DOCSLIB.ORG

Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device ©2017 Bordoni Et Al

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device ©2017 Bordoni Et Al International Journal of Complementary & Alternative Medicine Clinical Osteopathic Observation of Patients with Left- Ventricular Assistance Device Objective Clinical Paper The objective of the study was to investigate the presence and location of Volume 8 Issue 2 - 2017 osteopathic dysfunctions in this patient population, through palpation by qualified andpersonnel buccal such diaphragms. as qualified An osteopaths evaluation D.O. of theMethods: craniosacral The palpation rhythm evaluation was also 1Department of Cardiology, Institute of Hospitalization and concerned the spine, the respiratory diaphragm, the thoracic diaphragm, pelvic undertaken. Manual osteopathic evaluation was completed by the department Care with Scientific Address, Italy 2CRESO, School of Osteopathic Centre for Research and Studies, Italy on the second day after taking charge of the patient, before starting the cycle of 3Department of Radiological, Oncological and havecardiovascular thoracic outletrehabilitation. syndrome. Results: The dysfunction We detected of hypertonia the respiratory of the diaphragmparaspinal Anatomopathological Sciences, Italy 4 reflectsmuscles aat dysfunction the level of of C1-C2, the same C3-C4 side and of C7-T4, the buccal and highlightedand pelvic floors.that all Palpation patients Center for Life Nano Science@Sapienza, Istituto Italiano di Tecnologia, Italy hoped that the information highlighted is used in choosing the type of therapy by of craniosacral rhythm showed a slowing of the cranial pulse. Conclusions: It is *Corresponding author: and that it will encourage other researchers to conduct further research in the Bordoni Bruno, Foundation Don manual fieldpractitioners, and patients such with as osteopaths, L- VAD. physical therapists and chiropractors, Carlo Gnocchi IRCCS, Department of Cardiology, Institute of Hospitalization and Care with Scientific Address, S Keywords: Maria Nascente, Via Capecelatro 66, Milan 20100, Italy, Tel: Received:0039.02.3496300617; Email:| Published: Osteopathic; Left ventricular assist device; Fascia; Diaphragm; Rehabilitation July 14, 2017 August 01, 2017 Abbreviations: CHF: Chronic Heart Failure; EBM: Evidence- Based Medicine; L-VAD: Left Ventricular Assist Device specialists.day, put under Since electric the system charge. is Thecarried patient out mustwith thelearn ultimate to manage aim Introduction the device and its management, thanks to the training provided by Chronic heart failure (CHF) is a condition characterized by of having a transplant, it is referred to as “bridge therapy”, while the inability of the heart to ensure proper supply of oxygen to the if the use of L-VAD becomes a definitive therapeutic solution, it is body tissues [1]. The prevalence of this disease is found mainly described as a “destination therapy” [5,8], (Figure 1). in patients over 50 years of age.1 Heart disease from chronic age of the population and medical treatment that guarantees longerinsufficiency survival is forincreasing, the cardiac due patient to the [1-3].average When increase heart failurein the is in an advanced stage and the clinical condition allows, the Anotherpatient can treatment be put onoption the transplant in advanced list. heart However, failure the is mechanical number of organs available for transplant is lower than the demand [4,5]. pre-determined criteria for inclusion [6]. The most commonly surgicallyventricular implanted support, whichdevice can is left-ventricular be offered to patients assistance who device. meet (L-VAD), a mechanical pump that supports the cardiac pump function, intervening in support of left ventricle in severe Figure 1: Patient with L-VAD. dysfunction, and which, in the newer models, provides a continual instrumentation with a display where every day the medical staff theflow apex [7]. Connectedof the left ventricle.to a pump; A therepackage is a ofcannula external for batteries the outflow for To his left the machinery that carries replacement batteries, and thethat operation exits from of the the aorta, pump and is put one into for connectionthe inflow whichby means enters of anin connectionevaluates the with values the ofmain the controlpatient, unitas the or cyclescontroller per minute(front) and the batteriesspeed of onthe eitherflow. Theside wireof the comes patient out with of thea special peritoneum, belt. The in electric wire, called the drive line, which exits at the level of the subcutaneous tissue of the chest or peritoneum [7]. The system of external battery has a limited duration, approximately 12 hours in controller receives data from the continuous flow pump, and using a the newer models, and must be changed periodically during the link, can be transmitted the data to the computer. Submit Manuscript | http://medcraveonline.com Int J Complement Alt Med 2017, 8(2): 00255 Copyright: Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device ©2017 Bordoni et al. 2/8 Methods with a previous history of sternotomy cardiac surgery and thePatients positioning undergoing of a pacemakerimplantation / ofimplantable L-VAD, usually cardioverter present Setting and study partecipants mustdefibrillator be stable (PM and / ICD) they (Figure must be 2 able& 3). toThese handle patients the replacement are subject In our centre, Don Carlo Gnocchi Foundation IRCCS S. Maria ofto veryexternal long batteries periods ofbefore hospitalization, being discharged because to their home. condition These Nascente, during the time period between January 2011 and patients have to undergo strict medical supervision and can August 2016, 60 patients with L-VAD continuous flow implants access the cardiovascular rehabilitation programs; the results interventionwere hospitalized, patients of werewhich from 55 were an inpatient male and hospital. five women, with a minimum age of 23 years and a maximum age of 69. The post- patient with L-VAD system is subject to a number of complications Interventions of functional recovery are very slow but verifiable [6,9-11]. The both during the hospital stay, and at home, in particular anemia, During their hospitalization, they followed a cardiovascular respiratory problems, recurrent infections in the insertion of the we evaluated the presence of osteopathic dysfunctions in patients rehabilitation program, and an osteopathic evaluation for the VAD cable, and on rare occasions, thrombosis [5-7]. In this study detection of possible faults, using an identical palpation approach issues is missing from the existing literature. for each patient. The osteopathic somatic dysfunction is defined with L-VAD, as we have verified that a text citing osteopathic as an “impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural asymmetryelements [12]. and The the diagnosticrestriction criterionof movement for defining and the a increasesomatic dysfunction must include abnormalities in tissue palpation, the beforein muscular starting tone the [12].1 cycle The of assessmentcardiovascular was rehabilitation. performed by Thethe patientdepartment was onevaluated the second in daysupine after and taking standing charge positions. of the patient, The the patient was comfortable. evaluation areas were chosen for ease of access, while ensuring All patients who underwent osteopathic evaluation displayed wasa respiratory performed diaphragm by placing dysfunction, the hands under with thea range diaphragm of limited and Figure 2: movement. With the patient in the supine position, palpation (Figure 4). Small lateral offsets were actively induced to evaluate side the tubeFrom to the apexx-ray of can the be left observed ventricle. the The pump, patient where also to has the a theat the elasticity same time, of tissueswrapping and the whether fingers aroundthere were the costal preferential arches left there is the tube which will arrive to the aorta, while on the right movement vectors. Evaluating the respiratory diaphragmatic area device of ICD-PM. possibleusing active restrictions. stimuli, the structure was listened to see if breathing had any cranial-caudal limitations, assessing the existence of Figure 4 Figure 3: From the x-ray can be observed the pump above the performed by placing the hands under the diaphragm and at the : With the patient in the supine position, palpation was diaphragm muscle, and the close connection with the heart. same time, wrapping the fingers around the costal arches. Citation: Bordoni B, Marelli F, Morabito B, Sacconi B (2017) Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device. Int J Complement Alt Med 8(2): 00255. DOI: 10.15406/ijcam.2017.08.00255 Copyright: Clinical Osteopathic Observation of Patients with Left-Ventricular Assistance Device ©2017 Bordoni et al. 3/8 For the pelvic floor the operator positioned his hands areasPalpating which thestood paravertebral out as having muscles hypertonia as a whole, and byhypomobility placing the understandbilaterally on the the elastic iliac bones, response resting of the on tissues the anterior-superior and whether or iliac not open palm on the muscles, had the effect of highlighting specific spine. Perpendicular pressure was applied towards the bed, to of vertebral segments, when solicited to passive movement. there were preferential movement vectors (Figure 5). Once the Palpation was performed with open palm on the column, by active areas are assessed, the structure was listened to in order pressing
Load more

Recommended publications
  • The Diaphragm's Role in Increasing the Efficiency of the Kidney
    Opinion Article The Diaphragm’s Role in Increasing the Efficiency of the Kidney Function by Way of the Heart Rasheem J Northington* Department of Medicine, Professor at Five Towns College, Dix Hills, New York, USA Introduction The Positive Effect that Atrial Natriuretic The function of the thoracic diaphragm has the potential and Peptide has on the Kidneys capability of increasing the efficiency of the kidneys by way Atrial natriuretic peptide produces a positive effect on the of increasing their efficiency of filtration. kidneys. This positive effect that this peptide has on the The kidneys are the organs in the human that are responsible kidneys’ function is that it stimulates the kidneys to increase for removing wastes that are created from natural metabolic their filtration efficiency. This peptide stimulates the kidneys reactions in the body, as well as toxins, excess fluid, excess to increase their efficiency by the effect that it has on the ions including acids and other substances that serve no useful glomeruli, the capillaries in the kidneys that are responsible purpose in the body. for filtration. More specifically, atrial natriuretic peptide or ANP increases the efficiency of the kidneys by maximizing The excess accumulation of wastes in any system decreases the surface area of their glomerular capillaries that are the efficiency of the system, and when it comes to living available for filtration. This allows for the maximization of systems such as the humanbody, the accumulation of filtration and maximization of the cleansing of the blood by wastes in the body can also negatively impact health. It is these “glomerular” capillaries, contributing to an increase of important to have healthy working kidneys in order to the filtration rate.
    [Show full text]
  • Mechanical Insufflation/Excufflation in Patients with Neuromuscular Disease
    Diaphragm Dysfunction and Treatment in Amyotrophic Lateral Sclerosis Estelle S. Harris, MD Associate Professor of Medicine University of Utah 02/02/13 No Disclosers Outline of Talk • Case report VB • Introduction to ALS • Brief history of the diaphragm • Respiratory support and ALS • History of pacing • DPS in ALS • Summary CASE of VB I • 58 y/o F with PMH of MS (dx ‘98) with initial c/o difficulty with speech in Oct. of 2005 • March 2006 EMG showed denervation in multiple muscles including: – left arm, first dorsal interosseus on the right, thoracic paraspinal muscles and her tongue • FVC in 2008 was already <40% Case of VB II • January 2008 traveled to San Francisco, for possible enrollment into the ALS diaphragmatic pacing study • She did not qualify do to FVC (needed 50% at enrollment at >45% at implantation) • Returned, continued on BIPAP (12/5) at night and then later during most of the days Case VB III • April 2009- Presented with pneumonia and pCO2 of 94 • Underwent elective tracheostomy • Postoperative complication of ileus w/ progression to non-viable colon requiring emergent total colectomy • D/C for 2 weeks to rehab May 2009 • Remains on ventilator at home at present (almost 4 years) ALS • ALS is a progressive neurodegenerative disease affecting nerve cells in brain & spinal cord • Average life span of three years after onset • Progressive damage to motor neurons – most patients lose 1-3% of their breathing ability each month • Most ALS patients die from respiratory failure • < 5 percent of ALS patients choose tracheostomy
    [Show full text]
  • Laparoscopic Repair of Congenital Pleuroperitoneal Hernia Using a Polypropylene Mesh in a Dog
    Arq. Bras. Med. Vet. Zootec., v.67, n.6, p.1547-1553, 2015 Laparoscopic repair of congenital pleuroperitoneal hernia using a polypropylene mesh in a dog [Correção laparoscópica de hérnia pleuroperitoneal utilizando malha de polipropileno em cão] H.F. Hartmann1, P.C. Basso1, K.L. Faria1, M.T. Oliveira1, F.W. Souza1, É.V. Garcia1, J.P.S. Feranti1, M.A.M. Silva2, M.V. Brun1* 1Universidade Federal de Santa Maria Santa Maria, RS 2Universidade de Passo Fundo Passo Fundo, RS ABSTRACT Pleuroperitoneal hernias are the most uncommon type of diaphragmatic hernias in dogs and cats. The treatment of choice is surgery and may involve the use of prosthetic implant through celiotomy. In the current report, laparoscopic repair of a congenital pleuroperitoneal hernia using polypropylene mesh in a dog is described. The surgery was feasible. Appropriate reduction of the hernia was carried out and no complications were noted. Keywords: diaphragmatic hernia, congenital defect, videosurgery, canine RESUMO Hérnias pleuroperitoneais são o tipo mais incomum de hérnias diafragmáticas em cães e gatos. O tratamento de escolha é cirúrgico e pode envolver o uso de implantes protéticos na abordagem via laparotomia. No presente relato, é descrito o reparo de uma hérnia pleuroperitoneal congênita através de laparoscopia com utilização de malha de polipropileno. A cirurgia foi viável. Houve redução apropriada da hérnia sem observação de complicações. Palavras-chave: hérnia diafragmática, defeito congênito, videocirurgia, canino INTRODUCTION or pleural and peritoneal folds do not fuse. Thus, an incomplete diaphragm that allows the free Diaphragmatic defects occur most commonly displacement of viscera is formed (Thrall, 2010). due to trauma, but may also be associated The serous surface of the thoracic diaphragm with congenital abnormalities such as remains intact, preventing direct communication peritoneopericardial hernia, hiatal hernia, and between the pleural and peritoneal cavities less frequently, pleuroperitoneal hernia (Cariou (Cariou, 2009).
    [Show full text]
  • Anatomic Connections of the Diaphragm: Influence of Respiration on the Body System
    Journal of Multidisciplinary Healthcare Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Anatomic connections of the diaphragm: influence of respiration on the body system Bruno Bordoni1 Abstract: The article explains the scientific reasons for the diaphragm muscle being an important Emiliano Zanier2 crossroads for information involving the entire body. The diaphragm muscle extends from the trigeminal system to the pelvic floor, passing from the thoracic diaphragm to the floor of the 1Rehabilitation Cardiology Institute of Hospitalization and Care with mouth. Like many structures in the human body, the diaphragm muscle has more than one Scientific Address, S Maria Nascente function, and has links throughout the body, and provides the network necessary for breathing. Don Carlo Gnocchi Foundation, 2EdiAcademy, Milano, Italy To assess and treat this muscle effectively, it is necessary to be aware of its anatomic, fascial, and neurologic complexity in the control of breathing. The patient is never a symptom localized, but a system that adapts to a corporeal dysfunction. Keywords: diaphragm, fascia, phrenic nerve, vagus nerve, pelvis Anatomy and anatomic connections The diaphragm is a dome-shaped musculotendinous structure that is very thin (2–4 mm) and concave on its lower side and separates the chest from the abdomen.1 There is a central tendinous portion, ie, the phrenic center, and a peripheral muscular portion originating in the phrenic center itself.2 With regard to anatomic attachments,
    [Show full text]
  • Medical Term Meaning Relating to the Abdomen
    Medical Term Meaning Relating To The Abdomen Curmudgeonly Reginauld refurbish his landslide invigorated cousinly. Which Wallace domiciliated so jerkily that Flem styles her tomfool? Connective and Uruguayan Elton never albumenises psychologically when Montague closet his animus. There is an abnormal closed cavity, useful diagnostic procedures are prone to control movement of this year of abdomen to medical the term meaning relating to. But wicked people block the term stomach pain many experience pain related to the. Many causes crusty eyes in various states that. Pain during bowel sounds may be the medical terms from muscle cell that builds up in. Page helpful in relation to sugar often comes first glance, meaning relating to break down any disease on your healthcare team has many causes. 1 the part of such body between her chest engaged the hips including the cavity containing the stomach some other digestive organs 2 the hind part why the love of an arthropod as being insect abdomen noun. Skip the main content School and Medicine Homepage Emory University. This article should plan to go for additional diagnostic procedures to get pregnant and to medical the term meaning abdomen and skeletal development of dry granulated sugar often nonspecific and signs or. Medical Terminology Reference List- A GlobalRPH. An abdominal X-ray can help find the cause rose many abdominal problems. The bacterial production function in their upper digestive symptoms. Medical Terms Glossary Abdominal aorta Portion of the aorta within the. According to the Oxford English Dictionary this meaning developed in. Latin names for the strike include Ventriculus and Gaster many medical terms related to the get start in gastro- or gastric Note The image text is.
    [Show full text]
  • A Review of the Distribution of the Arterial and Venous Vasculature of the Diaphragm and Its Clinical Relevance
    Folia Morphol. Vol. 67, No. 3, pp. 159–165 Copyright © 2008 Via Medica R E V I E W A R T I C L E ISSN 0015–5659 www.fm.viamedica.pl A review of the distribution of the arterial and venous vasculature of the diaphragm and its clinical relevance M. Loukas1, El-Z. Diala1, R.S. Tubbs2, L. Zhan1, P. Rhizek1, A. Monsekis1, M. Akiyama1 1Department of Anatomical Sciences, School of Medicine, St. George’s University, Grenada, West Indies 2Section of Pediatric Neurosurgery, Children’s Hospital, Birmingham, AL, USA [Received 14 January 2008; Accepted 25 April 2008] The diaphragm is the major respiratory muscle of the body. As it plays such a vital role, a continuous arterial and venous blood supply is of the utmost importance. It is therefore not surprising to find described in the literature a complex system of anastomoses that contributes to the maintenance of this muscle’s life-preserving contraction. Understanding the anatomy of the dia- phragm and any divergence in its vasculature is literally vital to humanity. In the light of this, we review the literature on the blood supply to the diaphragm, with specific emphasis on the recent description of the inferior phrenic vessels and the superior phrenic artery, summarize the clinical significance of the dia- phragmatic vasculature and suggest future avenues of study to further expand on this current body of knowledge. (Folia Morphol 2008; 67: 159–165) Key words: diaphragm, hepatocellular carcinoma, inferior phrenic artery, superior phrenic artery INTRODUCTION aneurysm, transcatheter arterial embolism, and di- In view of the diaphragm’s current standing as gestive pathologies.
    [Show full text]
  • “Congenital Diaphragmatic Hernia” Embryological Basis
    43723 Ganesh Elumalai and Kelly Deosaran / Elixir Embryology 100 (2016) 43723-43728 Available online at www.elixirpublishers.com (Elixir International Journal) Embryology Elixir Embryology 100 (2016) 43723-43728 “CONGENITAL DIAPHRAGMATIC HERNIA” EMBRYOLOGICAL BASIS AND ITS CLINICAL SIGNIFICANCE Ganesh Elumalai and Kelly Deosaran Department of Embryology, College of Medicine, Texila American University, South America. ARTICLE INFO ABSTRACT Article history: Congenital Diaphragmatic Hernia (CDH) is defined by the presence of an orifice in the Received: 12 October 2016; diaphragm, more often left and posterolateral that permits the herniation of abdominal Received in revised form: contents into the thorax. The lungs are hypoplastic and have abnormal vessels that cause 13 November 2016; respiratory insufficiency and persistent pulmonary hypertension with high mortality. The Accepted: 23 November 2016; etiology is unknown although clinical, genetic and experimental evidence points to disturbances in the retinoid-signaling pathway during organogenesis. Chronic respiratory Keywords tract disease, neurodevelopmental problems, neuro-sensorial hearing loss and gastro- Diaphragmatic hernia, esophageal reflux are common problems in survivors. Much more research on several Bochdalek hernia, aspects of this severe condition is necessary. Hiatal hernia, © 2016 Elixir All rights reserved. Pulmonary hyperplasia, Pulmonary hypertension, Central tendon defects. Introductio n These contractions can happen due to different reasons The diaphragm is the dome-shaped sheet made up of which may include us eating too quickly, drinking carbonated muscle and tendon that serves as the main muscle of beverages, experiencing some acid indigestion or even if respiration. It plays a vital role in the course of breathing [1- we‟re dealing with a stressful day [15]. If any of these 2].
    [Show full text]
  • The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1
    Open Access Review Article DOI: 10.7759/cureus.7794 The Five Diaphragms in Osteopathic Manipulative Medicine: Myofascial Relationships, Part 1 Bruno Bordoni 1 1. Physical Medicine and Rehabilitation, Foundation Don Carlo Gnocchi, Milan, ITA Corresponding author: Bruno Bordoni, [email protected] Abstract Working on the diaphragm muscle and the connected diaphragms is part of the respiratory-circulatory osteopathic model. The breath allows the free movement of body fluids and according to the concept of this model, the patient's health is preserved thanks to the cleaning of the tissues by means of the movement of the fluids (blood, lymph). The respiratory muscle has several systemic connections and multiple functions. The founder of osteopathic medicine emphasized the importance of the thoracic diaphragm and body health. The five diaphragms (tentorium cerebelli, tongue, thoracic outlet, thoracic diaphragm and pelvic floor) represent an important tool for the osteopath to evaluate and find a treatment strategy with the ultimate goal of patient well-being. The two articles highlight the most up-to-date scientific information on the myofascial continuum for the first time. Knowledge of myofascial connections is the basis for understanding the importance of the five diaphragms in osteopathic medicine. In this first part, the article reviews the systemic myofascial posterolateral relationships of the respiratory diaphragm; in the second I will deal with the myofascial anterolateral myofascial connections. Categories: Medical Education, Anatomy, Osteopathic Medicine Keywords: diaphragm, osteopathic, fascia, myofascial, fascintegrity, physiotherapy Introduction And Background Osteopathic manual medicine (OMM) was founded by Dr AT Still in the late nineteenth century in America [1]. OMM provides five models for the clinical approach to the patient, which act as an anatomy physiological framework and, at the same time, can be a starting point for the best healing strategy [1].
    [Show full text]
  • The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine Kyle Hitscherich, OMS II; Kyle Smith, OMS II; Joshua A
    REVIEW The Glymphatic-Lymphatic Continuum: Opportunities for Osteopathic Manipulative Medicine Kyle Hitscherich, OMS II; Kyle Smith, OMS II; Joshua A. Cuoco, MS, OMS II; Kathryn E. Ruvolo, OMS III; Jayme D. Mancini, DO, PhD; Joerg R. Leheste, PhD; and German Torres, PhD From the Department The brain has long been thought to lack a lymphatic drainage system. Recent of Biomedical Sciences studies, however, show the presence of a brain-wide paravascular system (Student Doctors Hitscherich, Smith, appropriately named the glymphatic system based on its similarity to the lym- Cuoco, and Ruvolo and phatic system in function and its dependence on astroglial water flux. Besides Drs Leheste and Torres) the clearance of cerebrospinal fluid and interstitial fluid, the glymphatic system and the Department of Osteopathic Manipulative also facilitates the clearance of interstitial solutes such as amyloid-β and tau Medicine (Dr Mancini) from the brain. As cerebrospinal fluid and interstitial fluid are cleared through at the New York Institute of Technology College of the glymphatic system, eventually draining into the lymphatic vessels of the Osteopathic Medicine neck, this continuous fluid circuit offers a paradigm shift in osteopathic ma- (NYITCOM) in nipulative medicine. For instance, manipulation of the glymphatic-lymphatic Old Westbury. continuum could be used to promote experimental initiatives for nonphar- Financial Disclosures: macologic, noninvasive management of neurologic disorders. In the present None reported. review, the authors describe what is known about the glymphatic system and Support: Financial support for this work was provided identify several osteopathic experimental strategies rooted in a mechanistic in part by the Department of understanding of the glymphatic-lymphatic continuum.
    [Show full text]
  • Removable Parts for Detailed Study!
    Removable parts for detailed study! Interior detail Heart, 7-part This high quality model clearly shows over 30 different anatomi- cal regions in the heart. Comes with product manual for easy identification of anatomical features. The model is hori- zontally sectioned at the level of the valve plane. The following parts can be removed for detailed study: • Oesophagus • Aorta • Trachea • Front heart wall • Superior vena cava • Upper half of the heart On base. 20 x 15 x 17 cm; 1.1 kg M-1008548 Giant Heart, 8 times Life-Size This gigantic heart is one of a kind! See every detail of the heart with this giant 8 times life-size model. Constructed by hand, it is of great quality. The atria and ventricles of the heart are open to give a view of the interior, and show the accurately modelled bicuspid and major vessels adjacent to the heart. The coronary heart vessels are also Heart on Diaphragm, 3 times Life-Size, 10-part shown in amazing detail. This unique model depicts the structures of the heart while detailing how the On stand. heart relates to the thoracic diaphragm at 3 times life-size. Easily show how 100 x 90 x 70 cm; 35 kg the diaphragm separates the thoracic cavity from the abdominal cavity. M-1001244 The following parts of the heart can be removed for detailed study: • Oesophagus • Aorta Pulmonary artery stem • Trachea • Both atrium walls • Superior vena cava • Both ventricle walls Non-removable base, includes multilingual product manual. 41 x 33 x 28 cm; 3.6 kg M-1008547 Accurately mod- elled bicuspid and major vessels Connect With Us 74 HUMAN ANATOMY | Heart Models.
    [Show full text]
  • Prevalence of Diaphragmatic Muscle Weakness and Dyspnoea in Graves
    European Journal of Endocrinology (2002) 147 299–303 ISSN 0804-4643 CLINICAL STUDY Prevalence of diaphragmatic muscle weakness and dyspnoea in Graves’ disease and their reversibility with carbimazole therapy Ravinder Goswami, Randeep Guleria1, Arun Kumar Gupta2, Nandita Gupta, Raman Kumar Marwaha, Jitender Nath Pande1 and Narayana Kochupillai Departments of Endocrinology and Metabolism, 1Medicine and 2 Radiodiagnosis, All India Institute of Medical Sciences, New Delhi 110029, India (Correspondence should be addressed to R Goswami; Email: [email protected] or R Guleria; Email: [email protected]) Abstract Objectives: Dyspnoea is a common complaint among patients with thyrotoxicosis. However, its causative mechanisms have not been identified. We assessed the role of thoracic diaphragmatic muscle weakness in dyspnoea among patients with active Graves’ disease. Methods: Twenty-seven patients (19 female, 8 male) with active Graves’ disease were assessed for the clinical severity of dyspnoea, functional (pressure generating capacity) and anatomical aspects (thickness and excursion) of the diaphragm at presentation. The severity of dyspnoea was assessed using a visual analogue scale (VAS) and the 6 min walk test. Lung function tests, diaphragmatic strength (sniff oesophageal pressure, SniffPoeso), maximum inspiratory and expiratory pressures, diaphragmatic thickness and movements on real time ultrasonography were evaluated during normal and deep respiration. Twenty of the 27 patients were reassessed after achieving euthyroidism with carbimazole
    [Show full text]
  • Minding the Breath
    3rd Principle - Minding the Breath Sifu Chris Bouguyon, MMQ [email protected] T. 214-476-1721 Sifu Fayne Bouguyon, LMT [email protected] T. 214-476-1719 1719 Analog Drive Richardson, TX 75081 April Principle Qigong Focus: Minding the Breath This is the third Qigong Principle in our year long, exploration of self through each of 8 Qigong Principles. We will share perspective on all three layers, physical, mental and emotional. The level at which you participate is always up to you. Qigong Principle 3 - Minding the Breath The practice of mindfully optimizing the physical activity of breathing, becoming fully present within each moment in a way that relaxes your body, settles your mind and eases your heart. Physical Level Goal: Understand the importance and value of maintaining a full, relaxed breath. Yes, we all breathe, but how well do we breathe? Do you find your breathing pattern to be shallow and tight, full and relaxed or somewhere in between? Because the breath is an autonomic (automatic) process, we rarely pay attention to it which leads to many of us having irregular, shallow and interrupted breathing patterns. By consciously optimizing our breathing patterns, we begin to take control of our health on physical, mental and emotional levels. Mindful breath training can improve lung performance, increase oxygen uptake and release hormones which relax muscles and dilate blood vessels, leading to increased blood flow and improved lymph circulation. Mental Level Goal: Recognize and understand how mental disruptions can affect the quality of our breathing pattern. What happens when we concentrate intensely, fight heavy traffic or a watch a suspenseful movie? We have a tendency to hold or interrupt our natural breathing pattern.
    [Show full text]