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PURPOSE: The present study examines the differences of radiological diagnosis of lumbar prolaps with quantitative and morphological criteria. Advantages and disadvantages of both methods were analysed. METHOD: Concerning the "Deutsche Wirbelsäulenstudie" (DWS) 286 male and 278 female patients between 25 and 70 years of age undergoing clinical or ambulant therapy for radicular symptoms and the diagnosis of a lumbar prolaps in CT and/or MRT were integrated into our study. Actual MRT and CT pictures of the patients' lumbar spine were analysed by an independent radiologist (primary radiologist). Radiological diagnosis was concerned with quantitative and morphological criteria. Radiological images of 100 selected patients were reexamined by another radiologist (secondary radiologist). On the basis of these results, the interobserver reliability (kappa) was calculated. RESULTS: In 95.2% of all segments a prolaps was seen with quantitative and morphological criteria, in 4.5% a prolaps was analysed with quantitative and in 0.3% a prolaps was seen with morphological criteria. The radiological diagnosis of prolaps by quantitative criteria was confirmed by the operative findings. Many prolapses with lateral localisation were seen in these cases. Therefore radiological diagnosis on the basis of morphological criteria could be difficult. For both radiological methods similar interobserver reliabilities were calculated. To sum up both radiological methods are even equivalent. It is also possible to graduate the diagnosis with quantitative criteria. Detrimental effects of quantitative criteria could be difficulties in measurement with non-digital images. CONCLUSION: Besides several recommendations in the international literature on the radiological analysis of prolaps with morphological criteria, diagnosis with quantitative criteria is also an effective method.

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Surface electromyography (SEMG) is an important tool for work load assessment in ergonomics. Several different approaches using amplitude as well as frequency parameters give fruitful information depending on question at issue in the laboratory as well as in field studies. One basic factor determining the choice of analysis method is whether the SEMG is interpreted as an indicator of forces/torques or pure muscular activation. Two methods for occupational SEMG data reduction representing two different approaches to SEMG applications in ergonomics, Exposure Variation Analysis (EVA), and Joint Analysis of EMG Spectrum and Amplitude (JASA), applied on the same SEMG recording from three muscles during urology surgeon work, have been compared. The EVA method categorised the three muscle recordings as too static with no EMG gaps while the JASA method identifies fatigue in two of the three recordings. The practical relevance of these findings is discussed.

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OBJECTIVE: To determine whether treatment with creatine can improve exercise intolerance in myophosphorylase deficiency (McArdle disease). DESIGN: Double-blind, placebo-controlled crossover study with oral creatine monohydrate supplementation. PATIENTS: Nine patients with biochemically and genetically proven McArdle disease were treated. INTERVENTION: Five days of daily high-dose creatine intake (150 mg/kg body weight) were followed by daily low-dose creatine intake (60 mg/kg). Each treatment phase with creatine or placebo lasted 5 weeks. MAIN OUTCOME MEASURES: The effect of treatment was estimated at the end of each treatment phase by recording clinical scores, ergometer exercise test results, phosphorus 31 nuclear magnetic resonance spectroscopy, and surface electromyography. RESULTS: Of 9 patients, 5 reported improvement of muscle complaints with creatine. Force-time integrals (P =.03) and depletion of phosphocreatine (P =.04) increased significantly during ischemic exercise with creatine. Phosphocreatine depletion also increased significantly during aerobic exercise (P =.006). The decrease of median frequency in surface electromyograms during contraction was significantly larger (P =.03) with creatine. CONCLUSION: This is the first controlled study indicating that creatine supplementation improves skeletal muscle function in McArdle disease.

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OBJECTIVES: The aims of the study were to analyze muscular strain and fatigue of urologists during the performance of transurethral resections using direct and video endoscopy and to reduce the muscular effort by an ergonomic arrangement of the operation equipment. METHODS: The study was performed before, during and after the introduction of a video-guided resection method. Muscular strain and fatigue were studied by means of surface electromyograms derived from various shoulder and back muscles of surgeons. RESULTS: During direct endoscopy, muscular strain was found to be significantly higher for the shoulder muscles than during monitor endoscopy. The occurrence of muscular fatigue was established for at least one of the muscles under test in all operations during the application of direct endoscopy. A routine use of the video method was facilitated by arranging the operation equipment according to ergonomic principles. This results in a reduction in muscular fatigue, in particular for the trapezius muscle. For this muscle the number of operations accompanied with fatigue was lowered from about 80% before redesign to about 42% after redesign. CONCLUSION: Muscular strain and fatigue of urologists occurring during transurethral resections is reduced by applying video endoscopy instead of using direct endoscopy. The routine use of the video method requires an ergonomic arrangement of the operation equipment.

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An electromyographical field study was performed in the operating theatre on four surgeons during 15 urological operations. In the course of the operations two endoscopic techniques were applied alternately: (1) direct endoscopy, and (2) monitor endoscopy. During direct endoscopy the surgeon looks into the urethra and the bladder via an endoscope. In monitor endoscopy, by contrast, the operating area is observed via a video system consisting of a camera mounted on top of the endoscope and a monitor. During the operations surface electromyograms were derived from both trapezius muscles, the right deltoideus muscle and the left erector spinae muscle. An activity code describing the surgeons' activity was additionally recorded. Analysis of the activity recording reveals that the monitor endoscopic method is preferred in the first third of the operations, whereas preference is given to the direct method in the last third. The electromyographical measurements indicate that during monitor endoscopy the myoelectrical activity of both trapezius muscles and of the right deltoideus muscle is significantly reduced in comparison with the activity for the direct endoscopic technique. A significant influence of the surgical technique on the myoelectrical activity could not be established for the erector spinae muscle. The electromyographical findings reveal that the activity of the shoulder musculature required for the maintenance of the posture and the performance of the operation is significantly lower in monitor endoscopy than in direct endoscopy. Consequently, a clear reduction in muscular strain can be achieved during the performance of endoscopic operations in urology if a video system is employed.

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An electromyographical fatigue analysis was performed in the operating theatre on four surgeons during 14 urological operations in which 'direct endoscopy' (cf. Luttmann et al. 1996, Part I) was applied. Surface electromyograms (EMG) were derived from the m. trapezius on both sides of the body, the right m. deltoideus, and the left m. erector spinae. The surgeons' activities were documented by simultaneously recording an electrical activity code signal parallel to the EMGs. The electrical activity (EA) was formed from the raw EMG by rectification and continuous averaging. For purposes of spectral analysis, the EMGs were digitized and converted to the frequency domain by Fast Fourier Transformation. During the performance of endoscopic surgery, an increase in EA, as well as a spectral shift towards lower frequencies, are observed for at least one of the muscles under test in all of the operations. This indicates the development of muscular fatigue in the course of the operations. The finding is confirmed by applying a newly developed method for the joint analysis of the spectrum and the amplitude of EMGs (JASA) which permits discrimination between fatigue-induced and force-related changes in the EMG. Utilizing this method, the development of fatigue was confirmed for 11 of the 14 operations in the case of the right m. trapezius. The right trapezius muscle therefore constitutes a bottleneck for the performance of the operations. The endurance time was estimated from the increase in EA and compared with the actual duration of the operations. Since both are of the same order of magnitude, it is concluded that the final part of an operation has to be performed when the muscles are already fatigued. Application of the newly available method known as 'monitor endoscopy' (cf. Part I) can lead to a reduction in muscular strain and fatigue. This, in turn, will enable operations to be performed at less risk to the patient.

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During fatiguing contractions of muscles typical changes in the surface electromyogram (EMG) are found, like an increase in the EMG amplitude and a shift of the frequency spectrum towards lower values. Such changes can be used to indicate the occurrence of muscular fatigue. It has to be considered that EMG changes not only depend on muscular fatigue but also on the contraction force of the muscle under test. Suitable methods are shown which can, according to this condition, be applied for the determination of muscular fatigue occurring during occupational work.

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In a work physiology field study, the work flow and the electrocardiogram were recorded throughout whole shifts for six male refuse (garbage) collection workers who transported and emptied 1.1 m3 refuse containers. The work rate (WR), indicated by the number of 1.1 m3 containers emptied per unit of time, and the work pulse rate (WPR) were determined in the data evaluation. The work pulse rate increases with the work rate. The functional relationship can be approximated by a linear regression function (WPR = 20.9 + 35.8.WR). The work pulse rate reaches such high values that it must be assumed that the work cannot be performed continuously throughout the whole working day. Consequently, regular breaks should be provided. When determining the necessary duration of the breaks, it was assumed that an equilibrium between fatigue and recovery should be maintained during the working day. The recovery breaks should be at least long enough for the heart rate to return to the resting level. The necessary duration of the breaks was determined on the basis of the present field study and the laboratory investigations described in the literature. A minimum duration of 10 min per working hour results from the calculations. The breaks should be taken regularly at about hourly intervals. A transportation-capacity model is provided for the planning of the deployment of refuse workers. It permits calculation of the number of 1.1 m3 containers a three-man crew, comprising the refuse collection truck driver and two loaders, can empty during one shift. Both the logistical and ergonomic transportation capacities can be determined using the model. The logistical transportation capacity (TCL) indicates the number of containers which can be emptied per shift by a crew when only criteria such as the optimal utilization of the working time are considered. The ergonomic transportation capacity (TCE) is understood as the number of containers which can be emptied per shift taking into consideration the workers' strain and the recovery breaks they require. TCE amounts to between about 140 and 160 containers per shift depending on the type of city district. TCL is higher by between 20 and 30 containers per shift. In order to meet the demand of protecting workers' health, the number of containers to be emptied per shift by a three-man crew should not exceed the ergonomic transportation capacity.

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Previous biomechanical analyses of typical load manipulation tasks were mainly limited to sagittal-plane activities or to static cases. This paper includes the biomechanical determination and assessment of lumbar load during asymmetrical bi-manual materials handling tasks which involve lateral turning of the body, trunk inclination, and sagittal flexion and lateral bending of the spine. Diagonal lifting tasks were analysed for different values for load weight (0-40 kg) and task duration (0.75-1.5 s). Whereas a constant grasp height of 15 cm was assumed, the height for releasing the load differed (50, 100, 150 cm). A dynamic spatial human model ('The Dortmunder') was used for calculating the torque in the sagittal, frontal, and transversal planes through the lumbosacral joint and for determining the compressive and the sagittal and lateral shear force at the L5-S1 disc. The trajectories of body segments and load are computer-simulated on the basis of postures adopted during the movement. During diagonal lifting of loads, lumbosacral torque in the sagittal plane is considerably larger than the lateral bending and torsional torque components. Dynamic analyses result in higher maximum values in the lumbar-load time curves than static analyses. The shorter the time for task execution, the higher the resultant dynamic effects and, in consequence, the higher the lumbar load. Lumbosacral compression and shear increase with increasing load-release heights due to higher acceleration and retardation of body and load when the same grasp position and task duration are assumed. The maximum load-bearing capacity of the lumbar spine was determined on the basis of strength data for isolated lumbar segments provided in the literature. The compressive strength falls within the same range as the compressive forces calculated for asymmetrical lifting of loads up to 40 kg. On account of the wide scattering of the compressive strength values, the main influences were determined (age and gender). At an age of 40 years, strength is approx. 6.7 kN for males and 4.7 kN for females (decrease with age per decade: 1.0 kN males, 0.6 kN females). In order to avoid overestimating an individual's lumbar compressive strength, predicted values should be reduced, e.g., by the standard deviation in the male or female samples (2.6 kN or 1.5 kN). Although only a few maximum shear force values are available in the literature, comparison with the calculated values for diagonal lifting leads to the conclusion that sagittal and lateral shear should not be ignored in the assessment of lumbar load during asymmetrical handling tasks.

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The health consequences of long-term professional activity in loading for transport were investigated in an epidemiological study. This involved determining the frequency of orthopedic diseases within a series of transport workers and comparing it with the disease frequency in a comparable group with the same age distribution. The frequency of orthopedic diseases in transport workers is about 22% higher than in the other group. Most of the findings relate to the lower lumbar spine. An increase in the number of diseases can be observed in the transport workers even after a short period of professional activity. In order to examine the possible cause for the increased frequency of disease, the load on the lower lumbar spine was determined quantitatively using biomechanical model calculations. A three-dimensional biomechanical model that allows examination of both static and dynamic load was developed for this purpose. The influence of posture, the mass of the load to be transferred, and the acceleration of the load and the body on the mechanical spinal load were examined as typical examples of load manipulation. In the assessment of load, the compressive forces calculated were compared with the strength of the spinal elements. The compression forces on the lower lumbar spine are of the same order of magnitude as the strength. The high mechanical load can therefore be regarded as a possible cause of the high frequency of disease among persons whose professional activity involves lifting heavy loads.

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A dynamic biomechanical human model is presented which allows the quantification of mechanical parameters such as torque, compressive and shear forces, and pressure at the lumbar intervertebral discs. The human model comprises a total of 19 body segments. Various trunk flexions can be analysed due to the provision of 5 joints at the level of the 5 lumbar intervertebral discs. The influence of intraabdominal pressure on spinal load is considered. The inclusion of the influences of gravity and inertia permits the analysis of both static body postures and dynamic body movements. Since the model is 3-dimensional, the lumbar stress can be calculated during both symmetrical tasks in the median sagittal plane as well as during non-symmetrical ones. The influences on spinal stress of trunk inclination and the position of an external load relative to the body are quantified for various load weights up to 50 kg. The torque at the lumbo-sacral joint L5-S1 lies, dependent on posture and load lever-arm, within the range between 0 and 500 Nm; the compressive force on L5-S1 lies within the range between 0.4 and 10 kN, and the shear force at L5-S1 between 0.2 and 0.9 kN. The influences of lift velocity and jerky movement on lumbar stress are quantified. Simulated humpback and hollow-back postures are studied. The compressive forces at the 5 lumbar intervertebral discs are compared. The validity of the model is examined by comparing the model calculations with the intradiscal pressure measurements taken from the literature. Strength tests on lumbar intervertebral discs and vertebrae are collated from the literature in order to assess the lumbar stress during load lifting. The lumbar ultimate compression strength varies within a wide range. The mean value for a total of 307 lumbar segments amounts to 4.4 kN, the standard deviation to 1.9 kN. In conclusion, lumbar compressive force values during lifting fall within the same range as the strength values for the human lumbar spine.

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Material handling tasks result in high load on the skeletal system. Long-term employment in transportation jobs may therefore cause a high frequency of orthopaedic diseases, particularly in the spinal region. An epidemiological study was performed on employees from a large company in order to test this hypothesis. The medical history of 249 male transport workers was examined by means of statistical analysis of the orthopaedic diseases documented in the record file of their company's health service. For purposes of comparison, the same data evaluation was performed for an age-matched reference group consisting of 267 persons chosen randomly from among the male employees in the same company. The proportion of persons with orthopaedic diseases amounts to 77.1% among the transport workers and 62.9% among the reference persons. It is consequently 1.22 times higher for the transport workers than for the reference persons ("rate ratio RR" = 1.22). The greatest part of all orthopaedic diseases affects the spine. Within the spine, the lumbar region is the most frequently damaged. Both for the totality of all spinal sections as well as for diseases of particular spinal sections (cervical, thoracic, lumbar spine), the proportion of the transport workers with diseases is higher than that of the reference persons (RR between 1.20 and 1.36). The proportion of persons with spinal diseases increases with age in both groups. There is no observable difference between the groups with regard to the frequency of persons with degenerative diseases.(ABSTRACT TRUNCATED AT 250 WORDS)

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Situations causing high postural stress during the transport of dustbins were determined, and the load on the spine was estimated. Electromyographical analyses revealed workload situations with high muscular activities during the transport over edges. Thus the manipulation of large dustcontainers (1100 l) is rendered difficult by kerbstones. Because smaller dustbins (110 l-240 l) are often kept in basements or backyards, stairs must frequently be climed with a heavy load. To quantify the spinal stress, a biomechanical model was developed in order to calculate the torques and forces effective at the lumbosacral joint. In the computations several parameters and transport conditions, such as kerbstone height, were varied. That entails different working postures by the dustbins men. The influence on the load on the spine was estimated. The calculated results are compared with criteria taken from the literature. Special postures were devised to keep the torques and forces as small as possible, and thereby to decrease the health risk of the skeletal system when handling heavy weights like dustbins. In the case of a container transport, only two persons should manipulate and work in well-timed co-ordination and both in special postures. Finally, all dustbins should be positioned at places guaranteeing an easy transport over flat surfaces.

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In order to investigate the influence of changes in pCO2 on the fractional packed cell volume (FPCV, hematocrit) of whole blood, a device for measuring the conductivity was developed. This method allows an instantaneous and continuous determination of the FPCV, because the erythrocyte membrane has insulating properties, and, consequently, the resistance of blood depends on the relative cell volume. The steady state and transient relationships between FPCV and acid-base levels were investigated by combining this method with simultaneous recordings of pCO2. The experiments showed that addition of CO2 caused an increase in the resistance of whole blood, whereas the resistance of separated plasma decreased slightly and the resistance of true plasma remained almost constant. The change in the FPCV (delta H) can be described by a linear function of pH or log pCO2 (formula: see text). The transient response of the resistance, after a stepwise increase in the CO2 content, was found to be the slowest process in attaining an acid-base equilibrium. In blood with acetazolamide, the time courses of changes in pH and pCO2 were retarded, whereas the time course of the resistance change reflecting the swelling of the erythrocytes was nearly the same (T 50 approximately equal to 4 s). This may indicate a rate-limited water shift due to a slight water permeability of the erythrocyte membrane.

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