Home About us Contact
|
Home About us Contact | ||
|
|
||
Cuff
Kinds of Cuff Terms modified by Cuff Selected AbstractsCascaded multiple classifiers for secondary structure predictionPROTEIN SCIENCE, Issue 6 2000Mohammed Ouali Abstract We describe a new classifier for protein secondary structure prediction that is formed by cascading together different types of classifiers using neural networks and linear discrimination. The new classifier achieves an accuracy of 76.7% (assessed by a rigorous full Jack-knife procedure) on a new nonredundant dataset of 496 nonhomologous sequences (obtained from G.J. Barton and JA. Cuff). This database was especially designed to train and test protein secondary structure prediction methods, and it uses a more stringent definition of homologous sequence than in previous studies. We show that it is possible to design classifiers that can highly discriminate the three classes (H, E, C) with an accuracy of up to 78% for ,-strands, using only a local window and resampling techniques. This indicates that the importance of long-range interactions for the prediction of ,-strands has been probably previously overestimated. [source] Considerations for pacing of the cricoarytenoid dorsalis muscle by neuroprosthesis in horsesEQUINE VETERINARY JOURNAL, Issue 6 2010N. G. DUCHARME Summary Reasons for performing study: The success rate of prosthetic laryngoplasty is limited and may be associated with significant sequelae. Nerve muscle pedicle transplantation has been attempted but requires a year before function is restored. Objective: To determine the optimal parameters for functional electrical stimulation of the recurrent laryngeal nerve in horses. Methods: An experimental in vivo study was performed on 7 mature horses (2,21 years). A nerve cuff was placed on the distal end of the common trunk of the recurrent laryngeal nerve (RLN). In 6 horses the ipsilateral adductor branch of RLN was also transected. The electrodes were connected to programmable internal stimulator. Stimulation was performed using cathodic phase and then biphasic pulses at 24 Hz with a 0.427 ms pulse duration. Stimulation-response experiments were performed at monthly intervals, from one week following implantation. The study continued until unit failure or the end of project (12 months). Two of the horses were stimulated continuously for 60 min to assess onset of fatigue. Results: Excellent arytenoid cartilage abduction (mean arytenoid angle of 52.7°, range 48.5,56.2°) was obtained in 6 horses (laryngeal grades I or II (n = 3) and III (n = 2). Poor abduction was obtained in grade IV horses (n = 2). Arytenoid abduction was maintained for up to a year in one horse. Technical implant failure resulted in loss of abduction in 6 horses at one week to 11 months post operatively. Mean tissue impedance was 1.06 kOhm (range 0.64,1.67 kOhm) at one week, twice this value at 2 months (mean 2.32, range 1.11,3.75 kOhm) and was stable thereafter. Maximal abduction was achieved at a stimulation range of 0.65,7.2 mA. No electrical leakage was observed. Constant stimulation of the recurrent laryngeal nerve for 60 min led to full abduction without evidence of muscle fatigue. Conclusions: Functional electrical stimulation of the recurrent laryngeal nerve leading to full arytenoid abduction can be achieved. The minimal stimulation amplitude for maximal abduction angle is slightly higher than those for man and dogs. Clinical relevance: This treatment modality could eventually be applicable to horses with recurrent laryngeal neuropathy. [source] Cerebral Metabolism is Influenced by Muscle Ischaemia During Exercise in HumansEXPERIMENTAL PHYSIOLOGY, Issue 2 2003Mads K. Dalsgaard Maximal exercise reduces the cerebral metabolic ratio (O2/(glucose + 1/2lactate)) to < 4 from a resting value close to 6, and only part of this decrease is explained by the ,intent' to exercise. This study evaluated whether sensory stimulation of brain by muscle ischaemia would reduce the cerebral metabolic ratio. In 10 healthy human subjects the cerebral arterial-venous differences (a-v differences) for O2, glucose and lactate were assessed before, during and after three bouts of 10 min cycling with equal workload: (1) control exercise at light intensity, (2) exercise that elicited a high rating of perceived exertion due to a 100 mmHg thigh cuff, and (3) exercise followed by 5 min of post-exercise muscle ischaemia that increased blood pressure by , 20%. Control exercise did not significantly affect the a-v differences. However, during the recovery from exercise with thigh cuffs the cerebral metabolic ratio decreased from a resting value of 5.4 ± 0.2 to 4.0 ± 0.4 (mean ±s.e.m.. P < 0.05) as a discrete lactate efflux from the brain at rest shifted to a slight uptake. Also, following post-exercise muscle ischaemia, the cerebral metabolic ratio decreased to 4.5 ± 0.3 (P < 0.05). The results support the hypothesis that during exercise, cerebral metabolism is influenced both by the mental effort to exercise and by sensory input from skeletal muscles. [source] Generation and characterization of Csrp1 enhancer-driven tissue-restricted Cre-recombinase miceGENESIS: THE JOURNAL OF GENETICS AND DEVELOPMENT, Issue 5 2008Paige Snider Histological section showing beta-galactosidase staining (blue) of embryonic day 12.5 heart from a new cysteine-rich protein (Cspr1) transgenic mouse strain crossed to the R26R cre reporter mouse. Staining is found specifically in the outflow tract cushions and myocardial cuff. See the paper by Snider et al. in the March 2008 issue. [source] Plasma renin and the antihypertensive effect of the orally active renin inhibitor aliskiren in clinical hypertensionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 9 2007J. Nussberger Summary Background:, Aliskiren is the first in a new class of orally effective renin inhibitors for the treatment of hypertension. Methods:, In 569 patients with mild-to-moderate hypertension, blood pressure (BP), plasma renin activity (PRA) and plasma renin concentration (PRC) were measured before and after 8 weeks of double-blind treatment with once-daily oral doses of aliskiren (150, 300 or 600 mg), irbesartan 150 mg or placebo. Results:, Aliskiren 150, 300 and 600 mg and irbesartan 150 mg significantly reduced mean cuff sitting systolic BP (SBP) from baseline (p < 0.001 vs. placebo). Aliskiren 150, 300 and 600 mg significantly reduced geometric mean PRA by 69%, 71% and 75% from baseline respectively (p < 0.05 vs. placebo). Irbesartan 150 mg significantly increased PRA by 109% (p < 0.05 vs. placebo). Aliskiren dose-dependently increased PRC from baseline by 157%, 246% and 497%, at 150, 300 and 600 mg respectively, compared with a 9% decrease with placebo (p < 0.05). PRC increased significantly more with aliskiren 300 and 600 mg compared with irbesartan 150 mg (105%; p < 0.05). Regression analysis showed no significant correlations between baseline PRA and changes in SBP in any of the treatment groups, but interestingly, the slopes of the regression lines between changes in SBP and log-transformed baseline PRA were +2.0 for placebo and ,1.5, ,1.8 and ,2.3 for aliskiren 150, 300 and 600 mg respectively. The slope for irbesartan 150 mg (,1.4) was similar to that for aliskiren 150 mg. Conclusions:, Aliskiren reduces SBP and PRA and increases PRC dose-dependently. In contrast, irbesartan reduces SBP but increases both PRC and PRA. As PRA is a measurement of angiotensin I-generating capacity, PRA can be used for measuring the ability of an antihypertensive agent to prevent the generation or action of Ang II, either directly (renin inhibitors, beta-blockers, central ,2 -agonists) or indirectly (AT1 -receptor blockers, ACE inhibitors). [source] Adjuvant methotrexate, vinblastine, adriamycin, and cisplatin chemotherapy has potential to prevent recurrence of bladder tumors after surgical removal of upper urinary tract transitional cell carcinomaINTERNATIONAL JOURNAL OF UROLOGY, Issue 9 2008Norihito Soga Objectives: To evaluate the efficacy of adjuvant platinum based chemotherapy in upper urinary tract urothelial cancer following surgical resection in terms of survival benefit and inhibition of bladder cancer recurrence. Methods: Between April 1986 and August 2005, a total of 132 patients with a diagnosis of upper urinary tract urothelial cancer underwent radical nephroureterectomy with cuff of bladder at our department. A total of 46 patients (13 with pT2pN0M0 and 33 with pT3 pN0M0 transitional cell carcinoma without prior bladder cancer) were enrolled. Patients with locally advanced disease were divided into two groups: the adjuvant chemotherapy group (24 patients) who received adjuvant methotrexate, vinblastine, adriamycin, and cisplatin (M-VAC) and the non-adjuvant chemotherapy group who did not receive adjuvant M-VAC (22 patients). Results: There were no statistically significant differences in patient characteristics or 10-year survival between the two groups. The recurrence rate in the non-adjuvant chemotherapy group was significantly higher than in the adjuvant chemotherapy group (log-rank test, P < 0.0001). Only non-adjuvant chemotherapy was a significant and independent risk factor (hazard ratio 6.97) for the development of intravesical recurrence (P < 0.01). Conclusion: Adjuvant M-VAC is an important optional adjuvant therapy and can prevent recurrent bladder tumors following surgery for upper urinary tract transitional cell carcinoma. To determine whether adjuvant chemotherapy has further benefit, a randomized study would be needed. [source] Robot-Assisted Isolation of the Pulmonary Veins with Microwave EnergyJOURNAL OF CARDIAC SURGERY, Issue 1 2006F.A.C.S., J. Michael Smith M.D. This study evaluated the feasibility of performing a minimally invasive left atrial isolation on a beating heart using the da Vinci Robotic Surgical System and a flexible microwave probe (Flex 10 by AFx, Inc., Fremont, CA, USA), and the reliability of exit block pacing to confirm transmurality of the lesions created. Methods: On six canines, the Flex 10 probe was passed around the left atrium posterior to the superior vena cava, through the transverse sinus, and back through the oblique sinus via a right-chest-only approach using the da Vinci Robotic Surgical System. Prior to ablation, pacing outside the atrial cuff was confirmed. Ablation was then carried out on the beating heart and repeated (as needed) until electrical isolation was demonstrated by exit block pacing. Probe position was confirmed at the completion of the procedure via sternotomy. Analysis included acute histologic and gross examination of the targeted area. Results: There was no significant difference (p = 0.110) in procedure time, although it decreased 39.6% from the first three cases to the last three cases. Electrical evidence of electrical left atrial isolation was achieved in all subjects. Acute histologic examination confirmed transmurality inconsistently. Additionally, in two animals, the Flex 10 probe was found to be anterior to the left atrial appendage. All animals survived the procedure. Conclusion: A minimally invasive left atrial isolation procedure using monopolar microwave energy with the da Vinci Robotic Surgical System is simple and feasible. However, despite creating an electrical block, transmurality was not demonstrated consistently and further confirmation of catheter positioning is necessary during a right-chest-only approach. [source] The effect of clothes on sphygmomanometric blood pressure measurement in hypertensive patientsJOURNAL OF CLINICAL NURSING, Issue 13-14 2010Rukiye Pinar Aims., To test whether there is any difference between blood pressure readings with patients wearing clothes under the manometer's cuff and not wearing clothes. Background., The few studies published on this subject have shown that blood pressure measurements give similar results whether the patients' arm is covered by clothing or not. However, it has not been clarified whether this is also true in hypertensive patients. Method., Blood pressure was measured on non-sleeved arm, sleeved arm and again on non-sleeved arm in 258 hypertensive patients using a mercury-filled column sphygmomanometer. Three nurses who were experienced and specially trained for the study performed blood pressure measurements. They were unaware of the purpose of the research. Results., Measuring blood pressure with the manometer's cuff over participant's sleeved arm did not differ significantly from non-sleeved arm measurements. Relevance to clinical practice., Sleeves have no effect on blood pressure results. Blood pressure readings taken over the sleeves will be much more practical and time saving in busy departments like emergency rooms, during disasters like earthquake where decisions have to make in minutes. Additionally, it will be time saving for general health screening surveys. Finally, it may have preferable because of hygiene concerns, patient privacy and religious beliefs. [source] Sonography of the rotator cuff in painful shoulders performed without knowledge of clinical information: Results from 58 sonographic examinations with surgical correlationJOURNAL OF CLINICAL ULTRASOUND, Issue 1 2007Stefan Moosmayer MD Abstract Purpose. To assess the value of sonography as an isolated diagnostic test for the detection and quantification of rotator cuff tears. Methods. Preoperative sonographic examination was performed on 58 shoulders. Key biases on sonographic interpretation such as history-taking, physical examination, or concurrent imaging examinations were excluded by way of blinding. Tears of the rotator cuff were the positive findings of interest. Assessment of tear size and localization was done sonographically, and the results were compared with operative findings. Results. All 24 full-thickness tears observed at surgery had been diagnosed correctly via sonography. In 19 of 20 cases with an intact rotator cuff, preoperative sonography was negative. Thirteen of 14 partial-thickness tears were not detected via sonography; 1 was misinterpreted as a full-thickness tear. Location of the tears relative to the rotator cuff tendons was described correctly in 21 of 25 cases. For tear size measurement, the 95% range of agreement was less than ±1 cm. Conclusions. Blinded sonographic examination is effective in the detection and quantification of full-thickness tears of the rotator cuff but lacks sensitivity in the detection of partial-thickness tears. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 2007 [source] The I-gel®, a single-use supraglottic airway device with a non-inflatable cuff and an esophageal vent: an observational study in childrenACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009L. BEYLACQ Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Like the LMA-ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I,II, undergoing a short-duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH2O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I-gel® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management. [source] Diagnostic accuracy of shoulder ultrasound performed by a single operatorJOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 3 2007DM Cullen Summary Both diagnostic ultrasound and magnetic resonance imaging (MRI) are used for investigation of the presence and severity of rotator cuff lesions. There is no consensus as to which is the more accurate and cost-effective study. We sought to examine the sensitivity of ultrasound, when used by one experienced radiologist with modern equipment. We compared the ultrasound and surgical results obtained from 68 patients. Ultrasound showed a sensitivity of 89% and specificity of 100% (Positive Predictive Value 100%) for full-thickness tears, and a sensitivity of 79% and specificity of 94% (Positive Predictive Value 87%) for partial-thickness tears. We found that shoulder ultrasound, in the hands of an experienced radiologist with the use of modern high-resolution equipment, is highly sensitive in differentiating complete tears and partial-thickness tears. Our results are similar to the best published results for MRI and given that ultrasound is significantly cheaper and more available, ultrasound by an experienced radiologist should be considered as a primary diagnostic tool for imaging the rotator cuff. [source] Chondrogenic differentiation and lubricin expression of caprine infraspinatus tendon cellsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 6 2010Tadanao Funakoshi Abstract Reparative strategies for the treatment of injuries to tendons, including those of the rotator cuff of the shoulder, need to address the formation of the cartilage which serves as the attachment apparatus to bone and which forms at regions undergoing compressive loading. Moreover, recent work indicates that cells employed for rotator cuff repair may need to synthesize a lubricating glycoprotein, lubricin, which has recently been found to play a role in tendon tribology. The objective of the present study was to investigate the chondrogenic differentiation and lubricin expression of caprine infraspinatus tendon cells in monolayer and three-dimensional culture, and to compare the behavior with bone marrow-derived mesenchymal stem cells (MSCs). The results demonstrated that while tendon cells in various media, including chondrogenic medium, expressed lubricin, virtually none of the MSCs synthesized this important lubricating molecule. Also of interest was that the cartilage formation capacity of the tendon cells grown in pellet culture in chondrogenic medium was comparable with MSCs. These data inform the use of tendon cells for rotator cuff repair, including for fibrocartilaginous zones. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:716,725, 2010 [source] Expression of interleukin-1,, cyclooxygenase-2, and prostaglandin E2 in a rotator cuff tear in rabbitsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2007Hiroshi Koshima Abstract We investigated the specific factors related to shoulder pain due to a rotator cuff tear using a model in rabbits. A rotator cuff tear was surgically created, and the expression of interleukin-1, (IL-1,), prostaglandin E2 (PGE2), and cyclooxygenase-2 (COX-2) was analyzed. In the supernatant of the tissue culture of the torn tendon, IL-1, production was detected. The amount of IL-1, was highest 1 day after injury, and then decreased gradually to 21 days. PGE2, the mediator of pain and the product of COX-2, was also detected in the supernatant of the tissue culture. The production of PGE2 significantly increased to 7 days after injury, and then decreased to 21 days. RT-PCR analysis confirmed the mRNA expression of IL-1, and COX-2 in the torn tendon. Immunohistochemical study demonstrated that cells in the tendon stump were immunopositive for IL-1, and COX-2. Furthermore, in the affected joint, articular chondrocytes in the remote area from the tear expressed COX-2 strongly. When the rotator cuff is torn, IL-1, is produced in the torn tendon, and stimulates the expression of COX-2 in not only the torn tendon but also in articular chondrocytes. The COX-2 then produces PGE2, which would mediate shoulder pain. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:92,97, 2007 [source] Extracorporeal shock wave therapy for plantar fasciitis.JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 5 2003A double blind randomised controlled trial Abstract Background: Extracorporeal shock wave therapy (ESWT) is an increasingly popular therapeutic approach in the management of a number of tendinopathies. Benefit has been shown in calcific tendinitis of the rotator cuff, but evidence for its use in non-calcific disorders is limited. Aims: To perform a double blind randomised controlled trial of moderate dose shock wave therapy in plantar fasciitis. Methods: Adults with plantar fasciitis for at least 3 months were randomised to receive either active treatment (0.12 mJ/mm) or sham therapy, monthly for 3 months. Pain in the day, nocturnal pain and morning start-up pain were assessed at baseline, before each treatment and 1 and 3 months after completion of therapy. Results: Eighty-eight subjects participated and no differences existed between the groups at baseline. At 3 months, 37% of the subjects in the ESWT group and 24% in the sham group showed a positive response (50% improvement from baseline) with respect to pain. Positive responses in night pain occurred in 41% and 31% in the ESWT and sham groups, respectively. Positive responses in start-up pain occurred in 37% and 36% in the ESWT and sham groups, respectively. Both groups showed significant improvement over the course of the study, but no statistically significant difference existed between the groups with respect to the changes were seen in any of the outcome measures over the 6-month period. Conclusions: There appears to be no treatment effect of moderate dose ESWT in subjects with plantar fasciitis. Efficacy may be highly dependent upon machine types and treatment protocols. Further research is needed to develop evidence based recommendation for the use ESWT in musculoskeletal complaints. © 2003 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] On the applicability of two different stimulation techniques for intra-operative peroneal nerve conduction testingJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2001W. Nebelung Dysfunction of the peroneal nerve is an important complication of knee surgery. We compared two monitoring procedures of peroneal nerve function during a standardized operation, a closing wedge high tibial osteotomy. For two types of stimulation the evoked compound motor unit action potentials (CMAPs) were recorded on the tibialis anterior muscle. We used direct perineural electrical stimulation of the common peroneal nerve distal to the cuff (dCMAPs) after nerve identification in the surgical field. Additionally, magnetic stimulation of the sacral plexus proximal to the cuff (pCMAPs) was performed. It was found that dCMAPs were recorded during almost one hour of tourniquet time whereas the pCMAPs were blocked after 25,30 min in 9 out of 11 cases. On the other hand, the CMAP obtained after proximal stimulation exhibited a latency shift with tourniquet yielding an indicator of ischaemic changes present beneath and distal to the tourniquet cuff. In conclusion, different applicabilities of both stimulation techniques under tourniquet conditions were demonstrated. © 2001 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Reconstruction of the suprahepatic cuff injured during multiorgan procurement using the infrahepatic vena cava of the liver allograftLIVER TRANSPLANTATION, Issue 10 2007Fabrizio di Francesco [source] Two consecutive ruptures of the upper cuff of disposable laryngeal tubes during anaesthesia of a single patientACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2005L. Niemi-Murola No abstract is available for this article. [source] Simplified technique for heterotopic vascularized cervical heart transplantation in mice,MICROSURGERY, Issue 1 2005Quanxing Wang Ph.D. Technical problems have limited the widespread use of mouse vascularized heart transplantation as a medical research tool. In this report, we describe a simplified method for performing heterotopic cervical transplantation by the cuff technique. The right pulmonary artery of the donor heart is equipped with a 22-gauge cuff. The aortic arch is isolated and transected at the level of the brachiocephalic artery. After proximally ligating the inferior vena cava with 9-0 silk, the residual blood vessels and lungs are ligated proximally and then carefully transected. The carotid artery is then everted over the Teflon cuff. Using this modified procedure, the operation from harvesting the donor heart to skin closure of the recipient mouse can be completed within 35 min. This simplified method for mouse heart transplantation was shown to have a high success rate, and is practical for use in transplantation immunology research. © 2004 Wiley-Liss, Inc. Microsurgery 25:76,79, 2005. [source] Combined cuff and suture technique for orthotopic whole intestinal transplantation in ratsMICROSURGERY, Issue 3 2002Atsunori Nakao M.D. For the purpose of immunological study on small intestinal transplantation (SIT), rat SIT models using direct suture technique widely have been used, which requires at least several months of training for microsurgery. Alternatively, a simple cuff technique for SIT has been mainly used by us, which reduces warm-ischemic time and the training period, but the entire intestinal grafts usually obtain a limited blood supply. This report describes a modification of a combined cuff and suture technique for rat SIT to aid beginning microsurgical transplantation researchers. The advantages are 1) use of only arterial suturing, making it easier for beginners, with the cuff technique applied to the more difficult vein anastomosis; 2) achievement of better arterial inflow and graft survival than when the arterial cuff technique is used; and 3) doing only partial clamping of the aorta, which improves animal survival and success of the procedure. A very high successful rate in orthotopic whole SIT was achieved even by beginners. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:85,90 2002 [source] Repair of vaginal vault prolapse and pelvic floor relaxation using polypropylene mesh,NEUROUROLOGY AND URODYNAMICS, Issue 7 2005Matthew P. Rutman Abstract Aims The sacrouterine ligament/cardinal (SULC) complex and prerectal fascia attach at the perineal body, forming a single support unit preventing levator descent. Many patients with vault prolapse have levator descent and widening of the hiatus. Existing transvaginal procedures do not address pelvic floor descent. We describe a technique utilizing polypropylene mesh to repair pelvic floor relaxation and prevent levator descent, along with restoration of the SULC complex in vaginal vault repair. Materials and Methods We prospectively evaluated 50 patients who had a transvaginal mesh vault/posterior wall reconstruction. A T-shaped soft prolene mesh is prepared fixing the two arms of the mesh and recreating the SULC complex in support of the cuff. The vertical segment of the mesh is transferred over the prerectal fascia and secured to the pelvic floor musculature. The rectocele is repaired incorporating the mesh distally preventing pelvic floor descent. Surgical outcome was determined by patient self-assessment including quality of life (QoL) measure as well as pelvic examination using POP-Q staging. Results Mean age was 67 years. Mean follow-up was 6 months (range 3,12). There were no intraoperative complications. There have been two apical (4%) recurrences. Mean QoL score postoperatively on a 0,6 scale was 0.74 (0,=,delighted, 1,=,pleased). Pelvic floor descent has been repaired on all patients. Postoperative POP-Q reveals restoration of normal anatomy. Conclusions We report a new technique that recreates the SULC complex in support of the vaginal vault with the aid of prolene mesh. It is the first transvaginal procedure described to reconstruct the pelvic floor in attempt to prevent pelvic floor descent. Neurourol. Urdynam. © 2005 Wiley-Liss, Inc. [source] Physical Medicine and Rehabilitation (85)PAIN PRACTICE, Issue 1 2001Erbil Dursun Glenohumeral joint subluxation and reflex sympathetic dystrophy in hemiplegic patients. (Kocaeli University, Kocaeli, Turkey) Arch Phys Med Rehabil 1999; 81:944,946. This is a case-controlled study of the relationship between glenohumeral joint subluxation and reflex sympathetic dystrophy (RSD) in hemiplegic patients set in an inpatient rehabilitation hospital. Thirty-five hemiplegic patients with RSD (RSD group) and 35 hemiplegic patients without RSD (non-RSD group) were included in this study. Patients with rotator cuff rupture, brachial plexus injury, or spasticity greater than stage 2 on the Ashworth scale were excluded. Both the RSD and non-RSD groups were assessed for presence and grade of subluxation from radiographs using a 5-point categorization. The degree of shoulder pain of the non-RSD group was assessed by a visual analogue scale of 10 points. Glenohumeral subluxation was found in 74.3% of the RSD group and 40% of the non-RSD group (P = 0.004). In the non-RSD group, 78.6% of the patients with subluxation and 38.1% of the patients without subluxation reported shoulder pain (P = 0.019). No correlation was found between the degree of shoulder pain and grade of subluxation in the non-RSD group (P = 0.152). Conclude that the findings suggest that shoulder subluxation may be a causative factor for RSD. Therefore, prevention and appropriate treatment of glenohumeral joint subluxation should be included in rehabilitation of hemiplegic patients. Comment by Miles Day, MD. The purpose of this study was to examine the relationship between shoulder subluxation in hemiplegic patients and reflex sympathetic dystrophy. They also examined if subluxation is associated with shoulder pain and the grade of subluxation in patients with subluxation and no reflex sympathetic dystrophy (RSD). Patients with injuries to the rotator cuff of the brachial plexus, marked spasticity, and major trauma to joint structures were excluded as these can be precipitating factors for RSD. The study noted a significantly higher presence of shoulder subluxation within the RSD group and the presence of pain was significantly high in patients with shoulder subluxation in the non-RSD group. The take home message of this article is that any measure or treatment that can be applied to the glenohumeral joint should be performed to eliminate the possibility of the patient developing RSD and subsequently hindering further rehabilitation in these patients. [source] Mixed neuronal,glial tumor of the digestive tract: Distinctive entity from gastrointestinal stromal tumor?PATHOLOGY INTERNATIONAL, Issue 2 2002Marie-Laure Chambonniere A 53-year-old-woman presenting with pelvic discomfort was found to have a 9.5 cm tumor located in the wall of the ileon. Light microscopy showed that the tumor was made of fascicles of plump spindle cells and bizarre epithelioid cells. A cuff of lymphoid cells was also present at the tumor margin. The tumor cells strongly expressed tau protein, neuron-specific enolase, protein green product 9.5 and glial fibrillary acid protein (GFAP), but did not show positive immunostaining for S-100 protein, CD34 or CD117. The tumor showed unequivocal ultrastructural evidence of neural differentiation. Skeinoid fibers were scattered throughout the tumor. This is the first mixed neuronal,glial tumor of the digestive tract to be described in the literature. Such histological and immunohistochemical features could be misinterpreted as features of digestive schwannoma. We suggest that this tumor is distinct from gastrointestinal stromal tumors in lacking CD34 and CD117 expression. [source] Morphological spectrum of cyclin D1-positive mantle cell lymphoma: Study of 168 casesPATHOLOGY INTERNATIONAL, Issue 10 2001Yasushi Yatabe Immunostaining for cyclin D1 is essential for reliable diagnosis of mantle cell lymphoma (MCL). However, a small number of cyclin D1-positive lymphomas other than MCL have been encountered. Our goal was to investigate the morphological spectrum of MCL as a disease entity, based on cyclin D1 overexpression. We reviewed 181 biopsy specimens obtained from 168 cases of cyclin D1-positive MCL. Typical findings were the presence of nodular (53.9% of cases) or diffuse (46.1%) histological patterns, containing mantle zone patterns (16.8%), naked germinal centers (33.5%) and perivascular hyaline deposition (83.2%). Unusual findings of residual germinal centers with a mantle cuff (four cases) and follicular colonization (two cases) were seen. High magnification showed a monotonous proliferation of tumor cells with cytological diversity including small (3.0%), intermediate (43.1%), medium (34.1%), medium, large (13.2%) and large (6.6%) cells. Pleomorphic and blastic / blastoid variants were encountered in 9.6 and 7.2% of cases, respectively. Three cases had foci of cells of considerable size, with a moderately abundant pale cytoplasm resembling marginal zone B cells. Two cases showed an admixture of cells which appeared transformed and mimicked the histology of chronic lymphocytic leukemia / small lymphocytic leukemia. In one, neoplastic mantle zones were surrounded by sheets of mature plasma cells, resembling the plasma cell type of Castleman's disease. An admixture of areas characteristic of MCL and of other larger cells, indicating histological progression or a composite lymphoma, were observed in seven cases. In high-grade lesions of five cases, nuclear staining of cyclin D1 was rarely detected. In our experience, cyclin D1 expression was also found in nine lymphomas other than MCL (five plasma cell myelomas, three Hodgkin's disease and one anaplastic large cell lymphoma). The application of cyclin D1 staining prompted us to recognize the broad morphological spectrum of MCL. MCL can be diagnosed with the application of cyclin D1 immunostaining, if careful attention is given to architectural and cytological features. [source] The ProSealTM laryngeal mask airway in childrenPEDIATRIC ANESTHESIA, Issue 3 2005M. LOPEZ-GIL MD Summary Background :,The ProSealTM (PLMA) is a new laryngeal mask device with a modified cuff to improve the seal and a drain tube to provide access to the gastrointestinal tract. We assessed the performance of the size 2 (which has no dorsal cuff) and size 3 (which has a dorsal cuff) in terms of insertion success, efficacy of seal, tidal volume, gas exchange, fiberoptic position, gastric tube placement and frequency of problems. Methods :,Eighty children undergoing minor surgery were studied (n = 40, size 2 PLMA, weight 10,25 kg; n = 40, size 3 PLMA, weight >25,50 kg). Induction was with remifentanil and propofol. Insertion was with the introducer tool and by experienced users. Maintenance was with propofol or sevoflurane and pressure controlled ventilation. Results :,The first-time and overall insertion success rate was 84 and 100%, respectively. Oropharyngeal leak pressure was 31 ± 5 cmH2O. There were no gastric or drain tube air leaks. Tidal volume and gas exchange was adequate in all patients, other than two brief episodes of hypoxia because of airway reflex activation. The vocal cords and epiglottis were visible in 99 and 80%, respectively, via the airway tube. The first-time and overall insertion success rate for gastric tube insertion was 87 and 100%, respectively. During maintenance, the PLMA was removed in one patient with airway reflex activation and another required epinephrine for bronchospasm. There were no differences in performance between the sizes 2 and 3 PLMA. Conclusion :,The PLMA is an effective airway device in children and isolates the glottis from the esophagus when correctly positioned. Despite the lack of a dorsal cuff, the performance of the size 2 was similar to the size 3 PLMA in the age groups tested. [source] Endobronchial argon plasma coagulation for the management of post-intubation tracheal stenosisRESPIROLOGY, Issue 5 2006Masanori YASUO Abstract: Post-intubation tracheal stenosis is usually caused by pressure necrosis at the cuff. Despite the fact that this phenomenon is well known and both large volume and low pressure cuffs have been developed, this lesion nevertheless continues to occur. Although the best results for tracheal reconstruction are obtained by an experienced surgeon, not all patients are able to undergo this operation for either medical or personal reasons. Argon plasma coagulation (APC) using flexible bronchoscopy has been successfully employed in the treatment of post-intubation tracheal stenosis in two of the surgery-refused and inoperable patients. The patients immediately experienced a relief of symptoms after APC. APC was thus performed 3,4 times every 1,2 weeks for each patient. In addition, there were no complications related to this procedure. The number of published clinical reports describing APC in benign airway stenosis are increasing. APC has also been reported to have several advantages over other interventional endobronchial techniques in the management of tracheo-bronchial stenosis. We report two patients, and to our knowledge this is the first description of APC being used in the treatment of endobronchial dilatation for post-intubation tracheal stenosis. [source] Human cutaneous reactive hyperaemia: role of BKCa channels and sensory nervesTHE JOURNAL OF PHYSIOLOGY, Issue 1 2007Santiago Lorenzo Reactive hyperaemia is the increase in blood flow following arterial occlusion. The exact mechanisms mediating this response in skin are not fully understood. The purpose of this study was to investigate the individual and combined contributions of (1) sensory nerves and large-conductance calcium activated potassium (BKCa) channels, and (2) nitric oxide (NO) and prostanoids to cutaneous reactive hyperaemia. Laser-Doppler flowmetry was used to measure skin blood flow in a total of 18 subjects. Peak blood flow (BF) was defined as the highest blood flow value after release of the pressure cuff. Total hyperaemic response was calculated by taking the area under the curve (AUC) of the hyperaemic response minus baseline. Infusates were perfused through forearm skin using microdialysis in four sites. In the sensory nerve/BKCa protocol: (1) EMLA® cream (EMLA, applied topically to skin surface), (2) tetraethylammonium (TEA), (3) EMLA®+ TEA (Combo), and (4) Ringer solution (Control). In the prostanoid/NO protocol: (1) ketorolac (Keto), (2) NG -nitro- l -arginine methyl ester (l -NAME), (3) Keto +l -NAME (Combo), and (4) Ringer solution (Control). CVC was calculated as flux/mean arterial pressure and normalized to maximal flow. Hyperaemic responses in Control (1389 ± 794%CVCmax s) were significantly greater compared to TEA, EMLA and Combo sites (TEA, 630 ± 512, P= 0.003; EMLA, 421 ± 216, P < 0.001; Combo, 201 ± 200, P < 0.001%CVCmax s). Furthermore, AUC in Combo (Keto +l -NAME) site was significantly greater than Control (4109 ± 2777 versus 1295 ± 368%CVCmax s). These data suggest (1) sensory nerves and BKCa channels play major roles in the EDHF component of reactive hyperaemia and appear to work partly independent of each other, and (2) the COX pathway does not appear to have a vasodilatory role in cutaneous reactive hyperaemia. [source] Autoregulation of the cerebral circulation during sleep in newborn lambsTHE JOURNAL OF PHYSIOLOGY, Issue 3 2005Daniel A. Grant Autoregulation is a vital protective mechanism that maintains stable cerebral blood flow as cerebral perfusion pressure changes. We contrasted cerebral autoregulation across sleep,wake states, as little is known about its effectiveness during sleep. Newborn lambs (n= 9) were instrumented to measure cerebral blood flow (flow probe on the superior sagittal sinus) and cerebral perfusion pressure, then studied during active sleep (AS), quiet sleep (QS) and quiet wakefulness (QW). We generated cerebral autoregulation curves by inflating an occluder cuff around the brachiocephalic artery thereby lowering cerebral perfusion pressure. Baseline cerebral blood flow was higher (P < 0.05) and cerebral vascular resistance lower (P < 0.05) in AS than in QW (76 ± 8% and 133 ± 15%, respectively, of the AS value, mean ±s.d.) and in QS (66 ± 11% and 158 ± 30%). The autoregulation curve in AS differed from that in QS and QW in three key respects: firstly, the plateau was elevated relative to QS and QW (P < 0.05); secondly, the lower limit of the curve (breakpoint) was higher (P < 0.05) in AS (50 mmHg) than QS (45 mmHg); and thirdly, the slope of the descending limb below the breakpoint was greater (P < 0.05) in AS than QS (56% of AS) or QW (56% of AS). Although autoregulation functions in AS, the higher breakpoint and greater slope of the descending limb may place the brain at risk for vascular compromise should hypotension occur. [source] New Enhancements of the Scrotal One-Incision Technique for Placement of Artificial Urinary Sphincter Allow Proximal Cuff PlacementTHE JOURNAL OF SEXUAL MEDICINE, Issue 10 2010Steven K. Wilson MD ABSTRACT Introduction., Urinary incontinence impairs sexual functioning and sexual satisfaction. Traditional artificial urinary sphincter (AUS) implantation requires perineal incision for cuff placement and a second inguinal incision for reservoir and pump placement. We believed AUS could be placed easier and quicker through one scrotal incision. Aim., In an effort to effect more proximal placement of the cuff while keeping the advantages of the one scrotal incision technique, we report enhancements to the original surgical technique. Methods., Thirty patients have been operated upon using the enhanced technique. A modification of the SKW retractor system (AMS) facilitates deep bulbar exposure. Twenty patients were first time implantations and 10 were revisions with five of the revisions having had the original AUS placed by traditional two-incision technique. Two of the first time AUS patients received an inflatable penile prosthesis through the same incision. Main Outcome Measures., We evaluated site of cuff placement, sizes of cuffs used, postoperative continence status. Results., All of the virgin AUS required dissection of the bulbocavernosus muscle prior to cuff placement. In scrotally placed revisions, replacement cuffs were situated considerably proximal (4.5,7.5 cm) to the original cuff site. The perineal placed revisions were accomplished through a scrotal incision with replacement of two cuffs in the same site and the three other patients immediately distal. No intraoperative complications were seen. One patient developed scrotal hematoma requiring drainage. Only 15 patients are available for follow-up and all are socially continent (one pad or less). Conclusions., Transscrotal approach is used safely and efficiently for penile implants and AUS implantation. The new enhancements to the one-scrotal incision technique allow more proximal cuff placement as evidenced by the bulbocavernosus muscle dissection and use of larger cuffs. Continence rate is similar to rates achieved with perineal placement of cuff found in the literature. Wilson SK, Aliotta PJ, Salem EA, and Mulcahy JJ. New enhancements of the scrotal one incision technique for placement of artificial urinary sphincter allow proximal cuff placement. J Sex Med 2010;7:3510,3515. [source] Role of Postcircumcision Mucosal Cuff Length in Lifelong Premature Ejaculation: A Pilot StudyTHE JOURNAL OF SEXUAL MEDICINE, Issue 1 2008Seyed Reza Hosseini MD ABSTRACT Introduction., Premature ejaculation (PE) is the most prevalent sexual dysfunction among men. Several theories about its etiology have been made. One of the conflicting factors is the effect of circumcision on ejaculation, and there are some concerns about leaving so much mucosa during circumcision. Aim., In our study the relationship between mucosal cuff length and PE was investigated. Methods., Eighty-four circumcised men were studied, including 42 men with PE and 42 men without. The following data and measurements were investigated: age, education, smoking, intravaginal ejaculation latency time (IELT), circumcision timing, stretched penile, penile skin, and mucosal cuff lengths. Main Outcome Measure., Penile, mucosal cuff, and penile skin lengths, the IELT. Results., The mean penile, mucosal cuff, and penile skin lengths were 121.1 ± 12.8, 15.4 ± 4.8, and 80.8 ± 21.0 mm in PE men, respectively, and were 130.1 ± 10.4, 14.7 ± 3.4, and 88.7 ± 12.2 mm in the control group, respectively. No statistically significant differences were seen regarding the length of the penis (P = 0.80), mucosal cuff (P = 0.84), and penile skin (P = 0.99). The two groups were not different regarding education (P = 0.90), smoking (P = 0.70), and circumcision timing (P = 0.65). Conclusion., Postcircumcision mucosal cuff length is not a risk factor for PE. Hosseini SR, Khazaeli MH, and Atharikia D. Role of postcircumcision mucosal cuff length in lifelong premature ejaculation: A pilot study. J Sex Med 2008;5:206,209. [source] ORIGINAL RESEARCH,BASIC SCIENCE: A Prospective Study Examining the Anatomic Distribution of Nerve Density in the Human VaginaTHE JOURNAL OF SEXUAL MEDICINE, Issue 6 2006Rachel Pauls MD ABSTRACT Introduction., Women possess sufficient vaginal innervation such that tactile stimulation of the vagina can lead to orgasm. However, there are few anatomic studies that have characterized the distribution of nerves throughout the human vagina. Aim., The aim of this prospective study was to better characterize the anatomic distribution of nerves in the adult human vagina. A secondary aim was to assess whether vaginal innervation correlates with the subject's demographic information and sexual function. Methods., Full-thickness biopsies of anterior and posterior vagina (proximal and distal), cuff, and cervix were taken during surgery in a standardized manner. Specimens were prepared with hematoxylin and eosin, and S100 protein immunoperoxidase. The total number of nerves in each specimen was quantified. Enrolled patients completed a validated sexual function questionnaire (Female Sexual Function Index, FSFI) preoperatively. Main Outcome Measures., A description of vaginal innervation by location and an assessment of vaginal innervation in association with the subject's demographic information and sexual function. Results., Twenty-one patients completed this study, yielding 110 biopsy specimens. Vaginal innervation was somewhat regular, with no site consistently demonstrating the highest nerve density. Nerves were located throughout the vagina, including apex and cervix. No significant differences were noted in vaginal innervation based on various demographic factors, including age, vaginal maturation index, stage of prolapse, number of vaginal deliveries, or previous hysterectomy. There were no correlations between vaginal nerve quantity and FSFI domain and overall scores. Fifty-seven percent of the subjects had female sexual dysfunction; when compared to those without dysfunction, there were no significant differences in total or site-specific nerves. Conclusions., In a prospective study, vaginal nerves were located regularly throughout the anterior and posterior vagina, proximally and distally, including apex and cervix. There was no vaginal location with increased nerve density. Vaginal innervation was not associated with demographic information or sexual function. Pauls R, Mutema G, Segal J, Silva WA, Kleeman S, Dryfhout V, and Karram M. A prospective study examining the anatomic distribution of nerve density in the human vagina. J Sex Med 2006;3:979,987. [source] | |||||||||||||||||||||||||||||||||||||