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PubMed2001

[Enhanced continent mechanism of the tapered ileum in continent urinary reservoir].

OBJECTIVE: To construct a reliable continent tube that is easy to catheterize and is surgically simple. METHODS: From October 1999 through March 2001, 20 patients underwent a procedure in which ileal segment was tapered as an efferent tube and the partial efferent tube was placed between the back surface of the rectus muscle and the wall of the ileal pouch. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice of the tapered ileum was anastomosed to the umbilicus. Urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 17 months after operation. RESULTS: The stoma was easily catheterized with a 16 F catheter in all patients. One patient died of heart disease 55 days after the operation, while 18 of the remaining 19 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes showed the maximum close pressure with a full pouch of 46-124 cmH2O(91.53 +/- 17.21), and when the pouch was empty it was 34-84 cmH2O(66.68 +/- 11.60). The difference in the mean maximum closure pressure in full and empty pouches was statistically significant (t = 10.59, P < 0.01). At 6 to 17 months, urodynamic study was performed in 12 patients, the maximum closure pressure in the efferent tube was 77 to 154 cmH2O (100.92 +/- 20.88) when the pouch was filled with saline. When the pouch was empty, it was 56 to 115 cmH2O (74.08 +/- 14.59). The difference in the mean maximum closure pressure in full and empty pouches was statistically significant (t = 8.54, P < 0.01). Reservoir capacity was 360 to 750 ml (455 +/- 110.74). When it was filled to the maximum, the reservoir pressure was 16 to 35 cmH2O (23.17 +/- 5.82). There was no contractive wave in filling in any patient. CONCLUSIONS: This study indicates that the continent mechanism of the tapered ileum can be greatly enhanced by fixing it between the abdominal and pouch walls. This maneuver also provides easy catheterization and surgical simplicity.

Adult↗

PubMed2002

Urodynamic study of enhanced continent mechanism using tapered ileum as continent urinary reservoir.

OBJECTIVE: To investigate the effect of extramural support from the pouch and abdominal wall to enhance the continent mechanism of tapered ileum. METHODS: A total of 24 patients underwent a procedure in which an ileal segment was tapered into an efferent tube, of which a part was placed between the back surface of the rectus muscle and the ileal pouch wall. The internal orifice of the tapered ileum was anastomosed to the ileal pouch and its external orifice was anastomosed to the umbilicus. A urodynamic study of the efferent tubes and pouch was done 1.5 to 3 months and 6 to 24 months postoperatively. RESULTS: One patient died of heart disease 55 days postoperatively, while 22 of the remaining 23 were completely continent day and night. At 1.5 to 3 months, the urodynamic study of the efferent tubes demonstrated that the maximum closure pressure with a full pouch was 46 - 124 cmH(2)O (91.26 +/- 15.71 cmH(2)O) and with an empty pouch was 34 - 84 cmH(2)O (67 +/- 10.60 cmH(2)O). The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -11.78 and P = 0.00001). At 6 to 24 months, a second urodynamic study was performed on 18 cases, demonstrating a reservoir capacity of 420 to 750 ml (481.67 +/- 78.83 ml). Reservoir pressure was 6 to 9 cmH(2)O (7.17 +/- 1.17 cmH(2)O) when the pouch was filled to 50 ml, and 16 to 35 cmH(2)O (24.12 +/- 5.61 cmH(2)O) when it was filled to maximum capacity. There was no contractive wave during the filling in any patient. Maximum closure pressure in the efferent tube was 80 to 194 cm H(2)O (98.89 +/- 26.34 cmH(2)O) when the pouch was filled with saline, and 64 to 128 cmH(2)O (74.78 +/- 14.54 cmH(2)O) when the pouch was empty. The difference in mean maximum closure pressure in the full and empty pouches was statistically significant (t = -7.58 and P = 0.00003). CONCLUSIONS: This study indicates that the continent mechanism of tapered ileum may be greatly enhanced by extramural support from the abdominal and pouch walls.

Adult↗

PubMed1992

[Does a supportive "muscle corset" prevent spinal complaints?].

By strengthening trunk muscles, we hope to prevent back pain. The logic behind this argument is, however, fragmentary. The scientific evidence for the effectiveness of such measures is conflicting. Rigorous trials provide little indication as to the correctness of the above thesis. Thus further research on this important matter is necessary. Until it is available, primary prevention programs based on trunk strengthening exercise are lacking a scientific basis.

Humans↗

PubMedDate not supplied

[Clinical guideline for rehabilitation of patients with cervical whiplash at the primary care level].

Whiplash is a sprain of the ligament with strain of the paraspinal muscles due to acceleration or back acceleration of energy transmitted to the neck. The symptoms are neck pain, neck stiffness, muscular spasm and a multitude of discomforts that affect job-related and activities of daily living. In 2000, the Mexican Social Security System treated more than 15,000 cases of whiplash due to job-related activities. With this information, we organized an expert team in order to develop guidelines using methodology of evidence-based medicine and with a focus on early treatment prescribed by the general practitioner in order for the patient to obtain quick relief and to return the patient to his job and to his daily living activities as soon as possible.

Algorithms↗

PubMed1990

Hemihang-back recession: description of the technique and review of the literature.

We describe a modification of the hang-back and loop techniques that we call the hemihang-back recession, in which the muscle is reattached to the sclera posterior to the original insertion with a single, absorbable suture. We recommend it for difficult strabismus cases, specifically when recessions of 7 mm or more are required.

Adult↗

PubMed1989

Conservative treatment of patellofemoral subluxation.

As pointed out in the preface of this book, patellofemoral subluxation is probably the most common knee problem seen in many orthopedists' offices today. Whereas the other authors have emphasized the anatomy and diagnosis, this article should serve as a dry but basic instruction on the exercise program that has been used in our clinic. We have had a success rate with this program of approximately 80 per cent. Certainly not all of the 20 per cent that fail require surgery. The classic exercises are quadricep sets, straight leg raises, hip abductors, hip adductors, hip flexors, and hamstring stretches, which have endured the test of time. The prevention of flexion extension activity, such as running the stadium stairs in order to strengthen the quadriceps of the patient with patellofemoral subluxation should be emphasized. Complications of conservative treatment, such as low back pain, iliopsoas tendinitis, and muscle soreness and the treatment of these is described. Finally, the importance of stretching the hamstring muscles is a cornerstone in the treatment of patellofemoral problems. Likewise, a tight IT band can put abnormal stress on the lateral aspect of the patella. In this article I have tried to point out our approach to conservative treatment of patellofemoral subluxation.

Exercise Therapy↗

PubMed1989

Rehabilitation of the pelvis, hip, and thigh.

Low back pain, hip pain, and muscle strain of the thigh are common in athletes. Proper rehabilitation requires proper identification. Once identified, rehabilitation must include restoration of function as well as prevention of recurrence. This article discusses methods of identifying, rehabilitating, and preventing injuries to the pelvis, hip, and thigh.

Athletic Injuries↗

PubMed1984

Current concepts in the diagnosis and treatment of musculotendinous injuries.

A strain, by definition, is a stretching or tearing of a musculotendinous unit. The degree of disability associated with this injury is dictated by the location and severity of the injury and the specific needs of the patient. A strain can be arbitrarily classified as first, second, or third degree. A first-degree strain consists of minimal stretching of the musculotendinous unit without permanent injury; a second-degree strain indicates partial tearing of the musculotendinous unit; and a third-degree strain indicates complete disruption of a portion of this unit. Swelling, bleeding, and localized discomfort accompany the injury which may produce temporary disability. Initial treatment following an acute strain should consist of the use of ice, immobilization of the musculotendinous unit, and subsequent rehabilitation. Depending on the degree of disability and the specific structure injured, surgery may be indicated. Rehabilitation to a normal state following the initial healing phase is required prior to return to athletic competition.

Abdominal Muscles↗

PubMed1981

[The effect of the sympathetic nervous system on cervical spondylosis (author's transl)].

A study on the effect of injury to the cervical spine, especially the so-called whiplash injury of the neck, has revealed that many patients who have sustained cervical trauma complain of, or later develop, vertigo similar to that encountered in Ménière's syndrome. Some authors offer clinical evidence to show that vertigo results from cervical nerve root irritation which is due to hypertrophic arthritis of the cervical spine and which responds to cervical traction. The etiology of this symptom-complex, however, remains unknown and, presenting a controversial problem, while some authors point out that irritation of the sympathetic nervous system may be important in this symptom (Mèniére-like syndrome, Barré-Lieou syndrome). In this study, the significance of the sympathetic nervous system in cervical spondylosis was examined. A) The effect of electric stimulation (2V, 20cps, 1msec, 1mA) of the human anterior longitudinal ligament of the cervical spine on the finger plethysmograph (PTG). This stimulation resulted in manifest alteration of PTG, such as the appearance of tense wave or contracted wave, change of pattern and tachycardia. B) Stimulation of the tissue adjacent to the cervical vertebral column which affects the sympathetic nervous system by way of the central nervous system (ventro-median nucleus of hypothalamus: VMH) was examined by using local electroencephalogram (local-EEG) of cats. By electric stimulation (4-6V, 50cps, 1msec, 1mA) of the tissue adjacent to the cervical vertebral column, local-EEG of VMH was accelerated remarkably and blood pressure was increased. Stimulation of the sciatic nerve caused moderate acceleration with excessive electric stimulation (4-10V, 20cps, 1msec, 1mA); however, stimulation of muscles of the neck and back caused no acceleration. Sensitive receptors are probably located adjacent to the cervical vertebral column. Stimulation of the sympathetic nerve may result from stimulation of the central nervous system (hypothalamus) caused by irritation resulting from excessive instability of the cervical vertebrae. The stimulation of the sympathetic nerves may be important clinically in the pathogenesis of Barré-Lieou syndrome in cervical spondylosis.

Adult↗

PubMed1995

Ginger Jake and the blues: a tragic song of poisoning.

Prohibition, "The Noble Experiment", ushered in speakeasys, gangsters and bathtub gin in the 1920s. For many Americans, however, it led to a period of joblessness, hard times, and austerity. The story of Jamaican Ginger ("Jake") poisoning, in which batches of a cheap, alcoholic tonic were laced with tri-ortho cresyl phosphate (TOCP) is one of cynical despicable behavior on the part of those responsible and a tragic enduring legacy for the invisible group of Americans who were victimized. TOCP, a potent organophosphate, caused an axonal dying-back neuropathy affecting mainly large muscle groups. Jake poisoning struck about 50,000 adults, mostly poor middle-aged vagrants with little medical care or social standing. Their symptoms and stories were told not only in medical journals but also in song. Hillbilly jazzmen sang of the "Jake Leg Blues" with a resignation to the fate of their own undoing, brought on by the intemperance of a wasted life. The postscript is grim--those responsible received little punishment; many who drank "Jake" were left both uncompensated and crippled by irreversible paralysis.

Alcoholic Beverages↗

PubMed1993

[Spinal stenosis. A review].

Spinal stenosis is characterized by a broad spectrum of symptoms which are often vague. Therefore, patients suffering from this condition are typically seen by various specialists over a long period of time. Among the symptoms are various degrees of low back pain, neurogenic claudication, parasthesias, muscle weakness and reflex abnormalities. When spinal stenosis is suspected, CT-scanning seems to visualise stenosis well. Because the localisation of the stenosis is often unknown, myelography is still the first choice. CT-scanning can then provide supplementary information regarding the specific location. MR-scanning is not as yet used as a routine procedure, but will in time replace both procedures. Conservative treatment consisting in analgesics and physiotherapy is sufficient in some cases. When conservative treatment is not enough, surgical intervention consisting in decompression by broad laminectomy is performed. Fusion is performed when there are signs of vertebral instability or in young patients. Operational results are often good. Failure is seen following insufficient decompression.

Humans↗

PubMed1995

Stiff-man syndrome: report of a case.

A 40-year-old Taiwanese farmer developed progressive stiffness and pain in the lower back with intermittent cramps over a 3-year period. The cramps were extremely painful and the patient was sensitive to any sudden movement or external stimulation. His lower back was so stiff that the patient had great difficulty performing daily activities and walked with a rigid and straight back. The stiffness of the muscles subsided during normal sleep. Except for a left S1 radiculopathy, no other neurologic abnormalities were noted. Electromyography showed spontaneous continuous muscle fiber activity which was markedly suppressed after a trial with 20 mg intravenous diazepam. The muscular stiffness disappeared during treatment with oral diazepam 80 mg daily, which was tapered to 15 mg daily without any recurrence of spasm for 20 months. This is the first report of stiff-man syndrome in a Taiwanese patient and emphasizes the importance of recognizing this treatable disease.

Adult↗

PubMed1999

Enhanced continent mechanism of tapered ileum by extramural support from pouch-abdominal wall: an experimental study in dogs.

PURPOSE: To construct a reliable continent tube, which is easy to catheterize, we created and evaluated a new continent cutaneous diversion using a tapered ileum combined with extramural support from the pouch-abdominal wall. MATERIALS AND METHODS: Six dogs underwent a procedure in which two ileal segments were tapered and anastomosed to the ileal pouch. One of the segments (continent) was placed between the back surface of the rectus muscle and the wall of the ileal pouch creating a continent tube. The other segment (control) was brought out into the abdominal skin directly without any support from the pouch-abdominal wall. Urodynamic and radiological studies were carried out postoperatively in all dogs. RESULTS: In the continent tubes, the maximum closure pressure with a full pouch was significantly higher than those with an empty pouch (p<0.01). The maximum closure pressures of the continent tubes were significantly higher than those of the control tubes when the pouch was empty (p<0.01). The leak point pressures of the continent tubes were significantly higher than those of the control tubes (p<0.001). In all dogs, the retrograde radiogram of the continent tubes showed perfect canalization without stenosis. CONCLUSION: This study suggests that the continent mechanism of tapered ileum can be greatly enhanced by fixing it between the abdominal and pouch walls, also allowing easy catheterization in contrast to the submucosal tunnel technique.

Abdominal Muscles↗

PubMed2006

Arousal of negative emotions and symptom-specific reactivity in chronic low back pain patients.

Anger may have greater effects on chronic pain severity than other negative emotions and may do so by increasing muscle tension near the site of injury (symptom-specific reactivity). For patients with chronic low back pain (CLBP), relevant muscles are lower paraspinals (LP). Ninety-four CLBP patients and 79 controls underwent anger and sadness recall interviews. EMG and cardiovascular activity were recorded. Patients exhibited greater LP tension increases during anger and slower recovery than controls. Only patients showed greater LP reactivity during anger than sadness. For both groups, trapezius reactivity during anger and sadness did not differ. LP reactivity to anger correlated with everyday pain severity for patients. Anger-induced symptom-specific LP reactivity may be linked to chronic pain aggravation among CLBP patients.

Affect↗

PubMed1996

Mechanism and possible behavioural relevance of retinal movements in the ctenid spider Cupiennius salei

Like most spiders, the nocturnal hunting spider Cupiennius salei is able to move the retinae of its antero-median (AM) eyes. In the present study, the morphological and physiological properties of the eye muscles and the mechanism and behavioural relevance of retinal movements are investigated. The retinal movements are brought about by two forces: (i) contractions of the dorsal and ventral eye muscles, and (ii) the passive elastic restoring force of the eye tube and eye muscles (the presumed counteracting force). The dorsal eye muscle consists of 1518 striated fibres and is 600 µm long. The ventral eye muscle is longer (650 µm) and consists of 2022 striated fibres. The direction of the gaze of the retinae brought about by the eye muscles (active retinal movements) depends on the contraction states of the two eye muscles. The medially directed action of both eye muscles does not allow active movements of the eye tube in any lateral direction. Thus, the direction of gaze cannot actively be shifted medially. After active displacement of the retina, the elasticity of the eye tube and eye muscles passively moves the eye tube back to its resting position. There are two types of retinal movements. (i) Spontaneous microsaccades (duration 80 ms; excursion 3 °) are caused by the spontaneous contraction of only the dorsal eye muscle. They are ideally suited for preventing the adaptation of the sensory cells since their mean excursion (3 °) perfectly fits the inter-receptor angle (2.9 °) in the AM eye of Cupiennius salei. (ii) Induced movements (duration 100500 ms; excursions 415 °) are caused by the contraction of both eye muscles and occur only after mechanical stimulation. Induced movements were elicited by stimulating the mechanosensory organs (trichobothria and slit sense organs) of the spider's legs. A stimulus on one side of the spider induces movements of the ipsilateral retina only. We therefore suggest that induced retinal movements are saccades shifting the gaze of the spider laterally towards the site of mechanical stimulation. According to behavioural experiments, the ability of a spider to locate an immobile target is highly impaired after blinding its AM eyes. We suggest that the motility of the AM eyes is required to locate stationary objects.

Journal Article↗

PubMed2003

The mechanics of back-extensor torque production about the lumbar spine.

The purpose of this study was to develop and evaluate a biomechanical model of lumbar back extension over a wide range of positions for the lumbar spine, incorporating the latest information on muscle geometry and intra-abdominal pressure (IAP). Analysis of the Visible Human data was utilised in order to obtain anatomical information unavailable from the literature and magnetic resonance imaging was used to generate subject-specific anatomical descriptions. The model was evaluated by comparisons with measured maximal voluntary static back-extension torques. Predicted maximal specific muscle tensions agreed well with in vitro measurements from the literature. When modelling the maximal static back-extension torque production, it was possible to come fairly close to simultaneous equilibrium about all the lumbar discs simply by a uniform muscle activation of all back-extensor muscles (the caudal part showed, however, less agreement). This indicates that equilibrium in the lumbar spine is mainly regulated by passive mechanical properties, e.g. muscle length changes due to postural changes, rather than due to complex muscle coordination, as earlier proposed. The model showed that IAP (measured during torque exertions) contributes about 10% of the total maximal voluntary back-extensor torque and that it can unload the spine from compression. The spinal unloading effect from the IAP was greatest with the spine held in a flexed position. This is in opposition to the effects of changed muscle lever arm lengths, which for a given load would give the largest spinal unloading in the extended position. These findings have implications for the evaluation of optimal lifting techniques.

Abdomen↗

PubMed2006

Trapezius aplasia: indications for a dual developmental origin of the trapezius muscle.

Aplasia of the trapezius muscle is a rarely encountered, mostly asymptomatic anomaly. We report a case of isolated unilateral complete trapezius aplasia that was noticed during a dissection course. Apart from isolated cases, trapezius aplasia may occur in different combinations with other muscle aplasias. We suggest that the patterns of concomitant muscle involvement are indicative of a combined occipital and cervical somitogenic origin.

Aged↗

PubMed1989

Temporomandibular pain and dysfunction syndrome associated with generalized musculoskeletal pain: a retrospective study.

Sequential patients seen in a Temporomandibular Joint Clinic were reviewed for evidence of generalized musculoskeletal pain. A greater proportion of patients with myofascial pain dysfunction syndrome than those with other causes of temporomandibular joint pain and complaints of pain outside the jaw in the head and neck region, pain on neck muscle palpation and bilateral symptoms. Demographic and other abnormalities in these patients suggest similarities to fibromyalgia syndrome.

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