Formation of edema and fluid shifts during a long-haul flight.

PubMed

Mittermayr, Markus; Fries, Dietmar; Innerhofer, Petra; Schobersberger, Beatrix; Klingler, Anton; Partsch, Hugo; Fischbach, Uwe; Gunga, Hanns-Christian; Koralewski, Eberhard; Kirsch, Karl; Schobersberger, Wolfgang

2003-01-01

More than 1.5 billion passengers travel by aircraft every year. Leg edema, as a sign of venous stasis, is a well-known problem among passengers during and after long-haul flights. Until now, no studies have been done on the development of leg edema and fluid shifts under real flight conditions. The aim of our study was to evaluate edema formation in the leg and to investigate possible fluid shifts to the interstitial space under real flight conditions. Twenty participants, 10 without risk and 10 with moderate risk for venous thrombosis, were selected. They flew from Vienna to Washington, flight time 9 h, and returned 2 days later. Investigations were done 48 h before the flight, between the fifth and eighth flight hour on board to Washington and back to Vienna, immediately after arrival in Vienna, and 1 and 3 days after arrival. Plethysmographic measurements were carried out using an optoelectronic scanner system (Perometer). Thickness of the skin was measured at the forehead and in front of the tibia. There were no differences in all measurements between both groups. The volume of the leg increased from 8242 +/- 1420 mL to 8496 +/- 1474 mL after the flight (p <.001). Volume accumulation was distributed to the lower leg as well as to the thigh. Skin thickness in front of the tibia increased significantly during the flight (p <.05), and remained elevated 1 day after arrival. We have demonstrated that long-haul flights induce significant fluid accumulation in the lower extremity, involving the lower leg and thigh. This increase in tissue thickness was maintained for some days after the flights.

Ultrasonography of Skin Changes in Legs with Chronic Venous Disease.

PubMed

Caggiati, A

2016-10-01

In daily practice, ultrasonography (US) is used only to designate the location and pattern of venous lesions. Skin US is not performed between routine venous investigations. Skin morphology is evaluated by the same probes used for routine Duplex evaluation of superficial veins. US findings from evident skin lesions are comparatively evaluated with those from the surrounding apparently normal skin and from the contralateral leg. Inflammation and dermal edema can be found in the apparently normal skin of C2 legs. Swollen legs show thickening of the subcutaneous layer as a result of diffuse soaking or anechoic cavities, with or without dermal edema. Chronic hypodermitis is characterized by inflammatory edema in initial phases, and by liposclerosis in advanced cases. Recrudescence of inflammation provokes focal rarefactions of the subcutaneous layer, possibly related to ulcer opening. In legs with venous disorders, sonography refines clinical evaluation of the skin and may reveal changes not highlighted by inspection. Some of these changes could require further investigation because they have not yet been explained or described. Skin sonography should improve knowledge of the natural history of skin changes, as well as contribute to a better grading of venous diseases severity In particular, US evidence of cutaneous and subcutaneous changes in C2 legs should be considered to stratify the treatment in C2 legs, by identifying those in which varicose veins are not simply a cosmetic problem. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities.

PubMed

Matsuda, Masayuki; Sakurai, Kumi; Fushimi, Tomohisa; Yamamoto, Kanji; Rokuhara, Shiho; Hosaka, Naritoshi; Ikeda, Shu-ichi

2004-06-01

We report a patient with sarcoidosis who showed edema in the distal portion of all extremities, particularly the legs, as seen in remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Magnetic resonance imaging demonstrated diffuse abnormal intensity in subcutaneous tissues of both legs, and skin biopsy led to a diagnosis of sarcoidosis. Vascular endothelial growth factor (VEGF) showed a high serum level, which decreased soon after starting oral prednisolone, in parallel with an improvement in the limb edema. In this patient VEGF as well as infiltration by sarcoid granuloma in the skin might have played an important role in the pathogenesis of RS3PE-like symptoms in the extremities. When painful pitting edema is seen predominantly in the distal portion of all extremities, sarcoidosis as well as RS3PE should be considered as a possible diagnosis.

[Primary Malignant Melanoma of the Gallbladder].

PubMed

Ujiie, Daisuke; Miyamoto, Kotaro; Onozawa, Hisashi; Hoshi, Nobuhiro; Nakayama, Koichi; Urazumi, Kojiro; Takenoshita, Seiichi; Kusakabe, Takashi

2016-11-01

Primary malignant melanoma of the gallbladder is a rare disease, and 37 cases have been reported in the literature.The current patient was a 78-year-old man who was admitted with a pelvic tumor and left leg edema due to compression of the external iliac vein by the pelvic tumor.The edema improved following resection of the tumor, which was diagnosed at pathology as a malignant melanoma.After surgery, the patient became anorexic and complained of discomfort in the upper right abdomen.A whole body FDG-PET scan demonstrated significant uptake in the gallbladder and in the lymph nodes of the lower abdomen.The patient underwent open cholecystectomy, and the pathological diagnosis was malignant melanoma. Junctional activity was seen in the gallbladder, suggesting that this was the primary site.No melanocytic lesions of the skin or eyes were detected, further supporting the diagnosis of primary malignant melanoma of the gallbladder.Chemotherapy was initiated, but the patient died on February 28, 2016.

Edema associated with quetiapine

PubMed Central

Koleva, Hristina K.; Erickson, Mark A.; Vanderlip, Erik R.; Tansey, Janeta; Mac, Joseph; Fiedorowicz, Jess G.

2010-01-01

Background Edema associated with quetiapine has been described in only one case report to date and represents a potentially serious adverse reaction. Methods We present a case series of three patients who developed bilateral leg edema following initiation of quetiapine. Results One of these patients had a recurrence of edema with subsequent rechallenge. Another patient developed quetiapine-induced edema following a prior episode of olanzapine-induced edema. All the cases present a compelling temporal relationship between the drug challenge and the adverse event. Conclusions Prompt recognition and intervention with discontinuation of the offending agent is important for this potentially serious, seemingly idiosyncratic, vascular complication. PMID:19439156

Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome.

PubMed

Sala Almonacil, Vicente Andrés; Zaragozá García, José Miguel; Gómez Palonés, Francisco Julián; Plaza Martínez, Ángel; Ortíz Monzón, Eduardo

2012-08-01

Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

A long-distance fluid transport pathway within fibrous connective tissues in patients with ankle edema.

PubMed

Li, Hongyi; Yang, Chongqing; Lu, Kuiyuan; Zhang, Liyang; Yang, Jiefu; Wang, Fang; Liu, Dongge; Cui, Di; Sun, Mingjun; Pang, Jianxin; Dai, Luru; Han, Dong; Liao, Fulong

2016-10-05

Although the microcirculatory dysfunctions of edema formation are well documented, the draining pattern of dermal edema lacks information. This study was to assess the potential drainage pathways of the interstitial fluid in patients with ankle edema using the anatomical and histological methods. Four amputees of lower leg participated in this study. Fluorescent imaging agent was injected into lateral ankle dermis in one volunteered patient before the amputation and three lower legs after the amputation. Physiologically in the volunteer or enhanced by cyclical compression on three amputated limbs, several fluorescent longitudinal pathways from ankle dermis to the broken end of the amputated legs were subsequently visualized and studied using histological methods, laser confocal microscopy and electron microscopy methods respectively. Interestingly, the fluorescent pathways confirmed to be fibrous connective tissues and the presence of two types: those of the cutaneous pathway (located in dermis or the interlobular septum among adipose tissues within the hypodermis) and those of the perivascular pathway (located in connective tissues surrounding the veins and the arteries). The intrinsic three-dimensional architecture of each fluorescent pathway was the longitudinally running and interconnected fibril bundles, upon which, an interfacial transport pathway within connective tissues was visualized by fluorescein. The current anatomical data suggested that a unique long-distance transport pathway composed of oriented fibrous connective tissues might play a pathophysiological role in draining dermal edema besides vascular circulations and provide novel understandings of general fibrous connective tissues in life science.

A prospective study on MRI findings and prognostic factors in athletes with MTSS.

PubMed

Moen, M H; Schmikli, S L; Weir, A; Steeneken, V; Stapper, G; de Slegte, R; Tol, J L; Backx, F J G

2014-02-01

In medial tibial stress syndrome (MTSS) bone marrow and periosteal edema of the tibia on the magnetic resonance imaging (MRI) is frequently reported. The relationship between these MRI findings and recovery has not been previously studied. This prospective study describes MRI findings of 52 athletes with MTSS. Baseline characteristics were recorded and recovery was related to these parameters and MRI findings to examine for prognostic factors. Results showed that 43.5% of the symptomatic legs showed bone marrow or periosteal edema. Absence of periosteal and bone marrow edema on MRI was associated with longer recovery (P = 0.033 and P = 0.013). A clinical scoring system for sports activity (SARS score) was significantly higher in the presence of bone marrow edema (P = 0.027). When clinical scoring systems (SARS score and the Lower Extremity Functional Scale) were combined in a model, time to recovery could be predicted substantially (explaining 54% of variance, P = 0.006). In conclusion, in athletes with MTSS, bone marrow or periosteal edema is seen on MRI in 43,5% of the symptomatic legs. Furthermore, periosteal and bone marrow edema on MRI and clinical scoring systems are prognostic factors. Future studies should focus on MRI findings in symptomatic MTSS and compare these with a matched control group. © 2012 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Left atrial function in cats with left-sided cardiac disease and pleural effusion or pulmonary edema.

PubMed

Johns, S M; Nelson, O L; Gay, J M

2012-01-01

Congestive heart failure (CHF) in cats with left-sided heart disease is sometimes manifest as pleural effusion, in other cases as pulmonary edema. Those cats with pleural effusion have more severe left atrial (LA) dysfunction than cats with pulmonary edema. 30 healthy cats, 22 cats with pleural effusion, and 12 cats with pulmonary edema. All cats were client owned. Retrospective study. Measurements of LA size and function were made using commercial software on archived echocardiograms. Cases were identified through searches of medical records and of archived echocardiograms for cats with these conditions. There was no difference (P = .3) in LA size between cats with pleural effusion and cats with pulmonary edema. Cats with pleural effusion had poorer (P = .04) LA active emptying and increased (P = .006) right ventricular (RV) diameter when compared with cats with pulmonary edema and healthy cats. Cats that exhibited LA active emptying of <7.9%, total emptying of <13.6% (diameter) or <19.4% (area), or RV diameter of >3.6 mm were significantly (P < .001) more likely to manifest pleural effusion. Poorer LA function and increased RV dimensions are associated with pleural effusion in cats with left-sided heart disease. Copyright © 2012 by the American College of Veterinary Internal Medicine.

Effects of Mobile Phone Usage in Supporting Leg Lymphedema Self-care

PubMed Central

Okutsu, Ayako; Koiyabashi, Kikuyo

2014-01-01

Objective: The aim of this study was to implement self-care support for leg lymphedema patients using mobile phones and to investigate the effects thereof. Patients and Methods: A total of 30 patients with lymphedema following female genital cancer surgery (stages I to II) who were referred from a nearby gynecologist were randomly divided into groups for routine self-care support (control group) and mobile telephone-assisted support (intervention group) and received the self-care support appropriate to their group. The (total) circumference of the leg with edema, FACT-G (cancer patient QOL), MHP (mental health status), and self-care self-assessment were comparatively investigated at three months after the initial interview. Results: No significant reduction in the (total) circumferences of legs with edema was confirmed in either the control or intervention group. The intervention group was significantly better than the control group in terms of the activity circumstances and FACT-G mental status at three months after the initial interview. The intervention group was also significantly better in psychological, social, and physical items in the MHP. The intervention group was significantly better than the control group in terms of circumstances of self-care implementation at three months after the initial interview. Additionally, comparison of the circumstances of implementation for different aspects of self-care content showed that the intervention group was significantly better at selecting shoes, observing edema, moisturizing, self-drainage, wearing compression garments, and implementing bandaging. Conclusion: Compared with routine self-care support, mobile telephone-assisted support is suggested to be effective for leg lymphedema patients’ QOL and mental health status as well as their self-care behaviors. PMID:25648778

Reproducibility and day time bias correction of optoelectronic leg volumetry: a prospective cohort study.

PubMed

Engelberger, Rolf P; Blazek, Claudia; Amsler, Felix; Keo, Hong H; Baumann, Frédéric; Blättler, Werner; Baumgartner, Iris; Willenberg, Torsten

2011-10-05

Leg edema is a common manifestation of various underlying pathologies. Reliable measurement tools are required to quantify edema and monitor therapeutic interventions. Aim of the present work was to investigate the reproducibility of optoelectronic leg volumetry over 3 weeks' time period and to eliminate daytime related within-individual variability. Optoelectronic leg volumetry was performed in 63 hairdressers (mean age 45 ± 16 years, 85.7% female) in standing position twice within a minute for each leg and repeated after 3 weeks. Both lower leg (legBD) and whole limb (limbBF) volumetry were analysed. Reproducibility was expressed as analytical and within-individual coefficients of variance (CVA, CVW), and as intra-class correlation coefficients (ICC). A total of 492 leg volume measurements were analysed. Both legBD and limbBF volumetry were highly reproducible with CVA of 0.5% and 0.7%, respectively. Within-individual reproducibility of legBD and limbBF volumetry over a three weeks' period was high (CVW 1.3% for both; ICC 0.99 for both). At both visits, the second measurement revealed a significantly higher volume compared to the first measurement with a mean increase of 7.3 ml ± 14.1 (0.33% ± 0.58%) for legBD and 30.1 ml ± 48.5 ml (0.52% ± 0.79%) for limbBF volume. A significant linear correlation between absolute and relative leg volume differences and the difference of exact day time of measurement between the two study visits was found (P < .001). A therefore determined time-correction formula permitted further improvement of CVW. Leg volume changes can be reliably assessed by optoelectronic leg volumetry at a single time point and over a 3 weeks' time period. However, volumetry results are biased by orthostatic and daytime-related volume changes. The bias for day-time related volume changes can be minimized by a time-correction formula.

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis: A case report.

PubMed

Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

2017-11-01

Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. This patient was treated successfully with surgery. This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. The pitfall of misdiagnosing this tumor as DVT is a useful reminder.

Multimodal ultrasonographic assessment of leiomyosarcoma of the femoral vein in a patient misdiagnosed as having deep vein thrombosis

PubMed Central

Zhang, Mei; Yan, Feng; Huang, Bin; Wu, Zhoupeng; Wen, Xiaorong

2017-01-01

Abstract Rationale: Primary leiomyosarcoma (LMS) of the vein is a rare tumor that arises from the smooth muscle cells of the vessel wall and has an extremely poor prognosis. This tumor can occur in vessels such as the inferior vena cava, great saphenous vein, femoral vein, iliac vein, popliteal vein, and renal vein; the inferior vena cava is the most common site. LMS of the femoral vein can result in edema and pain in the lower extremity; therefore, it is not easy to be differentiated from deep vein thrombosis (DVT). Moreover, virtually no studies have described the ultrasonographic features of LMS of the vein in detail. Patient concerns: We present a case of a 55-year-old woman with LMS of the left femoral vein that was misdiagnosed as having deep vein thrombosis (DVT) on initial ultrasonographic examination. The patient began to experience edema and pain in her left leg seven months previously. She was diagnosed as having DVT on initial ultrasonographic examination, but the DVT treatment that she had received for 7 months failed to improve the status of her left lower limb. Diagnoses: She subsequently underwent re-examination by means of a multimodal ultrasonographic imaging approach (regular B-mode imaging, color Doppler imaging, pulsed-wave Doppler imaging, contrast-enhanced ultrasonography), which confirmed a diagnosis of LMS. Interventions: This patient was treated successfully with surgery. Outcomes: This case demonstrates that use of multiple ultrasonographic imaging techniques can be helpful to diagnose LMS accurately. Detection of vasculature in a dilated vein filled with a heterogeneous hypoechoic substance on ultrasonography is a sign of a tumor. Lessons: The pitfall of misdiagnosing this tumor as DVT is a useful reminder. PMID:29145269

Intermittent Massage as a Therapeutic Option for Compartment Syndrome after Embolectomy of the Lower Limbs.

PubMed

Pereira de Godoy, José Maria; de Fátima Guerreiro Godoy, Maria

2018-01-01

The case of a 54-year-old cardiac patient is reported, who was admitted to hospital with a complaint of sudden pain in the legs associated with edema, paresthesia, and coldness. Arterial embolism of the lower limbs was diagnosed and the patient was submitted to bilateral embolectomy. The patient evolved with a burning sensation, hypersensitivity in the right leg, swelling, and difficulty bending and stretching the sole of the foot and the knee. A physical examination detected edema and increased tension in the anterior, lateral, and posterior compartments. Treatment using intermittent massage of the leg during the evaluation of the patient was chosen in an attempt to stimulate lymphatic and venous drainage. After a few minutes of stimulation, there was significant improvement in the pain and edema. In 40 minutes, there was total reduction of the pain in the posterior and lateral compartments and improvement of over 50% in the anterior compartment. After this, the patient started to bend the knee without pain and bend the sole of the foot with slight pain. On the following day, the patient was walking around the hospital ward without difficulty. It seems that intermittent massage is a therapeutic option in selected cases of compartment syndrome.

[Medicinal plants useful in the cure of circulatory problems in legs].

PubMed

Alonso, Maria José

2005-03-01

Once the fundamentals of phyto-therapy in its western use are understood, this article presents concrete a application of medicinal plants: circulatory problems in legs, a problem which affects a growing sector of the population. According to epidemiological studies, close to 80% of adults suffer problems such as tired legs, swellings, edemas, cramps, or varicose veins during their lifetimes; these appear due to an insufficiency when veins can not conveniently transport blood to the heart.

A Pilot Study: Comparison of Arm Versus Ankle Noninvasive Blood Pressure Measurement at 2 Different Levels of Backrest Elevation.

PubMed

Henley, Nicole; Quatrara, Beth D; Conaway, Mark

2015-01-01

Standard practice for obtaining noninvasive blood pressure includes arm blood pressure (BP) cuff placement at the level of the heart; however, some critical care patients cannot have BPs taken in their arm because of various conditions, and ankle BPs are frequently used as substitutes. The aim of this study was to determine if there was a significant variation between upper arm and ankle BP measurements at different backrest elevations with consideration of peripheral edema factors. After institutional review board approval was obtained, a pilot study was implemented to evaluate noninvasive BP measurements of the arm and ankle with backrest elevation at 0° and 30° in a population of medical intensive care unit patients. Participants served as their own controls and were randomly assigned to left- versus right-side BP readings. Data were also collected on presence of arm versus ankle edema. A total of 30 participants enrolled in the study and provided 120 BP measurements. Blood pressure readings were analyzed in terms of diastolic and systolic findings as well as backrest elevations and edema presence. Thirteen participants presented with either arm or ankle edema. There was a statistical difference between the systolic arm and ankle BP measurements in the 0° (P = .008) and 30° (P < .001) backrest elevation positions. The correlation between arm and ankle diastolic BP is greater for participants without ankle edema (P = .038, r = 0.54) than for participants with ankle edema (P = .650, r = 0.14), but it is not statistically significant (P = .47). Even though ankle BPs are often substituted for arm BPs when the arm is unable to be used, ankle BPs and arm BPs are not interchangeable. Adjustments in backrest elevation and considerations of edema do not normalize the differences. Blood pressures obtained from the ankle are significantly greater than those obtained from the arm. This information needs to be considered when arms are not available and legs are used as surrogates for the upper arm.

Hyperthyroidism and atrial myxoma--an intriguing cardio-endocrine association.

PubMed

Kumar, Gautam; Chow, John T; Klarich, Kyle W; Dean, Diana S

2007-12-01

A 65-year-old woman presented with dyspnea and bilateral leg edema for 1 week, worsening fatigue for 1 month, and a 7-lb weight loss over the last summer. She was clinically and biochemically hyperthyroid. Echocardiography revealed a left atrial myxoma measuring 6.2 x 3.3 cm protruding into the mitral orifice and left ventricle during diastole. She was treated for Graves' disease with Iodine-131. Six weeks later, her left atrial myxoma measuring 10.1 x 6.2 x 2.4 cm was resected. She became euthyroid before surgery and then biochemically hypothyroid 6 weeks after radioiodine treatment, for which she subsequently required thyroxine replacement. Atrial myxomas are the most common primary cardiac neoplasms. At least 5% to 10% can be attributed to Carney's complex. More than two-thirds of patients with Carney's complex develop one or more cardiac myxomas. Although atrial myxomas in Carney's complex are histologically indistinguishable from the sporadic form, their clinical presentation and course is distinct. This is the first case of newly diagnosed Graves' disease that has been reported in association with an atrial myxoma. The features discussed in this article help differentiate between syndromic and sporadic atrial myxomas.

The efficacy of physiotherapy for the prevention and treatment of prenatal symptoms: a systematic review.

PubMed

Van Kampen, Marijke; Devoogdt, Nele; De Groef, An; Gielen, Annelies; Geraerts, Inge

2015-11-01

Several studies have described the evidence of prenatal physiotherapy for one symptom, but none has made an overview. We provided a systematic review on the effectiveness of prenatal physiotherapy. A full search was conducted in three electronic databases (Embase, PubMed/MEDLINE and PEDro), selecting randomized controlled trials concerning prenatal physiotherapy. Methodological quality was assessed using the PEDro scale. We identified 1,249 studies and after exclusions 54 studies were included concerning the evidence of prenatal physiotherapy. The majority of studies indicated a preventative effect for low back pain/pelvic girdle pain, weight gain, incontinence, and perineal massage. For leg edema, fear, and prenatal depression, the efficacy was only based on one study per symptom. No preventative effect was found for gestational diabetes, while literature concerning gestational hypertensive disorders was inconclusive. Regarding the treatment of low back pain/pelvic girdle pain and weight gain, most therapies reduced pain and weight respectively. Evidence regarding exercises for diabetes was contradictory and only minimally researched for incontinence. Foot massage and stockings reduced leg edema and leg symptoms respectively. Concerning gestational hypertensive disorders, perineal pain, fear, and prenatal depression no treatment studies were performed. The majority of studies indicated that prenatal physiotherapy played a preventative role for low back pain/pelvic girdle pain, weight gain, incontinence, and pelvic pain. Evidence for the remaining symptoms was inclusive or only minimally investigated. Regarding treatment, most studies indicated a reduction of low back pain/pelvic girdle pain, weight gain, incontinence, and the symptoms of leg edema.

49 CFR 572.15 - General description.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

49 CFR 572.15 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assembly SA 103C 030 Torso Assembly SA 103C 041 Upper Arm Assembly Left SA 103C 042 Upper Arm Assembly Right SA 103C 051 Forearm Hand Assembly Left SA 103C 052 Forearm Hand Assembly Right SA 103C 061Upper Leg Assembly Left SA 103C 062 Upper Leg Assembly Right SA 103C 071 Lower Leg Assembly Left SA 103C 072...

Changes on venous diameter and leg perimeter with different clinical treatments for moderate chronic venous disease: evaluation using Duplex scanning and perimeter measurements.

PubMed

Porto, C L Lascasas; Milhomens, A L M; Pires, C E; Xavier, S Salles; Sicuro, F; Bottino, D A; Bouskela, E

2009-06-01

To evaluate changes on venous diameter and perimeter of lower limbs in chronic venous disorder (CVD) patients after different clinical treatments for four weeks. Fifty-two female patients classified as C2,s or C2,3,s (CEAP classification) were allocated consecutively in three groups: Cirkan (40 mg of the root extract of Ruscus aculeatus + 100 mg of flavonoid hesperidine methylchalcone + 200 mg of vitamin C per pill); elastic compression stockings (ECS) and no treatment (NT). Diameters were determined by duplex ultrasound and perimeter with Leg-O-Meter. After treatment, Cirkan significantly decreased popliteal vein and great saphenous vein (GSV) diameters bilaterally and ECS decreased popliteal vein diameter bilaterally and GSV and varices only on the left limb. Perimeters changed only with ECS. Clinical scores changed between Cirkan x NT and ECS x Cirkan. Disability score varied for ECS x NT and Cirkan x NT. chi2 test detected different distribution frequency for C3 and C2 classes according to treatment: ECS (both limbs) and Cirkan (only left limb). Varices and anatomical scores did not change. ECS emerges as the most effective clinical treatment tested but improvements with Cirkan on vein diameter and CEAP class were also observed. Clinical scores improved due to pain relief and edema reduction (ECS). These findings point to a positive effect of Cirkan, suggesting that venotonic drugs should be taken into account in the treatment of CVD.

Sjogren's syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE).

PubMed Central

Choi, Young Mi; Sheen, Dong Hyuk; Lee, Yun Jong; Lee, Eun Bong; Song, Yeong Wook

2003-01-01

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually. PMID:12923344

Sjogren's syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE).

PubMed

Choi, Young Mi; Sheen, Dong Hyuk; Lee, Yun Jong; Lee, Eun Bong; Song, Yeong Wook

2003-08-01

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with Sjogren's syndrome experience arthritis during the disease course. We here describe the first case of Sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with Sjogren's syndrome. She was diagnosed RS3PE and Sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually.

The relationship between nocturnal polyuria and the distribution of body fluid: assessment by bioelectric impedance analysis.

PubMed

Torimoto, Kazumasa; Hirayama, Akihide; Samma, Shoji; Yoshida, Katsunori; Fujimoto, Kiyohide; Hirao, Yoshihiko

2009-01-01

Increased nocturnal urinary volume is closely associated with nocturia. We investigated the relationship between nocturnal polyuria and the variation of body fluid distribution during the daytime using bioelectric impedance analysis. A total of 34 men older than 60 years were enrolled in this study. A frequency volume chart was recorded. Nocturnal polyuria was defined as a nocturnal urine volume per 24-hour production of greater than 0.35 (the nocturnal polyuria index). Bioelectric impedance analysis was performed 4 times daily at 8 and 11 a.m., and 5 and 9 p.m. using an InBody S20 body composition analyzer (BioSpace, Seoul, Korea). A significant difference was found in mean +/- SEM 24-hour urine production per fat-free mass between the groups with and without nocturnal polyuria (17.8 +/- 1.4 vs 7.7 +/- 0.9 ml/kg). The increase in fluid in the legs compared with the volume at 8 a.m. was significantly larger at 5 p.m., while there was no difference in the arms or trunk. Nocturnal urine volume significantly correlated with the difference in fluid volume in the legs (r = 0.527, p = 0.0019) and extracellular fluid volume (r = 0.3844, p = 0.0248) between the volumes at 8 a.m. and 9 p.m. Overproduction of urine per fat-free mass leads to nocturnal polyuria. Extracellular fluid accumulates as edema in the legs during the day in patients with nocturnal polyuria. The volume of accumulated extracellular fluid correlates with nocturnal urine volume. We suggest that leg edema is the source of nocturnal urine volume and decreasing edema may cure nocturnal polyuria.

Normal values for segmental bioimpedance spectroscopy in pediatric patients.

PubMed

Avila, Maria Laura; Ward, Leigh C; Feldman, Brian M; Montoya, Madeline I; Stinson, Jennifer; Kiss, Alex; Brandão, Leonardo R

2015-01-01

Localized limb edema is a clinically relevant sign in diseases such as post-thrombotic syndrome and lymphedema. Quantitative evaluation of localized edema in children is mainly done by measuring the absolute difference in limb circumference, which includes fat and fat-free mass. Bioimpedance spectroscopy (BIS) provides information on the fluid volume of a body segment. Our objective was to determine normal ranges for segmental (arm and leg) BIS measurements in healthy children. Additionally, we determined the normal ranges for the difference in arm and ankle circumference and explored the influence of handedness and the correlation between techniques. Healthy children aged 1-18 years were recruited. The ratio of extracellular fluid content between contralateral limbs (estimated as the inter-arm and inter-leg extracellular impedance ratio), and the ratio of extracellular to intracellular fluid content for each limb (estimated as the intracellular to extracellular impedance ratio) were determined with a bioimpedance spectrometer. Arm and ankle circumference was determined with a Gulick II tape. We recruited 223 healthy children (48 infants, 54 preschoolers, 66 school-aged children, and 55 teenagers). Normal values for arm and leg BIS measurements, and for the difference in arm and ankle circumference were estimated for each age category. No influence of handedness was found. We found a statistically significant correlation between extracellular impedance ratio and circumference difference for arms among teenagers. We determined normal BIS ranges for arms and legs and for the difference in circumference between arms and between ankles in children. There was no statistically significant correlation between extracellular impedance ratio and difference in circumference, except in the case of arms in adolescents. This may indicate that limb circumference measures quantities other than fluid, challenging the adequacy of this technique to determine the presence of localized edema in most age groups.

Validity of a New Quantitative Evaluation Method that Uses the Depth of the Surface Imprint as an Indicator for Pitting Edema.

PubMed

Kogo, Haruki; Murata, Jun; Murata, Shin; Higashi, Toshio

2017-01-01

This study examined the validity of a practical evaluation method for pitting edema by comparing it to other methods, including circumference measurements and ultrasound image measurements. Fifty-one patients (102 legs) from a convalescent ward in Maruyama Hospital were recruited for study 1, and 47 patients (94 legs) from a convalescent ward in Morinaga Hospital were recruited for study 2. The relationship between the depth of the surface imprint and circumferential measurements, as well as the relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue on an ultrasonogram, were analyzed using a Spearman correlation coefficient by rank. There was no significant relationship between the surface imprint depth and circumferential measurements. However, there was a significant relationship between the depth of the surface imprint and the thickness of the subcutaneous soft tissue as measured on an ultrasonogram (correlation coefficient 0.736). Our findings suggest that our novel evaluation method for pitting edema, based on a measurement of the surface imprint depth, is both valid and useful.

Headaches -- danger signs

MedlinePlus

... tumor . Brain swelling (brain edema) from altitude sickness, carbon monoxide poisoning, or acute brain injury. Buildup of ... problems moving your arms or legs, loss of balance, confusion, or memory loss with your headache. Your ...

[Measurement of external pressure of peroneal nerve tract coming in contact with lithotomy leg holders using pressure distribution measurement system BIG-MAT®].

PubMed

Mizuno, Ju; Namba, Chikara; Takahashi, Toru

2014-10-01

We investigated external pressure on peroneal nerve tract coming in contact with two kinds of leg holders using pressure distribution measurement system BIG- MAT® (Nitta Corp., Osaka) in the lithotomy position Peak contact (active) pressure at the left fibular head region coming in contact with knee-crutch-type leg holder M® (Takara Belmont Corp., Osaka), which supports the left popliteal fossa, was 78.0 ± 26.4 mmHg. On the other hand, peak contact pressure at the left lateral lower leg region coming in contact with boot-support-type leg holder Bel Flex® (Takara Belmont Corp., Osaka), which supports the left lower leg and foot was 26.3±7.9 mmHg. These results suggest that use of knee-crutch-type leg holder is more likely to induce common peroneal nerve palsy at the fibular head region, but use of boot-support-type leg holder dose not easily induce superficial peroneal nerve palsy at the lateral lower leg region, because capillary blood pressure is known to be 32 mmHg. Safer holders for positioning will be developed to prevent nerve palsy based on the analysis of chronological change in external pressure using BIG-MAT® system during anesthesia.

Diffusion-weighted imaging and diffusion tensor imaging of asymptomatic lumbar disc herniation.

PubMed

Sakai, Toshinori; Miyagi, Ryo; Yamabe, Eiko; Fujinaga, Yasunari; N Bhatia, Nitin; Yoshioka, Hiroshi

2014-01-01

Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) were performed on a healthy 31-year-old man with asymptomatic lumbar disc herniation. Although the left S1 nerve root was obviously entrapped by a herniated mass, neither DWI nor DTI showed any significant findings for the nerve root. Decreased apparent diffusion coefficient (ADC) values and increased fractional anisotropy (FA) values were found. These results are contrary to those in previously published studies of symptomatic patients, in which a combination of increased ADC and decreased FA seem to have a relationship with nerve injury and subsequent symptoms, such as leg pain or palsy. Our results seen in an asymptomatic subject suggest that the compressed nerve with no injury, such as edema, demyelination, or persistent axonal injury, may be indicated by a combination of decreased ADC and increased FA. ADC and FA could therefore be potential tools to elucidate the pathomechanism of radiculopathy.

Hypoxic pulmonary vasoconstriction does not affect hydrostatic pulmonary edema formation.

PubMed

Cheney, F W; Bishop, M J; Eisenstein, B L; Artman, L D

1987-02-01

We studied the effects of regional hypoxic pulmonary vasoconstriction (HPV) on lobar flow diversion in the presence of hydrostatic pulmonary edema. Ten anesthetized dogs with the left lower lobe (LLL) suspended in a net for continuous weighing were ventilated with a bronchial divider so the LLL could be ventilated with either 100% O2 or a hypoxic gas mixture (90% N2-5% CO2-5% O2). A balloon was inflated in the left atrium until hydrostatic pulmonary edema occurred, as evidenced by a continuous increase in LLL weight. Left lower lobe flow (QLLL) was measured by electromagnetic flow meter and cardiac output (QT) by thermal dilution. At a left atrial pressure of 30 +/- 5 mmHg, ventilation of the LLL with the hypoxic gas mixture caused QLLL/QT to decrease from 17 +/- 4 to 11 +/- 3% (P less than 0.05), pulmonary arterial pressure to increase from 35 +/- 5 to 37 +/- 6 mmHg (P less than 0.05), and no significant change in rate of LLL weight gain. Gravimetric confirmation of our results was provided by experiments in four animals where the LLL was ventilated with an hypoxic gas mixture for 2 h while the right lung was ventilated with 100% O2. In these animals there was no difference in bloodless lung water between the LLL and right lower lobe. We conclude that in the presence of left atrial pressures high enough to cause hydrostatic pulmonary edema, HPV causes significant flow diversion from an hypoxic lobe but the decrease in flow does not affect edema formation.

Digital clubbing in primary intestinal lymphangiectasia: a case report.

PubMed

Wiedermann, Christian J; Kob, Michael; Benvenuti, Stefano; Carella, Rodolfo; Lucchin, Lucio; Piazzi, Lucia; Chilovi, Fausto; Mazzoleni, Guido

2010-08-01

Primary intestinal lymphangiectasia (PIL), also known as Waldmann's disease, is a rare disorder characterized by dilated intestinal lacteals resulting in lymph leakage into the small bowel lumen and responsible for protein-losing enteropathy leading to lymphopenia, hypoalbuminemia and hypogammaglobulinemia. The symptoms usually start in early infancy. We report a case of secondary hyperparathyroidism, osteopenia, monoclonal gammopathy and digital clubbing in a 57-year-old patient with a 12-year history of discontinuous diarrhea. Malabsorption with inability to gain weight, and finally weight loss and formation of leg edema were associated with protein-losing enteropathy. A low-fat diet associated with medium-chain triglyceride supplementation was clinically effective as medical management in reducing diarrhea and leg edema, and promoting weight gain. Double-balloon enteroscopy and small bowel biopsy histopathology confirmed dilated intestinal lacteals. Digital clubbing associated with primary intestinal lymphangiectasia which may causally be related to chronic platelet excess has not been reported before.

Iliac Vein Compression Syndrome due to Bladder Distention Caused by Urethral Calculi

PubMed Central

Ikegami, Akiko; Kondo, Takeshi; Tsukamoto, Tomoko; Ohira, Yoshiyuki; Ikusaka, Masatomi

2015-01-01

We report a rare case of iliac vein compression syndrome caused by urethral calculus. A 71-year-old man had a history of urethral stenosis. He complained of bilateral leg edema and dysuria for 1 week. Physical examination revealed bilateral distention of the superficial epigastric veins, so obstruction of both common iliac veins or the inferior vena cava was suspected. Plain abdominal computed tomography showed a calculus in the pendulous urethra, distention of the bladder (as well as the right renal pelvis and ureter), and compression of the bilateral common iliac veins by the distended bladder. Iliac vein compression syndrome was diagnosed. Bilateral iliac vein compression due to bladder distention (secondary to neurogenic bladder, benign prostatic hyperplasia, or urethral calculus as in this case) is an infrequent cause of acute bilateral leg edema. Detecting distention of the superficial epigastric veins provides a clue for diagnosis of this syndrome. PMID:25802794

Leg blood pressure measured in orthostatic posture is associated with left ventricular mass in normotensive subjects.

PubMed

Gemignani, Tiago; Matos-Souza, José R; Franchini, Kleber G; Nadruz, Wilson

2012-10-01

Changing from a supine to an orthostatic posture is associated with substantial increments in leg blood pressure (BP) levels, which could ultimately influence the hemodynamic burden imposed on the heart. This study investigated the relationship between brachial and leg BP measurements and the left cardiac chamber's structure and assessed the role of body posture changes in this regard. One hundred and thirty normotensive, nondiabetic, nonsmoking, normolipemic subjects were evaluated by a clinical history, anthropometry, the analysis of metabolic parameters, echocardiography, and the measurement of BP in the arm and the calf in both supine and orthostatic positions. Significant correlation coefficients between the leg BP measurements and the cardiac structure were detected, especially between the orthostatic pulse pressure (PP) and the left ventricular (LV) wall thickness (r = 0.38; P < 0.001), the orthostatic PP and the LV mass (r = 0.37; P < 0.001), and the orthostatic systolic BP (SBP) and the left atrial size (r = 0.35; P < 0.001). Stepwise and standard regression analysis adjusted for brachial BP and anthropometric and metabolic variables confirmed that the leg orthostatic PP was independently related to the LV wall thickness and mass. Moreover, the leg orthostatic SBP was associated with the left atrial dimension even after adding the LV mass to the statistical models. Finally, triglyceride levels and body surface area showed significant relationship with leg orthostatic PP and SBP, whereas brachial orthostatic PP and SBP were only associated with age and anthropometric variables. Orthostatic leg BP is independently associated with the cardiac structure in normotensive subjects.

Edema: diagnosis and management.

PubMed

Trayes, Kathryn P; Studdiford, James S; Pickle, Sarah; Tully, Amber S

2013-07-15

Edema is an accumulation of fluid in the interstitial space that occurs as the capillary filtration exceeds the limits of lymphatic drainage, producing noticeable clinical signs and symptoms. The rapid development of generalized pitting edema associated with systemic disease requires timely diagnosis and management. The chronic accumulation of edema in one or both lower extremities often indicates venous insufficiency, especially in the presence of dependent edema and hemosiderin deposition. Skin care is crucial in preventing skin breakdown and venous ulcers. Eczematous (stasis) dermatitis can be managed with emollients and topical steroid creams. Patients who have had deep venous thrombosis should wear compression stockings to prevent postthrombotic syndrome. If clinical suspicion for deep venous thrombosis remains high after negative results are noted on duplex ultrasonography, further investigation may include magnetic resonance venography to rule out pelvic or thigh proximal venous thrombosis or compression. Obstructive sleep apnea may cause bilateral leg edema even in the absence of pulmonary hypertension. Brawny, nonpitting skin with edema characterizes lymphedema, which can present in one or both lower extremities. Possible secondary causes of lymphedema include tumor, trauma, previous pelvic surgery, inguinal lymphadenectomy, and previous radiation therapy. Use of pneumatic compression devices or compression stockings may be helpful in these cases.

49 CFR 572.131 - General description.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Assembly 880105-300 Lower Torso Assembly 880105-450 Complete Leg Assembly—left 880105-560-1 Complete Leg Assembly—right 880105-560-2 Complete Arm Assembly—left 880105-728-1 Complete Arm Assembly—right 880105-728...

49 CFR 572.131 - General description.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Assembly 880105-300 Lower Torso Assembly 880105-450 Complete Leg Assembly—left 880105-560-1 Complete Leg Assembly—right 880105-560-2 Complete Arm Assembly—left 880105-728-1 Complete Arm Assembly—right 880105-728...

High day-to-day reliability in lower leg volume measured by water displacement.

PubMed

Pasley, Jeffrey D; O'Connor, Patrick J

2008-07-01

The day-to-day reliability of lower leg volume is poorly documented. This investigation determined the day-to-day reliability of lower leg volume (soleus and gastrocnemius) measured using water displacement. Thirty young adults (15 men and 15 women) had their right lower leg volume measured by water displacement on five separate occasions. The participants performed normal activities of daily living and were measured at the same time of day after being seated for 30 min. The results revealed a high day-to-day reliability for lower leg volume. The mean percentage change in lower leg volume across days compared to day 1 ranged between 0 and 0.37%. The mean within subjects coefficient of variation in lower leg volume was 0.72% and the coefficient of variation for the entire sample across days ranged from 5.66 to 6.32%. A two way mixed model intraclass correlation (30 subjects x 5 days) showed that the lower leg volume measurement was highly reliable (ICC = 0.972). Foot and total lower leg volumes showed similarly high reliability. Water displacement offers a cost effective and reliable solution for the measurement of lower leg edema across days.

Effect of modified bridge exercise on trunk muscle activity in healthy adults: a cross sectional study.

PubMed

Yoon, Jeong-Oh; Kang, Min-Hyeok; Kim, Jun-Seok; Oh, Jae-Seop

This is a cross-sectional study. University research laboratory. Fifteen healthy adults (mean age: 27.47 years) volunteered for this study. The individuals performed standard bridge exercise and modified bridge exercises with right leg-lift (single-leg-lift bridge exercise, single-leg-lift bridge exercise on an unstable surface, and single-leg-lift hip abduction bridge exercise). During the bridge exercises, electromyography of the rectus abdominis, internal oblique, erector spinae, and multifidus muscles was recorded using a wireless surface electromyography system. Two-way repeated-measures analysis of variance (exercise by side) with post hoc pairwise comparisons using Bonferroni correction was used to compare the electromyography data collected from each muscle. Bilateral internal oblique muscle activities showed significantly greater during single-leg-lift bridge exercise (95% confidence interval: right internal oblique=-8.99 to -1.08, left internal oblique=-6.84 to -0.10), single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right internal oblique=-7.32 to -1.78, left internal oblique=-5.34 to -0.99), and single-leg-lift hip abduction bridge exercise (95% confidence interval: right internal oblique=-17.13 to -0.89, left internal oblique=-8.56 to -0.60) compared with standard bridge exercise. Bilateral rectus abdominis showed greater electromyography activity during single-leg-lift bridge exercise on an unstable surface (95% confidence interval: right rectus abdominis=-9.33 to -1.13, left rectus abdominis=-4.80 to -0.64) and single-leg-lift hip abduction bridge exercise (95% confidence interval: right rectus abdominis=-14.12 to -1.84, left rectus abdominis=-6.68 to -0.16) compared with standard bridge exercise. In addition, the right rectus abdominis muscle activity was greater during single-leg-lift hip abduction bridge exercise compared with single-leg-lift bridge exercise on an unstable surface (95% confidence interval=-7.51 to -0.89). For erector spinae, muscle activity was greater in right side compared with left side during all exercises (95% confidence interval: standard bridge exercise=0.19-4.53, single-leg-lift bridge exercise=0.24-10.49, single-leg-lift bridge exercise on an unstable surface=0.74-8.55, single-leg-lift hip abduction bridge exercise=0.47-11.43). There was no significant interaction and main effect for multifidus. Adding hip abduction and unstable conditions to bridge exercises may be useful strategy to facilitate the co-activation of trunk muscles. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Optic nerve involvement in a borderline lepromatous leprosy patient on multidrug therapy.

PubMed

Prabha, Neel; Mahajan, Vikram K; Sharma, Surinder K; Sharma, Vikas; Chauhan, Pushpinder S; Mehta, Karaninder S; Abhinav, C; Khatri, Gaytri; Chander, Bal; Tuli, Rajiv

2013-12-01

Amidst the plethora of ocular complications of leprosy, involvement of the posterior segment or optic nerve is extremely rare. The mechanism of optic neuritis in leprosy is poorly understood. A 47 year-old man presented with a single lesion suggestive of mid-borderline (BB) leprosy over left periorbital region; the histology showed borderline lepromatous (BL) leprosy with a BI of 3+. After initial improvement with WHO MDT-MB and prednisolone (40 mg/d) he developed sudden and painless diminished vision in the left eye, about 3 weeks later. His visual acuity was 6/9 in the left and 6/6 in the right eye, and there was left optic disc edema, hyperemia and blurred disc margins. Treatment with prednisolone (60 mg/d) along with WHO MDT-MB continued. A month later he returned with painless diminished vision in the other eye as well. Visual acuity was 6/6 in the right and 6/12 in the left eye, and there was right optic disc edema and left optic disc atrophy. CT of the head and MRI of the brain were normal. Inflammatory edema of the orbital connective tissue or other surrounding structures, or direct infiltration of vasa nervosa with resultant vascular occlusion leading to optic nerve ischemia, seems the most plausible explanation of optic nerve involvement in this case.

Immortal Ozurdex: A 10-month follow-up of an intralenticular implant.

PubMed

Poornachandra, B; Kumar, Vinod B M; Jayadev, Chaitra; Dorelli, Subashchandra H; Yadav, Naresh Kumar; Shetty, Rohit

2017-03-01

A 78-year-old male who had received a dexamethasone implant (Ozurdex, Allergan, Inc., Irvine, CA, USA) 15 days back for recalcitrant diabetic macular edema in the left eye came to us for a second opinion. On examination, his corrected distance visual acuity was 20/20 in the right eye and 20/40 in the left eye. Early cataractous changes were present in both eyes. The intraocular pressure was within normal limits. The Ozurdex implant was seen lodged in the posterior cortex of the crystalline lens in the left eye, confirmed on anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy. Fundus examination showed moderate nonproliferative diabetic retinopathy in both eyes with macular edema and epiretinal membrane in the left eye, confirmed on OCT. The patient was noncompliant and returned after 10 months. Interestingly, the implant was still present in the same location with the same vision and anterior segment findings as before. The OCT showed a reduction in macular edema. The patient was advised regular follow-up and cataract surgery at a later date.

Transfer of short-term motor learning across the lower limbs as a function of task conception and practice order.

PubMed

Stöckel, Tino; Wang, Jinsung

2011-11-01

Interlimb transfer of motor learning, indicating an improvement in performance with one limb following training with the other, often occurs asymmetrically (i.e., from non-dominant to dominant limb or vice versa, but not both). In the present study, we examined whether interlimb transfer of the same motor task could occur asymmetrically and in opposite directions (i.e., from right to left leg vs. left to right leg) depending on individuals' conception of the task. Two experimental conditions were tested: In a dynamic control condition, the process of learning was facilitated by providing the subjects with a type of information that forced them to focus on dynamic features of a given task (force impulse); and in a spatial control condition, it was done with another type of information that forced them to focus on visuomotor features of the same task (distance). Both conditions employed the same leg extension task. In addition, a fully-crossed transfer paradigm was used in which one group of subjects initially practiced with the right leg and were tested with the left leg for a transfer test, while the other group used the two legs in the opposite order. The results showed that the direction of interlimb transfer varied depending on the condition, such that the right and the left leg benefited from initial training with the opposite leg only in the spatial and the dynamic condition, respectively. Our finding suggests that manipulating the conception of a leg extension task has a substantial influence on the pattern of interlimb transfer in such a way that the direction of transfer can even be opposite depending on whether the task is conceived as a dynamic or spatial control task. Copyright © 2011 Elsevier Inc. All rights reserved.

[Lower limb salvage with a free fillet fibula flap harvested from the contralateral amputated leg].

PubMed

Bouyer, M; Corcella, D; Forli, A; Mesquida, V; Semere, A; Moutet, F

2015-06-01

We report a unusual case of "fillet flap" to reconstruct the lower limb with the amputated contralateral leg. This kind of procedure was first described by Foucher et al. in 1980 for traumatic hand surgery as the "bank finger". A 34-year-old man suffered a microlight accident with bilateral open legs fractures. A large skin defect of the left leg exposed the ankle, the calcaneus and a non-vascularized part of the tibial nerve (10 cm). The patient came to the OR for surgical debridement and had massive bone resection of the left calcaneus. The right leg showed limited skin defect at the lower part, exposing the medial side of the ankle and a tibial bone defect, measuring 10 cm. Salvage the left leg was impossible due to complex nerve, bones and skin associated injuries, so this leg was sacrificed and used as a donor limb, to harvest a free fibula flap for contralateral tibial reconstruction. At 18 months of follow-up, the patient was very satisfied, the clinical result was very good on both lower limbs and X-rays showed excellent integration of the free fibula flap. The patient had normal dailies occupations, can run and have bicycle sport practice with a functional left leg fit prosthesis. This case showed an original application of the "fillet flap concept" to resolve complex and rare traumatic situations interesting the both lower limbs. In our opinion, this strategy must be a part of the plastic surgeon skills in uncommon situations. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Contribution of calcaneal and leg segment rotations to ankle joint dorsiflexion in a weight-bearing task.

PubMed

Chizewski, Michael G; Chiu, Loren Z F

2012-05-01

Joint angle is the relative rotation between two segments where one is a reference and assumed to be non-moving. However, rotation of the reference segment will influence the system's spatial orientation and joint angle. The purpose of this investigation was to determine the contribution of leg and calcaneal rotations to ankle rotation in a weight-bearing task. Forty-eight individuals performed partial squats recorded using a 3D motion capture system. Markers on the calcaneus and leg were used to model leg and calcaneal segment, and ankle joint rotations. Multiple linear regression was used to determine the contribution of leg and calcaneal segment rotations to ankle joint dorsiflexion. Regression models for left (R(2)=0.97) and right (R(2)=0.97) ankle dorsiflexion were significant. Sagittal plane leg rotation had a positive influence (left: β=1.411; right: β=1.418) while sagittal plane calcaneal rotation had a negative influence (left: β=-0.573; right: β=-0.650) on ankle dorsiflexion. Sagittal plane rotations of the leg and calcaneus were positively correlated (left: r=0.84, P<0.001; right: r=0.80, P<0.001). During a partial squat, the calcaneus rotates forward. Simultaneous forward calcaneal rotation with ankle dorsiflexion reduces total ankle dorsiflexion angle. Rear foot posture is reoriented during a partial squat, allowing greater leg rotation in the sagittal plane. Segment rotations may provide greater insight into movement mechanics that cannot be explained via joint rotations alone. Copyright © 2012 Elsevier B.V. All rights reserved.

Increased knee valgus alignment and moment during single-leg landing after overhead stroke as a potential risk factor of anterior cruciate ligament injury in badminton.

PubMed

Kimura, Yuka; Ishibashi, Yasuyuki; Tsuda, Eiichi; Yamamoto, Yuji; Hayashi, Yoshimitsu; Sato, Shuichi

2012-03-01

In badminton, knees opposite to the racket-hand side received anterior cruciate ligament (ACL) injuries during single-leg landing after overhead stroke. Most of them occurred in the backhand-side of the rear court. Comparing lower limb biomechanics during single-leg landing after overhead stroke between the forehand-side and backhand-side court may help explain the different injury rates depending on court position. The knee kinematics and kinetics during single-leg landing after overhead stroke following back-stepping were different between the forehand-side and backhand-side court. Controlled laboratory study. Hip, knee and ankle joint kinematic and knee kinetic data were collected for 17 right-handed female college badminton players using a 3-dimensional motion analysis system. Subjects performed single-left-legged landing after an overhead stroke following left and right back-stepping. The kinematic and kinetic data of the left lower extremities during landing were measured and compared between left and right back-steps. Hip flexion and abduction and knee valgus at the initial contact, hip and knee flexion and knee valgus at the maximum knee flexion and the maximum knee valgus moment were significantly larger for the left back-step than the right back-step (p<0.05). Significant differences in joint kinematics and kinetics of the lower extremity during single-leg landing after overhead stroke were observed between different back-step directions. Increased knee valgus angle and moment following back-stepping to the backhand-side might be related to the higher incidence of ACL injury during single-leg landing after overhead stroke.

Comparison between Unilateral and Bilateral Plyometric Training on Single and Double Leg Jumping Performance and Strength.

PubMed

Bogdanis, Gregory C; Tsoukos, Athanasios; Kaloheri, Olga; Terzis, Gerasimos; Veligekas, Panagiotis; Brown, Lee E

2017-04-18

This study compared the effects of unilateral and bilateral plyometric training on single and double-leg jumping performance, maximal strength and rate of force development (RFD). Fifteen moderately trained subjects were randomly assigned to either a unilateral (U, n=7) or bilateral group (B, n=8). Both groups performed maximal effort plyometric leg exercises two times per week for 6 weeks. The B group performed all exercises with both legs, while the U group performed half the repetitions with each leg, so that total exercise volume was the same. Jumping performance was assessed by countermovement jumps (CMJ) and drop jumps (DJ), while maximal isometric leg press strength and RFD were measured before and after training for each leg separately and both legs together. CMJ improvement with both legs was not significantly different between U (12.1±7.2%) and B (11.0±5.5%) groups. However, the sum of right and left leg CMJ only improved in the U group (19.0±7.1%, p<0.001) and was unchanged in the B group (3.4±8.4%, p=0.80). Maximal isometric leg press force with both legs was increased similarly between groups (B: 20.1±6.5%, U: 19.9±6.2%). However, the sum of right and left leg maximal force increased more in U compared to B group (23.8±9.1% vs. 11.9±6.2%, p=0.009, respectively). Similarly, the sum of right and left leg RFD0-50 and RFD0-100 were improved only in the U group (34-36%, p<0.01). Unilateral plyometric training was more effective at increasing both single and double-leg jumping performance, isometric leg press maximal force and RFD when compared to bilateral training.

Diastolic heart failure associated with hemangiosarcoma infiltrating left ventricular walls in a dog

PubMed Central

Osuga, Tatsuyuki; Nakamura, Kensuke; Morita, Tomoya; Kagawa, Yumiko; Ohta, Hiroshi; Takiguchi, Mitsuyoshi

2017-01-01

A 9-year-old Shetland sheepdog was diagnosed with cardiogenic pulmonary edema. Echocardiography revealed focally thickened left ventricular free wall and interventricular septum and left atrial dilation. Left ventricular systolic function was preserved. Doppler echocardiography of transmitral flow indicated restrictive left ventricular filling. Cardiac histopathology demonstrated hemangiosarcoma infiltrating the left ventricular walls. PMID:29089652

Diastolic heart failure associated with hemangiosarcoma infiltrating left ventricular walls in a dog.

PubMed

Osuga, Tatsuyuki; Nakamura, Kensuke; Morita, Tomoya; Kagawa, Yumiko; Ohta, Hiroshi; Takiguchi, Mitsuyoshi

2017-11-01

A 9-year-old Shetland sheepdog was diagnosed with cardiogenic pulmonary edema. Echocardiography revealed focally thickened left ventricular free wall and interventricular septum and left atrial dilation. Left ventricular systolic function was preserved. Doppler echocardiography of transmitral flow indicated restrictive left ventricular filling. Cardiac histopathology demonstrated hemangiosarcoma infiltrating the left ventricular walls.

Detection of Hand and Leg Motor Tract Injury Using Novel Diffusion Tensor MRI Tractography in Children with Central Motor Dysfunction

PubMed Central

Jeong, Jeong-Won; Lee, Jessica; Kamson, David O.; Chugani, Harry T.; JuhÁsz, Csaba

2015-01-01

Purpose To examine whether an objective segmenation of corticospinal tract (CST) associated with hand and leg movements can be used to detect central motor weakness in the corresponding extremities in a pediatric population. Material and Methods This retrospective study included diffusion tensor imaging (DTI) of 25 children with central paresis affecting at least one limb (age: 9.0±4.2 years, 15 boys, 5/13/7 children with left/right/both hemispheric lesions including ischemia, cyst, and gliosis), as well as 42 pediatric control subjects with no motor dysfunction (age: 9.0±5.5 years, 21 boys, 31 healthy/11 non-lesional epilepsy children). Leg- and hand-related CST pathways were segmented using DTI-maximum a posteriori (DTI-MAP) classification. The resulting CST volumes were then divided by total supratentorial white matter volume, resulting in a marker called “normalized streamline volume ratio (NSVR)” to quantify the degree of axonal loss in separate CST pathways associated with leg and hand motor functions. A receiver operating characteristic curve was applied to measure the accuracy of this marker to identify extremities with motor weakness. Results NSVR values of hand/leg CST selectively achieved the following values of accuracy/sensitivity/specificity: 0.84/0.84/0.57, 0.82/0.81/0.55, 0.78/0.75/0.55, 0.79/0.81/0.54 at a cut-off of 0.03/0.03/0.03/0.02 for right hand CST, left hand CST, right leg CST, and left leg CST, respectively. Motor weakness of hand and leg was most likely present at the cut-off values of hand and leg NSVR (i.e., 0.029/0.028/0.025/0.020 for left-hand/right-hand/left-leg/right-leg). The control group showed a moderate age-related increase in absolute CST volumes and a biphasic age-related variation of the normalized CST volumes, which were lacking in the paretic children. Conclusions This study demonstrates that DTI-MAP classification may provide a new imaging tool to quantify axonal loss in children with central motor dysfunction. Using this technique, we found that early-life brain lesions affect the maturational trajectory of the primary motor pathway which may be used as an effective marker to facilitate evidence-based treatment of paretic children. PMID:25959649

Detection of hand and leg motor tract injury using novel diffusion tensor MRI tractography in children with central motor dysfunction.

PubMed

Jeong, Jeong-Won; Lee, Jessica; Kamson, David O; Chugani, Harry T; Juhász, Csaba

2015-09-01

To examine whether an objective segmenation of corticospinal tract (CST) associated with hand and leg movements can be used to detect central motor weakness in the corresponding extremities in a pediatric population. This retrospective study included diffusion tensor imaging (DTI) of 25 children with central paresis affecting at least one limb (age: 9.0±4.2years, 15 boys, 5/13/7 children with left/right/both hemispheric lesions including ischemia, cyst, and gliosis), as well as 42 pediatric control subjects with no motor dysfunction (age: 9.0±5.5years, 21 boys, 31 healthy/11 non-lesional epilepsy children). Leg- and hand-related CST pathways were segmented using DTI-maximum a posteriori (DTI-MAP) classification. The resulting CST volumes were then divided by total supratentorial white matter volume, resulting in a marker called "normalized streamline volume ratio (NSVR)" to quantify the degree of axonal loss in separate CST pathways associated with leg and hand motor functions. A receiver operating characteristic curve was applied to measure the accuracy of this marker to identify extremities with motor weakness. NSVR values of hand/leg CST selectively achieved the following values of accuracy/sensitivity/specificity: 0.84/0.84/0.57, 0.82/0.81/0.55, 0.78/0.75/0.55, 0.79/0.81/0.54 at a cut-off of 0.03/0.03/0.03/0.02 for right hand CST, left hand CST, right leg CST, and left leg CST, respectively. Motor weakness of hand and leg was most likely present at the cut-off values of hand and leg NSVR (i.e., 0.029/0.028/0.025/0.020 for left-hand/right-hand/left-leg/right-leg). The control group showed a moderate age-related increase in absolute CST volumes and a biphasic age-related variation of the normalized CST volumes, which were lacking in the paretic children. This study demonstrates that DTI-MAP classification may provide a new imaging tool to quantify axonal loss in children with central motor dysfunction. Using this technique, we found that early-life brain lesions affect the maturational trajectory of the primary motor pathway which may be used as an effective marker to facilitate evidence-based treatment of paretic children. Copyright © 2015 Elsevier Inc. All rights reserved.

The MR appearance of volume overload in the lower extremities

NASA Technical Reports Server (NTRS)

Meler, J. D.; Solomon, M. A.; Steele, J. R.; Yancy, C. W. Jr; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)

1997-01-01

PURPOSE: Our goal was to describe the MR findings of volume overload (VO) in the lower extremities. METHOD: Fifteen individuals were studied, including eight healthy controls and seven patients with VO (four cardiac, three renal). MR evaluation included various SE techniques. Edema detection, localization, and symmetry were assessed subjectively. Relaxation time estimates were also made of the subcutaneous tissue, marrow, and three muscles. RESULTS: Subcutaneous tissue was markedly edematous in seven of seven patients and asymmetric in four of seven, whereas marrow was normal in all patients. Muscle edema was mild and asymmetric in six and two of seven patients, respectively. Perifascial fluid collections were identified in six of seven patients. CONCLUSION: Subcutaneous tissue edema is the dominant feature of VO in the lower extremities. Perifascial fluid is common but does not necessarily distribute symmetrically. Muscle edema is relatively mild. These findings should aid in identifying VO as the potential cause of swelling in patients with swollen legs.

Retinal vasculitis and cystoid macular edema after body tattooing: a case report.

PubMed

Moschos, M M; Guex-Crosier, Y

2004-05-01

To report a case of retinal vasculitis occurring after the placement of permanent tattoos. A 21-year-old male was referred to our department with impairment of visual acuity. Permanent tattoos covered the head, body, arms and legs. The patient was examined with ophthalmoscopy, fluorescein angiography, indocyanine green angiography and optical coherence tomography. Systemic medical and laboratory work-up were performed in order to exclude an infectious agent or an inflammatory disease. He had no history of intravenous drug abuse. Our patient presented severe posterior uveitis associated with retinal vasculitis and cystoid macular edema. Laboratory tests ruled out all diseases causing vasculitis. HIV and B, C hepatitis tests were negative. Cystoid macular edema and vasculitis were resolved after immunosuppressive therapy. This is the first description of a retinal vasculitis associated with cystoid macular edema in a completely healthy individual after the placement of permanent tattoos. A phagocytosis of tattoo pigments leading to their lysis is described in the literature as a mechanism causing vasculitis.

[Acute leg compartment syndrome after exertion].

PubMed

Misović, Sidor; Kronja, Goran; Ignjatović, Dragan; Tomić, Aleksandar

2005-03-01

A case of a 22-year old soldier, with a history of pain in the leg during heavy exercise, which desisted at rest, was presented. One day before admission, the patient had felt an extreme exertion-induced pain in his right leg which had not lessenned at rest. At the same time, the patient noticed persistent severe leg edema. On physical examination, the intracompartmental pressure was 62 mmHg (> 30 mmHg). The patient was urgently operated on, and fasciotomy according to Mubarak was used. At second surgery, the debridement of the muscles of the posterior group of the leg, and the evacuation of hemathoma from the anterior and lateral group of the right leg muscles were perfomed. Postoperative recovery was uneventful. Fasciotomy wounds were closed within 14 days of the surgery. The complete physical treatment was done. Follow-up examinations 1, 3, and 6 months afterwards were satisfactory. The soldier completed his compulsory military service without any sequelae. Laboratory results were normal. Overlooked, unrecognized or surgically untreated compartment syndrome can cause severe damage, including even the loss of the extremity.

Descemet Stripping Automated Endothelial Keratoplasty for Endothelial Dysfunction in Xeroderma Pigmentosum: A Clinicopathological Correlation and Review of Literature.

PubMed

Vira, Divya; Fernandes, Merle; Mittal, Ruchi

2016-07-01

Xeroderma pigmentosum (XP) mainly affects the ocular surface; however, endothelial damage may also occur. We would like to report changes in the endothelial-Descemet layer and review the literature on similar findings in patients with XP, including the role of Descemet stripping automated endothelial keratoplasty (DSAEK) in the management of a 21-year-old man who presented with nonresolving corneal edema in the right eye after excision biopsy for conjunctival intraepithelial neoplasia. His best-corrected visual acuity (BCVA) was 20/200 in the right eye and 20/20 in the left eye. On general examination, there was patchy hyperpigmentation of the exposed areas of skin suggestive of XP. On examination of the right eye, there was stromal edema involving the exposed half of cornea. The left eye appeared normal. Pachymetry readings were 860 and 600 μm in the right and left eye, respectively. Descemet stripping automated endothelial keratoplasty was performed for endothelial dysfunction and the stripped endothelium, and Descemet membrane (DM) was sent for histopathologic evaluation. Postoperatively, the donor lenticule was well apposed and the overlying stromal edema resolved. The patient achieved a BCVA of 20/30 in the right eye without progression of corneal scarring at 1-year follow-up. In the meanwhile, however, the left eye developed corneal edema. Histopathology revealed gross attenuation of endothelial cells with uniform thickness of the DM. Corneal endothelial dysfunction in XP is amenable to treatment with DSAEK.

Bilateral anterior segment dysgenesis with the presumed Peters' anomaly in a cat.

PubMed

Park, Sangwan; Kim, Kiwoong; Kim, Youngbeum; Seo, Kangmoon

2018-02-20

A seven-month-old female domestic shorthaired cat was presented for buphthalmos in the right eye and corneal cloudiness in the left eye. Full ophthalmic examinations were performed for both eyes and enucleation was done for the right nonvisual eye. Congenital glaucoma caused by anterior segment dysgenesis was confirmed for the right eye. In the left eye, slit-lamp examination revealed focal corneal edema with several iris strands from iris collarette to the affected posterior corneal surfaces. Circular posterior corneal defect was suggested to be the cause of edema. Goniodysgenesis, additionally, was identified. Taken together, the diagnosis of Peters' anomaly which is a subtype of anterior segment dysgenesis was suggested in the left eye.

Evaluation of lymphoma in a cat using 99mTc-sestamibi.

PubMed

Lenard, Zoe M; Zuber, Richard M; Nicoll, Robert G; O'Hara, Amanda J; Lester, Nola V

2005-01-01

This report describes the evaluation of cutaneous lymphoma in a cat using 99mTc-sestamibi. A mass in the left pes with extension to the left popliteal lymph node was diagnosed as B-cell lymphoma. Thoracic and abdominal radiography and abdominal ultrasound were unremarkable. Scintigraphy using 99mTc-sestamibi confirmed the lesion was confined to the left hind leg, and the leg was amputated. The cat made a full recovery.

49 CFR 572.190 - Incorporated materials.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Complete; (ix) Drawing No. 180-5000-1, Complete Leg Assembly, Left; (x) Drawing No. 180-5000-2, Complete Leg Assembly, Right; (xi) Drawing No. 180-6000-1, Arm Assembly Left Molded; (xii) Drawing No. 180-6000..., Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, telephone (202) 366-9826, and at the...

49 CFR 572.190 - Incorporated materials.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Complete; (ix) Drawing No. 180-5000-1, Complete Leg Assembly, Left; (x) Drawing No. 180-5000-2, Complete Leg Assembly, Right; (xi) Drawing No. 180-6000-1, Arm Assembly Left Molded; (xii) Drawing No. 180-6000..., Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, telephone (202) 366-9826, and at the...

Muscle MR Imaging in Tubular Aggregate Myopathy

PubMed Central

Beltrame, Valeria; Ortolan, Paolo; Coran, Alessandro; Zanato, Riccardo; Gazzola, Matteo; Frigo, Annachiara; Bello, Luca; Pegoraro, Elena; Stramare, Roberto

2014-01-01

Purpose To evaluate with Magnetic Resonance (MR) the degree of fatty replacement and edematous involvement in skeletal muscles in patients with Tubular Aggregate Myopathy (TAM). To asses the inter-observer agreement in evaluating muscle involvement and the symmetry index of fatty replacement. Materials and Methods 13 patients were evaluated by MR to ascertain the degree of fatty replacement (T1W sequences) according to Mercuri's scale, and edema score (STIR sequences) according to extent and site. Results Fatty replacement mainly affects the posterior superficial compartment of the leg; the anterior compartment is generally spared. Edema was generally poor and almost only in the superficial compartment of the leg. The inter-observer agreement is very good with a Krippendorff's coefficient >0.9. Data show a total symmetry in the muscular replacement (McNemar-Bowker test with p = 1). Conclusions MR reveals characteristic muscular involvement, and is a reproducible technique for evaluation of TAM. There may also be a characteristic involvement of the long and short heads of the biceps femoris. It is useful for aimed biopsies, diagnostic hypotheses and evaluation of disease progression. PMID:24722334

Abscopal effect of boron neutron capture therapy (BNCT): proof of principle in an experimental model of colon cancer.

PubMed

Trivillin, Verónica A; Pozzi, Emiliano C C; Colombo, Lucas L; Thorp, Silvia I; Garabalino, Marcela A; Monti Hughes, Andrea; González, Sara J; Farías, Rubén O; Curotto, Paula; Santa Cruz, Gustavo A; Carando, Daniel G; Schwint, Amanda E

2017-11-01

The aim of the present study was to evaluate, for the first time, the abscopal effect of boron neutron capture therapy (BNCT). Twenty-six BDIX rats were inoculated subcutaneously with 1 × 10 6 DHD/K12/TRb syngeneic colon cancer cells in the right hind flank. Three weeks post-inoculation, the right leg of 12 rats bearing the tumor nodule was treated with BPA-BNCT (BPA-Boronophenylalanine) at the RA-3 nuclear reactor located in Buenos Aires, Argentina, at an absorbed dose of 7.5 Gy to skin as the dose-limiting tissue. The remaining group of 14 tumor-bearing rats were left untreated and used as control. Two weeks post-BNCT, 1 × 10 6 DHD/K12/TRb cells were injected subcutaneously in the contralateral left hind flank of each of the 26 BDIX rats. Tumor volume in both legs was measured weekly for 7 weeks to determine response to BNCT in the right leg and to assess a potential influence of BNCT in the right leg on tumor development in the left leg. Within the BNCT group, a statistically significant reduction was observed in contralateral left tumor volume in animals whose right leg tumor responded to BNCT (post-treatment/pre-treatment tumor volume <1) versus animals who failed to respond (post/pre ≥1), i.e., 13 ± 15 vs 271 ± 128 mm 3 . In addition, a statistically significant reduction in contralateral left leg tumor volume was observed in BNCT-responsive animals (post/pre <1) vs untreated animals, i.e., 13 ± 15 vs 254 ± 251 mm 3 . The present study performed in a simple animal model provides proof of principle that the positive response of a tumor to BNCT is capable of inducing an abscopal effect.

[A case of nonclostridial gas gangrene of the leg complicated by severe pneumonia].

PubMed

Matsui, Seiko; Baba, Kenji; Suzuki, Kiyoshi; Yamaguchi, Etsuro

2005-10-01

A 73-year-old man admitted for febrile left leg pain with dyspnea, who had poorly controlled diabetes was found on admission to have severe hypoxia and chest X-ray showed infiltrates in the middle to lower left lung. X-rays of the left leg showed gas around the knee joint. These findings suggested severe pneumonia with gas gangrene, necessitating immediate debridement of the gas gangrene lesion and hyperbaric oxygenation. Antibiotics were also administered intravenously (panipenem/betamipron 0.5 g x 3/day, clindamycin 600 mg x 2/day, and erythromycin 500 mg x 3/day). We conducted fiberoptic bronchoscope daily because consolidation of the whole left lung developed with purulent sputum expectoration. Both pneumonia and gas gangrene gradually ameliorated avoiding amputation of theleg. Gas gangrene was cured without leaving sequelae such as motor dysfunction. Staphylococcus aureus was detected in both pus from the leg and sputum collected by bronchoscopy. Microorganisms showed the same pattern of sensitivity to antibiotics, suggesting a causal relationship between pneumonia and gas gangrene through the blood stream. Gas gangrene was considered the primary infection followed by pneumonia, since pain and swelling of the left leg preceded the airway symptoms. The present case illustrates in compromised hosts including diabetics, gas gangrene may develop taking an opportunity of airway infection, and that in some cases, early debridement of the lesion and optimal use of antibiotics may help cure this disease without aggressive surgery. Hyperbaric oxygenation may also be useful, although its validity must be investigated further.

FDG PET/CT Findings in Primary Diffuse Large B-cell Lymphoma, Leg Type.

PubMed

Ni, Chiayi; Lewis, Michael; Berenji, Gholam

2016-01-01

A 64-year-old man presented with complaints of worsening left foot pain and swelling. MRI showed a soft tissue mass overlying the dorsolateral aspect of the left foot. Following a 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT), the left foot mass was biopsied and pathology indicated a diagnosis of primary diffuse large B-cell lymphoma, leg type (PDLBCL, LT). Review of the PET/CT images demonstrated hypermetabolic activity associated with the left foot mass, multiple subcutaneous nodules/nodes, sclerotic osseous lesions in the lower extremities, and left external iliac/left inguinal lymphadenopathy. At the moment, the patient is undergoing chemotherapy.

MACULAR HOLE FORMATION FOLLOWED BY SPONTANEOUS CLOSURE AFTER PNEUMATIC RETINOPEXY IN A PATIENT WITH DIABETIC MACULAR EDEMA.

PubMed

Cohen, Michael N; Baumal, Caroline R

2018-05-10

To report early formation and spontaneous closure of a full-thickness macular hole that developed after successful pneumatic retinopexy in a patient who had been undergoing treatment for diabetic macular edema. Case report of a 68-year-old man with bilateral nonproliferative diabetic retinopathy who was currently undergoing anti-vascular endothelial growth factor treatment for bilateral diabetic macular edema. On presentation, visual acuity was 20/200 in the left eye, and examination revealed a bullous, macula-off retinal detachment with a single horseshoe tear at 12 o'clock in the left eye. Pneumatic retinopexy was performed followed by laser augmentation 3 days later. Three weeks postoperatively, he returned with visual acuity of 20/50 and a full-thickness macular hole in the left eye. Although he elected for initial observation, he returned 2 weeks later with visual acuity of 20/50 in both eyes and a retinal detachment with a single break at 10 o'clock in the right eye. The macular hole in the left eye had spontaneously resolved. Pneumatic retinopexy was performed to the right eye. Over 1 year after bilateral pneumatic retinopexy, his retina remains without recurrence of a macular hole in the left eye. In the early postoperative period after pneumatic retinopexy to repair a retinal detachment, a macular hole can form and spontaneously close.

Neuromuscular Activation During Short-Track Speed Skating in Young Athletes.

PubMed

Felser, Sabine; Behrens, Martin; Fischer, Susanne; Baeumler, Mario; Salomon, Ralf; Bruhn, Sven

2016-10-01

To investigate differences in muscle activation of both legs between the straight and the curve and changes in muscle activity during a 1000-m time trial (TT) and their relationship to the change in skating velocity in 9 young short-track speed skaters. The authors recorded skating times and EMG data from different leg muscles during maximum-effort skating trials on the straight and in the curve, as well as during a 1000-m TT. Muscle activation differs between the straight and the curves and between legs; ie, average activities of selected muscles of the right leg were significantly higher during skating through the curves than in the straights. This could not be observed for the left leg. The reduction in speed during the 1000-m TT highly correlates with the decrease in the muscle activity of both the tibialis anterior and the rectus femoris of the right leg. Muscle recruitment is different in relation to lap section (straight vs curve) and leg (right vs left leg). The decreased muscle activity of the tibialis anterior and rectus femoris of the right leg showed the highest relationships with the reduction in skating speed during the 1000-m TT.

Restoration of the ascending reticular activating system compressed by hematoma in a stroke patient

PubMed Central

Jang, Sung Ho; Seo, Jeong Pyo

2017-01-01

Abstract Rationale: We report on restoration of the ascending reticular activating system (ARAS), compressed by an intracerebral hematoma and perihematomal edema following a stroke. The restoration of the ARAS was demonstrated by diffusion tensor tractography (DTT). Patient concerns: In a 60-year-old male, a brain MRI taken at 2 weeks after the surgery showed a hematoma and perihematomal edema in the left posterolateral pons and cerebellum, which were markedly resolved on a brain MRI after 5 weeks. Diagnoses: Intraventricular hemorrhage. Interventions: Navigation-guided stereotactic drainage of a hematoma in the left cerebellum, comprehensive rehabilitative therapy, including hypersomnia medication (modafinil), physical therapy, and occupational therapy. Outcomes: His hypersomnia improved significantly with rehabilitation, with no daytime hypersomnia beginning 3 weeks after the surgery. On 2-week DTT, neither the neural tract of the left lower dorsal or ventral ARAS were reconstructed, but these neural tracts were wellreconstructed on 5-week DTT. Lessons: In conclusion, restoration of nonreconstructed neural tracts of the lower ARAS with the resolution of the hematoma and perihematomal edema was demonstrated in a stroke patient, using DTT. PMID:28207526

Intestinal Lymphangiectasia: Insights on Management and Literature Review.

PubMed

Alshikho, Mohamad J; Talas, Joud M; Noureldine, Salem I; Zazou, Saf; Addas, Aladdin; Kurabi, Haitham; Nasser, Mahmoud

2016-07-21

BACKGROUND Intestinal lymphangiectasia (IL) is a rare disease characterized by a dilatation of the intestinal lymphatics and loss of lymph fluid into the gastrointestinal tract leading to hypoproteinemia, edema, lymphocytopenia, hypogammaglobinemia, and immunological abnormalities. Iron, calcium, and other serum components (e.g., lipids, fat soluble vitamins) may also be depleted. A literature search revealed more than 200 reported cases of IL. Herein, we report our observations of a patient diagnosed with IL; we also present our conclusion for our review of the published literature. CASE REPORT A 24-year-old male was admitted to Aleppo University Hospital with the complaints of abdominal pain, headache, arthralgia, fever, and rigors. His past medical history was remarkable for frequent episodes of diarrhea, recurrent infections, and swelling in the lower limbs. In addition, he had been hospitalized several times in non-academic hospitals due to edema in his legs, cellulitis, and recurrent infections. In the emergency department, a physical examination revealed a patient in distress. He was weak, dehydrated, pale, and had a high-grade fever. His lower extremities were edematous, swollen, and extremely tender to touch. The overlying skin was erythematous and warm. Moreover, the patient was tachycardic, tacypneic, and moderately hypotensive. The patient was resuscitated with IV fluids, and Tylenol was administered to bring the temperature down. Blood tests showed anemia and high levels of inflammatory markers. The patient's white blood cell count was elevated with an obvious left shift. However, subsequent investigations showed that the patient had IL. Suitable diet modification plans were applied as a long-term management plan. CONCLUSIONS IL is a rare disease of challenging nature due to its systematic effects and lack of comprehensive studies that can evaluate the effectiveness of specific treatments in a large cohort of patients. MCT (medium-chain triglyceride) oils and diet modification strategies are effective in reducing the loss of body proteins and in maintaining near-normal blood levels of immunoglobulins. However, octreotide and MCT oils had no proven role in shrinking edema in our patient.

Presumed Arterial Gas Embolism After Breath-Hold Diving in Shallow Water.

PubMed

Harmsen, Stefani; Schramm, Dirk; Karenfort, Michael; Christaras, Andreas; Euler, Michael; Mayatepek, Ertan; Tibussek, Daniel

2015-09-01

Dive-related injuries are relatively common, but almost exclusively occur in recreational or scuba diving. We report 2 children with acute central nervous system complications after breath-hold diving. A 12-year-old boy presented with unilateral leg weakness and paresthesia after diving beneath the water surface for a distance of ∼25 m. After ascent, he suddenly felt extreme thoracic pain that resolved spontaneously. Neurologic examination revealed right leg weakness and sensory deficits with a sensory level at T5. Spinal MRI revealed a nonenhancing T2-hyperintense lesion in the central cord at the level of T1/T2 suggesting a spinal cord edema. A few weeks later, a 13-year-old girl was admitted with acute dizziness, personality changes, confusion, and headache. Thirty minutes before, she had practiced diving beneath the water surface for a distance of ∼25 m. After stepping out, she felt sudden severe thoracic pain and lost consciousness. Shortly later she reported headache and vertigo, and numbness of the complete left side of her body. Neurologic examination revealed reduced sensibility to all modalities, a positive Romberg test, and vertigo. Cerebral MRI revealed no pathologic findings. Both children experienced a strikingly similar clinical course. The chronology of events strongly suggests that both patients were suffering from arterial gas embolism. This condition has been reported for the first time to occur in children after breath-hold diving beneath the water surface without glossopharyngeal insufflation. Copyright © 2015 by the American Academy of Pediatrics.

Asymmetric balance control between legs for quiet but not for perturbed stance.

PubMed

Vieira, Osvaldo; Coelho, Daniel Boari; Teixeira, Luis Augusto

2014-10-01

Interlateral performance asymmetry in upright balance control was evaluated in this investigation by comparing unipedal stance on the right versus the left leg. Participants were healthy young adults, hand-foot congruent preference for the right body side. Balance performance was evaluated in unperturbed quiet stance and in the recovery of balance stability following a mechanical perturbation induced by unexpected load release. Evaluation was made under availability of full sensory information, and under deprivation of vision combined with distortion of sensory inputs from the feet soles. Results from perturbed posture revealed that muscular response latency and postural sway were symmetric between the legs. Unipedal stance was more stable when the body was supported on the right as compared with the left leg. No interaction was found between leg and sensory condition. Our findings are interpreted as resulting from specialization of the sensorimotor system controlling the right leg for continuous low-magnitude postural adjustments, while corrections to large-scale stance sway are symmetrically controlled between body sides.

A simple rule for quadrupedal gait generation determined by leg loading feedback: a modeling study

PubMed Central

Fukuoka, Yasuhiro; Habu, Yasushi; Fukui, Takahiro

2015-01-01

We discovered a specific rule for generating typical quadrupedal gaits (the order of the movement of four legs) through a simulated quadrupedal locomotion, in which unprogrammed gaits (diagonal/lateral sequence walks, left/right-lead canters, and left/right-lead transverse gallops) spontaneously emerged because of leg loading feedbacks to the CPGs hard-wired to produce a default trot. Additionally, all gaits transitioned according to speed, as seen in animals. We have therefore hypothesized that various gaits derive from a trot because of posture control through leg loading feedback. The body tilt on the two support legs of each diagonal pair during trotting was classified into three types (level, tilted up, or tilted down) according to speed. The load difference between the two legs led to the phase difference between their CPGs via the loading feedbacks, resulting in nine gaits (32: three tilts to the power of two diagonal pairs) including the aforementioned. PMID:25639661

Protection against high intravascular pressure in giraffe legs.

PubMed

Petersen, Karin K; Hørlyck, Arne; Ostergaard, Kristine H; Andresen, Joergen; Broegger, Torbjoern; Skovgaard, Nini; Telinius, Niklas; Laher, Ismael; Bertelsen, Mads F; Grøndahl, Carsten; Smerup, Morten; Secher, Niels H; Brøndum, Emil; Hasenkam, John M; Wang, Tobias; Baandrup, Ulrik; Aalkjaer, Christian

2013-11-01

The high blood pressure in giraffe leg arteries renders giraffes vulnerable to edema. We investigated in 11 giraffes whether large and small arteries in the legs and the tight fascia protect leg capillaries. Ultrasound imaging of foreleg arteries in anesthetized giraffes and ex vivo examination revealed abrupt thickening of the arterial wall and a reduction of its internal diameter just below the elbow. At and distal to this narrowing, the artery constricted spontaneously and in response to norepinephrine and intravascular pressure recordings revealed a dynamic, viscous pressure drop along the artery. Histology of the isolated median artery confirmed dense sympathetic innervation at the narrowing. Structure and contractility of small arteries from muscular beds in the leg and neck were compared. The arteries from the legs demonstrated an increased media thickness-to-lumen diameter ratio, increased media volume, and increased numbers of smooth muscle cells per segment length and furthermore, they contracted more strongly than arteries from the neck (500 ± 49 vs. 318 ± 43 mmHg; n = 6 legs and neck, respectively). Finally, the transient increase in interstitial fluid pressure following injection of saline was 5.5 ± 1.7 times larger (n = 8) in the leg than in the neck. We conclude that 1) tissue compliance in the legs is low; 2) large arteries of the legs function as resistance arteries; and 3) structural adaptation of small muscle arteries allows them to develop an extraordinary tension. All three findings can contribute to protection of the capillaries in giraffe legs from a high arterial pressure.

Extraventricular Neurocytoma in the Left Frontal Lobe: A Case Report and Literature Review.

PubMed

Chen, Fan; Jin, Rihua; Wu, Xinmin; Dong, Zengping; Chen, Dawei

2018-04-01

Neurocytoma is a rare brain neoplasm of neuroepithelial origin that occurs predominantly in the ventricular system adjacent to the interventricular foramen and septum pellucidum. However, extraventricular neurocytoma is an extremely rare entity, with poor clinical, radiologic, and histopathological characterization. Here we report a case of an extraventricular parafalcine neurocytoma in the left frontal lobe. We also examine previously reported cases of extraventricular neurocytoma in an attempt to provide an up-to-date summary of the condition. A literature search was performed using PubMed with specific key terms, inclusion criteria, and exclusion criteria. Selected case studies and case series were then compared, and statistical analyses were performed where appropriate. We report a 59-year-old woman presenting with weakness in her right leg and urinary incontinence. Physical examination revealed muscle strength of grade 3/5 in the right lower extremity. Brain magnetic resonance imaging showed a parafalcine mass in the left frontal lobe, with perilesional edema; the cerebral falx and lateral ventricle were shifted due to the compression. Gross total resection was performed. Histopathological examination revealed a neurocytoma. Immunohistochemical staining showed diffuse positivity for synaptophysin. MIB-1 staining for Ki-67 antibody showed a labeling index of 20%. No adjuvant radiation or chemotherapy was administered. Brain computed tomography performed at a 3-month follow-up showed no signs of recurrence. Extraventricular neurocytoma occurring in the brain parenchyma is a very rare central nervous system tumor. Its clinical and radiologic manifestations are nonspecific. The diagnosis depends on histopathological and immunohistochemical examination. Surgical resection should be the first-choice treatment. Copyright © 2018 Elsevier Inc. All rights reserved.

Injury of leg somatotopy of corticospinal tract at corona radiata by ventriculoperitoneal shunt

PubMed Central

Jang, Sung Ho; Kwon, Younghyeon

2018-01-01

Abstract Rationale: A 45-year-old right-handed female patient suffered head trauma after being hit by a truck that ran into a house. Patient concerns: The patient lost consciousness for 1 hour and experienced posttraumatic amnesia for 1 month after the accident. Diagnoses: She underwent conservative management for a subdural hematoma in the left frontotemporal lobes and intracerebral hematoma in the left frontal lobe. Interventions: The patient's Glasgow Coma Scale score was 11. She underwent a VP shunt operation, approached through the right posterior parietal area of the brain, at 4 months after onset. Approximately, 6 months after onset, she was admitted to the rehabilitation department of a university hospital. She presented with moderate weakness of the left leg: Medical Research Council scores: hip flexor; 3, knee extensor; 3+, ankle dorsiflexor; 3–. Brain magnetic resonance imaging revealed a leukomalactic lesion in the right posterior corona radiata along the shunt. Outcomes: On 6-month (2 months after the shunt operation) diffusion tensor tractography, the left CST showed partial injury in the posterior portion compared with the right CST. On 6-month transcranial magnetic stimulation study, the motor-evoked potential obtained at the left tibialis anterior muscle revealed lower amplitude than that on the right side. Lessons: Injury of leg somatotopy of a CST was demonstrated in a patient with leg weakness following a VP shunt operation. PMID:29517704

Injury of leg somatotopy of corticospinal tract at corona radiata by ventriculoperitoneal shunt: A case report.

PubMed

Jang, Sung Ho; Kwon, Younghyeon

2018-03-01

A 45-year-old right-handed female patient suffered head trauma after being hit by a truck that ran into a house. The patient lost consciousness for 1 hour and experienced posttraumatic amnesia for 1 month after the accident. She underwent conservative management for a subdural hematoma in the left frontotemporal lobes and intracerebral hematoma in the left frontal lobe. The patient's Glasgow Coma Scale score was 11. She underwent a VP shunt operation, approached through the right posterior parietal area of the brain, at 4 months after onset. Approximately, 6 months after onset, she was admitted to the rehabilitation department of a university hospital. She presented with moderate weakness of the left leg: Medical Research Council scores: hip flexor; 3, knee extensor; 3+, ankle dorsiflexor; 3-. Brain magnetic resonance imaging revealed a leukomalactic lesion in the right posterior corona radiata along the shunt. On 6-month (2 months after the shunt operation) diffusion tensor tractography, the left CST showed partial injury in the posterior portion compared with the right CST. On 6-month transcranial magnetic stimulation study, the motor-evoked potential obtained at the left tibialis anterior muscle revealed lower amplitude than that on the right side. Injury of leg somatotopy of a CST was demonstrated in a patient with leg weakness following a VP shunt operation.

Eosinophilic myocarditis due to Churg-Strauss syndrome with markedly elevated eosinophil cationic protein.

PubMed

Hara, Tomoya; Yamaguchi, Koji; Iwase, Takashi; Kadota, Muneyuki; Bando, Mika; Ogasawara, Kozue; Bando, Sachiko; Ise, Takayuki; Niki, Toshiyuki; Ueda, Yuka; Tomita, Noriko; Taketani, Yoshio; Yamada, Hirotsugu; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

2013-01-01

A 67-year-old woman with asthma visited our hospital with increasing dyspnea and new-onset paresthesia and purpura in her legs. Physical examination showed a wheeze, pretibial edema, and surrounding purpura. Chest X-rays showed cardiac decompensation and an electrocardiogram revealed a new ST-T change. Laboratory data showed leukocytosis, hypereosinophilia (10,450/μL), troponin T(+), elevated BNP, and markedly elevated eosinophil cationic protein (ECP) (> 150 ng/mL). Echocardiography revealed diffuse left ventricular hypokinesis (ejection fraction 30%) with increased wall thickness. Coronary angiography was normal. Cardiac magnetic resonance imaging implied diffuse myocardial edema and subendocardial late gadolinium enhancement. Skin biopsy of purpura showed superfi cial perivascular dermatitis with remarkable eosinophilic infiltrations. No evidence of drug allergies, parasitic infection, or myeloproliferative disorder was detected. Based on these findings, a diagnosis of eosinophilic myocarditis due to Churg-Strauss syndrome was considered. She was administered prednisolone at a dose of 1 mg/kg, cyclophosphamide, and diuretics. Several markers of eosinophilic myocarditis and heart failure gradually improved, including ECP. She was discharged 30 days later with no cardiac event. Eosinophilic myocarditis is characterized by predominantly eosinophilic infi ltration. Eosinophilic granule proteins, such as ECP and major basic protein, play important roles in the pathogenesis of eosinophilic myocarditis. We experienced a rare case of eosinophilic myocarditis due to Churg-Strauss syndrome. Markedly elevated ECP played an important role in the early diagnosis and subsequent reduction in ECP served as a marker of monitoring. In an asthmatic patient with dyspnea, hypereosinophilia, and vasculitis, Churg-Strauss syndrome with eosinophilic myocarditis should be considered.

Localized periorbital edema as a clinical manifestation of sulfite sensitivity.

PubMed

Park, H S; Nahm, D

1996-08-01

Sulfite is commonly used in pharmaceuticals as a preservative. We report a unique clinical presentation of localized periorbital edema on the left eye after administration of sulfite-containing dexamethasone. The patient's sulfite sensitivity was confirmed by sulfite oral provocation test: periorbital edema on the same site developed after ingestion of 200 mg sodium bisulfite. She was non-atopic and did not complain of any respiratory symptoms. Allergy skin prick test with 100 mg/ml sodium bisulfite showed a negative result. She also has aspirin-sensitive urticaria which was confirmed by oral provocation test. In conclusion, sulfite can induce a localized periorbital edema, an uncommon manifestation in sensitive patients. Further investigations are needed to clarify the pathogenetic mechanisms.

Diuretics Combined With Compression in Resistant Limb Edema of Advanced Disease-A Case Series Report.

PubMed

Gradalski, Tomasz

2018-04-01

The extremity edema of advanced disease is a common, multifactorial feature, which impairs patients' activities and quality of life. The most frequently chosen management is based on combined decongestive physiotherapy or pharmacotherapy (with diuretics or steroids). Subcutaneous lymphatic drainage in refractory edema may decrease the swelling, prevent spontaneous lymphorrhea, but also increase the risk of infection. Safe and effective conservative management in diuretics-resistant edemas is lacking. The objective of this prospective, observational study was to assess the effectiveness and tolerability of combined physiotherapeutic and diuretic therapy in edemas refractory to parenteral diuretics. A group of 19 patients with advanced disease and severe bilateral leg edema resistant to parenteral diuretic therapy were treated for three days with a combination of multilayer short-stretch compression bandaging and furosemide in hypersaline intravenous infusion. A clinically meaningful decrease in mean limb volume (of 1.52 L; 20.6%; P < 0.0001)-strongly correlating with patients' weight loss (ρ = 0.71; P = 0.0001), with a lowering of the intensity of complaints-was achieved. The treatment was well tolerated, without decreasing the performance status in any patient. Stable levels of blood pressure, laboratory kidney profile (potassium, sodium, creatinine clearance), and serum albumin were observed. Maintenance of the achieved results with a good compliance was seen during an informal follow-up at the hospice. The combination of compression therapy with hypersaline diuretics could be considered as a valuable option for refractory cases of limb edema in advanced disease. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Anterior Tibial Translation in Collegiate Athletes with Normal Anterior Cruciate Ligament Integrity

PubMed Central

Rosene, John M.; Fogarty, Tracey D.

1999-01-01

Objective: To examine differences in anterior tibial translation (ATT) among sports, sex, and leg dominance in collegiate athletes with normal anterior cruciate ligament integrity. Design and Setting: Subjects from various athletic teams were measured for ATT in right and left knees. Subjects: Sixty subjects were measured for ATT with a KT-1000 knee arthrometer. Measurements: Statistical analyses were computed for each sex and included a 2 × 3 × 4 mixed-factorial analysis of variance (ANOVA) for anterior cruciate ligament displacement, right and left sides, and force and sport. A 2 × 2 × 3 mixed-factorial ANOVA was computed to compare means for sex and force. A 2 × 3 mixed-factorial ANOVA was computed to compare sex differences across 3 forces. Results: For males and females, no significant interactions were found among leg, force, and sport for mean ATT, for leg and sport or leg and force, or for translation values between dominant and nondominant legs. Males had a significant interaction for force and sport, and a significant difference was found for side of body, since the right side had less translation than the left side. Females had greater ATT than males at all forces. Conclusions: Sex differences exist for ATT, and differences in ATT exist among sports for both sexes. Differences between the right and left sides of the body should be expected when making comparisons of ligamentous laxity. ImagesFigure 2.Figure 3.Figure 5. PMID:16558565

Molecular Identification of Human Fungal Pathogens

DTIC Science & Technology

2011-03-01

of the right lower tibia and fibula revealed nonenhancing edema of the skin and subcutaneous fat involving the medial distal right lower leg without...military hospital in Iraq and taken immediately to the operating room for complex pelvic fracture debridement and fixation, right lower extremity...patient’s comorbidities—which included acute kidney injury secondary to rhabdomyolysis, multiple fractures requiring surgical intervention, and pro

Soccer players have a better standing balance in nondominant one-legged stance

PubMed Central

Barone, Rosario; Macaluso, Filippo; Traina, Marcello; Leonardi, Vincenza; Farina, Felicia; Di Felice, Valentina

2011-01-01

The purpose of this study was to analyze the differences in standing balance during dominant and nondominant one-legged stance among athletes of different sports and sedentary subjects. The right-footed subjects of four groups (sedentary, n = 20; soccer, n = 20; basketball, n = 20; windsurfer n = 20) underwent 5-sec unipedal (left and right foot) stabilometric analysis with open eyes and closed eyes to measure center of pressure (COP) sway path and COP velocity (mean value, anteroposterior, and laterolateral in millimeters per second). The soccer group showed better standing balance on the left leg than the sedentary group (P < 0.05). No other significant differences were observed within and amongst groups. The soccer players have a better standing balance on the nondominant leg because of soccer activity. PMID:24198563

Localized unilateral periorbital edema induced by aspirin.

PubMed

Price, K S; Thomson, D M

1997-11-01

Aspirin intolerance manifested as bronchospasm or urticaria/angioedema has been observed since the beginning of this century. To report a novel case of intolerance to aspirin ingestion. Case report; routine skin testing; pulmonary function testing; aspirin challenge. A 30-year-old man with a history of left ocular trauma at the age of 10 noted a 3-year history of left periorbital angioedema after aspirin but not other nonsteroidal anti-inflammatory drugs. Incremental oral aspirin challenge resulted in this unilateral symptomatology at a dose of 673 mg. To the best of our knowledge, this is the first reported case of unilateral periorbital edema following aspirin ingestion.

Extensive deep vein thrombosis following prolonged gaming ('gamer's thrombosis'): a case report.

PubMed

Chang, Hsien-Cheng Leon; Burbridge, Hayley; Wong, Conroy

2013-10-08

The average time spent playing video games is increasing. Prolonged immobility associated with gaming may therefore be an important risk factor for venous thromboembolism. We report a case of deep vein thrombosis associated with prolonged playing of PlayStation® games. A 31-year-old Caucasian man, an exterior painter, presented with a three-day history of left leg pain and swelling after playing PlayStation® games for almost eight hours a day for four consecutive days. Doppler ultrasound of the left leg confirmed extensive left leg deep venous thrombosis requiring thrombolysis and anticoagulation. Video gaming should be considered a risk factor for venous thromboembolism. Further studies are needed to estimate the degree of risk associated with prolonged periods of playing video games, and education for preventing venous thrombosis should be provided to gamers.

Dominant side in single-leg stance stability during floor oscillations at various frequencies

PubMed Central

2014-01-01

Background We investigated lateral dominance in the postural stability of single-leg stance with anteroposterior floor oscillations at various frequencies. Methods Thirty adults maintained a single-leg stance on a force platform for 20 seconds per trial. Trials were performed with no oscillation (static condition) and with anteroposterior floor oscillations (2.5-cm amplitude) at six frequencies: 0.25, 0.5, 0.75, 1.0, 1.25 and 1.5 Hz (dynamic condition). A set of three trials was performed on each leg in each oscillation frequency in random order. The mean speed of the center of pressure in the anteroposterior direction (CoPap) was calculated as an index of postural stability, and frequency analysis of CoPap sway was performed. Footedness for carrying out mobilizing activities was assessed with a questionnaire. Results CoPap speed exponentially increased as oscillation frequency increased in both legs. The frequency analysis of CoPap showed a peak <0.3 Hz at no oscillation. The frequency components at 0.25-Hz oscillation included common components with no oscillation and those at 1.5-Hz oscillation showed the maximum amplitude among all conditions. Postural stability showed no significant difference between left- and right-leg stance at no oscillation and oscillations ≤1.25 Hz, but at 1.5-Hz oscillation was significantly higher in the right-leg stance than in the left-leg stance. For the lateral dominance of postural stability at individual levels, the lateral difference in postural stability at no oscillation was positively correlated with that at 0.25-Hz oscillation (r = 0.51) and negatively correlated with that at 1.5-Hz oscillation (r = -0.53). For 70% of subjects, the dominant side of postural stability was different at no oscillation and 1.5-Hz oscillation. In the subjects with left- or right-side dominance at no oscillation, 94% or 38% changed their dominant side at 1.5-Hz oscillation, with a significant difference between these percentages. In the 1.5-Hz oscillation, 73% of subjects had concordance between the dominant side of postural stability and that of mobilizing footedness. Conclusion In static conditions, there was no lateral dominance of stability during single-leg stance. At 1.5-Hz oscillation, the highest frequency, right-side dominance of postural stability was recognized. Functional role in supporting leg may be divided between left and right legs according to the change of balance condition from static to dynamic. PMID:25127541

Relationships and Predictive Capabilities of Jump Assessments to Soccer-Specific Field Test Performance in Division I Collegiate Players.

PubMed

Lockie, Robert G; Stage, Alyssa A; Stokes, John J; Orjalo, Ashley J; Davis, DeShaun L; Giuliano, Dominic V; Moreno, Matthew R; Risso, Fabrice G; Lazar, Adrina; Birmingham-Babauta, Samantha A; Tomita, Tricia M

2016-12-03

Leg power is an important characteristic for soccer, and jump tests can measure this capacity. Limited research has analyzed relationships between jumping and soccer-specific field test performance in collegiate male players. Nineteen Division I players completed tests of: leg power (vertical jump (VJ), standing broad jump (SBJ), left- and right-leg triple hop (TH)); linear (30 m sprint; 0⁻5 m, 5⁻10 m, 0⁻10, 0⁻30 m intervals) and change-of-direction (505) speed; soccer-specific fitness (Yo-Yo Intermittent Recovery Test Level 2); and 7 × 30-m sprints to measure repeated-sprint ability (RSA; total time (TT), performance decrement (PD)). Pearson's correlations ( r ) determined jump and field test relationships; stepwise regression ascertained jump predictors of the tests ( p < 0.05). All jumps correlated with the 0⁻5, 0⁻10, and 0⁻30 m sprint intervals ( r = -0.65⁻-0.90). VJ, SBJ, and left- and right-leg TH correlated with RSA TT ( r = -0.51⁻-0.59). Right-leg TH predicted the 0⁻5 and 0⁻10 m intervals (R² = 0.55⁻0.81); the VJ predicted the 0⁻30 m interval and RSA TT (R² = 0.41⁻0.84). Between-leg TH asymmetry correlated with and predicted left-leg 505 and RSA PD ( r = -0.68⁻0.62; R² = 0.39⁻0.46). Improvements in jumping ability could contribute to faster speed and RSA performance in collegiate soccer players.

Comparison of crossover and jab step start techniques for base stealing in baseball.

PubMed

Miyanishi, Tomohisa; Endo, So; Nagahara, Ryu

2017-11-01

Base stealing is an important tactic for increasing the chance of scoring in baseball. This study aimed to compare the crossover step (CS) and jab step (JS) starts for base stealing start performance and to clarify the differences between CS and JS starts in terms of three-dimensional lower extremity joint kinetics. Twelve male baseball players performed CS and JS starts, during which their motion and the force they applied to the ground were simultaneously recorded using a motion-capture system and two force platforms. The results showed that the normalised average forward external power, the average forward-backward force exerted by the left leg, and the forward velocities of the whole body centre of gravity generated by both legs and the left leg were significantly higher for the JS start than for the CS start. Moreover, the positive work done by hip extension during the left leg push-off was two-times greater for the JS start than the CS start. In conclusion, this study has demonstrated that the jab step start may be the better technique for a base stealing start and that greater positive work produced by left hip extension is probably responsible for producing its larger forward ground reaction force.

Leg Preference and Interlateral Asymmetry of Balance Stability in Soccer Players

ERIC Educational Resources Information Center

Teixeira, Luis Augusto; de Oliveira, Dalton Lustosa; Romano, Rosangela Guimaraes; Correa, Sonia Cavalcanti

2011-01-01

To examine the effect of long lasting practice on pedal behavior in sport, we compared experienced adult soccer players and nonsoccer players on leg preference in motor tasks requiring general mobilization, soccer related mobilization, and body balance stabilization. We also evaluated performance asymmetry between the right and left legs in static…

Localized periorbital edema as a clinical manifestation of sulfite sensitivity.

PubMed Central

Park, H. S.; Nahm, D.

1996-01-01

Sulfite is commonly used in pharmaceuticals as a preservative. We report a unique clinical presentation of localized periorbital edema on the left eye after administration of sulfite-containing dexamethasone. The patient's sulfite sensitivity was confirmed by sulfite oral provocation test: periorbital edema on the same site developed after ingestion of 200 mg sodium bisulfite. She was non-atopic and did not complain of any respiratory symptoms. Allergy skin prick test with 100 mg/ml sodium bisulfite showed a negative result. She also has aspirin-sensitive urticaria which was confirmed by oral provocation test. In conclusion, sulfite can induce a localized periorbital edema, an uncommon manifestation in sensitive patients. Further investigations are needed to clarify the pathogenetic mechanisms. PMID:8878807

Pilot study of the impact sacroiliac joint manipulation has on walking kinematics using motion analysis technology

PubMed Central

Ward, John S.; Coats, Jesse; Sorrels, Kenneth; Walters, Mathew; Williams, Trevor

2013-01-01

Objective The purpose of this study was to evaluate the feasibility of engaging in a series of larger studies measuring the effect of sacroiliac joint manipulation on walking kinematics using motion analysis technology. Methods Twelve college students engaged in a baseline 90-second gait analysis at 1.5 mph using infrared VICON cameras. Following this, they underwent a prone heel comparison test for functional leg length inequality. Upon examination, participants were then classified as follows: left short leg, right short leg, or no short leg. Participants in each of the 2 short leg branches of this study were then randomized to receive either chiropractic manipulative therapy to the posterior superior iliac spine on the short limb side or no manipulation. Recruitment was ongoing for this pilot study until 1 participant was recruited in each of the following 5 comparative study groups: left short leg—manipulation, left short leg—no manipulation (control 1), right short leg—manipulation, right short leg—no manipulation (control 2), and no short leg (control 3). All participants then underwent another 90-second gait analysis. Data were then grouped and submitted to a blinded biomechanist to determine if there were any unique biomechanical differences between the groups. Results No statistically significant differences were measured because of this being a pilot study with a small sample size. Conclusions The data from this study indicate that a series of larger studies with this design is feasible. PMID:24396314

Comparison of bedside assessed arm and leg fluid filtration determined by venous congestion plethysmography in perioperative cancer patients

PubMed Central

Hunsicker, Oliver; Heinig, Sandra; Dathe, Jana-Jennifer; Krannich, Alexander; Spies, Claudia; Feldheiser, Aarne

2017-01-01

Abstract In recent years, pathophysiology and clinical impact of microvascular fluid filtration has regained interest. As the latest data in surgical patients have been published almost 20 years ago, there is need for further research to better understand fluid filtration during the perioperative period. Venous congestion plethysmography (VCP) provides a rapid and noninvasive method, which has been shown suitable for the assessment of fluid filtration in limbs. Fluid filtration assessed by VCP can be obtained from forearm and calf measurement sites, while in many clinical situations a reduced access to the patient often restricts the measurements to patient's forearm. We aimed to investigate if fluid filtration obtained from forearm and calf measurement site is interchangeable in nonsedated perioperative patients. Fluid filtration by VCP was obtained simultaneously from forearm and calf in patients with ovarian cancer at 4 time points during the perioperative course and assessed by the difference of volume changes of the limb between third and sixth minutes (VC6-3min) during venous congestion. VC6-3min obtained from forearm and calf measurement sites was compared with respect to agreement and evaluated regarding the association with the presence of leg edema. A total of 74 paired measurements were analyzed in 29 patients. Forearm VC6-3min was significantly higher than calf VC6-3min (median [25th; 75th quartile], 0.6 (0.4; 0.9) vs 0.4 [0.3; 0.6] %, P = 0.008). Bland–Altman and Polar analysis revealed a poor agreement between forearm and calf VC6-3min at predefined time points and changes of VC6-3min during the perioperative course (bias +0.23%, limits of agreement [LOA] −1.1% to 1.6%; angular bias −2.5°, radial LOA −82° to +77°). Forearm VC6-3min was significantly increased in patients with presence of leg edema (0.7 (0.5; 1.0) vs 0.5 (0.4; 0.6) %, P < 0.001) while calf VC6-3min did not differ in patients with and without edema. This study indicates that forearm and calf measurement sites are not interchangeable when bedside assessing fluid filtration by VCP in nonsedated perioperative patients. Considering that only forearm fluid filtration was related to the presence of edema, forearm measurement site should be chosen as a primary site for assessing fluid filtration. PMID:28248863

Self-Described Differences Between Legs in Ballet Dancers: Do They Relate to Postural Stability and Ground Reaction Force Measures?

PubMed

Mertz, Laura; Docherty, Carrie

2012-12-01

Ballet technique classes are designed to train dancers symmetrically, but they may actually create a lateral bias. It is unknown whether dancers in general are functionally asymmetrical, or how an individual dancer's perceived imbalance between legs might manifest itself. The purpose of this study was to examine ballet dancers' lateral preference by analyzing their postural stability and ground reaction forces in fifth position when landing from dance-specific jumps. Thirty university ballet majors volunteered to participate in this study. The subjects wore their own ballet technique shoes and performed fundamental ballet jumps out of fifth position on a force plate. The force plate recorded center of pressure (COP) and ground reaction force (GRF) data. Each subject completed a laterality questionnaire that determined his or her preferred landing leg for ballet jumps, self-identified stronger leg, and self-identified leg with better balance. All statistical comparisons were made between the leg indicated on the laterality questionnaire and the other leg (i.e., if the dancer's response to a question was "left," the comparison was made with the left leg as the "preferred" leg and the right leg as the "non-preferred leg"). No significant differences were identified between the limbs in any of the analyses conducted (all statistical comparisons produced p values > 0.05). The results of this study indicate that a dancer's preferential use of one limb over the other has no bearing on GRFs or balance ability after landing jumps in ballet. Similarly, dancers' opinions of their leg characteristics (such as one leg being stronger than the other) seem not to correlate with the dancers' actual ability to absorb GRFs or to balance when landing from ballet jumps.

Extensive deep vein thrombosis following prolonged gaming (‘gamer’s thrombosis’): a case report

PubMed Central

2013-01-01

Introduction The average time spent playing video games is increasing. Prolonged immobility associated with gaming may therefore be an important risk factor for venous thromboembolism. We report a case of deep vein thrombosis associated with prolonged playing of PlayStation® games. Case presentation A 31-year-old Caucasian man, an exterior painter, presented with a three-day history of left leg pain and swelling after playing PlayStation® games for almost eight hours a day for four consecutive days. Doppler ultrasound of the left leg confirmed extensive left leg deep venous thrombosis requiring thrombolysis and anticoagulation. Conclusions Video gaming should be considered a risk factor for venous thromboembolism. Further studies are needed to estimate the degree of risk associated with prolonged periods of playing video games, and education for preventing venous thrombosis should be provided to gamers. PMID:24192285

Distinct disease phases in muscles of facioscapulohumeral dystrophy patients identified by MR detected fat infiltration.

PubMed

Janssen, Barbara H; Voet, Nicoline B M; Nabuurs, Christine I; Kan, Hermien E; de Rooy, Jacky W J; Geurts, Alexander C; Padberg, George W; van Engelen, Baziel G M; Heerschap, Arend

2014-01-01

Facioscapulohumeral muscular dystrophy (FSHD) is an untreatable disease, characterized by asymmetric progressive weakness of skeletal muscle with fatty infiltration. Although the main genetic defect has been uncovered, the downstream mechanisms causing FSHD are not understood. The objective of this study was to determine natural disease state and progression in muscles of FSHD patients and to establish diagnostic biomarkers by quantitative MRI of fat infiltration and phosphorylated metabolites. MRI was performed at 3T with dedicated coils on legs of 41 patients (28 men/13 women, age 34-76 years), of which eleven were re-examined after four months of usual care. Muscular fat fraction was determined with multi spin-echo and T1 weighted MRI, edema by TIRM and phosphorylated metabolites by 3D (31)P MR spectroscopic imaging. Fat fractions were compared to clinical severity, muscle force, age, edema and phosphocreatine (PCr)/ATP. Longitudinal intramuscular fat fraction variation was analyzed by linear regression. Increased intramuscular fat correlated with age (p<0.05), FSHD severity score (p<0.0001), inversely with muscle strength (p<0.0001), and also occurred sub-clinically. Muscles were nearly dichotomously divided in those with high and with low fat fraction, with only 13% having an intermediate fat fraction. The intramuscular fat fraction along the muscle's length, increased from proximal to distal. This fat gradient was the steepest for intermediate fat infiltrated muscles (0.07±0.01/cm, p<0.001). Leg muscles in this intermediate phase showed a decreased PCr/ATP (p<0.05) and the fastest increase in fatty infiltration over time (0.18±0.15/year, p<0.001), which correlated with initial edema (p<0.01), if present. Thus, in the MR assessment of fat infiltration as biomarker for diseased muscles, the intramuscular fat distribution needs to be taken into account. Our results indicate that healthy individual leg muscles become diseased by entering a progressive phase with distal fat infiltration and altered energy metabolite levels. Fat replacement then relatively rapidly spreads over the whole muscle.

Two simple leg net devices designed to protect lower-extremity skin grafts and donor sites and prevent decubitus ulcer.

PubMed

Hedman, Travis L; Chapman, Ted T; Dewey, William S; Quick, Charles D; Wolf, Steven E; Holcomb, John B

2007-01-01

Burn therapists routinely are tasked to position the lower extremities of burn patients for pressure ulcer prevention, skin graft protection, donor site ventilation, and edema reduction. We developed two durable and low-maintenance devices that allow effective positioning of the lower extremities. The high-profile and low-profile leg net devices were simple to fabricate and maintain. The frame was assembled using a three-quarter-inch diameter copper pipe and copper fittings (45 degrees, 90 degrees, and tees). A double layer of elasticized tubular netting was pulled over the frame and doubled back for leg support to complete the devices. The devices can be placed on any bed surface. The netting can be exchanged when soiled and the frame can be disinfected between patients using standard techniques. Both devices were used on approximately 250 patients for a total of 1200 treatment days. No incidence of pressure ulcer was observed, and graft take was not adversely affected. The devices have not required repairs or replacement. Medical providers reported they are easy to apply and effectively maintain proper positioning throughout application. Neither device interfered with the application of other positioning devices. Both devices were found to be an effective method of positioning lower extremities to prevent pressure ulcer, minimize graft loss and donor site morbidity, and reduce edema. The devices allowed for proper wound ventilation and protected grafted lower extremities on any bed surface. The devices are simple to fabricate and maintain. Both devices can be effectively used simultaneously with other positioning devices.

Fluid shifts and muscle function in humans during acute simulated weightlessness

NASA Technical Reports Server (NTRS)

Hargens, A. R.; Tipton, C. M.; Gollnick, P. D.; Mubarak, S. J.; Tucker, B. J.; Akeson, W. H.

1983-01-01

The acute effects of simulated weightlessness on transcapillary fluid balance, tissue fluid shifts, muscle function, and triceps surface reflex time were studied in eight supine human subjects who were placed in a 5 degrees head-down tilt position for 8 hr. Results show a cephalic fluid shift from the legs as indicated by facial edema, nasal congestion, increased urine flow, decreased creatinine excretion, reduced calf girth, and decreased lower leg volume. The interstitial fluid pressure in the tibialis anterior muscle and subcutaneous tissue of the lower leg was found to fall significantly, while other transcapillary pressures (capillary and interstitial fluid colloid osmotic pressures) were relatively unchanged. The total water content of the soleus muscle was unchanged during the head-down tilt. After head-down tilt, isometric strength and isokinetic strength of the plantar flexors were unchanged, while the triceps surae reflex time associated with plantar flexion movement slowed slightly. These results demonstrate a dehydration effect of head-down tilt on muscle and subcutaneous tissue of the lower leg that may affect muscle function.

Experimental myocardial infarction

PubMed Central

Kumar, Raj; Joison, Julio; Gilmour, David P.; Molokhia, Farouk A.; Pegg, C. A. S.; Hood, William B.

1971-01-01

The hemodynamic effects of tachycardia induced by atrial pacing were investigated in left ventricular failure of acute and healing experimental myocardial infarction in 20 intact, conscious dogs. Myocardial infarction was produced by gradual inflation of a balloon cuff device implanted around the left anterior descending coronary artery 10-15 days prior to the study. 1 hr after acute myocardial infarction, atrial pacing at a rate of 180 beats/min decreased left ventricular end-diastolic pressure from 19 to 8 mm Hg and left atrial pressure from 17 to 12 mm Hg, without change in cardiac output. In the healing phase of myocardial infarction 1 wk later, atrial pacing decreased left ventricular end-diastolic pressure from 17 to 9 mm Hg and increased the cardiac output by 37%. This was accompanied by evidence of peripheral vasodilation. In two dogs with healing anterior wall myocardial infarction, left ventricular failure was enhanced by partial occlusion of the circumflex coronary artery. Both the dogs developed pulmonary edema. Pacing improved left ventricular performance and relieved pulmonary edema in both animals. In six animals propranolol was given after acute infarction, and left ventricular function deteriorated further. However the pacing-induced augmentation of cardiac function was unaltered and, hence, is not mediated by sympathetics. The results show that the spontaneous heart rate in left ventricular failure of experimental canine myocardial infarction may be less than optimal and that maximal cardiac function may be achieved at higher heart rates. Images PMID:4395910

Characterization of symptoms and edema distribution in premenstrual syndrome

PubMed Central

Tacani, Pascale Mutti; Ribeiro, Danielle de Oliveira; Barros Guimarães, Barbara Evelyn; Machado, Aline Fernanda Perez; Tacani, Rogério Eduardo

2015-01-01

Background Premenstrual syndrome is a group of symptoms linked to the menstrual cycle, and edema is among these symptoms. Physiotherapy is often sought by many patients for the treatment of edema; however, for an adequate prescription of physiotherapeutic procedures, the distribution of edema throughout the body has yet to be characterized. Objective To determine the most frequent symptoms and body regions that present with edema in women during the premenstrual period. Subjects and methods Sixty women with a mean age of 24.6±4.7 years were evaluated during their premenstrual (between days 21 and 28) and menstrual period (between days 1 and 3), and the collected data included body mass, height, biotype (body-fat distribution), face, breast, limb-circumference measurements, and limb-volume estimate, and an adapted version of the Premenstrual Symptoms Screening Tool was used. Statistical analysis was performed using Student’s t-test and the test for equality of two proportions (P≤0.05). Results Premenstrual syndrome was identified in 91.7% of the women, and the most frequent symptoms were irritability (73.33%) and physical symptoms, including swelling (65%), and anxiety (58.3%). Edema was detected in the following areas: facial, epigastric, mammary, umbilical, and pubic, the mid-third of the arms, distal forearm, in both thighs and in the mid-third of the legs determined by circumference measurements, and in both upper and lower limbs, according to the estimated volume. Conclusion In this study population, the most frequent symptoms were irritability, physical symptoms, and anxiety, with distribution of edema in the face, breast, abdomen, pubic area, distal upper limb, and proximal lower limb. PMID:25792857

Ground scratching and preferred leg use in domestic chicks: changes in motor control in the first two weeks post-hatching.

PubMed

Dharmaretnam, Meena; Vijitha, V; Priyadharshini, K; Jashini, T; Vathany, K

2002-10-01

Lateralisation of a variety of visual functions: food discrimination, fear response, copulation, and performance of topographical and other tasks, such as olfactory and auditory functions, have been described in the domestic chick, Gallus gallus domesticus. A bias to left hemisphere control on day 8 and to the right on day 11 has also been demonstrated in the domestic chick. In this study we show that motor control as to foot preference in initiating a scratching bout and a tape-removing task is lateralised in both adults and chicks. There was a preference for the right leg to initiate a bout of ground scratching in both male and female adult birds. Second, foot preference is also affected by the changes in shifts of bias on day 8 and day 11. The right leg preference in initiating a ground scratching bout observed on day 5 is reversed to a left leg preference on day 8. This then reverts to the right leg preference after day 11. Hence it is postulated that the hemisphere that is not activated due to the bias of age controls the first leg to be used in initiating routine movements such as ground scratching. For the tape-removing task the right leg was used to remove a tape adhered to the beak of the chick for the trained group on day 8; but there was no preference in the naive group. Similarly, on day 11 a left foot bias was observed for the trained group and right foot bias for the naive group. To remove a tape the activated hemisphere on days of bias is used; whereas in a novel situation the foot use is reversed. Thus, footedness is affected by age, type of task, and changing hemispheric dominance.

Relationships and Predictive Capabilities of Jump Assessments to Soccer-Specific Field Test Performance in Division I Collegiate Players

PubMed Central

Lockie, Robert G.; Stage, Alyssa A.; Stokes, John J.; Orjalo, Ashley J.; Davis, DeShaun L.; Giuliano, Dominic V.; Moreno, Matthew R.; Risso, Fabrice G.; Lazar, Adrina; Birmingham-Babauta, Samantha A.; Tomita, Tricia M.

2016-01-01

Leg power is an important characteristic for soccer, and jump tests can measure this capacity. Limited research has analyzed relationships between jumping and soccer-specific field test performance in collegiate male players. Nineteen Division I players completed tests of: leg power (vertical jump (VJ), standing broad jump (SBJ), left- and right-leg triple hop (TH)); linear (30 m sprint; 0–5 m, 5–10 m, 0–10, 0–30 m intervals) and change-of-direction (505) speed; soccer-specific fitness (Yo-Yo Intermittent Recovery Test Level 2); and 7 × 30-m sprints to measure repeated-sprint ability (RSA; total time (TT), performance decrement (PD)). Pearson’s correlations (r) determined jump and field test relationships; stepwise regression ascertained jump predictors of the tests (p < 0.05). All jumps correlated with the 0–5, 0–10, and 0–30 m sprint intervals (r = −0.65–−0.90). VJ, SBJ, and left- and right-leg TH correlated with RSA TT (r = −0.51–−0.59). Right-leg TH predicted the 0–5 and 0–10 m intervals (R2 = 0.55–0.81); the VJ predicted the 0–30 m interval and RSA TT (R2 = 0.41–0.84). Between-leg TH asymmetry correlated with and predicted left-leg 505 and RSA PD (r = −0.68–0.62; R2 = 0.39–0.46). Improvements in jumping ability could contribute to faster speed and RSA performance in collegiate soccer players. PMID:29910304

Effect of LF 16-0687MS, a new nonpeptide bradykinin B2 receptor antagonist, in a rat model of closed head trauma.

PubMed

Pruneau, D; Chorny, I; Benkovitz, V; Artru, A; Roitblat, L; Shapira, Y

1999-11-01

Bradykinin is an endogenous nonapeptide which potently dilates the cerebral vasculature and markedly increases vascular permeability. These effects are mediated by B2 receptors located on the vascular endothelium. Previous experimental studies have shown that blockade of the kallikreinkinin system, which mediates the formation of bradykinin, afforded a reduction of the brain edema that developed following a cryogenic cortical lesion. In the present study, we investigated the effect of LF 16-0687MS, a novel nonpeptide B2 receptor antagonist, on cerebral edema and neurological severity score (NSS) after closed head injury to rats. LF 16-0687MS or its vehicle (NaCl 0.9%) was continuously infused at 10, 30, and 100 microg/kg/min over 23 h starting 1 h after a focal trauma to the left hemisphere was induced using a weight-drop device. The extent of edema formation was evaluated 24 h after trauma from left and right hemispheres samples by measurement of specific gravity and water content. In a separate study, a neurological severity score based on scoring of behavioural and motor functions was evaluated 1 h and over 1 week after trauma. LF 16-0687MS at 100 microg/kg/min markedly reduced the development of brain edema as indicated by a 68% increase in specific gravity (p<0.05) and a 64% decrease of water content (p<0.05) in the left hemisphere. In addition the recovery of neurological function was significantly improved by 100 microg/kg/min LF 16-0687MS from day 3 to day 7 after CHT. In a separate experiment, we also showed that LF 16-0687MS at 100 microg/kg/min given either 1 h before or 30 min after CHT did not affect mean arterial blood pressure. These results show that blockade of bradykinin B2 receptors is an effective approach to reduce cerebral edema and to improve neurological outcome after a focal contusion to the cranium.

Deboning broiler chicken legs and wings by dislocation of articular cartilage followed by stripping periosteum.

PubMed

Nakano, T; Ozimek, L; Betti, M

2012-11-01

The yield of deboned meat is an important economic factor affecting the profit of the meat industry. This study was undertaken to determine whether the yield of boneless meat from broiler chicken leg (thigh and drumstick) and wing (drumette and winglet) is improved by introducing a new deboning method consisting of articular cartilage dislocation followed by stripping periosteum. A total of 44 broiler chicken carcasses were used in the deboning experiment. Right and left legs or wings from the first 22 carcasses were assigned to the new and ordinary hand deboning methods, respectively. For the remaining 22 carcasses, right and left legs or wings were assigned to the ordinary and new methods, respectively. The weight of residue, composed of bone and small amounts of cartilage and noncartilaginous tissues obtained after deboning, was then compared between the right and left legs or wings to see the difference between the 2 methods. The removal of tibia, fibula, humerus, radius, or ulna resulted in formation of a hollow in boneless meat obtained. There was no difference (P > 0.05) between the right and left legs or wings in the weight of residue obtained after deboning as expected. The weight of residue was less (P < 0.05) with the new method compared with the ordinary method in all chicken parts examined. The difference of residue weight between the 2 methods accounted for 10, 12, 14, and 21% of the weight of residue obtained by the ordinary method in thigh, drumstick, drumette, and winglet, respectively. The new method may be useful to deboners at home kitchens as well as the poultry meat industry. The present study also showed the development of a secondary ossification center at the proximal end of the carpometacarpus of chickens. This is, to our knowledge, the first report of development of secondary ossification center in chicken wings.

[Efficacy of double balloon enteroscopy for patients with intestinal lymphangiectasia, case report of primary intestinal lymphangiectasia].

PubMed

Yakami, Yoshikazu; Watanabe, Kenji; Kameda, Natsuhiko; Machida, Hirohisa; Okazaki, Hirotoshi; Yamagami, Hirokazu; Shiba, Masatsugu; Fujiwara, Yasuhiro; Oshitani, Nobuhide; Arakawa, Tetsuo

2008-11-01

A 31-year-old man has visited our hospital, complaining diarrhea and leg edema. Blood test showed hypoalbuminea, but we couldn't find the reason by several examinations. Therefore, we performed double balloon enteroscopy, and intestinal lymphangiectasia was diagnosed histologically by biopsy. It's useful and effective to perform double balloon enteroscopy and histological examination for the unknown origin case of protein loosing enteropathy.

Sensors on instrumented socks for detection of lower leg edema--An in vitro study.

PubMed

Zhang, Song; Rajamani, Rajesh

2015-01-01

This paper presents the design, sensing principles and in vitro evaluation of a novel instrumented sock intended for prediction and prevention of acute decompensated heart failure. The sock contains a drift-free ankle size sensor and a leg tissue elasticity sensor. Both sensors are inexpensive and developed using innovative new sensing ideas. Preliminary tests with the sensor prototypes show promising results: The ankle size sensor is capable of measuring 1 mm changes in ankle diameter and the tissue elasticity sensor can detect 0.15 MPa differences in elasticity. A low-profile instrumented sock prototype with these two sensors has been successfully fabricated and will be evaluated in the future in an IRB-approved human study.

Obstacle avoidance locomotor tasks: adaptation, memory and skill transfer.

PubMed

Kloter, Evelyne; Dietz, Volker

2012-05-01

The aim of this study was to explore the neural basis of adaptation, memory and skill transfer during human stepping over obstacles. Whilst walking on a treadmill, subjects had to perform uni- and bilateral obstacle steps. Acoustic feedback information about foot clearance was provided. Non-noxious electrical stimuli were applied to the right tibial nerve during the mid-stance phase of the right leg, i.e. 'prior' to the right or 'during' the left leg swing over the obstacle. The electromyogram (EMG) responses evoked by these stimuli in arm and leg muscles are known to reflect the neural coordination during normal and obstacle steps. The leading and trailing legs rapidly adapted foot clearance during obstacle steps with small further changes when the same obstacle condition was repeated. This adaptation was associated with a corresponding decrease in arm and leg muscle reflex EMG responses. Arm (but not leg) muscle EMG responses were greater when the stimulus was applied 'during' obstacle crossing by the left leg leading compared with stimulation 'prior' to right leg swing over the obstacle. A corresponding difference existed in arm muscle background EMG. The results indicate that, firstly, the somatosensory information gained by the performance and adaptation of uni- and bilateral obstacle stepping becomes transferred to the trailing leg in a context-specific manner. Secondly, EMG activity in arm and leg muscles parallels biomechanical adaptation of foot clearance. Thirdly, a consistently high EMG activity in the arm muscles during swing over the obstacle is required for equilibrium control. Thus, such a precision locomotor task is achieved by a context-specific, coordinated activation of arm and leg muscles for performance and equilibrium control that includes adaptation, memory and skill transfer. © 2012 The Authors. European Journal of Neuroscience © 2012 Federation of European Neuroscience Societies and Blackwell Publishing Ltd.

Topological Analyses of Symmetric Eruptive Prominences

NASA Astrophysics Data System (ADS)

Panasenco, O.; Martin, S. F.

Erupting prominences (filaments) that we have analyzed from Hα Doppler data at Helio Research and from SOHO/EIT 304 Å, show strong coherency between their chirality, the direction of the vertical and lateral motions of the top of the prominences, and the directions of twisting of their legs. These coherent properties in erupting prominences occur in two patterns of opposite helicity; they constitute a form of dynamic chirality called the ``roll effect." Viewed from the positive network side as they erupt, many symmetrically-erupting dextral prominences develop rolling motion toward the observer along with right-hand helicity in the left leg and left-hand helicity in the right leg. Many symmetricaly-erupting sinistral prominences, also viewed from the positive network field side, have the opposite pattern: rolling motion at the top away from the observer, left-hand helical twist in the left leg, and right-hand twist in the right leg. We have analysed the motions seen in the famous movie of the ``Grand Daddy" erupting prominence and found that it has all the motions that define the roll effect. From our analyses of this and other symmetric erupting prominences, we show that the roll effect is an alternative to the popular hypothetical configuration of an eruptive prominence as a twisted flux rope or flux tube. Instead we find that a simple flat ribbon can be bent such that it reproduces nearly all of the observed forms. The flat ribbon is the most logical beginning topology because observed prominence spines already have this topology prior to eruption and an initial long magnetic ribbon with parallel, non-twisted threads, as a basic form, can be bent into many more and different geometrical forms than a flux rope.

A Case of Malignant Melanoma with In-Transit Metastasis That Responded to Intravenous Infusion of Interferon-β

PubMed Central

Arima, Masaru; Iwata, Youhei; Morita, Yusuke; Kobayashi, Tsukane; Sasaki, Ryousuke; Suzuki, Kayoko; Matsunaga, Kayoko

2014-01-01

A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-β was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion. PMID:24707255

A Case of Malignant Melanoma with In-Transit Metastasis That Responded to Intravenous Infusion of Interferon-β.

PubMed

Arima, Masaru; Iwata, Youhei; Morita, Yusuke; Kobayashi, Tsukane; Sasaki, Ryousuke; Suzuki, Kayoko; Matsunaga, Kayoko

2014-01-01

A 77-year-old man with a history of surgical resection of malignant melanoma involving the fifth toe of his left foot 14 years ago presented at the Kariya Toyota General Hospital with a 3-month history of skin ulcer at the same site and red nodules on the lower left leg. Malignant melanoma was suspected, and the patient was referred to our department. On examination, a skin ulcer measuring 25 × 20 mm was observed at the amputation site on the left foot. In addition, multiple red nodules were observed on the lower left leg. Skin biopsies of the ulcer and nodules revealed recurrent malignant melanoma with in-transit metastasis. Two weeks later, he developed acute myocardial infarction and was hospitalized at the Kariya Toyota General Hospital. One month later, the myocardial infarction ameliorated, and he was transferred to our department. As the myocardial infarction had decreased the patient's tolerance to surgery, interferon-β was administered by intravenous infusion. The skin ulcer and red nodules on the lower left leg disappeared 26 weeks after infusion had been initiated. The patient's progress has been satisfactory, with no evidence of recurrence or metastasis at 1 year and 9 months after the initiation of intravenous infusion.

No evidence of benefit from class-II compression stockings in the prevention of lower-limb lymphedema after inguinal lymph node dissection: results of a randomized controlled trial.

PubMed

Stuiver, M M; de Rooij, J D; Lucas, C; Nieweg, O E; Horenblas, S; van Geel, A N; van Beurden, M; Aaronson, N K

2013-09-01

Graduated compression stockings have been advocated for prevention of lymphedema after inguinal lymph node dissection (ILND) although scientific evidence of their efficacy in preventing lymphedema is lacking. The primary objective of this study was to assess the efficacy of class II compression stockings for the prevention of lymphedema in cancer patients following ILND. Secondary objectives were to investigate the influence of stockings on the occurrence of wound complications and genital edema, health-related quality of life (HRQoL) and body image. Eighty patients (45 with melanoma, 35 with urogenital tumors) who underwent ILND at two specialized cancer centers were randomly allocated to class II compression stocking use for six months or to a usual care control group. Lymphedema of the leg and genital area, wound complications, HRQoL, and body image were assessed at regular intervals prior to and up to 12 months after ILND. No significant differences were observed between groups in the incidence of edema, median time to the occurrence of edema, incidence of genital edema, frequency of complications, HRQoL, or body image. Based on the results of the current study, routine prescription of class II graduated compression stockings after ILND should be questioned and alternative prevention strategies should be considered.

Case report of metastatic invasive breast lobular carcinoma to the urinary bladder.

PubMed

Al Ibraheemi, Ahmed A

2016-01-01

Breast cancer is the most common cancer in women except skin cancer. The common metastatic sites include lymph node, lung, liver and bone. However, metastasis to the bladder is extremely rare. To our knowledge, this is the first case of breast cancer metastasis to urinary bladder in Jordan which is reported. Nine years after the initial diagnosis of lobular breast carcinoma, the patient suffered from left side leg edema; Ultrasonography and Computed tomography scanning showed thickening of posterior bladder wall and bilateral hydronephrosis. The biopsy of the bladder confirmed metastatic lesion from the breast. In contrast to the primary tumor, bladder metastasis showed negative expression of estrogen (ER) and progesterone (PR) receptors. However, Her2neu test was negative in both. The reported case confirms that bladder metastasis from breast cancer tend to occur late after the diagnosis of the primary tumor. Furthermore, bladder metastasis can be asymptomatic and heterogeneous in ER and PR expression in comparison with the primary tumor. This report supports the need for careful follow-up and early intervention whenever such clinical situation is suspected. This report supports further evaluation of receptor status at time of metastasis.

Neurofibromatosis, gigantism, elephantiasis neuromatosa and recurrent massive subperiosteal hematoma: a new case report and review of 7 case reports from the literature.

PubMed

Steenbrugge, F; Poffyn, B; Uyttendaele, D; Verdonk, R; Verstraete, K

2001-04-01

The authors report the case of a 13-year-old patient with neurofibromatosis (NF-I), who suffered blunt trauma to the left tibia in 1993. The diagnosis of subperiosteal hematoma was made. Treatment consisted of temporary rest. There was a recurrence in 1996, and the subperiosteal hematoma was drained. In 1997, a shortening osteotomy of the left tibia was performed. However, massive gigantism with elephantiasis of the left leg remained, causing a serious functional and cosmetic problem. In 1999, the leg was amputated above the knee. The literature is reviewed and 7 case reports are compared. The pathogenesis of subperiosteal hematoma is discussed.

The effect of hand dominance on martial arts strikes.

PubMed

Neto, Osmar Pinto; Silva, Jansen Henrique; Marzullo, Ana Carolina de Miranda; Bolander, Richard P; Bir, Cynthia A

2012-08-01

The main goal of this study was to compare dominant and non-dominant martial arts palm strikes under different circumstances that usually happen during martial arts and combative sports applications. Seven highly experienced (10±5 years) right hand dominant Kung Fu practitioners performed strikes with both hands, stances with left or right lead legs, and with the possibility or not of stepping towards the target (moving stance). Peak force was greater for the dominant hand strikes (1593.76±703.45 N vs. 1042.28±374.16 N; p<.001), whereas no difference was found in accuracy between the hands (p=.141). Additionally, peak force was greater for the strikes with moving stance (1448.75±686.01 N vs. 1201.80±547.98 N; p=.002) and left lead leg stance (1378.06±705.48 N vs. 1269.96±547.08 N). Furthermore, the difference in peak force between strikes with moving and stationary stances was statistically significant only for the strikes performed with a left lead leg stance (p=.007). Hand speed was higher for the dominant hand strikes (5.82±1.08 m/s vs. 5.24±0.78 m/s; p=.001) and for the strikes with moving stance (5.79±1.01 m/s vs. 5.29±0.90 m/s; p<.001). The difference in hand speed between right and left hand strikes was only significant for strikes with moving stance. In summary, our results suggest that the stronger palm strike for a right-handed practitioner is a right hand strike on a left lead leg stance moving towards the target. Copyright © 2011 Elsevier B.V. All rights reserved.

THE EFFECT OF HAND DOMINANCE ON MARTIAL ARTS STRIKES

PubMed Central

Neto, Osmar Pinto; Silva, Jansen Henrique; de Miranda Marzullo, Ana Carolina; Bolander, Richard P.; Bir, Cynthia A.

2011-01-01

The main goal of this study was to compare dominant and non-dominant martial arts palm strikes under different circumstances that usually happen during martial arts and combative sports applications. Seven highly experienced (10 ± 5 years) right hand dominant Kung Fu practitioners performed strikes with both hands, stances with left or right lead legs, and with the possibility or not of stepping towards the target (moving stance). Peak force was greater for the dominant hand strikes (1593.76 ± 703.45 N vs. 1042.28 ± 374.16 N; p < .001), whereas no difference was found in accuracy between the hands (p = .141). Additionally, peak force was greater for the strikes with moving stance (1448.75 ± 686.01 N vs. 1201.80 ± 547.98 N; p = .002) and left lead leg stance (1378.06 ± 705.48 N vs.1269.96 ± 547.08 N). Furthermore, the difference in peak force between strikes with moving and stationary stances was statistically significant only for the strikes performed with a left lead leg stance (p = .007). Hand speed was higher for the dominant hand strikes (5.82 ± 1.08 m/s vs. 5.24 ± 0.78 m/s; p = 0.001) and for the strikes with moving stance (5.79 ± 1.01 m/s vs. 5.29 ± 0.90 m/s; p < .001). The difference in hand speed between right and left hand strikes was only significant for strikes with moving stance. In summary, our results suggest that the stronger palm strike for a right-handed practitioner is a right hand strike on a left lead leg stance moving towards the target. PMID:22047701

Interlimb transfer of motor skill learning during walking: No evidence for asymmetric transfer.

PubMed

Krishnan, Chandramouli; Ranganathan, Rajiv; Tetarbe, Manik

2017-07-01

Several studies have shown that learning a motor skill in one limb can transfer to the opposite limb-a phenomenon called as interlimb transfer. The transfer of motor skills between limbs, however, has shown to be asymmetric, where one side benefits to a greater extent than the other. While this phenomenon has been well-documented in the upper-extremity, evidence for interlimb transfer in the lower-extremity is limited and mixed. This study investigated the extent of interlimb transfer during walking, and tested whether this transfer was asymmetric using a foot trajectory-tracking paradigm that has been specifically used for gait rehabilitation. The paradigm involved learning a new gait pattern which required greater hip and knee flexion during the swing phase of the gait while walking on a treadmill. Twenty young adults were randomized into two equal groups, where one group (right-to-left: RL) practiced the task initially with the dominant right leg and the other group (left-to-right: LR) practiced the task initially with their non-dominant left leg. After training, both groups practiced the task with their opposite leg to test the transfer effects. The changes in tracking error on each leg were computed to quantify learning and transfer effects. The results indicated that practice with one leg improved the motor performance of the other leg; however, the amount of transfer was similar across groups, indicating that there was no asymmetry in transfer. This finding is contradictory to most upper-extremity studies (where asymmetric transfer has been reported) and points out that both differences in neural processes and types of tasks may mediate interlimb transfer. Copyright © 2017 Elsevier B.V. All rights reserved.

Asymmetry of quadriceps muscle oxygenation during elite short-track speed skating.

PubMed

Hesford, Catherine Mary; Laing, Stewart J; Cardinale, Marco; Cooper, Chris E

2012-03-01

It has been suggested that, because of the low sitting position in short-track speed skating, muscle blood flow is restricted, leading to decreases in tissue oxygenation. Therefore, wearable wireless-enabled near-infrared spectroscopy (NIRS) technology was used to monitor changes in quadriceps muscle blood volume and oxygenation during a 500-m race simulation in short-track speed skaters. Six elite skaters, all of Olympic standard (age = 23 ± 1.8 yr, height = 1.8 ± 0.1 m, mass = 80.1 ± 5.7 kg, midthigh skinfold thickness = 7 ± 2 mm), were studied. Subjects completed a 500-m race simulation time trial (TT). Whole-body oxygen consumption was simultaneously measured with muscle oxygenation in right and left vastus lateralis as measured by NIRS. Mean time for race completion was 44.8 ± 0.4 s. VO2 peaked 20 s into the race. In contrast, muscle tissue oxygen saturation (TSI%) decreased and plateaued after 8 s. Linear regression analysis showed that right leg TSI% remained constant throughout the rest of the TT (slope value = 0.01), whereas left leg TSI% increased steadily (slope value = 0.16), leading to a significant asymmetry (P < 0.05) in the final lap. Total muscle blood volume decreased equally in both legs at the start of the simulation. However, during subsequent laps, there was a strong asymmetry during cornering; when skaters traveled solely on the right leg, there was a decrease in its muscle blood volume, whereas an increase was seen in the left leg. NIRS was shown to be a viable tool for wireless monitoring of muscle oxygenation. The asymmetry in muscle desaturation observed on the two legs in short-track speed skating has implications for training and performance.

Risk Factors Related to Lower Limb Edema, Compression, and Physical Activity During Pregnancy: A Retrospective Study.

PubMed

Ochalek, Katarzyna; Pacyga, Katarzyna; Curyło, Marta; Frydrych-Szymonik, Aleksandra; Szygula, Zbigniew

2017-06-01

The aim of the article was to assess risk factors and to analyze methods applied in the prevention and treatment of lower limb edema in pregnant women with a particular focus on compression therapy and exercise. Fifty-four women during the early 24-hour period following delivery were assigned to two groups-either to a group with swellings of lower limbs during pregnancy, located mostly in the region of feet and lower legs (Group A, n = 42), or to a group without edema (Group B, n = 12). Two subgroups, namely A1 and A2, were additionally distinguished in Group A. Compression therapy that consisted in wearing circular-knit compression garments, usually at compression level 1 (ccl1), with three cases of compression level 2 (ccl2) was applied only in Group A1 (n = 18 women). The analysis has led to a conclusion that there is a link between the occurrence of edema during pregnancy on the one hand and the pregravidity episodes of venous conditions (vascular insufficiency and thrombosis, p < 0.05) and the lack of physical exercise during pregnancy (p = 0.01) on the other hand. However, interdependence between the occurrence of edema and the number of times a female had been pregnant, physical activity before gravidity, or body mass index before gravidity has not been identified. Only 33% of the analyzed women applied compression therapy during pregnancy; a half of them continued to apply compression during the postpartum period. Compression therapy in combination with proper physical exercises appears to be an effective means to prevent and treat venous thrombosis and lower limb edema in pregnant women, yet further research in line with the principles of evidence-based medicine is required.

Transient myocardial tissue and function changes during a marathon in less fit marathon runners.

PubMed

Gaudreault, Valerie; Tizon-Marcos, Helena; Poirier, Paul; Pibarot, Philippe; Gilbert, Philippe; Amyot, Marc; Rodés-Cabau, Josep; Després, Jean-Pierre; Bertrand, Olivier; Larose, Eric

2013-10-01

Although regular physical activity improves health, strenuous exercise might transiently increase cardiac risk. Training and fitness might provide protection. We prospectively studied 20 recreational marathon runners without known cardiovascular disease or symptoms: at peak training before, immediately after, and 3 months after a 42.2-km marathon. Changes in global/segmental myocardial function, edema, resting perfusion, and fibrosis were measured. At peak training, runners exercised 8.1 ± 2.3 hours and 62 ± 18 km per week with mean maximal oxygen consumption (VO2max) of 53.2 ± 8.3 mL/kg/min. In response to the marathon, global left ventricular and right ventricular ejection fraction decreased in half of the runners; these runners had poorer peak training distance, training time, and fitness level. Change in global left ventricular ejection fraction was associated with VO2max. Overall, 36% of segments developed edema, 53% decreased function, and 59% decreased perfusion. Significant agreement was observed between segment decreasing function, decreasing perfusion, and developing edema. Myocardial changes were reversible at 3 months. Completing a marathon leads to localized myocardial edema, diminished perfusion, and decreased function occurring more extensively in less trained and fit runners. Although reversible, these changes might contribute to the transient increase in cardiac risk reported during sustained vigorous exercise. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Intractable nausea, vomiting and diarrhea in a Mexican woman with No recent travel history.

PubMed

Dimaunahan, C; Nader, S; Watson, R; Lewin, M R

2000-01-01

A 45-year-old Mexican woman with a history of noninsulin dependent diabetes mellitus (NIDDM), hypertension, and coronary artery disease presented to the hospital after 2 months of intractable nausea, vomiting and diarrhea-all made worse by eating and drinking. She reported fever, chills, anorexia and a documented 50-pound weight loss during this period. She denied the signs and symptoms of melena, hematochezia, steatorrhea or constipation. She also reported left leg pain and decreased sensation and strength of her left leg compared to the right leg. She had been hospitalized 2 weeks prior to admission with the same symptoms and a diagnosis of viral gastroenteritis. She was also treated for H. pylori, but subsequent biopsy results were negative by Steiner stain.

An unusual case of calcineurine inhibitor pain syndrome.

PubMed

Nickavar, Azar; Mehrazma, Mitra; Hallaji, Farideh

2014-09-01

Cyclosporine induced pain syndrome (CIPS) is a newly diagnosed complication of calcineurine inhibitors, mainly observed in solid organ and hematopoetic transplantations. The present case is a male child with steroid resistant nephrotic syndrome on low therapeutic level cyclosporine treatment. He presented with intractable and debilitating leg pain, with no reported history of previous injury or trauma. The pain was reluctant to antimicrobial and sedative treatment. MRI revealed bone marrow and soft tissue edema in the mid shaft of patient's right leg. Inspite of unusual manifestations, CIPS was suggested and cyclosporine discontinued. However, the pain did not improve and was resistant to calcium blocker. Subsequently, core decompression was performed as an unusual treatment of CIPS, revealing normal bone morphology. The pain improved rapidly and the patient was discharged a few days later.

Rapamycin alleviates brain edema after focal cerebral ischemia reperfusion in rats.

PubMed

Guo, Wei; Feng, Guoying; Miao, Yanying; Liu, Guixiang; Xu, Chunsheng

2014-06-01

Brain edema is a major consequence of cerebral ischemia reperfusion. However, few effective therapeutic options are available for retarding the brain edema progression after cerebral ischemia. Recently, rapamycin has been shown to produce neuroprotective effects in rats after cerebral ischemia reperfusion. Whether rapamycin could alleviate this brain edema injury is still unclear. In this study, the rat stroke model was induced by a 1-h left transient middle cerebral artery occlusion using an intraluminal filament, followed by 48 h of reperfusion. The effects of rapamycin (250 μg/kg body weight, intraperitoneal; i.p.) on brain edema progression were evaluated. The results showed that rapamycin treatment significantly reduced the infarct volume, the water content of the brain tissue and the Evans blue extravasation through the blood-brain barrier (BBB). Rapamycin treatment could improve histological appearance of the brain tissue, increased the capillary lumen space and maintain the integrity of BBB. Rapamycin also inhibited matrix metalloproteinase 9 (MMP9) and aquaporin 4 (AQP4) expression. These data imply that rapamycin could improve brain edema progression after reperfusion injury through maintaining BBB integrity and inhibiting MMP9 and AQP4 expression. The data of this study provide a new possible approach for improving brain edema after cerebral ischemia reperfusion by administration of rapamycin.

Laterality of radiographic osteoarthritis of the knee.

PubMed

Komatsu, Daigo; Ikeuchi, Kazuma; Kojima, Toshihisa; Takegami, Yasuhiko; Amano, Takafumi; Tsuboi, Masaki; Ishiguro, Naoki; Hasegawa, Yukiharu

2017-05-01

There are few reports of the laterality in radiological knee osteoarthritis (ROA). This study aimed to evaluate laterality in terms of the minimum joint space width (mJSW) and osteophyte areas (OFs) in a cross-sectorial general population screen and elucidate the association between laterality and risk of osteoarthritis. We enrolled 330 participants (mean age 64.6 years) and examined the presence of ROA (Kellgren-Lawrence grade ≧ 2) laterality in terms of the mJSW and OF on the medial tibia using auto-measuring software. Moreover, we examined the association between laterality and leg dominance. The right and left medial mJSWs were 4.02 ± 0.98 mm and 4.05 ± 1.01 mm, respectively, showing no laterality; the laterals were also similar. The participants who had osteophytes ≥1 mm 2 in the right, left, and bilateral knees were 15, 37, and 57 respectively, with osteophytes being significantly more common in the left knee. The OF was significantly larger in the left knee. Conversely, the medial and lateral mJSWs and OF did not differ according to leg dominance. The prevalence of ROA was higher and the OF was more pronounced in the left knee. However, the mJSW showed no laterality. Additionally, the mJSW and OF showed no differences according to leg dominance.

Effect of venous and lymphatic congestion on lymph capillary pressure of the skin in healthy volunteers and patients with lymph edema.

PubMed

Gretener, S B; Läuchli, S; Leu, A J; Koppensteiner, R; Franzeck, U K

2000-01-01

The aim of the present study was to assess the influence of venous and lymphatic congestion on lymph capillary pressure (LCP) in the skin of the foot dorsum of healthy volunteers and of patients with lymph edema. LCP was measured at the foot dorsum of 12 patients with lymph edema and 18 healthy volunteers using the servo-nulling technique. Glass micropipettes (7-9 microm) were inserted under microscopic control into lymphatic microvessels visualized by fluorescence microlymphography before and during venous congestion. Venous and lymphatic congestion was attained by cuff compression (50 mm Hg) at the thigh level. Simultaneously, the capillary filtration rate was measured using strain gauge plethysmography. The mean LCP in patients with lymph edema increased significantly (p < 0.05) during congestion (15.7 +/- 8.8 mm Hg) compared to the control value (12.2 +/- 8.9 mm Hg). The corresponding values of LCP in healthy volunteers were 4.3 +/- 2.6 mm Hg during congestion and 2.6 +/- 2.8 mm Hg during control conditions (p < 0.01). The mean increase in LCP in patients with lymph edema was 3.4 +/- 4.1 mm Hg, and 1.7 +/- 2.0 mm Hg in healthy volunteers (NS). The maximum spread of the lymph capillary network in patients increased from 13.9 +/- 6.8 mm before congestion to 18.8 +/- 8.2 mm during thigh compression (p < 0.05). No increase could be observed in healthy subjects. In summary, venous and lymphatic congestion by cuff compression at the thigh level results in a significant increase in LCP in healthy volunteers as well as in patients with lymph edema. The increased spread of the contrast medium in the superficial microlymphatics in lymph edema patients indicates a compensatory mechanism for lymphatic drainage during congestion of the veins and lymph collectors of the leg. Copyright 2000 S. Karger AG, Basel

Acute bilateral iliac artery occlusion secondary to blunt trauma: successful endovascular treatment.

PubMed

Sternbergh, W Charles; Conners, Michael S; Ojeda, Melissa A; Money, Samuel R

2003-09-01

Endovascular treatment of blunt vascular trauma has been infrequently reported. A 27-year-old man was crushed between a fork-lift truck and a concrete platform. The physical examination was remarkable for hemodynamic stability, significant lower abdominal ecchymosis and tenderness, obvious pelvic fracture, and gross hematuria. Vascular examination revealed no femoral pulses, no pedal signals bilaterally, and minimal left leg and no right leg motor function. Arteriograms revealed right common iliac artery and external iliac artery occlusion and a 2-cm near occlusion of the left external iliac artery. In the operating room, bilateral common femoral artery access was obtained, and retrograde arteriogram on the right side demonstrated free extravasation of contrast material at the level of the proximal external iliac artery. An angled glide wire was successfully traversed over the vascular injury, and two covered stents (Wallgraft, 10 x 50 mm and 8 x 30 mm) were deployed. The left iliac injury was similarly treated with an 8 x 30-mm covered stent. After calf fasciotomy, exploratory laparotomy revealed a severe sigmoid colon degloving injury, requiring resection and colostomy. A suprapubic catheter was placed because of bladder rupture, and an open-book pelvic fracture was treated with external fixation. Postoperatively the patient regained palpable bilateral pedal pulses and normal left leg function, but right leg paralysis persisted secondary to severe lumbar plexus nerve injury. Endovascular repair of blunt intra-abdominal arterial injuries is possible and should be particularly considered when fecal contamination, pelvic hematoma, or multiple associated injuries make conventional repair problematic.

Influence of unstable footwear on lower leg muscle activity, volume change and subjective discomfort during prolonged standing.

PubMed

Karimi, Zanyar; Allahyari, Teimour; Azghani, Mahmood Reza; Khalkhali, Hamidreza

2016-03-01

The present study was an attempt to investigate the effect of unstable footwear on lower leg muscle activity, volume change and subjective discomfort during prolonged standing. Ten healthy subjects were recruited to stand for 2 h in three footwear conditions: barefoot, flat-bottomed shoe and unstable shoe. During standing, lower leg discomfort and EMG activity of medial gastrocnemius (MG) and tibialis anterior (TA) muscles were continuously monitored. Changes in lower leg volume over standing time also were measured. Lower leg discomfort rating reduced significantly while subjects standing on unstable shoe compared to the flat-bottomed shoe and barefoot condition. For lower leg volume, less changes also were observed with unstable shoe. The activity level and variation of right MG muscle was greater with unstable shoe compared to the other footwear conditions; however regarding the left MG muscle, significant difference was found between unstable shoe and flat-bottomed shoe only for activity level. Furthermore no significant differences were observed for the activity level and variation of TA muscles (right/left) among all footwear conditions. The findings suggested that prolonged standing with unstable footwear produces changes in lower leg muscles activity and leads to less volume changes. Perceived discomfort also was lower for this type of footwear and this might mean that unstable footwear can be used as ergonomic solution for employees whose work requires prolonged standing. Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Intracerebral Hemorrhage Caused by Cerebral Hyperperfusion after Superficial Temporal Artery to Middle Cerebral Artery Bypass for Atherosclerotic Occlusive Cerebrovascular Disease

PubMed Central

Matano, Fumihiro; Murai, Yasuo; Mizunari, Takayuki; Adachi, Koji; Kobayashi, Shiro; Morita, Akio

Few papers have reported detailed accounts of intracerebral hemorrhage caused by cerebral hyperperfusion after superficial temporal artery to middle cerebral artery bypass (STA-MCA) bypass for atherosclerotic occlusive cerebrovascular disease. We report a case of vasogenic edema and subsequent intracerebral hemorrhage caused by the cerebral hyperperfusion syndrome (CHS) after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease disease without intense postoperative blood pressure control. A 63-year-old man with repeating left hemiparesis underwent magnetic resonance angiography (MRA), which revealed right internal carotid artery (ICA) occlusion. We performed a double bypass superficial temporal artery (STA)–middle cerebral artery (MCA) bypass surgery for the M2 and M3 branches. While the patient’s postoperative course was relatively uneventful, he suffered generalized convulsions, and computed tomography revealed a low area in the right frontal lobe on Day 4 after surgery. We considered this lesion to be pure vasogenic edema caused by cerebral hyperperfusion after revascularization. Intravenous drip infusion of a free radical scavenger (edaravone) and efforts to reduce systolic blood pressure to <120 mmHg were continued. The patient experienced severe left hemiparesis and disturbance of consciousness on Day 8 after surgery, due to intracerebral hemorrhage in the right frontal lobe at the site of the earlier vasogenic edema. Brain edema associated with cerebral hyperperfusion after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease should be recognized as a risk factor for intracerebral hemorrhage. The development of brain edema associated with CHS after STA-MCA bypass for atherosclerotic occlusive cerebrovascular disease requires not only intensive control of blood pressure, but also consideration of sedation therapy with propofol. PMID:28664022

T2 mapping provides multiple approaches to characterize muscle involvement in neuromuscular diseases: a cross-sectional study of lower leg muscles in 5–15 year old boys with Duchenne Muscular Dystrophy

PubMed Central

Arpan, Ishu; Forbes, Sean C; Lott, Donovan J; Senesac, Claudia R; Daniels, Michael J; Triplett, William T; Deol, Jasjit K; Sweeney, H Lee; Walter, Glenn A; Vandenborne, Krista

2012-01-01

Purpose Skeletal muscles of children with Duchenne muscular dystrophy (DMD) have enhanced susceptibility to damage and progressive lipid infiltration, which contribute to an increase in magnetic resonance proton transverse relaxation time (T2). Therefore, examining T2 changes in individual muscles may be useful for monitoring disease progression in DMD. In this study we utilized mean T2, percent elevated pixels, and T2 heterogeneity to assess changes in composition of dystrophic muscles. In addition, we used fat saturation (fatsat) to distinguish T2 changes due to edema and inflammation from fat infiltration in muscles. Methods Thirty subjects with DMD and 15 age-matched controls underwent T2-weighted imaging of their lower leg using 3-T MR system. T2 maps were developed and four lower leg muscles were manually traced (soleus, medial gastrocnemius, peroneal and tibialis anterior). Mean T2 of the traced regions of interest (ROI), width of T2 histograms, and percent-elevated pixels were calculated. Results We found that even in young children with DMD, muscles had elevated mean T2, were more heterogeneous, and had a greater percent-elevated pixels in the lower leg muscles than controls. T2 measures decreased with fat saturation, but were still higher (p<0.05) in dystrophic muscles than controls. Further, T2 measures showed positive correlations with timed functional tests (r=0.23–0.79). Conclusion The elevated T2 measures with and without fat saturation in all ages of DMD examined (5–15 years) compared to unaffected controls indicate that the dystrophic muscles have increased regions of damage, edema, and fat infiltration. This study shows that T2 mapping provides multiple approaches that can be effectively utilized to characterize muscle tissue in children with DMD even in the early stages of the disease. Therefore, T2 mapping may prove clinically useful in monitoring muscle changes due to disease process or therapeutic interventions in DMD. PMID:23044995

T₂ mapping provides multiple approaches for the characterization of muscle involvement in neuromuscular diseases: a cross-sectional study of lower leg muscles in 5-15-year-old boys with Duchenne muscular dystrophy.

PubMed

Arpan, Ishu; Forbes, Sean C; Lott, Donovan J; Senesac, Claudia R; Daniels, Michael J; Triplett, William T; Deol, Jasjit K; Sweeney, H Lee; Walter, Glenn A; Vandenborne, Krista

2013-03-01

Skeletal muscles of children with Duchenne muscular dystrophy (DMD) show enhanced susceptibility to damage and progressive lipid infiltration, which contribute to an increase in the MR proton transverse relaxation time (T₂). Therefore, the examination of T₂ changes in individual muscles may be useful for the monitoring of disease progression in DMD. In this study, we used the mean T₂, percentage of elevated pixels and T₂ heterogeneity to assess changes in the composition of dystrophic muscles. In addition, we used fat saturation to distinguish T₂ changes caused by edema and inflammation from fat infiltration in muscles. Thirty subjects with DMD and 15 age-matched controls underwent T₂ -weighted imaging of their lower leg using a 3-T MR system. T₂ maps were developed and four lower leg muscles were manually traced (soleus, medial gastrocnemius, peroneal and tibialis anterior). The mean T₂ of the traced regions of interest, width of the T₂ histograms and percentage of elevated pixels were calculated. We found that, even in young children with DMD, lower leg muscles showed elevated mean T₂, were more heterogeneous and had a greater percentage of elevated pixels than in controls. T₂ measures decreased with fat saturation, but were still higher (P < 0.05) in dystrophic muscles than in controls. Further, T₂ measures showed positive correlations with timed functional tests (r = 0.23-0.79). The elevated T₂ measures with and without fat saturation at all ages of DMD examined (5-15 years) compared with unaffected controls indicate that the dystrophic muscles have increased regions of damage, edema and fat infiltration. This study shows that T₂ mapping provides multiple approaches that can be used effectively to characterize muscle tissue in children with DMD, even in the early stages of the disease. Therefore, T₂ mapping may prove to be clinically useful in the monitoring of muscle changes caused by the disease process or by therapeutic interventions in DMD. Copyright © 2012 John Wiley & Sons, Ltd.

The effect of air bubbles on rabbit blood brain barrier.

PubMed

Hjelde, A; Bolstad, G; Brubakk, A O

2002-01-01

Several investigators have claimed that the blood brain barrier (BBB) may be broken by circulating bubbles, resulting in brain tissue edema. The aim of this study was to examine the effect of air bubbles on the permeability of BBB. Three groups of 6 rabbits were infused an isoosmotic solution of NaCl w/macrodex and 1% Tween. The solution was saturated with air bubbles and infused at rates of 50-100 ml hr(-1), a total of 1.6, 3.3, or 6.6 ml in each group, respectively. Two groups, each consisting of 6 rabbits, served as controls; one was infused by a degassed isoosmotic NaCl solution and one was sham-operated. All animals were left for 30 min before they were sacrificed. Specific gravity of brain tissue samples was determined using a brombenzene/kerosene gradient column, where a decrease in specific gravity indicates local brain edema. Specific gravity was significantly lower for left (P = 0.037) and right (P = 0.012) hemisphere white matter and left (P = 0.0015) and right (P = 0.002) hemisphere gray matter for the bubble-infused animals compared to the sham-operated ones. Infusion of degassed NaCl solution alone affected white left (P= 0.011) and right (P= 0.013), but not gray matter of both hemispheres. We speculate that insufficient degassing of the fluid may cause the effect of NaCl solution on the BBB of the white matter, indicating that the vessels of the white matter are more sensitive to gas bubbles than gray matter. Increasing the number of infused bubbles had no further impact on the development of cerebral edema, indicating that a threshold value was reached already at the lowest concentration of bubbles.

Handball Practice Enhances Bone Mass in Specific Sites Among Prepubescent Boys.

PubMed

Missawi, Kawther; Zouch, Mohamed; Chakroun, Yosra; Chaari, Hamada; Tabka, Zouhair; Bouajina, Elyès

2016-01-01

This investigation's purpose is to focus on the effects of practicing handball for at least 2 yr on bone acquisition among prepubescent boys. One hundred prepubescent boys aged 10.68 ± 0.85 yr were divided into 2 groups: 50 handball players (HP group) and 50 controls (C group). Bone mineral density (BMD), bone mineral content (BMC), and bone area (BA) were evaluated by using dual-photon X-ray absorptiometry on the whole body, lumbar spine (L2-L4), legs, arms, femoral necks, hips and radiuses. Results showed greater values of BMD in both right and left femoral neck and total hip in handball players than in controls. In addition, handball players had higher values of legs and right total hip BMC than controls without any obvious variation of BA measurement in all sites between groups. All results of the paired t-test displayed an obviously marked variation of bone mass parameters between the left and right sides in the trained group without any marked variation among controls. Data showed an increased BMD of the supporting sites between the left and the right leg among handball players. However, "BMC" results exhibited higher values in the right than in the left total hip, and in the right total radius than in the left correspondent site. In addition, differences in the "BA" measurements were observed in the left total hip and in the right arm. Specific bone sites are markedly stimulated by handball training in prepubescent boys. Copyright © 2016 International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Do oarsmen have asymmetries in the strength of their back and leg muscles?

PubMed

Parkin, S; Nowicky, A V; Rutherford, O M; McGregor, A H

2001-07-01

The aim of this study was to establish whether asymmetry of the strength of the leg and trunk musculature is more prominent in rowers than in controls. Nineteen oarsmen and 20 male controls matched for age, height and body mass performed a series of isokinetic and isometric strength tests on an isokinetic dynamometer. These strength tests focused on the trunk and leg muscles. Comparisons of strength were made between and within groups for right and left symmetry patterns, hamstring: quadriceps ratios, and trunk flexor and extensor ratios. The results revealed no left and right asymmetries in either the knee extensor or flexor strength parameters (including both isometric and isokinetic measures). Knee extensor strength was significantly greater in the rowing population, but knee flexor strength was similar between the two groups. No difference was seen between the groups for the hamstring: quadriceps strength ratio. In the rowing population, stroke side had no influence on leg strength. No differences were observed in the isometric strength of the trunk flexors and extensors between groups, although EMG activity was significantly higher in the rowing population. Patterns of asymmetry of muscle activity were observed between the left and right erector spinae muscles during extension, which was significantly related to rowing side (P < 0.01). These observations could be related to the high incidence of low back pain in oarsmen.

Simulation studies on multi-mode heat transfer from an open cavity with a flush-mounted discrete heat source

NASA Astrophysics Data System (ADS)

Gururaja Rao, C.; Nagabhushana Rao, V.; Krishna Das, C.

2008-04-01

Prominent results of a simulation study on conjugate convection with surface radiation from an open cavity with a traversable flush mounted discrete heat source in the left wall are presented in this paper. The open cavity is considered to be of fixed height but with varying spacing between the legs. The position of the heat source is varied along the left leg of the cavity. The governing equations for temperature distribution along the cavity are obtained by making energy balance between heat generated, conducted, convected and radiated. Radiation terms are tackled using radiosity-irradiation formulation, while the view factors, therein, are evaluated using the crossed-string method of Hottel. The resulting non-linear partial differential equations are converted into algebraic form using finite difference formulation and are subsequently solved by Gauss Seidel iterative technique. An optimum grid system comprising 111 grids along the legs of the cavity, with 30 grids in the heat source and 31 grids across the cavity has been used. The effects of various parameters, such as surface emissivity, convection heat transfer coefficient, aspect ratio and thermal conductivity on the important results, including local temperature distribution along the cavity, peak temperature in the left and right legs of the cavity and relative contributions of convection and radiation to heat dissipation in the cavity, are studied in great detail.

Transthoracic lung ultrasound in normal dogs and dogs with cardiogenic pulmonary edema: a pilot study.

PubMed

Rademacher, Nathalie; Pariaut, Romain; Pate, Julie; Saelinger, Carley; Kearney, Michael T; Gaschen, Lorrie

2014-01-01

Pulmonary edema is the most common complication of left-sided heart failure in dogs and early detection is important for effective clinical management. In people, pulmonary edema is commonly diagnosed based on transthoracic ultrasonography and detection of B line artifacts (vertical, narrow-based, well-defined hyperechoic rays arising from the pleural surface). The purpose of this study was to determine whether B line artifacts could also be useful diagnostic predictors for cardiogenic pulmonary edema in dogs. Thirty-one normal dogs and nine dogs with cardiogenic pulmonary edema were prospectively recruited. For each dog, presence or absence of cardiogenic pulmonary edema was based on physical examination, heartworm testing, thoracic radiographs, and echocardiography. A single observer performed transthoracic ultrasonography in all dogs and recorded video clips and still images for each of four quadrants in each hemithorax. Distribution, sonographic characteristics, and number of B lines per thoracic quadrant were determined and compared between groups. B lines were detected in 31% of normal dogs (mean 0.9 ± 0.3 SD per dog) and 100% of dogs with cardiogenic pulmonary edema (mean 6.2 ± 3.8 SD per dog). Artifacts were more numerous and widely distributed in dogs with congestive heart failure (P < 0.0001). In severe cases, B lines increased in number and became confluent. The locations of B line artifacts appeared consistent with locations of edema on radiographs. Findings from the current study supported the use of thoracic ultrasonography and detection of B lines as techniques for diagnosing cardiogenic pulmonary edema in dogs. © 2014 American College of Veterinary Radiology.

Recovery from Diabetic Macular Edema in a Diabetic Patient After Minimal Dose of a Sodium Glucose Co-Transporter 2 Inhibitor.

PubMed

Yoshizumi, Hideyuki; Ejima, Tetsushi; Nagao, Tetsuhiko; Wakisaka, Masanori

2018-04-19

BACKGROUND Diabetic macular edema (DME) causes serious visual impairments in diabetic patients. The standard treatments of DME are intra-vitreous injections of corticosteroids or anti-vascular endothelial growth factor antibodies and pan-photocoagulation. These treatments are unsatisfactory in their effects and impose considerable physical and economic burdens on the patients. CASE REPORT A 63-year-old woman was diagnosed as type 2 diabetes with retinopathy 7 years ago. Before the initiation of an SGLT2 inhibitor, the dipeptidyl peptidase-4 inhibitor, sitagliptin (50 mg daily), and metformin (250 mg dai- ly) were used for her glycemic control. The level of her hemoglobin A1c had been controlled around 7%. She began to feel decreased visual acuity and blurred vision of her left eye 8 months before the visit to our clin- ic. She was diagnosed as DME, which turned out to be corticosteroid-resistant. Her visual acuity further de- creased to 20/50. Metformin was changed to ipraglifl (25mg/day). Her left visual acuity started to improve after 4 weeks of treatment with ipragliflozin and improved to 20/22 after 24 weeks. The macular edema did not change until 12 weeks of the treatment, however, it decreased prominently after 16 weeks. CONCLUSIONS In our patient with steroid-resistant DME, her visual symptoms and macular edema recovered after the initiation of an SGLT2 inhibitor. SGLT2 inhibitors might be a potential candidate for the DME treatment.

Lower extremity kinematics of athletics curve sprinting.

PubMed

Alt, Tobias; Heinrich, Kai; Funken, Johannes; Potthast, Wolfgang

2015-01-01

Curve running requires the generation of centripetal force altering the movement pattern in comparison to the straight path run. The question arises which kinematic modulations emerge while bend sprinting at high velocities. It has been suggested that during curve sprints the legs fulfil different functions. A three-dimensional motion analysis (16 high-speed cameras) was conducted to compare the segmental kinematics of the lower extremity during the stance phases of linear and curve sprints (radius: 36.5 m) of six sprinters of national competitive level. Peak joint angles substantially differed in the frontal and transversal plane whereas sagittal plane kinematics remained unchanged. During the prolonged left stance phase (left: 107.5 ms, right: 95.7 ms, straight: 104.4 ms) the maximum values of ankle eversion (left: 12.7°, right: 2.6°, straight: 6.6°), hip adduction (left: 13.8°, right: 5.5°, straight: 8.8°) and hip external rotation (left: 21.6°, right: 12.9°, straight: 16.7°) were significantly higher. The inside leg seemed to stabilise the movement in the frontal plane (eversion-adduction strategy) whereas the outside leg provided and controlled the motion in the horizontal plane (rotation strategy). These results extend the principal understanding of the effects of curve sprinting on lower extremity kinematics. This helps to increase the understanding of nonlinear human bipedal locomotion, which in turn might lead to improvements in athletic performance and injury prevention.

Exploring Ways to Improve DTAG Deployment Success Rates With the ARTS Pneumatic Launcher

DTIC Science & Technology

2010-01-01

absorber system has been developed, (the giraffe leg technique or GL, Figure 2), which has the shock absorbing component in front of the tag. The ARTS...3 Figure 2: the new 1- and 4-spring shock absorbing robot (left) and the GL ( giraffe leg technique) with 3 studs (right) WORK

Selecting a treatment for primary varicose veins.

PubMed Central

Tremblay, J; Lewis, E W; Allen, P T

1985-01-01

The treatment of varicose veins includes injection/compression sclerotherapy and surgical stripping or ligation or both. Surgery appears to be favoured when the saphenous system is involved or when the patient is 35 to 64 years old or presents with ankle edema or flare. On the other hand, sclerotherapy has been found to be more effective in patients with dilated superficial veins or incompetent perforating veins in the lower legs and to be more acceptable and less expensive than surgical treatment. PMID:3891060

Specificity and sensitivity of noninvasive measurement of pulmonary vascular protein leak.

PubMed

Dauber, I M; Pluss, W T; VanGrondelle, A; Trow, R S; Weil, J V

1985-08-01

Noninvasive techniques employing external counting of radiolabeled protein have the potential for measuring pulmonary vascular protein permeability, but their specificity and sensitivity remain unclear. We tested the specificity and sensitivity of a double-radioisotope method by injecting radiolabeled albumin (131I) and erythrocytes (99mTc) into anesthetized dogs and measuring the counts of each isotope for 150 min after injection with an external gamma probe fixed over the lung. We calculated the rate of increase of albumin counts measured by the probe (which reflects the rate at which protein leaks into the extravascular space). To assess permeability we normalized the rate of increase in albumin counts for changes in labeled erythrocyte signal to minimize influence of changes in vascular surface area and thus derived an albumin leak index. We measured the albumin leak index and gravimetric lung water during hydrostatic edema (acutely elevating left atrial pressure by left atrial balloon inflation: mean pulmonary arterial wedge pressure = 22.6 Torr) and in lung injury edema induced by high- (1.0 g/kg) and low-dose (0.25 g/kg) intravenous thiourea. To test specificity we compared hydrostatic and high-dose thiourea edema. The albumin leak index increased nearly fourfold from control after thiourea injury (27.2 +/- 2.3 X 10-4 vs. 7.6 +/- 0.9 X 10-4 min-1) but did not change from control levels after elevating left atrial pressure (8.9 +/- 1.2 X 10-4 min-1) despite comparable increases in gravimetric lung water. To test sensitivity we compared low-dose thiourea with controls. Following low-dose thiourea, the albumin leak index nearly doubled despite the absence of a measurable increase in lung water. We conclude that a noninvasive double radioisotope measurement of pulmonary vascular protein leak, employing external counting techniques and a simplified method of calculation, is specific for lung injury and is also sensitive enough to detect lung injury insufficient to produce detectable pulmonary edema.

Effects of experimental leg length discrepancies on body posture and dental occlusion.

PubMed

Maeda, Nozomi; Sakaguchi, Kiwamu; Mehta, Noshir R; Abdallah, Emad F; Forgione, Albert G; Yokoyama, Atsuro

2011-07-01

The purpose of this study was to quantitatively evaluate the effects of experimental leg length discrepancies on body posture and dental occlusion. Thirty asymptomatic subjects (15 males and 15 females, ages 19-33, mean age 25.6 years) were included in this study and randomly assigned to one of two groups based on a table of random numbers. The only difference between group A and group B was the sequence of testing. Experimental leg length discrepancies were provided by using ten types of insoles with heights ranging from one to ten mm at one mm intervals, placed under both feet. The MatScan (Nitta Corp., Osaka, Japan) system was used to measure changes in body posture (center of foot pressure: COP) while subjects maintained the following three postural positions: 1. natural standing posture (control); 2. control with a heel lift under the right foot; or 3. control with a heel lift under the left foot. The T-Scan II system (Nitta Corp., Osaka, Japan) was used to analyze the results of changes in dental occlusion (center of occlusal force: COF) in the above-mentioned three postural positions. When subjects used a heel lift of six mm or more under the right foot, lateral weight distribution (LWD) shifted to the right side compared to the control (p<0.05). When a heel lift of four mm or more was used under the left foot, LWD shifted to the left side compared to the control (p<0.05). When subjects used a heel lift of eight mm or more under the right foot, occlusal force shifted to the right side compared to the control (p<0.05). When subjects used a heel lift of seven mm or more under the left foot, occlusal force shifted to the left side compared to the control (p<0.05). Based on these findings, it was concluded that leg length discrepancy affected body posture and dental occlusion.

Urban School Principals and the "No Child Left Behind" Act

ERIC Educational Resources Information Center

Gardiner, Mary E.; Canfield-Davis, Kathy; Anderson, Keith LeMar

2009-01-01

This exploratory study investigated how six practicing school principals responded to the requirements of the No Child Left Behind law (United States Congress Public Law 107-110, 2002, January, No Child Left Behind Act, http://www.ed.gov/policy/elsec/leg/esea02/107-110.pdf ) in light of the multicultural leadership demands presented by an urban…

Unusual neurological syndrome induced by atmospheric pressure change.

PubMed

Ptak, Judy A; Yazinski, Nancy A; Block, Clay A; Buckey, Jay C

2013-05-01

We describe a case of a 46-yr-old female who developed hypertension, tachycardia, dysarthria, and leg weakness provoked by pressure changes associated with flying. Typically during the landing phase of flight, she would feel dizzy and note that she had difficulty with speech and leg weakness. After the flight the leg weakness persisted for several days. The symptoms were mitigated when she took a combined alpha-beta blocker (labetalol) prior to the flight. To determine if these symptoms were related to atmospheric pressure change, she was referred for testing in a hyperbaric chamber. She was exposed to elevated atmospheric pressure (maximum 1.2 ATA) while her heart rate and blood pressure were monitored. Within 1 min she developed tachycardia and hypertension. She also quickly developed slurred speech, left arm and leg weakness, and sensory changes in her left leg. She was returned to sea level pressure and her symptoms gradually improved. A full neurological workup has revealed no explanation for these findings. She has no air collections, cysts, or other anatomic findings that could be sensitive to atmospheric pressure change. The pattern is most consistent with a vascular event stimulated by altitude exposure. This case suggests that atmospheric pressure change can produce neurological symptoms, although the mechanism is unknown.

Role of outstretched forelegs of flying beetles revealed and demonstrated by remote leg stimulation in free flight.

PubMed

Li, Yao; Cao, Feng; Vo Doan, Tat Thang; Sato, Hirotaka

2017-10-01

In flight, many insects fold their forelegs tightly close to the body, which naturally decreases drag or air resistance. However, flying beetles stretch out their forelegs for some reason. Why do they adopt this posture in flight? Here, we show the role of the stretched forelegs in flight of the beetle Mecynorrhina torquata Using leg motion tracking and electromyography in flight, we found that the forelegs were voluntarily swung clockwise in yaw to induce counter-clockwise rotation of the body for turning left, and vice versa. Furthermore, we demonstrated remote control of left-right turnings in flight by swinging the forelegs via a remote electrical stimulator for the leg muscles. The results and demonstration reveal that the beetle's forelegs play a supplemental role in directional steering during flight. © 2017. Published by The Company of Biologists Ltd.

Lateralization of splay posture in reticulated giraffe (Giraffa camelopardalis reticulate).

PubMed

Svoke, Joseph T

2017-02-01

Motor laterality is quite often studied in non-human primates, but rarely has been investigated within ungulates. The aim of the study was to use the naturally occurring splay behavior in giraffe as a method to look for the presence of laterality. Four male giraffes housed at Zoo Atlanta were watched for three months, recording their first leg moved to begin the splay posture and the total number of leg movements to achieve a secure stance. All four giraffe significantly moved their left leg first to begin the stance, which suggests at least individual level laterality. However, using the number of leg movements overall, the last leg moved was only significant in one individual. Copyright © 2016. Published by Elsevier B.V.

Aquaporin-1 Deficiency Protects Against Myocardial Infarction by Reducing Both Edema and Apoptosis in Mice

PubMed Central

Li, Lihua; Weng, Zhiyong; Yao, Chenjuan; Song, Yuanlin; Ma, Tonghui

2015-01-01

Many studies have determined that AQP1 plays an important role in edema formation and resolution in various tissues via water transport across the cell membrane. The aim of this research was to determine both if and how AQP1 is associated with cardiac ischemic injury, particularly the development of edema following myocardial infarction (MI). AQP1+/+ and AQP1−/− mice were used to create the MI model. Under physiological conditions, AQP1−/− mice develop normally; however, in the setting of MI, they exhibit cardioprotective properties, as shown by reduced cardiac infarct size determined via NBT staining, improved cardiac function determined via left ventricular catheter measurements, decreased AQP1-dependent myocardial edema determined via water content assays, and decreased apoptosis determined via TUNEL analysis. Cardiac ischemia caused by hypoxia secondary to AQP1 deficiency stabilized the expression of HIF-1α in endothelial cells and subsequently decreased microvascular permeability, resulting in the development of edema. The AQP1-dependent myocardial edema and apoptosis contributed to the development of MI. AQP1 deficiency protected cardiac function from ischemic injury following MI. Furthermore, AQP1 deficiency reduced microvascular permeability via the stabilization of HIF-1α levels in endothelial cells and decreased cellular apoptosis following MI. PMID:26348407

The laterality of the gallop gait in Thoroughbred racehorses

PubMed Central

Cully, Paulette; Lancaster, Bryony

2018-01-01

Laterality can be observed as side biases in locomotory behaviour which, in the horse, manifest inter alia as forelimb preferences, most notably in the gallop. The current study investigated possible leading-leg preferences at the population and individual level in Thoroughbred racehorses (n = 2095) making halt-to-gallop transitions. Videos of flat races in the UK (n = 350) were studied to record, for each horse, the lead-leg preference of the initial stride into gallop from the starting stalls. Races from clockwise (C) and anti-clockwise (AC) tracks were chosen alternately at random to ensure equal representation. Course direction, horse age and sex, position relative to the inside rail and finishing position were also noted. On C courses, the left/right ratio was 1.15, which represents a significant bias to the left (z = –2.29, p = 0.022), while on AC courses it was 0.92 (z = 0.51, p = 0.610). In both course directions, there was no significant difference between winning horses that led with the left leading leg versus the right (C courses, z = –1.32, p = 0.19 and AC courses, z = –0.74, p = 0.46). Of the 2,095 horses studied 51.26% led with their L fore and 48.74% with their R, with no statistically significant difference (z = -1.16, p = 0.25). Therefore, there was no evidence of a population level motor laterality. Additionally, 22 male and 22 female horses were randomly chosen for repeated measures of leading leg preference. A laterality index was calculated for each of the 44 horses studied using the repeated measures: 22 exhibited right laterality (of which two were statistically significant) and 21 exhibited left laterality (eight being statistically significant); one horse was ambilateral. Using these data, left lateralized horses were more strongly lateralized on an individual level than the right lateralized horses (t = 2.28, p = 0.03, DF = 34) and mares were more left lateralized than males (t = 2.4, p = 0.03, DF = 19). PMID:29883459

Cardiogenic Pulmonary Edema in a Dog Following Initiation of Therapy for Concurrent Hypoadrenocorticism and Hypothyroidism.

PubMed

Paik, Jooyae; Kang, Ji-Houn; Chang, Dongwoo; Yang, Mhan-Pyo

A 5 yr old intact female cocker spaniel dog weighing 7.8 kg was referred with anorexia, vomiting, and depression. At referral, the dog was diagnosed initially with typical hypoadrenocorticism, and 2 d later, concurrent primary hypothyroidism was detected. Hormonal replacement therapies, including fludrocortisone, prednisolone, and levothyroxine, were initiated, but a few days later the dog became abruptly tachypneic, and thoracic radiographs indicated the development of pulmonary edema. Echocardiography showed that there were abnormalities indicating impaired left ventricular function, although the heart valves were normal. Following treatment with pimobendan and furosemide, the pulmonary edema resolved. The dog had no recurrence of the clinical signs after 10 mo of follow-up, despite being off all cardiac medications; consequently, the cardiac failure was transient or reversible in this dog. The case report describes the stepwise diagnosis and successful treatment of cardiogenic pulmonary edema after initiation of hormonal replacement therapy for concurrent hypoadrenocorticism and hypothyroidism in a dog.

49 CFR 572.5 - General description.

Code of Federal Regulations, 2010 CFR

2010-10-01

... M080—Right leg assembly SA 150 M081—Left leg assembly SA 150 M010—Head assembly SA 150 M020—Neck... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES 50th Percentile Male § 572... grouped by component assemblies under the following nine headings: SA 150 M070—Right arm assembly SA 150...

Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine.

PubMed

Yadav, Prakash Kumar; Yadav, Ram Lochan; Sharma, Deepak; Shah, Dev Kumar; Thakur, Dilip; Limbu, Nirmala; Islam, Md Nazrul

2017-03-01

The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs. To evaluate the influence of chronic and strenuous paddling on right and left sural nerves. The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student's t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of ≤ 0.05 was considered significant. Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (μv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group. Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

Nerve Conduction Study on Sural Nerve among Nepalese Tailors Using Mechanical Sewing Machine

PubMed Central

Yadav, Ram Lochan; Sharma, Deepak; Shah, Dev Kumar; Thakur, Dilip; Limbu, Nirmala; Islam, Md. Nazrul

2017-01-01

Introduction The use of new technologies and innovations are out of access for people living in a developing country like Nepal. The mechanical sewing machine is still in existence at a large scale and dominant all over the country. Tailoring is one of the major occupations adopted by skilled people with lower socioeconomic status and education level. Sural nerves of both right and left legs are exposed to strenuous and chronic stress exerted by chronic paddling of mechanical sewing machine with legs. Aim To evaluate the influence of chronic and strenuous paddling on right and left sural nerves. Materials and Methods The study recruited 30 healthy male tailors with median age {34(31-37.25)} years (study group), and, 30 healthy male volunteers with age {34(32-36.25)} years (control group). Anthropometric measurements (age, height, weight, BMI and length of both right and left legs) as well as cardio respiratory measurements [Systolic Blood Pressure (SBP), Dystolic Blood Pressure (DBP), Pules Rate (PR) and Respiratory Rate (RR)] were recorded for each subject. Standard nerve conduction techniques using constant measured distances were applied to evaluate sural nerve (sensory) in both legs of each individual. The differences in variables between the study and control groups were tested using Student’s t-test for parametric variables and Mann-Whitney U test for nonparametric variables. A p-value of ≤ 0.05 was considered significant. Results Age, height, weight, body mass index and leg length were not significantly different between tailors and control groups. Cardio respiratory measurements (SBP, DBP, PR and RR) were also not significantly altered between both the groups. The sensory nerve conduction velocities (m/s) of the right {44.23(42.72-47.83) vs 50(46- 54)} and left sural nerves {45.97±5.86 vs 50.67±6.59} m/s were found significantly reduced in tailors in comparison to control group. Similarly amplitudes (μv) of right sural (20.75±5.42 vs 24.10±5.45) and left sural nerves {18.2(12.43-21.8) vs 32.0(26.5-35.25)} were significantly less in tailors in comparison to control group whereas, latencies (ms) of right sural {2.6(2.2-2.7) vs 2.0(2.0-2.250} and left sural nerve {2.4(2.07-2.72) vs 2.0(2.0-2.0)} were found significantly high in tailors as compared with control group. Conclusion Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left sural nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy. PMID:28511376

Refeeding syndrome in Southeastern Taiwan: Our experience with 11 cases

PubMed Central

Chen, Li-Ju; Chen, Huan-Lin; Bair, Ming-Jong; Wu, Chia-Hsien; Lin, I-Tsung; Lee, Yuan-Kai; Chu, Cheng-Hsin

2014-01-01

AIM: To present our experience with refeeding syndrome in southeastern Taiwan. METHODS: We conducted a retrospective study during a 2-year period at the Mackay Memorial Hospital, Taitung Branch. We enrolled patients with very little or no nutrition intake for more than 10 d, a high risk group of refeeding syndrome, including those suffering from alcohol abuse, cancerous cachexia, chronic malnutrition, and prolonged starvation. RESULTS: A total of 11 patients (7 males, 4 females) with nasogastric feeding were included as having refeeding syndrome. Most of them had the symptoms of diarrhea, lethargy, and leg edema. The initial nutritional supplement was found to be relatively high in calories (1355.1 ± 296.2 kcal/d), high in protein (47.3 ± 10.4 gm/d), low in vitamin B1 (2.0 ± 0.5 mg/d), low in potassium (1260.4 ± 297.7 mg/d), and low in phosphorus (660.1 ± 151.8 mg/d). Furthermore, hypophosphatemia (2.4 ± 0.9 mg/dL) was noted during follow-up. Based on the suggestions of a dietician and a gastroenterologist, the clinical disorders of diarrhea, malaise and leg edema were significantly improved. The level of phosphate was also increased (3.3 ± 0.6 mg/dL). CONCLUSION: Refeeding syndrome is an overlooked and risky disorder that has some potentially fatal complications. Nasogastric feeding in nursing homes is an important risk factor for patients and deserves greater attention based on the initial results of this study. PMID:25132771

Refeeding syndrome in Southeastern Taiwan: our experience with 11 cases.

PubMed

Chen, Li-Ju; Chen, Huan-Lin; Bair, Ming-Jong; Wu, Chia-Hsien; Lin, I-Tsung; Lee, Yuan-Kai; Chu, Cheng-Hsin

2014-08-14

To present our experience with refeeding syndrome in southeastern Taiwan. We conducted a retrospective study during a 2-year period at the Mackay Memorial Hospital, Taitung Branch. We enrolled patients with very little or no nutrition intake for more than 10 d, a high risk group of refeeding syndrome, including those suffering from alcohol abuse, cancerous cachexia, chronic malnutrition, and prolonged starvation. A total of 11 patients (7 males, 4 females) with nasogastric feeding were included as having refeeding syndrome. Most of them had the symptoms of diarrhea, lethargy, and leg edema. The initial nutritional supplement was found to be relatively high in calories (1355.1 ± 296.2 kcal/d), high in protein (47.3 ± 10.4 gm/d), low in vitamin B1 (2.0 ± 0.5 mg/d), low in potassium (1260.4 ± 297.7 mg/d), and low in phosphorus (660.1 ± 151.8 mg/d). Furthermore, hypophosphatemia (2.4 ± 0.9 mg/dL) was noted during follow-up. Based on the suggestions of a dietician and a gastroenterologist, the clinical disorders of diarrhea, malaise and leg edema were significantly improved. The level of phosphate was also increased (3.3 ± 0.6 mg/dL). Refeeding syndrome is an overlooked and risky disorder that has some potentially fatal complications. Nasogastric feeding in nursing homes is an important risk factor for patients and deserves greater attention based on the initial results of this study.

Preliminary Evaluation of a Diagnostic Tool for Prosthetics

DTIC Science & Technology

2017-10-01

volume change. Processing algorithms for data from the activity monitors were modified to run more efficiently so that large datasets could be...left) and blade style prostheses (right). Figure 4: Ankle ActiGraph correct position demonstrated for a left leg below-knee amputee cylindrical

In reply to: "Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation".

PubMed

Privratsky, Jamie R; Diaz, Sebastian; Nicoara, Alina; Daneshmand, Mani A

2018-05-01

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is an increasingly utilized life-saving measure. However, left-ventricular distention from inadequate left-ventricular off-loading can lead to unwanted pulmonary and cardiac complications. We are writing to indicate our agreement with a recent article by Brechot et al. published in the June 2017 issue where the authors demonstrated that intra-aortic balloon pump provides mechanical support to off-load the left ventricle during VA-ECMO, which prevents pulmonary edema.

The lower body muscle activation of intermediate to experienced kayakers when navigating white water.

PubMed

Murtagh, Misha; Brooks, Darrell; Sinclair, Jonathan; Atkins, Stephen

2016-11-01

In white-water kayaking, the legs play a vital part in turning, stabilising and bracing actions. To date, there has been no reported information on neuromuscular activation of the legs in an authentic white-water environment. The aim of the current study was to identify lower body muscle activation, using 'in-boat' electromyography (EMG), whilst navigating a white-water run. Ten experienced male kayakers (age 31.5 ± 12.5 yr, intermediate to advanced experience) completed three successful runs of an international standard white-water course (grade 3 rapids), targeting right and left sides of the course, in a zigzag formation. Surface EMG (sEMG) outputs were generated, bilaterally, for the rectus femoris (RF), vastus lateralis, biceps femoris and gastrocnemius, expressed as a percentage of a dynamic maximal voluntary contraction (dMVC). Only RF showed significantly higher activation than any muscle on the left side of the body, and only on the left side of the course (P = .004; ETA(2) = 0.56). Other results showed no significant difference between muscle activation in the right and left legs during each run, nor when assessed at either the right or left side of the course (P > .05). These findings indicate that contralateral symmetry in lower limb muscle activation is evident during white-water kayaking. This symmetry may provide a stable base to allow more asymmetrical upper body and trunk movements to be fully optimised. Lower body symmetry development should be considered useful in targeted training programmes for white-water kayakers.

Ventilation with positive end-expiratory pressure reduces extravascular lung water and increases lymphatic flow in hydrostatic pulmonary edema.

PubMed

Fernández Mondéjar, E; Vazquez Mata, G; Cárdenas, A; Mansilla, A; Cantalejo, F; Rivera, R

1996-09-01

To analyze the effect of different levels of positive end-expiratory pressure (PEEP) on extravascular lung water and on lymphatic drainage through the thoracic duct during hydrostatic pulmonary edema. Randomized, controlled, experimental study. Research laboratory of a tertiary care hospital. Eighteen beagle dogs weighing between 10 and 19 kg. Dogs were anesthetized and cannulated via a thoracic duct. Hydrostatic pulmonary edema was provoked by inflating the balloon of a Foley catheter in the left atrium. Different amounts of PEEP were applied. Extravascular lung water was determined by the double indicator dilution method (indocyanine green in glucoside solution at 0 degree C), and lymphatic drainage was measured every 30 mins. After a baseline measurement, the left atrial pressure was increased to 24 to 26 mm Hg, and measurements were recorded after 30, 60, 90, and 120 mins. The animals were divided into three groups. Group I (n = 6): PEEP of 20 cm H2O was instituted at 120 mins, and the other determinations were made without PEEP; group II (n = 7): PEEP of 10 cm H2O was instituted at 60 and 90 mins; group III (n = 5): PEEP of 20 cm H2O was instituted at 60 and 90 mins. Extravascular lung water increased after the increase of left atrial pressure in all three groups. After 90 mins, the extravascular lung water was significantly greater (p < .01) in group I (no PEEP application) at 21.2 +/- 5.1 mL/kg than in groups II and III (with 10 and 20 cm H2O of PEEP) at 12.8 +/- 2.01 and 14.8 +/- 4.8 mL/kg, respectively. Lymphatic drainage tended to increase over time in all three groups. Ninety minutes after the left atrial pressure increase, lymphatic drainage was significantly greater (p < .05) in group II, at 6.06 +/- 2.53 mL/kg/30 mins, than in group I, at 2.83 +/- 0.76 mL/kg/30 mins. a) The application of PEEP levels of between 10 and 20 cm H2O limits the increase of extravascular lung water in cases of hydrostatic pulmonary edema; and b) the application of 10 cm H2O of PEEP increases the lymphatic flow through the thoracic duct.

Novel diffusion tensor imaging technique reveals developmental streamline volume changes in the corticospinal tract associated with leg motor control

PubMed Central

Kamson, David O.; Juhász, Csaba; Chugani, Harry T.; Jeong, Jeong-Won

2014-01-01

Background Diffusion tensor imaging (DTI) has expanded our knowledge of corticospinal tract (CST) anatomy and development. However, previous developmental DTI studies assessed the CST as a whole, overlooking potential differences in development of its components related to control of the upper and lower extremities. The present cross-sectional study investigated age-related changes, side and gender differences in streamline volume of the leg- and hand-related segments of the CST in children. Subjects and methods DTI data of 31 children (1–14years; mean age: 6±4years; 17 girls) with normal conventional MRI were analyzed. Leg- and hand-related CST streamline volumes were quantified separately, using a recently validated novel tractography approach. CST streamline volumes on both sides were compared between genders and correlated with age. Results Higher absolute streamline volumes were found in the left leg-related CST compared to the right (p=0.001) without a gender effect (p=0.4), whereas no differences were found in the absolute hand-related CST volumes (p>0.4). CST leg-related streamline volumes, normalized to hemispheric white matter volumes, declined with age in the right hemisphere only (R=−.51; p=0.004). Absolute leg-related CST streamline volumes showed similar, but slightly weaker correlations. Hand-related absolute or normalized CST streamline volumes showed no age-related variations on either side. Conclusion These results suggest differential development of CST segments controlling hand vs. leg movements. Asymmetric volume changes in the lower limb motor pathway may be secondary to gradually strengthening left hemispheric dominance and is consistent with previous data suggesting that footedness is a better predictor of hemispheric lateralization than handedness. PMID:25027193

Novel diffusion tensor imaging technique reveals developmental streamline volume changes in the corticospinal tract associated with leg motor control.

PubMed

Kamson, David O; Juhász, Csaba; Chugani, Harry T; Jeong, Jeong-Won

2015-04-01

Diffusion tensor imaging (DTI) has expanded our knowledge of corticospinal tract (CST) anatomy and development. However, previous developmental DTI studies assessed the CST as a whole, overlooking potential differences in development of its components related to control of the upper and lower extremities. The present cross-sectional study investigated age-related changes, side and gender differences in streamline volume of the leg- and hand-related segments of the CST in children. DTI data of 31 children (1-14 years; mean age: 6±4 years; 17 girls) with normal conventional MRI were analyzed. Leg- and hand-related CST streamline volumes were quantified separately, using a recently validated novel tractography approach. CST streamline volumes on both sides were compared between genders and correlated with age. Higher absolute streamline volumes were found in the left leg-related CST compared to the right (p=0.001) without a gender effect (p=0.4), whereas no differences were found in the absolute hand-related CST volumes (p>0.4). CST leg-related streamline volumes, normalized to hemispheric white matter volumes, declined with age in the right hemisphere only (R=-.51; p=0.004). Absolute leg-related CST streamline volumes showed similar, but slightly weaker correlations. Hand-related absolute or normalized CST streamline volumes showed no age-related variations on either side. These results suggest differential development of CST segments controlling hand vs. leg movements. Asymmetric volume changes in the lower limb motor pathway may be secondary to gradually strengthening left hemispheric dominance and is consistent with previous data suggesting that footedness is a better predictor of hemispheric lateralization than handedness. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Maximal venous outflow velocity: an index for iliac vein obstruction.

PubMed

Jones, T Matthew; Cassada, David C; Heidel, R Eric; Grandas, Oscar G; Stevens, Scott L; Freeman, Michael B; Edmondson, James D; Goldman, Mitchell H

2012-11-01

Leg swelling is a common cause for vascular surgical evaluation, and iliocaval obstruction due to May-Thurner syndrome (MTS) can be difficult to diagnose. Physical examination and planar radiographic imaging give anatomic information but may miss the fundamental pathophysiology of MTS. Similarly, duplex ultrasonographic examination of the legs gives little information about central impedance of venous return above the inguinal ligament. We have modified the technique of duplex ultrasonography to evaluate the flow characteristics of the leg after tourniquet-induced venous engorgement, with the objective of revealing iliocaval obstruction characteristic of MTS. Twelve patients with signs and symptoms of MTS were compared with healthy control subjects for duplex-derived maximal venous outflow velocity (MVOV) after tourniquet-induced venous engorgement of the leg. The data for healthy control subjects were obtained from a previous study of asymptomatic volunteers using the same MVOV maneuvers. The tourniquet-induced venous engorgement mimics that caused during vigorous exercise. A right-to-left ratio of MVOV was generated for patient comparisons. Patients with clinical evidence of MTS had a mean right-to-left MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTS patients who had undergone endovascular treatment had a poststent mean ratio of 1.2 (P = 0.011). Interestingly, computed tomography and magnetic resonance imaging results, when available, were interpreted as positive in only 53% of the patients with MTS according to both our MVOV criteria and confirmatory venography. After intervention, the right-to-left MVOV ratio in the MTS patients was found to be reduced similar to asymptomatic control subjects, indicating a relief of central venous obstruction by stenting the compressive MTS anatomy. Duplex-derived MVOV measurements are helpful for detection of iliocaval venous obstruction, such as MTS. Right-to-left MVOV ratios and postengorgement spectral analysis are helpful adjuncts to duplex imaging for leg swelling. The MVOV maneuvers are well tolerated by patients and yields physiological data regarding central venous obstruction that computed tomography and magnetic resonance imaging fail to detect. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

Static innominate asymmetry and leg length discrepancy in asymptomatic collegiate athletes.

PubMed

Krawiec, C J; Denegar, C R; Hertel, J; Salvaterra, G F; Buckley, W E

2003-11-01

The objectives of the study were to assess: (1) static innominate asymmetry in the sagittal plane, (2) leg length discrepancy (LLD), and (3) the relationship between static innominate rotation and LLD in asymptomatic collegiate athletes. The study was an observational study by design which took place in a University athletic training research laboratory. The participants were twenty-four male and 20 female asymptomatic intercollegiate athletes who volunteered to take part in the study. Static innominate asymmetry was assessed with a caliper/inclinometer tool and LLD was measured with a tape measure using standard clinical methods. Results showed that forty-two subjects (95%) demonstrated some degree of static innominate asymmetry. In 32 subjects (73%), the right innominate was more anteriorly rotated than the left. Nearly all subjects were determined to have unequal leg lengths with a majority, 30 subjects (68%), showing a slightly longer left leg. Weak correlations (r=0.33 - 0.44) were identified between static innominate asymmetry and LLD. In Conclusion static innominate asymmetry and LLD are common among asymptomatic collegiate athletes. This information provides clinicians with normative data of common clinical measures in a physically active population.

Hemodynamic effect and safety of intermittent sequential pneumatic compression leg sleeves in patients with congestive heart failure.

PubMed

Bickel, Amitai; Shturman, Alexander; Sergeiev, Michael; Ivry, Shimon; Eitan, Arieh; Atar, Shaul

2014-10-01

Pneumatic leg sleeves are widely used after prolonged operations for prevention of venous stasis. In healthy volunteers they increase cardiac function. We evaluated the hemodynamic effects and safety of intermittent sequential pneumatic compression (ISPC) leg sleeves in patients with chronic congestive heart failure (CHF). We studied 19 patients with systolic left ventricular dysfunction and CHF. ISPC leg sleeves, each with 10 air cells, were operated by a computerized compressor, exerting 2 cycles/min. Hemodynamic and echocardiographic parameters were measured before, during, and after ISPC activation. The baseline mean left ventricular ejection fraction was 29 ± 9.2%, median 32%, range 10%-40%. Cardiac output (from 4.26 to 4.83 L/min; P = .008) and stroke volume (from 56.1 to 63.5 mL; P = .029) increased significantly after ISPC activation, without a reciprocal increase in heart rate, and declined after sleeve deactivation. Systemic vascular resistance (SVR) decreased significantly (from 1,520 to 1,216 dyne-s/cm5; P = .0005), and remained lower than the baseline level throughout the study. There was no detrimental effect on diastolic function and no adverse clinical events, despite increased pulmonary venous return. ISPC leg sleeves in patients with chronic CHF do not exacerbate symptoms and transiently improve cardiac output through an increase in stroke volume and a reduction in SVR. Copyright © 2014 Elsevier Inc. All rights reserved.

Not letting the left leg know what the right leg is doing: limb-specific locomotor adaptation to sensory-cue conflict.

PubMed

Durgin, Frank H; Fox, Laura F; Hoon Kim, Dong

2003-11-01

We investigated the phenomenon of limb-specific locomotor adaptation in order to adjudicate between sensory-cue-conflict theory and motor-adaptation theory. The results were consistent with cue-conflict theory in demonstrating that two different leg-specific hopping aftereffects are modulated by the presence of conflicting estimates of self-motion from visual and nonvisual sources. Experiment 1 shows that leg-specific increases in forward drift during attempts to hop in place on one leg while blindfolded vary according to the relationship between visual information and motor activity during an adaptation to outdoor forward hopping. Experiment 2 shows that leg-specific changes in performance on a blindfolded hopping-to-target task are similarly modulated by the presence of cue conflict during adaptation to hopping on a treadmill. Experiment 3 shows that leg-specific aftereffects from hopping additionally produce inadvertent turning during running in place while blindfolded. The results of these experiments suggest that these leg-specific locomotor aftereffects are produced by sensory-cue conflict rather than simple motor adaptation.

Treatment of reticular and telangiectatic leg veins: double-blind, prospective comparative trial of polidocanol and hypertonic saline.

PubMed

Peterson, Jennifer D; Goldman, Mitchel P; Weiss, Robert A; Duffy, David M; Fabi, Sabrina G; Weiss, Margaret A; Guiha, Isabella

2012-08-01

Sixty-three subjects' legs were randomized to receive treatment with polidocanol (POL) or hypertonic saline (HS) for telangiectasias and reticular leg veins. To compare the safety and efficacy of two sclerosing agents in three dermatologic surgery practices. After exclusion of saphenofemoral junction incompetence, each subject's veins were categorized (telangiectasias <1 mm and reticular veins 1-3 mm) and randomized. Telangiectasias were treated with POL 0.5% or 11.7% HS and reticular veins with POL 1% or 23.4% HS. An independent, blinded physician determined efficacy and adverse events. Subject satisfaction questionnaires were administered and global clinical improvement assessments performed. All patients completed four visits at 0, 1, 4, and 12 weeks. Patients reported significantly greater pain during treatment with HS (2.42) than POL (1.03) (p < .001). There were no significant differences in physician-assessed improvement of reticular leg veins or telangiectasias; subject- or physician-assessed overall improvement; or physician-assessed phlebitis, pigmentation, edema, or matting in either of the three practices or the entire cohort. Two subjects developed ulcerations with HS. No ulcerations or allergic reactions developed after POL injections. Both agents provided effective treatment, but HS caused 2.35 times as much pain during injections and resulted in two episodes of tissue necrosis. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries

PubMed Central

Hashemi, Helen; Endicott-Yazdani, Tiana R.; Oguayo, Christopher; Harmon, David M.; Tran, Tuan; Tsai-Nguyen, Ginger; Benavides, Raul; Spak, Cedric W.; Nguyen, Hoang-Lan

2018-01-01

ABSTRACT We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (≥1:1024) and positive immunoglobulin M titer (≥1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis. PMID:29686571

Bartonella endocarditis with glomerulonephritis in a patient with complete transposition of the great arteries.

PubMed

Hashemi, Helen; Endicott-Yazdani, Tiana R; Oguayo, Christopher; Harmon, David M; Tran, Tuan; Tsai-Nguyen, Ginger; Benavides, Raul; Spak, Cedric W; Nguyen, Hoang-Lan

2018-01-01

We describe a patient with history of dextro-transposition of the great vessels, ventricular septal defect, and pulmonary valve replacement who presented with fatigue, prolonged fever, and leg edema. He was found to have kidney injury, pancytopenia, and liver congestion. Echocardiogram revealed thickened leaflets with prolapsing vegetation on the pulmonary valve. Given the negative blood cultures, high Bartonella henselae immunogobulin G titer (≥1:1024) and positive immunoglobulin M titer (≥1:20), he was diagnosed with Bartonella endocarditis complicated with glomerulonephritis.

Very large pericardial effusion attributable to minoxidil: resolution without drainage of fluid.

PubMed

Shirwany, Arsalan; D'Cruz, Ivan A; Munir, Ahmad

2002-08-01

A 52-year-old man with a history of chronic hypertension presented with worsening dyspnea and leg edema. He had been on minoxidil for 10 years. The cardiac silhouette was markedly enlarged. Echocardiography and computed tomography showed a large pericardial effusion. His cardiac status was stable and he was in no cardiorespiratory distress. No attempt was made to drain the fluid. Minoxidil was discontinued, and a month later, the effusion had virtually disappeared. Cessation of minoxidil administration and conservative management may suffice, even though the pericardial effusion is large.

Keratoconjunctivitis and Periorbital Edema due to Ecballium elaterium.

PubMed

Brouzas, Dimitrios; Oanta, Mariana; Loukianou, Eleni; Moschos, Marillita

2012-01-01

To report on a case of keratoconjunctivitis with periorbital edema after accidental exposure to undiluted juice of Ecballium elaterium fruit during the ripening season of this plant. Case report. Keratoconjunctivitis with Descemet's membrane folds and superficial upper corneal well-defined edematous areas were noted after an Ecballium elaterium fruit burst and its juice splashed into the patient's left eye. Prompt administration of antibiotic and steroid eye drops along with per os antihistamine therapy, resulted in quick regression of symptoms. This report demonstrates the toxic effects of this herb to the eye and also that prompt therapy is effective.

[Asymmetric negative pressure pulmonary edema after acute upper airway obstruction: case report].

PubMed

Peixoto, Aldo José

2002-06-01

Negative pressure pulmonary edema after acute upper airway obstruction is a well-described event, though infrequently diagnosed and reported. This report aimed at presenting a case of upper airway obstruction negative pressure pulmonary edema following acute upper airway obstruction characterized by pulmonary edema asymmetry, being more prominent in the right lung. A 4-year-old boy, 17 kg, phisical status ASA I submitted to combined tonsillectomy, adenoidectomy and turbinate cauterization under general anesthesia with sevoflurane/nitrous oxide/O2. Surgery duration was 90 minutes without complications. During anesthetic recovery and spontaneously breathing, patient reacted to tracheal tube, which was removed. Following, ventilatory efforts resulted in chest wall retraction without apparent air movement, being impossible to ventilate him with facial mask. Symptoms evolved to severe hypoxemia (50% SpO2) requiring reintubation. At this point, it was observed that the lung was stiffer and there were bilateral rales characterizing pulmonary edema. A chest X-ray showed diffuse bilateral infiltrates, right upper lobe atelectasis and marked pulmonary edema asymmetry (right greater than left). Patient was mechanically ventilated with PEEP for 20 hours when he was extubated. There was a progressive pulmonary edema improvement and patient was discharged 48 hours later. Negative pressure pulmonary edema (NPPE) is a rare event with high morbidity risk. It is often not diagnosed and requires from the anesthesiologist an updated knowledge and adequate management. It is usually bilateral, rarely unilateral, and exceptionally asymmetric as in this case. Most cases are treated by mechanical ventilation with PEEP or CPAP without any other therapy. The prognosis is favorable, with most cases recovering within the first 24 hours.

Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water.

PubMed

Katzenelson, Rita; Perel, Azriel; Berkenstadt, Haiim; Preisman, Sergei; Kogan, Samuel; Sternik, Leonid; Segal, Eran

2004-07-01

Pulmonary edema is a severe and often life-threatening condition. The diagnosis of pulmonary edema and its quantification have great clinical significance and yet can be difficult. A new technique based on thermodilution measurement using a single indicator has recently been developed (PiCCO, Pulsion Medical Systems, AG Germany). This method allows the measurement of extravascular lung water and thus can quantify degree of pulmonary edema. The technique has not been compared with a gold standard, gravimetric measurement of extravascular lung water. Therefore, the objective of this study was to determine the ability of extravascular lung water measurement with the PiCCO to reflect the extravascular lung water as measured with a gravimetric technique in a dog model of pulmonary edema. Prospective, randomized animal study. A university animal research laboratory. Fifteen mongrel dogs (n = 5/group) weighing 20-30 kg. The dogs were anesthetized and mechanically ventilated. Five dogs served as controls; in five dogs hydrostatic pulmonary edema was induced using inflation of a left atrial balloon combined with fluid administration to maintain a high pulmonary artery occlusion pressure; and in five dogs pulmonary edema was induced by intravenous injection of oleic acid. After a period of stabilization in a state of pulmonary edema, extravascular lung water was measured with the PiCCO monitor. The animals were then killed, and extravascular lung water was measured using a gravimetric technique. There was a very close (r =.967, p <.001) relationship between transpulmonary thermodilution and gravimetric measurements. The measurement with the PiCCO was consistently higher, by 3.01 +/- 1.34 mL/kg, than the gravimetric measurement. Measurement of extravascular lung water using transpulmonary thermodilution with a single indicator is very closely correlated with gravimetric measurement of lung water in both increased permeability and hydrostatic pulmonary edema.

Contribution of Leg-Muscle Forces to Paddle Force and Kayak Speed During Maximal-Effort Flat-Water Paddling.

PubMed

Nilsson, Johnny E; Rosdahl, Hans G

2016-01-01

The purpose was to investigate the contribution of leg-muscle-generated forces to paddle force and kayak speed during maximal-effort flat-water paddling. Five elite male kayakers at national and international level participated. The participants warmed up at progressively increasing speeds and then performed a maximal-effort, nonrestricted paddling sequence. This was followed after 5 min rest by a maximal-effort paddling sequence with the leg action restricted--the knee joints "locked." Left- and right-side foot-bar and paddle forces were recorded with specially designed force devices. In addition, knee angular displacement of the right and left knees was recorded with electrogoniometric technique, and the kayak speed was calculated from GPS signals sampled at 5 Hz. The results showed that reduction in both push and pull foot-bar forces resulted in a reduction of 21% and 16% in mean paddle-stroke force and mean kayak speed, respectively. Thus, the contribution of foot-bar force from lower-limb action significantly contributes to kayakers' paddling performance.

Simultaneously measured inter-arm and inter-leg systolic blood pressure differences and cardiovascular risk stratification: a systemic review and meta-analysis.

PubMed

Singh, Sukhchain; Sethi, Ankur; Singh, Mukesh; Khosla, Kavia; Grewal, Navsheen; Khosla, Sandeep

2015-08-01

Association of inter-arm systolic blood pressure difference (IASBPD) with cardiovascular (CV) morbidity and mortality remains controversial. We aimed to thoroughly examine all available evidence on inter-limb blood pressure (BP) difference and its association with CV risk and outcomes. We searched PubMed, EMBASE, CINAHL, Cochrane library, and Ovid for studies reporting bilateral simultaneous BP measurements in arms or legs and risk of peripheral arterial disease (PAD), coronary artery disease, cerebrovascular disease, subclavian stenosis, or mortality. Random-effect meta-analysis was performed to compare effect estimates. Twenty-seven studies met inclusion criteria, but only 17 studies (18 cohorts) were suitable for analysis. IASBPD of 10 mmHg or more was associated with PAD (risk ratios, 2.22; 1.41-3.5; P = .0006; sensitivity 16.6%; 6.7-35.4; specificity 91.9%; 83.1-96.3; 8 cohorts; 4774 subjects), left ventricular mass index (standardized mean difference 0.21; 0.03-0.39; P = .02; 2 cohort; 1604 subjects), and brachial-ankle pulse wave velocity (PWV) (one cohort). Association of PAD remained significant at cutoff of 15 mmHg (risk ratios, 1.91; 1.28-2.84; P = .001; 5 cohorts; 1914 subjects). We could not find statistically significant direct association of coronary artery disease, cerebrovascular disease, CV, and all-cause mortality in subjects with IASBPD of 10 mmHg or more, 15 mmHg or more, and inter-leg systolic BP difference of 15 mmHg or more. Inter-leg BP difference of 15 mmHg or more was strong predictor of PAD (P = .0001) and brachial-ankle PWV (P = .0001). Two invasive studies showed association of IASBPD and subclavian stenosis (estimates could not be combined). In conclusion, inter-arm and leg BP differences are strong predictors of PAD. IASBPD may be associated with subclavian stenosis, high left ventricular mass effect, and higher brachial-ankle PWVs. Inter-leg BP difference may also be associated with high left ventricular mass effect and higher brachial-ankle PWVs. Presence of inter-limb BP difference may indicate higher global CV risk. Copyright © 2015 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Dynamic Propagation Channel Characterization and Modeling for Human Body Communication

PubMed Central

Nie, Zedong; Ma, Jingjing; Li, Zhicheng; Chen, Hong; Wang, Lei

2012-01-01

This paper presents the first characterization and modeling of dynamic propagation channels for human body communication (HBC). In-situ experiments were performed using customized transceivers in an anechoic chamber. Three HBC propagation channels, i.e., from right leg to left leg, from right hand to left hand and from right hand to left leg, were investigated under thirty-three motion scenarios. Snapshots of data (2,800,000) were acquired from five volunteers. Various path gains caused by different locations and movements were quantified and the statistical distributions were estimated. In general, for a given reference threshold è = −10 dB, the maximum average level crossing rate of the HBC was approximately 1.99 Hz, the maximum average fade time was 59.4 ms, and the percentage of bad channel duration time was less than 4.16%. The HBC exhibited a fade depth of −4 dB at 90% complementary cumulative probability. The statistical parameters were observed to be centered for each propagation channel. Subsequently a Fritchman model was implemented to estimate the burst characteristics of the on-body fading. It was concluded that the HBC is motion-insensitive, which is sufficient for reliable communication link during motions, and therefore it has great potential for body sensor/area networks. PMID:23250278

Dynamic propagation channel characterization and modeling for human body communication.

PubMed

Nie, Zedong; Ma, Jingjing; Li, Zhicheng; Chen, Hong; Wang, Lei

2012-12-18

This paper presents the first characterization and modeling of dynamic propagation channels for human body communication (HBC). In-situ experiments were performed using customized transceivers in an anechoic chamber. Three HBC propagation channels, i.e., from right leg to left leg, from right hand to left hand and from right hand to left leg, were investigated under thirty-three motion scenarios. Snapshots of data (2,800,000) were acquired from five volunteers. Various path gains caused by different locations and movements were quantified and the statistical distributions were estimated. In general, for a given reference threshold è = -10 dB, the maximum average level crossing rate of the HBC was approximately 1.99 Hz, the maximum average fade time was 59.4 ms, and the percentage of bad channel duration time was less than 4.16%. The HBC exhibited a fade depth of -4 dB at 90% complementary cumulative probability. The statistical parameters were observed to be centered for each propagation channel. Subsequently a Fritchman model was implemented to estimate the burst characteristics of the on-body fading. It was concluded that the HBC is motion-insensitive, which is sufficient for reliable communication link during motions, and therefore it has great potential for body sensor/area networks.

Indocyanine green angiography findings of cystoid macular edema secondary to paclitaxel therapy.

PubMed

Nomi, Nanami; Ota, Manami; Fukumura, Miho; Nuno, Yoshihisa; Hatano, Makoto; Wakuta, Makiko; Yanai, Ryoji; Kimura, Kazuhiro

2018-03-01

To report 2 cases of paclitaxel-related maculopathy manifesting as cystoid macular edema (CME) with late petaloid hyperfluorescence on indocyanine green angiography (IA). A 74-year-old man (patient 1) undergoing paclitaxel chemotherapy for gastric and metastatic liver cancer and a 69-year-old man (patient 2) receiving paclitaxel for hypopharyngeal cancer presented with anorthopia in both eyes. Spectral domain-optical coherence tomography (SD-OCT) revealed macular edema in both eyes of each patient. Fluorescein angiography showed weak petaloid pooling around the fovea in the late phase. IA revealed CME with petaloid hyperfluorescence that matched the region of macular edema detected by SD-OCT. The CME was attenuated in the right eye but not in the left eye of patient 1 at 2 weeks after discontinuation of paclitaxel treatment, whereas it was no longer apparent in either eye at 3 months. The CME was no longer detected in either eye of patient 2 at 3 months after discontinuation of paclitaxel. These cases suggest that paclitaxel-induced CME may result from intraretinal accumulation of intracellular fluid and minimal impairment of the blood retinal barrier.

Early optical detection of cerebral edema in vivo.

PubMed

Gill, Amandip S; Rajneesh, Kiran F; Owen, Christopher M; Yeh, James; Hsu, Mike; Binder, Devin K

2011-02-01

Cerebral edema is a significant cause of morbidity and mortality in diverse disease states. Currently, the means to detect progressive cerebral edema in vivo includes the use of intracranial pressure (ICP) monitors and/or serial radiological studies. However, ICP measurements exhibit a high degree of variability, and ICP monitors detect edema only after it becomes sufficient to significantly raise ICP. The authors report the development of 2 distinct minimally invasive fiberoptic near-infrared (NIR) techniques able to directly detect early cerebral edema. Cytotoxic brain edema was induced in adult CD1 mice via water intoxication by intraperitoneal water administration (30% body weight intraperitoneally). An implantable dual-fiberoptic probe was stereotactically placed into the cerebral cortex and connected to optical source and detector hardware. Optical sources consisted of either broadband halogen illumination or a single-wavelength NIR laser diode, and the detector was a sensitive NIR spectrometer or optical power meter. In one subset of animals, a left-sided craniectomy was performed to obtain cortical biopsies for water-content determination to verify cerebral edema. In another subset of animals, an ICP transducer was placed on the contralateral cortex, which was synchronized to a computer and time stamped. Using either broadband illumination with NIR spectroscopy or single-wavelength laser diode illumination with optical power meter detection, the authors detected a reduction in NIR optical reflectance during early cerebral edema. The time intervals between water injection (Time Point 0), optical trigger (defined as a 2-SD change in optical reflectance from baseline), and defined threshold ICP values of 10, 15 and 20 mm Hg were calculated. Reduction in NIR reflectance occurred significantly earlier than any of the ICP thresholds (p < 0.001). Saline-injected control mice exhibited a steady baseline optical signal. There was a significant correlation between reflectance change and tissue specific gravity of the cortical biopsies, further validating the dual-fiberoptic probe as a direct measure of cerebral edema. Compared with traditional ICP monitoring, the aforementioned minimally invasive NIR techniques allow for the significantly earlier detection of cerebral edema, which may be of clinical utility in the identification and thus early treatment of cerebral edema.

Knee Brace Would Lock And Unlock Automatically

NASA Technical Reports Server (NTRS)

Myers, Neill; Forbes, John; Shadoan, Mike; Baker, Kevin

1995-01-01

Proposed knee brace designed to aid rehabilitation of person who suffered some muscle damage in leg. Not limited to locking in straight-leg position and, instead, locks at any bend angle. Does not prevent knee from bearing weight. Instead, knee brace allows knee to bear weight and locks only when foot and lower leg bear weight. Thus, brace prevents flexion that wearer desired to prevent but could not prevent because of weakened muscles. Knee bends freely to exercise knee-related muscles. Knee brace strapped at upper end to leg above knee, and anchored at lower end by stirrup under foot. Joint mechanism (identical mechanisms used in left and right assemblies) allows knee joint to flex freely except when weight applied to heel.

Spontaneous resolution of avascular necrosis of femoral heads following cure of Cushing's syndrome.

PubMed

Pazderska, A; Crowther, S; Govender, P; Conlon, K C; Sherlock, M; Gibney, J

2016-01-01

Avascular necrosis (AVN) is a rare presenting feature of endogenous hypercortisolism. If left untreated, complete collapse of the femoral head may ensue, necessitating hip replacement in up to 70% of patients. The majority of the described patients with AVN due to endogenous hypercortisolaemia required surgical intervention. A 36-year-old female, investigated for right leg pain, reported rapid weight gain, bruising and secondary amenorrhoea. She had abdominal adiposity with violaceous striae, facial plethora and hirsutism, atrophic skin, ecchymosis and proximal myopathy. Investigations confirmed cortisol excess (cortisol following low-dose 48h dexamethasone suppression test 807nmol/L; 24h urinary free cortisol 1443nmol (normal<290nmol)). Adrenocorticotrophic hormone (ACTH) was <5.0pg/mL. CT demonstrated subtle left adrenal gland hypertrophy. Hypercortisolaemia persisted after left adrenalectomy. Histology revealed primary pigmented micronodular adrenal disease. Post-operatively, right leg pain worsened and left leg pain developed, affecting mobility. MRI showed bilateral femoral head AVN. She underwent right adrenalectomy and steroid replacement was commenced. Four months after surgery, leg pain had resolved and mobility was normal. Repeat MRI showed marked improvement of radiological abnormalities in both femoral heads, consistent with spontaneous healing of AVN. We report a case of Cushing's syndrome due to primary pigmented nodular adrenocortical disease, presenting with symptomatic AVN of both hips. This was managed conservatively from an orthopaedic perspective. Following cure of hypercortisolaemia, the patient experienced excellent recovery and remains symptom free 4 years after adrenalectomy. This is the first report of a favourable outcome over long-term follow-up of a patient with bilateral AVN of the hip, which reversed with treatment of endogenous hypercortisolaemia. AVN of femoral head can be a presenting feature of hypercortisolism, both endogenous and exogenous.Rarely, treatment of hypercortisolaemia can reverse AVN without the need for orthopaedic intervention.Primary pigmented nodular adrenal disease is a rare cause of ACTH-independent Cushing's syndrome.

The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players.

PubMed

Freckleton, Grant; Cook, Jill; Pizzari, Tania

2014-04-01

Hamstring muscle strain injuries (HMSI) are the greatest injury problem in kicking sports such as Australian Rules Football. Reduced hamstring muscle strength is commonly perceived to be a risk factor for hamstring injury; however, evidence is inconclusive. Testing hamstring strength with the hip and knee at functional angles and assessing endurance parameters may be more relevant for examining the risk of hamstring injury. The primary aim of this prospective study was to examine if reduced hamstring muscle strength assessed with the single leg hamstring bridge (SLHB) was a risk factor for hamstring injury. Hamstring muscle strength of 482 amateur and semielite players from 16 football clubs, mean age 20.7 (range 16-34 years), was tested during the 2011 preseason. Players were then monitored throughout the 2011 playing season for HMSI. A total of 28 hamstring injuries, 16 right and 12 left, were recorded. Players who sustained a right HMSI during the season had a significantly lower mean right SLHB score (p=0.029), were older (p=0.002) and were more likely to have sustained a past right hamstring injury (p=0.02) or right knee injury (p=0.035). For left-sided hamstring injury, the injured group was more likely to be left leg dominant (p=0.001), older athletes (p=0.002) and there was a trend towards a history of left hamstring injury (p=0.07). This study demonstrated a significant deficit in preseason SLHB scores on the right leg of players that subsequently sustained a right-sided hamstring injury. Age, previous knee injury and a history of hamstring injury were other risk factors supported in this study. Low hamstring strength appears to be a risk factor for hamstring injury; however, due to the confounding variables and low injury rate in this study, further studies are required.

Correct, fake and absent pre-information does not affect the occurrence and magnitude of the bilateral force deficit.

PubMed

Donath, Lars; Siebert, Tobias; Faude, Oliver; Puta, Christian

2014-05-01

The present study examined whether different pre-information conditions could lead to a volitional modulation of the occurrence and magnitude of the bilateral force deficit (BFD) during isometric leg press. Twenty trained male adults (age: 24.5 ± 1.7 years; weight: 77.5 ± 7.1 kg; height: 1.81 ± 0.05 m) were examined on three days within a week. Isometric leg press was performed on a negatively inclined leg press slide. Each participant completed three maximal isometric strength test sessions with different pre-information conditions given in a graphical chart: no pre-information (NPI; first day), false pre-information (FPI; bilateral force > sum of unilateral forces; second or third day) and correct pre-information (CPI; bilateral force < sum of unilateral forces; second or third day) during bilateral, unilateral-left and unilateral-right leg-press. The sum of left- and right-sided force values were calculated for bilateral (FBL = FBL_left + FBL_right) and unilateral (FUL = FUL_left + FUL_right) analyses. Force data for NPI revealed: Mean (SD): FUL_NPI = 3023 N (435) vs. FBL_NPI = 2812 (453); FPI showed FUL_FPI = 3013 N (459) vs. FBL_FPI = 2843 (446) and the CPI revealed FUL_CPI = 3035 (425) vs. FBL_CPI = 2844 (385). The three (no, false, correct) x 2 (FUL, FBL) rANOVA revealed a high significant main effect of Force (F = 61.82, p < 0.001). No significant main effect of the factor Condition and no significant interaction between Force x Condition was observed. The BFD does not rely on the trueness of the given pre-information (no, false, correct). Cognition-based volitional influences on the BFD on supra-spinal level seem negligible. Key pointsBFD is reliable occurring phenomenonAvailable theoretical knowledge does not affect the BFDAlternating sport should include alternating strength exercises.

Subcutaneous Crotaline Fab antivenom for the treatment of rattlesnake envenomation in a porcine model.

PubMed

Offerman, Steven R; Barry, J David; Richardson, William H; Tong, Tri; Tanen, Dave; Bush, Sean P; Clark, Richard F

2009-01-01

This study was designed to investigate whether the local, subcutaneous injection of Crotaline Fab antivenom (CroFab) at the rattlesnake envenomation site would result in less extremity edema when compared to intravenous (i.v.) antivenom infusion alone. This is a randomized, three-arm laboratory experiment using a porcine model. Each animal was anesthetized, intubated, and maintained on mechanical ventilation. About 6 mg/kg of Crotalus atrox venom was injected subcutaneously at the hock of the right hind leg. Animals were then randomized to immediately receive subcutaneous and i.v. antivenom (SC/IV), i.v. antivenom only, or saline control. SC/IV animals received two vials of CroFab subcutaneously at the envenomation site and two vials intravenously. IV animals received four vials of CroFab intravenously. Limb edema was tracked by serial circumference and volumetric measurements over an 8-h period. Limb circumference was measured at four pre-determined locations hourly. Limb volume was measured by a water displacement method at baseline, 4, and 8 h. Twenty-six animals were randomized to the three treatment groups. The SC/IV and IV arms included nine animals each. Two animals in the SC/IV group died suddenly during the study, leaving seven animals for data analysis. There were eight controls. Increasing limb edema was observed in all groups. No differences were detected in limb circumferences or limb volumes between control and either treatment arms. In this porcine model of crotaline envenomation, no differences in limb edema were found between animals treated with SC/IV or IV CroFab when compared to saline controls.

Treatment of essential hypertension with calcium channel blockers: what is the place of lercanidipine?

PubMed

Burnier, Michel; Pruijm, Menno; Wuerzner, Gregoire

2009-08-01

In all actual clinical guidelines, dihydropyridine calcium channel blockers (CCBs) belong to the recommended first line antihypertensive drugs to treat essential hypertension. Several recent large clinical trials have confirmed their efficacy not only in lowering blood pressure but also in reducing cardiovascular morbidity and mortality in hypertensive patients with a normal or high cardiovascular risk profile. In clinical trials such as ALLHAT, VALUE or ASCOT, an amlodipine-based therapy was at least as effective, when not slightly superior, in lowering blood pressure and sometimes more effective in preventing target organ damages than blood pressure lowering strategies based on the use of diuretics, beta-blockers and blockers of the renin-angiotensin system. One of the main clinical side effects of the first and second generation CCBs including amlodipine is the development of peripheral edema. The incidence of leg edema can be markedly reduced by combining the CCB with a blocker of the renin-angiotensin system. This strategy has now led to the development of several fixed-dose combinations of amlodipine and angiotensin II receptor antagonists. Another alternative to lower the incidence of edema is to use CCBs of the third generation such as lercanidipine. Indeed, although no major clinical trials have been conducted with this compound, clinical studies have shown that lercanidipine and amlodipine have a comparable antihypertensive efficacy but with significantly less peripheral edema in patients receiving lercanidipine. In some countries, lercanidipine is now available in a single-pill association with an ACE inhibitor thereby further improving its efficacy and tolerability profile.

Left atrium and pulmonary artery compression due to aortic aneurysm causing heart failure symptoms.

PubMed

Jorge, Antonio José Lagoeiro; Martins, Wolney de Andrade; Moutinho, Victor M; Rezende, Juliano M; Alves, Patricia Y; Villacorta, Humberto; Silveira, Pedro F; Couto, Antonio A

2018-06-01

Patients with thoracic aortic aneurysm (TAA) are mostly asymptomatic and TAA is rarely related to heart failure (HF). We report the case of an 80-year-old female patient, with type A TAA without dissection, with right pulmonary artery and left atrium compression, who presented with HF, preserved ejection fraction and acute pulmonary edema. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Transient Encephalopathy from Angiographic Contrast: A Rare Complication in Neurointerventional Procedures

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guimaraens, Leopoldo, E-mail: guimaraens@mimsl.es; Vivas, Elio; Fonnegra, Andres

Neurotoxicity from contrast media used in angiography is a rare complication from these procedures. The infrequency with which it is encountered makes it a diagnostic challenge. We present the case of a 51-year-old male who, 30 min after successful angiography for treatment of a right carotid-ophthalmic fusiform aneurysm with a stent, developed psychomotor agitation, disorientation, and progressive left faciobrachial hemiparesis (4/5). An emergency nonenhanced CT showed marked cortical enhancement and edema in the right cerebral hemisphere. Cortical enhancement is thought to be secondary to contrast extravasation due to disruption of the blood-brain barrier. Angiography was performed immediately, without any pathologicmore » findings. After this procedure there was an increase in the left faciobrachial hemiparesis (3/5), right gaze deviation, Gerstmann syndrome, and left anosognosia and left homonymous hemianopsia. Endovenous dexamethasone and mannitol were initiated. Twenty-four hours later an MRI showed no signs of acute infarct, just gyriform signal increase in the right cerebral hemisphere on FLAIR and a decrease in the edema observed before. The patient had progressive improvement of his neurological deficit. A control MRI done 5 days later was normal. The patient recovered completely and was discharged. This rare entity should be kept in mind but diagnosed only when all other causes have been ruled out, because more important and frequent causes, such as acute infarct, must be excluded promptly.« less

Vibration upshot of operating mechanical sewing machine: an insight into common peroneal nerve conduction study.

PubMed

Yadav, Prakash Kumar; Yadav, Ram Lochan; Sharma, Deepak; Shah, Dev Kumar; Sapkota, Niraj Khatri; Thakur, Dilip; Limbu, Nirmala; Islam, Md Nazrul

2017-01-01

Most of the people associated with tailoring occupation in Nepal are still using mechanical sewing machine as an alternative of new technology for tailoring. Common peroneal nerves of both right and left legs are exposed to strenuous and chronic stress exerted by vibration and paddling of mechanical sewing machine. The study included 30 healthy male tailors and 30 healthy male individuals. Anthropometric variables as well as cardio respiratory variables were determined for each subject. Standard Nerve Conduction Techniques using constant measured distances were applied to evaluate common peroneal nerve (motor) in both legs of each individual. Data were analyzed and compared between study and control groups using Man Whitney U test setting the significance level p  ≤ 0.05. Anthropometric and cardio respiratory variables were not significantly altered between the study and control groups. The Compound muscle action potential (CMAP) latency of common peroneal nerves of both right [(11.29 ± 1.25 vs. 10.03 ± 1.37), P  < 0.001] and left [(11.28 ± 1.38 vs. 10.05 ± 1.37), P  < 0.01] legs was found to be significantly prolonged in study group as compared to control group. The Amp-CMAP of common peroneal nerves of both right [(4.57 ± 1.21 vs. 6.22 ± 1.72), P  < 0.001] and left [(4.31 ± 1.55 vs. 6.25 ± 1.70), P  < 0.001] legs was found significantly reduced in study group as compared to control group. Similarly, the motor nerve conduction velocity (MNCV) of common peroneal nerves of both right [(43.72 ± 3.25 vs. 47.49 ± 4.17), P  < 0.001] and left [(42.51 ± 3.82 vs. 46.76 ± 4.51), P  < 0.001] legs was also found to be significantly reduced in study group in comparison to control group. Operating mechanical sewing machine by paddling chronically and arduously could have attributed to abnormal nerve conduction study parameters due to vibration effect of the machine on right and left common peroneal nerves. The results of present study follow the trend towards presymptomatic or asymptomatic neuropathy similar to subclinical neuropathy.

49 CFR 572.180 - Incorporated materials.

Code of Federal Regulations, 2010 CFR

2010-10-01

...) Drawing No. 175-3000, Shoulder Assembly; (v) Drawing No. 175-3500, Arm Assembly, Left; (vi) Drawing No.... 175-6000 Pelvis Assembly; (xi) Drawing No. 175-7000-1, Leg Assembly—left; (xii) Drawing No. 175-7000-2... Operations, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, telephone (202) 366-9826, and at...

49 CFR 572.180 - Incorporated materials.

Code of Federal Regulations, 2011 CFR

2011-10-01

...) Drawing No. 175-3000, Shoulder Assembly; (v) Drawing No. 175-3500, Arm Assembly, Left; (vi) Drawing No.... 175-6000 Pelvis Assembly; (xi) Drawing No. 175-7000-1, Leg Assembly—left; (xii) Drawing No. 175-7000-2... Operations, Room W12-140, 1200 New Jersey Avenue, SE., Washington, DC 20590, telephone (202) 366-9826, and at...

Managing a Female Patient with Left Low Back Pain and Sacroiliac Joint Pain with Therapeutic Exercise: A Case Report

PubMed Central

2011-01-01

ABSTRACT Purpose: The purpose of this case study is to describe the management of a female patient with chronic left low back pain and sacroiliac joint pain (LBP/SIJP) using unique unilateral exercises developed by the Postural Restoration Institute (PRI) to address pelvic asymmetry and left hip capsule restriction, which is consistent with a Right Handed and Left Anterior Interior Chain pattern of postural asymmetry. Client Description: The client was 65-year-old woman with a 10-month history of constant left LBP/SIJP and leg pain. Intervention: The patient was seen six times to correct pelvic position/posture and left hip posterior capsule restriction via (1) muscle activation (left hamstrings, adductor magnus, and anterior gluteus medius) and (2) left hip adduction to lengthen the left posterior capsule/ischiofemoral ligament. Stabilization exercises included bilateral hamstrings, gluteus maximus, adductors, and abdominals to maintain pelvic position/posture. Measures and Outcome: Left Ober's test (initially positive) was negative at discharge. Pain as measured on the Numeric Pain Rating Scale (initially 1/10 at best and 8/10 at worst) was 0/10–0/10 at discharge. Oswestry Disability Index score (initially 20%) was 0% at discharge. The patient no longer had numbness in her left leg, and sexual intercourse had become pain free. Implications: Interventions to restore and maintain the optimal position of pelvis and hip (femoral head in the acetabulum) may be beneficial for treating patients with chronic LBP/SIJP. The patient's pain was eliminated 13 days after she first performed three exercises to reposition the pelvis and restore left posterior hip capsule extensibility and internal rotation. PMID:22379254

Bilateral macular edema in a patient treated with tamoxifen: a case report and review of the literature.

PubMed

Zafeiropoulos, Paraskevas; Nanos, Panagiotis; Tsigkoulis, Evangelos; Stefaniotou, Maria

2014-01-01

We present a case of a 41-year-old female patient with progressive bilateral visual loss. On examination, her best corrected visual acuity (BCVA) in her right eye was 3/10 and her BCVA in her left eye was 2/10. Fundus and optical coherence tomography examination revealed severe bilateral macular edema. She had been diagnosed with breast cancer 6 years ago and was receiving tamoxifen at a dosage of 20 mg/day ever since. Tamoxifen therapy was discontinued, and the patient received 250 mg of acetazolamide three times a day for a period of 1 month. Both foveae regained their normal contour within 2 months, and her vision was restored to 10/10 BCVA 3 months later. To our knowledge, this is the first case reported where bilateral intraretinal macular edema is the only retinal manifestation in a patient on oral tamoxifen.

A rare cause of severe periorbital edema and dermonecrotic ulcer of the eyelid in a child: brown recluse spider bite.

PubMed

Taşkesen, Mustafa; Akdeniz, Sedat; Taş, Taşkin; Keklikçi, Uğur; Taş, Mehmet Ali

2011-01-01

Spider bites are a worldwide problem. Brown recluse spider bites can lead to severe local or systemic clinical effects, such as edema, necrotic ulcer, rashes, fever, chills, nausea, vomiting, malaise, arthralgia, myalgia, hemolysis, leukocytosis, disseminated intravascular coagulation, renal failure, and death. Eyelid bites from brown recluse spiders are rare. We report a child with severe facial edema and a dermonecrotic ulcer on the eyelid. Upon laboratory examination, leukocytosis with a significant left shift was detected. The patient was treated with antibiotics, systemic corticosteroid and conservative therapy that included saline compresses and ocular lubrication. No surgical excision was required. Vision was not impaired. A dermonecrotic ulcer is a severe complication of brown recluse spider bites. Since the diagnosis is difficult, clinical and epidemiological findings and a detailed history are important for an accurate diagnosis.

The Role of Complex Treatment in Mixed Leg Ulcers - A Case Report of Vascular, Surgical and Physical Therapy.

PubMed

Wollina, Uwe; Heinig, Birgit; Stelzner, Christian; Hansel, Gesina; Schönlebe, Jacqueline; Tchernev, Georgi; Lotti, Torello

2018-01-25

Leg ulcers are a burden to patients, their families and society. The second most common cause of chronic leg ulcers is the mixed arterio-venous type. An 80-year-old female patient presented to our department due to painful enlarging chronic leg ulcer of mixed arteriovenous origin on her left lower leg. She suffered from peripheral arterial occlusive disease stage I and chronic venous insufficiency Widmer grade IIIa, and a number of comorbidities. The aim of our ulcer treatment was a complete and stable wound closure that was hampered by arterial occlusion, exposed tendon, and renal insiffuciency. To improve the prognosis for ulcer surgery, we performed percutaneous transluminal angioplasty, transcutaneous CO 2 and deep ulcer shaving. The wound was closed by sandwich transplantation using elastin-collagen dermal template and meshed split skin graft. She had a 100% graft take with rapid reduction of severe wound pain. Complex approaches are necessary, to gain optimum results in leg ulcer therapy in mixed leg ulcers. Therapeutic nihilism should be abandonend.

An Adult Case of Fulminant Mumps Keratitis With Positive Viral RNA in Aqueous Humor Detected by RT-PCR.

PubMed

Shibata, Teppei; Takahashi, Yoriko; Okamoto, Ayako; Sasaki, Hiroshi; Kitagawa, Kazuko

2016-04-01

To report an adult case of mumps keratitis with mumps virus in aqueous humor and decreased corneal endothelial cell density. Case report. A 60-year-old female with a 39°C fever and bilateral parotid swelling diagnosed with mumps and treated for photophobia, pain, redness, and decreased vision in 1 eye, was referred to our hospital when her condition deteriorated despite receiving betamethasone phosphate instillation and antiglaucoma agents for elevated intraocular pressure (52 mm Hg) and iritis. Her right eye was normal, whereas her left eye showed 20/400 visual acuity, 21 mm Hg intraocular pressure, ciliary injection and edema, opacity, and Descemet folds in the entire cornea. Round white keratic precipitates were present on the posterior corneal surface, whereas anterior chamber cells could not be examined in detail because of corneal edema. Mumps virus was detected by reverse transcriptase polymerase chain reaction in an aqueous humor sample taken at the time of admission. Following diagnosis of keratitis, administration of 30 mg oral prednisolone daily and frequent instillation of betamethasone phosphate steadily improved her corneal edema and opacity. In her left eye, visual acuity recovered to 20/16 and keratitis was resolved at 4 weeks; however, corneal endothelial cell density was significantly decreased to less than 400 per square millimeter. Mumps keratitis may cause severe corneal endothelial cell loss.

The effect of periorbital cooling on pain, edema and ecchymosis after rhinoplasty: a randomized, controlled, observer-blinded study.

PubMed

Kayiran, Oguz; Calli, Caglar

2016-03-01

Success and satisfactory results in rhinoplasty are established not only with flawless surgery but also with meticulous perioperative care. Pain stays at the centre of these circumstances. Besides, several contributing perioperative factors such as periorbital edema and ecchymosis play key role on the patients' comfort. Septorhinoplasty was carried out in 50 patients between February and May 2014 under general anesthesia. Local anesthesia with lidocaine and adrenaline combination was done prior to incision. Following the procedure, silicone gel packs were applied. One periorbital region was cooled after surgery whereas the opposite site was left uncooled. Periorbital edema-ecchmosis and pain intensity were graded and noted 1 hour, 1 day, 3 days, 1 week and 1 month after surgery. Cold application seriously reduced postoperative edema and ecchymosis at the first week (p=0.001 for the first 3 days and p=0.006 at first week). Pain was reduced with cooling not on the first hour (p>0.05), but on the forthcoming days throughout the first week (p<0.005). Operation time revealed that primary cases were carried out quicker than revisional surgery. Moreover, pain scores were found lower in primary cases than revisions, especially in the first 3 days. These finding were approved statistically. Cooling of the periorbital region reduces edema and ecchymosis as well as pain; however 3 days of use is enough after rhinoplasty. One hour after surgery, cooling does not affect the pain but reduce edema and ecchymosis.

Keratoconjunctivitis and Periorbital Edema due to Ecballium elaterium

PubMed Central

Brouzas, Dimitrios; Oanta, Mariana; Loukianou, Eleni; Moschos1st, Marillita

2012-01-01

Purpose To report on a case of keratoconjunctivitis with periorbital edema after accidental exposure to undiluted juice of Ecballium elaterium fruit during the ripening season of this plant. Methods Case report. Results Keratoconjunctivitis with Descemet's membrane folds and superficial upper corneal well-defined edematous areas were noted after an Ecballium elaterium fruit burst and its juice splashed into the patient's left eye. Prompt administration of antibiotic and steroid eye drops along with per os antihistamine therapy, resulted in quick regression of symptoms. Conclusions This report demonstrates the toxic effects of this herb to the eye and also that prompt therapy is effective. PMID:22529808

Connective Tissue Reflex Massage for Type 2 Diabetic Patients with Peripheral Arterial Disease: Randomized Controlled Trial

PubMed Central

Castro-Sánchez, Adelaida María; Moreno-Lorenzo, Carmen; Matarán-Peñarrocha, Guillermo A.; Feriche-Fernández-Castanys, Belen; Granados-Gámez, Genoveva; Quesada-Rubio, José Manuel

2011-01-01

The objective of this study was to evaluate the efficacy of connective tissue massage to improve blood circulation and intermittent claudication symptoms in type 2 diabetic patients. A randomized, placebo-controlled trial was undertaken. Ninety-eight type 2 diabetes patients with stage I or II-a peripheral arterial disease (PAD) (Leriche-Fontaine classification) were randomly assigned to a massage group or to a placebo group treated using disconnected magnetotherapy equipment. Peripheral arterial circulation was determined by measuring differential segmental arterial pressure, heart rate, skin temperature, oxygen saturation and skin blood flow. Measurements were taken before and at 30 min, 6 months and 1 year after the 15-week treatment. After the 15-week program, the groups differed (P < .05) in differential segmental arterial pressure in right lower limb (lower one-third of thigh, upper and lower one-third of leg) and left lower limb (lower one-third of thigh and upper and lower one-third of leg). A significant difference (P < .05) was also observed in skin blood flow in digits 1 and 4 of right foot and digits 2, 4 and 5 of left foot. ANOVA results were significant (P < .05) for right and left foot oxygen saturation but not for heart rate and temperature. At 6 months and 1 year, the groups differed in differential segmental arterial pressure in upper third of left and right legs. Connective tissue massage improves blood circulation in the lower limbs of type 2 diabetic patients at stage I or II-a and may be useful to slow the progression of PAD. PMID:19933770

Noncardiogenic Pulmonary Edema as a Result of Urosepsis

DTIC Science & Technology

2010-03-01

cause could be aortic stenosis , which may require surgery to correct, or it could be coronary artery disease, which can be treated through a variety...systolic dysfunction. Left ventricular dysfunction can occur due to many processes such as aortic or mitral valve dysfunction, coronary artery disease

Hemofiltration in ex vivo lung perfusion-a study in experimentally induced pulmonary edema.

PubMed

Nilsson, Tobias; Hansson, Christoffer; Wallinder, Andreas; Malm, Carl-Johan; Silverborn, Martin; Ricksten, Sven-Erik; Dellgren, Göran

2016-02-01

Ex vivo lung perfusion (EVLP) can potentially reduce pulmonary edema. In a pig model with induced pulmonary edema, we evaluated the effect of hemofiltration (HF) during EVLP on lung function, perfusate oncotic pressure, and lung weight. In anesthetized pigs (n = 14), pulmonary edema was induced by a balloon in the left atrium, combined with crystalloid infusion (20 mL/kg), for 2 hours. The lungs were harvested, stored cold for 2 hours, and randomized to EVLP, with or without a hemofilter (HF and noHF groups, respectively, n = 7 for each). EVLP was performed with cellular perfusate at a hematocrit of 10% to 15%. Oncotic pressure, lung performance, and weight were measured before and after 180 minutes of EVLP reconditioning with or without HF. After in vivo induction of edema, arterial oxygen tension (Pao2)/inspired oxygen fraction (Fio2), and compliance decreased by 63% and 16%, respectively. Pao2/Fio2 was considerably improved at first evaluation ex vivo in both groups. HF increased oncotic pressure by 43% and decreased lung weight by 15%. The effects were negligible in the noHF group. Compliance decreased in both groups during reconditioning, although less so in the HF group (P < .05). Pao2/Fio2, shunt fraction, and oxygen saturation remained unchanged in both groups. Pulmonary flow index decreased in both groups, and was partially reversed by nitroglycerin. Dorsal atelectatic consolidations were seen in both groups. In this lung-edema model, EVLP reconditioning with hyperoncotic solution did not affect the degree of lung edema. HF during EVLP increased perfusate oncotic pressure, decreased lung weight with beneficial effects on compliance, but did not improve lung oxygenation capacity. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Myotonic dystrophy mimicking postpolio syndrome in a polio survivor.

PubMed

Lim, Jae-Young; Kim, Kyoung-Eun; Choe, Gheeyoung

2009-02-01

We describe a 38-yr-old polio survivor with newly developed weakness from myotonic dystrophy. He suffered muscle atrophy and weakness in his legs as a result of poliomyelitis at the age of 3 yrs. After a stable interval of about 30 yrs, he felt new weakness and fatigue in his legs. Electromyography revealed generalized myotonic discharges, early recruitment, and findings of chronic denervation in his left leg. Genetic testing was consistent with myotonic dystrophy type 1. A biopsy from the right gastrocnemius revealed findings of both myotonic dystrophy and chronic denervation. This case report shows the importance of considering other uncommon conditions in the differential diagnoses of postpolio syndrome.

Microcephaly/lymphedema and terminal deletion of the long arm of chromosome 13

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fryns, J.P.

1995-07-03

Recently, we examined a 2-year-old boy with the association of microcephaly and significant pedal edema that extended to the distal parts of the legs. Prometaphase chromosome studies showed a small terminal deletion in the long arm of chromosome 13 of band 13q34, karyotype 46,XY,del(13)(q34{yields}qter). The present finding of a small terminal 13q34 deletion in this young boy with microcephaly/lymphedema is a first indication that the lymphedema/microcephaly association can be due to a small terminal 13q deletion. 2 refs.

Sensitivity and specificity of fluorescence microlymphography for detecting lymphedema of the lower extremity.

PubMed

Keo, Hong H; Schilling, Marianne; Büchel, Roland; Gröchenig, Ernst; Engelberger, Rolf P; Willenberg, Torsten; Baumgartner, Iris; Gretener, Silvia B

2013-06-01

Fluorescence microlymphography (FML) is used to visualize the lymphatic capillaries. A maximum spread of the fluorescence dye of ≥ 12 mm has been suggested for the diagnosis of lymphedema. However, data on sensitivity and specificity are lacking. The aim of this study was to investigate the accuracy of FML for diagnosing lymphedema in patients with leg swelling. Patients with lower extremity swelling were clinically assessed and separated into lymphedema and non-lymphatic edema groups. FML was studied in all affected legs and the maximum spread of lymphatic capillaries was measured. Test accuracy and receiver operator characteristic (ROC) analysis was performed to assess possible threshold values that predict lymphedema. Between March 2008 and August 2011 a total of 171 patients (184 legs) with a median age of 43.5 (IQR 24, 54) years were assessed. Of those, 94 (51.1%) legs were diagnosed with lymphedema. The sensitivity, specificity, positive and negative likelihood ratio and positive and negative predictive value were 87%, 64%, 2.45, 0.20, 72% and 83% for the 12-mm cut-off level and 79%, 83%, 4.72, 0.26, 83% and 79% for the 14-mm cut-off level, respectively. The area under the ROC curve was 0.82 (95% CI: 0.76, 0.88). Sensitivity was higher in the secondary versus primary lymphedema (95.0% vs 74.3%, p = 0.045). No major adverse events were observed. In conclusion, FML is a simple and safe technique for detecting lymphedema in patients with leg swelling. A cut-off level of ≥ 14-mm maximum spread has a high sensitivity and high specificity of detecting lymphedema and should be chosen.

Periocular necrotizing fasciitis in an infant.

PubMed

Proia, Alan D

Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, Young-Min, E-mail: ymhan@chonbuk.ac.kr; Kwak, Ho-Sung; Jin, Gong-Young

2006-06-15

A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a casemore » of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism.« less

Strength and muscle mass loss with aging process. Age and strength loss.

PubMed

Keller, Karsten; Engelhardt, Martin

2013-10-01

aging process is associated with changes in muscle mass and strength with decline of muscle strength after the 30(th) life year. The aim of this study was to investigate these changes in muscle mass and strength. for this analysis 26 participants were subdivided in two groups. Group 1 comprises participants aged <40 years (n=14), group 2 those >40 years (n=12). We assessed anthropometrics, range of motions, leg circumferences and isometric strength values of the knee joints. besides comparable anthropometrics, circumferences and strength were higher in group 1 than in group 2. Circumference of upper leg (20 cm above knee articular space) showed for right leg a trend to a significant (median: 54.45 cm (1(st) quartile: 49.35/3(rd) quartile: 57.78) vs 49.80 cm (49.50/50.75), p=0.0526) and for left leg a significant 54.30 cm (49.28/58.13) vs 49.50 cm (48.00/52.53), p=0.0356) larger circumference in group 1. Isometric strength was in 60° knee flexion significantly higher in group 1 than in group 2 for right (729.88N (561.47/862.13) vs 456.92N (304.67/560.12), p=0.00448) and left leg (702.49N (581.36/983.87) vs 528.49N (332.95/648.58), p=0.0234). aging process leads to distinct muscle mass and strength loss. Muscle strength declines from people aged <40 years to those >40 years between 16.6% and 40.9%.

Applying Bayesian hierarchical models to examine motorcycle crashes at signalized intersections.

PubMed

Haque, Md Mazharul; Chin, Hoong Chor; Huang, Helai

2010-01-01

Motorcycles are overrepresented in road traffic crashes and particularly vulnerable at signalized intersections. The objective of this study is to identify causal factors affecting the motorcycle crashes at both four-legged and T signalized intersections. Treating the data in time-series cross-section panels, this study explores different Hierarchical Poisson models and found that the model allowing autoregressive lag-1 dependence specification in the error term is the most suitable. Results show that the number of lanes at the four-legged signalized intersections significantly increases motorcycle crashes largely because of the higher exposure resulting from higher motorcycle accumulation at the stop line. Furthermore, the presence of a wide median and an uncontrolled left-turn lane at major roadways of four-legged intersections exacerbate this potential hazard. For T signalized intersections, the presence of exclusive right-turn lane at both major and minor roadways and an uncontrolled left-turn lane at major roadways increases motorcycle crashes. Motorcycle crashes increase on high-speed roadways because they are more vulnerable and less likely to react in time during conflicts. The presence of red light cameras reduces motorcycle crashes significantly for both four-legged and T intersections. With the red light camera, motorcycles are less exposed to conflicts because it is observed that they are more disciplined in queuing at the stop line and less likely to jump start at the start of green.

Acute pulmonary edema following inflation of arterial tourniquet.

PubMed

Santhosh, M C B; Pai, R B; Rao, R P

2014-10-01

Arterial tourniquets are used as one of the methods for reducing blood loss and for allowing blood free surgical field. A 20-year-old, 45 kg healthy female with a sphere shaped pendunculated hemangioma in the popliteal fossa of her left lower limb was applied with arterial tourniquet after exsanguination. The procedure was performed under general anesthesia. Soon after exsanguination and tourniquet inflation, the patient developed pulmonary edema which subsided after deflating the tourniquet. The clinical evolution, treatment and pathophysiology of this complication are described. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Simultaneous occurrence of a severe Morel-Lavallée lesion and gluteal muscle necrosis as a sequela of transcatheter angiographic embolization following pelvic fracture: a case report.

PubMed

Shimizu, Takayoshi; Matsuda, Shuichi; Sakuragi, Atsushi; Tsukie, Tomio; Kawanabe, Keiichi

2015-03-26

Morel-Lavallée lesions are posttraumatic hemolymphatic collections caused by disruption of the interfascial planes between the subcutaneous soft tissue and muscle. Severe peripelvic Morel-Lavallée lesions have rarely been reported in the literature. By contrast, a number of cases of gluteal muscle necrosis following transcatheter angiographic embolization for pelvic fracture have been reported. Each entity can result in severe infection and sepsis, and the mortality rate in such cases is quite high. However, to date, no previous reports have described a case in which these life-threatening entities occurred simultaneously. A 32-year-old Asian man simultaneously developed severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis with sepsis following transcatheter angiographic embolization after an unstable pelvic fracture. Extremely large skin and soft tissue defects, which were untreatable with any commonly used flaps, were generated after repeated debridement. In addition, a deep-bone infection was suspected in his left fractured iliac bone, while motor function was almost completely lost in his left leg, possibly as a sequela of transcatheter angiographic embolization. As a result of his condition, a left hemipelvectomy was unavoidable. A pedicled fillet flap from his sacrificed left limb was used for the treatment of the defects and to provide a durable base for a prosthesis. Our patient survived and returned to his previous job 24 months after the surgery wearing a prosthetic left leg. As illustrated by the present case, severe peripelvic Morel-Lavallée lesions and gluteal muscle necrosis following transcatheter angiographic embolization can occur simultaneously after unstable pelvic fractures. Physicians should recognize that these entities can result in life-threatening sepsis and, therefore, should attempt to detect them as early as possible. When hemipelvectomy is unavoidable, a pedicled upper and lower leg in-continuity fillet flap may provide satisfactory outcomes.

Differences in Muscle Oxygenation, Perceived Fatigue and Recovery between Long-Track and Short-Track Speed Skating

PubMed Central

Hettinga, Florentina J.; Konings, Marco J.; Cooper, Chris E.

2016-01-01

Due to the technical nature of speed skating, that is affecting physiological mechanisms such as oxygenation and blood flow, this sport provides a unique setting allowing us to uncover novel mechanistic insights of the physiological response to exercise in elite middle-distance and endurance sports. The present study aimed to examine the influence of skating mode (short-track vs. long-track) on muscle oxygenation, perceived fatigue, and recovery in elite speed skating. Muscle oxygenation of 12 talented short-track speed skaters was continuously monitored during a long-track (LT) and a short-track (ST) skating time-trial of maximal effort using near-infrared spectroscopy (NIRS) on the m. vastus lateralis for both legs. Video captures were made of each testing session for further interpretation of the muscle oxygenation. To determine recovery, perceived exertion was measured 2 and 4 h after each testing sessions. Repeated measures ANOVA's were used for statistical analysis (p < 0.05). After a rapid desaturation in both legs directly after the start, an asymmetry in muscle oxygenation between both legs was found during LT (tissue saturation-index (TSI%)-slope: left = 0.053 ± 0.032; right = 0.023 ± 0.020, p < 0.05) and ST speed skating (TSI%-slope: left = 0.050 ± 0.052, right = 0.001 ± 0.053, p < 0.05). Resaturation of the right leg was relatively lower in ST compared to LT. For the left leg, no difference was found between skating modes in muscle oxygenation. Respectively, two (ST = 5.8 ± 2.0; LT = 4.2 ± 1.5) and 4 h (ST = 4.6 ± 1.9; LT = 3.1 ± 1.6) after the time-trials, a higher rate of perceived exertion was found for ST. Based on our results, ST seems more physiologically demanding, and longer periods of recovery are needed after training compared to LT. Technical aspects unique to the exercise mode seem to impact on oxygenation, affecting processes related to the regulation of exercise intensity such as fatigue and recovery. PMID:28018244

Differences in Muscle Oxygenation, Perceived Fatigue and Recovery between Long-Track and Short-Track Speed Skating.

PubMed

Hettinga, Florentina J; Konings, Marco J; Cooper, Chris E

2016-01-01

Due to the technical nature of speed skating, that is affecting physiological mechanisms such as oxygenation and blood flow, this sport provides a unique setting allowing us to uncover novel mechanistic insights of the physiological response to exercise in elite middle-distance and endurance sports. The present study aimed to examine the influence of skating mode (short-track vs. long-track) on muscle oxygenation, perceived fatigue, and recovery in elite speed skating. Muscle oxygenation of 12 talented short-track speed skaters was continuously monitored during a long-track (LT) and a short-track (ST) skating time-trial of maximal effort using near-infrared spectroscopy (NIRS) on the m. vastus lateralis for both legs. Video captures were made of each testing session for further interpretation of the muscle oxygenation. To determine recovery, perceived exertion was measured 2 and 4 h after each testing sessions. Repeated measures ANOVA's were used for statistical analysis ( p < 0.05). After a rapid desaturation in both legs directly after the start, an asymmetry in muscle oxygenation between both legs was found during LT (tissue saturation-index (TSI%)-slope: left = 0.053 ± 0.032; right = 0.023 ± 0.020, p < 0.05) and ST speed skating (TSI%-slope: left = 0.050 ± 0.052, right = 0.001 ± 0.053, p < 0.05). Resaturation of the right leg was relatively lower in ST compared to LT. For the left leg, no difference was found between skating modes in muscle oxygenation. Respectively, two ( ST = 5.8 ± 2.0; LT = 4.2 ± 1.5) and 4 h ( ST = 4.6 ± 1.9; LT = 3.1 ± 1.6) after the time-trials, a higher rate of perceived exertion was found for ST. Based on our results, ST seems more physiologically demanding, and longer periods of recovery are needed after training compared to LT. Technical aspects unique to the exercise mode seem to impact on oxygenation, affecting processes related to the regulation of exercise intensity such as fatigue and recovery.

Primary orbital precursor T-cell lymphoblastic lymphoma: Report of a unique case

PubMed Central

Stenman, Lisa; Persson, Marta; Enlund, Fredrik; Clasen-Linde, Erik; Stenman, Göran; Heegaard, Steffen

2016-01-01

Primary T-cell lymphoblastic lymphoma (T-LBL) in the eye region is very rare. The present study described a unique case of T-LBL involving the extraocular muscles. A 22-year-old male patient presented with a 3-week history of headache, reduced visual acuity and edema of the left eye. Clinical examination revealed left-sided exophthalmus, periorbital edema, chemosis, and reduced motility of the left eye. A magnetic resonance imaging scan revealed thickening of the left orbital muscles and a positron emission tomography-computed tomography scan also demonstrated activity in a subclavicular lymph node. Histopathological analysis of both lesions revealed infiltration by medium-sized neoplastic lymphoid cells with a high nuclear-cytoplasmic ratio and a high mitotic index. Immunostaining revealed positivity for CD2, CD3, CD99, Tia-1, and GranzymB, and variable positivity for CD4. There was no involvement of the bone marrow. Based on the clinical and histopathological findings, a diagnosis of T-LBL was made. There was no evidence of NOTCH1 mutation or rearrangements of the ETV6 and MLL genes and high-resolution array-based comparative genomic hybridization (arrayCGH) analysis revealed a normal genomic profile. The patient received chemotherapy according to the high-risk NOPHO protocol, followed by myeloablative allogenic bone marrow transplantation. At 35 months after diagnosis, the patient remained in complete first remission, but without light perception on his left eye. To the best of our knowledge, this is the first report of a case of T-LBL involving the extraocular muscles. Although primary T-LBL in the eye region is very rare, our findings demonstrate that lymphoma should be considered in the differential diagnosis of patients with similar symptoms. PMID:27900092

Reversible Edema-Like Changes Along the Optic Tract Following Pipeline-Assisted Coiling of a Large Anterior Communicating Artery Aneurysm.

PubMed

La Pira, Biagia; Brinjikji, Waleed; Hunt, Christopher; Chen, John J; Lanzino, Giuseppe

2017-06-01

Aneurysmal volume expansion after endovascular treatment is caused by intra-aneurysmal thrombosis in the early postembolization period. Although postembolization mass effect on cranial nerves and other adjacent structures has been previously reported, we are unaware of reports involving the anterior visual pathway. A 66-year-old woman with a 2-week history of blurred vision without headache was found to have a large, unruptured anterior communicating artery aneurysm. One month after endovascular treatment of the aneurysm with coiling and flow diversion, the patient developed decreased vision in her right eye and a left homonymous hemianopia. Magnetic resonance imaging demonstrated compression of the right optic nerve, chiasm, and edema of the right optic tract. The patient was treated with a course of high dose corticosteroids, and over the course of several weeks, her vision improved and the optic tract edema resolved. We alert clinicians to this rare but potentially reversible visual complication of endovascular treatment of intracranial aneurysms.

Brain abscess mimicking lung cancer metastases; a case report.

PubMed

Asano, Michiko; Fujimoto, Nobukazu; Fuchimoto, Yasuko; Ono, Katsuichiro; Ozaki, Shinji; Kimura, Fumiaki; Kishimoto, Takumi

2013-01-01

A 76-year-old woman came to us because of staggering, fever, dysarthria, and appetite loss. Magnetic resonance imaging (MRI) of the brain revealed multiple masses with surrounding edema. Chest X-ray and computed tomography demonstrated a mass-like lesion in the left lung and left pleural effusion. Lung cancer and multiple brain metastases were suspected. However, the brain lesions demonstrated a high intensity through diffusion-weighted MRI. The finding was an important key to differentiate brain abscesses from lung cancer metastases. Copyright © 2013 Elsevier Inc. All rights reserved.

Left Ventricular Noncompaction Cardiomyopathy and Recurrent Polymorphic Ventricular Tachycardia: A Case Report and Literature Review.

PubMed

Akinseye, Oluwaseun A; Ibebuogu, Uzoma N; Jha, Sunil K

2017-01-01

Noncompaction cardiomyopathy is a rare phenotype of cardiomyopathy associated with severe cardiac arrhythmia and thromboembolic complications. A 55-year-old woman presented with frank pulmonary edema and received a diagnosis of noncompaction cardiomyopathy. Left ventricular noncompaction cardiomyopathy is increasingly being diagnosed because of advances in imaging modalities. It is important to differentiate this new phenotype of cardiomyopathy from others because its diagnosis, management, and prognosis differ. We reviewed the literature and summarized the diagnostic criteria, associated complications, initial and long-term management, and the recommendation for family screening.

Idiopathic glaucoma in an 11-year-old crossbred mare.

PubMed

Rizzo, Daniella

2017-05-01

An 11-year-old crossbred mare was presented with left eye buphthalmia, a mydriatic minimally responsive pupil, locally extensive ventral corneal edema, and corneal striae. Intraocular pressures exceeding 80 mmHg lead to a presumptive diagnosis of glaucoma. Following several days of treatment there was no improvement and enucleation was performed.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abboud, Georges, E-mail: drgeorgesabboud@hotmail.com; Midulla, Marco, E-mail: marcomidu@gmail.com; Lions, Christophe, E-mail: c-lions@chru-lille.fr

The May-Thurner syndrome is a well-known anatomical anomaly where the left common iliac vein (LCIV) is compressed between the right common iliac artery and the fifth vertebral body. This report describes the case of a 'right-sided' May-Thurner syndrome where the right common iliac vein (RCIV) is compressed by the left common iliac artery in a patient with a left-sided inferior vena cava (IVC). A 26-year-old woman was admitted to our institution with acute edema of the right lower limb. The diagnosis of May-Thurner syndrome was done by CT scan and confirmed by phlebography. An endovascular treatment with stenting was carriedmore » out, with good patency and clinical result at 12-month follow-up.« less

Posterior Epidural Migration of an Extruded Lumbar Disc Mimicking a Facet Cyst: A Case Report

PubMed Central

Yoo, Young Sun; Ju, Chang Il; Kim, Dong Min

2015-01-01

Dorsal extradural migration of extruded disc material is clinically uncommon. We report a rare case of posterior epidural migration of an extruded lumbar disc mimicking a facet cyst. A 32-year-old man was admitted to our institute with a 2-week history of severe low back pain and radiating pain in the left leg. The magnetic resonance (MR) images revealed a dorsally located, left-sided extradural cystic mass at the L2-3 level. The initial diagnosis was an epidural facet cyst because of the high signal intensity on MR images and its location adjacent to the facet joint. Intraoperatively, an encapsulated mass of soft tissue adherent to the dural sac was observed and excised. The pathological diagnosis was degenerated disc material. After surgery, the patient experienced complete relief from leg pain. PMID:25883662

Benefits of Ilizarov automated bone distraction for nerves and articular cartilage in experimental leg lengthening.

PubMed

Shchudlo, Nathalia; Varsegova, Tatyana; Stupina, Tatyana; Shchudlo, Michael; Saifutdinov, Marat; Yemanov, Andrey

2017-09-18

To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage. Twenty-nine dogs were divided in two experimental groups: Group M - leg lengthening with manual distraction (1 mm/d in 4 steps), Group A - automated distraction (1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30 th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peroneal and tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed. Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage (thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group. Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes.

Benefits of Ilizarov automated bone distraction for nerves and articular cartilage in experimental leg lengthening

PubMed Central

Shchudlo, Nathalia; Varsegova, Tatyana; Stupina, Tatyana; Shchudlo, Michael; Saifutdinov, Marat; Yemanov, Andrey

2017-01-01

AIM To determine peculiarities of tissue responses to manual and automated Ilizarov bone distraction in nerves and articular cartilage. METHODS Twenty-nine dogs were divided in two experimental groups: Group M - leg lengthening with manual distraction (1 mm/d in 4 steps), Group A - automated distraction (1 mm/d in 60 steps) and intact group. Animals were euthanized at the end of distraction, at 30th day of fixation in apparatus and 30 d after the fixator removal. M-responses in gastrocnemius and tibialis anterior muscles were recorded, numerical histology of peroneal and tibialis nerves and knee cartilage semi-thin sections, scanning electron microscopy and X-ray electron probe microanalysis were performed. RESULTS Better restoration of M-response amplitudes in leg muscles was noted in A-group. Fibrosis of epineurium with adipocytes loss in peroneal nerve, subperineurial edema and fibrosis of endoneurium in some fascicles of both nerves were noted only in M-group, shares of nerve fibers with atrophic and degenerative changes were bigger in M-group than in A-group. At the end of experiment morphometric parameters of nerve fibers in peroneal nerve were comparable with intact nerve only in A-group. Quantitative parameters of articular cartilage (thickness, volumetric densities of chondrocytes, percentages of isogenic clusters and empty cellular lacunas, contents of sulfur and calcium) were badly changed in M-group and less changed in A-group. CONCLUSION Automated Ilizarov distraction is more safe method of orthopedic leg lengthening than manual distraction in points of nervous fibers survival and articular cartilage arthrotic changes. PMID:28979852

Sonographic evidence of ascites, pleura-pericardial effusion and gallbladder wall edema for dengue fever.

PubMed

Motla, M; Manaktala, S; Gupta, V; Aggarwal, M; Bhoi, S K; Aggarwal, P; Goel, A

2011-10-01

Radiographic findings of dengue fever have not yet been clearly elucidated in relation to clinical and serological findings, despite the fact that two-fifths of the world population lives in areas where the virus is endemic. The current study is a retrospective analysis of ultrasonographic (USG) features of patients presenting with probable dengue fever during the outbreak of DF of 2006 in North India. Case records of a 169 patients with probable dengue fever were included. Ten individual sonographic parameters were reviewed vis-à-vis ascites, hepatomegaly, splenomegaly, gall bladder wall edema (GBWE), pleural effusion (right or left or both), pericardial effusion, pericholecystic collection, perinephric collection. Subjects who had GB wall thickness >3 mm as measured on ultrasound were identified as positive for GBWE. The cases were analyzed in view of their serological profile. The mean age of the subjects was 27.9 +/- 13.4 years. The mean value of the platelet count was 57.4 +/- 22.3 x 103/cmm. The most common ultrasonographic feature was ascites (126, 74.6%) followed by gall bladder wall edema (122, 72%), hepatomegaly (78, 46.2%), splenomegaly (66, 39.1%) and pericholecystic collection (63, 37.3%); 48 (28.4%) subjects demonstrated evidence of pleural effusion on the right side, while 19 (11.2%) had bilateral effusion. None of the subjects had an isolated left pleural effusion. Twenty-seven (16%) subjects reported bleeding manifestations in the form of petechiae and five (3%) developed renal dysfunction. Presence of pleural and pericardial effusions was found to be specific while ascites and GBWE were identified as highly sensitive markers for seropositive Primary DF. Ultrasonographic evidence of ascites, pleuro-pericardial effusion, and gallbladder wall edema are rapidly acquired, non-invasive markers of dengue and can be helpful before serological investigations become available. These findings may indicate severity and may herald the onset of bleeding (petechiae) or predict the development of acute renal dysfunction.

The Interday Measurement Consistency of and Relationships Between Hamstring and Leg Musculo-articular Stiffness.

PubMed

Waxman, Justin P; Schmitz, Randy J; Shultz, Sandra J

2015-10-01

Hamstring stiffness (K(HAM)) and leg stiffness (K(LEG)) are commonly examined relative to athletic performance and injury risk. Given these may be modifiable, it is important to understand day-to-day variations inherent in these measures before use in training studies. In addition, the extent to which K(HAM) and K(LEG) measure similar active stiffness characteristics has not been established. We investigated the interday measurement consistency of K(HAM) and K(LEG), and examined the extent to which K(LEG) predicted K(HAM) in 6 males and 9 females. K(HAM) was moderately consistent day-to-day (ICC(2,5) = .71; SEM = 76.3 N·m(-1)), and 95% limits of agreement (95% LOA) revealed a systematic bias with considerable absolute measurement error (95% LOA = 89.6 ± 224.8 N·m(-1)). Day-to-day differences in procedural factors explained 59.4% of the variance in day-to-day differences in K(HAM). Bilateral and unilateral K(LEG) was more consistent (ICC(2,3) range = .87-.94; SEM range = 1.0-2.91 kN·m(-1)) with lower absolute error (95% LOA bilateral= -2.0 ± 10.3; left leg = -0.36 ± 3.82; right leg = -1.05 ± 3.61 kN·m(-1)). K(LEG) explained 44% of the variance in K(HAM) (P < .01). Findings suggest that procedural factors must be carefully controlled to yield consistent and precise K(HAM) measures. The ease and consistency of K(LEG), and moderate correlation with K(HAM), may steer clinicians toward K(LEG) when measuring lower-extremity stiffness for screening studies and monitoring the effectiveness of training interventions over time.

Anthropometrical, physiological, and tracked power profiles of elite taekwondo athletes 9 weeks before the Olympic competition phase.

PubMed

Ball, Nick; Nolan, Emily; Wheeler, Keane

2011-10-01

Physiological, anthropometric, and power profiling data were retrospectively analyzed from 4 elite taekwondo athletes from the Australian National Olympic team 9 weeks from Olympic departure. Power profiling data were collected weekly throughout the 9-week period. Anthropometric skinfolds generated a lean mass index (LMI). Physiological tests included a squat jump and bench throw power profile, bleep test, 20-m sprint test, running VO2max test, and bench press and squat 3 repetition maximum (3RM) strength tests. After this, the athletes power, velocity, and acceleration profile during unweighted squat jumps and single-leg jumps were tracked using a linear position transducer. Increases in power, velocity, and acceleration between weeks and bilateral comparisons were analyzed. Athletes had an LMI of 37.1 ± 0.4 and were 173.9 ± 0.2 m and 67 ± 1.1 kg. Relatively weaker upper body (56 ± 11.97 kg 3RM bench press) compared to lower body strength (88 ± 2.89 kg 3RM squat) was shown alongside a VO2max of 53.29 ml(-1)·min(-1)·kg, and a 20-m sprint time of 3.37 seconds. Increases in all power variables for single-leg squat and squat jumps were found from the first session to the last. Absolute peak power in single-leg squat jumps increased by 13.4-16% for the left and right legs with a 12.9% increase in squat jump peak power. Allometrically scaled peak power showed greater increases for single-leg (right leg: 18.55%; left: 23.49%) and squat jump (14.49%). The athlete's weight did not change significantly throughout the 9-week mesocycle. Progressions in power increases throughout the weeks were undulating and can be related to the intensity of the prior week's training and athlete injury. This analysis has shown that a 9-week mesocycle before Olympic departure that focuses on core lifts has the ability to improve power considerably.

The influence of changes in trunk and pelvic posture during single leg standing on hip and thigh muscle activation in a pain free population.

PubMed

Prior, Simon; Mitchell, Tim; Whiteley, Rod; O'Sullivan, Peter; Williams, Benjamin K; Racinais, Sebastien; Farooq, Abdulaziz

2014-03-27

Thigh muscle injuries commonly occur during single leg loading tasks and patterns of muscle activation are thought to contribute to these injuries. The influence trunk and pelvis posture has on hip and thigh muscle activation during single leg stance is unknown and was investigated in a pain free population to determine if changes in body posture result in consistent patterns of changes in muscle activation. Hip and thigh muscle activation patterns were compared in 22 asymptomatic, male subjects (20-45 years old) in paired functionally relevant single leg standing test postures: Anterior vs. Posterior Trunk Sway; Anterior vs. Posterior Pelvic Rotation; Left vs. Right Trunk Shift; and Pelvic Drop vs. Raise. Surface EMG was collected from eight hip and thigh muscles calculating Root Mean Square. EMG was normalized to an "upright standing" reference posture. Repeated measures ANOVA was performed along with associated F tests to determine if there were significant differences in muscle activation between paired test postures. In right leg stance, Anterior Trunk Sway (compared to Posterior Sway) increased activity in posterior sagittal plane muscles, with a concurrent deactivation of anterior sagittal plane muscles (p: 0.016 - <0.001). Lateral hip abductor muscles increased activation during Left Trunk Shift (compared to Right) (p :≤ 0.001). Lateral Pelvic Drop (compared to Raise) decreased activity in hip abductors and increased hamstring, adductor longus and vastus lateralis activity (p: 0.037 - <0.001). Changes in both trunk and pelvic posture during single leg stance generally resulted in large, predictable changes in hip and thigh muscle activation in asymptomatic young males. Changes in trunk position in the sagittal plane and pelvis position in the frontal plane had the greatest effect on muscle activation. Investigation of these activation patterns in clinical populations such as hip and thigh muscle injuries may provide important insights into injury mechanisms and inform rehabilitation strategies.

Central adaptations in aerobic circuit versus walking/jogging trained cardiac patients.

PubMed

Goodman, L S; McKenzie, D C; Nath, C R; Schamberger, W; Taunton, J E; Ammann, W C

1995-06-01

This study was done to determine (a) whether in coronary artery disease (CAD) left ventricular (LV) adaptations differed after 6 months of walking/jogging (legs-only, LO) versus aerobic circuit training (arms and legs, AL) versus a control group, and (b) whether a transfer of fitness to the untrained arms in the LO group was related to superior LV adaptations. Peak oxygen uptake for arm and leg ergometry and for cycle ergometry using radionuclide cardiac angiography were performed before and after training. Leg and arm VO2peak increased significantly by 13% in the AL group, and by 13% and 7%, respectively, for the LO group. LV function was greater after training for the LO versus the AL group. Improvements in systolic and diastolic function and a speculated hypervolemia explain these LV adaptations. In CAD patients, walking/jogging produces greater LV function improvements versus circuit training, possibly due to differences in the exercised muscle mass.

Effect of foot massage to decrease physiological lower leg oedema in late pregnancy: a randomized controlled trial in Turkey.

PubMed

Coban, Ayden; Sirin, Ahsen

2010-10-01

This study aims to evaluate the effect of foot massage for decreasing physiological lower leg oedema in late pregnancy. Eighty pregnant women were randomly divided into two groups; study group had a 20 min foot massage daily for 5 days whereas the control group did not receive any intervention beyond standard prenatal care. The research was conducted between March and August 2007 in Manisa Province Health Ministry Central Primary Health Care Clinic 1, in Manisa, Western Turkey. Compared with the control group, women in the experimental group had a significantly smaller lower leg circumference (right and left, ankle, instep and metatarsal-phalanges joint) after 5 days of massage. The results obtained from our research show that foot massage was found to have a positive effect on decreasing normal physiological lower leg oedema in late pregnancy. © 2010 Blackwell Publishing Asia Pty Ltd.

Passive heat exposure induced by hot water leg immersion increased oxyhemoglobin in pre-frontal cortex to preserve oxygenation and did not contribute to impaired cognitive functioning

NASA Astrophysics Data System (ADS)

Wijayanto, Titis; Toramoto, Sayo; Tochihara, Yutaka

2013-07-01

This study investigated the effects of passive heat exposure on pre-frontal cortex oxygenation and cognitive functioning, specifically to examine whether the change in pre-frontal cortex oxygenation coincided with cognitive functioning during heat exposure. Eleven male students who participated in this study immersed their lower legs to the knees in three different water temperatures, 38 °C, 40 °C, and 42 °C water in an air temperature of 28 º C and 50 % relative humidity for 60 min. After 45 min of leg immersion they performed cognitive functioning tasks assessing their short-term memory while immersing their lower legs. There were higher rectal temperature ( P < 0.05) and higher increase of oxyhemoglobin in both left ( P < 0.05) and right ( P < 0.05) pre-frontal cortex at the final stage of 45-min leg immersion in the 42 °C condition with unaltered tissue oxygenation index among the three conditions ( P > 0.05). No statistical difference in cognitive functioning among the three conditions was observed with a higher increase of oxyhemoglobin during the cognitive functioning in the 42 °C condition for the left ( P = 0.05) and right ( P < 0.05) pre-frontal cortex. The findings of this study suggest, first, passive heat exposure increases oxygen delivery in the pre-frontal cortex to maintain pre-frontal cortex oxygenation; second, there is no evidence of passive heat exposure in cognitive functioning in this study; and third, the greater increases of oxyhemoglobin in the pre-frontal cortex during cognitive functioning at the hottest condition suggests a recruitment of available neural resources or greater effort to maintain the same performance at the same level as when they felt thermally comfortable.

[A case report: elephantiasis].

PubMed

Karagöz, Ergenekon; Karaahmetoğlu, Gökhan; Acar, Ali; Turhan, Vedat; Oncül, Oral; Görenek, Levent

2012-01-01

Klippel-Trenaunay syndrome (KTS) is a rare disease and a syndrome that is characterized by the triad of congenital port wine stains,venous malformations with or without varicose veins, bone or soft tissue hypertrophy. Lymphatic filariasis is a filarial disease which usually occurs with genital anomalies, pathologies associated with lymphedema or elephantiasis caused by a filarial infectious agent. In this case report, a 20-year-old male patient admitted to our clinic for diagnosis and treatment with right leg edema and lesions compatible with dermatological manifestations. In the list of differential diagnosis, filarial elephantiasis was also thought, consequently KTS was diagnosed. (Turkiye Parazitol Derg 2012; 36: 188-90).

Renal paradoxical embolism in a hypertensive young adult without acute ischemic symptoms.

PubMed

Nara, Mizuho; Komatsuda, Atsushi; Fujishima, Masumi; Fujishima, Naohito; Nara, Miho; Iino, Takako; Ito, Hiroshi; Sawada, Ken-ichi; Wakui, Hideki

2011-08-01

A 22-year-old woman, who often carried heavy books, was admitted for evaluation of hyperreninemic hypertension. Two months prior to admission, she noted leg edema. Radiological examinations revealed bilateral renal infarction with no other abnormal findings. An echocardiography showed a patent foramen ovale (PFO). Hypertension was considered secondary to renal infarction caused by paradoxical embolism through PFO. Antihypertensive and anticoagulant therapy led to improvement of hypertension. In previously reported cases of renal paradoxical embolism, multiorgan involvement was usually observed. Our case is unique in that embolism was confirmed only in the kidneys, and that clinical characteristics of renal embolism were not observed.

[Tenotomy of carpal and digital flexor tendons for correction of congenital neuromyodysplasia in a calf].

PubMed

Sohrt, J T; Heppelmann, M; Rehage, J; Staszyk, C

2013-01-01

In a 7-day-old heifer calf, a bilateral flexural deformity of the forelimbs involving the digital flexor tendons, the suspensory ligament and the ulnar and radial carpal flexor tendons was diagnosed. After 2 weeks of conservative treatment consisting of manual stretching of the legs and the application of splints and wooden blocks, which were glued to the soles and extended beyond the tip of the claws, the right forelimb could be extended sufficiently to allow weight bearing, whereas the left forelimb could be passively extended to only approximately 120°. Therefore, tenotomy of the ulnar carpal flexor tendon, the digital flexor tendons and the suspensory ligament was carried out in the left leg. A support bandage was then applied to the leg for 8 weeks, after which the carpus and fetlock could be completely extended passively. Flexural deformity of the carpus caused by contracture of the carpal flexor tendons was treated by means of a tenotomy of the ulnar carpal flexor tendon proximal to the accessory carpal bone, which allowed preservation of the carpal tunnel and avoided the risk of iatrogenic damage to nerves and the carpal joint capsule.

Laterality versus jumping performance in men and women.

PubMed

Trzaskoma, Zbigniew; Ilnicka, Lidia; Wiszomirska, Ida; Wit, Andrzej; Wychowański, Michał

2015-01-01

The aim of this study was to investigate relationships between functional asymmetry of lower limbs, taking into account morphological features of the feet, and jumping ability in men and women. The study population consisted of 56 subjects, 30 women (age: 20.29 ± 0.59 years; body mass: 58.13 ± 4.58 kg, body height: 165.60 ± 5.03 cm) and 26 men (age: 20.41 ± 0.78 years, body mass: 78.39 ± 8.42 kg, body height: 181.15 ± 6.52 cm). The measurements of longitudinal arches were performed with the plan- tographic method on the basis of Clarke's angle mapped on a computer foot print. The measurements of jumping performance during bilateral (two legs) and unilateral (single-leg) counter movement jump (CMJ) were done on force plate. All subjects jumped three times each type of jump (total 9 jumps): three right leg, three left leg and three two legs. We put the test results through a detailed statistical analysis with the Statistica 8.0. The t-test for dependent variables and the Wilcoxon signed-rank test for divergent variances of the fea- tures compared. The analysis of relationships between the chosen podometric and plantographic features and jumping performance was conducted on the basis of the Pearson product-moment correlation coefficient (for the features which presented normal distribution, according to the Shapiro-Wilk test). The correlations between values of height of single-leg jumps (right and left) and bilateral jumps, and foot indices were found in few cases only in men who had greater values of jump height with the non-dominant limb. We did not find a significant difference in jumping ability between the dominant limb and the non-dominant limb in women. We found bilateral deficits in jumping ability in the study groups, though we did not find significant differences (P ≤ 0.05) between the values for women (a mean of 6.5%) and for men (a mean of 8.4%). We found significant gender differences of the correlations between the values of height of jumps (single-leg and bilateral jumps) and foot indices.

Trunk orientation causes asymmetries in leg function in small bird terrestrial locomotion.

PubMed

Andrada, Emanuel; Rode, Christian; Sutedja, Yefta; Nyakatura, John A; Blickhan, Reinhard

2014-12-22

In contrast to the upright trunk in humans, trunk orientation in most birds is almost horizontal (pronograde). It is conceivable that the orientation of the heavy trunk strongly influences the dynamics of bipedal terrestrial locomotion. Here, we analyse for the first time the effects of a pronograde trunk orientation on leg function and stability during bipedal locomotion. For this, we first inferred the leg function and trunk control strategy applied by a generalized small bird during terrestrial locomotion by analysing synchronously recorded kinematic (three-dimensional X-ray videography) and kinetic (three-dimensional force measurement) quail locomotion data. Then, by simulating quail gaits using a simplistic bioinspired numerical model which made use of parameters obtained in in vivo experiments with real quail, we show that the observed asymmetric leg function (left-skewed ground reaction force and longer leg at touchdown than at lift-off) is necessary for pronograde steady-state locomotion. In addition, steady-state locomotion becomes stable for specific morphological parameters. For quail-like parameters, the most common stable solution is grounded running, a gait preferred by quail and most of the other small birds. We hypothesize that stability of bipedal locomotion is a functional demand that, depending on trunk orientation and centre of mass location, constrains basic hind limb morphology and function, such as leg length, leg stiffness and leg damping. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

A case of anti aquapolin-4 antibody positive myelitis with hyperhidrosis, following herpes zoster.

PubMed

Suda, Machiko; Tsutsumiuchi, Michiko; Uesaka, Yoshikazu; Hayashi, Nobukazu

2017-01-31

We report an acute myelitis in a 53-year-old woman that occurred in 7 days after the diagnosis of Th5-6 herpes zoster. Clinical examination revealed hyperhidrosis of left side of her face, neck, arm and upper chest. She also had muscle weakness of her left leg and sensory impairment for light touch and temperature in her chest and legs. Spinal cord MRI demonstrated a longitudinal T 2 -hyperintense lesion extending from Th1 to 7. In the axial imaging, the lesion dominantly located in the left side gray matter. Hyperhidrosis, weakness and sensory impairment were improved after intravenous therapy with acyclovir and methylprednisolone. VZV (varicella zoster virus) IgG index of the cerebrospinal fluid was high and serological anti aquaporin-4 antibodies were positive at the time of the admission. This case had both characteristics of VZV myelitis and neuromyelitis optica spectrum disorder. Myelitis relapsed 19 months after the first attack. We believe that sympathetic hyper reactivity due to thoracic spinal cord lesion was responsible for the hyperhidrosis in our patient.

Shoe collar height effect on athletic performance, ankle joint kinematics and kinetics during unanticipated maximum-effort side-cutting performance.

PubMed

Lam, Gilbert Wing Kai; Park, Eun Jung; Lee, Ki-Kwang; Cheung, Jason Tak-Man

2015-01-01

Side-step cutting manoeuvres comprise the coordination between planting and non-planting legs. Increased shoe collar height is expected to influence ankle biomechanics of both legs and possibly respective cutting performance. This study examined the shoe collar height effect on kinematics and kinetics of planting and non-planting legs during an unanticipated side-step cutting. Fifteen university basketball players performed maximum-effort side-step cutting to the left 45° direction or a straight ahead run in response to a random light signal. Seven successful cutting trials were collected for each condition. Athletic performance, ground reaction force, ankle kinematics and kinetics of both legs were analysed using paired t-tests. Results indicated that high-collar shoes resulted in less ankle inversion and external rotation during initial contact for the planting leg. The high-collar shoes also exhibited a smaller ankle range of motion in the sagittal and transverse planes for both legs, respectively. However, no collar effect was found for ankle moments and performance indicators including cutting performance time, ground contact time, propulsion ground reaction forces and impulses. These findings indicated that high-collar shoes altered ankle positioning and restricted ankle joint freedom movements in both legs, while no negative effect was found for athletic cutting performance.

A novel method of edema fluid drainage in obstructive lymphedema of limbs by implantation of hydrophobic silicone tubes.

PubMed

Olszewski, Waldemar L; Zaleska, Marzanna

2015-10-01

Lymphedema of limbs is caused by partial or total obstruction of lymphatic collectors as a consequence of skin and deep soft tissue inflammation, trauma of soft tissues and bones, lymphadenectomy, and irradiation in cancer therapy. According to the statistics of the World Health Organization, around 300 million people are affected by pathologic edema of limbs. Effective treatment of such large cohorts has been a challenge for centuries. However, none of the conservative and surgical methods applied so far proved to restore the shape and function of limbs to normal conditions. Actually, physiotherapy is the therapy of choice as a main modality or supplementary to surgical procedures divided into two groups: the bridging drainage and excisional techniques. The microsurgical operations can be performed if some parts of the peripheral collecting lymphatics remain patent and partially drain edematous regions. However, in advanced cases of lymphedema, all main lymphatics are obstructed and tissue fluid accumulates in the interstitial spaces, spontaneously forming "blind channels" or "lakes." The only solution would be to create artificial pathways for edema fluid flow away to the nonobstructed regions where absorption of fluid can take place. The aim of this study was to form artificial pathways for edema fluid flow by subcutaneous implantation of silicone tubes placed along the limb from the lower leg to the lumbar or hypogastric region. In a group of 20 patients with obstructive lymphedema of the lower limbs that developed after lymphadenectomy and irradiation of the pelvis because of uterine cancer with unsuccessful conservative therapy, implantation was done, followed by external compression as intermittent pneumatic compression and elastic support of tissues. Postoperative circumference measurements, lymphoscintigraphy, and ultrasonography of tissues were carried out during 2 years of follow-up. There was a fast decrease of calf circumference since the day of implantation during weeks by a mean 3% with stabilization afterward. Patency of tubes and accumulation of fluid around them were seen on ultrasonography and lymphoscintigraphy in all cases. No tissue cellular reaction to silicone tubes was noted. The simplicity of the surgical procedure, decrease of limb edema, and lack of tissue reaction to the implant make the method worth applying in advanced stages of lymphedema with large volumes of accumulated tissue edema fluid. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

An unusual case of feline acute corneal hydrops: atypical disease presentation and possible in vivo detection of Descemet's membrane detachment in the cat's unaffected eye.

PubMed

Schlesener, Brittany N; Scott, Erin M; Vallone, Lucien V

2017-11-07

A 1-year-old, female spayed, domestic shorthair cat presented for blepharospasm of the right eye. Slit-lamp biomicroscopic examination showed focal corneal ulceration and presumptive keratomalacia of the right eye. Examination of the left eye was normal apart from a focal endothelial opacity. Within the first 24 h of medical management, the right eye developed marked corneal edema and globular anterior protrusion of the corneal surface consistent with feline acute corneal hydrops (FACH). Surgical management consisted of a bridge conjunctival graft, nictitating membrane flap, and temporary tarsorrhaphy. Resolution of corneal edema and pain occurred in the right eye within 24 days. Spectral domain optical coherence tomography (SD-OCT) of the anterior segment was performed in both eyes. Conjunctival tissue from the bridge graft precluded examination of deeper corneal structures in the right eye. The left eye displayed a focal separation of the corneal endothelium and Descemet's membrane from the overlying stroma. These SD-OCT findings are similar to the analogous syndrome found in humans and represent a potential etiology for FACH of the right eye in the case presented here. Unfortunately, the cat was lost to follow-up and the progression of this lesion to FACH in the left eye could not be determined. © 2017 American College of Veterinary Ophthalmologists.

Correlation Between Subacute Sensorimotor Deficits and Brain Edema in Rats after Surgical Brain Injury.

PubMed

McBride, Devin W; Wang, Yuechun; Adam, Loic; Oudin, Guillaume; Louis, Jean-Sébastien; Tang, Jiping; Zhang, John H

2016-01-01

No matter how carefully a neurosurgical procedure is performed, it is intrinsically linked to postoperative deficits resulting in delayed healing caused by direct trauma, hemorrhage, and brain edema, termed surgical brain injury (SBI). Cerebral edema occurs several hours after SBI and is a major contributor to patient morbidity, resulting in increased postoperative care. Currently, the correlation between functional recovery and brain edema after SBI remains unknown. Here we examine the correlation between neurological function and brain water content in rats 42 h after SBI. SBI was induced in male Sprague-Dawley rats via frontal lobectomy. Twenty-four hours post-ictus animals were subjected to four neurobehavior tests: composite Garcia neuroscore, beam walking test, corner turn test, and beam balance test. Animals were then sacrificed for right-frontal brain water content measurement via the wet-dry method. Right-frontal lobe brain water content was found to significantly correlate with neurobehavioral deficits in the corner turn and beam balance tests: the number of left turns (percentage of total turns) for the corner turn test and distance traveled for the beam balance test were both inversely proportional with brain water content. No correlation was observed for the composite Garcia neuroscore or the beam walking test.

Risk of Central Nervous System Decompression Sickness in Air Diving to No-Stop Limits

DTIC Science & Technology

2009-01-01

190 9 1 10 1. Weak, faint, vertigo 2. Heavy legs, abnormal gait 3. Vertigo and cardiorespiratory symptoms 4. Bilateral numbness and paresthesia ...original report," were included. 6. Pain in both feet, paresthesia 7. Hearing deficit, anisocoria, nystagmus, confusion, emotionally labile, abnormal...tandem gait 8. Scintillating scotoma, abnormal left foot dorsiflexion 9. Weakness, general left side paresthesia , numbness, abnormal gait 10. See

A new genus of long-legged flies displaying remarkable wing directional asymmetry

Treesearch

Justin B. Runyon; Richard L. Hurley

2004-01-01

A previously unknown group of flies is described whose males exhibit directional asymmetry, in that the left wing is larger than, and of a different shape from, the right wing. To our knowledge, wing asymmetry of this degree has not previously been reported in an animal capable of flight. Such consistent asymmetry must result from a left­right axis during development...

Effects of Preventative Ankle Taping on Planned Change-of-Direction and Reactive Agility Performance and Ankle Muscle Activity in Basketballers

PubMed Central

Jeffriess, Matthew D.; Schultz, Adrian B.; McGann, Tye S.; Callaghan, Samuel J.; Lockie, Robert G.

2015-01-01

This study investigated the effects of preventative ankle taping on planned change-of-direction and reactive agility performance and peak ankle muscle activity in basketballers. Twenty male basketballers (age = 22.30 ± 3.97 years; height = 1.84 ± 0.09 meters; body mass = 85.96 ± 11.88 kilograms) with no ankle pathologies attended two testing sessions. Within each session, subjects completed six planned and six reactive randomized trials (three to the left and three to the right for each condition) of the Y-shaped agility test, which was recorded by timing lights. In one session, subjects had both ankles un-taped. In the other, both ankles were taped using a modified subtalar sling. Peak tibialis anterior, peroneus longus (PL), peroneus brevis (PB), and soleus muscle activity was recorded for both the inside and outside legs across stance phase during the directional change, which was normalized against 10-meter sprint muscle activity (nEMG). Both the inside and outside cut legs during the change-of-direction step were investigated. Repeated measures ANOVA determined performance time and nEMG differences between un-taped and taped conditions. There were no differences in planned change-of-direction or reactive agility times between the conditions. Inside cut leg PL nEMG decreased when taped for the planned left, reactive left, and reactive right cuts (p = 0.01). Outside leg PB and soleus nEMG increased during the taped planned left cut (p = 0.02). There were no other nEMG changes during the cuts with taping. Taping did not affect change-of-direction or agility performance. Inside leg PL activity was decreased, possibly due to the tape following the line of muscle action. This may reduce the kinetic demand for the PL during cuts. In conclusion, ankle taping did not significantly affect planned change-of-direction or reactive agility performance, and did not demonstrate large changes in activity of the muscle complex in healthy basketballers. Key points Ankle taping using the modified subtalar sling will not affect planned change-of-direction or reactive agility performance as measured by the Y-shaped agility test in healthy male basketball players. Ankle taping using the modified subtalar sling will also generally not affect the activity of the muscles about the ankle. There was some indication for reductions in the activity of the PL in the inside leg of certain cuts. The tape used for the modified subtalar sling may have supported the line of action of the PL, which could reduce the kinetic demand placed on this muscle, and provide a potential fatigue-reducing component for cutting actions. The subtalar sling taping of the ankle in healthy basketball players did not have any adverse effects on the muscle activity of the ankle-foot complex during planned change-of-direction or reactive agility performance tasks. PMID:26664285

Use of US in the evaluation of patients with symptoms of deep venous thrombosis of the lower extremities.

PubMed

Useche, Juan N; de Castro, Alfredo M Fernández; Galvis, Germán E; Mantilla, Rodolfo A; Ariza, Alvaro

2008-10-01

Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT. (c) RSNA, 2008.

Systemic complications of fluid resuscitation.

PubMed

Weinstein, P D; Doerfler, M E

1992-04-01

Fluid administration in critically ill individuals is frequently a major component of their therapy. There are important effects on blood pressure and maintenance of cardiac output and oxygen delivery, as detailed elsewhere in this text. There are also potentially negative side effects of this therapy, which have been less well defined. Edema of the gastrointestinal tract has been well described, primarily with crystalloid infusions. Gastrointestinal edema may have very complicated effects on albumin kinetics, fluid flux, and ion flux. It may lead to development of ileus. Increased nasogastric tube output may be incorrectly construed as unremitting obstruction rather than a result of the aforementioned changes and increased crystalloid loads. The relationships of intestinal edema to intestinal absorptive function and diarrhea are less clear. At present, changes in type of fluid infusion or correction of serum albumin level to normal cannot be uniformly recommended. The myocardium, although showing evidence of edema with crystalloid infusion, may appear to benefit from colloidal, osmotically active suspensions in the all too few studies that have been done. To date, there is no study giving evidence of clinically different outcome using a variety of fluids that cause, reduce, or prevent this edema. The presence or absence of myocardial edema may be important in patients who demonstrate decreased ventricular function during sepsis or other disorders in which aggressive fluid administration is routine. Edema of the skin has been associated primarily with decreased oxygen tension. Other studies have shown an association with impaired wound healing or increased risk of infection. A direct causal relationship can only be inferred. We are left with a sense that aggressive fluid resuscitation with crystalloid, although improving oxygen delivery, may have other deleterious effects on organ systems, such as the gastrointestinal tract, myocardium, and integument. The edema resulting from crystalloid administration may lessen or negate the benefits of increased oxygen delivery. Care needs to be taken in interpreting any alteration in organ function with respect to the fluid type and volume being administered. An alternative choice of therapy is lacking at present. The role of colloid has not been as well investigated as that of crystalloid and further study is warranted before any benefits become clear.

Reaction to the sensory integration therapy in children with postural stability deficits.

PubMed

Maciaszek, Janusz; Kilan, Natalia; Bronikowski, Michal

2016-10-05

The goal was to examine the influence of sensory integration therapy (SIT) on one leg standing in children with deficits of the postural stability. 28 children 4 - 6 year old that could not stand on one leg for more than 20 seconds were randomly divided into control "C" and experimental "E" groups. Group "C" participated in standard classes in the kindergarten. Group "E" participated in sensory integration therapy (SIT) for 2 weeks, 5 times a week (additionally to the standard classes). Results of the experiment show that the skill of standing on one leg has significantly improved (p<0.01) in the group that underwent additional therapy. The change in time of standing on the right leg with eyes open in the E group was statistically and significantly higher than the changes observed in the same time in group C (F = 22.5, p = 0.001' η2 = 0.44). Similarly, significant changes in time of standing on the right leg with eyes closed were observed in group E. The foregoing changes were bigger in group E than in group C (F = 16. 1 , p = 0.004, η2 = 0.36). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (p>0.05), there were significant differences between groups in right leg standing test with eyes open or closed on posttest. (p<0.05). Similar results were observed during on the one, left leg standing. The time of one leg standing with both eyes open and closed improved more significantly in group E than in group C (F = 20.4, p = 0.001, η2 = 0.42 respectively for the test with eyes open and F = 7.4, p = 0.010, η2 = 0.21 for the test with eyes closed). The analysis post hoc revealed that while there were no significant differences between the two groups on the pretest (p>0.05), there were significant differences between groups in left leg standing test with eyes open or closed on posttest. (p<0.05). Research conducted show that there is a positive influence of SIT on children with low level of postural stability. Its significant improvement in children with low levels of postural stability is important not only for the current functioning of those children but for their future - by protecting them from falling down and from injuries.

Biomechanical study on axillary crutches during single-leg swing-through gait.

PubMed

Goh, J C; Toh, S L; Bose, K

1986-08-01

This paper describes a kinetic and kinematic study on axillary crutches during one-leg swing-through gait. The primary objective is to evaluate the interplay of forces at the crutch and body interfaces and to relate them in the understanding of problems associated with the use of axillary crutches. Ten normal adult male subjects with simulated left leg impairment participated in the study. For data acquisition, the VICON kinematic system, a Kistler force plate and an instrumented crutch (with force transducers at the two upper struts close to the axillary bar and one near the crutch tip) were used. Results showed that the peak ground reaction force on the weight-bearing leg during lower limb stance increased by 21.6 percent bodyweight. The peak reaction force transmitted to the arm during crutch stance was 44.4 percent bodyweight. These increased loadings could be detrimental to patients with unsound weight-bearing leg and upper extremities respectively. When the crutches were used incorrectly, 34 percent bodyweight was carried by the underarm. This could cause undue pressure over the neurovascular structures at the axillary region.

A Case of Delayed Flare-up Allergic Dermatitis Caused by Jellyfish Sting.

PubMed

Manabe, Yasuaki; Mabuchi, Tomotaka; Kawai, Mayu; Ota, Tami; Ikoma, Norihiro; Ozawa, Akira; Horita, Takushi

2014-09-20

A 7-year-old boy, taking lessons at a yacht school at Enoshima in Kanagawa prefecture in Japan, recognized a linear eruption on his left lower leg during practice in August 2012. As it gradually enlarged, he visited a local medical clinic. The eruption initially improved with topical treatment but exacerbated in October of the same year. Although topical treatment was started again, there was minimal improvement, so the patient visited our hospital in December. At his first visit, he had a hard linear nodule on his left lower leg, and papules with excoriation were scattered over the lower limbs. Considering eczema, topical steroid treatment and occlusive dressing technique were started but the nodule remained. Based on the clinical course, clinical features, and laboratory findings, the lesion was considered to be delayed flare-up allergic dermatitis caused by a jellyfish sting [1].

Leaflet embolisation from Duromedics valves: a report of two cases.

PubMed

Kumar, N; Balasundaram, S; Rickard, M; al Halees, Z; Duran, C M

1991-12-01

Embolization of parts of mechanical valves has been reported since the inception of prosthetic valve implantation. We report here two cases of embolization of one hemileaflet of a Duromedic bileaflet prosthesis in the mitral position due to a pivot fracture. Both presented with moderately severe mitral regurgitation and pulmonary edema and were successfully managed by replacement of the malfunctioning prostheses. The embolised disc was located in the left common iliac artery by abdominal ultrasound and removed by an inguinal, retroperitoneal approach with low morbidity. Both patients left hospital and are doing well to-date.

Test-retest reliability of cardinal plane isokinetic hip torque and EMG.

PubMed

Claiborne, Tina L; Timmons, Mark K; Pincivero, Danny M

2009-10-01

The objective of the present study was to establish test-retest reliability of isokinetic hip torque and prime mover electromyogram (EMG) through the three cardinal planes of motion. Thirteen healthy young adults participated in two experimental sessions, separated by approximately one week. During each session, isokinetic hip torque was evaluated on the Biodex Isokinetic Dynamometer at a velocity of 60 deg/s. Subjects performed three maximal-effort concentric and eccentric contractions, separately, for right and left hip abduction/adduction, flexion/extension, and internal/external rotation. Surface EMGs were sampled from the gluteus maximus, gluteus medius, adductor, medial and lateral hamstring, and rectus femoris muscles during all contractions. Intraclass correlation coefficients (ICC - 2,1) and standard errors of measurement (SEM) were calculated for peak torque for each movement direction and contraction mode, while ICCs were only computed for the EMG data. Motions that demonstrated high torque reliability included concentric hip abduction (right and left), flexion (right and left), extension (right) and internal rotation (right and left), and eccentric hip abduction (left), adduction (left), flexion (right), and extension (right and left) (ICC range=0.81-0.91). Motions with moderate torque reliability included concentric hip adduction (right), extension (left), internal rotation (left), and external rotation (right), and eccentric hip abduction and adduction (right), flexion (left), internal rotation (right and left), and external rotation (right and left) (ICC range=0.49-0.79). The majority of the EMG sampled muscles (n=12 and n=11 for concentric and eccentric contractions, respectively) demonstrated high reliability (ICC=0.81-0.95). Instances of low, or unacceptable, EMG reliability values occurred for the medial hamstring muscle of the left leg (both contraction modes) and the adductor muscle of the right leg during eccentric internal rotation. The major finding revealed high and moderate levels of between-day reliability of isokinetic hip peak torque and prime mover EMG. It is recommended that the day-to-day variability estimates concomitant with acceptable levels of reliability be considered when attempting to objectify intervention effects on hip muscle performance.

An atypical limping teenager.

PubMed

Liegeois, Claire; Stewart, Charles

2015-08-14

A 13-year-old boy presented with a 5-day history of left-sided limp of gradual onset. There was no history of trauma. He developed a fever and rigours a few days before presenting to the paediatric emergency department. On examination, he was tender on palpating the left gluteal area on active mobilisation of the left hip and could not weight bear on the left leg. Pelvic X-rays and ultrasound of the left hip were normal. The blood results showed raised inflammatory markers and normal white cell count. The blood cultures were positive for Staphylococcus aureus. On day 2, a left hip MRI was performed as well as CT-guided drainage. Diagnosis of left sacroiliac septic arthritis was made. After an initial lack of improvement under intravenous ceftriaxone, a drain was inserted and left in situ for 8 days with double intravenous antibiotic therapy instituted. The patient made a full recovery. 2015 BMJ Publishing Group Ltd.

47-year-old man with left leg numbness.

PubMed

Mahta, Ali; Kim, Ryan Y; Saad, Ali G; Kesari, Santosh

2013-03-01

A 47-year-old white male with a history of uveitis, hypercalcemia and nephrolithiasis presented with acute onset partial seizure. On exam he had decreased sensation to light touch on his left lower extremity. A Brain MRI revealed a right frontal mass, which was initially thought to be a metastatic lesion or a primary brain tumor. However, biopsy of the lesion revealed it to be a non-caseating granulomatous lesion consistent with neurosarcoidosis.

An Athlete's Nightmare: Tearing the ACL

MedlinePlus

... rather than "muscle dominant." Golf great Tiger Woods will miss the remainder of the 2008 season due to an ACL injury and a double stress fracture in his left leg. Photo: Ross Kinnaird/Getty Images Dr. Boden believes that one ...

Pathological Studies of “Sudden Death Syndrome” in Broiler Chickens

PubMed Central

Ononiwu, J.C.; Thomson, R.G.; Carlson, H.C.; Julian, R.J.

1979-01-01

Sudden death syndrome usually occurs in heavy, fast-growing and healthy-looking broilers. Most of the affected birds are males. The characteristic necropsy changes are seen in well-fleshed broilers with edema and generalized pulmonary congestion, recently ingested feed in the crop and gizzard, distended intestine with creamy content and empty gall bladder. The liver and kidneys are slightly enlarged and the latter have patchy areas of subcapsular hemorrhage. The heart contains clotted blood in the atria but the ventricles are often empty and the left ventricle in particular assumes a hypertrophied appearance. Microscopic examination of heart muscle reveals degeneration of fibers, separation of cardiac muscle fibers by edema and infiltration of heterophils. The lungs have severe vascular congestion, inflammatory cell infiltration in the mucosa of the secondary bronchi and edema fluid in the tertiary bronchi and interlobular connective tissue. The liver has moderate bile duct hyperplasia, periportal hepatitis and mononuclear cell infiltration adjacent to bile ducts which possibly leads to bile duct constriction. The kidneys have subcapsular and parenchymatous hemorrhage. ImagesFIGURE 1.FIGURE 2. PMID:436100

Extensive basal ganglia edema caused by a traumatic carotid-cavernous fistula: a rare presentation related to a basal vein of Rosenthal anatomical variation.

PubMed

Ract, Isabelle; Drier, Aurélie; Leclercq, Delphine; Sourour, Nader; Gabrieli, Joseph; Yger, Marion; Nouet, Aurélien; Dormont, Didier; Chiras, Jacques; Clarençon, Frédéric

2014-07-01

The authors report a very rare presentation of traumatic carotid-cavernous fistula (CCF) with extensive edema of the basal ganglia and brainstem because of an anatomical variation of the basal vein of Rosenthal (BVR). A 45-year-old woman was admitted to the authors' institution for left hemiparesis, dysarthria, and a comatose state caused by right orbital trauma from a thin metal rod. Brain MRI showed a right CCF and vasogenic edema of the right side of the brainstem, right temporal lobe, and basal ganglia. Digital subtraction angiography confirmed a high-flow direct CCF and revealed a hypoplastic second segment of the BVR responsible for the hypertension in inferior striate veins and venous congestion. Endovascular treatment was performed on an emergency basis. One month after treatment, the patient's symptoms and MRI signal abnormalities almost totally disappeared. Basal ganglia and brainstem venous congestion may occur in traumatic CCF in cases of a hypoplastic or agenetic second segment of the BVR and may provoke emergency treatment.

Femoral fracture repair and postoperative management in new zealand white rabbits.

PubMed

Reuter, Jon D; Ovadia, Shira; Howell, Paula; Jaskwich, David H

2002-07-01

Low bone density and large muscle mass predispose rabbits to femoral fractures. However, there are few reports describing treatment and prognosis. Two New Zealand White rabbits presented with unilateral left rear limb abduction and lateral rotation of the distal left rear limb 2 and 17 days after experimental surgery to create a "stair step" in the patellar groove of the left medial femoral chondyle. This procedure was performed after approval by the Institutional Animal Care and Use Committee. Radiography revealed a spiral oblique mid-shaft fracture of the left femur in both rabbits. Open fracture reduction was undertaken. Because of the presence of screws and Kirschner-wires in the medial femoral condyle, a lateral approach to surgical correction was chosen. Intramedullary fixation was used to reduce and stabilize the fractures. A 0.062" Kirschner wire was selected for the intramedullary device, because it was sufficiently flexible to allow easy passage into the femoral canal while being sufficiently stiff to promote reduction of the fracture. In addition, the ends of the fracture were secured with a 0.032" Kirschner cerclage wire to provide additional control of rotation and angulation. Then we assessed the range of motion of the knee joint to determine fracture stability and ensure that the hardware did not impinge on soft-tissue elements. After closure and application of sterile dressing, the hind legs were hobbled proximal to the hock by using elastic veterinary wrap in a figure-eight pattern to maintain limb alignment and prevent formation of pressure ulcers. Intraoperative fluoroscopic evaluation and postoperative radiographs confirmed fracture reduction. Bruising and seroma formation occurred at the surgical site, and transient anorexia developed. Rabbits were treated with fluids, analgesics, antibiotics, and fitted with Elizabethan collars. They were housed in isolation to limit excessive environmental stimulation, which could alarm them and provoke "thumping" of the rear legs. Muscular weakness and atrophy developed in the affected legs, but the fractures remained immobilized. Radiographs obtained 21 days after surgery confirmed marked callus formation and integrity of the implanted hardware. Four weeks after surgical fixation, both rabbits showed increased muscle development in the repaired leg and were ambulating normally. The long-term prognosis was excellent. These cases demonstrate that repair of femoral fractures in rabbits can be achieved by using basic orthopedic techniques and diligent post-operative management.

Limited interlimb transfer of locomotor adaptations to a velocity-dependent force field during unipedal walking.

PubMed

Houldin, Adina; Chua, Romeo; Carpenter, Mark G; Lam, Tania

2012-08-01

Several studies have demonstrated that motor adaptations to a novel task environment can be transferred between limbs. Such interlimb transfer of motor commands is consistent with the notion of centrally driven strategies that can be generalized across different frames of reference. So far, studies of interlimb transfer of locomotor adaptations have yielded disparate results. Here we sought to determine whether locomotor adaptations in one (trained) leg show transfer to the other (test) leg during a unipedal walking task. We hypothesized that adaptation in the test leg to a velocity-dependent force field previously experienced by the trained leg will be faster, as revealed by faster recovery of kinematic errors and earlier onset of aftereffects. Twenty able-bodied adults walked unipedally in the Lokomat robotic gait orthosis, which applied velocity-dependent resistance to the legs. The amount of resistance was scaled to 10% of each individual's maximum voluntary contraction of the hip flexors. Electromyography and kinematics of the lower limb were recorded. All subjects were right-leg dominant and were tested for transfer of motor adaptations from the right leg to the left leg. Catch trials, consisting of unexpected removal of resistance, were presented after the first step with resistance and after a period of adaptation to test for aftereffects. We found no significant differences in the sizes of the aftereffects between the two legs, except for peak hip flexion during swing, or in the rate at which peak hip flexion adapted during steps against resistance between the two legs. Our results indicate that interlimb transfer of these types of locomotor adaptation is not a robust phenomenon. These findings add to our current understanding of motor adaptations and provide further evidence that generalization of adaptations may be dependent on the movement task.

Reconstruction of the arcuate fasciculus for surgical planning in the setting of peritumoral edema using two-tensor unscented Kalman filter tractography.

PubMed

Chen, Zhenrui; Tie, Yanmei; Olubiyi, Olutayo; Rigolo, Laura; Mehrtash, Alireza; Norton, Isaiah; Pasternak, Ofer; Rathi, Yogesh; Golby, Alexandra J; O'Donnell, Lauren J

2015-01-01

Diffusion imaging tractography is increasingly used to trace critical fiber tracts in brain tumor patients to reduce the risk of post-operative neurological deficit. However, the effects of peritumoral edema pose a challenge to conventional tractography using the standard diffusion tensor model. The aim of this study was to present a novel technique using a two-tensor unscented Kalman filter (UKF) algorithm to track the arcuate fasciculus (AF) in brain tumor patients with peritumoral edema. Ten right-handed patients with left-sided brain tumors in the vicinity of language-related cortex and evidence of significant peritumoral edema were retrospectively selected for the study. All patients underwent 3-Tesla magnetic resonance imaging (MRI) including a diffusion-weighted dataset with 31 directions. Fiber tractography was performed using both single-tensor streamline and two-tensor UKF tractography. A two-regions-of-interest approach was applied to perform the delineation of the AF. Results from the two different tractography algorithms were compared visually and quantitatively. Using single-tensor streamline tractography, the AF appeared disrupted in four patients and contained few fibers in the remaining six patients. Two-tensor UKF tractography delineated an AF that traversed edematous brain areas in all patients. The volume of the AF was significantly larger on two-tensor UKF than on single-tensor streamline tractography (p < 0.01). Two-tensor UKF tractography provides the ability to trace a larger volume AF than single-tensor streamline tractography in the setting of peritumoral edema in brain tumor patients.

Study on Mucin in Normal-Appearing Leg Skin.

PubMed

Fernandez-Flores, Angel

2017-03-01

Dermal deposits of mucin in the legs have been described associated with venous insufficiency. However, some degree of stasis dermatitis is generally common in aged individuals. Therefore, some amount of mucin is expected a priori in the reticular dermis of aged patients, even in the absence of clinical lesions. To test this hypothesis, the authors investigated the mucin in the legs of aged individuals without any dermatologic disease. Cutaneous samples were taken from the legs of 15 autopsy cases. A sample of the skin of the legs (either from the left or the right leg without any distinction being made) was randomly taken (without selecting any specific area or attending to macroscopical features). The skin samples were fixed in formaldehyde, and sections obtained from all samples were stained with hematoxylin and eosin, iron, and Alcian blue. Iron deposits were graded as 0/4 in 7 cases, as 1/4 in 4 cases, as 2/4 in 2 cases, and as 4/4 in 2 cases. Cases with greater deposits of iron also had other signs of stasis, such as neovascularization. All the samples scored 0 for dermal mucin deposits in the reticular dermis. The authors conclude that mucin deposits in the legs are not inherent to aging. Therefore, any mucin deposit in the reticular dermis, as well as expansion of the periadnexal dermis by mucin deposits, should be considered abnormal.

[Penetrating injury of the lungs and multiple injuries of lower extremities caused by aircraft bombs splinters].

PubMed

Golubović, Zoran; Stanić, Vojkan; Trenkić, Srbobran; Stojiljković, Predrag; Stevanović, Goran; Lesić, Aleksandar; Golubović, Ivan; Milić, Dragan; Visnjić, Aleksandar; Najman, Stevo

2010-08-01

Injuries caused by aircraft bombs cause severe damages to the human body. They are characterized by massive destruction of injured tissues and organs, primary contamination by polymorph bacterial flora and modified reactivity of the body. Upon being wounded by aircraft bombs projectiles a victim simultaneously sustains severe damages of many organs and organ systems due to the fact that a large number of projectiles at the same time injure the chest, stomach, head and extremities. We presented a patient, 41 years of age, injured by aircraft bomb with hemo-pneumothorax and destruction of the bone and soft tissue structures of the foot, as well as the treatment result of such heavy injuries. After receiving thoracocentesis and short reanimation, the patient underwent surgical procedure. The team performed thoracotomy, primary treatment of the wound and atypical resection of the left lung. Thoracic drains were placed. The wounds on the lower leg and feet were treated primarily. Due to massive destruction of bone tissue of the right foot by cluster bomb splinters, and impossibility of reconstruction of the foot, guillotine amputation of the right lower leg was performed. Twelve days after the wounding caused by cluster bomb splinters, soft tissue of the left lower leg was covered by Tirsch free transplant and the defect in the area of the left foot was covered by dorsalis pedis flap. The transplant and flap were accepted and the donor sites were epithelized. Twenty-six days following the wounding reamputation was performed and amputation stump of the right lower leg was closed. The patient was given a lower leg prosthesis with which he could move. Upon being wounded by aircraft bomb splinters, the injured person sustains severe wounds of multiple organs and organ systems due to simultaneous injuries caused by a large number of projectiles. It is necessary to take care of the vital organs first because they directly threaten the life of the wounded patient. Despite adequate surgical treatment of war wounds of the feet, because of massive defect of bone and soft tissue, amputation may be the only rational solution of the treatment. The resection of the lung may be succesfull method for the severe destruction of the lung.

Traumatic central retinal artery occlusion with sickle cell trait.

PubMed

Sorr, E M; Goldberg, R E

1975-10-01

An 8-year-old black boy with sickle cell trait struck his left brow and globe on the edge of a table and had immediate blurring of vision. Six days later visual acuity was light projection, and traumatic iritis with secondary glaucoma and perimacular edema were present. Fluorescein angiography indicated obstructed peripheral and perimacular arterioles and dye leakage from the disk.

Near-infrared spectroscopy technique to evaluate the effects of drugs in treating traumatic brain edema

NASA Astrophysics Data System (ADS)

Xie, J.; Qian, Z.; Yang, T.; Li, W.; Hu, G.

2011-01-01

The aim of this study was to evaluate the effects of several drugs in treating traumatic brain edema (TBE) following traumatic brain injury (TBI) using near-infrared spectroscopy (NIRs) technology. Rats with TBE models were given hypertonic saline (HS), mannitol and mannitol+HS respectively for different groups. Light scattering properties of rat's local cortex was measured by NIRs within the wavelength range from 700 to 850 nm. TBE models were built in rats' left brains. The scattering properties of the right and left target corresponding to the position of normal and TBE tissue were measured and recorded in vivo and real-time by a bifurcated needle probe. The brain water contents (BWC) were measured by the wet and dry weight method after injury and treatment hours 1, 6, 24, 72 and 120. A marked linear relationship was observed between reduced scattering coefficient (μs') and BWC. By recording μs' of rats' brains, the entire progressions of effects of several drugs were observed. The result may suggest that the NIRs techniques have a potential for assessing effects in vivo and real-time on treatment of the brain injury.

Effects of physiotherapy combined with sirolimus in a patient with vascular malformation: A case report.

PubMed

Akbayrak, Türkan; Orhan, Ceren; Baran, Emine; Kaya, Serap; Coskun, Gürsoy; Varan, Ali

2016-01-01

The aim of the present case report was to investigate the effects of a physiotherapy program combined with sirolimus in a child patient with upper extremity edema and joint limitation due to low-flow vascular malformation. This case report included an 11-year-old male patient (26 kg, 130 cm) diagnosed with congenital lymphovascular malformation on the left and right chest. The patient, who had edema on the upper left extremity and experienced joint limitations, was administered complete decongestive therapy (CDT) and manual therapy in combination with sirolimus. Physiotherapy included a total of 24 sessions, 3 sessions a week for 8 weeks. Following the physiotherapy, the patient was assigned to a home therapy program, and then the maintenance phase of the CDT was initiated. Evaluations were carried out at baseline, at the end of week 8, and after 12 months. Following the physiotherapy program combined with sirolimus, a decrease in extremity volume, an increase in joint movement range, and an improvement in disease-related complaints were observed. Physiotherapy methods combined with sirolimus may be an effective treatment method in patients with vascular malformations. However, further studies with larger sample size are warranted.

Fluid Redistribution in Sleep Apnea: Therapeutic Implications in Edematous States

PubMed Central

da Silva, Bruno Caldin; Kasai, Takatoshi; Coelho, Fernando Morgadinho; Zatz, Roberto; Elias, Rosilene M.

2018-01-01

Sleep apnea (SA), a condition associated with increased cardiovascular risk, has been traditionally associated with obesity and aging. However, in patients with fluid-retaining states, such as congestive heart failure and end-stage renal disease, both prevalence and severity of SA are increased. Recently, fluid shift has been recognized to play an important role in the pathophysiology of SA, since the fluid retained in the legs during the day shifts rostrally while recumbent, leading to edema of upper airways. Such simple physics, observed even in healthy individuals, has great impact in patients with fluid overload. Correction of the excess fluid volume has risen as a potential target therapy to improve SA, by attenuation of nocturnal fluid shift. Such strategy has gained special attention, since the standard treatment for SA, the positive airway pressure, has low compliance rates among its users and has failed to reduce cardiovascular outcomes. This review focuses on the pathophysiology of edema and fluid shift, and summarizes the most relevant findings of studies that investigated the impact of treating volume overload on SA. We aim to expand horizons in the treatment of SA by calling attention to a potentially reversible condition, which is commonly underestimated in clinical practice. PMID:29404327

A Case of Duplicated Right Vertebral Artery.

PubMed

Motomura, Mayuko; Watanabe, Koichi; Tabira, Yoko; Iwanaga, Joe; Matsuuchi, Wakako; Yoshida, Daichi; Saga, Tsuyoshi; Yamaki, Koh-Ichi

2018-04-27

We encountered a case of duplicated right vertebral artery during an anatomical dissection course for medical students in 2015. Two vertebral arteries were found in the right neck of a 91-year-old female cadaver. The proximal leg of the arteries arose from the area between the right subclavian artery and the right common carotid artery that diverged from the brachiocephalic artery. The distal leg arose from the right subclavian artery as expected. The proximal leg entered the transverse foramen of the fourth cervical vertebra and the distal leg entered the transverse foramen of the sixth cervical vertebra. The two right vertebral arteries joined to form one artery just after the origin of the right vertebral artery of the brachiocephalic artery entered the transverse foramen of the fourth cervical vertebra. This artery then traveled up in the transverse foramina and became the basilar artery, joining with the left vertebral artery. We discuss the embryological origin of this case and review previously reported cases.

Oculopalpebral borreliosis as an unusual manifestation of Lyme disease.

PubMed

Murillo, Giovana; Ramírez, Beatriz; Romo, L Angel; Muñoz-Sanz, Agustín; Hileeto, Denise; Calonge, Margarita

2013-01-01

To report the case of acrodermatitis chronica atrophicans as an ocularpalpebral manifestation of Lyme borreliosis, with peripheral keratopathy and associated vasculitis. Case report. A 16-year-old girl, with a 4-year history of recurrent left eye photophobia, intense redness, and superior eyelid edema, presented with lid erythema, ptosis, superficial venous tortuosity, conjunctival hyperemia, corneal thinning with precipitates, and vascularization. Borrelia burgdorferi was confirmed by immunoblotting. Treatments with doxycycline followed by ceftriaxone were only partially effective. Eyelid biopsy revealed spirochetes and vasculitis with deposition of immunoglobulin G. Oral cefuroxime for 28 days was ineffective. Due to the vasculitis, immunosuppression with azathioprine and topical cyclosporine were given for 4 months. Since then she has been free of flare-ups. Lyme borreliosis should be considered in patients with recurrent chronic lid edema and associated keratopathy.

Experimental muscle pain challenges the postural stability during quiet stance and unexpected posture perturbation.

PubMed

Hirata, Rogério Pessoto; Ervilha, Ulysses Fernandes; Arendt-Nielsen, Lars; Graven-Nielsen, Thomas

2011-08-01

Musculoskeletal pain impairs postural control and stability. Nine subjects stood as quietly as possible on a moveable force platform before, during, and after experimental pain in the right leg muscles. A moveable force platform was used to measure the center of pressure and provided unexpected perturbations. Lower limb muscle activity, joint angles, and foot pressure distributions were measured. Hypertonic saline was used to induce pain in the vastus lateralis, vastus medialis, or biceps femoris muscle of the right leg. Compared to baseline and control sessions, pain in the knee extensor muscles during quiet standing evoked: 1) larger sway area, greater medial-lateral center of pressure displacement and higher speed (P < .05); 2) increased sway displacement in the anterior-posterior direction (P < .05); and 3) increased electromyography (EMG) activity for left tibialis anterior and left erector spinae muscles (P < .05). Pain provoked longer time to return to an equilibrium posture after forward EMG activity for, and pain in vastus medialis muscle decreased the time for the maximum hip flexion during this perturbation (P < .05). These results show that muscle pain impairs postural stability during quiet standing and after unexpected perturbation, which suggest that people suffering from leg muscle pain are more vulnerable to falls. This article presents the acute responses to leg muscle pain on the postural control. This measure could potentially help clinicians who seek to assess how pain responses may contribute to patient's postural control and stability during quiet standing and after recovering from unexpected perturbations. Copyright © 2011 American Pain Society. Published by Elsevier Inc. All rights reserved.

Effects of once weekly NMES training on knee extensors fatigue and body composition in a person with spinal cord injury.

PubMed

Gorgey, Ashraf S; Caudill, Caelb; Khalil, Refka E

2016-01-01

Single-subject case (male, 33 years of age, T6 SCI AIS A). To determine the effect of surface neuromuscular electrical stimulation (NMES) training conducted once weekly on improving fatigue resistance as well as regional and whole body composition in an individual with spinal cord injury (SCI). Laboratory setting within a SCI Center. Surface NMES resistance training (RT) of the paralyzed knee extensors was conducted once weekly for 12 weeks using ankle weights. Knee extensor fatigue index was determined by the number of repetitions (reps) achieved out of 30 reps. Total and regional body composition including percentage body fat (%BF), fat mass (FM), lean mass (LM) were conducted before the first session and one week after the last training session using whole-body dual-energy X-ray absorptiometry. The participant had a compliance rate of 83% and he was able to lift 6 and 2 lbs on the right and left legs, respectively. Right knee extensors showed greater fatigue resistance compared to the left one. Leg LM increased by 6% accompanied with decrease in arm, trunk and total body LM by -4.7%, -13%, -5%, respectively. The %BF increased by 8%, 7.3%, 15.5%, 11.5% for arm, legs, trunk and total body. Once weekly of NMES RT evokes local positive changes in leg LM without reciprocating the continuous loss in LM or gain in FM in other regions and total body. Training was effective in increasing strength as well as fatigue resistance of the trained knee extensors.

Bilateral neuromuscular and force differences during a plyometric task.

PubMed

Ball, Nick B; Scurr, Joanna C

2009-08-01

The purpose of this article is to compare the bilateral neuromuscular and force contribution during a plyometric bounce drop jump task and to assess the affects of nonsimultaneous foot placement. Sixteen male participants performed bounce drop jumps from a height of 0.4 m. Mean peak electromyography activity of the soleus, medial, and lateral gastrocnemius of both legs was recorded from each phase of the drop jump and normalized to a reference dynamic muscle action. Resultant ground reaction force, ground contact time, and duration of the drop jumps were recorded from each leg. Multivariate analysis of variance was used to compare bilateral electromyographic activity, resultant peak ground reaction force, and contact duration. Pearson's correlations (r) ascertained relationships between normalized electromyographic activity and contact time. Significant differences were shown between left and right triceps surae normalized electromyography during precontact and contact40ms (p < 0.01). No significant differences were present in the contactpost40ms phase (p > 0.01). Significant differences were found between normalized soleus electromyography and both gastrocnemii for both legs during precontact (p < 0.01). No significant differences were found for within-leg normalized electromyography for the contact40ms phases and contactpost40ms phase (p > 0.01). Weak relationships were found between normalized electromyographic activity and nonsimultaneous foot contact (r < 0.2). This study showed differences between left and right triceps surae in neuromuscular strategies engaged in the early stages of a drop jump task. Differences in contact time initiation were present; however, they are not significant enough to cause neuromuscular differences in the plantar flexor muscles.

THE EFFECT OF THE GROWTH HORMONE FROM THE ANTERIOR LOBE OF THE PITUITARY ON BONE UNDER CONDITIONS OF IRRADIATION (in Russian)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ivanova, E.A.

1963-05-21

Young rats 3 to 4 days old were given an x-ray dose of 1000 r on the left hind leg. A daily dose of 200 gamma of growth hormone obtained from the pituitary of a bull was administered, until the animals were killed on the 36th, 41st, and 44th days after the irradiation. The length of the tibia in the left and right legs was determined by x rays. In the irradiated animals, the ratio of the length of the left tibia to the right tibia was about 0.50, and the introduction of growth hormone into the rat had onlymore » a slight effect on tibial growth. The bones were then fixed in a Zenkerformalin fluid, and cytological studies were carried out. These studies show that irradiation of the extremity of a four-day rat with an x-ray dose of 2000 r resulted in deep disturbances in the cartilage bone with subsequent arrest in the development of the bone. The introduction of growth hormone ameliorated the changes in bone structure, but did not result in normal bone development. (TTT)« less

[Acute heart failure: acute cardiogenic pulmonary edema and cardiogenic shock].

PubMed

Sánchez Marteles, Marta; Urrutia, Agustín

2014-03-01

Acute cardiogenic pulmonary edema and cardiogenic shock are two of the main forms of presentation of acute heart failure. Both entities are serious, with high mortality, and require early diagnosis and prompt and aggressive management. Acute pulmonary edema is due to the passage of fluid through the alveolarcapillary membrane and is usually the result of an acute cardiac episode. Correct evaluation and clinical identification of the process is essential in the management of acute pulmonary edema. The initial aim of treatment is to ensure hemodynamic stability and to correct hypoxemia. Other measures that can be used are vasodilators such as nitroglycerin, loop diuretics and, in specific instances, opioids. Cardiogenic shock is characterized by sustained hypoperfusion, pulmonary wedge pressure > 18 mmHg and a cardiac index < 2.2l/min/m(2). The process typically presents with hypotension (systolic blood pressure < 90 mmHg or a decrease in mean arterial pressure > 30 mmHg) and absent or reduced diuresis (< 0.5 ml/kg/h). The most common cause is left ventricular failure due to acute myocardial infarction. Treatment consists of general measures to reverse acidosis and hypoxemia, as well as the use of vasopressors and inotropic drugs. Early coronary revascularization has been demonstrated to improve survival in shock associated with ischaemic heart disease. Copyright © 2014 Elsevier España, S.L. All rights reserved.

Traumatic thrombosis of internal carotid artery sustained by transfer of kinetic energy.

PubMed

Kalcioglu, Mahmut Tayyar; Celbis, Osman; Mizrak, Bulent; Firat, Yezdan; Selimoglu, Erol

2012-06-01

A 31-year-old male patient with a fatal thrombosis of the internal carotid artery caused by gun shot injury was presented in this case report. The patient was referred to the hospital with a diffuse edema on his left cheek. On otolaryngologic examination, there was a bullet entrance hole at the left mandibular corpus. No exit hole could be found. The finding from his axial computed tomography of neck and paranasal sinuses was normal. On neurological examination, a dense right hemiparesis was observed. In his cerebral angiogram, left common carotid artery was totally obliterated. Diffuse ischemia was observed in the left cerebral hemisphere. Despite intensive interventions, the patient died 4 days after the accident. In the autopsy, a large thrombosis was obtained in the left common carotid artery. This case emphasizes a fatal kinetic energy effect in vascular structures. It is stressed that a gun shot injury could be fatal with its indirect kinetic energy effects at subacute phase.

LOWER EXTREMITY FUNCTIONAL TESTS AND RISK OF INJURY IN DIVISION III COLLEGIATE ATHLETES

PubMed Central

Heiderscheit, Bryan C.; Manske, Robert C.; Niemuth, Paul E.; Rauh, Mitchell J.

2013-01-01

Purpose/Background: Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single‐leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time‐loss sports‐related low back or lower extremity injury. Methods: A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Results: Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time‐loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side‐to‐side asymmetry between SLH distances had a 4‐fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3‐fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. Conclusions: The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. Clinical Relevance: The single‐leg hop for distance and the lower extremity functional test, when administered to Division III athletes during the preseason, may help identify those at risk for a time‐loss low back or lower extremity injury. Level of Evidence: 2 PMID:23772338

Lower extremity functional tests and risk of injury in division iii collegiate athletes.

PubMed

Brumitt, Jason; Heiderscheit, Bryan C; Manske, Robert C; Niemuth, Paul E; Rauh, Mitchell J

2013-06-01

Functional tests have been used primarily to assess an athlete's fitness or readiness to return to sport. The purpose of this prospective cohort study was to determine the ability of the standing long jump (SLJ) test, the single-leg hop (SLH) for distance test, and the lower extremity functional test (LEFT) as preseason screening tools to identify collegiate athletes who may be at increased risk for a time-loss sports-related low back or lower extremity injury. A total of 193 Division III athletes from 15 university teams (110 females, age 19.1 ± 1.1 y; 83 males, age 19.5 ± 1.3 y) were tested prior to their sports seasons. Athletes performed the functional tests in the following sequence: SLJ, SLH, LEFT. The athletes were then prospectively followed during their sports season for occurrence of low back or LE injury. Female athletes who completed the LEFT in $118 s were 6 times more likely (OR=6.4, 95% CI: 1.3, 31.7) to sustain a thigh or knee injury. Male athletes who completed the LEFT in #100 s were more likely to experience a time-loss injury to the low back or LE (OR=3.2, 95% CI: 1.1, 9.5) or a foot or ankle injury (OR=6.7, 95% CI: 1.5, 29.7) than male athletes who completed the LEFT in 101 s or more. Female athletes with a greater than 10% side-to-side asymmetry between SLH distances had a 4-fold increase in foot or ankle injury (cut point: >10%; OR=4.4, 95% CI: 1.2, 15.4). Male athletes with SLH distances (either leg) at least 75% of their height had at least a 3-fold increase (OR=3.6, 95% CI: 1.2, 11.2 for the right LE; OR=3.6, 95% CI: 1.2, 11.2 for left LE) in low back or LE injury. The LEFT and the SLH tests appear useful in identifying Division III athletes at risk for a low back or lower extremity sports injury. Thus, these tests warrant further consideration as preparticipatory screening examination tools for sport injury in this population. The single-leg hop for distance and the lower extremity functional test, when administered to Division III athletes during the preseason, may help identify those at risk for a time-loss low back or lower extremity injury. 2.

Accuracy of tissue Doppler echocardiography in the diagnosis of new-onset congestive heart failure in patients with levels of B-type natriuretic peptide in the midrange and normal left ventricular ejection fraction.

PubMed

Arques, Stephane; Roux, Emmanuel; Sbragia, Pascal; Pieri, Bertrand; Gelisse, Richard; Ambrosi, Pierre; Luccioni, Roger

2006-09-01

Based on the hypothesis that it reflects left ventricular (LV) diastolic pressures, B-type natriuretic peptide (BNP) is largely utilized as first-line diagnostic complement in the emergency diagnosis of congestive heart failure (HF). The incremental diagnostic value of tissue Doppler echocardiography, a reliable noninvasive estimate of LV filling pressures, has been reported in patients with preserved LV ejection fraction and discrepancy between BNP levels and the clinical judgment, however, its clinical validity in such patients in the presence of BNP concentrations in the midrange, which may reflect intermediate, nondiagnostic levels of LV filling pressures, is unknown. 34 patients without history of HF, presenting with acute dyspnea at rest, BNP levels of 100-400 pg/ml and normal LV ejection fraction were prospectively enrolled (17 with congestive HF and 17 with noncardiac cause). Tissue Doppler echocardiography was performed within 3 hours after admission. Unlike BNP (P = 0.78), Boston criteria (P = 0.0129), radiographic pulmonary edema (P = 0.0036) and average E/Ea ratio (P = 0.0032) were predictive of congestive HF by logistic regression analysis. In this clinical setting, radiographic pulmonary edema had a positive predictive value of 80% in the diagnosis of congestive HF. In patients without evidence of radiographic pulmonary edema, average E/Ea > 10 was a powerful predictor of congestive HF (area under the ROC curve of 0.886, P < 0.001, sensitivity 100% and specificity 78.6%). By better reflecting LV filling pressures, bedside tissue Doppler echocardiography accurately differentiates congestive HF from noncardiac cause in dyspneic patients with intermediate, nondiagnostic BNP levels and normal LV ejection fraction.

Albumin augmentation improves condition of guinea pig hearts after 4 hr of cold ischemia.

PubMed

Jacob, Matthias; Paul, Oliver; Mehringer, Laurenz; Chappell, Daniel; Rehm, Markus; Welsch, Ulrich; Kaczmarek, Ingo; Conzen, Peter; Becker, Bernhard F

2009-04-15

Major causes of death after heart transplantation are right ventricular pump failure and, chronically, cardiac allograft vasculopathy. Traditional preservation techniques focus on immediate cardioplegia, without particularly considering vascular demands. Recently, the endothelial surface layer, composed of the endothelial glycocalyx and plasma proteins, was discovered to play a major role in vascular barrier function, edema formation, and leukocyte-to-endothelial interaction. The impact of augmenting a traditional preservation solution with plasma colloid albumin was therefore investigated. Guinea pig hearts underwent cold ischemic storage for 4 hr using Bretschneider's solution (histidine-tryptophan-ketoglutarate [HTK]) without and with augmentation with 1 g% human albumin. After reperfusion, intracoronary adhesion of polymorphonuclear granulocytes, edema formation, left and right heart performance of pressure-to-volume work, and glycocalyx shedding were assessed. Intracoronary retention of leukocytes was doubled in the traditional group (36.4+/-6.6%), whereas it remained at basal values after albumin preservation (23.5+/-2.4%; P<0.05). Addition of albumin to HTK significantly decreased edema formation (wet to dry weight ratio 6.9+/-0.1 vs. 7.2+/-0.2; P<0.05). Although left heart performance was comparable, right heart cardiac output was doubled in hearts having received HTK containing albumin versus HTK alone (94+/-14 vs. 50+/-11 mL/min/g; P<0.05). Glycocalyx shedding was significantly reduced when the hearts were stored under albumin protection. Augmenting HTK with human albumin improves endothelial integrity and heart performance after 4 hr cold ischemia, because of a marked protection of the endothelial glycocalyx. For the prevention of acute and chronic graft failure, the glycocalyx might represent a new target.

ROCHFORD, AL - ASTRONAUT COOPER, GORDON L. - LIFE VEST CHECK - PRELAUNCH ACTIVITIES - MERCURY-ATLAS (MA)-9 - MSC

NASA Image and Video Library

1963-03-01

S63-03964 (1963) --- Al Rochford, Crew Systems, Manned Space Center, assists astronaut L. Gordon Cooper Jr., in checking his life vest, normally stowed in a pocket in the lower left leg. Photo credit: NASA

Alpha-Tocopherol Reduces Brain Edema and Protects Blood-Brain Barrier Integrity following Focal Cerebral Ischemia in Rats.

PubMed

Haghnejad Azar, Adel; Oryan, Shahrbanoo; Bohlooli, Shahab; Panahpour, Hamdollah

2017-01-01

This study was conducted to examine the neuroprotective effects of α-tocopherol against edema formation and disruption of the blood-brain barrier (BBB) following transient focal cerebral ischemia in rats. Ninety-six male Sprague-Dawley rats were divided into 3 major groups (n = 32 in each), namely the sham, and control and α-tocopherol-treated (30 mg/kg) ischemic groups. Transient focal cerebral ischemia (90 min) was induced by occlusion of the left middle cerebral artery. At the end of the 24-hour reperfusion period, the animals were randomly selected and used for 4 investigations (n = 8) in each of the 3 main groups: (a) assessment of neurological score and measurement of infarct size, (b) detection of brain edema formation by the wet/dry method, (c) evaluation of BBB permeability using the Evans blue (EB) extravasation technique, and (d) assessment of the malondialdehyde (MDA) and reduced glutathione (GSH) concentrations using high-performance liquid chromatography methods. Induction of cerebral ischemia in the control group produced extensive brain edema (brain water content 83.8 ± 0.11%) and EB leakage into brain parenchyma (14.58 ± 1.29 µg/g) in conjunction with reduced GSH and elevated MDA levels (5.86 ± 0.31 mmol/mg and 63.57 ± 5.42 nmol/mg, respectively). Treatment with α-tocopherol significantly lowered brain edema formation and reduced EB leakage compared with the control group (p < 0.001, 80.1 ± 0.32% and 6.66 ± 0.87 µg/g, respectively). Meanwhile, treatment with α-tocopherol retained tissue GSH levels and led to a lower MDA level (p < 0.01, 10.17 ± 0.83 mmol/mg, and p < 0.001, 26.84 ± 4.79 nmol/mg, respectively). Treatment with α-tocopherol reduced ischemic edema formation and produced protective effects on BBB function following ischemic stroke occurrence. This effect could be through increasing antioxidant activity. © 2016 S. Karger AG, Basel.

Characterization and quantification of cerebral edema induced by synchrotron x-ray microbeam radiation therapy

NASA Astrophysics Data System (ADS)

Serduc, Raphaël; van de Looij, Yohan; Francony, Gilles; Verdonck, Olivier; van der Sanden, Boudewijn; Laissue, Jean; Farion, Régine; Bräuer-Krisch, Elke; Siegbahn, Erik Albert; Bravin, Alberto; Prezado, Yolanda; Segebarth, Christoph; Rémy, Chantal; Lahrech, Hana

2008-03-01

Cerebral edema is one of the main acute complications arising after irradiation of brain tumors. Microbeam radiation therapy (MRT), an innovative experimental radiotherapy technique using spatially fractionated synchrotron x-rays, has been shown to spare radiosensitive tissues such as mammal brains. The aim of this study was to determine if cerebral edema occurs after MRT using diffusion-weighted MRI and microgravimetry. Prone Swiss nude mice's heads were positioned horizontally in the synchrotron x-ray beam and the upper part of the left hemisphere was irradiated in the antero-posterior direction by an array of 18 planar microbeams (25 mm wide, on-center spacing 211 mm, height 4 mm, entrance dose 312 Gy or 1000 Gy). An apparent diffusion coefficient (ADC) was measured at 7 T 1, 7, 14, 21 and 28 days after irradiation. Eventually, the cerebral water content (CWC) was determined by microgravimetry. The ADC and CWC in the irradiated (312 Gy or 1000 Gy) and in the contralateral non-irradiated hemispheres were not significantly different at all measurement times, with two exceptions: (1) a 9% ADC decrease (p < 0.05) was observed in the irradiated cortex 1 day after exposure to 312 Gy, (2) a 0.7% increase (p < 0.05) in the CWC was measured in the irradiated hemispheres 1 day after exposure to 1000 Gy. The results demonstrate the presence of a minor and transient cellular edema (ADC decrease) at 1 day after a 312 Gy exposure, without a significant CWC increase. One day after a 1000 Gy exposure, the CWC increased, while the ADC remained unchanged and may reflect the simultaneous presence of cellular and vasogenic edema. Both types of edema disappear within a week after microbeam exposure which may confirm the normal tissue sparing effect of MRT. For more information on this article, see medicalphysicsweb.org

Effects of budesonide on the lung functions, inflammation and apoptosis in a saline-lavage model of acute lung injury.

PubMed

Mokra, D; Kosutova, P; Balentova, S; Adamkov, M; Mikolka, P; Mokry, J; Antosova, M; Calkovska, A

2016-12-01

Diffuse alveolar injury, edema, and inflammation are fundamental signs of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Whereas the systemic administration of corticosteroids previously led to controversial results, this study evaluated if corticosteroids given intratracheally may improve lung functions and reduce edema formation, migration of cells into the lung and their activation in experimentally-induced ALI. In oxygen-ventilated rabbits, ALI was induced by repetitive saline lung lavage, until PaO2 decreased to < 26.7 kPa in FiO 2 1.0. Then, one group of animals was treated with corticosteroid budesonide (Pulmicort susp inh, AstraZeneca; 0.25 mg/kg) given intratracheally by means of inpulsion regime of high-frequency jet ventilation, while another group was non-treated, and both groups were oxygen-ventilated for following 5 hours. Another group of animals served as healthy controls. After sacrifice of animals, left lung was saline-lavaged and protein content was measured and cells in the lavage fluid were determined microscopically. Right lung tissue was used for estimation of edema formation (expressed as wet/dry weight ratio), for histomorphological investigation, immunohistochemical determination of apoptosis of lung cells, and for determination of markers of inflammation and lung injury (IL-1β, IL-6, IL-8, TNF-α, IFNγ, esRAGE, caspase-3) by ELISA methods. Levels of several cytokines were estimated also in plasma. Repetitive lung lavage worsened gas exchange, induced lung injury, inflammation and lung edema and increased apoptosis of lung epithelial cells. Budesonide reduced lung edema, cell infiltration into the lung and apoptosis of epithelial cells and decreased concentrations of proinflammatory markers in the lung and blood. These changes resulted in improved ventilation. Concluding, curative intratracheal treatment with budesonide alleviated lung injury, inflammation, apoptosis of lung epithelial cells and lung edema and improved lung functions in a lavage model of ALI. These findings suggest a potential of therapy with inhaled budesonide also for patients with ARDS.

Application of non-invasive cerebral electrical impedance measurement on brain edema in patients with cerebral infarction.

PubMed

He, Lan Ying; Wang, Jian; Luo, Yong; Dong, Wei Wei; Liu, Li Xu

2010-09-01

To investigate the change of brain edema in patients with cerebral infarction by non-invasive cerebral electrical impedance (CEI) measurements. An invariable secure current at a frequency of 50 kHz and an intensity of 0.1 mA was given into a person's brain. CEI values of the bilateral hemisphere of 200 healthy volunteers and 107 patients with cerebral infarction were measured by non-invasive brain edema monitor. The results of perturbative index (PI) converted from CEI were compared with the volumes of brain edema, which were calculated by an image analysing system according to magnetic resonance imaging or computed tomography. (1) In the healthy volunteers, PI values in the left and right hemisphere were 7.98 +/- 0.95 and 8.02 +/- 0.71 respectively, and there was no significant difference between the two sides (p>0.05). Age, gender and different measuring times did not obviously affect PI values (p>0.05). (2) In the cerebral infarction group, CEI measurements were more sensitive to the volumes of lesion, which were more than 20 ml. The positive ratio of PI was higher when the volumes of infarction were >20 ml (80.0%): the ratio of PI was 75.9% when the volumes of infarction were 20-50 ml and it was 83.3% when the volumes of lesion were more than 50 ml. PI was lower when the volumes were less than 20 ml. (3) PI of the infarction side increased obviously 3-5 days after onset; the difference of two sides was the most significant. There was a positive correlation between PI of the infarction side and volume of infarction. PI may be a sensitive parameter for non-invasive monitoring of the change of brain edema in patients with cerebral infarction. CEI is a valuable method for the early detection of brain edema.

[Domiciliary noninvasive positive pressure ventilation in chronic alveolar hypoventilation].

PubMed

Casas, J P; Robles, A M; Pereyra, M A; Abbona, H L; López, A M

2000-01-01

Effectiveness of treatment with domiciliary nocturnal noninvasive positive pressure ventilation is analyzed in a group of patients with chronic alveolar hypoventilation of different etiologies. It was applied with two levels of pressure (BiPAP) via nasal mask. Criteria for evaluation were symptomatology and improvement in gas exchange. Data were analyzed by Student t tests. A total of 13 patients were included, mean age 55.7 range 20 to 76 years (5 male 8 female). Main diagnosis was tuberculosis in 6, four of them having had surgical procedure (thoracoplasty 2, frenicectomy 1 and neumonectomy 1), myopathy 3 (myasthenia gravis 1, muscular dystrophy 1 and diaphragmatic paralysis 1), obesity-hypoventilation syndrome 1, escoliosis 1, bronchiectasis 1 and cystic fibrosis 1. These last two patients were on waiting list for lung transplantation. At the moment of consultation, the symptoms were: dysnea 13/13 (100%), astenia 13/13 (100%), hypersomnolency 10/13 (77%), cephalea 9/13 (69%), leg edema 6/13 (46%), loss of memory 6/13 (46%). Regarding gas exchange, they showed hypoxemia and hypercapnia. Mean follow up was of 2.2 years (range 6 months to 4 years). Within the year, all 13 patients became less dyspneic. Astenia, hypersomnolency, cephalea, leg edema and memory loss disappeared. Improvement in gas exchange was: PaO2/FiO2 from 269 +/- 65.4 (basal) to 336.7 +/- 75.3 post-treatment (p = 0.0018). PaCO2 from 70.77 +/- 25.48 mmHg (basal) to 46.77 +/- 8.14 mmHg (p = 0.0013). Ventilatory support was discontinued en 5 patients: three because of pneumonia requiring intubation and conventional mechanical ventilation, two of them died and one is still with tracheostomy; One patient with bronchiectasis and one with cystic fibrosis were transplanted. The remaining eight patients are stable. In conclusion, chronic alveolar hypoventilation can be effectively treated with domiciliary nocturnal noninvasive ventilation. Long term improvement in symptomatology and arterial blood gases can be obtained without significant complications.

Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study

PubMed Central

Burne, S; Khan, K; Boudville, P; Mallet, R; Newman, P; Steinman, L; Thornton, E

2004-01-01

Objective: To investigate in a military setting the potential role of intrinsic biomechanical and anthropometric risk factors for, and the incidence of, exertional medial tibial pain (EMTP). Methods: A prospective clinical outcome study in a cohort of 122 men and 36 women at the Australian Defence Force Academy. Each cadet underwent measurements of seven intrinsic variables: hip range of motion, leg length discrepancy, lean calf girth, maximum ankle dorsiflexion range, foot type, rear foot alignment, and tibial alignment. Test–retest reliability was undertaken on each variable. A physician recorded any cadet presenting with diagnostic criteria of EMTP. Records were analysed at 12 months for EMTP presentation and for military fitness test results. Results: 23 cadets (12 men, 11 women) met the criteria for EMTP after 12 months, with a cross gender (F/M) odds ratio of 3.1. In men, both internal and external range of hip motion was greater in those with EMTP: left internal (12°, p = 0.000), right internal (8°, p = 0.014), left external (8°, p = 0.042), right external (9°, p = 0.026). Lean calf girth was lower by 4.2% for the right leg (p = 0.040) but by only 2.9% for the left leg (p = 0.141). No intrinsic risk factor was associated with EMTP in women. EMTP was the major cause for non-completion of the run component of the ADFA fitness test in both men and women. Conclusions: Greater internal and external hip range of motion and lower lean calf girth were associated with EMTP in male military cadets. Women had high rates of injury, although no intrinsic factor was identified. Reasons for this sex difference need to be identified. PMID:15273181

Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study.

PubMed

Burne, S G; Khan, K M; Boudville, P B; Mallet, R J; Newman, P M; Steinman, L J; Thornton, E

2004-08-01

To investigate in a military setting the potential role of intrinsic biomechanical and anthropometric risk factors for, and the incidence of, exertional medial tibial pain (EMTP). A prospective clinical outcome study in a cohort of 122 men and 36 women at the Australian Defence Force Academy. Each cadet underwent measurements of seven intrinsic variables: hip range of motion, leg length discrepancy, lean calf girth, maximum ankle dorsiflexion range, foot type, rear foot alignment, and tibial alignment. Test-retest reliability was undertaken on each variable. A physician recorded any cadet presenting with diagnostic criteria of EMTP. Records were analysed at 12 months for EMTP presentation and for military fitness test results. 23 cadets (12 men, 11 women) met the criteria for EMTP after 12 months, with a cross gender (F/M) odds ratio of 3.1. In men, both internal and external range of hip motion was greater in those with EMTP: left internal (12 degrees, p = 0.000), right internal (8 degrees, p = 0.014), left external (8 degrees, p = 0.042), right external (9 degrees, p = 0.026). Lean calf girth was lower by 4.2% for the right leg (p = 0.040) but by only 2.9% for the left leg (p = 0.141). No intrinsic risk factor was associated with EMTP in women. EMTP was the major cause for non-completion of the run component of the ADFA fitness test in both men and women. Greater internal and external hip range of motion and lower lean calf girth were associated with EMTP in male military cadets. Women had high rates of injury, although no intrinsic factor was identified. Reasons for this sex difference need to be identified.

Serratia marcescens osteomyelitis in an infant.

PubMed

Mayer, Chad W; Bangash, Shahid; Bocchini, Joseph A; Lowery-Nordberg, Mary; Bahna, Sami L

2006-01-01

Neutrophil dysfunction can result from oxidative burst defect or from glucose-6-phosphate dehydrogenase (G6PD) deficiency; we noted both in the same patient. A 4-month-old male infant with G6PD deficiency presented with swelling of the left middle finger, left leg, and right big toe. At 5 weeks of age he was hospitalized for fever for 2 days. A maternal uncle died at 5 years of age and a male maternal cousin died at the age of 21 months, both reportedly diagnosed with chronic granulomatous disease (CGD). On physical examination, he had a swollen erythematous left third finger, left distal leg swelling, and right big toe abscess. None of these areas was significantly tender. WBC was 18.7 x 10(3)/mm(3) with 37% PMN and 5% bands. The x-ray films showed osteomyelitis in the left third proximal phalanx and the distal right first metatarsal. Culture from the toe abscess grew Serratia marcescens. His neutrophil oxidative burst was tested by the dihydrorhodamine-123 assay and was markedly suppressed, typical of CGD. The mother and maternal grandmother were found to be CGD carriers. He was treated with i.v. antibiotics for 4 weeks and was discharged on prophylactic trimethoprim, itraconazole and interferon gamma, with substantial reduction in infections. Infection in this infant was unusual in its nature, in affecting multiple sites, and in its causative organism. Immune deficiency was suspected, particularly of the phagocytic component, but could not be attributed to his moderate degree of primary G6PD deficiency. Additional immunologic evaluation and the family history led to the diagnosis of X-linked CGD.

[Beneficial effect of thyrotropin-releasing hormone in combination with HSD on hemorrhagic shock with pulmonary edema at high altitude in the rat].

PubMed

Hu, De-yao; Liu, Liang-ming; Li, Ping; Liu, Jian-cang; Liu, Hou-dong; He, Yan-mei; Huo, Xiao-ping; Tian, Kun-lun; Shi, Quan-gui; Xiao, Nan; Zhou, Xue-wu

2003-05-01

To study the effects of thyrotropin-releasing hormone (TRH) in combination with hypertonic saline/dextran (7.5% NaCl + 6% Dextran 40, HSD ) on hemorrhagic shock with pulmonary edema in the rats which were recently brought to high altitude. Forty-nine SD rats, transported to Lasa, Tibet, which was 3,760 meters above the sea level, were anesthetized one week later with sodium pentobarbital (30 mg/kg, intraperitoneal). Hemorrhagic shock with pulmonary edema was induced by hemorrhage (50 mm Hg maintained for 1 hour,1 mm Hg=0.133 kPa) plus intravenous injection of oleic acid (50 microl/kg). They were equally divided into seven groups (n=7): normal control, hemorrhagic shock, hemorrhagic shock with pulmonary edema (HSPE), HSPE plus TRH (5 mg/kg), HSPE plus HSD (4 ml/kg), and HEPE plus TRH and HSD in combination. Hemodynamic parameters including mean arterial blood pressure(MAP), left intraventricular systolic pressure (LVSP) and the maximal change rate of intraventricular pressure rise or decline (+/- dp/dt max) were observed at 15, 30, 60 and 120 minutes, blood gases were analyzed at 30 and 120 minutes, and the water content of lung and brain was determined at 120 minutes after drug administration. TRH or HSD used alone or in combination significantly increased MAP, LVSP and +/- dp/dt max (P<0.05 or P<0.01 ), ameliorated acid-base imbalance, and decreased the water content of lung and brain. The effect of the two in combination was superior to either drug used alone. TRH in combination with HSD can be used in the treatment of hemorrhagic shock with pulmonary edema at high altitude.

Epilepsy and restless legs syndrome.

PubMed

Geyer, James D; Geyer, Emery E; Fetterman, Zachary; Carney, Paul R

2017-03-01

Restless legs syndrome (RLS) is a common neurological movement disorder occurring in approximately 10% of the general population. The prevalence of moderately severe RLS is 2.7% overall (3.7% for women and 1.7% for men). Epilepsy is also a common neurological disorder with significant associated morbidity and impact on quality of life. We evaluated the severity and frequency of primary RLS in patients with localization-related temporal lobe epilepsy (TLE) and investigated the role of prodromal RLS symptoms as a warning sign and lateralizing indicator. All epilepsy patients seen in the outpatient clinic were screened for movement disorders from 2005 to 2015. Ninety-eight consecutive patients with localization-related TLE (50 right TLE and 48 left TLE) who met inclusion criteria were seen in the outpatient clinic. The control group consisted of 50 individuals with no history or immediate family history of epilepsy. Each patient was evaluated with the International Restless Legs Study Group (IRLSSG) questionnaire, NIH RLS diagnostic criteria, ferritin level, and comprehensive sleep screening including polysomnography. Furthermore, patients with obstructive sleep apnea or a definite cause of secondary restless legs syndrome such as low serum ferritin or serum iron levels were also excluded from the study. There was a significant association between the type of epilepsy and whether or not patients had RLS χ 2 (1)=10.17, p<.01, using the χ 2 Goodness of Fit Test. Based on the odds ratio, the odds of patients having RLS were 4.60 times higher if they had right temporal epilepsy than if they had left temporal epilepsy, serving as a potential lateralizing indicator. A prodromal sensation of worsening RLS occurred in some patients providing the opportunity to intervene at an earlier stage in this subgroup. We identified frequent moderate to severe RLS in patients with epilepsy. The frequency of RLS was much more common than would typically be seen in patients of similar age. The restlessness was typically described as moderately severe. The RLS symptoms were more common and somewhat more severe in the right TLE group than the left TLE group. Copyright © 2016 Elsevier Inc. All rights reserved.

Journal of Special Operations Medicine. Volume 10, Edition 2, Spring 2010

DTIC Science & Technology

2010-01-01

national (LN) male carried to the firebase clinic by his family in severe pain with swelling of his left thigh following a motor- Fracture Detection...tient. (Image 1a) Once the patient’s pain was controlled, the 18D used CR for comparison and con- firmation. (Image 1b) Case 2: Distal Fibular...swollen left leg. The 18D used US to confirm a suspected fracture. (Image 4a) Once the pain was con- trolled the 18D confirmed the fractured tibia with CR

Disseminated viridians streptococcus (Streptococcus mitis) infection presenting with toxic shock-like syndrome.

PubMed

Intalapaporn, Poj; Wongcharoen, Sunee; Chinapha, Anongnart; Jariyasethpong, Tavatchai

2013-03-01

The authors report a case of a 35-year-old man with no known underlying disease who presented with fever, cellulitis with hemorrhagic blebs on the left leg, monoarthricular left knee arthritis, multiple organ failure and septic shock. His clinical syndrome was compatible with toxic shock syndrome and his blood grew alpha hemolytic (viridians) Streptococcus mitis. To our knowledge, there are few reported cases of toxic shock syndrome cause by Streptococcus mitis in immune-competent adults.

[Extensive left-leg venous thrombosis in young patients: Should we perform extended tests?

PubMed

Gómez Carrillo, Víctor; Pérez de Pedro, Ivan; Salazar de Troya, Cristina; Vallejo Herrera, Verónica

2016-01-01

We report 3 cases of left iliac vein thrombosis whose underlying cause was right iliac artery compression syndrome, also known as May-Thurner syndrome. Endovascular treatment with anatomical correction (stent placement) was applied in 2 of the cases; anticoagulant therapy was maintained given the presence of associated hypercoagulability. A thorough understanding of this diagnosis is important so that an attempt at anatomical correction can be proposed to complement anticoagulant therapy in the interest of improving prognosis.

Assessment of bicycle-car accidents under four different types of collision.

PubMed

Raslavičius, Laurencas; Bazaras, Liudas; Keršys, Artūras; Lukoševičius, Vaidas; Makaras, Rolandas; Eidukynas, Valdas

2017-03-01

Bicycle riders are among the highest risk group in traffic. A cyclist simulation study captured kinematics and injuries to legs, pelvis, neck, and head for one human body size. We analyzed the number of parameters (forces acting on left and right tibia, head injury criterion, neck tensile force, neck shear force, and pelvic acceleration) for each of the four different cases: bicyclist ride out-residential driveway, motorist overtaking-undetected bicyclist, bicyclist left turn-same direction, and bicyclist right turn-opposite direction. The comparison of simulation outcomes for leg injuries with official hospital records has shown a very good correlation in terms of injury severity prediction. This study concludes that if countermeasures to prevent fatal cyclist injury in car impacts were to be concentrated on mitigating head and neck impact to the windscreen of the car, a dominant share of fatal cyclist crashes and severe traumatic head injury cases at collision speeds exceeding 40 km/h could be prevented.

[Necrotizing fasciitis, myositis, arthritis, and streptococcal toxic shock syndrome caused by group G Streptococcus. Report of one case].

PubMed

Ayala-Gaytán, Juan Jacobo; Martínez-Vela, Ángel; Náñez-Terreros, Homero; Guajardo-Lara, Claudia Elena; Valdovinos-Chávez, Salvador Bruno

2014-01-01

Necrotizing fasciitis (NF), myositis, and streptococcal toxic shock syndrome (STSS) associated with group G ß-hemolytic streptococcus (GGS) occasionally coincide. We describe a case of GGS simultaneously occurring with NF, myositis, arthritis, and STSS in an 83-year-old woman with sequelae of cerebrovascular disease, hospitalized after two days of fever and with a painful swollen left foot. She was hypotensive, her foot had purplish discoloration, which showed blisters spreading to the lower third of the leg, and no crepitus was present. Fluid, vasopressive support, tigecyclin, and clindamycin were used. Debrided tissue and fluid aspirated from the knee joint revealed Gram-positive cocci. The patient developed renal and respiratory failure on the fifth day, requiring support. She underwent amputation above the knee of the left leg, after which her condition improved. She was discharged one month later. GGS can cause life-threatening infections such as NF, myositis, and/or STSS. GGS usually afflicts aging patients with comorbid states, and occasionally healthy subjects.

Osteomyelitis as the only manifestation of late latent syphilis: case report and literature review.

PubMed

Liu, Z-Y; Zhang, Y; Qiu, K-F; Du, S-X

2011-06-01

Bone infection, particularly of the skull and the long bones of the legs and arms, despite being a common characteristic of tertiary stage syphilis and congenital syphilis in the past, is seldom encountered clinically due to effective antibiotic therapy. We report a case of a 62-year-old man who presented with one-month acute pain in the left leg. Treponema pallidum particle agglutination test was positive, and radiography showed a pathological fracture of the left tibiofibula. Surgical debridement and biopsy of the bone marrow were performed and a pathological diagnosis of syphilis osteomyelitis was entertained. The patient's symptoms resolved completely after a six-week course of penicillin. We identified 17 previously published cases of bone lesions of syphilis, eight of which had syphilitic osteomyelitis, seven were syphilitic osteitis and two had syphilitic periostitis. We suggest that bone lesions such as osteomyelitis caused by syphilis can be the only manifestation of late latent syphilis.

Anthropometry as a predictor of high speed performance.

PubMed

Caruso, J F; Ramey, E; Hastings, L P; Monda, J K; Coday, M A; McLagan, J; Drummond, J

2009-07-01

To assess anthropometry as a predictor of high-speed performance, subjects performed four seated knee- and hip-extension workouts with their left leg on an inertial exercise trainer (Impulse Technologies, Newnan GA). Workouts, done exclusively in either the tonic or phasic contractile mode, entailed two one-minute sets separated by a 90-second rest period and yielded three performance variables: peak force, average force and work. Subjects provided the following anthropometric data: height, weight, body mass index, as well as total, upper and lower left leg lengths. Via multiple regression, anthropometry attempted to predict the variance per performance variable. Anthropometry explained a modest (R2=0.27-0.43) yet significant degree of variance from inertial exercise trainer workouts. Anthropometry was a better predictor of peak force variance from phasic workouts, while it accounted for a significant degree of average force and work variance solely from tonic workouts. Future research should identify variables that account for the unexplained variance from high-speed exercise performance.

Proteus syndrome: a case report.

PubMed

Pangkanon, S; Limpongsanurak, W; Sangtawesin, V

2001-05-01

Proteus syndrome is a rare genetic disorder, characterized by partial gigantism of the hands and/or feet, asymmetry of the limbs, plantar hyperplasia, multiple hamartomatous subcutaneous tumors, hyperostoses, and long bone overgrowth. A one day old Thai male infant is reported with macrosomia, hemihypertrophy of the left side of the face and left leg, large feet, macrodactyly of toes, plantar hyperplasia, large subcutaneous mass with a violet-red surface over the left side of the chest wall and a large port-wine stain involving the lateral aspect of the right chest wall. The clinical findings, diagnostic criteria, differential diagnosis, and management of the Proteus syndrome are reviewed.

Measurement of Hybrid III Dummy Properties and Analytical Simulation Data Base Development

DTIC Science & Technology

1988-02-01

Rotation 50 for Itunading Manikin 29 Ilbow Vlexion-Extention at 00 Rotation for )7 oatvd Manikin 30U 1 lbow Y’l.A,*o-" r t inuon at 900 Medial Potation I8...Upper Am 129 10 Left Upper Arm 130 11 Right Fcreerm 131 12 Left Forearm 132 13 R :%ght Hand 133 14 Left Hand 134 15 Seated Right Upper Leg 135 16 Seated...Point Height 3.ref +.1 -- -- D "HO Point Location from 5.4ref_.l - - Beck Line R Shoulder Pivot Location 3.5+.2 3.7 4.4 from Beck Line I Thigh

Effect of lysophosphatidylcholine on the filtration coefficient in intact dog lungs

NASA Technical Reports Server (NTRS)

Butler, B. D.; Davies, I.; Drake, R. E.

1989-01-01

Lysophosphatidylcholine (lyso-Pc) is a lysophospholipid normally found in low concentrations in the lung. At high concentrations lyso-Pc, instilled into the airways, causes pulmonary edema. The hypothesis was tested that the edema caused by lyso-Pc was due to an increase in pulmonary microvascular membrane permeability. In 11 anesthetized dogs, the left lower lobes (LLL) were continuously weighed while lyso-Pc (20 mM) was instilled into the LLL airways. After 30 min, the microvascular membrane fluid filtration coefficient (Kf) was determined from the relationship between the rate of LLL weight gain and the pulmonary microvascular pressure. Kf was not significantly different between the lyso-Pc-treated lobes vs control lobes. The data do not support the hypothesis that lyso-Pc, instilled into the airways, causes an increase in pulmonary microvascular permeability.

Pilot study of the impact that bilateral sacroiliac joint manipulation using a drop table technique has on gait parameters in asymptomatic individuals with a leg length inequality.

PubMed

Ward, John; Sorrels, Ken; Coats, Jesse; Pourmoghaddam, Amir; Deleon, Carlos; Daigneault, Paige

2014-03-01

The purpose of this study was to pilot test our study procedures and estimate parameters for sample size calculations for a randomized controlled trial to determine if bilateral sacroiliac (SI) joint manipulation affects specific gait parameters in asymptomatic individuals with a leg length inequality (LLI). Twenty-one asymptomatic chiropractic students engaged in a baseline 90-second walking kinematic analysis using infrared Vicon® cameras. Following this, participants underwent a functional LLI test. Upon examination participants were classified as: left short leg, right short leg, or no short leg. Half of the participants in each short leg group were then randomized to receive bilateral corrective SI joint chiropractic manipulative therapy (CMT). All participants then underwent another 90-second gait analysis. Pre- versus post-intervention gait data were then analyzed within treatment groups by an individual who was blinded to participant group status. For the primary analysis, all p-values were corrected for multiple comparisons using the Bonferroni method. Within groups, no differences in measured gait parameters were statistically significant after correcting for multiple comparisons. The protocol of this study was acceptable to all subjects who were invited to participate. No participants refused randomization. Based on the data collected, we estimated that a larger main study would require 34 participants in each comparison group to detect a moderate effect size.

Tolerance of Lower Body Negative Pressure (LBNP) in endurance runners, weightlifters, swimmers and nonathletes

NASA Technical Reports Server (NTRS)

1980-01-01

Thirteen endurance runners (R), 12 weightlifters (WL), 12 swimmers (SW) and 10 nonathletes (NA) were tested for their tolerance of lower body negative pressure (LBNP) in consecutive 5 minute stages at -20, -30, -40, -50 and -60 torr. Each subject also performed an exercise test on a bicycle ergometer with progressive workloads to exhaustion to determined aerobic capacity. The R had a much higher aerobic capacity than any of the other groups, but a significantly lower LBNP tolerance. While responses in heart rate and pulse pressure were quite similar in all 4 groups, the rate of increase in leg volume relative to LBNP stress (leg compliance, LC) was considerably greater in R than in the other athletes and NA. The greater LC in R could be attributed not only to a more rapid shift of blood to the lower extremities but also to a greater tendency for edema formation, both contributing to a more rapid loss in effective central blood volume for a given LBNP stress. These results substantiate earlier observations which led to the conclusion that endurance running is not advisable as a training regimen for astronauts.

[Surgical treatment of acute deep leg and pelvic vein trombosis].

PubMed

Gall, F; Husfeldt, K J

1977-08-25

In the last 3 years 93 cases of iliofermoral trombosis were treated by surgery. We prefer the method used by Brunner, but under general anaesthesia and using a Bentley-Autotransfusion-System (ATS). The average age of our patients was 55 years (age ranged between 17 and 87 years). No lethal pulmonary embolism was observed. 2, 1 percent of the patients died following apoplex or acute heart failure. Of 67 patients who were operated on 6 months ago or more 70 percent have no further complaints, 28 percent still have some residual edema and only 2 patients have a severe postthrombotic syndrome. 50 percent of 40 control-phlebograms demonstrated patency of all veins. 20 percent had short segmentary occlusions with definite signs of recanalisation, while in 27 percent of the cases occlusions of the lower leg and thigh were found, the iliac veins being free. Only 2 postoperative phlebograms showed a complete iliofemoral venous occlusion. Our results prove, that the operative thrombectomy is a successful method, with which the main complications of the iliofemoral thrombosis-pulmonary embolisation and postthrombotic syndrome-can difinitely be reduced. Also because of better long term results, the operative therapy of acute ilofemoral thrombosis should be generally prefered instead of conservative treatment.

Medical management of venous ulcers.

PubMed

Pascarella, Luigi; Shortell, Cynthia K

2015-03-01

Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

Percutaneous Image-Guided Aspiration and Sclerosis of Adventitial Cystic Disease of the Femoral Vein

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnson, Jason M.; Kiankhooy, Armin; Bertges, Daniel J.

2009-07-15

Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease mainly seen in arteries. Seventeen cases have been reported in the world literature. We report the first known case of ACD successfully treated with percutaneous image-guided ethanol sclerosis. Computed tomography showed a cystic mass adherent to the wall of the common femoral vein. An ultrasound examination revealed a deep venous thrombosis of the leg, secondary to extrinsic compression of the common femoral vein. Three years prior to our procedure, the cyst was aspirated, which partially relieved the patient's symptoms. Over the following 3more » years the patient's symptoms worsened and a 10-cm discrepancy in thigh size developed, in addition to the deep venous thrombosis associated with lower-extremity edema. Using ultrasound guidance and fluoroscopic control, the cyst was drained and then sclerosed with absolute ethanol. The patient's symptoms and leg swelling resolved completely within several weeks. Follow-up physical examination and duplex ultrasound 6 months following sclerosis demonstrated resolution of the symptoms and elimination of the extrinsic compression effect of the ACD on the common femoral vein.« less

Fatigue-related firing of muscle nociceptors reduces voluntary activation of ipsilateral but not contralateral lower limb muscles.

PubMed

Kennedy, David S; Fitzpatrick, Siobhan C; Gandevia, Simon C; Taylor, Janet L

2015-02-15

During fatiguing upper limb exercise, maintained firing of group III/IV muscle afferents can limit voluntary drive to muscles within the same limb. It is not known if this effect occurs in the lower limb. We investigated the effects of group III/IV muscle afferent firing from fatigued ipsilateral and contralateral extensor muscles and ipsilateral flexor muscles of the knee on voluntary activation of the knee extensors. In three experiments, we examined voluntary activation of the knee extensors by measuring changes in superimposed twitches evoked by femoral nerve stimulation. Subjects attended on 2 days for each experiment. On one day a sphygmomanometer cuff occluded blood flow of the fatigued muscles to maintain firing of group III/IV muscle afferents. After a 2-min extensor contraction (experiment 1; n = 9), mean voluntary activation was lower with than without maintained ischemia (47 ± 19% vs. 87 ± 8%, respectively; P < 0.001). After a 2-min knee flexor maximal voluntary contraction (MVC) (experiment 2; n = 8), mean voluntary activation was also lower with than without ischemia (59 ± 21% vs. 79 ± 9%; P < 0.01). After the contralateral (left) MVC (experiment 3; n = 8), mean voluntary activation of the right leg was similar with or without ischemia (92 ± 6% vs. 93 ± 4%; P = 0.65). After fatiguing exercise, activity in group III/IV muscle afferents reduces voluntary activation of the fatigued muscle and nonfatigued antagonist muscles in the same leg. However, group III/IV muscle afferents from the fatigued left leg had no effect on the unfatigued right leg. This suggests that any "crossover" of central fatigue in the lower limbs is not mediated by group III/IV muscle afferents. Copyright © 2015 the American Physiological Society.

Thoracic radiography in the cat: Identification of cardiomegaly and congestive heart failure.

PubMed

Guglielmini, Carlo; Diana, Alessia

2015-12-01

Thoracic radiography is one of the most commonly employed diagnostic tools for the clinical evaluation of cats with suspected heart disease and is the standard diagnostic method in the confirmation of cardiogenic pulmonary edema. In the past, interpretation of feline radiographs focused on a description of the qualitative radiographic features of feline heart disease or the measurement of the cardiac silhouette in healthy cats and cats with different cardiovascular disorders. More recently, studies have begun to critically address the issue of the diagnostic accuracy of thoracic radiography in the diagnostic work-up of cats with heart disease. In these studies, qualitative and quantitative radiographic parameters were compared to echocardiographic findings to evaluate the usefulness of thoracic radiography for the identification of cardiac enlargement and pulmonary edema in the cat. Thoracic radiography is reasonably specific but has a low sensitivity when identifying cardiomegaly in cats with mild structural heart disease. Feline cardiogenic pulmonary edema has a variable radiographic presentation and several specific radiographic findings (i.e., enlargement of the left atrium and the pulmonary veins) can be absent or non-recognizable in affected cats. Copyright © 2015 Elsevier B.V. All rights reserved.

Type 3 Neovascularization Associated with Retinitis Pigmentosa.

PubMed

Sayadi, Jihene; Miere, Alexandra; Souied, Eric H; Cohen, Salomon Y

2017-01-01

To report a case of type 3 neovascular lesion in a patient with retinitis pigmentosa (RP) complicated by macular edema. A 78-year-old man with a long follow-up for RP was referred for painless visual acuity decrease in the right eye. Best-corrected visual acuity was 20/125 in the right eye and 20/40 in the left. Fundus examination showed typical RP and macular edema in both eyes. In the right eye, spectral domain optical coherence tomography revealed a marked cystic macular edema associated with disruption of the Bruch membrane/retinal pigment epithelium complex overlying a pigmentary epithelium detachment, with a vascular structure which appeared to originate from the deep capillary plexus and to be connected with the subretinal pigment epithelium space. Optical coherence tomography angiography showed a high-flow vessel infiltrating the outer retinal layers in the deep capillary plexus segmentation, and a tuft-shaped, bright, high-flow network that seemed to be connected with the subretinal pigment epithelium space in the outer retinal layer segmentation. This presentation was consistent with an early type 3 neovascular lesion in the right eye. Type 3 neovascularization may be considered a possible complication of RP.

Postcorrective surgery improvement of nocturnal hypoxemia in a case of partial anomalous pulmonary venous connection and aberrant hepatic vein drainage.

PubMed

Agrawal, Abhinav; Palkar, Atul V; Sahni, Sonu; Vatsia, Sheel K; Shah, Rakesh D; Talwar, Arunabh

2016-01-01

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly that leads to an anatomical left-to-right shunt. Termination of the intrahepatic inferior vena cava (IVC) with its azygos continuation associated with the hepatic venous connection to the left atrium (LA) is also a rare congenital anomaly that results in an anatomical right-to-left shunt. A 65-year-old male presented with severe dyspnea on exertion and pedal edema. He was further diagnosed at our clinic and was found to have both the aforementioned congenital abnormalities, creating a bidirectional shunt. On further investigation, he was found to have nocturnal hypoxemia on overnight oximetry. The patient was successfully treated via surgical corrections of the congenital anomalies leading to symptomatic improvement as well as the resolution of nocturnal hypoxemia.

Validity and Reliability of a New Device (WIMU®) for Measuring Hamstring Muscle Extensibility.

PubMed

Muyor, José M

2017-09-01

The aims of the current study were 1) to evaluate the validity of the WIMU ® system for measuring hamstring muscle extensibility in the passive straight leg raise (PSLR) test using an inclinometer for the criterion and 2) to determine the test-retest reliability of the WIMU ® system to measure hamstring muscle extensibility during the PSLR test. 55 subjects were evaluated on 2 separate occasions. Data from a Unilever inclinometer and WIMU ® system were collected simultaneously. Intraclass correlation coefficients (ICCs) for the validity were very high (0.983-1); a very low systematic bias (-0.21°--0.42°), random error (0.05°-0.04°) and standard error of the estimate (0.43°-0.34°) were observed (left-right leg, respectively) between the 2 devices (inclinometer and the WIMU ® system). The R 2 between the devices was 0.999 (p<0.001) in both the left and right legs. The test-retest reliability of the WIMU ® system was excellent, with ICCs ranging from 0.972-0.995, low coefficients of variation (0.01%), and a low standard error of the estimate (0.19-0.31°). The WIMU ® system showed strong concurrent validity and excellent test-retest reliability for the evaluation of hamstring muscle extensibility in the PSLR test. © Georg Thieme Verlag KG Stuttgart · New York.

Penetrating abdomino-thoracic injuries: report of four impressive, spectacular and representative cases as well as their challenging surgical management.

PubMed

Eder, Frank; Meyer, Frank; Huth, Christof; Halloul, Zuhir; Lippert, Hans

2011-03-01

Gunshot wounds are rare events in European countries, but stab and impalement injuries occur more frequently and are often spectacular. The aim of the study was to describe several types of penetrating abdomino-thoracic injuries as well as the appropriate surgical interventions, including complex wound management. The representative case series includes four patients with abdomino-thoracic penetrating trauma (two impalements and two stabbings), who were treated in a surgical university hospital (tertiary) centre during a 12-month period. 1. A man was impaled on a steel pipe, which entered the body above the right kidney and behind the liver through the mediastinum via the right thorax, passing the heart and aortic arch up to the left clavicle. The rod was removed via sternotomy and median laparotomy. Only the left subclavian vein required repair. Postoperatively, a residual lesion of the left brachial plexus caused temporary pneumonia. 2. A leg of a collapsing chair drilled into a woman's left foramen obturatorium and exited the body at the right anterior iliac spine. At a regional hospital, the chair leg was removed and the canal caused by gluteal penetration was excised. Exploratory laparotomy revealed peritonitis resulting from a perforated ileum. The injury was repaired with segmental resection and anastomosis. Postoperative right inguinal wound necrosis necessitated excision and vacuum-assisted closure sealing. The patient has residual paresthesia in her left leg resulting from a sacral plexus lesion. 3. During an altercation, a man was stabbed twice in the right thorax. The right pulmonary lobe, the diaphragm, and the liver dome between segment VIII and V were injured. The patient also had a large scalp avulsion at the left and right parietooccipital site and transection of the biceps muscle at the middle third of the right humerus. The chest injuries, approached via right subcostal incision and right anterior thoracotomy were managed with liver packing (two towels, removed after 2 days), suture of the diaphragm, and pleural drainage. 4. A man was stabbed in the left thorax, resulting in pneumothorax and lesions of the diaphragm and left third of the transversal colon, and the neck, resulting in lesions of the pharynx and internal jugular vein. These injuries were approached with left thoracic drainage and suture of the colon and diaphragm lesions. Subsequent right thoracotomy was required to treat right pleural empyema caused by bronchopneumonia as a consequence of blunt thoracic trauma. In addition, the patient required relaparotomy to drain an abscess within the Douglas space and Billroth II gastric resection to control recurrent Forrest-Ia bleeding. Penetrating abdomino-thoracic injuries demand immediate life-saving measures, transfer to a trauma centre, appropriate resuscitative care, prompt diagnosis, and surgical intervention by an interdisciplinary team of abdominal, vascular, and cardiac surgeons. If these measures are provided, outcomes are maximized, mortality is minimized, and permanent damage can be avoided.

Case report of an unusual combination of purulent pericarditis and false aneurysm of the ascending aorta.

PubMed

Meier, David; Kirsch, Matthias; Qanadli, Salah Dine; Muller, Olivier; Fishman, Daniel; Trana, Catalina

2018-01-29

Purulent pericarditis is an uncommon entity, which is, in very rare cases, associated to infection of the aorta. We present the case of a 42-year-old male patient, who was admitted to hospital complaining of tiredness, diarrhea and leg edema. Clinical examination revealed a hypotensive and obviously shocked patient. He was ultimately diagnosed with a rare combination of purulent pericarditis followed by false aneurysm of the ascending aorta. He was successfully treated by surgical pericardial drainage, replacement of the ascending aorta and antibiotics. Mycotic aneurysms can rarely be associated with purulent pericarditis. Our literature review shows that there are two mechanisms explaining this association and that in most of the published cases infective endocarditis could not be demonstrated.

Ocular sporotrichosis: A frequently misdiagnosed cause of granulomatous conjunctivitis in epidemic areas.

PubMed

Yamagata, João Paulo M; Rudolph, Fabiana B; Nobre, Maria Clara L; Nascimento, Leninha V; Sampaio, Felipe Maurício S; Arinelli, Andrea; Freitas, Dayvison F

2017-12-01

Sporotrichosis is a subcutaneous mycosis caused by Sporothrix sp., a dimorphic fungus. Although the cutaneous form is the most frequent form, the ocular presentation has been increasingly diagnosed in epidemic areas. We describe three cases of ocular sporotrichosis with the involvement of the ocular adnexa due to autoinoculation without trauma with successful antifungal treatment. Patient 1: A 68-year-old woman presented with granulomatous conjunctivitis of the right eye with an ulcerated nodule on the right temporal region for 5 months. Patient 2: A 46-year-old woman with conjunctival hyperemia of the left eye with associated periorbital edema and erythema for the past 4 months was referred to the Dermatology Department due to an ulcerated nodule on the left malar region. Patient 3: A 14-year-old boy presented to the emergency department with inferior palpebral edema with a 5-day evolution. Specimens were obtained from the lesions of the three patients, and the cultures were positive for Sporothrix sp. The three cases were diagnosed as ocular sporotrichosis and were successfully treated with itraconazole (200-400 mg/d). Two of the three patients developed sequelae such as conjunctival fibrosis and symblepharon. We emphasize the importance of the ophthalmologist being familiar with the diagnosis and management of this rare and frequently misdiagnosed form of sporotrichosis.

Intestinal Lymphangiectasia: Insights on Management and Literature Review

PubMed Central

Alshikho, Mohamad J.; Talas, Joud M.; Noureldine, Salem I.; Zazou, Saf; Addas, Aladdin; Kurabi, Haitham; Nasser, Mahmoud

2016-01-01

Patient: Male, 24 Final Diagnosis: Intestinal lymphangiectasia Symptoms: Frequent episodes of diarrhea • recurrent infections • swelling in the lower limbs Medication: Octreotide • MCT oils Clinical Procedure: Endoscopic exam • Doppler ultrasound study • abdominal CT scan Specialty: Gastroenterology and Hepatology Objective: Rare disease Background: Intestinal lymphangiectasia (IL) is a rare disease characterized by a dilatation of the intestinal lymphatics and loss of lymph fluid into the gastrointestinal tract leading to hypoproteinemia, edema, lymphocytopenia, hypogammaglobinemia, and immunological abnormalities. Iron, calcium, and other serum components (e.g., lipids, fat soluble vitamins) may also be depleted. A literature search revealed more than 200 reported cases of IL. Herein, we report our observations of a patient diagnosed with IL; we also present our conclusion for our review of the published literature. Case Report: A 24-year-old male was admitted to Aleppo University Hospital with the complaints of abdominal pain, headache, arthralgia, fever, and rigors. His past medical history was remarkable for frequent episodes of diarrhea, recurrent infections, and swelling in the lower limbs. In addition, he had been hospitalized several times in non-academic hospitals due to edema in his legs, cellulitis, and recurrent infections. In the emergency department, a physical examination revealed a patient in distress. He was weak, dehydrated, pale, and had a high-grade fever. His lower extremities were edematous, swollen, and extremely tender to touch. The overlying skin was erythematous and warm. Moreover, the patient was tachycardic, tacypneic, and moderately hypotensive. The patient was resuscitated with IV fluids, and Tylenol was administered to bring the temperature down. Blood tests showed anemia and high levels of inflammatory markers. The patient’s white blood cell count was elevated with an obvious left shift. However, subsequent investigations showed that the patient had IL. Suitable diet modification plans were applied as a long-term management plan. Conclusions: IL is a rare disease of challenging nature due to its systematic effects and lack of comprehensive studies that can evaluate the effectiveness of specific treatments in a large cohort of patients. Medium-chain triglyceride (MCT) oils and diet modification strategies are effective in reducing the loss of body proteins and in maintaining near-normal blood levels of immunoglobulins. However, octreotide and MCT oils had no proven role in reducing lymphedema in our patient. PMID:27440277

Mechanisms of Left-Right Coordination in Mammalian Locomotor Pattern Generation Circuits: A Mathematical Modeling View

PubMed Central

Talpalar, Adolfo E.; Rybak, Ilya A.

2015-01-01

The locomotor gait in limbed animals is defined by the left-right leg coordination and locomotor speed. Coordination between left and right neural activities in the spinal cord controlling left and right legs is provided by commissural interneurons (CINs). Several CIN types have been genetically identified, including the excitatory V3 and excitatory and inhibitory V0 types. Recent studies demonstrated that genetic elimination of all V0 CINs caused switching from a normal left-right alternating activity to a left-right synchronized “hopping” pattern. Furthermore, ablation of only the inhibitory V0 CINs (V0D subtype) resulted in a lack of left-right alternation at low locomotor frequencies and retaining this alternation at high frequencies, whereas selective ablation of the excitatory V0 neurons (V0V subtype) maintained the left–right alternation at low frequencies and switched to a hopping pattern at high frequencies. To analyze these findings, we developed a simplified mathematical model of neural circuits consisting of four pacemaker neurons representing left and right, flexor and extensor rhythm-generating centers interacting via commissural pathways representing V3, V0D, and V0V CINs. The locomotor frequency was controlled by a parameter defining the excitation of neurons and commissural pathways mimicking the effects of N-methyl-D-aspartate on locomotor frequency in isolated rodent spinal cord preparations. The model demonstrated a typical left-right alternating pattern under control conditions, switching to a hopping activity at any frequency after removing both V0 connections, a synchronized pattern at low frequencies with alternation at high frequencies after removing only V0D connections, and an alternating pattern at low frequencies with hopping at high frequencies after removing only V0V connections. We used bifurcation theory and fast-slow decomposition methods to analyze network behavior in the above regimes and transitions between them. The model reproduced, and suggested explanation for, a series of experimental phenomena and generated predictions available for experimental testing. PMID:25970489

Sudden post-traumatic sciatica caused by a thoracic spinal meningioma.

PubMed

Mariniello, Giuseppe; Malacario, Francesca; Dones, Flavia; Severino, Rocco; Ugga, Lorenzo; Russo, Camilla; Elefante, Andrea; Maiuri, Francesco

2016-10-01

Spinal meningiomas usually present with slowly progressive symptoms of cord and root compression, while a sudden clinical onset is very rare. A 35-year-old previously symptom-free woman presented sudden right sciatica and weakness of her right leg following a fall with impact to her left foot. A neurological examination showed paresis of the right quadriceps, tibial and sural muscles, increased bilateral knee and ankle reflexes and positive Babinski sign. Magnetic resonance imaging (MRI) revealed the presence of a spinal T11 meningioma in the left postero-lateral compartment of the spinal canal; at this level, the spinal cord was displaced to the contralateral side with the conus in the normal position. At surgery, a meningioma with dural attachment of the left postero-lateral dural surface was removed. The intervention resulted in rapid remission of both pain and neurological deficits. Spinal meningiomas may exceptionally present with sudden pain and neurological deficits as result of tumour bleeding or post-traumatic injury of the already compressed nervous structures, both in normal patients and in those with conus displacement or tethered cord. In this case, the traumatic impact of the left foot was transmitted to the spine, resulting in stretching of the already compressed cord and of the contralateral lombosacral roots. This case suggests that low thoracic cord compression should be suspected in patients with post-traumatic radicular leg pain with normal lumbar spine MRI. © The Author(s) 2016.

Injury Source and Correlation Analysis of Riders in Car-Electric Bicycle Accidents.

PubMed

Zou, Tiefang; Yi, Liang; Cai, Ming; Hu, Lin; Li, Yuelin

2018-01-01

The knowledge about the injury source and correlation of riders in car-electric bicycle accident will be helpful in the cross validation of traces and vehicle safety design. In order to know more information about such kind of knowledge, 57 true car-electric bicycle accidents were reconstructed by PC-Crash and then data on injury information of riders were collected directly from the reconstructed cases. These collected data were validated by some existing research results firstly, and then 4 abnormal cases were deleted according to the statistical method. Finally, conclusions can be obtained according to the data obtained from the remaining 53 cases. Direct injuries of the head and right leg are from the road pavement upon low speed; the source laws of indirect head injuries are not obvious. Upon intermediate and high speed, the injuries of the above parts are from automobiles. Injuries of the left leg, femur, and right knee are from automobiles; left knee injuries are from automobiles, the road pavement and automobiles, respectively, upon low, intermediate, and high speed. The source laws of indirect torso injuries are not obvious upon intermediate and low speed, which are from automobiles upon high speed, while direct torso injuries are from the road pavement. And there is no high correlation between all parts of the injury of riders. The largest correlation coefficient was the head-left femur and left femur-right femur, which was 0.647, followed by the head-right femur (0.638) and head-torso which was 0.617.

The effects of target distance on pivot hip, trunk, pelvis, and kicking leg kinematics in Taekwondo roundhouse kicks.

PubMed

Kim, Jae-Woong; Kwon, Moon-Seok; Yenuga, Sree Sushma; Kwon, Young-Hoooo

2010-06-01

The study purpose was to investigate the effects of target distance on pivot hip, trunk, pelvis, and kicking leg movements in Taekwondo roundhouse kick. Twelve male black-belt holders executed roundhouse kicks for three target distances (Normal, Short, and Long). Linear displacements of the pivot hip and orientation angles of the pelvis, trunk, right thigh, and right shank were obtained through a three-dimensional video motion analysis. Select displacements, distances, peak orientation angles, and angle ranges were compared among the conditions using one-way repeated measure ANOVA (p < 0.05). Several orientation angle variables (posterior tilt range, peak right-tilted position, peak right-rotated position, peak left-rotated position, and left rotation range of the pelvis; peak hyperextended position and peak right-flexed position of the trunk; peak flexed position, flexion range and peak internal-rotated position of the hip) as well as the linear displacements of the pivot hip and the reach significantly changed in response to different target distances. It was concluded that the adjustment to different target distances was mainly accomplished through the pivot hip displacements, hip flexion, and pelvis left rotation. Target distance mainly affected the reach control function of the pelvis and the linear balance function of the trunk.

Back pain and leg complaints that revealed non–small cell carcinoma: a case study

PubMed Central

Crisp, Casey A.; Pierce, Angela N.

2011-01-01

Objective The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer. Clinical Features A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain. Intervention and Outcome Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed. Conclusion Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain. PMID:22014908

Asymmetric adaptation in human walking using the Tethered Pelvic Assist Device (TPAD).

PubMed

Vashista, Vineet; Reisman, Darcy S; Agrawal, Sunil K

2013-06-01

Human nervous system is capable of modifying motor commands in response to alterations in walking conditions. Previous research has shown that external perturbations that induce gait asymmetry can lead to adaptation in gait parameters. Such strategies have also been shown to temporarily restore gait symmetry in subjects with post stroke hemiparesis. This work aims to develop an experimental paradigm to induce gait asymmetry in human subjects by applying external asymmetric forces on the pelvis through the Tethered Pelvic Assist Device (TPAD). These external forces on the pelvis have the potential to influence the swing and the stance phases of both legs. Eight healthy subjects participated in the experiment where a higher resistive force was applied on the pelvis during the swing phase of the left leg as compared to the right leg. We hypothesized that such asymmetrically applied forces on the pelvis will lead to asymmetric adaptation in the human walking.

[Cross replantation in a case of bilateral amputation of the legs].

PubMed

Girot, J; Marin-Braun, F; Merle, M; Xenard, J

1988-01-01

A case is reported of a patient aged 32 years who suffered bilateral traumatic amputation of the legs by a wagon. Neither of his two feet could be re-implanted to its original site. In spite of the severity of the lesions, reconstructive surgery was attempted by crossed re-implantation of the right foot onto the stump of the left leg. After bony shortening by 20 cm and internal fixation of the tibia, revascularisation was achieved by suture of the posterior tibial vascular pedicle. Primary repair of the posterior tibial nerve allowed protective sensibility to recover in the sole of the foot. Secondarily, a free musculo-cutaneous graft from the latissimus dorsi improved skin cover. Bony union occurred after 10 months. Prolonged rehabilitation resulted in satisfactory walking and activities of daily living and a return to work 18 months after the accident.

HSD is a better resuscitation fluid for hemorrhagic shock with pulmonary edema at high altitude.

PubMed

Liu, Liang-Ming; Hu, De-Yao; Zhou, Xue-Wu; Liu, Jiang-Cang; Li, Ping

2008-12-01

To investigate the fluid tolerance of hemorrhagic shock with pulmonary edema (HSPE) at high altitude in unacclimated rats and the beneficial effect of 7.5% hypertonic saline/6% dextran (HSD). One hundred seventy-six Sprague-Dawley rats, transported to LaSa, Tibet, 3,760 m above the sea level, were anesthetized with sodium pentobarbital (30 mg/kg, i.p.) within 1 week. Hemorrhagic shock with pulmonary edema was induced by bloodletting (50 mmHg for 1 h) plus intravenous injection of oleic acid (50 microL/kg). Seventy-seven rats were equally divided into 11 groups (n = 7/group) including sham-operated control group; hemorrhagic shock control group; HSPE control group; HSPE plus 0.5-, 1.0-, 1.5-, 2.0-, or 3.0-fold volumes of lactated Ringer's solution (LR) groups; and HSPE plus 4, 6, and 8 mL/kg of HSD groups. Hemodynamic parameters including mean arterial blood pressure, left intraventricular systolic pressure, and the maximal change rate of intraventricular pressure rise or decline (+/-dp/dtmax) were observed at baseline and at 15, 30, 60, and 120 min after infusion; blood gases were measured at 30 and 120 min after infusion, and the water content of lung and brain was determined at 120 min after infusion. Additional 99 rats were used to observe the effect of these treatments on the survival time of HSPE rats; 0.5 volume of LR infusion slightly increased the mean arterial blood pressure, left intraventricular systolic pressure, and +/-dp/dtmax and prolonged the survival time of HSPE animals as compared with the HSPE group (P < 0.05 - 0.01); it did not increase the water content of lung and brain and had no marked influences on blood gases. One volume of LR infusion had somewhat improved the hemodynamic parameters for HSPE animals, but had no apparent effect on the survival time and the water content of lung and brain. Lactate Ringer's solution infusion, 1.5, 2, and 3 volumes, significantly deteriorated the hemodynamic parameters, increased the water content of lung, and decreased the survival time of HSPE animals. Hypertonic saline/6% dextran (4 - 8 mL/kg) significantly increased the hemodynamic parameters, improved the blood gases, decreased the water content of lung and brain, and prolonged the survival time of HSPE rats. Among the three dosages of HSD, 6 mL/kg of HSD had the best effect. The tolerance of fluid infusion for hemorrhagic shock with pulmonary edema at high altitude is significantly decreased. More than one volume of LR infusion would aggravate the pulmonary edema and exacerbate the resuscitation effect, but only one volume of LR cannot reach the effective volume resuscitation. Small volume of HSD could better resuscitate hemorrhagic shock with pulmonary edema at high altitude.

The effect of compressed air massage on skin blood flow and temperature.

PubMed

Mars, Maurice; Maharaj, Sunil S; Tufts, Mark

2005-01-01

Compressed air massage is a new treatment modality that uses air under pressure to massage skin and muscle. It is claimed to improve skin blood flow but this has not been verified. Several pilot studies were undertaken to determine the effects of compressed air massage on skin blood flow and temperature. Skin blood flow (SBF), measured using laser Doppler fluxmetry and skin temperature was recorded under several different situations: (i) treatment, at 1 Bar pressure using a single-hole (5-mm) applicator head, for 1 min at each of several sites on the right and left lower legs, with SBF measured on the dorsum of the left foot; (ii) at the same treatment pressure, SBF was measured over the left tibialis anterior when treatment was performed at different distances from the probe; (iii) SBF and skin temperature of the lower leg were measured with treatment at 0 or 1 Bar for 45 min, using two different applicator heads; (iv) SBF was measured on the dorsum of the foot of 10 subjects with treatment for 1 min at 0, 0.5, 1, 1.5 and 2 Bar using three different applicator heads. (i) SBF of the left foot was not altered by treatment of the right leg or chest, but was significantly increased during treatment of the left sole and first web, p < 0.0001. (ii) SBF over the tibialis anterior was increased when treatment was 5 cm from the probe, p < 0.0001, but not when 10 cm away. iii) SBF was significantly elevated throughout the 45-min treatments at 1 Bar and returned to normal within 1 min of stopping treatment. Skin temperature fell by 6.8 degrees C and 4.3 degrees C after 45-min treatments at 1 Bar, and slight rewarming occurred within 15 min. At 0 Bar, no change in SBF or temperature was noted. (iv) A near-linear increase in SBF was noted with increasing treatment pressure for two of the three applicator heads. Compressed air massage causes an immediate increase in SBF, and an immediate fall in SBF when treatment is stopped. The effect appears to be locally and not centrally mediated and is related to the pressure used. Treatment cools the skin for at least 15 min after a 45-min treatment.

Acute Presentation of Chiari I Malformation with Hemiparesis in a Pediatric Patient.

PubMed

Miranda, Stephen P; Kimmell, Kristopher T; Silberstein, Howard J

2016-01-01

Chiari I malformation (CM-I) is defined by cerebellar tonsillar herniation through the foramen magnum. Patients typically present with chronic complaints, including headache, dizziness, and numbness, although there are few reports in the literature of pediatric patients presenting acutely with neurological deficit caused by CM-I. We report a child who presented acutely with hemiparesis and magnetic resonance imaging findings consistent with CM-I and spinal cord edema. A 3-year old boy with normal development presented with difficulty walking and increased drooling. His mother stated he was running into objects and had balance issues for several days. Neurological examination showed ataxia with falling to the right after a few steps and weakness of the right arm and leg. His medical history was remarkable only for mild asthma, although he had recently been treated for an upper respiratory viral infection. Computed tomography of the head demonstrated no brainstem mass. Magnetic resonance imaging of the head and cervical spine showed tonsillar ectopia approximately 2 cm below the craniocervical junction with increased T2 signal in the spinal cord from C1 to C3 consistent with syringomyelia and cord edema. The patient underwent suboccipital craniectomy with removal of the posterior arch of C1 and dural patch graft. His postoperative course was unremarkable, with complete resolution of his symptoms at his 1-month follow-up visit. This case highlights an unusual presentation of CM-I with neurological deficit related to spinal cord edema, possibly precipitated by the "water-hammer" effect of this patient's coughing fits. Providers should be aware of the acute presentations of CM-I. Copyright © 2016 Elsevier Inc. All rights reserved.

Choroid vascular occlusion and ischemic optic neuropathy after facial calcium hydroxyapatite injection- a case report.

PubMed

Chou, Chien-Chih; Chen, Hsin-Han; Tsai, Yi-Yu; Li, You-Ling; Lin, Hui-Ju

2015-03-08

We reported a case of sudden monocular vision loss after calcium hydroxyapatite (CaHA) injection into the nasal tip and dorsum with detailed retina images. A healthy, 35-year-old woman received CaHA filler injection for nose augmentation. Ten minutes after the procedure, she developed nausea, vomiting, headache, ptosis, and left periorbital pain. After 30 minutes, she complained of progressively blurring vision in the left eye. The best-corrected visual acuity (BCVA) in her left eye was 30 cm ahead of hand motion. Left exotropia was noted in primary gaze. Limitations in adduction, supraduction, and infraduction of the left eye were also observed. Slit lamp examination of the left eye revealed a pink conjunctiva, a clear cornea, a mild anterior chamber reaction, a sluggish papillary light reflex, and a semi-dilated pupil. A positive relative afferent pupillary defect was observed in the left eye. Fundus examination revealed optic disc edema and some linear whitish opacity over the superior and temporal sites in the left eye, suggesting multiple CaHA emboli in the choroid vessels. Although the majority of adverse reactions are mild and transient, surgeons should be alert about extremely rare serious adverse events such as visual loss.

Concurrent Acute Retinal Necrosis in a Patient With Iridocorneal Endothelial Syndrome.

PubMed

Vignesh, A P; Srinivasan, Renuka

2016-11-01

To report a rare case of concurrent acute retinal necrosis in a patient with iridocorneal endothelial syndrome (ICE). Case report. A 42-year-old woman showed acute diminution of vision in the right eye. Her fundus examination revealed features of acute retinal necrosis. She had also experienced gradual diminution of vision in her left eye for 5 years. The examination of her left eye revealed corneal edema with mild corectopia and increased intraocular pressure with abnormal endothelium on specular microscopy pointing to a diagnosis of ICE. This is a rare case where concurrent acute retinal necrosis and ICE syndrome are present in the same patient, possibly pointing to a common viral etiology causing both entities.

Agraphia of the left hand with dysfunction of the left superior parietal region without callosal lesions.

PubMed

Kinno, Ryuta; Ohashi, Hideaki; Mori, Yukiko; Shiromaru, Azusa; Ono, Kenjiro

2018-03-01

A 28-year-old right-handed man noticed weakness in his legs, three days after an ephedrine overdose. Initial brain magnetic resonance imaging showed lesions in the parietal regions bilaterally. Computed tomography angiography showed segmental and multifocal vasoconstriction of the cerebral arteries. After treatment, clinical and radiological findings resolved, suggesting the patient had reversible cerebral vasoconstriction syndrome with posterior reversible encephalopathy syndrome. However, he had residual agraphia of the left hand. Language testing revealed no difficulties in oral expression, auditory comprehension, understanding of written language, or writing with the right hand. I-123 iodoamphetamine single-photon emission computed tomography showed residual dysfunction in the left superior parietal lobule. There were no apparent signs of other disconnection syndromes or neuroimaging abnormalities in the corpus callosum. We diagnosed left-hand agraphia due to left parietal dysfunction. Our case suggests that left superior parietal dysfunction without callosal lesions is a possible cause of left-hand agraphia. Neural mechanisms for writing with the right or left hand may be separable at the cortical level.

Hemispheric Asymmetry and Pun Comprehension: When Cowboys Have Sore Calves

ERIC Educational Resources Information Center

Coulson, Seana; Severens, Els

2007-01-01

Event-related potentials (ERPs) were recorded as healthy participants listened to puns such as ''During branding, cowboys have sore calves.'' To assess hemispheric differences in pun comprehension, visually presented probes that were either highly related (COW), moderately related (LEG), or unrelated, were presented in either the left or right…

Lymphovenous Anastomosis and Secondary Resection for Noonan Syndrome with Vulvar Lymphangiectasia

PubMed Central

Tielemans, Hanneke J.P.; Ulrich, Dietmar J.O.

2016-01-01

Summary: In this case report we describe the use of a 2-stage approach to treat severe recurrent vulvar lymphangiectasia in a patient with Noonan syndrome. First, 3 functional lymphatic vessels were identified and anastomosed to venules in an end-to-end fashion. Then, in a second surgical procedure, the vulvar lesions were resected as much as possible and the vulva was reconstructed. By the 12-month follow-up the patient had recovered well. Although there were still some small vesicles on the left labia there was no more ooze, itch, and pain. Lymphatic mapping using indocyanine green showed improvement of the edema of her vulva region and patent LVA. In addition to the demonstration of this 2-stage approach, this case report also demonstrates the benefits of preemptive LVA before performing surgery that may be at high risk for postoperative lymph edema. PMID:27622088

Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome Caused by Crystal-Induced Arthritis of the Wrist: A Case Report

PubMed Central

Hakozaki, Michiyuki; Fukuda, Hironari; Tajino, Takahiro; Kikuchi, Shinichi; Abe, Satoshi; Konno, Shinichi

2013-01-01

Objective To describe a rare case of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome caused by gouty arthritis. Clinical Presentation and Intervention A 76-year-old man presented with swelling and pain in the dorsum of feet and hands bilaterally. From the laboratory and radiologic findings, the diagnosis of gout-induced RS3PE syndrome was made. Conservative therapy with nonsteroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injection in the wrist joint completely and rapidly resolved all symptoms. The patient was successfully treated with oral administration of NSAIDs and a one-time intra-articular corticosteroid injection in the left wrist joint. Conclusion This case demonstrated the importance of considering the possibility of crystal-induced arthritis such as gout and pseudogout, as well as malignant disease, when diagnosing the primary disease responsible for RS3PE syndrome. PMID:23006891

Brain lesions associated with clostridium perfringens type D epsilon toxin in a Holstein heifer calf.

PubMed

Mete, A; Garcia, J; Ortega, J; Lane, M; Scholes, S; Uzal, F A

2013-09-01

A 6-month-old dairy heifer calf with no premonitory signs was acutely down after the morning feeding and could not rise. On presentation, the heifer was in right lateral recumbency and moribund with opisthotonus and left hind limb paddling. Following euthanasia, gross examination of the brain revealed multifocal loss of gray-white matter distinction and extensive petechiae throughout the brainstem. On histopathological examination, there was striking white matter edema and marked perivascular proteinaceous edema surrounding many arterioles and venules (microangiopathy), mainly in the white matter of the internal capsule, thalamus, midbrain, cerebellum, and cerebellar peduncles. The perivascular neuropil was strongly positive for Alzheimer precursor protein A4. Clostridium perfringens epsilon toxin was detected in the intestinal contents. This is the first report of microangiopathy in postneonatal cattle associated with the detection of epsilon toxin in the intestinal contents.

Left ventricular inflow tract obstruction secondary to a myxoma in a dog.

PubMed

Fernandez-del Palacio, M Josefa; Sanchez, Joaquin; Talavera, Jesus; Martínez, Carlos

2011-01-01

This is the first description of a left ventricular inflow tract obstruction secondary to a myxoma in a dog. A 4 yr old, male fox terrier presented with a 1 mo history of cough and exercise intolerance. Expiratory dyspnea, pulmonary crackles, irregular cardiac rhythm, and a grade 4/6 pansystolic cardiac murmur over the left cardiac apex were the most important features on physical examination. The electrocardiogram revealed atrial fibrillation. Thoracic radiographs showed left-sided cardiac enlargement and mild pulmonary edema, especially in the hilar area. Two-dimensional transthoracic echocardiography showed severe left atrial dilation and a homogenous, echodense mass involving both leaflets of the mitral valve and the posteromedial papillary muscle, inducing mitral stenosis. Spectral Doppler echocardiography was consistent with severe left ventricular inflow tract obstruction secondary to a mass. Therapy for congestive heart failure was prescribed. Follow-up examinations of the dog 1 mo, 2 mo, and 6 mo after diagnosis showed an improvement in clinical signs, but similar echocardiographic features. Eleven months after diagnosis, the dog was euthanized at the owner's request because of recurrent congestive heart failure. The postmortem examination showed the cardiac tumor was consistent with a myxoma.

Overnight fluid shifts in subjects with and without obstructive sleep apnea

PubMed Central

Ding, Ning; Lin, Wei; Zhang, Xi-Long; Ding, Wen-Xiao; Gu, Bing; Ni, Bu-Qing; Zhang, Wei; Zhang, Shi-Jiang

2014-01-01

Objective To investigate the characteristics of baseline body fluid content and overnight fluid shifts between non-obstructive sleep apnea (non-OSA) and obstructive sleep apnea (OSA) subjects. Methods A case-controlled study was performed between February 2013 and January 2014, with 36 (18 OSA and 18 non-OSA) outpatients enrolled in this study. Polysomnographic parameters and results of body fluid were compared between the two groups. Results There were no differences in age, weight, and body mass index (BMI) between groups. Compared with the non-OSA group, OSA group had significantly higher neck circumference (NC) and fluid volume shift in the legs. OSA patients had higher left and right leg fluid indices than non-OSA subjects. There were significant correlations between apnoea-hypopnoea index and baseline fluid indices in both legs as well as the reduction in overnight change in both legs fluid volume. The increase in NC was also significantly correlated with the reduction in overnight change in both legs fluid volume, but not with the change in head and neck fluid volume. There were significant correlations between change in NC and increased fluid shifts in head and neck volume. Conclusions OSA patients had a higher baseline fluid content in both legs as compared with non-OSA subjects, which may be the basic factor with regards to fluid shifts in OSA patients. The increase in head and neck fluid shift volume did not directly correlate with the severity of OSA. PMID:25589967

Diastolic dysfunction in the critically ill patient.

PubMed

Suárez, J C; López, P; Mancebo, J; Zapata, L

2016-11-01

Left ventricular diastolic dysfunction is a common finding in critically ill patients. It is characterized by a progressive deterioration of the relaxation and the compliance of the left ventricle. Two-dimensional and Doppler echocardiography is a cornerstone in its diagnosis. Acute pulmonary edema associated with hypertensive crisis is the most frequent presentation of diastolic dysfunction critically ill patients. Myocardial ischemia, sepsis and weaning failure from mechanical ventilation also may be associated with diastolic dysfunction. The treatment is based on the reduction of pulmonary congestion and left ventricular filling pressures. Some studies have found a prognostic role of diastolic dysfunction in some diseases such as sepsis. The present review aims to analyze thoroughly the echocardiographic diagnosis and the most frequent scenarios in critically ill patients in whom diastolic dysfunction plays a key role. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

Stanford Type A Acute Aortic Dissection with Intimal Intussusception.

PubMed

Yanase, Yohsuke; Ohkawa, Akihito; Inoue, Satomi; Niida, Yukihiro

2018-03-17

In case of complete circumferential dissection of the ascending aorta, the dissected flap has the potential to fold backwards, causing several complications. We report two cases of Stanford type A acute aortic dissection (AAD) whose intimal flaps intussuscepted into the left ventricular outflow tract.Case 1: A 41-year-old man with AAD in whom transthoracic echocardiography (TTE) showed the dissected flap as folded back into the left ventricular outflow tract, causing severe aortic regurgitation (AR) with rapidly progressing acute pulmonary edema. Despite performing salvage surgery, the patient could not be rescued.Case 2: An 81-year-old man with annuloaortic ectasia developed Stanford type A AAD. TTE showed an extremely mobile intimal flap intussuscepting into the left ventricular outflow tract. However, AR was not severe as it was prevented by the flap itself. The patient was rescued by performance of the modified Bentall procedure.

Takotsubo-like syndrome triggered by fludrocortisone overdose for Addison's disease: a case report.

PubMed

Campean, Radu; Hasun, Matthias; Stöllberger, Claudia; Bucher, Johannes; Finsterer, Josef; Schnack, Christoph; Weidinger, Franz

2016-10-12

Reversible left ventricular dysfunction, also termed Takotsubo cardiomyopathy, is rarely reported in Addison's disease after initiation of hormone replacement therapy. The pathogenesis of this cardiomyopathy is unknown. A 41-year-old white woman with a history of autoimmune Hashimoto thyroiditis diagnosed 3 years earlier and acute adrenal insufficiency diagnosed 3 weeks earlier presented with new onset of heart failure New York Heart Association class IV, which had started shortly after initiation of hormone replacement therapy with hydrocortisone 20 mg/day and fludrocortisone 0.3 mg/day. Nine days before admission she had collapsed because of dizziness and had a cerebral concussion and open fracture of her nasal bone, however, no further investigations were carried out at that time. A physical examination revealed leg edema, tachycardia, tachypnea, bilateral basal crepitations, and blood pressure 110/70 mmHg. An electrocardiogram showed sinus tachycardia, low voltage, negative T-waves in V 5 and V 6 and a corrected QT interval of 590 ms. Echocardiography revealed a reduced left ventricular systolic function with an ejection fraction of 30 %, and septal, apical, and anterior wall akinesia. Cardiac magnetic resonance imaging showed relative enhancement of gadolinium, indicating hyperemia and capillary leakage, and no myocardial scars. Because of the improvement in her cardiac function, lack of cardiovascular risk factors, and lack of signs for ischemia on magnetic resonance imaging, no coronary angiography was carried out. The results of sellar and renal magnetic resonance imaging were normal. Her troponin T was slightly elevated. Bisoprolol and ramipril were started. Her fludrocortisone dose was reduced to 0.05 mg/day. Her electrocardiogram and systolic function, documented by echocardiography and magnetic resonance imaging, normalized within 6 months. Although we could not exclude coronary artery disease by coronary angiography, her clinical course and instrumental findings suggest Takotsubo cardiomyopathy of the apical type. Fludrocortisone overdosage and increased myocardial vulnerability due to cortisol deficiency might be pathogenetic factors, whereas myocarditis is unlikely. When hormone replacement in patients with Addison's disease is initiated, cardiac function should be monitored by electrocardiogram and echocardiography.

Validating the HERDOO2 rule to guide treatment duration for women with unprovoked venous thrombosis: multinational prospective cohort management study.

PubMed

Rodger, Marc A; Le Gal, Gregoire; Anderson, David R; Schmidt, Jeannot; Pernod, Gilles; Kahn, Susan R; Righini, Marc; Mismetti, Patrick; Kearon, Clive; Meyer, Guy; Elias, Antoine; Ramsay, Tim; Ortel, Thomas L; Huisman, Menno V; Kovacs, Michael J

2017-03-17

Objective  To prospectively validate the HERDOO2 rule (Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30; or Older age, ≥65 years), which states that women with none or one of the criteria can safely discontinue anticoagulants after short term treatment. Design  Prospective cohort management study. Setting  44 secondary or tertiary care centres in seven countries. Participants  Of 3155 consecutive eligible participants with a first unprovoked venous thromboembolism (VTE, proximal leg deep vein thrombosis or pulmonary embolism) who completed 5-12 months of short term anticoagulant treatment, 370 declined to participate, leaving 2785 enrolled participants. 2.3% were lost to follow-up. Interventions  Women with none or one of the HERDOO2 criteria were classified as at low risk of recurrent VTE and discontinued anticoagulants (intervention arm), whereas anticoagulant management for high risk women (≥2 HERDOO2 criteria) and men was left to the discretion of the clinicians and patients (observation arm). Main outcome measure  Recurrent symptomatic VTE (independently and blindly adjudicated) over one year of follow-up. Results  Of 1213 women, 631 (51.3%) were classified as low risk and 591 discontinued oral anticoagulant treatment. In the primary analysis, 17 low risk women who discontinued anticoagulants developed recurrent VTE during 564 patient years of follow-up (3.0% per patient year, 95% confidence interval 1.8% to 4.8%). In 323 high risk women and men who discontinued anticoagulants, 25 had VTE during 309 patient years of follow-up (8.1%, 5.2% to 11.9%), whereas in 1802 high risk women and men who continued anticoagulants 28 had recurrent VTE during 1758 patient years of follow-up (1.6%, 1.1% to 2.3%). Conclusions  Women with a first unprovoked VTE event and none or one of the HERDOO2 criteria have a low risk of recurrent VTE and can safely discontinue anticoagulants after completing short term treatment. Trial registration  clinicaltrials.gov NCT00967304. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Due Process Hearing Case Study

ERIC Educational Resources Information Center

Bateman, David F.

2009-01-01

Marnie is a resident of an unnamed School District ("the District"). In January 2000 at the age of 13, Marnie was involved in a bicycle accident that severely damaged her central nervous system, leaving her without use of her legs or left hand and cognitively impaired. She had not received special education previously. By September 2001,…

20 CFR 220.21 - Initial evaluation of a previous occupational disability.

Code of Federal Regulations, 2013 CFR

2013-04-01

... his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his... facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files...

20 CFR 220.21 - Initial evaluation of a previous occupational disability.

Code of Federal Regulations, 2014 CFR

2014-04-01

... his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his... facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files...

20 CFR 220.21 - Initial evaluation of a previous occupational disability.

Code of Federal Regulations, 2011 CFR

2011-04-01

... his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his... facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files...

20 CFR 220.21 - Initial evaluation of a previous occupational disability.

Code of Federal Regulations, 2010 CFR

2010-04-01

... his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his... facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files...

20 CFR 220.21 - Initial evaluation of a previous occupational disability.

Code of Federal Regulations, 2012 CFR

2012-04-01

... his left leg in an automobile accident which occurred on June 16, 1982. For a period of 18 months following the accident the claimant underwent 2 surgical procedures which restored the functional use of his... facts disclosed above, beginning June 16, 1982 (the date of the automobile accident). The claimant files...

The Netherlands strain of BTV serotype 8 in white-tailed deer

USDA-ARS?s Scientific Manuscript database

To determine the susceptibility of U.S. white-tailed deer to the European strain of BTV-8 (EU-BTV-8) isolated in The Netherlands, eight seronegative deer were injected subcutaneously in the neck and intradermally in the inner left leg. Two deer were sham inoculated to serve as uninfected controls an...

Chiropractic management of a patient with lumbar spine pain due to synovial cyst: a case report

PubMed Central

Cox, James M.

2012-01-01

Introduction The purpose of this study is to report the findings resulting from chiropractic care using flexion distraction spinal manipulation for a patient with low back and radicular pain due to spinal stenosis caused by a synovial cyst. Case Report A 75-year-old man presented with low back pain radiating to the right anterior thigh and down the left posterior leg of 3 years' duration. Physical and imaging examinations showed a synovial cyst–induced spinal stenosis at the right L3-L4 level and bilateral L4-L5 spinal stenosis. Intervention and Outcomes Flexion distraction spinal manipulation and physiological therapeutics were applied at the levels of stenosis. After 4 visits, the patient noted total absence of the right and left lower extremity pain and no adverse reaction to treatment. After 3 months of treatment and 16 visits, his low back and buttock pain were minimal; and he had no leg pain. Conclusion Lumbar synovial cyst and stenosis–generated low back and radicular pain was 80% relieved in a 75-year-old man following Cox flexion distraction spinal manipulation. PMID:22942836

A postmenopausal woman with sciatica from broad ligament leiomyoma: a case report.

PubMed

Tsai, Ya-Chu May

2016-10-31

Unilateral lower abdominal pain and/or sciatic nerve pain is a common presentation in the elderly population. The prevalence of broad ligament leiomyoma is <1 % with the prevalence declining after the menopause and it is rare for broad ligament leiomyomas to be clinically significant. Thus, we highlight a case of symptomatic broad ligament leiomyoma in a postmenopausal woman whose symptoms improved after definitive treatment. A 62-year-old postmenopausal Macedonian woman was referred to our gynecological department with unexplained pain in her left leg and left iliac fossa region on walking. There was minimal relief with increasing analgesia use prescribed by the family physician. Investigations revealed an ipsilateral adnexal mass and subsequent treatment with laparoscopic broad ligament myomectomy helped to alleviate her symptoms. Our case highlights the importance of staying mindful of alternate diagnoses when presented with a common presentation of iliac fossa pain and pain in the leg. Although broad ligament leiomyomas are benign tumors, the uncommon symptomatic presentation led us to report and focus some attention on this type of tumor.

A pilot investigation of the hypoalgesic effects of transcutaneous electrical nerve stimulation upon low back pain in people with multiple sclerosis.

PubMed

Al-Smadi, J; Warke, K; Wilson, I; Cramp, A F L; Noble, G; Walsh, D M; Lowe-Strong, A S

2003-11-01

To investigate the hypoalgesic effects of transcutaneous electrical nerve stimulation (TENS) upon low back pain (LBP) in people with multiple sclerosis (MS). A randomized double-blind placebo controlled clinical pilot study. Fifteen people with MS were recruited and randomly allocated to one of the following groups under double blind conditions (n = 5 per group): TENS 1 (4 Hz, 200 micros), TENS 2 (110 Hz, 200 micros), placebo TENS. Treatment was applied for 45 minutes three times a week for six weeks with a four-week follow-up. The following outcome measures were taken at weeks 1, 6, and 10: visual analogue scale (VAS) (for current LBP, right leg pain, left leg pain); Leeds Multiple Sclerosis Quality of Life Questionnaire; Roland Morris Disability Questionnaire; Short Form-36 (SF-36) Version 1; and the McGill Pain Questionnaire (MPQ). VAS for current LBP, right and left leg pain were also taken before and after treatment, and once a week during the follow-up period. Analysis showed no statistically significant effects for any of the data. However, both active treatment groups showed a trend of improvement in the majority of the outcome measures. Active TENS was more effective than placebo TENS in decreasing VAS scores following each treatment although results were not statistically significant. Further work in this area is warranted and should include a larger number of participants in the form of a randomized controlled clinical trial to determine the efficacy of this modality.

Preemptive hemodynamic intervention restricting the administration of fluids attenuates lung edema progression in oleic acid-induced lung injury.

PubMed

Gil Cano, A; Gracia Romero, M; Monge García, M I; Guijo González, P; Ruiz Campos, J

2017-04-01

A study is made of the influence of preemptive hemodynamic intervention restricting fluid administration upon the development of oleic acid-induced lung injury. A randomized in vivo study in rabbits was carried out. University research laboratory. Sixteen anesthetized, mechanically ventilated rabbits. Hemodynamic measurements obtained by transesophageal Doppler signal. Respiratory mechanics computed by a least square fitting method. Lung edema assessed by the ratio of wet weight to dry weight of the right lung. Histological examination of the left lung. Animals were randomly assigned to either the early protective lung strategy (EPLS) (n=8) or the early protective hemodynamic strategy (EPHS) (n=8). In both groups, lung injury was induced by the intravenous infusion of oleic acid (OA) (0.133mlkg -1 h -1 for 2h). At the same time, the EPLS group received 15mlkg -1 h -1 of Ringer lactate solution, while the EPHS group received 30mlkg -1 h -1 . Measurements were obtained at baseline and 1 and 2h after starting OA infusion. After 2h, the cardiac index decreased in the EPLS group (p<0.05), whereas in the EPHS group it remained unchanged. Lung compliance decreased significantly only in the EPHS group (p<0.05). Lung edema was greater in the EPHS group (p<0.05). Histological damage proved similar in both groups (p=0.4). In this experimental model of early lung injury, lung edema progression was attenuated by preemptively restricting the administration of fluids. Copyright © 2016 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

[Air bags and eye injuries: chemical burns and major traumatic ocular lesions--a case study].

PubMed

Bendeddouche, K; Assaf, E; Emadisson, H; Forestier, F; Salvanet-Bouccara, A

2003-10-01

The authors report a case of bilateral eye lesions with extended visual sequelae after the inflation of a driver's airbag during a head-on collision. The superficial facial lesions were accompanied by bilateral eye lesions, reaching both the anterior and posterior segments. Bilateral periorbital palpebral hematomas; voluminous bipalpebral edema combined with severe -conjunctival edema, corneal erosions, and edema; bilateral hyphema; pupillary changes with multiple iris sphincter breaks and weak pupillary light reflex only on the right eye; retrocession of the iridocorneal angle; and on fundus examination both retinas had posterior and peripheral hemorrhages and Berlin retinal edema. Five years after the trauma and 4 years after posttraumatic surgery for cataract that had progressively appeared on the left eye, the visual acuity is 25/20 in both eyes notwithstanding a small paracentral scotoma related to a break in the Bruch membrane. A review of the literature shows several types of ophthalmological lesions related to the airbag mechanism, which after combustion of an alkaline powder inflates at a very high speed, resulting in a risk of corneal-conjunctive-palpebral alkaline burns added to an eye contusion, which may be responsible for severe lesions. The American studies distinguish three factors affecting the seriousness of these airbag accidents: (a) wearing glasses, (b) position and size of the driver, and (c) inflation force of the airbag. Wearing a seatbelt is mandatory to minimize the violence of the oculofacial impact. After facial trauma from an airbag, an ophthalmological examination is necessary to assess of the chemical burns of the tissues exposed to the alkaline powder and possible major ocular lesions.

[Klinefelter's syndrome associated with mixed connective tissue disease (Sharp's syndrome) and thrombophilia with postthrombotic syndrome].

PubMed

Kasten, Robert; Pfirrmann, Gudrun; Voigtländer, Volker

2005-08-01

A 43-year-old male with eunuchoid body proportions and a history of deep venous thromboses in the right leg presented with recurrent ulcers in the right perimalleolar region for 6 years. Karyotyping revealed a 47 XXY Klinefelter's syndrome, while serologic testing showed protein S deficiency, hyperhomocysteinemia and positive lupus anticoagulant. He also had mixed connective tissue disease (Sharp's syndrome) with acrosclerosis, proximal finger edema, Raynaud's phenomenon, and high titers of ANA and U1-RNP-antibodies, as well as osteoporosis. There is evidence that patients with Klinefelter's syndrome are prone to develop connective tissue diseases and thrombophilia as a result of low androgen levels. Substitution of testosterone in Klinefelter's syndrome can have a favorable therapeutic effect on the associated connective tissue disease, thrombophilia and osteoporosis.

Partially irreversible paresis of the deep peroneal nerve caused by osteocartilaginous exostosis of the fibula without affecting the tibialis anterior muscle.

PubMed

Paprottka, Felix Julian; Machens, Hans-Günther; Lohmeyer, Jörn Andreas

2012-08-01

Dysfunction of the lower limb's muscles can cause severe impairment and immobilisation of the patient. As one of the leg's major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Injury Source and Correlation Analysis of Riders in Car-Electric Bicycle Accidents

PubMed Central

Yi, Liang; Hu, Lin; Li, Yuelin

2018-01-01

The knowledge about the injury source and correlation of riders in car-electric bicycle accident will be helpful in the cross validation of traces and vehicle safety design. In order to know more information about such kind of knowledge, 57 true car-electric bicycle accidents were reconstructed by PC-Crash and then data on injury information of riders were collected directly from the reconstructed cases. These collected data were validated by some existing research results firstly, and then 4 abnormal cases were deleted according to the statistical method. Finally, conclusions can be obtained according to the data obtained from the remaining 53 cases. Direct injuries of the head and right leg are from the road pavement upon low speed; the source laws of indirect head injuries are not obvious. Upon intermediate and high speed, the injuries of the above parts are from automobiles. Injuries of the left leg, femur, and right knee are from automobiles; left knee injuries are from automobiles, the road pavement and automobiles, respectively, upon low, intermediate, and high speed. The source laws of indirect torso injuries are not obvious upon intermediate and low speed, which are from automobiles upon high speed, while direct torso injuries are from the road pavement. And there is no high correlation between all parts of the injury of riders. The largest correlation coefficient was the head-left femur and left femur-right femur, which was 0.647, followed by the head-right femur (0.638) and head-torso which was 0.617. PMID:29849757

Ground reaction force comparison of bilateral symmetry with pneumatic resistance squat device and free weights - biomed 2009.

PubMed

Paulus, David C; Schilling, Brian K

2009-01-01

The unloading of spaceflight leads to bone and muscle atrophy, and a pneumatic resistance squat exercise countermeasure has the potential to provide optimized controllable resistance in a lightweight and compact configuration. However each end of the barbell in the proposed device is connected to a separate resistance cylinder which could lead to bilaterally asymmetric loading. Therefore, the purpose of the study is to compare the unilateral ground reaction forces (GRF) of the new squat device compared to free weights. Four previously trained men (mean +/- SD; age = 20+/-2 years, body mass = 99+/-18 kg) performed three sets of three repetitions of maximal exertion squat exercises with pneumatically controlled constant resistance and free weights each with a resistance level set to half of the body weight of each subject. Unilateral GRF data for each lifting modality at the negative to positive transition of the squat exercise was measured with a force plate under each foot. The pneumatic resistance GRF (N; mean +/- SD) was 749+/-114 on the left leg and 786+/-123 on the right leg and the free weight GRF was 786+/-114 left and 861+/-111 right resulting in a 5% difference between left and right GRF with pneumatics and 9% difference with free weights. The correlation coefficient between left and right GRF was 0.92 with pneumatics and 0.80 with free weights. Because the pneumatic device elicited more bilaterally symmetric GRF than traditional free weights, the separate resistance cylinders are an acceptable design configuration.

[A reversible cause of dilated cardiomyopathy: hypocalcemia].

PubMed

Benzarouel, D; Hasni, K; Ashab, H; El Hattaoui, M

2014-04-01

Hypocalcemia is very rare reversible cause of dilated cardiomyopathy (DCMP) witch can concern one or both ventricules. We here presented two cases of DCMP that caused by hypocalcemia and recovered totally after oral calcium and vitamin D supplementation. CASE PRESENTATION 1: A 29-year-old Caucasian female was admitted in our hospital due to congestive heart failure with dyspnea (NYHA class IV) and generalized edema for 2days. She had a history of total thyroidectomy one year a go. She had taken synthyroid as a daily medication associated to calcium supplementation and vitamin D because of hypoparathyroidism. Patient was not compliant to treatment. Trans thoracic echocardiography (TTE) showed a dilated left ventricule (LV) with global hypokinesia with 28% of left ventricule ejection and moderate mitral regurgitation. Laboratory test showed a severe hypocalcemia. After correction of hypocalcemia, there was a clear clinical improvement and four months later a total recovery was found. CASE PRESENTATION 2: A 44-year-old Caucasian male was referred to the hospital for rebel congestive heart failure with dyspnea and edema of lower limbs despite optimal treatment. Patient had no medical past history. TEE showed dilated cardiomyopathy with severe alteration of left ventricule systolic function (25%). Biological tests showed a hypocalcemia and primary hypoparathyroidism. An improvement of symptoms after correction of metabolic disorder was found. LV gradually recovered its performance. Patients outcome in end stage heart failure is different from the classical outcomes in patients with hypocalcemia induced heart disease. DCMP induced by hypocalcemia should be considered in patients with heart failure associated with medical conditions leading to hypocalcemia. It requires a specific treatment. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Peripheral neuropathy as a complication of diabetic ketoacidosis in a child with newly diagnosed diabetes type 1 - case report.

PubMed

Baszyńska-Wilk, Marta; Wysocka-Mincewicz, Marta; Świercz, Anna; Świderska, Jolanta; Marszał, Magdalena; Szalecki, Mieczysław

2017-12-08

Neurological complications of diabetic ketoacidosis are considered to be very serious clinical problem. The most common complication is cerebral edema. However this group includes also less common syndromes such as ischemic or hemorrhagic stroke, cerebral venous and sinus thrombosis or very rare peripheral neuropathy. We present a case of 9-year old girl with new onset type 1 diabetes, diabetic ketoacidosis, cerebral edema, multifocal vasogenic brain lesions and lower limbs peripheral paresis. The patient developed polydipsia and polyuria one week before admission to the hospital. In laboratory tests initial blood glucose level 1136 mg/dl and acidosis (pH 7.1; BE-25.9) were noted. She was admitted to the hospital in a critical condition and required treatment in intensive care unit. Computed tomography scan showed brain edema and hipodense lesion in the left temporal region. Brain MRI revealed more advanced multifocal brain lesions Nerve conduction studies demonstrated damage of the motor neuron in both lower extremities with dysfunction in both peroneal nerves and the right tibial nerve. As a result of diabetological, neurological treatment and physiotherapy patient's health state gradually improved. Acute neuropathy after ketoacidosis is rare complication and its pathomechanism is not clear. Patients with DKA require careful monitoring of neurological functions even after normalization of glycemic parameters.

Central-Variant Posterior Reversible Encephalopathy Syndrome with Albuminocytologic Dissociation.

PubMed

Lee, Sang-Woo; Lee, Seung-Jae

2018-01-01

Posterior reversible encephalopathy syndrome (PRES) is a disorder of reversible vasogenic brain edema which mainly involves the parieto-occipital lobes in various clinical settings. The main mechanism is known to be cerebral autoregulation failure and endothelial dysfunction leading to the disruption of the blood-brain barrier. We report the case of a 47-year-old woman with PRES which involved the brain stem and thalami, sparing the cerebral hemispheres. She was admitted to the emergency room because of acute-onset confusion. Her initial blood pressure was 270/220 mm Hg. Routine blood lab tests showed pleocytosis, hyperglycemia, and azotemia. Brain magnetic resonance imaging (MRI) showed a lesion of vasogenic edema involving nearly the whole area of pons, the left side of the midbrain, and the bilateral medial thalami. Cerebrospinal fluid (CSF) examination revealed an increased level of protein with normal white blood cell count. With conservative care, the patient markedly recovered 3 days after symptom onset, and a follow-up MRI confirmed complete resolution of the vasogenic edema. This case suggests that PRES can rarely involve the "central zone" only, sparing the cerebral hemispheres, which may be confused with other neurological diseases. Besides, the CSF albuminocytologic dissociation may suggest the disruption of the blood-brain barrier in patients with PRES.

Muscle Microvascular Blood Flow, Oxygenation, pH, and Perfusion Pressure Decrease in Simulated Acute Compartment Syndrome.

PubMed

Challa, Sravya T; Hargens, Alan R; Uzosike, Amarachi; Macias, Brandon R

2017-09-06

The current gold standard for diagnosing acute compartment syndrome (ACS) is an assessment of clinical signs, invasive measurement of intramuscular pressure (IMP), and measurement of local perfusion pressure. However, IMP measurements have several shortcomings, including pain, risk of infection, risk of technique error, plugging of the catheter tip, lack of consensus on the diagnostic pressure threshold, and lack of specificity and sensitivity. The objective of this study was to evaluate muscle hemodynamics, oxygenation, and pH as diagnostic parameters in a human model of ACS. We hypothesized that as IMP increases, muscle microvascular blood flow, oxygenation, and pH decrease in the anterior compartment of a leg at heart level and that they decrease significantly more when the leg is elevated further. An external pneumatic leg pressure chamber, combined with a venous stasis thigh cuff, was used to increase IMP and simulate ACS. Eight healthy subjects (5 males and 3 females; mean age, 26 years) had photoplethysmography and near-infrared spectroscopy-pH sensors placed over the middle aspect of the tibialis anterior muscle of the right (experimental) and left (control) legs. Leg chamber pressure conditions (40, 50, and 60 mm Hg) were applied in a randomized order after baseline measurements were taken. Data were collected continuously for each 11-minute pressure condition, with an 11-minute recovery period after each condition, and the average of the last 6 minutes was used for data analyses. The same protocol was repeated with each subject's legs elevated 12 cm above heart level. Data were analyzed using repeated-measures analysis of variance (ANOVA). As IMP increased, muscle microvascular blood flow (p = 0.01), oxygenation (p < 0.001), and pH (p < 0.001) all decreased significantly in the experimental leg compared with the control leg. At all IMP levels, leg elevation significantly decreased muscle oxygenation (p = 0.013) and perfusion pressure (p = 0.03) compared with the control leg at heart level. These results indicate that muscle microvascular blood flow, oxygenation, pH, and perfusion pressure decrease significantly as IMP increases in a human model of ACS. This study identifies hemodynamic and metabolic parameters as potential noninvasive diagnostic tools for ACS.

Physiological Interaction of Heart and Lung in Thoracic Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghobadi, Ghazaleh; Veen, Sonja van der; Department of Cell Biology, University of Groningen, University Medical Center Groningen, Groningen

Introduction: The risk of early radiation-induced lung toxicity (RILT) limits the dose and efficacy of radiation therapy of thoracic tumors. In addition to lung dose, coirradiation of the heart is a known risk factor in the development RILT. The aim of this study was to identify the underlying physiology of the interaction between lung and heart in thoracic irradiation. Methods and Materials: Rat hearts, lungs, or both were irradiated to 20 Gy using high-precision proton beams. Cardiopulmonary performance was assessed using breathing rate measurements and F{sup 18}-fluorodeoxyglucose positron emission tomography ({sup 18}F-FDG-PET) scans biweekly and left- and right-sided cardiac hemodynamicmore » measurements and histopathology analysis at 8 weeks postirradiation. Results: Two to 12 weeks after heart irradiation, a pronounced defect in the uptake of {sup 18}F-FDG in the left ventricle (LV) was observed. At 8 weeks postirradiation, this coincided with LV perivascular fibrosis, an increase in LV end-diastolic pressure, and pulmonary edema in the shielded lungs. Lung irradiation alone not only increased pulmonary artery pressure and perivascular edema but also induced an increased LV relaxation time. Combined irradiation of lung and heart induced pronounced increases in LV end-diastolic pressure and relaxation time, in addition to an increase in right ventricle end-diastolic pressure, indicative of biventricular diastolic dysfunction. Moreover, enhanced pulmonary edema, inflammation and fibrosis were also observed. Conclusions: Both lung and heart irradiation cause cardiac and pulmonary toxicity via different mechanisms. Thus, when combined, the loss of cardiopulmonary performance is intensified further, explaining the deleterious effects of heart and lung coirradiation. Our findings show for the first time the physiological mechanism underlying the development of a multiorgan complication, RILT. Reduction of dose to either of these organs offers new opportunities to improve radiation therapy treatment of thoracic tumors, potentially facilitating increased treatment doses and tumor control.« less

Adverse Heart-Lung Interactions in Ventilator-induced Lung Injury.

PubMed

Katira, Bhushan H; Giesinger, Regan E; Engelberts, Doreen; Zabini, Diana; Kornecki, Alik; Otulakowski, Gail; Yoshida, Takeshi; Kuebler, Wolfgang M; McNamara, Patrick J; Connelly, Kim A; Kavanagh, Brian P

2017-12-01

In the original 1974 in vivo study of ventilator-induced lung injury, Webb and Tierney reported that high Vt with zero positive end-expiratory pressure caused overwhelming lung injury, subsequently shown by others to be due to lung shear stress. To reproduce the lung injury and edema examined in the Webb and Tierney study and to investigate the underlying mechanism thereof. Sprague-Dawley rats weighing approximately 400 g received mechanical ventilation for 60 minutes according to the protocol of Webb and Tierney (airway pressures of 14/0, 30/0, 45/10, 45/0 cm H 2 O). Additional series of experiments (20 min in duration to ensure all animals survived) were studied to assess permeability (n = 4 per group), echocardiography (n = 4 per group), and right and left ventricular pressure (n = 5 and n = 4 per group, respectively). The original Webb and Tierney results were replicated in terms of lung/body weight ratio (45/0 > 45/10 ≈ 30/0 ≈ 14/0; P < 0.05) and histology. In 45/0, pulmonary edema was overt and rapid, with survival less than 30 minutes. In 45/0 (but not 45/10), there was an increase in microvascular permeability, cyclical abolition of preload, and progressive dilation of the right ventricle. Although left ventricular end-diastolic pressure decreased in 45/10, it increased in 45/0. In a classic model of ventilator-induced lung injury, high peak pressure (and zero positive end-expiratory pressure) causes respiratory swings (obliteration during inspiration) in right ventricular filling and pulmonary perfusion, ultimately resulting in right ventricular failure and dilation. Pulmonary edema was due to increased permeability, which was augmented by a modest (approximately 40%) increase in hydrostatic pressure. The lung injury and acute cor pulmonale is likely due to pulmonary microvascular injury, the mechanism of which is uncertain, but which may be due to cyclic interruption and exaggeration of pulmonary blood flow.

Extensibility and stiffness of the hamstrings in patients with nonspecific low back pain.

PubMed

Halbertsma, J P; Göeken, L N; Hof, A L; Groothoff, J W; Eisma, W H

2001-02-01

To investigate the extensibility and stiffness of the hamstrings in patients with nonspecific low back pain (LBP). An experimental design. A university laboratory for human movement analysis in a department of rehabilitation medicine. Forty subjects, a patient group (20) and a healthy control group (20). Subjects laid supine on an examination table with a lift frame, with left leg placed in a sling at the ankle. Straight leg raising, pulling force, and activity of hamstring and back muscles were recorded with electrodes. Patients indicated when they experienced tension or pain. The lift force, leg excursion, pelvic-femoral angle, first sensation of pain, and the electromyogram of the hamstrings and back muscles measured in an experimental straight-leg raising set-up. The patient group showed a significant restriction in range of motion (ROM) and extensibility of the hamstrings compared with the control group. No significant difference in hamstring muscle stiffness can be assessed between both groups. The restricted ROM and the decreased extensibility of the hamstrings in patients with nonspecific LBP is not caused by increased muscle stiffness of the hamstrings, but determined by the stretch tolerance of the patients.

Decreased muscle oxygenation and increased arterial blood flow in the non-exercising limb during leg exercise.

PubMed

Shiroishi, Kiyoshi; Kime, Ryotaro; Osada, Takuya; Murase, Norio; Shimomura, Kousuke; Katsumura, Toshihito

2010-01-01

We evaluated arterial blood flow, muscle tissue oxygenation and muscle metabolism in the non-exercising limb during leg cycling exercise. Ten healthy male volunteers performed a graded leg cycling exercise at 0, 40, 80, 120 and 160 watts (W) for 5 min each. Tissue oxygenation index (TOI) of the non-exercising left forearm muscle was measured using a near-infrared spatially resolved spectroscopy (NIR(SRS)), and non-exercising forearm blood flow ((NONEX)FBF) in the brachial artery was also evaluated by a Doppler ultrasound system. We also determined O(2) consumption of the non-exercising forearm muscle (NONEXV(O)(2mus)) by the rate of decrease in O(2)Hb during arterial occlusion at each work rate. TOI was significantly decreased at 160 W (p < 0.01) compared to the baseline. The (NONEX)V(O)(2mus) at each work rate was not significantly increased. In contrast, (NONEX)FBF was significantly increased at 120 W (p < 0.05) and 160 W (p < 0.01) compared to the baseline. These results suggest that the O(2) supply to the non-exercising muscle may be reduced, even though (NONEX)FBF increases at high work rates during leg cycling exercise.

Left ventricular ejection fraction may not be useful as an end point of thrombolytic therapy comparative trials.

PubMed

Califf, R M; Harrelson-Woodlief, L; Topol, E J

1990-11-01

In the era of comparative and adjunctive trials in reperfusion therapy, the need to develop alternative end points for mortality reduction is clear. Left ventricular ejection fraction, which has been commonly used as a surrogate, is problematic due to missing values, technically inadequate studies, and lack of correlation with mortality results in controlled reperfusion trials performed to date. In this paper, we present a composite clinical end point that includes, in order, severity of adverse outcome death, hemorrhagic stroke, nonhemorrhagic stroke, poor ejection fraction (less than 30%), reinfarction, heart failure, and pulmonary edema. Such a composite index may be useful to detect true therapeutic benefit in reperfusion trials without necessitating greater than 20-30,000 patient enrollment.

Clinical feasibility of gait training with a robotic exoskeleton (WPAL) in an individual with both incomplete cervical and complete thoracic spinal cord injury: A case study.

PubMed

Tanabe, Shigeo; Koyama, Soichiro; Saitoh, Eiichi; Hirano, Satoshi; Yatsuya, Kanan; Tsunoda, Tetsuya; Katoh, Masaki; Gotoh, Takeshi; Furumoto, Ayako

2017-01-01

Patients with tetraplegia can achieve independent gait with lateral-type powered exoskeletons; it is unclear whether medial-type powered exoskeletons allow for this. To investigate gait training with a medial-type powered exoskeleton wearable power-assist locomotor (WPAL) in an individual with incomplete cervical (C5) and complete thoracic (T12) spinal cord injury (SCI). The 60-session program was investigated retrospectively using medical records. Upon completion, gait performance was examined using three-dimensional motion analyses and surface electromyography (EMG) of the upper limbs. The subject achieved independent gait with WPAL and a walker in 12 sessions. He continuously extended his right elbow; his left elbow periodically flexed/extended. His pelvic inclination was larger than the trunk inclination during single-leg stance. EMG activity was increased in the left deltoid muscles during ipsilateral foot-contact. The right anterior and medial deltoid muscle EMG activity increased just after foot-off for each leg, as did the right biceps activity. Continuous activity was observed in the left triceps throughout the gait cycle; activity was unclear in the right triceps. These results suggest the importance of upper limb residual motor function, and may be useful in extending the range of clinical applications for robotic gait rehabilitation in patients with SCI.

Monozygotic twins with CAPN5 autosomal dominant neovascular inflammatory vitreoretinopathy.

PubMed

Rowell, Hannah A; Bassuk, Alexander G; Mahajan, Vinit B

2012-01-01

The purpose of this study was to describe the clinical findings in a set of monozygotic twins with autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV) over a 23-year period. A pair of female twins were examined between 26 and 49 years of age. The concordance and discordance of their clinical features were determined. The CAPN5 gene was sequenced using genomic DNA. Both twins of an affected father demonstrated Stage I ADNIV with mild vitreous cells and a negative b-wave on electroretinography. Genetic analysis confirmed a guanine to thymine nucleotide (c.728G>T, pArg243Leu) mutation in the CAPN5 gene. Over the course of 23 years, each twin progressed to stage III disease, showing posterior uveitis, cystoid macular edema, intraocular fibrosis, early retinal neovascularization, retinal degeneration, and cataract. Disease progression varied moderately between each twin and was asymmetrical between eyes. Twin A had 20/70 and 20/125 in the right and left eye, respectively, and underwent vitrectomy surgery and intravitreal injections with bevacizumab for recurrent cystoid macular edema. Twin B maintained 20/20 and 20/40 in the right and left eye, respectively without intervention. There was asymmetry between the eyes and some discordance in the rate of disease progression in these monozygotic twins with ADNIV. The overall high disease concordance suggests genetic factors play a major role in clinical manifestations in CAPN5 vitreoretinopathy.

Telemedicine in wound care.

PubMed

Chanussot-Deprez, Caroline; Contreras-Ruiz, José

2008-12-01

Telemedical wound care is one of the applications of teledermatology. We present our experience using telemedicine in the successful assessment and treatment of three patients with hard-to-heal ulcers. Three patients were seen at the PEMEX General Hospital in Veracruz, Mexico. The first patient was a 53-year-old man with hypertension, morbid obesity, chronic venous insufficiency, recurrent erysipelas, leg ulcers and lymphoedema. There was one ulcer on his left lower leg (20 x 10 cm) and one on his right leg (9 x 7 cm). The second patient was a 73-year-old woman with class III obesity and ulcers in her right leg, secondary to surgical debridement of bullous erysipelas. The third patient was a 51-year-old female with rheumatoid arthritis with one ulcer on each leg and chronic lymphostasis. Photographs with a digital camera were taken and sent weekly via email to a wound care specialist in Mexico City. The photographs allowed the expert to diagnose and evaluate the chronic wounds periodically. In the present cases, telemedicine allowed us to have a rapid evaluation, diagnosis and treatment. The images were of enough quality to be useful and small enough to be sent via regular email to the remote physician who immediately gave his feedback. The expert was confident to give therapeutic recommendations in this way, and we considered this method to be very cost-effective, saving the patient and the health care system, especially in transportation.

Comparison of a combination diode laser and radiofrequency device (Polaris) and a long-pulsed 1064-nm Nd:YAG laser (Lyra) on leg telangiectases. Histologic and immunohistochemical analysis.

PubMed

Prieto, Victor; Zhang, Peter; Sadick, Neil S

2006-12-01

Several devices have been proposed for the treatment of leg telangiectases. For most of these devices the histologic changes induced in the dermis are not well characterized. Three volunteers with class I-II red and blue 0.1-2.0 mm leg telangiectases were treated with the Lyra (Laserscope, San Jose, CA, USA) and the Polaris (Syneron Medical Ltd, Yokneam, Israel) devices to the left and right legs, respectively. Two 3-mm punches were taken from either site 7 days after treatment. The specimens were routinely processed and also stained for elastic tissue and collagen tissue. After treatment, specimens treated with both the Polaris and the Lyra showed intermediate-sized vessels with complete thrombosis and extensive hemorrhage in both the dermis and subcutis. The overlying epidermis also evidenced damage characterized as focal full-thickness necrosis. Special stains confirmed the damage to the vessels. All other skin structures were morphologically unremarkable. An average of 50-75% clinical clearing occurred using both modalities of a single treatment session. Our study confirms that both devices result in severe damage to small, intermediate-sized vessels, thus explaining the reported clinical improvement of leg telangiectases. The expression of hsp70 in the dermal vessels and overlying epidermis is consistent with a direct thermal effect delivered by either device.

[Improving venous tone and capillary sealing. Effect of a combination of Ruscus extract and hesperidine methyl chalcone in healthy probands in heat stress].

PubMed

Rudofsky, G

1989-06-30

The drug combination of Ruscus-extract and hesperidine methyl chalcone (HMC) involves two basic mechanisms in the treatment of venous diseases: increase in venous tonicity and edema protection. This was shown in a double-blind study on 20 healthy volunteers by comparing the effectiveness of the individual substances, the combination and a placebo on the venous hemodynamics and the volume of the foot. Ruscus-extract augments the tonicity of the venous wall. This is expressed by a decrease in venous capacity (p less than 0.01), a reduction in the blood pool in the lower leg under orthostatic conditions, and a decrease in tissue volume of the foot and ankle (p less than 0.01). HMC lowers the capillary filtration rate (p less than 0.01) but augmented the blood pool. The increase in blood volume can be explained by dehydration of the tissue of the lower leg lowering the pressure of tissue on the venous system and increasing the blood pool in the limb. After administration of the combination, the blood volume was between the Ruscus and HMC volumes, while the effects on filtration rate, venous capacity and tissue volume corresponded to the changes seen after administration of HMC and Ruscus extract alone.

US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yilmaz, Saim, E-mail: ysaim@akdeniz.edu.tr; Ceken, Kagan; Alimoglu, Emel

2013-02-15

Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocainemore » solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1-10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.« less

[CRITERION-RELATED VALIDITY OF SIT-AND-REACH TEST AS A MEASURE OF HAMSTRING EXTENSIBILITY IN OLDER WOMEN].

PubMed

López-Miñarro, Pedro Ángel; Vaquero-Cristóbal, Raquel; Muyor, José María; Espejo-Antúnez, Luis

2015-07-01

lumbo-sacral posture and the sit-andreach score have been proposed as measures of hamstring extensibility. However, the validity is influenced by sample characteristics. to determine the validity of lumbo-horizontal angle and score in the sit-and-reach test as measures of hamstring extensibility in older women. a hundred and twenty older women performed the straight leg raise test with both leg, and the sit-and-reach test (SR) in a random order. For the sitand- reach test, the score and the lumbo-sacral posture in bending (lumbo-horizontal angle, L-Hfx) were measured. the mean values of straight leg raise in left and right leg were 81.70 ± 13.83º and 82.10 ± 14.36º, respectively. The mean value of EPR of both legs was 81.90 ± 12.70º. The mean values of SR score and L-Hfx were -1.54 ± 8.09 cm and 91.08º ± 9.32º, respectively. The correlation values between the mean straight leg raise test with respect to lumbo-sacral posture and SR score were moderate (L-Hfx: r = -0.72, p < 0.01; SR: r = 0.70, p < 0.01). Both variables independently explained about 50% of the variance (L-Hfx: R2 = 0.52, p < 0,001; SR: R2 = 0.49, p < 0,001). the validity of lumbo-sacral posture in bending as measure of hamstring muscle extensibility on older women is moderate, with similar values than SR score. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Marked improvement of Churg–Strauss syndrome neuropathy by intravenous immunoglobulin and cyclophosphamide

PubMed Central

Umeda, Akira; Yamane, Tateki; Takeuchi, Jin; Imai, Yasuo; Suzuki, Keisuke; Yumura, Wako

2014-01-01

A 42-year-old Japanese man developed Churg–Strauss syndrome 7 years after being diagnosed with chronic eosinophilic pneumonia. Prominent eosinophilia, subcutaneous nodules, and neuropathy in the left leg were seen. A pathological diagnosis of necrotizing vasculitis was determined by a biopsy of a subcutaneous nodule. The leg pain was severe and there was prominent atrophy of the thigh and calf, but the muscle weakness was mild. Serum anti-myeloperoxidase anti-neutrophil cytoplasmic antibody was positive. Because the initial treatment with an intravenous methylprednisolone pulse at 1 g/day for 3 days was not sufficient, a onetime treatment with intravenous cyclophosphamide at 15 mg/kg and intravenous immunoglobulin therapy (IVIG) at 400 mg/kg/day for 5 days were administered. Peripheral eosinophilia improved and the leg pain significantly improved. IVIG was repeated 1 month later and symptoms gradually improved further. The early diagnosis of Churg–Strauss syndrome and the early initiation of IVIG with cyclophosphamide were thought to be important. PMID:25473575

Back pain and leg complaints that revealed non-small cell carcinoma: a case study.

PubMed

Crisp, Casey A; Pierce, Angela N

2011-09-01

The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer. A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain. Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed. Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain. Copyright © 2011 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.

Neural mechanisms in body fluid homeostasis.

PubMed

DiBona, G F

1986-12-01

Under steady-state conditions, urinary sodium excretion matches dietary sodium intake. Because extracellular fluid osmolality is tightly regulated, the quantity of sodium in the extracellular fluid determines the volume of this compartment. The left atrial volume receptor mechanism is an example of a neural mechanism of volume regulation. The left atrial mechanoreceptor, which functions as a sensor in the low-pressure vascular system, is located in the left atrial wall, which has a well-defined compliance relating intravascular volume to filling pressure. The left atrial mechanoreceptor responds to changes in wall left atrial tension by discharging into afferent vagal fibers. These fibers have suitable central nervous system representation whose related efferent neurohumoral mechanisms regulate thirst, renal excretion of water and sodium, and redistribution of the extracellular fluid volume. Efferent renal sympathetic nerve activity undergoes appropriate changes to facilitate renal sodium excretion during sodium surfeit and to facilitate renal sodium conservation during sodium deficit. By interacting with other important determinants of renal sodium excretion (e.g., renal arterial pressure), changes in efferent renal sympathetic nerve activity can significantly modulate the final renal sodium excretion response with important consequences in pathophysiological states (e.g., hypertension, edema-forming states).

Avascular necrosis of the femoral heads in a red panda (Ailurus fulgens fulgens): possible Legg-Calve-Perthes disease.

PubMed

Delclaux, María; Talavera, Covadonga; López, Manuel; Sánchez, Jose Miguel; García, María Isabel

2002-09-01

A 17-mo-old captive-born female red panda (Ailurus fulgens fulgens) presented with a sudden onset of lameness in its left hind leg was diagnosed radiographically as having possible severe, bilateral Legg-Calve-Perthes disease with fracture of the great trochanter of the left femur. Surgical repair of the fracture was performed using pins and a tension band wire through a lateral approach to the hip. This is the first case reported at Madrid Zoo-Aquarium, where 63 individuals have been bred over 15 yr.

Immediate effects of adding a sciatic nerve slider technique on lumbar and lower quadrant mobility in soccer players: a pilot study.

PubMed

Méndez-Sánchez, Roberto; Alburquerque-Sendín, Francisco; Fernández-de-las-Peñas, Cesar; Barbero-Iglesias, Fausto J; Sánchez-Sánchez, Carmen; Calvo-Arenillas, José I; Huijbregts, Peter

2010-06-01

The objective of this study was to assess the immediate effect of a sciatic nerve slider technique added to sustained hamstring stretching on lumbar and lower quadrant flexibility. This was a randomized controlled pilot study. Eight (8) healthy male soccer players (21 +/- 3 years) were randomly assigned to 2 groups. Group A received 5 minutes of bilateral sustained hamstring stretching. Group B additionally received 60 seconds of a sciatic nerve slider technique for each leg. Pre- and postintervention outcomes taken by an assessor blinded to the treatment allocation of the participants included metric distance on finger-to-floor, sit and reach, and the modified Schöber tests and goniometric range of each hip for the straight-leg raise and each knee for seated slump test. Baseline between-group differences were examined with an independent t test and a two-way repeated-measures analysis of variance with p < 0.05 and p < 0.025 analyzed effects of the interventions. There were no significant between-group baseline differences (p > 0.2). There was a significant effect for time on all outcomes (p < 0.01) other than the sit and reach test (p = 0.8). A significant interaction between group . time with greater improvements in group B was found for the modified Schöber test (F = 5.5; p < 0.05), left straight-leg raise (F = 6.1; p < 0.05) and slump test in either leg (left F = 28.7; p = 0.002; right F = 4.9; p < 0.05). Adding a sciatic nerve slider technique to sustained hamstring stretching led to greater immediate increases in both lumbar and lower quadrant flexibility in young healthy soccer players as measured by four of the seven outcomes used. Study limitations and suggestions for future studies are discussed.

Model development to study strategies of younger and older adults getting up from the floor.

PubMed

Schwickert, L; Oberle, C; Becker, C; Lindemann, U; Klenk, J; Schwenk, M; Bourke, A; Zijlstra, W

2016-04-01

Long lies after a fall remain a public health challenge. Many successful fall prevention programmes have been developed but only few of them include recovery strategies after a fall. Once better understood, such movement strategies could be implemented into training interventions. A model of motion sequences describing successful movement strategies for rising from the floor in different age groups was developed. Possible risk factors for poor rising performance such as flexibility and muscle power were evaluated. Fourteen younger subjects between 20 and 50 years of age and 10 healthy older subjects (60+ years) were included. Movement strategies and key components of different rising sequences were determined from video analyses. The temporal parameters of transfers and number of components within the motion sequences were calculated. Possible explanatory variables for differences in rising performance were assessed (leg extension power, flexibility of the knee- and hip joints). Seven different components were identified for the lie-to-stand-walk transfer, labelled as lying, initiation, positioning, supporting, elevation, or stabilisation component followed by standing and/or walking. Median time to rise was significantly longer in older subjects (older 5.7s vs. younger 3.7s; p < 0.001), and leg extension power (left p = 0.002, right p = 0.013) and knee flexibility (left p = 0.019, right p = 0.025) were significantly lower. The number of components for rising was correlated with hip flexibility (r = 0.514) and maximal power (r = 0.582). The time to rise was correlated with minimal goniometric knee angle of the less flexible leg (r = 0.527) and maximal leg extension power (r = 0.725). A motion sequence model containing seven different components identified by individual key-frames could be established. Age-related differences in rising strategies and performance were identified.

Influence of manual lymphatic drainage on health-related quality of life and symptoms of chronic venous insufficiency: a randomized controlled trial.

PubMed

dos Santos Crisóstomo, Rute Sofia; Costa, Daniela Sofia Albino; de Luz Belo Martins, Catarina; Fernandes, Tânia Isabel Russo; Armada-da-Silva, Paulo A

2015-02-01

To evaluate the efficacy of manual lymphatic drainage (MLD) in improving health-related quality of life (HRQOL), symptomatology, and physical status in patients with chronic venous insufficiency (CVI). Single-blind randomized controlled trial. Health community attendant service. Subjects with CVI (N=41) were randomly assigned to an experimental group (n=20; mean age, 54.6±11.3y) or control group (n=21; mean age, 46.8±11.1y). The experimental group completed 10 lower extremity MLD sessions over 4 weeks and 1 educational session. The control group only attended the educational session. Outcome measures were taken at baseline (t0), at the end of 4 weeks (t1), and after 2 months for follow-up (t2). HRQOL was assessed with the Chronic Venous Insufficiency Quality of Life Questionnaire-20, symptoms (fatigue, heaviness) were assessed with a visual analog scale, severity of the disease was assessed with the Venous Clinical Severity Score (VCSS) (total score, score for each item), leg volumetry was assessed with perimeters, and plantar/dorsiflexion strength and ankle range of motion (ROM) were assessed with dynamometry. A significant interaction group×time effect was found for pain on HRQOL (F2,78=3.507; P=.035; partial η2=.087), clinical severity (F2,78=5.231; P=.007; partial η2=.118), especially for venous edema (assessed with the VCSS), fatigue (F1.67,65.21=4.690; P=.012; partial η2=.107), and heaviness (F1.57,61.32=9.702; P=.001; partial η2=.199), with the experimental group improving from t0 to t1 and t0 to t2 in all of these outcomes. No effect of MLD treatment could be found for ankle muscle strength, ankle ROM, and leg volume. Short-term MLD treatment ameliorates CVI severity and related edema, symptoms, and pain HRQOL in patients with CVI. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Lymphoscintigraphic findings in chylous reflux in a lower extremity.

PubMed

Berenji, Gholam R; Iker, Emily; Glass, Edwin C

2007-09-01

Lymphoscintigraphy is a useful and safe tool for the diagnostic evaluation of a swollen extremity. Unilateral leg swelling with cutaneous chylous vesicles is a common manifestation of chylous reflux. The authors present a case of chylous reflux in an 11-year-old boy who presented with swelling and skin lesions of the left lower extremity.

Topical anti-inflammatory activity of Solanum corymbiflorum leaves.

PubMed

Piana, Mariana; Camponogara, Camila; Boligon, Aline Augusti; Machado, Michel Mansur; de Brum, Thiele Faccim; Oliveira, Sara Marchesan; de Freitas Bauermann, Liliane

2016-02-17

Solanum corymbiflorum is popularly known as "baga-de-veado" and its leaves are applied on inflamed legs, scabies, tick bite, boils, mastitis, low back pain and otitis. The aim of this study was evaluate anti-inflammatory in vivo activity and relate this activity with antioxidant compounds present in the extract of S. corymbiflorum leaves. The extract from S. corymbiflorum leaves topically applied was able to reduce the croton oil-induced ear edema and myeloperoxidase (MPO) activity with maximum inhibition of 87±3% and 45±7%, rescpectively in the dose of 1mg/ear. Similar results were found for positive control dexamethasone, which presented inhibitions of ear edema and MPO activity of 89±3% and 50±3%, respectively in a dose of 0.1mg/ear. These findings are due, at least in part, the presence of polyphenols (195.28mg GAE/g) and flavonoids, as chlorogenic acid (59.27mg/g), rutin (12.72mg/g), rosmarinic acid, caffeic acid and gallic acid found by high performance liquid chromatography (HPLC) analysis. This species showed potencial antioxidant by 1,1-diphenyl-2-picrylhydrazyl (DPPH), and carbonyl groups in proteins methods which may be related with the presence of this compounds. This species possess anti-inflammatory activity confirming their popular use for the local treatment of skin inflammatory disorders. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Edema worsens target coverage in high-dose-rate interstitial brachytherapy of mobile tongue cancer: a report of two cases.

PubMed

Yoshida, Ken; Yamazaki, Hideya; Kotsuma, Tadayuki; Akiyama, Hironori; Takenaka, Tadashi; Masui, Koji; Yoshioka, Yasuo; Uesugi, Yasuo; Shimbo, Taiju; Yoshikawa, Nobuhiko; Yoshioka, Hiroto; Arika, Takumi; Tanaka, Eiichi; Narumi, Yoshifumi

2017-02-01

We report our study on two patients to highlight the risk of underdosage of the clinical target volume (CTV) due to edema during high-dose-rate interstitial brachytherapy (HDR-ISBT) of mobile tongue cancer. To treat the lateral side of the CTV, flexible applicator tubes were implanted on the mouth floor. Two-dimensional planning was performed using X-ray images for Case 1, and three-dimensional (3D) planning was performed using computed tomography (CT) for Case 2. Prescribed doses for both cases were 54 Gy in nine fractions. Case 1 was treated for cancer of the right lateral border of the tongue in 2005. Tongue edema occurred after implantation, and part of the lateral border of the tongue protruded between the applicator tubes. Acute mucosal reaction abated in the protruded area earlier than in the other parts of the CTV. In this case, the tumor recurred in this area 5 months after the treatment. Case 2 was treated for cancer of the left lateral border of the tongue. Because tongue edema occurred in this case also, plastic splints were inserted between the applicator tubes to push the edematous region into the irradiated area. The mucosal surface of the CTV was covered by the 70% isodose, and 100% isodose line for before and after splint insertion. Local control of the tumor was achieved 4 years after treatment. To ensure sufficient target coverage, 3D image-based planning using CT should be performed, followed by re-planning using repeated CT as needed. Also, the development of devices to prevent protrusion of the edematous tissue outside the target area will help to ensure the full dosing of CTV.

Longitudinal brain white matter alterations in minimal hepatic encephalopathy before and after liver transplantation.

PubMed

Lin, Wei-Che; Chou, Kun-Hsien; Chen, Chao-Long; Chen, Hsiu-Ling; Lu, Cheng-Hsien; Li, Shau-Hsuan; Huang, Chu-Chung; Lin, Ching-Po; Cheng, Yu-Fan

2014-01-01

Cerebral edema is the common pathogenic mechanism for cognitive impairment in minimal hepatic encephalopathy. Whether complete reversibility of brain edema, cognitive deficits, and their associated imaging can be achieved after liver transplantation remains an open question. To characterize white matter integrity before and after liver transplantation in patients with minimal hepatic encephalopathy, multiple diffusivity indices acquired via diffusion tensor imaging was applied. Twenty-eight patients and thirty age- and sex-matched healthy volunteers were included. Multiple diffusivity indices were obtained from diffusion tensor images, including mean diffusivity, fractional anisotropy, axial diffusivity and radial diffusivity. The assessment was repeated 6-12 month after transplantation. Differences in white matter integrity between groups, as well as longitudinal changes, were evaluated using tract-based spatial statistical analysis. Correlation analyses were performed to identify first scan before transplantation and interval changes among the neuropsychiatric tests, clinical laboratory tests, and diffusion tensor imaging indices. After transplantation, decreased water diffusivity without fractional anisotropy change indicating reversible cerebral edema was found in the left anterior cingulate, claustrum, postcentral gyrus, and right corpus callosum. However, a progressive decrease in fractional anisotropy and an increase in radial diffusivity suggesting demyelination were noted in temporal lobe. Improved pre-transplantation albumin levels and interval changes were associated with better recoveries of diffusion tensor imaging indices. Improvements in interval diffusion tensor imaging indices in the right postcentral gyrus were correlated with visuospatial function score correction. In conclusion, longitudinal voxel-wise analysis of multiple diffusion tensor imaging indices demonstrated different white matter changes in minimal hepatic encephalopathy patients. Transplantation improved extracellular cerebral edema and the results of associated cognition tests. However, white matter demyelination may advance in temporal lobe.

Minimizing Leg Length Discrepancy After Intramedullary Nailing of Comminuted Femoral Shaft Fractures: A Quality Improvement Initiative Using the Scout Computed Tomography Scanogram.

PubMed

Gheraibeh, Petra; Vaidya, Rahul; Hudson, Ian; Meehan, Robert; Tonnos, Frederick; Sethi, Anil

2018-05-01

To prevent leg length discrepancy (LLD) after locked femoral nailing in patients with comminuted femoral shaft fractures. Prospective consecutive case series aimed at quality improvement. Level 1 Trauma Center PATIENTS:: Ninety-eight consecutive patients with a comminuted femoral shaft fracture underwent statically locked intramedullary nailing, with a focused attempt at minimizing LLD during surgery. A computed tomography scanogram of both legs was performed on postoperative day 1 to assess for residual LLD. Patients were offered the option to have LLD >1.5 cm corrected before discharge. LLD >1.5 cm. Twenty-one patients (21.4%) were found to have an LLD >1.5 cm. An LLD >1.5 cm occurred in 10/55 (18%) antegrade nail patients and 11/43 (26%) retrograde nail patients (P = 0.27). No difference was noted based on the mechanism of injury, surgeon training and OTA/AO type B versus C injury. Ninety of 98 patients left with <1.5 cm LLD, 13/21 had a correction all to ≤0.6 cm, and 8 decided to accept the LLD and declined early correction. No patient left the hospital with an LLD >1.5 cm after locked intramedullary nailing for a comminuted femoral shaft fracture without being informed and the option of early correction. We recommend using a full-length computed tomography scanogram after IM nailing of comminuted femur fractures to prevent iatrogenic LLD. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Xenomelia: a new right parietal lobe syndrome.

PubMed

McGeoch, Paul D; Brang, David; Song, Tao; Lee, Roland R; Huang, Mingxiong; Ramachandran, V S

2011-12-01

Damage to the right parietal lobe has long been associated with various disorders of body image. The authors have recently suggested that an unusual behavioural condition in which otherwise rational individuals desire the amputation of a healthy limb might also arise from right parietal dysfunction. Four subjects who desired the amputation of healthy legs (two right, one left and one, at first, bilateral and then left only) were recruited and underwent magnetoencephalography (MEG) scans during tactile stimulation of sites above and below the desired amputation line. Regions of interest (ROIs) in each hemisphere (superior parietal lobule (SPL), inferior parietal lobule, S1, M1, insula, premotor cortex and precuneus) were defined using FreeSurfer software. Analysis of average MEG activity across the 40-140 ms post-stimulation timeframe was carried out using an unpaired t test. This revealed significantly reduced activation only in the right SPL ROI for the subjects' affected legs when compared with both subjects' unaffected legs and that of controls. The right SPL is a cortical area that appears ideally placed to unify disparate sensory inputs to create a coherent sense of having a body. The authors propose that inadequate activation of the right SPL leads to the unnatural situation in which the sufferers can feel the limb in question being touched without it actually incorporating into their body image, with a resulting desire for amputation. The authors introduce the term 'xenomelia' as a more appropriate name than apotemnophilia or body integrity identity disorder, for what appears to be an unrecognised right parietal lobe syndrome.

Acupuncture-induced changes of pressure pain threshold are mediated by segmental inhibition--a randomized controlled trial.

PubMed

Baeumler, Petra I; Fleckenstein, Johannes; Benedikt, Franziska; Bader, Julia; Irnich, Dominik

2015-11-01

Our aim was to distinguish between spinal and supraspinal mechanisms in the intact nervous system by comparing homosegmental and heterosegmental effects of electroacupuncture (EA) and manual acupuncture (MA) on sensory perception in healthy volunteers by means of quantitative sensory testing. Seventy-two healthy volunteers were randomly assigned to receive either MA or EA at SP 6, SP 9, GB 39, and ST 36 at the left leg or relaxed for 30 minutes (control group [CG]). Blinded examiners assessed 13 sensory modalities (thermal and mechanical detection and pain thresholds) at the upper arms and lower legs before and after intervention by means of a standardized quantitative sensory testing battery. Change scores of all 13 sensory thresholds were compared between groups. The main outcome measure was the change score of the pressure pain threshold (PPT). There were no baseline differences between groups. Pressure pain threshold change scores at the lower left leg, in the same segment as the needling site, differed significantly (P = 0.008) between the EA (median: 103.01 kPa) and CG groups (median: 0.00 kPa) but not between the MA (median: 0.00 kPa) and CG groups. No further significant change score differences were found between one of the acupuncture groups and the CG. The PPT can be changed by EA. The PPT increase was confined to the segment of needling, which indicates that it is mainly mediated by segmental inhibition in the spinal cord. This underscores the importance of segmental needling and electrical stimulation in clinical practice.

Reliability of a Skin Diagnostic Device in Assessing Hydration and Erythema.

PubMed

Huimin, Koh; Rowledge, Alexandra M; Borzdynski, Caroline J; Miller, Charne; Frescos, Nicoletta; McKenzie, Gayle; Perry, Elizabeth; McGuiness, William

2017-10-01

To examine the reliability of a skin diagnostic device, the SD202 (Courage+Khazaka GmBH, Cologne, Germany), in assessing hydration and erythema of periwound skin and pressure injury-prone areas. Intrarater reliabilities from 3 cross-sectional and prospective studies are reported. Patients attending an outpatient, nurse-led wound dressing clinic (n = 16), a podiatrist-led high-risk foot clinic (n = 17), and residents (n = 38) at a single residential aged-care facility. Skin hydration and erythema levels assessed using the SD202. High internal consistency was maintained for consecutive skin hydration and erythema measures at a single point on the venous leg ulcer periwound (α > .996 and α > .970 for hydration and erythema, respectively) and for the pressure-prone areas of the sacrum (α > .916), right (α > .994) and left (α > .967) ischium, right (α > .989) and left (α > .916) trochanter, right (α > .985) and left (α > .992) calcaneus, and right (α > .991) and left (α > .990) lateral malleolus. High consistency was also found for the measures obtained at 4 different locations around the periwound for the venous leg ulcer (α > .935 and α > .870 for hydration and erythema, respectively). In diabetic foot ulcer assessment, acceptable internal consistency of hydration measures around the periwound was observed (α > .634). Internal consistency of erythema measures was variable, ranging from low to high reliability, particularly among predebridement measures. Using the protocols outlined in this study, the SD202 demonstrates high reliability for assessing skin hydration and erythema levels. It is possible that the SD202 can be used in clinical practice as an appropriate tool for skin hydration and erythema assessment.

RS3PE Syndrome with Iliopsoas Bursitis Distinguished from an Iliopsoas Abscess Using a CT-guided Puncture.

PubMed

Fukui, Shoichi; Iwamoto, Naoki; Tsuji, Sosuke; Umeda, Masataka; Nishino, Ayako; Nakashima, Yoshikazu; Suzuki, Takahisa; Horai, Yoshiro; Koga, Tomohiro; Kawashiri, Shin-ya; Ichinose, Kunihiro; Hirai, Yasuko; Tamai, Mami; Nakamura, Hideki; Origuchi, Tomoki; Kawakami, Atsushi

2015-01-01

A 55-year-old man was diagnosed with remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome. Contrast-enhanced computed tomography for cancer screening showed a mass with low-density centers with an enhanced rim in the left iliopsoas muscle. We suspected an iliopsoas abscess and performed computed-tomography-guided puncture of the mass. Both Gram staining and the culture of the fluid were negative. We diagnosed the patient with RS3PE syndrome with iliopsoas bursitis and administered low-dose corticosteroids without antibiotics. The symptoms, including left hip pain, quickly disappeared following treatment. Clinicians should be aware that iliopsoas bursitis may resemble an iliopsoas abscess. As a result, it is important to make an accurate differential diagnosis.

Cerebral venous hypertension and blindness: a reversible complication.

PubMed

Cuadra, Salvador A; Padberg, Frank T; Turbin, Roger E; Farkas, Jeffrey; Frohman, Larry P

2005-10-01

A 57-year-old woman developed blindness during treatment for sarcoidosis-induced end-stage renal disease. An initial renal transplantation failed, and hemoaccess was maintained with multiple central catheters and upper extremity prosthetic arteriovenous grafts. A successful second transplantation eliminated her need for hemodialysis, but a right brachial to internal jugular graft remained patent. Progressive visual loss 2 years after transplantation prompted ophthalmic evaluation which initially revealed unilateral left optic nerve edema and visual loss, ultimately worsening over several months to no light perception in the left eye, 20/60 vision in the right eye, and bilateral papilledema. Arteriography demonstrated cerebral venous hypertension attributed to the functioning hemoaccess graft. Permanent graft occlusion normalized the papilledema, and visual field defects in the right eye and visual acuity returned to 20/20 in the right eye.

Effects of deferoxamine on blood-brain barrier disruption after subarachnoid hemorrhage.

PubMed

Li, Yanjiang; Yang, Heng; Ni, Wei; Gu, Yuxiang

2017-01-01

Blood brain barrier (BBB) disruption is a key mechanism of subarachnoid hemorrhage (SAH)-induced brain injury. This study examined the mechanism of iron-induced BBB disruption after SAH and investigated the potential therapeutic effect of iron chelation on SAH. Male adult Sprague-Dawley rats had an endovascular perforation of left internal carotid artery bifurcation or sham operation. The rats were treated with deferoxamine (DFX) or vehicle (100mg/kg) for a maximum of 7 days. Brain edema, BBB leakage, behavioral and cognitive impairment were examined. In SAH rat, the peak time of brain edema and BBB impairment in the cortex was at day 3 after SAH. SAH resulted in a significant increase in ferritin expression in the cortex. The ferritin positive cells were colocalized with endothelial cells, pericytes, astrocytes, microglia and neurons. Compared with vehicle, DFX caused less ferritin upregulation, brain water content, BBB impairment, behavioral and cognitive deficits in SAH rats. The results suggest iron overload could be a therapeutic target for SAH induced BBB damage.

Topical anesthesia-induced keratopathy after laser-assisted subepithelial keratectomy.

PubMed

Rao, Srinivas K; Wong, Victoria W Y; Cheng, Arthur C K; Lam, Philip T H; Lam, Dennis S C

2007-08-01

A 42-year-old woman had uneventful bilateral laser-assisted subepithelial keratectomy (LASEK) to correct myopia. She experienced intense pain in the first postoperative week and obtained topical oxybuprocaine for pain relief. Subsequently, she developed bilateral persistent corneal epithelial defects, epithelial edema, and bullae that failed to heal with bandage contact lens and topical lubricants. Over the next 4 months, there was progressive corneal stromal thinning and descemetocele formation in 1 eye, requiring application of cyanoacrylate glue, and stromal edema and scarring in the other eye, which resulted in a visual acuity of counting fingers. Investigations did not reveal associated infection or an underlying immunological disorder; however, the patient admitted to excessive use of topical anesthetic eyedrops in the post-LASEK period. She subsequently had penetrating keratoplasty and lens extraction with IOL implantation in the right eye. The left eye healed with central corneal scarring. This case illustrates that serious sight-threatening complications may occur after LASEK due to abuse of topical anesthetic agents.

[Survival pronostic factors in Mexican patients with multiforme glioblastoma].

PubMed

Hernández-Reyna, Ricardo; Medellín-Sánchez, Roberto; Cerda-Flores, Ricardo M; Calderón-Garcidueñas, Ana Laura

2010-01-01

To study the pre- and transoperative factors that influence patients' survival with GM. Clinical and pathological records of all confirmed cases of GM diagnosed between 2000 and 2006 were included. Postoperative survival was divided in less or more than 8 months. χ2 test was used. One hundred and twenty patients (45 women and 75 men) were studied. Age range was from 7 to 85 years, 3.3% were 16 years old or younger and 12.5% were 70 years old or older. Headache was the most frequent complain, 40 patients developed hemiparesia and 6 had parestesias. Predominance of white matter hemispheric lesions was observed: right hemispheric tumors 65 (54%), left lesions 30 (25%) and bilateral tumors 7%. Histologically, 1.6% of GM had a sarcomatous component; 35% of patients survived less than 8 months. A difference between patients survival was the preoperative Karnofsky Performance Scale Score and the degree of cerebral edema during the surgical procedure. Pre-operative Karnofsky evaluation and edema during the surgical procedure were significant prognostic factors for survival.

Uneventful Anterior Migration of Intravitreal Ozurdex Implant in a Patient with Iris-Sutured Intraocular Lens and Descemet Stripping Automated Endothelial Keratoplasty.

PubMed

Zafar, Andleeb; Aslanides, Ioannis M; Selimis, Vasileios; Tsoulnaras, Konstantinos I; Tabibian, David; Kymionis, George D

2018-01-01

We report here the case of a patient with anterior segment migration of intravitreal dexamethasone implant as well as its management and outcome. The patient had the following sequence of events: complicated cataract surgery, iris-sutured intraocular lens implant, followed by cystoid macular edema treated with intravitreal Avastin, retinal vein occlusion treated with intravitreal dexamethasone implant, corneal decompensation treated with Descemet stripping automated endothelial keratoplasty (DSAEK), and finally recurrence of macular edema treated with repeated intravitreal dexamethasone implant. Dexamethasone implant had completely dissolved from the eye 12 weeks after insertion without any complication. A conservative approach with regular monitoring in the situation of a quiet anterior segment without any corneal decompensation can provide enough time for the implant to dissolve without causing any complication to the involved eye, avoiding any additional surgical intervention, as presented in this case report. Despite the fact that the implant was left for natural dissolution, there were no adverse effects related to the graft or the eye.

Long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep vein thrombosis in the TROMBOTEK trial.

PubMed

Kurtoglu, Mehmet; Koksoy, Cuneyt; Hasan, Ekim; Akcalı, Yigit; Karabay, Ozalp; Filizcan, Ugur

2010-11-01

The present study was designed to evaluate the long-term efficacy and safety of once-daily enoxaparin plus warfarin for the outpatient ambulatory treatment of lower-limb deep venous thrombosis (DVT). A total of 246 patients, comprising 128 men (mean age, 54.28±16.48 years) and 118 women (mean age, 50.11±16.47 years) with symptomatic lower extremity DVT, were included in this open-label, single-arm, multicenter, phase IV clinical trial conducted at 14 centers in Turkey. All patients were administered subcutaneous enoxaparin (1.5 mg/kg, once-daily) until international normalized ratio (INR) levels reached to 2 to 3, followed by oral warfarin (5 mg/d) for at least 3 months and elastic compression stockings (30-40 mm Hg). Clinical signs (leg circumference), symptoms (edema, pain, tenderness), recanalization rates upon duplex ultrasound examination, laboratory findings (D-dimer and INR levels), and postthrombotic syndrome status with CEAP classification were the efficacy parameters evaluated every 3 months during 18 months of follow-up. Safety end points included minor and major bleeding as well as serious adverse events. Ambulatory treatment with enoxaparin plus warfarin significantly reduced physical symptoms, including tenderness, edema, pain (P<.001), and the circumference of the affected leg (P<.001). The leg circumference difference in almost all patients was <1.5 cm at the end of 18 months (P<.001). Recanalization rates for occluded iliofemoral vein were 76.1% at 3 months and 86.5% at 18 months (P<.001). An early and significant decrease obtained in D-dimer levels on day 10 continued to decline significantly until month 6 and remained unchanged afterwards (P<.001). Of four patients diagnosed with major bleeding during oral anticoagulant use, three recovered with conservative treatment (reduction in hemoglobin levels in 2 developed at visit 2 [day 10] and intracranial bleeding in 1 developed at visit 3 [day 30]), and one patient required a hysterectomy after menorrhagia developed at visit 7 (month 18). Two of the 65 (9.9%) adverse events documented were serious adverse events, but none of the serious adverse events leading to death were related to the study medications. Ambulatory treatment with enoxaparin plus warfarin seems to be effective in symptomatic healing and in clinical improvement by reducing thrombus formation and organization at all levels of lower extremity venous system with DVT, without a significant major bleeding risk. Therefore, the results of our conventional conservative treatment are in line with 1A level evidence reported in the recent American College of Chest Physicians guideline. Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Bilateral effects of 6 weeks' unilateral acupuncture and electroacupuncture on ankle dorsiflexors muscle strength: a pilot study.

PubMed

Zhou, Shi; Huang, Li-Ping; Liu, Jun; Yu, Jun-Hai; Tian, Qiang; Cao, Long-Jun

2012-01-01

To determine the effect of unilateral manual acupuncture at selected acupoints on ankle dorsiflexion strength of both limbs, and compare the effect with that of electroacupuncture at the same acupoints and sham points. Randomized controlled trial. Rehabilitation laboratory of a university. Young men (N=43) were randomly allocated into 4 groups: control; manual acupuncture and electroacupuncture on 2 acupoints (ST-36 and ST-39); and electroacupuncture on 2 nonacupoints. These points were located on the tibialis anterior muscle. The participants in the experimental groups received 15 to 30 minutes of acupuncture or electroacupuncture on the right leg in each session, 3 sessions per week for 6 weeks. The maximal strength in isometric ankle dorsiflexion of both legs was assessed before and after the experimental period. Repeated-measures analysis of variance identified significant and similar strength gains (range, 35%-64% in the right leg and 32%-49% in the left leg; P<.01) in all acupuncture groups, but not in the control group (-2% to 2%, P>.05). Unilateral manual acupuncture and electroacupuncture at the acupoints can improve muscle strength in both limbs, and electroacupuncture at the nonacupoints as used in this study can also induce similar strength gains. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Pretence and Deception: One Cognitive Watershed or Two?

ERIC Educational Resources Information Center

Peskin, Joan

A total of 48 Canadian, middle-class 3-year-olds participated in a study of their abilities to predict the actions of a story character with a false belief and a story character engaged in pretence. In the experimental situation, a red puppet with pen-markers for legs left an "inky trail" to the location of a hidden treasure in one of…

Stateside Care of Marines and Sailors Injured in Iraq at the National Naval Medical Center in Bethesda, Maryland

DTIC Science & Technology

2008-01-01

IED blast. Marine #1 is a 22- year-old who sustained injuries to the head resulting in a subdural hematoma , traumatic amputation of the left leg, and...AIKEN et alarm, which has since compromised circulation to the lower part of his right arm. He has been on hourly circulation checks since the hematoma

Thermographic imaging of the superficial temperature in racing greyhounds before and after the race.

PubMed

Vainionpää, Mari; Tienhaara, Esa-Pekka; Raekallio, Marja; Junnila, Jouni; Snellman, Marjatta; Vainio, Outi

2012-01-01

A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp.) at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis) were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs.

Thermographic Imaging of the Superficial Temperature in Racing Greyhounds before and after the Race

PubMed Central

Vainionpää, Mari; Tienhaara, Esa-Pekka; Raekallio, Marja; Junnila, Jouni; Snellman, Marjatta; Vainio, Outi

2012-01-01

A total of 47 racing greyhounds were enrolled in this study on two race days (in July and September, resp.) at a racetrack. Twelve of the dogs participated in the study on both days. Thermographic images were taken before and after each race. From the images, superficial temperature points of selected sites (tendo calcaneus, musculus gastrocnemius, musculus gracilis, and musculus biceps femoris portio caudalis) were taken and used to investigate the differences in superficial temperatures before and after the race. The thermographic images were compared between the right and left legs of a dog, between the raced distances, and between the two race days. The theoretical heat capacity of a racing greyhound was calculated. With regard to all distances raced, the superficial temperatures measured from the musculus gastrocnemius were significantly higher after the race than at baseline. No significant differences were found between the left and right legs of a dog after completing any of the distances. Significant difference was found between the two race days. The heat loss mechanisms of racing greyhounds during the race through forced conduction, radiation, evaporation, and panting can be considered adequate when observing the calculated heat capacity of the dogs. PMID:23097633

Severe Cerebral Vasospasm and Childhood Arterial Ischemic Stroke After Intrathecal Cytarabine.

PubMed

Tibussek, Daniel; Natesirinilkul, Rungrote; Sun, Lisa R; Wasserman, Bruce A; Brandão, Leonardo R; deVeber, Gabrielle

2016-02-01

We report on 2 patients who developed widespread cerebral vasospasm and arterial ischemic strokes (AIS) after application of intrathecal (IT) cytarabine. In a 3-year-old child with acute lymphoblastic leukemia (ALL), left leg weakness, hyperreflexia, and clonus were noted 4 days after her first dose of IT cytarabine during the induction phase of her chemotherapy. Cerebral MRI revealed multiple acute cerebral ischemic infarcts and widespread cerebral vasospasm. A 5-year-old girl complained of right arm and leg pain and began limping 11 days after IT cytarabine. Symptoms progressed to right dense hemiplegia, left gaze deviation, headache, and speech arrest. MRI revealed 2 large cortical areas of diffusion restriction in the right frontal and left parietal lobes. Cerebral magnetic resonance angiography (MRA) showed irregular narrowing affecting much of the intracranial arterial circulation. Although the first child fully recovered from her neurologic symptoms, the second patient had persistent hemiplegia on follow-up. Including this report, there are now 4 pediatric ALL cases of severe cerebral vasospasm and AIS in the context of IT cytarabine administration, strongly suggesting a true association. Differential diagnosis and management issues are discussed. Along with the more widespread use of MRI and MRA, the true frequency of this severe adverse effect will become clearer in future. For any child with neurologic symptoms within hours or days of receiving IT cytarabine, a low threshold for cerebral imaging with MRI and MRA is recommended. Copyright © 2016 by the American Academy of Pediatrics.

Reversible atrial fibrillation following Crotalinae envenomation.

PubMed

Quan, Dan; Zurcher, Kenneth

2017-01-01

Cardiotoxicity is a documented complication of Crotalinae envenomation. Reported cardiac complications following snake envenomation have included acute myocardial infarction, electrocardiogram abnormalities and arrhythmias. Few reports exist describing arrhythmia induced by viper envenomation and to our knowledge none describe arrhythmia induced by Crotalinae envenomation. This report concerns the first known case of atrial fibrillation precipitated by rattlesnake bite. A 73-year-old Caucasian man with a past medical history of hypertension, hyperlipidemia, type 1 diabetes mellitus, and a baseline first-degree atrioventricular block presented to the emergency department following a rattlesnake bite to his left lower leg. He developed pain and swelling in his left leg two-hour post-envenomation and subsequently received four vials of Crotalidae polyvalent immune fab (ovine). At three-hour post-envenomation following transfer to the intensive care unit, an electrocardiogram revealed new-onset atrial fibrillation. An amiodarone drip was started and the patient successfully converted to normal sinus rhythm approximately six hours after he was found to be in atrial fibrillation. A transthoracic echocardiogram revealed mild concentric left ventricular hypertrophy and an ejection fraction of 72%. He was discharged the following day with no hematological abnormalities and a baseline first-degree atrioventricular block. This is the first documented case of reversible atrial fibrillation precipitated by Crotalinae envenomation. In patients with pertinent risk factors for developing atrial fibrillation, physicians should be aware of the potential for this arrhythmia. Direct toxic effects of venom or structural and electrophysiological cardiovascular abnormalities may predispose snakebite patients to arrhythmia, warranting extended and attentive cardiac monitoring.

The relative kicking frequency of infants born full-term and preterm during learning and short-term and long-term memory periods of the mobile paradigm.

PubMed

Heathcock, Jill C; Bhat, Anjana N; Lobo, Michele A; Galloway, James C

2005-01-01

Infants born preterm differ in their spontaneous kicking, as well as their learning and memory abilities in the mobile paradigm, compared with infants born full-term. In the mobile paradigm, a supine infant's ankle is tethered to a mobile so that leg kicks cause a proportional amount of mobile movement. The purpose of this study was to investigate the relative kicking frequency of the tethered (right) and nontethered (left) legs in these 2 groups of infants. Ten infants born full-term and 10 infants born preterm (<33 weeks gestational age, <2,500 g) and 10 comparison infants participated in the study. The relative kicking frequencies of the tethered and nontethered legs were analyzed during learning and short-term and long-term memory periods of the mobile paradigm. Infants born full-term showed an increase in the relative kicking frequency of the tethered leg during the learning period and the short-term memory period but not for the long-term memory period. Infants born preterm did not show a change in kicking pattern for learning or memory periods, and consistently kicked both legs in relatively equal amounts. Infants born full-term adapted their baseline kicking frequencies in a task-specific manner to move the mobile and then retained this adaptation for the short-term memory period. In contrast, infants born preterm showed no adaptation, suggesting a lack of purposeful leg control. This lack of control may reflect a general decrease in the ability of infants born preterm to use their limb movements to interact with their environment. As such, the mobile paradigm may be clinically useful in the early assessment and intervention of infants born preterm and at risk for future impairment.

Is there a relationship between complaints of impaired balance and postural control disorder in community-dwelling elderly women? A cross-sectional study with the use of posturography

PubMed Central

Tanaka, Erika H.; Santos, Paulo F.; Reis, Júlia G.; Rodrigues, Natalia C.; Moraes, Renato; Abreu, Daniela C. C.

2015-01-01

Background: Risk of falls increases as age advances. Complaints of impaired balance are very common in the elderly age group. Objectives: The objective of this study was to investigate whether the subjective perception of impaired balance was associated with deficits in postural control (objective analysis) in elderly community-dwelling women. Method: Static posturography was used in two groups: elderly women with (WC group) and without (NC group) complaints of impaired balance. The area, mean sway amplitude and mean speed of the center of pressure (COP) in the anterior-posterior (AP) and medial-lateral (ML) directions were analyzed in three stances: single-leg stance, double-leg stance and tandem stance, with eyes open or closed on two different surfaces: stable (firm) and unstable (foam). A digital chronometer was activated to measure the time limit (Tlimit) in the single-leg stance. Kruskal-Wallis tests followed by Mann-Whitney tests, Friedman analyses followed by post hoc Wilcoxon tests and Bonferroni corrections, and Spearman statistical tests were used in the data analysis. Differences of p<0.05 were considered statistically significant. Results: The results of posturography variables revealed no differences between groups. The timed single-leg stance test revealed a shorter Tlimit in the left single-leg stance (p=0.01) in WC group compared to NC group. A negative correlation between posturography variables and Tlimit was detected. Conclusions: Posturography did not show any differences between the groups; however, the timed single-leg stance allowed the authors to observe differences in postural control performance between elderly women with and those without complaints of impaired balance. PMID:26083602

Is there a relationship between complaints of impaired balance and postural control disorder in community-dwelling elderly women? A cross-sectional study with the use of posturography.

PubMed

Tanaka, Erika H; Santos, Paulo F; Reis, Júlia G; Rodrigues, Natalia C; Moraes, Renato; Abreu, Daniela C C

2015-01-01

Risk of falls increases as age advances. Complaints of impaired balance are very common in the elderly age group. The objective of this study was to investigate whether the subjective perception of impaired balance was associated with deficits in postural control (objective analysis) in elderly community-dwelling women. Static posturography was used in two groups: elderly women with (WC group) and without (NC group) complaints of impaired balance. The area, mean sway amplitude and mean speed of the center of pressure (COP) in the anterior-posterior (AP) and medial-lateral (ML) directions were analyzed in three stances: single-leg stance, double-leg stance and tandem stance, with eyes open or closed on two different surfaces: stable (firm) and unstable (foam). A digital chronometer was activated to measure the time limit (Tlimit) in the single-leg stance. Kruskal-Wallis tests followed by Mann-Whitney tests, Friedman analyses followed by post hoc Wilcoxon tests and Bonferroni corrections, and Spearman statistical tests were used in the data analysis. Differences of p<0.05 were considered statistically significant. The results of posturography variables revealed no differences between groups. The timed single-leg stance test revealed a shorter Tlimit in the left single-leg stance (p=0.01) in WC group compared to NC group. A negative correlation between posturography variables and Tlimit was detected. Posturography did not show any differences between the groups; however, the timed single-leg stance allowed the authors to observe differences in postural control performance between elderly women with and those without complaints of impaired balance.

Eight weeks of local vibration training increases dorsiflexor muscle cortical voluntary activation.

PubMed

Souron, Robin; Farabet, Adrien; Féasson, Léonard; Belli, Alain; Millet, Guillaume Y; Lapole, Thomas

2017-06-01

The aim of this study was to evaluate the effects of an 8-wk local vibration training (LVT) program on functional and corticospinal properties of dorsiflexor muscles. Forty-four young subjects were allocated to a training (VIB, n = 22) or control (CON, n = 22 ) group. The VIB group performed twenty-four 1-h sessions (3 sessions/wk) of 100-Hz vibration applied to the right tibialis anterior. Both legs were tested in each group before training (PRE), after 4 (MID) and 8 (POST) wk of training, and 2 wk after training (POST 2W ). Maximal voluntary contraction (MVC) torque was assessed, and transcranial magnetic stimulation (TMS) was used to evaluate cortical voluntary activation (VA TMS ), motor evoked potential (MEP), cortical silent period (CSP), and input-output curve parameters. MVC was significantly increased for VIB at MID for right and left legs [+7.4% ( P = 0.001) and +6.2% ( P < 0.01), respectively] and remained significantly greater than PRE at POST [+12.0% ( P < 0.001) and +10.1% ( P < 0.001), respectively]. VA TMS was significantly increased for right and left legs at MID [+4.4% ( P < 0.01) and +4.7% ( P < 0.01), respectively] and at POST [+4.9% ( P = 0.001) and +6.2% ( P = 0.001), respectively]. These parameters remained enhanced in both legs at POST 2W MEP and CSP recorded during MVC and input-output curve parameters did not change at any time point for either leg. Despite no changes in excitability or inhibition being observed, LVT seems to be a promising method to improve strength through an increase of maximal voluntary activation, i.e., neural adaptations. Local vibration may thus be further considered for clinical or aging populations. NEW & NOTEWORTHY The effects of a local vibration training program on cortical voluntary activation measured with transcranial magnetic stimulation were assessed for the first time in dorsiflexors, a functionally important muscle group. We observed that training increased maximal voluntary strength likely because of the strong and repeated activation of Ia spindle afferents during vibration training that led to changes in the cortico-motoneuronal pathway, as demonstrated by the increase in cortical voluntary activation. Copyright © 2017 the American Physiological Society.

Linezolid-induced optic neuropathy with a rare pathological change in the inner retina.

PubMed

Ishii, Nobuhito; Kinouchi, Reiko; Inoue, Masatomo; Yoshida, Akitoshi

2016-12-01

We report a case of linezolid-induced optic neuropathy with transient microcystic spaces in the inner retina. We observed the retina using Fourier-domain optical coherence tomography (FD-OCT) in a patient with linezolid-induced optic neuropathy. A 49-year-old woman presented to our department with a 1-week history of bilateral photophobia. At the first visit, her best-corrected visual acuity (VA) was 0.6 in the right eye and 0.5 in the left eye. She had moderate optic disk edema and central scotomas bilaterally. FD-OCT showed bilateral microcystic spaces in the retina. Microcystic spaces were seen in the retinal nerve fiber layer (RNFL) and at the border of the RNFL and the retinal ganglion cell layer. Magnetic resonance imaging and laboratory tests showed no positive findings except for an elevated lactic acid level. One week after the first visit, the VA levels decreased to 0.06 and 0.07 in the right and left eyes, respectively. Because the patient had a 7-month history of linezolid treatment for persistent pyogenic arthritis, we suspected linezolid-induced optic neuropathy and immediately terminated treatment with this drug. The optic disk edema and the microcystic spaces in the retina resolved, and the VA improved to 1.2 at 6 weeks after linezolid withdrawal. Microcystic spaces, which resolved with linezolid withdrawal, were observed in linezolid-induced optic neuropathy. The microcystic spaces in the inner retina can be the first retinal sign of some optic neuropathies.

Antinuclear Matrix Protein 2 Autoantibodies and Edema, Muscle Disease, and Malignancy Risk in Dermatomyositis Patients.

PubMed

Albayda, Jemima; Pinal-Fernandez, Iago; Huang, Wilson; Parks, Cassie; Paik, Julie; Casciola-Rosen, Livia; Danoff, Sonye K; Johnson, Cheilonda; Christopher-Stine, Lisa; Mammen, Andrew L

2017-11-01

Dermatomyositis (DM) patients typically present with proximal weakness and autoantibodies that are associated with distinct clinical phenotypes. We observed that DM patients with autoantibodies recognizing the nuclear matrix protein NXP-2 often presented with especially severe weakness. The aim of this study was to characterize the clinical features associated with anti-NXP-2 autoantibodies. There were 235 DM patients who underwent testing for anti-NXP-2 autoantibodies. Patient characteristics, including muscle strength, were compared between those with and without these autoantibodies. The number of cancer cases observed in anti-NXP-2-positive subjects was compared with the number expected in the general population. Of the DM patients, 56 (23.8%) were anti-NXP-2-positive. There was no significant difference in the prevalence of proximal extremity weakness in patients with and without anti-NXP-2. In contrast, anti-NXP-2-positive patients had more prevalent weakness in the distal arms (35% versus 20%; P = 0.02), distal legs (25% versus 8%; P < 0.001), and neck (48% versus 23%; P < 0.001). Anti-NXP-2-positive subjects were also more likely to have dysphagia (62% versus 35%; P < 0.001), myalgia (46% versus 25%; P = 0.002), calcinosis (30% versus 17%; P = 0.02), and subcutaneous edema (36% versus 19%; P = 0.01) than anti-NXP-2-negative patients. Five anti-NXP-2-positive subjects (9%) had cancer-associated myositis, representing a 3.68-fold increased risk (95% confidence interval 1.2-8.6) compared to the expected prevalence in the general population. In DM, anti-NXP-2 autoantibodies are associated with subcutaneous edema, calcinosis, and a muscle phenotype characterized by myalgia, proximal and distal weakness, and dysphagia. As anti-NXP-2-positive patients have an increased risk of cancer, we suggest that they undergo comprehensive cancer screening. © 2017, American College of Rheumatology.

Superficial Vein Thrombophlebitis in a Football Athlete.

PubMed

Schleich, Kevin T; Smoot, M Kyle

2016-03-01

A 22-year-old professional football player presented to a preparticipation physical examination with a 2-week history of left leg discomfort extending from the groin to the knee over the previous 2 weeks. He was found to have superficial vein thrombophlebitis (SVT) of the left great saphenous vein extending from the knee to within approximately 1.6 cm of the saphenofemoral junction. There is paucity in the literature regarding the management of SVT, particularly in actively training athletes. This case addresses the considerations of anticoagulation management for SVT as well as the unique challenge of managing anticoagulation therapy in an athlete that is actively training.

Squamous cell carcinoma lung: Presented with bilateral lower limb deep venous thrombosis with gangrene formation

PubMed Central

Saha, Kaushik; Sengupta, Amitabha; Patra, Anupam; Jash, Debraj

2013-01-01

Bilateral venous thrombosis due to underlying malignancy is a rare entity. It is worthy to search for malignancy in patients of bilateral venous gangrene. Our patient presented with severe bilateral leg pain as a result of venous gangrene. There was associated left sided massive pleural effusion with scalp nodule. Fine needle aspiration cytology of scalp nodule revealed metastatic squamous cell carcinoma and fiber optic bronchoscopy guided biopsy from growth at left upper lobe bronchus confirmed the case as squamous cell carcinoma lung. It was rare for squamous cell carcinoma lung to present as bilateral venous gangrene with anticardiolipin antibody negative. PMID:24455526

Chronic Inflammatory Demyelinating Polyneuropathy Variant with Creatine-Kinase Elevation and Vanishing Effect of Immunoglobulins.

PubMed

Finsterer, Josef; Aliyev, Rahim

2017-07-27

BACKGROUND Whether creatine-kinase (CK) is elevated or not in chronic inflammatory demyelinating polyneuropathy (CIDP) and its variants is not comprehensively investigated. CASE REPORT We report the case of a 47-year-old male who developed weakness of the left lower leg and the right index finger at age 42 years. At age 44 years, paresthesias and dysesthesias of both lower legs and mild right lower leg weakness additionally developed. CK was recurrently elevated since age 42 years but paraprotein and anti-myelin-associated glycoprotein (MAG)-antibodies were negative. Nerve conduction studies at age 43 years showed an axonal and demyelinating lesion with conduction blocks. Cerebrospinal fluid (CSF) investigations revealed mild pleocytosis and elevated protein, which is why CIDP variant was diagnosed. Immunoglobulins were administered with success. Because of recurrent relapses, immunoglobulins were increased at age 45 years, resulting in stabilization. Currently, the patient is infusing immunoglobulins subcutaneously himself. CONCLUSIONS CIDP variants may go along with CK elevation, an axonal lesion, pleocytosis, and asymmetry of the lesion. A vanishing effect of immunoglobulins over time may be characteristic of CIDP variants.

An Ultralightweight and Living Legged Robot.

PubMed

Vo Doan, Tat Thang; Tan, Melvin Y W; Bui, Xuan Hien; Sato, Hirotaka

2018-02-01

In this study, we describe the most ultralightweight living legged robot to date that makes it a strong candidate for a search and rescue mission. The robot is a living beetle with a wireless electronic backpack stimulator mounted on its thorax. Inheriting from the living insect, the robot employs a compliant body made of soft actuators, rigid exoskeletons, and flexure hinges. Such structure would allow the robot to easily adapt to any complex terrain due to the benefit of soft interface, self-balance, and self-adaptation of the insect without any complex controller. The antenna stimulation enables the robot to perform not only left/right turning but also backward walking and even cessation of walking. We were also able to grade the turning and backward walking speeds by changing the stimulation frequency. The power required to drive the robot is low as the power consumption of the antenna stimulation is in the order of hundreds of microwatts. In contrast to the traditional legged robots, this robot is of low cost, easy to construct, simple to control, and has ultralow power consumption.

Opportunistic sampling to quantify plastics in the diet of unfledged Black Legged Kittiwakes (Rissa tridactyla), Northern Fulmars (Fulmarus glacialis) and Great Cormorants (Phalacrocorax carbo).

PubMed

Acampora, Heidi; Newton, Stephen; O'Connor, Ian

2017-06-30

Seabirds can interact with marine litter, mainly by entanglement or ingestion. The ingestion of plastics can lead to starvation or physical damage to the digestive tract. For chicks, it could additionally lead to reduced growth, affecting survival and fledging. This study quantified the ingestion of plastics by seabird chicks via an opportunistic sampling strategy. When ringing is carried out at colonies, birds may spontaneously regurgitate their stomach contents due to the stress or as a defence mechanism. Regurgitates were collected from nestlings of three different species: Black-legged Kittiwake (Rissa tridactyla, n=38), Northern Fulmar (Fulmarus glacialis, n=14) and Great Cormorant (Phalacrocorax carbo, n=28). Plastic was present in all species, with the highest frequency of occurrence (FO) in Northern Fulmar chicks (28.6%), followed by Black-legged Kittiwakes (7.9%) and Great Cormorants (7.1%). The observed load of plastics on chicks, which have not yet left the nest, highlights the pervasive nature of plastic pollution. Copyright © 2017 Elsevier Ltd. All rights reserved.

Comparative study of the femoroacetabular impingement (FAI) prevalence in male semiprofessional and amateur soccer players.

PubMed

Lahner, Matthias; Walter, Philipp Alexander; von Schulze Pellengahr, Christoph; Hagen, Marco; von Engelhardt, Lars Victor; Lukas, Carsten

2014-08-01

Femoroacetabular impingement (FAI) represents a novel approach to the mechanical etiology of hip osteoarthritis. The cam-type femoroacetabular impingement deformity occurs frequently in young male athletes. The aim of our study was to evaluate the prevalence of FAI in male semiprofessional soccer players using clinical examination and magnetic resonance imaging (MRI), compared to amateur soccer players. In MRI, the α angle of Nötzli is determined for quantifying FAI. According to power analysis, a total of 22 asymptomatic semiprofessional soccer players with a median of 23.3 years of age (range 18-30 years) and 22 male amateur soccer players with a median of 22.5 years of age (control group, range 18-29 years) underwent an MRI to measure the hip α angle of Nötzli. The α angle of the kicking legs of the semiprofessional group and the amateur group were analyzed. The study group was moreover evaluated by the Hip Outcome Score (HOS) and a clinical hip examination including range of motion (ROM) and impingement tests. In the semiprofessional group, 19 soccer players had a right kicking leg and 1 soccer player had a left kicking leg. 2 soccer players kicked with two feet. In the semi-professional group, the mean value of the α angle of the kicking leg (57.3 ± 8.2°) was significantly higher than in the amateur group (51.7 ± 4.8°, P = 0.008). In the semi-professional group, 15 (62.5 %) of 24 kicking legs had an increased α angle >55°, while 5 (27.3 %) kicking legs of the amateur group had an α angle >55°. Five semi professional soccer players had findings in clinical examination, whereof 4 had an increased α angle >55°. No participant of the amateur group showed pathological results in the clinical examination (P = 0.0484). Overall, semiprofessional soccer players had a higher proportion of an increased α angle than the amateur group. Semiprofessional players have a higher prevalence of an increased α angle in the kicking leg than the amateur group at the same age. The kicking leg is predisposed for FAI.

Lateral asymmetry of the Hoffmann reflex: relation to cortical laterality.

PubMed Central

Goode, D J; Glenn, S; Manning, A A; Middleton, J F

1980-01-01

Lateral asymmetry of the Hoffmann reflex (H-reflex) recovery curve was found in seven subjects with no personal or family history of neurological or psychiatric disorder. Differences between recovery curves from the right and left leg were larger than differences in the same leg on two successive test days. In a group of 27 psychiatric inpatients, lateral asymmetry of the later portion of the recovery curve was correlated with cortical laterality, as measured by selective identification of differing verbal stimuli presented simultaneously to both ears (DL) and to total laterality scores, a sum of visual half-field, DL, and motor laterality scores. Asymmetry of the recovery curve is related in part to cortical laterality, possibly through selective activation of cortical motor centres on the preferred side. PMID:7420106

Use of sugammadex in a patient with progressive muscular atrophy and in a patient with amyotrophic lateral sclerosis

PubMed Central

Yoo, Jae Hwa; Kim, Soon Im; Park, Sun Young; Jun, Mi Roung; Kim, Yong Eun; Kim, Hyoung June

2017-01-01

Abstract Introduction: We herein present 2 cases involving the combination of rocuronium and sugammadex in patients with motor neuron disease. The patients were a 54-year-old man with progressive muscular atrophy who underwent removal of internal fixators in the arm and leg, and a 66-year-old woman with amyotrophic lateral sclerosis who underwent skin grafting in the left lower leg. General anesthesia was induced with propofol, rocuronium, and remifentanil and maintained with desflurane and remifentanil. At the end of the surgical procedure, we administered sugammadex. Three or 4 minutes after administration of sugammadex, the patients began to breathe spontaneously and were extubated without complications. Conclusion: Sugammadex can be used successfully to reverse neuromuscular blockade in patients with motor neuron disease. PMID:28591053

The impact of shallow burial on differential decomposition to the body: a temperate case study.

PubMed

Schotsmans, Eline M J; Van de Voorde, Wim; De Winne, Joan; Wilson, Andrew S

2011-03-20

Extant literature contains a number of specific case studies on differential decomposition involving adipocere formation or desiccation, but few describe the co-occurrence of these features within a temperate climate. The case of a 65-year-old male, partially buried in a shallow grave for 7 months, is presented in which the soft tissues of the body were outwardly well preserved. The right leg was desiccated, some parts of the body were covered with adipocere (head, neck, right shoulder, upper torso and left leg) and other parts could be classified as in the early stages of decomposition. In this study the taphonomic variables resulting in differential decomposition with desiccation and adipocere formation are discussed. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Metabolic changes observed in astronauts

NASA Technical Reports Server (NTRS)

Leach, Carolyn S.; Cintron, N. M.; Krauhs, J. M.

1991-01-01

Results of medical experiments with astronauts reveal rapid loss of volume (2 l) from the legs and a transient early increase in left ventricular volume index. These findings indicate that, during space flight, fluid is redistributed from the legs toward the head. In about 2 days, total body water decreases 2 to 3 percent. Increased levels of plasma renin activity and antidiuretic hormone while blood sodium and plasma volume are reduced suggest that space flight-associated factors are influencing the regulatory systems. In addition to fluid and electrolyte loss, Skylab astronauts lost an estimated 0.3 kg of protein. Endocrine factors, including increased cortisol and thyroxine and decreased insulin, are favorable for protein catabolism. The body appears to adapt to weightlessness at some physiologic cost. Readaptation to earth's gravity at landing becomes another physiologic challenge.

Suppression of Rabbit VX‐2 Subcutaneous Tumor Growth by Gadolinium Neutron Capture Therapy

PubMed Central

Tokita, Nobuhiko; Tokuuye, Koichi; Satoh, Michinao; Churei, Hisahiko; Pechoux, Cécile Le; Kobayashi, Tooru; Kanda, Keiji

1993-01-01

VX‐2 tumors growing in hind legs of New Zealand White rabbits (n=4) were exposed to thermal neutrons for 40 min (2.1 × 1012 neutrons cm−2) while one of two hind leg tumors of each rabbit was infused continuously with meglumine gadopentetate through a branch of the left femoral artery. The contralateral (uninfused) tumors served as controls. Although no differential distribution of gadolinium was achieved between the tumor and its adjacent normal tissue, the gadolinium concentration in the infused tumor was approximately 5–6 fold higher than that in the contralateral tumor. Growth of gadolinium‐infused tumors was significantly inhibited compared to that of control tumors (P<0.05) between the 16th and 23rd days after treatment. PMID:8407547

[Pharmacological analysis of anti-inflammatory effects of low-intensity extremely high-frequency electromagnetic radiation].

PubMed

Gapeev, A B; Lushnikov, K V; Shumilina, Iu V; Chemeris, N K

2006-01-01

The anti-inflammatory effect of low-intensity extremely high-frequency electromagnetic radiation (EHF EMR, 42.0 GHz, 0.1 mW/cm2) was compared with the action of the known anti-inflammatory drug sodium diclofenac and the antihistamine clemastine on acute inflammatory reaction in NMRI mice. The local inflammatory reaction was induced by intraplantar injection of zymosan into the left hind paw. Sodium diclofenac in doses of 2, 3, 5, 10, and 20 mg/kg or clemastine in doses of 0.02, 0.1, 0.2, 0.4, and 0.6 mg/kg were injected intraperitoneally 30 min after the initiation of inflammation. The animals were whole-body exposed to EHF EMR for 20 min at 1 h after the initiation of inflammation. The inflammatory reaction was assessed over 3 - 8 h after the initiation by measuring the footpad edema and hyperthermia of the inflamed paw. Sodium diclofenac in doses of 5 - 20 mg/kg reduced the exudative edema on the average by 26% as compared to the control. Hyperthermia of the inflamed paw decreased to 60% as the dose of was increased diclofenac up to 20 mg/kg. EHF EMR reduced both the footpad edema and hyperthermia by about 20%, which was comparable with the effect of a single therapeutic dose of diclofenac (3 - 5 mg/kg). The combined action of diclofenac and the exposure to the EHF EMR caused a partial additive effect. Clemastine in doses of 0.02-0.4 mg/kg it did not cause any significant effects on the exudative edema, but in a dose of 0.6 mg/kg it reduced edema by 14 - 22% by 5 - 8 h after zymosan injection. Clemastine caused a dose-dependent increase in hyperthermia of inflamed paw at doses of 0.02-0.2 mg/kg and did not affect the hyperthermia at doses of 0.4 and 0.6 mg/kg. The combined action of clemastine and EHF EMR exposure caused a dose-dependent abolishment of the anti-inflammatory effect of EHF EMR. The results obtained suggest that both arachidonic acid metabolites and histamine are involved in the realization of anti-inflammatory effects of low-intensity

Journal of Special Operations Medicine, Volume 6, Edition 3

DTIC Science & Technology

2006-01-01

between the lower leg muscular planes. These are often times located in multiple places and not radiographically detectable. Volume 6, Edition 3...tinged. Physical examination was remarkable for rales and rhonchi at the left base. There was no jugular venous distension or tracheal deviation... muscular or subcutaneous epinephrine are the first-line treatments for these rare but serious conditions; respi- ratory and intravascular fluid may

Is everything clear about Tako-tsubo syndrome?

PubMed

Petrov, Ivo S; Tokmakova, Mariya P; Marchov, Daniel N; Kichukov, Kostadin N

2011-01-01

Tako-tsubo syndrome is a novel cardio-vascular disease affecting predominantly postmenopausal women exposed to unexpected strong emotional or physical stress, in the absence of significant coronary heart disease. It is characterized by acute onset of severe chest pain and/or acute left ventricular failure, ECG-changes, typical left ventricular angiographic findings, good prognosis and positive resolution of the morphological and clinical manifestations. First described in 1990 in Japan by Sato, Tako-tsubo cardiomyopathy is characterized by transient contractile abnormalities of the left ventricle, causing typical left ventricular apical ballooning at end-systole with concomitant compensatory basal hyperkinesia. There are also atypical forms, presenting with left ventricular systolic dysfunction which affects the mid-portions of the left ventricle. The etiology of the disease still remains unclear. Many theories have been put forward about the potential underlying pathophysiological mechanisms that may trigger this syndrome among which are the theory of catecholamine excess, the theory of multivessel coronary vasospasm, the ischemic theory, and the theory of microvascular dysfunction and dynamic left ventricular gradient induced by elevated circulating catecholamine levels. Adequate management of Tako-tsubo syndrome demands immediate preparation for coronary angiography. Once the diagnosis is made, treatment is primarily symptomatic and includes monitoring for complications. Patients with Tako-tsubo syndrome most frequently develop acute LV failure, pulmonary edema, rhythm and conductive disturbances and apical thrombosis. Treatment is symptomatic and includes administration of diuretics, vasodilators and mechanical support of circulation with intra-aortic balloon counterpulsation.

Use of calcium channel blockers in hypertrophic cardiomyopathy.

PubMed

Lorell, B H

1985-02-22

Recent studies in patients with either obstructive or nonobstructive hypertrophic cardiomyopathy have suggested that increased resistance to diastolic filling of the stiff left ventricle may be an important mechanism contributing to symptoms. These observations have led to exploration of the effects of calcium channel blockers on systolic and diastolic function in patients with hypertrophic cardiomyopathy. Acute hemodynamic studies using verapamil and nifedipine have shown that these agents tend to cause: (1) a slight fall in systemic arterial pressure and reflex increase in heart rate; (2) a reduction in left ventricular outflow gradient in most but not all patients; and (3) variable effect on left-side heart filling pressures. In contrast to beta-adrenergic blockers, these hemodynamic effects are not associated with depression of systolic function, but appear to be related to improved left ventricular distensibility. Clinical trials have suggested that long-term administration of verapamil in patients with hypertrophic cardiomyopathy promotes improvement in symptomatic status and exercise tolerance in many but not all patients; similar results have been reported in preliminary studies using nifedipine. Potential major adverse effects include depression of sinoatrial activity and atrioventricular conduction with verapamil, and marked hypotension and, rarely, pulmonary edema with both verapamil and nifedipine.

Tako-tsubo cardiomyopathy observed in a patient with sepsis and transient hyperthyroidism.

PubMed

Sarullo, Filippo M; Americo, Luigi; Accardo, Salvatore; Cicero, Sergio; Schicchi, Rossella; Schirò, Maria; Castello, Antonio

2009-03-01

A 55-years-old woman, with a history of hypertension and ischemic stroke with residual left hemiparesis, was admitted to our hospital because of dyspnoea with clinical evidence of acute pulmonary edema. She was found to have a sinus tachycardia with ST-elevation in leads D1, aVL and V1-V4 in the electrocardiogram, and akinesis of the left ventricular apex with overall left ventricular systolic function being severely impaired and an ejection fraction of 28% on echocardiography. Orotracheal intubation was performed and mechanical ventilation was immediately started. Emergency cardiac catheterization was performed 2 h after the symptom onset. Coronary angiography showed no significant coronary artery disease. Blood analysis revealed an increase in the creatine kinase MB fraction, a significant positive detection in troponin T, a white blood cell count of 35000 per microliter, C-reactive protein of 59,9 mg/dl, and transient elevation in the concentration of free triiodothyronine, free thyroxine, thyroid globulin antibody, and thyroid peroxidase antibody. The symptoms improved during the next days, and follow-up echocardiography 18 days later showed complete resolution of the left ventricular dysfunction. These data suggest that tako-tsubo cardiomyopathy may be induced in patients with sepsis and transient hyperthyroidism.

[Cavernous sinus thrombosis as a rare cause of exophthalmos in childhood : A case report].

PubMed

Kamawal, A; Schmidt, M A; Rompel, O; Gusek-Schneider, G C; Mardin, C Y; Trollmann, R

2017-05-01

Complications of acute bacterial sinusitis mostly occur in children and adolescents. In particular, intracranial spread of the infection can lead to severe even fatal courses of the disease. This article is a case report about a 13-year-old boy suffering from left-sided headache, meningismus and exophthalmos as presenting symptoms. Cranial magnetic resonance imaging (MRI) showed merely right-sided sphenoid sinusitis; however, the diffusion-weighted MRI sequence indicated a left-sided cavernous sinus thrombosis, which could be confirmed by computed tomography (CT) angiography. Cerebrospinal fluid diagnostics showed significant leukocytosis confirming secondary meningitis. Finally, exophthalmos was explained by parainfectious cavernous sinus thrombosis and periorbital edema. This case report highlights the importance of extended and specific diagnostic imaging in cases of clinically suspected complications in children and adolescents with sinusitis and the diagnostic significance of diffusion-weighted MRI.

Characteristic findings of magnetic resonance imaging (MRI) and computed tomography (CT) for severe chronic laminitis in a Thoroughbred horse

PubMed Central

YAMADA, Kazutaka; INUI, Tomohiro; ITOH, Megumi; YANAGAWA, Masashi; SATO, Fumio; TOMINARI, Masataka; MIZOBE, Fumiaki; KISHIMOTO, Miori; SASAKI, Naoki

2017-01-01

ABSTRACT A Thoroughbred horse with severe chronic laminitis of both forelimbs was evaluated on the same day with magnetic resonance imaging (MRI) and computed tomography (CT). Both MRI and CT revealed loss of the dorsal aspect of the cortical bone of the 3rd phalanx and sclerosis. CT reflected the status of the horny layer and bone of the affected feet, while MRI depicted inflammation of the laminar corium, together with tendon edema. On the 3-dimensional CT venogram, vessels were visualized in both the right and left forelimbs, although there was a difference in the vasculature of the coronary plexus and circumflex vessels between the right and left forelimbs. A combination of both MRI and CT provides detailed information regarding pathological conditions. PMID:28955162

Cavernous hemangioma of the orbit: an unusual acute presentation

PubMed Central

Louisraj, Sophia; Ponnudurai, Thendral; Rodriguez, Dominic; Thomas, Philip A; Nelson Jesudasan, Christadoss Arul

2017-01-01

We report an unusual presentation of an orbital cavernous hemangioma in a 26-year-old female, who noted sudden redness and swelling of the left eye (LE) on waking up. At presentation, upper eyelid edema with periorbital ecchymosis and subconjunctival hemorrhage were noted in the LE. Although there was transient symptomatic relief with topical medications, blurring of vision developed in the LE. When seen 10 days later, the patient’s LE showed axial proptosis. Magnetic resonance imaging revealed an intraconal soft tissue mass in the superomedial quadrant of the left orbit. Superior orbitotomy with mass excision was done; histopathological examination of the excised mass revealed a cavernous hemangioma. The patient had complete visual recovery following surgery. To our knowledge, an acute presentation of an orbital cavernous hemangioma with subconjunctival hemorrhage and periorbital ecchymosis has not previously been reported. PMID:28769595

A rare type of Usher's syndrome.

PubMed

Antunica, Antonela Gverović; Kastelan, Snjezana; Bućan, Kajo; Ivanković, Mira; Radman, Maja; Karaman, Ksenija

2013-12-01

A case is presented of a very rare type of Usher's syndrome detected in a 30-year-old woman in her 28th week of pregnancy. She reported left eye visual impairment with a one-month history. She underwent standard ophthalmologic examination with additional procedures scheduled after childbirth, including fluorescein angiography, visual field (Goldman and Octopus) and electroretinography. Fundus examination revealed pallor of the optic disk, diffuse retinal blood vessel narrowing, no retinal pigmentation, left macular edema, vitreous liquefaction, and posterior vitreous detachment. Goldman perimetry showed narrowing of all isopters to 10 degrees, and Octopus perimetry showed peripheral decrease of retinal sensitivity. Electroretinography confirmed the diagnosis of retinitis pigmentosa sine pigmento. Upon collecting case history records, hearing disorders originating from childhood were discovered. To our knowledge, this type of retinitis in Usher's syndrome has been reported only once in the available literature.

The effects of massage therapy after decompression and fusion surgery of the lumbar spine: a case study.

PubMed

Keller, Glenda

2012-01-01

Spinal fusion and decompression surgery of the lumbar spine are common procedures for problems such as disc herniations. Various studies for postoperative interventions have been conducted; however, no massage therapy studies have been completed. The objective of this study is to determine if massage therapy can beneficially treat pain and dysfunction associated with lumbar spinal decompression and fusion surgery. Client is a 47-year-old female who underwent spinal decompression and fusion surgery of L4/L5 due to chronic disc herniation symptoms. The research design was a case study in a private clinic involving the applications of seven, 30-minute treatments conducted over eight weeks. Common Swedish massage and myofascial techniques were applied to the back, shoulders, posterior hips, and posterior legs. Outcomes were assessed using the following measures: VAS pain scale, Hamstring Length Test, Oswestry Disability Index, and the Roland-Morris Disability Questionnaire. Hamstring length improved (in degrees of extension) from pretreatment measurements in the right leg of 40° and left leg 65° to post-treatment measurement at the final visit, when the results were right 50° and left 70°. The Oswestry Disability Index improved 14%, from 50% to 36% disability. Roland-Morris Disability decreased 1 point, from 3/24 to 2/24. The VAS pain score decreased by 2 points after most treatments, and for three of the seven treatments, client had a post-treatment score of 0/10. Massage for pain had short-term effects. Massage therapy seemed to lengthen the hamstrings bilaterally. Massage therapy does appear to have positive effects in the reduction of disability. This study is beneficial for understanding the relationship between massage therapy and clients who have undergone spinal decompression and fusion. Further research is warranted.

Eccentric-Overload Training in Team-Sport Functional Performance: Constant Bilateral Vertical Versus Variable Unilateral Multidirectional Movements.

PubMed

Gonzalo-Skok, Oliver; Tous-Fajardo, Julio; Valero-Campo, Carlos; Berzosa, César; Bataller, Ana Vanessa; Arjol-Serrano, José Luis; Moras, Gerard; Mendez-Villanueva, Alberto

2017-08-01

To analyze the effects of 2 different eccentric-overload training (EOT) programs, using a rotational conical pulley, on functional performance in team-sport players. A traditional movement paradigm (ie, squat) including several sets of 1 bilateral and vertical movement was compared with a novel paradigm including a different exercise in each set of unilateral and multi-directional movements. Forty-eight amateur or semiprofessional team-sport players were randomly assigned to an EOT program including either the same bilateral vertical (CBV, n = 24) movement (squat) or different unilateral multidirectional (VUMD, n = 24) movements. Training programs consisted of 6 sets of 1 exercise (CBV) or 1 set of 6 exercises (VUMD) × 6-10 repetitions with 3 min of passive recovery between sets and exercises, biweekly for 8 wk. Functional-performance assessment included several change-of-direction (COD) tests, a 25-m linear-sprint test, unilateral multidirectional jumping tests (ie, lateral, horizontal, and vertical), and a bilateral vertical-jump test. Within-group analysis showed substantial improvements in all tests in both groups, with VUMD showing more robust adaptations in pooled COD tests and lateral/horizontal jumping, whereas the opposite occurred in CBV respecting linear sprinting and vertical jumping. Between-groups analyses showed substantially better results in lateral jumps (ES = 0.21), left-leg horizontal jump (ES = 0.35), and 10-m COD with right leg (ES = 0.42) in VUMD than in CBV. In contrast, left-leg countermovement jump (ES = 0.26) was possibly better in CBV than in VUMD. Eight weeks of EOT induced substantial improvements in functional-performance tests, although the force-vector application may play a key role to develop different and specific functional adaptations.

An Automatic Gait Feature Extraction Method for Identifying Gait Asymmetry Using Wearable Sensors

PubMed Central

Vassallo, Michael

2018-01-01

This paper aims to assess the use of Inertial Measurement Unit (IMU) sensors to identify gait asymmetry by extracting automatic gait features. We design and develop an android app to collect real time synchronous IMU data from legs. The results from our method are validated using a Qualisys Motion Capture System. The data are collected from 10 young and 10 older subjects. Each performed a trial in a straight corridor comprising 15 strides of normal walking, a turn around and another 15 strides. We analyse the data for total distance, total time, total velocity, stride, step, cadence, step ratio, stance, and swing. The accuracy of detecting the stride number using the proposed method is 100% for young and 92.67% for older subjects. The accuracy of estimating travelled distance using the proposed method for young subjects is 97.73% and 98.82% for right and left legs; and for the older, is 88.71% and 89.88% for right and left legs. The average travelled distance is 37.77 (95% CI ± 3.57) meters for young subjects and is 22.50 (95% CI ± 2.34) meters for older subjects. The average travelled time for young subjects is 51.85 (95% CI ± 3.08) seconds and for older subjects is 84.02 (95% CI ± 9.98) seconds. The results show that wearable sensors can be used for identifying gait asymmetry without the requirement and expense of an elaborate laboratory setup. This can serve as a tool in diagnosing gait abnormalities in individuals and opens the possibilities for home based self-gait asymmetry assessment. PMID:29495299

Simple and easy assessment of falling risk in the elderly by functional reach test using elastic stick.

PubMed

Demura, Shin-Ichi; Yamada, Takayoshi

2007-10-01

Dynamic balance ability related to maintaining postural stability during movement is closely tied to fall risk in the elderly. The functional reach (FR) test has been developed to evaluate their dynamic balance. Although a simple and new FR test using an elastic stick has been proposed by modifying the above original FR test, the abilities related to both FR tests are judged to differ because of the large difference in the testing method. This study aimed to compare center of gravity fluctuation, muscle activity and functional reach distance as measured by the original FR test and the elastic stick FR test. First, reach distance, back/forth and right/left moving distance of the center of gravity, and activity of the lower leg muscles (soleus and tibialis anterior) were compared between both tests based on data obtained from 30 young male adults. All parameters except for the right/left moving distance were significantly larger in the elastic stick FR test. Next, the reach distance was examined in both FR tests using 53 elderly subjects; it was significantly longer in the elastic stick FR test, but showed no significant sex difference. The reach distance in both tests was significantly shorter (about 7 cm) in the elderly than in young adults. In conclusion, the elastic stick FR test involves greater leg muscle strength exertion and forward transferring of the center of gravity as compared with the original FR test. Because the elastic stick FR test relates largely to leg muscle function and equilibrium function, it may be more useful for evaluating the dynamic balance ability of the elderly.

Role of echocardiography/Doppler in cardiogenic shock: silent mitral regurgitation.

PubMed

Goldman, A P; Glover, M U; Mick, W; Pupello, D F; Hiro, S P; Lopez-Cuenca, E; Maniscalco, B S

1991-08-01

Two cases of cardiogenic shock and pulmonary edema due to acute, severe, silent mitral regurgitation are discussed. The mechanism for the mitral regurgitation was papillary muscle rupture in the setting of acute myocardial infarction. Echocardiography established the presence, severity, and cause of the mitral regurgitation and the associated hyperdynamic left ventricular function in the setting of cardiogenic shock. Transesophageal echocardiography is excellent for assessing the mitral valve in critically ill patients in whom transthoracic echocardiography may be inadequate or misleading. This allowed for emergency mitral valve replacement without prolonged attempts at medical stabilization.

Management of an unusual sciatica.

PubMed

Bourghli, Anouar; Chaballout, Ahmed; Obeid, Ibrahim; Boissiere, Louis; Vital, Jean-Marc; Khoury, Ghassan

2016-11-01

Extraforaminal entrapment of the L5 nerve root is uncommon, and its management can sometimes be very challenging. We present the case of a 57-year-old female, complaining of a sciatica in her left leg, for 3 years, with no response to any kind of conservative treatment. MRI and CT scan revealed the presence of a large L5S1 strictly lateral osteophyte compressing the left L5 root in its extraforaminal path. The patient underwent a left anterior retroperitoneal approach with assistance from a vascular surgeon given the very close relation between the osteophyte and the left common iliac vein, lying just on top of it, osteophyte was removed in one piece with the use of an osteotome after retraction of the vessels. The patient progressively recovered from her left sciatic pain with a satisfactory clinical result at 1 year. Literature is sparse on the treatment of extraforaminal entrapment of the L5 nerve root; the current case shows a successful treatment strategy with the use of an anterior approach for direct vision of the lesion and good control of the vessels.

The effect of levosimendan on myocardial ischemia–reperfusion injury in streptozotocin-induced diabetic rats

PubMed Central

Kiraz, Hasan Ali; Poyraz, Fatih; Kip, Gülay; Erdem, Özlem; Alkan, Metin; Arslan, Mustafa; Özer, Abdullah; Şivgin, Volkan; Çomu, Faruk Metin

2015-01-01

Objective Ischemia/reperfusion (I/R) injury is an important cause of myocardial damage by means of oxidative, inflammatory, and apoptotic mechanisms. The aim of the present study was to examine the potential cardio protective effects of levosimendan in a diabetic rat model of myocardial I/R injury. Methods A total of 18 streptozotocin-induced diabetic Wistar Albino rats (55 mg/kg) were randomly divided into three equal groups as follows: the diabetic I/R group (DIR) in which myocardial I/R was induced following left thoracotomy, by ligating the left anterior descending coronary artery for 60 min, followed by 2 h of reperfusion; the diabetic I/R levosimendan group (DIRL), which underwent I/R by the same method while taking levosimendan intraperitoneal 12 µg kg−1; and the diabetic control group (DC) which underwent sham operations without tightening of the coronary sutures. As a control group (C), six healthy age-matched Wistar Albino rats underwent sham operations similar to the DC group. Two hours after the operation, the rats were sacrificed and the myocardial tissue samples were examined by light microscopy for evidence of myonecrosis and inflammatory cell infiltration. Results Myonecrosis findings were significantly different among groups (p=0.008). Myonecrosis was more pronounced in the DIR group compared with the C, DC, and DIRL groups (p=0.001, p=0.007 and p=0.037, respectively). Similarly, the degree of inflammatory cell infiltration showed significant difference among groups (p<0.0001). Compared with C, DC, and DIRL groups, the inflammatory cell infiltration was significantly higher among the DIR group (p<0.0001, p<0.0001, and p=0.020, respectively). Also, myocardial tissue edema was significantly different among groups (p=0.006). The light microscopic myocardial tissue edema levels were significantly higher in the DIR group than the C, DC, and DIRL groups (p=0.001, p=0.037, and p=0.014, respectively). Conclusion Taken together, our data indicate that levosimendan may be helpful in reducing myocardial necrosis, myocardial inflammation, and myocardial tissue edema resulting from ischemia–reperfusion injury. PMID:26649830

[Effectiveness of nasal positive pressure ventilation in the management of acute refractory left ventricular insufficiency].

PubMed

Chesi, G; Pinelli, G; Galimberti, D; Navazio, A; Montanari, P

1994-04-01

Ehen refractory to optimal medical treatment cardiogenic pulmonary edema requires mechanical ventilation as a last therapeutic resource. In recent years an increasing number of authors reported their experience in the management of acute or subacute respiratory failure with non-invasive mechanical ventilation by nasal mask. Encouraged by the first promising results reported in literature we experimented this new therapeutic tool in a first group of seven elderly patients (mean age: 76.57--range: 65-89); they all had been admitted for severe cardiogenic pulmonary edema unresponsive to maximal doses of the conventional drugs available for treating acute decompensated heart failure. The enrolled patients were treated with intermittent ventilation administered by nasal mask at selected values of inspiratory positive airway pressure (IPAP) that were comprised between 10 and 20 cm H2O. At the same time an expiratory positive airway pressure (EPAP) at values comprised between 3 and 8 cm H2O was applied. Ventilation was continued for variable periods of 3-24 hours until acceptable values of PaO2 and PaCO2 were obtained. The ventilation modality was spontaneous, spontaneous-time or timed depending on the patients' level of consciousness at starting time. A good short-term outcome was achieved in all the patients regardless of the ventilation modality applied. The main blood gas alteration was severe hypercapnia with acidosis in three patients, while the other four presented critical hypoxemia unresponsive to simple oxygen supply even if delivered by high-flow Venturi mask. Four of our seven patients were discharged from hospital in satisfactory haemodynamic conditions; the remaining three died during hospitalization from refractory heart failure. In this our preliminary experience the therapeutic approach with nasal positive pressure ventilation (NPPV) and EPAP proved to be very effective to improve the signs and symptoms of acute refractory cardiogenic pulmonary edema as it avoided the need of invasive mechanical ventilation. It was well tolerated by all our patients; besides it was not difficult to use or time-consuming for physician and nurses. On the other hand it didn't modify our patients' medium or long-time prognosis which was strictly related to their preexisting left ventricular pump derangement.

Intramuscular pressures in antigravity muscles using gravity-independent, pneumatic hardware.

PubMed

Macias, Brandon R; Minocha, Ranjeet; Cutuk, Adnan A; Hill, James; Shiau, Jonathon; Hargens, Alan R

2008-08-01

Resistive exercise helps prevent muscle atrophy in microgravity, but better exercise equipment is needed. Therefore, the purpose of this study was to determine if a pneumatic, gravity-independent leg-press device (LPD) provides sufficient force to leg musculature. We hypothesized that intramuscular pressure (IMP), a quantitative index of muscle force, is greater in the antigravity superficial posterior and deep posterior compartments than in the non-antigravity anterior compartment during bilateral leg-press exercise. Millar pressure transducers were inserted into the anterior, lateral, superficial posterior, and deep posterior muscle compartments of the left leg of eight healthy subjects (three women, five men). Subjects were supine on the Keiser SX-1, a pneumatic LPD. Then maximal voluntary contraction (MVC) was determined; each subject performed three consecutive voluntary contractions at approximately 18%, 50%, and 100% MVC while continuously measuring IMP. Repeated measures ANOVA were used to determine differences of IMPs between compartments and loads. The magnitudes of IMP (mean +/- SEM) at 18 - 3% (abbreviated approximately 18%), 50%, and 100% MVC in the superficial and deep posterior compartments were significantly greater than that in the anterior compartment during exercise (P < 0.05). Additionally, IMPs in all four compartments significantly rose as resistance increased at approximately 18%, 50%, and 100% MVC (P < 0.05). The LPD provides significantly increased resistance to all four compartments, but with greater loading of the antigravity compartments as compared to the non-antigravity compartment. Since antigravity muscles of the leg are contained primarily in the superficial and deep posterior compartments, the LPD may help prevent muscle atrophy associated with microgravity.

Muscle Activity in Single- vs. Double-Leg Squats.

PubMed

DeFOREST, Bradley A; Cantrell, Gregory S; Schilling, Brian K

Muscular activity, vertical displacement and ground reaction forces of back squats (BS), rear-leg elevated split squats (RLESS) and split squats (SS) were examined. Nine resistance-trained men reported for two sessions. The first session consisted of the consent process, practice, and BS 1-repetition maximum testing. In the second session, participants performed the three exercises while EMG, displacment and ground reaction force data (one leg on plate) were collected. EMG data were collected from the gluteus maximus (GMX), biceps femoris (BF), semitendinosus (ST), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), and medial gastrocnemius (MGas) of the left leg (non-dominant, front leg for unilateral squats). Load for BS was 85% one repetition maximum, and RLESS and SS were performed at 50% of BS load. Repeated measures ANOVA was used to compare all variables for the three exercises, with Bonferroni adjustments for post hoc multiple comparisons, in addition to calculation of standardized mean differences (ES). Muscle activity was similar between exercises except for biceps femoris, which was significantly higher during RLESS than SS during both concentric and eccentric phases (ES = 2.11; p=0.012 and ES= 2.19; p=0.008), and significantly higher during BS than the SS during the concentric phase (ES = 1.78; p=0.029). Vertical displacement was similar between all exercises. Peak vertical force was similar between BS and RLESS and significantly greater during RLESS than SS (ES = 3.03; p=0.001). These findings may be helpful in designing resistance training programs by using RLESS if greater biceps femoris activity is desired.

Muscle Activity in Single- vs. Double-Leg Squats

PubMed Central

DeFOREST, BRADLEY A.; CANTRELL, GREGORY S.; SCHILLING, BRIAN K.

2014-01-01

Muscular activity, vertical displacement and ground reaction forces of back squats (BS), rear-leg elevated split squats (RLESS) and split squats (SS) were examined. Nine resistance-trained men reported for two sessions. The first session consisted of the consent process, practice, and BS 1-repetition maximum testing. In the second session, participants performed the three exercises while EMG, displacment and ground reaction force data (one leg on plate) were collected. EMG data were collected from the gluteus maximus (GMX), biceps femoris (BF), semitendinosus (ST), rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM), tibialis anterior (TA), and medial gastrocnemius (MGas) of the left leg (non-dominant, front leg for unilateral squats). Load for BS was 85% one repetition maximum, and RLESS and SS were performed at 50% of BS load. Repeated measures ANOVA was used to compare all variables for the three exercises, with Bonferroni adjustments for post hoc multiple comparisons, in addition to calculation of standardized mean differences (ES). Muscle activity was similar between exercises except for biceps femoris, which was significantly higher during RLESS than SS during both concentric and eccentric phases (ES = 2.11; p=0.012 and ES= 2.19; p=0.008), and significantly higher during BS than the SS during the concentric phase (ES = 1.78; p=0.029). Vertical displacement was similar between all exercises. Peak vertical force was similar between BS and RLESS and significantly greater during RLESS than SS (ES = 3.03; p=0.001). These findings may be helpful in designing resistance training programs by using RLESS if greater biceps femoris activity is desired. PMID:27182408

Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises

PubMed Central

Drysdale, Cheri L.; Earl, Jennifer E.

2004-01-01

Objective: To investigate surface electromyographic (EMG) activity of the rectus abdominus and external oblique abdominus muscles during pelvic-tilt and abdominal-hollowing exercises performed in different positions. Design and Setting: 2 × 3 (exercise by position) within-subjects design with repeated measures on both factors. All testing was performed in a university laboratory. Subjects: Twenty-six healthy, active young adult females. Measurements: Surface EMG activity was recorded from the left and right rectus abdominus and external oblique muscles while the 2 exercises (pelvic tilt and abdominal hollowing) were performed in different positions (standard, legs supported, and legs unsupported). The standard position was supine in the crook-lying position, the supported position was with hips and knees flexed to 90° and legs supported on a platform, and the unsupported position was with hips and knees flexed to 90° without external support. Peak EMG activity was normalized to a maximum voluntary isometric contraction for each muscle. Results: For the rectus abdominus, there was an interaction between position and activity. Abdominal hollowing produced significantly less activity than the pelvic tilt in all positions. The difference between the 2 exercises with the legs unsupported was of a greater magnitude than the other 2 positions. For the external obliques, there was significantly lower activity during the abdominal hollowing compared with the pelvic tilting. The greatest muscle activity occurred with the legs-unsupported position during both exercises. Conclusions: Abdominal-hollowing exercises produced less rectus abdominus and external oblique activity than pelvic-tilting exercises. Abdominal hollowing may be performed with minimal activation of the large global abdominal muscles. PMID:15085209

Surface Electromyographic Activity of the Abdominal Muscles During Pelvic-Tilt and Abdominal-Hollowing Exercises.

PubMed

Drysdale, Cheri L.; Earl, Jennifer E.; Hertel, Jay

2004-03-01

OBJECTIVE: To investigate surface electromyographic (EMG) activity of the rectus abdominus and external oblique abdominus muscles during pelvic-tilt and abdominal-hollowing exercises performed in different positions. DESIGN AND SETTING: 2 x 3 (exercise by position) within-subjects design with repeated measures on both factors. All testing was performed in a university laboratory. SUBJECTS: Twenty-six healthy, active young adult females. MEASUREMENTS: Surface EMG activity was recorded from the left and right rectus abdominus and external oblique muscles while the 2 exercises (pelvic tilt and abdominal hollowing) were performed in different positions (standard, legs supported, and legs unsupported). The standard position was supine in the crook-lying position, the supported position was with hips and knees flexed to 90 degrees and legs supported on a platform, and the unsupported position was with hips and knees flexed to 90 degrees without external support. Peak EMG activity was normalized to a maximum voluntary isometric contraction for each muscle. RESULTS: For the rectus abdominus, there was an interaction between position and activity. Abdominal hollowing produced significantly less activity than the pelvic tilt in all positions. The difference between the 2 exercises with the legs unsupported was of a greater magnitude than the other 2 positions. For the external obliques, there was significantly lower activity during the abdominal hollowing compared with the pelvic tilting. The greatest muscle activity occurred with the legs-unsupported position during both exercises. CONCLUSIONS: Abdominal-hollowing exercises produced less rectus abdominus and external oblique activity than pelvic-tilting exercises. Abdominal hollowing may be performed with minimal activation of the large global abdominal muscles.

Bilateral contact ground reaction forces and contact times during plyometric drop jumping.

PubMed

Ball, Nick B; Stock, Christopher G; Scurr, Joanna C

2010-10-01

Drop jumping (DJ) is used in training programs aimed to improve lower extremity explosive power. When performing double-leg drop jumps, it is important to provide an equal stimulus to both legs to ensure balanced development of the lower legs. The aim of this study was to bilaterally analyze the ground reactions forces and temporal components of drop jumping from 3 heights. Ten recreationally active male subjects completed 3 bounce-drop jumps from 3 starting heights (0.2, 0.4, and 0.6 m). Two linked force platforms were used to record left- and right-leg peak vertical force, time to peak force, average force, ground contact time, impulse and time differential. Between-height and between-leg comparisons for each variable were made using a multivariate analysis of variance with post hoc Wilcoxon tests (p < 0.05). Results indicated that force and time variables increased as drop jump height increased (p < 0.0001). Post hoc analyses showed that at 0.2- and 0.4-m bilateral differences were present in the time to peak force, average force, and impulse. No bilateral differences for any variables were shown at 0.6-m starting height. The contact time for all jumps was <0.26 seconds. At 0.2 m, only 63% of the subjects had a starting time differential of <0.01 seconds, rising to 96.3% at 0.6 m. The results indicated that 0.6 m is the suggested drop jump height to ensure that no bilateral differences in vertical forces and temporal components occur; however, shorter contact times were found at the lower heights.

Transitional Vertebra and Spina Bifida Occulta Related with Chronic Low Back Pain in a Young Patient

PubMed Central

Habib, Maham; Babar, Sumbal; Kundi, Asif K; Assad, Salman; Sheikh, Amjad

2016-01-01

Bertolotti’s syndrome (BS) must be considered as a differential diagnosis in a young patient presenting with low back pain (LBP). We present a case of a 26-year-old male complaining of mild chronic LBP for six years, radiating to his left thigh for the past six months. He has been taking non-steroidal anti-inflammatory drugs (NSAIDs) with skeletal muscle relaxants for pain relief. The X-ray and computed tomography (CT) imagings showed congenital enlargement of the left transverse process of the fifth lumbar (L5) vertebra forming pseudo-articulation with the sacrum and unilateral pars interarticularis defect at the L4 level on the left side, respectively. He has managed with gabapentin 100 mg three times a day for his neuropathic left leg pain. On follow-up, the patient reported that his pain has improved with gabapentin and it decreased from 8/10 to 4/10 on the visual analogue scale. PMID:27904817

Transitional Vertebra and Spina Bifida Occulta Related with Chronic Low Back Pain in a Young Patient.

PubMed

Kundi, Maryam; Habib, Maham; Babar, Sumbal; Kundi, Asif K; Assad, Salman; Sheikh, Amjad

2016-10-19

Bertolotti's syndrome (BS) must be considered as a differential diagnosis in a young patient presenting with low back pain (LBP). We present a case of a 26-year-old male complaining of mild chronic LBP for six years, radiating to his left thigh for the past six months. He has been taking non-steroidal anti-inflammatory drugs (NSAIDs) with skeletal muscle relaxants for pain relief. The X-ray and computed tomography (CT) imagings showed congenital enlargement of the left transverse process of the fifth lumbar (L5) vertebra forming pseudo-articulation with the sacrum and unilateral pars interarticularis defect at the L4 level on the left side, respectively. He has managed with gabapentin 100 mg three times a day for his neuropathic left leg pain. On follow-up, the patient reported that his pain has improved with gabapentin and it decreased from 8/10 to 4/10 on the visual analogue scale.

Trousseau's syndrome in a patient with advanced stage gastric cancer.

PubMed

Chien, Tai-Long; Rau, Kung-Ming; Chung, Wen-Jung; Tai, Wei-Chen; Wang, Shih-Ho; Chiu, Yi-Chun; Wu, Keng-Liang; Chou, Yeh-Pin; Wu, Chia-Che; Chen, Yen-Hao; Chuah, Seng-Kee

2015-09-14

Patients with cancer are at high risk for thrombotic events, which are known collectively as Trousseau's syndrome. Herein, we report a 66-year-old male patient who was diagnosed with terminal stage gastric cancer and liver metastasis and who had an initial clinical presentation of upper gastrointestinal bleeding. Acute ischemia of the left lower leg that resulted in gangrenous changes occurred during admission. Subsequent angiography of the left lower limb was then performed. This procedure revealed arterial thrombosis of the left common iliac artery with extension to the external iliac artery, the left common iliac artery, the posterior tibial artery, and the peroneal artery, which were occluded by thrombi. Aspiration of the thrombi demonstrated that these were not tumor thrombi. The interesting aspect of our case was that the disease it presented as arterial thrombotic events, which may correlate with gastric adenocarcinoma. In summary, we suggested that the unexplained thrombotic events might be one of the initial presentations of occult malignancy and that thromboprophylaxis should always be considered.

Fibrillary glomerulonephritis associated with monoclonal gammopathy of undetermined significance showing lambda-type Bence Jones protein.

PubMed

Nagao, Tomoaki; Okura, Takafumi; Miyoshi, Ken-Ichi; Watanabe, Sanae; Manabe, Seiko; Kurata, Mie; Irita, Jun; Fukuoka, Tomikazu; Higaki, Jitsuo

2005-09-01

A 79-year-old woman was admitted to our hospital because of leg edema due to a nephrotic syndrome. Urinary and serum immunoelectrophoresis showed positive for the lambda type of Bence Jones protein. A bone marrow aspiration test revealed mild plasmacytosis (6.4% of the total cells). These findings confirmed her diagnosis of monoclonal gammopathy of undetermined significance (MGUS). Her renal biopsy specimen revealed mild mesangial cell proliferation and an increase in the mesangial matrix. Immunofluorescence studies showed positive staining for IgG, IgA, C3, and kappa and lambda light chains in the capillary wall and mesangium area. Electron microscopy showed that the electron deposits in the thickened basement membrane were formed by randomly arranged 16- to 18-nm nonbranching fibrils. A Congo red stain for amyloid was negative. These findings corresponded with the diagnosis of fibrillary glomerulonephritis. Therefore, this case showed a rare combination of fibrillary glomerulonephritis and MGUS.

Nephrotic syndrome and Guillan-Barré Syndrome: a rare association in child.

PubMed

Bouyahia, Olfa; Khelifi, Ibtissem; Gharsallah, Lamia; Harzallah, Kais; Mrad, Sonia Mazigh; Ghargah, Tahar; Boukthir, Samir; Azza, Sammoud El Gharbi

2010-01-01

Only few cases of nephrotic syndrome associated with Guillain-Barre Syndrome (GBS) have been reported in the adult and pediatric literature. A 3-year-old boy was initially admitted to our hospital following five days of progressive weakness of his extremities, fatigue, right leg pain and numbness. There was no past history of renal or neurological disease. Cerebro-spinal fluid studies showed a protein level of 92 mg/dL and a white cell count of 1 per high-power field. The diagnosis of GBS was verified with a nerve conduction velocity test as well as. The GBS symptoms improved gradually on intravenous immunoglobulin. Three weeks later, he developed severe proteinuria and edema; laboratory investigation showed nephrotic syndrome which responded to steroid therapy. Renal biopsy showed minimal change glomerulonephritis. He remained free of proteinuria during his 20 months of follow-up.

First reported case of tenofovir-induced photoallergic reaction

PubMed Central

Verma, Rajesh; Vasudevan, Biju; Shankar, Subramanian; Pragasam, Vijendran; Suwal, Bhabendra; Venugopal, Ruby

2012-01-01

A 50-year-old man, a known case of human immunodeficiency virus infection for the past 1 year, was on antiretroviral therapy in the form of stavudine, lamivudine, and nevirapine. Three days after replacing stavudine with tenofovir, he developed redness on the face and neck and within 48 h the rash became generalized. Dermatological examination revealed involvement of photoexposed areas of the face in the form of erythema and ill-defined hyperpigmented plaques, with mild periorbital edema. There was specific involvement of V and nape of the neck. Extensive erythema and scaling were also present on buttocks, thighs, and upper third of legs. A diagnosis of photoallergic dermatitis to tenofovir was considered and confirmed by histopathology and photopatch test. He responded well to the stoppage of the drug and oral corticosteroids. This is the first report of a photoallergic reaction to tenofovir in the literature. PMID:23112433

Postradiation ureteral obstruction: a reappraisal

DOE Office of Scientific and Technical Information (OSTI.GOV)

Muram, D.; Oxorn, H.; Curry, R.H.

1981-02-01

Thirty-four patients who received radiation therapy for carcinoma of the cervix developed hydronephrosis. Twelve of 34 (35%) had no evidence of pelvic malignancy, and the obstruction was caused by periureteral fibrosis. The incidence of obstructive uropathy due to periureteral fibrosis not associated with recurrent tumor increased when the obstructing lesion was unilateral, the clinical staging of the cervical carcinoma prior to therapy was Stage IB or Stage II rather than Stage III or Stage IV, and the obstructing lesion appeared 2 or more years after the completion of radiation therapy. The appearance of hydronephrosis in association with ipsilateral leg edema,more » and sciatic pain in these patients strongly suggest a recurrent tumor. The diagnosis of periureteral fibrosis should be considered in all patients who develop obstruction of the urinary tract after radiation therapy for carcinoma of the cervix. Laparotomy is indicated if all other methods of investigation fail to confirm the presence of a malignant lesion.« less

Motor imagery during action observation increases eccentric hamstring force: an acute non-physical intervention.

PubMed

Scott, Matthew; Taylor, Stephen; Chesterton, Paul; Vogt, Stefan; Eaves, Daniel Lloyd

2018-06-01

Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force gains for MI during AO (AO + MI) against two pure MI training groups. Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO + MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions. Hamstring strength only increased significantly following AO + MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO + MI was moderate and likely beneficial (d = 0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO + MI (0.72), although small for pure MI (0.39). Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO + MI interventions, over and above pure MI, for injury prevention and rehabilitation. Implications for rehabilitation While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation. In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase. Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical strength, but our study shows that motor imagery during observation of Nordic hamstring exercises offers a safe, affordable and more effective way to facilitate eccentric hamstring strength gains, compared with pure motor imagery. Despite using bilateral imagery and observation training conditions in the present study, strength gains were restricted to the right leg, potentially due to a left hemispheric dominance in motor simulation.

Anatomical location of the corticospinal tract according to somatotopies in the centrum semiovale.

PubMed

Seo, Jeong Pyo; Chang, Pyung-Hun; Jang, Sung Ho

2012-08-15

Little is known about the somatotopic location of the corticospinal tract (CST) in the centrum semiovale (CS). We investigated the somatotopic location of the CST in the CS in the human brain using diffusion tensor tractography (DTT). Fifty-two healthy volunteers were recruited for this study. Diffusion tensor images (DTIs) were obtained at 1.5T, and CSTs for the hand and leg were obtained using FMRIB software. Normalized DTT images were reconstructed using the Montreal Neurological Institute echo-planar imaging template supplied with the SPM. Individual DTI data were calculated as number of pixels in the CS. In the mediolateral direction, average distances of the highest probabilistic locations for hand and leg somatotopies were 25.57 mm and 21.72 mm from the midline between the right and left hemispheres, respectively. For the anteroposterior direction, the average distance of the highest probabilistic locations for hand and leg somatotopies were 0.4 mm and 5.2 mm behind the horizontal line between the medial end of the central sulcus and midline, respectively. In conclusion, hand somatotopy of the CST was found to be located at about 26 mm lateral to the midline almost along the horizon line between the medial end of central sulcus and midline, and leg somatotopy of the CST was found to be located medioposteriorly to the hand somatotopy of the CST. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Training Rapid Stepping Responses in an Individual With Stroke

PubMed Central

Inness, Elizabeth L.; Komar, Janice; Biasin, Louis; Brunton, Karen; Lakhani, Bimal; McIlroy, William E.

2011-01-01

Background and Purpose Compensatory stepping reactions are important responses to prevent a fall following a postural perturbation. People with hemiparesis following a stroke show delayed initiation and execution of stepping reactions and often are found to be unable to initiate these steps with the more-affected limb. This case report describes a targeted training program involving repeated postural perturbations to improve control of compensatory stepping in an individual with stroke. Case Description Compensatory stepping reactions of a 68-year-old man were examined 52 days after left hemorrhagic stroke. He required assistance to prevent a fall in all trials administered during his initial examination because he showed weight-bearing asymmetry (with more weight borne on the more-affected right side), was unable to initiate stepping with the right leg (despite blocking of the left leg in some trials), and demonstrated delayed response times. The patient completed 6 perturbation training sessions (30–60 minutes per session) that aimed to improve preperturbation weight-bearing symmetry, to encourage stepping with the right limb, and to reduce step initiation and completion times. Outcomes Improved efficacy of compensatory stepping reactions with training and reduced reliance on assistance to prevent falling were observed. Improvements were noted in preperturbation asymmetry and step timing. Blocking the left foot was effective in encouraging stepping with the more-affected right foot. Discussion This case report demonstrates potential short-term adaptations in compensatory stepping reactions following perturbation training in an individual with stroke. Future work should investigate the links between improved compensatory step characteristics and fall risk in this vulnerable population. PMID:21511992

Venous Thromboembolism Due to Oral Contraceptive Intake and Spending Nights in a Vehicle -A Case from the 2016 Kumamoto Earthquakes.

PubMed

Sueta, Daisuke; Akahoshi, Rika; Okamura, Yoshinori; Kojima, Sunao; Ikemoto, Tomokazu; Yamamoto, Eiichiro; Izumiya, Yasuhiro; Tsujita, Kenichi; Kaikita, Koichi; Katabuchi, Hidetaka; Hokimoto, Seiji

2017-01-01

A 40-year-old woman experiencing sudden dyspnea went to her personal doctor for advice. She was previously diagnosed with endometriosis and prescribed oral contraceptives for treatment. During earthquakes, she spent 7 nights sleeping in a vehicle. The patient had swelling and pain in her left leg and high D-dimer concentration levels. A contrast-enhanced computed tomography scan revealed a contrast deficit in the bilateral pulmonary artery and in the left lower extremity. She was diagnosed with pulmonary thromboembolism (PTE), and anticoagulation therapy was initiated. This present case is the first report of PTE attributed to the use of oral contraceptives after earthquakes.

Periorbital edema associated with separate courses of ibuprofen and naproxen.

PubMed

Balas, Morad; Plakogiannis, Roda; Sinnett, Mark

2010-06-01

A case of periorbital edema associated with separate courses of ibuprofen and naproxen is reported. An 80-year-old African- American woman with a history of osteoarthritis and hypertension came to the clinic. Her medication regimen included fosinopril sodium 40 mg daily, which she began two years prior. She had no known drug allergies and denied consuming any over-the-counter medications or herbal substances and reported a negative atopic status. She had seen her primary care provider several days prior and reported pain in the hands, fingers, and ankles, which would escalate in the morning and progressively lessen during the course of the day. Her physician prescribed naproxen 375 mg every eight hours as needed. After ingesting two doses of naproxen, she developed itching, swelling, and erythema around the left eye that became progressively worse and spread to the right eye. She contacted her primary care physician, who instructed her to discontinue the naproxen, and the reaction resolved within three days. The patient was maintained on acetaminophen for the arthritic pain with no issues. Approximately three months prior, ibuprofen 600 mg every eight hours as needed was prescribed for the same pain. She stated that after ingesting two doses of ibuprofen, she experienced a reaction similar to that recently experienced with naproxen. At that time, she was instructed to discontinue the ibuprofen, and her symptoms resolved. An elderly woman developed periorbital edema after taking ibuprofen on one occasion and naproxen on another.

Congenital Eccrine Angiomatous Hamartoma: A Rare Entity Revisited

PubMed Central

Mendiratta, Vibhu; Malik, Meenu; Agrawal, Mahima; Jain, Manjula; Gupta, Brijnandan

2018-01-01

Eccrine angiomatous hamartoma (EAH) is a rare benign malformation characterized by eccrine and vascular components. It usually presents at birth or during early infancy or childhood on lower extremities as a nodule or plaque. We report a case of asymptomatic tumoral swelling over the left leg in a 5-month-old Indian infant since birth. This was diagnosed as EAH on histopathology and confirmed on immunohistochemistry. PMID:29854641

KSC-69P-0852

NASA Image and Video Library

1969-11-14

CAPE CANAVERAL, Fla. -- At the Kennedy Space Center in Florida, President Richard M. Nixon speaks in the Launch Control Center after the successful liftoff of the Apollo 12 space vehicle, which sent astronauts Charles Conrad, Jr., Richard F. Gordon and Alan Bean on the first leg of their lunar landing mission. With the President are Paul Donnelly, Launch Operations manager, on the left, and First Lady Pat Nixon, on the right. Photo Credit: NASA

Evaluation of Reproductive Function for Patients with Chronic Radiation Sickness

DTIC Science & Technology

1998-05-01

diseases: diseases of the respiratory organs (bronchoectasis), diabetes , hepatic and renal insufficiency. The method of choice used to identify the causes...of the patients was infantilism , i.e., retarded and insufficient sexual development. As is indicated in publication [29], in 4 cases out of 940 the...both legs and left forearm after a railway disaster. The two remaining women, twins born in 1944, were diagnosed with infantilism which is

Ruptured Baker's cyst with compartment syndrome: an extremely unusual complication.

PubMed

Hamlet, Mark; Galanopoulos, Ilias; Mahale, Avinash; Ashwood, Neil

2012-12-20

A 69-year-old man presented with sudden onset of pain with acute tense swelling of his left leg. Initially he was treated empirically with antibiotics for cellulitis while the possibility of deep vein thrombosis was ruled out. His symptoms gradually worsened with progressive distal neurological deficit and increasing pain. Further investigations suggested that he had a ruptured Baker's cyst in the calf with development of compartment syndrome.

West nile poliomyelitis in a 7-year-old child.

PubMed

Hainline, Margaret L; Kincaid, John C; Carpenter, Denise L; Golomb, Meredith R

2008-11-01

West Nile poliomyelitis is a well-described neurologic manifestation of West Nile viral infection in adults. However, few reports have described this manifestation in children infected with West Nile virus. We describe a 7-year-old boy who developed West Nile poliomyelitis with flaccid paralysis of his left leg. Electrodiagnostic testing and radiologic imaging confirmed anterior horn cell injury. We report on his course clinically and electrodiagnostically over 20 months.

Tissue damage caused by the intramuscular injection of long-acting penicillin.

PubMed

Schanzer, H; Jacobson, J H

1985-04-01

In order to elucidate whether tissue damage produced on occasion by intramuscular injection of long-acting penicillin is due to accidental intra-arterial injection or vasospasm, two types of experiments were carried out in rabbits. In the first set of experiments, six New Zealand White rabbits were given intra-arterial injections of 0.4 mL of a mixture containing 300,000 U of penicillin G benzathine and 300,000 units of penicillin procaine per milliliter (Bicillin C-R) into the left femoral artery and 0.4 mL of normal saline into the right femoral artery as autocontrol. In a second set of experiments, 0.4 mL of the same penicillin preparation was injected in the space surrounding the left femoral artery in five New Zealand rabbits, and 0.4 mL of normal saline was injected in a similar fashion around the right femoral artery as control. The legs of the rabbits that received the intra-arterial injection of penicillin invariably developed ischemic manifestations. None of the legs of rabbits given intra-arterial injections of normal saline had pathologic manifestations. None of the rabbits that received the periarterial penicillin preparation or normal saline developed abnormalities. These results strongly suggest that the tissue damage produced by penicillin is secondary to the intra-arterial administration of the drug.

Effects of Vestibular Rehabilitation on Balance Control in Older People with Chronic Dizziness: A Randomized Clinical Trial.

PubMed

Ricci, Natalia Aquaroni; Aratani, Mayra Cristina; Caovilla, Heloísa Helena; Ganança, Fernando Freitas

2016-04-01

The aim of this study was to compare the effects of vestibular rehabilitation protocols on balance control in elderly with dizziness. This is a randomized clinical trial with 3-mo follow-up period. The sample was composed of 82 older individuals with chronic dizziness from vestibular disorders. The control group was treated according to the Conventional Cawthorne & Cooksey protocol (n = 40), and the experimental group was submitted to a Multimodal Cawthorne & Cooksey protocol (n = 42). Measures included Dynamic Gait Index, fall history, hand grip strength, Time Up-and-Go Test, sit-to-stand test, multidirectional reach, and static balance tests. With the exception of history of falls, Forward Functional Reach, Unipedal Right and Left Leg Eyes Closed, and Sensorial Romberg Eyes Open, all outcomes improved after treatments. Such results persisted at follow-up period, with the exception of the Tandem Eyes Open and the Timed Up-and-Go manual. The between-group differences for Sensorial Romberg Eyes Closed (4.27 secs) and Unipedal Left Leg Eyes Open (4.08 secs) were significant after treatment, favoring the Multimodal protocol. Both protocols resulted in improvement on elderly's balance control, which was maintained during a short-term period. The multimodal protocol presented better performance on specific static balance tests.

Two cases of bilateral amiodarone-associated optic neuropathy.

PubMed

Chassang, B; Bonnin, N; Moisset, X; Citron, B; Clavelou, P; Chiambaretta, F

2014-03-01

The widespread use of amiodarone is limited by its toxicity, notably to the optic nerve. We report two cases of bilateral optic nerve neuropathy due to amiodarone, and provide a detailed description of the disease. The first case was a 59-year-old man complaining from insidious monocular loss of vision within ten months of initiating amiodarone. Funduscopy and optical coherence tomography showed bilateral optic disc edema. The second case was a 72-year-old man presenting with a decrease in visual acuity in his left eye for a month. Funduscopy showed a left optic nerve edema, and fluorescein angiography showed bilateral papillitis. In both cases, the clinical presentation was not suggestive of ischemic neuropathy, because of the preservation of visual acuity and the insidious onset. In addition, both cardiovascular and inflammatory work-up were normal. An amiodarone-associated neuropathy was suspected, and amiodarone was discontinued with the approval of the cardiologist, with complete regression of the papilledema and a stabilization of visual symptoms. Differentiating between amiodarone-associated optic neuropathy and anterior ischemic optic neuropathy may be complicated by the cardiovascular background of such patients. The major criterion is the absence of a severe decrease in visual acuity; other criteria are the normality of cardiovascular and inflammatory work-up, and the improvement or the absence of worsening of symptoms after discontinuation of amiodarone. Amiodarone-associated neuropathy remains a diagnosis of exclusion, and requires amiodarone discontinuation, which can only be done with the approval of a cardiologist, and sometimes requires replacement therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

High Intracranial Pressure Induced Injury in the Healthy Rat Brain.

PubMed

Dai, Xingping; Bragina, Olga; Zhang, Tongsheng; Yang, Yirong; Rao, Gutti R; Bragin, Denis E; Statom, Gloria; Nemoto, Edwin M

2016-08-01

We recently showed that increased intracranial pressure to 50 mm Hg in the healthy rat brain results in microvascular shunt flow characterized by tissue hypoxia, edema, and increased blood-brain barrier permeability. We now determined whether increased intracranial pressure results in neuronal injury by Fluoro-Jade stain and whether changes in cerebral blood flow and cerebral metabolic rate for oxygen suggest nonnutritive microvascular shunt flow. Intracranial pressure was elevated by a reservoir of artificial cerebrospinal fluid connected to the cisterna magna. Arterial blood gases, cerebral arterial-venous oxygen content difference, and cerebral blood flow by MRI were measured. Fluoro-Jade stain neurons were counted in histologic sections of the right and left dorsal and lateral cortices and hippocampus. University laboratory. Male Sprague Dawley rats. Arterial pressure support if needed by IV dopamine infusion and base deficit corrected by sodium bicarbonate. Fluoro-Jade stain neurons increased 2.5- and 5.5-fold at intracranial pressures of 30 and 50 mm Hg and cerebral perfusion pressures of 57 ± 4 (mean ± SEM) and 47 ± 6 mm Hg, respectively (p < 0.001) (highest in the right and left cortices). Voxel frequency histograms of cerebral blood flow showed a pattern consistent with microvascular shunt flow by dispersion to higher cerebral blood flow at high intracranial pressure and decreased cerebral metabolic rate for oxygen. High intracranial pressure likely caused neuronal injury because of a transition from normal capillary flow to nonnutritive microvascular shunt flow resulting in tissue hypoxia and edema, and it is manifest by a reduction in the cerebral metabolic rate for oxygen.

[Angle-closure glaucoma secondary to nonspecific orbital inflammatory: case report].

PubMed

Násser, Luciano Sólia; Liendo da Costa, Vera Lucia; Taniguchi, Marcel Papa; Bolanho, Anamaria; Petrilli, Ana Maria Noriega

2007-01-01

The nonspecific orbital inflammatory presents several clinical forms. When it evolves the posterior segment of the eye, usually by contiguity, it can lead to serious damage to vision functions. Posterior scleritis causes permanent damage to the vision and rarely progresses to acute glaucoma. E.N., a 24-year-old black man, complained of pain in the left eye (OS) for ten days, with low visual acuity, malaise, nauseas and vomiting. On ophthalmologic examination, he presented proptosis, restricted eye movements and edema on the upper left eyelid. Best-corrected visual acuity was 20/20 in OD and counting fingers at 1.5m in OS. The intraocular pressure was 14 mmHg in OD and 34 mmHg in OS. The biomicroscopy presented in OS conjunctival hyperemia cornea with keratic precipitates, shallow anterior chamber with cells and flare 2+. Gonioscopy in OS showed angle-closure of 360 masculine. The ophthalmoscopic examination revealed increased vascular tortuosity and posterior pole edema. Treatment for acute glaucoma was initiated and complementary tests were ordered. Ocular ultrasonography and orbit computerized tomography showed a diffuse thickening of the ocular wall and extrinsic muscles. Other tests were normal. The presumptive diagnosis was acute nonspecific orbital inflammation affecting the ocular bulb posterior segment together with acute glaucoma. He initiated on prednisone 60 mg/day PO. After two weeks of systemic corticotherapy, the patient was asymptomatic, with evident regression of proptosis and scleritis and normal intraocular pressure (11 mmHg in AU). Although not very frequent, acute glaucoma may be present in orbital inflammatory process and should be treated with systemic corticotherapy and topical medication.

Acute dimethyl sulfoxide therapy in brain edema. Part 3: effect of a 3-hour infusion.

PubMed

Del Bigio, M; James, H E; Camp, P E; Werner, R; Marshall, L F; Tung, H

1982-01-01

Albino rabbits with experimental brain edema produced by a combined cryogenic left hemisphere lesion and metabolic 6-aminonicotinamide lesion were administered a 3-hour intravenous infusion of dimethyl sulfoxide (DMSO). Simultaneous recording of intracranial pressure (ICP), systolic arterial pressure (SAP), and central venous pressure (CVP) and electroencephalography were performed while the animals were being ventilated mechanically to produce a constant Pa CO2 value (38-42 torr). At the end of the infusion, the brain water and electrolyte contents were measured. There was a persistent and progressive reduction of ICP during the infusion, the nadir occurring at 3 hours (p less than 0.005 from zero time), with no change in SAP or CVP. There was a reduction of brain water in both hemispheres when compared to untreated controls, but this was significant for the right hemisphere only (p less than 0.005). There was a significant reduction of the brain sodium content for both hemispheres, but no significant change occurred in brain potassium content. The DMSO infusion was effective not only in reducing ICP, but also in sustaining this reduction for 3 hours.

Enterococcus faecalis Endogenous Endophthalmitis from Valvular Endocarditis

PubMed Central

Barge, Sidnei; Rothwell, Renata; Varandas, Rosário; Agrelos, Luís

2013-01-01

We report a case of a 74-year-old female, with a mitral heart valve, who presented with pain and blurred vision in the right eye for 2 days. Her visual acuity was light perception (LP) in the right eye and 20/40 in the left eye. Slit lamp examination showed corneal edema and hypopyon, and a view of the right fundus was impossible. Echography showed vitreous condensation. One day after presentation, the patient developed acute lung edema requiring hospitalization, so she was not submitted to vitreous tap and intravitreal treatment. The cardiac and systemic evaluations revealed a mitral endocarditis secondary to Enterococcus faecalis. The patient improved systemically with treatment with gentamicin, vancomycin, and linezolid. Her visual acuity remained as no LP, and her intraocular pressure (IOP) has been controlled with brimonidine bid despite developing a total cataract with 360° posterior synechia. A cardiac source for endogenous endophthalmitis should be considered in the presence of a prosthetic cardiac valve. The treatment and followup must be made in cooperation with a cardiologist specialist, but the ophthalmologist can play a key role in the diagnosis. PMID:23936701

Management of brain metastasis in a patient with advanced epithelial ovarian carcinoma by gamma-knife radiosurgery.

PubMed

Nikolaoul, Marinos; Stamenković, Srdjan; Stergiou, Christos; Skarleas, Christos; Torrens, Michael

2015-01-01

Brain metastases from epithelial ovarian cancer (EOC) are rare events. We present a rare case of single ovarian cancer metastasis to the brain treated with gamma-knife radiosurgery (GKRS). A 65-year-old woman with advanced EOC presented with severe neurologic symptoms. A single brain metastasis of 3.2 cm with surrounding edema in the left parietal lobe was detected by brain magnetic resonance imaging (MRI) scan during the work-up. The decision to perform GKRS was due to a surgical inaccessibility of intracranial lesion. Twelve weeks after the procedure, the MRI scan showed reduction in the diameter of brain metastasis and surrounding edema and the patient returned to good mental and motor performance.The patient survived for 22 months following treatment and died from a progressive intra-abdominal disease. Prognosis of ovarian cancer patients with brain metastases is generally poor regardless of treatment. Our case shows that GKRS as primary treatment modality for the control of ovarian cancer metastases to the brain was effective and can be considered as a treatment of choice if international selection criteria are followed.

Uneventful Anterior Migration of Intravitreal Ozurdex Implant in a Patient with Iris-Sutured Intraocular Lens and Descemet Stripping Automated Endothelial Keratoplasty

PubMed Central

Zafar, Andleeb; Aslanides, Ioannis M.; Selimis, Vasileios; Tsoulnaras, Konstantinos I.; Tabibian, David; Kymionis, George D.

2018-01-01

Purpose We report here the case of a patient with anterior segment migration of intravitreal dexamethasone implant as well as its management and outcome. Methods The patient had the following sequence of events: complicated cataract surgery, iris-sutured intraocular lens implant, followed by cystoid macular edema treated with intravitreal Avastin, retinal vein occlusion treated with intravitreal dexamethasone implant, corneal decompensation treated with Descemet stripping automated endothelial keratoplasty (DSAEK), and finally recurrence of macular edema treated with repeated intravitreal dexamethasone implant. Results Dexamethasone implant had completely dissolved from the eye 12 weeks after insertion without any complication. Conclusion A conservative approach with regular monitoring in the situation of a quiet anterior segment without any corneal decompensation can provide enough time for the implant to dissolve without causing any complication to the involved eye, avoiding any additional surgical intervention, as presented in this case report. Despite the fact that the implant was left for natural dissolution, there were no adverse effects related to the graft or the eye. PMID:29643797

Cardiomyopathy in captive African hedgehogs (Atelerix albiventris).

PubMed

Raymond, J T; Garner, M M

2000-09-01

From 1994 to 1999, 16 captive African hedgehogs (Atelerix albiventris), from among 42 necropsy cases, were diagnosed with cardiomyopathy. The incidence of cardiomyopathy in this study population was 38%. Fourteen of 16 hedgehogs with cardiomyopathy were males and all hedgehogs were adult (>1 year old). Nine hedgehogs exhibited 1 or more of the following clinical signs before death: heart murmur, lethargy, icterus, moist rales, anorexia, dyspnea, dehydration, and weight loss. The remaining 7 hedgehogs died without premonitory clinical signs. Gross findings were cardiomegaly (6 cases), hepatomegaly (5 cases), pulmonary edema (5 cases), pulmonary congestion (4 cases), hydrothorax (3 cases), pulmonary infarct (1 case), renal infarcts (1 case), ascites (1 case), and 5 cases showed no changes. Histologic lesions were found mainly within the left ventricular myocardium and consisted primarily of myodegeneration, myonecrosis, atrophy, hypertrophy, and disarray of myofibers. All hedgehogs with cardiomyopathy had myocardial fibrosis, myocardial edema, or both. Other common histopathologic findings were acute and chronic passive congestion of the lungs, acute passive congestion of the liver, renal tubular necrosis, vascular thrombosis, splenic extramedullary hematopoiesis, and hepatic lipidosis. This is the first report of cardiomyopathy in African hedgehogs.

Internal Carotid Artery Agenesis with an Intercavernous Anastomosis: A Rare Case.

PubMed

Erdogan, Mucahid; Senadim, Songul; Ince Yasinoglu, K Nur; Selcuk, H Hakan; Atakli, H Dilek

2017-10-01

Agenesis of the internal carotid artery (ICA) is a rare vascular anomaly that was first observed postmortem. Various anastomoses supply the distal vessels at the site of agenesis. Of these anastomoses, an intercavernous anastomosis is very rare. This paper presents a patient with ischemic stroke in whom we discovered left ICA agenesis and an ipsilateral intercavernous anastomosis. A 58-year-old man with a history of myocardial infarction and diabetes mellitus presented with sudden-onset difficulty in speaking, numbness on the left side of the face, and weakness of the left arm and leg. Neurological examination revealed dysarthria, left facial paralysis, left hemiparesis, and bilateral absence of the plantar reflexes. Diffusion-weighted magnetic resonance imaging showed a right middle cerebral artery (MCA) infarction. On cranial and cervical magnetic resonance angiography, the left ICA could not be seen distal to the bifurcation; the left MCA was supplied through an intercavernous anastomosis between the right ICA and the left ICA. Cranial computed tomography (CT) revealed the absence of the left carotid canal. Digital subtraction angiography led to a diagnosis of left ICA agenesis with an intercavernous anastomosis. The patient was discharged on acetylsalicylic acid and warfarin. ICA agenesis with an intercavernous anastomosis is a rare vascular anomaly that should be differentiated from secondary causes of ICA stenosis and occlusions by showing agenesis of the carotid canal on cranial CT. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Acute Lameness in a Roller Pigeon ( Columba livia ) with Multicentric Lymphosarcoma.

PubMed

Williams, Susan M; Williams, Robert J; Gogal, Robert M

2017-06-01

A 3-yr-old adult female roller pigeon ( Columba livia ) used as part of a breeding pair for an ongoing research study presented with acute left limb lameness. Palpation of the left leg and region revealed a large lump near the coxofemoral joint. The bird was able to ambulate in the cage, but would not brood her hatchling. The bird was humanely euthanized and necropsy was performed. Grossly, multiple large white to pale tan nodules were noted in the pancreas, lung, rib cage, intestines, and unilaterally in the left kidney. Microscopic examination of the various organs revealed neoplastic proliferation of round cells consistent with lymphoblasts. Immunohistochemistry was performed with the use of antibodies to CD3, CD79a, CD20, and CD21 to phenotype the cells. The results indicated that the neoplastic infiltrating cells were predominantly of T-cell origin.

Effect of transforaminal epidural polydeoxyribonucleotide injections on lumbosacral radiculopathy: A case report.

PubMed

Kang, Keum Nae; Kim, Tae Woong; Koh, Jin Woo; Oh, Han Byeol; Mun, Jong-Uk; Seo, Mi Sook; Kim, Young Uk

2017-06-01

Transforaminal epidural glucocorticoids administration is widely performed for the management of lumbosacral radiculopathy. However, it may worsen the condition of patients with type 2 diabetes mellitus (DM). Polydeoxyribonucleotide (PDRN) was recently noted as a substitute for glucocorticoids. A 44-year-old male patient was admitted to our pain clinic with symptoms of low back pain with severe pain and tingling sensation of left posterolateral leg. He had type 2 DM medicated with Glimepiride and Metformin. Blood glucose level was 367 mg/dL. He declined to use glucocorticoid. He was diagnosed as left foraminal disc protrusion at L4-5, left subarticular disc protrusion at L5-S1. Fluoroscopically guided transforaminal epidural PDRN injections were carried out. The patient was followed up for more than 6 months and demonstrated good improvement in lumbosacral radiculopathy without any complications. This is the first successful report on epidural injection of PDRN.

Recording electrocardiograms using 3-limb lead cables instead of the standard 4: a modification to minimize incorrect electrode placements.

PubMed

Soliman, Elsayed Z

2008-01-01

The similarity between and the number of limb lead cables play an important role in the frequency of incorrect connection of limb electrodes. Hence, a modified electrocardiogram (ECG) acquisition procedure is proposed in this brief communication, whereby the left-leg (LL) and right-leg (RL) electrode cables are combined into 1 cable, referred to as combined LL/RL cable. The electrode wires in the combined LL/RL cable are connected to 2 electrodes placed on both sides of the LL. The combined LL/RL cable is unique enough (being thicker) not to be mistaken with the upper limb electrode cables. The proposed modification will not in any way influence the ECG waveforms or amplitudes, and it can be expected to substantially reduce incorrect limb electrode placements.

Extraction and Classification of Human Gait Features

NASA Astrophysics Data System (ADS)

Ng, Hu; Tan, Wooi-Haw; Tong, Hau-Lee; Abdullah, Junaidi; Komiya, Ryoichi

In this paper, a new approach is proposed for extracting human gait features from a walking human based on the silhouette images. The approach consists of six stages: clearing the background noise of image by morphological opening; measuring of the width and height of the human silhouette; dividing the enhanced human silhouette into six body segments based on anatomical knowledge; applying morphological skeleton to obtain the body skeleton; applying Hough transform to obtain the joint angles from the body segment skeletons; and measuring the distance between the bottom of right leg and left leg from the body segment skeletons. The angles of joints, step-size together with the height and width of the human silhouette are collected and used for gait analysis. The experimental results have demonstrated that the proposed system is feasible and achieved satisfactory results.

Pseudocyclops schminkei (Copepoda, Calanoida, Pseudocyclopidae): a new species from Okinawa

NASA Astrophysics Data System (ADS)

Chullasorn, Supawadee; Ferrari, Frank D.; Dahms, Hans-Uwe

2010-03-01

Both genders of Pseudocyclops schminkei n. sp. are described from a pearl fishery aquarium on Zamami Island, Okinawa, Japan; it is the 37th species of the genus. Pseudocyclops schminkei sp. nov. differs from other species of the magnus species group in the shape of the lobes of distal exopodal segment of the male left leg 5, and the morphology of setae on middle and distal exopodal segment of male right swimming leg 2. Aspects of the morphology of P. xiphophorus and P. bilobatus are redescribed, and an unnamed Pseudocyclops sp. from the Shedd Aquarium in Chicago, IL, is briefly noted. Females of P. schminkei sp. nov., P. xiphophorus and Pseudocyclops sp. could not be separated from each other with the small number of specimens available in this study for the former two species.

Histiocytic Sarcoma and Bilateral Facial Vein Thrombosis in a Siberian Hamster (Phodopus sungorus).

PubMed

Coble, Dondrae J; Shoemaker, Margaret; Harrington, Bonnie; Dardenne, Adrienne D; Bolon, Brad

2015-04-01

A 21-mo-old, male Siberian hamster (Phodopus sungorus) presented with left-sided facial swelling, proptosis of the left eye, and blepharospasm of the right eye. The hamster had been used only for breeding. Because of the poor prognosis, the hamster was euthanized without additional diagnostic assays or treatments. Routine gross pathologic evaluation demonstrated exophthalmos and presumptive hyphema of the left eye, bilateral facial edema, freely movable nodules within the mesentery, white foci within the liver, and a large mass effacing the cranial pole of the right kidney. On histologic evaluation, the mesenteric nodules and liver foci expressed histiocytic marker CD163 and thus were diagnosed as sites of histiocytic sarcoma, whereas the kidney mass was a well-differentiated renal cell carcinoma. The facial swelling resulted from bilateral, chronic, severe, branching thrombi in many facial veins. Additional age-related histopathologic findings were observed in other organs, including diffuse glomerulopathy, nesidioblastosis (pancreatic islet neoformation), and multiple foci of severe cartilage degeneration in the axial skeleton. To our knowledge, this report provides the first description of histiocytic sarcoma in a Siberian hamster.

Contemporary review on the pathogenesis of takotsubo syndrome: The heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals.

PubMed

Y-Hassan, Shams; De Palma, Rodney

2017-02-01

Takotsubo syndrome (TS), an increasingly recognized acute cardiac disease entity, is characterized by a unique pattern of circumferential and typically regional left ventricular wall motion abnormality resulting in a conspicuous transient ballooning of the left ventricle during systole. The mechanism of the disease remains elusive. However, the sudden onset of acute myocardial stunning in a systematic pattern extending beyond a coronary artery territory; the history of a preceding emotional or physical stress factor in two thirds of cases; the signs of sympathetic denervation at the regions of left ventricular dysfunction on sympathetic scintigraphy; the finding of myocardial edema and other signs consistent with (catecholamine-induced) myocarditis shown by cardiac magnetic resonance imaging; and the contraction band necrosis on histopathological examination all argue strongly for the involvement of the cardiac sympathetic nervous system in the pathogenesis of TS. In this narrative review, extensive evidence in support of local cardiac sympathetic nerve hyperactivation, disruption and norepinephrine spillover causing TS in predisposed patients is provided. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Reliability of a new test battery for fitness assessment of the European Astronaut corps.

PubMed

Petersen, Nora; Thieschäfer, Lutz; Ploutz-Snyder, Lori; Damann, Volker; Mester, Joachim

2015-01-01

To optimise health for space missions, European astronauts follow specific conditioning programs before, during and after their flights. To evaluate the effectiveness of these programs, the European Space Agency conducts an Astronaut Fitness Assessment (AFA), but the test-retest reliability of elements within it remains unexamined. The reliability study described here presents a scientific basis for implementing the AFA, but also highlights challenges faced by operational teams supporting humans in such unique environments, especially with respect to health and fitness monitoring of crew members travelling not only into space, but also across the world. The AFA tests assessed parameters known to be affected by prolonged exposure to microgravity: aerobic capacity (VO2max), muscular strength (one repetition max, 1 RM) and power (vertical jumps), core stability, flexibility and balance. Intraclass correlation coefficients (ICC3.1), standard error of measurement and coefficient of variation were used to assess relative and absolute test-retest reliability. Squat and bench 1 RM (ICC3.1 = 0.94-0.99), hip flexion (ICC3.1 = 0.99) and left and right handgrip strength (ICC3.1 = 0.95 and 0.97), showed the highest test-retest reliability, followed by VO2max (ICC3.1 = 0.91), core strength (ICC3.1 = 0.78-0.89), hip extension (ICC3.1 = 0.63), the countermeasure (ICC3.1 = 0.76) and squat (ICC3.1 = 0.63) jumps, and single right- and left-leg jump height (ICC3.1 = 0.51 and 0.14). For balance, relative reliability ranged from ICC3.1 = 0.78 for path length (two legs, head tilted back, eyes open) to ICC3.1 = 0.04 for average rotation velocity (one leg, eyes closed). In a small sample (n = 8) of young, healthy individuals, the AFA battery of tests demonstrated acceptable test-retest reliability for most parameters except some balance and single-leg jump tasks. These findings suggest that, for the application with astronauts, most AFA tests appear appropriate to be maintained in the test battery, but that some elements may be unreliable, and require either modification (duration, selection of task) or removal (single-leg jump, balance test on sphere) from the battery. The test battery is mobile and universally applicable for occupational and general fitness assessment by its comprehensive composition of tests covering many systems involved in whole body movement.

Study of the variations of fall induced hip fracture risk between right and left femurs using CT-based FEA.

PubMed

Faisal, Tanvir R; Luo, Yunhua

2017-10-03

Hip fracture of elderly people-suffering from osteoporosis-is a severe public health concern, which can be reduced by providing a prior assessment of hip fracture risk. Image-based finite element analysis (FEA) has been considered an effective computational tool to assess the hip fracture risk. Considering the femoral neck region is the weakest, fracture risk indicators (FRI) are evaluated for both single-legged stance and sideways fall configurations and are compared between left and right femurs of each subject. Quantitative Computed Tomography (QCT) scan datasets of thirty anonymous patients' left and right femora have been considered for the FE models, which have been simulated with an equal magnitude of load applied to the aforementioned configurations. The requirement of bilateral hip assessment in predicting the fracture risk has been explored in this study. Comparing the sideways fall and single-legged stance, the FRI varies by 64 to 74% at the superior aspects and by 14 to 19% at the inferior surfaces of both the femora. The results of this in vivo analysis clearly substantiate that the fracture is expected to initiate at the superior surface of femoral neck region if a patient falls from his/her standing height. The distributions of FRI between the femurs vary considerably, and the variability is significant at the superior aspects. The p value (= 0.02) obtained from paired sample t-Test yields p value ≤ 0.05, which shows the evidence of variability of the FRI distribution between left and right femurs. Moreover, the comparison of FRIs between the left and right femur of men and women shows that women are more susceptible to hip fracture than men. The results and statistical variation clearly signify a need for bilateral hip scanning in predicting hip fracture risk, which is clinically conducted, at present, based on one hip chosen randomly and may lead to inaccurate fracture prediction. This study, although preliminary, may play a crucial role in assessing the hip fractures of the geriatric population and thereby, reducing the cost of treatment by taking predictive measure.

Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure).

PubMed

Caldentey, Guillem; Khairy, Paul; Roy, Denis; Leduc, Hugues; Talajic, Mario; Racine, Normand; White, Michel; O'Meara, Eileen; Guertin, Marie-Claude; Rouleau, Jean L; Ducharme, Anique

2014-02-01

This study sought to assess the prognostic value of physical examination in a modern treated heart failure population. The physical examination is the cornerstone of the evaluation and monitoring of patients with heart failure. Yet, the prognostic value of congestive signs (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) has not been assessed in the current era. A post-hoc analysis was conducted on all 1,376 patients, 81% male, mean age 67 ± 11 years, with symptomatic left ventricular systolic dysfunction enrolled in the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial. The prognostic value of baseline physical examination findings was assessed in univariate and multivariate Cox regression analyses. Peripheral edema was observed in 425 (30.9%), jugular venous distension in 297 (21.6%), a third heart sound in 207 (15.0%), and pulmonary rales in 178 (12.9%) patients. Death from cardiovascular causes occurred in 357 (25.9%) patients over a mean follow-up of 37 ± 19 months. All 4 physical examination findings were associated with cardiovascular mortality in univariate analyses (all p values <0.01). In multivariate analyses, taking all 4 signs as potential covariates, only rales (hazard ratio 1.41; 95% confidence interval: 1.07 to 1.86; p = 0.013) and peripheral edema (hazard ratio: 1.25; 95% confidence interval: 1.00 to 1.57; p = 0.048) were associated with cardiovascular mortality, independent of other variables. In the modern era, congestive signs on the physical examination (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) continue to provide important prognostic information in patients with congestive heart failure. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Cavernous sinus thrombosis caused by contralateral sphenoid sinusitis: a case report

PubMed Central

2013-01-01

Objective To report a rare case of unilateral cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. Case report A 33-year-old female visited our hospital for severe, right-sided, temporal headache, chemosis, periorbital edema, and proptosis. These signs were associated with congested erythematous nasal mucosa with purulent discharge from the right superior nasal meatus. Contrast enhanced CT showed dilated left superior ophthalmic vein, suggestive of thrombosis, contrast enhancement of the left cavernous sinuses, and dilation of cavernous sinus, indicating cavernous sinus inflammation. The right maxillary, ethmoid and sphenoid sinuses showed mucosal thickening and retention of purulent material. She was diagnosed with cavernous sinus thrombosis caused by contralateral sphenoid sinusitis. All clinical symptoms and signs improved after endoscopic sphenoidotomy and appropriate medical treatment. Conclusions Sphenoiditis can cause contralateral cavernous sinus thrombosis. Early surgical sphenoidotomy and aggressive medical treatment are the cornerstones of successful management of this life-threatening complication. PMID:23497466

Supra hepatic inferior vena cava and right atrial thrombosis following a traffic car crash.

PubMed

Sabzi, Feridoun; Karim, Hosein; Haghi, Marjan

2016-07-01

We present a case of nephrotic syndrome associated with right atrial and supra hepatic vein part of inferior vena caval thrombosis. This patient presented with dyspena, lower extremity edema and back pain after a vehicle accident and blunt trauma to the abdomen. Trauma should be considered not only as a thrombophilic pre-disposition, but also as a predisposing factor to IVC endothelium injury and thrombosis formation. Echocardiography revealed supra hepatic vein IVC thrombosis floating to the right atrium. A C-T scan with contrast also showed pulmonary artery emboli to the left upper lobe. With open heart surgery, the right atrial and IVC clot were extracted and the main left and right pulmonary arteries were evaluated for possible clot lodging. The patient had an uneventful postoperative recovery and thrombosis has not reoccurred with periodical follow-up examinations. © 2016 KUMS, All rights reserved.

Neck Pain One Week after Pacemaker Generator Replacement.

PubMed

Graham, Ross F; Wightman, John M

2015-07-01

The incidence of cardiac pacemaker implantation has risen markedly in the past three decades, making awareness of possible postprocedural complications critical to the emergency physician. This case is the first documented instance of internal jugular (IJ) deep vein thrombosis (DVT) from an uncomplicated pacemaker generator replacement. A patient presented to an Emergency Department with a 2-day history of mild left temporal headache migrating to his left neck. The patient did not volunteer this information, but review of systems revealed a temporary transvenous pacemaker inserted through the right IJ vein 1 week previously during a routine exchange of a left-sided cardiac pacemaker generator. Manipulation of the existing pacemaker wires entering the left subclavian vein was minimal. Computed tomographic angiography of the neck demonstrated near-complete thrombotic occlusion of the entire length of his left IJ vein. This required hospital admission for observation and treatment with anticoagulation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: DVT, with thrombotic extension into adjacent vessels anywhere along the course of pacemaker wires, should be considered by the emergency provider in the evaluation of head, neck, or upper extremity symptoms after recent or remote implantation or manipulation of a transvenous cardiac pacemaker, including generator replacement. Failure to identify and treat appropriately could result in significant morbidity and mortality from airway edema, septic thrombophlebitis, superior vena cava syndrome, superior sagittal sinus thrombosis, or pulmonary embolism. Published by Elsevier Inc.

Changes in neural resting state activity in primary and higher-order motor areas induced by a short sensorimotor intervention based on the Feldenkrais method

PubMed Central

Verrel, Julius; Almagor, Eilat; Schumann, Frank; Lindenberger, Ulman; Kühn, Simone

2015-01-01

We use functional magnetic resonance imaging to investigate short-term neural effects of a brief sensorimotor intervention adapted from the Feldenkrais method, a movement-based learning method. Twenty-one participants (10 men, 19–30 years) took part in the study. Participants were in a supine position in the scanner with extended legs while an experienced Feldenkrais practitioner used a planar board to touch and apply minimal force to different parts of the sole and toes of their left foot under two experimental conditions. In the local condition, the practitioner explored movement within foot and ankle. In the global condition, the practitioner focused on the connection and support from the foot to the rest of the body. Before (baseline) and after each intervention (post-local, post-global), we measured brain activity during intermittent pushing/releasing with the left leg and during resting state. Independent localizer tasks were used to identify regions of interest (ROI). Brain activity during left-foot pushing did not significantly differ between conditions in sensorimotor areas. Resting state activity (regional homogeneity, ReHo) increased from baseline to post-local in medial right motor cortex, and from baseline to post-global in the left supplementary/cingulate motor area. Contrasting post-global to post-local showed higher ReHo in right lateral motor cortex. ROI analyses showed significant increases in ReHo in pushing-related areas from baseline to both post-local and post-global, and this increase tended to be more pronounced post-local. The results of this exploratory study show that a short, non-intrusive sensorimotor intervention can have short-term effects on spontaneous cortical activity in functionally related brain regions. Increased resting state activity in higher-order motor areas supports the hypothesis that the global intervention engages action-related neural processes. PMID:25972804

The effect of topical arnica on muscle pain.

PubMed

Adkison, Julie D; Bauer, David W; Chang, Terence

2010-10-01

The herb Arnica montana, in topical formulations, has been reputed to decrease bruising and muscle pain. This claim has been inadequately and incompletely addressed. To determine whether topical A. montana cream could decrease subjective leg pain following calf raises. Secondary outcomes were effects on ankle range of motion and muscle tenderness. A randomized, double-blind, placebo-controlled trial was conducted in 53 subjects. Active range of motion was measured in both ankles, and then a series of calf-raises were completed according to a standardized protocol. Each participant received 2 tubes of cream, 1 with active arnica and 1 with placebo. The creams were applied to the lower legs immediately after the exercise, and again at 24 and 48 hours postexercise according to the "RIGHT" or "LEFT" labels. At 48 hours postexercise, subjects had their ankle range of motion and muscle tenderness measured. Subjects used the analog scale to rate pain in each leg at baseline, 24 hours, 48 hours, and 72 hours. No significant differences in pain scores were seen before exercise (arnica: 0.07 vs placebo: 0.09, p = 0.32). Pain scores on legs treated with arnica were higher than scores on those receiving placebo 24 hours after exercise (3.04 vs 2.36, respectively; p < 0.005). Pain scores on day 3 (arnica: 3.44 vs placebo: 3.20, p = 0.66) and day 4 (arnica: 2.36 vs placebo: 2.31, p = 0.62) were not significantly different. There was no difference in muscle tenderness (arnica: 1.05 vs placebo: 1.05, p = 1.0). Ankle range of motion did not differ significantly on either day 1 (arnica: 64.70 degrees vs placebo: 66.15, p = 0.352 or day 3 (arnica: 63.32 degrees vs placebo: 65.94, p = 0.058). Rather than decreasing leg pain, arnica was found to increase leg pain 24 hours after eccentric calf exercises. This effect did not extend to the 48-hour measurement.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simone, Brittany A.; Ly, David; Savage, Jason E.

Purpose: Although ionizing radiation is critical in treating cancer, radiation-induced fibrosis (RIF) can have a devastating impact on patients' quality of life. The molecular changes leading to radiation-induced fibrosis must be elucidated so that novel treatments can be designed. Methods and Materials: To determine whether microRNAs (miRs) could be responsible for RIF, the fibrotic process was induced in the right hind legs of 9-week old CH3 mice by a single-fraction dose of irradiation to 35 Gy, and the left leg served as an unirradiated control. Fibrosis was quantified by measurements of leg length compared with control leg length. By 120 days aftermore » irradiation, the irradiated legs were 20% (P=.013) shorter on average than were the control legs. Results: Tissue analysis was done on muscle, skin, and subcutaneous tissue from irradiated and control legs. Fibrosis was noted on both gross and histologic examination by use of a pentachrome stain. Microarrays were performed at various times after irradiation, including 7 days, 14 days, 50 days, 90 days, and 120 days after irradiation. miR-15a, miR-21, miR-30a, and miR-34a were the miRs with the most significant alteration by array with miR-34a, proving most significant on confirmation by reverse transcriptase polymerase chain reaction, c-Met, a known effector of fibrosis and downstream molecule of miR-34a, was evaluated by use of 2 cell lines: HCT116 and 1522. The cell lines were exposed to various stressors to induce miR changes, specifically ionizing radiation. Additionally, in vitro transfections with pre-miRs and anti-miRs confirmed the relationship of miR-34a and c-Met. Conclusions: Our data demonstrate an inverse relationship with miR-34a and c-Met; the upregulation of miR-34a in RIF causes inhibition of c-Met production. miRs may play a role in RIF; in particular, miR-34a should be investigated as a potential target to prevent or treat this devastating side effect of irradiation.« less

microRNA alterations driving acute and late stages of radiation-induced fibrosis in a murine skin model.

PubMed

Simone, Brittany A; Ly, David; Savage, Jason E; Hewitt, Stephen M; Dan, Tu D; Ylaya, Kris; Shankavaram, Uma; Lim, Meng; Jin, Lianjin; Camphausen, Kevin; Mitchell, James B; Simone, Nicole L

2014-09-01

Although ionizing radiation is critical in treating cancer, radiation-induced fibrosis (RIF) can have a devastating impact on patients' quality of life. The molecular changes leading to radiation-induced fibrosis must be elucidated so that novel treatments can be designed. To determine whether microRNAs (miRs) could be responsible for RIF, the fibrotic process was induced in the right hind legs of 9-week old CH3 mice by a single-fraction dose of irradiation to 35 Gy, and the left leg served as an unirradiated control. Fibrosis was quantified by measurements of leg length compared with control leg length. By 120 days after irradiation, the irradiated legs were 20% (P=.013) shorter on average than were the control legs. Tissue analysis was done on muscle, skin, and subcutaneous tissue from irradiated and control legs. Fibrosis was noted on both gross and histologic examination by use of a pentachrome stain. Microarrays were performed at various times after irradiation, including 7 days, 14 days, 50 days, 90 days, and 120 days after irradiation. miR-15a, miR-21, miR-30a, and miR-34a were the miRs with the most significant alteration by array with miR-34a, proving most significant on confirmation by reverse transcriptase polymerase chain reaction, c-Met, a known effector of fibrosis and downstream molecule of miR-34a, was evaluated by use of 2 cell lines: HCT116 and 1522. The cell lines were exposed to various stressors to induce miR changes, specifically ionizing radiation. Additionally, in vitro transfections with pre-miRs and anti-miRs confirmed the relationship of miR-34a and c-Met. Our data demonstrate an inverse relationship with miR-34a and c-Met; the upregulation of miR-34a in RIF causes inhibition of c-Met production. miRs may play a role in RIF; in particular, miR-34a should be investigated as a potential target to prevent or treat this devastating side effect of irradiation. Published by Elsevier Inc.

The effects of dance training program on the postural stability of middle aged women.

PubMed

Kostić, Radmila; Uzunović, Slavoljub; Purenović-Ivanović, Tijana; Miletić, Đurđica; Katsora, Georgija; Pantelić, Saša; Milanović, Zoran

2015-11-01

The aim of the study was to determine the effects of Greek folk dancing on postural stability in middle age women. Sixty-three women aged from 47-53 participated in this study. All participants were randomly divided into the experimental group - 33 participants (mean ± SD; body height=160.13 ± 12.07 cm, body mass=63.81 ± 10.56 kg), and the control group - 30 participants (mean ± SD; body height=160.63 ± 6.22 cm, body mass=64.79 ± 8.19 kg). The following tests were used to evaluate the motor balance and posture stability of participants; the double-leg stance along the length of a balance beam (eyes open), the double-leg stance along the width of a balance beam (eyes open), the single-leg stance (eyes open) and the double-leg stance on one's toes (eyes closed). The Functional Reach Test for balance and the Star Excursion Balance Test were used to evaluate dynamic balance. The multivariate analysis of covariance of static and dynamic balance between participants of the experimental and control group at the final measuring, with neutralized differences at the initial measuring (Wilks' λ=0.45), revealed a significant difference (p<0.05). The intergroup difference at the final measuring was also found to be significant (p<0.05) for the following variables; the double-leg stance on one's toes, the Functional Reach Test, balance of the right anterolateral, balance of the right posterolateral and balance of the left posteromedial. An organized dance activity programme does lead to the improvement of static and dynamic balance in middle aged women. Copyright© by the National Institute of Public Health, Prague 2015.

A new anchialine Stephos Scott from the Yucatan Peninsula with notes on the biogeography and diversity of the genus (Copepoda, Calanoida, Stephidae)

PubMed Central

Suárez-Morales, Eduardo; Gutiérrez-Aguirre, Martha A.; Cervantes-Martínez, Adrián; Iliffe, Thomas M.

2017-01-01

Abstract Surveys of the anchialine crustacean fauna of the Yucatan Peninsula (YP), Mexico, have revealed the occurrence of calanoid copepods. The genus Stephos Scott, 1892, belonging to the family Stephidae is among the most frequent and widely distributed groups in anchialine caves but has not been hitherto recorded from the YP. Recent collections from an anchialine cave in an island off the northern coast of the YP yielded many specimens of a new species of Stephos. The new taxon, S. fernandoi sp. n., is described here based on male and female specimens. The new species is clearly distinguished from its congeners by the following characters: male left fifth leg with three terminal lamellae plus subdistal process, right leg with distal row of peg-like elements; female fifth leg with single long, acute apical process; genital double-somite with two rows each of 4 long spinules adjacent to operculum; legs 2-4 with articulated setae. The diversity of the genus shows regional differences; the Australia-Western Pacific region is the most diverse (eleven species), followed by the Mediterranean (seven species) and the Northeastern Atlantic (six species); only four species are known from the Northwestern Tropical Atlantic (NWTA). The morphology of the female fifth leg was examined to explore possible biogeographic trends in the genus; patterns suggest multiple colonization events in the highly diverse regions and a relatively recent radiation in the NWTA, characterized by anchialine forms. The introduction of stephid copepods in the region may be a relatively recent event derived from colonization of benthopelagic ancestral forms and subsequent invasion onto cave habitats. The new species appears to be linked to the strictly anchialine Miostephos. PMID:28769658

A new anchialine Stephos Scott from the Yucatan Peninsula with notes on the biogeography and diversity of the genus (Copepoda, Calanoida, Stephidae).

PubMed

Suárez-Morales, Eduardo; Gutiérrez-Aguirre, Martha A; Cervantes-Martínez, Adrián; Iliffe, Thomas M

2017-01-01

Surveys of the anchialine crustacean fauna of the Yucatan Peninsula (YP), Mexico, have revealed the occurrence of calanoid copepods. The genus Stephos Scott, 1892, belonging to the family Stephidae is among the most frequent and widely distributed groups in anchialine caves but has not been hitherto recorded from the YP. Recent collections from an anchialine cave in an island off the northern coast of the YP yielded many specimens of a new species of Stephos . The new taxon, S. fernandoi sp. n. , is described here based on male and female specimens. The new species is clearly distinguished from its congeners by the following characters: male left fifth leg with three terminal lamellae plus subdistal process, right leg with distal row of peg-like elements; female fifth leg with single long, acute apical process; genital double-somite with two rows each of 4 long spinules adjacent to operculum; legs 2-4 with articulated setae. The diversity of the genus shows regional differences; the Australia-Western Pacific region is the most diverse (eleven species), followed by the Mediterranean (seven species) and the Northeastern Atlantic (six species); only four species are known from the Northwestern Tropical Atlantic (NWTA). The morphology of the female fifth leg was examined to explore possible biogeographic trends in the genus; patterns suggest multiple colonization events in the highly diverse regions and a relatively recent radiation in the NWTA, characterized by anchialine forms. The introduction of stephid copepods in the region may be a relatively recent event derived from colonization of benthopelagic ancestral forms and subsequent invasion onto cave habitats. The new species appears to be linked to the strictly anchialine Miostephos .

Short communication: Automatic washing of hooves can help control digital dermatitis in dairy cows.

PubMed

Thomsen, Peter T; Ersbøll, Annette Kjær; Sørensen, Jan Tind

2012-12-01

The objectives of this study were to develop and test a system for automatic washing of the hooves of dairy cows and to evaluate the effect of frequent automatic washing on the prevalence of digital dermatitis (DD). An automatic hoof washer was developed in an experimental dairy herd and tested in 6 commercial dairy herds in 2 experiments (1 and 2). In the experimental herd, automatic hoof washing resulted in cleaner hooves. In experiments 1 and 2, cows were washed after each milking on the left side only, leaving the right side unwashed as a within-cow control. In experiment 1, hooves were washed with a water and 0.4% soap solution. In experiment 2, hooves were washed with water only. In each experiment, DD was scored in a hoof-trimming chute approximately 60 d after the start of hoof washing. Data were analyzed using a generalized linear mixed model. The outcome was the DD status of each leg (DD positive or DD negative). Herd and cow within herd were included as random effects, and treatment (washing or control) was included as a fixed effect. The statistical analyses showed that the odds ratio of having DD was 1.48 in the control leg compared with the washed leg in experiment 1. In experiment 2, the odds ratio of having DD was 1.27 in the control leg compared with the washed leg. We concluded that automatic washing of hooves with water and soap can help decrease the prevalence of DD in commercial dairy herds. Copyright © 2012 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

A human cadaver fascial compartment pressure measurement model.

PubMed

Messina, Frank C; Cooper, Dylan; Huffman, Gretchen; Bartkus, Edward; Wilbur, Lee

2013-10-01

Fresh human cadavers provide an effective model for procedural training. Currently, there are no realistic models to teach fascial compartment pressure measurement. We created a human cadaver fascial compartment pressure measurement model and studied its feasibility with a pre-post design. Three faculty members, following instructions from a common procedure textbook, used a standard handheld intra-compartment pressure monitor (Stryker(®), Kalamazoo, MI) to measure baseline pressures ("unembalmed") in the anterior, lateral, deep posterior, and superficial posterior compartments of the lower legs of a fresh human cadaver. The right femoral artery was then identified by superficial dissection, cannulated distally towards the lower leg, and connected to a standard embalming machine. After a 5-min infusion, the same three faculty members re-measured pressures ("embalmed") of the same compartments on the cannulated right leg. Unembalmed and embalmed readings for each compartment, and baseline readings for each leg, were compared using a two-sided paired t-test. The mean baseline compartment pressures did not differ between the right and left legs. Using the embalming machine, compartment pressure readings increased significantly over baseline for three of four fascial compartments; all in mm Hg (±SD): anterior from 40 (±9) to 143 (±44) (p = 0.08); lateral from 22 (±2.5) to 160 (±4.3) (p < 0.01); deep posterior from 34 (±7.9) to 161 (±15) (p < 0.01); superficial posterior from 33 (±0) to 140 (±13) (p < 0.01). We created a novel and measurable fascial compartment pressure measurement model in a fresh human cadaver using a standard embalming machine. Set-up is minimal and the model can be incorporated into teaching curricula. Copyright © 2013 Elsevier Inc. All rights reserved.

Four-phase or two-phase signal plan? A study on four-leg intersection by cellular automaton simulations

NASA Astrophysics Data System (ADS)

Jin, Cheng-Jie; Wang, Wei; Jiang, Rui

2016-08-01

The proper setting of traffic signals at signalized intersections is one of the most important tasks in traffic control and management. This paper has evaluated the four-phase traffic signal plans at a four-leg intersection via cellular automaton simulations. Each leg consists of three lanes, an exclusive left-turn lane, a through lane, and a through/right-turn lane. For a comparison, we also evaluate the two-phase signal plan. The diagram of the intersection states in the space of inflow rate versus turning ratio has been presented, which exhibits four regions: In region I/II/III, congestion will propagate upstream and laterally and result in queue spillover with both signal plans/two-phase signal plan/four-phase signal plan, respectively. Therefore, neither signal plan works in region I, and only the four-phase signal plan/two-phase signal plan works in region II/III. In region IV, both signal plans work, but two-phase signal plan performs better in terms of average delays of vehicles. Finally, we study the diagram of the intersection states and average delays in the asymmetrical configurations.

A case of 45,X/47,XXX mosaic Turner syndrome with limb length discrepancy.

PubMed

Hishimura-Yonemaru, Nozomi; Okuhara, Koji; Takahashi, Nobuhiro; Tonoki, Hidefumi; Iizuka, Susumu; Tajima, Toshihiro

2017-01-01

Patients with Turner syndrome (TS) frequently show short stature and skeletal deformities, such as kyphosis and scoliosis. However, to the best of our knowledge, limb length discrepancy (LLD) has not yet been reported in patients with TS. The case of a 12-yr-old girl with 45,X/47,XXX mosaic TS showing LLD is herein presented. She was on GH therapy for short stature and was noted to have scoliosis in the standing position at a regular examination; however, the scoliosis became less evident in the supine position, which is indicative of LLD. The length of the left leg was 5.0 cm shorter than that of the right leg when measured. She was referred to orthopedics and underwent right distal femoral and right proximal tibial staple epiphysiodesis to shorten the abnormally long limb at 10 yr 6 mo of age. One year after the operation, the LLD decreased from 5.0 to 1.5 cm. During this period, GH was continued. LLD is a rare complication in TS, but when patients with TS show scoliosis in the standing position, re-evaluation for scoliosis in the supine position should be performed and the lengths of both legs should be measured.

Brucellosis associated with deep vein thrombosis.

PubMed

Tolaj, Ilir; Mehmeti, Murat; Ramadani, Hamdi; Tolaj, Jasmina; Dedushi, Kreshnike; Fejza, Hajrullah

2014-11-19

Over the past 10 years more than 700 cases of brucellosis have been reported in Kosovo, which is heavily oriented towards agriculture and animal husbandry. Here, brucellosis is still endemic and represents an uncontrolled public health problem. Human brucellosis may present with a broad spectrum of clinical manifestations; among them, vascular complications are uncommon. Hereby we describe the case of a 37-year-old male patient with brucellosis complicated by deep vein thrombosis on his left leg.

Effects of Techa River Radiation Contamination on the Reproductive Function of Residents

DTIC Science & Technology

2006-11-01

general somatic diseases such as diseases of the respiratory organs (bronchiectasis), diabetes , hepatic, and renal insufficiency. The method of choice...the diagnosis of CRS in some of the patients was infantilism , i.e., retard- ed and insufficient sexual development. As is indicated in a previous...legs and left forearm after a railway disaster. The two remaining women, twins born in 1944, were diagnosed with infantilism , which is evidently the

Psoriasiform keratosis - case report.

PubMed

Pires, Carla Andréa Avelar; Sousa, Brena Andrade de; Nascimento, Carla do Socorro Silva do; Moutinho, Ana Thais Machado; Miranda, Mario Fernando Ribeiro de; Carneiro, Francisca Regina Oliveira

2014-01-01

Psoriasiform Keratosis is a rare clinic entity. The etiopathogenesis remains unknown and the disease is characterized by a solitary, scaly or keratotic papule, or plaque mainly located on the extremities. Histopathological features closely resemble those of psoriasis. We report the case of a 70-year-old woman presenting a solitary and asymptomatic keratotic plaque, located on the back of the left leg, unresponsive to topical corticosteroids. We performed an excisional biopsy and histopathology was consistent with psoriasiform keratosis.

Coastal and Submesoscale Process Studies for ASIRI and Data Serving for ASIRI Participants

DTIC Science & Technology

2014-09-30

spatial distributions of Chlorophyll fluorescence, colored dissolved organic matter (CDOM), and apparent oxygen utilization (AOU). It is evident that...Vertical section of tem perature (left) and salinity (right) w ith density in black contours, from 4 long tracks surveyed in Leg 2 (N ovem ber 2013) from...vertical derivative of the downwelling light is proportional to the radiant heating rate at depth. This figure shows that deeply penetrating blue