ABSTRACT
This study examined errors introduced by a posture matching approach (3DMatch) relative to dynamic three-dimensional rigid link and EMG-assisted models. Eighty-eight lifting trials of various combinations of heights (floor, 0.67, 1.2 m), asymmetry (left, right and center) and mass (7.6 and 9.7 kg) were videotaped while spine postures, ground reaction forces, segment orientations and muscle activations were documented and used to estimate joint moments and forces (L5/S1). Posture matching over predicted peak and cumulative extension moment (p < 0.0001 for all variables). There was no difference between peak compression estimates obtained with posture matching or EMG-assisted approaches (p = 0.7987). Posture matching over predicted cumulative (p < 0.0001) compressive loading due to a bias in standing, however, individualized bias correction eliminated the differences. Therefore, posture matching provides a method to analyze industrial lifting exposures that will predict kinetic values similar to those of more sophisticated models, provided necessary corrections are applied.
Subject(s)
Electromyography/instrumentation , Posture/physiology , Spine/physiology , Weight-Bearing/physiology , Biomechanical Phenomena/physiology , Electromyography/methods , Humans , Imaging, Three-Dimensional/instrumentation , Imaging, Three-Dimensional/methods , Models, Anatomic , Statistics as Topic , Stress, Mechanical , Task Performance and Analysis , Videotape RecordingABSTRACT
We investigated the incidence of the trigeminocardiac reflex (TCR) during ethylene vinyl alcohol copolymer (Onyx Liquid Embolic System, ev3 Neurovascular, Irvine, CA, USA) embolisation of intracranial dural arteriovenous fistulas (DAVFs) and evaluated the post-procedural recovery of these patients. Between June 2006 and July 2009, 21 patients (11 females, 10 males) with a mean age of 61years (range: 25-85years) underwent 28 Onyx embolisations of intracranial DAVFs at our institution. The case histories of these patients were reviewed retrospectively. A TCR occurred in three (10.7%) of the embolisations, with bradycardia lower than 60 beats/minute and a drop in mean arterial blood pressure of 20% or more. The reflex was blunted promptly with intravenous atropine, and follow-up of these patients showed no complications that might have been directly related to it. The TCR may occur during Onyx embolisation of intracranial DAVFs. Recognition of this phenomenon allows for early detection and appropriate intraoperative management.
Subject(s)
Central Nervous System Vascular Malformations/drug therapy , Embolization, Therapeutic/methods , Polyvinyls/therapeutic use , Reflex/drug effects , Trigeminal Nerve Diseases/drug therapy , Adult , Bradycardia/drug therapy , Bradycardia/etiology , Cavernous Sinus/drug effects , Cavernous Sinus/pathology , Central Nervous System Vascular Malformations/complications , Cerebral Angiography , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Trigeminal Nerve Diseases/complicationsABSTRACT
The cavernous sinus dural arteriovenous fistulas of three patients were successfully embolised by using Onyx (Onyx Liquid Embolic System, MTI, Irvine, CA, USA) as the sole embolic agent, through direct percutaneous transorbital punctures of the cavernous sinuses. Our early experience suggests that this direct approach, coupled with the unique physical properties of Onyx, is a safe and effective alternative to treat cavernous sinus dural arteriovenous fistulas when the conventional transvenous routes are inaccessible.
Subject(s)
Cavernous Sinus/diagnostic imaging , Central Nervous System Vascular Malformations/therapy , Dimethyl Sulfoxide/administration & dosage , Embolization, Therapeutic/methods , Orbit/surgery , Polyvinyls/administration & dosage , Punctures/methods , Cavernous Sinus/drug effects , Central Nervous System Vascular Malformations/diagnostic imaging , Hemostatics/administration & dosage , Humans , Orbit/diagnostic imaging , Radiography, Interventional/methods , Treatment OutcomeABSTRACT
PURPOSE: The introduction of laparoscopic nephroureterectomy highlights the need for the critical appraisal of approaches to the distal ureter at surgery for upper tract transitional cell carcinoma. We compared differences after endoscopic ureteral detachment and open bladder cuff excision in nephroureterectomy. MATERIALS AND METHODS: A total of 138 patients underwent open nephroureterectomy for upper urinary tract transitional cell carcinoma from 1982 to 2005 with a median followup of 43 months. Of these patients 90 underwent endoscopic ureteral detachment and 48 underwent bladder cuff excision. Demographic, perioperative and oncological outcome data were collected in all cases. Statistical analyses were performed using the Student t test, chi-square and log rank tests, and logistic and Cox regression. RESULTS: Mean operative duration was significantly lower in the endoscopic detachment group than in the bladder cuff group (p <0.01). There were 49 (54.4%) bladder recurrences in the endoscopic detachment group, of which 8 (16.3%) were muscle invasive and 3 (3.3%) developed at the resection site. There were 23 (47.9%) bladder recurrences in the bladder cuff group, of which 3 (13.0%) were muscle invasive and 2 (4.2%) developed at the resection site. All 5 resection site tumors occurred after excision of muscle invasive distal ureteral tumors and 4 of these had positive margins. There were no differences in recurrence-free survival or disease specific survival between the groups. Operation subtype did not predict oncological outcome on univariate or multivariate analysis. CONCLUSIONS: Endoscopic ureteral detachment reduces operative duration and is associated with equivalent oncological outcomes compared with open bladder cuff excision in nephroureterectomy. Caution should be exercised in patients with low ureteral tumors.
Subject(s)
Carcinoma, Transitional Cell/surgery , Endoscopy/methods , Neoplasm Recurrence, Local/mortality , Urologic Neoplasms/surgery , Aged , Carcinoma, Transitional Cell/mortality , Carcinoma, Transitional Cell/pathology , Chi-Square Distribution , Cohort Studies , Female , Follow-Up Studies , Humans , Laparotomy/methods , Length of Stay , Logistic Models , Male , Middle Aged , Nephrectomy/methods , Pain, Postoperative/physiopathology , Postoperative Complications , Proportional Hazards Models , Retrospective Studies , Risk Assessment , Statistics, Nonparametric , Survival Analysis , Treatment Outcome , Ureter/surgery , Ureteroscopy/methods , Urinary Bladder/surgery , Urologic Neoplasms/mortality , Urologic Neoplasms/pathologyABSTRACT
OBJECTIVES: We have previously reported the ability of D17DT (formerly GnRH-DT) vaccination to produce castrate levels of androgens in men with advanced prostate cancer. This study examines the efficacy and tolerability of 3 and 15 micrograms of D17DT in 12 patients with advanced prostate cancer to establish a dose-response relationship. METHODS: 12 patients received either 3 or 15 micrograms of D17DT as 3 deep intramuscular injections over 6 weeks. Outcome was assessed in terms of physical and biochemical evaluations of clinical progression and antibody titres. RESULTS: Significant titres of anti-GnRH antibodies were detected in 2 out of 6 subjects who received 15 micrograms of D17DT; suppression of testosterone to castrate levels accompanied by a significant and prolonged reduction in PSA was also demonstrated. No responses were seen following treatment with 3 micrograms of D17DT. CONCLUSION: The induction of anti-GnRH antibodies through vaccination with 15 micrograms D17DT can produce and sustain castrate levels of testosterone in men with advanced prostate cancer.
