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PubMed1995

Cooling-induced changes in muscular performance and EMG activity of agonist and antagonist muscles.

The effect of whole body cooling on the muscular performance and electromyographic (EMG) activity of agonist and antagonist muscles during dynamic exercise was studied. Eleven slightly clothed male subjects were exposed to ambient temperatures of 27 degrees C and 10 degrees C for 60 min. After the exposures the subjects performed an overhead ball throwing test. Five balls, weighing from 0.3 kg to 3.0 kg were thrown and the velocity of the balls was measured. The EMG activity of two agonist-antagonist muscle pairs (m. triceps brachii--m. deltoideus and m. rectus abdominis--m. erector spinae) were measured during throwing. Cooling decreased mean skin temperature by 6.3 +/- 0.5 degree C (mean +/- SE). The temperature of m. triceps brachii decreased by 4.0 +/- 1.6 degrees C and 1.8 +/- 0.6 degrees C from the depth of 20 and 30 mm underneath the skin surface, respectively. The corresponding values of m. deltoideus were 5.1 +/- 0.4 degrees C and 3.2 +/- 0.8 degrees C. The cooling-induced decrement in ball velocity varied from 9.4 +/- 3.3% (0.3-kg ball) to 5.6 +/- 2.8% (3.0-kg ball) (p < 0.001-0.01). After cooling, the time to reach the maximal level of integrated electromyographic (IEMG) activity in m. triceps brachii (agonist) was increased (30-42%, p < 0.05-0.001). Moreover, cooling decreased the mean IEMG activity m. triceps brachii, while the activity of m. deltoideus (antagonist) was increased. The alteration was significant (p < 0.05-0.001) with the three lightest balls.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Granny knot for interrupted 10-0 nylon sutures in cataract sections.

A granny knot instead of a reef (square) knot is advocated for 10-0 nylon interrupted sutures in limbal cataract sections, especially under a conjunctival flap. The second of the two throws is looped in the direction opposite to that in a reef knot so that the free ends lie at right angles to the plane of the suture. The second throw is used to "run down" the first to tighten the suture. To avoid postoperative erosion through conjunctiva, the ends are cut long with a blade while they lie flush with the sclera. The knot is locked when the traction required to tighten the suture is released and the thinned nylon recovers its original diameter on each side of the knot.

Cataract Extraction↗
PubMed1996

A comparison of the strength of knots tied by hand and at laparoscopy.

BACKGROUND: The strength of knots tied at laparoscopy was compared with that of hand-tied knots. STUDY DESIGN: The force needed to undo or break eight types of knots that were tied in fresh postmortem human stomachs was measured. The knotting performance of nylon, polyglactin 910, braided silk, polytetrafluoroethylene, braided polyester fiber, braided polyester suture, polyamide 66, and polydiaxone was also compared. RESULTS: Measurements of knot strength of two to six half hitches (hand tied) showed that four half hitches were necessary to tie a secure nonslipping knot with most monofilament threads (nylon, polytetrafluoroethylene, braided polyester suture, and polyamide 66), while three half hitches were adequate to secure a knot when polyglactin 910, braided polyester fiber, silk, and polydiaxone were used. Additional throws did not increase knot strength once the knot no longer slipped (p = NS). Some commonly tied knots, three half hitches and surgical knots at laparoscopy were weaker than the same hand-tied knots (p < 0.05) but an additional throw increased knot security (p < 0.01). Differences between laparoscopic and hand-tied knot strengths were greater for monofilament than multifilament threads. There was a wider distribution of strengths for laparoscopically tied than hand-tied knots. Four half hitches were the most secure configuration for laparoscopically tied knots and were significantly stronger than three half hitches and surgical knots (p < 0.01). The extracorporeally tied slipknot (Roeder loop) was significantly less secure than four half hitches (p < 0.05). CONCLUSIONS: This study demonstrates that laparoscopically formed knots may be weaker than those tied by hand and shows that improvements in knot strength at laparoscopy can be achieved by choice of optimal knot configuration for different suture materials.

Evaluation Studies as Topic↗
PubMed1995

Management of multidirectional instability.

Since 1980, several authors have reported successful treatment of multidirectional instability with use of the inferior capsular shift. Neer's initial report in a series of 32 patients noted only one unsatisfactory result. One decade later he reported that ¿more than 100 additional inferior capsular shifts have been done with similar satisfactory results.¿ The authors have reported preliminary results following 75 inferior capsular shifts performed in young athletes. Eighty-nine percent were able to return to their major sport while seventy-three percent maintained the same level of competitiveness. Seven patients (9.3%) reported a single episode of probable subluxation that was not followed by recurrent instability and did not affect the final result, whereas two patients (2.7%) dislocated postoperatively. Both of these cases were associated with a traumatic episode. The average loss of external rotation was 7 deg. Altchek and Warren reported their results following a T-plasty modification of the Bankart procedure for multidirectional instability in 42 shoulders. The patient population differed somewhat because 38 of the 42 cases had a Bankart lesion or detachment of the labrum and glenohumeral ligament complex. Patient satisfaction was rated excellent for 40 (95%) of the shoulders. The average loss of external rotation was 5 deg. Altchek and Warren noted that throwing athletes were unable to throw a ball with as much speed as before the operation. Additionally, 7 of 42 shoulders (16%) demonstrated 2+ or greater posterior instability postoperatively. There were four cases of symptomatic recurrent instability, one anterior and three posterior, while one patient required a posterior stabilization 2 years postoperatively. Recently Cooper and Brems' reviewed their series of 43 shoulders in 38 patients with a minimum 2-year follow-up after inferior capsular shift. Thirty-nine of 43 shoulders (91%) were rated by the patient as satisfactory with no recurrent instability. Postoperatively recurrent symptomatic instability developed in four patients (11%). Two of these patients required subsequent revision inferior capsular shifts and one of those went on to a humeral head replacement for arthritis of dislocation. The latter patient had received a prior Bristow procedure. Cooper and Brems concluded that the inferior capsular shift procedure provided satisfactory objective and subjective results. Failures and recurrences of symptomatic instability generally occurred in the early postoperative period less than 2 years following surgery. Their findings did not demonstrate a deterioration of the results, with a follow-up of 6 years. The authors recently reported the results after inferior capsular shift from classic multidirectional instability in 52 shoulders. Thirty-six shoulders were approached from the anterior side and 16 from posterior. All were completely immobilized in a brace for 6 weeks postoperatively. Forty-nine shoulders were observed over 2 to 11 years (average: 5 years). Satisfactory results were achieved in 94% of cases. Turkel and coworkers demonstrated that anterior glenohumeral stability is provided by varying regions of the capsule depending on arm position. Similarly, Warner and coworkers have recently demonstrated that inferior humeral translation is restrained by the anterosuperior capsule and ligaments with the arm at the side, and by the inferior capsule and ligaments with the arm in abduction. This is consistent with the clinical findings of Neer and Foster, who described inferior humeral translation with the arm at the side and with the arm in abduction in patients with multidirectional instability, and emphasized reducing redundant capsular volume on all sides at the time of surgical reconstruction. The capsular shift procedure eliminates laxity in the rotator interval, anterosuperior capsule, and anteroinferior capsule.(ABSTRACT TRUNCATED)

Arm Injuries↗
PubMed1996

Laparoscopic knot security.

The security of several types of laparoscopic and open knots and varying suture materials was tested in an attempt to improve suture and knot selection for advanced laparoscopic procedures. Six different types of knots and five suture materials were tested. All sutures were of 2-0 size, and laparoscopic knots were tied using a pelvic trainer. A typical number of square throws was used for each suture. Stress was gradually applied by withdrawing the ends of a manual digital tensiometer until either the knot slipped or the suture parted. The maximum stress withstood by the knot-suture complex was recorded, as was whether the knot was secure (i.e., whether the knot held until the suture broke). The data were analyzed using analysis of variance to compare the knot security of the various knot types and the different sutures using a given knot. No significant difference was found in security or stress resistance between laparoscopic square and open square knots or in the Dacron, polypropylene, and expand polytetrafluoroethylene (ePTFE) extracorporeal and intracorporeal knots, with the exception of ePTFE intracorporeal knots, which were significantly less secure (p = 0.028). Silk suture was significantly less secure than all the other sutures tested for all knots tested (p < 0.0001). The Roeder's and Fisherman's knots were the least secure of all laparoscopic knots in all sutures tested (p < 0.0001), with the exception of polyglactin tied with a fisherman's knot, which was as secure as the extracorporeal and intracorporeal polyglactin knots. These experiments showed laparoscopic square knots to be as secure as open square knots; removing the operating finger from the knot does not seem to affect the security of a well-tied square knot. Furthermore, of the permanent sutures tested, there was no substantive difference in the security of laparoscopic intracorporeally and extracorporeally tied knots, except that ePTFE was more secure when tied with extracorporeal throws. Our data also suggest that silk is not as secure as other permanent suture materials.

Humans↗
PubMed1996

Arthroscopic decompression of the shoulder in athletes.

A careful history, a detailed physical examination, appropriate radiographs, and additional diagnostic tests, when indicated, usually can isolate a specific diagnosis in athletes with shoulder pain. An individual rehabilitation program frequently alleviates symptoms and allows athletes to return to their sporting activities. When nonoperative approaches fail, arthroscopic treatment with acromioplasty and coracoacromial ligament release, as appropriate, allows patients to follow through with a successful rehabilitation program. The success rate for return to non-throwing sports is very good. High-caliber athletes participating in throwing sports should be counseled regarding the possibility of a less successful outcome.

Arthroscopy↗
PubMed1996

The assessment of human dynamic muscular function: a comparison of isoinertial and isokinetic tests.

This investigation compared the relationship of isokinetic and isoinertial tests of muscular function to dynamic upper body performances. The electromiyographic activity of each of the tests of muscular function, as recorded by surface electrodes, were examined to determine whether neural differences underlie the ability of the test to relate to performance. Twenty four subjects performed isokinetic and isoinertial tests of muscular function in a bench press movement. The isokinetic tests were performed at velocities of 60, 90 and 120 deg/s while the isoinertial tests were performed at loads of 30%, 60% and 130% of the one repetition maximum. Subjects also performed the following tests of dynamic performance: a maximum one repetition bench press (1 RM), a seated shotput throw and two drop bench press throws from a height of 0.25 m at various loads. Forces/torques, displacement and electromyographic data were recorded from the isoinertial and isokinetic tests. Both the isoinertial and isokinetic parameters were related to the various measures of upper body performance (r = 0.33-0.94), however, neither was superior at predicting performance. Further, the relationship between the tests of muscular function were consistently high (r = 0.75-0.88). This was the case, even though the magnitude of the EMG signals were significantly higher in the isoinertial, as compared to the isokinetic tests. It is postulated that structural considerations, such as a specific testing position, rather than neural factors, underlie the observed results. These results support previous research which has reported the existence of a generality of strength across dynamic testing modalities.

Adult↗
PubMed2026

Not just when, but how: An exploratory dual-control approach to video feedback in motor learning.

The present study provides exploratory evidence for a novel dual-control paradigm. It examines whether combining temporal over video feedback timing with learner-controlled interactive playback functions (pause, slow-motion, rewind) would enhance motor skill acquisition beyond temporal autonomy alone. Sixty-four novice adults were randomly assigned to one of four conditions: Full Control (self-controlled timing + interactive replay), Partial Control (self-controlled timing + non-interactive replay), Yoked Full Control (externally controlled timing + interactive replay), or Yoked Partial Control (externally controlled timing + non-interactive replay). Motor accuracy (Radial Error), movement consistency (Bivariate Variable Error), technical execution, and self-efficacy were assessed at pre-test, 24-h retention, and 72-h retention following two acquisition sessions on a dart-throwing task (120 trials total). The Full Control group demonstrated the greatest and most durable learning gains across all outcomes. The Group &#xd7; Time interaction was significant across all dependent variables (&#x3b7;2&#x209a; ranging from 0.140 to 0.234), with Full Control demonstrating superior retention at both 24 and 72&#xa0;h relative to other groups (though differences relative to Partial Control were more pronounced at 72-h retention). Critically, the Yoked Full Control group showed comparatively weaker outcomes despite access to the same interactive playback functions. These findings suggest that interactive video tools may be most useful when learners can regulate both when feedback is accessed and how it is inspected. Theoretical and practical implications for the design of learner-centered video feedback systems are discussed.

Humans↗
PubMed1991

The pseudotumor syndrome. Disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly.

We report a series of eight cases that show a close resemblance to, but are not identical with, pseudotumor cerebri (PTC) as normally defined. The majority of these cases are characterized by raised intracranial pressure without ventriculomegaly. They include two cases of cranial venous outflow obstruction in which clinical or radiologic abnormalities precluded the diagnosis of PTC proper (cases 1 and 2); one case of chronic meningitis in which an abnormal cerebrospinal fluid (CSF) composition precluded the diagnosis of PTC (case 3); two cases without either papilledema or a measured increase of CSF pressure, which in other respects, particularly in response to treatment, resembled PTC (cases 4 and 5); and three cases of what is thought to represent an infantile form of PTC (cases 6 through 8). The purpose of the analysis of these cases is twofold. First, it is argued that these cases throw light on the mechanism of PTC itself, supporting a concept of a disturbance of CSF circulation in this condition, and that they are themselves illuminated by considerations of typical PTC. Second, the cases are used to frame a proposed classification of the pseudotumor syndrome aimed at broadening the diagnostic criteria applied currently to PTC. It is suggested that the pseudotumor syndrome has a single underlying mechanism (disturbed CSF circulation) and that recognition of this mechanism not only clarifies the pathophysiologic processes of PTC but also has important diagnostic and therapeutic implications.

Adolescent↗
PubMed2000

Prevalence of symptoms of gastroesophageal reflux during childhood: a pediatric practice-based survey. Pediatric Practice Research Group.

OBJECTIVES: To determine the prevalence of symptoms associated with gastroesophageal reflux (GER) in 3- to 17-year-old children, to describe the prevalence of factors associated with GER in these children, and to determine the percentage of symptomatic children who have been treated. DESIGN: A cross-sectional survey. SETTING: Sixteen pediatric practice research group practices in the Chicago, Ill, area (urban, suburban, and semirural). PARTICIPANTS: A total of 566 parents of 3- to 9-year-old children, 584 parents of 10- to 17-year-old children, and 615 children aged 10 to 17 years. INTERVENTION: None. MAIN OUTCOME MEASURE: Reported frequency of symptoms associated with GER. RESULTS: Parents of 3- to 9-year-old children reported that their children experienced a sensation of heartburn ("burning/painful feeling in middle of chest"), epigastric pain ("stomachache above belly button"), and regurgitation ("sour taste or taste of throw up") 1.8%, 7.2%, and 2.3% of the time, respectively. Parents of 10- to 17-year-old children reported that their children experienced the same symptoms 3.5%, 3.0%, and 1.4% of the time, while children aged 10 to 17 years reported the symptoms 5.2%, 5.0%, and 8.2% of the time, respectively. Complaints of abdominal pain ("stomachache") were most common, reported by 23.9% and 14.7% of parents of 3- to 9-year-old and 10- to 17-year-old children and by 27.9% of children aged 10 to 17 years. In those aged 10 to 17 years, heartburn reported by the children was associated with reported cigarette use (odds ratio, 6.5; 95% confidence interval, 2-21); no other complaint was associated with cigarette, alcohol, or caffeine consumption or passive smoking exposure. In 3- to 9-year-old children, no complaint was associated with caffeine consumption or passive smoking exposure. Reported treatment in the past week with antacids was 0.5% according to parents of children aged 3 to 9 years and 1.9% and 2.3% according to parents of children aged 10 to 17 years and children aged 10 to 17 years, respectively. Treatment with over-the-counter histamine receptor blockers was 0% for children aged 3 to 9 years and 10 to 17 years, as reported by their parents, and 1.3% for those aged 10 to 17 years, as reported by themselves. CONCLUSIONS: Symptoms suggestive of GER are not rare in childhood, yet only a fraction of children with symptoms are treated with over-the-counter antacids or histamine2 antagonists. Prospective longitudinal data are needed to determine which children with symptoms of GER actually have GER disease and are at risk of developing complications.

Adolescent↗
PubMed1997

Capuchin monkey (Cebus apella) grips for the use of stone tools.

This research examined capuchin monkey (Cebus apella) grips for the use of throwing, nut-cracking and cutting tools. We provided subjects with stones and apparatus that accommodated the use of stones as tools. Our subjects exhibited five grips, two of which the animals used when force was the primary consideration (power grips) and three of which the animals used when accuracy of sensory judgment and instrumentation was required (precision grips). We believe that the range of contexts in which capuchins use stone tools, combined with the ability of capuchins to employ both power and precision grips as part of their tool repertoire, indicate that Cebus apella can be used to identify grips that facilitated hominid lithic technology.

Animals↗
PubMed1996

Determinants of age at menarche as early life predictors of breast cancer risk.

Age at menarche is one of the few established risk factors for breast cancer; identification of its exogenous determinants could throw light on the origins of breast cancer. We have undertaken an epidemiologic study in Greece to ascertain whether: 1) energy intake, an indicator of physical activity, is associated with later age at menarche; 2) energy-adjusted fat intake is related to earlier age at menarche; and 3) other macronutrients and anthropometric variables are predictors of age at menarche. Anthropometric, socio-economic, familiar, nutritional and lifestyle predictors of age at menarche were studied by interviewing in person 345 female students 9 to 16 years old attending 8 schools of Greater Athens. Menarche was the outcome variable in a proportional hazards model assessing the mutually adjusted incidence rate ratio by a series of predictor variables. In a complementary analysis, age at menarche was the dependent variable among menstruating girls. Consistent results were derived from the main and the complementary analysis. Increased height and body mass index accelerate the occurrence of menarche. Maternal and daughter's ages at menarche are correlated, but there is no evidence of an association with paternal education. Various measures of moderate physical activity as well as increased total energy intake were associated with a delay in age at menarche. Energy-adjusted macronutrients were not associated with age at menarche. It appears that an alteration of energy balance in early life through increased physical activity could delay age at menarche and reduce the risk for breast cancer in later life.

Adolescent↗
PubMed1996

Pitcher's arm: an electrodiagnostic enigma.

Every major league baseball pitcher, most minor league pitchers, but only few amateur pitchers that we have studied have had reduced sensory nerve action potentials in the throwing arm. We present 6 clinical cases which demonstrate the spectrum of "pitcher's arm." These cases suggest that the phenomenon is a pathologic process, probably an example of a repetitive use syndrome affecting the brachial plexus. Although it does not appear to impact performance, it has clear implications for the interpretation of electrodiagnostic studies in symptomatic pitchers.

Action Potentials↗
PubMed1996

Knot performance of polypropylene sutures.

A mechanical performance test using an Instron Tensile Tester demonstrated the superior handling characteristics of Surgipro suture as compared to Prolene suture that facilitated knot construction without suture breakage. For both granny and square knots, the knot run down forces for the Surgipro sutures were significantly less than those encountered for comparable knots for Prolene sutures. This propensity of the two-throw knots of Surgipro sutures to advance without breakage considerably facilitated knot construction.

Materials Testing↗
PubMed1999

Enhancing knot security by heat treatment of knot ears.

Heat treatment of the ears of knotted sutures markedly enhances knot security. Using coated polyester sutures commonly used in arthroscopic surgery, heat treatment of the knot ears allows secure knot construction to be achieved with a two throw granny (1 x 1) or square (1 = 1) knot. A heat source is being designed for secure knot construction in arthroscopic surgery.

Arthroscopy↗
PubMed1999

Differential modulation of a common memory retrieval network revealed by positron emission tomography.

Functional neuroimaging is uniquely placed to examine the dynamic nature of normal human memory, the distributed brain networks that support it, and how they are modulated. Memory has traditionally been classified into context-specific memories personally experienced ("episodic memory") and impersonal non-context-specific memories ("semantic memory"). However, we suggest that another useful distinction is whether events are personally relevant or not. Typically the factors of personal relevance and temporal context are confounded, and it is as yet not clear the precise influence of either on how memories are stored or retrieved. Here we focus on the retrieval of real-world memories unconfounding personal relevance and temporal context during positron emission tomography (PET) scanning. Memories differed along two dimensions: They were personally relevant (or not) and had temporal specificity (or not). Recollection of each of the resultant four memory subtypes-autobiographical events, public events, autobiographical facts, and general knowledge-was associated with activation of a common network of brain regions. Within this system, however, enhanced activity was observed for retrieval of personally relevant, time-specific memories in left hippocampus, medial prefrontal cortex, and left temporal pole. Bilateral temporoparietal junctions were activated preferentially for personal memories, regardless of time specificity. Finally, left parahippocampal gyrus, left anterolateral temporal cortex, and posterior cingulate cortex were involved in memory retrieval irrespective of person or time. Our findings suggest that specializations in memory retrieval result from associations between subsets of regions within a common network. We believe that these findings throw new light on an old debate surrounding episodic and declarative theories of memory and the precise involvement of the hippocampus.

Adult↗
PubMed1996

Information technology, medical education, and anatomy for the twenty-first century.

Medicine is experiencing an escalating explosion of information. With more data available about more topics, the key questions are how to access and make sense of the medical information jungle. Skill in choosing and applying information is essential for both medical education and practice and will require new approaches to mastering data. Medical education, like medicine itself, will continue to be driven by technology, and we can expect our students to be increasingly computer literate. Thus the role of medical education will become more one of how to use this information than of obtaining the information itself. What medical education must focus on is the processing of information for appropriate medical care. This, in turn, depends upon practitioners having contexts in which the relevance and significance of information can be evaluated. New imaging technologies and molecular advances demand a broader understanding of both health and disease. With the information explosion "on line," how can a student use this to understand the structure and function of the human body in four dimensions? Anatomy, the structural basis for life, provides a unique and necessary perspective on the human body from the molecular to the macroscopic. A solid foundation in anatomy is the best preparation for an effective physical examination and for safe, efficient basic clinical procedures. Finally, anatomy laboratories provide a context for learning other important aspects of medicine-group process, clinical problem solving, and a sensitivity to human mortality. Advocating for these unique features of our discipline in medical education is the task facing anatomists as we end this millennium. The challenges and opportunities for us have never been greater, if we don't throw out the baby with the bath water.

Anatomy↗
PubMed1998

Urinary bladder bilharziasis as a cause of impaired bladder muscle contractility.

In an attempt to evaluate the effect of bilharziasis on bladder contractility as a factor in the genesis of voiding disorders, 44 cases of bilharzial bladder neck obstruction diagnosed using traditional methods (symptomatological, radiographic, and endoscopic) were subjected to complete urodynamic evaluation (flowmetry, cystometry, pressure/flow study, and stop-flow test). Their parameters were compared with those of 28 patients with urodynamically obstructed benign prostatic hyperplasia and 8 nonsymptomatic controls. Contractility parameters (isometric detrusor pressure, maximum estimated flow rate, detrusor power at maximum flow) were calculated for the studied cases and their distribution according to the Schafer pressure/flow diagram was evaluated. Bladder biopsy including the detrusor was evaluated in all 72 patients. Poor bladder contractility associated with an extensive bilharzial effect on the detrusor muscle was found to be the major abnormality in 20 of 44 patients with presumed bilharzial bladder neck obstruction with no evidence of urodynamic outflow obstruction. We believe such a workup is essential in cases of suspected obstruction associated with bilharziasis to throw light on the pathophysiology of the voiding disorders, avoid unnecessary surgery, and provide a better prognosis.

Adult↗