Strength and endurance training of an individual with left upper and lower limb amputations.

Purpose: The purpose of this article is to describe the development of a strength and endurance training programme designed to prepare an individual with a left glenohumeral disarticulation and transtibial amputation for a bike trip across the USA.

Method: The subject was scheduled for training three times per week over a two-month period followed by two times per week for an additional two months. Training consisted of a resistance training circuit using variable resistance machines, cycling using a recumbent stationary bike, and core stability training using stability ball exercises.

Physical therapy intervention following surgical treatment of carpal tunnel syndrome in an individual with a history of postmastectomy lymphedema.

Background And Purpose: This case report describes the physical therapy examination, intervention, and outcomes for a patient with lymphedema following breast cancer treatment who underwent carpal tunnel release.

Case Description: The patient was a 53-year-old woman with right upper-limb lymphedema and symptoms of carpal tunnel syndrome (CTS) in her right hand who underwent a carpal tunnel release. Management of her lymphedema included the use of general anesthesia with reduced tourniquet time in conjunction with physical therapy, which included use of compression bandaging, limb positioning, and exercise.

Characterization of organic matrix macromolecules from the shells of the Antarctic scallop, Adamussium colbecki.

The highly acidic soluble organic matrix (SM) isolated from shells of the Antarctic scallop, Adamussium colbecki, was shown to consist of 1.5% carbohydrate by weight and 12.8% phosphate by weight.

Hemolytic differences among artificial cardiac valves used in a ventricular assist pump.

Ventricular assist devices (VADs) required for cardiac support may produce clinically significant hemolysis. VAD valves differ in both mechanics and hemodynamics. Therefore, we examined a ball valve, a modified tilting disc (MTD) valve, a polyurethane trileaflet valve, and a Björk-Shiley monostrut valve to determine their degrees of hemolysis.

A facilitative role for carbonic anhydrase activity in matrix vesicle mineralization.

Carbonic anhydrase (CA) which catalyzes the reversible hydrolysis of carbon dioxide is known to be important in osteoclastic bone resorption, however, suggested roles in calcium phosphate mineral formation have not been previously demonstrated. Biochemical evidence is provided for the presence of CA in growth plate matrix vesicles (MV) and the level of activity determined by enzyme assay. Inhibition of CA activity with the specific inhibitor acetazolamide resulted in reduced rates of MV mineralization.

A completely implanted left ventricular assist device. Chronic in vivo testing.

A completely implantable left ventricular assist device (LVAD) designed for permanent circulatory support has recently been tested in animals without the use of percutaneous leads, using transcutaneous energy transmission and wireless telemetry. The LVAD consists of a brushless DC motor and rollerscrew energy converter, a pusher plate actuated blood pump with a seamless segmented polyurethane blood sac, Bjork-Shiley Delrin disk monostrut valves, an implanted compliance chamber, an implanted electronic controller and battery, and a transcutaneous energy transmission system. The blood pump/energy converter assembly weighs 565 g and displaces 295 cc.

An annular compliance chamber for the Pennsylvania State University electric total artificial heart.

To eliminate the need for a separate parapleural compliance chamber, we are currently investigating the feasibility of an annular compliance chamber. This chamber wraps around the energy converter and fits between the blood pumps of the Pennsylvania State University electric total artificial heart. For the 100 cc total artificial heart, the compliance chamber volume is 76 ml and the tissue contacting surface area is approximately 85 cm2.

An electrically powered total artificial heart. Over 1 year survival in the calf.

An electric motor driven orthotopic artificial heart was implanted in a 110 kg female Holstein calf as part of a series of 12 such implants intended to demonstrate the in vivo durability and compatibility of the device. The device uses pusher plates set into motion by a reversing brushless DC motor and roller screw to alternately eject two cylindrical sac type blood pumps. The pumps use Bjork-Shiley Delrindisc convexo-concave or monostrut valves.

An electric artificial heart for clinical use.

Advances in microelectronics, high-strength magnets, and control system design now make replacement of the heart using an implantable, electrically powered pump feasible. The device described herein is a compact, dual pusher plate unit with valved polyurethane sac-type ventricles positioned at either end. The power unit consists of a small, brushless direct current motor and a motion translator.

Hemodynamic effects of a new right ventricular assist device.

A right ventricular assist device (VAD) based on the principle of counterpulsation has been developed at our institution. The device is a valveless, pneumatically actuated, 40 cc, sac-type pump, with a single inlet-outlet port. For right ventricular support, the "Uniport" pump is anastamosed end-to-side to the pulmonary artery.

In vitro and in vivo evaluation of a right ventricular assist device.

A simple right ventricular assist device (RVAD) has been developed. This device will be useful in situations where biventricular failure has been partially treated by placement of a left ventricular assist device, or when right ventricular failure occurs in isolation. This pneumatically actuated, R-wave synchronized, sac type pump contains no valves, and is connected by a graft to the pulmonary artery.

In vivo determinants of energy consumption in electric motor driven artificial hearts.

To identify factors responsible for energy consumption, a retrospective investigation of the in-vivo performance of the 100 ml electric motor-driven left ventricular assist device (ELVAD), and the e-motor 100 ml total artificial heart, was undertaken. Multivariate regression analysis of the device parameters demonstrated that device flow, and estimated outlet pressure, were the most significant independent variables for predicting changes in motor power. Weighted least-square curvefit, using the product of these two variables, showed that changes in energy consumption can be well predicted for the ventricular assist device (r2 = 0.

Postoperative cardiac support with a pulsatile assist pump: techniques and results.

Since 1980 this group has employed a pulsatile assist pump(s) in 23 patients. Postoperative survival was 39% (9/23). In this group, 16 patients have required left ventricular support; 9 have been weaned from the pump, and 7 have survived (44%).

A segmented polyurethane composite prosthetic anterior cruciate ligament in vivo study.

A segmented polyurethane prosthetic anterior cruciate ligament prototype has been developed and its in vivo integrity assessed in canine subjects. Prosthetic ligaments surgically implanted for 3, 4, 6, 8, 12, and 16 months were assessed clinically in living subjects, at time of autopsy, and microscopically postautopsy. It was found that the ligaments were adequate in strength to provide stability and last for periods up to 16 months.

The compliance problem: a major obstacle in the development of implantable blood pumps.

The compliance problem represents a major obstacle in the development of implantable blood pumps. The motor-driven pumps are enclosed in an airtight casing with gas in the motor space. The trapped gas in the motor space either increases the load on the motor during systole or impedes blood sac filling.

Clinical effectiveness of mechanical ventricular bypass in treating postoperative heart failure.

Our group has designed an air-powered, sac-type ventricular assist pump (VAP) that has a smooth polyurethane surface and Bjork-Shiley-type valves. This VAP has undergone extensive testing in calves and has been available for clinical use during the last 5 years. When properly employed, the circulatory support permitted immediate separation of the patient from bypass.

Approaches to the artificial heart. Invited speaker.

Over the last two decades, the implantable artificial heart has evolved from an idea to a device capable of completely supporting the circulation for periods now exceeding 5 months. Although initial animal studies were limited by thromboembolism and device breakage, the usual causes of death in experimental animals are now infection, atrioventricular valve obstruction, elastomer bladder calcification, or inadequate cardiac output because of the relatively rapid growth of the young calves. As a result of the bulky nature of the energy converter and the substantial risk of infection with large diameter percutaneous tubes, clinical use of their air-powered artificial hearts will be limited to patients who are awaiting or being prepared for heart transplantation.

Calcification inside artificial hearts: inhibition by warfarin-sodium.

Intracavitary calcium phosphate deposits were observed in smooth, elastomeric blood pump sacs implanted in male calves for periods of 115 to 166 days. These deposits occurred predominantly on the flexing surface of the sacs. In contrast, similar pump sacs remained generally free of mineral deposits for up to 150 days in calves treated with the anticoagulant warfarin-sodium.