Relation of free silicone to human breast carcinoma

Of 12 women with carcinoma of the breast and coexistent silicone mastopathy, nine had had injections of liquid silicone for breast augmentation; three had leaking silicone-gel prostheses. The clinical findings indicated that early diagnosis was obscured by the silicone-induced mastopathy, which rendered the interpretation of physical findings and mammograms difficult. The pathologic findings were suggestive of a possible adverse effect of the presence of free silicone within the breast tissue, axillary nodes, and axillary fat. Although no causal relationship between silicone and breast carcinoma is implied, a heightened awareness of the possible coexistence of silicone mastopathy and breast carcinoma is necessary.

The prevalence of peripheral arterial disease in a defined population

Because patients with peripheral arterial disease (PAD) may be asymptomatic or may present with atypical symptoms or findings, the true population prevalence of PAD is essentially unknown. We used four highly reliable, sophisticated noninvasive tests (segmental blood pressure, flow velocity by Doppler ultrasound, postocclusive reactive hyperemia, and pulse reappearance half-time) to assess the prevalence of large-vessel PAD and small-vessel PAD in an older (average age 66 years) defined population of 613 men and women. A total of 11.7% of the population had large-vessel PAD on noninvasive testing, and nearly half of those with large-vessel PAD also had small-vessel PAD (5.2%). An additional 16.0% of the population had isolated small-vessel PAD. Large-vessel PAD increased dramatically with age and was slightly more common in men and in subjects with hyperlipidemia. Isolated small-vessel PAD, by contrast, was essentially unrelated to sex, hyperlipidemia, or age, although it was somewhat less common before age 60. Intermittent claudication rates in this population were 2.2% in men and 1.7% in women, and abnormalities in femoral or posterior tibial pulse were present in 20.3% of men and 22.1% of women compared with the noninvasively assessed large-vessel PAD rate of 11.7%. Thus assessment of large-vessel PAD prevalence by intermittent claudication dramatically underestimated the true large-vessel PAD prevalence and assessment by peripheral pulse examination dramatically overestimated the true prevalence.

Temperature-induced changes in neuromuscular function: central and peripheral mechanisms

Three series of experimental tests were conducted on subjects under both elevated and depressed thermal conditions. Tripartite series consisted of whole-body immersion excepting the head, whole-body immersion excepting the head and response limb, and immersion of the discrete-response limb. Measures of physiological and behavioural responses were made at sequential .4 degrees C changes during whole-body immersions and approximately 5 degrees C changes of water temperature during the immersion of a limb only. Results suggested that velocity of nerve conduction decreased with thermal depression. Premotor, motor, simple, and choice reaction times varied differentially as a function of the hot and cold conditions. Implications of these differential effects on neuromuscular function are examined with respect to person-machine performance in artificially induced or naturally occurring extremes of ambient temperature.

Microscopic rhinoscopy in the treatment of inverted papillomas

Inverted papillomas are endophytic lesions arising from tissues in the nose and paranasal sinuses noted for their local destruction, propensity to recur, and tendency for malignant transformation. It has been well documented that complete removal is essential in the prevention of recurrence; however, use of the operating microscope to ensure this has not been widely described in the past. We present 4 patients, ages 36 to 56, for whom the operating microscope was used intra-operatively and for follow-up examinations. The patients have been followed for 1 to 5 years without any evidence of recurrence to date. We submit that the operating microscope is an extremely valuable tool for the surgical treatment of this lesion in light of the absolute necessity for its complete removal.

Spontaneous rupture of the esophagus presenting with unilateral proptosis

An unusual case of spontaneous rupture of the esophagus (Boerhaave syndrome) presented initially with only unilateral proptosis secondary to orbital emphysema, without significant chest or abdominal symptoms. The classical signs of chest pain and cardiovascular collapse were absent. The diagnosis was suggested by the presence of mediastinal emphysema on chest roentgenogram. Boerhaave syndrome was seen after a barium swallow, and the patient was taken immediately to surgery and he survived without further complications. The presence of subcutaneous or mediastinal emphysema with or without other classical signs or symptoms should prompt an aggressive search for its origin. Because a decrease in mortality and morbidity occurs with early detection of this syndrome, a brief review of common and uncommon symptoms is presented.

Risk spreading as an adaptive strategy in iteroparous life histories

It has long been conjectured, though without satisfactory proof, that life tables with a long reproductive span are advantageous in an environment where fecundity or immature survival rates fluctuate randomly. In the present analysis we recast the nonlinear Leslie matrix problem as an autoregressive time series model for the birth rate, with random addition and removal of newborn. This transformation renders the model linear with respect to the environmental variation, allowing ready solution for the ultimate population size and for the conditions resulting in stationarity of the population distribution. We show that for life tables where the fecundities of all adult age classes are the same (no restrictions are put on the survivorship schedule, or on the age at first reproduction), and where density dependence operates via total adult density, the realized growth rate is less than the growth rate calculated from the mean Leslie matrix associated with the population's growth history. The degree of the discrepancy increases with the environmental variability, and decreases with iteroparity, thus completing a proof which confirms the correctness of the initial conjecture for a class of biologically reasonable life-table models.

Attention and regulation of EEG alpha-attenuation responses

Two experiments with 16 normal adults of both sexes tested the hypothesis that inattention to a biofeedback display is associated with increased variability of those physiological processes that had been regulated by the biofeedback. Each experiment was a repeated-measures-on-independent-subjects-design. Dependent variables were the time durations and the mean rms power of two mutually exclusive segments of the parietal-occipital EEG: alpha and not-alpha segments. Independent variables were combination of counting tasks and instructions to look at, listen to, and count visual and auditory flashes and clicks. The durations of alpha and not-alpha segments were controlled or regulated by means of an alpha-contingent visual feedback stimulus, Attention to the feedback stimulus was challenged by instructions to count other, noncontingent stimuli. Control of alpha and not-alpha segments was least for conditions of (1) "sham" feedback, and (2) feedback with instructions to count noncontingent auditory clicks, which were presented 3/sec while the feedback visual stimuli were occurring. A new EEG test of attention and distraction was suggested.

On the space-time structure of human interlimb co-ordination

In three experiments we show, using behavioural measures of movement outcome, as well as movement trajectory information and resultant kinematic profiles, that there is a strong tendency for the limbs to be co-ordinated as a unitary structure even under conditions where the movements are of disparate difficulty. Environmental constraints (an obstacle placed in the path of one limb, but not in the other) are shown to modulate the space-time behaviour of both limbs (Experiment II). Our results obtain for symmetrical (Experiment I) as well as asymmetrical movements that involve non-homologous muscle groups (Experiment III). These findings suggest that in multi-joint limb movements, the many degrees of freedom are organised to function temporarily as a single coherent unit that is uniquely specific to the task demands placed on it. For movements in general, and two-handed movements in particular, such units are revealed in a partitioning of the relevant force demands for each component (a force scaling characteristic) and a preservation of the internal “topology” of the action, as indexed by the relative timing among components. These features, as well as systematic deviations from perfect synchrony between the limbs can be rationalised by a model that assumes the limbs behave qualitatively like non-linear oscillators.

Exploring the functional significance of physiological tremor: a biospectroscopic approach

The functional significance of physiological tremor - the high frequency (8-12 Hz), low amplitude oscillation that occurs during the maintenance of steady limb postures - is not known. Often tremor, perhaps because of its pathological manifestations, is considered a source of unwanted noise in the system, something to be damped out or controlled. An examination of the phase relationship between tremor and rapid voluntary finger movement in normal subjects suggests a very different view. In four experiments in which tremor displacement and accompanying electromyographic activity were simultaneously monitored, we show a clear and systematic relationship between tremor and movement initiation. Empirically obtained frequency distributions of tremor peak-to-movement initiation time were most closely aligned to a probability density function (derived via numerical integration techniques) that assumed movements were initiated when the muscle-joint system possessed peak momentum. This relationship - evaluated by Chi-square goodness-of-fit tests - was evident regardless of whether the movements were self-paced (Experiments 1 and 2) or in response to an auditory reaction time signal (Experiments 3 and 4). The addition of a load to the finger in Experiments 2 and 4, though tending to reduce tremor frequency, did not prove disruptive, nor did a fractionated reaction time analysis reveal any significant inertial contribution to the maintenance of the phase relationship. These data are consistent with an emerging view that the motor control system is sensitive to its own dynamics, and suggest that under certain conditions normal physiological tremor is a potentially exploitable oscillation intrinsic to the motor system.

Reduction of variability of EEG occipital, parietal, and central alpha rhythms by visual feedback stimulation

Two experiments, each with 24 normal right-handed adults, examined variability of the response of EEG alpha rhythms during repeated visual stimulations that were contingent on the occurrence of those rhythms. Within-trial variability of alpha durations and no-alpha (alpha blocking) durations were recorded from bipolar derivations along two bilateral posterior-anterior lines. Variability was significantly lower for: (1) the contingent EEG connected to the stimulus compared to the contralateral EEG, which was recorded simultaneously but was not connected to the stimulus; (2) occipitoparietal EEGs compared to parietocentral EEGs; (3) alpha durations compared to no-alpha durations. Differences in variability among the four EEG locations on the left or the right side were significant for contingent EEGs but not for contralateral nonconnected EEGs. The results were interpreted to be a demonstration that feedback EEG method can be applied to research on the functional topography of an EEG response to sensory stimuli in terms of the reduction of variability of the response that can be achieved with feedback.

Carcinoid tumor of the thymus associated with a parathyroid adenoma

A parathyroid adenoma occurred synchronously with a thymic carcinoid tumor in a 34-year-old man. A sibling was known to have an insulinoma, pituitary adenoma, and parathyroid hyperplasia. The simultaneous occurrence of these tumors, in association with the noted family history, suggests a possible multiple endocrine adenomatosis variant. A description of both tumors is provided along with a review of the literature on thymic carcinoid tumors.

Are movements prepared in parts? Not under compatible (naturalized) conditions

This set of experiments is concerned with the specification of movement parameters hypothesized to be involved in the initiation of movement. Experiment 1 incorporated the precuing method developed by Rosenbaum in which a precue provided partial information of the upcoming movement before the stimulus to move. Under conditions in which precues were provided by letter symbols and stimuli were color-coded dots mapped to response keys. Rosenbaum found reaction times to be slower for the specification of arm than for direction, and both to be slower than the specification of extent. In Experiment 1, using precue and stimulus conditions that paralleled those employed by Rosenbaum, we obtained very similar findings. The three follow-up experiments extended these findings to more naturalized stimulus-response compatible conditions. We used a method in which precues and stimuli were directly specified through vision and mapped in a one-to-one manner with responses. In Experiment 2, although reacion times decreased as a function of the number of parameters precued, there were no systematic effects of precuing particular parameters. In Experiments 3 and 4, we incorported an ambiguous precue that, while serving to reduce task uncertainty, failed to provide any specific information as to the arm, direction, or extent of the upcoming movement. Initiation times did not systematically vary as a function of the type of parameter precued nor were there significant differences between specific and ambiguous precue conditions. In sum, only in Experiment 1 in which precues and stimuli involved complex cognitive transformations was there support for Rosenbaum's parameter specification model. When we employed highly compatible conditions, designed to reflect a real-world environment, we failed to obtain any tendency for movement parameters to be serially specified. We discuss grounds for suspecting the generality of parameter specification models and propose an alternative approach that is consonant with the dynamic characteristics of the motor control system.

Are movements prepared in parts? Not under compatible (naturalized) conditions

This set of experiments is concerned with the specification of movement parameters hypothesized to be involved in the initiation of movement. Experiment 1 incorporated the precuing method developed by Rosenbaum in which a precue provided partial information of the upcoming movement before the stimulus to move. Under conditions in which precues were provided by letter symbols and stimuli were color-coded dots mapped to response keys. Rosenbaum found reaction times to be slower for the specification of arm than for direction, and both to be slower than the specification of extent. In Experiment 1, using precue and stimulus conditions that paralleled those employed by Rosenbaum, we obtained very similar findings. The three follow-up experiments extended these findings to more naturalized stimulus-response compatible conditions. We used a method in which precues and stimuli were directly specified through vision and mapped in a one-to-one manner with responses. In Experiment 2, although reacion times decreased as a function of the number of parameters precued, there were no systematic effects of precuing particular parameters. In Experiments 3 and 4, we incorported an ambiguous precue that, while serving to reduce task uncertainty, failed to provide any specific information as to the arm, direction, or extent of the upcoming movement. Initiation times did not systematically vary as a function of the type of parameter precued nor were there significant differences between specific and ambiguous precue conditions. In sum, only in Experiment 1 in which precues and stimuli involved complex cognitive transformations was there support for Rosenbaum's parameter specification model. When we employed highly compatible conditions, designed to reflect a real-world environment, we failed to obtain any tendency for movement parameters to be serially specified. We discuss grounds for suspecting the generality of parameter specification models and propose an alternative approach that is consonant with the dynamic characteristics of the motor control system.

On the coordination of two-handed movements

In a set of three experiments, we show that after an auditory "go" signal, subjects simultaneously initiate and terminate two-handed movements to targets of widely disparate difficulty. This is the case when the movements required are (a) lateral and away from the midline of the body (Experiment 1), (b) toward the midline of the body (Experiment 2), and (c) in the forward direction away from the body midline (Experiment 3). Kinematic data obtained from high-speed cinematography (200 frames/sec) point to a tight coordinative coupling between the two hands. Although the hands move at entirely different speeds to different points in space, times to peak velocity and acceleration are almost perfectly synchronous. We believe that the brain produces simultaneity of action as the optimal solution for the two-handed task by organizing functional groupings of muscles (coordinative structures) that are constrained to act as a single unit.

Movement coding and memory in retarded children

Three experiments on the coding and retention of movement-generated information were performed on two groups of mildly retarded children varying in MA. The cue to be reproduced in each case was the terminal position of the limb that studies with adults have shown to require central processing activity for maintained performance. In Experiment 1, although the older MA group was superior, both groups showed similar decrements in performance over a 15-second retention interval. In Experiment 2 the procedures were adopted in an attempt to overcome performance deficits. Subjects were allowed to choose (preselect) their own movements voluntarily in addition to performing constrained, experimenter-defined movements. Preselected reproduction was superior to constrained at all three retention intervals (0, 7, and 15 seconds) but was not statistically different among age groups. Also, performance was maintained for both groups over 7 seconds but deteriorated over 15 seconds. These results were replicated in Experiment 3, which also showed that an interpolated motor task designed to block rehearsal processes interfered with reproduction at the 7- and 15-second retention-interval conditions. The findings indicated that mildly retarded children could maintain motor information over brief time periods and also illustrated the important contribution of the planning component in facilitating the coding of motoric information.

On the nature of human interlimb coordination

Movement time varies as a function of amplitude and requirements for precision, according to Fitts' law, but when subjects perform two-handed movements to targets of widely disparate difficulty they do so simultaneously. The hand moving to an "easy" target moves more slowly to accommodate its "difficult" counterpart, yet both hands reach peak velocity and acceleration synchronously. This result suggests that the brain produces simultaneity of action not by controlling each limb independently, but by organizing functional groupings of muscles that are constrained to act as a single unit.

On the coordination of two-handed movements

In a set of three experiments, we show that after an auditory "go" signal, subjects simultaneously initiate and terminate two-handed movements to targets of widely disparate difficulty. This is the case when the movements required are (a) lateral and away from the midline of the body (Experiment 1), (b) toward the midline of the body (Experiment 2), and (c) in the forward direction away from the body midline (Experiment 3). Kinematic data obtained from high-speed cinematography (200 frames/sec) point to a tight coordinative coupling between the two hands. Although the hands move at entirely different speeds to different points in space, times to peak velocity and acceleration are almost perfectly synchronous. We believe that the brain produces simultaneity of action as the optimal solution for the two-handed task by organizing functional groupings of muscles (coordinative structures) that are constrained to act as a single unit.