Management of narrower anastomotic colonic strictures

Management of narrower (<5-mm) colonic anastomotic stricture mainly is performed endoscopically by repeated balloon dilation often ineffectively. The use of metal self-expanding stents in the malignant and benign stricture of the large bowel has been suggested only recently, and is still being debated. In this report we propose a single-stage procedure that we developed to manage narrower anastomotic colonic stricture. A 60-year-old man 2 years previously had undergone surgery for perforated sigmoid diverticulitis by means of Hartmann's procedure. He was submitted to two mechanical recanalization attempts, both of which failed with dehiscence of anastomoses. He reached us with a significant stricture of the colorectal anastomoses (smaller than 5 mm in diameter) and a diversion ileostomy. After two endoscopic balloon dilations, we observed the relapse of the anastomotic stricture, so we decided to draw up another strategy. We performed a dilation with a TTS balloon, leaving a metallic self-expanding covered stent in situ for 3 months. The aim was to achieve the definitive healing of the anastomotic scar tissue at the desired diameter. We removed the stent during the ileostomy closure. At the time of this writing, 18 months of follow-up evaluation, the patient defecates without any problem.     

Development and evaluation of a gyroscope-based wheel rotation monitor for manual wheelchair users

Abstract

Objective

To develop and evaluate a wireless gyroscope-based wheel rotation monitor (G-WRM) that can estimate speeds and distances traveled by wheelchair users during regular wheelchair propulsion as well as wheelchair sports such as handcycling, and provide users with real-time feedback through a smartphone application.

Methods

The speeds and the distances estimated by the G-WRM were compared with the criterion measures by calculating absolute difference, mean difference, and percentage errors during a series of laboratory-based tests. Intraclass correlations (ICC) and the Bland–Altman plots were also used to assess the agreements between the G-WRM and the criterion measures. In addition, battery life and wireless data transmission tests under a number of usage conditions were performed.

Results

The percentage errors for the angular velocities, speeds, and distances obtained from three prototype G-WRMs were less than 3% for all the test trials. The high ICC values (ICC (3,1) > 0.94) and the Bland–Altman plots indicate excellent agreement between the estimated speeds and distances by the G-WRMs and the criterion measures. The battery life tests showed that the device could last for 35 hours in wireless mode and 139 hours in secure digital card mode. The wireless data transmission tests indicated less than 0.3% of data loss.

Conclusion

The results indicate that the G-WRM is an appropriate tool for tracking a spectrum of wheelchair-related activities from regular wheelchair propulsion to wheelchair sports such as handcycling. The real-time feedback provided by the G-WRM can help wheelchair users self-monitor their everyday activities.     

万向型螺丝刀的研制与临床应用

目的:研制用于封闭股骨交锁髓内钉中心孔尾端的万向型螺丝刀,以缩短尾帽植入髓内钉的手术时间,提高植入准确性.方法:回顾性研究2018年6月至2019年6月收治的股骨转子间骨折行交锁髓内钉(femoral inter-locking intramedullary nail,FIIN)手术患者77例,男28例,女49例,年龄...     

Power seat function usage and wheelchair discomfort for power wheelchair users

Objectives: To investigate correlations between power seat functions (PSFs) usage and wheelchair discomfort.

Design: Quasi-experimental design: Time series design.

Setting: In-home trial in participants’ home/community.

Participants: Thirteen power wheelchair users who independently used power wheelchairs equipped with PSFs as their primary means of mobility.

Main Outcome Measures: PSF usage variables include the frequency of performing repositioning and using PSFs (tilt, recline, legrests and seat elevation), wheelchair occupancy, and driving distance. The Tool for Assessing Wheelchair disComfort (TAWC) were used to evaluate general discomfort and discomfort intensity.

Results: Spearman correlation coefficient showed that the frequency of using tilt, recline, and legrest is significantly correlated with discomfort intensity. Multiple regression analysis with backward stepwise indicated that these functions can explain 43.8% of the variance (R2?=?.438, F(3,33)?=?8.588, P?Conclusions: For people who used power wheelchairs equipped with PSFs, correlation analysis and regression modeling provided evidence from the quantitative data that increasing the frequency of using PSFs may decrease wheelchair discomfort. Future studies should include interventions to encourage people to use their PSFs appropriately.     

High-frequency jet ventilation is beneficial during shock wave lithotripsy utilizing a newer unit with a narrower focal zone

Introduction:

High-frequency jet ventilation (HFJV) during shock wave lithotripsy (SWL) has been reported using older lithotripsy units with larger focal zones. We investigated how HFJV affects the clinical parameters of SWL using a newer lithotripsy unit with a smaller focal zone.

Methods:

We reviewed all patients who underwent SWL by a single surgeon (KVA) from July 2006 until December 2007 with the Siemens Lithostar Modularis (Siemens AG, Erlangen, Germany). Either HFJV or conventional anesthetic techniques were used based on the anesthesiologists’ preference. Preoperative imaging was reviewed for stone size, number and location. Total operating room time, procedure time, number of shocks and total energy delivery were analyzed. Postoperative imaging was reviewed for stone-free rates.

Results:

A total of 112 patients underwent SWL with 80 undergoing conventional anesthesia, and 32 with HFJV. Age, body mass index, preoperative stone size and number were not significantly different between the groups. The HFJV group required significantly less total shocks (3358 vs. 3754, p = 0.0015) and total energy (115.8 joules vs. 137.2 joules, p = 0.0015). Total operating room time, SWL procedure time and postoperative stone-free rates were not significantly different.

Conclusions:

Previous studies using older SWL units with larger focal zones have demonstrated that HFJV can be effective in reducing total shocks and total energy. Our data is consistent with these studies, but also shows benefit with newer units that have narrower focal zones.     

Assessment of wheelchair driving performance in a virtual reality-based simulator

Abstract

Objective

To develop a virtual reality (VR)-based simulator that can assist clinicians in performing standardized wheelchair driving assessments.

Design

A completely within-subjects repeated measures design.

Methods

Participants drove their wheelchairs along a virtual driving circuit modeled after the Power Mobility Road Test (PMRT) and in a hallway with decreasing width. The virtual simulator was displayed on computer screen and VR screens and participants interacted with it using a set of instrumented rollers and a wheelchair joystick. Driving performances of participants were estimated and compared using quantitative metrics from the simulator. Qualitative ratings from two experienced clinicians were used to estimate intra- and inter-rater reliability.

Results

Ten regular wheelchair users (seven men, three women; mean age ± SD, 39.5 ± 15.39 years) participated. The virtual PMRT scores from the two clinicians show high inter-rater reliability (78–90%) and high intra-rater reliability (71–90%) for all test conditions. More research is required to explore user preferences and effectiveness of the two control methods (rollers and mathematical model) and the display screens.

Conclusions

The virtual driving simulator seems to be a promising tool for wheelchair driving assessment that clinicians can use to supplement their real-world evaluations.     

Effects of a wheelchair ergometer training programme on spinal cord-injured persons

STUDY DESIGN: Before and after investigation of the effects of a wheelchair ergometer Training programme. OBJECTIVE: To investigate the effects of an original interval-training programme on work capacity and cardiorespiratory variables with spinal cord-injured persons (SCIP's) on a wheelchair-specific ergometer. SETTING: BESANCON, FRANCE. METHODS: Seven SCIP's (male) performed 45 min of wheelchair ergometry three times per week, for 6 weeks. Training effects on maximal dynamic performance and endurance capacity were studied by comparison of performance and cardiorespiratory responses observed during both a maximal progressive test (10 W/2 min) and the same training session performed before and after training. RESULTS: Training induced significant improvements in maximal tolerated power (+19.6%), in peak oxygen consumption (VO2,+16%), and in oxygen pulse (O2p,+18.7%). At ventilatory threshold, significant improvements were also observed in power output (+63%), VO2VT(+ 34.1), ventilation VEVT(+ 37.1%), and V2pVT(+ 19.9% ). Heart rate and ventilation were significantly lower (-11 and -14.6%, respectively) after training at the same work rate, while VO2 was unchanged. Between the first and the last training session, the total physical work was improved by 24.7%, whereas heart rate was unchanged. CONCLUSION: An interval-training programme individualised to each paraplegic subject using a wheelchair ergometer can significantly improve the fitness level and endurance capacity.     

Interval training program on a wheelchair ergometer for paraplegic subjects

BACKGROUND: Various combinations of training intensity, duration and frequency are often proposed to people with spinal cord injuries in order to improve their fitness. However, no consensus about a specific training program has been reached for such a population. OBJECTIVE: This study investigated the effects of a short interval training program specifically designed for patients with spinal cord injuries. METHODS: Paraplegic men performed 30-min wheelchair ergometry three times per week, for 4 weeks. Maximal dynamic performance and endurance capacity were studied before and after the training program with an incremental test (10 W/2 min) until volitional fatigue and a constant work rate test, respectively. Cardiorespiratory responses were continuously studied during each of these tests. RESULTS: Training induced significant improvement in maximal tolerated power (+27.9%), and in peak oxygen consumption ([VO2, +18.5%). After training the subjects were able to maintain the load applied during the constant test (total mechanical work +210.7%), for a significantly longer time. The heart rate, [VO2 and ventilation values observed when the volunteers ended their first constant load test were significantly higher (+10%, +10%, +40% respectively) than those obtained after a similar time period during the second constant load test which was performed after the training program. CONCLUSION: After this short training period, with an appropriate combination of different types of training, duration, intensity and frequency exercises, we observed a significant improvement in the fitness level and endurance capacity of paraplegic subjects.     

The Jena universal perfusion system: a universal cardiopulmonary bypass circuit for cardiac surgery

Cardiopulmonary bypass (CPB) is a standard technique in cardiac surgery, which itself contributes to postoperative morbidity. Neurologic sequelae after CPB is caused by air embolism or systemic inflammatory response due to artificial surface and is closely related to the characteristics of the extracorporeal circuit. Minimized systems without a venous reservoir take these factors into account. They require a differentiated volume management to avoid excessive negative pressure in the venous line, which may lead to spontaneous formation of microbubbles and are said to cause air embolism. Perfusion technology also offers systems with closed soft-bag and open hard-shell reservoirs, that require individual setups with little flexibility. We developed an all-purpose perfusion system for application as cardiopulmonary bypass. The central part is a compound reservoir, consisting of a lower hard shell and an upper self-expanding shell, which is capable of actively increasing volume. It allows application of the circuit as closed or open system. Crossclamping the inflow turns the system into a minimized circuit, in which the reservoir compensates volume when backflow is low and safeguards against excessive subzero pressure. The system has been applied in pilot experiments. In cardiac surgery today patients present at higher ages and with complex comorbidities. Not all of them are suitable candidates for off-pump procedures and might profit from perfusion technology with reduced adverse effects. The Jena Universal Perfusion System (JUPS) may be applied as a minimized system with the option to compensate low venous backflow and allows flexible extension to a closed or open circuit anytime during the procedure.     

Range of motion and stroke frequency differences between manual wheelchair propulsion and pushrim-activated power-assisted wheelchair propulsion

BACKGROUND/OBJECTIVE: The objective of this study was to examine the use and efficacy of a pushrim-activated power-assist wheelchair (PAPAW) in the reduction of upper extremity range of motion (ROM) and stroke frequency in manual wheelchair users. METHODS: Ten manual wheelchair users were evaluated using a repeated-measures design with and without the use of a PAPAW for maximum ROM of shoulder flexion/extension, abduction/adduction, internal/external rotation, and horizontal flexion/extension; elbow flexion/extension; wrist flexion/extension, supination/pronation, and ulnar/radial deviation; and stroke frequency. Participants propelled a Quickie 2 manual wheelchair configured as a PAPAW and their own wheelchair on a computer-controlled dynamometer at 3 different resistance levels and 2 different speeds. RESULTS: The use of the PAPAW significantly (P < 0.05) decreased shoulder flexion/extension and horizontal flexion/extension, elbow flexion/extension, and wrist flexion/extension and ulnar/radial deviation for many speed and resistance combinations. Univariate analysis revealed that stroke frequency was unaltered in all cases. CONCLUSION: These findings provide the foundation for studying the utility of the PAPAW in reducing the risk of upper limb injury and neuropathy in the manual wheelchair user population.     

Biomechanics and strength of manual wheelchair users

BACKGROUND/OBJECTIVE: Previous investigations have identified muscular imbalance in the shoulder as a source of pain and injury in manual wheelchair users. Our aim was to determine whether a correlation exists between strength and pushrim biomechanical variables including: tangential (motive) force (Ft), radial force (Fr), axial force (Fz), total (resultant) force (FR), fraction of effective force (FEF), and cadence. METHODS: Peak isokinetic shoulder strength (flexion [FLX], extension [EXT], abduction [ABD], adduction [ADD], internal rotation [IR], and external rotation [ER]) was tested in 22 manual wheelchair users with a BioDex system for 5 repetitions at 60 degrees/s. Subjects then propelled their own manual wheelchair at 2 speeds, 0.9 m/s (2 mph) and 1.8 m/s (4 mph), for 20 seconds, during which kinematic (OPTOTRAK) and kinetic (SMARTWHEEL) data were collected. Peak isokinetic forces in the cardinal planes were correlated with pushrim biomechanical variables. RESULTS: All peak torque strength variables correlated significantly (P < or = 0.05) with Ft, Fr, and FR, but were not significantly correlated with Fz, FEF, or cadence. Finally, there were no relationships found between muscle strength ratios (for example, FLX/EXT) and Ft, Fr, FR, Fz, or FEF. CONCLUSION: There was a correlation between strength and force imparted to the pushrim among wheelchair users; however, there was no correlation found in wheelchair propulsion or muscle imbalance. Clinicians should be aware of this, and approach strength training and training in wheelchair propulsion techniques separately.     

The wheelchair axillary view of the shoulder

The wheelchair axillary view of the shoulder allows a good image to be obtained in the seated position, and it can be used in the nonambulatory or multiply injured patient.     

Influence of creatine supplementation on 800 m wheelchair performance: a pilot study

STUDY DESIGN: Double-blind, placebo-controlled, randomly assigned, crossover. OBJECTIVE: To assess the influence of a short-term oral creatine supplementation on 800 m wheelchair performance. SETTING: Swiss Paraplegic Centre, Nottwil, Switzerland. SUBJECTS: In total, six (four male, two female subjects) competitive wheelchair athletes participated in the study. Their age was 33.0+/-9.1 years, height 171.5+/-7.7 cm and weight 63.1+/-6.2 kg. Average weekly training volume was 10.0+/-3.7 h. All of them have been engaged in regular training for over 10.5+/-7.2 years. METHODS: During the two treatment periods, subjects ingested 4 x 5 g of creatine monohydrate or placebo (maltodextrin) daily during 6 days in a randomised order. A washout period of 4 weeks lay in-between the two supplementation periods. Before and after each treatment period athletes performed an all-out 800 m wheelchair test on a training roller. Time to complete 800 m, rate of perceived exertion (RPE), lactate concentrations and heart rate were measured. Before each test, body weight was determined. RESULTS: Times to complete 800 m before and after creatine supplementation (102.8+/-13.9 versus 100.5+/-11.3 s) compared to before and after placebo supplementation (101.6+/-15.6 versus 99.5+/-13.8 s) were not significantly different. Moreover, for all other parameters measured, no significant differences between creatine and placebo supplementation were found. CONCLUSION: A short-term oral creatine supplementation compared to placebo seems not to enhance performance over 800 m in trained, spinal cord-injured, wheelchair athletes.     

Effects of respiratory resistance training with a concurrent flow device on wheelchair athletes

BACKGROUND/OBJECTIVE: To determine the effect of respiratory resistance training (RRT) with a concurrent flow respiratory (CFR) device on respiratory function and aerobic power in wheelchair athletes. METHODS: Ten male wheelchair athletes (8 with spinal cord injuries, 1 with a neurological disorder, and 1 with postpolio syndrome), were matched by lesion level and/or track rating before random assignment to either a RRT group (n = 5) or a control group (CON, n = 5). The RRT group performed 1 set of breathing exercises using Expand-a-Lung, a CFR device, 2 to 3 times daily for 10 weeks. Pre/posttesting included measurement of maximum voluntary ventilation (MVV), maximum inspiratory pressure (MIP), and peak oxygen consumption (V(O2peak)). RESULTS: Repeated measures ANOVA revealed a significant group difference in change for MIP from pre- to posttest (P < 0.05). The RRT group improved by 33.0 cm H2O, while the CON group improved by 0.6 cm H2O. Although not significant, the MW increased for the RRT group and decreased for the CON group. There was no significant group difference between V(O2peak) for pre/posttesting. Due to small sample sizes in both groups and violations of some parametric statistical assumptions, nonparametric tests were also conducted as a crosscheck of the findings. The results of the nonparametric tests concurred with the parametric results. CONCLUSIONS: These data demonstrate that 10 weeks of RRT training with a CFR device can effectively improve MIP in wheelchair athletes. Further research and a larger sample size are warranted to further characterize the impact of Expand-a-Lung on performance and other cardiorespiratory variables in wheelchair athletes.     

Toward a paradigm for universal procedures of valve repair

We developed novel methods to simplify valve repair techniques.Adequate exposure is crucial for mitral valve surgery. The right side of the pericardium is sutured to the chest wall, and both cava are mobilized and hitched up to the left. Then a longitudinal incision of the right side of the left atrium allows excellent exposure of the mitral valve.We have developed a new device for replace neochordae. This double-armed, double-hooked device is inserted through the loop formed by the neochordae, which is anchored on the papillary muscle and pass through the prolapsing segment. The device pulls up both leaflets and maintains the neochordae at the same length as that of the opposing normal chordae during tying slippery neochordae.A simple method to repair large prolapsing posterior leaflet was developed. The middle of the prolapsed portion is cut, and both sides are laid each other. The water test is made to confirm accurate closure,and 2 layers are sutured.A novel method for adjustable tricuspid annuloplasty was developed. A flexible annuroplasty band,through which an expanded polytetrafluoroethylene (ePTFE) thread was passed, was secured to the tricuspid annulus. The thread was snared from outside of the ejecting heart under observation by echocardiogram.