History and national survey on reflex hammers: which is the chosen one of Brazilian neurologists? / História e questionário nacional sobre martelos de reflexo: qual é o escolhido dos neurologistas brasileiros?

Abstract Background Percussion is an important part of the neurological examination and reflex hammers are necessary to obtain it properly. Objective We aimed to review the historical aspects of the main reflex hammers and to define the favorite one of Brazilian neurologists. Methods We searched original and review articles about historical aspects of the reflex hammers in Scielo and Pubmed and conducted an online survey to investigate the favorite reflex hammer of Brazilian neurologists. Results In the first part, we describe the major milestones in the creation of the reflex hammers. Following, we exhibit the results of the online survey: Babinski-Rabiner was the most voted. Conclusions The origins of the reflex hammers goes back long before their creation, from a basic clinical examination method: percussion. Since the description of deep tendon reflexes and the creation of percussion hammers, much has been improved in this technique. Among all the hammers surveyed, the Babinski-Rabiner was the chosen one by a significant portion of Brazilian neurologists.

Resumo Antecedentes A percussão é uma parte importante do exame neurológico e os martelos de reflexo são necessários para obtê-la adequadamente. Objetivo Nós visamos revisar os aspectos históricos dos principais martelos de reflexo neurológico e definir qual é o preferido dos neurologistas brasileiros. Métodos Procuramos artigos originais e artigos de revisão sobre os aspectos históricos dos martelos de reflexo na Scielo e no Pubmed, e conduzimos um questionário online para investigar qual é o preferido dos neurologistas brasileiros. Resultados Na primeira parte, descrevemos os principais marcos na criação dos martelos de reflexo. Na sequência, expomos os resultados do questionário online: Babinski-Rabiner foi o martelo mais votado. Conclusões A origem dos martelos de reflexos vem muito antes de sua criação, a partir de um método de exame clínico básico: a percussão. Desde a descrição dos reflexos tendinosos profundos e da criação de martelos de percussão, muito se aperfeiçoou sobre essa técnica. Dentre todos os martelos pesquisados, o de Babinski-Rabiner foi o escolhido por uma parcela significativa dos neurologistas brasileiros.

Experience of auscultatory percussion for vertebral compression fracture / 全日本鍼灸学会雑誌

A vertebral compression fracture is a red flag for low back pain. The closed-fist percussion sign is a useful physical examination, but there is a possibility of misdiagnosis. A 58-year-old woman complaining of low back pain with suddenly developed pain at rest. Physical examination using x-rays and closed-fist percussion sign were negative, but auscultatory percussion was positive. As a result, vertebral compression fracture was diagnosed by magnetic resonance imaging (MRI). Auscultatory percussion is a method that can determine a vertebral compression fracture without causing pain, and is necessary to improve accuracy in the future.

The Effects of Chest Physiotherapy on Applied to Patients Mechanicalventilated: In Patients with Acute Lung Injury / 중환자간호학회지

PURPOSE: The purpose of this study was to examine the effects of two single chest physiotherapies mechanically ventilated patients with acute lung injury.METHOD: Participants were 30 ICU patients depending entirely on ventilators without self-respiration. Each patients received two single chest physiotherapiesvibration palm cup percussion at hour intervals. Data were analyzed one-way ANOVA and Wilcoxon signed-rank test. Statistical significance was accepted at a p value less than .05.RESULTS: ibration therapy, dynamic compliance and statics compliance demonstrated a significant increase immediately and remained increased until 30 minutes after chest physiotherapy. palm cum percussion therapy saturation showed a significant increase immediately chest physiotherapyut there were no significant differences in tidal volume, dynamic compliance and statics compliance.CONCLUSION: In this study, we analyzed the effects of oscillation method and palm cup percussion method separately for each type of chest physiotherapy. Nursing interventions that actively utilize vibration methods should be provided to patients with respiratory diseases.

Drilling: medical indications and surgical technique / Drilling: indicações e técnica

SUMMARY Introduction: anovulation is a major cause of female infertility, and polycystic ovary syndrome (PCOS) is the leading cause of anovulation. While undergoing drug-induced ovulation, women with PCOS usually have a satisfactory response recruiting follicles, but some are unable to recruit follicles or often produce an excessive number of follicles, which can result in ovarian hyper-stimulation syndrome and/or multiple pregnancy. Surgical laparoscopy with ovarian "drilling" may prevent or reduce the need for drug-induced ovulation. Objective: to identify the current indications of laparoscopic ovarian drilling and the best surgical technique. Method: a review of the medical literature based on systematic search in the Medline, Lilacs and Cochrane databases, using as keywords laparoscopy, polycystic ovary syndrome, and drilling. Results: we found 105 articles in the literature, 27 of these highly relevant, describing findings on ovarian drilling. Conclusion: laparoscopic drilling is indicated for patients with polycystic ovary syndrome with ovulatory resistance to the use of clomiphene citrate, body mass index less than 30 kg/m2 and preoperative luteinizing hormone above 10 IU/L. The preferred surgical technique should be the realization of 5 to 10 perforations on the surface of each ovary bilaterally using monopolar energy.

RESUMO Introdução: a anovulação é uma das principais causas de infertilidade feminina, e a síndrome dos ovários policísticos (SOP) é a principal causa de anovulação. As mulheres com SOP, quando submetidas a indução medicamentosa da ovulação, costumam ter resposta satisfatória, recrutando folículos. No entanto, algumas podem não recrutar folículos ou, muitas vezes, têm uma produção excessiva deles, o que pode resultar em síndrome de hiperestímulo ovariano e/ou gravidez múltipla. O tratamento cirúrgico por laparoscopia comdrilling ovariano pode evitar ou reduzir a necessidade de indução da ovulação com medicamentos. Objetivos: identificar as indicações atuais do drilling ovariano laparoscópico e qual a melhor técnica operatória. Método: revisão da literatura médica, por meio de busca sistemática nas bases de dados MEDLINE, LILACS e Cochrane, utilizando as palavras-chave: laparoscopia, síndrome dos ovários micropolicísticos edrilling. Resultados: foram encontrados 105 artigos na literatura, sendo 27 de grande relevância descrevendo achados sobre o drilling ovariano. Conclusão: o drilling laparoscópico está indicado para pacientes com SOP com resistência ovulatória ao uso do citrato de clomifeno, índice de massa corpórea (IMC) inferior a 30 kg/m2 e hormônio luteinizante (LH) pré-cirúrgico superior 10 UI/L. A técnica operatória de preferência deve ser a realização de 5 a 10 perfurações na superfície de cada ovário bilateralmente por meio do uso de energia monopolar.

The relationship between the expression of Toll-like receptor 4 and neurological function after fluid percussion brain injury in rats / 中华行为医学与脑科学杂志

Objective To investigate the expression of Toll-like receptor 4 (TLR4),and explore its relationship with neurological function after fluid percussion brain injury in rats.Methods 56 adult rats were randomly divided into traumatic brain injury group(TBI group,n=48) and sham operation group(SO group,n=8).The experimental models were established.The water content of edematous brain and the expression of TLR4 were measured with dry-wet measure,immunohistochemistry and Western Blot at 1 h,6 h,12 h,24 h,3 d,7 d after shock respectively.Results Compared with SO group,neuronal function score decreased in TBI group from 6 h(3.86±0.42),reached to the lowest level at 24 h(2.65±0.32),and gradually rose at 3rd day (3.25±0.17).TLR4 immunoreactive expression increased from 6 h,reached its maxmum at 24 h,lasted to 3rd day,and then began to drop at 7th day.The linear regression analysis indicated that expression of TLR4 had negative correlation with change of neuronal function score (r 1 =-0.824,r w =-0.867,P＜0.05).Conclusion TLR4 expression is upregulated following fluid percussion injury in rats and involved in neurological function impairment by inducing secondary inflammatory brain injury.

A Pilot Randomized Control Cross over Study Evaluating the Effectiveness and Safety of Mechanical Percussor Compared with Conventional Chest Physiotherapy in Adults with Productive Cough

Introduction: Conventional Chest Physiotherapy (CCPT) remains the mainstay of treatment for sputum mobilization in patients with productive cough such as bronchiectasis and “Chronic Obstructive Airway Disease” (COPD). However CCPT is time consuming requires the assistance of a physiotherapist and limits the independence of the patient. Mechanical percussors which are electrical devices used to provide percussion to the external chest wall might provide autonomy and greater compliance. We compared safety and efficacy of a mechanical chest percusser devised by Formedic Technology with conventional chest percussion. Methods: Twenty patients (mean age 64years) were randomly assigned to receive either CCPT or mechanical percussor on the first day and crossed over by “Latin square randomisation” to alternative treatment for 6 consecutive days and the amount of sputum expectorated was compared by dry and wet weight. Adverse events and willingness to use was assessed by a home diary and a questionnaire. Results: There were 13 males and 7 females, eight diagnosed as bronchiectasis and 12 COPD. The mean dry weight of sputum induced by CCPT (0.54g + 0.32) was significantly more compared with MP (0.40g + 0.11); p-value = 0.002. The mean wet weight of sputum with CCPT (10.71g + 8.70) was also significantly more compared with MP (5.99g + 4.5); p-value < 0.001. There were no significant difference in adverse events and majority of patients were willing to use the device by themselves. Conclusion: The mechanical percussor although produces less sputum is well tolerated and can be a useful adjunct to CCPT

Effect of normabaric hyperoxia treatment on neuronal damage following fluid percussion injury in the striatum of mice: A morphological approach.

Traumatic brain injury (TBI) causes significant mortality in most developing countries worldwide. At present, it is imperative to identify a treatment to address the devastating post-TBI consequences. Therefore, the present study has been performed to assess the specific effect of immediate exposure to normabaric hyperoxia (NBO) after fluid percussion injury (FPI) in the striatum of mice. To execute FPI, mice were anesthetised and sorted into (i) a TBI group, (ii) a sham group without injury and (iii) a TBI group treated with immediate exposure to NBO for 3 h. Afterwards, brains were harvested for morphological assessment. The results revealed no changes in morphological and neuronal damage in the sham group as compared to the TBI group. Conversely, the TBI group showed severe morphological changes as well as neuronal damage as compared to the TBI group exposed to NBO for 3 h. Interestingly, our findings also suggested that NBO treatment could diminish the neuronal damage in the striatum of mice after FPI. Neuronal damage was evaluated at different points of injury and the neighbouring areas using morphology, neuronal apoptotic cell death and pan-neuronal markers to determine the complete neuronal structure. In conclusion, immediate exposure to NBO following FPI could be a potential therapeutic approach to reduce neuronal damage in the TBI model.

The relationship between the expression of inflammatory cytokines and neuronal function score of fluid percussion brain injury in rats / 中华行为医学与脑科学杂志

Objective To investigate the expression of inflanmatory cytokines such as interlukin-1β (IL-1 β),interlukin-6 (IL-6),tumor necrosis factor-α (TNF-α) and intercelluar adhesion molecule-1 (ICAM-1),and explore their relationships with neuronal function score after fluid percussion brain injury in rats.Methods The experimental models were established in 48 adult rats.The water content of edematous brain and the expression of IL-Iβ,IL-6,TNF-α and ICAM-1 were measured with dry-wet measure,immunohistochemistry at 6 h,12 h,24 h,3 d,7 d after operation respectively.Results Compared with animals of shame operation (SO) group,neuronal function score decreased in TBI group from 6h (3.78±0.84),reached to the lowest level at 24h (2.65±0.32),and gradually increased at 3d (4.75±0.71).IL-6,IL-1β,TNF-α and ICAM-limmunoreactive expression increased from 6h,reached its maxmum at 24h,lasted to 3th day,and began to decrease at 7d.The linear regression analysis indicated that expression of IL-1β,IL-6,TNF-α and ICAM-1 had negative correlations with change of neuronal function score(r=-0.912,r=-0.892,r=-0.794,r=-0.887 respectively,P＜0.05).Conclusion IL-6,IL-1β,TNF-α and ICAM-1 expression is upregulated following fluid percussion injury in rats,and shows negative correlations with neuronal function score.The possible mechanisms is that inflammatory cytokines are involved in nerve function impairment by inducing secondary brain injury.

Foreign Body Removal at Right Main Bronchus in A Neonate / 대한구급학회지

Foreign body in the airway could be a life-threatening risk, especially for young pediatric patients. A 6-day old male patient with foreign body, which was located deep in the right main bronchus was being admitted. Although we tried three times to remove it with rigid bronchoscopic forceps under the general anesthesia, we failed. Before switching to surgical treatment, we changed the Trendelenburg position and tapped his back several times in order to alter the foreign body toward the forcep. Finally we were able to catch and extract the foreign body successfully. We suggest that back percussion with the Trendelenburg position is a useful solution to remove a foreign body within a deep airway.

The relationship between the pathological changes and neuronal function score of graded fluid percussion brain injury in rats / 中华行为医学与脑科学杂志

ObjectiveTo observe the relationship between neuronal function score and pathological changes of fluid percussion brain injury in rats and to explore their clinical significances.MethodsThe fluid percussion models of brain injury in rats were established by using the improved device with three kinds impact pressure such as 0.1 MPa,0.2 MPa,0.3 MPa,and vital signs and mortality rate were observed.Behavior changes,brain water content,histological changes were observed by Shapira and Wahld method,dry-wet measure,light microscopy at 1 h,6 h,12 h,24 h,3 d and 7 d after operation respectively.ResultsThe animals accepted impact pressure of 0.1 MPa showed temporary hypopnea with mortality rate of 2.08％,those of 0.2 MPa suffered apnoea of ( 10.88 ±2.69 ) s with mortality rate of 4.17％ and those of 0.3 MPa suffered apnoea of ( 20.60 ± 3.02 ) s with mortality rate of 16.67％.As the impact pressure increased,nervous function score minimumly decreased to (7.17 ±0.75) of 0.1 MPa group,(4.83 ± 0.75 ) of 0.2 MPa group and (2.67 ± 0.52) of 0.3 MPa group respectively,and recovered more slowly.Brain water content maximumly reached to (81.12 ± 0.03 )％,(82.74 ± 1.11 )％ and (83.89± 0.04) ％ at time point of 24 h respectively.The brain injury was involved in the outer layer of cerebral cortex,hippocampal formation and brain stem respectively and histological observation verified above findings.Conclusion Light,moderate and heavy fluid percussion brain injury in rats have more and more low nervous function scores,which have positive relationship with more and more serious pathological changes.

The relationship between the change of aquaporin4,brain edema and neuronal function score of fluid percussion brain injury in rats / 中华行为医学与脑科学杂志

ObjectiveTo observe the relationship between neuronal function score,brain edema and aquaporin4(AQP4) expression of fluid percussion brain injury in rats.MethodsThe fluid percussion models of brain injury of rats were established by using the improved device.Nervous function score,brain water content,histological changes,AQP4 expression were observed by Shapira and Wahld method,dry-wet measure,light microscopy,immunohistochemistry and western blot at 1 h,6 h,12 h,24 h,3 d and 7 d after operation respectively.ResultsNervous function score in TBI group decreased at 12 h( 11.17 ± 1.32),reached its minimum at 24 h( 10.17± 0.75),and recoved partially at 3rd day( 10.66 ± 1.37 ).The water content obviusly increased in those of TBI group at 12h( (80.27 ±1.47)％ ),reached its peak at 24h( (82.19 ±0.97)％ ),and then began to drop at 3d ( (8 1.74 ± 1.69 ) ％ ),while Western blot showed that AQP4 immunoreactive expression obviusly increased at 12 h (OD:0.65 ±0.05),reached its maximum at 24h( OD:0.72 ±0.08),and decreased at 3d( OD:0.56 ±0.07),and immunohistochemistry showed the same trendency of AQP4 expression as that of Western blot.The linear regression analysis indicated that nervous function score had a negtive correlation with expression of AQP4 in edematous brain and change of brain water content respectively ( r =- 0.615,P ＜ 0.01 ; r =- 0.605,P ＜ 0.05 ).ConclusionNervous function score of fluid percussion brain injury in rats decrease,has negative relationship with brain edema and AQP4 expression,and possible mechanisms is that AQP4 is indirectly involed in nerve function impairment by mediating brain edema.

Chest Physiotherapy on the Respiratory Mechanics and Elimination of Sputum in Paralyzed and Mechanically Ventilated Patients With Acute Lung Injury: A Pilot Study

PURPOSE: Chest physiotherapy (CPT) is commonly used for mechanically ventilated patients, but little is known about its physiological effects, particularly in patients with acute lung injury (ALI). The aim of the study was to determine the benefits and risks of delivering multimodal respiratory physiotherapy to mechanically ventilated patients with ALI receiving paralytic agents. METHODS: A repeated measure-experimental design using a counterbalancing method was employed. Fifteen patients received CPT (vibration, percussion, or palm-cup percussion) in addition to the routine CPT in a randomized order. Another 15 patients, contraindicated for the percussion technique, received routine CPT including manual hyperinflation and position change, and were observed as a comparative group. The effects of CPT were evaluated by measuring the volume of aspirated secretions and the dynamic lung compliance (Cd) over time. For the adverse effects, peripheral oxygen saturation (SpO2) was recorded. Cd and SpO2 were recorded at the baseline period, immediately after the physiotherapy treatment, and at 10, 20, 30 and 60 minutes posttreatment. RESULTS: The volume of collected secretions did not differ significantly when compared between the groups (p = .838). Cd increased significantly over time in the manual percussion (p = .042) and palm-cup percussion (p = .046) group, where Cd in the latter remained elevated twice longer than in the former. None of the CPT techniques exerted major detrimental effects on SpO2. CONCLUSIONS: We found that the palm-cup percussion technique was the most effective in increasing Cd without any accompanying detrimental effects on SpO2. However, additional CPT did not affect the volume of aspirated secretions.

Effects of interleukin-6 in hypothalamus on gastric mucosal injury in rats with stress ulcer / 中华急诊医学杂志

Objective To clarify the role of hypothalamic IL-6 in gastric mucosal blood flow, gastric juice pH value and gastric mucosal injury. Method Model of gastric stress ulcer was established by fluid percussion to make craniocerebral trauma. Twenty male SD rats fed for one week in the experiment room were randomly(random number) divided into control group, one hour group, six hours group and 12 hours group after injury. The levels and distribution of IL-6 in hypothalamus were detected by using immunohistochemistry and Western blot. Simultaneously, gastric pH value, gastric mucosal blood flow and gastric mucosal injury index of rats in each group were measured, and the histology of gastric mucosa was observed. Results IL-6 immunoreactive cells were widely distributed in neuronal cells of hypothalamus of the stressed rats especially in the para-ventricular nucleus (PVN).One hour after injury, the pH value rapidly declined, and the lowest point appeared 6 hours later. One hour after injury, the injury of gastric mucosa was found, and the injury became worse and worse as time got longer and longer. The ulcer index (UI) was increased. One hour after injury, there was a brief increase in blood flow to the peak in gastric mucosa, and then the blood flow declined until 6 hours elapsed and got stable. The experiment prompted the gastric stress ulcer appeared. Conclusions In the SD rats with gastric stress ulcer induced by craniocerebral injury incurred by hydraulic percussion, the hypothalamic IL-6 may activate neuronendocrine metabolism mediated through the activation of PVN, inducing gastric mucosal injury.

Comparison of Discharging Sputum with Machine Vibration and Percussion on Back in Patients with Spinal Cord Injury Complicated by Lung Infection / 中国康复理论与实践

@#ObjectiveTo compare the effects of discharging sputum with machine vibration and percussion on back in patients with spinal cord injury (SCI) complicated with lung infection.Methods33 patients were divided into machine group (n=18, discharging sputum with machine vibration) and percussion group (n=15, discharging sputum with percussion on back). Then the auscultation of lungs, change of Sp2, abatement time of fever, white blood cells count and X-ray results of chest were compared to estimate the effect of discharging sputum.ResultsThere was a significant difference in the auscultation of lungs between the two groups ( P<0.05), while no significant difference was founded in the SpO2 between two groups after sputum discharged ( P>0.05). The abatement time of fever was shortened significantly in the machine group after treatment( P<0.05). The X-ray results improved significantly in the machine group, compared with percussion group ( P< 0.05).ConclusionThe effect of discharging sputum with machine vibration is better than percussion on back.

Comparison of Discharging Sputum with Machine Vibration and Percussion on Back in Patients with Spinal Cord Injury Complicated by Lung Infection / 中国康复理论与实践

@#ObjectiveTo compare the effects of discharging sputum with machine vibration and percussion on back in patients with spinal cord injury (SCI) complicated with lung infection.Methods33 patients were divided into machine group (n=18, discharging sputum with machine vibration) and percussion group (n=15, discharging sputum with percussion on back). Then the auscultation of lungs, change of Sp2, abatement time of fever, white blood cells count and X-ray results of chest were compared to estimate the effect of discharging sputum.ResultsThere was a significant difference in the auscultation of lungs between the two groups ( P<0.05), while no significant difference was founded in the SpO2 between two groups after sputum discharged ( P>0.05). The abatement time of fever was shortened significantly in the machine group after treatment( P<0.05). The X-ray results improved significantly in the machine group, compared with percussion group ( P< 0.05).ConclusionThe effect of discharging sputum with machine vibration is better than percussion on back.

Effects of fluid percussion injury on survival and differentiation of human embryonic neural stem cells in rats / 中国康复理论与实践

@#ObjectiveTo investigate the effects of fluid percussion injury(FPI) on survival and differentiation of transplanted human embryonic neural stem cells (HNSCs) in rats. MethodsThe HNSCs were separated from the cerebral cortex of the 8-week-old fetal and were cultured in DMEM/F12 combinated with EGF, bFGF and LIF. The rat models of FPI were made with fluid percussion system. The HNSCs labeled with BrdU were transplanted into the injured zone 24 hours after brain injury, then the rats were killed at the 1st and 4th week post-transplanted stages, and the brain slices were stained with immunocytochemistry. The GFAP, MAP-2, and BrdU positive cells were investigated.ResultsThe transplanted HNSCs migrated to the whole brain, and differentiated into GFAP and MAP-2 positive cells. MAP-2 positive cells were observed at 1 week post-transplanted stage, on the contrary, more GFAP positive cells were discovered 4 weeks after transplantation. Part of the HNSCs migrated to the choroids plexus of the lateral ventricle and microvessels. ConclusionThe transplanted HNSCs survive in the injured zone, and differentiate into astrocytes gradually during the recovery. The host devours part of the HNSCs.

Clinical Observations of Spontaneous Osteonecrosis of the Medial Tibial Plateau / 全日本鍼灸学会雑誌

[Objective] We analyzed the clinical findings in 5 patients with osteonecrosis in the medial condyle of the tibia. We also evaluated the usefulness of a tibial percussion test that we developed for examination of differences between the healthy and affected sides in percussion caused by knocking on the tibial rough surface.<BR>[Methods] The subjects were 5 females, who consulted our hospital with a chief complaint of gonalgia and in whom conditions such as osteonecrosis in the medial condyle of the tibia were confirmed by MRI in 4 limbs. In addition to X-p, MRI findings, medical findings by interview, and findings by physical examination were evaluated as clinical findings. Furthermore, the tibial percussion test was performed.<BR>[Results] The causes of pain in the knee joint were unclear in all patients. Pain was severe in 3 patients and marked in 2 patients. Physical examination showed marked tenderness in the medial articular gap and tenderness in the medial condyle of the tibia. In all patients, a difference in the percussion findings between the healthy and affected sides was confirmed by the tibial percussion test.<BR>[Conclusions] These findings indicated that the tibia percussion test in addition to confirmation of characteristic clinical conditions, such as the initial condition of the disease and the severity of tenderness, is useful for the evaluation of conditions of this disease.

Quantitative Analysis of Patellar Tendon Reflexes with Newly Designed Percussion Instrument

OBJECTIVE: There has been some existing problems with the electrical reflex hammer. The occurrence of pressure build up with percussion and change of hammering points is one example. In order to make improvements on this device, we conducted studies with a newly designed percussion instrumental stimulator. METHOD: The data collected from the first group was based on the manual percussion of electrical reflex hammer on the patella ligament. The data collected from the second group by usage of a newly designed instrumental stimulator maintained steady pressure and time and target position on the electrical reflex hammer. Comparisons were made between the two group. RESULTS: Our single measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 84.67%, 91.23%, 73.63%, and 83.29%. The 10 repeated measure of latency and amplitude on the manual and instrumental percussion group resulted in the reliability of 99.95%, 99.97%, 99.90%, and 99.94%. CONCLUSION: From our experiment on the tendon reflex, we found out that it is important to have an instrumental stimulator that can maintain steady pressure while it is applying percussion to accurate data. On manual percussion, it is important to obtain data based on mean value of repeated measurements.

Use of Models in Teaching Palpation and Percussion in a Basic Diagnosis Training Course / 医学教育

In 1994, a basic diagnosis training course was introduced for 2nd-year medical students at Jichi Medical School (JMS) to teach basic interview and physical examination skills with an emphasis on diagnostic processes and principles. In planning and preparing the course, instructors at JMS frequently held discussions to determine learning objectives and activities. We used a comprehensive manual for small-group teaching to standardize lectures as much as possible. In all sessions of the basic physical examination, students were taught in small groups. We also constructed original models to teach palpation and percussion. These models allowed students to participate actively and helped them understand the principles, skills, and findings of palpation and percussion. Instructors at JMS concluded that the models were useful training tools.

Laser Doppler Estimated Cortical Hemodynamic Changes of Modified Fluid-Percussion Injury Model for Head Trauma Including Hyperosmolar Agent Infusion

A study of cortical blood flow changes using laser Doppler was conducted in seven head injuried rats with subsequent intravenous administration of mannitol. Cortical blood flow after head trauma by the fluid-percussion model was decreased in 6 cases and initially increased and then decreased in 1 case. Cortical blood flows were dramatically increased about three to six times after intravenous administration of mannitol. These results suggest that the modified fluid-percussion cortical injury system is more stable and consistent than the old fluid-percussion injury model. It, therefore, seems applicable to be used as experimental models for head trauma.