Relationship between the margin of manoeuvre and the return to work after a long-term absence due to a musculoskeletal disorder: an exploratory study

Purpose.?The application of the margin of manoeuvre (MM) concept in work rehabilitation is new. It allows for variations in both health status and work demands, and the interaction between the two, to be taken into account. The objective of this exploratory study was to document the relationship between the presence of an MM in the workplace and the return to work (RTW), after a long-term absence.

Methods.?This study used the data collected during an earlier study that sought to identify the dimensions and indicators of the MM. The data were analysed on three levels, and the convergences and divergences in the MM indicators and dimensions in relation to the RTW were grouped accordingly.

Results.?Eleven workers and five clinicians participated in this study. The results support the proposition that the presence of a sufficient MM in the workplace is associated with RTW of individuals at the end of a rehabilitation programme despite a long-term absence (n == 6), and conversely, that its absence would appear to be associated with a non-return to work (n == 4).

Conclusions.?A better understanding of this concept will help further the development of a tool to assist clinicians in their task of assessing a worker's capacity to return to a given job.     

Pneumocephalus – an unreported risk of Valsalva's manoeuvre following cochlear implantation

Abstract

We describe a case of pneumocephalus as an unusual early postoperative complication following cochlear implantation. The aetiology of this condition we attribute to the patient's habit of ‘ear popping’ using Valsalva's manoeuvre     

Pneumocoele after cochlear implantation

Abstract

Objective and importance

Scalp pneumocoele is a rare complication of cochlear implantation surgery. We present the largest case series to date; consisting of four cases over 8 years from one centre. The presentation, diagnosis, and management of each case are reviewed. Previously unreported complications of pneumocoeles are highlighted.

Clinical presentation

Three of our four cases, consisting of two adults (aged 53 and 81 years) and one child (aged 26 months), developed scalp pneumocoeles within the first 3 months of implantation. Another child (aged 10) developed pneumocoele 7 years after surgery. The common diagnostic features include a soft, non-tender, fluctuant swelling over the receiver/stimulator package. In all cases, pneumocoeles were triggered by Valsalva's or Toynbee's manoeuvres. Complications include infection (case one) and reduction in cochlear implant (CI) function (cases three and four), secondary to displacement of the receiver/stimulator package or electrode displacement.

Intervention/technique

Diagnosis is made from clinical history and examination. Aspiration results in reduction of pneumocoeles. This is not necessary for smaller pneumocoeles as they may resolve spontaneously. Additional investigations may reveal complications of pneumocoeles, such as X-rays for implant displacement, and inflammatory marker to detect signs of infection. To prevent the recurrence of pneumocoeles, patients are advised to avoid Valsalva's or Toynbee's manoeuvres. There were no recurrences of pneumocoeles.

Conclusion

Post-cochlear implantation pneumocoeles can be associated with harmful complications such as infection and CI dysfunction. The mechanism of pneumocoele formation is discussed, and strategies for its prevention are examined.     

Reduction of ischemia reperfusion injury after liver resection and hepatic inflow occlusion by α-lipoic acid in humans

AIM:To evaluate the protective effects of preconditioning by α-lipoic acid (LA) in patients undergoing hepatic resection under inflow occlusion of the liver.METHODS:Twenty-four patients undergoing liver resection for various reasons either received 600 mg LA or NaCl 15 min before transection performed under inflow occlusion of the liver. Blood samples and liver wedge biopsy samples were obtained after opening of the abdomen immediately after inflow occlusion of the liver, and 30 min after the end of inflow occlusion of the liver.RESULTS:Serum levels of aspartate transferase and alanine transferase were reduced at all time points in patients who received LA in comparison to those who received NaCL. This was accompanied by reduced histomorphological features of oncosis. We observed TUNELpositive hepatocytes in the livers of the untreated patients, especially after 30 min of ischemia. LA attenuated this increase of TUNEL-positive hepatocytes. Under preconditioning with LA, ATP content was significantly enhanced after 30 min of ischemia and after 30 min of reperfusion.CONCLUSION:This is the first report on the potential for LA reducing ischemia/reperfusion injury (IRI) of the liver in humans who were undergoing liver surgery.Beside its simple and rapid application, side effects did not occur. LA might therefore represent a new strategy against hepatic IRI in humans.     

Effect of posture on baroreflex sensitivity in healthy subjects

Summary. In this study we investigated whether body position has significant effects on baroreflex sensitivity in healthy subjects. Baroreflex sensitivity was calculated from pressure overshoot after the release of a Valsalva strain in the supine and sitting positions in 10 subjects. At rest, no difference was found in supine and sitting mean R-R intervals (837±82 and 858±86 ms, respectively), whereas systolic and diastolic blood pressures were lower in the supine position (111.3±24.6 vs. 141.2±12.6 mmHg, P<0.01 and 54.8±14.7 vs. 75.6±13.4 mmHg, P<0.001, respectively). Baroreflex sensitivity in the supine (9.0±4.1 ms±mmHg^-1) and sitting positions (8.8±4.9 msXmmHg^-1) did not differ significantly from each other. The correlation between supine and sitting baroreflex sensitivity was 0.96 (P<0.001) and in 9 out of 10 subjects the discrepancy between supine and sitting baroreflex sensitivity was <2.0 ms±mmHg^-1. We conclude that baroreflex sensitivity measured in the supine and sitting positions do not differ significantly from each other.     

静脉穿刺两种持针手法在临床运用中的效果

[目的]探讨静脉穿刺两种持针手法的临床运用效果.[方法]对右手二指持针法行静脉穿刺和三指持针法的临床效果进行观察比较.[结果]发现三指持针法穿刺的成功率高于二指持针法,并且三指持针法能不同程度地降低病人的疼痛感.[结论]三指持针法静脉穿刺在临床工作中能提高静脉穿刺的成功率,减轻病人痛苦,同时也能提高工作效率.     

Cardiovascular autonomic control is disturbed in nocturnal teethgrinders

Summary. To examine the hypothesis of disturbed autonomic function, non-invasive cardiovascular reflex tests were performed on 11 sleep bruxists in the waking state. The tests included the Valsalva manoeuvre, a deep-breathing test, and an orthostatic test (standing up). The R-R intervals were monitored continuously, and blood pressure was measured non-invasively and continuously using the Finapres method. In total, 64% of bruxists showed abnormalities in at least two variables reflecting the cardiovascular autonomic function. Abnormalities were found in blood pressure regulation during the Valsalva strain, and in the immediate biphasic heart rate response during standing up, but not in the vagally mediated deep-breathing difference. These findings suggest that bruxism is accompanied by abnormalities in autonomic function, particularly in sympathetic vasoconstrictor function.     

Systolic and diastolic changes in human coronary blood flow during Valsalva manoeuvre

Valsalva manoeuvre is reported to be sometimes successful for the relief of angina pectoris. The present study investigated how haemodynamic changes produced by Valsalva manoeuvre can interact to improve the relationship between cardiac work and coronary blood flow. Ten male subjects aged 53 ± 12 years (SD) were considered. Blood velocity in the internal mammary artery, previously anastomosed to the left descending coronary artery, was studied with Doppler technique. The subjects performed Valsalva manoeuvres by expiring into a tube connected to a mercury manometer, to develop a pressure of 40 mmHg. The arterial blood pressure curve was continuously monitored with a Finapres device from a finger of the left hand. During expiratory effort, an increase in heart rate and a decrease in arterial pulse pressure were followed by a more delayed and progressive increase in mean and diastolic pressures. Systolic blood velocity markedly decreased along with the reduction in pulse pressure and increase in heart rate. By contrast, diastolic and mean coronary blood velocities did not show any significant change. Since it is known that the Valsalva manoeuvre strongly reduces stroke volume and cardiac output, it is likely that a reduction in cardiac work also takes place. Since in diastole, i.e. when the myocardial wall is better perfused, coronary blood velocity did not show any significant reduction, it is likely that unchanged perfusion in the presence of reduced cardiac work is responsible for the relief from angina sometimes observed during Valsalva manoeuvre. It is also likely that the increase in heart rate prevents the diastolic and mean blood coronary velocity from decreasing during the expiratory strain, when an increased sympathetic discharge could cause vasoconstriction through the stimulation of the coronary α‐receptors.