RESUMEN
We report the development and initial evaluation of a device for robotic assisted upper extremity repetitive therapy (RUPERT). Intense repetitive physical therapies provided by individualized interaction between the patient and a rehabilitation specialist to overcome upper extremity impairment after stroke are beneficial, however, they are expensive and difficult to evaluate quantitatively and objectively. The need is urgent and growing for a low cost, safe and easy to use robotic device to assist the patient and the therapist to fully achieve the potential benefit of task-based repetitive physical therapies. We designed a pneumatic muscle (PM) driven therapeutic device, the RUPERT, that is wearable and provides assistive forces required to move the arm during performance of several critical tasks of daily living. The robot has four degrees of freedom at shoulder, elbow and wrist. The sensors feedback position and force information for quantitative evaluation of task performance. It has the potential of providing a take-home method of supplementing therapy. The device can also provide real-time, objective assessment of functional improvement of therapy.
RESUMEN
At authors clinic 563 coronary artery bypass graft procedures were done from 1. January 1998 to 15. September 1999. 134 coronary revascularizations were performed from the same surgical team on beating heart using the same surgical technic at normothermia. Out of them, 98 operations were done with and 36 without ECC support respectively. Patients were operated on with this sophisticated technic exclusively during this period. Conversion to cardiac arrest was not necessary in any case. Male/female ratio was 76/58, 84% of the patients suffered from one or more preoperative myocardial infarction. The average bypass number was 2.7/patient. Arterial revascularization was performed in 94%. Postoperative mortality was 2.2% (3 pts). The postoperative inotropic demand, myocardial infarction rate (CK-MB release) and the amount of bleeding was very low. Mean postoperative stay in the ICU decreased to the average of 19 hrs. Patients normally left hospital on the 7th postoperative day. This operative technique--performed by an experienced surgeon--is less invasive for the heart and other organ systems, the incidence of complications can be decreased and the principle of complete revascularization is not compromised.
Asunto(s)
Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/cirugía , Puente de Arteria Coronaria/efectos adversos , Enfermedad de la Arteria Coronaria/patología , Paro Cardíaco Inducido , Humanos , Resultado del TratamientoRESUMEN
Authors report on the revascularization resulted by noninvasive and invasive interferences carried out 6-9 months after surgery and on the improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude that recoronarography performed in 12 patients revealed diminished patency rate as compared to the estimated rate, especially in those cases, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly. However Dipyridamole Thallium scintigraphy showed marked improvement in perfusion in all cases. NYHA functional status noticeably improved in the re-examined patients.
Asunto(s)
Infarto del Miocardio/cirugía , Revascularización Miocárdica , Adulto , Anciano , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Factores de TiempoRESUMEN
Authors report the type of revascularization, the result of noninvasive and invasive investigations carried out 6-9 months after surgery, improvement of functional status of 56 postinfarction patients with recurrent angina pectoris. They conclude, that recoronarography performed in 12 patients revealed diminished patency rate compared to the estimated predictive one, especially in those, where complete revascularization was considered to have been carried out. Ejection fraction, wall motion score by ventriculography and echocardiography did not seem to improve significantly. However Dipyridamol Thallium scintigraphy showed marked improvement in perfusion in all cases. NYHA functional status has noticeably improved in the reexamined patients.
Asunto(s)
Infarto del Miocardio/fisiopatología , Revascularización Miocárdica , Ecocardiografía , Pruebas de Función Cardíaca , Humanos , TalioRESUMEN
Twelve single chamber atrial demand (AAI) pacemakers have been implanted for the control of the symptomatic sick sinus syndrome and hypersensitive carotis sinus syndrome at the Postgraduate Medical University during the last year. The patient selection was based upon the long-term monitoring and the electrophysiological studies. In the presence of the intact atrioventricular conduction the "pysiological" pacing has been maintained using "J" shaped endocavital atrial electrodes being connected with simple or multiprogrammable generators. Late AV block was not observed. Authors propose the spreading of AAI stimulation due to its hemodynamical advantages comparing with VVI pacing.
Asunto(s)
Arritmias Cardíacas/cirugía , Estimulación Cardíaca Artificial/métodos , Seno Carotídeo/fisiopatología , Marcapaso Artificial , Síndrome del Seno Enfermo/cirugía , Anciano , Anciano de 80 o más Años , Electrocardiografía , Femenino , Atrios Cardíacos/fisiopatología , Humanos , MasculinoRESUMEN
Out of 318 aortic valve replacements performed between July 1, 1984 and June 30, 1989, aneurysm of the ascending aorta was found in 17 cases. In 7 of these cases employment of conduit was required due to the dimension of the aneurysm. In 5 cases they performed Bentall procedure: aortic valve replacement combined with conduit of the ascending aorta with the replantation of the coronaries. Based on the data of the literature and the acceptable early and late results of their own they conclude, that in case of simultaneous occurrence of aortic valve disease and aneurysm of the ascending aorta the Bentalll procedure is the method of choice.
Asunto(s)
Aneurisma de la Aorta/complicaciones , Insuficiencia de la Válvula Aórtica/complicaciones , Adulto , Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Vasos Coronarios/cirugía , Femenino , Prótesis Valvulares Cardíacas , Humanos , Masculino , Síndrome de Marfan/complicaciones , ReimplantaciónRESUMEN
The possible protective effect of endocavital cooling with a balloon left ventricular vent was studied by post cross clamp time rhythm, ECG, DC shock need, dynamics of temperature changes in the interventricular septum, and positive inotropic support requirement in 60 extracorporeal operations (18 aortic valve replacement, 26 aortocoronary bypass and 16 combined procedures) performed by the same team of surgeons with an identical technique and anaesthetic protocol. The results were compared to the data of 60 similar procedures carried out earlier by the same team but without the balloon technique. We conclude that endocavital cooling may have certain additive effects to chemical cardioplegia, especially in cases with left ventricular hypertrophy, multiple coronary stenoses, and in combined procedures.