Thesis (M. Tech.) -- Central University of Technology, Free State, 2008 / Motivated by the challenges associated with demonstrating the cervicothoracic junction, a study was conducted at Pelonomi Regional Hospital from May 2006 to June 2007. In this study, two projections of the cervicothoracic junction were done, with the only difference between them being the orientation of the arms. One projection was done using the swimmer’s projection and the other using an adaptation of the swimmer’s projection where the orientation of the arms was reversed. The sample, consisting of 45 patients, was referred from the emergency department and wards. Most of the patients (95.5%) were examined using a computed radiography system providing digital images that were printed using a laser film printer. Other patients were examined using conventional film/screen systems. The objectives of this study were to compare the two imaging techniques with reference to diagnostic quality of the projections, diagnosis of pathology and repeat rate. Radiographers obtained the two projections of the cervical spine; the researcher collected the images and distributed these to three participating radiologists on a rotational basis. The radiologists evaluated the films using a set of criteria; a biostatistician analysed the results of these evaluations. In all the criteria of image quality the swimmer’s projection showed better results. There were also, however, instances where the adapted swimmer’s had better results. The differences in percentages were not significant enough to show any statistical difference between the resultant images of the two techniques. No valid deduction could be made in relation to the demonstration of pathology due to variable instances of pathology evaluated by the radiologists. The repeat rate of the adapted swimmer’s projection compared well with the swimmer’s projection. Though the swimmer’s projection had better results for most of the criteria used in this study, no unequivocal, statistically significant evidence of it demonstrating C7-T1 better could be found. What was evident was the validity of the adapted swimmer’s projection as an alternative under certain conditions. Knowing that there is an alternative method to visualising the C7- T1 junction could be beneficial not only to radiography, but also to our patients. In cases where the swimmer’s projection is not possible due to extremity injuries, an alternative arm orientation can be useful. The alternative can also address the problem regarding multiple repeats of the swimmer’s projection.

Thesis (M.Tech.: Chiropractic)-Dept. of Chiropractic, Durban University of Technology, 2007 xi, 38 leaves, Annexures 1-2 / Background: Various congenital spinal anomalies are common findings in the general population. Their clinical significance is controversial with no definitive association been made between any specific congenital spinal anomaly to any clinical features. Project Design: This research study was designed in the form of a quantitative, non-experimental, empirical clinical survey. Method: Data was obtained from thoracic and lumbar spine radiographs contained in the Chiropractic Day Clinic at the Durban University of Technology from 1 January 1997 to 31 December 2005 and from the corresponding patient files. Through the research procedure, 519 thoracic and lumbar spine radiographs were located in the confines of the Chiropractic Day Clinic. Due to the exclusion criteria of a past or present history of trauma to the thoracic or lumbar spine areas, 147 radiographs were excluded. Objectives 1.To determine the period prevalence (1 January 1997 – 31 December 2005) of congenital thoracic and lumbar spine anomalies. 2.To determine if there is any association between the presenting clinical features and the congenital thoracic and lumbar spine anomalies in general. 3.To determine if there is any association between the presenting clinical features and individual congenital thoracic and lumbar spine anomalies. 4.To compare subjects presenting clinical features with reported clinical features from literature.

A 53 year-old male presented with a one-day history of a swollen arm and dull, aching pain in the right upper extremity. The patient reported commencing exercising daily over the prior week with a modified, oscillating dumbbell; commonly referred to as a Shake Weight. Imaging revealed an occlusive thrombus in the right axillary, proximal brachial and basilic veins. The patient was treated with a 24-hour tPA infusion followed by mechanical thrombectomy, balloon angioplasty, and stent placement for a residual thrombus and stenosis. The patient was discharged the following day on warfarin and aspirin. This is the first report of effort-induced thrombosis of the upper extremity following the use of a modified, oscillating dumbbell. Due to the growing popularity of modified dumbbells and the possible risk for axillary vein thrombosis, consideration should be made to caution consumers of this potential complication.

<p><i>Chlamydophila pneumoniae</i> (<i>C. pneumoniae</i>) has been suggested as a stimulator of chronic inflammation in atherosclerosis. <i>C. pneumoniae</i> DNA was demonstrated in aortic biopsies in 50% of patients with stable angina pectoris or acute coronary syndrome undergoing coronary artery bypass grafting. <i>C. pneumoniae</i> mRNA, a marker of replicating bacteria, was demonstrated in 18% of the aortic biopsies. </p><p>Inflammation may have a role in the pathogenesis of thoracic aortic aneurysm, aortic dissection and aortic valve stenosis. <i>C. pneumoniae </i>DNA was demonstrated in aortic biopsies in 26% of thoracic aortic aneurysm patients and in 11% of aortic dissection patients undergoing thoracic surgery and in 22% of stenotic aortic heart valves from patients undergoing aortic valve replacement. No bacterial mRNA was demonstrated in these aortic biopsies, nor in the valves, suggesting that the infection has passed into a persistent state. <i>C. pneumoniae</i> DNA was demonstrated in peripheral blood mononuclear cells in only 5% of aortic valve stenosis patients and not in thoracic aortic aneurysm or aortic dissection patients, suggesting that the bacterium disseminated to the cardiovascular tissue long before the patient required surgery. The copper/zinc ratio in serum, a marker of infection/inflammation, was significantly elevated in thoracic aortic aneurysm patients, supporting an inflammatory pathogenesis. Patients positive for <i>C. pneumoniae</i> in the aortic valve had more advanced coronary atherosclerosis, further supporting a possible role for <i>C. pneumoniae</i> in atherosclerosis. </p><p>Mice were infected with <i>C. pneumoniae</i> that disseminated to all organs investigated (i.e. lungs, heart, aorta, liver and spleen). Trace element concentrations were altered in infected animals with an increased copper/zinc ratio in serum, a progressively increased iron concentration in the liver and a progressively decreased iron concentration in serum. Iron is important for <i>C. pneumoniae</i> metabolism, and a changed iron homeostasis was noted in infected mice by alterations in iron-regulating proteins, such as DMT1 and hepcidin.</p>

Background: Insufficient exposure assessment is a suggested contributing factor to the current lack of clearly characterised relationships between occupational biomechanical risk factors and musculoskeletal disorders. Minimal attention has been paid to the potential bias of measurement tools from expected true values (i.e. accuracy) or between measurement tools, and empirical data on the magnitudes of variance contributed by methodological factors for measurement tool precision are lacking. Aim: The aim of this thesis was to quantify aspects of bias and precision in three commonly employed biomechanical risk factor assessment tools - inclinometry, observation, and electromyography (EMG) - and provide recommendations guiding their use. Methods: Upper arm elevation angles (UAEAs) were assessed using inclinometers (INC) and by computer-based posture-matching observation, and bias relative to true angles was calculated. Calibration models were developed for INC data, and their efficacy in correcting measurement bias was evaluated. The total variance of trapezius and erector spinae (ES) EMG recordings during cyclic occupational work was partitioned into biological and methodological sources, including the variance uniquely attributable to sub-maximal normalisation. Using algorithms to estimate the precision of a group mean, the efficacy of different trapezius EMG study designs was evaluated. Using precision criteria, the efficacy of different normalisation methods was assessed for ES EMG recordings. Results and Discussion: Inclinometer measured UAEAs were biased from true angles, with increasing bias at higher angles. In contrast, computer based posture-matching observations were not biased from true angles.  Calibration models proved effective at minimizing INC data bias. The dispersion of estimates between- and within- observers at any given set angle underlined the importance of repeated observations when estimating UAEAs.  For EMG, a unique but relatively small component of the total variance was attributable to the methodological process of normalisation. Performing three repeats of the trapezius EMG normalisation task proved optimal at minimizing variance for one-day EMG studies, while two repeats sufficed for multi-day EMG studies. A prone normalisation task proved superior for maximizing normalised lumbar ES EMG precision. Conclusion: Key aspects of measurement tool accuracy, bias between tools, and tool precision were quantified, and recommendations were made to guide future research study design.

Background: Thoracic aortic aneurysms and dissections (TAAD) have a genetic component with an estimated 20-25% of the patients having a positive family history. An aneurysm often precedes a dissection. Acute aortic dissections are associated with high mortality and morbidity, even when operated on. Complications due to prophylactic surgery are considerably fewer. Therefore, patients at risk for dissection should be identified, followed-up and evaluated for prophylactic intervention. Aims: 1. To establish reference values for ascending (AoA) and descending aortic (AoD) diameters measured by computed tomography. 2. To study the effectiveness of phenotypic cascade screening in families with an inherited form of thoracic aortic aneurysms and dissections (FTAAD) and to address questions that arise when screening for a genetic disorder is applied. 3. To study the agreement of aortic diameters obtained by TTE and MRI and to study aortic stiffness in individuals from families with FTAAD. 4. To perform exome sequencing in order to identify pathogenic sequence variants causing FTAAD, to characterize the phenotype, and to compare thoracic aortic diameter and stiffness in mutation carriers and non-carriers. Results: Paper I: The diameter of the thoracic aorta increased by 0.17 mm (0.12 – 0.20 mm) per year. The mean sex-related difference in diameter was 1.99 mm (1.28 – 2.60 mm) with men having larger aortas than women. The mean difference in aortic diameter per unit BMI was 0.27 mm (0.14 – 0.44 mm). Upper normal limits for the AoA can be calculated by the formula D (mm)=31+0.16*age and for the AoD by D (mm)=21+0.16*age. Paper II: Of 106 individuals from families with FTAAD but without known thoracic aortic disease, 19 individuals (18%) were identified to have a dilated AoA. The expected number of individuals in this group with an autosomal dominant disease would have been 40 (p&lt;0.0001). In first-degree relatives younger than 40, we found only one individual with a dilated aorta although the expected number of individuals with disease causing mutation would have been 10. Paper III: Of 116 individuals investigated, 21 were identified with thoracic aortic dilatation and 95 individuals with normal thoracic aortic diameter. Aortic stiffness increased with age and diameter. The individuals with aortic dilatation were older than those without (49 vs. 37 years, p=0.001) and showed lower aortic elastic properties. The diameters measured by TTE and MRI correlated strongly (r2=0.93). The mean difference in diameters between the two methods was 0.72 mm (95% CI 0.41-1.02) with TTE giving larger diameters than MRI. Paper IV: From exome sequencing and segregation analysis, a 2-bp deletion in the MYLK gene (c.3272_3273del) was identified to cause FTAAD. The age and the aortic diameter at dissection or rupture varied in the family members. We did not find any differences in aortic diameter, aortic stiffness, or pulse wave velocity between carriers and non-carriers. Conclusions: Thoracic aortic diameter increases with age, and sex and body size are also associated with the diameter. In FTAAD, screening identifies family members with a previously unknown aortic dilatation. However, a normal aortic diameter does not exclude an individual from being a carrier of FTAAD. TTE can be used in follow-up for the ascending aorta. Individuals identified to have a dilated thoracic aorta have increased aortic stiffness compared to individuals with normal thoracic aortic diameter. The MYLK mutation (c.3272_3273del) causes thoracic aortic dissections with variable clinical expression. No differences in aortic stiffness were identified between MYLK mutation carriers and non-carriers.

A novel technique for saphenous vein (SV) graft harvesting, the No-touch technique (NT), has been developed at the Dept. of Cardiovascular surgery, Örebro University hospital. With NT the SV is harvested with a pedicle of surrounding tissue. This avoids graft spasm and eliminates the need for distension. The surrounding tissue acts as a structural support and is a rich source of vaso-dilating agents. A randomized controlled trial (RCT) has shown a significantly higher patency rate for NT SV grafts compared to SV grafts harvested with conventional technique (CT). This thesis evaluates some of the properties of the surrounding tissue and compares patency rates between NT SV and radial artery (RA) grafts and patency rates for internal thoracic artery (ITA) grafts harvested with and without surrounding tissue. Paper I investigated vasa vasorum (VV) in SV grafts and showed that the NT preserves an intact VV whereas CT does not. This could be one of the mechanisms underlying the improved patency for NT SV grafts. Paper II evaluated VV and associated nitric oxide (NO) in SV and arterial grafts. SV grafts showed a higher number and larger VV, which correlated with NO production, compared to arterial grafts. NT SV grafts showed higher activity for e-NOS compared to CT SV grafts. Paper III is a RCT comparing patency rates between NT SV and RA grafts, three years after surgery, showing a significantly higher patency rate for NT SV grafts. Paper IV is a RCT comparing patency rates for ITA graft harvested with and without surrounding tissue and did not show any difference between graft preparations. In conclusion, the NT for SV graft harvesting preserves an intact vasa vasorum and associated NO production. NT SV grafts show a higher patency rate than RA grafts. Harvesting of ITA with or without surrounding tissue does not affect patency rate.

Dissertation submitted in partial compliance with the requirements for the Master's Degree in Technology: Chiropractic, Durban University of Technology, 2007. / Background: Various congenital spinal anomalies are common findings in the general population. Their clinical significance is controversial with no definitive association been made between any specific congenital spinal anomaly to any clinical features. Project Design: This research study was designed in the form of a quantitative, non-experimental, empirical clinical survey. Method: Data was obtained from thoracic and lumbar spine radiographs contained in the Chiropractic Day Clinic at the Durban University of Technology from 1 January 1997 to 31 December 2005 and from the corresponding patient files. Through the research procedure, 519 thoracic and lumbar spine radiographs were located in the confines of the Chiropractic Day Clinic. Due to the exclusion criteria of a past or present history of trauma to the thoracic or lumbar spine areas, 147 radiographs were excluded. Objectives 1.To determine the period prevalence (1 January 1997 – 31 December 2005) of congenital thoracic and lumbar spine anomalies. 2.To determine if there is any association between the presenting clinical features and the congenital thoracic and lumbar spine anomalies in general. 3.To determine if there is any association between the presenting clinical features and individual congenital thoracic and lumbar spine anomalies. 4.To compare subjects presenting clinical features with reported clinical features from literature. / M

Purpose: This study evaluated the effect of lung volume at the catch position to force and power outputs during single maximal effort strokes in rowing. Responses were compared when the participants were ‘fresh’ and following specific inspiratory muscle fatigue (IMF). In addition, a single subject pilot study was performed to characterise the changes in intra-thoracic (ITP), intra-abdominal (IAP) and trans-diaphragmatic (Pdi) pressures during a 30 second maximal effort piece on a rowing ergometer. Methods: Nine male rowers of international standard participated in the research. Static force, as well as the power produced during a single stroke were assessed at residual volume (RV), 25%TLC, 50%TLC, 75%TLC, total lung capacity (TLC), and a self-selected lung volume (S-S). Lung volumes were derived from maximal flow-volume loops (MFVLs) and achieved using online real-time feedback. Inspiratory muscle fatigue (IMF) was induced by breathing against an inspiratory load equivalent to 80% baseline maximal inspiratory pressure (MIP), at a breathing frequency (fB) of 15 breaths per minute, and a duty cycle of 0.6. Expiration was unimpeded. The single subject pilot study was undertaken using balloon catheters to measure ITP, IAP, and Pdi during a 30 second maximal effort free-rating piece on the ergometer. Results: There was no significant effect of lung volume upon either force or power production. The RMF protocol induced a significant reduction in MIP (159.9 ± 70.8 vs. 106.8 ± 58.7 cmH2O; p = 0.000), but not maximal expiratory pressure (MEP; 159.9 ± 79.2 vs. 166.6 ± 53.0 cmH2O; p = 0.376). RMF induced a significant reduction in force output with increasing lung volume, across all lung volumes (mean force 1313.4 ± 31.9 vs. 1209.6 ± 45.0N; p < 0.008), but not power (mean power 598.6 ± 31.9 vs. 592.7 ± 45.0W; p > 0.05). Self-selected lung volumes were consistent across all tests for force and power (mean 38.1 ± 6.9% [Force] vs. 28.2 ± 0.6% [Power]; p > 0.017). The pilot study indicated that internal pressures fluctuate markedly during maximal effort rowing (pressure, [max, min, average] cmH2O; IAP [144.69, 7.46, 73.59], ITP [75, -22.65, 15.34], Pdi [111.84, 7.09, 58.83]), suggesting that the trunk muscles play an active role in power production during rowing. Conclusion: The present study suggests that there is no significant effect of lung volume on force or power when athletes are in a fresh condition. However, a decrement in force production is present with inspiratory muscle fatigue. Combined with evidence of high internal pressures during maximal effort rowing, these data may indicate a role for the inspiratory muscles in force production during rowing.

Bronchial asthma incidence constitutes a compelling health and socioeconomical problem. Patients of all ages suffer from asthma, and no methods of effective prevention or healing are currently available. Poorly controlled asthma causes increase of financial expenditure as well as remarkable restriction of activities of daily living; it might even lead to death. In Czech republic, the number of patients with asthma is estimated at 500 000. The aim of this study is to evaluate effects of yoga exercise as a potential effective adjunct treatment on bronchial asthma state in adults. Theoretic part of the thesis describes pathological changes present in respiratory system, breathing pattern disorders and postural functions characteristic for patients suffering asthma disease. It also represents a brief summary of up to date findings of possible mechanisms on which are Spiral yoga and pranayama based, especially on these which can have an influence on obstructive lung disorders. Experimental part deals with the methodology and it reveals the process of making randomized clinical pilot study. Between 11 adult participants were investigated at the start and at the end of a three-month- long therapy. Investigation included pulmonary function tests, thoracic perimeter measurement, spine mobility...