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Transcatheter aortic valve replacement (TAVR) has become a mainstay of treatment in the management of severe aortic stenosis. It is a challenging procedure that requires expertise in obtaining proper access, delivery of catheters to and beyond the aortic valve, and finally accurate deployment of the aortic bioprosthesis. Patients with aortic anomalies portend an added challenge in performing TAVR procedures. We present the case of a patient incidentally found to have a right dominant double aortic arch who underwent successful TAVR for severe aortic stenosis.

The central nervous system (CNS) is thought to develop motor strategies that minimize various hidden criteria, such as end-point variance or effort. A large body of literature suggests that the dominant arm is specialized for such open-loop optimization-like processes whilst the non-dominant arm is specialized for closed-loop control. Building on recent results suggesting that the brain plans arm movements that takes advantage of gravity effects to minimize muscle effort, the present study tests the hypothesized superiority of the dominant arm motor system for effort minimization. Thirty participants (22.5 ± 2.1 years old; all right-handed) performed vertical arm movements between two targets (40° amplitude), in two directions (upwards and downwards) with their two arms (dominant and non-dominant). We recorded the arm kinematics and the electromyographic activity of the anterior and posterior deltoid to compare two motor signatures of the gravity-related optimization process; i.e., directional asymmetries and negative epochs on phasic muscular activity. We found that these motor signatures were still present during movements performed with the non-dominant arm, indicating that the effort-minimization process also occurs for the non-dominant motor system. However, these markers were reduced compared with movements performed with the dominant arm. This difference was especially prominent during downward movements, where the optimization of gravity effects occurs early in the movement. Assuming that the dominant arm is optimal to minimize muscle effort, as suggested by previous studies, the present results support the hypothesized superiority of the dominant arm motor system for effort-minimization.

A crucial ability for athletes playing sports that involve coincidence timing actions is the motor timing ability. The efficiency of perceptual and motor processes underlying the motor timing ability has been related to the motor experience gained in interceptive sports, such as tennis. In the present study, the motor timing ability in young tennis players (TP) and age-matched control participants (CTRL) was compared by means of a synchronization paradigm. Participants were asked to perform finger-opposition movements in synch to a metronome beating 0.5 and 2 Hz in (1) a bimanual coordination test, which compared the performance of the dominant hand with that of the contralateral hand, and (2) a movement lateralization test, which compared the motor performance of the dominant hand during single-hand and bimanual tasks (BTs). The motor performance was evaluated through movement strategy [defined by touch duration (TD), inter-tapping interval (ITI), and movement frequency] and movement accuracy (temporal accuracy defined by the synchronization error and spatial accuracy defined by the percentage of correct touches—%CORR_SEQ). Results showed that motor expertise significantly influences movement strategy in the bimanual coordination test; TD of TP was significantly higher than those of CTRL, specifically at 0.5 Hz. Furthermore, overall ITI values of TP were lower than those of CTRL. Lastly, in the movement lateralization test, the %CORR_SEQ executed with the right dominant hand by TP in the BT was significantly higher than those of CTRL. A discussion about the role of motor expertise in the timing ability and the related neurophysiological adaptations is provided.

Introduction: After chronic impairment of the right dominant hand, some individuals are able to compensate with increased performance with the intact left nondominant hand. This process may depend on the nondominant (right) hemisphere's ability to access dominant (left) hemisphere mechanisms. To predict or modulate patients' ability to compensate with the left hand, we must understand the neural mechanisms and connections that underpin this process. Methods: We studied 17 right-handed healthy adults who underwent resting-state functional connectivity (FC) magnetic resonance imaging scans before 10 days of training on a left-hand precision drawing task. We sought to identify right-hemisphere areas where FC from left-hemisphere seeds (primary motor cortex, intraparietal sulcus [IPS], inferior parietal lobule) would predict left-hand skill learning or magnitude. Results: Left-hand skill learning was predicted by convergent FC from left primary motor cortex and left IPS onto the same small region (0.31 cm(3)) in the right superior parietal lobule (SPL). Discussion: For patients who must compensate with the left hand, the right SPL may play a key role in integrating left-hemisphere mechanisms that typically control the right hand. Our study provides the first model of how interhemispheric functional connections in the human brain may support compensation after chronic injury to the right hand. IMPACT STATEMENT: This article presents the first model of how the human brain applies left-hemisphere (dominant hand [DH]) specializations to support the right hemisphere for compensatory action with the nondominant hand (NDH). Compensation with the NDH is critical for the rehabilitation after many neurological disorders that lead to irreversible impairment of the DH (e.g., stroke, amputation, nerve injury), but no effective therapies exist to promote compensation because the neural mechanisms remain unknown. Therefore, this article will open up new directions in rehabilitation neuroscience by presenting a testable model of the connections that underpin much needed (and currently nonexistent) therapies.

Introduction: Semantic dementia (SD) is characterized by fluent speech, anomia, and loss of word and object knowledge with varying degrees of right and left anterior-medial temporal lobe hypometabolism on [18F] fluorodeoxyglucose (FDG)-PET. We assessed neurobehavioral features in SD patients across 3 FDG-PET-defined metabolic patterns and investigated progression over time. Methods: Thirty-four patients with SD who completed FDG-PET were classified into a left- and right-dominant group based on the degree of hypometabolism in each temporal lobe. The left-dominant group was further subdivided depending on whether hypometabolism in the right temporal lobe was more or less than 2 standard deviations from controls (left+ group). Neurobehavioral characteristics determined using the Neuropsychiatric Inventory Questionnaire (NPI-Q) were compared across groups. Progression of NPI-Q scores and FDG-PET hypometabolism was assessed in 14 patients with longitudinal follow-up. Results: The right-dominant group performed worse on the NPI-Q and had a greater frequency of abnormal behaviors and more severe disinhibition compared to the left-dominant group. Performance on the NPI-Q and severity of disinhibition correlated with right medial and lateral, but not left, temporal lobe hypometabolism. Severity of abnormal behaviors worsened over time in most left-dominant and left+ patients but appeared to improve in the 2 right-dominant patients with longitudinal follow-up. All groups showed progressive worsening of metabolism in both temporal lobes over time, with hypometabolism spreading from anteromedial to posterior temporal regions. However, the degree of temporal lobe asymmetry remained relatively constant over time. Conclusion: In SD, neurobehavioral features, especially disinhibition, are associated with right medial and lateral temporal lobe hypometabolism and commonly develop over time even in patients that present with left-dominant patterns of hypometabolism.

A 23-month-old female child accidentally fell while inside a factory, and 2–5 fingers (Tamai IV area) of her right dominant hand were completely cut off by a high-speed cutting machine gear (Fig. 3.1a, b). The amputated fingers were refrigerated immediately after the injury.

Background: Unbalanced forms of atrioventricular septal defect continue to be challenging and present poor surgical outcomes. Echocardiographic indicators such as atrioventricular valve index, right ventricle/left ventricle inflow angle, and size of the ventricular septal defect have been identified as relevant discriminators that may guide surgical strategy. Our purpose is to describe another metric to refine surgical decision-making. Methods: We outline a geometrical description of the anatomic features of atrioventricular septal defect and describe equations that help explain the interplay between the main echocardiographic variables. Results: A new metric called “indexed ventricular septal defect” is defined as the size of the defect in relation to the valve diameter. We derive a final equation relating this index with the atrioventricular valve index and the right ventricle/left ventricle inflow angle. In the light of that equation, we discuss the interdependence of variables and employ data from a Congenital Heart Surgeons’ Society study to set the limits of the new index. Conclusion: Combined use of indexed ventricular septal defect and atrioventricular valve index might help clarify surgical decision-making in patients with mild and moderate unbalance (modified atrioventricular valve index between 0.2 and 0.39). For indexed ventricular septal defect smaller than 0.2, biventricular repair may be recommended. Between 0.2 and 0.35, this strategy could probably be achieved depending on other factors. However, other strategies should be considered for those patients showing an indexed ventricular septal defect between 0.35 and 0.5. For values above 0.5 to 0.55, univentricular palliation might be a reasonable strategy.

Unbalance in atrioventricular septal defect can be found in more than one anatomic level and in different degrees at each level. The definition of “unbalance” has historically been focused in comparing the dimensions of main cardiac structures, such as the atrioventricular valve and the ventricles. However, the hemodynamic aspects of unbalance need to be considered as having, at least, similar relevance. New concepts and already described parameters must be combined and understood as a whole to help the surgical decision-making process.

Hot sand baths are used for the treatment musculoskeletal diseases. The aim of this study was to assess beneficial effect of black sand bathing in the treatment of antenatal carpal tunnel syndrome (CTS). Study was conducted in single case with CTS of the right dominant hand. The treatment time was 20 min/day, 5 days/week for 2 weeks. CTS were evaluated using a visual analogue scale (VAS), pinch gauge dynamometer and Boston Carpal Tunnel Questionnaire (BCTQ) with electrophysiological studies at baseline and at week 2. Pain intensity (VAS) was decreased (34.2%), Tip, Key and Tripod pinch strengths were increased (14.29%), (19.23%) and (21.74%) respectively. Mean scores on the BCTQ-SSS and BCTSQ-FSS were decreased (23.69%) and (20.7%) respectively. Electrophysiological studies revealed that decreased mMDL (11.47%), increased mSNCV (9.23%) at the end of treatment. The black sand bathing is supported as a complementary therapy in antenatal CTS.

Cardiologists and cardiac surgeons may have the clinical conception that the contralateral rudimentary vessel in a left or right dominant coronary tree should not be revascularised because of its nonsignificant myocardial blood supply. We would like to highlight and argue that this conception should be challenged in subjects with ischemia driven life threatening arrhythmias caused by the anomalous course of the rudimentary artery. Hereby we would like to contribute to the appropriate clinical approach of young subjects with an acute coronary syndrome. We describe two young patients with an Acute Coronary Syndrome who appear to have an anomalous rudimentary right coronary artery. These cases may suggest that even in a left dominant coronary system an anomalous origin of the RCA can be life threatening. Surgery should be considered at the time that this symptomatic anomaly is identified.

With usually preserved communication, unlike left hemisphere aphasia–related communication impairment, right hemisphere (RH) lesions reveal a manifold of cognitive disorders. Each of these may be the key to monitoring an improvement or deterioration of the clinical status or disease pathophysiology. Furthermore, the RH is dominant for more known entities (at least measurable by us thus far) than the left hemisphere (Table 9.1).

Intracranial venous hypertension is a rare presentation of meningiomas in the transverse-sigmoid sinus region. We describe a case of a young patient presenting with intracranial hypertension due to a meningioma causing compression of the dominant sigmoid sinus. We were able to document the cerebral venous pressure gradient across the lesion confirming our hypothesis that compression of the sigmoid sinus from the meningioma was the cause of intracranial hypertension. The patient is a 17-year-old male who presented with intracranial hypertension due to meningioma at the right dominant sigmoid sinus, which was treated by a Simpson grade IV surgical resection followed by stereotactic radiosurgery. Following treatment, his papilledema resolved and he remains symptom-free at 18 months. In conclusion, venous manometry is a useful adjunct to diagnose intracranial hypertension in non-idiopathic causes of intracranial hypertension. A multimodal management approach of intracranial hypertension due to outflow obstruction from the dominant sinus led to an excellent recovery on follow up.

A 90-year-old man, with Parkinson’s disease, presented to the emergency department with a penetrating finger injury that was caught in the door-handle after a fall. He couldn’t recall the detailed mechanism of fall, but he lost his balance and fell backwards while holding the door-handlewith his right dominant hand.

Background Fulfilling the activities of daily living requires skilfulness. Knowledge of the skill level of healthy people helps therapists evaluate and treat patients. Therefore, this study was conducted to determine spatial resolution of children aged six to eleven years old by Box and Block and Nine Hole Peg test. Methods This study was a descriptive cross-sectional study of 90 healthy children aged six to eleven years old. The ability of healthy children was once measured after becoming familiar with how they performed the Box and Block test and Nine Hole Peg test. Results In this study, Children in the age range of eleven to twelve, nine to ten, and seven to eight years in the Box and Block test presented a mean ± SD of 71.23 ± 8.14, 63.21 ± 2.93, and 57.90 ± 3.78 blocks in the right dominant hand, and 67.87 ± 6.33, 64.21 ± 4.47, and 56.94 ± 4.41 blocks in the left dominant hand, respectively. Using the Nine Hole Peg test obtained a mean ± SD of 19.87 ± 1.61, 19.83 ± 2.26, and 22.84 ± 2.38 seconds in the right dominant hands and 21.83 ± 2.27, 21.38 ± 2.55, and 27.74 ± 2.36 seconds in the left dominant hand. Conclusions The study found that using the Box and Block test and the Nine Hole Peg test can distinguish between skills of healthy children with children, who have special needs at any age and, they receive interventions based on the difference in range.

Introduction This study experiments the incidence of a 2 mm thin median bar (BM®) and truncated median bar (BMt®) plantar relief in bilateral pelvic instabilities, considering the effect of the presence or not of plantar afferences inefficiency on unipedal stabilometric performance [1] . Method Eleven subjects with bilateral pelvic instability at the unipedal pelvic stability test (TSPU) [1] and with a right dominant foot were evaluated. Randomized measurements were performed in bipodal stance on force platform (Medicapteurs©, Fusyo®, France) for 31.6 sec at 40 Hz and then in unipedal stance for 5 sec at 40 Hz on each foot, eyes open and eyes closed under three conditions: – Control; – BM® – BMt®. Repeated and factorial variance analyses were then carried out. The population was divided into two groups according to their Plantar Quotient (PQ) greater or less than 100 determined by the bipodal registrations [2] . Results Seven subjects showed a QP greater than 100 and 4 subjects a QP less than 100. The BM® and BMt® stimuli enhanced the Surface of the Centre of Pressure (CoP) on the right foot with eyes closed. Taking into account the QP, subjects with a QP greater than 100 were enhanced on the surface of the CoP with BMt® only. In this condition, both median bars (BM® and BMt®) enhanced the subjects if their QP was less than 100. Conclusion This study on bilateral pelvic instabilities with thin plantar stimuli confirms their therapeutic interest in these dysfunctions of postural control and illustrates fundamental interest of two notions: – foot dominance and; – efficiency or inefficiency of plantar afferences. These results require further research that considers these intra and inter individual differences.

Purpose. This study was conducted to prove the difference of dominant hand and non dominant hand in hand functions. Methods. We study difference of dominant hand and non dominant hand in hand functions that 40 university students participated in the study and performed a correlation between Jebsen-Taylor Hand Function test, O'conner Finger Dexterity test and Purdue Pegboard test. Results. In left dominant hand are functional of small common object, simulated feeding and large light object in Jebsen-Taylor Hand Function Test.Also O’conner Finger dexterity test are functional in left dominant hand and same result in Purdue pegboard test. Conclusion. The results of this study was left dominant hand is more functional than right dominant hand. So, we suggests that both hand using are improving of hand function in right dominant hand. Key Words: Dominant hand, Jebsen-Taylor Hand Function test, O’conner Finger dexterity test, Purdue pegboard test* Corresponding Author : ptsmyung@masan.ac.kr

The present study used functional near-infrared spectroscopy (fNIRS), and investigated the differences in neural activation of ipsi- or contralateral hemispheres between right dominant and left non-dominant hands among right-handed subjects using consecutive motor tasks with muscle contraction and relaxation. The subjects performed tasks under four conditions: (1) right hand up (R-Up), (2) left hand up (L-Up), (3) right hand down (R-Down), and (4) left hand down (L-Down). The peak amplitude of oxy-Hb was significantly larger at the contralateral than ipsilateral hemisphere in the premotor area (PM) under the R-Up condition, and no significant differences were observed between contra- and ipsilateral hemispheres under the L-Up condition. In addition, the peak amplitude was more negative at the contra- than ipsilateral hemisphere in the PM under the R-Down condition, while the peak amplitude was significantly more negative at the ipsi- than contralateral hemisphere in the PM under the L-Down condition. These results suggest that the PM of the left hemisphere among right-handed subjects plays an important role in muscle contraction and relaxation with force control.

While the Fontan operation is a reliable treatment option for many complex congenital heart defects, the development of pulmonary arteriovenous malformations (PAVMs) remains a problematic outcome for some Fontan patients. Pulmonary arteriovenous malformations stem from an imbalance of hepatic blood flow in the pulmonary system. Balancing this hepatic flow has shown promising results in the treatment of PAVMs. We report the clinical course of a young patient with heterotaxy syndrome and an unbalanced right dominant atrioventricular septal defect. This patient developed PAVMs following a Fontan procedure, however, the PAVMs were resolved following the revision of the original Fontan conduit to a bifurcated conduit.

Stop-signal paradigms operationalize a basic test of goal-directed behaviour whereby an overarching stop goal that is performed intermittently must be maintained throughout ongoing performance of a reaction time go task (go goal). Previous studies of sustained brain activation during stop-signal task performance in humans did not observe activation of the dorsolateral prefrontal cortex (DLPFC) that, in concert with the parietal cortex, is known to subserve goal maintenance. Here we explored the hypothesis that a DLPFC and parietal network has a key role in supporting ongoing stop-signal task performance. We used a blocked functional magnetic resonance imaging design that included blocks of trials containing typical stop-signal paradigm stimuli that were performed under three conditions: Stop condition, which required reaction time responding to go stimuli and inhibition of cued responses upon presentation of a stop signal; Go condition, identical except that the tone was ignored; and Passive condition, which required only quiescent attention to stimuli. We found that, whereas a distributed corticothalamic network was more active in Stop compared with Go, only the right DLPFC and bilateral parietal cortex survived after masking that contrast with Stop compared with Passive. These findings indicate that sustained activation of a right dominant frontoparietal network supports stop goal processes during ongoing performance of the stop-signal task.

[EN] Background: Ablation of drivers maintaining atrial fibrillation (AF) has been demonstrated as an effective therapy. Drivers in the form of rapidly activated atrial regions can be noninvasively localized to either left or right atria (LA, RA) with body surface potential mapping (BSPM) systems. This study quantifies the accuracy of dominant frequency (DF) measurements from reduced-leads BSPM systems and assesses the minimal configuration required for ablation guidance. Methods: Nine uniformly distributed lead sets of eight to 66 electrodes were evaluated. BSPM signals were registered simultaneously with intracardiac electrocardiograms (EGMs) in 16 AF patients. DF activity was analyzed on the surface potentials for the nine leads configurations, and the noninvasive measures were compared with the EGM recordings. Results: Surface DF measurements presented similar values than panoramic invasive EGM recordings, showing the highest DF regions in corresponding locations. The noninvasive DFs measures had a high correlation with the invasive discrete recordings; they presented a deviation of 0.8 for leads configurations with 12 or more electrodes. Conclusions: Reduced-leads BSPM systems enable noninvasive discrimination between LA versus RA DFs with similar results as higher-resolution 66-leads system. Our findings demonstrate the possible incorporation of simplified BSPM systems into clinical planning procedures for AF ablation., This work was supported in part by Generalitat-Valenciana Grants [ACIF/2013/021]; Instituto de SaludCarlos III, Ministerio de Ciencia e Innovacion [PI13/00903, PI13-01882, PI14/00857, PI16/01123, TEC2013-46067-R, DTS16/0160 and IJCI-2014-22178] cofound by FEDER.; Spanish Society of Cardiology [Clinical research Grants 2015]; Ministerio de Ciencia e Innovacion [Red RICRD12.0042.0001]; and the National Heart, Lung, and Blood Institute [P01-HL039707, P01-HL087226 and R01-HL118304].

This study investigated the asymmetry of bilateral interference in a bimanual isometric force pulse task and the relation of the degree of interference with the asymmetry of the force levels and the hand dominance. One hand produced force pulses with the same peak force target, while the other hand produced different peak forces in blocked conditions with force target ratios between the hands that ranged from 1:1 to 16:1. There was asymmetric interference between the hands in that the hand performing the same peak forces showed stronger (i.e., higher bias and variable error) interference with the hand performing the different peak force than vice versa. The force-time properties also correlated more strongly when the different peak forces were generated by the left non-dominant than the right dominant hand. With increasing peak force ratios, the extent of interference became stronger and plateaued around the force ratio of 8:1 indicating a boundary condition to the asymmetric interference between hands. The results extend to bimanual isometric force control the dependence of bilateral asymmetric interference on task demands and hand dominance and provide further evidence on the degree of bilateral interference with task asymmetry.

The purpose of the present study was to investigate the trend of handgrip strength and to assess the normative values of this trait in randomly selected 747 unrelated, normal, healthy Indian males (325 right hand and 92 left hand dominant) and females (297 right hand and 33 left hand dominant) aged 6 - 25 years from different schools and Guru Nanak Dev University, Amritsar, Punjab, India. Three anthropometric measurements, viz. height, weight and BMI were carried out with standard techniques. Handgrip strength was measured using a standard adjustable digital handgrip dynamometer (Takei Scientific Instruments Co. LTD, Japan) at standing position with shoulder adducted and neutrally rotated and elbow in full extension. The findings of the present study indicated a gradual increment of both right and left handgrip strength from 6 to 23 years in males and from 6 to age 21 years in females. Statistically highly significant sex differences (p

Koley S, Singh J, Sandhu JS. Anthropometric and physiological characteristics on Indian inter-university volleyball players. J. Hum. Sport Exerc. Vol. 5, No. 3, pp. 389-399, 2010. The purpose of this study was of two-folds, firstly, to evaluate the anthropometric profile of Indian inter-university volleyball players and, secondly, to search the correlation of body mass index, % body fat, hand grip strength (right dominant) and Vo2max. with other anthropometric characteristics studied. Eleven anthropometric characteristics, four body composition parameters, two physical and two physiological variables and nine arm anthropometric characteristics were measured on randomly selected 63 inter-university Indian volleyball players (38 males and 25 females) aged 18–25 years from Guru Nanak Dev University, Amritsar, Punjab, India with adequate controls (n = 102, 52 males and 50 females). The results indicated that male volleyball players were taller (6.63%) and heavier (7.31%) and female volleyball players were slightly taller (0.31%) and lighter (3.74%) than their control counterparts. One way analysis of variance showed significant (p≤0.004-0.000) between group differences in all the variables (except hip circumference) between volleyball players and controls. In volley players, significantly positive correlations were found with BMI and other 19 variables, with percent body fat and 6 variables, with right hand grip strength and 20 variables and with Vo2max and other 19 variables, and significantly negative correlations were found with percent body fat and other 16 variables, with right hand grip strength and other 7 variables and with Vo2max with other 8 variables. The findings of the present study might be useful in future investigation on player selection, talent identification in volleyball and training program development. Key words: ANTHROPOMETRIC CHARACTERISTICS, HAND GRIP STRENGTH, VO2MAX, INDIAN INTER-UNIVERSITY VOLLEYBALL PLAYERS.

A 31 year-old professional motorcycle racer had an accident, resulting in an axial–ulnar dislocation of his right dominant wrist with derangement of the trapeziocapitate joint and dorsal dislocation of the capitate together with the triquetrum, the hamate and the corresponding metacarpals. Open reduction and wire fixation obtained excellent functional results at 1 year. This pattern of carpal derangement has not been previously described in the literature.

A 48-year-old male presented himself in my office with painful dorsal nodules on his fingers in association with a recurrent Dupuytren’s contracture of his small finger of his right dominant hand. Prior, he underwent surgery with open selective fasciectomy 4 years ago for his right small finger due to Dupuytren’s contracture. However, Dupuytren’s contracture recurred within 18 months following conventional open surgery as limited fasciectomy. He had a positive family history for Dupuytren’s contracture. Regarding knuckle pads in his family history, the patient was not quite sure about.

This study compared the degree of wrist movement available in two commercial wrist orthoses of the same design but constructed of different fabrics. Twenty participants with normal wrist movement had their right dominant wrist range of flexion and extension measured using an isokinetic dynamometer. The results showed that neither orthosis immobilised the wrist. The mean total range of movement in the neoprene orthosis (73.55°) was significantly greater (p

We describe a case of congenitally corrected transposition with a double aortic arch. This unique combination of lesions highlights the importance of a complete anatomic assessment prior to referral for surgery.

Background: Visuomotor performance can be improved by repetitive training on consecutive days. The aim of this study was to assess the training effect of visuomotor tracking in healthy subjects and hemiparetic patients with stroke and in moderately impaired patients with Parkinson’s disease. Methods: 39 healthy right-handed subjects, 15 patients after acute cerebral artery stroke, and 15 patients with mid-stage Parkinson’s disease were trained with the commercially available, multifunctional PABLOR-device. This handhold device is equipped with force and acceleration sensors and connected to a personal computer for on-line data display and data storage. On three consecutive days the subjects were trained to navigate a target through obstacles in a virtual reality environment. Performance was assessed by modulation of force production and rotation of the hand in a visuomotor tracking paradigm using the PABLOR-device. Results: The main findings were that training of the right dominant hand improved visuomotor coordination of hand rotation movements in both hands in the healthy subjects (p=0.0015). Training of the right affected hand improved visuomotor coordination of hand rotation movements in either patient group (p=0.026). In contrast, training improved the visuomotor coordination of force tracking of the dominant hand only in the healthy subjects (p

Background . In right-dominant unbalanced atrioventricular (AV) canal, there are no criteria to judge adequacy of the left ventricle for biventricular repair. The purpose of this study was to test the hypothesis that right ventricular volume overload in this condition results in right-to-left septal bowing and contributes to the appearance of a small left ventricle. Methods . Five consecutive neonates and young infants (age range, 23 days to 5 months; median age, 3 months) with right-dominant unbalanced complete AV canal underwent biventricular repair. Preoperative and postoperative echocardiographic measurements of left (LV) and right ventricular size and AV valve component size were made. Potential LV volume was assessed preoperatively using a theoretic model that assumed a normalization of septal bowing. Results . There was no perioperative mortality; 1 patient died 71 days postoperatively of problems related to the left AV valve. Preoperatively, all patients had severe LV hypoplasia, with a mean end-diastolic indexed true LV volume of 14.8 ± 9.1 mL/m 2 , indexed potential LV volume of 32.0 ± 18.8 mL/m 2 , left AV valve to total AV valve ratio of 0.30 ± 0.06, and LV to right ventricular long-dimension ratio of 0.65 ± 0.1. Postoperatively, all patients had indexed true LV volumes greater than 30 mL/m 2 (mean volume, 35.6 ± 3.9 mL/m 2 ), and the left AV valve to total AV valve ratio and the LV to right ventricular long-dimension ratio increased to 0.42 ± 0.03 and 0.88 ± 0.11, respectively. Both preoperative potential and true LV volumes correlated well with postoperative true LV volumes: r = 0.90 ( p = 0.040) and r = 0.93 ( p = 0.023), respectively. Increases in LV length and left AV annulus size indicated contributions of volume loading and surgical patching to the right of the ventricular crest to the increase in LV size. Conclusions . In our small series, preoperative indexed potential LV volume of 15 mL/m 2 or greater (present in all patients) allowed biventricular repair of right-dominant unbalanced AV canal. Any previous criteria for LV hypoplasia in this condition need to be reconsidered. This study also has implications for other right-sided volume-loaded lesions in which the left ventricle initially is judged to be hypoplastic but in which biventricular repair may be feasible. (Ann Thorac Surg 1997;63:1657–63)

Hemispheric language dominance was established for 368 epilepsy surgery candidates based on results of objective language performance during the intracarotid amobarbital procedure. Eighty-three percent of patients were found to be left hemisphere dominant, while six percent were right dominant, and eleven percent demonstrated some degree of bilateral language representation. Bilateral patients were grouped according to modality-specific patterns of language performance in each hemisphere, with a majority demonstrating left hemisphere superiority in over all language processing. Variables affecting atypical language development are reviewed and results are considered in the context of previous research.

Background— Definition and management of right dominant unbalanced atrioventricular septal defect (AVSD) remains challenging because unbalance entails a spectrum of left heart hypoplasia. Previous work has highlighted atrioventricular valve (AVV) index as a reasonable defining echocardiographic measure. We sought to assess which additional echocardiographic features might provide further characterization. Methods and Results— From a multi-institutional cohort of complete AVSD, 52 preoperative echocardiograms of patients with presumed right dominant unbalanced AVSD (based on AVV index) and 60 randomly selected preoperative echocardiograms from patients with presumed balanced AVSD were reviewed. Cluster analysis of echocardiographic variables was used to group patients with similar features. Discriminant function analysis was used to explore which variables differentiated these groups. Three groups were identified from the cluster analysis. Echocardiographic variables that differentiated these groups were right ventricle:left ventricle inflow angle, LV width/LV length, left AVV color diameter at smallest inflow, left AVV color diameter at annulus, right AVV overriding left atrium, and LV width. Based on procedures and outcomes, 1 group likely represented balanced patients, whereas 2 groups with similar outcomes likely represented unbalanced patients. The dominant differentiating echocardiographic variable between the 3 cluster groups was the right ventricle:LV inflow angle (partial R 2 =0.86), defined as the angle between the base of the right ventricle and LV free wall, using the crest of the ventricular septum as apex of the angle. Conclusions— The angle of right ventricle/LV inflow and other surrogates of inflow may be important defining echocardiographic measures of right dominant unbalanced AVSD, although confirmation is needed.

A 76-year-old gentleman underwent carpal tunnel decompression on his right dominant hand under local anaesthesia. He was diabetic and otherwise healthy. He presented 3 days after with ischaemic blisters of his lateral three and a half fingers on the finger tips. This complication following carpal tunnel decompression or following the use of local anaesthetics at the wrist has not been documented so far in the literature on the PUBMED data base. The authors wish to highlight this rather unusual complication encountered following this common procedure in orthopaedic surgical practice.

We report the stenting of a long lesion situated in an anomalous right dominant coronary artery arising from the left sinus of Valsalva. The patient was referred to our unit with a diagnosis of progressive angina and no other cardiopathy. We emphasize the convenience of having a good arrangement of the guiding-catheter with the original and the initial course of the artery, and also having a suitable support for the treatment programmed.

Our research group has employed near-infrared spectroscopy (NIRS) as a simple, noninvasive method to investigate neurophysiological mechanisms of response to mental stress and to evaluate the efficacy of relaxation methods for prevention of stress-induced diseases. NIRS revealed that the right prefrontal cortex (PFC) plays a key role in regulation of the hypothalamic-pituitary-adrenal (HPA) system and the autonomic nervous system (ANS) in response to stress. Subjects with right dominant PFC activity during mental stress might be more sensitive to psychological stress associated with hyperactivity of the stress response system.Relaxation induced by administration of fragrance altered the dominant side of the stress-induced PFC activity from the right to the left side, and reduced the hyperactivity of the HPA system. NIRS may be helpful in prevention of stress-induced diseases, since it allows us to assess conveniently and noninvasively the level of mental stress and the effectiveness of various relaxation methods.

Summary The importance of the platysma muscle in plastic surgery is well known. During surgery, we have observed that the platysmal fibres do not merely decussate and interlace from each side but that sometimes one side of the muscle overlaps and covers the other side. The aim of this study was to clarify the precise anatomical variations in the decussation and overlapping patterns of the platysma muscle in 70 Korean cadavers. We defined three groups (types I–III) and four patterns (types A-D) according to the length of decussation and the pattern of overlapping, respectively. In 60 specimens (85.7%) we observed decussation and in 10 (14.3%) we did not. In type I there was 0–20 mm of decussating fibres below the mandibular border (43% of specimens). In type II, the decussation of fibres extended over more than 20 mm (43% of specimens). Type III had no decussation (14% of specimens). The proportions of type A (interlacing pattern), type B (right dominant), type C (left dominant) and type D (no decussation) were 41%, 29%, 16% and 14%, respectively. In 45% of the specimens, one side of the platysma covered and overlapped the other side. This is relevant to the removal of the subplatysmal fat in corset platysmaplasty, submental Z-plasty and vertical myectomy of the platysma muscle.

Complete atrioventricular (AV) canal defects usually have right and left valve components of approximately equal size, although unbalanced forms do occur. Optimal management of unbalanced AV canal defects is controversial, with no proven guidelines for choosing between biventricular repair and univentricular palliation. We describe successful biventricular repair of a right-dominant unbalanced AV canal with severe left AV valve stenosis. This case illustrates that severely unbalanced AV canal defects can be repaired successfully by tailoring the AV valve to distribute it equally between the ventricles, The increase in left ventricular volume after surgery exceeded prediction based on conformational change alone.

Hands were transplanted from brain-dead donors for the treatment of two male unilateral amputees, aged 35 years and 32 years, involved in the Italian Hand Transplantation Programme. Each had lost his right dominant hand, in a farming accident and an explosion, respectively. In one case artificial sensibility was applied postoperatively using a Sensor Glove that transformed vibrotactile stimuli induced by touch, to stereophonic vibroacoustic stimuli perceived through earphones. The principle is based on the brain's capacity for multimodal plasticity, implying that deprivation of one sense (somatosensory) can be compensated for by another sense (auditory). Functional magnetic resonance images (fMRI) taken at regular intervals showed that cortical remodelling of the transplanted hand within the sensory-motor maps occurred early in the patient who used the artificial sensibility regimen compared with the one who did not. We conclude that postoperative use of a device using hearing as a substitution for sensation in hand transplantation may have considerable potential value for speeding up cortical integration of a transplanted hand.

Prosopagnosia, the inability to recognize faces, has a history going back to Charcot and Hughlings-Jackson, but was first named by Bodamer in 1947. Its anatomical loci are still unclear. However, progressive prosopagnosia is normally linked to right dominant temporal lobe atrophy, and diagnosed as part of frontotemporal lobar degeneration. Here we report a case of prosopagnosia linked to posterior cortical atrophy. Although case reports of posterior cortical atrophy-prosopagnosia do already exist, it is normally described as an accessory symptom. The interest of our own posterior cortical atrophy patient, possibly the first such case, is that he had a rare apperceptive type of prosopagnosia unrelated to the associative, frontotemporal lobar degeneration-type.