The effect of exercise on motor performance tasks used in the neurological assessment of sports-related concussion.

Sports-related concussion is assessed using both cognitive and motor performance tasks. There is limited understanding of how exercise affects these measures. The purpose of this study was to investigate the effect of moderate-intensity exercise on three selected measures of motor performance. A repeated measures design was used to compare baseline motor performance scores with post-exercise scores with an exercise intervention modelled on the physiological demands of a team sport. 30 physically active subjects performed timed motor performance tasks: Finger-to-Nose (FTN), Tandem Gait (TG) and Single Leg Stance (SLS). The tasks were administered twice pre-exercise and twice post-exercise. FTN, TG and SLS demonstrated high test-retest reliability (ICC values >0.8). 15 minutes of moderate-intensity exercise caused a significant improvement in FTN (T2 = 2.66 (SD 0.38), T3 = 2.49 (0.32); p<0.001) and TG (T2 = 13.08 (2.84), T3 = 12.23 (2.22); p = 0.001), but not in SLS (T2 = 5.94 (4.99), T3 = 5.91 (5.54); p = 0.507). Improvement in the performance of motor tasks after exercise has implications for the immediate assessment of sports-related concussion, given that measures of motor performance are utilised in concussion assessment instruments.

[Sigmoid diverticulitis -- indications for surgery and choice of procedure]. / Indikationen zur Sigmaresektion bei Divertikulitis. Wann wird operiert?

The first attack of uncomplicated diverticulitis is treated conservatively. Sigmoid resection is indicated for recurrent diverticulitis, in patients with manifest stenosis or fistula and for such emergencies as perforation, ileus or bleeding. Early surgery after the first episode is recommended for patients under 50 years of age, or immunocompromised patients. This is particularly true for patients with radiological signs of severe diverticulitis. Today elective sigmoid resection is a laparoscopic procedure. Properly carried out, the operation effects a definitive cure. The morbidity and mortality of the operation is low, and re-operations for recurrent diverticulitis are the exception. In the emergency situation a two-stage procedure is often necessary.

Transport of tools and mental representation: is capuchin monkey tool behaviour a useful model of Plio-Pleistocene hominid technology?

Capuchin monkeys display greatly developed tool-using capacities, performing successfully a variety of tool-tasks. Impressed by their achievements in this respect, some investigators have suggested that capuchin tool-using behaviour could be used as a model of the tool behaviour of the first hominids. The transport of tools, a task requiring complex cognitive capabilities, is an essential ingredient in the technological behaviour of the first hominids. In this way, to qualify as another source for modelling hominid behavioural evolution, capuchins had to exhibit proficiency in the transport of tools. We investigated this problem through experiments designed to elicit the transport of objects. The results showed that the monkeys were able to transport food to be processed with the use of tools, but failed when the tools themselves had to be transported. Our hypothesis is that a limited capacity for abstract representation, together with the lack of a regulatory system ensuring that the food would not be lost and consumed by another individual during the search for and transport of the tools, were responsible for such a failure. We conclude that the tool-using behaviour of capuchins presents no functional analogy with the tool behaviour of the Plio-Pleistocene hominids, and that capuchin monkeys are a very inadequate source for modelling Plio-Pleistocene hominid's technological behaviour.

[Indications for intramedullary stabilization of shaft fractures in childhood. What is reliable, what is assumption?]. / Indikation zur intramedullären Stabilisierung von Schaftfrakturen im Kindesalter. Was ist gesichert, was ist Vermutung?

For some 15 years the elastically stable medullary nailing (ESIN) has been used in fracture treatment in children. The group of Nancy (Prevot and colleagues) first described the procedure for shaft fractures in children. Now the method is the standard procedure for stabilisation of long bone diaphyseal and metaphyseal fractures. During recent years a number of papers have described good and excellent results with this method, especially for shaft fractures of femur and forearm. In some papers there are also methods for articular fractures in more demanding techniques presented. Also when we have no evidence-based studies, we can say from the experience out of the last years that the ESIN is a biological, minimally invasive fracture treatment to achieve a high level of reduction and stabilisation in fractures in children. The use of titanium nails leeds to a higher rate of flexural elasticity and so the titanium nails are more recommended for this method.

The use of transpositional skin flaps in closing plantar defects: a case report.

Large defects on the plantar aspect of the foot can be too extensive to permit primary repair by suturing alone. Such defects can be closed through the use of skin flaps. The authors present an overview of skin flaps and suggest a transpositional skin flap as one type of reconstructive treatment for this problem.

Emergency laparoscopy. Technical support for the laparoscopic diagnosis of intestinal ischemia.

BACKGROUND: Laparoscopic diagnosis of intestinal ischemia is difficult. Dark-colored bowels are not a reliable indicator for infarction, because there is no correlation between color and oxygenation. The same picture is produced by intraluminal blood or feces. False diagnoses are described. METHODS: We analyzed various techniques for assessing intestinal oxygenation and perfusion to support laparoscopic diagnosis. In this study laparoscopy was performed on eight pigs. A 10-cm segment of intestine was fixed to the abdominal wall and rendered ischemic. Measurements of the ischemic segment and normal intestine were taken using laser-Doppler, Doppler ultrasound, spectrophotometer, and pulse oximeter. Doppler ultrasound and pulse oximetry were unsuitable in our model, as was laser-Doppler flowmetry. RESULTS: Only the spectrophotometer proved a highly sensitive means of assessing bowel oxygenation. CONCLUSIONS: This method provides the desired additional information about intestinal oxygenation, thus helping to interpret the laparoscopic picture of dark bowels.

Comparison of laparoscopic handsewn suture techniques for experimental small-bowel anastomoses.

Laparoscopic techniques have only rarely been applied to procedures on the small bowel. A comparison of three handsewn intracorporeal anastomoses was carried out. Thirty pigs were divided into three groups, and a different technique was used in each group (SK, single knot; RS, running suture; CL, clip suture). Half of the animals had a relaparoscopy on day 4. The duration of the procedure was recorded, and the quality of anastomotic healing was assessed by morphological, radiological, mechanical, and biochemical examinations. The animals were sacrificed on postoperative day 14. The anastomoses in the SK group took significantly longer than in the RS or CL groups. The mean duration of relaparoscopy was 28 min. Bursting pressure values and hydroxyproline concentrations were without any significant difference. The SK and CL groups showed a good alignment of the layers and the RS showed necrosis and overlying mucosa. Most complications were noted in RS. The results demonstrate that manual small-bowel anastomoses can be performed laparoscopically. Single-knot and clip sutures are reliable techniques. The ongoing development of new instruments and the three-dimensional technique will basically improve the construction of intracorporeal anastomoses.

Effects of the Pringle maneuver on hemodynamics during laparoscopic liver resection in the pig.

The Pringle maneuver (PM) is recognized in conventional liver surgery as a method of controlling bleeding. To determine the hemodynamic effects of the PM during pneumoperitoneum (PP) for laparoscopic liver resection, we measure hemodynamic and blood gas changes in 7 healthy pigs. All variables were recorded 5 min before and 10 and 30 min after employing PP or PM and 10 min after discontinuation of PM. After the induction of PP, cardiac index and arterial carbon dioxide tension significantly increased, accompanied by a significant decrease in pH. After the beginning of PM, cardiac index and mean arterial and central venous pressures decreased significantly, whereas the heart rate rose markedly. After discontinuation of the PM, the systemic vascular resistance index decreased, and the heart rate remained elevated. These results demonstrate severe hemodynamic deterioration with PP and a subsequent PM. The latter should, therefore, be considered only as a last resort for the control of bleeding during laparoscopic liver surgery.

[Endoscopic hemostasis in bleeding gastroduodenal ulcer--a contribution to the cost aspect]. / Endoskopische Blutstillung bei der gastroduodenalen Ulkusblutung--Ein Beitrag zur Kostenproblematik.

Endoscopic injections of fibrin glue for the treatment of gastroduodenal ulcer hemorrhage have been increasingly used instead of sclerosing agents since 1987. Sclerosants have the drawback that they themselves have tissue-destroying or rather ulcerogenic effects. A difficult form of administration and a relatively high price are set against the good biological properties of the fibrin glue. In a randomized study comparing fibrin glue with polidocanol there was a statistically significant lower rebleeding rate in the fibrin group. The data of this study were analysed with regard to economic aspects. They showed an improved cost-benefit and cost-effectiveness ratio of the fibrin glue compared with polidocanol.

Vacuum-supported endoscopic access.

The rapid increase in the number of endoscopic operations performed has resulted in a corresponding rise in the incidence of severe complications. This issue has generated widespread concern at recent congresses. It is now indisputable that safer access to the abdominal cavity is required. We have developed a technique of vacuum-supported visual access which allows the surgeon to anticipate dangerous sites of access and avoid injuries to internal organs or retroperitoneal blood vessels. The procedure has two major advantages: Firstly, a pre-peritoneal approach allows the surgeon to visualise the structures behind the peritoneum, and secondly, puncture of the insufflation-needle is facilitated and the depth of insertion is minimised. The underlying principle is to use negative pressure to elevate the peritoneum. Using this approach, the principles of open surgery are adhered to during abdominal access, thereby avoiding visceral injury.

[Therapy and follow-up of gastroesophageal chemical burns]. / Therapie und Verlauf gastroösophagealer Verätzungen.

We report a retrospective analysis of 61 patients admitted during the years 1974 to 1992 after having recently swallowed a corrosive agent. Within 24 hours, the localisation, severity and extent of the injury had been determined by endoscopy. In 13 patients the injury was restricted to the oropharynx, and in 48 it involved esophagus, stomach and duodenum. Fourteen had sustained a second degree injury, and 16 a third degree injury. Out of five patients with third degree injuries who were treated by operation within the first three days, two survived. Two patients operated upon for complications after 10 days of conservative treatment died. The total mortality was 21%, but 56% for those who had received a third degree injury. Thirteen patients developed a stenosis (27% of those with gastroesophageal lesions). Esophageal strictures were dilatated with bougies, but stomach stenoses were treated by resection. Of the 12 patients treated by dilatation, 4 sustained perforations and 4 of them were free of symptoms for a considerable period of time (more than 4 years).

Experience with TEM in Germany.

Transanal endoscopic microsurgery (TEM) presents a minimally invasive procedure for local removal of large adenomas as well as early carcinomas of the rectum. 57 surgical departments/clinics, which practice this method in Germany were asked about their experience. 44 questionnaires were evaluated. Indications for the 1,900 recorded operations were 1,411 adenomas, 433 carcinomas (curative intention: 286; palliative intention: 147), and 56 other procedures. The conversion rate to laparotomy was dependent on the experience with this surgical method (1.2%-11.6%). A radical rectal resection as a second step was performed in 5.7% of patients in the case of advanced carcinoma in the histologic examination of the specimen. Complications appeared in 120 patients (6.3%), 77 patients (4.0%) recovered with conservative treatment, and 43 (2.3%) had to undergo surgery. The mortality rate was 0.2% (3/1,900 pts).

[Laparoscopic techniques in therapy of choledocholithiasis]. / Laparoskopische Techniken zur Therapie der Choledocholithiasis.

Several methods for therapy of common bile duct stones (CBDS) during laparoscopic cholecystectomy are available. After intraoperative cholangiography laparoscopic removal of CBDS can be achieved via the cystic duct or a choledochotomy using a thin cholangioscope, balloon catheters and Dormia baskets. Lithotripsy (electrohydraulic or laser) is necessary in presence of larger stones. Also combined procedures with intraoperative antegrade or retrograde papillotomy have been described. Published studies show that laparoscopic common bile duct exploration can be performed successfully by experienced surgeons. However, these procedures are demanding and time-consuming. Further evaluation is essential.

Effect of human bowel wall distension on translocation of indigenous bacteria and endotoxins.

The effect of colonic distension on the translocation of indigenous bacteria and endotoxins was prospectively assessed in 50 consecutive patients undergoing colonoscopy. Semiquantitative bacteriologic cultures, chromogenic LAL testing for endotoxemia, and serial determinations of inflammatory markers were used. At the end of the endoscopic procedure, true bacteremia was found in only two patients with obstructing colorectal cancer. There was no evidence of systemic endotoxemia either being induced or increased during the observation period. The endotoxin detoxifying plasma capacity was elevated in patients with preexisting inflammation and did not change within this period. Levels of TNF-alpha, interleukin-6 (IL-6), and elastase (E alpha 1PI) did not differ from baseline values. C3 alpha levels increased in 20% of the patients, whereas fibrinopeptide A values rose by up to 10(2) during colonoscopy. However, since neither endotoxin, TNF alpha, nor IL-6 levels were found to be elevated in this study, the excessive activation of the coagulation system must be related to the distension of bowel wall vessels rather than to an effect of endotoxins escaping from the lumen.

Coral's hidden riches.

PIP: The mysterious sea surface conceals the coral reef ecosystem, making it difficult for planners and decision makers to understand the consequences of their decisions on channel dredging, marina construction, industries along the water's edge, and upstream logging. Reef systems support a rich diversity of life and fish. They provide a natural breakwater and have touristic value. Many species dependent on reef ecosystems produce very active biochemical compounds which have pharmaceutical value (e.g. anticancer drugs and antibiotics). Further, people have used the boulder coral to develop a model for bone implants. Coral reefs protect coastal villages and hotels from rising sea levels. People directly exploit, overharvest, and destroy coral reefs and thus are the major threat to reef biodiversity. The 2 reasons for these human actions against reefs are subsistence and development activities. Local communities need to be included in the conservation planning process of coral reefs and benefit from reef conservation. Poor or divided institutional responsibilities and capacity are the main obstacles to achieving reef conservation in the western Indian Ocean, Coral reef conservation should include a system of parks and reserves supported by a wide focused coastal zone management. Research is needed to provide information on reef species and distribution, uses, and threats, and the processes that sustain reefs. We need to promote coral reefs and mangroves as natural fish farms, wave breakers, shore defenders, leisure areas, and reservoirs of many other goods and services.^ieng

[Contribution and limitations of peroperative radiotherapy combined with excision-curettage in the treatment of gastric cancers]. / Apports et limites de la radiothérapie peropératoire associée à l'exérèse-curage dans le traitement des cancers gastriques.

Macro- or microscopic residual tumor after surgery is the dominating prognostic factor in the treatment of gastric cancer. The majority of patients die of local recurrence and peritoneal spread. Therefore, in addition to gastrectomy and extended lymphadectomy (compartments 1 & 2) in some centers a adjuvant intraoperative radiotherapy is performed. Recent results of adjuvant intraoperative radiotherapy for gastric cancer revealed a lower local recurrence but there was no improvement in the survival rate for advanced tumor stages. These results are confirmed by our prospective study including 36 patients till now: in the group of 21 survivors there is no sign of a local recurrence. In 15 patients which died meanwhile there was only one case of local recurrence (median follow-up: 9 months, range 1-30 months). Peritoneal spread and liver metastasis were observed as the most frequent cause of death (tumor stage IIIB and IV only).

Laparoscopic cholecystectomy after unsuccessful shock-wave therapy.

Extracorporeal shock-wave therapy of gallstones was begun at the Surgical Department of the University of Freiburg, Germany, in March 1988; 85 patients were treated up to September 1991. The stone-free rate differed with the gallstone group. Patients with solitary stones less than 20 mm in diameter showed a significantly higher rate after 18 months of lithotripsy and dissolution therapy than patients with multiple stones (p < 0.01), that is, 83% and 49%, respectively. Open cholecystectomy was necessary for seven patients with complications following fragmentation. After starting laparoscopic cholecystectomy, eight patients decided in favor of this procedure because of constant biliary symptoms. These patients had a mean duration of dissolution therapy of 19 months. The minimal invasive procedure is an alternative for patients with unsuccessful lithotripsy and lysis who initially demanded conservative treatment. Indication for shock-wave therapy is limited to only a small group of patients with solitary cholesterol gallstones less than 20 mm who reject laparoscopic surgery.