure that facilitates the removal of a pars plana cannula. A 2-cm 4-O black silk suture is passed under the double-throw knot, which secures the infusion cannula. When the ends of the silk suture are pulled, the double-throw knot opens easily, allowing the cannula to be removed.

Catheterization↗
PubMed1986

Enthesopathies (lesions of muscular insertions) as indicators of the activities of neolithic Saharan populations.

Enthesopathies are bony lesions involving the sites of insertion of muscles or ligaments. Those caused by hyperactivity of the relevant muscles may be distinguished clearly from those of metabolic or inflammatory origin. Observations from sporting and occupational medicine indicate that specific enthesopathies are correlated with different activities. Examination of the enthesopathies present on two groups of well-preserved neolithic skeletons from separate regions of the Sahara with different paleoenvironments show that overall 20% of the skeletons presented lesions. Three different forms of enthesopathy involved the arm, principally the elbow, and may be tentatively correlated with javelin throwing, wood cutting, and archery. Two types of lesion involving the foot were observed in skeletons from a hunter-gatherer population and may be correlated with much walking or running over hard ground. I suggest that the analysis of such lesions on ancient skeletons may, in concert with other archaeological data, throw light on the activities of ancient people.

Bone Diseases↗
PubMed1987

Adaptive significance of small body size: strength and motor performance of school children in Mexico and Papua New Guinea.

The postulated superior functional efficiency in association with reduced body size under conditions of chronic protein-energy undernutrition was considered in school children from rural Mexico and coastal Papua New Guinea. Grip strength and three measures of motor performance were measured in cross-sectional samples of children 6-16 years of age from a rural agricultural community in Oaxaca, Mexico, and from the coastal community Pere on Manus Island, Papua New Guinea. The strength and performance of a mixed-longitudinal sample of well nourished children from Philadelphia was used as a reference. The Oaxaca and Pere children are significantly shorter and lighter and are not as strong as the well nourished children. Motor performances of Pere children compare favorably to those of the better-nourished Philadelphia children, whereas those of the Oaxaca children are poorer. Throwing performance is more variable. When expressed relative to body size, strength is similar in the three samples, but the running and jumping performances of Pere children per unit body size are better than the relative performances of Oaxaca and Philadelphia children. Throwing performance per unit body size is better in the undernourished children. The influence of age, stature, and weight on the performance of Oaxaca and Pere children is generally similar to that for well nourished children. These results suggest that the hypothesized adaptive significance of small body size for the functional efficiency of populations living under conditions of chronic undernutrition varies between populations and with performance tasks.

Adolescent↗
PubMed1988

Gluteus maximus muscle function and the origin of hominid bipedality.

Bipedality not only frees the hands for tool use but also enhances tool use by allowing use of the trunk for leverage in applying force and thus imparting greater final velocity to tools. Since the weight and acceleration of the trunk and forelimbs on the hindlimbs must be counteracted by muscles such as m. gluteus maximus that control pelvic and trunk movements, it is suggested that the large size of the cranial portion of the human gluteus maximus muscle and its unique attachment to the dorsal ilium (which is apparent in the Makapan australopithecine ilium) may have contributed to the effectiveness with which trunk movement was exploited in early hominid foraging activities. To test this hypothesis, the cranial portions of both right and left muscles were investigated in six human subjects with electromyography during throwing, clubbing, digging, and lifting. The muscles were found to be significantly recruited when the trunk is used in throwing and clubbing, initiating rotation of the pelvis and braking it as trunk rotation ceases and the forelimb accelerates. They stabilize the pelvis during digging and exhibit marked and prolonged activity when the trunk is maintained in partial flexion during lifting of heavy objects.

Adult↗
PubMed1993

Influence of surgeon's tying technique on knot security.

The purpose of this study was to determine the influence of the surgeon's tying technique on knot security using 0 and 2-0 monofilament and multifilament nylon sutures. Using an Instron Tensile Tester and a portable tensiometer, knot security was achieved with these sutures using four-throw square knots (1 = 1 = 1 = 1). After didactic and psychomotor skill training, medical students were taught to construct the four-throw square knot using either a two-hand tie or an instrument tie. Using the portable tensiometer, their knot tying techniques were judged to be superior to those used by surgeons. The surgeon's faulty technique can easily be corrected by didactic information and psychomotor skill training.

Clinical Competence↗
PubMed1995

Ball experiments in 32 acute akinetic catatonic patients: deficits of internal initiation and generation of movements.

We undertook ball experiments in 32 akinetic catatonic patients in order to determine specific functional deficits in the motor system in akinetic catatonia. Standardized ball experiments (catching, throwing, stopping, kicking) were conducted in 32 acute akinetic catatonic patients (23 without neuroleptics on admission), diagnosed according to Lohr, Rosebush, and the Diagnostic and Statistical Manual of Mental Disorders (3rd ed, revised) on days 0 and 21. Additionally, associated psychopathology was evaluated using different scales on days 0 and 21: the Global Assessment Scale, the Brief Psychiatric Rating Scale, the Hamilton-Anxiety Scale, the scale for the assessment of negative symptoms (SANS), and the Simpson scale for extrapyramidal side effects (SEPS). Significantly more patients were able to perform more externally guided tasks (catching, stopping) than internally guided tasks (throwing, kicking). Patients showed significantly more posturing and awkward movements on day 0 than on day 21. There was a significantly positive correlation between hypokinetic extrapyramidal features (SEPS) and negative symptoms with their cognitive alterations (SANS) on day 0. The findings suggest a deficit of internal initiation, as in parkinsonism, as well as a dysfunction in the generation of voluntary movements in akinetic catatonia. We assume an underactivity in the dorsolateral prefrontal cortex and the supplementary motor area with consecutive down-regulation of the cortical-striatal-thalamic circuit, the "motor loop," in catatonia.

Acute Disease↗
PubMed1993

A portable tensiometer for assessing surgeon's knot tying technique.

The purpose of this study was to determine the influence of surgeon's tying technique on knot security using O and 2-O monofilament and multifilament nylon sutures. By use of an Instron Tensile Tester and a portable tensiometer, knot security was achieved with these sutures using four-throw square knots (1 = 1 = 1 = 1). After didactic and psychomotor skill training, medical students were taught to construct the four-throw square knot using either a two-hand tie or an instrument tie. By use of the portable tensiometer, their knot tying techniques were judged to be superior to those used by a cohort of obstetricians and gynecologists. The surgeon's faulty technique can easily be corrected by didactic information and psychomotor skill training.

Suture Techniques↗
PubMed1989

A comparison between three brands of 10.0 nylon sutures.

10.0 nylon sutures from three different manufacturers were compared on the basis of the scanning electron microscopic aspect, the maximum tensile strength of the thread and the maximum tensile strength of the knot (single throw). Scanning electron microscopy revealed identical surface characteristics and identical diameters (approximately 30 micrometers) for all threads. Threads which had been pulled on became wavy and showed markedly thinned and flattened segments. Maximum tensile strength was measured by a simple device, which is described. The maximum tensile strength of the thread varied considerably between the three brands (from 31.3 gr, S.D. 2.0 gr, to 46.2 gr, S.D. 3.7 gr.) The maximum tensile strength of the knot (single throw) was approximately the same for all three (ranging from 25.9 gr, S.D. 4.1 gr to 28.2 gr, S.D. 2.6 gr).

Microscopy, Electron, Scanning↗
PubMed1996

Poor correlations between isometric tests and dynamic performance: relationship to muscle activation.

The purpose of this research was to perform isometric tests at two joint angles and examine their relationship to dynamic performance. In addition, electromyograph data were collected from the triceps brachii and pectoralis major muscles to compare underlying neural characteristics between the isometric tests and dynamic movement. A group of 24 healthy male subjects performed two isometric tests in a bench press position, at elbow angles of 90 and 120 degrees. From these data, the maximal force and rate of force development were determined. In addition, each subject performed a seated medicine ball throw as a measure of dynamic upper body performance. Correlations showed that isometric measurements of force (r = 0.47-0.55) and rate of force development (r = 0.08-0.31) were poor predictors of dynamic performance. The angle of isometric assessment had little effect on the relationship between the tests and measurements of performance. The myo-electric data was processed in terms of the integrated electromyogram and the Fourier transformed frequency spectrum. These data demonstrated differences in the neural activation patterns of the musculature, between the isometric 90 degrees test and the medicine ball throw. The poor relationship between isometric tests and medicine ball performance was consequently, at least partially, attributed to differing motor unit activation patterns between isometric and dynamic movement. The results of this research strongly suggest that isometric tests have limited value when assessing dynamic upper body performance.

Adult↗
PubMed1996

MR arthrography of elbow: evaluation of the ulnar collateral ligament of elbow.

OBJECTIVE: The purpose of this study was to evaluate ulnar collateral ligament (UCL) injury of the elbow in throwing athletes by MRI and MR arthrography. DESIGN: Ten elbows of throwing athletes were examined on both plain MRI and MR saline arthrography and the injuries subsequently surgically proven. Spin-echo (SE) T1-weighted and fast SE T2-weighted coronal images were obtained. RESULTS: The UCL was unclear in all ten cases on T1-weighted MRI. In five cases an avulsion fracture was also found on T1-weighted MRI. On T2-weighted MRI, abnormal high-intensity areas were identified in or around the UCL. On T2-weighted MR arthrography images, extracapsular high-intensity areas, which represent extracapsular leakage, were found in four of five cases with avulsion fracture. At surgery, all these four cases showed avulsion fractures with instability; the other case had a fracture but it was stable and adherent to the humerus. On T2-weighted MR arthrography images, an extracapsular high-intensity area was found in one of the five cases without avulsion fracture. At surgery this patient had a complete tear of the UCL itself. CONCLUSION: MR arthrography provided additional information for evaluating the degree of UCL injury.

Adolescent↗
PubMed2006

Fatal impalement injury of the head due to a curtain rail.

During a dispute, a boy was injured by a curtain rail which penetrated the skull in the left frontal region and led to severe brain injury. Despite intensive medical care, death occurred 10 days later due to malignant cerebral edema. With regard to the question whether the trauma resulted from throwing or pushing, some biomechanical aspects are discussed including individual morphologic findings as well as the kinetic energy required for penetrating the skull. According to the calculated data, we conclude that the velocity necessary for penetrating could be reached by throwing the curtain rail.

Adolescent↗
PubMed1999

Effects of heavy resistance training on maximal and explosive force production, endurance and serum hormones in adolescent handball players.

To determine the effects of 6-weeks of heavy-resistance training on physical fitness and serum hormone status in adolescents (range 14-16 years old) 19 male handball players were divided into two different groups: a handball training group (NST, n = 10), and a handball and heavy-resistance strength training group (ST, n = 9). A third group of 4 handball goalkeepers of similar age served as a control group (C, n = 4). After the 6-week training period, the ST group showed an improvement in maximal dynamic strength of the leg extensors (12.2%; P < 0.01) and the upper extremity muscles (23%; P < 0.01), while no changes were observed in the NST and C groups. Similar differences were observed in the maximal isometric unilateral leg extension forces. The height of the vertical jump increased in the NST group from 29.5 (SD 4) cm to 31.4 (SD 5) cm (P < 0.05) while no changes were observed in the ST and C groups. A significant increase was observed in the ST group in the velocity of the throwing test [from 71.7 (SD 7) km x h(-1) to 74.0 (SD 7) km x h(-1); P < 0.001] during the 6-week period while no changes were observed in the NST and C groups. During a submaximal endurance test running at 11 km x h(-1), a significant decrease in blood lactate concentration occurred in the NST group [from 3.3 (SD 0.9) mmol x l(-1) to 2.4 (SD 0.8) mmol x l(-1); P < 0.01] during the experiment, while no change was observed in the ST or C groups. Finally, a significant increase (P < 0.01) was noted in the testosterone:cortisol ratio in the C group, while the increase in the NST group approached statistical significance (P < 0.08) and no changes in this ratio occurred in the ST group. The present findings suggested that the addition of 6-weeks of heavy resistance training to the handball training resulted in gains in maximal strength and throwing velocity but it compromised gains in leg explosive force production and endurance running. The tendency for a compromised testosterone:cortisol ratio observed in the ST group could have been associated with a state of overreaching or overtraining.

Adolescent↗