Electromyographic study relating to shoulder motion: control of shoulder joint by functional electrical stimulation.

The purpose of this study is to create the standard stimulation patterns of shoulder motion from electromyographic (EMG) data in 13 healthy human volunteers in order to control the movement of the paralyzed shoulder in quadriplegic and hemiplegic patients by functional electrical stimulation (FES). Simultaneous EMG measurement was made at 24 points of 17 major muscles relating to shoulder motion. Since the number of the output channels in the portable FES apparatus is limited, 12 major muscles were selected from statistically processing these EMG data and stimulation patterns were created based on the EMG data of these muscles. Thus three standard stimulation patterns were created to move the shoulder, i.e., (i) 90 degrees flexion to 90 degrees horizontal abduction, (ii) 90 degrees flexion to 20 degrees horizontal adduction, and (iii) 90 degrees abduction to 90 degrees horizontal adduction. With the created stimulation patterns, the restoration of the shoulder motion in plegic patients was successful and it will be reported in the next paper.     

Incidence of pulmonary hypertension and its clinical relevance in patients with sarcoidosis

OBJECTIVE: To investigate the frequency of pulmonary hypertension (PH) and clinical parameters associated with PH in sarcoidosis patients. METHODS: A prospective, observational study was performed on 246 consecutive Japanese sarcoidosis patients followed up at the outpatient sarcoidosis clinic in the Central Clinic of Kyoto. The patients were evaluated for PH by Doppler echocardiography. Among these patients, 192 underwent pulmonary function tests. In addition, high-resolution CT of the lung was evaluated for the presence of lymph node enlargement, lung opacity, and thickening of bronchovascular bundles in 122 patients. PH was defined as estimated systolic pulmonary artery pressure (sPAP) > or = 40 mm Hg. The frequency of PH was evaluated, and clinical parameters were compared between patients with PH and those without PH. RESULTS: Among 212 patients who were successfully evaluated for sPAP, 12 patients (5.7%) had PH. Patients with PH had the following clinical characteristics: advanced chest radiographic stage, decreased oxygen saturation, predominantly male gender, and decreased percentage of predicted vital capacity, percentage of predicted FVC, percentage of predicted FEV1, percentage of predicted functional residual capacity, and percentage of predicted total lung capacity (%TLC). Multivariate logistic regression analysis showed that decreased %TLC was independently associated with PH. There was a weak negative correlation between sPAP and %TLC (p < 0.05). CONCLUSIONS: The frequency of PH in Japanese sarcoidosis patients was 5.7% evaluated with Doppler echocardiography. Decreased lung volume increases the risk of PH developing in patients with sarcoidosis.     

Diploic meningioma contiguous to a contralateral parasagittal meningioma: CT and MR features.

A patient with a diploic meningioma is presented. Computed tomography (CT) scan revealed an intradiploic tumor which seemed contiguous at a point to a contralateral, recurrent parasagittal meningioma. On CT, density of the diploic meningioma was similar to that of the parasagittal meningioma, but the contrast study showed that the former enhanced much less than the latter. Magnetic resonance (MR) imaging demonstrated that the diploic tumor was heterogeneous and much less enhanced with Gadolinium-DTPA (Gd-DTPA) than the parasagittal meningioma on T1-weighted image, although they were very similar in signal intensities on T2-weighted and proton density-weighted MR images without Gd-DTPA. Reasons for such marked differences in enhancement patterns are discussed.     

Cerebral blood flow studies using N-isopropyl I-123 p-iodoamphetamine in cerebral ischemic lesions

Eighteen patients were studied for cerebral blood perfusion abnormalities using N-isopropyl I-123 p-iodoamphetamine (IMP) and rotating dual gamma camera emission computed tomography (ECT). All were stroke patients, 10 with cerebral vasospasm after an aneurysmal rupture, 3 with an occlusion of the middle cerebral artery, 2 with an occlusion of the internal carotid artery (IC), one with an IC stenosis, one with Moyamoya disease and one with RIND. Four patients had extracranial-intracranial (EC-IC) bypass operations. In three of them, CBF studies were done before and after bypass surgery. An arterial line was placed in the left radial artery and connected to a Harvard pump. IMP (1.5-3 mCi) was injected into an arm vein while at the same time an arterial blood sample was withdrawn at a constant speed for 5 minutes. Scanning was started 35 minutes after IMP injection. After a scan, multiple transverse, coronal and sagittal section images were reconstructed with a minicomputer. We determined the values of regional CBF in the regions of interest using an image. Transmission computed tomography (CT) studies were performed on the same day. In eight patients, CBF study by 133Xe inhalation method (NOVO cerebrograph) was done. ECT showed diffuse low perfusion in two patients and focal low perfusion in 16 patients while CT showed abnormalities in 9 patients (50%). ECT abnormalities were more extensive than CT abnormalities. The values of rCBF in the superficial brain determined by ECT were similar to those examined by the inhalation method (ISI). Significant increase in rCBF was observed after the bypass operations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vascular endoscopy for intravascular surgery--an experimental study.

A combination of endoscope and high-pressure saline irrigation system was tested in the occlusion of experimental aneurysms, and angioplasty and fibrinolysis of vascular occlusive lesions in canine femoral arteries. Endoscopy provided detailed information about the aneurysmal orifice and lumen and aided balloon placement and detachment. Endoscopy visualized the dynamic changes accompanying thrombolysis and the fine intimal injury due to angioplasty invisible on angiography. Vascular endoscopy is valuable for pre-, intra-, and postoperative evaluation of intravascular interventions.     

Do Pessaries Prevent the Progression of Pelvic Organ Prolapse?

Pessaries are used for the management of pelvic organ prolapse, but it is unknown whether a pessary will prevent progression of this condition. The purpose of this study was to describe the course of pelvic organ prolapse among women using a pessary for at least 1 year. Among 56 consecutive women fitted with a pessary, 19 (33.9%) continued its use under our care for at least 1 year. We compared baseline and follow-up examinations, using the Pelvic Organ Prolapse Quantitation examination system. At baseline, 16 (84.2%) had stage 3 or 4 prolapse. After 1 year we observed a significant improvement in the stage of disease (P = 0.045, Wilcoxon signed rank test). Four women (21.1%, 95% confidence interval −0.2, 43.7%) had an improvement in stage. No women had worsening in stage of prolapse. These data suggest that there may be a therapeutic effect associated with the use of a supportive pessary. Correspondence and offprint requests to: Dr V. L. Handa, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, 600 North Wolfe Street, Harvey 319, Baltimore, MD 21287, USA. Tel: (410) 614-4495; Fax: (410) 955-1003; Email: vhanda1@jhmi.edu