RESUMEN
INTRODUCTION: Hepatocellular carcinoma (HCC) in ectopic liver tissue is extremely rare. PRESENTATION OF CASE: A 64-year-old woman presented initially with abdominal complaints. Computed tomography (CT) revealed a tumor in the diaphragm and laparoscopic resection of the tumor was performed. Histology showed HCC. During the next 4 years four more tumors, all of which showed HCC on histology and were located extrahepatically, was treated with laparoscopic resection. During this course the patient was followed with regular thoracoabdominal CT and measurement of serum alpha-fetoprotein (AFP). A negative magnetic resonance imaging (MRI) examination of the liver excluded a primary intrahepatic tumor. DISCUSSION: The literature available on ectopic HCC and the guidelines for management of HCC do not address the postoperative surveillance of patients undergoing curative treatment. A follow-up regime has been proposed by Hatzaras et al. (2014) to include cross-sectional imaging of the liver and measurement of serum AFP levels [1]. CT would be the preferred study of choice in a total radiologic investigation of the abdomen. While MRI is prone to artifacts due to movements, CT scans allows so rapid recordings that this no longer is an issue. An early investigation of the liver for intrahepatic HCC should nevertheless be performed early to exclude primary intrahepatic HCC. CONCLUSION: We recommend that patients with ectopic HCC should be followed every 6 months with measurement of AFP and abdominal CT imaging. MRI of the liver should be performed early to exclude primary intrahepatic HCC.
RESUMEN
PURPOSE: Orbicularis oculi muscle tension and muscle blood flow have been shown to be objective measures of eyestrain during visually demanding activities, such as computer work. In line with this, positive associations between eye-related pain and muscle blood flow in orbicularis oculi have been observed. A hypothesis regarding work situations with cognitive tasks and low-level muscle activity, such as computer work, proposes that muscle pain originates from the blood vessel-nociceptor interactions of the connective tissue of the muscle. Noninvasive muscle blood flow measurements in the orbicularis oculi muscle are preferable to using an invasive technique. The aim of this study was to test reproducibility and stability of muscle blood recordings in orbicularis oculi using photoplethysmography. METHODS: In the reproducibility tests, 12 subjects were tested twice within 1 to 5 weeks. To study the stability of the method, six of the subjects were randomly selected and tested four more times within 2 to 6 weeks. Test subjects were doing identical visually demanding computer work for 10 minutes in each test. RESULTS: The short-term repeatability of muscle blood flow measurements was considered good, but the stability of blood flow recordings over time in orbicularis oculi was low because of a greater within-subject maximum variability compared with between-subject average variability. CONCLUSIONS: Investigators should be aware of the effect of time, possibly attributed to confounding factors such as environmental changes and mental stress, when comparing photoplethysmography muscle blood flow recordings.
Asunto(s)
Músculos Faciales/irrigación sanguínea , Músculos Oculomotores/irrigación sanguínea , Fotopletismografía/métodos , Adulto , Astenopía/fisiopatología , Velocidad del Flujo Sanguíneo/fisiología , Terminales de Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Flujo Sanguíneo Regional/fisiología , Reproducibilidad de los ResultadosRESUMEN
PURPOSE: Eye strain during visually demanding computer work may include glare and increased squinting. The latter may be related to elevated tension in the orbicularis oculi muscle and development of muscle pain. The aim of the study was to investigate the development of discomfort symptoms in relation to muscle activity and muscle blood flow in the orbicularis oculi muscle during computer work with visual strain. METHODS: A group of healthy young adults with normal vision was randomly selected. Eye-related symptoms were recorded during a 2-h working session on a laptop. The participants were exposed to visual stressors such as glare and small font. Muscle load and blood flow were measured by electromyography and photoplethysmography, respectively. RESULTS: During 2 h of visually demanding computer work, there was a significant increase in the following symptoms: eye-related pain and tiredness, blurred vision, itchiness, gritty eyes, photophobia, dry eyes, and tearing eyes. Muscle load in orbicularis oculi was significantly increased above baseline and stable at 1 to 1.5% maximal voluntary contraction during the working sessions. Orbicularis oculi muscle blood flow increased significantly during the first part of the working sessions before returning to baseline. There were significant positive correlations between eye-related tiredness and orbicularis oculi muscle load and eye-related pain and muscle blood flow. Subjects who developed eye-related pain showed elevated orbicularis oculi muscle blood flow during computer work, but no differences in muscle load, compared with subjects with minimal pain symptoms. CONCLUSIONS: Eyestrain during visually demanding computer work is related to the orbicularis oculi muscle. Muscle pain development during demanding, low-force exercise is associated with increased muscle blood flow, possible secondary to different muscle activity pattern, and/or increased mental stress level in subjects experiencing pain compared with subjects with minimal pain.
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Astenopía/fisiopatología , Computadores , Músculo Esquelético/fisiopatología , Músculos Oculomotores/fisiopatología , Dolor/fisiopatología , Adulto , Astenopía/etiología , Actitud hacia los Computadores , Electromiografía , Femenino , Humanos , Masculino , Músculo Esquelético/irrigación sanguínea , Músculos Oculomotores/irrigación sanguínea , Dolor/diagnóstico , Dolor/etiología , Dimensión del Dolor , Fotopletismografía , Valores de Referencia , Flujo Sanguíneo Regional , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
This study investigated the effect of moving from small offices to a landscape environment for 19 Visual Display Unit (VDU) operators at Alcatel Denmark AS. The operators reported significantly improved lighting condition and glare situation. Further, visual discomfort was also significantly reduced on a Visual Analogue Scale (VAS). There was no significant correlation between lighting condition and visual discomfort neither in the small offices nor in the office landscape. However, visual discomfort correlated significantly with glare in small offices i.e. more glare is related to more visual discomfort. This correlation disappeared after the lighting system in the office landscape had been improved. There was also a significant correlation between glare and itching of the eyes as well as blurred vision in the small offices, i.e. more glare more visual symptoms. Experience of pain was found to reduce the subjective assessment of work capacity during VDU tasks. There was a significant correlation between visual discomfort and reduced work capacity in small offices and in the office landscape. When moving from the small offices to the office landscape, there was a significant reduction in headache as well as back pain. No significant changes in pain intensity in the neck, shoulder, forearm, and wrist/hand were observed. The pain levels in different body areas were significantly correlated with subjective assessment of reduced work capacity in small offices and in the office landscape. By careful design and construction of an office landscape with regard to lighting and visual conditions, transfer from small offices may be acceptable from a visual-ergonomic point of view.
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Terminales de Computador , Ergonomía , Enfermedades Profesionales/prevención & control , Estrés Fisiológico/fisiología , Adulto , Terminales de Computador/normas , Humanos , Iluminación/normas , Enfermedades Musculoesqueléticas/fisiopatología , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Profesionales/fisiopatología , Dolor/fisiopatología , Dolor/prevención & control , Dimensión del Dolor , Encuestas y Cuestionarios , Visión Ocular/fisiología , Lugar de Trabajo/psicología , Lugar de Trabajo/normasRESUMEN
This study investigated the effect of moving from single-occupancy offices to a landscape environment. Thirty-two visual display unit (VDU) operators reported no significant change in visual discomfort. Lighting conditions and glare reported subjectively showed no significant correlation with visual discomfort. Experience of pain was found to reduce subjectively rated work capacity during VDU tasks. The correlation between visual discomfort and reduced work capacity for single-occupancy offices was rs=.88 (p=.000) and for office landscape rs=.82 (p=.000). Eye blink rate during habitual VDU work was recorded for 12 operators randomly selected from the 32 participants in the office landscape. A marked drop in eye blink rate during VDU work was found compared to eye blink rate during easy conversation. There were no significant changes in pain intensity in the neck, shoulder, forearm, wrist/hand, back or headache (.24Asunto(s)
Terminales de Computador
, Ergonomía
, Enfermedades Musculoesqueléticas/epidemiología
, Enfermedades Profesionales/epidemiología
, Salud Laboral
, Adulto
, Astenopía/epidemiología
, Parpadeo
, Humanos
, Diseño Interior y Mobiliario
, Iluminación
, Persona de Mediana Edad
, Enfermedades Musculoesqueléticas/prevención & control
, Noruega/epidemiología
, Estrés Psicológico/epidemiología
, Interfaz Usuario-Computador
, Lugar de Trabajo
RESUMEN
This study investigated the effect of moving from single occupancy offices to a landscape environment. Thirty-four Visual Display Unit (VDU) operators reported significantly worsened condition of lighting and glare in addition to increased visual discomfort. For visual discomfort, the difference with 95% confidence interval was 10.7 (1.9-19.5) Visual Analog Scale (VAS) as group mean value. The most reasonable explanation for these results may be that the operators were glared from high luminance from the windows, when the Venetian blinds were not properly used. Glare was significantly correlated with visual discomfort, rs=0.35. Both illuminance and luminance in the work area, and contrast reduction on the VDU screen were in line with recommendations from CIE for VDU work. In a regression analysis, the visual discomfort explained 53% of the variance in the neck and shoulder pain. In the office landscape, the eye blink rate during habitual VDU work was recorded for 12 randomly selected operators from the 34 participants. A marked drop in eye blink rate during VDU work was found when this was compared to "easy conversation" (VDU work, mean=9.7 blinks per minute; "easy conversation," mean=21.4 blinks per minute). Participants reported many of the organizational and psychosocial conditions and work factors worse when landscape office was compared to single occupancy office. These factors may have influenced the musculoskeletal pain. However, the pain level was still low at 6 years and not significantly different when compared with the start of the study period, except for a small but significant increase in shoulder pain. In this study, visual discomfort is clearly associated with pain in the neck and shoulder area.
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Astenopía , Terminales de Computador , Ergonomía , Diseño Interior y Mobiliario , Enfermedades Musculoesqueléticas , Psicología , Interfaz Usuario-Computador , Femenino , Humanos , Masculino , Persona de Mediana Edad , Noruega , Encuestas y Cuestionarios , Lugar de TrabajoRESUMEN
The MEPS (musculoskeletal--eyestrain--psychosocial--stress) study involved an extensive degree of multidisciplinary and multicultural cooperation. The objective was to examine the effects of multiple ergonomic interventions on visual, musculoskeletal, postural, and psychosocial outcomes amongst operators of visual display terminals (VDTs). The inherent complexity of a comprehensive ergonomic investigation requires participation of researchers from a variety of disciplines, as well as comparisons among populations with different geographical and cultural backgrounds. The design and execution of the resulting research protocol presents a number of challenges. This paper discusses the advantages and pitfalls associated with multidisciplinary multinational cooperation. Advantages include the necessity for development of a common language and perspective providing a basis for future collaboration. Pitfalls include logistic and coordination difficulties associated with conducting standardized procedures in different locations, as well as the inherent potential for professional conflict. It is argued that such pitfalls ought to be understood and integrated into the project planning process.
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Ergonomía , Cooperación Internacional , Estudios Multicéntricos como Asunto/métodos , Proyectos de Investigación , Protocolos Clínicos/normas , Terminales de Computador , Bases de Datos Factuales , Humanos , Comunicación Interdisciplinaria , Modelos Teóricos , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Encuestas y Cuestionarios/normasRESUMEN
This special issue of the International Journal of Occupational Safety and Ergonomics (JOSE) reports the results from an extensive multinational and multidisciplinary collaborative investigation of the impacts on visual display terminal (VDT) work of musculoskeletal, visual, ergonomic, and psychosocial factors. For brevity, this effort has been referred to as the MEPS project (musculoskeletal--eyestrain--psychosocial--stress). This paper lays out the basic methodological structure of the study. The study was conducted in 4 countries utilizing VDT data entry workers as the primary subject population. A battery of objective and subject assessment measures, including muscle load, visual function, physical and visual strain, postural, ergonomic and psychosocial factors, were assessed at 3 different points in time. A pre-test was given prior to an ergonomic intervention. Two post-tests were given 1 month and 1 year after the ergonomic intervention.
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Terminales de Computador , Ergonomía/métodos , Cooperación Internacional , Enfermedades Musculoesqueléticas/prevención & control , Proyectos de Investigación , Trastornos de la Visión/prevención & control , Electromiografía/instrumentación , Electromiografía/métodos , Ergonomía/instrumentación , Femenino , Humanos , Masculino , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/psicología , Noruega , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/psicología , Examen Físico , Polonia , Postura , Ausencia por Enfermedad , Factores Socioeconómicos , Estadística como Asunto/métodos , Encuestas y Cuestionarios , Suecia , Resultado del Tratamiento , Estados Unidos , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Trastornos de la Visión/psicologíaRESUMEN
The Norwegian MEPS (musculoskeletal--visual--psychosocial--stress) study included 3 groups: data entry, data dialogue (female) and data dialogue (male). Before intervention, the data entry group reported significantly more symptoms and signs of musculoskeletal illness and had longer periods in front of the video display terminal (VDT) without a break. The ergonomic intervention consisted mainly of ergonomic information and training. After intervention, the data dialogue female group reported a significant reduction in shoulder pain in parallel with a reduction in trapezius load. Increasing the understanding in how to adjust the work stand and chair may have been contributing factors to reducing the pain level. There was a significant reduction in eye problems in all groups; the greatest reduction in eye symptoms was seen in the groups who had new optometric corrections.
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Terminales de Computador , Ergonomía/métodos , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Trastornos de la Visión/etiología , Trastornos de la Visión/prevención & control , Adulto , Electromiografía , Femenino , Humanos , Cooperación Internacional , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/psicología , Noruega , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/psicología , Optometría/métodos , Dolor/diagnóstico , Dolor/etiología , Dolor/prevención & control , Dolor/psicología , Examen Físico , Postura , Distribución por Sexo , Factores Socioeconómicos , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/psicología , Lugar de TrabajoRESUMEN
A group of routine data entry operators (female) was included in the Polish MEPS (musculoskeletal--eyestrain--psychosocial--stress) study. Before the intervention, ergonomic assessment revealed improper working conditions such as inadequate lighting, uncomfortable chairs, and lack of forearm and wrist support while medical examination revealed that trapezius muscle load along with upper arm, head and back angles were higher than advisable. Subjects complained about neck and shoulder pain, visual problems, and psychosocial conditions. The ergonomic intervention included installation of new luminaires and Venetian blinds, new chairs, repair of ventilators, and optometric corrections. The results after the intervention showed mainly improvement in chair comfort, lighting conditions, visual strain, and sitting posture. However, financial limitations did not allow satisfactory completion of the intervention leading to a mixed interpretation of the results.
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Terminales de Computador , Ergonomía/métodos , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Trastornos de la Visión/etiología , Trastornos de la Visión/prevención & control , Adulto , Ergonomía/instrumentación , Femenino , Humanos , Cooperación Internacional , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/psicología , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/psicología , Dolor/diagnóstico , Dolor/etiología , Dolor/prevención & control , Dolor/psicología , Examen Físico , Polonia , Postura , Factores Socioeconómicos , Resultado del Tratamiento , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/psicología , Lugar de TrabajoRESUMEN
Three groups of data entry female visual display terminal (VDT) workers from Norway (n = 30), Poland (n = 33) and the USA (n = 29) were compared. Before intervention, the Norwegian group reported more neck pain compared with the Polish group. The Polish group reported less shoulder pain than both the U.S. and the Norwegian groups. The clinical examination documented fewer symptoms and signs of musculoskeletal illness among the Polish participants compared with the Norwegian and the U.S. groups. After intervention, the Norwegian group reported a reduction in neck pain while the U.S. group reported a reduction in shoulder pain. The Polish group reported an increase in neck, shoulder and forearm pain at follow-up compared to after intervention. The Polish group recorded higher flexion of the upper arm at follow-up parallel with an increase of pain in the upper part of the body. Visual discomfort showed variable results in the 3 countries.
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Terminales de Computador , Ergonomía/métodos , Cooperación Internacional , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Trastornos de la Visión/etiología , Trastornos de la Visión/prevención & control , Adulto , Electromiografía/instrumentación , Electromiografía/métodos , Ergonomía/instrumentación , Femenino , Humanos , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/psicología , Noruega , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Enfermedades Profesionales/psicología , Optometría/métodos , Dolor/diagnóstico , Dolor/etiología , Dolor/prevención & control , Dolor/psicología , Examen Físico/métodos , Polonia , Postura , Factores Socioeconómicos , Resultado del Tratamiento , Estados Unidos , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/psicologíaRESUMEN
PURPOSE: Three types of progressive additions lenses (PAL) specially designed for VDU-work and one single vision lens were compared in a prospective field study. The aim was to investigate if these progressive lenses created a difference in the development of visual discomfort compared to single vision lenses when working on an optimized VDU-workstation. METHODS: The study had a prospective, parallel group design, with four groups of VDU-workers. Approximately 40 subjects in each group, selected after careful task analysis with special attention towards the visual angles and distances to the work tasks. The groups were followed over one year. A questionnaire concerning visual conditions, working conditions, discomfort in different body areas, the status of the subjects' optometric corrections, psychological factors both at work and at home, amount, frequency and duration of VDU-work etc. was filled in before the intervention, after six months and after one year. No other contact was made with the subjects. The VDU-lenses included were Interview (Essilor), Gradal RD (Zeiss) and Technica (American Optical). Pain intensity and duration were assessed on a 100 mm Visual Analogue Scale (VAS) before the intervention, and six and twelve months after the intervention. All subjects were given a complete optometric examination. RESULTS: Only small changes in the development of headache and visual discomfort were registered. However, the subjective evaluation of area of clear vision and overall satisfaction was significantly improved for the Interview and Gradal RD lens (p < 0.05). There were no significant changes for Technica and single vision lenses. CONCLUSION: Lens designs that cover viewing distances from near and out to approximately 2 meters work well compared to lens designs trying to cover greater range of clear vision. When tasks analysis shows that single vision correction may be used, this is still an acceptable solution.
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Terminales de Computador , Anteojos , Presbiopía/fisiopatología , Presbiopía/terapia , Trastornos de la Visión/fisiopatología , Cefalea/prevención & control , Humanos , Dolor de Cuello/prevención & control , Satisfacción del Paciente , Estudios Prospectivos , Diseño de Prótesis , Encuestas y CuestionariosRESUMEN
Three different types of spectacle lenses, specially designed for visual display unit (VDU) work, were compared with single-vision lenses regarding postural load. The different corrections effect on postural load was measured by using electromyography. Muscle loads were recorded from the trapezius muscle and the infraspinatus muscle. Continuous measurements of body posture were measured by using three dual axis inclinometers attached to the head, back, and upper arm. No significant differences were found between the single-vision lenses and the specially designed VDU lenses regarding muscle load. Small differences were found regarding the head angle. The study concludes that these new lens designs create interesting opportunities for the optometrist to optimize the visual conditions for VDU workers.