Correlations between postural stability and strength of lower body extremities of women population living in long-term care facilities

The present study was aimed at analyzing correlation between strength of lower body extremities and postural stability in function of age. A pool of 180 women divided into 6 age groups (65-69, 70-74, 75-79, 80-84, 85-89 and 90-94 years) was examined. They all were informed-consent participants. The results suggest that age is negatively correlated with lower body strength and positively correlated with decrease of postural balance. There is also an exponential correlation between the strength of lower body part and postural balance. The conclusion was derived that postural stability is at least partially controlled by the strength of lower body. The age of 75 in women population seems to be a threshold above which the neurodegenerative and muscle degeneration processes are responsible for significant increase of risk of fall.     

Dual myocardial scintigraphy mismatch in an infant with Bland-White-Garland syndrome

Bland-White-Garland syndrome (BWG) is a rare disorder that includes abnormalities of the coronary arteries that cause severe myocardial ischemia or infarction in infancy. In this case report, we describe an infant with BWG evaluated by dual single photon emission computed tomography using thallium-201 and I-123 beta-methyl-p-iodophenyl-pentadecanoic acid before and after surgery.     

Consecuencias de las contracciones excéntricas del diafragma sobre su función

Introduction and Objectives

Eccentric contractions are those that occur after a muscle has been stretched, and they can predispose the muscle to damage. Most previous studies have been performed on limb muscles, and the potential consequences of eccentric contractions on the respiratory muscles are therefore unknown. The aim of this study was to evaluate the effects of repeated eccentric contractions on diaphragmatic function.

Methods

In 6 dogs, the diaphragm was stretched by applying pressure on the abdominal wall, and consecutive series of eccentric contractions were induced by bilateral supramaximal stimulation. The effect of these contractions on the diaphragm was then evaluated by applying bilateral twitch and tetanic stimulation of the phrenic nerves and measuring the changes in abdominal pressure and the shortening of the right and left hemidiaphragms (by sonomicrometry). Structural study of the muscle was also performed in 4 animals.

Results

Eccentric contractions were successfully achieved in all cases. Stimulation-induced diaphragmatic pressures became lower immediately after these contractions: twitch pressure fell by 53% and tetanic pressure by 67% after the first 10 eccentric contractions (P<.001 in both cases). Tetanic stimulation also demonstrated an early deterioration in contractility, which fell by 29% in the right hemidiaphragm (P<.05) and by 14% in the left hemidiaphragm (P<.001). Functional impairment was persistent, lasting at least 12 hours, and was associated with sarcomeric and sarcolemmal damage.

Conclusions

This experimental model, which enabled the effects of eccentric contractions to be studied in the diaphragm, revealed a deterioration of muscle function that persisted for hours and that appeared to be partly due to structural damage. In the clinical setting, physiologic or therapeutic maneuvers that increase the resting length of the diaphragm should be used with caution.     

Use of modified McMaster method for the diagnosis of intestinal helminth infections and estimating parasitic egg load in human faecal samples in non-endemic areas

Summary  A modified McMaster method has been used for the diagnosis and estimating helminth egg load in human faecal samples obtained from random consecutive patients in the areas non-endemic for helminth infections (Slovak Republic, North West Russia). Both positive and negative findings were in a 100 % concordance to those obtained with a reference method accepted in clinical diagnostic laboratories (microscopy of the native stool smear). The McMaster method was efficient in detecting nematode eggs in patients’ stool samples with egg load varying from very low (15–60 epg for T. trichiura) to moderate (1650–4500 epg for A. lumbricoides). Therefore, this method may be successfully (and with a better technical feasibility) used for the diagnosis of intestinal helminth infections in non-endemic areas, with further quantitative analysis of the sample when required.     

At the Cutting Edge of the Impossible: A Tribute to Vladimir P. Demikhov

Vladimir P. Demikhov (1916–1998) performed the world''s first experimental intrathoracic transplantations and coronary artery bypass operation. His successes heralded the era of modern heart and lung transplantation and the surgical treatment of coronary artery disease. Even though he was one of the greatest experimental surgeons of the 20th century, his international isolation fueled speculation, suppositions, and myths. Ironically, his transplantation of a dog''s head drew more publicity than did his pioneering thoracic surgical accomplishments, and he became an easy target for criticism. An account of Demikhov''s life and work is presented herein.Key words: Cardiac surgical procedures/history/methods, coronary artery bypass, Demikhov V, dogs, heart transplantation/history, history of medicine, 20th century, lung transplantation/history, Russia, thoracic surgery, USSR

What I want and aim at is confoundedly difficult, and yet I do not think I aim too high. I want to do drawings which touch some people … I want to progress so far that people will say of my work, he feels deeply, he feels tenderly—notwithstanding my so-called roughness, perhaps even because of it. It seems pretentious to talk this way now, but this is the reason why I want to push on with all my strength. What am I in most people''s eyes? A nonentity or an eccentric and disagreeable man—somebody who has no position in society and never will have, in short, the lowest of the low. Very well … then I should want my work to show what is in the heart of such an eccentric, of such a nobody. This is my ambition, which is, in spite of everything, founded less on anger than on love.¹—Vincent van Gogh (1853–1890)

Vladimir P. Demikhov''s success with experimental coronary artery surgery and intrathoracic organ transplantations heralded the modern era of heart and lung transplantation and the surgical treatment of coronary artery disease. However, Demikhov is known today mainly as a legendary surgeon who experimentally transplanted a second head onto a dog. His international isolation fueled speculation, suppositions, and myths. Although Demikhov''s contributions to cardiothoracic surgery became internationally recognized during recent decades,^2–10 almost no details were known about him. Presented here is the biography of the man behind the legends—one of the greatest experimental surgeons of the 20th century.     

Translocation of Prosthetic Aortic Valve in Advanced Prosthetic Valve Endocarditis

Advanced prosthetic valve endocarditis is often associated with substantial destruction of the tissues adjacent to the prosthesis. Removal of the infected prosthesis and débridement of the infected tissues make implantation of a new prosthesis challenging. Herein, we discuss successful surgical aortic valve translocation in a 50-year-old man who had advanced acute prosthetic valve endocarditis with destruction of the aortic annulus. One year after being discharged from the hospital, the patient was asymptomatic with good exercise tolerance.Key words: Aortic valve, bacterial infections, heart valve diseases/complications/surgery, heart valve prosthesis implantation/methods, hypothermia, induced, postoperative complications/microbiology, reoperation, treatment outcomeAdvanced prosthetic valve endocarditis (PVE) associated with periprosthetic abscess and dehiscence of the prosthesis carries high morbidityand mortality rates.^1,2 Here, we describe the surgical management of apatient who had advanced PVE and a destroyed aortic annulus. The infected prosthesis was removed, and extra-anatomic implantation of a prosthetic aortic valve was performed.     

Extracorporeal Membrane Oxygenation Using the Tandem Heart System's Catheters

We describe the initial—and successful—use of the TandemHeart System''s catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System''s catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure.Key words: Extracorporeal circulation, extracorporeal membrane oxygenation/instrumentation/methods, heart failure/therapy, heart-assist devices, hemodynamics, methods, pneumonia/complications, respiratory insufficiency/therapy, technology assessment, biomedical, treatment outcomeExtracorporeal membrane oxygenation (ECMO) first came into wide clinical use as a tool to enable open-heart surgery through cardiopulmonary bypass (CPB) in the 1960s.^1,2 By the 1970s, there was hope that ECMO technology could provide effective temporary oxygenation in patients who had a major, yet reversible, lung injury but in whom mechanical ventilation was not completely effective.³ A generation later, ECMO technology is a well-established, widely used method of support in neonatal and pediatric patients who experience severe respiratory failure.⁴ In contrast, progress in the application of ECMO to improve outcomes of respiratory failure in adults has been much slower. A large National Institutes of Health-sponsored trial of ECMO use in severe respiratory failure of various causes⁵ failed to show a benefit and thereby dampened enthusiasm for this application for more than a decade. New technology and implementation methods, however, have reinvigorated interest in the use of ECMO when severe respiratory failure occurs in adults.^6,7 Indeed, data from the recently completed, large, prospective CESAR trial suggest that ECMO may already be of great usefulness in patients who are experiencing severe respiratory failure.^8–10There have also been encouraging reports of the successful use of ECMO to support patients who are experiencing acute right-heart failure,¹¹ acute refractory left-heart failure,¹² postcardiotomy heart failure,¹³ prolonged cardiac arrest,¹⁴ and postoperative cardiogenic shock.¹⁵ In these circumstances, ECMO has served temporarily (sometimes along with mechanical hemodynamic support) until heart recovery, or as a bridge to heart transplantation, heart–lung transplantation, or the placement of a left ventricular (LV) assist device.The TandemHeart® PTVA® System (CardiacAssist, Inc.; Pittsburgh, Pa) is a new, percutaneously placed, ventricular assist device that has proved to be effective in the short-term management of acute heart failure.¹⁶ The system features innovative vascular-access catheters that enable a minimally invasive approach to mechanical LV assistance. We report here the 1st experience of using these catheters to perform ECMO, in 2 patients. One patient had severe primary respiratory failure, and the other had respiratory failure and right-heart failure caused by severe pulmonary hypertension. The TandemHeart catheters were placed in different intravascular locations in each patient. Our experience suggests that the TandemHeart catheter system can offer innovative and superior options for ECMO delivery to different populations of patients who experience cardiopulmonary failure.