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PubMed2006

Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal.

BACKGROUND: Undiagnosed tracheobronchial foreign body aspiration (FBA) or delayed extraction can lead to serious morbidity. The aim of this study was to evaluate anesthetic and periinterventional morbidity of a straightforward regime using rigid bronchoscopy to rule out or remove a tracheobronchial foreign body in children with suspicion of FBA. METHODS: We retrospectively analyzed rigid bronchoscopy charts of children with suspicion of acute (< or = 24 h) and subacute (>24 h-2 weeks) tracheobronchial FBA (1990-2003). Patient characteristics, duration of fasting, technique/course of anesthesia induction, and duration/course of rigid bronchoscopy were taken. Anesthetic, periinterventional complications and length of hospital stay were noted. Data are given in median (range [interquartile range]). RESULTS: A total of 287 children were included in this study. Median age was 1.7 years (0.2-14.2 [1.2-2.5]); in 72.1% a tracheobronchial foreign body was found and removed. Fasting time before induction of anesthesia was 5 h (1-14 [4.0-7.0]). Anesthesia adverse events were seen in 0.7%, whereas periinterventional complication from rigid bronchoscopy was observed in 7.6%. Hospital discharge within 4 h after bronchoscopy was possible in 65.2%. Complications of delayed diagnosis (>24 h) were prolonged duration of rigid bronchoscopy because of severe mucosal changes or difficulties in foreign body extraction. CONCLUSIONS: General anesthesia for rigid bronchoscopy to rule out a tracheobronchial foreign body in children carries low morbidity. Most of the complications originated from the foreign body itself especially in patients with late diagnosis. The risk for serious complications caused by retained foreign bodies outweighs the low morbidity of explorative rigid bronchoscopy in children with suspected FBA or children with prolonged cough or pulmonary infection unresponsive to medical treatment.

Anesthesia, General↗
PubMed2005

Comparison of rigid vs flexible sigmoidoscopy in detection of significant anorectal lesions.

OBJECTIVE: Sigmoidoscopy is an essential tool in colorectal clinics in the detection of anorectal lesions including rectosigmoid adenomas and carcinomas. However, rigid sigmoidoscope (RS) is still more widely used than flexible sigmoidoscope (FS) as the primary investigation, despite the fact that the latter is more comfortable to the patient and has greater diagnostic yield. Hence we wanted to compare the two modalities in terms of diagnostic use for picking up significant anorectal lesions. METHODS: A retrospective review of all patients referred to the colorectal clinic who had undergone both rigid and flexible sigmoidoscopy for investigation of colorectal symptoms in 2001 was done. Findings recorded during rigid and flexible sigmoidoscopy including depth of insertion, site of lesion and complications were analysed. RESULTS: 152 patients underwent both rigid and flexible sigmoidoscopy as part of investigation of colorectal symptoms. Of the 115 (75.6%) declared normal by RS, 39 (33.9%) had significant lesions including 7 polyps and 4 malignant lesions within 20 cm of the anal verge during FS. Of the 31 patients (20.4%) in whom RS was not helpful due to faecal loading, 15 (48.4%) had significant lesions including 4 malignancies and 1 polyp --all within 20 cm of the anal verge during FS. Only 2 polyps and 1 malignant lesion were picked up by both flexible and rigid sigmoidoscopy. There were no complications in both procedures. CONCLUSION: Since flexible sigmoidoscopy is superior to rigid sigmoidoscopy in terms of patient comfort, diagnostic value and ease of doing procedures like biopsy and polypectomy; it can be used as a front line investigation to exclude colorectal pathology in out patient clinics. The utility of rigid sigmoidoscope is in question and in view of obvious shortcomings, may be replaced by flexible sigmoidoscopy, though obvious resource constraints need to be considered.

Humans↗
PubMed1978

Geriatric rigidity and its psychotherapeutic implications.

The elderly tend to be more rigid than younger adults in their attitudes and personalities, and such rigidity is correlated with poor adjustment. However, the rigidity is not the cause of the poor adjustment; rather, it is an attempted solution. One of the patterns of rigidity is an outgrowth of the lifestyle of pessimism, suspicion, self-reliance, self-discipline, determination, and endurance. Two case studies are presented illustrating how rigidity can channel thoughts and prevent the brooding which works itself into depression or anxiety, while simultaneously reinforcing self-help behavior. Geriatric psychotherapy should be problem-centered and should not launch a frontal assault on rigidity or attempt to reconstruct the patient's personality. Behavioral modification, authority, and motivation slogans can be used in conjunction with the rigidity to improve the patient's coping ability.

Adaptation, Psychological↗
PubMed2004

Relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity recorded by the RigiScan Plus.

OBJECTIVE: We studied the relationship between penile hemodynamic parameters assessed by color Doppler ultrasonography and penile rigidity estimated by objective measurement. PATIENTS AND METHODS: A total 37 patients with erectile dysfunction were examined. After intracavernous injection of 20 microg prostaglandin E1, we measured their penile hemodynamic parameters in the cavernous arteries by color Doppler ultrasonography. Simultaneously, the RigiScan Plus device was used for real-time evaluation of penile rigidity. Hemodynamic parameters were correlated with penile rigidity. RESULTS: Peak systolic velocity and resistive index were significantly correlated with penile tip (r = 0.54, r = 0.72, respectively) and base (r = 0.55, r = 0.76, respectively) rigidity; there was no significant correlation between end-diastolic velocity and penile rigidity. CONCLUSIONS: Peak systolic velocity and resistive index were strongly correlated with penile rigidity in patients with erectile dysfunction during intracavernous pharmacological testing. The resistive index in particular appeared to be the most valid parameter for assessment of penile rigidity.

Adult↗
PubMed1975

Relationship of non-verbal rigidity and creative perceptions.

The relationship of rigidity and creative perceptions of 214 Hungarian adolescent males and females was explored using a non-verbal test of rigidity (Breskin Rigidity Test) and a measure of creative perceptions (Something About Myself). Males and females were divided into Moderately Rigid and Low Rigid groups. An analysis of variance of the data showed no significant differences in creative perceptions relative to rigidity level, sex, or interaction of rigidity level and sex.

Adolescent↗
PubMed2004

A randomised trial of rigid stump dressing following trans-tibial amputation for peripheral arterial insufficiency.

BACKGROUND: A multicentre randomised controlled trial to determine the effect of a rigid plaster dressing applied at the time of trans-tibial amputation on the number of days to casting for a prosthesis, and the incidence of post-operative stump infection. METHODS: Patients requiring trans-tibial amputation were randomised to one of 2 groups: In Group 1 (intervention) a rigid above-knee plaster dressing was applied at operation and patients were managed according to a standard protocol. Group 2 (control) had the individual surgeons' usual non-rigid dressing regime. Rehabilitation data were extracted from the national physiotherapy database. On completion of the trial a questionnaire was sent to all participants. RESULTS: 14 surgeons in 7 centres enrolled 154 patients, with 96 ultimately cast for a prosthesis. Patients who received a rigid dressing (n = 78) had reduced days to casting (median 36, confidence interval 30-47) when compared with other dressings (n = 76) (median 42, confidence interval 36-45), these differences did not reach statistical significance. There was no significant difference in post-operative infection rates in the two groups. 64% of surgeons, and all physiotherapists and vascular nurses responding to the post-trial questionnaire felt that the rigid dressing was an improvement on their normal regime and wished to continue with the technique. CONCLUSIONS: Despite a median reduction of 6 days in time to casting in patients treated with a rigid post-operative dressing this failed to reach statistical significance. The majority of participants who replied to the post-trial questionnaire expressed a wish to continue using the rigid dressing technique. To confirm that the trends shown in this trial are statistically valid a larger trial is needed.

Amputation, Surgical↗
PubMed1990

[Analysis of nocturnal penile tumescence with continuous monitoring of penile rigidity].

By continuous and simultaneous recording of nocturnal penile rigidity and circumferential expansion (tumescence), nocturnal penile rigidity and tumescence have been classified into 6 patterns: normal, dissociation, uncoupling, short episode, low amplitude and flat trace. The monitoring will be helpful to diagnose underlying disorders involving erectile impotence, if the pattern of nocturnal penile rigidity and tumescence are related with the disorders. This study analyzed the relationship between the pattern of nocturnal penile rigidity and tumescence and associated disorders in 105 patients with erectile impotence. Of 15 patients with central nervous system disorders, 9 (60%) had a pattern of short episode of rigidity. In 29 patients with cardiovascular disorders, the patterns of dissociation, low amplitude and flat trace were the main findings and observed in 41, 41, 35% of the group, respectively. No patients with diabetes mellitus showed normal pattern. Although the group of non insulin dependent diabetes mellitus (21 patients) had various patterns of rigidity and tumescence, the insulin dependent group (14 patients) mainly showed patterns of low amplitude (21%) and/or flat trace (71%). The continuous and simultaneous monitoring of penile rigidity and tumescence will be helpful, with an integral analysis of its pattern and other examinations, for accurate diagnosis of underlying disorders of organic impotence, besides for differentiation of organic impotence from psychogenic one.

Adult↗
PubMed2004

Endoscopic transaxillary thyroid lobectomy: flexible vs rigid laparoscope.

BACKGROUND: The use of the endoscopic procedure for thyroid lobectomy in benign solitary thyroid nodule has been developed rapidly and increasingly refined in recent years. The early results are technically feasible, safe and mainly provide promising cosmetic results, some show a quicker recovery. The authors wanted to know if this procedure can be performed via rigid laparoscope which is simple, less expensive and widely available in many surgical centers. OBJECTIVES: The aims of this study were to evaluate operative time, blood loss, complication of flexible compared to 30 degrees rigid laparoscope in endoscopic transaxillary thyroid lobectomy for solitary thyroid nodule. METHOD: From February 2004 to June 2004, 13 cases of benign solitary thyroid nodule underwent the endoscopic transaxillary thyroid lobectomy. Flexible laparoscope techniques were performed in 9 cases and 30 degrees rigid laparoscope in the other 4 cases. Port site, number of ports and dissected method were the same in both procedures by the same surgeon. Operative time, blood loss, post-operative results were measured for evaluation. RESULTS: From 13 cases, 9 in the flexible laparoscope group and 4 in the rigid laparoscope group. All but one in the flexible group with torn internal jugular vein were successful. The mean operation time was 165.42 +/- 35.06 minutes, which was 175.63 +/- 35.70 minutes for flexible laparoscope group and 145 +/- 26.45 minutes for rigid laparoscope group. There was no recurrent laryngeal nerve injury and no subcutaneous emphysema. The patients were satisfied with the cosmetic results. CONCLUSION: On the basis of early experience with these 13 patients, the authors believe that endoscopic thyroidectomy using the rigid laparoscope has proved to be no different in the intra-operative results, so the authors do aimed to show that with the rigid laparoscope which is available in many surgical centers, less expensive and easy in maintenance will provide another surgical option for treatment of thyroid nodule, with maximized cosmetic effect.

Adult↗
PubMedDate not supplied

[The rigid spine syndrome].

Five patients with the clinical picture of rigid spine syndrome are presented. Three of them were females. All these patients fulfilled the clinical criteria for rigid spine syndrome. On the basis of the analysis of these patients and the data from literature, it was established that Dystrophia musculorum progressiva--Emery-Dreifuse was one of the causes of rigid spine syndrome in one patient. In the other four patients unspecific myopathic changes were found. The only common feature was marked proliferation of endomysium and perimysium (connective tissue). An effort was made to solve the nosological problems on the contemporary level of knowledge. The heterogenous group of rigid spine syndrome was divided into the three subgroups: 1) Rigid spine syndrome with nosologically determined neuromuscular disorder; 2) Rigid spine syndrome on myopathic basis, but nonspecific and unrecognizable as an entity; 3) Rigid spine syndrome with disorders of non-neuromuscular origin, but with that related to bones, joints or connective tissue.

Adolescent↗
PubMed1994

Analysis of microtubule rigidity using hydrodynamic flow and thermal fluctuations.

We report the use of two independent new methods to measure the flexural rigidity of microtubules. Microtubules were grown off axonemal pieces adhering to a glass coverslip. In the first method, a hydrodynamic flow was applied to microtubules and the flexural rigidity was derived from the analysis of the bending shape of the microtubules at equilibrium in the flow. In the second method, the flexural rigidity was derived from the thermal fluctuations of the free end of axoneme-bound microtubules. With both methods, the flexural rigidity of standard GDP microtubules was estimated to be 0.85 +/- 0.2 x 10(-23) newtons x m2 which corresponded to a persistence length of 2 +/- 0.2 mm. Binding of ligands known to affect the biochemical properties of microtubules affected their rigidity. The structural analogs of inorganic phosphate AlF4- and [BeF3-, H2O], which bind to the site of the gamma-phosphate of GTP on GDP microtubule and reconstitute the GDP-Pi microtubule intermediate state of GTP hydrolysis, cause an approximately 3-fold increase in microtubule flexural rigidity and persistence length. Taxol and taxotere, antitumoral microtubule-stabilizing drugs, in contrast cause a decrease in flexural rigidity and appear to affect the three-dimensional superstructure of microtubules, which can no longer be considered as semi-flexible rods. The relationship between the mechanical properties of microtubules and their biological function is discussed.

Animals↗
PubMed1993

Membrane rigidity of red blood cells parasitized by different strains of Plasmodium falciparum.

Changes in the structure of parasitized red blood cells may influence their ability to circulate. We have used a micropipette technique to examine the effects of invasion and maturation of Plasmodium falciparum on the membrane rigidity of red blood cells. In the presence of immature, ring form parasites from different laboratory strains, membrane rigidity remained unchanged as compared with uninfected red cells. However, development of more mature pigmented trophozoites caused a marked increase in membrane rigidity. Parasites from knobless strains caused a less-pronounced increase than parasites from knob-positive strains. Using closely synchronized cultures, the dependence of membrane rigidity on parasite maturation was studied in more detail for selected knob-positive and knobless strains. Over a period of 12 hours, while trophozoites developed into schizonts, no further rigidification of the red cell membrane occurred. The increase in membrane rigidity, occurring with the initial development of pigmented trophozoites, may be related to insertion of neoantigens into the red cell surface or modification of native membrane proteins that also occur at this time. In contrast to others, we found no effect of parasite-culture supernatant, harvested at different stages, on the rigidity of uninfected cells exposed to it. Interstrain variation of membrane rigidity could influence pathophysiology in several ways: by promoting margination and cytoadherence of knob-positive strains in the microcirculation, by modulating clearance of parasitized cells by the reticuloendothelial system, and by influencing ischemic complications of severe falciparum malaria.

Animals↗
PubMed1982

Unilateral injection of morphine into the nucleus accumbens induces akinesia and catalepsy, but no spontaneous muscular rigidity in rats.

The role of the nucleus accumbens in the generation of the signs of morphine-induced "catatonia" namely akinesia, catalepsy and muscular rigidity, was studied in rats. Morphine was injected into the nucleus accumbens and either spontaneous locomotor activity or catalepsy or activity in the electromyogram of the gastrocnemius-soleus muscle, signalling the appearance of rigidity, were recorded. Unilateral injections of 5 micrograms of morphine induced a decrease of locomotor activity and weak catalepsy; 15 micrograms of morphine completely abolished locomotor activity (akinesia) and produced a very pronounced catalepsy. All these effects were antagonized by naloxone (2 mg/kg i.p.). Injections of morphine into the nucleus accumbens did not induce muscular rigidity. In contrast, injection of morphine (15 micrograms) into the head of the caudate nucleus, which induced a pronounced muscular rigidity, did not noticeably alter the locomotor activity nor did it produce catalepsy. Our results suggest that 1) the nucleus accumbens is relevant for systemically administered morphine to produce akinesia and catalepsy, but is not noticeably involved in the development of muscular rigidity; 2) they provide evidence that morphine-induced catalepsy is largely due to a strong akinesia, and that muscular rigidity, observed after morphine administration, does not contribute to positive scores in the catalepsy test.

Animals↗
PubMed1995

Nitrous oxide produces a biphasic effect on opiate-induced muscle rigidity in the rat.

Muscle rigidity is a side effect of potent opiate agonists like alfentanil. Older clinical studies suggested that nitrous oxide (N2O) augments opiate rigidity, but this has never been rigorously examined in an animal model. Sixty-two Wistar rats were placed in a Plexiglas box through which fresh gas flowed at 4 l/min. Muscle rigidity was assessed using gastrocnemius electromyographic (EMG) activity. Rats were exposed to either 60% N2O in O2 or 100% O2, EMG was measured for 10 min, alfentanil (0, 50, 175, or 350 micrograms/kg) was administered intravenously, and data were collected for 45 min. Alfentanil produced a dose-dependent increase in EMG activity in both O2 and N2O groups (p < 0.001). At 1 min postalfentanil, N2O caused significantly more rigidity than 100% O2 (p < 0.001). However, beginning at 5 min, N2O attenuated both the magnitude and the duration of rigidity. Study of a separate group of animals breathing 30% O2 demonstrated that N2O's attenuating effect on alfentanil rigidity was not due to reduced inspired oxygen concentration. These results are described by a theoretical model of the pharmacodynamic interactions of alfentanil and nitrous oxide.

Alfentanil↗
PubMedDate not supplied

Pretreatment with sedative-hypnotics, but not with nondepolarizing muscle relaxants, attenuates alfentanil-induced muscle rigidity.

STUDY OBJECTIVE: To evaluate and compare the efficacy of various pretreatment agents to attenuate or prevent opioid-induced muscle rigidity using a well-established, previously described clinical protocol. DESIGN: Prospective, controlled, single-blind, partially randomized study. SETTING: Large medical center. PATIENTS: ASA physical status I-III patients undergoing elective surgical procedures of at least 3 hours' duration. INTERVENTIONS: The effect of pretreatment with nondepolarizing muscle relaxants (atracurium 40 micrograms/kg or metocurine 50 micrograms/kg), benzodiazepine agonists (diazepam 5 mg or midazolam 2.5 mg), or thiopental sodium 1 mg/kg on the increased muscle tone produced by alfentanil 175 micrograms/kg was compared with a control group (given no pretreatment). MEASUREMENTS AND MAIN RESULTS: Rigidity was assessed quantitatively by measuring the electromyographic activity of five muscle groups (biceps, intercostals, abdominals, quadriceps, and gastrocnemius). Rigidity also was rated qualitatively by attempts to initiate and maintain mask ventilation, attempts to flex an extremity, and the occurrence of myoclonic movements. Pretreatment with the two nondepolarizing muscle relaxants had no effect on the severe muscle rigidity produced by high-dose alfentanil. Whereas thiopental was only mildly effective, the benzodiazepines midazolam and diazepam significantly attenuated alfentanil rigidity (p < 0.05). CONCLUSION: This study suggests that benzodiazepine pretreatment is frequently, but not always, effective in preventing opioid-induced muscle rigidity.

Abdominal Muscles↗
PubMedDate not supplied

Single-staged double anterior and posterior spinal reconstruction for rigid adult spinal deformity: a report of four cases.

BACKGROUND CONTEXT: Sequential anterior/posterior spinal reconstruction for rigid adult spinal deformity has become a standard operative option. Single-staged double anterior/posterior spinal reconstruction for rigid double major curvature has not been reported in the literature to date. PURPOSE: To report a previously unreported approach for rigid double major curvature of the thoracic and thoracolumbar spine with emphasis on indications and avoiding complications. STUDY DESIGN: Four cases of sequential double anterior/posterior spinal reconstruction are reported. METHODS: Single-staged double anterior spinal reconstruction was performed on four adult patients with rigid thoracic and thoracolumbar scoliosis. Osteotomies were performed by the anterior and posterior approach and followed by posterior instrumentation. A right thoracotomy and left retropleural/retroperitoneal approach was performed for each patient followed by the posterior approach in a single stage. RESULTS: Only one complication occurred, a posterior dural tear, treated without incident. A high level of patient satisfaction and return to activity was noted. Solid arthrodesis with good coronal and sagittal balance occurred in all patients. CONCLUSIONS: Single-staged double anterior/posterior spinal reconstruction for rigid adult deformity can be performed safely and effectively with good patient outcome. The procedure should be reserved only for those patients with severe double major curvature of similar magnitude and rigidity.

Adult↗
PubMed1999

Genetic heterogeneity of congenital muscular dystrophy with rigid spine syndrome.

Rigid spine syndrome is a neuromuscular disorder characterised by early rigidity of the spine due to axial muscle contractures, generally associated with muscle weakness, limb-joint contractures, and often respiratory failure. This phenotype may be associated with several muscular diseases. In cases of merosin-positive congenital muscular dystrophies (CMD) with rigid spine syndrome, we have recently identified a new locus (RSMD1) on chromosome 1p35-36. In the present study, we report the clinical, morphological and genetic analysis of other patients affected by a CMD with rigid spine syndrome from nine consanguineous families. Homozygosity mapping showed that the disease was linked to RSMD1 in one of the nine families. The other families were excluded from RSMD1, and the patients presented highly variable phenotypes suggesting the involvement of more than one gene defect in rigid spine syndrome. Nevertheless, a subgroup of patients who never walked, and had very early rigidity of the spine and scoliosis, may be considered for further genetic analysis.

Adult↗
PubMed1987

Labial kinematics during speech in patients with parkinsonian rigidity.

Studies of orofacial motor control in Parkinson's disease (PD) have demonstrated that these subjects may exhibit hypokinesia and bradykinesia, as well as increased muscle tone. Yet the relationship between aberrations of orofacial movement and muscle rigidity remains unclear. Measures of labial muscle rigidity and movement were made for 12 parkinsonian and 9 age-matched control subjects. Displacement amplitude, peak instantaneous velocity, and movement time were evaluated during repetitive syllable productions. The results showed that while mean parkinsonian displacement amplitudes and velocities were lower than the normal control subjects, there was no statistical relationship between labial rigidity and the degree of movement abnormality. It is concluded that while rigidity may play a part in the overall disability, it does not sufficiently explain the labial articulatory difficulties associated with parkinsonism. This is in agreement with the literature on limb rigidity and movement aberrations in PD, suggesting that rigidity and bradykinesia may represent independent pathophysiological phenomena.

Aged↗
PubMed1985

In vitro interaction between halothane and succinylcholine in human skeletal muscle: implications for malignant hyperthermia and masseter muscle rigidity.

This study examines in vitro the contractures induced by halothane and succinylcholine in skeletal muscle taken as biopsy specimens from 42 patients referred to the authors' laboratory for diagnosis of malignant hyperthermia (MH) susceptibility. In addition, possible differences between the response of preparations from these same patients with and without a history of masseter muscle rigidity following succinylcholine (SCh) administration were determined to investigate the in vitro relationship of masseter muscle rigidity to MH. Halothane 3%-induced contractures in preparations from MH susceptibles were similar, whether the group had a history of masseter muscle rigidity (1.15 +/- 0.18 g; n = 10) or not (1.02 +/- 0.21 g; n = 14). Halothane did not induce significant contractures in those diagnosed as normals. Succinylcholine alone did not elicit contractures from preparations derived from MH susceptibles or nonsusceptibles. Succinylcholine induced significant contractures in all preparations preexposed to halothane. Preparations from MH-negative patients with a history of masseter muscle rigidity were rendered sensitive to halothane (contractures of 1.17 +/- 0.30 g; n = 4) when SCh was present. In contrast, halothane added in the presence of SCh did not induce contractures to the same extent in preparations from MH-negative patients without a history of masseter muscle rigidity. This is the first reported in vitro method by which to examine the clinically troublesome interaction between SCh and halothane. This approach also may prove to be important in further investigations of the relationship between masseter muscle rigidity and MH.

Caffeine↗