Physiatrists


Good Samaritan
1111 E McDowell Rd
Phoenix, AZ 85006
602-239-2380
Locations and availability (1)

Education ?

Medical School
The Queen's University Of Belfast (1959)
Foreign school

Awards & Distinctions ?

Appointments
University of Arizona College of Medicine
Research Professor, Pharmacology
Associations
American Board of Physical Medicine and Rehabilitation
American Association of Neuromuscular and Electrodiagnostic Medicine

Publications & Research

Dr. Herman has contributed to 63 publications.
Title A Semi-automated Analysis Method of Small Sensory Nerve Fibers in Human Skin-biopsies.
Date April 2010
Journal Journal of Neuroscience Methods
Excerpt

Computerized detection method (CDM) software programs have been extensively developed in the field of astronomy to process and analyze images from nearby bright stars to tiny galaxies at the edge of the Universe. These object-recognition algorithms have potentially broader applications, including the detection and quantification of cutaneous small sensory nerve fibers (SSNFs) found in the dermal and epidermal layers, and in the intervening basement membrane of a skin punch biopsy. Here, we report the use of astronomical software adapted as a semi-automated method to perform density measurements of SSNFs in skin-biopsies imaged by Laser Scanning Confocal Microscopy (LSCM). In the first half of the paper, we present a detailed description of how the CDM is applied to analyze the images of skin punch biopsies. We compare the CDM results to the visual classification results in the second half of the paper. Abbreviations used in the paper, description of each astronomical tools, and their basic settings and how-tos are described in the appendices. Comparison between the normalized CDM and the visual classification results on identical images demonstrates that the two density measurements are comparable. The CDM therefore can be used - at a relatively low cost - as a quick (a few hours for entire processing of a single biopsy with 8-10 scans) and reliable (high-repeatability with minimum user-dependence) method to determine the densities of SSNFs.

Title [selective Doppler-guided Hemorrhoidal Artery Ligation As a Minimaly Invasive Method of Treatment of Hemorrhoidal Disease].
Date September 2009
Journal Przegla̧d Lekarski
Excerpt

The aim of this study was to present the experience of two centres concerning minimal invasive technique for treating hemorrhoids--Doppler Guided Hemorrhoidal Artery Ligation (DGHAL). From our own experience and based on the literature--we can say that DGHAL is a minimally invasive, safe and effective method in grade II and III hemorrhoids. It can also be recommended in selected grade IV cases combined with anodermal folds resection. A properly carried out operation should involve no intra- and postoperative complications. However, this procedure requires more controlled trials on a larger group of patients and long term follow-up (longer than 3 years postoperatively).

Title Two-center Experience in the Treatment of Hemorrhoidal Disease Using Doppler-guided Hemorrhoidal Artery Ligation: Functional Results After 1-year Follow-up.
Date January 2009
Journal Surgical Endoscopy
Excerpt

Doppler-guided hemorrhoidal artery ligation (DGHAL), as a method of treating hemorrhoidal disease, is currently used in many centers across Europe, Asia, and Australia. The aim of our study was to evaluate the clinical effectiveness and functional results of DGHAL as estimated by means of anorectal manometry.

Title Muscle Metabolism During Overground Walking in Persons with Poststroke Hemiparesis.
Date October 2008
Journal Topics in Stroke Rehabilitation
Excerpt

Muscle energy metabolism is associated with speed, endurance, and effort during walking, yet data regarding muscle metabolism during walking in persons with poststroke hemiparesis have not been published. The primary purpose of this study was to compare the energy metabolism during overground walking in persons with poststroke hemiparesis to controls. The secondary purpose was to determine whether the walking behavior of persons with poststroke hemiparesis conforms to the fuel selection patterns previously observed in controls.

Title Disturbances of the Parasympathetic Branch of the Autonomic Nervous System in Patients with Gastroesophageal Reflux Disease (gerd) Estimated by Short-term Heart Rate Variability Recordings.
Date January 2008
Journal Journal of Physiology and Pharmacology : an Official Journal of the Polish Physiological Society
Excerpt

Gastro-esophageal reflux disease (GERD) is the result of the acid contents regurgitation back from the stomach into the esophagus. According to the endoscopic findings, GERD can be divided into two main forms: non-erosive (NERD) and erosive reflux esophagitis. The pathogenesis of GERD is associated with the impaired function of the antireflux barrier. Disturbances of the autonomic nervous system (ANS), especially parasympathetic part of the ANS, may be also involved in the pathogenesis of this disease. The aim of our study was to establish the parasympathetic activity in patients with reflux esophagitis and in patients with symptomatic endoscopically negative reflux. Working hypothesis was the question, whether the possible parasympathetic activity disturbances, which are observed in all GERD patients, may be regarded as the primary or secondary to the esophagitis. All the participants (20 pts. with NERD, 20 pts. with reflux esophagitis and 20 healthy controls) underwent esophageal manometry, 24-hour ambulatory pH-monitoring, resting heart rate variability (HRV) recording and the deep breathing (DB) test with the continuous HRV recording. The results of the spectral analysis both of the short-term, resting HRV recordings and DB-evoked revealed the disturbances of the main power spectra components - LF and HF in both groups of patients in comparison with the control group. In our opinion, the observed HRV spectra changes in both groups of patients support the hypothesis that not only is the parasympathetic activity impairment associated with the pathogenesis of GERD but it is also the primary factor contributing to the pathophysiological mechanism of reflux.

Title Influence of Vagal Nerve Stimulation on Food Intake and Body Weight--results of Experimental Studies.
Date December 2007
Journal Journal of Physiology and Pharmacology : an Official Journal of the Polish Physiological Society
Excerpt

The paper reviews recent advances in vagal nerve stimulation for the control of food intake and body weight. The vagal nerves are the predominant pathway in the "brain-gut axis" responsible for short term regulation of food intake. Stimulation of afferent vagal traffic attenuates food intake by vagal projections to nucleus tractus solitarius, arcuate nucleus and its convergence's to thalamic center of satiety. A few studies have been published in this field so far. All of them are consistent and show significant decrease in body mass during vagal stimulation. Due to promising results of experimental studies, clinical trials are expected in the near future.

Title [current Concepts of Diverticular Disease Pathophysiology].
Date May 2007
Journal Folia Medica Cracoviensia
Excerpt

The first description of diverticular disease (DD) is dated on XVIIIth century. During last decades the DD prevalence continuously increases, especially in western countries. Nowadays, in developed countries, DD of the left colon is one of the most common diseases of gastro-intestinal tract. Because of the prevalence and costs of treatment it is still in the limelight of scientists and medical professionals. This article summarizes basic epidemiological data and discusses actual concepts of DD pathophysiology. Despite fact DD becomes more and more important, its pathophysiology remains to be unrevealed yet. Further clinical, molecular and epidemiological studies are needed to show the process and particular stages of diverticula development and progression.

Title Prevalence of Somatic Small Fiber Neuropathy in Obesity.
Date April 2007
Journal International Journal of Obesity (2005)
Excerpt

Somatic cutaneous small sensory fiber neuropathy (SSFN) can be an early manifestation of impaired glucose tolerance and diabetes mellitus and/or insulin resistance among obese subjects and is often associated with pain, wound occurrence and impaired wound healing. It is yet unclear as to whether SSFN is prevalent among obese individuals without glucose and/or insulin dysregulation despite abundant evidence of delayed wound healing.

Title 24-hour Heart Rate Variability in Patients with Gastroesophageal Reflux Disease.
Date December 2006
Journal Folia Medica Cracoviensia
Excerpt

The GERD pathogenesis may be associated with disturbances of the autonomic nervous system (ANS), which can be revealed using heart rate variability studies (HRV). The aim of presented study was to estimate the circadian ANS activity in 24-hour HRV recordings in GERD patients, both in non-erosive form (NERD), and with erosive, inflammatory changes in the esophagus (ERD patients). Our results demonstrated disturbances in the parasympathetic ANS part, but they also delivered the proofs for possible sympathetic disorder. That is why the autonomic neuropathy in GERD patients may have mixed character.

Title Non-invasive Assessment of the Gracilis Muscle by Means of Surface Electromyography Electrode Arrays.
Date September 2006
Journal The Journal of Surgical Research
Excerpt

The purpose of the study was the non-invasive investigation of the innervation zone (IZ) location of the gracilis muscle of both thighs by means of surface electromyography (EMG).

Title Superiority of Preemptive Analgesia with Intraperitoneal Instillation of Bupivacaine Before Rather Than After the Creation of Pneumoperitoneum for Laparoscopic Cholecystectomy: a Randomized, Double-blind, Placebo-controlled Study.
Date August 2006
Journal Surgical Endoscopy
Excerpt

This study aimed to evaluate the optimal timing of preemptive analgesia with bupivacaine peritoneal instillation in a prospective, randomized, double-blind, placebo-controlled trial.

Title Low-pressure Pneumoperitoneum Combined with Intraperitoneal Saline Washout for Reduction of Pain After Laparoscopic Cholecystectomy: a Prospective Randomized Study.
Date April 2006
Journal Surgical Endoscopy
Excerpt

We designed a prospective randomized clinical trial to investigate whether intraperitoneal saline washout combined with a low-pressure pneumoperitoneum (LPSW) was superior to low-pressure pneumoperitoneum (LP) alone as a means of reducing postoperative pain and analgesic consumption in the early recovery period after laparoscopic cholecystectomy (LC).

Title Anorectal and Urinary Dysfunction After Surgery for Rectal Cancer.
Date January 2006
Journal Folia Medica Cracoviensia
Excerpt

Despite several studies conducted, the relationship between anorectal and urinary dysfunction has not been ultimately determined.

Title [microchip Neuromodulation of the Autonomic System with Magnetic Field Energy Supply].
Date January 2006
Journal Folia Medica Cracoviensia
Excerpt

We describe technical solution of the problem MC magnetic field energy supply showing that system is effective in the neuromodulation of the vagal activity associated with food intake. Effect of MC on decrease of food intake were related to strength of the magnetic field (19-350).

Title Phenomenology of Muscle Overactivity in the Upper Motor Neuron Syndrome.
Date October 2005
Journal Europa Medicophysica
Title Fuel Oxidation During Human Walking.
Date July 2005
Journal Metabolism: Clinical and Experimental
Excerpt

Human adults walk at a characteristic speed, but the mechanisms responsible for this ubiquitous and reproducible behavior remain unknown. In this study, preferred walking speed (PWS) was 4.7 +/- 0.1 km h -1 in 12 overnight-fasted adults, mean age 30.0 +/- 2.6 years. Indirect calorimetry was used to measure fuel oxidation during level treadmill walking from 3.2 to 7.2 km h -1 progressively increased at increments of 0.8 km h -1 and 10.0-min intervals. Corroborating many previous reports, the O2 cost of transport (mL O2 kg -1 km -1 ) was numerically lowest at 4.8 km h -1 , near PWS, but was not significantly different than 5.6 km h -1 . The impact of walking speed on the fuel selection of skeletal muscle was much more dramatic. At speeds less than or equal to PWS, muscle carbohydrate (CHO) oxidation rates were quite low, in the range that could be matched by gluconeogenesis. Above 4.8 km h -1 , CHO oxidation rate increased abruptly and tracked the perception of effort (RPE). Stepwise linear regression revealed that CHO oxidation explained 70% of the variance in RPE, and speed provided an additional 4%. In contrast, the other variables included in the analysis, fat oxidation rate, heart rate, and O2 cost of transport, contributed no additional explained variance in RPE. We conclude that PWS is just below a threshold speed, above which CHO oxidation abruptly increases. The central nervous system may be guided by the perception of effort in selecting a PWS that minimizes dependence on CHO oxidation. We further conclude that skeletal muscle metabolic control is an important factor to be taken into account by the central nervous system motor control of human locomotion.

Title [biofeedback As a Conservative Treatment of Fecal Incontinence].
Date August 2004
Journal Przegla̧d Lekarski
Excerpt

Faecal incontinence (SI) is defined as uncontrolled evacuation of stool in an inappropriate time or place, occurring at least two times a month. The other definition of SI is an inability to refrain from defecation till the moment thought to be appropriate from sociologic point of view. SI is an extremely stressful disease, which according to different sources, concerns about 2.5 to 7% of the adult population. The frequency of SI incidence raises with age, and it concerns about 60% of patients in geriatric health--care institutions. Nowadays there are many types of casual treatment of SI. One of the "first line" methods, if there is no extensive mechanical injury of sphincteric complex, is biofeedback (BF) training. In our study we presented principles of biofeedback treatment, a historical outline of the mentioned method and other conservative methods of SI treatment. We also presented, on the basis of literature, actual state of art concerning effectiveness and possibilities of therapeutic application of BF and results of clinical research, concerning application of BF training in faecal continence impairment in the adult population.

Title [evaluation of Intersitial Cells of Cajal (icc) in the Large Intestine of Humans].
Date October 2003
Journal Folia Medica Cracoviensia
Excerpt

Interstitial Cells of Cajal (ICC) are the pacemaker cells of the smooth muscle of the gastrointestinal (GI) tract. They are binding these muscle with the enterous nervous system and play an important role in the regulation of motility of the GI tract. Disturbiud in activity of those cells were observed in many functional diseases of the GI tract. The aim of this study was to evaluate the localization and morphological differences of the ICC between some region of the human colon. In this work we have performed the immunohistochemical method, using the monoclonal and policlonal specific antibodies against c-kit receptor (CD117) in paraffin embedded block. We find the ICC in the wall of colon in the muscle layers, mainly localized in the region of the myenteric plexus. No difference of the ICC between other region of the colon were observed in our specimen. In some cases of patients with diverticulosis we have observed less of ICC according to the control group. It's only early result, but let us know, that ICC play an important role in the pathogenesis of the motility disturbances of the GI tract.

Title The Usefulness of Low-pressure Pneumoperitoneum in Laparoscopic Surgery.
Date October 2003
Journal Folia Medica Cracoviensia
Excerpt

The aim of the study was to assess the usefulness of low-pressure pneumoperitoneum (LP) in laparoscopic surgery. A consecutive group of 152 patients qualified for laparoscopic cholecystectomy (LC) was assessed as to the possibility of performing the procedure with LP 7 mmHg. The following exclusion criteria were used: Body Mass Index (BMI) > 27 and laparotomy in medical history. The subsequent stage of the trial included 82 (53.9%) patients (73 females, 9 males) meeting the inclusion criteria. The mean BMI was 25.23 +/- 1.4; mean age was 46 +/- 7.8 years. All the patients suffered from symptomatic uncomplicated gallstones confirmed in ultrasound. The pneumoperitoneum was created in a blind way with a Veress needle up to pressure of 12 mmHg and the first 10 mm TERNAMIAN-EndoTip trocar was introduced under direct visual control. After the placement of other trocars, the working pressure was reduced from 12 mmHg to 7 mmHg. The pCO2 concentration was monitored intraoperatively by a capnometer. Among 82 patients included into the study the LPLC was successfully performed in 73 (89%) patients. In 8 (9.75%) patients the working pressure had to be increased to 15 mm Hg due to the gallbladder exceeding 12 cm in length and difficulties in its proper mobilization required to visualize the neck of the gallbladder. All these patients were male and 3 of them were 55 years of age or more. In 1 (1.22%) patient conversion was necessary because of difficulties in identification of anatomical structures within the Calot's triangle. LC can be performed with a use of the LP technique in the majority of patients with BMI < 27 and no previous history of laparotomy. Gallbladder assessed in preoperative ultrasound as longer than 12 cm as well as male sex and age over 55 years indicate a higher risk of failure of the 4-trocar LPLC technique.

Title Influence of Different Pressures of Pneumoperitoneum on the Autonomic System Function During Laparoscopy.
Date October 2003
Journal Folia Medica Cracoviensia
Excerpt

The effects of different pressure values of pneumoperitoneum on the activity of the autonomic nervous system (ANS) have not been investigated in detail. In this prospective study, 20 patients qualified for laparoscopic cholecystectomy were randomised to either low-pressure (LP = 7 mmHg) or standard-pressure (SP = 12 mmHg) pneumoperitoneum groups, 10 patients each. The anesthesia was induced with fentanyl and thiopental and maintained with isoflurane. Ventilation was mechanically controlled (18 breaths per minute, end-tidal CO2 30-35 mmHg, instant capnometer monitoring). Intraabdominal pressure was maintained automatically by a CO2 insufflator. Patient were kept in a horizontal position. The ANS was evaluated by heart rate variability (HRV) analysis (POSTER ECG 2002 System) measured intraoperatively in three recordings of 5 minutes each: in awake patient, after induction of general anesthesia, and after creation of pneumoperitoneum. Power spectral analysis of HRV was applied, the low-frequency (LF = 0.05-0.15 Hz) and high frequency (HF = 0.15-0.45 Hz) spectral density of the HRV were analysed using the Fast Fourier Transform algorithm. The appropriate statistical analysis of data was performed. LF density decreased at the anesthetized stage and increased at the insufflated stage in both groups (p < 0.01). LP resulted in lower sympathetic activation than SP pneumoperitoneum (LF: 68.12 +/- 6.56 nu vs. 78.26 +/- 5.43 nu, p < 0.01; HF: 24 +/- 2.48 nu vs. 15.56 +/- 2.54 nu, p < 0.05). In conclusion: pneumoperitoneum leads to sympathetic activation of the ANS. LP in comparison to SP pneumoperitoneum with carbon dioxide results in significantly decreased sympathetic activation during laparoscopy.

Title A Prospective Randomized Trial on Comparison of Low-pressure (lp) and Standard-pressure (sp) Pneumoperitoneum for Laparoscopic Cholecystectomy.
Date May 2003
Journal Surgical Endoscopy
Excerpt

This study aimed to investigate the advantages and disadvantages of LP (7 mmHg) in comparison to SP (12 mm Hg) pneumoperitoneum in a prospective randomized clinical trial.

Title The Effect of Transcutaneous Nerve Stimulation on Intraductal Biliary Pressure in Post-cholecystectomy Patients with T-drainage.
Date March 2003
Journal European Journal of Gastroenterology & Hepatology
Excerpt

To evaluate the effects of transcutaneous electrical nerve stimulation (TENS) on intraductal biliary pressure (IDP) in basal conditions and after intravenous morphine and oral meal stimulation.

Title Pancreatic Carcinoma-induced Changes in Gastric Myoelectric Activity and Emptying.
Date October 2002
Journal Hepato-gastroenterology
Excerpt

Twenty patients with histologically confirmed pancreatic carcinoma without any endoscopic evidence of gastroduodenal obstruction were included in the study. The aim was to determine changes in gastric myoelectric activity and liquid/solid gastric emptying induced by pancreatic tumor.

Title [preliminary Results of Dynamic Gracilloplasty in the Treatment of Fecal Incontinence]
Date June 2002
Journal Przegla̧d Lekarski
Excerpt

Transposition of the gracilis muscle and its continuous electrical stimulation became a widely accepted method for treatment of patients with severe fecal incontinence. This method introduced to clinical practice by Baeten, Williams and Cavina has also been applied in total anorectal reconstruction following abdominoperineal rectum resection due to rectal cancer. This paper describes our (limited so far) experience with dynamic gracilloplasty procedure in the treatment of fecal incontinence in six patients with injury of anal sphincters. Complete preoperative work up was based on the clinical symptoms of fecal incontinence evaluated in detail according to Jorge and Wexner Incontinence Scoring System and the clinicomanometric continence criteria according to Holscheider scale. Anorectal manometry, transanal endosono-graphy, defecography and barostat study were performed in each patient before and following surgery. Dynamic gracilloplasty procedure was performed according to the modified Baeten procedure--as a one stage procedure. Medtronic equipment (IPG Pulse Generator 3023) was applied for gracilis stimulation. Short term program of fast-to-slow muscle conversion was applied starting from the second week following surgery. Patients were prospectively evaluated after surgery in terms of clinical symptoms and anorectal physiology. Complete fecal continence was achieved in all patients during the first month following surgery. There were no serious postoperative complications. It was shown during anorectal manometry that dynamic gracilloplsty could increase the anal sphincter pressure up to the range of healthy subjects, thus to prevent fecal leakage. The overall clinical and manometic results confirm the feasibility of anal dynamic gracilloplasty to restore fecal continence in patients with complete lost of sphincter function due to its traumatic injury or atresia. This technique deserves wider application also in Poland, since our initial results are encouraging. CONCLUSION: According to our limited experience dynamic gracilloplasty proved safe and effective procedure for the treatment end-stage fecal incontinence. Complete preoperative diagnostic work-up is essential for proper patients selection and surgical procedure should be performed in a specialised surgical center.

Title Anorectal Sphincter Function and Rectal Barostat Study in Patients Following Transanal Endoscopic Microsurgery.
Date February 2002
Journal International Journal of Colorectal Disease
Excerpt

BACKGROUND AND AIMS: This study evaluated the effect of transanal endoscopic microsurgery (TEM) on anorectal sphincter functions and determined the risk factors for anorectal dysfunctions (including incontinence). PATIENTS AND METHODS: A study group of 33 patients with small, mobile rectal tumors (adenoma and carcinoma) located up to 12 cm from the anal verge underwent anorectal motility studies (using pull-through anorectal manometry and rectal barostat) and endoanal ultrasound prior to surgery and 3 weeks and 6 months after TEM; controls were 20 healthy volunteers. RESULTS: Resting and squeeze anal pressures were reduced 3 weeks after TEM. Resting anal pressure remained reduced 6 months after surgery; the changes were related to low preoperative levels and to the internal anal sphincter defects rather than to the procedure duration or the type of surgery. High-pressure zone length and vector volume were decreased 3 weeks after TEM and restored 6 months later. Rectoanal inhibitory reflex, reflex sphincter contraction, rectoanal pressure gradients, threshold and maximal tolerable volume of rectal sensitivity, and compliance were significantly changed 3 weeks after TEM; only rectal wall compliance remained low at 6 months. The rectoanal inhibitory reflex, reflex sphincter contraction, rectal sensitivity, and compliance were related to the extent and type of excision (partial or full thickness). Anal ultrasound revealed internal anal sphincter defects in 29% of patients studied 3 weeks after TEM. Only 76% of patients were fully continent. Disturbed anorectal function (including partial fecal incontinence) was observed in up to 50% of patients at 3 weeks. Partial and moderate anorectal dysfunction was found in 21% patients 6 months after surgery. The main risk factors of anorectal dysfunctions following TEM included: postoperative internal anal sphincter defects, low preoperative resting anal pressure, disturbed rectoanal coordination, extent (>50% of wall circumference) and the depth (full thickness) of tumor excision. CONCLUSION: TEM has a relevant but temporary effect on anorectal motility. As a result of TEM procedures 21% of the patients had disturbed anorectal functions, mostly due to the extent or depth of tumor excision (influencing rectal compliance and rectoanal coordination), and to the sphincter defects lowering resting anal pressure. Preoperative anorectal motility studies and anal ultrasound allow the identification of patients with the risk of postoperative anorectal dysfunctions.

Title Hollow Beams of Simple Polarization for Trapping and Storing Atoms.
Date February 2002
Journal Journal of the Optical Society of America. A, Optics, Image Science, and Vision
Excerpt

We propose a scheme for producing and magnifying a hollow beam, as might be desired for purposes of storing and guiding cold atoms, through the use of a simple spherically aberrating lens and a projection lens. The field is a superposition of J0 Bessel fields, so that simple (linear, circular) polarizations can be utilized. analyze some of the beam properties through analytical approximations. Some examples of field zeros along the optical axis are given, together with some of their characteristics. Numerical calculations largely confirm the validity of the analytical expressions. For the most important zero nearly all of the beam power is contained within the first two Bessel spacings, with a resulting highly efficient trapping. Isophotes are calculated and displayed for the region surrounding this null point. They have regular shapes, for which we give an approximate expression.

Title [current Diagnosis of Gastroduodenal Reflux and Biliary Gastritis].
Date August 2001
Journal Przegla̧d Lekarski
Excerpt

Though primary and secondary duodenogastric reflux (DGR) have been accepted in the medical literature as separate clinical units, reliable and standardised methods of detection have not been known since long. Therefore, the role of DGR in the pathogenesis of upper GI tract diseases makes a problem. So far applied measurement techniques allow only indirect diagnosis of DGR, which is often unphysiological and not objective. These methods do not allow also quantitative evaluation. Unsatisfying results obtained with the use of these methods and further search for the effective system of 24-hour monitoring of bilirubin concentration, which is indirect marker of alkaline reflux Bilitec 2000 is the most physiologic technique of ambulatory recording of the retrograde duodenogastric reflux. It makes possible objective diagnosing of alkaline gastritis as a result of excessive exposure of gastric mucose to destructive effect of bile and pancreatic juice.

Title [pathogenesis and Significance of Gastroduodenal Reflux].
Date August 2001
Journal Przegla̧d Lekarski
Excerpt

For over a century duodenogastric reflux (DGR) has been considered the main cause of the primary or secondary alkaline gastritis. In the first case it occurred in patients who had not been operated earlier, in the latter one in those after surgery of stomach, duodenum, gallbladder and bile ducts. Since first time many reports of clinical and experimental studies have demonstrated destructive effect of pancreatic enzymes, bile acids and their by-products on stomach mucose producing in consequence non-specific histologic lesions. It has been also observed that duodenogastric reflux plays the basic role in the patho-genesis of gastritis and other GI tract diseases (gastric ulcer, reflux oesophagitis, progressing metaplasia or oesophageal and gastric cancer). As far as diagnosing of alkaline gastritis requires histologic confirmation, duodenogastric reflux brings many more problems. However, the progress in medicine and technology allow direct measurement of quality and quantity of this reflux.

Title Gastrointestinal Motility in Surgical Clinic.
Date February 2001
Journal Przegla̧d Lekarski
Title Propagation and Focusing of Bessel-gauss, Generalized Bessel-gauss, and Modified Bessel-gauss Beams.
Date January 2001
Journal Journal of the Optical Society of America. A, Optics, Image Science, and Vision
Excerpt

The propagation of Bessel-Gauss, generalized Bessel-Gauss, and modified Bessel-Gauss beams, for which the exact form of the optical fields is known, is analyzed according to the approximate theory developed previously by the authors [J. Opt. Soc. Am. 17, 1021 (2000)]. Approximations are developed for the fields themselves that are highly accurate and yet are simple in their form and physical description. A set of simple equations is developed, which directly give the parameters describing an image beam following passage through a perfect lens of focal length f, starting with any of the above-mentioned object beams. Ray propagation for these types of beams is described, and it is specifically noted that the intensity maxima do not follow straight paths, while the auxiliary F(rho, z) function in fact does follow straight paths.

Title [stomach Electrostimulation--new Possibility for Treating Gastroparesis].
Date October 2000
Journal Folia Medica Cracoviensia
Excerpt

This paper presents a large range of methods of human gastric pacing. Based on our own experience and literature authors discuss a variety of pacing models, current parameters and place of stimulation. We described a new method of intragastric stimulation as a method of treatment of postoperative, pharmacotherapy resistant gastroparesis. Five patients were included in to the study (3 male and 2 female). The current parameters were as follow: square profile, amplitude 2V (2mA), frequency 6 ips.p.m., duration 3 hours. Two electrodes located on nasogastric catheter (external diameter 1.5 mm) were placed in antral region of the stomach and connected to the computer preprogrammed stimulator. Electrostimulation was accompanied by the continuous cutaneous EGG monitoring (Synectics Sweden). Excellent results were obtained in 3 patients (60%) with disappearance of symptoms, rumbling, normalization in gastric myoelectric rhythm (2-4 cpm > 85%) and with increase in amplitude (average 250%). In one patient with the gastrectasia, symptoms returned next day and stimulation had to be repeated for several days. In another one results were not satisfying. Authors conclude that gastric pacing has made tremendous progress fast developing method in last decade and in most patient is efficient for treatment postoperative gastroparesis.

Title [intraoperative Manometry in Laparoscopic Antireflux Procedures --indications, Methods and Clinical Results]
Date March 2000
Journal Przegla̧d Lekarski
Excerpt

The aim of the study is evaluating the efficiency of intraoperative manometry during laparoscopic Nissen fundoplication and its ability to prevent postoperative complications. METHOD: Sixteen patients with Gastroesophageal Reflux Disease were included in the study. Clinical examinations, x-ray, endoscopy, pH-metry, and manometric studies were performed before, and 3-6 m.o. after surgery. Fourteen patients were undergoing Nissen fundoplication, and two "floppy Nissen" fundoplications due to the specific preoperative manometric indications. RESULTS: Postoperatively the mean proportion of time at pH < 4.0 on pH-metry decreased from 188 min. (range 96-263) to 8.5 min. (range 2-25). Mean number of reflux episodes significantly lowered after fundoplication from 18.9 (range 2-36) to 0.5 (range 0-3). Gastroesophageal junction mean pressure measured postoperatively reached 24.7 mmHg, and was significantly higher than preoperatively (8.9 mmHg). Mean length of LES increased from 1.2 cm (range 0.8-2.5) to 3.6 cm (range 2.4-4.6) postoperatively. CONCLUSIONS: Laparoscopic Nissen fundoplication assisted by the simultaneous continuous intraoperative manometry is feasible and effective procedure. Continuous LES pressure monitoring during laparoscopic fundoplication with simultaneous computer-video assisted display can be advised as an objective method of intraoperative evaluation of antireflux mechanism.

Title A Novel Method for Locomotion Training.
Date May 1999
Journal The Journal of Head Trauma Rehabilitation
Excerpt

This article describes a novel therapeutic system for locomotion training and learning for patients with a wide range of neurological and musculoskeletal disorders. The technique embraces the notion that locomotion therapy should be goal oriented and task specific. The task specificity includes a partial weight-bearing device that permits the posture/equilibrium, movement, and weight-bearing components of gait function to operate concurrently, even in patients with serious deficits. In addition, it allows interaction with therapists and others to facilitate locomotion control, particularly during the early stages of gait therapy. Neurobiological bases for this technique and early clinical results are discussed, and two case studies of patients with traumatic brain injury (TBI) are presented. Although well-designed efficacy studies are needed, clearly this therapeutic approach to locomotor disorders among TBI patients meets the various criteria for recovery of gait function established in this article.

Title Decreased Incidence of Scoliosis in Hearing-impaired Children. Implications for a Neurologic Basis for Idiopathic Scoliosis.
Date May 1995
Journal Spine
Excerpt

STUDY DESIGN. A retrospective survey of the incidence of positive scoliosis screenings in schools for the hearing impaired was performed. OBJECTIVES. The incidence rate of scoliosis in a population with a high incidence of vestibular dysfunction was compared with the national normative incidence rate. The comparison was done to investigate the contribution of the vestibular system to scoliosis. SUMMARY OF BACKGROUND DATA. Several reports have emphasized a possible neural etiology to idiopathic scoliosis. Based on the experimental hypothesis that an altered vestibular processing is critical for the production of scoliosis, 100 schools for the hearing impaired were surveyed to determine their incidence of positive screenings for scoliosis. Because it is known that hearing-impaired children have a high incidence of vestibular dysfunction, it was hypothesized that their screening incidence would change if the vestibular system contributed to idiopathic scoliosis. METHODS. Surveys were sent to 100 schools for the hearing impaired asking for their most recent scoliosis screening data. RESULTS. Of the 40 surveys returned, 28 schools for the hearing impaired conducted routine scoliosis screenings, of which 17 had demographics representative of the national norms. Of the 3127 students screened at these 17 schools, 1.2% of the students screened positive for scoliosis. This is significantly less than national incidence rate of 4%-10%. CONCLUSION. The results suggested that hearing-impaired students may be a population that is protected from idiopathic scoliosis by a neural dysfunction. These data strongly suggest that idiopathic scoliosis has a neural etiology.

Title Behavioral Characterization of the Excitatory and Desensitizing Effects of Intravesical Capsaicin and Resiniferatoxin in the Rat.
Date March 1994
Journal Pain
Excerpt

This study characterized the excitatory (nociceptive) and desensitizing (antinociceptive) properties of the natural pungent substances, capsaicin (CAP) and resiniferatoxin (RTX) instilled in the bladder (intravesical, i.ves.) via an indwelling cannula in awake, freely moving rats. The incidence of 9 behaviors was scored for 10 min following i.ves. vehicle or RTX (1.0 nmol). Abdominal licking and head-turning occurred significantly more often in RTX-treated rats compared to vehicle controls, whereas head-grooming, locomotion, rearing and biting did not differ between the two groups. Little or no vocalization, defecation or hindlimb hyperextension was observed in either RTX- or vehicle-treated rats. A second injection of either vehicle or RTX administered to RTX-treated rats 60 min later did not significantly increase abdominal licking or head-turning compared to vehicle controls; this subsequent lack of excitation was taken as a measure of desensitization. In a separate experiment, the first injection of i.ves. RTX (0.1-3.0 nmol) increased licking in a dose-dependent manner; in contrast, the first injection of i.ves. CAP (0.1-3.0 mumol) significantly increased licking only at the intermediate dose tested, 1.0 mumol. With each subsequent injection of the same drug and dose at 30-min intervals, licking increased to a lesser extent, such that it was not significantly different from control after the fourth injection. Rats treated with i.ves. CAP or RTX also did not show increased licking when administered the opposite treatment 30 min later (RTX or CAP, respectively), indicating cross-desensitization; however, i.ves. administration of a third, higher dose of RTX reinstated licking behavior in these 'desensitized' rats. Subcutaneous administration of CAP (18-180 mg/kg) or RTX (18-180 micrograms/kg) dose-dependently attenuated the excitatory response to i.ves. CAP and RTX administered 2 days later. Whereas rats treated systemically with RTX also were desensitized to the excitatory effects of RTX instilled in the eye (evaluated in the eye-wipe assay), rats treated i.ves. with RTX and vehicle-treated rats showed a normal eye-wiping response. Finally, pretreatment with i.ves. ruthenium red, a cation channel blocker, antagonized the excitatory and desensitizing effects of i.ves. RTX. This study demonstrates that repeated application of both CAP and RTX into the bladder produces behavioral effects indicative of local sensory afferent desensitization. I.ves. CAP and RTX appear to produce their excitatory and desensitizing effects via a common mechanism, which is dependent on cation channel activation.(ABSTRACT TRUNCATED AT 400 WORDS)

Title Intrathecal Baclofen Suppresses Central Pain in Patients with Spinal Lesions. A Pilot Study.
Date March 1993
Journal The Clinical Journal of Pain
Excerpt

To assess the efficacy of acute intrathecal (i.t.) baclofen on chronic, dysesthetic, and spasm-related pain (SRP) among patients with spinal spasticity [i.e., multiple sclerosis (MS), spinal cord injury (SCI), transverse myelitis (TMy)].

Title Clonidine Inhibits Vesico-sphincter Reflexes in Patients with Chronic Spinal Lesions.
Date July 1991
Journal Archives of Physical Medicine and Rehabilitation
Excerpt

When administered systemically to spinalized animals, clonidine, the prototypic alpha 2 adrenergic receptor agonist, purportedly acts at spinal sites to suppress motor responses related to painful peripheral and vesical stimulation and spasticity, and to improve vesicourethral coordination. Hence, the action of clonidine (400 micrograms in three divided doses in a 16-hour span) on spinal vesical and somatic reflexes was examined in five patients with suprasacral spinal cord lesions by assessing volume-induced micturition reflexes and limb motor discharges that occurred spontaneously or were elicited by noxious and nonnoxious cutaneous stimulation. Clonidine caused a significant reduction in (1) blood pressure, (2) amplitude of detrusor contraction, and (3) vesical external urethral sphincter dyssynergia. Limb motor electromyography discharges were not markedly attenuated, although spatiotemporal changes (eg, irradiation, after-discharges) were observed in some of the patients. The results are ascribed to binding to spinal cord alpha 2 adrenergic receptors located on segmental and intersegmental (propriospinal) interneurons, released from descending inhibition, with greater motor system specificity on striated sphincter innervation. Clonidine may be clinically effective in the treatment of hyperactive micturition reflexes in patients with chronic spinal lesions.

Title [irritable Bowel Syndrome: Pathophysiological Basis of Therapeutic Management].
Date March 1991
Journal Przegla̧d Lekarski
Title Gastric Emptying of Liquids in Patients with Peptic Ulcer Disease.
Date September 1990
Journal Acta Physiologica Polonica
Excerpt

This study was designed to determine the rates of gastric emptying of water, saline and a 20% glucose solution in patients with gastric and duodenal ulcers. In all subjects, gastric emptying was fastest after administration of the saline, slower with water and the slowest with glucose. Significant statistical differences (p less than 0.05) in emptying rates between normal subjects and the group with duodenal ulcer were seen when water and saline but not glucose were used. We conclude that inhibitory effects of the osmotic receptors are not changed in gastric and duodenal ulcer patients. However, the emptying rates were higher when osmotic stimulus was withheld.

Title Effects of Bombesin on the Micturition Reflex of the Anesthetized Rat.
Date October 1989
Journal Proceedings of the Western Pharmacology Society
Title The Effect of a Low Dose of Intrathecal Morphine on Impaired Micturition Reflexes in Human Subjects with Spinal Cord Lesions.
Date October 1988
Journal Anesthesiology
Excerpt

The potential therapeutic value of a low dose (200-250 micrograms) of intrathecal (i.t.) morphine on bladder capacity was tested in six subjects with chronic suprasacral spinal cord lesions. Micturition reflexes were examined by saline fill cystometry accompanied by EMG recordings from the external anal and urethral sphincters and selected lower limb muscles. Hyperactive detrusor reflexes were associated with a low capacity bladder in five of the six subjects. All subjects revealed vesicoexternal sphincter dyssynergia, and vesical-induced and spontaneous contractions of the abdominal and lower limb musculature. The results was incontinence and frequent catheterizations. Within 5-15 min of the bolus morphine injection into the L1-2 i.t. space, bladder capacity increased to near-maximal values in all subjects. Soon thereafter, uninhibited detrusor contractions, spontaneous motor discharges, and vesicosomatic (limb) reactions were abolished. A peak effect was observed within 2-4 h. Alterations of bladder capacity persisted for 18-22 h. Side effects included pruritus and nausea. Intrathecal morphine acts at sacral spinal cord sites, e.g., primary afferents and/or dorsal horn neurons, mediating vesicovesical and vesicosomatic (sphincter, limb) reflexes, and spontaneous motor discharges. Clinically, i.t. morphine may be an effective therapy for individuals with suprasacral spinal cord lesions when a low capacity bladder interferes with their quality of life.

Title A Microcomputer Workstation for Assessing Function.
Date September 1987
Journal Psychopharmacology Bulletin
Title [proximal Gastric Vagotomy in the Treatment of Duodenal Ulcer; Its Evaluation in the Light of a 10-year Prospective Study].
Date January 1985
Journal Polskie Archiwum Medycyny Wewnętrznej
Title [5 Years' Results of Prospective Clinical Studies on the Treatment of Duodenal Ulcer by Vagotomy or Denervation of the Gastric Corpus and Fundus].
Date June 1984
Journal Polski Tygodnik Lekarski (warsaw, Poland : 1960)
Title [the Quantitative Evaluation of Indications for Surgical Treatment of Acid-peptic Ulcer and Its Clinical Usefullness (author's Transl)].
Date December 1980
Journal Przegla̧d Lekarski
Title Neuromotor and Neuropsychological Manifestations of "total Therapy" in Children with Acute Lymphoblastic Leukemia.
Date November 1980
Journal Cancer Treatment Reviews
Title Use of Augmented Sensory Feedback to Achieve Symmetrical Standing.
Date June 1978
Journal Physical Therapy
Excerpt

Ambulatory patients with hemiparesis were given auditory feedback of weight bearing on the involved leg in order to achieve symmetrical standing. A device for augmented sensory feedback, the Limb Load Monitor, was used for the training. Patients who could correct their limb loading pattern during the first treatment session learned to achieve symmetrical standing. Results are also related to the magnitude of weight bearing on the involved limb and the side on which the lesion occurs. These findings suggest that the patients utilized the feedback signal to control an inherent activity.

Title [the Current Possibilities of the Laser Radiation Use in Digestive Tract Endoscopy (author's Transl)].
Date February 1978
Journal Przegla̧d Lekarski
Title Incidence of Conversion Symptoms in Children Evaluated Psychiatrically.
Date January 1976
Journal Missouri Medicine
Title Rehabilitation Medicine: Planning a Residency Curriculum.
Date September 1974
Journal Archives of Physical Medicine and Rehabilitation
Title Stump-socket Fit of Below-knee Prostheses: Comparison of Three Methods of Measurement.
Date January 1974
Journal Archives of Physical Medicine and Rehabilitation
Title Effects of Local Hypothermia on Reflex and Voluntary Activity.
Date April 1971
Journal Physical Therapy
Title Bessel-like Beams Modulated by Arbitrary Radial Functions
Date
Journal Journal of the Optical Society of America. A, Optics, Image Science, and Vision
Excerpt

An approximate method for determining the radial and axial intensity of a Bessel-like beam is presented for the general case in which a radial Bessel distribution of any order is modulated by an arbitrary function. For Bessel-Gauss, generalized Bessel-Gauss, and Bessel-super-Gauss beams, this simple approximation yields results that are very close to the exact values, while they are exact for Bessel beams. A practical beam that can be generated with a combination of simple lenses is also analyzed and illustrated.

Title Hole Gratings for Laser Damage Testing.
Date
Journal Applied Optics
Title Diffraction and Focusing of Gaussian Beams.
Date
Journal Applied Optics
Title Transverse Focuser for Optical Acceleration.
Date
Journal Applied Optics
Excerpt

We describe a novel design of an inverse ?erenkov accelerator for preinjected relativistic electrons. It utilizes synchronous linearly polarized input pulses focused by relatively small opposing sections of a conical mirror. The focal volume remains centered on the acceleration path throughout its entire length. Several advantages over existing designs are described, including, for any given wavelength, much larger acceleration areas that allow for much simpler preoptics and electron injection geometries and eventual self-compensation of nonlinear optical effects and compensation of ?erenkov material dispersion.

Title Rayleigh Range and the M(2) Factor for Bessel-gauss Beams.
Date
Journal Applied Optics
Excerpt

The M(2) factor of Bessel-Gauss beams derived by Borghi and Santarsiero [Opt. Lett. 22, 262-264 (1997)] is shown to predict the e(-2) axial position rather than the half-intensity position of the on-axis intensity as the Rayleigh range divided byM(2) for large values of k(t)w(0). For small values of k(t)w(0), the half-intensity axial position of the J(0) Bessel-Gauss beam is the Rayleigh range divided by M(2). Also, the ratio of the half-intensity lengths of J(0) Bessel-Gauss and comparable Gaussian beams having the same radial size of their central regions is shown to be M(2)/1.3. For equal input powers and largek(t)w(0), the values of peak intensity times effective range for J(0)Bessel-Gauss beams is a constant and is a factor of 1.3 larger than the corresponding product for the comparable simple Gaussianbeam.

Title Doppler Guided Haemorrhoidal Arterial Ligation with Recto-anal-repair (rar)for the Treatment of Advanced Haemorrhoidal Disease.
Date
Journal Colorectal Disease : the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Excerpt

Abstract AIM: A modification of haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given. METHOD: Thirty patients underwent DGHAL combined with RAR. Each had rectal examination, anorectal manometry and Quality of Life assessment before and three months after the procedure. RESULTS: Twenty-nine patients were included in the final analysis. There were three (10,34%) cases of intraoperative and one (3,45%) of postoperative bleeding. Three months after RAR (17.24%) cases with minor residual mucosal prolapse were detected, and three (10,34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at three months after RAR were significantly lower than before the procedure (p<0,05). One (3,45%) patient reported occasional soiling three months after RAR. CONCLUSION: RAR is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease.

Title Nonlinear Reflection Properties of Germanium Associated with Thermal Effects.
Date
Journal Applied Optics
Excerpt

Thermal excitations on a germanium surface under simultaneous irradiation by two monochromatic optical beams, one strong and one weak, are predicted as functions of the angular separation and frequency difference between the beams, their relative polarization, their intensities, and pulse durations. Nonlinear optical reflection for Q-switched ruby laser pulses is then described. Weak reflected and diffracted beam intensities show tendencies in which the former is preferentially enhanced for a downshifted weak beam frequency, while the latter depends only on the shift magnitude. Both are suppressed for large shifts or large angular separations between input beams.

Title Focusing and Magnification in Gaussian Beams.
Date
Journal Applied Optics
Title Fuel Oxidation at the Walk-to-run-transition in Humans.
Date
Journal Metabolism: Clinical and Experimental
Excerpt

Multiple factors (including anthropometric, kinetic, mechanical, kinematic, perceptual, and energetic factors) are likely to play a role in the walk-to-run transition in humans. The primary purpose of the present study was to consider an additional factor, the metabolic fuel source. Indirect calorimetry was used to measure fuel oxidation, and perception of effort was recorded as 10 overnight-fasted adults locomoted on a level treadmill at speeds progressing from 1.56 to 2.46 m s(-1) in increments of 0.11 m s(-1) and 10.0 minutes under 3 conditions: (1) unconstrained choice of gait, (2) walking at all speeds, and (3) running at all speeds. The preferred transition speed was 2.08 +/- 0.03 m s(-1). Gait transition from walking to running increased oxygen consumption rate, decreased the perception of effort, and decreased the rate of carbohydrate oxidation. We propose that, in an evolutionary context, gait transition, guided by the perception of effort, can be viewed as a carbohydrate-sparing strategy.

Title Apodization of Diffractionless Beams.
Date
Journal Applied Optics
Title High-efficiency Diffractionless Beams of Constant Size and Intensity.
Date
Journal Applied Optics
Excerpt

Design considerations are presented for pairs of spherically aberrating elements that produce diffractionless beams of high efficiency and nearly constant size and intensity over specified ranges of axial position. An approximate design, assuming an aberration quadratic in radial ray positions, is followed by a final lens (mirror) specification that is verified through meridional ray tracing. This then provides an accurate determination of beam characteristics. Examples are presented that represent a variety of applications. As a design aid, a simple prescription is given for generating families of substantially different Bessel-like beams from any given pair of elements under small changes in element separation. Pattern sizes and ranges are compared with those of Gaussian beams, shadow lengths are examined for Bessel-type beams, and beam efficiencies are fully analyzed.


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