Exercise with vibration dumb-bell enhances neuromuscular excitability measured using TMS.

AIM: The purpose of the study was to examine the effects of exercise without vibration and exercise with vibration (27 Hz) on the cortical silent period (CSP) and cortical motor threshold (CMT) measured using transcranial magnetic stimulation (TMS). METHODS: In 22 university athletes, a circular coil attached to a TMS stimulator was applied over the contralateral motor cortex of the target forearm. Resting cortical motor thresholds for dominant and non-dominant extremities were measured for each participant. Then, 15 biceps curls (15 flexion and 15 extension movements) were performed with the dominant arm using a single vibration dumbbell with the vibration turned off. On a different day, the same biceps curl protocol was performed with the dumbbell vibrating at 27 Hz (2 mm amplitude). A supra-threshold TMS stimulus (1.5x CMT) was delivered while participants were voluntarily contracting the flexor digitorum sublimus muscle (30% MVC grip strength) to determine cortical silent periods before and after each upper extremity exercise protocol. Cortical motor thresholds were measured at rest and after the vibration exercise protocol. RESULTS: All subjects completed the study protocol as designed. After TMS, the CSP in the dominant (exercised) extremities increased after exercise without vibration from a resting (pre-exercise) mean of 57.3 ms to 70.4 ms (P<0.05) and after exercise with vibration, the CSP decreased to a mean of 49.4 ms (P<0.02). The CSP in the non-dominant (unexercised) extremities decreased from resting values of 75.6 ms to 69.3 ms (P=0.935) after the exercise-only protocol and decreased to 49.4 ms (P<0.01) after the vibration exercise protocol. The cortical motor threshold in exercised extremities decreased from a resting mean of 41.4 µV to a postvibration exercise mean of 38.6 µV (P<0.01). In non-exercised extremities, the CMT also decreased, from mean of 43.5 µV to 39.9 µV after the vibration-exercise (P<0.01). CONCLUSION: Vibration exercise enhances bilateral corticospinal excitability, as demonstrated by a shortened cortical silent period and lower cortical motor threshold in both exercised and non-exercised extremities.

Assessment of the efficacy of bio-absorbable oxidized regenerated cellulose for prevention of post-operative pericardial adhesion in the rabbit model.

Pericardial adhesions complicate re-operative cardiac surgery and several attempts have been made to reduce adhesion formation. The efficacy of bio-absorbable oxidized regenerated cellulose in preventing post-operative pericardial adhesions was evaluated in the present study. Forty New Zealand white rabbits were divided into four groups of 10. In all rabbits an area of pericardium (2 x 2 cm) was excised. The wound was left open in groups 1 and 2 but replaced with bio-absorbable oxidized regenerated cellulose in groups 3 and 4. Rabbits in groups 1 and 3 were killed 3 weeks after surgery and those in groups 2 and 4 were killed at 6 weeks. Groups 1 and 2 showed more severe pericardial adhesions, more fibrous reaction and increased visibility of coronary vessels than groups 3 and 4, although there was no difference in inflammation. Light microscopy showed a mesothelium-like cell layer in groups 3 and 4. It is concluded that bio-absorbable oxidized regenerated cellulose may be suitable in patients receiving staged cardiac surgery and in those with a high probability of re-operation.

Symptomatic bilateral carotid artery stenoses 7 years after coronary artery bypass surgery in a young patient with familial hypercholesterolemia.

We present a patient suffering from homozygous familial hypercholesterolemia, who developed coronary artery disease in the age of 15 treated with three vessels coronary artery bypass grafting (CABG) operation. 7 years after CABG surgery symptomatic bilateral carotid artery stenoses were observed. Both internal carotid arteries were stented. The combination of pharmacologic therapy with life-long LDL-apheresis is the current treatment of choice.

Pseudoaneurysm of the brachial artery in two infants following accidental arterial puncture.

A pseudoaneurysm is defined as an aneurysmatic sac surrounded byfibrous tissue instead of other vascular layers such as the muscular one. It is a rare incident in infants especially in the brachial artery. Blunt trauma and vascular access attempts are the most common etiologic factors. We present two infants with brachial artery pseudoaneurysm in the antecubital region following accidental arterial puncture.

Postoperative graft thrombosis in Fontan procedure.

Fontan repair could be used as the definitive palliation in many forms of complex cyanotic congenital heart disease. But thrombosis can occur after a modified Fontan operation (right atrium-right ventricular connection with a conduit). Appropriate management of this complication includes thrombolytic therapy, thrombectomy and revision (if surgically remediable causes of the thrombosis are identified) or redo operation. Two repair operations were performed for the treatment of thrombosis of the right side of the heart in patients in whom we had previously performed Bjork modification (right atrium-right ventricular connection with a conduit). The thromboses occurred 6 and 9 years after the operation, respectively. In both cases, the redo Fontan operation was successfully performed using a dacron tube graft. Patients were anticoagulated after the operation. Risk of thrombosis of the right side of the heart after the Fontan repair may be minimized with the use of prophylactic anticoagulation in high-risk patients soon after the operation.

Congenital broncho-oesophageal fistula associated with bronchiectasis in adults. Report of two cases and review of the literature.

Congenital broncho-oesophageal fistula is a rare entity in adult patients. This anomaly may cause various symptoms such as respiratory infections, coughing bouts when eating or drinking and even haemoptysis. Even rarer than its occurrence with the above-mentioned symptoms is its presentation with bronchiectasis. A congenital broncho-oesophageal fistula presenting with bronchiectasis in a 28-year-old male and 36-year-old female are described. In reported cases, symptoms of chronic recurrent pulmonary suppuration were initially attributed to alternative aetiologies. In both cases, with such an unusual presentation, the observation of the fistulous tract was coincidental. Surgical division of the fistula associated with lobectomy resulted in complete resolution of symptoms.

False aneurysm of the brachial artery in an infant following attempted venipuncture.

False aneurysms have rarely been described in the pediatric age-group. Here a case of false aneurysm of the brachial artery following accidental arterial puncture at the site of attempted venipuncture is reported. Having obtained vascular control with digital compression, the arterial repair was performed by direct suture technique. The characteristics and differential diagnosis of false aneurysms are described. The majority of false aneurysms occur as complications of percutaneous catheterization.