The Decline in America’s Reputation: Why

DTIC Science & Technology

2008-06-11

The Administration’s rhetoric about and unilateral military action against al- Qaeda and Saddam Hussein (and threats against Iran) have been...countries include Turkey, a long-standing U.S. ally, and Kuwait, the country that the United States liberated from Saddam Hussein’s rule as part of a...that it would not be bound by other nations’ opinions on the matter. According to Dr. Kull: [T]he complaint is not really that Saddam Hussein

Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment.

PubMed

Balke, Maurice; Bielefeld, Rebecca; Schmidt, Carolin; Dedy, Nicolas; Liem, Dennis

2012-03-01

Calcifying tendinitis is a common and painful disorder of the shoulder characterized by the presence of calcific deposits in the tendons of the rotator cuff. When nonoperative treatment over a prolonged period of time fails, surgical treatment should be considered. Midterm success rates are inconsistent, and the role of subacromial decompression is still unclear. Our hypotheses were that the rate of supraspinatus tears after arthroscopic treatment of calcifying tendinitis is comparable with that in the contralateral uninvolved shoulder and that subacromial decompression does not have beneficial effects compared with calcium removal alone. Case series; Level of evidence, 4. In 70 shoulders of 62 patients with a mean age of 54 years, arthroscopic removal of calcium deposits of the supraspinatus tendon was performed. In 44 shoulders, additional subacromial decompression was performed. After a mean follow-up of 6 years (range, 2-13 years), patients were clinically investigated, and function was statistically evaluated using Constant and American Shoulder and Elbow Surgeons (ASES) scores. Affected and contralateral shoulders were examined by ultrasound in 48 shoulders, and rotator cuff tears were documented. The mean Constant scores of the operated shoulders were significantly lower than those of the healthy shoulders (P < .001). The ASES scores significantly (P < .001) increased after surgery but were still lower than the ASES scores of the healthy shoulders (P < .001). Concerning the additional subacromial decompression, there were no significant differences in the overall ASES and Constant scores; the subitem "pain" was significantly better in the subacromial decompression group (P = .048). Ultrasound examination at last follow-up (48 shoulders) showed a partial supraspinatus tendon tear in 11 operated and 3 contralateral shoulders. Although the good clinical results after arthroscopic treatment of calcifying tendinitis of the shoulder persist midterm, the affected shoulders present significantly lower clinical scores than healthy shoulders. The rate of partial supraspinatus tendon tears seems to be higher after calcium removal. Additional subacromial decompression seems to reduce postoperative pain.

Worse self-reported outcomes but no limitations in performance-based measures in patients with long-standing hip and groin pain compared with healthy controls.

PubMed

Wörner, Tobias; Sigurðsson, Haraldur B; Pålsson, Anders; Kostogiannis, Ioannis; Ageberg, Eva

2017-01-01

This study aimed to evaluate patient-reported outcomes as well as lower extremity and trunk muscle function in patients with long-standing hip and groin pain, in comparison with matched, healthy controls. It was hypothesized that patients with long-standing hip and groin pain would report more deficiency on the Copenhagen Hip and Groin Outcome Score (HAGOS) and have worse outcomes on performance-based measures than healthy controls. Nineteen patients with long-standing hip and groin pain and 19 healthy, activity level-, age-, gender-, and weight-matched controls were assessed with the HAGOS for self-reported outcomes, and a parallel squat (w/kg), single-leg triple jump (cm), single-leg rise (n), barbell roll-out (% of height), and plank test (s) for performance-based measures. Independent sample t test was performed to assess between-group differences. The paired t test was used to analyse between-limb differences in unilateral performance tasks. The patients had worse scores than the controls in all HAGOS subscales (p ≤ 0.001), while no statistically significant differences were observed for any performance measure between groups or between symptomatic and non-symptomatic limbs. Despite significant self-reported functional limitations on the HAGOS, there were no significant differences between groups in performance-based strength or power measures. The results of this study highlight the need to identify performance-based measures, sensitive to functional deficiencies in patients with long-standing hip and groin pain in order to complement the clinical picture obtained by patient-reported outcomes such as the HAGOS. III.

Editorial Commentary: Subacromial Decompression Is Unnecessary in Most Routine Rotator Cuff Repairs.

PubMed

Solomon, Daniel J

2017-07-01

There is no need to perform subacromial decompression in partial bursal-sided rotator cuff repairs to obtain a good result. This, paired with the findings of previous studies of full-thickness rotator cuff repairs, suggests that extrinsic factors rarely affect the rotator cuff. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Communication breakdown: clinicians disagree on subacromial impingement.

PubMed

de Witte, Pieter Bas; de Groot, Jurriaan H; van Zwet, Erik W; Ludewig, Paula M; Nagels, Jochem; Nelissen, Rob G H H; Braman, Jon P

2014-03-01

"Subacromial impingement syndrome (SIS)" is often used as a diagnostic label, but has become more controversial as such in the literature. We assessed views on SIS in clinical practice using a survey with 63 0-10 VAS items among orthopedic surgeons and physical therapists from the United States and the Netherlands. Multivariate regression and cluster analyses were applied to identify consensus items and to study profession and/or nationality effects on item ratings. Most items received neutral or highly variable ratings. Twenty-nine were considered associated with SIS, including worsening of pain with overhead activities, painful arc and a positive Neer's test. Seven items were regarded pleading against SIS, including loss of passive motion. Activity modifications and physical therapy are the most important treatments according to therapists, who highly valued motion-related etiologic mechanisms. Surgeons, with higher ratings for intrinsic and anatomic etiologies, appreciated the use of subacromial corticosteroids and surgery. Clinicians from different professional backgrounds have different views on what SIS is, and even within professional groups, variations are substantial. This has to be taken into account when communicating about SIS symptoms, for example, in intercollegial consultation or scientific research. The authors suggest cautious use of (subacromial) impingement syndrome as a diagnostic label.

Ultrasound imaging to tailor the treatment of acute shoulder pain: a randomised controlled trial in general practice.

PubMed

Ottenheijm, Ramon P G; Cals, Jochen W L; Winkens, Bjorn; Weijers, René E; de Bie, Rob A; Dinant, Geert-Jan

2016-11-21

To determine the clinical effectiveness of ultrasound tailored treatment in patients with acute subacromial disorders. Pragmatic randomised controlled trial. Dutch general practice. Patients aged 18-65 years with acute (duration <3 months) unilateral shoulder pain and no previous treatment, in whom the general practitioner suspected a subacromial disorder was enrolled. All patients underwent ultrasound imaging of the affected shoulder. Patients who were still symptomatic after a qualification period of 2 weeks with standard treatment were randomised to treatment tailored to ultrasound diagnosis (disclosure of the ultrasound diagnosis) or usual care (non-disclosure of the ultrasound diagnosis). Patient-perceived recovery using the Global Perceived Effect questionnaire at 1 year. 129 patients were included. 18 patients recovered during the 2-week qualification period, resulting in 111 randomised patients; 56 were allocated to ultrasound tailored treatment and 55 to usual care. After 1 year, no statistically significant differences in recovery were found between the ultrasound tailored treatment group (72.5% (37/51)) and the usual care group (60% (30/50), OR 2.24 (95% CI 0.72 to 6.89; p=0.16)). Also, healthcare use was similar. This study has shown no clinically significant difference in the primary outcome measure between the ultrasound tailored treatment and usual care groups. Furthermore, there was no overall difference in healthcare resources used between groups. Although no formal cost data are included, one can only assume that the ultrasound examinations are additional costs for the intervention group, which cannot be justified in routine practice based on this trial. Based on this study, no change in current pragmatic guidelines to incorporate early ultrasound imaging can be recommended. NTR2403; Results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears.

PubMed

von Wehren, Lutz; Blanke, Fabian; Todorov, Atanas; Heisterbach, Patricia; Sailer, Jannis; Majewski, Martin

2016-12-01

Rotator cuff tears are one of the most common causes of shoulder malfunction and pain, which lead to a significant reduction in the quality of life. This present study investigated the effects of subacromial platelet-rich plasma injections [i.e. autologous conditioned plasma (ACP) injections] as compared to standard subacromial cortisone injection therapy in 50 patients with partial rotator cuff tears. Before injection, and 6 weeks, 12 weeks and 6 months thereafter, the patients were assessed by the Constant-Murley score (CMS), the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the simple shoulder test (SST) and a pain visual analogue scale (VAS). An MRI was also performed before and 6 months after injection. Both patient groups had statistically significant better shoulder score outcomes over time. ASES, SST and CMS outcomes after 12 versus 6 weeks were better in the ACP group as compared to the cortisone group. VAS, ASES and CMS outcomes after 12 weeks versus baseline in the ACP group were better as compared to the cortisone group. There was a statistically significant difference between ACP group and cortisone group 12 weeks after injection regarding VAS, ASES, SST and CMS in favour of the ACP group. The MRI showed an improvement in grade of tendinopathy in both groups, however, without statistically significant differences between the two groups. Compared with cortisone injections, ACP injections show earlier benefit as compared to cortisone injections although a statistically significant difference after 6 months could not be found. Therefore, subacromial ACP injections are a good alternative to subacromial cortisone injections, especially in patients with contraindication to cortisone. Therapeutic study, Level III.

Guideline for diagnosis and treatment of subacromial pain syndrome

PubMed Central

Diercks, Ron; Bron, Carel; Dorrestijn, Oscar; Meskers, Carel; Naber, René; de Ruiter, Tjerk; Willems, Jaap; Winters, Jan; van der Woude, Henk Jan

2014-01-01

Treatment of “subacromial impingement syndrome” of the shoulder has changed drastically in the past decade. The anatomical explanation as “impingement” of the rotator cuff is not sufficient to cover the pathology. “Subacromial pain syndrome”, SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows: (1) The diagnosis SAPS can only be made using a combination of clinical tests. (2) SAPS should preferably be treated non-operatively. (3) Acute pain should be treated with analgetics if necessary. (4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms. (5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture. (6) Occupational interventions are useful when complaints persist for longer than 6 weeks. (7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered. (8) Strict immobilization and mobilization techniques are not recommended. (9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage). (10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management. (12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. PMID:24847788

Evaluating the Role of Subacromial Impingement in Rotator Cuff tendinopathy: Development and Analysis of a Novel Murine Model.

PubMed

Cong, Guang-Ting; Lebaschi, Amir H; Camp, Christopher L; Carballo, Camila B; Nakagawa, Yusuke; Wada, Susumu; Deng, Xiang-Hua; Rodeo, Scott A

2018-04-23

Subacromial impingement of the rotator cuff is understood as a contributing factor in the development of rotator cuff tendinopathy. However, changes that occur in the impinged tendon are poorly understood and warrant further study. To enable further study of rotator cuff tendinopathy, we performed a controlled laboratory study to determine feasibility and baseline characteristics of a new murine model for subacromial impingement. This model involves surgically inserting a microvascular clip into the subacromial space in adult C57Bl/6 mice. Along with a sham surgery arm, 90 study animals were distributed among time point groups for sacrifice up to 6 weeks. All animals underwent bilateral surgery (total N = 180). Biomechanical, histologic, and molecular analyses were performed to identify and quantify the progression of changes in the supraspinatus tendon. Decreases in failure force and stiffness were found in impinged tendon specimens compared to sham and no-surgery controls at all study time points. Semi-quantitative scoring of histologic specimens demonstrated significant, persistent tendinopathic changes over 6 weeks. Quantitative real-time polymerase chain reaction analysis of impinged tendon specimens demonstrated persistently increased expression of genes related to matrix remodeling, inflammation, and tendon development. Overall, this novel murine subacromial impingement model creates changes consistent with acute tendonitis, which may mimic the early stages of rotator cuff tendinopathy. This article is protected by copyright. All rights reserved Clinical Significance: A robust, simple, and reproducible animal model of rotator cuff tendinopathy is a valuable research tool to allow further studies of cellular and molecular mechanisms and evaluation of therapeutic interventions in rotator cuff tendinopathy. This article is protected by copyright. All rights reserved.

The effect of scapular position on subacromial contact behavior: a cadaver study.

PubMed

Muraki, Takayuki; Yamamoto, Nobuyuki; Sperling, John W; Steinmann, Scott P; Cofield, Robert H; An, Kai-Nan

2017-05-01

Patients with subacromial impingement were reported to show abnormal scapular positions during shoulder elevation. However, the relationship between the scapular positions and subacromial impingement is unclear. The purpose of this study was to biomechanically determine the effect of scapular position on subacromial contact behavior by using fresh frozen cadavers. The peak contact pressure on the coracoacromial arch was measured with a flexible tactile force sensor in 9 fresh frozen cadaver shoulders. The measurement was performed during passive glenohumeral elevation in the scapular plane ranging from 30° to 75°. The scapular downward and internal rotations and anterior tilt were simulated by tilting the scapula in 5° increments up to 20°. The measurement was also performed with combination of scapular downward and internal rotations and anterior tilt positions. The peak contact pressure decreased linearly with anterior tilt, and a significant difference between neutral scapular position (1.06 ± 0.89 MPa) and anterior tilt by 20° (0.46 ± 0.18 MPa) was observed (P < .05). However, the scapular positioning in the other directions did not change the peak contact pressure significantly. Furthermore, any combination of abnormal scapular positions did not affect peak contact pressure significantly. Scapular anterior tilt decreased peak contact pressure during passive shoulder elevation. In addition, scapular downward and internal rotations had little effect on peak contact pressure. The abnormal scapular motion reported in previous studies might not be directly related to symptoms caused by subacromial impingement. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Subacromial bursitis following human papilloma virus vaccine misinjection.

PubMed

Uchida, Soshi; Sakai, Akinori; Nakamura, Toshitaka

2012-12-17

A patient presented at our clinic with severe subacromial bursitis, which persisted for several months following a third booster injection with Cervarix™. Chronic subacromial bursitis manifested itself in this patient after what appeared to be the misinjection of vaccine in close proximity to the acromion. This bursitis was resistant to conventional physiotherapy and to corticosteroid therapy, but was responsive to arthroscopic surgery. Since such patients may present to an arthroscopic surgeon only months after receiving a vaccine injection, this etiological link may not be fully appreciated by treating clinicians. Further, the accuracy of injection in the deltoid region also appears under appreciated, and this report highlights the importance of accurate injection to the deltoid region or in certain cases, the value of simply changing the injection site to another larger muscle. Copyright © 2012 Elsevier Ltd. All rights reserved.

Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial.

PubMed

Rabini, Alessia; Piazzini, Diana B; Bertolini, Carlo; Deriu, Laura; Saccomanno, Maristella F; Santagada, Domenico A; Sgadari, Antonio; Bernabei, Roberto; Fabbriciani, Carlo; Marzetti, Emanuele; Milano, Giuseppe

2012-04-01

Single-blind randomized clinical trial, with a follow-up of 24 weeks. To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.

Facial reanimation with gracilis muscle transfer neurotized to cross-facial nerve graft versus masseteric nerve: a comparative study using the FACIAL CLIMA evaluating system.

PubMed

Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro

2013-06-01

Longstanding unilateral facial paralysis is best addressed with microneurovascular muscle transplantation. Neurotization can be obtained from the cross-facial or the masseter nerve. The authors present a quantitative comparison of both procedures using the FACIAL CLIMA system. Forty-seven patients with complete unilateral facial paralysis underwent reanimation with a free gracilis transplant neurotized to either a cross-facial nerve graft (group I, n=20) or to the ipsilateral masseteric nerve (group II, n=27). Commissural displacement and commissural contraction velocity were measured using the FACIAL CLIMA system. Postoperative intragroup commissural displacement and commissural contraction velocity means of the reanimated versus the normal side were first compared using the independent samples t test. Mean percentage of recovery of both parameters were compared between the groups using the independent samples t test. Significant differences of mean commissural displacement and commissural contraction velocity between the reanimated side and the normal side were observed in group I (p=0.001 and p=0.014, respectively) but not in group II. Intergroup comparisons showed that both commissural displacement and commissural contraction velocity were higher in group II, with significant differences for commissural displacement (p=0.048). Mean percentage of recovery of both parameters was higher in group II, with significant differences for commissural displacement (p=0.042). Free gracilis muscle transfer neurotized by the masseteric nerve is a reliable technique for reanimation of longstanding facial paralysis. Compared with cross-facial nerve graft neurotization, this technique provides better symmetry and a higher degree of recovery. Therapeutic, III.

[The role of arthroscopy in subacromial pathology. Retrospective study of a series of arthroscopic acromioplasties].

PubMed

Schiepers, P; Pauwels, P; Penders, W; Brandelet, B; Putz, P

2000-12-01

The authors report the results of a retrospective study of 59 arthroscopic acromioplasties. Objective shoulder assessment was made following the relative Constant score and UCLA rating scale. Subjective satisfaction of the patient was assessed on an analogic scale. The patients were divided into 3 groups, according to the subacromial pathology treated. The first group (27 shoulders in 23 patients) included patients with subacromial impingement without a complete rotator cuff tear. The objective result, between 80 and 90%, was close to results in others series reported. Distinction between patients with no tear or partial tear of the cuff showed better results for patients with partial tears. This surprising finding may be at least partially explained by the fact that these patients were older than those without a cuff tear. The results of this study, and the review of the literature, confirmed the value of subacromial decompression as a treatment for impingement without complete cuff tear resistant to at least 6 months of conservative treatment; comparison between surgical and arthroscopic series showed similar results. The second group (19 shoulders in 19 patients) included patients with impingement and complete cuff tear. The objective results and the literature review led us to specify indications. Subacromial decompression with debridment of the tear has given excellent results in older patients--over 60 for most authors--when the tear was limited. In our study, the function of the shoulder at revision was good when the tear was limited to the supraspinatus and part of the infraspinatus. The third group (13 shoulders in 10 patients) included patients with calcifying tendinitis. Arthroscopic acromioplasty was performed in every case; excision of the calcification was performed in less than half of the cases and did not influence the final result. The calcifications had disappeared at revision in all cases. This may suggest that the treatment of the associated impingement was the most important procedure in these cases.

Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial space in primary shoulder arthroscopies.

PubMed

Patzer, Thilo; Petersdorf, Sabine; Krauspe, Ruediger; Verde, Pablo Emilio; Henrich, Birgit; Hufeland, Martin

2018-05-01

We hypothesized that the prevalence of Propionibacterium acnes in patients undergoing primary shoulder arthroscopy is equal in the glenohumeral space compared with the subacromial space. Patients aged 18 years or older with shoulder arthroscopies were included. The exclusion criteria were prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, and antibiotic therapy within 14 days preoperatively. After standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen. Sample cultivation was conducted according to standardized criteria for bone and joint aspirate samples and incubated for 14 days. Matrix-assisted laser desorption-ionization time-of-flight spectrometry was used for specimen identification in positive culture results. The study prospectively included 115 consecutive patients with normal C-reactive protein levels prior to surgery (54.8% men; mean age, 47.2 ± 14.6 years). P acnes was detected on the skin after disinfection in 36.5% of patients, in the glenohumeral space in 18.9%, and in the subacromial space in 3.5% (P = .016). The prevalence of P acnes is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies. The results do not confirm the contamination theory but also cannot clarify whether P acnes is a commensal or enters the joint hematologically or even lymphatically or via an unknown pathway. Despite standardized surgical skin disinfection, P acnes can be detected in skin swab samples in more than one-third of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The role of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis: a case series.

PubMed

Vad, Vijay B; Solomon, Jennifer; Adin, David R

2005-06-01

To study the efficacy of subacromial shoulder irrigation in the treatment of calcific rotator cuff tendinosis. Consecutive case series. Musculoskeletal rehabilitation clinic. Twenty-eight tennis players (16 women, 12 men; mean age, 44.3y) with calcific rotator cuff tendinosis, who failed conservative measures. Subjects underwent fluoroscopically guided subacromial shoulder irrigation (50-75 mL of normal saline in 10 mL aliquots) followed by a corticosteroid injection (5 mL solution of 1 mL triamcinolone [40 mg/mL] and 4 mL of 0.5% bupivacaine). After the procedure, all patients completed the same exercise regimen. LInsalata Shoulder Rating Questionnaire (LSRQ) score, visual numeric pain score, and patient satisfaction. At 1-year follow-up, 85.7% reported a successful outcome with significant improvements in the LSQR and numeric pain scores. Our minimally invasive approach was safe, well tolerated, and effective, which should make it useful in providing relief for patients with rotator cuff tendinosis.

Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression.

PubMed

Kraeutler, Matthew J; Reynolds, Kirk A; Long, Cyndi; McCarty, Eric C

2015-06-01

The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Managing Bell's palsy.

PubMed

2006-07-01

Each year in the UK, around 1 in 5,000 people develop Bell's palsy--a unilateral lower motor neurone facial weakness of rapid onset that can be physically and psychologically disabling. While around 71% of patients recover normal function of the facial muscles without treatment, 13% are left with slight weakness and 16% with moderate to severe weakness resulting in major facial dysfunction. People who recover usually do so quickly, with 85% of them reporting some improvement in the first 3 weeks. There is longstanding controversy about what, if any, treatment should be initiated for Bell's palsy. Here we discuss the management of patients with this condition.

Ultrasound-Guided Application of Percutaneous Electrolysis as an Adjunct to Exercise and Manual Therapy for Subacromial Pain Syndrome: a Randomized Clinical Trial.

PubMed

de-Miguel-Valtierra, Lorena; Salom-Moreno, Jaime; Fernández-de-Las-Peñas, César; Cleland, Joshua A; Arias-Buría, José L

2018-05-16

This randomized clinical trial compared the effects of adding US-guided percutaneous electrolysis into a program consisting of manual therapy and exercise on pain, related-disability, function and pressure sensitivity in subacromial pain syndrome. Fifty patients with subacromial pain syndrome were randomized into manual therapy and exercise or percutaneous electrolysis group. All patients received the same manual therapy and exercise program, one session per week for 5 consecutive weeks. Patients assigned to the electrolysis group also received the application of percutaneous electrolysis at each session. The primary outcome was Disabilities of the Arm, Shoulder and Hand (DASH). Secondary outcomes included pain, function (Shoulder Pain and Disability Index-SPADI) pressure pain thresholds (PPTs) and Global Rating of Change (GROC). They were assessed at baseline, post-treatment, and 3, and 6 months after treatment. Both groups showed similar improvements in the primary outcome (DASH) at all follow-ups (P=0.051). Subjects receiving manual therapy, exercise, and percutaneous electrolysis showed significantly greater changes in shoulder pain (P<0.001) and SPADI (P<0.001) than those receiving manual therapy and exercise alone at all follow-ups. Effect sizes were large (SMD>0.91) for shoulder pain and function at 3 and 6 months in favour of the percutaneous electrolysis group. No between-groups differences in PPT were found. The current clinical trial found that the inclusion of US-guided percutaneous electrolysis in combination with manual therapy and exercise resulted in no significant differences for related-disability (DASH) than the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Nevertheless, differences were reported for some secondary outcomes such as shoulder pain and function (SPADI). Whether or not these effects are reliable should be addressed in future studies Perspective This study found that the inclusion of US-guided percutaneous electrolysis into a manual therapy and exercise program resulted in no significant differences for disability and pressure pain sensitivity than the application of manual therapy and exercise alone in patients with subacromial pain syndrome. Copyright © 2018. Published by Elsevier Inc.

The "Hoover" (vacuum cleaner) technique for calcifying tendonitis deposits excision and removal of the calcific debris.

PubMed

Ehud, Atoun; Ehud, Rath; Alexander, Van Tongel; Ali, Narvani; Giusseppe, Sforza; Ofer, Levy

2012-07-01

A new technical tip for the improvement of the arthroscopic treatment of symptomatic calcifying tendinitis is described. Arthroscopic excision of calcifying tendonitis may result with multiple minute calcific debris in the subacromial bursa, causing severe post operative pain due to chemical irritation of the bursa. We suggest the use of a bladeless shaver barrel as a "Hoover" (vacuum cleaner) for arthroscopic clearance of these miniature calcific debris from the subacromial space after resection of the major deposits. The use of this technique resulted in good clinical outcome with improved post operative pain.

Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain.

PubMed

Marks, Darryn; Comans, Tracy; Thomas, Michael; Ng, Shu Kay; O'Leary, Shaun; Conaghan, Philip G; Scuffham, Paul A; Bisset, Leanne

2016-12-01

Physiotherapists increasingly manage shoulder referrals in place of orthopaedic doctors. Better understanding the agreement between these professionals will help inform the safety, quality and potential costs of these care models. To establish the level of agreement between a physiotherapist and an orthopaedic surgeon regarding diagnosis, management and corticosteroid injection, in a representative sample of orthopaedic shoulder referrals. Blinded inter-rater agreement study. 274 public orthopaedic shoulder patients were independently assessed by a physiotherapist and an orthopaedic surgeon. Management, subacromial corticosteroid injection, diagnosis and investigation decisions were compared using inter-rater reliability statistics. Agreement between the physiotherapist and the orthopaedic surgeon was near perfect for surgical versus nonsurgical management (Gwets agreement coefficient AC1 = 0.93, 95%CI: 0.90-0.93), safety of injection (AC1 = 0.85, CI: 0.79-0.91) and investigations requested (AC1 = 0.87, CI: 0.83-0.91); substantial for the presence of subacromial pain (AC1 = 0.74, CI: 0.66-0.81) and diagnosis (AC1 = 0.72, CI: 0.66-0.78); and moderate regarding delivery of subacromial corticosteroid injection as an immediate treatment (AC1 = 0.48, CI 0.33-0.53), with the physiotherapist less inclined to select corticosteroid injection as the first intervention. In this study a physiotherapist with prescribing and injection training made decisions analogous to those of an orthopaedic surgeon at initial consultation for orthopaedic shoulder pain, including the safe identification of patients for subacromial injection, without prior screening of referrals by orthopaedic doctors. Australia and New Zealand Clinical Trials Registry, number 12612000532808. Copyright © 2016 Elsevier Ltd. All rights reserved.

The effect of a rotator cuff tear and its size on three-dimensional shoulder motion.

PubMed

Kolk, Arjen; Henseler, Jan Ferdinand; de Witte, Pieter Bas; van Zwet, Erik W; van der Zwaal, Peer; Visser, Cornelis P J; Nagels, Jochem; Nelissen, Rob G H H; de Groot, Jurriaan H

2017-06-01

Rotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo. In this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n=34), 2) an isolated supraspinatus tear (n=21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n=54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion. In the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p<0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p=0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p<0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p=0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation. The massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential. Copyright © 2017 Elsevier Ltd. All rights reserved.

Postoperative fentanyl patch versus subacromial bupivacaine infusion in arthroscopic shoulder surgery.

PubMed

Merivirta, Riika; Äärimaa, Ville; Aantaa, Riku; Koivisto, Mari; Leino, Kari; Liukas, Antti; Kuusniemi, Kristiina

2013-07-01

The purpose of our study was to compare the effectiveness of subacromial bupivacaine infusion and a transdermal fentanyl patch in the treatment of postoperative pain after arthroscopic shoulder surgery. Sixty patients with rotator cuff disease scheduled for elective arthroscopic shoulder surgery were enrolled in the study. For the treatment of postoperative pain, 30 patients constituted group F and received a 12.0-μg/h fentanyl patch for 72 hours and saline solution infusion in a subacromial manner at the rate of 4 mL/h. The remaining 30 patients constituted group B and received a placebo patch and an infusion of 2.5-mg/mL bupivacaine in a subacromial manner for 72 hours. The primary outcome measure was the postoperative numerical rating scale pain score. The consumption of opioids, ibuprofen, and acetaminophen was also recorded. The Constant scores and general recovery were followed up until the 90th postoperative day. There was no statistically significant difference in the numerical rating scale scores (P = .60) between the groups. No differences in the use of rescue analgesic were observed except that the patients receiving bupivacaine used more ibuprofen (median, 1,200 mg v 600 mg) during the day of surgery (P = .042). No difference was found in general recovery between the groups. A fentanyl patch delivering 12-μg/h fentanyl offers an easy and safe treatment option as a part of multimodal analgesia with few adverse effects in the treatment of postoperative pain in a carefully selected patient group after arthroscopic shoulder surgery. Level I, randomized controlled trial. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effects of repetitive shoulder activity on the subacromial space in manual wheelchair users.

PubMed

Lin, Yen-Sheng; Boninger, Michael; Worobey, Lynn; Farrokhi, Shawn; Koontz, Alicia

2014-01-01

This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P<0.01) occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P=0.008). Increased shoulder pain was associated with AHD percentage narrowing after ER (P≤0.007). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.

Effects of Repetitive Shoulder Activity on the Subacromial Space in Manual Wheelchair Users

PubMed Central

Lin, Yen-Sheng; Boninger, Michael; Worobey, Lynn; Farrokhi, Shawn; Koontz, Alicia

2014-01-01

This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P < 0.01) occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P = 0.008). Increased shoulder pain was associated with AHD percentage narrowing after ER (P ≤ 0.007). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain. PMID:25215283

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

Carr, D.H.; Hadjis, N.S.; Banks, L.M.

Thirty-seven patients with histologic proof of cholangiocarcinoma at the confluence were examined by computed tomography (CT) to determine whether this examination is of value in the assessment of these patients for surgery and whether there are any features specific to this type of tumor. Thirty-two patients showed intrahepatic duct dilatation; six of these showed dilatation of ducts in one lobe only. Eighteen patients had intrahepatic low-attenuation areas, while eight had a mass lesion in the porta hepatis. The results of this study show that CT provides useful anatomic information preoperatively but that the appearances are nonspecific. Lobar atrophy is highlymore » suggestive of hilar cholangiocarcinoma, either of long-standing or with unilateral portal venous involvement.« less

Ultrasound-Guided Percutaneous Electrolysis and Eccentric Exercises for Subacromial Pain Syndrome: A Randomized Clinical Trial

PubMed Central

Arias-Buría, José L.; Truyols-Domínguez, Sebastián; Valero-Alcaide, Raquel; Salom-Moreno, Jaime; Atín-Arratibel, María A.; Fernández-de-las-Peñas, César

2015-01-01

Objective. To compare effects of ultrasound- (US-) guided percutaneous electrolysis combined with an eccentric exercise program of the rotator cuff muscles in subacromial pain syndrome. Methods. Thirty-six patients were randomized and assigned into US-guided percutaneous electrolysis (n = 17) group or exercise (n = 19) group. Patients were asked to perform an eccentric exercise program of the rotator cuff muscles twice every day for 4 weeks. Participants assigned to US-guided percutaneous electrolysis group also received the application of galvanic current through acupuncture needle on each session once a week (total 4 sessions). Shoulder pain (NPRS) and disability (DASH) were assessed at baseline, after 2 sessions, and 1 week after the last session. Results. The ANOVA revealed significant Group∗Time interactions for shoulder pain and disability (all, P < 0.01): individuals receiving US-guided percutaneous electrolysis combined with the eccentric exercises experienced greater improvement than those receiving eccentric exercise alone. Conclusions. US-guided percutaneous electrolysis combined with eccentric exercises resulted in small better outcomes at short term compared to when only eccentric exercises were applied in subacromial pain syndrome. The effect was statistically and clinically significant for shoulder pain but below minimal clinical difference for function. Future studies should investigate the long-term effects and potential placebo effect of this intervention. PMID:26649058

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.

PubMed

Nejati, Parisa; Ghahremaninia, Armita; Naderi, Farrokh; Gharibzadeh, Safoora; Mazaherinezhad, Ali

2017-05-01

Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. Randomized controlled trial; Level of evidence, 1. This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective.

Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging.

PubMed

Park, In; Lee, Hyo-Jin; Kim, Sung-Eun; Bae, Sung-Ho; Byun, Chu-Hwan; Kim, Yang-Soo

2015-11-01

Subacromial impingement is a common cause of shoulder pain and one cause of rotator cuff disease. We aimed to identify which shoulder motions cause subacromial impingement by measuring the vertical displacement and peak strain of the coracoacromial ligament using ultrasound speckle tracking imaging. Sixteen shoulders without shoulder disability were enrolled. All subjects were men, and the average age was 28.6 years. The vertical displacement and peak strain of the coracoacromial ligament were analyzed by the motion tracing program during the following active assisted motions (active motion controlled by the examiner): (1) forward flexion in the scapular plane, (2) horizontal abduction in the axial plane, (3) external rotation with the arm at 0° abduction (ER0), (4) internal rotation with the arm at 0° abduction (IR0), (5) internal rotation with the arm at 90° abduction (IR90), and (6) internal rotation at the back (IRB). The mean vertical displacement of the coracoacromial ligament during forward flexion (2.2 mm), horizontal abduction (2.2 mm), and IR90 (2.4 mm) was significantly greater than that during the other motions (ER0, -0.7 mm; IR0, 0.5 mm; IRB, 1.0 mm; P < .003). The mean peak strain was significantly higher in forward flexion (6.88%), horizontal abduction (6.58%), and IR90 (4.88%) than with the other motions (ER0, 1.42%; IR0, 1.78%; IRB, 2.61%; P < .003). Forward flexion, horizontal abduction, and IR90 showed higher vertical displacement and peak strain of the coracoacromial ligament, causing subacromial impingement. It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arthroscopic Subacromial Spacer Implantation in Patients With Massive Irreparable Rotator Cuff Tears: Clinical and Radiographic Results of 39 Retrospectives Cases.

PubMed

Deranlot, Julien; Herisson, Olivier; Nourissat, Geoffroy; Zbili, David; Werthel, Jean David; Vigan, Marie; Bruchou, Francois

2017-09-01

To evaluate the clinical and radiographic outcome of a biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tear. Between January 2011 and December 2014, all shoulders with symptomatic massive irreparable rotator cuff tears treated at our institution with arthroscopic implantation of a biodegradable subacromial spacer followed for at least 1 year were included in our series. Patients with osteoarthritis ≥ grade 3 in the Hamada classification were excluded. Outcome measures included pre- and postoperative, range of motion, Constant score, acromiohumeral distance, and Hamada classification on anteroposterior and lateral radiographs. Thirty-nine consecutive shoulders (37 patients) met the inclusion criteria. The mean age of patients was 69.8 (53-84) years. At the last follow-up (mean 32.8 ± 12.4 months), range of motion was significantly increased for all patients in anterior elevation (from 130° to 160°, P = .02), abduction (from 100° to 160°, P = .01), and external rotation (from 30° to 45°, P = .0001). The mean Constant score was also significantly (P < .001) improved from 44.8 (±15.2) preoperatively to 76.0 (±17.1) at the last follow-up. The mean acromiohumeral distance significantly (P = .002) decreased from 8.2 mm (±3.4) to 6.2 mm (±3.1) at the last follow-up. The Hamada score progressed of 1 radiographic stage in 4 shoulders (15%) and progressed of 3 stages in 2 (4%), whereas the other 32 shoulders remained stable. No intra- or postoperative complications were found except for 1 patient who required a revision for spacer migration. Arthroscopic implantation of a subacromial spacer for irreparable rotator cuff tear leads to significant improvement in shoulder function at a minimum of 1 year postoperatively. Level IV, therapeutic case series; treatment study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Effectiveness of Standardized Physical Therapy Exercises for Patients With Difficulty Returning to Usual Activities After Decompression Surgery for Subacromial Impingement Syndrome: Randomized Controlled Trial.

PubMed

Christiansen, David Høyrup; Frost, Poul; Falla, Deborah; Haahr, Jens Peder; Frich, Lars Henrik; Andrea, Linda Christie; Svendsen, Susanne Wulff

2016-06-01

Little is known about the effectiveness of exercise programs after decompression surgery for subacromial impingement syndrome. For patients with difficulty returning to usual activities, special efforts may be needed to improve shoulder function. The purpose of this study was to evaluate the effectiveness at 3 and 12 months of a standardized physical therapy exercise intervention compared with usual care in patients with difficulty returning to usual activities after subacromial decompression surgery. A multicenter randomized controlled trial was conducted. The study was conducted in 6 public departments of orthopedic surgery, 2 departments of occupational medicine, and 2 physical therapy training centers in Central Denmark Region. One hundred twenty-six patients reporting difficulty returning to usual activities at the postoperative clinical follow-up 8 to 12 weeks after subacromial decompression surgery participated. A standardized exercise program consisting of physical therapist-supervised individual training sessions and home training was used. The primary outcome measure was the Oxford Shoulder Score. Secondary outcome measures were the Constant Score and the Fear-Avoidance Beliefs Questionnaire. At 3 and 12 months, follow-up data were obtained for 92% and 83% of the patients, respectively. Intention-to-treat analyses suggested a between-group difference on the Oxford Shoulder Score favoring the exercise group at 3 months, with an adjusted mean difference of 2.0 (95% confidence interval=-0.5, 4.6), and at 12 months, with an adjusted mean difference of 5.8 (95% confidence interval=2.8, 8.9). Significantly larger improvements for the exercise group were observed for most secondary and supplementary outcome measures. The nature of the exercise intervention did not allow blinding of patients and care providers. The standardized physical therapy exercise intervention resulted in statistically significant and clinically relevant improvement in shoulder pain and function at 12 months compared with usual care. © 2016 American Physical Therapy Association.

Efficacy of a Subacromial Corticosteroid Injection for Persistent Pain After Arthroscopic Rotator Cuff Repair.

PubMed

Shin, Sang-Jin; Do, Nam-Hoon; Lee, Juyeob; Ko, Young-Won

2016-09-01

Corticosteroid injections have been widely used for reducing shoulder pain. However, catastrophic complications induced by corticosteroid such as infections and tendon degeneration have made surgeons hesitant to use a corticosteroid injection as a pain control modality, especially during the postoperative recovery phase. To determine the effectiveness and safety of a subacromial corticosteroid injection for persistent pain control during the recovery period and to analyze the factors causing persistent pain after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. A total of 458 patients who underwent arthroscopic rotator cuff repair were included in this study. Patient-specific parameters, tear size and pattern, and pain intensity were reviewed. Seventy-two patients were administered a postoperative subacromial corticosteroid injection under ultrasound guidance. The corticosteroid injection was administered to patients who awakened overnight because of constant severe shoulder pain or whose pain was exacerbated at the time of rehabilitation exercises within 8 weeks after surgery. Pain intensity, patient satisfaction, and functional outcomes using the American Shoulder and Elbow Surgeons (ASES) and Constant scores were compared between the patients with and without a subacromial corticosteroid injection. The retear rate was evaluated with magnetic resonance imaging at 6 months postoperatively. In patients with an injection, the mean (±SD) visual analog scale for pain (pVAS) score was 7.7 ± 1.2 at the time of the injection. This significantly decreased to 2.3 ± 1.4 at the end of the first month after the injection, demonstrating a 70.2% reduction in pain (P < .01). At 3 months after the injection, the mean pVAS score was 1.2 ± 1.8. Functional outcomes at final follow-up showed no significant differences between patients with and without an injection (ASES score: 90.1 ± 14.6 with injection, 91.9 ± 8.2 without injection [P = .91]; Constant score: 89.1 ± 12.9 with injection, 84.5 ± 13.0 without injection [P = .17]). Patients with an injection showed no significant increase in the retear rate (6.8% with injection, 18.4% without injection; P = .06). According to the tear pattern, L-shaped rotator cuff tears (41.8%) showed a higher occurrence of severe postoperative persistent pain. Preoperative shoulder stiffness was revealed as a predisposing factor for persistent pain (odds ratio, 0.2; P = .04). A subacromial corticosteroid injection can be considered as a useful and safe modality for the treatment of patients having severe persistent pain during the recovery phase after arthroscopic rotator cuff repair. © 2016 The Author(s).

Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis.

PubMed

Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y

2016-05-01

Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.

A Scandcleft randomised trials of primary surgery for unilateral cleft lip and palate: 1. Planning and management.

PubMed

Semb, Gunvor; Enemark, Hans; Friede, Hans; Paulin, Gunnar; Lilja, Jan; Rautio, Jorma; Andersen, Mikael; Åbyholm, Frank; Lohmander, Anette; Shaw, William; Mølsted, Kirsten; Heliövaara, Arja; Bolund, Stig; Hukki, Jyri; Vindenes, Hallvard; Davenport, Peter; Arctander, Kjartan; Larson, Ola; Berggren, Anders; Whitby, David; Leonard, Alan; Neovius, Erik; Elander, Anna; Willadsen, Elisabeth; Bannister, R Patricia; Bradbury, Eileen; Henningsson, Gunilla; Persson, Christina; Eyres, Philip; Emborg, Berit; Kisling-Møller, Mia; Küseler, Annelise; Granhof Black, Birthe; Schöps, Antje; Bau, Anja; Boers, Maria; Andersen, Helene Søgaard; Jeppesen, Karin; Marxen, Dorte; Paaso, Marjukka; Hölttä, Elina; Alaluusua, Suvi; Turunen, Leena; Humerinta, Kirsti; Elfving-Little, Ulla; Tørdal, Inger Beate; Kjøll, Lillian; Aukner, Ragnhild; Hide, Øydis; Feragen, Kristin Billaud; Rønning, Elisabeth; Skaare, Pål; Brinck, Eli; Semmingsen, Ann-Magritt; Lindberg, Nina; Bowden, Melanie; Davies, Julie; Mooney, Jeanette; Bellardie, Haydn; Schofield, Nina; Nyberg, Jill; Lundberg, Maria; Karsten, Agneta Linder-Aronson; Larson, Margareta; Holmefjord, Anders; Reisæter, Sigvor; Pedersen, Nina-Helen; Rasmussen, Therese; Tindlund, Rolf; Sæle, Paul; Blomhoff, Reidunn; Jacobsen, Gry; Havstam, Christina; Rizell, Sara; Enocson, Lars; Hagberg, Catharina; Najar Chalien, Midia; Paganini, Anna; Lundeborg, Inger; Marcusson, Agneta; Mjönes, Anna-Britta; Gustavsson, Annica; Hayden, Christine; McAleer, Eilish; Slevan, Emma; Gregg, Terry; Worthington, Helen

2017-02-01

Longstanding uncertainty surrounds the selection of surgical protocols for the closure of unilateral cleft lip and palate, and randomised trials have only rarely been performed. This paper is an introduction to three randomised trials of primary surgery for children born with complete unilateral cleft lip and palate (UCLP). It presents the protocol developed for the trials in CONSORT format, and describes the management structure that was developed to achieve the long-term engagement and commitment required to complete the project. Ten established national or regional cleft centres participated. Lip and soft palate closure at 3-4 months, and hard palate closure at 12 months served as a common method in each trial. Trial 1 compared this with hard palate closure at 36 months. Trial 2 compared it with lip closure at 3-4 months and hard and soft palate closure at 12 months. Trial 3 compared it with lip and hard palate closure at 3-4 months and soft palate closure at 12 months. The primary outcomes were speech and dentofacial development, with a series of perioperative and longer-term secondary outcomes. Recruitment of 448 infants took place over a 9-year period, with 99.8% subsequent retention at 5 years. The series of reports that follow this introductory paper include comparisons at age 5 of surgical outcomes, speech outcomes, measures of dentofacial development and appearance, and parental satisfaction. The outcomes recorded and the numbers analysed for each outcome and time point are described in the series. ISRCTN29932826.

High-resolution ultrasound of rotator cuff and biceps reflection pulley in non-elite junior tennis players: anatomical study.

PubMed

Tagliafico, Alberto; Cadoni, Angela; Bignotti, Bianca; Martinoli, Carlo

2014-07-18

Tennis is believed to be potentially harmful for the shoulder, therefore the purpose of this study is to evaluate the anatomy of the rotator cuff and the coraco-humeral ligament (CHL) in a-symptomatic non-elite junior tennis players with high-resolution ultrasound (US). From August 2009 to September 2010 n = 90 a-symptomatic non-elite junior tennis players (mean age ± standard deviation: 15 ± 3) and a control group of age- and sex- matched subjects were included. Shoulder assessment with a customized standardized protocol was performed. Body mass index, dominant arm, years of practice, weekly hours of training, racket weight, grip (Eastern, Western and semi-Western), kind of strings were recorded. Abnormalities were found at ultrasound in 14/90 (15%) players. Two players had supraspinatus tendinosis, two had subacromial impingement and ten had subacromial bursitis. CHL thickness resulted comparable in the dominant and non-dominant arms (11.3 ± 4.4 mm vs. 13 ± 4.2, p > 0.05). Multivariate analysis demonstrated that no association was present among CHL thickness and the variables evaluated. In the control group, abnormalities were found at ultrasound in 6/60 (10%) subjects (sub-acromial bursitis). No statistically significant differences between players and control group were found (p = 0.71). In a-symptomatic non-elite junior tennis players only minor shoulder abnormalities were found.

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial

PubMed Central

Nejati, Parisa; Ghahremaninia, Armita; Naderi, Farrokh; Gharibzadeh, Safoora; Mazaherinezhad, Ali

2017-01-01

Background: Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. Hypothesis: Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. Results: Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. Conclusion: Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective. PMID:28567426

Evaluation of an exercise concept focusing on eccentric strength training of the rotator cuff for patients with subacromial impingement syndrome.

PubMed

Bernhardsson, Susanne; Klintberg, Ingrid Hultenheim; Wendt, Gunilla Kjellby

2011-01-01

To evaluate the effect on pain intensity and function of an exercise concept focusing on specific eccentric strength training of the rotator cuff in patients with subacromial impingement syndrome. Single-subject research design with baseline and treatment phases (AB design). Home-based training programme supervised and supported by visits to physiotherapy clinic. Ten patients, mean (SD) age 54 (8.6) years, symptom duration 12 (9.1) months. Daily eccentric strengthening exercises of the rotator cuff during 12 weeks. Pain intensity, assessed with a visual analogue scale, and function, using the Patient-Specific Functional Scale. Shoulder function evaluated with the Constant score, and shoulder-related quality of life evaluated with the Western Ontario Rotator Cuff Index. Pain intensity decreased significantly in eight of the ten subjects. Function improved significantly in all ten subjects. Constant score increased in nine subjects and Western Ontario Rotator Cuff Index increased in seven subjects. Mean Constant score for the whole group increased significantly from 44 to 69 points (P = 0.008). Mean Western Ontario Rotator Cuff Index increased from 51 to 71% (P = 0.021). A 12-week eccentric strengthening programme targeting the rotator cuff and incorporating scapular control and correct movement pattern can be effective in decreasing pain and increasing function in patients with subacromial impingement syndrome. A randomized controlled trial is necessary to provide stronger evidence of the method.

[Diagnostic value of a predictive model for complete ruptures of the rotator cuff associated to subacromial impingement].

PubMed

Águila-Ledesma, I R; Córdova-Fonseca, J L; Medina-Pontaza, O; Núñez-Gómez, D A; Calvache-García, C; Pérez-Atanasio, J M; Torres-González, R

2017-01-01

Pathology related to the rotator cuff remains among the most prevalent musculoskeletal diseases. There is an increasing need for imaging studies (MRI, US, arthroscopy) to test the diagnostic performance of the medical history and physical examination. To prove the diagnostic value of a clinical-radiographic predictive model to find complete ruptures of the rotator cuff. Descriptive, observational, prospective, transversal and analytical study. Fifty-five patients with preoperative shoulder pain were evaluated with 13 predictive variables: age > 50 years, nocturnal pain, muscle weakness, clinical signs of Neer, Hawkins, Jobe, external rotation lag (ERLS), belly-press, bear hug, and lift-off, radiographic measurement of subacromial space, acromial index and critical shoulder angle. Sensitivity, specificity, and positive and negative predictive values were measured in each variable, comparing the results of each one against the postoperative findings. Of the 55 patients evaluated, 42 had a complete rupture of the rotator cuff in the postoperative period. The eight variables with a higher diagnostic value were selected and a ROC curve was performed, providing an area under the curve of 0.88. This predictive model uses eight variables (age > 50 years, nocturnal pain, muscle weakness, Jobe, Hawkins, ERLS, subacromial space ≤ 6 mm, and critical shoulder angle > 35°), which together add the predictive value of 0.88 (AUC) to diagnose complete ruptures of the supraspinatus tendon.

Subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder manual therapy plus exercise intervention in individuals with subacromial impingement syndrome: a prospective, randomized controlled clinical trial pilot study.

PubMed

Wright, Alexis A; Donaldson, Megan; Wassinger, Craig A; Emerson-Kavchak, Alicia J

2017-09-01

To determine the subacute effects of cervicothoracic spinal thrust/non-thrust in addition to shoulder non-thrust plus exercise in patients with subacromial pathology. This was a randomized, single blinded controlled trial pilot study. This trial was registered at ClinicalTrials.gov (NCT01753271) and reported according to Consolidated Standards of Reporting Trials requirements. Patients were randomly assigned to either shoulder treatment plus cervicothoracic spinal thrust/non-thrust or shoulder treatment-only group. Primary outcomes were average pain intensity (Numeric Pain Rating Scale) and physical function (Shoulder Pain and Disability Index) at 2 weeks, 4 weeks, and patient discharge. 18 patients, mean age 43.1(15.8) years satisfied the eligibility criteria and were analyzed for follow-up data. Both groups showed statistically significant improvements in both pain and function at 2 weeks, 4 weeks, and discharge. The between-group differences for changes in pain or physical function were not significant at any time point. The addition of cervicothoracic spinal thrust/non-thrust to the shoulder treatment-only group did not significantly alter improvement in pain or function in patients with subacromial pathology. Both approaches appeared to provide an equally notable benefit. Both groups improved on all outcomes and met the criteria for clinical relevance for both pain and function. 2b.

The split hypoglossal nerve versus the cross-face nerve graft to supply the free functional muscle transfer for facial reanimation: A comparative study.

PubMed

Amer, Tarek A; El Kholy, Mohamed S

2018-05-01

Long-standing cases of facial paralysis are currently treated with free functional muscle transfer. Several nerves are mentioned in the literature to supply the free muscle transfer. The aim of this study is to compare the split hypoglossal nerve and the cross-face nerve graft to supply the free functional muscle transfer in facial reanimation. Of 94 patients with long-standing, unilateral facial palsy, 49 were treated using the latissimus dorsi muscle supplied by the split hypoglossal nerve, and 45 patients were treated using the latissmus dorsi muscle supplied by healthy contralateral buccal branch of the facial nerve. The excursion gained by the free muscle transfer supplied by the split hypoglossal nerve (mean 19.20 ± 6.321) was significantly higher (P value 0.001) than that obtained by the contralateral buccal branch of the facial nerve (mean 14.59 ± 6.245). The split hypoglossal nerve appears to be a good possible option to supply the free vascularised muscle transfer in facial reanimation. It yields a stronger excursion in less time than the contralateral cross-face nerve graft. Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

PubMed

Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

2016-08-01

The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P < 0.001). While the kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P < 0.05). Addition of kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate kinesiotaping and corticosteroid injections into the treatment plan for patients with shoulder impingement syndrome. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for amaximumof 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Effect of Battlefield Acupuncture and Physical Therapy Versus Physical Therapy Alone After Shoulder Surgery

ClinicalTrials.gov

2018-05-14

Opioid Use; Pain, Postoperative; SLAP Lesion; Bankart Lesion; Subacromial Impingement Syndrome; Rotator Cuff Tear; Glenohumeral Dislocation; Glenohumeral Subluxation; Hill Sach Lesion; Bony Bankart Lesion; Acromioclavicular Separation

Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies.

PubMed

Vrotsou, Kalliopi; Ávila, Mónica; Machón, Mónica; Mateo-Abad, Maider; Pardo, Yolanda; Garin, Olatz; Zaror, Carlos; González, Nerea; Escobar, Antonio; Cuéllar, Ricardo

2018-05-10

The objective of this study was to evaluate the psychometric properties of the Constant-Murley Score (CMS) in various shoulder pathologies, based on a systematic review and expert standardized evaluations. A systematic review was performed in MEDLINE and EMBASE databases. Titles and abstracts were reviewed and finally the included articles were grouped according to patients' pathologies. Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally. Five individual pathologies (i.e. subacromial, fractures, arthritis, instability and frozen shoulder) and two additional groups (i.e. various pathologies and healthy subjects) were considered. Overall EMPRO scores ranged from 58.6 for subacromial to 30.6 points for instability. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder. Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the other evaluated attributes. The current evidence does not support the CMS as a gold standard in shoulder evaluation. Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed. Systematic review.

Muscle shortening maneuver and not topical anti-inflammatory therapy is effective in reducing the width of subacromial-subdeltoid bursa in shoulder impingement syndrome

NASA Astrophysics Data System (ADS)

Melchiorre, Daniela; Lippi, Paolo; Marchi, Alberto; Maresca, Marco; Bravi, Riccardo; Eros, Quarta; Lazzerini, Patrizia; Bagni, Maria Angela

2018-04-01

Aim of the study was to compare the efficacy of a muscle shortening maneuver (MSM) with the efficacy of a topical NSAID (flurbiprofen) in patients with subacromial impingement syndrome (SIS). The effects of these therapies were evaluated by sonographic exam (US). SIS was diagnosed by US in 78 patients with painful shoulder. Thirty patients (first group) were treated with topical flurbiprofen for 15 days. Forty-eight patients (second group) were treated with MSM, which was performed once. The shoulder was analyzed in all patients by US before and after treatment. Before treatment and 15 days after treatment, pain by Visual Analogue Scale (VAS), range of motion (ROM) and Neer's Test were evaluated. Pain was decreased by both treatments. In only 8 patients of the first group, the encroachment of acromion into the rotator cuff was no more detectable by US after the treatment; ROM increased (> 45°) only in 11 patients (36%) and the width of subacromial-subdeltoid bursa (SSB) was not significantly reduced. At variance with the results obtained in the first group, in all patients of the second group the encroachment of acromion was no more detectable by US, ROM increased (> 45°) and the width of SSB was significantly reduced after the maneuver. Both topical flurbiprofen and MSM were helpful in pain control, but better results, with decrease of width of SSB assessed by US, were obtained by MSM.

Diclofenac Patch for Treatment of Mild to Moderate Tendonitis or Bursitis

ClinicalTrials.gov

2008-08-05

Rotator Cuff Tendonitis; Bicipital Tendonitis; Subdeltoid Bursitis of the Shoulder; Subacromial Bursitis of the Shoulder; Medial Epicondylitis of the Elbow; Lateral Epicondylitis of the Elbow; DeQuervain's Tenosynovitis of the Wrist

Ultrasound-guided subacromial injections of sodium hyaluronate for the management of rotator cuff tendinopathy: a prospective comparative study with rehabilitation therapy.

PubMed

Merolla, G; Bianchi, P; Porcellini, G

2013-06-01

Rotator cuff (RC) tendinopathy is a common cause of pain and shoulder dysfunction. The literature evidence suggests that a combination of overuse and extrinsic compression may induce chronic RC tendinopathy. Aim of the current study was to compare the results of subacromial sodium hyaluronate injections with rehabilitation therapy. We enrolled 48 patients (M/F: 26/22; mean age: 50 years; shoulder right/left: 29/19) with persistent shoulder pain for at least 4 months. Exclusion criteria were as follows: RC tear, calcifying tendinitis, glenohumeral instability, osteoarthritis, rheumatic diseases, physical therapy and/or injection in the previous 4 months, shoulder surgery, anesthetic nerve block, trauma, and severe medical diseases. The included subjects received either two ultrasound-guided subacromial hyaluronic acid (HA) injections (25 patients, HA group) at baseline and 14 days, or underwent rehabilitation therapy (23 patients, Physio group) including active shoulder mobilization, soft tissue stretching and humeral head positioner and propeller muscles strengthening for 30 days (3 sessions every week). Clinical assessment of shoulder function was performed with visual analog scale score for pain (0-100), Oxford Shoulder Score (OSS), and Constant-Murley Score (CS). Overall, patients were examined at baseline, week 2, week 4, week 12, and week 24. Statistical significance was set at 5 % (p < 0.05). Reduction in overall pain in the HA group was statistically significant at week 2 (p < 0.05) week 4 (p < 0.05), week 12 comparing to baseline. Similarly, pain subscores (at night and with activity) were significantly lower at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05), respectively. In the Physio group, pain decreased significantly at week 2 (p < 0.05) but not maintained at week 4 (p > 0.05), week 12 (p > 0.05), and week 24 (p > 0.05). CS and OSS in the HA group increased significantly at week 2 (p < 0.05), week 4 (p < 0.05), and week 12 (p < 0.05). A non-statistically significant increase in clinical scores was found at week 24 (p > 0.05). A significant improvement of CS and OSS we found in the Physio group at week 2 (p < 0.05), but not at weeks 4, 12, and 24 (p > 0.05). Subacromial HA injections could be an effective and safe alternative treatment for patients suffering from RC tendinopathy. We believe that the results of this study are encouraging but not lasting and we might suppose that a series of three to four subacromial sodium hyaluronate injections could provide good mid- and long-term clinical benefits.

The role of platelet-rich plasma in rotator cuff repair.

PubMed

Mei-Dan, Omer; Carmont, Michael R

2011-09-01

The shoulder is a common source of disability resulting from traumatic and degenerate tears of the rotator cuff, subacromial impingement, and osteoarthritis. Nonoperative management has focused on treatment of the predisposing factors, the use of analgesics and anti-inflammatory medication usually in association with local anesthetic and steroid injections. Surgical intervention allows debridement of the degenerate cuff and partial thickness cuff tears, subacromial bursitis, impinging bone spurs and osteophytes together with rotator cuff repairs. Repairs of degenerate and torn tissue are often prone to failure due to many intrinsic and extrinsic factors. It is assumed that some biological therapies might improve clinical, mechanical, and histologic outcomes. Injections of platelet-rich plasma (PRP) have led to reduced pain and improved recovery in other degenerate pathologies areas together with the restoration of function. This study reviews the current literature on PRP and in particular discusses its relevance in the treatment of rotator cuff tears.

[Cost-effectiveness of local steroid combined with therapeutic exercise in subacromial impingement syndrome].

PubMed

Ramírez-Ortiz, Julio; Mendoza-Eufracio, José Dolores; García-Viveros, María Ricarda; Márquez-Celedonio, Félix Guillermo

2017-01-01

The most common cause of injury is shoulder impingement syndrome. Management includes physical therapy, analgesics, steroids and surgery. The aim of the study was to determine the cost-effectiveness of using steroids combined with therapeutic exercise at home in the chronic impingement syndrome. Clinical trial randomized in 30 people with subacromial impingement syndrome underwent two treatments: steroid and at home rehabilitation booklet evaluated at the first and fourth week through UCLA Shoulder rating scale. We studied 17 men (56.7 %) and 13 women (43.3 %), mean age was 42.87 years. Group 2 earned greater improvement in UCLA Shoulder rating scale 18.87 at baseline and 27.60 at the end. With 30.27 accumulated disability days for group 1, and 14.80 for group 2. The combination of local steroids with therapeutic exercise is more effective clinically and declining disability compared to conventional physical therapy.

Calcific tendinitis of the rotator cuff: management options.

PubMed

Suzuki, Kentaro; Potts, Aaron; Anakwenze, Oke; Singh, Anshu

2014-11-01

Calcific tendinitis of the rotator cuff tendons is a common cause of shoulder pain in adults and typically presents as activity-related shoulder pain. It is thought to be an active, cell-mediated process, although the exact pathophysiology remains unclear. Nonsurgical management continues to be the mainstay of treatment; most patients improve with modalities such as oral anti-inflammatory medication, physical therapy, and corticosteroid injections. Several options are available for patients who fail nonsurgical treatment, including extracorporeal shock wave therapy, ultrasound-guided needle lavage, and surgical débridement. These modalities alleviate pain by eliminating the calcific deposit, and several recent studies have demonstrated success with the use of these treatment options. Surgical management options include arthroscopic procedures to remove calcific deposits and subacromial decompression; however, the role of subacromial decompression and repair of rotator cuff defects created by removing these deposits remains controversial. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

Unilateral mastitis obliterans presented as a palpable breast mass in a patient with long-standing diabetes mellitus.

PubMed

Blay, J; Medina, R; Rausell, N; Fonfria, C; Atares, M; Requeni, L; Vilar, J

2012-01-01

Mastitis obliterans is an uncommon and late manifestation of ductal ectasia. We report a case of a woman with a long-term type 2 diabetes, referred to us because of a palpable right breast mass. Mammography showed an asymmetry in the palpated area. Ultrasonography was consistent with a an irregular, hypoechoic mass with indistinct margins and linear tracts to the skin. The biopsy showed a fibrotic component surrounding dilated galactophore ducts, which were collapsed by an infiltrate of lymphocytes and histiocytes corresponding to mastitis obliterans. The differential diagnosis should be made between diabetic fibrous mastopathy, granulomatous mastitis and lobular carcinoma. In our opinion, the therapeutic approach should depend on the symptomatology and should be individualized for each patient owing to the lack of information on this pathology, adopting therefore a conservative attitude.

Update on managing Bell's palsy.

PubMed

2008-07-01

Each year in the UK, around 1 in 5,000 people develops Bell's palsy--idiopathic unilateral lower motor neurone facial weakness of rapid onset. Of those who are not treated, about 16% end up with permanent moderate to severe weakness, which can result in facial dysfunction and disfigurement, and psychological difficulties. There has been longstanding controversy about what, if any, treatment should be given, with potential alternatives including corticosteroids, antiviral drugs, acupuncture and physiotherapy. We last reviewed this condition in 2006, indicating that "published trials on the efficacy of drug treatments have been poor and no firm conclusions can be drawn about the benefit of any single drug", and "it is unclear what place, if any, acupuncture and physiotherapy have in the management of patients with Bell's palsy". Here we update our conclusions in the light of recently published evidence.

A biomechanical cadaveric study comparing superior capsule reconstruction using fascia lata allograft with human dermal allograft for irreparable rotator cuff tear.

PubMed

Mihata, Teruhisa; Bui, Christopher N H; Akeda, Masaki; Cavagnaro, Matthew A; Kuenzler, Michael; Peterson, Alexander B; McGarry, Michelle H; Itami, Yasuo; Limpisvasti, Orr; Neo, Masashi; Lee, Thay Q

2017-12-01

Biomechanical and clinical success of the superior capsule reconstruction (SCR) using fascia lata (FL) grafts has been reported. In the United States, human dermal (HD) allograft has been used successfully for SCRs; however, the biomechanical characteristics have not been reported. Eight cadaveric shoulders were tested in 5 conditions: (1) intact; (2) irreparable supraspinatus tear; (3) SCR using FL allograft with anterior and posterior suturing; (4) SCR using HD allograft with anterior and posterior suturing; and (5) SCR using HD allograft with posterior suturing. Rotational range of motion, superior translation, glenohumeral joint force, and subacromial contact were measured at 0°, 30°, and 60° of glenohumeral abduction in the scapular plane. Graft dimensions before and after testing were also recorded. Biomechanical parameters were compared using a repeated-measures analysis of variance with Tukey post hoc test, and graft dimensions were compared using a Student t-test (P < .05). Irreparable supraspinatus tear significantly increased superior translation, superior glenohumeral joint force, and subacromial contact pressure, which were completely restored with the SCR FL allografts. Both SCR HD allograft repairs partially restored superior translation and completely restored subacromial contact and superior glenohumeral joint force. The HD allografts significantly elongated by 15% during testing, whereas the FL allograft lengths were unchanged. Single-layered HD SCR allografts partially restored superior glenohumeral stability, whereas FL allograft SCR completely restored the superior glenohumeral stability. This may be due to the greater flexibility of the HD allograft, and the SCR procedure used was developed on the basis of FL grafts. Published by Elsevier Inc.

PARot--assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial.

PubMed

Carr, Andrew; Cooper, Cushla; Murphy, Richard; Watkins, Bridget; Wheway, Kim; Rombach, Ines; Beard, David

2013-06-11

Platelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171-1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies. PARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP. Current Controlled Trials: ISRCTN10464365.

Scapular Stabilization and Muscle Strength in Manual Wheelchair Users with Spinal Cord Injury and Subacromial Impingement.

PubMed

Wilbanks, Susan R; Bickel, C Scott

2016-01-01

Background: Manual wheelchair users with spinal cord injury (SCI) are frequently diagnosed with subacromial impingement. Objective: To determine whether the pattern of muscle imbalance and impaired scapular stabilization in able-bodied (AB) adults with impingement is different from that in manual wheelchair users with SCI and impingement. Methods: The following measurements were collected from 22 adults with subacromial impingement (11 SCI, 11 AB): ratio of normalized muscle electrical activity of upper and lower trapezius (UT:LT) during arm abduction; force during abduction, adduction, internal rotation, external rotation, and push and pull; ratios of force for abduction to adduction (AB:ADD), internal to external rotation (IR:ER), and push to pull (PUSH:PULL). Results: Shoulders with impingement had significantly higher UT:LT activation (1.46 ± 0.52) than shoulders without impingement (0.93 ± 0.45) ( P = .006), regardless of wheelchair user status. Significant differences between AB participants and those with SCI were observed for ABD:ADD ( P = .005), PUSH:PULL ( P = .012), and pull strength ( P = .043). Participants with SCI had a significantly greater ABD:ADD (1.37 ± 0.36) than AB participants (1.04 ± 0.22) ( P = .002) and a significantly greater PUSH:PULL (1.53 ± 0.36) than AB participants (1.26 ± 0.18) ( P = .005) because of decreased strength in adduction ( P = .021) and pull ( P = .013). Conclusions: Strategies targeting the posterior shoulder girdle for AB adults are appropriate for manual wheelchair users with SCI and impingement and should focus on scapular retractors and arm adductors with emphasis on scapular depression and posterior tilting.

Limb symmetry during double-leg squats and single-leg squats on land and in water in adults with long-standing unilateral anterior knee pain; a cross sectional study.

PubMed

Severin, Anna C; Burkett, Brendan J; McKean, Mark R; Wiegand, Aaron N; Sayers, Mark G L

2017-01-01

The presence of pain during movement typically results in changes in technique. However, the physical properties of water, such as flotation, means that water-based exercise may not only reduce compensatory movement patterns but also allow pain sufferers to complete exercises that they are unable to perform on land. The purpose of this study was to assess bilateral kinematics during double-leg squats and single-leg squats on land and in water in individuals with unilateral anterior knee pain. A secondary aim was to quantify bilateral asymmetry in both environments in affected and unaffected individuals using a symmetry index. Twenty individuals with unilateral knee pain and twenty healthy, matched controls performed body weight double- and single-leg squats in both environments while inertial sensors (100 Hz) recorded trunk and lower body kinematics. Repeated-measures statistics tested for environmental effects on movement depths and peak angles within the anterior knee pain group. Differences in their inter-limb symmetry in each environments was compared to the control group using analysis of variance tests. Water immersion allowed for greater movement depths during both exercises (double-leg squat: +7 cm, p  = 0.032, single-leg squat: +9 cm, p  = 0.002) for the knee pain group. The double-leg squat was symmetrical on land but water immersion revealed asymmetries in the lower body frontal plane movements. The single-leg squat revealed decreased hip flexion and frontal plane shank motions on the affected limb in both environments. Water immersion also affected the degree of lower limb asymmetry in both groups, with differences also showing between groups. Individuals with anterior knee pain achieved increased squat depth during both exercises whilst in water. Kinematic differences between the affected and unaffected limbs were often increased in water. Individuals with unilateral anterior knee pain appear to utilise different kinematics in the affected and unaffected limb in both environments.

Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program.

PubMed

Maenhout, Annelies; Van Eessel, Valerie; Van Dyck, Lieselot; Vanraes, Aagje; Cools, Ann

2012-09-01

Loss of internal rotation range of motion (ROM) on the dominant side is well documented in athletes performing overhead sports activity. This altered motion pattern has been shown to change glenohumeral and scapular kinematics. This could compromise the subacromial space and explain the association between glenohumeral internal rotation deficit (GIRD) and subacromial impingement. First, to quantify acromiohumeral distance (AHD) and compare between the dominant and nondominant side in overhead athletes with GIRD of more than 15°. Second, to investigate the effect of a sleeper stretch program on ROM and AHD. Controlled laboratory study. Range of motion was measured with a digital inclinometer and AHD was measured with ultrasound in 62 overhead athletes with GIRD (>15°) at baseline. Differences between sides were analyzed. Athletes were randomly allocated to the stretch (n = 30) or control group (n = 32). The stretch group performed a 6-week sleeper stretch program on the dominant side. Change of range of motion and AHD were measured and analyzed in both groups after 6 weeks. The dominant side showed a significant internal rotation deficit (-24.7° ± 6.3°) and horizontal adduction deficit (-11.8° ± 7.4°) and the dominant side AHD was significantly smaller with the arm at neutral (-0.4 ± 0.6 mm) and at 45° (-0.5 ± 0.8 mm) and 60° (-0.6 ± 0.7 mm) of active abduction compared with the nondominant side. After stretching, significant increase of internal rotation (+13.5° ± 0.8°), horizontal adduction (+10.6° ± 0.9°) ROM and AHD (+0.5 to +0.6mm) was observed at the dominant side of the stretch group compared with prestretching measurements. No significant change of AHD was seen in the nondominant side of the stretch group and in both sides of the control group. The AHD, a 2-dimensional measure for subacromial space, was found to be smaller on the dominant side in athletes with GIRD and was found to increase after a 6-week sleeper stretch program. These findings might provide insight into the relation between GIRD and subacromial impingement but future studies are needed to determine clinical implications.

Avoiding Shoulder Injury from Resistance Training.

ERIC Educational Resources Information Center

Durall, Chris J.; Manske, Robert C.; Davies, George J.

2001-01-01

Identifies shoulder exercises commonly performed in fitness centers that may contribute to or exacerbate glenohumeral joint (shoulder) injury, describing alternative exercises that may be substituted and a offering rationale for the variations. The article focuses on anterior and posterior glenohumeral instability, subacromial impingement (primary…

The effectiveness of low laser therapy in subacromial impingement syndrome: a randomized placebo controlled double‐blind prospective study

PubMed Central

Dogan, Sebnem Koldas; AY, Saime; Evcik, Deniz

2010-01-01

OBJECTIVES: Conflicting results were reported about the effectiveness of Low level laser therapy on musculoskeletal disorders. The aim of this study was to investigate the effectiveness of 850‐nm gallium arsenide aluminum (Ga‐As‐Al) laser therapy on pain, range of motion and disability in subacromial impingement syndrome. METHODS: A total of 52 patients (33 females and 19 males with a mean age of 53.59±11.34 years) with subacromial impingement syndrome were included. The patients were randomly assigned into two groups. Group I (n = 30, laser group) received laser therapy (5 joule/cm2 at each point over maximum 5‐6 painful points for 1 minute). Group II (n = 22, placebo laser group) received placebo laser therapy. Initially cold pack (10 minutes) was applied to all of the patients. Also patients were given an exercise program including range of motion, stretching and progressive resistive exercises. The therapy program was applied 5 times a week for 14 sessions. Pain severity was assessed by using visual analogue scale. Range of motion was measured by goniometer. Disability was evaluated by using Shoulder Pain and Disability Index. RESULTS: In group I, statistically significant improvements in pain severity, range of motion except internal and external rotation and SPADI scores were observed compared to baseline scores after the therapy (p<0.05). In Group II, all parameters except range of motion of external rotation were improved (p<0.05). However, no significant differences were recorded between the groups (p>0.05). CONCLUSIONS: The Low level laser therapy seems to have no superiority over placebo laser therapy in reducing pain severity, range of motion and functional disability. PMID:21120304

Effects of weighted and un-weighted pendulum exercises on ultrasonographic acromiohumeral distance in patients with subacromial impingement syndrome.

PubMed

Akkaya, Nuray; Akkaya, Semih; Gungor, Harun R; Yaşar, Gokce; Atalay, Nilgun Simsir; Sahin, Fusun

2017-01-01

Although functional results of combined rehabilitation programs are reported, there have been no reports studying the effects of solo pendulum exercises on ultrasonographic measurements of acromiohumeral distance (AHD). To investigate the effects of weighted and un-weighted pendulum exercises on ultrasonographic AHD and clinical symptoms in patients with subacromial impingement syndrome. Patients with subacromial impingement syndrome were randomized to performing weighted (1.5 kilograms hand held dumbbell, N= 18) or un-weighted (free of weight, N= 16) pendulum exercises for 4 weeks, 3 sessions/day. Exercises were repeated for each direction of shoulder motion in each session (ten minutes). Clinical situation was evaluated by Constant score and Shoulder Pain Disability Index (SPADI). Ultrasonographic measurements of AHD at 0°, 30° and 60° shoulder abduction were performed. All clinical and ultrasonographic evaluations were performed at the beginning of the exercise program and at end of 4 weeks of exercise program. Thirty-four patients (23 females, 11 males; mean age 41.7 ± 8.9 years) were evaluated. Significant clinical improvements were detected in both exercise groups between pre and post-treatment evaluations (p < 0.05). There was no significant difference for pre and post-treatment AHD measurements at 0°, 30°, and 60° shoulder abduction between groups (p > 0.05). There was no significant difference for pre and post-treatment narrowing of AHD (narrowing of 0°-30°, and 0°-60°) between groups (p > 0.05). While significant clinical improvements were achieved with both weighted and un-weighted solo pendulum exercises, no significant difference was detected for ultrasonographic AHD measurements between exercise groups.

Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis.

PubMed

Jowett, Sue; Crawshaw, Dickon P; Helliwell, Philip S; Hensor, Elizabeth M A; Hay, Elaine M; Conaghan, Philip G

2013-08-01

To perform a cost-effectiveness analysis of subacromial corticosteroid injection combined with exercise compared with exercise alone in patients with moderate to severe shoulder pain from subacromial impingement syndrome. A within-trial cost-effectiveness analysis with 232 patients randomized to physiotherapy-led injection combined with exercise (n = 115) or exercise alone (n = 117). The analysis was from a health care perspective with 24-week follow-up. Resource use information was collected from all patients on interventions, medication, primary and secondary care contacts, private health care use and over-the-counter purchases. The measure of outcome was quality-adjusted life years (QALYs), calculated from EQ-5D responses at baseline and three further time points. An incremental cost-effectiveness analysis was conducted. Mean per patient NHS costs (£255 vs £297) and overall health care costs (£261 vs £318) were lower in the injection plus exercise arm, but this difference was not statistically significant. Total QALYs gained were very similar in the two trial arms (0.3514 vs 0.3494 QALYs), although slightly higher in the injection plus exercise arm, indicating that injection plus exercise may be the dominant treatment option. At a willingness to pay of £20,000 per additional QALY gained, there was a 61% probability that injection plus exercise was the most cost-effective option. Injection plus exercise delivered by therapists may be a cost-effective use of resources compared with exercise alone and lead to lower health care costs and less time off work. International Standard Randomised Controlled Trial Number Register, http://www.controlled-trials.com/isrctn/, ISRCT 25817033.

Subacromial impingement syndrome--effectiveness of physiotherapy and manual therapy.

PubMed

Gebremariam, Lukas; Hay, Elaine M; van der Sande, Renske; Rinkel, Willem D; Koes, Bart W; Huisstede, Bionka M A

2014-08-01

The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy. The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results. Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found. Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn. 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.

Shoulder function and work disability after decompression surgery for subacromial impingement syndrome: a randomised controlled trial of physiotherapy exercises and occupational medical assistance.

PubMed

Svendsen, Susanne W; Christiansen, David H; Haahr, Jens Peder; Andrea, Linda C; Frost, Poul

2014-06-21

Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function. A recent Danish study showed that 10% of a nationwide cohort of patients retired prematurely within two years after surgery. Few studies have compared effects of different postoperative exercise programmes on shoulder function, and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability. This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression. The study is a mainly pragmatic multicentre randomised controlled trial. The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region. Patients aged ≥18-≤63 years, who still have shoulder symptoms 8-12 weeks after surgery, constitute the study population. Around 130 participants are allocated to: 1) physiotherapy exercises, 2) occupational medical assistance, 3) physiotherapy exercises and occupational medical assistance, and 4) usual care. Intervention manuals allow individual tailoring. Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder. Randomisation is computerised with allocation concealment by randomly permuted block sizes. Statistical analyses will primarily be performed according to the intention-to-treat principle. The paper presents the rationale, design, methods, and operational aspects of the Shoulder Intervention Project (SIP). SIP evaluates a new rehabilitation approach, where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care. If successful, the project may serve as a model for rehabilitation of surgical shoulder patients. Current Controlled Trials ISRCTN55768749.

Prevalence of calcific deposits within the rotator cuff tendons in adults with and without subacromial pain syndrome: clinical and radiologic analysis of 1219 patients.

PubMed

Louwerens, Jan K G; Sierevelt, Inger N; van Hove, Ruud P; van den Bekerom, Michel P J; van Noort, Arthur

2015-10-01

Calcific tendinopathy is one of the most frequent causes of pain in the shoulder and is characterized by the presence of calcific deposits in the rotator cuff; however, calcific deposits have also been described in asymptomatic individuals. Only a few authors have reported epidemiologic data on the prevalence of calcific deposits in the rotator cuff. This study analyzed clinical and radiological data of 1219 adults with and without subacromial pain syndrome (SAPS) to assess the prevalence of calcific deposits in the rotator cuff. Multivariate analysis was used to define risk factors associated with the presence of symptomatic calcific tendinopathy. Calcific deposits were found in the rotator cuff of 57 of 734 asymptomatic patients (7.8%). Of 485 patients with SAPS, 42.5% had calcific deposits. Age between 30 and 60 years (odds ratio [OR], 8.0; 95% confidence interval [CI], 2.5-26.3; P < .001), subacromial pain (OR, 7.1; 95% CI, 5.1-9.9, P < .001), and female gender (OR, 1.5; 95% CI, 1.1-2.0; P = .014) were significantly associated with increased odds of calcific deposits. This study demonstrates that women aged between 30 and 60 years with SAPS and a calcific deposit of >1.5 cm in length have the highest chance of suffering from symptomatic calcific tendinopathy of the rotator cuff. The prevalence rates of 7.8% in asymptomatic patients and 42.5% in patients with SAPS provide a current view on the epidemiology of calcific deposits in the rotator cuff. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

PubMed

Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

2012-05-01

The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff disease.

PubMed

Handa, Akiyoshi; Gotoh, Masafumi; Hamada, Kazutoshi; Yanagisawa, Kazuhiro; Yamazaki, Hitoshi; Nakamura, Masato; Ueyama, Yoshito; Mochida, Joji; Fukuda, Hiroaki

2003-11-01

Vascular endothelial growth factor (VEGF) is a glycoprotein that plays an important role in neovascularization and increases vascular permeability. We reported that VEGF is involved in motion pain of patients with rotator cuff disease by causing synovial proliferation in the subacromial bursa (SAB). The present study investigates whether VEGF is also involved in the development of shoulder contracture in diabetics with rotator cuff disease. We examined 67 patients with rotator cuff disease, including 36 with complete cuff tears, 20 with incomplete tears, and 11 without apparent tears (subacromial bursitis). The patients were into groups according to the presence or absence of diabetes (14 type II diabetics and 53 non-diabetics). Specimens of the synovium of the SAB were obtained from all patients during surgery. Expression of the VEGF gene in the synovium of the subacromial bursa was evaluated by using the reverse transcriptase polymerase chain reaction. The VEGF protein was localized by immunohistochemistry, and the number of vessels was evaluated based on CD34 immunoreactivity. The results showed that VEGF mRNA was expressed in significantly more diabetics (100%, 14/14) than in non-diabetics (70%, 37/53) (P=0.0159, Fisher's test). Investigation of VEGF isoform expression revealed VEGF121 in all 14 diabetics and in 37 of the 53 non-diabetics, VEGF165 in 12 of the 14 diabetics and in 21 of the 53 non-diabetics, and VEGF189 in 1 of the 14 diabetics and in 2 of the 53 non-diabetics. No VEGF206 was expressed in either group. VEGF protein was localized in both vascular endothelial cells and synovial lining cells. The mean number of VEGF-positive vessels and the vessel area were also significantly greater in the diabetics (p<0.015, Mann-Whitney U test). Synovial proliferation and shoulder joint contracture were more common in the diabetics (P=0.0329 and P=0.073, respectively; Fisher's test). The mean preoperative range of shoulder motion significantly differed in terms of elevation between two groups: 103.8 degrees in diabetics and 124.9 degrees in no diabetics (p=0.0039 Mann-Whitney U test). In contrast, external rotation did not significantly differ: 44 degrees in diabetics and 49 degrees in non-diabetics (p=0.4957, Mann-Whitney U test). These results suggest that VEGF121 and VEGF165 expression in the SAB is responsible for the development of shoulder joint contracture, especially in elevation, among type II diabetic patients with rotator cuff disease.

Targeted knockout of TNF-α by injection of lentivirus-mediated siRNA into the subacromial bursa for the treatment of subacromial bursitis in rats.

PubMed

Wang, Yi; Li, Quan; Wei, Xianzhao; Xu, Jie; Chen, Qi; Song, Shuang; Lu, Zhe; Wang, Zimin

2015-09-01

Subacromial bursitis (SAB) is the major source of pain in rotator cuff disease. Although multiple investigations have provided support for the role of inflammatory cytokines in SAB, few have focussed on the use these cytokines in the treatment of SAB. The aim of the present study was to observe the therapeutic efficacy of lentivirus‑mediated RNA interference (RNAi) on carrageenan‑induced SAB by injecting lentivirus‑tumor necrosis factor (TNF)‑α‑RNAi expressing TNF‑α small interfering (si)RNA. Using screened siRNA segments, an siRNA was designed. A lentivirus vector expressing siRNA was established and packed as lentivirus particles. A lentivirus that expressed the negative sequence was used as a lentivirus‑negative control (NC). The carrageenan‑induced SAB model was established in 32 male Sprague‑Dawley rats. The modeled rats were randomly assigned to four groups: Lentivirus‑RNAi treatment group, lentivirus‑NC group, SAB group and phosphate‑buffered saline (PBS) blank control group. The lentivirus was injected (1x10(7) transducing units) into the subacromial bursa of the rats in the lentivirus‑RNAi group and lentivirus‑NC group, whereas 100 µl PBS was injected at the same site in the SAB group and the PBS blank control group. At 5 weeks following injection, the animals were sacrificed and venous blood was obtained. The effect of TNF‑α interference and the expression of inflammatory cytokines were determined by reverse transcription‑quantitative polymerase chain reaction, western blotting, hematoxylin and eosin staining, Van Gieson's staining and immunofluorescence. The expression of TNF‑α was decreased in the lentivirus‑TNF‑α‑RNAi group compared with that in the SAB group. Morphological observations revealed that the number of inflammatory cells were reduced and damage to tendon fibers was attenuated in this group, suggesting that the downregulation of the protein expression levels of TNF‑α‑associated nuclear factor‑κB, matrix metalloproteinase (MMP)1, MMP9, cyclooxygenase (COX)‑1 and COX‑2 may exert a therapeutic effect on inflammation of the SAB caused by rheumatoid arthritis. It was also found that the expression of stromal cell‑derived growth factor‑1 was downregulated in the lentivirus‑TNF‑α‑RNAi group. Therefore, the present study demonstrated that lentivirus‑mediated TNF‑α RNAi effectively inhibited the inflammatory response in SAB, and that injection of a lentivirus vector into the affected region is an effective way of achieving RNAi in vivo.

Biomechanical analysis of articular-sided partial-thickness rotator cuff tear and repair.

PubMed

Mihata, Teruhisa; McGarry, Michelle H; Ishihara, Yoko; Bui, Christopher N H; Alavekios, Damon; Neo, Masashi; Lee, Thay Q

2015-02-01

Articular-sided partial-thickness rotator cuff tears are common injuries in throwing athletes. The superior shoulder capsule beneath the supraspinatus and infraspinatus tendons works as a stabilizer of the glenohumeral joint. To assess the effect of articular-sided partial-thickness rotator cuff tear and repair on shoulder biomechanics. The hypothesis was that shoulder laxity might be changed because of superior capsular plication in transtendon repair of articular-sided partial-thickness rotator cuff tears. Controlled laboratory study. Nine fresh-frozen cadaveric shoulders were tested by using a custom shoulder-testing system at the simulated late-cocking phase and acceleration phase of throwing motion. Maximum glenohumeral external rotation angle, anterior translation, position of the humeral head apex with respect to the glenoid, internal impingement area, and glenohumeral and subacromial contact pressures were measured. Each specimen underwent 3 stages of testing: stage 1, with the intact shoulder; stage 2, after creation of articular-sided partial-thickness tears of the supraspinatus and infraspinatus tendons; and stage 3, after transtendon repair of the torn tendons by using 2 suture anchors. Articular-sided partial-thickness tears did not significantly change any of the shoulder biomechanical measurements. In the simulated late-cocking phase, transtendon rotator cuff repair resulted in decreased maximum external rotation angle by 4.2° (P = .03), posterior shift of the humeral head (1.1-mm shift; P = .02), decreased glenohumeral contact pressure by 1.7 MPa (56%; P = .004), and decreased internal impingement area by 26.4 mm(2) (65%; P < .001) compared with values in the torn shoulder. In the acceleration phase, the humeral head shifted inferiorly (1.2-mm shift; P = .03 vs torn shoulder), and glenohumeral anterior translation (1.5-mm decrease; P = .03 vs torn shoulder) and subacromial contact pressure (32% decrease; P = .004 vs intact shoulder) decreased significantly after transtendon repair. Transtendon repair of articular-sided partial-thickness supraspinatus and infraspinatus tears decreased glenohumeral and subacromial contact pressures at time zero; these changes might lead to reduced secondary subacromial and internal impingements and consequently progression to full-thickness rotator cuff tear. However, repair of the tendons decreased anterior translation and external rotation and changed the positional relationship between the humeral head and the glenoid. Careful attention should be paid to shoulder laxity and range of motion when transtendon repair is chosen to treat articular-sided partial-thickness rotator cuff tears, specifically in throwing athletes. © 2014 The Author(s).

Rotator cuff tendinopathy: a model for the continuum of pathology and related management.

PubMed

Lewis, Jeremy S

2010-10-01

Pathology of the soft tissues of the shoulder including the musculotendinous rotator cuff and subacromial bursa are extremely common and are a principal cause of pain and suffering. Competing theories have been proposed to explain the pathoaetiology of rotator cuff pathology at specific stages and presentations of the condition. This review proposes a model to describe the continuum of the rotator cuff pathology from asymptomatic tendon through full thickness rotator cuff tears. The pathoaetiology of rotator cuff failure is multifactorial and results from a combination of intrinsic, extrinsic and environmental factors. Recently a new and generic model detailing the continuum of tendon pathology has been proposed. This model is relevant for the rotator cuff and provides a framework to stage the continuity of rotator cuff pathology. Furthermore, it provides a structure to identify the substantial deficiencies in our knowledge base and areas where research would improve our understanding of the pathological and repair process, together with assessment and management. The strength of this model adapted for the rotator cuff tendons and subacromial bursa will be tested in its ability to incorporate and adapt to emerging research.

Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both?

PubMed

Seitz, Amee L; McClure, Philip W; Finucane, Sheryl; Boardman, N Douglas; Michener, Lori A

2011-01-01

The etiology of rotator cuff tendinopathy is multi-factorial, and has been attributed to both extrinsic and intrinsic mechanisms. Extrinsic factors that encroach upon the subacromial space and contribute to bursal side compression of the rotator cuff tendons include anatomical variants of the acromion, alterations in scapular or humeral kinematics, postural abnormalities, rotator cuff and scapular muscle performance deficits, and decreased extensibility of pectoralis minor or posterior shoulder. A unique extrinsic mechanism, internal impingement, is attributed to compression of the posterior articular surface of the tendons between the humeral head and glenoid and is not related to subacromial space narrowing. Intrinsic factors that contribute to rotator cuff tendon degradation with tensile/shear overload include alterations in biology, mechanical properties, morphology, and vascularity. The varied nature of these mechanisms indicates that rotator cuff tendinopathy is not a homogenous entity, and thus may require different treatment interventions. Treatment aimed at addressing mechanistic factors appears to be beneficial for patients with rotator cuff tendinopathy, however, not for all patients. Classification of rotator cuff tendinopathy into subgroups based on underlying mechanism may improve treatment outcomes. 2010 Elsevier Ltd. All rights reserved.

Shoulder function and work disability after decompression surgery for subacromial impingement syndrome: a randomised controlled trial of physiotherapy exercises and occupational medical assistance

PubMed Central

2014-01-01

Background Surgery for subacromial impingement syndrome is often performed in working age and postoperative physiotherapy exercises are widely used to help restore function. A recent Danish study showed that 10% of a nationwide cohort of patients retired prematurely within two years after surgery. Few studies have compared effects of different postoperative exercise programmes on shoulder function, and no studies have evaluated workplace-oriented interventions to reduce postoperative work disability. This study aims to evaluate the effectiveness of physiotherapy exercises and occupational medical assistance compared with usual care in improving shoulder function and reducing postoperative work disability after arthroscopic subacromial decompression. Methods/Design The study is a mainly pragmatic multicentre randomised controlled trial. The trial is embedded in a cohort study of shoulder patients referred to public departments of orthopaedic surgery in Central Denmark Region. Patients aged ≥18–≤63 years, who still have shoulder symptoms 8–12 weeks after surgery, constitute the study population. Around 130 participants are allocated to: 1) physiotherapy exercises, 2) occupational medical assistance, 3) physiotherapy exercises and occupational medical assistance, and 4) usual care. Intervention manuals allow individual tailoring. Primary outcome measures include Oxford Shoulder Score and sickness absence due to symptoms from the operated shoulder. Randomisation is computerised with allocation concealment by randomly permuted block sizes. Statistical analyses will primarily be performed according to the intention-to-treat principle. Discussion The paper presents the rationale, design, methods, and operational aspects of the Shoulder Intervention Project (SIP). SIP evaluates a new rehabilitation approach, where physiotherapy and occupational interventions are provided in continuity of surgical episodes of care. If successful, the project may serve as a model for rehabilitation of surgical shoulder patients. Trial registration Current Controlled Trials ISRCTN55768749. PMID:24952581

Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears.

PubMed

Shams, Ahmed; El-Sayed, Mohamed; Gamal, Osama; Ewes, Waled

2016-12-01

Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant-Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0-5 scale. Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration. II.

PARot – assessing platelet-rich plasma plus arthroscopic subacromial decompression in the treatment of rotator cuff tendinopathy: study protocol for a randomized controlled trial

PubMed Central

2013-01-01

Background Platelet-rich plasma (PRP) is an autologous platelet concentrate. It is prepared by separating the platelet fraction of whole blood from patients and mixing it with an agent to activate the platelets. In a clinical setting, PRP may be reapplied to the patient to improve and hasten the healing of tissue. The therapeutic effect is based on the presence of growth factors stored in the platelets. Current evidence in orthopedics shows that PRP applications can be used to accelerate bone and soft tissue regeneration following tendon injuries and arthroplasty. Outcomes include decreased inflammation, reduced blood loss and post-treatment pain relief. Recent shoulder research indicates there is poor vascularization present in the area around tendinopathies and this possibly prevents full healing capacity post surgery (Am J Sports Med36(6):1171–1178, 2008). Although it is becoming popular in other areas of orthopedics there is little evidence regarding the use of PRP for shoulder pathologies. The application of PRP may help to revascularize the area and consequently promote tendon healing. Such evidence highlights an opportunity to explore the efficacy of PRP use during arthroscopic shoulder surgery for rotator cuff pathologies. Methods/Design PARot is a single center, blinded superiority-type randomized controlled trial assessing the clinical outcomes of PRP applications in patients who undergo shoulder surgery for rotator cuff disease. Patients will be randomized to one of the following treatment groups: arthroscopic subacromial decompression surgery or arthroscopic subacromial decompression surgery with application of PRP. The study will run for 3 years and aims to randomize 40 patients. Recruitment will be for 24 months with final follow-up at 1 year post surgery. The third year will also involve collation and analysis of the data. This study will be funded through the NIHR Biomedical Research Unit at the Oxford University Hospitals NHS Trust. Trial registration Current Controlled Trials: ISRCTN10464365 PMID:23758981

SHORT-TERM EFFECTS OF INSTRUMENT-ASSISTED SOFT TISSUE MOBILIZATION ON PAIN FREE RANGE OF MOTION IN A WEIGHTLIFTER WITH SUBACROMIAL PAIN SYNDROME.

PubMed

Coviello, Joseph Paul; Kakar, Rumit Singh; Reynolds, Timothy James

2017-02-01

While there is limited evidence supporting the use of soft tissue mobilization techniques for Subacromial Pain Syndrome (SAPS), synonymous with subacromial impingement syndrome, previous studies have reported successful outcomes using soft tissue mobilization as a treatment technique. The purpose of this case report is to document the results of Instrument-Assisted Soft Tissue Mobilization (IASTM) for the treatment of SAPS. Diagnosis was reached based on the subject's history, tenderness to palpation, and four out of five positive tests in the diagnostic cluster. Treatment consisted of three visits where the IASTM technique was applied to the pectoral muscles as well as periscapular musculature followed by retesting pain-free shoulder flexion active range of motion (AROM) and Numerical Pain Rating Scale (NPRS) during active shoulder flexion. Scapulothoracic mobilization and stretching were performed after AROM measurement. The subject reported an NPRS of 0/10 and demonstrated improvements in pain free flexion AROM in each of the three treatment sessions post-IASTM: 85 ° to 181 °, 110 ° to 171 °, and 163 ° to 174 ° with some carryover in pain reduction and pain free AROM to the next treatment. Through three treatments, DASH score improved by 17.34%, Penn Shoulder Score improved 29%, worst NPRS decreased from 4/10 to 0/10, and a GROC score of 6. IASTM may have a beneficial acute effect on pain free shoulder flexion. In conjunction with scapulothoracic mobilizations and stretching, IASTM may improve function, decrease pain, and improve patient satisfaction. While this technique will not ameliorate the underlying pathomechanics contributing to SAPS, it may serve as a valuable tool to restore ROM and decrease pain allowing the patient to reap the full benefits of a multi-modal treatment approach. 5.

Three-dimensional scapular dyskinesis in hook-plated acromioclavicular dislocation including hook motion.

PubMed

Kim, Eugene; Lee, Seunghee; Jeong, Hwa-Jae; Park, Jai Hyung; Park, Se-Jin; Lee, Jaewook; Kim, Woosub; Park, Hee Jin; Lee, So Yeon; Murase, Tsuyoshi; Sugamoto, Kazuomi; Ikemoto, Sumika

2018-06-01

The purpose of this study is to analyze the 3-dimensional scapular dyskinesis and the kinematics of a hook plate relative to the acromion after hook-plated acromioclavicular dislocation in vivo. Reported complications of acromioclavicular reduction using a hook plate include subacromial erosion and impingement. However, there are few reports of the 3-dimensional kinematics of the hook and scapula after the aforementioned surgical procedure. We studied 15 cases of acromioclavicular dislocation treated with a hook plate and 15 contralateral normal shoulders using computed tomography in the neutral and full forward flexion positions. Three-dimensional motion of the scapula relative to the thorax during arm elevation was analyzed using a computer simulation program. We also measured the distance from the tip of the hook plate to the greater tuberosity, as well as the angular motion of the plate tip in the subacromial space. Decreased posterior tilting (22° ± 10° vs 31° ± 8°) in the sagittal plane and increased external rotation (19° ± 9° vs 7° ± 5°) in the axial plane were evident in the affected shoulders. The mean values of translation of the hook plate and angular motion against the acromion were 4.0 ± 1.6 mm and 15° ± 8°, respectively. The minimum value of the distance from the hook plate to the humeral head tuberosity was 6.9 mm during arm elevation. Acromioclavicular reduction using a hook plate may cause scapular dyskinesis. Translational and angular motion of the hook plate against the acromion could lead to subacromial erosion. However, the hook does not seem to impinge directly on the humeral head. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Cyclic nocturnal awakening: a warning sign of a cluster bout.

PubMed

Martins, Isabel Pavão

2015-04-01

Cluster headache is an excruciating unilateral headache with autonomic symptoms whose periodic nocturnal activity, which interrupts sleep, has been attributed to a hypothalamic generator. We describe a patient with a longstanding episodic cluster headache who experienced, on two occasions, a period of nocturnal awakenings without pain or autonomic symptoms, lasting one week before the onset of a cluster bout. Awakenings occurred twice/night at the same hours of impending cluster attacks and had no apparent trigger, being unusual for this patient who had no previous sleep disturbances. Neurological examination and brain imaging were normal. This case documents two new aspects of cluster headache. It suggests that repeated nocturnal awakenings can be a warning sign of an impending cluster period, a finding that may have therapeutic implications, and also that hypothalamic activation may begin several days before trigemino-autonomic symptoms, thus behaving as a true bout generator. © International Headache Society 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Vertical parasagittal hemispherotomy for Sturge-Weber syndrome in early infancy: case report and literature review.

PubMed

Liu, Xiangyu; Otsuki, Taisuke; Takahashi, Akio; Kaido, Takanobu

2016-01-01

The authors here present a rare case of a 3-month-old infant with unilateral Sturge-Weber syndrome (SWS) who had excellent seizure control and no aggravation of previous existed neurological deficits after vertical parasagittal hemispherotomy (VPH). To our knowledge, this patient with SWS was the youngest one who received VPH. The use of VPH results in a successful treatment of intractable epilepsy in a patient with seizure onset in early infancy. At follow-up, the patient's neurodevelopmental status has been improved since the surgery. It is generally accepted that early-onset seizures in children with SWS are associated with worse neurological and developmental outcomes. However, when surgical treatment should be considered and how it should be performed remain a longstanding controversy. We promote early surgery in children with SWS and early-onset epilepsy. We suggest that VPH may be a useful adjuvant in the management of SWS with refractory epilepsy in early infancy and this procedure carries low neurological risk.

Aquarium Portal Technique for PASTA Lesion Repair.

PubMed

Meyer, Dominik C; Gerber, Christian; Familiari, Filippo

2017-10-01

The simultaneous arthroscopic exposure of the subacromial and intra-articular space of the shoulder is challenging in the presence of only partial-thickness rotator cuff tears. We present our experience and method of entering the joint through the opened rotator cuff interval from an anterosuperior portal between the coracoid process and anterior acromion. With moderate (approximately 30°) abduction and external rotation, the rotator interval opens readily, offering a view with the camera toward the anterior edge of the supraspinatus tendon. An anterior view on the anterior leading edge of the supraspinatus tendon is obtained, showing the subacromial space above and the glenohumeral space below the tendon, similar to the view in an aquarium. The rotator cuff can be elevated using a rod inserted intra-articularly from posterior, whereas anchors and other instruments may be inserted from lateral. This approach offers the advantages of full exposure of the posterior undersurface of the rotator cuff insertion; a convenient approximately 90° angle between the camera and instruments; and no need to change portals for anchor placement, tendon stitching, or suture handling. The objective of this Technical Note is to describe our arthroscopic repair approach (aquarium technique) to PASTA (partial articular supraspinatus tendon avulsion) lesions.

US appearance of partial-thickness supraspinatus tendon tears: Application of the string theory. Pictorial essay.

PubMed

Guerini, H; Fermand, M; Godefroy, D; Feydy, A; Chevrot, A; Morvan, G; Gault, N; Drapé, J L

2012-02-01

The supraspinatus tendon is composed of 5 different layers consisting of intertwining bundles. On a front portion of the tendon, the layers become coated bundles which insert on the trochanter. At the insertion, the superficial or bursal surface of the tendon corresponding to the tendon fibers in contact with the subacromial bursa can be distinguished from the deep surface corresponding to the fibers in contact with the glenohumeral joint. A tendon tear may involve partial or total disruption of the tendon fibers and is called full-thickness tear if it affects the entire tendon, and partial-thickness tear if it involves only part of the tendon. Partial-thickness tears of the supraspinatus tendon include lesions of the superficial, deep and central surface or tendon delamination.A contrast enhanced examination requires injection of contrast agent into the joint (arthrography followed by computed tomography (CT) or magnetic resonance imaging (MRI)) to study the deep surface, and injection into the subacromial bursa (bursography followed by CT) to study the superficial surface. MRI and ultrasound (US) examination allow the study of these different tendon layers without the use of contrast agent (which is not possible at CT).

Fifteen-year survey of one-stage latissimus dorsi muscle transfer for treatment of longstanding facial paralysis.

PubMed

Takushima, Akihiko; Harii, Kiyonori; Asato, Hirotaka; Kurita, Masakazu; Shiraishi, Tomohiro

2013-01-01

Neurovascular free muscle transfer is one of the main reconstructive options for established or long-standing facial paralysis. The two-stage gracilis muscle transfer combined with the cross-face nerve graft (two-stage method) has been supplanted by one-stage reconstruction using the latissimus dorsi muscle (LD) at our institution. This study retrospectively evaluated the results of one-stage LD transfer. Between September 1993 and December 2008, 344 patients (133 males, 211 females; age range, 5-75 years) with unilateral facial paralysis underwent 351 one-stage LD transfers. Patients were evaluated with a custom grading scale. Differences in grading scale score were compared according to age, past surgical history and the duration from operation to neuromuscular recovery. Contraction of the transferred muscle was recognised in 305 (87.0%) transfers. The duration until neuromuscular recovery ranged from 3 to 16 months (average ± standard deviation: 6.48 ± 1.92 months). The grading scale was significantly lower in middle-age group than in younger and elder groups (P < 0.01). Duration until neuromuscular recovery was significantly different when comparing the younger group and the oldest group. There was no difference in grading scale score or in duration until neuromuscular recovery when comparing the patients with a past surgical history and those without. The grading scale negatively correlated with the duration until neuromuscular recovery. The results are consistent and statistical analysis revealed the versatility of the one-stage LD transfer. Although we believe the two-stage method is still a good option for facial reanimation, the one-stage method is advantageous regarding the shorter period of recovery and little donor-site morbidity. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Morphological analysis of acromion and hook plate for the fixation of acromioclavicular joint dislocation.

PubMed

Yoon, Jong Pil; Lee, Yeon Soo; Song, Geun Soo; Oh, Joo Han

2017-03-01

Acromioclavicular (AC) joint dislocation is a common sports injury. Hook plate fixation is currently widely used to treat this injury, as it can promote the natural healing of the ligament with good clinical outcomes. However, subacromial erosion and impingement are frequently observed post-operatively. It was hypothesized that the morphology and the contact characteristics between the hook portion and the acromion are the main causes of complications after hook plate fixation with the currently available commercial designs. Three-dimensional reconstructed models of the AC joint obtained from the computed tomographic scans of 23 male and 23 female patients (mean age, 61.1 ± 6.3 years) were evaluated, and multiple anatomical parameters were measured. For the subacromial positioning of the hook plate, an actual hook plate (Synthes Inc., West Chester, PA, USA) was scanned, and the contact between the hook plate and the acromion was estimated. The thicknesses of the acromion and distal clavicle were 9.7 ± 1.5 mm (10.7 mm in men; 8.6 mm in women) and 11.3 ± 1.6 mm (11.6 mm in men; 10.0 mm in women), respectively. The width of the acromion was 28.5 ± 3.6 mm. The mean inclination angle between the hook plate and the acromion was 29.3° ± 9.7° (27.9° in men; 30.6° in women). The hook plate made a point contact with the acromion at 9.2 ± 3.3 mm (31.5 %) from the lateral end of the acromion. The results revealed that the hook made a pinpoint contact with the undersurface of the acromion, and this might explain why complications commonly occur after hook plate fixation. The force concentration phenomenon associated with the hook plate of existing designs results from cases of morphological mismatch, such as excessive inclination and improper occupation of the subacromial space.

Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: A literature-based critical review.

PubMed

Al-Mamgani, Abrahim; van Werkhoven, Erik; Navran, Arash; Karakullukcu, Baris; Hamming-Vrieze, Olga; Machiels, Melanie; van der Velden, Lilly-Ann; Vogel, Wouter V; Klop, W Martin

2017-09-01

The head and neck region has rich regional lymphatic network, with a theoretical risk on contralateral metastasis from oropharyngeal cancer (OPC). There is a long-standing convention to irradiate the great majority of these tumors electively to both sides of the neck to reduce the risk of contralateral regional failure (cRF), but this can induce significant toxicity. We aimed to identify patient groups where elective contralateral irradiation may safely be omitted. PubMed and EMBASE were searched for original full-text articles in English with a combination of search terms related to the end points: cRF in OPC primarily treated by radiotherapy only to the ipsilateral neck and identifying predictive factors for increased incidence of cRF. The data from the identified studies were pooled, the incidence of cRF was calculated and the correlation with different predictive factors was investigated. Eleven full-text articles met the inclusion criteria. In these studies, 1116 patients were treated to the ipsilateral neck alone. The mean incidence of cRF was 2.42% (range 0-5.9%, 95% CI 1.6-3.5%). The incidence of cRF correlated only with T-stage (p=0.008), and involvement of midline (p=0.001). However, the significant correlation with T-stage can be explained by the very low incidence of cRF among T1 (0.77%), and disappeared when the incidence of cRF was compared between T2, T3,and T4 (p=0.344). The incidence of cRF in patients with OPC is very low, with involvement of midline providing the most significant prognosticator. These results call for trials on unilateral elective irradiation in selected groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases.

PubMed

Akduman, Davut; Haksever, Mehmet; Yanilmaz, Muhammed; Solmaz, Fevzi

2016-08-01

Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

Attitudes toward management of patients with subacromial pain in Swedish primary care.

PubMed

Johansson, K; Adolfsson, L; Foldevi, M

1999-06-01

We aimed to describe the attitudes among GPs and physiotherapists toward the diagnostic approach and management of patients with a common shoulder disorder. A questionnaire was sent out to 188 GPs and 71 physiotherapists. The total response rate was 71.8%. The questions were based on a written case simulation with cues about history and symptoms. The results showed a unanimous opinion of the diagnosis. Rotator cuff tendinitis was marked as the most probable. The two groups showed similarities in the way that they would examine the patient. The GPs referred the patients to the physiotherapists significantly more often than the other way around. The most probable choice of treatment made by the GPs was non-steroidal anti-inflammatory drugs (NSAIDs) and by the physiotherapists, movement exercises together with ergonomics. Most treatment alternatives had at least 20% of the responders marking a neutral attitude, and few treatments were disregarded. We conclude that in Swedish primary care GPs and physiotherapists have a uniform diagnostic approach towards patients with subacromial pain, but their choice of treatment reflects an uncertainty about the effectiveness of conservative treatments. The questioned pathogenesis of the suggested diagnosis and lack of research regarding the efficacy of conservative treatments could explain this uncertainty.

Association between kyphosis and subacromial impingement syndrome: LOHAS study.

PubMed

Otoshi, Kenichi; Takegami, Misa; Sekiguchi, Miho; Onishi, Yoshihiro; Yamazaki, Shin; Otani, Koji; Shishido, Hiroaki; Kikuchi, Shinichi; Konno, Shinichi

2014-12-01

Kyphosis is a cause of scapular dyskinesis, which can induce various shoulder disorders, including subacromial impingement syndrome (SIS). This study aimed to clarify the impact of kyphosis on SIS with use of cross-sectional data from the Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). The study enrolled 2144 participants who were older than 40 years and participated in health checkups in 2010. Kyphosis was assessed by the wall-occiput test (WOT) for thoracic kyphosis and the rib-pelvic distance test (RPDT) for lumbar kyphosis. The associations between kyphosis, SIS, and reduction in shoulder elevation (RSE) were investigated. Age- and gender-adjusted logistic regression analysis demonstrated significant association between SIS and WOT (odds ratio, 1.65; 95% confidence interval, 1.02, 2.64; P < .05), whereas there was no significant association between SIS and RPDT. Multivariable logistic regression analysis demonstrated no significant association between SIS and both WOT and RPDT, whereas there was significant association between SIS and RSE. RSE plays a key role in the development of SIS, and thoracic kyphosis might influence the development of SIS indirectly by reducing shoulder elevation induced by the restriction of the thoracic spine extension and scapular dyskinesis. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome. A prospective randomized double-blind study.

PubMed

Everts, P A; Devilee, R J J; Brown Mahoney, C; van Erp, A; Oosterbos, C J M; Stellenboom, M; Knape, J T A; van Zundert, A

2008-01-01

Platelet-leukocyte gel (PLG) is being used during various surgical procedures in an attempt to enhance the healing process. We studied the effects of PLG on postoperative recovery of patients undergoing open subacromial decompression (OSD). PLG was produced from platelet-leukocyte-rich plasma (P-LRP), prepared from a unit of whole blood. Forty patients were included in the study. Self-assessed evaluations, using the American Shoulder and Elbow Surgeons scoring system of activities of daily living (ADL), joint instability, pain levels, pain medications, and clinical evaluations for range of motion were conducted. Platelet and leukocyte counts were significantly increased in the P-LRP compared to baseline counts. Treated patients demonstrated decreased visual analog scales for pain and used significantly less pain medication, had an improved range of motion during passive forward elevation, external rotation, external rotation with arm at 90 degrees abduction, internal rotation, and cross body adduction compared to control patients (p < 0.001). No differences in the instability score were observed between the groups. Furthermore, treated patients performed more ADL (p < 0.05). In the PLG-treated group, recovery was faster and patients returned earlier to daily activities and also took less pain medication than control subjects. Copyright 2008 S. Karger AG, Basel.

PHYSICAL THERAPY INTERVENTION FOR A FORMER POWER LIFTER AFTER ARTHROSCOPIC MICROFRACTURE PROCEDURE FOR GRADE IV GLENOHUMERAL CHONDRAL DEFECTS

PubMed Central

Sum, Jonathan

2011-01-01

Background: Power lifting places the shoulder complex at risk for injury. Microfracture is a relatively new procedure for chondral defects of the glenohumeral joint and is not well described in the literature. Objectives: The purpose of this case report is to describe the post-operative rehabilitation used with a power lifter who underwent a microfracture procedure to address glenoid and humeral chondral defects, debridement of type I superior labral anterior-posterior lesion, and a subacromial decompression. Case Description: The patient was a 46 year-old male who was evaluated nine weeks status-post arthroscopic microfracture procedure for glenoid and humeral chondral defects, debridement of superior labral anterior-posterior (SLAP) lesion, and subacromial decompression. Rehabilitation consisted of postural education, manual therapy, rotator cuff and scapular strengthening, dynamic stabilization, weightbearing exercises, and weight training over nine weeks (24 sessions). Lifting modifications were addressed. Outcomes: Results of the QuickDASH indicate that activities of daily living (ADLs), work, and sports modules all improved significantly, and the patient was able to return to recreational power lifting with limited discomfort or restrictions. Discussion: A structured post-operative physical therapy treatment program allowed this patient to return to recreational power lifting while restoring independent function for work-related activities and ADLs. PMID:21655454

Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066].

PubMed

Bron, Carel; Wensing, Michel; Franssen, Jo Lm; Oostendorp, Rob Ab

2007-11-05

Shoulder disorders are a common health problem in western societies. Several treatment protocols have been developed for the clinical management of persons with shoulder pain. However available evidence does not support any protocol as being superior over others. Systematic reviews provide some evidence that certain physical therapy interventions (i.e. supervised exercises and mobilisation) are effective in particular shoulder disorders (i.e. rotator cuff disorders, mixed shoulder disorders and adhesive capsulitis), but there is an ongoing need for high quality trials of physical therapy interventions. Usually, physical therapy consists of active exercises intended to strengthen the shoulder muscles as stabilizers of the glenohumeral joint or perform mobilisations to improve restricted mobility of the glenohumeral or adjacent joints (shoulder girdle). It is generally accepted that a-traumatic shoulder problems are the result of impingement of the subacromial structures, such as the bursa or rotator cuff tendons. Myofascial trigger points (MTrPs) in shoulder muscles may also lead to a complex of symptoms that are often seen in patients diagnosed with subacromial impingement or rotator cuff tendinopathy. Little is known about the treatment of MTrPs in patients with shoulder disorders.The primary aim of this study is to investigate whether physical therapy modalities to inactivate MTrPs can reduce symptoms and improve shoulder function in daily activities in a population of chronic a-traumatic shoulder patients when compared to a wait-and-see strategy. In addition we investigate the recurrence rate during a one-year-follow-up period. This paper presents the design for a randomized controlled trial to be conducted between September 2007 - September 2008, evaluating the effectiveness of a physical therapy treatment for non-traumatic shoulder complaints. One hundred subjects are included in this study. All subjects have unilateral shoulder pain for at least six months and are referred to a physical therapy practice specialized in musculoskeletal disorders of the neck-, shoulder-, and arm. After the initial assessment patients are randomly assigned to either an intervention group or a control-group (wait and see). The primary outcome measure is the overall score of the Dutch language version of the DASH (Disabilities of Arm, Shoulder and Hand) questionnaire. Since there is only little evidence for the efficacy of physical therapy interventions in certain shoulder disorders, there is a need for further research. We found only a few studies examining the efficacy of MTrP therapy for shoulder disorders. Therefore we will perform a randomised clinical trial of the effect of physical therapy interventions aimed to inactivate MTrPs, on pain and impairment in shoulder function in a population of chronic a-traumatic shoulder patients. We opted for an intervention strategy that best reflects daily practice. Manual high velocity thrust techniques and dry-needling are excluded. Because in most physical therapy interventions, blinding of the patient and the therapist is not possible, we will perform a randomised, controlled and observer-blinded study. This randomized clinical trial is registered at current controlled trials ISRCTN75722066.

Physiotherapy assessment of patients with rotator cuff pathology

PubMed Central

2014-01-01

Pathology of the rotator cuff and sub-acromial bursa are considered to be the main cause of shoulder pain and dysfunction. In the absence of trauma, conservative care, including physiotherapy is the primary treatment. This paper aims to present the key features of a physiotherapy assessment, excluding diagnostic tests for rotator cuff pathology. It describes and explores how assessment can be used to direct management options and develop a treatment plan. PMID:27582940

Physical tests for shoulder impingements and local lesions of bursa, tendon or labrum that may accompany impingement.

PubMed

Hanchard, Nigel C A; Lenza, Mário; Handoll, Helen H G; Takwoingi, Yemisi

2013-04-30

Impingement is a common cause of shoulder pain. Impingement mechanisms may occur subacromially (under the coraco-acromial arch) or internally (within the shoulder joint), and a number of secondary pathologies may be associated. These include subacromial-subdeltoid bursitis (inflammation of the subacromial portion of the bursa, the subdeltoid portion, or both), tendinopathy or tears affecting the rotator cuff or the long head of biceps tendon, and glenoid labral damage. Accurate diagnosis based on physical tests would facilitate early optimisation of the clinical management approach. Most people with shoulder pain are diagnosed and managed in the primary care setting. To evaluate the diagnostic accuracy of physical tests for shoulder impingements (subacromial or internal) or local lesions of bursa, rotator cuff or labrum that may accompany impingement, in people whose symptoms and/or history suggest any of these disorders. We searched electronic databases for primary studies in two stages. In the first stage, we searched MEDLINE, EMBASE, CINAHL, AMED and DARE (all from inception to November 2005). In the second stage, we searched MEDLINE, EMBASE and AMED (2005 to 15 February 2010). Searches were delimited to articles written in English. We considered for inclusion diagnostic test accuracy studies that directly compared the accuracy of one or more physical index tests for shoulder impingement against a reference test in any clinical setting. We considered diagnostic test accuracy studies with cross-sectional or cohort designs (retrospective or prospective), case-control studies and randomised controlled trials. Two pairs of review authors independently performed study selection, assessed the study quality using QUADAS, and extracted data onto a purpose-designed form, noting patient characteristics (including care setting), study design, index tests and reference standard, and the diagnostic 2 x 2 table. We presented information on sensitivities and specificities with 95% confidence intervals (95% CI) for the index tests. Meta-analysis was not performed. We included 33 studies involving 4002 shoulders in 3852 patients. Although 28 studies were prospective, study quality was still generally poor. Mainly reflecting the use of surgery as a reference test in most studies, all but two studies were judged as not meeting the criteria for having a representative spectrum of patients. However, even these two studies only partly recruited from primary care.The target conditions assessed in the 33 studies were grouped under five main categories: subacromial or internal impingement, rotator cuff tendinopathy or tears, long head of biceps tendinopathy or tears, glenoid labral lesions and multiple undifferentiated target conditions. The majority of studies used arthroscopic surgery as the reference standard. Eight studies utilised reference standards which were potentially applicable to primary care (local anaesthesia, one study; ultrasound, three studies) or the hospital outpatient setting (magnetic resonance imaging, four studies). One study used a variety of reference standards, some applicable to primary care or the hospital outpatient setting. In two of these studies the reference standard used was acceptable for identifying the target condition, but in six it was only partially so. The studies evaluated numerous standard, modified, or combination index tests and 14 novel index tests. There were 170 target condition/index test combinations, but only six instances of any index test being performed and interpreted similarly in two studies. Only two studies of a modified empty can test for full thickness tear of the rotator cuff, and two studies of a modified anterior slide test for type II superior labrum anterior to posterior (SLAP) lesions, were clinically homogenous. Due to the limited number of studies, meta-analyses were considered inappropriate. Sensitivity and specificity estimates from each study are presented on forest plots for the 170 target condition/index test combinations grouped according to target condition. There is insufficient evidence upon which to base selection of physical tests for shoulder impingements, and local lesions of bursa, tendon or labrum that may accompany impingement, in primary care. The large body of literature revealed extreme diversity in the performance and interpretation of tests, which hinders synthesis of the evidence and/or clinical applicability.

Propionibacterium acnes in shoulder surgery: true infection, contamination, or commensal of the deep tissue?

PubMed

Hudek, Robert; Sommer, Frank; Kerwat, Martina; Abdelkawi, Ayman F; Loos, Franziska; Gohlke, Frank

2014-12-01

Propionibacterium acnes has been linked to chronic infections in shoulder surgery. Whether the bacterium is a contaminant or commensal of the deep tissue is unclear. We aimed to assess P. acnes in intraoperative samples of different tissue layers in patients undergoing first-time shoulder surgery. In 118 consecutive patients (mean age, 59.2 years; 75 men, 43 women), intraoperative samples were correlated to preoperative subacromial injection, the type of surgical approach, and gender. One skin, one superficial, one deep tissue, and one test sample were cultured for each patient. The cultures were positive for P. acnes in 36.4% (n = 43) of cases. Subacromial injection was not associated with bacterial growth rates (P = .88 for P. acnes; P = .20 for bacteria other than P. acnes; P = .85 for the anterolateral approach; P = .92 for the deltopectoral approach; P = .56 for men; P = .51 for women). Skin samples were positive for P. acnes in 8.5% (n = 10), superficial samples were positive in 7.6% (n = 9), deep samples were positive in 13.6% (n = 16), and both samples (superficial and deep) were positive in 15.3% (n = 18) of cases (P < .0001). P. acnes was detected in the anterolateral approach in 27.1% (n = 32) of cases and in the deltopectoral approach in 9.3% (n = 11) of cases (P = .01; relative risk, 1.93; 95% confidence interval, 1.08-3.43). Thirty-five of the P. acnes-positive patients were men (81.4%), and 8 patients were women (18.6%; P = .001; relative risk, 2.51; 95% confidence interval, 1.28-4.90). P. acnes was detected in more than one third of patients undergoing first-time shoulder surgery. Preoperative subacromial injection was not associated with bacterial growth. P. acnes was observed more frequently in the deep tissues than in the superficial tissues. The relative risk for obtaining a positive P. acnes culture was 2-fold greater for the anterolateral approach than for the deltopectoral approach, and the risk was 2.5-fold greater for men. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids.

PubMed

de Witte, Pieter Bas; Selten, Jasmijn W; Navas, Ana; Nagels, Jochem; Visser, Cornelis P J; Nelissen, Rob G H H; Reijnierse, Monique

2013-07-01

Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). Randomized controlled trial; Level of evidence, 1. Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group.

Hamstring Injury After Swimming in a Patient With Multiple Hereditary Osteochondromatosis.

PubMed

Dönmez, Gürhan; Özçakar, Levent; Korkusuz, Feza

2016-09-01

Reported here is a 20-year-old male suffered a hamstring strain after a prolonged bout of swimming. After ultrasound imaging, the patient's injury was considered to be the result of nearby osteochondromas. Case reports have been previously published concerning anterior cruciate ligament injury, rotator cuff tears, subacromial impingement, or femoroacetabular impingement in multiple osteochondromatosis. However, to the best of our knowledge, this is the first reported case of a hamstring injury secondary to an osteochondroma.

3D scapular orientation on healthy and pathologic subjects using stereoradiographs during arm elevation.

PubMed

Ohl, Xavier; Hagemeister, Nicola; Zhang, Cheng; Billuart, Fabien; Gagey, Olivier; Bureau, Nathalie J; Skalli, Wafa

2015-11-01

Alterations of the scapular kinematics in different pathologic conditions have been widely studied. However, results have shown considerable discrepancies concerning the direction and the amplitude of scapular movement. The lack of consistency in the literature probably has several explanations. The purpose of this study was to analyze scapular orientation with the arm at rest and with 90° lateral elevation in healthy and pathologic subjects by use of stereoradiographs. All participants (n = 65) underwent a clinical examination and magnetic resonance imaging of the shoulder to assess rotator cuff status. Participants were separated into 3 groups: healthy, rotator cuff tear (RCT), and RCT and subacromial impingement syndrome (RCT+ SIS). A 3-dimensional model of the scapula was fitted to each low-dose stereoradiograph acquired with the arm at rest and 90° arm elevation. Orientation of the scapula with the arm at rest was not significantly different between groups. During lateral elevation, scapular orientation was not significantly different between the healthy group and the RCT group. However, upward rotation was significantly reduced in the RCT + SIS group. Alterations of scapular kinematics in symptomatic subjects are multifactorial. We observed a link between clinically assessed subacromial impingement and scapular orientation during lateral elevation of the arm. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Comparison of virtual reality exergaming and home exercise programs in patients with subacromial impingement syndrome and scapular dyskinesis: Short term effect.

PubMed

Pekyavas, Nihan Ozunlu; Ergun, Nevin

2017-05-01

The aim of this study was to compare the short term effects of home exercise program and virtual reality exergaming in patients with subacromial impingement syndrome (SAIS). A total of 30 patients with SAIS were randomized into two groups which are Home Exercise Program (EX Group) (mean age: 40.6 ± 11.7 years) and Virtual Reality Exergaming Program (WII Group) (mean age: 40.33 ± 13.2 years). Subjects were assessed at the first session, at the end of the treatment (6 weeks) and at 1 month follow-up. The groups were assessed and compared with Visual Analogue Scale (based on rest, activity and night pain), Neer and Hawkins Tests, Scapular Retraction Test (SRT), Scapular Assistance Test (SAT), Lateral Scapular Slide Test (LSST) and shoulder disability (Shoulder Pain and Disability Index (SPADI)). Intensity of pain was significantly decreased in both groups with the treatment (p < 0.05). The WII Group had significantly better results for all Neer test, SRT and SAT than the EX Group (p < 0.05). Virtual reality exergaming programs with these programs were found more effective than home exercise programs at short term in subjects with SAIS. Level I, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Acromiohumeral Distance During Neuromuscular Electrical Stimulation of the Lower Trapezius and Serratus Anterior Muscles in Healthy Participants.

PubMed

Bdaiwi, Alya H; Mackenzie, Tanya Anne; Herrington, Lee; Horsley, Ian; Cools, Ann M

2015-07-01

Compromise to the acromiohumeral distance has been reported in participants with subacromial impingement syndrome compared with healthy participants. In clinical practice, patients with subacromial shoulder impingement are given strengthening programs targeting the lower trapezius (LT) and serratus anterior (SA) muscles to increase scapular posterior tilt and upward rotation. We are the first to use neuromuscular electrical stimulation to stimulate these muscle groups and evaluate how the muscle contraction affects the acromiohumeral distance. To investigate if electrical muscle stimulation of the LT and SA muscles, both separately and simultaneously, increases the acromiohumeral distance and to identify which muscle-group contraction or combination most influences the acromiohumeral distance. Controlled laboratory study. Human performance laboratory. Twenty participants (10 men and 10 women, age = 26.9 ± 8.0 years, body mass index = 23.8) were screened. Neuromuscular electrical stimulation of the LT and SA. Ultrasound measurement of the acromiohumeral distance. Acromiohumeral distance increased during contraction via neuromuscular electrical stimulation of the LT muscle (t(19) = -3.89, P = .004), SA muscle (t(19) = -7.67, P = .001), and combined LT and SA muscles (t(19) = -5.09, P = .001). We observed no differences in the increased acromiohumeral distance among the 3 procedures (F(2,57) = 3.109, P = .08). Our results supported the hypothesis that the muscle force couple around the scapula is important in rehabilitation and scapular control and influences acromiohumeral distance.

Shoulder kinematics during the wall push-up plus exercise.

PubMed

Lunden, Jason B; Braman, Jonathan P; Laprade, Robert F; Ludewig, Paula M

2010-03-01

The push-up plus exercise is a common therapeutic exercise for improving shoulder function and treating shoulder pathology. To date, the kinematics of the push-up plus exercise have not been studied. Our hypothesis was that the wall push-up plus exercise would demonstrate increased scapular internal rotation and increased humeral anterior translation during the plus phase of the exercise, thereby potentially impacting the subacromial space. Bone pins were inserted in the humerus and scapula in 12 healthy volunteers with no history of shoulder pathology. In vivo motion during the wall push-up plus exercise was tracked using an electromagnetic tracking system. During the wall push-up plus exercise, from a starting position to the push-up plus position, there was a significant increase in scapular downward rotation (P < .05) and internal rotation (P < .05). The pattern of glenohumeral motion was humeral elevation (P < .05) and movement anterior to the scapular plane (P < .05), with humeral external rotation remaining relatively constant. We found that during a wall push-up plus exercise in healthy volunteers, the scapula was placed in a position potentially associated with shoulder impingement. Because of the shoulder kinematics of the wall push-up plus exercise, utilization of this exercise without modification early on in shoulder rehabilitation, especially in patients with subacromial impingement, should be considered cautiously. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Bell's palsy: aetiology, clinical features and multidisciplinary care.

PubMed

Eviston, Timothy J; Croxson, Glen R; Kennedy, Peter G E; Hadlock, Tessa; Krishnan, Arun V

2015-12-01

Bell's palsy is a common cranial neuropathy causing acute unilateral lower motor neuron facial paralysis. Immune, infective and ischaemic mechanisms are all potential contributors to the development of Bell's palsy, but the precise cause remains unclear. Advancements in the understanding of intra-axonal signal molecules and the molecular mechanisms underpinning Wallerian degeneration may further delineate its pathogenesis along with in vitro studies of virus-axon interactions. Recently published guidelines for the acute treatment of Bell's palsy advocate for steroid monotherapy, although controversy exists over whether combined corticosteroids and antivirals may possibly have a beneficial role in select cases of severe Bell's palsy. For those with longstanding sequaelae from incomplete recovery, aesthetic, functional (nasal patency, eye closure, speech and swallowing) and psychological considerations need to be addressed by the treating team. Increasingly, multidisciplinary collaboration between interested clinicians from a wide variety of subspecialties has proven effective. A patient centred approach utilising physiotherapy, targeted botulinum toxin injection and selective surgical intervention has reduced the burden of long-term disability in facial palsy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Scapulothoracic dissociation with acromioclavicular separation: a case report of a novel fixation method.

PubMed

Merk, Bradley R; Minihane, Keith P; Shah, Nirav A

2008-09-01

We present a case of 39-year-old female with a scapulothoracic dissociation and acromioclavicular (AC) separation and who had fixation of the AC joint with a locking plate, coracoclavicular screw, and transarticular AC screw. The coracoclavicular and AC relationships were maintained during postoperative rehabilitation and after hardware removal. Use of a locking plate can lead to good functional outcome without the complications associated with the use of pin and wire constructs or without violating the subacromial space.

Optic radiations are thinner and show signs of iron deposition in patients with long-standing remitting-relapsing multiple sclerosis: an enhanced T2*-weighted angiography imaging study.

PubMed

Zeng, Chun; Du, Silin; Han, Yongliang; Fu, Jialiang; Luo, Qi; Xiang, Yayun; Chen, Xiaoya; Luo, Tianyou; Li, Yongmei; Zheng, Yineng

2018-04-30

This study aimed to investigate iron deposition and thickness and signal changes in optic radiation (OR) by enhanced T 2 * -weighted angiography imaging (ESWAN) in patients with relapsing-remitting multiple sclerosis (RRMS) with unilateral and bilateral lesions or no lesions. Fifty-one RRMS patients (42 patients with a disease duration [DD] ≥ 2 years [group Mor], nine patients with a DD < 2 years [group Les]) and 51 healthy controls (group Con) underwent conventional magnetic resonance imaging (MRI) and ESWAN at 3.0 T. The mean phase value (MPV) of the OR was measured on the phase image, and thickness and signal changes of the OR were observed on the magnitude image. The average MPVs for the OR were 1,981.55 ± 7.75 in group Mor, 1,998.45 ± 2.01 in group Les, and 2,000.48 ± 5.53 in group Con. In group Mor, 28 patients with bilateral OR lesions showed bilateral OR thinning with a heterogeneous signal, and 14 patients with unilateral OR lesions showed ipsilateral OR thinning with a heterogeneous signal. In the remaining nine patients without OR lesions and in group Con, the bilateral OR had a normal appearance. In the patients, a negative correlation was found between DD and OR thickness and a positive correlation was found between MPV and OR thickness. We confirmed iron deposition in the OR in the RRMS patients, and the OR thickness was lower in the patients than in the controls. • Enhanced T 2 * -weighted magnetic resonance angiography (ESWAN) provides new insights into multiple sclerosis (MS). • Focal destruction of the optic radiation (OR) is detectable by ESWAN. • Iron deposition in OR can be measured on ESWAN phase image in MS patients. • OR thickness was lower in the patients than in the controls. • Iron deposition and thickness changes of the OR are associated with disease duration.

Platelet-rich plasma versus steroid injection for subacromial impingement syndrome.

PubMed

Say, F; Gurler, D; Bulbul, M

2016-04-01

To compare the 6-week and 6-month outcome in 60 patients who received a single-dose injection of platelet-rich plasma (PRP) or steroid for subacromial impingement syndrome (SIS). 22 men and 38 women (mean age, 49.7 years) opted to receive a single-dose injection of PRP (n=30) or steroid (n=30) for SIS that had not responded to conservative treatment for >3 months. The PRP or a mixture of 1 ml 40 mg methylprednisolone and 8 ml prilocaine was administered via a dorsolateral approach through the interval just beneath the dorsal acromial edge. Both groups were instructed to perform standard rotator cuff stretching and strengthening exercises for 6 weeks. The use of non-steroid anti-inflammatory drugs was prohibited. Patients were evaluated before and 6 weeks and 6 months after treatment using the Constant score, visual analogue scale (VAS) for pain, and range of motion (ROM) of the shoulder. No local or systemic complication occurred. Improvement in the Constant score and VAS for pain at week 6 and month 6 was significantly better following steroid than PRP injection. The difference in the Constant score was greater than the mean clinically important difference of 10.4. Nonetheless, the 2 groups were comparable for improvement in ROM of the shoulder. Steroid injection was more effective than PRP injection for treatment of SIS in terms of the Constant score and VAS for pain at 6 weeks and 6 months.

The presence and influence of posterior capsule tightness on different shoulder problems.

PubMed

Duzgun, Irem; Turgut, Elif; Çinar-Medeni, Özge; Kafa, Nihan; Tuna, Zeynep; Elbasan, Bulent; Oskay, Deran

2017-01-01

In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies. This study set about to compare the role of posterior capsule tightness in different shoulder problems. One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb. It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05). This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.

Comparison of continuous interscalene block and subacromial infusion of local anesthetic for postoperative analgesia after open shoulder surgery.

PubMed

Baskan, Semih; Cankaya, Deniz; Unal, Hidayet; Yoldas, Burak; Taspinar, Vildan; Deveci, Alper; Tabak, Yalcin; Baydar, Mustafa

2017-01-01

This study compared the efficacy of continuous interscalene block (CISB) and subacromial infusion of local anesthetic (CSIA) for postoperative analgesia after open shoulder surgery. This randomized, prospective, double-blinded, single-center study included 40 adult patients undergoing open shoulder surgery. All patients received a standardized general anesthetic. The patients were separated into group CISB and group CSIA. A loading dose of 40 mL 0.25% bupivacaine was administered and patient-controlled analgesia was applied by catheter with 0.1% bupivacaine 5 mL/h throughout 24 h basal infusion, 2 mL bolus dose, and 20 min knocked time in both groups postoperatively. Visual analog scale (VAS) scores, additional analgesia need, local anesthetic consumption, complications, and side effects were recorded during the first 24 h postoperatively. The range of motion (ROM) score was recorded preoperatively and in the first and third weeks postoperatively. A statistically significant difference was determined between the groups in respect of consumption of local anesthetic, VAS scores, additional analgesia consumption, complications, and side effects, with lower values recorded in the CISB group. There were no significant differences in ROM scoring in the preoperative and postoperative third week between the two groups but there were significant differences in ROM scoring in the postoperative first week, with higher ROM scoring values in the group CISB patients. The results of this study have shown that continuous interscalene infusion of bupivacaine is an effective and safe method of postoperative analgesia after open shoulder surgery.

Hook plate fixation of acute displaced lateral clavicle fractures: mid-term results and a brief literature overview

PubMed Central

2012-01-01

Background The clavicle hook plate achieves like most other operative techniques, a high percentage of union and a low percentage of complications however concerns about long term complications still exist, particularly the involvement of the acromioclavicular joint. Methods To evaluate the results and long term effects in use of this plate we performed a retrospective analysis with a mean follow up of 65 months (5.4 years) of 28 consecutive patients with acute displaced lateral clavicle fractures, treated with the clavicle hook plate. Results Short term functional results in all patients were good to excellent. All but one patient had a united fracture (96%). Nine patients (32%) developed impingement symptoms and in 7 patients (25%) subacromial osteolysis was found. These findings resolved after plate removal. Twenty-four patients were re-evaluated at a mean follow-up period of 5.4 years. The Constant-Murley score was 97 and the DASH score was 3.5. Four patients (14%) developed acromioclavicular joint arthrosis of which one was symptomatic. Three patients (11%) had extra articular ossifications of which one was symptomatic. There was no relation between the impingement symptoms, subacromial osteolysis and development of acromioclavicular joint arthrosis or extra articular ossifications. Conclusions The clavicle hook plate is a good primary treatment option for the acute displaced lateral clavicle fracture with few complications. At mid term the results are excellent and no long term complications can be addressed to the use of the plate. PMID:22236647

Can symptomatic acromioclavicular joints be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging?

PubMed

Choo, Hye Jung; Lee, Sun Joo; Kim, Jung Han; Cha, Seong Sook; Park, Young Mi; Park, Ji Sung; Lee, Jun Woo; Oh, Minkyung

2013-04-01

To evaluate retrospectively whether symptomatic acromioclavicular joints can be differentiated from asymptomatic acromioclavicular joints on 3-T MR imaging. This study included 146 patients who underwent physical examination of acromioclavicular joints and 3-T MR imaging of the shoulder. Among them, 67 patients showing positive results on physical examination were assigned to the symptomatic group, whereas 79 showing negative results were assigned to the asymptomatic group. The following MR findings were compared between the symptomatic and asymptomatic groups: presence of osteophytes, articular surface irregularity, subchondral cysts, acromioclavicular joint fluid, subacromial fluid, subacromial bony spurs, joint capsular distension, bone edema, intraarticular enhancement, periarticular enhancement, superior and inferior joint capsular distension degree, and joint capsular thickness. The patients were subsequently divided into groups based on age (younger, older) and the method of MR arthrography (direct MR arthrography, indirect MR arthrography), and all the MR findings in each subgroup were reanalyzed. The meaningful cutoff value of each significant continuous variable was calculated using receiver operating characteristic analysis. The degree of superior capsular distension was the only significant MR finding of symptomatic acromioclavicular joints and its meaningful cutoff value was 2.1mm. After subgroup analyses, this variable was significant in the older age group and indirect MR arthrography group. On 3-T MR imaging, the degree of superior joint capsular distension might be a predictable MR finding in the diagnosis of symptomatic acromioclavicular joints. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Internal- and External-Rotation Peak Toque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training.

PubMed

Lee, Dong-Rour; Kim, Laurentius Jongsoon

2016-08-01

Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain. To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players. Single-group pretest, posttest. Biomechanics laboratory. 23 Little League Baseball players with subacromial impingement syndrome. The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk. The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s. The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s. CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

Variability in attachment of the coracoacromial ligament in relation with its morphology.

PubMed

Alraddadi, Abdulrahman; Alashkham, Abduelmenem; Lamb, Clare; Soames, Roger

2017-12-01

The coracoacromial ligament (CAL) presents with variable morphology and plays a significant role in the development of subacromial impingement syndrome. Sectioning the CAL has been suggested to relieve impingement of the rotator cuff. The aim of the current study was to investigate the CAL attachment in relation with ligament morphology. The CAL was investigated in 220 cadaveric shoulders from 58 males and 59 females, with a median age of 82 years (range 53-102 years). CALs were classified according to three factors: (1) number of bands present; (2) shape; and (3) attachment to the acromial and coracoid processes. 35 (16%) CALs had a single band, 84 (38%) two bands, and 101 (46%) three or more bands. CAL shape was either broadband (14: 6%), quadrangular (21: 10%), Y-shaped (84: 38%), or multiple-banded (101: 46%). More ligaments were attached to the medial aspect of the acromion (60%) and medial end of the coracoid (75%) than those restricted to the anterior edge of the acromion (40%) and posterior aspect of the coracoid (25%). Multiple-banded ligaments attached significantly more medially at the acromion and coracoid processes, while single band ligament attachments were restricted to the anterior edge of the acromion and posterior aspect of the coracoid process. The CAL has variable morphology and attachments with interconnections to different structures around the shoulder. CALs with a medial acromial attachment may narrow the subacromial space leading to further shoulder impingement.

Delayed onset of transversus abdominus in long-standing groin pain.

PubMed

Cowan, Sallie M; Schache, Anthony G; Brukner, Peter; Bennell, Kim L; Hodges, Paul W; Coburn, Paul; Crossley, Kay M

2004-12-01

Long-standing groin pain is a persistent problem that is commonly difficult to rehabilitate. Theoretical rationale indicates a relationship between the motor control of the pelvis and long-standing groin pain; however, this link has not been investigated. The current experiment aimed to evaluate motor control of the abdominal muscles in a group of Australian football players with and without long-standing groin pain. Ten participants with long-standing groin pain and 12 asymptomatic controls were recruited for the study. Participants were elite or subelite Australian football players. Fine-wire and surface electromyography electrodes were used to record the activity of the selected abdominal and leg muscles during a visual choice reaction-time task (active straight leg raising). When the asymptomatic controls completed the active straight leg raise (ASLR) task, the transversus abdominus contracted in a feed-forward manner. However, when individuals with long-standing groin pain completed the ASLR task, the onset of transversus abdominus was delayed (P < 0.05) compared with the control group. There were no differences between groups for the onset of activity of internal oblique, external oblique, and rectus abdominus (all P > 0.05). The finding that the onset of transversus abdominus is delayed in individuals with long-standing groin pain is important, as it demonstrates an association between long-standing groin pain and transversus abdominus activation.

Carcinoma in situ testis, the progenitor of testicular germ cell tumours: a clinical review.

PubMed

Hoei-Hansen, C E; Rajpert-De Meyts, E; Daugaard, G; Skakkebaek, N E

2005-06-01

Testicular germ cell tumours (TGCT), including seminomas, embryonal carcinomas, teratomas and yolk sac tumours, have a common precursor, the carcinoma in situ (CIS) cell. Recent gene expression studies displaying close similarity of CIS cells to embryonic stem cells support the longstanding theory that CIS most likely originates in utero from fetal gonocytes. The clinical association between the testicular dysgenesis syndrome components (TGCT, cryptorchidism, genital malformations, some forms of decreased spermatogenesis) also implies a prenatal origin. Despite high cure rates of TGCT, efforts should be made to obtain diagnosis at the CIS stage, as intervention is possible before an invasive tumour develops, thus reducing the necessity for intensive therapy. CIS may be suspected in patients with an assumed extragonadal GCT or cryptorchidism, and in intersex patients and selected cases with infertility (presenting with atrophic testes and ultrasonic microlithiasis). Surgical testicular biopsy seems the only reliable diagnostic method. The management of choice of unilateral CIS is orchidectomy, or localised irradiation in bilateral cases. At least 5% of TGCT patients present with contralateral CIS; therefore, contralateral biopsy is recommended at the time of orchidectomy. Further research is warranted to identify causal factors explaining the increasing incidence of TGCT and to obtain a method of non-invasive CIS detection.

Retinal pigmentary changes in chronic uveitis mimicking retinitis pigmentosa.

PubMed

Sevgi, D Damla; Davoudi, Samaneh; Comander, Jason; Sobrin, Lucia

2017-09-01

To present retinal pigmentary changes mimicking retinitis pigmentosa (RP) as a finding of advanced uveitis. We retrospectively reviewed charts of patients without a family history of inherited retinal degenerations who presented with retinal pigment changes and signs of past or present intraocular inflammation. Comprehensive eye examination including best-corrected visual acuity, slit-lamp examination and dilated fundus examination was performed on all patients in addition to color fundus photography, optical coherence tomography, fluorescein angiography (FA), and full-field electroretinogram testing. We identified five patients with ages ranging from 33 to 66 years, who presented with RP-like retinal pigmentary changes which were eventually attributed to longstanding uveitis. The changes were bilateral in three cases and unilateral in two cases. Four of five cases presented with active inflammation, and the remaining case showed evidence of active intraocular inflammation during follow-up. This study highlights the overlapping features of advanced uveitis and RP including the extensive pigmentary changes. Careful review of possible past uveitis history, detailed examination of signs of past or present inflammation and ancillary testing, with FA often being most helpful, are required for the correct diagnosis. This is important, because intervention can prevent further damage if the cause of the pigmentary changes is destructive inflammation.

Relationship between extrinsic factors and the acromio-humeral distance.

PubMed

Mackenzie, Tanya Anne; Herrington, Lee; Funk, Lenard; Horsley, Ian; Cools, Ann

2016-06-01

Maintenance of the subacromial space is important in impingement syndromes. Research exploring the correlation between biomechanical factors and the subacromial space would be beneficial. To establish if relationship exists between the independent variables of scapular rotation, shoulder internal rotation, shoulder external rotation, total arc of shoulder rotation, pectoralis minor length, thoracic curve, and shoulder activity level with the dependant variables: AHD in neutral, AHD in 60° arm abduction, and percentage reduction in AHD. Controlled laboratory study. Data from 72 male control shoulders (24.28years STD 6.81 years) and 186 elite sportsmen's shoulders (25.19 STD 5.17 years) were included in the analysis. The independent variables were quantified and real time ultrasound was used to measure the dependant variable acromio-humeral distance. Shoulder internal rotation and pectoralis minor length, explained 8% and 6% respectively of variance in acromio-humeral distance in neutral. Pectoralis minor length accounted for 4% of variance in 60° arm abduction. Total arc of rotation, shoulder external rotation range, and shoulder activity levels explained 9%, 15%, and 16%-29% of variance respectively in percentage reduction in acromio-humeral distance during arm abduction to 60°. Pectorals minor length, shoulder rotation ranges, total arc of shoulder rotation, and shoulder activity levels were found to have weak to moderate relationships with acromio-humeral distance. Existence and strength of relationship was population specific and dependent on arm position. Relationships only accounted for small variances in AHD indicating that in addition to these factors there are other factors involved in determining AHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Acromiohumeral Distance During Neuromuscular Electrical Stimulation of the Lower Trapezius and Serratus Anterior Muscles in Healthy Participants

PubMed Central

Bdaiwi, Alya H.; Mackenzie, Tanya Anne; Herrington, Lee; Horsley, Ian; Cools, Ann M.

2015-01-01

Context Compromise to the acromiohumeral distance has been reported in participants with subacromial impingement syndrome compared with healthy participants. In clinical practice, patients with subacromial shoulder impingement are given strengthening programs targeting the lower trapezius (LT) and serratus anterior (SA) muscles to increase scapular posterior tilt and upward rotation. We are the first to use neuromuscular electrical stimulation to stimulate these muscle groups and evaluate how the muscle contraction affects the acromiohumeral distance. Objective To investigate if electrical muscle stimulation of the LT and SA muscles, both separately and simultaneously, increases the acromiohumeral distance and to identify which muscle-group contraction or combination most influences the acromiohumeral distance. Design Controlled laboratory study. Setting Human performance laboratory. Patients or Other Participants Twenty participants (10 men and 10 women, age = 26.9 ± 8.0 years, body mass index = 23.8) were screened. Intervention(s) Neuromuscular electrical stimulation of the LT and SA. Main Outcome Measure(s) Ultrasound measurement of the acromiohumeral distance. Results Acromiohumeral distance increased during contraction via neuromuscular electrical stimulation of the LT muscle (t19 = −3.89, P = .004), SA muscle (t19 = −7.67, P = .001), and combined LT and SA muscles (t19 = −5.09, P = .001). We observed no differences in the increased acromiohumeral distance among the 3 procedures (F2,57 = 3.109, P = .08). Conclusions Our results supported the hypothesis that the muscle force couple around the scapula is important in rehabilitation and scapular control and influences acromiohumeral distance. PMID:25933249

Subacromial impingement syndrome: An electromyographic study of shoulder girdle muscle fatigue.

PubMed

Alizadehkhaiyat, Omid; Roebuck, Margaret M; Makki, Ahmed T; Frostick, Simon P

2018-02-01

Muscle fatigue affecting glenohumeral and/or scapular muscles is suggested as one of the contributing factors to the development of subacromial impingement syndrome (SAIS). Nonetheless, the fatigability of shoulder girdle muscles in association with the pathomechanics of SAIS has not been reported. This study aimed to measure and compare fatigue progression within the shoulder girdle musculature of patients and healthy controls. 75 participants including 39 patients (20 females; 19 males) and 36 healthy controls (15 females; 21 males) participated in the study. Study evaluated the progression of muscle fatigue in 15 shoulder girdle muscles by means of surface and fine-wire EMG during submaximal contraction of four distinct movements (abduction, flexion, internal and external rotation). Shoulder strength, subjective pain experience (McGill Pain Questionnaire), and psychological status (Hospital Anxiety and Depression Scale) were also assessed. The results were compared between patient and control groups according to the gender. Despite marked fatigue observed in the majority of muscles particularly during flexion and abduction at 90°, overall results indicated a lower tendency of fatigue progression in the impingement group across the tests (p < 0.05 - p < 0.001). Shoulder Strength, pain experience, and psychological status were significantly different between the two groups (P < .05). Lower tendency to fatigue progression in the impingement group can be attributed to the presence of fear avoidance and pain-related muscle inhibition, which in turn lead to adaptations in motor programme to reduce muscle recruitment and activation. The significantly higher levels of pain experience and anxiety/depression in the impingement group further support this proposition. Copyright © 2017 Elsevier Ltd. All rights reserved.

Role of anti-adhesive barriers following rotator cuff repair surgery: an experimental study.

PubMed

Kalem, Mahmut; Şahin, Ercan; Songür, Murat; Zehir, Sinan; Armangil, Mehmet; Demirtaş, Mehmet A

2016-01-01

This experimental study investigates the effectiveness of expanded polytetrafluoroethylene (Dualmesh®, Gore Medical, Flagstaff, AZ, USA), sodium hyaluronate-carboxymethyl cellulose (Seprafilm®, Genzyme, Cambridge, MA, USA), and polysiloxane (silicone) as anti-adhesive barriers for inhibition of fibrosis in the subacromial area following rotator cuff repair. Rabbit rotator cuff tenotomy and repair was conducted on 24 rabbits in 4 groups: control (Group A), Dualmesh® (Group B), Seprafilm® (Group C), and silicone (Group D). Anti-adhesive barrier materials were sutured over the repaired rotator cuff. Macroscopic and histological evaluations were made at the end of the sixth postoperative week. Macroscopic evaluation revealed that minimal adhesion occurred in the control and silicone groups, while the Seprafilm® and Dualmesh® groups showed evidence of fibrosis. Microscopic evaluation revealed diffuse fibrosis and collagen accumulation in the Dualmesh® and Seprafilm® groups, whereas minimal collagen deposition and inflammatory cell reaction was found among the silicone and control groups. Significant differences were found between the silicone and Dualmesh® (p=0.001) and silicone and Seprafilm® groups (p=0.002), as well as between the control and Dualmesh® (p=0.002) and control and Seprafilm® groups (p=0.002). Expanded polytetrafluoroethylene (ePTFE/Dualmesh®) and sodium hyaluronate carboxymethyl cellulose (SH-CMC/Seprafilm®) did not prevent or attenuate postoperative subacromial fibrosis following cuff tear repair. Nor did silicone prevent or attenuate fibrosis. More detailed research is needed for development of an effective anti-adhesive barrier for use after rotator cuff tear surgery.

Point-of-Care Ultrasonography Findings and Care Use Among Patients Undergoing Ultrasound-Guided Shoulder Injections.

PubMed

Lee, Se Won; Tiu, Timothy; Roberts, Jeremy; Lee, Brian; Bartels, Matthew N; Oh-Park, Mooyeon

2018-01-01

The aims of the study were to assess the overall reduction of pain in patients undergoing ultrasound-guided shoulder injections and to characterize the preinjection point-of-care ultrasound findings and use of clinical services postinjection including the use of magnetic resonance imaging and surgeries. Data of 172 patients who underwent ultrasound-guided subacromial subdeltoid injection or glenohumeral joint injection were reviewed for preinjection point-of-care ultrasound findings, change in pain intensity at 2 mos from baseline, and use of care at 6 mos' postinjection. Pain intensity was measured by the numeric rating scale and a dichotomous report of global impression of significant improvement in pain. Responders were defined as those with 50% or more reduction in numeric rating scale or those with global impression of 50% or more improvement. There were 141 responders among the 172 patients analyzed. Full-thickness rotator cuff tears were higher in the ultrasound-guided subacromial subdeltoid injection group when compared with the glenohumeral joint injection group (P = 0.038) and abnormal bicipital tendon findings higher in the glenohumeral joint injection group (P = 0.016). There were no significant differences in specific abnormal U findings between responders versus nonresponders. Twelve patients had a shoulder magnetic resonance imaging and four patients underwent operative interventions after the injection. Overall pain reduction after ultrasound-guided shoulder injections was favorable in the short term. There was no specific preinjection point-of-care ultrasound findings associated with clinical pain reduction after injection. Additional imaging and operative intervention after ultrasound-guided shoulder injections seemed to be relatively low.

Muscle activity of the core during bilateral, unilateral, seated and standing resistance exercise.

PubMed

Saeterbakken, Atle Hole; Fimland, Marius Steiro

2012-05-01

Little is known about the effect of performing common resistance exercises standing compared to seated and unilaterally compared to bilaterally on muscle activation of the core. Thus, the purpose of this study was to compare the electromyographic activity (EMG) of the superficial core muscles (i.e. rectus abdominis, external oblique and erector spinae) between seated, standing, bilateral and unilateral dumbbell shoulder presses. 15 healthy males performed five repetitions at 80% of one-repetition maximum of the exercises in randomized order. Results were analyzed with a two-way analysis of variance and a Bonferroni post hoc test. The position × exercise interaction was significantly different for rectus abdominis (P = 0.016), but not for external oblique (P = 0.100) and erector spinae (P = 0.151). The following EMG results were observed: For rectus abdominis: ~49% lower in seated bilateral versus unilateral (P < 0.001), similar in standing bilateral versus unilateral (P = 0.408), ~81% lower in bilateral seated versus standing (P < 0.001), ~59% lower in unilateral seated versus standing (P < 0.001); For external oblique: ~81% lower in seated bilateral versus unilateral (P < 0.001), ~68% lower in standing bilateral than unilateral (P < 0.001), ~58% lower in bilateral seated versus standing (P < 0.001), ~28% lower in unilateral seated versus standing (P = 0.002); For erector spinae: similar in seated bilateral versus unilateral (P = 0.737), ~18% lower in standing bilateral versus unilateral (P = 0.001), similar in seated versus standing bilateral (P = 0.480) and unilateral (P = 0.690). In conclusion, to enhance neuromuscular activation of the superficial core muscles, standing exercises should be used instead of seated exercises, and unilateral exercises should be used instead of bilateral exercises.

A Chinese patient with pusher syndrome and unilateral spatial neglect syndrome.

PubMed

Chen, Xiao-Wei; Lin, Cheng-He; Zheng, Hua; Lin, Zhen-Lan

2014-07-01

To observe clinical manifestations, behavioral characteristics, and effects of rehabilitation on a patient with pusher syndrome and unilateral spatial neglect caused by right thalamic hemorrhage. Assessment of pusher syndrome was made by the Scale for Contraversive pushing (SCP), and unilateral spatial neglect syndrome was diagnosed using line cancellation, letter and star cancellation, line bisection tests and copy and continuation of graphic sequence test. Behavioral therapy, occupational therapy, reading training and traditional Chinese medicine methods were adopted for treatment of pusher syndrome and unilateral spatial neglect. The patient showed typical pusher syndrome and unilateral spatial neglect symptoms. The pusher syndrome and unilateral spatial neglect symptoms were significantly improved following rehabilitation treatments. Pusher syndrome and unilateral spatial neglect syndrome occurred simultaneously after right thalamic hemorrhage. Early rehabilitation therapy can reduce the symptoms of pusher syndrome and unilateral spatial neglect syndrome and improve motor function.

Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

PubMed

Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

2010-10-01

In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness, distinct patterns of tumor extension and bony invasion, and anatomical variations in the caliber and course of the internal carotid artery. Specific operative techniques for addressing each of these intraoperative challenges are discussed. Transsphenoidal surgery in patients with longstanding acromegaly frequently poses greater challenges than operations for other types of sellar lesions, yet these challenges may be safely and effectively overcome with the anticipation of specific issues and implementation of various intraoperative techniques.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma.

PubMed

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer-specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer-specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p =0.11). Bilateral mastectomy did not provide a clinically or statistically significant breast cancer-specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy.

Association between unilateral or bilateral mastectomy and breast cancer death in patients with unilateral ductal carcinoma

PubMed Central

Agarwal, Shailesh; Pappas, Lisa; Agarwal, Jayant

2017-01-01

Background Utilization of bilateral mastectomy for unilateral breast cancer is increasing despite cost and surgical risks with conflicting reports of survival benefit. Current studies evaluating death after bilateral mastectomy have included patients treated both with breast conservation therapy and unilateral mastectomy. In this study, we directly compared breast cancer–specific death of patients who underwent bilateral or unilateral mastectomy for unilateral breast cancer using a matched cohort analysis. Methods This was an observational study of women diagnosed with unilateral breast cancer from 1998 through 2002, using the Surveillance, Epidemiology, and End Results (SEER) database. A 4-to-1 matched cohort of patients was selected including 14,075 patients. Mortality of the groups was compared using Cox proportional hazards models for cause-specific death. Results A total of 41,510 patients diagnosed with unilateral breast cancer were included. Unilateral mastectomy was performed in 93% of patients, while bilateral mastectomy was performed in the remaining 7% of patients. When 4-to-1 matching was performed, 11,260 unilateral mastectomy and 2,815 bilateral mastectomy patients were included. Patients with bilateral mastectomy did not have a significantly lower hazard of breast cancer–specific death when compared with patients with unilateral mastectomy (hazard ratio: 0.92 vs 1.00, p=0.11). Conclusion Bilateral mastectomy did not provide a clinically or statistically significant breast cancer–specific mortality benefit over unilateral mastectomy based on a matched cohort analysis of a nationwide population database. These findings should be interpreted in the context of patient preference and alternative benefits of bilateral mastectomy. PMID:29180900

Impact of unilateral conductive hearing loss due to aural atresia on academic performance in children.

PubMed

Kesser, Bradley W; Krook, Kaelyn; Gray, Lincoln C

2013-09-01

This study evaluates the effect of unilateral conductive hearing loss secondary to aural atresia on elementary school children's academic performance. Case control survey and review of audiometric data. One hundred thirty-two surveys were mailed to families of children with aural atresia, and 48 surveys were sent to families of children with unilateral sensorineural hearing loss (SNHL) to identify rates of grade retention, use of any resource, and behavioral problems. Audiometric data of the cohort were tabulated. Of the 40 atresia patients, none repeated a grade, but 65% needed some resources: 12.5% currently use a hearing aid, 32.5% use(d) a frequency-modulated system in school, 47.5% had an Individualized Education Plan, and 45% utilized speech therapy. Compared to the unilateral SNHL group and a cohort of children with unilateral SNHL in an earlier study, children with unilateral atresia were less likely to repeat a grade. Children in both unilateral atresia and SNHL groups were more likely to utilize some resource in the academic setting compared to the unilateral SNHL children in the prior study. Unilateral conductive hearing loss due to aural atresia has an impact on academic performance in children, although not as profound when compared to children with unilateral SNHL. The majority of these children with unilateral atresia utilize resources in the school setting. Parents, educators, and health care professionals should be aware of the impact of unilateral conductive hearing loss and offer appropriate habilitative services. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Common Soft Tissue Musculoskeletal Pain Disorders.

PubMed

Hubbard, Matthew J; Hildebrand, Bernard A; Battafarano, Monica M; Battafarano, Daniel F

2018-06-01

Soft tissue musculoskeletal pain disorders are common in the primary care setting. Early recognition and diagnosis of these syndromes minimizes patient pain and disability. This article gives a brief overview of the most common soft tissue musculoskeletal pain syndromes. The authors used a regional approach to organize the material, as providers will encounter these syndromes with complaints of pain referring to an anatomic location. The covered disorders include myofascial pain syndrome, rotator cuff tendinopathy, bicipital tendinopathy, subacromial bursitis, olecranon bursitis, epicondylitis, De Quervain disease, trigger finger, trochanteric bursitis, knee bursitis, pes anserine bursitis, Baker cyst, plantar fasciitis, and Achilles tendinopathy. Published by Elsevier Inc.

Rapidly fluctuating anosmia: A clinical sign for unilateral smell impairment.

PubMed

Negoias, Simona; Friedrich, Hergen; Caversaccio, Marco D; Landis, Basile N

2016-02-01

Reports about fluctuating olfactory deficits are rare, as are reports of unilateral olfactory loss. We present a case of unilateral anosmia with contralateral normosmia, presenting as rapidly fluctuating anosmia. The olfactory fluctuation occurred in sync with the average nasal cycle duration. Examination after nasal decongestion, formal smell testing, and imaging revealed unilateral, left-sided anosmia of sinonasal cause, with right-sided normosmia. We hypothesize that the nasal cycle induced transient anosmia when blocking the normosmic side. Fluctuating olfactory deficits might hide a unilateral olfactory loss and require additional unilateral testing and thorough workup. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Are bilateral idiopathic clubfeet more severe than unilateral feet? A severity and treatment analysis.

PubMed

Agarwal, Anil; Agrawal, Nargesh; Barik, Sitanshu; Gupta, Neeraj

2018-01-01

Evidences suggest that different subgroups of idiopathic clubfoot exist with differences in severity and treatment outcomes. This study compares the severity and treatment outcomes of unilateral and bilateral clubfoot. We retrospectively studied 161 patients (bilateral 66, unilateral 95) with primary idiopathic clubfeet to evaluate the differences in severity and treatment. The parameters analyzed were precasting Pirani score, number of casts required, pretenotomy Pirani score, pretenotomy dorsiflexion, rate of tenotomy, and post-tenotomy dorsiflexion achieved. A Pirani score of at least 5 was classified as very severe and 4.5 or less was classified as less severe. There were 49=(74.24%) male and 17 (25.75%) female patients in the bilateral group and 76 (80%) male and 19 (20%) female patients in the unilateral group. Out of 95 unilateral patients, 34 were left sided (35.8%). Comparing severity, the mean precasting Pirani score in bilateral patients (5.4 ± 0.6) was statistically more than the unilateral patients (4.9 ± 0.7). The number of casts required was significantly more in bilateral feet compared to unilateral (bilateral 5.3 ± 1.7, unilateral 4.7 ± 1.7; p < 0.011). Achilles tenotomy was required in all feet. Post Ponseti treatment, the foot deformity correction achieved (pretenotomy Pirani score, pretenotomy, and post-tenotomy dorsiflexion) was statistically similar in both unilateral and bilateral feet. Idiopathic bilateral clubfoot was more severe than unilateral foot at initial presentation and required more number of corrective casts. Post Ponseti treatment, the deformity correction in bilateral foot was similar to unilateral foot.

Unilateral photophobia or phonophobia in migraine compared with trigeminal autonomic cephalalgias.

PubMed

Irimia, P; Cittadini, E; Paemeleire, K; Cohen, A S; Goadsby, P J

2008-06-01

Our objective was to compare the presence of self-reported unilateral photophobia or phonophobia, or both, during headache attacks comparing patients with trigeminal autonomic cephalalgias (TACs)--including cluster headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and paroxysmal hemicrania--or hemicrania continua, and other headache types. We conducted a prospective study in patients attending a referral out-patient clinic over 5 months and those admitted for an intramuscular indomethacin test. Two hundred and six patients were included. In episodic migraine patients, two of 54 (4%) reported unilateral photophobia or phonophobia, or both. In chronic migraine patients, six of 48 (13%) complained of unilateral photophobia or phonophobia, or both, whereas none of the 24 patients with medication-overuse headache reported these unilateral symptoms, although these patients all had clinical symptoms suggesting the diagnosis of migraine. Only three of 22 patients (14%) suffering from new daily persistent headache (NDPH) experienced unilateral photophobia or phonophobia. In chronic cluster headache 10 of 21 patients (48%) had unilateral photophobia or phonophobia, or both, and this symptom appeared in four of five patients (80%) with episodic cluster headache. Unilateral photophobia or phonophobia, or both, were reported by six of 11 patients (55%) with hemicrania continua, five of nine (56%) with SUNCT, and four of six (67%) with chronic paroxysmal hemicrania. Unilateral phonophobia or photophobia, or both, are more frequent in TACs and hemicrania continua than in migraine and NDPH. The presence of these unilateral symptoms may be clinically useful in the differential diagnosis of primary headaches.

Unilateral scrotal angiomas: An expression of underlying varicocele.

PubMed

Tromp, Elise E; Kouwenhoven, Stijn T P; Quint, Koen D; Gmelig Meijling, Kevin A; Genders, Roel E

2016-01-01

The current case report describes a 35-year-old man who presented with unilateral scrotal angiomas. The presence of unilateral scrotal angiomas was associated with an underlying varicocele on the ipsilateral side due to increased venous pressure. In case of unilateral scrotal angiomas further examination for underlying pathology is necessary.

Unilateral advancement of the maxillary minor segment by distraction osteogenesis in patients with repaired unilateral cleft lip and palate: report of two cases.

PubMed

Kuroe, Kazuto; Iino, Shoichiro; Shomura, Kenji; Okubo, Akiro; Sugihara, Kazumasa; Ito, Gakuji

2003-05-01

Collapse of the maxillary minor segment with lateral crossbite is a common feature in patients with repaired unilateral cleft lip/palate because of maxillary alveolar bony defect and palatal scar tissue. Distraction osteogenesis (DOG) is an effective technique of lengthening and augmentation for bone and gingiva. This case report describes the effects of unilateral advancement of the maxillary minor segment by DOG in two patients with the repaired unilateral cleft lip/palate.

Supraspinatus tendon micromorphology in individuals with subacromial pain syndrome.

PubMed

Pozzi, Federico; Seitz, Amee L; Plummer, Hillary A; Chow, Kira; Bashford, Gregory R; Michener, Lori A

Cross-sectional cohort. Tendon collagen organization can be estimated by peak spatial frequency radius (PSFR) on ultrasound images. Characterizing PSFR can define the contribution of collagen disruption to shoulder symptoms. The purpose of this was to characterize the (1) supraspinatus tendon PSFR in participants with subacromial pain syndrome (SPS) and healthy controls; (2) PSFR between participants grouped on a tendon visual quality score; and (3) relationship between PSFR with patient-reported pain, function, and shoulder strength. Participants with SPS (n = 20) and age, sex, and arm-dominance-matched healthy controls (n = 20) completed strength testing in scaption and external rotation, and patient-reported pain, and functional outcomes. Supraspinatus tendon ultrasound images were acquired, and PSFR was calculated for a region of interest 15 mm medial to the supraspinatus footprint. PSFR was compared between groups using an independent t-test and an analysis of variance to compare between 3 groups for visually qualitatively rated tendon abnormalities. Relationships between PSFR with pain, function, and strength were assessed using Pearson correlation coefficient. Supraspinatus tendon PSFR was not different between groups (P = .190) or tendon qualitative ratings (P = .556). No relationship was found between PSFR and pain, functional loss, and strength (P > .05). Collagen disruption (PSFR) measured via ultrasound images of the supraspinatus tendon was not different between participants with SPS or in those with visually rated tendon defects. PSFR is not related to shoulder pain, function, and strength, suggesting that supraspinatus tendon collagen disorganization may not be a contributing factor to shoulder SPS. However, collagen disruption may not be isolated to a single region of interest. 3b: case-control study. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Scapula kinematics of pull-up techniques: Avoiding impingement risk with training changes.

PubMed

Prinold, Joe A I; Bull, Anthony M J

2016-08-01

Overhead athletic activities and scapula dyskinesia are linked with shoulder pathology; pull-ups are a common training method for some overhead sports. Different pull-up techniques exist: anecdotally some are easier to perform, and others linked to greater incidences of pathology. This study aims to quantify scapular kinematics and external forces for three pull-up techniques, thus discussing potential injury implications. An observational study was performed with eleven participants (age=26.8±2.4 years) who regularly perform pull-ups. The upward motions of three pull-up techniques were analysed: palms facing anterior, palms facing posterior and wide-grip. A skin-fixed scapula tracking technique with attached retro-reflective markers was used. High intra-participant repeatability was observed: mean coefficients of multiple correlations of 0.87-1.00 in humerothoracic rotations and 0.77-0.90 for scapulothoracic rotations. Standard deviations of hand force was low: <5% body weight. Significantly different patterns of humerothoracic, scapulothoracic and glenohumeral kinematics were observed between the pull-up techniques. The reverse technique has extreme glenohumeral internal-external rotation and large deviation from the scapula plane. The wide technique has a reduced range of pro/retraction in the same HT plane of elevation and 90° of arm abduction with 45° external rotation was observed. All these factors suggest increased sub-acromial impingement risk. The scapula tracking technique showed high repeatability. High arm elevation during pull-ups reduces sub-acromial space and increases pressure, increasing the risk of impingement injury. Wide and reverse pull-ups demonstrate kinematics patterns linked with increased impingement risk. Weight-assisted front pull-ups require further investigation and could be recommended for weaker participants. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study.

PubMed

Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, Johan Hviid; Thomsen, Jane Frølund; Frost, Poul

2013-11-01

The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. The study was based on the Musculoskeletal Research Database at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from a job exposure matrix based on expert judgment. We applied multivariable Cox regression. During 280 125 person-years of follow-up among 37 402 persons, 557 first-time operations for SIS occurred. Crude surgery rates increased from 1.1 to 2.5 per 1000 person-years with increasing shoulder load. Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR(adj)) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load showed an HR(adj) of 4.52 (95% CI 2.87-7.13). Subanalyses based on 18 856 persons showed an HR(adj) of 5.40 (95% CI 2.88-10.11) for complaints located specifically in the shoulder in combination with high shoulder load. Based on these findings, persons with neck-shoulder and especially shoulder complaints in combination with high shoulder load seem an obvious target group for interventions aimed at reducing exposures to prevent surgery for SIS.

[The effects of hook plates on the subacromial space--a clinical and MRT study].

PubMed

Hackenberger, J; Schmidt, J; Altmann, T

2004-01-01

The analysis of middle- and long-term results after treatment of acromioclavicular joint injuries with a hook plate as a temporary implant and a comparison of the results with those described in literature have been made. In a retrospective study we were able to conduct follow-up examinations on 28 out of 39 Tossy III patients (72 %) who received surgical treatment using a hook plate according to Dreithaler. Examinations took place on average 3.0 (1.2-5.6) years after surgery. A special focus of attention was the effect of the hook plate on the subacromial space. Accordingly, physical examination was supplemented by sonography of the shoulder as well as comparative bilateral shoulder MRI. 86 % of our patients expressed satisfaction with the functional outcome of surgery as opposed to 54 % concerning its cosmetic result. In shoulder sonography no patient turned out to have suffered a higher grade rotator cuff lesion, whereas age-related degenerative alterations were found in 46 % of the patients. Instability under load was found in 7 patients (25 %). Among these were 3 with severe instability (11 %). 2 patients (7 %) were found to have a permanent subluxation of the acromioclavicular joint with partial range of motion impairment. All scores monitored (DASH, Taft, Constant-Murley) on average returned good to excellent results. MRI scans displayed no case of higher grade rotator cuff lesion. In accordance with the findings of ultrasound imaging a higher incidence of extraarticular ossification was found as well as, in some cases, arthrosis of the acromioclavicular joint. In our opinion, the hook plate designed by Dreithaler is easy to handle and serves as a qualified implant for temporary stabilisation of the acromioclavicular joint with middle- and long-term good to excellent results.

Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder.

PubMed

Aleem, Alexander W; Syed, Usman Ali M; Nicholson, Thema; Getz, Charles L; Namdari, Surena; Beredjiklian, Pedro K; Abboud, Joseph A

2017-09-01

Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of <7% had an average rise in blood glucose of 38 mg/dL compared to 98 mg/dL in the poorly controlled group after injection ( P <0.001). Well-controlled patients' glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients ( P <0.001). After corticosteroid injection, patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.

Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials.

PubMed

Warrender, William J; Syed, Usman Ali M; Hammoud, Sommer; Emper, William; Ciccotti, Michael G; Abboud, Joseph A; Freedman, Kevin B

2017-06-01

Effective postoperative pain management after shoulder arthroscopy is a critical component to recovery, rehabilitation, and patient satisfaction. This systematic review provides a comprehensive overview of level 1 and level 2 evidence regarding postoperative pain management for outpatient arthroscopic shoulder surgery. Systematic review. We performed a systematic review of the various modalities reported in the literature for postoperative pain control after outpatient shoulder arthroscopy and analyzed their outcomes. Analgesic regimens reviewed include regional nerve blocks/infusions, subacromial/intra-articular injections or infusions, cryotherapy, and oral medications. Only randomized control trials with level 1 or level 2 evidence that compared 2 or more pain management modalities or placebo were included. We excluded studies without objective measures to quantify postoperative pain within the first postoperative month, subjective pain scale measurements, or narcotic consumption as outcome measures. A combined total of 40 randomized control trials met our inclusion criteria. Of the 40 included studies, 15 examined nerve blocks, 4 studied oral medication regimens, 12 studied subacromial infusion, 8 compared multiple modalities, and 1 evaluated cryotherapy. Interscalene nerve blocks (ISBs) were found to be the most effective method to control postoperative pain after shoulder arthroscopy. Increasing concentrations, continuous infusions, and patient-controlled methods can be effective for more aggressively controlling pain. Dexamethasone, clonidine, intrabursal oxycodone, and magnesium have all been shown to successfully improve the duration and adequacy of ISBs when used as adjuvants. Oral pregabalin and etoricoxib administered preoperatively have evidence supporting decreased postoperative pain and increased patient satisfaction. On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic shoulder surgery.

How is shoulder ultrasound done in Italy? A survey of clinical practice.

PubMed

Zappia, Marcello; Aliprandi, Alberto; Pozza, Simona; Doniselli, Fabio Martino; Gitto, Salvatore; Sconfienza, Luca Maria

2016-12-01

To define when an ultrasound examination of the shoulder can be considered complete and how many examinations currently performed in Italy are actually complete according to that definition. Reports and images of previously performed ultrasound examinations of the shoulder of patients seen in 2014 for interventional procedures were reviewed for the following items, according to guidelines published by the European Society of Musculoskeletal Radiology: long biceps, subscapularis, supraspinatus, external rotators, acromioclavicular joint, subacromial bursa, subacromial space, coraco-acromial ligament, and the posterior recess. The first six items were considered mandatory in a complete shoulder ultrasound examination. The specialization of the performing physician was noted. The number of complete examinations performed by different physicians was compared with the number of incomplete examinations. We analyzed 324 examinations (212 women, 112 men; mean age = 47 ± 12 years). The most frequently reported item was the supraspinatus tendon (83 %), the least frequently reported was the posterior recess (3 %). The image that was most frequently found was the long head of the biceps tendon (77 %), the least frequently found was the coraco-acromial ligament (3 %). The median number of images/examination was 6 (25th-75th percentiles, range 4-9). The mean number of unrecognizable images was 3 (2-4). A radiologist performed the examination in 269 patients (83 %). The rate of complete examinations was 47 %. The number of complete examinations performed by physicians from different specialties was not significantly different from that of incomplete examinations (P = 0.228). Complete shoulder ultrasound examinations account for less than 50 % of those performed in clinical practice in some Italian regions. Standardized scanning protocols and structured reporting may help to improve this figure and consistency among providers performing these examinations.

Rilonacept in the treatment of subacromial bursitis: A randomized, non-inferiority, unblinded study versus triamcinolone acetonide.

PubMed

Carroll, Matthew B; Motley, Spencer A; Wohlford, Susanna; Ramsey, Bryan C

2015-12-01

Subacromial bursitis is caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament and acromion. While multiple cytokines are implicated, interleukin-1 beta appears to play a prominent role. Rilonacept, an interleukin-1 trap, may be an alternative to corticosteroid injection for the management of this condition. This single center, randomized, non-inferiority, unblinded study recruited 33 subjects over 9 months. Twenty subjects received 160mg intrabursal injection of rilonacept and 13 received a 6mL mixture of lidocaine, bupivacaine, and 80mg triamcinolone acetonide. QuickDASH, subject reported pain, and adverse events were recorded at time of injection, 2 days later, 2 weeks later, and 4 weeks later. Primary outcome was improvement in QuickDASH 4 weeks post-injection. Secondary outcomes were improvement in subject reported pain and occurrence of adverse events at 4 weeks. Both study groups were equally matched for age, gender, ethnicity, and site of bursa injection. Both medications demonstrated a statistically significant improvement in QuickDASH 4 weeks post-injection, but triamcinolone acetonide injection offered greater improvement (P=0.004). Both medications demonstrated improvement in subject reported pain but between group comparison at 4 weeks showed that triamcinolone was superior (P=0.044). No statistically significant differences in adverse events were noted between groups, but subjects who received rilonacept experienced more episodes of diarrhea and headache. While improvement in QuickDASH and pain was noted with a single intrabursal injection of rilonacept at 4 weeks, injection with triamcinolone acetonide was more efficacious. This trial was registered with www.clinicaltrials.gov (NCT01830699). Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Combined Fluoroscopic and Arthroscopic Detection and Removal of a Foreign Body Lost During Elective Shoulder Arthroscopy: A Case Report.

PubMed

Schmiddem, Uli; Hawi, N; Suero, E M; Meller, R

2017-01-01

We report a case of a lost metal platelet from a radiofrequency ablation probe (VAPR VUE Radiofrequency System, Cool Pulse 90, DePuy, Synthes, Switzerland) in the shoulder joint during elective arthroscopic cuff repair. To the best of our knowledge, this kind of an incident during elective arthroscopy has not been described in the literature so far. In addition, we present an algorithm on how to deal with such an incident. A 69-year-old woman underwent an arthroscopic subacromial decompression and rotator cuff repair for a torn supraspinatus tendon. While performing the subacromial decompression and after swapping the portals from lateral to posterior, the metal platelet of the electrocautery device got detached from the instrument and lost in the operation field. Several attempts to visualize the lost platelet with the camera failed. Finally, intraoperative fluoroscopic imaging was used to detect the platelet. To confirm the definitive whereabouts of the platelet, two spinal needles were positioned perpendicular to another under x-ray control, both pointing at the missing platelet. After determining the exact location, the platelet could finally be visualized with the camera and removed. Due to this incident, the operation time was extended extensively, and the patient as well as the theatre team was exposed to an unnecessary amount of radiation. This report indicates that an extraordinary incident such as the detachment of a component of the arthroscopic equipment during surgery is possible and should be kept in mind by the surgeon. Therefore, we believe that it is essential to perform a test of integrity at least at the end of every operation. In addition, we are presenting an algorithm on how to deal with the situation of a lost foreign body during arthroscopy, which can be applied to any joint.

Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases.

PubMed

Tempelaere, Christine; Pierrart, Jérome; Lefèvre-Colau, Marie-Martine; Vuillemin, Valérie; Cuénod, Charles-André; Hansen, Ulrich; Mir, Olivier; Skalli, Wafa; Gregory, Thomas

2016-01-01

MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases. Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI. The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05). The Dynamic MRI enabled a novel measure; 'Looseness', i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position.

Quantitative and qualitative analyses of subacromial impingement by kinematic open MRI.

PubMed

Tasaki, Atsushi; Nimura, Akimoto; Nozaki, Taiki; Yamakawa, Akira; Niitsu, Mamoru; Morita, Wataru; Hoshikawa, Yoshimitsu; Akita, Keiichi

2015-05-01

Quantitative and qualitative kinematic analyses of subacromial impingement by 1.2T open MRI were performed to determine the location of impingement and the involvement of the acromioclavicular joint. In 20 healthy shoulders, 10 sequential images in the scapular plane were taken in a 10-s pause at equal intervals from 30° to maximum abduction in neutral and internal rotation. The distances between the rotator cuff (RC) and the acromion and the acromioclavicular joint were measured. To comprehend the positional relationships, cadaveric specimens were also observed. Although asymptomatic, the RC came into contact with the acromion and the acromioclavicular joint in six and five cases, respectively. The superior RC acted as a depressor for the humeral head against the acromion as the shoulder elevated. The mean elevation angle and distance at the closest position between the RC and the acromion in neutral rotation were 93.5° and 1.6 mm, respectively, while those between the RC and the acromioclavicular joint were 86.7° and 2.0 mm. When comparing this distance and angle, there was no significant difference between the RC to the acromion and to the acromioclavicular joint. The minimum distance between the RC and the acromion was significantly shorter than that between the greater tuberosity and the acromion. The location of RC closest to the acromion and the acromioclavicular joint differed significantly. Although asymptomatic, contact was found between the RC and the acromion and the acromioclavicular joint. The important role of the RC to prevent impingement was observed, and hence, dysfunction of the RC could lead to impingement that could result in a RC lesion. The RC lesions may differ when they are caused by impingement from either the acromion or the acromioclavicular joint.

Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

PubMed Central

Tempelaere, Christine; Pierrart, Jérome; Lefèvre-Colau, Marie-Martine; Vuillemin, Valérie; Cuénod, Charles-André; Hansen, Ulrich; Mir, Olivier; Skalli, Wafa; Gregory, Thomas

2016-01-01

Background MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases. Methods Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI. Results The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05). Conclusion The Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position. PMID:27434235

Explicit and implicit motor learning in children with unilateral cerebral palsy.

PubMed

van der Kamp, John; Steenbergen, Bert; Masters, Rich S W

2017-07-30

The current study aimed to investigate the capacity for explicit and implicit learning in children with unilateral cerebral palsy. Children with left and right unilateral cerebral palsy and typically developing children shuffled disks toward a target. A prism-adaptation design was implemented, consisting of pre-exposure, prism exposure, and post-exposure phases. Half of the participants were instructed about the function of the prism glasses, while the other half were not. For each trial, the distance between the target and the shuffled disk was determined. Explicit learning was indicated by the rate of adaptation during the prism exposure phase, whereas implicit learning was indicated by the magnitude of the negative after-effect at the start of the post-exposure phase. Results No significant effects were revealed between typically developing participants and participants with unilateral cerebral palsy. Comparison of participants with left and right unilateral cerebral palsy demonstrated that participants with right unilateral cerebral palsy had a significantly lower rate of adaptation than participants with left unilateral cerebral palsy, but only when no instructions were provided. The magnitude of the negative after-effects did not differ significantly between participants with right and left unilateral cerebral palsy. The capacity for explicit motor learning is reduced among individuals with right unilateral cerebral palsy when accumulation of declarative knowledge is unguided (i.e., discovery learning). In contrast, the capacity for implicit learning appears to remain intact among individuals with left as well as right unilateral cerebral palsy. Implications for rehabilitation Implicit motor learning interventions are recommended for individuals with cerebral palsy, particularly for individuals with right unilateral cerebral palsy Explicit motor learning interventions for individual with cerebral palsy - if used - best consist of singular verbal instruction.

The Relationship between Binaural Benefit and Difference in Unilateral Speech Recognition Performance for Bilateral Cochlear Implant Users

PubMed Central

Yoon, Yang-soo; Li, Yongxin; Kang, Hou-Yong; Fu, Qian-Jie

2011-01-01

Objective The full benefit of bilateral cochlear implants may depend on the unilateral performance with each device, the speech materials, processing ability of the user, and/or the listening environment. In this study, bilateral and unilateral speech performances were evaluated in terms of recognition of phonemes and sentences presented in quiet or in noise. Design Speech recognition was measured for unilateral left, unilateral right, and bilateral listening conditions; speech and noise were presented at 0° azimuth. The “binaural benefit” was defined as the difference between bilateral performance and unilateral performance with the better ear. Study Sample 9 adults with bilateral cochlear implants participated. Results On average, results showed a greater binaural benefit in noise than in quiet for all speech tests. More importantly, the binaural benefit was greater when unilateral performance was similar across ears. As the difference in unilateral performance between ears increased, the binaural advantage decreased; this functional relationship was observed across the different speech materials and noise levels even though there was substantial intra- and inter-subject variability. Conclusions The results indicate that subjects who show symmetry in speech recognition performance between implanted ears in general show a large binaural benefit. PMID:21696329

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

PubMed Central

Perez-Brena, Norma; Updegraff, Kimberly A.; Umaña-Taylor, Adriana J.

2013-01-01

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully understand how family processes are embedded within culture. The goals of this study were to describe mothers’ and fathers’ decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including parent-unilateral, joint, and youth-unilateral decision-making, and to examine the socio-cultural and family characteristics associated with these different types of decision-making in 246 Mexican-origin families. Mothers reported more joint and youth-unilateral decision-making and less parent-unilateral decision-making than did fathers. Fathers reported more youth-unilateral decision-making with sons than with daughters. Further, for mothers, more traditional gender role attitudes and higher levels of mother-adolescent conflict were associated with more parent-unilateral and less joint decision-making. In contrast, for fathers, lower levels of respect values were associated with more youth-unilateral decision-making with sons, and higher levels of parent-adolescent warmth was associated with more youth-unilateral decision-making with daughters. The importance of understanding the different correlates of mothers’ and fathers’ decision-making with sons versus daughters is discussed. PMID:21484288

Distraction of the temporomandibular joint condyle in patients with unilateral non-reducing disc displacement: Fact or fiction?

PubMed

Yıldız, Melih; Çağatay Dayan, Süleyman; Şakar, Olcay; Sülün, Tonguç

2017-07-24

This study investigated the distractive effect of a unilateral pivot splint on patients with unilateral disc displacement without reduction. The study group was comprised of 18 patients who had no history of treatment with removable prosthetic restorations of molars, premolars, or canine teeth, and no previous treatment for temporomandibular disorder. Joint spaces measurements made on magnetic resonance images indicated the affected side to be narrower than the healthy side. Unilateral distraction splints were made for all patients. An ultrasonic motion analyzer was used to measure the vertical shift occurring on the affected side as patients closed their mouths with maximal force with the splint in their mouths. Closing with maximal force on the unilateral distraction splint led to a noticeable downward movement of the affected condyle. The findings of this study indicate that the TMJ condyle of patients with unilateral disc displacement without reduction may be unilaterally distracted if the articular space is narrowed.

Material deprivation and health: a longitudinal study.

PubMed

Tøge, Anne Grete; Bell, Ruth

2016-08-08

Does material deprivation affect the consequences of ill health? Answering this question requires that we move beyond the effects of income. Longitudinal data on material deprivation, longstanding illness and limiting longstanding illness enables investigations of the effects of material deprivation on risk of limiting longstanding illness. This study investigates whether a shift from affording to not affording a car predicts the probability of limiting longstanding ill (LLSI). The 2008-2011 longitudinal panel of Statistics on Income, Social Inclusion and Living Conditions (EU-SILC) is utilised. Longitudinal fixed effects logit models are applied, using LLSI as dependent variable. Transition from affording a car to not affording a car is used as a proxy for material deprivation. All models are controlled for whether the person becomes longstanding ill (LSI) as well as other time-variant covariates that could affect the results. The analysis shows a statistically significant increased odds ratio of LLSI when individuals no longer can afford a car, after controlling for confounders and LSI in the previous year (1.129, CI = 1.022-1.248). However, when restricting the sample to observations where respondents report longstanding illness the results are no longer significant (1.032, CI = 0.910-1.171). The results indicate an individual level effect of material deprivation on LLSI, suggesting that material resources can affect the consequences of ill health.

Injection Therapies for Rotator Cuff Disease.

PubMed

Lin, Kenneth M; Wang, Dean; Dines, Joshua S

2018-04-01

Rotator cuff disease affects a large proportion of the overall population and encompasses a wide spectrum of pathologies, including subacromial impingement, rotator cuff tendinopathy or tear, and calcific tendinitis. Various injection therapies have been used for the treatment of rotator cuff disease, including corticosteroid, prolotherapy, platelet-rich plasma, stem cells, and ultrasound-guided barbotage for calcific tendinitis. However, the existing evidence for these therapies remains controversial or sparse. Ultimately, improved understanding of the underlying structural and compositional deficiencies of the injured rotator cuff tissue is needed to identify the biological needs that can potentially be targeted with injection therapies. Copyright © 2017 Elsevier Inc. All rights reserved.

A virtual reality assessment and training system for unilateral neglect.

PubMed

Kim, Kwanguk; Kim, Jaehun; Ku, Jeonghun; Kim, Deog Young; Chang, Won Hyek; Shin, Dong Ik; Lee, Jang Han; Kim, In Young; Kim, Sun I

2004-12-01

Patients with unilateral neglect have problems reporting, responding, or orienting to novel or meaningful stimuli that is presented to the side opposite to that of a brain lesion. This creates a serous problem in regards to daily living activities. However, the established methods for assessing and training of unilateral neglect patients have several deficits. Recently, virtual reality (VR) technologies have been used as an assessment and treatment tool for rehabilitation. Hence, this study designed a VR system to assess and train unilateral neglect patients. In addition, the suitability and feasibility of our VR system for unilateral neglect patients was verified.

Associations of Anisometropia with Unilateral Amblyopia, Interocular Acuity Difference and Stereoacuity in Preschoolers

PubMed Central

Ying, Gui-shuang; Huang, Jiayan; Maguire, Maureen; Quinn, Graham; Kulp, Marjean Taylor; Ciner, Elise; Cyert, Lynn; Orel-Bixler, Deborah

2012-01-01

Purpose To evaluate the relation of anisometropia with unilateral amblyopia, interocular acuity difference (IAD) and stereoacuity, among Head Start preschoolers, using both clinical notation and vector notation analyses. Design Multicenter, cross-sectional study. Participants 3- to 5-year-old participants in the Vision In Preschoolers (VIP) Study (N=4040). Methods Secondary analysis of VIP data from participants who had comprehensive eye examinations including monocular visual acuity (VA) testing, stereoacuity testing, and cycloplegic refraction. VA was retested with full cycloplegic correction when retest criteria were met. Unilateral amblyopia was defined as IAD ≥2 lines in logarithm of the Minimum Angle of Resolution (logMAR). Anisometropia was defined as ≥0.25 D (diopter) difference in spherical equivalent (SE) or in cylinder power, and also two approaches using power vector notation. The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity were compared between anisometropic and isometropic children. Main Outcomes Measures The percentage with unilateral amblyopia, mean IAD, and mean stereoacuity. Results Compared with isometropic children, anisometropic children had a higher percentage of unilateral amblyopia (8% vs. 2%), larger mean IAD (0.07 vs. 0.05 logMAR) and worse mean stereoacuity (145 vs.117 arc sec) (all p<0.0001). Larger amounts of anisometropia were associated with higher percentages of unilateral amblyopia, larger IAD, and worse stereoacuity (trend p<0.001). Percentage of unilateral amblyopia was significantly increased with spherical equivalent (SE) anisometropia >0.5 D, cylindrical anisometropia >0.25 D, the vertical/horizontal meridian (J0) or oblique meridian (J45) >0.125 D, or vector dioptric distance (VDD) >0.35 D (all p<0.001). VDD had higher ability in detecting unilateral amblyopia than cylinder, SE, J0 and J45 (p<0.001). Conclusions The presence of and amount of anisometropia were associated with the presence of unilateral amblyopia, larger IAD and worse stereoacuity. The threshold level of anisometropia at which unilateral amblyopia becomes significant was lower than current guidelines. VDD is more accurate than spherical equivalent anisometropia or cylindrical anisometropia in identifying preschoolers with unilateral amblyopia. PMID:23174398

Are unilateral and bilateral patellar tendinopathy distinguished by differences in anthropometry, body composition, or muscle strength in elite female basketball players?

PubMed Central

Gaida, J; Cook, J; Bass, S; Austen, S; Kiss, Z

2004-01-01

Background: Overuse injury to the patellar tendon (patellar tendinopathy) is a major reason for interrupted training and competition for elite athletes. In both sexes, the prevalence of unilateral and bilateral tendinopathy has been shown to differ. It has been proposed that bilateral pathology may have a different aetiology from unilateral pathology. Investigation of risk factors that may be unique to unilateral and bilateral patellar tendinopathy in female athletes may reveal insights into the aetiology of this condition. Objectives: To examine whether anthropometry, body composition, or muscle strength distinguished elite female basketball players with unilateral or bilateral patellar tendinopathy. Methods: Body composition, anthropometry, and muscle strength were compared in elite female basketball players with unilateral (n = 8), bilateral (n = 7), or no (n = 24) patellar tendinopathy. Body composition was analysed using a dual energy x ray absorptiometer. Anthropometric measures were assessed using standard techniques. Knee extensor strength was measured at 180°/s using an isokinetic dynamometer. z scores were calculated for the unilateral and bilateral groups (using the no tendinopathy group as controls). z scores were tested against zero. Results: The tibia length to stature ratio was approximately 1.3 (1.3) SDs above zero in both the affected and non-affected legs in the unilateral group (p<0.05). The waist to hip ratio was 0.66 (0.78) SD above zero in the unilateral group (p<0.05). In the unilateral group, leg lean to total lean ratio was 0.42 (0.55) SD above zero (p<0.07), the trunk lean to total lean ratio was 0.63 (0.68) SD below zero (p<0.05), and leg fat relative to total fat was 0.47 (0.65) SD below zero (p<0.09). In the unilateral group, the leg with pathology was 0.78 (1.03) SD weaker during eccentric contractions (p<0.07). Conclusions: Unilateral patellar tendinopathy has identifiable risk factors whereas bilateral patellar tendinopathy may not. This suggests that the aetiology of these conditions may be different. However, interpretation must respect the limitation of small subject numbers. PMID:15388543

Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial.

PubMed

Bergenfelz, Anders; Lindblom, Pia; Tibblin, Sten; Westerdahl, Johan

2002-11-01

To compare unilateral and bilateral neck exploration for primary hyperparathyroidism in a prospective randomized controlled trial. Based on the assumption that unilateral neck exploration for a solitary parathyroid adenoma should reduce operating time and morbidity, a variety of minimally invasive procedures have challenged the idea that bilateral neck exploration is the gold standard for the surgical treatment of primary hyperparathyroidism. However, to date, no open prospective randomized trial has been published comparing unilateral and bilateral neck exploration. Ninety-one patients with the preoperative diagnosis of primary hyperparathyroidism were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. The primary end-point was the use of postoperative medication for hypocalcemic symptoms. Eighty-eight patients (97%) were cured. Histology and cure rate did not differ between the two groups. Patients in the bilateral group consumed more oral calcium, had lower serum calcium values on postoperative days 1 to 4, and had a higher incidence of early severe symptomatic hypocalcemia compared with patients in the unilateral group. In addition, for patients undergoing surgery for a solitary parathyroid adenoma, unilateral exploration was associated with a shorter operative time. The cost for the two procedures did not differ. Patients undergoing a unilateral procedure had a lower incidence of biochemical and severe symptomatic hypocalcemia in the early postoperative period compared with patients undergoing bilateral exploration. Unilateral neck exploration with intraoperative parathyroid hormone assessment is a valid surgical strategy in patients with primary hyperparathyroidism with distinct advantages, especially for patients with solitary parathyroid adenoma.

Unilateral Versus Bilateral Neck Exploration for Primary Hyperparathyroidism

PubMed Central

Bergenfelz, Anders; Lindblom, Pia; Tibblin, Sten; Westerdahl, Johan

2002-01-01

Objective To compare unilateral and bilateral neck exploration for primary hyperparathyroidism in a prospective randomized controlled trial. Summary Background Data Based on the assumption that unilateral neck exploration for a solitary parathyroid adenoma should reduce operating time and morbidity, a variety of minimally invasive procedures have challenged the idea that bilateral neck exploration is the gold standard for the surgical treatment of primary hyperparathyroidism. However, to date, no open prospective randomized trial has been published comparing unilateral and bilateral neck exploration. Methods Ninety-one patients with the preoperative diagnosis of primary hyperparathyroidism were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. The primary end-point was the use of postoperative medication for hypocalcemic symptoms. Results Eighty-eight patients (97%) were cured. Histology and cure rate did not differ between the two groups. Patients in the bilateral group consumed more oral calcium, had lower serum calcium values on postoperative days 1 to 4, and had a higher incidence of early severe symptomatic hypocalcemia compared with patients in the unilateral group. In addition, for patients undergoing surgery for a solitary parathyroid adenoma, unilateral exploration was associated with a shorter operative time. The cost for the two procedures did not differ. Conclusions Patients undergoing a unilateral procedure had a lower incidence of biochemical and severe symptomatic hypocalcemia in the early postoperative period compared with patients undergoing bilateral exploration. Unilateral neck exploration with intraoperative parathyroid hormone assessment is a valid surgical strategy in patients with primary hyperparathyroidism with distinct advantages, especially for patients with solitary parathyroid adenoma. PMID:12409657

Unilateral hippocampal inactivation or lesion selectively impairs remote contextual fear memory.

PubMed

Zhou, Heng; Zhou, Qixin; Xu, Lin

2016-10-01

Contextual fear memory depends on the hippocampus, but the role of unilateral hippocampus in this type of memory remains unclear. Herein, pharmacological inactivation or excitotoxic lesions were used to study the role of unilateral hippocampus in the stages of contextual fear memory. The pharmacological experiments revealed that compared with the control groups, unilateral hippocampal blockade did not impair 1-day recent memory following learning, whereas bilateral hippocampal blockade significantly impaired this memory. The lesion experiments showed that compared with the control groups, the formed contextual fear memory was retained for 7 days and that 30-day remote memory was markedly reduced in unilateral hippocampal lesion groups. These results indicate that an intact bilateral hippocampus is required for the formation of remote memory and that unilateral hippocampus is sufficient for recent contextual fear memory.

Importance of unilateral examination in olfactometry.

PubMed

Furukawa, M; Kamide, M; Miwa, T; Umeda, R

1988-01-01

Hyposmia, the decreased sense of smell, and anosmia, the loss of sense of smell, may be unilateral or bilateral. If the olfactory acuity examined by means of bilateral test is normal, olfactory disorders are not found; unilateral examination is therefore necessary for definite evaluation of olfactory acuity. As evidence, 7 cases out of 94 patients with chronic rhinosinusitis and 6 cases out of 12 patients who received the surgery of anterior cranial fossa showed definite different olfactory threshold between nasal cavities, and there were no patients who recognized the diminished sense of smell in spite of unilateral high olfactory threshold. Additionally, we have experienced that a patient with brain tumor was diagnosed by the help of unilateral olfactory test. We thus strongly recommend the unilateral olfactometry as a method for simple and reliable test in clinical measurement of the sense of smell.

Pilot study of cognition in children with unilateral hearing loss.

PubMed

Ead, Banan; Hale, Sandra; DeAlwis, Duneesha; Lieu, Judith E C

2013-11-01

The objective of this study was to obtain preliminary data on the cognitive function of children with unilateral hearing loss in order to identify, quantify, and interpret differences in cognitive and language functions between children with unilateral hearing loss and with normal hearing. Fourteen children ages 9-14 years old (7 with severe-to-profound sensorineural unilateral hearing loss and 7 sibling controls with normal hearing) were administered five tests that assessed cognitive functions of working memory, processing speed, attention, and phonological processing. Mean composite scores for phonological processing were significantly lower for the group with unilateral hearing loss than for controls on one composite and four subtests. The unilateral hearing loss group trended toward worse performance on one additional composite and on two additional phonological processing subtests. The unilateral hearing loss group also performed worse than the control group on the complex letter span task. Analysis examining performance on the two levels of task difficulty revealed a significant main effect of task difficulty and an interaction between task difficulty and group. Cognitive function and phonological processing test results suggest two related deficits associated with unilateral hearing loss: (1) reduced accuracy and efficiency associated with phonological processing, and (2) impaired executive control function when engaged in maintaining verbal information in the face of processing incoming, irrelevant verbal information. These results provide a possible explanation for the educational difficulties experienced by children with unilateral hearing loss. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

[Characteristics of opening movement in patients with unilateral mastication].

PubMed

Jia, Ling; Wang, Yun; Wang, Mengya

2016-08-01

To analyze characteristics of mandibular movement in patients with unilateral mastication.
 Undergraduate students in oral medicine from Grade 2011 and 2012 in Wannan Medical College were enrolled for this study by cluster sampling method, which include 30 people with unilateral mastication and 30 people with bilateral mastication. The surface electromyogram (sEMG) of masseter muscle and anterovent of digastric muscle were recorded and the trajectory of mandibular incisor point was recorded simultaneously in the maximum opening and closing movement. The results were analyzed by SPSS 19.0 software.
 Average electrical peak of left anterior digastric muscle and right anterior digastric muscle in the unilateral chewing group was lower than that in the bilateral chewing group (P<0.05). The jaw tangent point trajectory was separate in the unilateral chewing group. There were significant differences at the opening type between the 2 groups. The vertical displacement and the sagittal displacement in the unilateral chewing group were significantly lower than those in the bilateral chewing group (P<0.01). There was significant positive correlation between the average peak potential of masseter muscle and displacement on the right side.
 Average electrical peak of left masseter muscle, left anterior digastric muscle, and right anterior digastric muscle decreases in the unilateral chewing group. Jaw tracking in most people deflects to the working side. Opening and closing jaw tracking is separate in 50% unilateral chewing individuals with the decreased opening degree. Unilateral chewing leads to changes in muscle performance accompanied by trajectory anomalies.

Unilateral retinitis pigmentosa sine pigmento.

PubMed Central

Pearlman, J T; Saxton, J; Hoffman, G

1976-01-01

A patient presented with unilateral findings of night blindness shown by impaired rod function and dark adaptation, constricted visual fields with good central acuity, a barely recordable electro-retinographic b-wave, and a unilaterally impaired electro-oculogram. There were none of the pigmentary changes usually associated with retinitis pigmentosa. The unaffected right eye was normal in all respects. Therefore the case is most probably one of unilateral retinitis pigmentosa sine pigmento. Images PMID:952804

Unilateral retinitis pigmentosa sine pigmento.

PubMed

Pearlman, J T; Saxton, J; Hoffman, G

1976-05-01

A patient presented with unilateral findings of night blindness shown by impaired rod function and dark adaptation, constricted visual fields with good central acuity, a barely recordable electro-retinographic b-wave, and a unilaterally impaired electro-oculogram. There were none of the pigmentary changes usually associated with retinitis pigmentosa. The unaffected right eye was normal in all respects. Therefore the case is most probably one of unilateral retinitis pigmentosa sine pigmento.

Arthroscopically assisted acromioclavicular joint reconstruction.

PubMed

Baumgarten, Keith M; Altchek, David W; Cordasco, Frank A

2006-02-01

Arthroscopically assisted acromioclavicular joint reconstruction avoids the large incisions necessary with open reconstructions. This acromioclavicular joint reconstruction technique via the subacromial space does not violate the rotator interval or require screw removal. The patient is placed in a modified beach-chair position. The arthroscope is placed into the subacromial space, and a bursectomy is performed through a lateral subacromial portal. The coracoacromial ligament is released from the acromion with an electrocautery and an arthroscopic elevator. A nonabsorbable suture is passed through the coracoacromial ligament with a suture passer, and an arthroscopic suture grasper is used to deliver both ends of the suture out through the lateral portal. The coracoid is identified and isolated using a radiofrequency ablator placed through the anterior portal while visualizing through the lateral portal. A percutaneous shuttle device is passed through the skin superomedial to the coracoid. The shuttle is visualized entering superior to the coracoid and is passed just medial to the coracoid. Once the tip of the shuttle can be visualized in the recess inferior to the coracoid, the shuttle loop is advanced. A suture grasper is used to deliver both ends of the shuttle out through the anterior portal. A semitendinosus allograft is used to reconstruct the coracoclavicular ligament. A nonabsorbable suture is passed through both ends of the allograft. Three strands of nonabsorbable suture are braided together. The tendon and the braided suture are shuttled around the coracoid. At this point, both the braided suture and the allograft tendon enter the anterior portal, wrap around the coracoid base, and exit the anterior portal. A 3-cm incision is made over the distal clavicle. A hole is drilled through the clavicle with a 5-mm drill. A loop of 22-gauge wire is passed through the hole in the clavicle, and a looped suture is shuttled through the hole. A curved clamp is used to create a tunnel from the acromioclavicular joint, under the deltoid, to the anterior portal. The ends of the braided suture and the tendon sutures are grasped by the clamp and pulled out the acromioclavicular joint incision. The limbs of the braided suture and the tendon suture that pass medial to the coracoid are shuttled through the hole in the clavicle using the looped suture that was previously passed through the clavicle. The acromioclavicular joint is reduced by pushing down on the distal clavicle with a bone tamp while simultaneously lifting the acromion upward by superiorly loading the humerus at the elbow. Once the acromioclavicular joint is reduced or slightly over-reduced, the braided suture is tied down securely. The acromioclavicular joint should remain reduced even after the manual reduction maneuver is released. The semitendinosus allograft is tensioned around the distal end of the clavicle and sutured to itself with a nonabsorbable suture. The released coracoacromial ligament is retrieved from the clavicular incision and sutured to the distal clavicle and semitendinosus allograft. The incision is closed in standard fashion, and a sling is applied.

Effects of bilateral and unilateral locus coeruleus lesions on beam-walking recovery after subsequent unilateral sensorimotor cortex suction-ablation in the rat.

PubMed

Goldstein, L B

1997-01-01

The recovery of beam-walking ability following a unilateral sensorimotor cortex lesion in the rat is hypothesized to be noradrenergically-mediated. We carried out two experiments to further test this hypothesis. In the first experiment, bilateral 6-hydroxydopamine locus coeruleus (LC) lesions or sham LC lesions were made 2 weeks prior to a right sensorimotor cortex suction-ablation lesion or sham cortex lesion. In the second experiment, unilateral left or right LC lesions or sham LC lesions were made 2 weeks prior to a right sensorimotor cortex lesion or sham cortex lesion. Beam-walking recovery was measured over the 12 days following cortex lesioning in each experiment. Bilateral, unilateral left, and unilateral right LC lesions resulted in impaired recovery. These data provide additional support for the hypothesis that beam-walking recovery after sensorimotor cortex injury is, at least in part, noradrenergically mediated.

Metastatic carcinoma of the breast: a case with the unusual presentation of unilateral periorbital edema.

PubMed

Kuo, Shu-Chen; Hsiao, Shih-Chuan; Chiou, Chien-Chun; Chen, Fen-Fen; Huang, Kuo-Chan

2008-01-01

Metastasis of mammary cancer involving the orbit is common, and it typically presents with enophthalmos and restrictions of ocular motility. We report a case of mammary cancer with the unusual presentation of unilateral periorbital edema only. The possible mechanisms of unilateral periorbital swelling are discussed. Metastasis of breast cancer involving unilateral eyelid edema was diagnosed in a 66-year-old woman. A biopsy was performed to confirm the etiology after vague neuroimaging findings. The diagnosis was based on the histopathologic features of carcinomatous cells in the excised specimen. Insidious, progressive unilateral upper and lower eyelid swelling of the right eye disappeared after one cycle of palliative chemotherapy. Neither restriction nor proptosis developed in the whole course. Possible metastasis should be considered as a possible etiology of unilateral eyelid edema, even without a palpable mass or limitation of ocular motility. A biopsy should be performed in cases of unexplained eyelid edema.

A comparison of the brainstem auditory evoked response in healthy ears of unilaterally deaf dogs and bilaterally hearing dogs.

PubMed

Plonek, M; Nicpoń, J; Kubiak, K; Wrzosek, M

2017-03-01

Auditory plasticity in response to unilateral deafness has been reported in various animal species. Subcortical changes occurring in unilaterally deaf young dogs using the brainstem auditory evoked response have not been evaluated yet. The aim of this study was to assess the brainstem auditory evoked response findings in dogs with unilateral hearing loss, and compare them with recordings obtained from healthy dogs. Brainstem auditory evoked responses (amplitudes and latencies of waves I, II, III, V, the V/I wave amplitude ratio, wave I-V, I-III and III-V interpeak intervals) were studied retrospectively in forty-six privately owned dogs, which were either unilaterally deaf or had bilateral hearing. The data obtained from the hearing ears in unilaterally deaf dogs were compared to values obtained from their healthy littermates. Statistically significant differences in the amplitude of wave III and the V/I wave amplitude ratio at 75 dB nHL were found between the group of unilaterally deaf puppies and the control group. The recordings of dogs with single-sided deafness were compared, and the results showed no statistically significant differences in the latencies and amplitudes of the waves between left- (AL) and right-sided (AR) deafness. The recordings of the brainstem auditory evoked response in canines with unilateral inborn deafness in this study varied compared to recordings from healthy dogs. Future studies looking into electrophysiological assessment of hearing in conjunction with imaging modalities to determine subcortical auditory plasticity and auditory lateralization in unilaterally deaf dogs are warranted.

The Role of Unilateral Balloon Kyphoplasty for the Treatment of Patients with OVCFS: A Systematic Review and Meta-Analysis.

PubMed

Xiang, Guang-Heng; Tong, Min-Ji; Lou, Chao; Zhu, Si-Pin; Guo, Wei Jun; Ke, Chen Rong

2018-05-01

An increasing number of studies have been conducted to apply unilateral balloon kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs). However, the efficacy and safety of unilateral kyphoplasty and whether a unilateral or a bilateral approach is superior is controversial. The purpose of this study was to evaluate the role of unilateral balloon kyphoplasty and use meta-analysis to compare the efficacy and safety of unilateral and bilateral kyphoplasty in patients with OVCFs. A systematic literature search was conducted from 1970 to April 2017 using Medline database and the Cochrane Central Register of Controlled Trials. Articles were limited to those published in English. Randomized controlled trials and nonrandomized comparative studies were also included. The following search terms were used: "osteoporotic vertebral compression fractures," or "OVCF," and "unilateral kyphoplasty," or "unipedicular approach," or "single balloon kyphoplasty," or "one balloon kyphoplasty." A comprehensive search of reference lists of retrieved articles and previous published reviews was also performed to ensure inclusion of all possible studies. All potential articles were independently reviewed by 2 investigators for inclusion into the final analysis. MINORS score was used for nonrandomized studies, and Detsky quality index was applied for prospective randomized controlled trials. Systematic review and meta-analysis was performed for the included studies. After unilateral balloon kyphoplasty the mean postoperative visual analog score (VAS) was from 1.74 to 4.77, mean postoperative kyphotic angle was from 5.9º to 11.22º, and complications involving cement leaks was from 6.8 to 21.9% or adjacent level fractures was from 0 to 5.6%). Unilateral kyphoplasty had significantly lower operative time, and less bone cement volume; however, the postoperative VAS, Oswestry Disability Index (ODI), vertebral height restoration rate, and cement leakage and adjacent vertebral fracture rate, were similar to bilateral kyphoplasty. Only 6 randomized controlled trials and 3 retrospective comparative studies were selected for analysis. Heterogeneity was detected among the studies when we pooled the outcomes. Based on the available evidence, the clinical and radiological results of unilateral balloon kyphoplasty were as good as those of bilateral balloon kyphoplasty for the treatment of OVCFs. And unilateral kyphoplasty had advantages in terms of operation time, radiation exposure, and cost. Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral compression fractures, complications of balloon kyphoplasty, meta-analysis.

Unilateral retinitis pigmentosa. A case report.

PubMed

Nazar, C; Feldman, M; González, R; Espinoza, R

2017-06-01

A 27-year-old woman with a history of nyctalopia and constriction of visual field of the right eye. The ophthalmological examination showed a visual field and electroretinogram that were compatible with unilateral retinitis pigmentosa (RP). After a one year follow-up, the unilateral condition remained. Unilateral retinitis pigmentosa is a rare condition, with a frequency between 0.2%-5% of the RP. It mainly affects women and older age groups than bilateral RP. For a definitive diagnosis, it is necessary to have a funduscopy and electroretinogram (ERG) altered unilaterally, and exclude infectious, inflammatory, and vascular causes. Copyright © 2016 Sociedad Española de Oftalmología. Publicado por Elsevier España, S.L.U. All rights reserved.

Visual outcome and impact on quality of life after surgeries differ in children operated for unilateral and bilateral cataract (Pune study 2011)

PubMed Central

Paryani, Mukesh; Khandekar, Rajiv B.; Dole, Kuldeep; Dharmadhikari, Sheetal; Rishikeshi, Nikhil

2012-01-01

Background: We compared vision and quality of life (VQL) of children aged 5-15 years and operated for unilateral and bilateral cataract between 2008 and 2010 in western India. Materials and Methods: In this cohort study, ophthalmologists assessed vision, anterior and posterior segment of eyes with cataract. Children completed a functional vision questionnaire (LVP-FVQ). Follow up at 6 months after surgery included the best corrected visual acuity (BCVA), FVQ and eye assessment. The improvement of BCVA and quality of life were compared in group of unilateral and bilateral cataract. Result: A total of 20 (70%) bilateral and 7 (39%) unilateral cataract were operated within 1 month of detection. All 48 eyes with bilateral cataract were congenital and 12 (67%) unilateral cataract were traumatic. Among bilateral group, 27 eyes [56.2% (95% confidence interval (CI) 44.4-72.2)] and in unilateral group 11 eyes [61.1% (95% CI 38.6-83.6)] had vision ≥ 20/60 at 6 months follow up. The visual gain was significantly higher in children who were operated between 1 month and 1 year of detection (adjusted Odds ratio (OR) = 15.6 P = 0.03). Positive impact on VQL in bilateral group was noted in 50%, 27%, and 13% children for subscale of distant vision, near vision, and field of vision, respectively. There was positive impact in these subscales among children with unilateral cataract. Thirty percent eyes with bilateral cataract and 22% of eyes with unilateral cataract improved their vision. Surgery within 1 month of cataract was significant predictor of improved vision (OR = 16.6 P = 0.02). Conclusion: Vision and VQL improved in children with unilateral and bilateral cataract. However, it was better 6 months following surgery in children with bilateral cataract than in children with unilateral cataract. PMID:23439722

The Clinical and Service Outcomes of Unilateral and Bilateral ECT Electrode Placements in Australian Aged Psychiatry Services.

PubMed

D'Cunha, Craig; Plakiotis, Christos; Macfarlane, Stephen; Moss, Francine; Reddy, Murali; Singh, Dhiren; Tofler, David; White, Erica; O'Connor, Daniel W

2016-03-01

The aim of the study was to determine whether depressed aged inpatients treated with brief pulse unilateral electroconvulsive therapy (ECT) differed from those treated with bilateral (bitemporal or bifrontal) ECT with respect to numbers of treatments, length of hospital admission, changes in scores on depression and cognitive scales, and serious adverse effects. An audit of routinely collected data regarding 221 acute ECT courses in 7 public aged psychiatry services in Victoria, Australia. Patients given unilateral, bifrontal, and bitemporal treatments were similar with respect to personal, clinical, and treatment characteristics. Most treatments were administered in line with local clinical guidelines and were rated as effective. Psychiatrists preferred unilateral ECT in the first instance with stimulus dosing based on patients' seizure thresholds. Approximately a quarter of unilateral courses were switched later to bitemporal placement, most probably because of insufficient progress. Bilateral treatments were associated with a larger number of treatments, less improvement in scores on mood and cognitive scales, and more refusals to continue treatment than unilateral-only ECT. Brief pulse unilateral ECT proved more effective than bitemporal and bifrontal ECT for most aged patients, especially when coupled with stimulus dosing based on seizure threshold.

Unilateral spinal anesthesia using low-flow injection through a 29-gauge Quincke needle.

PubMed

Meyer, J; Enk, D; Penner, M

1996-06-01

Restriction of sympathetic denervation during spinal anesthesia may minimize hemodynamic alterations. Theoretically, the use of nonisobaric anesthetics may allow unilateral anesthesia and thus restrict sympathetic denervation to one side of the body. The present prospective study investigates the incidence of unilateral spinal anesthesia using hyperbaric bupivacaine 0.5% (1.4 mL, 1.6 mL, 1.8 mL, or 2.0 mL) injected via a 29-gauge Quincke needle with a pump-controlled injection flow of 1 mL/min. In 96 consecutive patients undergoing unilateral surgery of the lower extremities, spinal anesthesia was performed in the lateral decubitus position, which was maintained for 20 min postinjection. Increases in foot temperature of at least 0.5 degrees C were defined as sympathetic blockade. The incidence of unilateral block was not significantly influenced by the amount of bupivacaine. For all 96 patients, the incidence of unilateral sympathetic and complete motor block was 69% and 77%, respectively. Frequency of unilateral sensory block (assessed by pinprick and temperature discrimination) was significantly lower (28%). Strict unilateral spinal anesthesia was achieved in 24 cases (25%). Twenty minutes after injection of the local anesthetic, mean arterial blood pressure decreased significantly in patients with bilateral sympathetic blockade from 87 +/- 8 to 83 +/- 8 mm Hg (P < 0.01) but not in patients with unilateral sympathetic blockade (from 87 +/- 11 to 85 +/- 10 mm Hg). In conclusion, low-flow injection (1 mL/min) of hyperbaric bupivacaine 0.5% via a 29-gauge Quincke needle prevented bilateral sympathetic blockade in more than 69% of the patients. The data further suggest that loss of temperature discrimination alone is not a reliable estimation of sympathetic block.

Effect of unilateral and bilateral use of laterally wedged insoles with arch supports on impact loading in medial knee osteoarthritis.

PubMed

Abd El Megeid Abdallah, Amira Abdallah

2016-04-01

Increased impact loading is implicated in knee osteoarthritis development and progression. This study examined the impact ground reaction force (GRF) peak, its loading rate, its relative timing to stance phase timing, and walking speed during unilateral and bilateral use of laterally wedged insoles with arch supports. Within-subject design. Thirty-three female patients with medial knee osteoarthritis were examined with (unilateral 6° and 11°, and bilateral 0°, 6°, and 11°) and without insole use. Repeated measures MANOVA revealed that the impact force increased significantly in bilateral 11° versus unilateral 6° and without-insole conditions. The loading rate decreased significantly in unilateral 11° versus bilateral 6° insoles. The relative timing increased significantly in each of bilateral 6°, bilateral 11°, and unilateral 11° versus bilateral 0° insoles and in each of bilateral 11° and unilateral 11° versus without-insole condition. There were significant positive correlations between the walking speed and each of the force and loading rate. The Chi-square test revealed insignificant association between the insole condition and the presence of impact forces. Unilateral 11° insoles are capable of reducing impact loading possibly through increasing foot pronation. Walking slowly is another possible strategy to reduce loading. Unilaterally applied 11° laterally wedged insoles are capable of reducing and delaying the initial impact ground reaction forces and reducing their loading rates during walking in patients with medial knee osteoarthritis, thus reducing osteoarthritis progression. Walking slowly could also be used as a strategy to reduce impact loading. © The International Society for Prosthetics and Orthotics 2015.

Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial.

PubMed

Westerdahl, Johan; Bergenfelz, Anders

2007-12-01

To compare long-term patient outcome in a prospective randomized controlled trial between unilateral and bilateral neck exploration for primary hyperparathyroidism (pHPT). Minimal invasive and/or focused parathyroidectomy has challenged the traditional bilateral neck exploration for pHPT. Between 1997 and 2001, we conducted the first unselected randomized controlled trial of unilateral versus bilateral neck exploration for pHPT. The results showed that unilateral exploration is a surgical strategy with distinct advantages in the early postoperative period. However, concerns have been raised that limited parathyroid exploration could increase the risk for recurrent pHPT during long-term follow-up. Ninety-one patients with the diagnosis of pHPT were randomized to unilateral or bilateral neck exploration. Preoperative scintigraphy and intraoperative parathyroid hormone measurement guided the unilateral exploration. Gross morphology and frozen section determined the extent of parathyroid tissue resection in the bilateral group. Follow-up was performed after 6 weeks, 1 year, and 5 years postoperatively. Seventy-one patients were available for 5-year follow-up. There were no differences in serum ionized calcium and parathyroid hormone, respectively, between patients in the unilateral and bilateral group. Overall 6 patients have been found to have persistent (n = 3) or recurrent (n = 3) pHPT; 4 patients in the unilateral group (3 of these 4 patients were bilaterally explored) and 2 patients in the bilateral group. Three of 6 failures were unexpectedly found to have multiple endocrine neoplasia mutations. One patient with solitary adenoma in the bilateral group still required vitamin D substitution 5 years after surgery. Unilateral neck exploration with intraoperative parathyroid hormone assessment provides the same long-term results as bilateral neck exploration, and is thus a valid strategy for the surgical treatment of pHPT.

Eight indicators of unilateral pregnancy.

PubMed

Melchionne, Kevin

2010-12-01

Unintended pregnancy often leads to undesirable outcomes for both mothers and children. However, the definition of unintended pregnancy in the sociology of family formation has been restricted to the intentions of mothers. The intentions of fathers--and, with them, the possible role of disagreement about pregnancy intention--remain outside most conceptual frameworks and research programs. This article draws together a number of indicators of unilateral pregnancy in research on contemporary family formation in the United States. Studies of pregnancy intendedness and contraceptive use consistently provide evidence suggesting a significant role for unilateral pregnancy in family formation. Working on the assumption that unilateral pregnancy presents great potential for social dislocation, this article argues for the integration of the concept of unilateral pregnancy into the theoretical framework informing research on family formation.

Platelet-rich plasma for calcific tendinitis of the shoulder: a case report.

PubMed

Seijas, Roberto; Ares, Oscar; Alvarez, Pedro; Cusco, Xavier; Garcia-Balletbo, Montserrat; Cugat, Ramon

2012-04-01

We report a 44-year-old woman with calcific tendinitis of the shoulder treated with platelet-rich plasma injection. Prior to this, she had no improvement of the symptoms after 6 weeks of ultrasound treatment, Codman exercises, and anti-inflammatory treatment. Platelet-rich plasma was injected into the subacromial area 3 times at 2-week intervals. She had progressive improvement of pain after 2 weeks, and was asymptomatic at week 6. The patient then underwent the previous protocol of rehabilitation. At the one-year follow-up, the patient was pain-free and had complete resolution of calcific tendinitis. The patient had regained full range of movement and had resumed all her activities.

The roles of amensalistic and commensalistic interactions in large ecological network stability

PubMed Central

Mougi, Akihiko

2016-01-01

Ecological communities comprise diverse species and their interactions. Notably, ecological and evolutionary studies have revealed that reciprocal interactions such as predator–prey, competition, and mutualism, are key drivers of community dynamics. However, there is an argument that many species interactions are asymmetric, where one species unilaterally affects another species (amensalism or commensalism). This raises the unanswered question of what is the role of unilateral interactions in community dynamics. Here I use a theoretical approach to demonstrate that unilateral interactions greatly enhance community stability. The results suggested that amensalism and commensalism were more stabilizing than symmetrical interactions, such as competition and mutualism, but they were less stabilizing than an asymmetric antagonistic interaction. A mix of unilateral interactions increased stability. Furthermore, in communities with all interaction types, unilateral interactions tended to increase stability. This study suggests that unilateral interactions play a major role in maintaining communities, underlining the need to further investigate their roles in ecosystem dynamics. PMID:27406267

Look over there! Unilateral gaze increases geographical memory of the 50 United States.

PubMed

Propper, Ruth E; Brunyé, Tad T; Christman, Stephen D; Januszewskia, Ashley

2012-02-01

Based on their specialized processing abilities, the left and right hemispheres of the brain may not contribute equally to recall of general world knowledge. US college students recalled the verbal names and spatial locations of the 50 US states while sustaining leftward or rightward unilateral gaze, a procedure that selectively activates the contralateral hemisphere. Compared to a no-unilateral gaze control, right gaze/left hemisphere activation resulted in better recall, demonstrating left hemisphere superiority in recall of general world knowledge and offering equivocal support for the hemispheric encoding asymmetry model of memory. Unilateral gaze- regardless of direction- improved recall of spatial, but not verbal, information. Future research could investigate the conditions under which unilateral gaze increases recall. Sustained unilateral gaze can be used as a simple, inexpensive, means for testing theories of hemispheric specialization of cognitive functions. Results support an overall deficit in US geographical knowledge in undergraduate college students. Copyright © 2011 Elsevier Inc. All rights reserved.

Comparative study of unilateral versus bilateral inferior oblique recession/anteriorization in unilateral inferior oblique overaction.

PubMed

Mostafa, Attiat M; Kassem, Rehab R

2018-05-01

To compare the effect of, and the rate of subsequent development of iatrogenic antielevation syndrome after, unilateral versus bilateral inferior oblique graded recession-anteriorization to treat unilateral inferior oblique overaction. Thirty-four patients with unilateral inferior oblique overaction were included in a randomized prospective study. Patients were equally divided into 2 groups. Group UNI underwent unilateral, group BI bilateral, inferior oblique graded recession-anteriorization. A successful outcome was defined as orthotropia, or within 2 ∆ of a residual hypertropia, in the absence of signs of antielevation syndrome, residual inferior oblique overaction, V-pattern, dissociated vertical deviation, or ocular torticollis. A successful outcome was achieved in 11 (64.7%) and 13 (76.5%) patients in groups UNI and BI, respectively (p = 0.452). Antielevation syndrome was diagnosed as the cause of surgical failure in 6 (35.3%) and 2 (11.8%) patients, in groups UNI and BI, respectively (p = 0.106). The cause of surgical failure in the other 2 patients in group BI was due to persistence of ocular torticollis and hypertropia in a patient with superior oblique palsy and a residual V-pattern and hypertropia in the other patient. The differences between unilateral and bilateral inferior oblique graded recession-anteriorization are insignificant. Unilateral surgery has a higher tendency for the subsequent development of antielevation syndrome. Bilateral surgery may still become complicated by antielevation syndrome, although at a lower rate. In addition, bilateral surgery had a higher rate of undercorrection. Further studies on a larger sample are encouraged.

Comparison of characteristics observed in tinnitus patients with unilateral vs bilateral symptoms, with both normal hearing threshold and distortion-product otoacoustic emissions.

PubMed

Zagólski, Olaf; Stręk, Paweł

2017-02-01

Tinnitus characteristics in normal-hearing patients differ between the groups with unilateral and bilateral complaints. The study was to determine the differences between tinnitus characteristics observed in patients with unilateral vs bilateral symptoms and normal hearing threshold, as well as normal results of distortion-product otoacoustic emissions (DPOAEs). The patients answered questions concerning tinnitus duration, laterality, character, accompanying symptoms, and circumstances of onset. The results of tympanometry, auditory brainstem responses, tinnitus likeness spectrum, minimum masking level (MML), and uncomfortable loudness level were evaluated. Records of 380 tinnitus sufferers were examined. Patients with abnormal audiograms and/or DPOAEs were excluded. The remaining 66 participants were divided into groups with unilateral and bilateral tinnitus. Unilateral tinnitus in normal-hearing patients was diagnosed twice more frequently than bilateral. Tinnitus pitch was higher in the group with bilateral tinnitus (p < .001). MML was lower in unilateral tinnitus (p < .05). Mean age of patients was higher in the unilateral tinnitus group (p < .05). Mean tinnitus duration was longer (p < .05) and hypersensitivity to sound was more frequent (p < .05) in the bilateral tinnitus group. Repeated exposure to excessive noise was the most frequent cause in the bilateral tinnitus group.

A Comparison of Right Unilateral and Sequential Bilateral Repetitive Transcranial Magnetic Stimulation for Major Depression: A Naturalistic Clinical Australian Study.

PubMed

Galletly, Cherrie A; Carnell, Benjamin L; Clarke, Patrick; Gill, Shane

2017-03-01

A great deal of research has established the efficacy of repetitive transcranial magnetic stimulation (rTMS) in the treatment of depression. However, questions remain about the optimal method to deliver treatment. One area requiring consideration is the difference in efficacy between bilateral and unilateral treatment protocols. This study aimed to compare the effectiveness of sequential bilateral rTMS and right unilateral rTMS. A total of 135 patients participated in the study, receiving either bilateral rTMS (N = 57) or right unilateral rTMS (N = 78). Treatment response was assessed using the Hamilton depression rating scale. Sequential bilateral rTMS had a higher response rate than right unilateral (43.9% vs 30.8%), but this difference was not statistically significant. This was also the case for remission rates (33.3% vs 21.8%, respectively). Controlling for pretreatment severity of depression, the results did not indicate a significant difference between the protocols with regard to posttreatment Hamilton depression rating scale scores. The current study found no statistically significant differences in response and remission rates between sequential bilateral rTMS and right unilateral rTMS. Given the shorter treatment time and the greater safety and tolerability of right unilateral rTMS, this may be a better choice than bilateral treatment in clinical settings.

Acute antidepressant effects of right unilateral ultra-brief ECT: a double-blind randomised controlled trial.

PubMed

Mayur, Prashanth; Byth, Karen; Harris, Anthony

2013-07-01

Shortening the pulse width to 0.3 ms holds neurophysiological and clinical promise of making ECT safer by limiting cognitive side effects. However, the antidepressant effects of right ultra-brief unilateral ECT are under contention. In an acute ECT course, antidepressant equivalence of ultra-brief right unilateral ECT to the high-dose brief pulse right unilateral ECT was investigated. Severely depressed patients were randomised to 1 ms-brief pulse (n=18) or 0.3 ms ultra-brief pulse (n=17) right unilateral ECT, both at high-dose (6 times threshold stimulus dose) given thrice weekly. Depression severity was measured using the Montgomery Asberg Depression Rating Scale at baseline, after 8 treatments and after the acute course of ECT. Depression severity declined equally in both groups: F (1.27,41.97)=0.31, p=0.63. Median time in days to remission (95%CI) was in brief pulse ECT: 26 (18.6-33.4) and ultra-brief pulse ECT:28 (17.9-38.0). The small sample study in the study increases the likelihood of type 2 error. In severe depression, high-dose ultra-brief right unilateral ECT appears to show matching acute antidepressant response to an equally high-dose brief pulse right unilateral ECT. Copyright © 2012 Elsevier B.V. All rights reserved.

Unilateral vs bilateral hip bone mineral density measurement for the diagnosis of osteoporosis.

PubMed

Ikegami, Shota; Kamimura, Mikio; Uchiyama, Shigeharu; Mukaiyama, Keijiro; Kato, Hiroyuki

2014-01-01

It has not been established whether unilateral or bilateral hip dual-energy X-ray absorptiometry (DXA) is preferable for the diagnosis of osteoporosis. We investigated the discordance in DXA measurements in bilateral hips to determine whether unilateral DXA is valid for osteoporosis diagnosis. The subjects were 2964 Japanese patients without a previous diagnosis of primary osteoporosis. We measured bilateral femoral bone mineral density (BMD) and calculated indices, related to the unilateral results, for predicting contralateral hip osteoporosis. A likelihood ratio (LR) of a negative test (LR [-]) of less than 0.2 was considered to exclude the diagnosis. In the normal spinal BMD group, the sensitivity of unilateral DXA for women was 27-73% and LR (-) was 0.28-0.73; the sensitivity for men was 0-50% and LR (-) was 0.51-1.00; the diagnosis of contralateral osteoporosis was not excluded. Sensitivity increased and LR (-) increased with worsening spinal BMD status; however, LR (-) did not meet the cutoff for exclusion. We could exclude unilateral hip osteoporosis, in women only, by performing contralateral femoral DXA; this necessitated lowering the T-score cutoff from -2.5 to -2.0. Unilateral femoral DXA is not useful for excluding the diagnosis of contralateral hip osteoporosis. Copyright © 2014 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

Unilateral versus bilateral thyroarytenoid Botulinum toxin injections in adductor spasmodic dysphonia: a prospective study

PubMed Central

Upile, Tahwinder; Elmiyeh, Behrad; Jerjes, Waseem; Prasad, Vyas; Kafas, Panagiotis; Abiola, Jesuloba; Youl, Bryan; Epstein, Ruth; Hopper, Colin; Sudhoff, Holger; Rubin, John

2009-01-01

Objectives In this preliminary prospective study, we compared unilateral and bilateral thyroarytenoid muscle injections of Botulinum toxin (Dysport) in 31 patients with adductor spasmodic dysphonia, who had undergone more than 5 consecutive Dysport injections (either unilateral or bilateral) and had completed 5 concomitant self-rated efficacy and complication scores questionnaires related to the previous injections. We also developed a Neurophysiological Scoring (NPS) system which has utility in the treatment administration. Method and materials Data were gathered prospectively on voice improvement (self-rated 6 point scale), length of response and duration of complications (breathiness, cough, dysphagia and total voice loss). Injections were performed under electromyography (EMG) guidance. NPS scale was used to describe the EMG response. Dose and unilateral/bilateral injections were determined by clinical judgment based on previous response. Time intervals between injections were patient driven. Results Low dose unilateral Dysport injection was associated with no significant difference in the patient's outcome in terms of duration of action, voice score (VS) and complication rate when compared to bilateral injections. Unilateral injections were not associated with any post treatment total voice loss unlike the bilateral injections. Conclusion Unilateral low dose Dysport injections are recommended in the treatment of adductor spasmodic dysphonia. PMID:19852852

Speech perception in noise in unilateral hearing loss.

PubMed

Mondelli, Maria Fernanda Capoani Garcia; Dos Santos, Marina de Marchi; José, Maria Renata

2016-01-01

Unilateral hearing loss is characterized by a decrease of hearing in one ear only. In the presence of ambient noise, individuals with unilateral hearing loss are faced with greater difficulties understanding speech than normal listeners. To evaluate the speech perception of individuals with unilateral hearing loss in speech perception with and without competitive noise, before and after the hearing aid fitting process. The study included 30 adults of both genders diagnosed with moderate or severe sensorineural unilateral hearing loss using the Hearing In Noise Test - Hearing In Noise Test-Brazil, in the following scenarios: silence, frontal noise, noise to the right, and noise to the left, before and after the hearing aid fitting process. The study participants had a mean age of 41.9 years and most of them presented right unilateral hearing loss. In all cases evaluated with Hearing In Noise Test, a better performance in speech perception was observed with the use of hearing aids. Using the Hearing In Noise Test-Brazil test evaluation, individuals with unilateral hearing loss demonstrated better performance in speech perception when using hearing aids, both in silence and in situations with a competing noise, with use of hearing aids. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Unilateral retinitis pigmentosa and cone-rod dystrophy

PubMed Central

Farrell, Donald F

2009-01-01

Purpose: The purpose of this paper is to report 14 new cases of unilateral retinitis pigmentosa and three new cases of cone-rod dystrophy and to compare the similarities and dissimilarities to those found in the bilateral forms of these disorders. Methods: A total of 272 cases of retinitis pigmentosa and 167 cases of cone-rod dystrophy were studied by corneal full field electroretinograms and electrooculograms. The student t-test was used to compare categories. Results: The percentage of familial and nonfamilial cases was the same for the bilateral and unilateral forms of the disease. In our series, unilateral retinitis pigmentosa makes up approximately 5% of the total population of retinitis pigmentosa, while unilateral cone-rod dystrophy makes up only about 2% of the total. In the familial forms of unilateral retinitis pigmentosa the most common inheritance pattern was autosomal dominant and all affected relatives had bilateral disease. Conclusion: Unilateral retinitis pigmentosa and cone-rod dystrophy appear to be directly related to the more common bilateral forms of these disorders. The genetic mechanisms which account for asymmetric disorders are not currently understood. It may be a different unidentified mutation at a single loci or it is possible that nonlinked mutations in multiple loci account for this unusual disorder. PMID:19668577

Increasing knowledge of best practices for occupational therapists treating post-stroke unilateral spatial neglect: results of a knowledge-translation intervention study.

PubMed

Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

2012-02-01

The aim of this study was to investigate: (i) the feasibility of delivering a multi-modal knowledge translation intervention specific to the management of acute post-stroke unilateral spatial neglect; and (ii) the impact of the knowledge translation intervention on occupational therapists' knowledge of evidence-based unilateral spatial neglect problem identification, assessment and treatment, and self-efficacy related to evidence-based practice implementation. A 3-period (pre-post) repeated measures design. Acute care occupational therapists treating patients with post-stroke unilateral spatial neglect were recruited from two major Canadian cities. Participants completed two pre-intervention assessments, took part in a day-long interactive multi-modal knowledge translation intervention and a subsequent 8-week follow-up, and completed a post-intervention assessment. Knowledge of evidence-based problem identification, assessment and treatment of unilateral spatial neglect, and self-efficacy to perform evidence-based practice activities were measured using standard scales. The intervention was tested on 20 occupational therapists. Results indicate a significant improvement in knowledge of best practice unilateral spatial neglect management (p < 0.000) and evidence-based practice self-efficacy in carrying out evidence-based practice activities (p < 0.045) post-intervention. Use of a multi-modal knowledge translation intervention is feasible and can significantly improve occupational therapists' knowledge of unilateral spatial neglect best practices and self-efficacy. The findings should help advance best practices specific to the management of post-stroke unilateral spatial neglect as well as informing knowledge translation studies in other areas of practice.

RS3PE presenting in a unilateral pattern: case report and review of the literature.

PubMed

Keenan, Robert T; Hamalian, Gareen M; Pillinger, Michael H

2009-06-01

To review the clinical features and pathophysiologic implications of remitting seronegative symmetrical synovitis with pitting edema (RS(3)PE) presenting in a unilateral manner. We identified and characterized an index case of RS(3)PE presenting in a unilateral pattern. We subsequently performed a systematic literature search to identify other reports of patients with unilateral RS(3)PE. The index case was a 76-year-old male with a prior history of right hemiparesis owing to a cerebrovascular accident 25 years prior, who developed a classic picture of RS(3)PE involving hand (metacarpophalageal and wrist joint) arthritis and dorsal pitting edema, accompanied by an elevated erythrocyte sedimentation rate, but only in the nonhemiparetic hand. The condition responded rapidly to low-dose prednisone. Our literature search identified 5 other cases of unilateral RS(3)PE, including 2 presented only in the Italian or German literature. Of the 5 cases, 2 were in patients with preexisting neurologic disease, in which the neurologically affected side was spared. One additional case initially presented as unilateral disease but rapidly progressed to bilaterality. Two cases presented in a fully unilateral manner despite no reported neurologic abnormalities on the unaffected sides. While RS(3)PE is almost always a symmetric disease of the upper extremities, it may rarely present in a unilateral fashion. The apparent ability of neuropathic changes to protect against the expression of RS(3)PE in an extremity suggests a role for neural and possibly other local factors in the genesis/modulation of the onset or maintenance of RS(3)PE.

Is the side with the best masticatory performance selected for chewing?

PubMed

Rovira-Lastra, Bernat; Flores-Orozco, Elan Ignacio; Salsench, Juan; Peraire, Maria; Martinez-Gomis, Jordi

2014-12-01

This study assessed the degree of relationship between masticatory laterality and lateral asymmetry of masticatory performance using silicon pieces enclosed in a latex bag. Forty-two young adults with natural dentition participated in this cross-sectional, observational study. They performed four different masticatory assays, each consisting of five trials of chewing three pieces of silicon for 20 cycles. In one assay, they were asked to masticate unbagged silicon free-style, whilst in the three other assays they were asked to masticate bagged silicon free-style, unilaterally on the right-hand side and unilaterally on the left-hand side. The preferred chewing side was determined by calculating the asymmetry index for both the free-style assays. Masticatory performance was determined by sieving the silicon particles and the cycle duration was also recorded. Data were analysed using independent samples or paired t-test and linear regression. Masticatory function using the bagged silicon was similar to that using the unbagged silicon. A significant and positive relationship was observed between the preferred chewing side expressed as the asymmetry index and the side with better masticatory performance. Alternate unilateral chewers demonstrated better masticatory performance than unilateral chewers. However, when free-style and unilateral chewing were compared for each subject, unilateral chewing was found to be as efficient as - or even more efficient than - free-style chewing. There is a positive association between the preferred chewing side and the more efficient side. Alternate unilateral mastication per se does not promote better masticatory performance than consistently unilateral mastication. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Use of Physiotherapy among Patients with Subacromial Impingement Syndrome: Impact of Sex, Socio-Demographic and Clinical Factors

PubMed Central

Christiansen, David Høyrup; Frost, Poul; Frich, Lars Henrik; Falla, Deborah; Svendsen, Susanne Wulff

2016-01-01

Background Physiotherapy with exercises is generally recommended in the treatment of patients with subacromial impingement syndrome (SIS). Objective We aimed to investigate the use of physiotherapy in patients with SIS in Danish hospital settings as part of initial non-surgical treatment and after SIS-related surgery and to evaluate to which extent sex, socio-demographic and clinical factors predict the use of physiotherapy. Methods Using national health registers, we identified 57,311 patients who had a first hospital contact with a diagnosis of ICD-10, groups M75.1–75.9, 1 July 2007 to 30 June 2011. Records of physiotherapy were extracted within 52 weeks after first contact (or until surgery), and for surgically treated patients within 26 weeks after surgery. Predictors of the use of physiotherapy after first contact and after surgery were analysed as time-to-event. Results Within 52 weeks after first contact, 43% of the patients had physiotherapy and 30% underwent surgery. Within 26 weeks after surgery, 80% had a record of physiotherapy. After first contact and after surgery, exercise was part of physiotherapy in 65% and 84% of the patients, respectively. A public hospital contact, physiotherapy before hospital contact, administrative region, female sex, a diagnosis of other or unspecified disorders (M75.8-M75.9), and surgical procedure predicted higher use of physiotherapy. Low education level predicted slightly lower use of physiotherapy after first contact, but not after surgery. Conclusion In patients with SIS in Danish hospital settings, physiotherapy was more often used after surgery than as part of initial non-surgical treatment. The use of physiotherapy was less common among men than women, whereas unequal use of physiotherapy in relation to education level was not noticeable. The use of physiotherapy with exercises in initial non-surgical treatment was relatively limited. PMID:26954692

Surgery for subacromial impingement syndrome in relation to occupational exposures, lifestyle factors and diabetes mellitus: a nationwide nested case-control study.

PubMed

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2017-10-01

To estimate the risk of surgery for subacromial impingement syndrome (SIS) in relation to occupational exposures, lifestyle factors and diabetes mellitus. We conducted a case-control study nested in a register-based cohort study of the Danish working population. For each of 3000 first-time cases of surgery for SIS, two age-matched and sex-matched controls were drawn. Cases and controls received a questionnaire on job history and other factors. Job histories were combined with a psychosocial job exposure matrix (JEM) and the updated Shoulder JEM, which provided exposure intensities on measurement scales. Ten-year cumulative exposures to upper arm elevation >90°, repetitive shoulder movements, forceful shoulder exertions and hand-arm vibrations (HAVs) were estimated. We used conditional logistic regression. There were 5396 persons (60%) who answered the questionnaire. For occupational mechanical exposures, the adjusted OR (OR adj ) ranged from 1.9 (95% CI 1.5 to 2.5 for HAVs) to 2.5 (95% CI 1.9 to 3.5 for force) among men and 1.7 (95% CI 1.2 to 2.5 for HAVs) to 2.0 (95% CI 1.3 to 2.9 for force) among women. No statistically significant associations were found for occupational psychosocial factors. Body mass index (BMI) and pack-years of smoking showed OR adj up to 2.0. Diabetes mellitus showed OR adj of 1.5 (95% CI 1.1 to 2.2) for men and 2.2 (95% CI 1.4 to 3.4) for women. Our findings add to the evidence of an increased risk of surgery for SIS in relation to occupational cumulative mechanical exposures, even when an increased risk in relation to BMI, smoking and diabetes mellitus is taken into account. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population.

PubMed

Jensen, Andrew R; Cha, Peter S; Devana, Sai K; Ishmael, Chad; Di Pauli von Treuheim, Theo; D'Oro, Anthony; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

2017-10-01

Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Cohort study; Level of evidence, 3. All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01). In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs.

Evaluation of the Trends, Concomitant Procedures, and Complications With Open and Arthroscopic Rotator Cuff Repairs in the Medicare Population

PubMed Central

Jensen, Andrew R.; Cha, Peter S.; Devana, Sai K.; Ishmael, Chad; Di Pauli von Treuheim, Theo; D’Oro, Anthony; Wang, Jeffrey C.; McAllister, David R.; Petrigliano, Frank A.

2017-01-01

Background: Medicare insures the largest population of patients at risk for rotator cuff tears in the United States. Purpose: To evaluate the trends in incidence, concomitant procedures, and complications with open and arthroscopic rotator cuff repairs in Medicare patients. Study Design: Cohort study; Level of evidence, 3. Methods: All Medicare patients who had undergone open or arthroscopic rotator cuff repair from 2005 through 2011 were identified with a claims database. Annual incidence, concomitant procedures, and postoperative complications were compared between these 2 groups. Results: In total, 372,109 rotator cuff repairs were analyzed. The incidence of open repairs decreased (from 6.0 to 4.3 per 10,000 patients, P < .001) while the incidence of arthroscopic repairs increased (from 4.5 to 7.8 per 10,000 patients, P < .001) during the study period. Patients in the arthroscopic group were more likely to have undergone concomitant subacromial decompression than those in the open group (87% vs 35%, P < .001), and the annual incidence of concomitant biceps tenodesis increased for both groups (from 3.8% to 11% for open and 2.2% to 16% for arthroscopic, P < .001). While postoperative complications were infrequent, patients in the open group were more likely to be diagnosed with infection within 6 months (0.86% vs 0.37%, P < .001) but no more likely to undergo operative debridement (0.43% vs 0.26%, P = .08). Additionally, patients in the open group were more likely to undergo intervention for shoulder stiffness within 1 year (1.4% vs 1.1%, P = .01). Conclusion: In the Medicare population, arthroscopic rotator cuff repairs have increased in incidence and now represent the majority of rotator cuff repair surgery. Among concomitant procedures, subacromial decompression was most commonly performed despite evidence suggesting a lack of efficacy. Infections and stiffness were rare complications that were slightly but significantly more frequent in open rotator cuff repairs. PMID:29051905

Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

PubMed

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2014-11-01

The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. 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.

Surgery for subacromial impingement syndrome in relation to intensities of occupational mechanical exposures across 10-year exposure time windows.

PubMed

Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

2018-03-01

We aimed to identify intensities of occupational mechanical exposures (force, arm elevation and repetition) that do not entail an increased risk of surgery for subacromial impingement syndrome (SIS) even after prolonged durations of exposure. Additionally, we wanted to evaluate if exposure to hand-arm vibration (HAV) is an independent risk factor. We used data from a register-based cohort study of the entire Danish working population (n=2 374 403). During follow-up (2003-2008), 14 118 first-time events of surgery for SIS occurred. For each person, we linked register-based occupational codes (1993-2007) to a general population job exposure matrix to obtain year-by-year exposure intensities on measurement scales for force, upper arm elevation >90° and repetition and expert rated intensities of exposure to HAV. For 10-year exposure time windows, we calculated the duration of exposure at specific intensities above minimal (low, medium and high). We used a logistic regression technique equivalent to discrete survival analysis adjusting for cumulative effects of other mechanical exposures. We found indications of safe exposure intensities for repetition (median angular velocity <45°/s), while force exertion ≥10% of maximal voluntary electrical activity and upper arm elevation >90° >2 min/day implied an increased risk reaching ORs of 1.7 and 1.5 after 10 years at low intensities. No associations were found for HAV. We found indications of safe exposure intensities for repetition. Any intensities of force and upper arm elevation >90° above minimal implied an increased risk across 10-year exposure time windows. No independent associations were found for HAV. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The Effects of Rigid Scapular Taping on the Subacromial Space in Athletes With and Without Rotator Cuff Tendinopathy: A Randomized-Controlled Study.

PubMed

Leong, Hio Teng; Fu, Siu Ngor

2018-02-21

Reduction of the subacromial space (SAS) during arm elevation may contribute to rotator cuff tendinopathy. The effects of scapular taping on the SAS in athletes with and without RC tendinopathy is unknown. To investigate the immediate effects of scapular taping on the SAS in athletes with and without RC tendinopathy. Randomized-controlled with repeated measures. University laboratory. Forty-three male volleyball players (17 asymptomatic and 26 with RC tendinopathy, mean age = 22.9±3.5 years) participated in the study. Three scapular taping protocols - no taping (control), taping with tension (therapeutic taping) and taping without tension (sham taping). Ultrasound measurements of the SAS with the arm at 0° and 60° of shoulder abduction, and the change in the SAS between 0° and 60° of shoulder abduction (SAS 0°-60° ) were calculated. Athletes with RC tendinopathy demonstrated larger SAS with therapeutic taping at 60° of shoulder abduction (6.9±1.9 mm vs. 5.8±1.7 mm, mean difference = 1.1 mm, 95% CI = -1.80 - -0.39, p=0.002) when compared to the no taping condition. The tendinopathy group also showed less reduction in the SAS with therapeutic taping during SAS 0°-60° (2.0±1.4 mm vs. 2.8±1.4 mm, p=0.023) when compared to the no taping condition. When tape was applied to the scapula in asymptomatic athletes, our results showed a relatively small increase in the SAS with therapeutic taping during arm resting at 0° of abduction when compared to the no taping condition (8.7±0.9 mm vs. 8.3±0.8 mm, mean difference = 0.4 mm, 95% CI = -0.71 - -0.11, p=0.008). Athletes with RC tendinopathy demonstrated less reduction of the SAS with rigid scapular taping during early arm abduction. Such observation was not evidenced in asymptomatic athletes.

Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review.

PubMed

McCreesh, Karen M; Crotty, James M; Lewis, Jeremy S

2015-03-01

Narrowing of the subacromial space has been noted as a common feature of rotator cuff (RC) tendinopathy. It has been implicated in the development of symptoms and forms the basis for some surgical and rehabilitation approaches. Various radiological methods have been used to measure the subacromial space, which is represented by a two-dimensional measurement of acromiohumeral distance (AHD). A reliable method of measurement could be used to assess the impact of rehabilitation or surgical interventions for RC tendinopathy; however, there are no published reviews assessing the reliability of AHD measurement. The aim of this review was to systematically assess the evidence for the intrarater and inter-rater reliability of radiological methods of measuring AHD, in order to identify the most reliable method for use in RC tendinopathy. An electronic literature search was carried out and studies describing the reliability of any radiological method of measuring AHD in either healthy or RC tendinopathy groups were included. Eighteen studies met the inclusion criteria and were appraised by two reviewers using the Quality Appraisal for reliability Studies checklist. Eight studies were deemed to be of high methodological quality. Study weaknesses included lack of tester blinding, inadequate description of tester experience, lack of inclusion of symptomatic populations, poor reporting of statistical methods and unclear diagnosis. There was strong evidence for the reliability of ultrasound for measuring AHD, with moderate evidence for MRI and CT measures and conflicting evidence for radiographic methods. Overall, there was lack of research in RC tendinopathy populations, with only six studies including participants with shoulder pain. The results support the reliability of ultrasound and CT or MRI for the measurement of AHD; however, more studies in symptomatic populations are required. The reliability of AHD measurement using radiographs has not been supported by the studies reviewed. 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.

A CRPS-IgG-transfer-trauma model reproducing inflammatory and positive sensory signs associated with complex regional pain syndrome.

PubMed

Tékus, Valéria; Hajna, Zsófia; Borbély, Éva; Markovics, Adrienn; Bagoly, Teréz; Szolcsányi, János; Thompson, Victoria; Kemény, Ágnes; Helyes, Zsuzsanna; Goebel, Andreas

2014-02-01

The aetiology of complex regional pain syndrome (CRPS), a highly painful, usually post-traumatic condition affecting the limbs, is unknown, but recent results have suggested an autoimmune contribution. To confirm a role for pathogenic autoantibodies, we established a passive-transfer trauma model. Prior to undergoing incision of hind limb plantar skin and muscle, mice were injected either with serum IgG obtained from chronic CRPS patients or matched healthy volunteers, or with saline. Unilateral hind limb plantar skin and muscle incision was performed to induce typical, mild tissue injury. Mechanical hyperalgesia, paw swelling, heat and cold sensitivity, weight-bearing ability, locomotor activity, motor coordination, paw temperature, and body weight were investigated for 8days. After sacrifice, proinflammatory sensory neuropeptides and cytokines were measured in paw tissues. CRPS patient IgG treatment significantly increased hind limb mechanical hyperalgesia and oedema in the incised paw compared with IgG from healthy subjects or saline. Plantar incision induced a remarkable elevation of substance P immunoreactivity on day 8, which was significantly increased by CRPS-IgG. In this IgG-transfer-trauma model for CRPS, serum IgG from chronic CRPS patients induced clinical and laboratory features resembling the human disease. These results support the hypothesis that autoantibodies may contribute to the pathophysiology of CRPS, and that autoantibody-removing therapies may be effective treatments for long-standing CRPS. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Bilateral DCIS following gynecomastia surgery. Role of nipple sparing mastectomy. A case report and review of literature☆

PubMed Central

Noor, L.; McGovern, P.; Bhaskar, P.; Lowe, J.W.

2011-01-01

Bilateral ductal carcinoma in situ of breast is a very rare disease in men. Ductal carcinoma in situ (DCIS) is an abnormal proliferation that involves the ductal epithelium and it has the potential of evolving into an invasive tumour. Gynaecomastia (female like breast in men) is a benign condition though it is associated with a reported 3% incidence of unilateral invasive breast cancer.2 Synchronous bilateral breast cancer in association with gynaecomastia is exceptionally rare. The recommended treatment for DCIS in male is mastectomy. So far only 2 cases of bilateral DCIS in male patients has been reported in the literature treated with skin and nipple sparing mastectomies. We report another case of synchronous bilateral DCIS in a male treated with skin and nipple sparing mastectomies. A 44 year-old man with history of long-standing gynecomastia. He had no identifiable risk factor for the development of cancer. His pre operative assessment of breast including mammograms was normal. He underwent bilateral subcutaneous mastectomies, with subsequent incidental diagnosis of synchronous bilateral ductal carcinoma in situ. The case was discussed in multidisciplinary team meeting and the need for further surgery was felt including excision of nipple areola complex. However considering patient wishes, cosmetic outcome and recent literature it was decided to preserve nipple areola complex (NAC) with regular follow up evaluation. Our patient at completion of 18 months of treatment is doing well with no signs of local recurrence. PMID:22096697

Reproducibility of Tactile Assessments for Children with Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Auld, Megan Louise; Ware, Robert S.; Boyd, Roslyn Nancy; Moseley, G. Lorimer; Johnston, Leanne Marie

2012-01-01

A systematic review identified tactile assessments used in children with cerebral palsy (CP), but their reproducibility is unknown. Sixteen children with unilateral CP and 31 typically developing children (TDC) were assessed 2-4 weeks apart. Test-retest percent agreements within one point for children with unilateral CP (and TDC) were…

Hemodynamic stability ensured by a low dose, low volume, unilateral hypobaric spinal block: modification of a technique.

PubMed

Elzinga, L; Marcus, M; Peek, D; Borg, P; Jansen, J; Koster, J; Enk, D

2009-01-01

We report the case of an 89-year-old female with a history of arterial hypertension, intermittent rapid atrial fibrillation and severe aortic valve stenosis, suffering from femoral neck fracture. Hyperbaric unilateral spinal anesthesia is a known technique to obtain stable hemodynamics combined with the possibility of continuous neurologic evaluation and preservation of cognitive functions. Because a hyperbaric unilateral technique can be very painful in case of traumatic hip fracture, a low dose, low volume, unilateral hypobaric spinal block may be an adequate alternative. In the present case report, a unilateral hypobaric spinal anesthesia was performed using 5 mg of bupivacaine in a 1.5 mL volume and a slow and steady, "air-buffered", directed injection technique, to allow an urgent hip arthroplasty. During surgery the patient was kept in the lateral recumbent position. Hemodynamics remained stable throughout the entire procedure without any need for vasoconstrictors. The impact of aortic valve stenosis combined with atrial fibrillation on anesthetic management and our considerations to opt for a unilateral hypobaric spinal anesthesia are discussed.

Analysis of laterality and percentage of tumor involvement in 1386 prostatectomized specimens for selection of unilateral focal cryotherapy.

PubMed

Mouraviev, Vladimir; Mayes, Janice M; Madden, John F; Sun, Leon; Polascik, Thomas J

2007-04-01

In total, 1386 paraffin embedded radical prostatectomy specimens from patients with clinically localized prostate cancer (PCa) excised between 2002-06 were analyzed. Pathologic assessment paid particular attention to laterality and percentage of tumor involvement (PTI) along with pathologic Gleason Score (pGS). Completely unilateral cancers were identified in 254 (18.3%) patients, and in 39% cases of them the signs of clinically significant PCa were revealed. The majority of unilateral tumors (72%) were low volume with a PTI of < or =5. This study suggests that only a select group of men diagnosed with PCa have completely unilateral cancers that would be amenable to focal ablation therapy targeting 1 lobe. Further study is needed to develop predictive models for those patients likely to have small, unilateral cancers that may be amenable to focal therapy.

Cone-Beam Computed Tomography Analysis of the Nasopharyngeal Airway in Nonsyndromic Cleft Lip and Palate Subjects.

PubMed

Al-Fahdawi, Mahmood Abd; Farid, Mary Medhat; El-Fotouh, Mona Abou; El-Kassaby, Marwa Abdelwahab

2017-03-01

  To assess the nasopharyngeal airway volume, cross-sectional area, and depth in previously repaired nonsyndromic unilateral cleft lip and palate versus bilateral cleft lip and palate patients compared with noncleft controls using cone-beam computed tomography with the ultimate goal of finding whether cleft lip and palate patients are more liable to nasopharyngeal airway obstruction.   A retrospective analysis comparing bilateral cleft lip and palate, unilateral cleft lip and palate, and control subjects. Significance at P ≤ .05.   Cleft Care Center and the outpatient clinic that are both affiliated with our faculty.   Cone-beam computed tomography data were selected of 58 individuals aged 9 to 12 years: 14 with bilateral cleft lip and palate and 20 with unilateral cleft lip and palate as well as 24 age- and gender-matched noncleft controls.   Volume, depth, and cross-sectional area of nasopharyngeal airway were measured.   Patients with bilateral cleft lip and palate showed significantly larger nasopharyngeal airway volume than controls and patients with unilateral cleft lip and palate (P < .001). Patients with bilateral cleft lip and palate showed significantly larger cross-sectional area than those with unilateral cleft lip and palate (P < .001) and insignificant cross-sectional area compared with controls (P > .05). Patients with bilateral cleft lip and palate showed significantly larger depth than controls and those with unilateral cleft lip and palate (P < .001). Patients with unilateral cleft lip and palate showed insignificant nasopharyngeal airway volume, cross-sectional area, and depth compared with controls (P > .05).   Unilateral and bilateral cleft lip and palate patients did not show significantly less volume, cross-sectional area, or depth of nasopharyngeal airway than controls. From the results of this study we conclude that unilateral and bilateral cleft lip and palate patients at the studied age and stage of repaired clefts are not more prone to nasopharyngeal airway obstruction than controls.

Effects of unilateral and bilateral plyometric training on power and jumping ability in women.

PubMed

Makaruk, Hubert; Winchester, Jason B; Sadowski, Jerzy; Czaplicki, Adam; Sacewicz, Tomasz

2011-12-01

Makaruk, H, Winchester, JB, Sadowski, J, Czaplicki, A, and Sacewicz, T. Effects of unilateral and bilateral plyometric training on power and jumping ability in women. J Strength Cond Res 25(12): 3311-3318, 2011-The purpose of this study was to examine the effects of unilateral and bilateral plyometric exercise on peak power and jumping performance during different stages of a 12-week training and detraining in women. Forty-nine untrained but physically active female college students were randomly assigned to 1 of 3 groups: unilateral plyometric group (n = 16), bilateral plyometric group (BLE; n = 18), and a control group (n = 15). Peak power and jumping ability were assessed by means of the alternate leg tests (10-second Wingate test and 5 alternate leg bounds), bilateral leg test (countermovement jump [CMJ]) and unilateral leg test (unilateral CMJ). Performance indicators were measured pretraining, midtraining, posttraining, and detraining. Differences between dependent variables were assessed with a 3 × 4 (group × time) repeated analysis of variance with Tukey's post hoc test applied where appropriate. Effect size was calculated to determine the magnitude of significant differences between the researched parameters. Only the unilateral plyometric training produced significant (p < 0.05) improvement in all tests from pretraining to midtraining, but there was no significant (p < 0.05) increase in performance indicators from midtraining to posttraining. The BLE group significantly (p < 0.05) improved in all tests from pretraining to posttraining and did not significantly (p > 0.05) decrease power and jumping ability in all tests during detraining. These results suggest that unilateral plyometric exercises produce power and jumping performance during a shorter period when compared to bilateral plyometric exercises but achieved performance gains last longer after bilateral plyometric training. Practitioners should consider the inclusion of both unilateral and bilateral modes of plyometric exercise to elicit rapid improvements and guard against detraining.

Bitemporal Versus High-Dose Unilateral Twice-Weekly Electroconvulsive Therapy for Depression (EFFECT-Dep): A Pragmatic, Randomized, Non-Inferiority Trial.

PubMed

Semkovska, Maria; Landau, Sabine; Dunne, Ross; Kolshus, Erik; Kavanagh, Adam; Jelovac, Ana; Noone, Martha; Carton, Mary; Lambe, Sinead; McHugh, Caroline; McLoughlin, Declan M

2016-04-01

ECT is the most effective treatment for severe depression. Previous efficacy studies, using thrice-weekly brief-pulse ECT, reported that high-dose (6× seizure threshold) right unilateral ECT is similar to bitemporal ECT but may have fewer cognitive side effects. The authors aimed to assess the effectiveness and cognitive side effects of twice-weekly moderate-dose (1.5× seizure threshold) bitemporal ECT with high-dose unilateral ECT in real-world practice. This was a pragmatic, patient- and rater-blinded, noninferiority trial of patients with major depression (N=138; 63% female; age=56.7 years [SD=14.8]) in a national ECT service with a 6-month follow-up. Participants were independently randomly assigned to bitemporal or high-dose unilateral ECT. The primary outcome was change in the 24-item Hamilton Depression Rating Scale (HAM-D) score after the ECT course; the prespecified noninferiority margin was 4.0 points. Secondary outcomes included response and remission rates, relapse status after 6 months, and cognition. Of the eligible patients, 69 were assigned to bitemporal ECT and 69 to unilateral ECT. High-dose unilateral ECT was noninferior to bitemporal ECT regarding the 24-item HAM-D scores after the ECT course (mean difference=1.08 points in favor of unilateral ECT [95% CI=-1.67 to 3.84]). There were no significant differences for response and remission or 6-month relapse status. Recovery of orientation was quicker following unilateral ECT (median=19.1 minutes versus 26.4 minutes). Bitemporal ECT was associated with a lower percent recall of autobiographical information (odds ratio=0.66) that persisted for 6 months. Twice-weekly high-dose unilateral ECT is not inferior to bitemporal ECT for depression and may be preferable because of its better cognitive side-effect profile.

Prepubertal unilateral gynecomastia: report of 2 cases.

PubMed

Demirbilek, Hüseyin; Bacak, Gökhan; Baran, Rıza Taner; Avcı, Yahya; Baran, Ahmet; Keleş, Ayşenur; Özbek, Mehmet Nuri; Alanay, Yasemin; Hussain, Khalid

2014-12-01

Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up.

Prepubertal Unilateral Gynecomastia: Report of 2 Cases

PubMed Central

Demirbilek, Hüseyin; Bacak, Gökhan; Baran, Rıza Taner; Avcı, Yahya; Baran, Ahmet; Keleş, Ayşenur; Özbek, Mehmet Nuri; Alanay, Yasemin; Hussain, Khalid

2014-01-01

Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up. PMID:25541897

Optimal dose of hyperbaric bupivacaine 0.5% for unilateral spinal anesthesia during diagnostic knee arthroscopy

PubMed Central

Atef, HM; El-Kasaby, AM; Omera, MA; Badr, MD

2010-01-01

Objective To determine the dose of hyperbaric bupivacaine 0.5% required for unilateral spinal anesthesia during diagnostic knee arthroscopy. Patients and methods This prospective, randomized, clinical study was performed in 80 patients who were assigned to four groups to receive different doses of intrathecal hyperbaric bupivacaine (5 mg, 7.5 mg, 10 mg and 12.5 mg in Groups 1, 2, 3, and 4 respectively). Onset of sensory and motor block, hemodynamic changes, regression of motor block, and incidence of complications were recorded. Results Unilateral sensory block was reported in 90% and 85% of patients in Group 1 and Group 2, respectively, but not in any patient in Group 3 and Group 4. Unilateral motor block (modified Bromage scale 0) was reported in 95% of patients in Group 1, 90% in Group 2, and only 5% in Group 3, while no patient in Group 4 showed unilateral motor block. The time required for regression of motor block (Bromage scale 0) was prolonged with higher doses. The incidence of nausea, vomiting, and urine retention was similar in the study groups. Conclusion Unilateral sensory and motor block can be achieved with doses of 5 mg and 7.5 mg hyperbaric bupivacaine 0.5% with a stable hemodynamic state. However, 7.5 mg of hyperbaric bupivacaine 0.5% was the dose required for adequate unilateral spinal anesthesia. PMID:22915874

Associations between orthopaedic disturbances and unilateral crossbite in children with asymmetry of the upper cervical spine.

PubMed

Korbmacher, Heike; Koch, L; Eggers-Stroeder, G; Kahl-Nieke, B

2007-02-01

The objective of the present study was to detect possible associations between unilateral crossbite and orthopaedic disturbances in children with asymmetry of the upper cervical spine. Fifty-five children aged 3-10 years (22 girls and 33 boys) with a unilateral crossbite and 55 gender- and age-matched children with a symmetric occlusion but no crossbite, who served as the control group, were selected from an orthopaedic cohort of 240 patients. In all children, asymmetry of the upper cervical region was confirmed by radiographs and palpation. The following orthopaedic aspects were investigated: oblique shoulder and pelvis, scoliosis, functional leg length difference, and laxity of ligaments of the foot. The differences between the groups were analysed by means of an unpaired t-test. An increased occurrence of orthopaedic parameters in the frontal plane was observed in children with a unilateral malocclusion. A unilateral crossbite was not necessarily combined with a pathological orthopaedic variable, but statistically, children with a unilateral malocclusion showed more often an oblique shoulder (P = 0.004), scoliosis (P = 0.04), an oblique pelvis (P = 0.007), and a functional leg length difference (P = 0.002) than children with symmetry. The results suggest that a unilateral crossbite in children with asymmetry of the upper cervical spine is associated with orthopaedic disturbances. There is no evidence of a causal link.

Gender comparisons between unilateral and bilateral landings.

PubMed

Weinhandl, Joshua T; Joshi, Mukta; O'Connor, Kristian M

2010-11-01

The increased number of women participating in sports has led to a higher knee injury rate in women compared with men. Among these injuries, those occurring to the ACL are commonly observed during landing maneuvers. The purpose of this study was to determine gender differences in landing strategies during unilateral and bilateral landings. Sixteen male and 17 female recreational athletes were recruited to perform unilateral and bilateral landings from a raised platform, scaled to match their individual jumping abilities. Three-dimensional kinematics and kinetics of the dominant leg were calculated during the landing phase and reported as initial ground contact angle, ranges of motion (ROM) and peak moments. Lower extremity energy absorption was also calculated for the duration of the landing phase. Results showed that gender differences were only observed in sagittal plane hip and knee ROM, potentially due to the use of a relative drop height versus the commonly used absolute drop height. Unilateral landings were characterized by significant differences in hip and knee kinematics that have been linked to increased injury risk and would best be classified as "stiff" landings. The ankle musculature was used more for impact absorption during unilateral landing, which required increased joint extension at touchdown and may increase injury risk during an unbalanced landing. In addition, there was only an 11% increase in total energy absorption during unilateral landings, suggesting that there was a substantial amount of passive energy transfer during unilateral landings.

Determinants of Autobiographical Memory in Patients with Unilateral Temporal Lobe Epilepsy or Excisions

ERIC Educational Resources Information Center

St-Laurent, Marie; Moscovitch, Morris; Levine, Brian; McAndrews, Mary Pat

2009-01-01

Patients with unilateral temporal lobe epilepsy from hippocampal origin and patients with unilateral surgical excision of an epileptic focus located in the medial temporal lobe were compared to healthy controls on a version of the Autobiographical Interview (AI) adapted to assess memory for event-specific and generic personal episodes. For both…

Children with Mild Bilateral and Unilateral Hearing Loss: Parents' Reflections on Experiences and Outcomes

ERIC Educational Resources Information Center

Fitzpatrick, Elizabeth; Grandpierre, Viviane; Durieux-Smith, Andrée; Gaboury, Isabelle; Coyle, Doug; Na, Eunjung; Sallam, Nusaiba

2016-01-01

Children with mild bilateral and unilateral hearing loss are now commonly identified early through newborn hearing screening initiatives. There remains considerable uncertainty about how to support parents and about which services to provide for children with mild bilateral and unilateral hearing loss. The goal of this study was to learn about…

Motor Learning of a Bimanual Task in Children with Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Hung, Ya-Ching; Gordon, Andrew M.

2013-01-01

Children with unilateral cerebral palsy (CP) have been shown to improve their motor performance with sufficient practice. However, little is known about how they learn goal-oriented tasks. In the current study, 21 children with unilateral CP (age 4-10 years old) and 21 age-matched typically developed children (TDC) practiced a simple bimanual…

Effect of cage design, supplemental posterior instrumentation and approach on primary stability of a lumbar interbody fusion - A biomechanical in vitro study.

PubMed

Schmoelz, Werner; Sandriesser, Sabrina; Loebl, Oded; Bauer, Marlies; Krappinger, Dietmar

2017-10-01

There are various techniques and approaches for lumbar interbody fusion differing in access, cage type and type of supplemental posterior instrumentation. While a transforaminal access usually includes a hemifacetectomy, the facet joint can be preserved with a more lateral extraforaminal access. The supplemental posterior instrumentation required for both fusion techniques is still debated. The purpose of the present study was to compare primary stability of the two accesses for two different cage types with none, unilateral and bilateral supplemental posterior instrumentation. Six monosegmental lumbar functional spinal units (FSUs) were included in each of the two groups, and subjected to a flexibility test. As cages, a newly designed cage was compared to a standard cage in the following states: (a) native, (b) stand-alone cage, (c) bilateral internal fixator, (d) unilateral internal fixator, (e) unilateral facetectomy+bilateral internal fixator, (f) unilateral facetectomy+unilateral internal fixator and (g) unilateral facetectomy with stand-alone cage. For comparison the range of motion was normalized to the native state and the effects of the facetectomy, cage type, and supplemental instrumentation was compared. Within the subject comparison showed a significantly higher flexibility for the unilateral facetectomy in all motion directions (p<0.001). In between subject comparison showed a significant effect of cage type on flexibility in flexion/extension (p=0.002) and lateral bending (p=0.028) but not in axial rotation (p=0.322). The type of supplemental posterior fixation had a significant effect on the flexibility in all motion directions (stand-alone>unilateral fixator>bilateral fixator). Cage design and approach type are affecting the primary stability of lumbar interbody fusion procedures while the type of posterior instrumentation is the most influencing factor. Copyright © 2017 Elsevier Ltd. All rights reserved.

LogMAR and Stereoacuity in Keratoconus Corrected with Spectacles and Rigid Gas-permeable Contact Lenses.

PubMed

Nilagiri, Vinay Kumar; Metlapally, Sangeetha; Kalaiselvan, Parthasarathi; Schor, Clifton M; Bharadwaj, Shrikant R

2018-04-01

This study showed an improvement in three-dimensional depth perception of subjects with bilateral and unilateral keratoconus with rigid gas-permeable (RGP) contact lens wear, relative to spectacles. This novel information will aid clinicians to consider RGP contact lenses as a management modality in keratoconic patients complaining of depth-related difficulties with their spectacles. The aim of this study was to systematically compare changes in logMAR acuity and stereoacuity from best-corrected spherocylindrical spectacles to RGP contact lenses in bilateral and unilateral keratoconus vis-à-vis age-matched control subjects. Monocular and binocular logMAR acuity and random-dot stereoacuity were determined in subjects with bilateral (n = 30; 18 to 24 years) and unilateral (n = 10; 18 to 24 years) keratoconus and 20 control subjects using standard psychophysical protocols. Median (25th to 75th interquartile range) monocular (right eye) and binocular logMAR acuity and stereoacuity improved significantly from spectacles to RGP contact lenses in the bilateral keratoconus cohort (P < .001). Only monocular logMAR acuity of affected eye and stereoacuity improved from spectacles to RGP contact lenses in the unilateral keratoconus cohort (P < .001). There was no significant change in the binocular logMAR acuity from spectacles to RGP contact lenses in the unilateral keratoconus cohort. The magnitude of improvement in binocular logMAR acuity and stereoacuity was also greater for the bilateral compared with the unilateral keratoconus cohort. All outcome measures of cases with RGP contact lenses remained poorer than control subjects (P < .001). Binocular resolution and stereoacuity improve from spectacles to RGP contact lenses in bilateral keratoconus, whereas only stereoacuity improves from spectacles to RGP contact lenses in unilateral keratoconus. The magnitude of improvement in visual performance is greater for the binocular compared with the unilateral keratoconus cohort.

Computed tomography demonstrates abnormalities of contralateral ear in subjects with unilateral sensorineural hearing loss.

PubMed

Marcus, Sonya; Whitlow, Christopher T; Koonce, James; Zapadka, Michael E; Chen, Michael Y; Williams, Daniel W; Lewis, Meagan; Evans, Adele K

2014-02-01

Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT. IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as "normal" based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 "normal" temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group. Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls. Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from "normal" and/or a lateral semicircular canal bony island central lucency disparity of >5% from "normal" may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Application of strict criteria in adrenal venous sampling increases the proportion of missed patients with unilateral disease who benefit from surgery for primary aldosteronism.

PubMed

Kline, Gregory; Leung, Alexander; So, Benny; Chin, Alex; Harvey, Adrian; Pasieka, Janice L

2018-06-01

Adrenal vein sampling (AVS) is intended to confirm unilateral forms of primary aldosteronism, which are amenable to surgical cure. Excessively strict AVS criteria to define lateralization may result in many patients incorrectly categorized as bilateral primary aldosteronism and opportunity for surgical cure missed. Retrospective review of an AVS-primary aldosteronism database in which surgical cases are verified by standardized outcomes. Having used 'less strict' AVS criteria for lateralization, we examined the distribution of AVS lateralization indices in our confirmed unilateral primary aldosteronism cases both with and without cosyntropin stimulation. The proportion of proven unilateral cases that would have been missed with stricter AVS interpretation criteria was calculated. Particular focus was given to the proportion of missed cases according to use of international guidelines. False-positive lateralization with 'less strict' interpretation was also calculated. Of 80 surgical primary aldosteronism cases, 10-23% would have been missed with AVS lateralization indices of 3 : 1 to 5 : 1, with or without cosyntropin. If strict selectivity indices (for confirmation of catheterization) were combined with strict lateralization indices, up to 70% of unilateral primary aldosteronism cases could have been missed. Use of Endocrine Society AVS guidelines would have missed 21-43% of proven unilateral cases. 'Less strict' AVS interpretation yielded one case (1.2%) of false lateralization. Excessively strict AVS interpretation criteria will result in a high rate of missed unilateral primary aldosteronism with subsequent loss of opportunity for intervention. Use of more lenient lateralization criteria will improve the detection rate of unilateral primary aldosteronism with very low false-positive rate.

[Primary hyperaldosteronism due to unilateral adrenal hyperplasia with surgical resolution].

PubMed

Rubio-Puchol, O; Garzón-Pastor, S; Salom-Vendrell, C; Hernández-Mijares, A

Unilateral adrenal hyperplasia is a rare cause of primary hyperaldosteronism (around a 3%) that has surgical treatment. A case of a patient with hypertension resistant to conventional therapy in treatment with 7 drugs who presented with primary hyperaldosteronism due to unilateral adrenal hyperplasia is presented. A left adrenalectomy was performed, and the patient had a good clinical response, with no need of any drug after 2 years of surgery. Unilateral adrenal hyperplasia is a different entity and it is not an asymmetric variant of the bilateral adrenal hyperplasia. In the study of patients with primary hyperaldosteronism and imaging tests with absence of adenoma is a diagnosis that must be considered before cataloguing patients with bilateral adrenal hyperplasia and start a medical treatment, because unilateral adrenal hyperplasia would have a surgical resolution. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Unilateral retinitis pigmentosa occurring in an individual with a mutation in the CLRN1 gene.

PubMed

Sim, Peng Yong; Jeganathan, V Swetha E; Wright, Alan F; Cackett, Peter

2018-03-15

This case report depicts the clinical course of a female patient with unilateral retinitis pigmentosa, who first presented at the age of 12 years. Fundus photography at the time revealed unilateral pigmentary retinopathy, which was associated with extinguished electroretinogram (ERG) signal. At 35 years of age, fundus examination revealed deterioration of pre-existing unilateral pigmentary retinopathy with progressive visual field defect detected on Goldmann visual field testing. ERG findings remained unchanged and multifocal ERG showed unilateral decrease in amplitude in the affected eye. The patient was referred for genetic counselling. Next-generation sequencing identified a deleterious heterozygous c.118T>G (p.Cys40Gly) mutation in the CLRN1 gene. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Unilateral occipital nerve stimulation for bilateral occipital neuralgia: a case report and literature review

PubMed Central

Liu, Aijun; Jiao, Yongcheng; Ji, Huijun; Zhang, Zhiwen

2017-01-01

Objectives The aim of this study is to present a case of successful relief of bilateral occipital neuralgia (ON) using unilateral occipital nerve stimulation (ONS) and to discuss the possible underlying mechanisms. Materials and methods We present the case of a 59-year-old female patient with severe bilateral ON treated with unilateral ONS. We systematically reviewed previous studies of ONS for ON, discussing the possible mechanisms of ONS in the relief of ON. Results The patient reported complete pain relief after consistent unilateral ONS during the follow-up period. The underlying mechanisms may be linked to the relationship between pain and several brain regions, including the pons, midbrain, and periaqueductal gray. Conclusion ONS is an effective and safe option for treating ON. Future studies will be required to clarify the mechanisms by which unilateral occipital stimulation provided relief for bilateral neuralgia in this case. PMID:28176938

Unilateral occipital nerve stimulation for bilateral occipital neuralgia: a case report and literature review.

PubMed

Liu, Aijun; Jiao, Yongcheng; Ji, Huijun; Zhang, Zhiwen

2017-01-01

The aim of this study is to present a case of successful relief of bilateral occipital neuralgia (ON) using unilateral occipital nerve stimulation (ONS) and to discuss the possible underlying mechanisms. We present the case of a 59-year-old female patient with severe bilateral ON treated with unilateral ONS. We systematically reviewed previous studies of ONS for ON, discussing the possible mechanisms of ONS in the relief of ON. The patient reported complete pain relief after consistent unilateral ONS during the follow-up period. The underlying mechanisms may be linked to the relationship between pain and several brain regions, including the pons, midbrain, and periaqueductal gray. ONS is an effective and safe option for treating ON. Future studies will be required to clarify the mechanisms by which unilateral occipital stimulation provided relief for bilateral neuralgia in this case.

Acute Calcific Bursitis After Ultrasound-Guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report.

PubMed

Kang, Bo-Sung; Lee, Seung Hak; Cho, Yung; Chung, Sun Gun

2016-08-01

Ultrasound-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain early after ultrasound-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated her pain completely. Therefore, a high index of suspicion for acute calcific bursitis is required in patients with unresolved or aggravated pain after barbotage. Repeated barbotage could be effective for this condition. Copyright © 2016 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Grip Force Coordination during Bimanual Tasks in Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Islam, Mominul; Gordon, Andrew M.; Skold, Annika; Forssberg, Hans; Eliasson, Ann-Christin

2011-01-01

Aim: The aim of the study was to investigate coordination of fingertip forces during an asymmetrical bimanual task in children with unilateral cerebral palsy (CP). Method: Twelve participants (six males, six females; mean age 14y 4mo, SD 3.3y; range 9-20y;) with unilateral CP (eight right-sided, four left-sided) and 15 age-matched typically…

Hand Function in Relation to Brain Lesions and Corticomotor-Projection Pattern in Children with Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Holmstrom, Linda; Vollmer, Brigitte; Tedroff, Kristina; Islam, Mominul; Persson, Jonas Ke; Kits, Annika; Forssberg, Hans; Eliasson, Ann-Christin

2010-01-01

Aim: To investigate relationships between hand function, brain lesions, and corticomotor projections in children with unilateral cerebral palsy (CP). Method: The study included 17 children (nine males, eight females; mean age 11.4 [SD 2.4] range 7-16y), with unilateral CP at Gross Motor Function Classification System level I and Manual Ability…

Song Recognition by Young Children with Cochlear Implants: Comparison between Unilateral, Bilateral, and Bimodal Users

ERIC Educational Resources Information Center

Bartov, Tamar; Most, Tova

2014-01-01

Purpose: To examine song identification by preschoolers with normal hearing (NH) versus preschoolers with cochlear implants (CIs). Method: Participants included 45 children ages 3;8-7;3 (years;months): 12 with NH and 33 with CIs, including 10 with unilateral CI, 14 with bilateral CIs, and 9 bimodal users (CI-HA) with unilateral CI and…

The effect of severity of unilateral vestibular dysfunction on symptoms, disabilities and handicap in vertiginous patients.

PubMed

Bamiou, D E; Davies, R A; McKee, M; Luxon, L M

1999-02-01

This study compares the symptoms, disabilities and handicap, as assessed by means of a questionnaire, in two groups of patients with a unilateral peripheral vestibular disorder: those with a total canal paresis and those with a partial canal paresis, as judged by the duration parameter using the Fitzgerald Hallpike caloric test in the absence of optic fixation. The results of the study indicate that the severity of dizziness, the Dizziness Index (severity x frequency) and the overall level of disabilities related to visual vertigo are less severe in unilateral profound or total loss of vestibular function than in unilateral mild vestibular loss.

A stimulus-centered reading disorder for words and numbers: Is it neglect dyslexia?

PubMed

Arduino, Lisa S; Daini, Roberta; Caterina Silveri, Maria

2005-12-01

A single case, RCG, showing a unilateral reading disorder without unilateral spatial neglect was studied. The disorder was characterized by substitutions of the initial (left) letters of words, nonwords and Arabic numbers, independently of egocentered spatial coordinates. MRI showed a bilateral lesion with the involvement of the splenium. Although, within the framework of the visual word recognition model proposed by Caramazza and Hillis (1990), RCG disorder could be defined as a stimulus-centered neglect dyslexia, we discuss the hypothesis of a dissociation in neural correlates and mechanisms between the syndrome of unilateral spatial neglect and such a unilateral reading disorder.

Unilateral lesion of dorsal hippocampus in adult rats impairs contralateral long-term potentiation in vivo and spatial memory in the early postoperative phase.

PubMed

Li, Hongjie; Wu, Xiaoyan; Bai, Yanrui; Huang, Yan; He, Wenting; Dong, Zhifang

2012-05-01

It is well documented that bilateral hippocampal lesions or unilateral hippocampal lesion at birth causes impairment of contralateral LTP and long-term memory. However, effects of unilateral hippocampal lesion in adults on contralateral in vivo LTP and memory are not clear. We here examined the influence of unilateral electrolytic dorsal hippocampal lesion in adult rats on contralateral LTP in vivo and spatial memory during different postoperative phases. We found that acute unilateral hippocampal lesion had no effect on contralateral LTP. However, contralateral LTP was impaired at 1 week after lesion, and was restored to the control level at postoperative week 4. Similarly, spatial memory was also impaired at postoperative week 1, and was restored at postoperative week 4. In addition, the rats at postoperative week 1 showed stronger spatial exploratory behavior in a novel open-field environment. The sham operation had no effects on contralateral LTP, spatial memory and exploration at either postoperative week 1 or week 4. These results suggest that unilateral dorsal hippocampal lesion in adult rats causes transient contralateral LTP impairment and spatial memory deficit. Copyright © 2012 Elsevier B.V. All rights reserved.

Intracortical inhibition and facilitation with unilateral dominant, unilateral nondominant and bilateral movement tasks in left- and right-handed adults.

PubMed

McCombe Waller, Sandy; Forrester, Larry; Villagra, Federico; Whitall, Jill

2008-06-15

To investigate intracortical inhibition and facilitation in response to unilateral dominant, nondominant and bilateral biceps activation and short-term upper extremity training in right- and left-handed adults. Paired-pulse transcranial magnetic stimulation was used to measure intracortical excitability in motor dominant and nondominant cortices of 26 nondisabled adults. Neural facilitation and inhibition were measured in each hemisphere during unilateral dominant, nondominant and bilateral arm activation and after training in each condition. No differences were seen between right- and left-handed subjects. Intracortical facilitation and decreased inhibition were seen in each hemisphere with unilateral activation/training of contralateral muscles and bilateral muscle activation/training. Persistent intracortical inhibition was seen in each hemisphere with ipsilateral muscle activation/training. Inhibition was greater in the nondominant hemisphere during dominant hemisphere activation (dominant arm contraction). Strongly dominant individuals show no difference in intracortical responses given handedness. Intracortical activity with unilateral and bilateral arm activation and short-term training differs based on hemispheric dominance, with the motor dominant hemisphere exerting a larger inhibitory influence over the nondominant hemisphere. Bilateral activation and training have a disinhibitory effect in both dominant and nondominant hemispheres.

Forced in-plane vibration of a thick ring on a unilateral elastic foundation

NASA Astrophysics Data System (ADS)

Wang, Chunjian; Ayalew, Beshah; Rhyne, Timothy; Cron, Steve; Dailliez, Benoit

2016-10-01

Most existing studies of a deformable ring on elastic foundation rely on the assumption of a linear foundation. These assumptions are insufficient in cases where the foundation may have a unilateral stiffness that vanishes in compression or tension such as in non-pneumatic tires and bushing bearings. This paper analyzes the in-plane dynamics of such a thick ring on a unilateral elastic foundation, specifically, on a two-parameter unilateral elastic foundation, where the stiffness of the foundation is treated as linear in the circumferential direction but unilateral (i.e. collapsible or tensionless) in the radial direction. The thick ring is modeled as an orthotropic and extensible circular Timoshenko beam. An arbitrarily distributed time-varying in-plane force is considered as the excitation. The Equations of Motion are explicitly derived and a solution method is proposed that uses an implicit Newmark scheme for the time domain solution and an iterative compensation approach to determine the unilateral zone of the foundation at each time step. The dynamic axle force transmission is also analyzed. Illustrative forced vibration responses obtained from the proposed model and solution method are compared with those obtained from a finite element model.

Corneal thickness of eyes with unilateral age-related macular degeneration.

PubMed

Arikan, Sedat; Ersan, Ismail; Kara, Selcuk; Gencer, Baran; Korkmaz, Safak; Vural, Azer Sara

2015-01-01

To compare the central corneal thicknesses (CCT), peripheral corneal thicknesses, and corneal volumes (CV) of the 2 eyes of patients with unilateral age-related macular degeneration (AMD). Twenty patients who were diagnosed with unilateral AMD were included in this prospective study for the purpose of making comparison between the diseased and healthy eyes. Optical coherence tomography and fundus fluorescein angiography imaging were applied to all patients in order to confirm and reveal the presence of unilateral AMD. Then, the measurements of CCT, peripheral corneal thickness measured 4 mm distant from the center of the cornea (4 mm CT), and CV of each eye of these patients were obtained through the rotating Scheimpflug corneal topographer. Wilcoxon signed-rank test did not demonstrate a statistically significant difference between the 2 eyes of patients with unilateral AMD when we compared the CCT and CV of diseased and healthy eyes (p>0.05). However, 4 mm CT of the diseased eyes of these patients were statistically significantly thicker than the healthy eyes (p<0.05). The significant difference in terms of 4 mm CT between the diseased and healthy eyes of patients with unilateral AMD may demonstrate the possible effect of peripheral corneal thickness on the development of AMD.

Increased incidence of pseudarthrosis after unilateral instrumented transforaminal lumbar interbody fusion in patients with lumbar spondylosis: Clinical article.

PubMed

Gologorsky, Yakov; Skovrlj, Branko; Steinberger, Jeremy; Moore, Max; Arginteanu, Marc; Moore, Frank; Steinberger, Alfred

2014-10-01

Transforaminal lumbar interbody fusion (TLIF) with segmental pedicular instrumentation is a well established procedure used to treat lumbar spondylosis with or without spondylolisthesis. Available biomechanical and clinical studies that compared unilateral and bilateral constructs have produced conflicting data regarding patient outcomes and hardware complications. A prospective cohort study was undertaken by a group of neurosurgeons. They prospectively enrolled 80 patients into either bilateral or unilateral pedicle screw instrumentation groups (40 patients/group). Demographic data collected for each group included sex, age, body mass index, tobacco use, and Workers' Compensation/litigation status. Operative data included segments operated on, number of levels involved, estimated blood loss, length of hospital stay, and perioperative complications. Long-term outcomes (hardware malfunction, wound dehiscence, and pseudarthrosis) were recorded. For all patients, preoperative baseline and 6-month postoperative scores for Medical Outcomes 36-Item Short Form Health Survey (SF-36) outcomes were recorded. Patient follow-up times ranged from 37 to 63 months (mean 52 months). No patients were lost to follow-up. The patients who underwent unilateral pedicle screw instrumentation (unilateral cohort) were slightly younger than those who underwent bilateral pedicle screw instrumentation (bilateral cohort) (mean age 42 vs. 47 years, respectively; p = 0.02). No other significant differences were detected between cohorts with regard to demographic data, mean number of lumbar levels operated on, or distribution of the levels operated on. Estimated blood loss was higher for patients in the bilateral cohort, but length of stay was similar for patients in both cohorts. The incidence of pseudarthrosis was significantly higher among patients in the unilateral cohort (7 patients [17.5%]) than among those in the bilateral cohort (1 patient [2.5%]) (p = 0.02). Wound dehiscence occurred for 1 patient in the unilateral cohort. Reoperation was offered to 8 patients in the unilateral cohort and 1 patient in the bilateral cohort (p = 0.03). The physical component scores of the Medical Outcomes SF-36 outcomes improved significantly for all patients (p < 0.001). Transforaminal lumbar interbody fusion with either unilateral or bilateral segmental pedicular instrumentation is an effective treatment for lumbar spondylosis. Because patients with unilateral constructs were 7 times more likely to experience pseudarthrosis and require reoperation, TLIF with bilateral constructs might be the biomechanically superior technique.

Kinetic Modeling of Next-Generation High-Energy, High-Intensity Laser-Ion Accelerators

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

Albright, Brian James; Yin, Lin; Stark, David James

One of the long-standing problems in the community is the question of how we can model “next-generation” laser-ion acceleration in a computationally tractable way. A new particle tracking capability in the LANL VPIC kinetic plasma modeling code has enabled us to solve this long-standing problem

Differences Between New and Long-Standing US Gun Owners: Results From a National Survey.

PubMed

Wertz, Joseph; Azrael, Deborah; Hemenway, David; Sorenson, Susan; Miller, Matthew

2018-07-01

To quantify the proportion of current US gun owners who are new to owning firearms and compare new versus long-standing gun owners with respect to their firearms and firearm-related behaviors. We performed a cross-sectional analysis of a nationally representative probability-based online survey conducted in 2015 in the United States. We defined new gun owners as current firearm owners who acquired all of their firearms within the past 5 years, but who lived in a home without a gun at some time over the past 5 years. We defined long-standing firearm owners as all other current gun owners. New gun owners represented 10% of all current US adult gun owners. In addition to being younger than long-standing gun owners, new gun owners were more likely to be liberal, own fewer guns, own handguns, own guns only for protection, and store guns in a safe manner. Gun ownership is dynamic, with approximately 1 million Americans becoming new gun owners each year. Public Health Implications. Clinical guidelines should be updated to explicitly endorse re-evaluating household firearm status at regular intervals.

Longitudinal Development of Hand Function in Children with Unilateral Cerebral Palsy

ERIC Educational Resources Information Center

Holmefur, Marie; Krumlinde-Sundholm, Lena; Bergstrom, Jakob; Eliasson, Ann-Christin

2010-01-01

Aim: The aim of this study was to describe how the usefulness of the hemiplegic hand develops in children with unilateral cerebral palsy (CP) aged between 18 months and 8 years. Method: A prospective longitudinal study of 43 children (22 males, 21 females) with unilateral CP was conducted. Inclusion age was 18 months to 5 years 4 months (mean 2y…

Visual Field Function in School-Aged Children with Spastic Unilateral Cerebral Palsy Related to Different Patterns of Brain Damage

ERIC Educational Resources Information Center

Jacobson, Lena; Rydberg, Agneta; Eliasson, Ann-Christin; Kits, Annika; Flodmark, Olof

2010-01-01

Aim: To relate visual field function to brain morphology in children with unilateral cerebral palsy (CP). Method: Visual field function was assessed using the confrontation technique and Goldmann perimetry in 29 children (15 males, 14 females; age range 7-17y, median age 11y) with unilateral CP classified at Gross Motor Function Classification…

Gerstmann's syndrome and unilateral optic ataxia in the emergency department

PubMed Central

Barbosa, Breno José Alencar Pires; de Brito, Marcelo Houat; Rodrigues, Júlia Chartouni; Kubota, Gabriel Taricani; Parmera, Jacy Bezerra

2017-01-01

ABSTRACT. A 75-year-old right-handed woman presented to the emergency department with simultanagnosia and right unilateral optic ataxia. Moreover, the patient had agraphia, acalculia, digital agnosia and right-left disorientation, consistent with complete Gerstmann's syndrome. This case highlights the concurrence of Gerstmann's syndrome and unilateral optic ataxia in the acute phase of a left middle cerebral artery stroke. PMID:29354229

Effect of Observation of Simple Hand Movement on Brain Activations in Patients with Unilateral Cerebral Palsy: An fMRI Study

ERIC Educational Resources Information Center

Dinomais, Mickael; Lignon, Gregoire; Chinier, Eva; Richard, Isabelle; Minassian, Aram Ter; The Tich, Sylvie N'Guyen

2013-01-01

The aim of this functional magnetic resonance imaging (fMRI) study was to examine and compare brain activation in patients with unilateral cerebral palsy (CP) during observation of simple hand movement performed by the paretic and nonparetic hand. Nineteen patients with clinical unilateral CP (14 male, mean age 14 years, 7-21 years) participated…

Postero-Lateral Disc Prosthesis Combined With a Unilateral Facet Replacement Device Maintains Quantity and Quality of Motion at a Single Lumbar Level

PubMed Central

Nayak, Aniruddh N.; Doarn, Michael C.; Gaskins, Roger B.; James, Chris R.; Cabezas, Andres F.; Castellvi, Antonio E.

2014-01-01

Background Mechanically replacing one or more pain generating articulations in the functional spinal unit (FSU) may be a motion preservation alternative to arthrodesis at the affected level. Baseline biomechanical data elucidating the quantity and quality of motion in such arthroplasty constructs is non-existent. Purpose The purpose of the study was to quantify the motion-preserving effect of a posterior total disc replacement (PDR) combined with a unilateral facet replacement (FR) system at a single lumbar level (L4-L5). We hypothesized that reinforcement of the FSU with unilateral FR to replace the resected, native facet joint following PDR implantation would restore quality and quantity of motion and additionally not change biomechanics at the adjacent levels. Study Design In-vitro study using human cadaveric lumbar spines. Methods Six (n = 6) cadaveric lumbar spines (L1-S1) were evaluated using a pure-moment stability testing protocol (±7.5 Nm) in flexion-extension (F/E), lateral bending (LB) and axial rotation (AR). Each specimen was tested in: (1) intact; (2) unilateral FR; and (3) unilateral FR + PDR conditions. Index and adjacent level ROM (using hybrid protocol) were determined opto-electronically. Interpedicular travel (IPT) and instantaneous center of rotation (ICR) at the index level were radiographically determined for each condition. ROM, ICR, and IPT measurements were compared (repeated measures ANOVA) between the three conditions. Results Compared to the intact spine, no significant changes in F/E, LB or AR ROM were identified as a result of unilateral FR or unilateral FR + PDR. No significant changes in adjacent L3-L4 or L5-S1 ROM were identified in any loading mode. No significant differences in IPT were identified between the three test conditions in F/E, LB or AR at the L4-L5 level. The ICRs qualitatively were similar for the intact and unilateral FR conditions and appeared to follow placement (along the anterior-posterior (AP) direction) of the PDR in the disc space Conclusion Biomechanically, quantity and quality of motion are maintained with combined unilateral FR + PDR at a single lumbar spinal level. PMID:25694929

Experience of a Tertiary-Level Urology Center in the Clinical Urological Events of Rare and Very Rare Incidence. VI. Unusual Events in Urolithiasis: 1. Long-Standing Urethral Stones without Underlying Anatomical Abnormalities in Male Children.

PubMed

Gadelkareem, Rabea A; Shahat, Ahmed A; Abdelhafez, Mohamed F; Moeen, Ahmed M; Ibrahim, Abdelrady S; Safwat, Ahmed S

2018-06-06

The study aimed to present our center's experience with long-standing urethral stones in male children with normal urethra. Retrospective search of our center data was done for the cases of long-standing urethral stones with normal urethra in male children during the period July 2001 - June 2016. Demographic and clinical data were studied. Of more than 54,000 urolithiasis procedures, 17 male children (0.031%) were operated for long-standing urethral stones with normal urethra. In 14 cases (82.4%), residence was rural and parental education levels were low or none. All children were regularly prompted voiding with a history of difficulty or dysuria. All the stones lodged in the posterior urethra with an approximate mean duration of 2 months. The mean stone size of 11.29 ± 3.88 mm and rough surfaces in 88.2% of cases represented the main predisposing factors. Major complications included rectal prolapse in 1 case and vesicoureteral reflux in 3 cases. Endoscopic push-back was followed by disintegration in 76.5% or cystolithotomy in 17.7%, while it failed in 1 case that was treated by cystolithotomy. Long-standing urethral stones in male children with normal urethra are very rare misdiagnoses. Stone topography and sociocultural factors predisposed to their lodgments and negligence. Endoscopic treatment is the best approach. © 2018 S. Karger AG, Basel.

[Effects on cervical spondylosis of vertebral artery type and the concentrations of plasma NPY and UII in the patients treated with the modified acupuncture at unilateral/bilateral Renying (ST 9)].

PubMed

Wang, Yanfu; Ma, Chaoyang; Li, Lingxiao; Zhang, Ting; Gui, Xinghua; Chen, Hao

2018-05-12

To observe the differences in the clinical therapeutic effects on cervical spondylosis of vertebral artery type (CSA) between the modified acupuncture and the routine acupuncture at unilateral/bilateral Renying (ST 9) as well as the impacts on the concentrations of plasma neuropeptide Y (NPY) and urotensinⅡ(UⅡ) in the patients. A total of 160 patients were divided into a modified bilateral acupuncture group, a modified unilateral acupuncture group, a routine bilateral acupuncture group and a routine unilateral acupuncture group, 40 cases in each one according to the random number table. In the modified bilateral acupuncture group, the modified acupuncture was applied bilaterally to Renying (ST 9). In the modified unilateral acupuncture group, the modified acupuncture was applied unilaterally to Renying (ST 9). In the routine bilateral acupuncture group, the routine acupuncture was applied bilaterally to Renying (ST 9). In the routine unilateral acupuncture group, the routine acupuncture was applied unilaterally to Renying (ST 9). The treatment was given once every day, continuously for 6 days as one course. Two courses of treatment were required at the interval of 1 day. In each group, before and after treatment, we observed the peak systolic blood flow velocity (Vs) of the vertebral artery (VA) and the basilar artery (BA), cervical vertigo symptoms and functional assessment scales (ESCV) and the concentration of plasma NPY and UⅡ. The clinical therapeutic effects were compared among the groups. After treatment, the clinical therapeutic effect in the modified bilateral acupuncture group was 90.0% (36/40), which was better than 80.0% (32/40) in the modified unilateral acupuncture group, 77.5% (35/40) in the routine bilateral acupuncture group and 65.0% (26/40) in the routine unilateral acupuncture group (all P <0.05). After treatment, Vs of VA and BA was improved remarkably in every group (all P <0.01), and the result in the modified bilateral acupuncture group was higher than those in the other groups (all P <0.01). After treatment, ESCV scores were all increased remarkably in every group (all P <0.01). ESCV score and improvement index in the modified bilateral acupuncture group were all higher than those in the other groups ( P <0.05, P <0.01). After treatment, the concentrations of plasma NPY and UⅡ were all reduced remarkably in every group (all P <0.01) and the differences were significant among the groups (all P <0.01). The modified bilateral acupuncture at Renying (ST 9) effectively regulates the blood supply of the vertebral basilar artery and improves the cerebral circulation. The effects are superior to those of the unilateral acupuncture at Renying (ST 9).

Asymmetric vestibular evoked myogenic potentials in unilateral Menière patients

PubMed Central

Wit, H. P.

2010-01-01

Vestibular evoked myogenic potentials (VEMPs) were measured in 22 unilateral Menière patients with monaural and binaural stimulation with 250 and 500 Hz tone bursts. For all measurement situations significantly lower VEMP amplitudes were on average measured at the affected side compared to the unaffected side. Unilateral Menière patients have, in contrast to normal subjects, asymmetric VEMPs, indicating a permanently affected vestibular (most likely otolith) system at the side of hearing loss. The diagnostic value of VEMP amplitude asymmetry measurement in individual patients is low, because of the large overlap of the VEMP amplitude asymmetry range for unilateral Menière patients with that for normal subjects. PMID:20665043

Unilateral RS3PE in a Patient of Seronegative Rheumatoid Arthritis.

PubMed

Varshney, Ankur Nandan; Kumar, Nilesh; Tiwari, Ashutosh; Anand, Ravi; Prasad, Sashi Ranjan; Anand, Arvind; Mishra, Abhinandan; Singh, N K

2013-01-01

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare but well-reported clinical entity. It is classically described as symmetrical involvement of both upper extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. We hereby report a case of unilateral RS3PE in a patient of seronegative rheumatoid arthritis which was initially misdiagnosed as cellulitis and was given high dose antibiotics without any significant improvement. Later a rheumatologic consultation leads to a prompt diagnosis, and treatment with steroids leads to dramatic reversal of symptoms. This case demonstrates the rare presentation of this rare clinical entity and highlights the necessity of awareness regarding unilateral disease to clinicians.

Influence of nasoalveolar molding on skeletal development in patients with unilateral cleft lip and palate at 5 years of age.

PubMed

Akarsu-Guven, Bengisu; Arisan, Arda; Ozgur, Figen; Aksu, Muge

2018-04-01

The aim of this retrospective study was to assess the influence of presurgical nasoalveolar molding (NAM) on skeletal development in patients with operated unilateral cleft lip and palate at 5 years of age. Lateral cephalometric radiographs of 26 unilateral cleft lip and palate patients who had undergone presurgical NAM (NAM group) and 20 unilateral cleft lip and palate patients who did not have any presurgical NAM (non-NAM group) were analyzed. The radiographs were digitally traced using Quick Ceph Studio software (version 3.5.1.r (1151); Quick Ceph Systems, San Diego, Calif). Independent samples t tests were performed for statistical analysis. No significant differences were observed in sagittal and vertical skeletal measurements between the NAM and non-NAM groups. NAM resulted in no significant difference in skeletal development in unilateral cleft lip and palate patients compared with those without NAM in early childhood. Copyright © 2018. Published by Elsevier Inc.

Complexity vs. unity in unilateral spatial neglect.

PubMed

Rode, G; Fourtassi, M; Pagliari, C; Pisella, L; Rossetti, Y

Unilateral spatial neglect constitutes a heterogeneous syndrome characterized by two main entangled components: a contralesional bias of spatial attention orientation; and impaired building and/or exploration of mental representations of space. These two components are present in different subtypes of unilateral spatial neglect (visual, auditory, somatosensory, motor, allocentric, egocentric, personal, representational and productive manifestations). Detailed anatomical and clinical analyses of these conditions and their underlying disorders show the complexity of spatial cognitive deficits and the difficulty of proposing just one explanation. This complexity is in contrast, however, to the widely acknowledged effectiveness of rehabilitation of the various symptoms and subtypes of unilateral spatial neglect, exemplified in the case of prism adaptation. These common effects are reflections of the unity of the physiotherapeutic mechanisms behind the higher brain functions related to multisensory integration and spatial representations, whereas the paradoxical aspects of unilateral spatial neglect emphasize the need for a greater understanding of spatial cognitive disorders. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Callosal disconnection syndrome in a left-handed patient due to infarction of the total length of the corpus callosum.

PubMed

Lausberg, H; Göttert, R; Münssinger, U; Boegner, F; Marx, P

1999-03-01

We report on a left-handed patient with an ischemic infarction affecting exclusively the total length of the corpus callosum. This lesion clinically correlated with an almost complete callosal disconnection syndrome as described in callosotomy subjects, including unilateral verbal anosmia, hemialexia, unilateral ideomotor apraxia, unilateral agraphia, unilateral tactile anomia, unilateral constructional apraxia, lack of somesthetic transfer and dissociative phenomena. Despite the patient's left-handedness, his pattern of deficits was similar to the disconnection syndrome found in right-handers. Our report focusses on motor dominance and praxis. We followed-up the improvement in left apraxia and investigated the ability to initiate and learn a new visuo-motor skill. The results permit two tentative assumptions: (1) that the improvement in left apraxia was due to a compensatory increase in ipsilateral proximal muscle control, and (2) that motor dominance, i.e. the competence to initiate and learn a new movement pattern, was hemispherically dissociable from manual dominance in the sense of praxis control.

Changes in regional blood flow induced by unilateral subthalamic nucleus stimulation in patients with Parkinson's disease.

PubMed

Tanei, Takafumi; Kajita, Yasukazu; Nihashi, Takashi; Kaneoke, Yoshiki; Takebayashi, Shigenori; Nakatsubo, Daisuke; Wakabayashi, Toshihiko

2009-11-01

Changes in regional cerebral blood flow (rCBF) induced by unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) were investigated in 7 consecutive patients with Parkinson's disease, 4 men and 3 women (mean age 62.3 +/- 8.1 years), who underwent rCBF measurement by N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography at rest before and after unilateral STN DBS preoperatively in the on-drug condition, and postoperatively in the on-drug and on-stimulation condition. Statistical parametric mapping was used to identify significant changes in rCBF from the preoperative to the postoperative conditions. rCBF was increased in the bilateral cingulate cortices and bilateral cerebellar hemispheres. rCBF was decreased in the bilateral medial frontal cortices and left superior temporal cortex. Unilateral STN DBS produced rCBF changes in the bilateral cingulate cortices, cerebellar hemispheres, and medial frontal cortices. These findings indicate that unilateral STN DBS affects rCBF in both hemispheres.

Avulsion of the puborectalis muscle is associated with asymmetry of the levator hiatus.

PubMed

Dietz, H P; Bhalla, R; Chantarasorn, V; Shek, K L

2011-06-01

To determine the degree of levator hiatal asymmetry in women with unilateral avulsion of the puborectalis muscle in order to estimate the likely effect of successful reconstruction. We reviewed datasets of women seen between May 2005 and January 2009 in a tertiary urogynecological unit. Archived ultrasound volume datasets were analyzed for hiatal dimensions and puborectalis muscle trauma in patients with unilateral avulsion. From 929 eligible datasets we identified 71 patients with isolated complete unilateral tears. Unilateral avulsion was associated with a significant increase in hiatal area (P ≤ 0.002). Relative to a hypothetical normal hiatus (intact hemi-area × 2), avulsion was associated with a larger hiatus on Valsalva maneuver (+2.1 cm(2) or 7%). Unilateral puborectalis muscle avulsion results in an asymmetric increase in the size of the levator hiatus. This increase is relatively minor, accounting for < 10% of hiatal area. Surgical repair of an avulsion may have only limited effects on hiatal dimensions. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

How to quantify binaural hearing in patients with unilateral hearing using hearing implants.

PubMed

Snik, Ad; Agterberg, Martijn; Bosman, Arjan

2015-01-01

Application of bilateral hearing devices in bilateral hearing loss and unilateral application in unilateral hearing loss (second ear with normal hearing) does not a priori lead to binaural hearing. An overview is presented on several measures of binaural benefits that have been used in patients with unilateral or bilateral deafness using one or two cochlear implants, respectively, and in patients with unilateral or bilateral conductive/mixed hearing loss using one or two percutaneous bone conduction implants (BCDs), respectively. Overall, according to this overview, the most significant and sensitive measure is the benefit in directional hearing. Measures using speech (viz. binaural summation, binaural squelch or use of the head shadow effect) showed minor benefits, except for patients with bilateral conductive/mixed hearing loss using two BCDs. Although less feasible in daily practise, the binaural masking level difference test seems to be a promising option in the assessment of binaural function. © 2015 S. Karger AG, Basel.

Horizontal localization and speech intelligibility with bilateral and unilateral hearing aid amplification.

PubMed

Köbler, S; Rosenhall, U

2002-10-01

Speech intelligibility and horizontal localization of 19 subjects with mild-to-moderate hearing loss were studied in order to evaluate the advantages and disadvantages of bilateral and unilateral hearing aid (HA) fittings. Eight loudspeakers were arranged in a circular array covering the horizontal plane around the subjects. Speech signals of a sentence test were delivered by one, randomly chosen, loudspeaker. At the same time, the other seven loudspeakers emitted noise with the same long-term average spectrum as the speech signals. The subjects were asked to repeat the speech signal and to point out the corresponding loudspeaker. Speech intelligibility was significantly improved by HAs, bilateral amplification being superior to unilateral. Horizontal localization could not be improved by HA amplification. However, bilateral HAs preserved the subjects' horizontal localization, whereas unilateral amplification decreased their horizontal localization abilities. Front-back confusions were common in the horizontal localization test. The results indicate that bilateral HA amplification has advantages compared with unilateral amplification.

Biomechanical differences between unilateral and bilateral landings from a jump: gender differences.

PubMed

Pappas, Evangelos; Hagins, Marshall; Sheikhzadeh, Ali; Nordin, Margareta; Rose, Donald

2007-07-01

To determine the effect of landing type (unilateral vs. bilateral) and gender on the biomechanics of drop landings in recreational athletes. This study used a repeated measures design to compare bilateral and unilateral landings in male and female athletes. A repeated measures multivariate analysis of variance (type of landing*gender) was performed on select variables. Biomechanics laboratory. Sixteen female and 16 male recreational athletes. Kinetic, kinematic, and electromyographic (EMG) data were collected on participants while performing bilateral and unilateral landings from a 40-cm platform. Compared to bilateral landings, subjects performed unilateral landings with increased knee valgus, decreased knee flexion at initial contact, decreased peak knee flexion, decreased relative hip adduction, and increased normalized EMG of the rectus femoris, medial hamstrings, lateral hamstrings, and medial gastrocnemius (P < 0.005). During both types of landing, females landed with increased knee valgus and normalized vertical ground reaction force (VGRF) compared to males (P < 0.009), however, the interaction of landing type*gender was not significant (P = 0.29). Compared to bilateral landings, male and female recreational athletes performed unilateral landings with significant differences in knee kinematic and EMG variables. Female athletes landed with increased knee valgus and VGRF compared to males during both types of landing.

Clinical and surgical management of unilateral prepubertal gynecomastia

PubMed Central

Ferraro, Giuseppe Andrea; De Francesco, Francesco; Romano, Tiziana; Grandone, Anna; D’Andrea, Francesco; Miraglia Del Giudice, Emanuele; Perrone, Laura; Nicoletti, Gianfranco

2014-01-01

INTRODUCTION Gynecomastia is the benign proliferation of the glandular tissue in the male breast. This condition is thought to be caused by the imbalance between estrogen action relative to androgen action at the breast tissue level. Bilateral gynecomastia is frequently found in the neonatal period, early in puberty, and with increasing age. Prepubertal unilateral gynecomastia in the absence of endocrine abnormalities is extremely rare, with only a few cases in literature. PRESENTATION OF CASE We present an otherwise healthy boy of 12 years old with unilateral breast masses. No abnormalities were found on ultrasonography and on all endocrine parameters. Treatment consisted in a new “modified” Webster technique. DISCUSSION The results confirmed validity of this technique in terms of esthetic and functional results, and patient satisfaction. Atypical presentations of gynecomastia are often not recognized. The main pathophysiology of gynecomastia is alteration in the balance between the stimulatory effect of estrogen and the inhibitory effects of androgens on the development of the breast. If there is no causal treatment, surgical resection is the therapy of first choice. CONCLUSION The exact mechanism of unilateral gynecomastia formation in our case is unclear. The evaluation of unilateral gynecomastia can therefore be complex. In conclusion, the surgical treatment of unilateral gynecomastia requires an individual approach, based on an appropriate diagnostic algorithm. PMID:25437663

Exposure of wide cerebellomedullary cisterns for vascular lesion surgeries in cerebellomedullary cisterns: opening of unilateral cerebellomedullary fissures combined with lateral foramen magnum approach.

PubMed

Matsushima, Toshio; Kawashima, Masatou; Inoue, Kohei; Matsushima, Ken; Miki, Koichi

2014-11-01

To clarify microsurgical anatomic features of the cerebellomedullary fissure (CMF), the natural cleavage plane between the cerebellum and the medulla, and its relationship to the cerebellomedullary cistern (CMC) and to describe a surgical technique that uses the unilateral trans-CMF approach for CMC surgeries. In the anatomic study, 2 formalin-fixed cadaver heads were used. In the clinical study, 3 patients with vertebral artery-posterior inferior cerebellar artery aneurysms and 3 patients with glossopharyngeal neuralgia were surgically treated through the unilateral trans-CMF approach combined with the transcondylar fossa approach, which is a lateral foramen magnum approach. The CMC was present at the lateral end of the CMF. The CMF was closed by arachnoidal adhesion, and the cerebellar hemisphere was superiorly attached to the cerebellar peduncle. After the unilateral CMF was completely opened, the cerebellar hemisphere was easily retracted rostrodorsally. Clinically, almost completely opening the unilateral CMF markedly enabled the retraction of the biventral lobule to obtain a wide surgical field safely for vascular CMC lesions. We present 2 representative cases. Combined unilateral trans-CMF/lateral foramen magnum approaches provide a wide and close surgical field in the CMC, allowing easy and safe CMC surgery. Copyright © 2014 Elsevier Inc. All rights reserved.

[Low dose isobaric, hyperbaric, or hypobaric bupivacaine for unilateral spinal anesthesia.].

PubMed

Imbelloni, Luiz Eduardo; Beato, Lúcia; Gouveia, Marildo A; Cordeiro, José Antônio

2007-06-01

Unilateral spinal anesthesia has its advantages, especially in patients undergoing outpatient basis surgeries. Low dose, slow speed of administration, and the lateral positioning make easier the unilateral distribution in spinal anesthesia. Isobaric, hyperbaric, and hypobaric solutions of bupivacaine were compared in the unilateral spinal anesthesia in patients undergoing outpatient basis orthopedic surgeries. One hundred and fifty patients were randomly divided in three groups to receive 5 mg of 0.5% isobaric bupivacaine (Iso Group), 5 mg of 0.5% hyperbaric bupivacaine (Hyper Group), or 5 mg of 0.15% hypobaric bupivacaine (Hypo Group). The solutions were administered in the L3-L4 space with the patient in the lateral decubitus and remaining in this position for 20 minutes. Sensitive anesthesia was evaluated by the pin prick test. Motor blockade was determined by the modified Bromage scale. Both blockades were compared with the opposite side and among themselves. There was a significant difference between the side of the surgery and the opposite side in all three groups at 20 minutes, but the frequency of unilateral spinal anesthesia was greater with the hyperbaric and hypobaric solutions. Sensitive and motor blockades were observed in 14 patients in the Iso Group, 38 patients in the Hyper Group, and 40 patients in the Hypo Group. Patients did not develop any hemodynamic changes. Postpuncture headache and transitory neurological symptoms were not observed. Spinal anesthesia with hypobaric and hyperbaric solutions present a higher frequency of unilateral anesthesia. After 20 minutes, isobaric bupivacaine mobilized into cerebrospinal fluid (CSF) resulted in unilateral spinal anesthesia in only 28% of the patients.

Unilateral versus bilateral stent insertion for malignant hilar biliary obstruction.

PubMed

Chang, Gang; Xia, Feng-Fei; Li, Hong-Fu; Niu, Su; Xu, Yuan-Shun

2017-11-01

To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction. From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups. Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002). Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.

Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy--a feasibility study.

PubMed

Thier, Mark; Nordenström, Erik; Bergenfelz, Anders; Westerdahl, Johan

2009-09-01

We report the surgical treatment of a consecutive series of scan negative patients with the intention of unilateral parathyroid exploration with the aid of intraoperative quick PTH (qPTH). The study included 35 consecutive sestamibi scan negative patients (27 women, eight men) with sporadic pHPT subjected to first time surgery. Median age was 70 years and median preoperative calcium level 2.8 mmol/L. Thirty-three patients had a histological diagnosis of a parathyroid adenoma (median weight 0.48 g [range 0.12 g-2.5 g]). Nineteen patients were explored bilaterally and 16 patients (46%) were operated unilaterally. The median operation time was 40 min in the unilateral group and 95 min in the bilateral group (p < 0.001). Three patients were treated for postoperative hypocalcemia after bilateral exploration versus none in the unilateral group (p = 0.23). With a minimum of 12 months of follow-up, 33 patients (94.3%) were cured. One case of recurrent HPT presented after bilateral exploration with visualization of four glands. One case of persistent HPT was observed after unilateral exploration. qPTH was predictive of operative failure in both patients. Forty-six percent of the patients in our study could be operated unilaterally with a total cure rate of 94%. Patients in the unilateral group had a significant shorter operation time and a lower incidence of postoperative hypocalcemia. In conclusion our investigation shows that limited parathyroid exploration can safely be performed on patients with negative sestamibi scintigraphy by the aid of qPTH.

Does unilateral single-event multilevel surgery improve gait in children with spastic hemiplegia? A retrospective analysis of a long-term follow-up.

PubMed

Schranz, Christian; Kruse, Annika; Kraus, Tanja; Steinwender, Gerhardt; Svehlik, Martin

2017-02-01

Single event multilevel surgery (SEMLS) has become a standard intervention for children with cerebral palsy (CP). SEMLS proved to improve the gait in bilateral spastic cerebral palsy and those improvements can be maintained in the long term. However there is no evidence on the long-term outcome of unilateral SEMLS in children with unilateral spastic cerebral palsy. The gait analyses and clinical data of 14 children (9 male/5 female, mean age 12.1) with unilateral CP (6 children Gross Motor Function Classification System Scale level I and 8 children level II) were retrospectively reviewed at four time-points: preoperatively, 1year, 3-5 years and approximately 10 years after unilateral SEMLS. The Gait Profile Score (GPS) of the affected leg was used as a main and the number of fine tuning procedures as well as complications rate (Clavien-Dindo classification) as secondary outcome measures. The gait improved postoperatively and the GPS of the affected leg significantly declined by 3.73° which is well above the minimal clinical important difference of 1.6°. No deterioration of GPS occurred throughout the follow-up period. Therefore the postoperative improvement was maintained long-term. However, additional fine-tuning procedures had to be performed during the follow-up in 5 children and three complications occurred (one level II and two level III). The results indicate that children with unilateral cerebral palsy benefit from unilateral SEMLS and maintain gait improvements long-term. Copyright © 2016 Elsevier B.V. All rights reserved.

Neuronal network-based mathematical modeling of perceived verticality in acute unilateral vestibular lesions: from nerve to thalamus and cortex.

PubMed

Glasauer, S; Dieterich, M; Brandt, T

2018-05-29

Acute unilateral lesions of vestibular graviceptive pathways from the otolith organs and semicircular canals via vestibular nuclei and the thalamus to the parieto-insular vestibular cortex regularly cause deviations of perceived verticality in the frontal roll plane. These tilts are ipsilateral in peripheral and in ponto-medullary lesions and contralateral in ponto-mesencephalic lesions. Unilateral lesions of the vestibular thalamus or cortex cause smaller tilts of the perceived vertical, which may be either ipsilateral or contralateral. Using a neural network model, we previously explained why unilateral vestibular midbrain lesions rarely manifest with rotational vertigo. We here extend this approach, focussing on the direction-specific deviations of perceived verticality in the roll plane caused by acute unilateral vestibular lesions from the labyrinth to the cortex. Traditionally, the effect of unilateral peripheral lesions on perceived verticality has been attributed to a lesion-based bias of the otolith system. We here suggest, on the basis of a comparison of model simulations with patient data, that perceived visual tilt after peripheral lesions is caused by the effect of a torsional semicircular canal bias on the central gravity estimator. We further argue that the change of gravity coding from a peripheral/brainstem vectorial representation in otolith coordinates to a distributed population coding at thalamic and cortical levels can explain why unilateral thalamic and cortical lesions have a variable effect on perceived verticality. Finally, we propose how the population-coding network for gravity direction might implement the elements required for the well-known perceptual underestimation of the subjective visual vertical in tilted body positions.

Bilateral totally extraperitoneal (TEP) repair of the ultrasound-diagnosed asymptomatic contralateral inguinal hernia.

PubMed

Malouf, Phillip A; Descallar, Joseph; Berney, Christophe R

2018-02-01

The aim of this series is to determine the clinical utility of routine ultrasound (US) of the contralateral, clinically normal groin when a unilateral inguinal hernia is referred for hernia repair-specifically assessing the morbidity and short-term change in quality-of-life (QoL) due to repair of this occult contralateral hernia when also repairing the symptomatic side. TEP inguinal hernia repair affords the opportunity to repair any groin hernia through the same small incisions. US detects 96.6% of groin hernias with 84.4% specificity. 234 consecutive male patients with clinically unilateral and clinically bilateral hernia were enrolled; those with a clinically unilateral hernia were sent for groin US and if positive, a bilateral TEP groin hernia repair was performed (USBH). If negative, a unilateral TEP groin hernia repair was performed (UNIH). Carolina's comfort scales (CCS) and visual analogue scores (VAS) were recorded at 2 and 6 weeks postoperatively, while a modified CCS (MCCS) was recorded for all patients preoperatively. Bilateral TEP repair resulted in higher VAS scores than unilateral repair at 2 weeks but not 6 weeks. CCS were worse in the USBH group than UNIH group at 2 weeks but were similar by 6 weeks. Complications' rates were similar amongst all 3 groups. Factors contributing to worse scores were: smaller hernia, complications, worse preoperative MCCS results, recurrent hernia and bilateral rather than unilateral repair. Bilateral TEP for the clinically unilateral groin hernia with an occult contralateral groin hernia can be performed without increased morbidity, accepting a minor and very temporary impairment of QoL.

Speech and Language Consequences of Unilateral Hearing Loss: A Systematic Review.

PubMed

Anne, Samantha; Lieu, Judith E C; Cohen, Michael S

2017-10-01

Objective Unilateral hearing loss has been shown to have negative consequences for speech and language development in children. The objective of this study was to systematically review the current literature to quantify the impact of unilateral hearing loss on children, with the use of objective measures of speech and language. Data Sources PubMed, EMBASE, Medline, CINAHL, and Cochrane Library were searched from inception to March 2015. Manual searches of references were also completed. Review Methods All studies that described speech and language outcomes for children with unilateral hearing loss were included. Outcome measures included results from any test of speech and language that evaluated or had age-standardized norms. Due to heterogeneity of the data, quantitative analysis could not be completed. Qualitative analysis was performed on the included studies. Two independent evaluators reviewed each abstract and article. Results A total of 429 studies were identified; 13 met inclusion criteria and were reviewed. Overall, 7 studies showed poorer scores on various speech and language tests, with effects more pronounced for children with severe to profound hearing loss. Four studies did not demonstrate any difference in testing results between patients with unilateral hearing loss and those with normal hearing. Two studies that evaluated effects on speech and language longitudinally showed initial speech problems, with improvement in scores over time. Conclusions There are inconsistent data regarding effects of unilateral hearing loss on speech and language outcomes for children. The majority of recent studies suggest poorer speech and language testing results, especially for patients with severe to profound unilateral hearing loss.

Pterional approach versus unilateral frontal approach on tuberculum sellae meningioma: Single centre experiences

PubMed Central

Arifin, Muhammad Zafrullah; Mardjono, Ignatius; Sidabutar, Roland; Wirjomartani, Beny Atmadja; Faried, Ahmad

2012-01-01

Introduction: Tuberculum Sellae Meningioma is one of the most challenging surgeries among neurosurgeons. Many approaches have been established in the effort of removing the tumor and some of them are supported by an advanced neurosurgical technology. In this study, we aim to compare the efficacy of the two most common approaches, the pterional and the unilateral frontal. Materials and Methods: This was a restrospective study that aimed to observe the efficacy of the two most common approaches used in our center, the pterional and the unilateral frontal, in resecting the tuberculum sellae meningioma, which was held in Dr. Hasan Sadikin General Hospital, Bandung, from July 2007-July 2010. Twenty patients were enrolled with half of them operated by the pterional approach and the rest by unilateral frontal approach. We evaluated six parameters: tumor size, degree of tumor removal, surgery duration, post-operative cerebral edema, patients' outcome, and length of stay, which were evaluated to take measure of the efficacy of each procedure. Results: We found that the pterional approach gave more advantages than the unilateral frontal. Total tumor removal, especially in tumor size ≥ 3 cm was achieved in a greater number of subjects in the pterional (P<0.023). Other advantages of the pterional compared to the unilateral frontal were a shorter surgical duration (P=0.024), shorter length of stay (P=0.009) and less frequency of post-operative cerebral edema incidence (P=0.023). Conclusion: According to our facilities and conditions, it seems that the pterional approach have more advantages than the unilateral frontal approach in tuberculum sellae meningioma surgery. PMID:22639687

Neurophysiological mechanisms and functional impact of mirror movements in children with unilateral spastic cerebral palsy.

PubMed

Kuo, Hsing-Ching; Friel, Kathleen M; Gordon, Andrew M

2018-02-01

Children with unilateral spastic cerebral palsy (CP) often have mirror movements, i.e. involuntary imitations of unilateral voluntary movements of the contralateral upper extremity. The pathophysiology of mirror movements has been investigated in small and heterogeneous cohorts in the literature. Specific pathophysiology of mirror movements and their impact on upper extremity function require systematic investigation in larger and homogeneous cohorts of children with unilateral spastic CP. Here we review two possible neurophysiological mechanisms underlying mirror movements in children with CP and those with typical development: (1) an ipsilateral corticospinal tract projecting from the contralesional motor cortex (M1) to both upper extremities; (2) insufficient interhemispheric inhibition between the two M1s. We also discuss clinical implications of mirror movements in children with unilateral CP and suggest that a thorough examination of the relationship between the pathophysiology and clinical manifestations of mirror movements is warranted. We suggest two premises: (1) the presence of mirror movements is indicative of an ipsilateral corticospinal tract reorganization; and (2) the corticospinal tract organization may affect patients' responses to certain treatment. If these premises are supported through future research, mirror movements should be clinically evaluated for patient selection to maximize benefits of therapy, hence promoting individualized medicine in this population. Mirror movements may be indicative of the underlying corticospinal tract reorganization in children with unilateral spastic cerebral palsy (CP). Future research will benefit from systematic investigations of the relationship between mirror movements and its pathophysiology. Mirror movements may be a potential biomarker for individualized medicine in children with unilateral spastic CP. © 2017 Mac Keith Press.

Five-year progression of unilateral age-related macular degeneration to bilateral involvement: the Three Continent AMD Consortium report

PubMed Central

Joachim, Nichole; Colijn, Johanna Maria; Kifley, Annette; Lee, Kristine E; Buitendijk, Gabriëlle H S; Klein, Barbara E K; Myers, Chelsea E; Meuer, Stacy M; Tan, Ava G; Holliday, Elizabeth G; Attia, John; Liew, Gerald; Iyengar, Sudha K; de Jong, Paulus T V M; Hofman, Albert; Vingerling, Johannes R; Mitchell, Paul; Klaver, Caroline C W; Klein, Ronald; Wang, Jie Jin

2018-01-01

Purpose To assess the 5-year progression from unilateral to bilateral age-related macular degeneration (AMD) and associated risk factors. Design Pooled data analyses of three prospective population-based cohorts, the Blue Mountains Eye Study, Beaver Dam Eye Study and Rotterdam Study. Methods Retinal photography and interview with comprehensive questionnaires were conducted at each visit of three studies. AMD was assessed following the modified Wisconsin AMD grading protocol. Progression to bilateral any (early and late) or late AMD was assessed among participants with unilateral involvement only. Factors associated with the progression were assessed using logistic regression models while simultaneously adjusting for other significant risk factors. Results In any 5-year duration, 19–28% of unilateral any AMD cases became bilateral and 27–68% of unilateral late AMD became bilateral. Factors associated with the progression to bilateral involvement of any AMD were age (per year increase, adjusted OR 1.07), carrying risk alleles of the complement factor H and age-related maculopathy susceptibility 2 genes (compared with none, OR 1.76 for 1 risk allele and OR 3.34 for 2+ risk alleles), smoking (compared with non-smokers, OR 1.64 for past and OR 1.67 for current smokers), and the presence of large drusen area or retinal pigmentary abnormalities in the first eye. Conclusion One in four to one in five unilateral any AMD cases, and up to one in two unilateral late AMD cases, progressed to bilateral in 5 years. Known AMD risk factors, including smoking, are significantly associated with the progression to bilateral involvement. PMID:28108569

Mechanics in the Production of Mandibular Fractures: A Clinical, Retrospective Case-Control Study

PubMed Central

Yang, Rongtao; Li, Zhi; Li, Zubing

2016-01-01

As the mandible is susceptible to fracture, the aim of this study was to use multivariate logistic regression analysis to identify and distinguish various internal factors that may influence the location of mandibular fractures. The study included 1131 patients with maxillofacial fractures during the period from January 2000 to December 2009 to evaluate the association of mandibular fracture location (unilateral symphysis, body, angle, condylar, or bilateral condylar fractures) with various internal factors. Among the 1131 patients, 869 had mandibular fractures. Data on age, sex, soft tissue injuries, dental trauma, and maxillofacial fracture type were collected and analyzed using multivariate logistic regression. In total, 387, 210, 139, 319, and 172 patients were diagnosed with unilateral symphysis, body, angle, unilateral, or bilateral condylar fractures, respectively. The dental trauma in patients with bilateral condylar fractures differed from that in patients with unilateral condylar fractures. Patients with mandibular fracture (unilateral symphysis, body, unilateral or bilateral condylar) possessed an approximately equal risk of soft tissue injuries in the mandible. Patients with either unilateral or bilateral condylar fractures were associated with a low risk of mandibular angle fracture (OR < 1). Similarly, patients with mandibular angle fracture were associated with a low risk of unilateral or bilateral condylar fractures (OR < 1). Moreover, patients with symphysis fracture were associated with a low risk of bilateral condylar fractures (90 of 387 [23.3%], OR 0.899). By contrast, patients with bilateral condylar fractures were associated with a high risk of symphysis fracture (90 of 172 [52.3%], OR 17.38). Patients with condylar fractures, particularly those with bilateral condylar fractures, were infrequently associated with secondary mandibular fractures. Mandibular fractures tended to have less of an association with midfacial fractures. The occurrence of mandibular fractures is strongly correlated with age, sex, soft tissue injuries, dental trauma, and the pattern and position of the maxillofacial fractures in patients. PMID:26900699

Unilateral jumps in different directions: a novel assessment of soccer-associated power?

PubMed

Murtagh, Conall F; Vanrenterghem, Jos; O'Boyle, Andrew; Morgans, Ryland; Drust, Barry; Erskine, Robert M

2017-11-01

We aimed to determine whether countermovement jumps (CMJs; unilateral and bilateral) performed in different directions assessed independent lower-limb power qualities, and if unilateral CMJs would better differentiate between elite and non-elite soccer players than the bilateral vertical (BV) CMJ. Elite (n=23; age, 18.1±1.0years) and non-elite (n=20; age, 22.3±2.7years) soccer players performed three BV, unilateral vertical (UV), unilateral horizontal-forward (UH) and unilateral medial (UM) CMJs. Jump performance (height and projectile range), kinetic and kinematic variables from ground reaction forces, and peak activation levels of the vastus lateralis and biceps femoris (BF) muscles from surface electromyography, were compared between jumps and groups of players. Peak vertical power (V-power) was greater in BV (220.2±30.1W/kg) compared to UV (144.1±16.2W/kg), which was greater than UH (86.7±18.3W/kg) and UM (85.5±13.5W/kg) (all, p<0.05) but there was no difference between UH and UM (p=1.000). Peak BF EMG was greater in UH compared to all other CMJs (p≤0.001). V-power was greater in elite than non-elite for all CMJs (p≤0.032) except for BV (p=0.197). Elite achieved greater UH projectile range than non-elite (51.6±15.4 vs. 40.4±10.4cm, p=0.009). We have shown that UH, UV and UM CMJs assess distinct lower-limb muscular power capabilities in soccer players. Furthermore, as elite players outperformed non-elite players during unilateral but not BV CMJs, unilateral CMJs in different directions should be included in soccer-specific muscular power assessment and talent identification protocols, rather than the BV CMJ. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

A naturalistic study of high-dose unilateral ECT among severely depressed inpatients: how does it work in the clinical practice?

PubMed

Alves, Lucas P C; Freire, Thiago F V; Fleck, Marcelo P A; Rocha, Neusa S

2016-11-11

Naturalistic studies can be useful tools to understand how an intervention works in the real clinical practice. This study aims to investigate the outcomes in a naturalistically treated depressed inpatients cohort, who were referred, or not, to unilateral ECT. Depressed adults according to MINI admitted in a psychiatric unit were divided in unilateral ECT treated and non-ECT treated. Main outcomes were: depression improvement in Hamilton Rating Scale for Depression (HDRS-17) scores; response (HDRS-17 improvement ≥50 %); remission (HDRS-17 score ≤7); length of hospitalization. Forty-three patients were included in unilateral ECT group and 104 in non-ECT group. No differences of psychotic symptoms, melancholic features or past maniac episode were found between groups. Unilateral ECT group had a mean HDRS-17 score higher than non-ECT group at admission (ECT: 25.05 ± 1.03; non-ECT: 21.61 ± 0.69; p = 0.001), but no significant difference was found at discharge (ECT: 7.70 ± 0.81; non-ECT: 7.40 ± 0.51; p = 0.75). Unilateral ECT group had a larger HDRS-17 score reduction during treatment (ECT: 18.24 ± 1.18; non-ECT:14.20 ± 0.76; p = 0.004). There were no significant differences in response and remission rates between groups. Unilateral ECT group had longer mean duration of hospitalization in days (ECT: 35.48 ± 2.48; non-ECT: 24.57 ± 1.50; p < 0.001), but there were no difference in mean time of treatment (ECT group:27.66 ± 1.95; non-ECT: 24.57 ± 1.50; p = 0.25). Unilateral high-dose ECT is still a useful treatment option, in the real world clinical practice, to reduce the intensity of depressive symptoms in highly depressed inpatients.

Induction of cortical plasticity and improved motor performance following unilateral and bilateral transcranial direct current stimulation of the primary motor cortex.

PubMed

Kidgell, Dawson J; Goodwill, Alicia M; Frazer, Ashlyn K; Daly, Robin M

2013-07-01

Transcranial direct current stimulation (tDCS) is a non-invasive technique that modulates the excitability of neurons within the primary motor cortex (M1). Research shows that anodal-tDCS applied over the non-dominant M1 (i.e. unilateral stimulation) improves motor function of the non-dominant hand. Similarly, previous studies also show that applying cathodal tDCS over the dominant M1 improves motor function of the non-dominant hand, presumably by reducing interhemispheric inhibition. In the present study, one condition involved anodal-tDCS over the non-dominant M1 (unilateral stimulation) whilst a second condition involved applying cathodal-tDCS over the dominant M1 and anodal-tDCS over non-dominant M1 (bilateral stimulation) to determine if unilateral or bilateral stimulation differentially modulates motor function of the non-dominant hand. Using a randomized, cross-over design, 11 right-handed participants underwent three stimulation conditions: 1) unilateral stimulation, that involved anodal-tDCS applied over the non-dominant M1, 2) bilateral stimulation, whereby anodal-tDCS was applied over the non-dominant M1, and cathodal-tDCS over the dominant M1, and 3) sham stimulation. Transcranial magnetic stimulation (TMS) was performed before, immediately after, 30 and 60 minutes after stimulation to elucidate the neural mechanisms underlying any potential after-effects on motor performance. Motor function was evaluated by the Purdue pegboard test. There were significant improvements in motor function following unilateral and bilateral stimulation when compared to sham stimulation at all-time points (all P < 0.05); however there was no difference across time points between unilateral and bilateral stimulation. There was also a similar significant increase in corticomotor excitability with both unilateral and bilateral stimulation immediately post, 30 minutes and 60 minutes compared to sham stimulation (all P < 0.05). Unilateral and bilateral stimulation reduced short-interval intracortical inhibition (SICI) immediately post and at 30 minutes (all P < 0.05), but returned to baseline in both conditions at 60 minutes. There was no difference between unilateral and bilateral stimulation for SICI (P > 0.05). Furthermore, changes in corticomotor plasticity were not related to changes in motor performance. These results indicate that tDCS induced behavioural changes in the non-dominant hand as a consequence of mechanisms associated with use-dependant cortical plasticity that is independent of the electrode arrangement.

Bilateral versus unilateral interlaminar approach for bilateral decompression in patients with single-level degenerative lumbar spinal stenosis: a multicenter retrospective study of 175 patients on postoperative pain, functional disability, and patient satisfaction.

PubMed

den Boogert, Hugo F; Keers, Joost C; Marinus Oterdoom, D L; Kuijlen, Jos M A

2015-09-01

The bilateral and unilateral interlaminar techniques for bilateral decompression both demonstrate good results for the treatment of degenerative lumbar spinal stenosis (DLSS). Although there is some discussion about which approach is more effective, studies that directly compare these two popular techniques are rare. To address this shortcoming, this study compares postoperative functional disability, pain, and patient satisfaction among patients with single-level DLSS who underwent bilateral decompression using either a bilateral or unilateral approach. This retrospective study included patients who underwent operations between November 1, 2009, and October 1, 2011. These patients underwent single-level bilateral decompressive surgery using either the bilateral or unilateral interlaminar approach at one of 5 participating hospitals. Exclusion criteria included previous lumbar surgery, additional disc surgery, and spondylolisthesis requiring fusion surgery. Primary outcome measures included bodily pain (as reported using the visual analog scale [VAS]), the Roland-Morris Disability Questionnaire (RMDQ), and the Oswestry Disability Index (ODI). In addition, reductions in leg and back symptoms and the patient's general evaluation of the procedure were queried. Finally, patient satisfaction and surgical parameters were evaluated. Questionnaires were sent to each patient's home, and electronic patient files were used to collect the data. One hundred and seventy-five patients returned the questionnaire (74.4% response rate; 68 and 107 patients who underwent the bilateral or unilateral approach, respectively). Mean age at surgery was 68 years (range 34-89 years), and the mean follow-up period was 14.2 months (range 3.3-27.4 years). There were no significant differences in ODI (20.3 vs 22.6 for the bilateral and unilateral approaches, respectively), RMDQ (3.99 vs 4.8, respectively), or pain scores between treatment groups. Back symptoms were reduced in 74.8% (bilateral: 74.6% vs unilateral: 75%; not significant), and leg symptoms in 80.6% of the patients (bilateral: 73.1% vs unilateral: 85.4%; p = 0.048). In total, 72.1% (bilateral) and 80.0% (unilateral) of patients reported good overall treatment results (p = 0.226). Significantly more patients in the unilateral group reported a better overall satisfaction with the procedure (82.1% vs 69.1%; p = 0.047). There were no differences in postoperative functional disability and pain between the surgical techniques. The significant differences in patient satisfaction and reduction in leg symptoms were unrelated to surgical technique. The overall treatment results were satisfactory. Both techniques are safe and effective options for treating patients with single-level DLSS.

Unilateral RS3PE in a Patient of Seronegative Rheumatoid Arthritis

PubMed Central

Varshney, Ankur Nandan; Kumar, Nilesh; Tiwari, Ashutosh; Anand, Ravi; Prasad, Sashi Ranjan; Anand, Arvind; Mishra, Abhinandan; Singh, N. K.

2013-01-01

Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare but well-reported clinical entity. It is classically described as symmetrical involvement of both upper extremities. Asymmetrical involvement had also been reported, but unilateral presentation is very rare. We hereby report a case of unilateral RS3PE in a patient of seronegative rheumatoid arthritis which was initially misdiagnosed as cellulitis and was given high dose antibiotics without any significant improvement. Later a rheumatologic consultation leads to a prompt diagnosis, and treatment with steroids leads to dramatic reversal of symptoms. This case demonstrates the rare presentation of this rare clinical entity and highlights the necessity of awareness regarding unilateral disease to clinicians. PMID:23662237

Decennial trends and inequalities in healthy life expectancy: The HUNT Study, Norway.

PubMed

Storeng, Siri H; Krokstad, Steinar; Westin, Steinar; Sund, Erik R

2018-02-01

Norway is experiencing a rising life expectancy combined with an increasing dependency ratio - the ratio of those outside over those within the working force. To provide data relevant for future health policy we wanted to study trends in total and healthy life expectancy in a Norwegian population over three decades (1980s, 1990s and 2000s), both overall and across gender and educational groups. Data were obtained from the HUNT Study, and the Norwegian Educational Database. We calculated total life expectancy and used the Sullivan method to calculate healthy life expectancies based on self-rated health and self-reported longstanding limiting illness. The change in health expectancies was decomposed into mortality and disability effects. During three consecutive decades we found an increase in life expectancy for 30-year-olds (~7 years) and expected lifetime in self-rated good health (~6 years), but time without longstanding limiting illness increased less (1.5 years). Women could expect to live longer than men, but the extra life years for females were spent in poor self-rated health and with longstanding limiting illness. Differences in total life expectancy between educational groups decreased, whereas differences in expected lifetime in self-rated good health and lifetime without longstanding limiting illness increased. The increase in total life expectancy was accompanied by an increasing number of years spent in good self-rated health but more years with longstanding limiting illness. This suggests increasing health care needs for people with chronic diseases, given an increasing number of elderly. Socioeconomic health inequalities remain a challenge for increasing pensioning age.

Outcome of Endodontically Treated Teeth Diagnosed With Cracked Tooth

DTIC Science & Technology

2015-06-01

However, variable symptoms complicate the diagnosis (9). In a study of 32 patients presenting with diffuse longstanding orofacial pain eventually...883-92. 22)Byrnjulsen A, Fristad I, Grevstad T, Hals-Kvinnsland I. Incompletely fractured teeth associated with diffuse longstanding orofacial pain ...cracked tooth is highly associated with discomfort. Patients often describe a momentary, sudden, sharp, lancinating pain that results in continuous tooth

Development of Graves' disease after long-standing hypothyroidism on treatment, with acute toxicity to thionamides and lithium.

PubMed

Gupta, Yashdeep; Singh, Sandeep; Ammini, Ariachery C

2012-08-01

Thyroid hyperfunction in a patient with long-standing hypothyroidism is uncommon. Here, we describe and discuss the unusual scenario of development of severe skin rash to carbimazole, with subsequent acute toxicity to lithium in clinically indicated doses, in a patient who manifested hyperthyroidism after being on treatment for hypothyroidism for 7 years.

Ageing with long-standing hearing impairment and deafness.

PubMed

Gething, L

2000-09-01

Until recently, ageing with a long-standing disability had not been a major consideration for governments around the world. Policy and planning for this substantial subgroup had not kept abreast with developments in regard to the growing numbers of older people in general. Consultations held in Australia provided information and recommendations for use by governments and service agencies. The focus was on the viewpoints of consumers. This article reports results for people with long-standing deafness and hearing impairment. It is believed that disadvantages throughout life act to restrict freedom of choice and well-being in old age. Important factors perceived to underlie disadvantage include lifelong restricted access to the opportunities afforded by education and employment and their concomitant effects on the ability to develop the skills, attitudes and knowledge necessary for independence in old age; attitudes of others (including service providers); and the complexity and inflexibility of service systems. However, there are positive aspects. Comparison with published reports about people who acquired hearing loss as a result of the ageing process suggests that people with long-standing disability have learned to live with their situation. In contrast, people whose loss was associated with ageing often report emotional issues and isolation.

Perfluorodecalin lavage of a longstanding lung atelectasis in a child with spinal muscle atrophy.

PubMed

Henrichsen, Thore; Lindenskov, Paal H H; Shaffer, Thomas H; Loekke, Ruth J V; Fugelseth, Drude; Lindemann, Rolf

2012-04-01

Persistent lung atelectasis is difficult to treat and perfluorochemical (PFC) liquid may be an option for bronchioalveolar lavage (BAL). A 4-year-old girl with spinal muscle atrophy was admitted in respiratory failure. On admission, the X-ray confirmed the persistence of total right-sided lung atelectasis, which had been present for 14 months. She was endotracheally intubated and ventilated from the day of admission. BAL with normal saline was performed twice without improvement. Following failed extubation and being dependent on continuous respiratory support, a trial of BAL using PFC liquid (Perfluorodecalin HP) was carried out. The PFC was delivered through the endotracheal tube on three consecutive days. A loading dose of 3 ml/kg was administered, followed by a varying dose in order to more effectively lavage the lungs. She tolerated the procedure well the first 2 days, although there were no clinical signs of improvement in the atelectasis. Intentionally, higher inflation pressures were applied after PFC instillation on day 3. Chest X-ray then showed hazy infiltrates on her left lung and she required more ventilatory support. However, lung infiltrates cleared over the next 3 days. A tracheotomy was done 6 days after the last PFC instillation. She had a slow recovery and was successfully decanulated. Clinical improvement of lung function was seen including less need of BiPAP and oxygen. A chest CT scan showed then functional lung tissue appearing in the previous total atelectatic right lung. Lavage with PFC can safely be performed with a therapeutic effect in a child with unilateral total lung atelectasis. Copyright © 2011 Wiley Periodicals, Inc.

A low-dose bupivacaine: a comparison of hyperbaric and hypobaric solutions for unilateral spinal anesthesia.

PubMed

Kaya, Menşure; Oğuz, Selma; Aslan, Kemal; Kadioğullari, Nihal

2004-01-01

The injection of small doses of local anesthetic solutions through pencil-point directional needles and maintaining the lateral decubitus position for 15 to 30 minutes after the injection have been suggested to facilitate the unilateral distribution of spinal anesthesia. We evaluated the effects of hypobaric and hyperbaric bupivacaine in attempting to achieve unilateral spinal anesthesia for patients undergoing lower limb orthopedic surgery. Fifty patients were randomly allocated into 2 groups to receive either 1.5 mL hyperbaric bupivacaine 0.5% (7.5 mg; n = 25) or 4.2 mL hypobaric bupivacaine 0.18% (7.5 mg; n = 25). Drugs were administered at the L3-4 interspace with the patient in the lateral position. Patients remained in this position for 15 minutes before turning supine for the operation. Spinal block was assessed by pinprick and modified Bromage scale on both sides. Unilateral spinal block was observed in 20 patients in the hyperbaric group (80%) and in 19 patients in the hypobaric group (76%) while in the lateral position. However, 15 minutes after patients were turned supine, unilateral spinal anesthesia decreased to 68% of cases in the hyperbaric group and 24% of cases in the hypobaric group (P <.05). The motor block was more intense during the first 5 and 10 minutes (P <.05), but at the end of operation there was no difference between the groups. The hemodynamic changes were similar between the groups. As a result, unilateral spinal anesthesia with hyperbaric and hypobaric bupivacaine provided a rapid motor and sensory recovery and good hemodynamic stability, but more unilateral spinal block was achieved in patients in the hyperbaric group when compared with patients in the hypobaric group.

Acute effects of unilateral whole body vibration training on single leg vertical jump height and symmetry in healthy men.

PubMed

Shin, Seungho; Lee, Kyeongjin; Song, Changho

2015-12-01

[Purpose] The aim of the present study was to investigate the acute effects of unilateral whole body vibration training on height and symmetry of the single leg vertical jump in healthy men. [Subjects] Thirty males with no history of lower limb dysfunction participated in this study. [Methods] The participants were randomly allocated to one of three groups: the unilateral vibratory stimulation group (n=10), bilateral vibratory stimulation group (n=10), and, no vibratory stimulation group (n=10). The subjects in the unilateral and bilateral stimulation groups participated in one session of whole body vibration training at 26 Hz for 3 min. The no vibratory stimulation group subjects underwent the same training for 3 min without whole body vibration. All participants performed the single leg vertical jump for each lower limb, to account for the strong and weak sides. The single leg vertical jump height and symmetry were measured before and after the intervention. [Results] The single leg vertical jump height of the weak lower limb significantly improved in the unilateral vibratory stimulation group, but not in the other groups. The single leg vertical jump height of the strong lower limb significantly improved in the bilateral vibratory stimulation group, but not in the other groups. The single leg vertical jump symmetry significantly improved in the unilateral vibratory stimulation group, but not in the other groups. [Conclusion] Therefore, the present study found that the effects of whole body vibration training were different depending on the type of application. To improve the single leg vertical jump height in the weak lower limbs as well as limb symmetry, unilateral vibratory stimulation might be more desirable.

Sequencing bilateral and unilateral task-oriented training versus task oriented training alone to improve arm function in individuals with chronic stroke.

PubMed

McCombe Waller, Sandy; Whitall, Jill; Jenkins, Toye; Magder, Laurence S; Hanley, Daniel F; Goldberg, Andrew; Luft, Andreas R

2014-12-14

Recovering useful hand function after stroke is a major scientific challenge for patients with limited motor recovery. We hypothesized that sequential training beginning with proximal bilateral followed by unilateral task oriented training is superior to time-matched unilateral training alone. Proximal bilateral training could optimally prepare the motor system to respond to the more challenging task-oriented training. Twenty-six participants with moderate severity hemiparesis Intervention: PARTICIPANTS received either 6-weeks of bilateral proximal training followed sequentially by 6-weeks unilateral task-oriented training (COMBO) or 12-weeks of unilateral task-oriented training alone (SAEBO). A subset of 8 COMB0 and 9 SAEBO participants underwent three functional magnetic resonance imaging (fMRI) scans of hand and elbow movement every 6 weeks. Fugl-Meyer Upper extremity scale, Modified Wolf Motor Function Test, University of Maryland Arm Questionnaire for Stroke, Motor cortex activation (fMRI). The COMBO group demonstrated significantly greater gains between baseline and 12-weeks over all outcome measures (p = .018 based on a MANOVA test) and specifically in the Modified Wolf Motor Function test (time). Both groups demonstrated within-group gains on the Fugl-Meyer Upper Extremity test (impairment) and University of Maryland Arm Questionnaire for Stroke (functional use). fMRI subset analyses showed motor cortex (primary and premotor) activation during hand movement was significantly increased by sequential combination training but not by task-oriented training alone. Sequentially combining a proximal bilateral before a unilateral task-oriented training may be an effective way to facilitate gains in arm and hand function in those with moderate to severe paresis post-stroke compared to unilateral task oriented training alone.

Posteroanterior cephalometric changes in subjects with temporomandibular joint disorders

PubMed Central

Almăşan, O C; Băciuţ, M; Hedeşiu, M; Bran, S; Almăşan, H; Băciuţ, G

2013-01-01

Objectives The aim of the study was to establish the changes in posteroanterior cephalometric variables in subjects with temporomandibular joint disorders (TMDs). Methods Posteroanterior cephalograms of 61 subjects (age range 16–36.6 years, standard deviation 4.88 years) were used to determine cephalometric differences. Subjects were classified according to the Research Diagnostic Criteria for Temporomandibular Joint Disorders into three groups: unilateral TMD, bilateral TMD and no TMD. 14 linear and angular measurements were assessed on the posteroanterior cephalogram. For assessing facial asymmetry, the asymmetry index for bilateral measurements was calculated between the right and the left side. In cases with unilateral TMD, the asymmetry index was calculated using the difference between the unaffected and affected side. The differences among multiple groups were analysed using the one-way analysis of variance test and Scheffé post hoc test. Results 47 subjects were females (77%) and 14 were males (23%). 19 subjects had unilateral TMDs and 16 subjects had bilateral TMDs. The asymmetry index of the distance from the horizontal plane to the antegonion was higher in subjects with unilateral TMD than in patients with bilateral or no TMD (p < 0.05). Also, the asymmetry index of the distances from the vertical plane to the condyle (p = 0.05), gonion (Go) (p = 0.0004), antegonion (p = 0.002) and chin (Ch) (p = 0.02) was higher in subjects with unilateral TMDs. The asymmetry index of the O point–Go–Go′ and O point–Ch–Ch′ angles differed significantly in subjects with unilateral TMDs (p < 0.05). Conclusions Unilateral TMDs are associated with changes in posteroanterior cephalometric measurements. The assessment of posteroanterior cephalometric variables could be used as a key factor for evaluating the presence of TMDs. PMID:23253565

Quantitative comparison of cortical and deep grey matter in pathological subtypes of unilateral cerebral palsy.

PubMed

Scheck, Simon M; Pannek, Kerstin; Fiori, Simona; Boyd, Roslyn N; Rose, Stephen E

2014-10-01

The aim of this study was to quantify grey matter changes in children with unilateral cerebral palsy (UCP), differentiating between cortical or deep grey matter (CDGM) lesions, periventricular white matter (PWM) lesions, and unilateral and bilateral lesions. In a cross-sectional study we obtained high resolution structural magnetic resonance images from 72 children (41 males, 31 females, mean age 10y 9mo [SD 3y 1mo], range 5y 1mo-17y 1mo) with UCP (33 left, 39 right hemiplegia; Manual Ability Classification System level I n=29, II n=43; Gross Motor Function Classification System level I n=46, II n=26), and 19 children with typical development (CTD; eight males, 11 females, mean age 11y 2mo [SD 2y 7mo], range 7y 8mo-16y 4mo). Images were classified by lesion type and analyzed using voxel-based morphometry (VBM) and subcortical volumetric analysis. Deep grey matter volumes were not significantly different between children with CDGM and PWM lesions, with the thalamus, putamen, and globus pallidus being reduced unilaterally in both groups compared with CTD (p≤0.001). Children with CDGM lesions additionally showed widespread cortical changes involving all lobes using VBM (p<0.01). Children with bilateral lesions had reduced thalamus and putamen volumes bilaterally (p<0.001). The thalamic volume was reduced bilaterally in children with unilateral lesions (p=0.004). Lesions to the PWM cause secondary changes to the deep grey matter structures similar to primary changes seen in CDGM lesions. Despite having a unilateral phenotype, grey matter changes are observed bilaterally, even in children with unilateral lesions. © 2014 Mac Keith Press.

Unilateral pseudogynecomastia: an occupational hazard in manual metal-pressing factories?

PubMed

Spyropoulou, Georgia-Alexandra; Karamatsoukis, Stavros; Foroglou, Pericles

2011-04-01

Five cases of unilateral occupation-related pseudogynecomastia are presented. All the patients in these cases worked in the same metal-pressing factory. One patient with grade 4 unilateral gynecomastia in the right breast presented to the authors' outpatient department asking persistently for surgery. He also reported that all his male colleagues working in the same business (a total of 5) had different degrees of unilateral gynecomastia. Their line of work involved holding a long round rod under the axilla and then pressing the distal end of it firmly against a spinning metal plate. The patient underwent a superior pedicle breast reduction, with 1,800 ml of tissue removed from his right breast. Unfortunately, the patient experienced partial nipple loss. However, he was satisfied with the final result, and good symmetry was achieved. All five patients who worked in the same metal-pressing factory presented with unilateral gynecomastia and were examined in our department. Their average age was 51.4 years. All the patients had normal hormonal and biochemical status, and the results of screening for toxins and heavy metal exposure were negative. All the patients were heavy smokers. At examination, none of the patients had nipple discharge or retraction, skin changes, galactorrhea, or lymphadenopathy. Examination showed one patient with grade 4, three patients had grade 2, and one patient with grade 1 unilateral gynecomastia. The authors believe that gynecomastia may be considered an occupational risk in analogous metal-pressing factories because all the workers in this factory presented with some degree of unilateral gynecomastia. However, they emphasize that this may simply be an observational phenomenon without a true cause and effect relationship.

[Investigation of body weight ratios on joint structures at different knee flexion angles in patients with unilateral knee arthroplasty].

PubMed

Bakırhan, Serkan; Unver, Bayram; Karatosun, Vasfi

2013-01-01

The study aims to determine body weight ratios between extremities in patients with unilateral total knee arthroplasty (TKA) at 12 months postoperatively at the static-standing position at 30, 60 and 90 degrees of knee flexion. The study included 52 female patients (mean age 65.6±10.6 years; range 40 to 83 years) who underwent unilateral primary TKA. The force-platform was used to calculate the body-weight ratios of the patients. Body weight ratios on the operated and non-operated limbs of the unilateral TKA patients were examined at standing-static position at 30, 60 and 90 degrees of knee flexion on the force-platform according to their age and body mass index (BMI). The pain levels of the patients were evaluated using the visual analog scale. It was found that unilateral TKA patients placed their body weight on the non-operated limb more at the standing-static position, and 30, 60 and 90 degrees of knee flexion at 12 months postoperatively (p<0.05). It was also found that as the knee flexion degree increased with age, so did TKA patients place their body weight on the nonoperated limb more (p<0.05), and that BMI had no effect on the load distribution difference over the two extremities (p>0.05). During the postoperative period, load asymmetry between the two extremities in patients with unilateral TKA remains the same due to advancing age. This accelerates the osteoarthritis process on the non-operated knee. It is concluded that the age factor should be taken into account while planning physiotherapy and rehabilitation programs for unilateral TKA patients and knee exercise programs aiming to place load over the operated limb should be arranged.

The Fate of Nephrons in Congenital Obstructive Nephropathy: Adult Recovery is Limited by Nephron Number Despite Early Release of Obstruction.

PubMed

Sergio, Maria; Galarreta, Carolina I; Thornhill, Barbara A; Forbes, Michael S; Chevalier, Robert L

2015-11-01

Urinary tract obstruction and reduced nephron number often occur together as a result of maldevelopment of the kidneys and the urinary tract. We determined the role of nephron number on adaptation of the remaining nephrons of mice subjected to neonatal partial unilateral ureteral obstruction followed through adulthood. Wild-type and Os/+ mice (the latter with 50% fewer nephrons) underwent sham operation or partial unilateral ureteral obstruction in the first 2 days of life. Additional mice underwent release of unilateral ureteral obstruction at 7 days. All kidneys were harvested at 3 weeks (weaning) or 6 weeks (adulthood). Glomerular number and area, glomerulotubular junction integrity, proximal tubular volume fraction and interstitial fibrosis were measured by histomorphometry. In the obstructed kidney unilateral ureteral obstruction caused additional nephron loss in Os/+ but not in wild-type mice. Glomerular growth from 3 to 6 weeks was impaired by ipsilateral obstruction and not preserved by release in wild-type or Os/+ mice. Proximal tubular growth was impaired and interstitial collagen was increased by ipsilateral obstruction in all mice. These conditions were attenuated by release of unilateral ureteral obstruction in wild-type mice but were not restored in Os/+ mice. Unilateral ureteral obstruction increased interstitial collagen in the contralateral kidney while release of obstruction enhanced tubular growth and reduced interstitial collagen. Unilateral ureteral obstruction in early postnatal development impairs adaptation to reduced nephron number and induces additional nephron loss despite release of obstruction. Premature and low birth weight infants with congenital obstructive nephropathy are likely at increased risk for progression of chronic kidney disease. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

MOG antibody–positive, benign, unilateral, cerebral cortical encephalitis with epilepsy

PubMed Central

Ogawa, Ryo; Takahashi, Toshiyuki; Kaneko, Kimihiko; Akaishi, Tetsuya; Takai, Yoshiki; Sato, Douglas Kazutoshi; Nishiyama, Shuhei; Misu, Tatsuro; Kuroda, Hiroshi; Aoki, Masashi; Fujihara, Kazuo

2017-01-01

Objective: To describe the features of adult patients with benign, unilateral cerebral cortical encephalitis positive for the myelin oligodendrocyte glycoprotein (MOG) antibody. Methods: In this retrospective, cross-sectional study, after we encountered an index case of MOG antibody–positive unilateral cortical encephalitis with epileptic seizure, we tested for MOG antibody using our in-house, cell-based assay in a cohort of 24 consecutive adult patients with steroid-responsive encephalitis of unknown etiology seen at Tohoku University Hospital (2008–2014). We then analyzed the findings in MOG antibody–positive cases. Results: Three more patients, as well as the index case, were MOG antibody–positive, and all were adult men (median age 37 years, range 23–39 years). The main symptom was generalized epileptic seizure with or without abnormal behavior or consciousness disturbance. Two patients also developed unilateral benign optic neuritis (before or after seizure). In all patients, brain MRI demonstrated unilateral cerebral cortical fluid-attenuated inversion recovery hyperintense lesions, which were swollen and corresponded to hyperperfusion on SPECT. CSF studies showed moderate mononuclear pleocytosis with some polymorphonuclear cells and mildly elevated total protein levels, but myelin basic protein was not elevated. A screening of encephalitis-associated autoantibodies, including aquaporin-4, glutamate receptor, and voltage-gated potassium channel antibodies, was negative. All patients received antiepilepsy drugs and fully recovered after high-dose methylprednisolone, and the unilateral cortical MRI lesions subsequently disappeared. No patient experienced relapse. Conclusions: These MOG antibody–positive cases represent unique benign unilateral cortical encephalitis with epileptic seizure. The pathology may be autoimmune, although the findings differ from MOG antibody–associated demyelination and Rasmussen and other known immune-mediated encephalitides. PMID:28105459

Hemivertebra resection with posterior unilateral intervertebral fusion and transpedicular fixation for congenital scoliosis: results with at least 3 years of follow-up.

PubMed

Feng, Yi; Hai, Yong; Zhao, Sheng; Zang, Lei

2016-10-01

The main treatment for congenital scoliosis is posterior hemivertebra resection with bilateral transpedicular fixation. Reports describing posterior unilateral intervertebral fusion and transpedicular screw fixation are rare, with no long-term follow-up results, especially in older children. Retrospective analysis of the long-term outcomes of unilateral fusion and fixation after hemivertebra resection for congenital scoliosis. From April 2004 to May 2012, 19 consecutive cases (12 males; age range 2.3-13.4 years) of congenital scoliosis treated by hemivertebra resection with posterior unilateral or bilateral exposure and unilateral intervertebral fusion with transpedicular screw instrumentation alone were investigated retrospectively. All cases were followed-up for at least 3 years. The mean Cobb angle of the segmental scoliosis was improved from 34.8 to 13.4° (correction rate 61.5 %). The mean Cobb angle of the segmental kyphosis was improved from 23.5 to 5.8° (correction rate 75.3 %). The mean correction rates of compensatory cranial and caudal curves were 46.1 and 54.5 %, respectively. 11 patients (57.8 %) exhibited continuous segmental curve improvement during the follow-up. One pedicle fracture and one instrumentation failure were recorded. Unilateral transpedicular screw fixation provides satisfactory correction of the spinal deformity in both very young and older children. Unilateral intervertebral fusion and transpedicular fixation represents an advisable alternative method for the correction of congenital scoliosis and has advantages of reduced trauma, less surgery time and lower expense. Furthermore, the non-fused concave side offers the opportunity for correction of subsequent spine deformity.

Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions.

PubMed

Pasternak, Jesse D; Seib, Carolyn D; Seiser, Natalie; Tyrell, J Blake; Liu, Chienying; Cisco, Robin M; Gosnell, Jessica E; Shen, Wen T; Suh, Insoo; Duh, Quan-Yang

2015-10-01

Adrenal incidentalomas are found in 1% to 5% of abdominal cross-sectional imaging studies. Although the workup and management of unilateral lesions are well established, limited information exists for bilateral incidentalomas. To compare the natural history of patients having bilateral incidentalomas with those having unilateral incidentalomas. Retrospective analysis of a prospective database of consecutive patients referred to an academic multidisciplinary adrenal conference. The setting was a tertiary care university hospital among a cohort of 500 patients with adrenal lesions between July 1, 2009, and July 1, 2014. Prevalence, age, imaging characteristics, biochemical workup, any intervention, and final diagnosis. Twenty-three patients with bilateral incidentalomas and 112 patients with unilateral incidentalomas were identified. The mean age at diagnosis of bilateral lesions was 58.7 years. The mean lesion size was 2.4 cm on the right side and 2.8 cm on the left side. Bilateral incidentalomas were associated with a significantly higher prevalence of subclinical Cushing syndrome (21.7% [5 of 23] vs 6.2% [7 of 112]) (P = .009) and a significantly lower prevalence of pheochromocytoma (4.3% [1 of 23] vs 19.6% [22 of 112]) (P = .003) compared with unilateral lesions, while rates of hyperaldosteronism were similar in both groups (4.3% [1 of 23] vs 5.4% [6 of 112]) (P > .99). Only one patient with bilateral incidentalomas underwent unilateral resection. The mean follow-up was 4 years (range, 1.2-13.0 years). There were no occult adrenocortical carcinomas. Bilateral incidentalomas are more likely to be associated with subclinical Cushing syndrome and less likely to be pheochromocytomas. Although patients with bilateral incidentalomas undergo a workup similar to that in patients with unilateral lesions, differences in their natural history warrant a greater index of suspicion for subclinical Cushing syndrome.

Intrafamilial phenotypic heterogeneity of the Poland complex: a case report.

PubMed

Parano, E; Falsaperla, R; Pavone, V; Toscano, A; Bolan, E A; Trifiletti, R R

1995-08-01

Three cases of familial unilateral gluteal hypoplasia are reported. The index case in addition to having gluteal hypoplasia also has unilateral pectoral muscle hypoplasia. Another relative has unilateral symbrachydactyly of the distal phalanges of one foot. All four affected individuals in our pedigree were female. We propose that our cases are best classified as part of the Poland complex of anomalies. Our cases emphasize that intrafamilial phenotypic heterogeneity is possible within the Poland complex.

A comparison of low dose hyperbaric levobupivacaine and hypobaric levobupivacaine in unilateral spinal anaesthesia.

PubMed

Kaya, M; Oztürk, I; Tuncel, G; Senel, G Ozalp; Eskiçirak, H; Kadioğullari, N

2010-11-01

The aim of this study was to compare the clinical effects and characteristics of hyperbaric and hypobaric levobupivacaine for unilateral spinal anaesthesia. Sixty patients were randomly allocated into two groups to receive either 7.5 mg (1.5 ml) hyperbaric levobupivacaine 0.5% or 7.5 mg (4 ml) hypobaric levobupivacaine 0.1875% for elective arthroscopic surgery of the knee under spinal anaesthesia. The level and duration of sensory block, intensity and duration of motor block were recorded. Unilateral sensory block was observed in 27 patients (90%) in the hyperbaric group and 24 patients (80%) in the hypobaric group in the lateral position. After 15 minutes, patients were turned to supine to redistribute the spinal block toward the non-operative side, but spinal anaesthesia was still unilateral in 18 patients (60%) in the hyperbaric group and 10 patients (33%) in the hypobaric group (P = 0.038). Time to readiness for home discharge and complete recovery of sensory block were similar in both groups. In the hyperbaric group, the motor block scores were higher on the operative side during first 10 minutes than they were in the hypobaric group (P < 0.002). Motor block regression was faster in the hyperbaric group (P = 0.01). Hyperbaric and hypobaric levobupivacaine both provided satisfactory unilateral spinal anaesthesia with good haemodynamic stability for arthroscopic surgery, but with more frequent unilateral spinal anaesthesia in the hyperbaric group.

Revisiting neurofibromatosis type 2 diagnostic criteria to exclude LZTR1-related schwannomatosis.

PubMed

Smith, Miriam J; Bowers, Naomi L; Bulman, Michael; Gokhale, Carolyn; Wallace, Andrew J; King, Andrew T; Lloyd, Simon K L; Rutherford, Scott A; Hammerbeck-Ward, Charlotte L; Freeman, Simon R; Evans, D Gareth

2017-01-03

To determine the specificity of the current clinical diagnostic criteria for neurofibromatosis type 2 (NF2) relative to the requirement for unilateral vestibular schwannoma (VS) and at least 2 other NF2-related tumors. We interrogated our Manchester NF2 database, which contained 205 individuals meeting NF2 criteria who initially presented with a unilateral VS. Of these, 83 (40.7%) went on to develop a contralateral VS. We concentrated our genetic analysis on a group of 70 who initially fulfilled NF2 criteria with a unilateral vestibular schwannoma and at least 2 additional nonintradermal schwannomas. Overall, 5/70 (7%) individuals with unilateral VS and at least 2 other schwannomas had a pathogenic or likely pathogenic LZTR1 mutation. Twenty of the 70 subsequently developed bilateral disease. Of the remaining 50, 5 (10%) had a germline LZTR1 mutation, equivalent to the number (n = 5) with a germline NF2 mutation. The most common etiology for unilateral VS and 2 additional NF2-associated tumors in this cohort was mosaic NF2. Germline LZTR1 and germline NF2 mutations were equally common in our cohort. This indicates that LZTR1 must be considered when making a diagnosis of NF2 in the presence of unilateral VS in individuals without a germline NF2 mutation. © 2016 American Academy of Neurology.

Use of prism adaptation in children with unilateral brain lesion: Is it feasible?

PubMed

Riquelme, Inmaculada; Henne, Camille; Flament, Benoit; Legrain, Valéry; Bleyenheuft, Yannick; Hatem, Samar M

2015-01-01

Unilateral visuospatial deficits have been observed in children with brain damage. While the effectiveness of prism adaptation for treating unilateral neglect in adult stroke patients has been demonstrated previously, the usefulness of prism adaptation in a pediatric population is still unknown. The present study aims at evaluating the feasibility of prism adaptation in children with unilateral brain lesion and comparing the validity of a game procedure designed for child-friendly paediatric intervention, with the ecological task used for prism adaptation in adult patients. Twenty-one children with unilateral brain lesion randomly were assigned to a prism group wearing prismatic glasses, or a control group wearing neutral glasses during a bimanual task intervention. All children performed two different bimanual tasks on randomly assigned consecutive days: ecological tasks or game tasks. The efficacy of prism adaptation was measured by assessing its after-effects with visual open loop pointing (visuoproprioceptive test) and subjective straight-ahead pointing (proprioceptive test). Game tasks and ecological tasks produced similar after-effects. Prismatic glasses elicited a significant shift of visuospatial coordinates which was not observed in the control group. Prism adaptation performed with game tasks seems an effective procedure to obtain after-effects in children with unilateral brain lesion. The usefulness of repetitive prism adaptation sessions as a therapeutic intervention in children with visuospatial deficits and/or neglect, should be investigated in future studies. Copyright © 2015 Elsevier Ltd. All rights reserved.

The effect of extracapsular injuries on growth and development of the mandible condyle: an experimental study in growing dogs.

PubMed

Liu, Siying; Tian, Lei; Ding, Mingchao; Liu, Yanpu; Li, Guiyu; Chen, Jinwu; Ding, Yin

2016-11-01

To investigate the effects of condylar extracapsular injuries on the development of the mandibular condyle and try to find a way to treat condylar hyperplasia by electively using such injuries to restrict the overdeveloped mandibular condyle. Sixty 6-month-old beagle puppies were divided randomly into five groups: blank control; unilateral fracture to the condylar neck; unilateral fracture to the condylar neck treated with rigid internal fixation; unilateral periosteum injury; unilateral decortication of the condylar neck. Computed tomography, 99 m Tc single-photon emission computed tomography, and tetracycline-calcein double-labeling were performed after surgery. The puppies were sacrificed 12 and 24 weeks after surgery. Morphologic analyses and examination of growth activity were done. Unilateral fracture of the condylar neck without fixation caused local morphologic changes during the early postoperative period, but compensatory growth of the condyle altered such changes after healing. The other types of injury failed to inhibit the growth of the condyle and the mandible, whereas functional deviation of the chin was found after unilateral fracture of the condylar neck with or without fixation. The four types of extracapsular injury described here failed to inhibit the growth of the mandibular condyle and could not be selected as alternatives to treat condylar hyperplasia. Copyright © 2016 Elsevier Inc. All rights reserved.

Unilateral Outer Bow Expanded Cervical Headgear Force System: 3D Analysis Using Finite Element Method.

PubMed

Geramy, Allahyar; Mortezai, Omid; Esmaily, Masomeh; Darvishpour, Hojat

2015-04-01

Headgears are among the effective orthodontic appliances to achieve treatment goals. Unilateral molar distal movement is sometimes needed during an orthodontic treatment, which can be achieved by an asymmetric headgear. Different unilateral headgears have been introduced. The main goal of this study was to analyze the force system of unilateral expanded outer bow asymmetric headgears by the finite element method (FEM). Six 3D finite element models of a mesiodistal slice of the maxilla containing upper first molars, their periodontal ligaments (PDLs), cancellous bone, cortical bone, and a cervical headgear with expanded outer bow attached to maxillary first molars were designed in SolidWorks 2010 and meshed in ANSYS Workbench ver. 12.1. The models were the same except for the degree of outer bow expansion. The outer bow ends were loaded with 2 N force. The distal driving force and the net moment were evaluated. A decrease in the distalizing force in the normal side molar from 1.69 N to 1.37 N was shown by increasing the degree of unilateral expansion. At the same time, the force increased from 2.19 N to 2.49 N in the expanded side molar. A net moment increasing from 2.26 N.mm to 4.64 N.mm was also shown. Unilateral outer bow expansion can produce different distalizing forces in molars, which increase by increasing the expansion.

Strain Distribution in a Kennedy Class I Implant Assisted Removable Partial Denture under Various Loading Conditions

PubMed Central

Shahmiri, Reza; Aarts, John M.; Bennani, Vincent; Swain, Michael V.

2013-01-01

Purpose. This in vitro study investigates how unilateral and bilateral occlusal loads are transferred to an implant assisted removable partial denture (IARPD). Materials and Methods. A duplicate model of a Kennedy class I edentulous mandibular arch was made and then a conventional removable partial denture (RPD) fabricated. Two Straumann implants were placed in the second molar region, and the prosthesis was modified to accommodate implant retained ball attachments. Strain gages were incorporated into the fitting surface of both the framework and acrylic to measure microstrain (μStrain). The IARPD was loaded to 120Ns unilaterally and bilaterally in three different loading positions. Statistical analysis was carried out using SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) with an alpha level of 0.05 to compare the maximum μStrain values of the different loading conditions. Results. During unilateral and bilateral loading the maximum μStrain was predominantly observed in a buccal direction. As the load was moved anteriorly the μStrain increased in the mesial area. Unilateral loading resulted in a twisting of the structure and generated a strain mismatch between the metal and acrylic surfaces. Conclusions. Unilateral loading created lateral and vertical displacement of the IARPD. The curvature of the dental arch resulted in a twisting action which intensified as the unilateral load was moved anteriorly. PMID:23737788

Unilateral fixation for treatment of occipitocervical instability in children with congenital vertebral anomalies of the craniocervical junction.

PubMed

Mazur, Marcus D; Ravindra, Vijay M; Brockmeyer, Douglas L

2015-04-01

OBJECT Patients with occipitocervical (OC) instability from congenital vertebral anomalies (CVAs) of the craniocervical junction (CCJ) often have bony abnormalities that make instrumentation placement difficult. Within this patient population, some bilateral instrumentation constructs either fail or are not feasible, and a unilateral construct must be used. The authors describe the surgical management and outcomes of this disorder in patients in whom unilateral fixation constructs were used to treat OC instability. METHODS From a database of OC fusion procedures, the authors identified patients who underwent unilateral fixation for the management of OC instability. Patient characteristics, surgical details, and radiographic outcomes were reviewed. In each patient, CT scans were performed at least 4 months after surgery to evaluate for fusion. RESULTS Eight patients with CVAs of the CCJ underwent unilateral fixation for the treatment of OC instability. For 4 patients, the procedure occurred after a bilateral OC construct failed or infection forced hardware removal. For the remainder, it was the primary procedure. Two patients required reoperation for hardware revision and 1 developed nonunion requiring revision of the bone graft. Ultimately, 7 patients demonstrated osseous fusion on CT scans and 1 had a stable fibrous union. CONCLUSIONS These findings demonstrate that a unilateral OC fixation is effective for the treatment of OC instability in children with CVAs of the CCJ in whom bilateral screw placement fails or is not feasible.

Revisiting neurofibromatosis type 2 diagnostic criteria to exclude LZTR1-related schwannomatosis

PubMed Central

Smith, Miriam J.; Bowers, Naomi L.; Bulman, Michael; Gokhale, Carolyn; Wallace, Andrew J.; King, Andrew T.; Lloyd, Simon K.L.; Rutherford, Scott A.; Hammerbeck-Ward, Charlotte L.; Freeman, Simon R.

2017-01-01

Objective: To determine the specificity of the current clinical diagnostic criteria for neurofibromatosis type 2 (NF2) relative to the requirement for unilateral vestibular schwannoma (VS) and at least 2 other NF2-related tumors. Methods: We interrogated our Manchester NF2 database, which contained 205 individuals meeting NF2 criteria who initially presented with a unilateral VS. Of these, 83 (40.7%) went on to develop a contralateral VS. We concentrated our genetic analysis on a group of 70 who initially fulfilled NF2 criteria with a unilateral vestibular schwannoma and at least 2 additional nonintradermal schwannomas. Results: Overall, 5/70 (7%) individuals with unilateral VS and at least 2 other schwannomas had a pathogenic or likely pathogenic LZTR1 mutation. Twenty of the 70 subsequently developed bilateral disease. Of the remaining 50, 5 (10%) had a germline LZTR1 mutation, equivalent to the number (n = 5) with a germline NF2 mutation. Conclusions: The most common etiology for unilateral VS and 2 additional NF2-associated tumors in this cohort was mosaic NF2. Germline LZTR1 and germline NF2 mutations were equally common in our cohort. This indicates that LZTR1 must be considered when making a diagnosis of NF2 in the presence of unilateral VS in individuals without a germline NF2 mutation. PMID:27856782

Old models explain new observations of butterfly movement at patch edges.

PubMed

Crone, Elizabeth E; Schultz, Cheryl B

2008-07-01

Understanding movement in heterogeneous environments is central to predicting how landscape changes affect animal populations. Several recent studies point out an intriguing and distinctive looping behavior by butterflies at habitat patch edges and hypothesize that this behavior requires a new framework for analyzing animal movement. We show that this looping behavior could be caused by a longstanding movement model, biased correlated random walk, with bias toward habitat patches. The ability of this longstanding model to explain recent observations reinforces the point that butterflies respond to habitat heterogeneity and do not move randomly through heterogeneous environments. We discuss the implications of different movement models for predicting butterfly responses to landscape change, and our rationale for retaining longstanding movement models, rather than developing new modeling frameworks for looping behavior at patch edges.

Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture.

PubMed

Kommers, Sofie C; Boffano, Paolo; Forouzanfar, Tymour

2015-12-01

Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains. In this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases. In total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation. Based on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Unilateral right anterior capsulotomy for refractory major depression with comorbid obsessive-compulsive disorder.

PubMed

Riestra, Alonso R; Aguilar, Jaime; Zambito, Gerardo; Galindo y Villa, Gabriela; Barrios, Fernando; García, Carla; Heilman, Kenneth M

2011-12-01

Treatment-resistant major depression (MDD) and obsessive-compulsive disorder (OCD) remain a major cause of suffering and disability. These disorders may be treated with functional neurosurgery that almost always is bilateral but some patients might benefit from unilateral procedures. We performed a unilateral right anterior capsulotomy (AC) in a 45-year-old right-handed woman with MDD and comorbid OCD. This unilateral procedure was based on the results of neuropsychological testing and an 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) that revealed right hemisphere deficits in this patient. Following surgery, Hamilton Depression scale (HAM-D) decreased 57% at 1 and 2 years and 54% at 3 years and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decreased 58% at 1 year, 77% at 2 years, and 96% at 3 years. There was a slight decrement of verbal memory and phonemic fluency after the procedure that could also be related to changes in medication. Right basal ganglia abnormalities revealed by FDG-PET remained unchanged 16 months postoperatively. Overall this unilateral right AC was effective for the treatment of this woman's disorders with minimal adverse side effects.

Voice-related quality of life (V-RQOL) following type I thyroplasty for unilateral vocal fold paralysis.

PubMed

Hogikyan, N D; Wodchis, W P; Terrell, J E; Bradford, C R; Esclamado, R M

2000-09-01

Unilateral vocal fold paralysis is a common clinical problem which frequently causes severe dysphonia. Various treatment options exist for this condition, with the type I thyroplasty being one of the more commonly performed surgical procedures for vocal rehabilitation. The Voice-Related Quality of Life (V-RQOL) Measure is a validated outcomes instrument for voice disorders. This study measured the V-RQOL of patients with unilateral vocal fold paralysis who had undergone a type I thyroplasty and compared these scores to those of patients with untreated and uncompensated unilateral vocal fold paralysis and to normals. Treated patients had significantly higher domain and overall V-RQOL scores than untreated patients, but also scored lower than normals. These differences were true across gender and age. Patients who were more distant from surgery had lower V-RQOL scores than those who had more recently been treated. It is concluded that type I thyroplasty leads to a significantly higher V-RQOL for patients with unilateral vocal fold paralysis. This study also demonstrates further the utility of patient-oriented measures of treatment outcome.

Language-specific dysgraphia in Korean patients with right brain stroke: influence of unilateral spatial neglect.

PubMed

Jang, Dae-Hyun; Kim, Min-Wook; Park, Kyoung Ha; Lee, Jae Woo

2015-03-01

The purpose of the present study was to investigate the relationship between Korean language-specific dysgraphia and unilateral spatial neglect in 31 right brain stroke patients. All patients were tested for writing errors in spontaneous writing, dictation, and copying tests. The dysgraphia was classified into visuospatial omission, visuospatial destruction, syllabic tilting, stroke omission, stroke addition, and stroke tilting. Twenty-three (77.4%) of the 31 patients made dysgraphia and 18 (58.1%) demonstrated unilateral spatial neglect. The visuospatial omission was the most common dysgraphia followed by stroke addition and omission errors. The highest number of errors was made in the copying and the least was in the spontaneous writing test. Patients with unilateral spatial neglect made a significantly higher number of dysgraphia in the copying test than those without. We identified specific dysgraphia features such as a right side space omission and a vertical stroke addition in Korean right brain stroke patients. In conclusion, unilateral spatial neglect influences copy writing system of Korean language in patients with right brain stroke.

Unilateral cancer-associated retinopathy: a case report.

PubMed

Javaid, Zartash; Rehan, Shahzaib M; Al-Bermani, Ayad; Payne, Gareth

2016-08-01

We write to report a rare case of unilateral cancer-associated retinopathy previously undocumented in the literature. Cancer-associated retinopathy is an uncommon paraneoplastic syndrome. It is characterised by retinal antigen autoantibodies causing rod and cone dysfunction and abnormal electroretinography findings with consequent progressive visual loss.Our patient, known to have a primary cervical intraepithelial neoplasia, presented with unilateral blurred vision as well as a disturbance in colour and night vision. Electroretinography findings of reduced a and b waves in the right eye, together with a fundoscopic appearance of a mottled retinal pigment epithelium, attenuated blood vessels and optic disc pallor were consistent with unilateral cancer-associated retinopathy. Posterior subtenon injections of triamcinolone were administered to control active disease. With periocular steroid injections, at 4 years, our patient's visual acuity remained relatively stable and her condition persisted strictly unilaterally. Cancer-associated retinopathy may be the first presenting sign of an underlying malignancy or may indicate its recurrence. Moreover, in patients with a diagnosed gynaecological malignancy, visual symptoms could reflect cancer-associated retinopathy. In our patient visual symptoms came secondary to the diagnosis of cancer. © The Author(s) 2015.

Nearly total absence of pulmonary perfusion with corresponding technetium-99m MDP and gallium-67 uptake in a patient with mediastinal neuroblastoma

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

Garty, I.; Koren, A.; Moguilner, G.

1985-08-01

A case of unilateral nearly total hypoperfusion of the left lung in a 13-month-old girl is presented. The combination of the lung hypoperfusion and accumulation of the Tc-99m MDP and Ga-67 citrate in the same area suggested the preoperative diagnosis of mediastinal neuroblastoma. Explorative thoracotomy revealed the presence of a neuroblastoma compressing the left lung pedicle. The described scintigraphic appearance in the pediatric age group is suggested as typical of mediastinal neuroblastoma. This pathology should be included in the following gamuts in nuclear medicine: unilateral decrease or absent lung perfusion, unilateral diffuse chest uptake of Ga-67 citrate, and unilateral pulmonarymore » uptake in bone scintigraphy.« less

Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery.

PubMed

Ochi, Kentaro; Ohashi, Toru; Watanabe, Shoji

2003-02-01

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

Spatial Release from Masking in Children: Effects of Simulated Unilateral Hearing Loss

PubMed Central

Corbin, Nicole E.; Buss, Emily; Leibold, Lori J.

2016-01-01

Objectives The purpose of this study was twofold: 1) to determine the effect of an acute simulated unilateral hearing loss on children’s spatial release from masking in two-talker speech and speech-shaped noise, and 2) to develop a procedure to be used in future studies that will assess spatial release from masking in children who have permanent unilateral hearing loss. There were three main predictions. First, spatial release from masking was expected to be larger in two-talker speech than speech-shaped noise. Second, simulated unilateral hearing loss was expected to worsen performance in all listening conditions, but particularly in the spatially separated two-talker speech masker. Third, spatial release from masking was expected to be smaller for children than for adults in the two-talker masker. Design Participants were 12 children (8.7 to 10.9 yrs) and 11 adults (18.5 to 30.4 yrs) with normal bilateral hearing. Thresholds for 50%-correct recognition of Bamford-Kowal-Bench sentences were measured adaptively in continuous two-talker speech or speech-shaped noise. Target sentences were always presented from a loudspeaker at 0° azimuth. The masker stimulus was either co-located with the target or spatially separated to +90° or −90° azimuth. Spatial release from masking was quantified as the difference between thresholds obtained when the target and masker were co-located and thresholds obtained when the masker was presented from +90° or − 90°. Testing was completed both with and without a moderate simulated unilateral hearing loss, created with a foam earplug and supra-aural earmuff. A repeated-measures design was used to compare performance between children and adults, and performance in the no-plug and simulated-unilateral-hearing-loss conditions. Results All listeners benefited from spatial separation of target and masker stimuli on the azimuth plane in the no-plug listening conditions; this benefit was larger in two-talker speech than in speech-shaped noise. In the simulated-unilateral-hearing-loss conditions, a positive spatial release from masking was observed only when the masker was presented ipsilateral to the simulated unilateral hearing loss. In the speech-shaped noise masker, spatial release from masking in the no-plug condition was similar to that obtained when the masker was presented ipsilateral to the simulated unilateral hearing loss. In contrast, in the two-talker speech masker, spatial release from masking in the no-plug condition was much larger than that obtained when the masker was presented ipsilateral to the simulated unilateral hearing loss. When either masker was presented contralateral to the simulated unilateral hearing loss, spatial release from masking was negative. This pattern of results was observed for both children and adults, although children performed more poorly overall. Conclusions Children and adults with normal bilateral hearing experience greater spatial release from masking for a two-talker speech than a speech-shaped noise masker. Testing in a two-talker speech masker revealed listening difficulties in the presence of disrupted binaural input that were not observed in a speech-shaped noise masker. This procedure offers promise for the assessment of spatial release from masking in children with permanent unilateral hearing loss. PMID:27787392

An Old Road Rapidly Aging? The Settlement of Apollo's Long-Standing False Claims Act Lawsuit and the Changing Appeal of Commission-Based Recruitment

ERIC Educational Resources Information Center

Observatory on Borderless Higher Education, 2010

2010-01-01

Last month, higher education company the Apollo Group, Inc. (Apollo) confirmed that it entered into an agreement with the United States (US) federal government to resolve a long-standing lawsuit concerning its subsidiary, the for-profit University of Phoenix (Phoenix). Originating in 2003, the False Claims Act lawsuit filed by university officials…

A cross-sectional study of cryptorchidism in children: testicular volume and hormonal function at 18 years of age

PubMed Central

Varela-Cives, R.; Méndez-Gallart, R.; Estevez-Martínez, E.; Rodríguez-Barca, P.; Bautista-Casasnovas, A.; Pombo-Arias, M.; Tojo-Sierra, R.

2015-01-01

Purpose To evaluate the relationship between unilateral or bilateral criptorchidism, patient age, primary location of the gonad and modality of treatment with testicular volume and hormonal status at 18 years in patients diagnosed and treated for cryptorchidism during childhood. Materials and Methods Testicular volume, LH, FSH, and testosterone were evaluated in 143 young men at 18 years treated in childhood for unilateral (n=103) or bilateral (n=40) cryptorchidism. Results Unilateral cryptorchidism: Location of testis was prescrotal in 36 patients, inguinal in 52 and non-palpable in 15. The mean volume was 9.7 mL compared to 16.2 mL. for the spontaneously descended testicle in unilateral cryptorchidism. However, 22 patients who received HCG had a significantly bigger testis (11.8 mL.) than those treated with primary surgery (9.2 mL). The results showed a significant positive correlation between testicular volume and patient age at treatment. Bilateral cryptorchidism Location of testis was prescrotal in 34 cases, inguinal in 40 and 6 patients with non-palpable testicles. Mean volume at 18 years was 12.9 mL, greater than unilateral cryptorchid testis (9.7 mL) but smaller than healthy contralateral in unilateral cases (16.2 mL). There were significant differences in the testicular growth for bilateral patients with testicular descent after being treated with HCG (14.4 mL) in respect with those untreated (11.1 mL) or those who underwent primary surgery (11.4 mL). There was a significant positive correlation between the testicular volume and palpable (12.4 mL) or non-palpable testis (10.4 mL). There was a correlation between unilateral or bilateral cryptorchidism and levels of FSH. Conclusions Testicular volume and hormonal function at 18 years for patients diagnosed and treated for cryptorchidism during childhood are strongly influenced by whether the undescended testis was unilateral or bilateral. Location of the testes at diagnosis or age of initial treatment exerts no definite effect on testicular volume improvement or hormonal levels at 18 years of age. PMID:25928530

No Exacerbation of Knee Joint Pain and Effusion Following Preoperative Progressive Resistance Training in Patients Scheduled for Total Knee Arthroplasty: Secondary Analyses From a Randomized Controlled Trial.

PubMed

Skoffer, Birgit; Dalgas, Ulrik; Maribo, Thomas; Søballe, Kjeld; Mechlenburg, Inger

2017-11-09

Preoperative progressive resistance training (PRT) is controversial in patients scheduled for total knee arthroplasty (TKA), because of the concern that it may exacerbate knee joint pain and effusion. To examine whether preoperative PRT initiated 5 weeks prior to TKA would exacerbate pain and knee effusion, and would allow a progressively increased training load throughout the training period that would subsequently increase muscle strength. Secondary analyses from a randomized controlled trial. University Hospital and a Regional Hospital. A total of 30 patients who were scheduled for TKA due to osteoarthritis and assigned as the intervention group. Patients underwent unilateral PRT (3 sessions per week). Exercise loading was 12 repetitions maximum (RM) with progression toward 8 RM. The training program consisted of 6 exercises performed unilaterally. Before and after each training session, knee joint pain was rated on an 11-point scale, effusion was assessed by measuring the knee joint circumference, and training load was recorded. The first and last training sessions were initiated by 1 RM testing of unilateral leg press, unilateral knee extension, and unilateral knee flexion. The median pain change score from before to after each training session was 0 at all training sessions. The average increase in knee joint effusion across the 12 training sessions was a mean 0.16 cm ± 0.23 cm. No consistent increase in knee joint effusion after training sessions during the training period was found (P = .21). Training load generally increased, and maximal muscle strength improved as follows: unilateral leg press: 18% ± 30% (P = .03); unilateral knee extension: 81% ± 156% (P < .001); and unilateral knee flexion: 53% ± 57% (P < .001). PRT of the affected leg initiated shortly before TKA does not exacerbate knee joint pain and effusion, despite a substantial progression in loading and increased muscle strength. Concerns for side effects such as pain and effusion after PRT seem unfounded. To be determined. Copyright © 2017. Published by Elsevier Inc.

Reduction of the subacromial space in athletes with and without rotator cuff tendinopathy and its association with the strength of scapular muscles.

PubMed

Leong, Hio Teng; Tsui, Sammi Sin Mei; Ng, Gabriel Yin-Fat; Fu, Siu Ngor

2016-12-01

To compare the reduction of subacromial space (SAS) during arm abduction between overhead athletes with and without rotator cuff (RC) tendinopathy, and to explore the relationship between the strength of scapular muscles with the SAS. Cross-sectional study. Sixty-six athletes (33 healthy and 33 with RC tendinopathy, mean age=22.3 years) participated in the study. Ultrasound measurement of the SAS with arm at 0°, 30° and 60° of shoulder abduction were taken, and the maximal isometric force in upper, middle and lower trapezius, and serratus anterior with manual muscle tests (MMT) were assessed using a handheld dynamometer. The change in SAS during arm abduction from 0° to 30° (SAS 0°-30° ), 30° to 60° (SAS 30°-60° ) and 0° to 60° (SAS 0°-60° ) was compared between groups. Differences in force produced with scapular muscles MMT between groups and relationships with reduction in SAS were explored. We found more reduction of the SAS during SAS 0°-30° in athletes with RC tendinopathy (0.44±1.22mm) than healthy athletes (-0.06±1.41mm) (p=0.045). Athletes with RC tendinopathy demonstrated significant decrease in all scapular muscles MMT strength when compared to their healthy counterparts (p<0.05). In healthy athletes, a lower middle and lower trapezius MMT strength were moderately associated with a greater reduction in SAS during 0° to 30° (r=-0.445, p=0.016 and r=-0.423, p=0.022, respectively) and 0° to 60° of shoulder abduction (r=-0.415, p=0.018 and r=-0.504, p=0.003, respectively). Athletes with RC tendinopathy demonstrated more reduction in the SAS during early arm abduction. Decreased strength of middle and lower trapezius was related to reduction of the SAS. Copyright © 2016 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

PubMed

Southerst, Danielle; Yu, Hainan; Randhawa, Kristi; Côté, Pierre; D'Angelo, Kevin; Shearer, Heather M; Wong, Jessica J; Sutton, Deborah; Varatharajan, Sharanya; Goldgrub, Rachel; Dion, Sarah; Cox, Jocelyn; Menta, Roger; Brown, Courtney K; Stern, Paula J; Stupar, Maja; Carroll, Linda J; Taylor-Vaisey, Anne

2015-01-01

Musculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity. Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best-evidence synthesis principles. Where available, we computed mean changes between groups, relative risks and 95 % CI. We screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults. The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice. CRD42014009899.

Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up.

PubMed

Kesikburun, Serdar; Tan, Arif Kenan; Yilmaz, Bilge; Yaşar, Evren; Yazicioğlu, Kamil

2013-11-01

Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT. To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT. Randomized controlled trial; Level of evidence, 1. A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. Outcome measures (Western Ontario Rotator Cuff Index [WORC], Shoulder Pain and Disability Index [SPADI], 100-mm visual analog scale [VAS] of shoulder pain with the Neer test, and shoulder range of motion) were assessed at baseline and at 3, 6, 12, and 24 weeks and 1 year after injection. Comparison of the patients revealed no significant difference between the groups in WORC, SPADI, and VAS scores at 1-year follow-up (P = .174, P = .314, and P = .904, respectively). Similar results were found at other assessment points. Within each group, the WORC, SPADI, and VAS scores showed significant improvements compared with baseline at all time points (P < .001). In the range of motion measures, there were no significant group × time interactions. At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.

Clinical and radiological outcome of conservative vs. surgical treatment of atraumatic degenerative rotator cuff rupture: design of a randomized controlled trial.

PubMed

Lambers Heerspink, Frederik O; Hoogeslag, Roy Ag; Diercks, Ron L; van Eerden, Pepijn Jm; van den Akker-Scheek, Inge; van Raay, Jos Jam

2011-01-26

Subacromial impingement syndrome is a frequently observed disorder in orthopedic practice. Lasting symptoms and impairment may occur when a subsequent atraumatic rotator cuff rupture is also present. However, degenerative ruptures of the rotator cuff can also be observed in asymptomatic elderly individuals. Treatment of these symptomatic degenerative ruptures may be conservative or surgical. Acceptable results are reported for both treatment modalities. No evidence-based level-1 studies have been conducted so far to compare these treatment modalities. The objective of this study is to determine whether there is a difference in outcome between surgical reconstruction and conservative treatment of a degenerative atraumatic rotator cuff tendon rupture. A randomized controlled trial will be conducted. Patients aged between 45 and 75 with a symptomatic atraumatic rotator cuff rupture as diagnosed by MRI will be included. Exclusion criteria are traumatic rotator cuff rupture, frozen shoulder and diabetes mellitus. Patients will be randomized into two groups. Conservative treatment includes physical therapy according to a standardized protocol, NSAIDs and, if indicated, subacromial infiltration with a local anesthetic and corticosteroids. Surgical reconstruction is performed under general anesthesia in combination with an interscalenus plexus block. An acromioplasty with reconstruction of the rotator cuff tendon is performed, as described by Rockwood et al. Measurements take place preoperatively and 6 weeks, 3 months, 6 months and 1 year postoperatively. The primary outcome measure is the Constant score. Secondary measures include both disease-specific and generic outcome measures, and an economic evaluation. Additionally, one year after inclusion a second MRI will be taken of all patients in order to determine whether extent and localization of the rupture as well as the amount of fatty degeneration are prognostic factors. Both surgical as conservative treatment of a symptomatic atraumatic rotator cuff tendon rupture is used in current practice. There is a lack of level-1 studies comparing surgical vs. conservative treatment. This randomized controlled trial has been designed to determine whether the surgical treatment of a degenerative atraumatic rotator cuff tendon rupture may lead to a better functional and radiological outcome than conservative treatment after one year of follow-up. Netherlands Trial Register (NTR): NTRTC2343.

Poor health as a potential risk factor for job loss due to automation: the case of Norway.

PubMed

Hessel, Philipp; Christiansen, Solveig; Skirbekk, Vegard

2018-03-01

This study aimed to quantify the extent to which health characteristics of workers are related to the potential risk of experiencing job displacement due to automation. Linking the 2015 Norwegian Statistics on Income and Living Conditions survey (n=6393) with predicted probabilities of automation by occupation, we used Kruskal-Wallis tests and multivariate generalised linear models to assess the association between long-standing illnesses and risk of job automation. Individuals with long-standing illnesses face substantially greater risks of losing their job due to automation. Whereas the average risk of job automation is 57% for men and 49% for women with long-standing illnesses, the risk is only 50% for men and 44% for women with limitations (p<0.001). Controlling for age, having a long-standing illness significantly increases the relative risk of facing job automation among men (risk ratio (RR) 1.13, 95% CI 1.09 to 1.19), as well as women (RR 1.11, 95% CI 1.05 to 1.17). While, among men, the association between long-standing illness and risk of job automation remains significant when controlling for education and income, it becomes insignificant among women. Individuals with poor health are likely to carry the highest burden of technological change in terms of worsening employment prospects because of working in occupations disproportionally more likely to be automated. Although the extent of technology-related job displacement will depend on several factors, given the far-reaching negative consequences of job loss on health and well-being, this process represents a significant challenge for public health and social equity. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessment of the cochlear nerve to facial nerve size ratio using MR multiplanar reconstruction of the internal auditory canal in patients presenting with acquired long-standing hearing loss

PubMed Central

Hey, Constanze; Shaaban, Mohamed S; Elabd, Amr M; Hassan, Hebatallah H M; Gruber-Rouh, Tatjana; Kaltenbach, Benjamin; Harth, Marc; Ackermann, Hanns; Stöver, Timo; Vogl, Thomas J; Nour-Eldin, Nour-Eldin A

2017-01-01

Objective: To test using the facial nerve as a reference for assessment of the cochlear nerve size in patients with acquired long-standing sensorineural hearing loss (SNHL) using MRI multiplanar reconstruction. Methods: The study was retrospectively performed on 86 patients. Group 1 (study group, n = 53) with bilateral long-standing SNHL. Group 2 (control group, n = 33) without hearing loss. The nerve size was measured by drawing a region of interest around the cross-sectional circumference of the nerve in multiplanar reconstruction images. Results: No significant correlation was noted between the cochlear nerve and facial nerve size, and the patient's age, gender and weight (p > 0.05). In Group 1, the mean ratio of the cochlear to facial nerve size was 0.99 ± 0.30 (range: 0.52–1.86) and 1.12 ± 0.35 (range: 0.34–2.3) for the right and left sides, respectively. In Group 2, it was 1.18 ± 0.23 (range: 0.78–1.71) and 1.25 ± 0.25 (range: 0.85–1.94) for the right and left sides, respectively. The cochlear nerve size was statistically (p = 0.0004) smaller in Group 1 than in Group 2. Conclusion: The cochlear nerve size and the cochlear to facial nerve size ratio are significantly smaller in patients with acquired long-standing SNHL. Advances in knowledge: The facial nerve can be used as a reference for assessment of the cochlear nerve in patients with acquired long-standing SNHL. PMID:28368665

Unilateral blindness with third cranial nerve palsy and abnormal enhancement of extraocular muscles on magnetic resonance imaging of orbit after the ingestion of methanol.

PubMed

Chung, Tae Nyoung; Kim, Sun Wook; Park, Yoo Seok; Park, Incheol

2010-05-01

Methanol is generally known to cause visual impairment and various systemic manifestations. There are a few reported specific findings for methanol intoxication on magnetic resonance imaging (MRI) of the brain. A case is reported of unilateral blindness with third cranial nerve palsy oculus sinister (OS) after the ingestion of methanol. Unilateral damage of the retina and optic nerve were confirmed by fundoscopy, flourescein angiography, visual evoked potential and electroretinogram. The optic nerve and extraocular muscles (superior rectus, medial rectus, inferior rectus and inferior oblique muscle) were enhanced by gadolinium-DTPA on MRI of the orbit. This is the first case report of permanent monocular blindness with confirmed unilateral damage of the retina and optic nerve, combined with third cranial nerve palsy after methanol ingestion.

Asymmetry of the leg alignment affects trunk bending in the coronal plane after unilateral total knee arthroplasty.

PubMed

Harato, Kengo; Yoshida, Hiroki; Otani, Toshiro

2013-08-01

Unilateral total knee arthroplasty (TKA) would produce asymmetric changes of lower extremity in patients with bilateral varus deformity. Our purpose was to investigate whether asymmetry of the leg alignment would affect trunk bending in the coronal plane after unilateral TKA. Twenty patients (mean 76 years old) with bilateral end-stage knee osteoarthritis (OA) participated. Spine images during relaxed standing were obtained on pre- and postoperative day 21. As a result, the shoulder tilted more to the TKA side and the pelvis inclined more to the contralateral OA side. These results suggested that the trunk would bend away from the contralateral OA side after unilateral TKA in patients with bilateral end-stage knee OA and varus deformity. Asymmetry of the leg alignment led to asymmetric trunk bending. Copyright © 2013 Elsevier Inc. All rights reserved.

Early correction of unilateral scissor bite using transforce appliance and modified twin block appliance

PubMed Central

Chandorikar, Harshal; Nagrik, Arun; Bhad, Wasundhara A; Chavan, Santosh J; Doshi, Umal H

2017-01-01

Early treatment of scissor bite has been advocated mainly to prevent function jaw shift that can eventually lead to permanent skeletal asymmetry and temporomandibular joint pathosis. Although unilateral scissor bite is more common, most of the times, bilateral mandibular expansion is indicated. Lingual transforce appliance can be useful in such cases. This article presents a patient with unilateral scissor bite in mixed dentition with alveolar narrowing. Transforce appliance was used for scissor bite correction followed by modified twin block appliance for stabilization and settling of occlusion till the eruption of premolars. The case was finished with fixed mechanotherapy. Two years after completion of treatment, results were well maintained. Our results suggest that lingual transforce appliance along with careful management of occlusion is effective in the early management of severe unilateral scissor bite. PMID:28546961

Unilateral Outer Bow Expanded Cervical Headgear Force System: 3D Analysis Using Finite Element Method

PubMed Central

Mortezai, Omid; Esmaily, Masomeh; Darvishpour, Hojat

2015-01-01

Objectives: Headgears are among the effective orthodontic appliances to achieve treatment goals. Unilateral molar distal movement is sometimes needed during an orthodontic treatment, which can be achieved by an asymmetric headgear. Different unilateral headgears have been introduced. The main goal of this study was to analyze the force system of unilateral expanded outer bow asymmetric headgears by the finite element method (FEM). Materials and Methods: Six 3D finite element models of a mesiodistal slice of the maxilla containing upper first molars, their periodontal ligaments (PDLs), cancellous bone, cortical bone, and a cervical headgear with expanded outer bow attached to maxillary first molars were designed in SolidWorks 2010 and meshed in ANSYS Workbench ver. 12.1. The models were the same except for the degree of outer bow expansion. The outer bow ends were loaded with 2 N force. The distal driving force and the net moment were evaluated. Results: A decrease in the distalizing force in the normal side molar from 1.69 N to 1.37 N was shown by increasing the degree of unilateral expansion. At the same time, the force increased from 2.19 N to 2.49 N in the expanded side molar. A net moment increasing from 2.26 N.mm to 4.64 N.mm was also shown. Conclusion: Unilateral outer bow expansion can produce different distalizing forces in molars, which increase by increasing the expansion. PMID:26622282

Prevalence of dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate.

PubMed

Rullo, R; Festa, V M; Rullo, R; Addabbo, F; Chiodini, P; Vitale, M; Perillo, L

2015-09-01

To examine the prevalence of different types of dental anomalies in children with nonsyndromic cleft lip, unilateral cleft lip-palate, and bilateral cleft lip-palate. A sample of 90 patients (aged 4-20 years) affected by isolated cleft lip, unilateral and bilateral cleft lip and palate was examined. Cleft patients were classified into one of three groups according to cleft type: (1) Unilateral Cleft Lip-Palate, (2) Bilateral Cleft Lip-Palate, and (3) Cleft Lip. Intraoral exams, panoramic radiographs and dental casts, were used to analyse the prevalence of the various dental anomalies included in this study. There were no statistically significant differences between patients with cleft lip, unilateral cleft lip and palate and bilateral cleft lip and palate. The congenital absence of the cleft-side lateral incisor was observed in 40% of the sample, and a total of 30% patients showed supernumerary teeth at the incisors region. Second premolar agenesis was found in 4.4% of patients, whereas in 18.9% of the sample there was an ectopic dental eruption. Lateral or central incisors rotation was noted in 31.1% of the sample, while shape anomaly, lateral incisor microdontia, and enamel hypoplasia were detected respectively in 25.6%, 5.6% and 18.9% of cleft patients. High prevalence of different dental anomalies in children with cleft lip and unilateral and bilateral cleft lip and palate has been confirmed. This study, in particular, shows the presence of ectopic and rotated teeth in the cleft area.

Airway Obstruction and the Unilateral Cleft Lip and Palate Deformity: Contributions by the Bony Septum.

PubMed

Friel, Michael T; Starbuck, John M; Ghoneima, Ahmed M; Murage, Kariuki; Kula, Katherine S; Tholpady, Sunil; Havlik, Robert J; Flores, Roberto L

2015-07-01

Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). A 2-year retrospective review of all subjects with unilateral CLP who underwent CBCT imaging (n = 22) and age-matched controls (n = 9) who underwent CT imaging was conducted. Control CT scans were used to determine the segment of nasal septum comprised almost entirely of bone. The CBCT of the nasal airway was assessed using Dolphin software to determine the contribution of the bony septum to septal deviation and airway obstruction. The nasal septum posterior to the midpoint between anterior and posterior nasal spine is comprised of 96% bone. The nasal airway associated with this posterior bony segment was 43.1% (P < 0.001) larger by volume on the non-cleft side in patients with unilateral CLP. The average septal deviation within the posterior bony segment was 5.4 mm, accounting for 74.4% of the maximal deviation within the nasal airway. The average airway stenosis within the posterior bony nasal airway was 0.45 mm (0-2.2 mm). In patients with unilateral CLP, the bony nasal septum can demonstrate significant deviation and airway stenosis. Surgeons should consider a bony septoplasty in their treatment algorithm in unilateral CLP patients who have reached skeletal maturity.

Spine Topographical Distribution of Skin α-Synuclein Deposits in Idiopathic Parkinson Disease.

PubMed

Donadio, Vincenzo; Incensi, Alex; Rizzo, Giovanni; Scaglione, Cesa; Capellari, Sabina; Fileccia, Enrico; Avoni, Patrizia; Liguori, Rocco

2017-05-01

Phosphorylated α-synuclein (p-syn) in skin nerves mainly in the proximal sites is a promising neurodegenerative biomarker for idiopathic Parkinson disease (IPD). However, the p-syn spine distribution particularly in patients with unilateral motor dysfunctions remains undefined. This study aimed to investigate in IPD p-syn differences between left and right cervical spine sites in patients with prevalent unilateral motor symptoms, and cervical and thoracic spine sites in patients with bilateral motor symptoms. We enrolled 28 IPD patients fulfilling clinical diagnostic criteria associated with abnormal nigro-striatal DatScan and cardiac MIBG: 15 with prevalently unilateral motor symptoms demonstrated by DatScan; 13 with bilateral motor symptoms and DatScan abnormalities. Patients underwent skin biopsy searching for intraneural p-syn deposits: skin samples were taken from C7 paravertebral left and right sites in unilateral patients and from cervical (C7) and thoracic (Th12) paravertebral spine regions in bilateral patients. Unilateral patients displayed 20% of abnormal p-syn deposits in the affected motor site, 60% in both sites and 20% only in the non-affected site. P-syn was found in all patients in C7 but in only 62% of patients in Th12. Our data showed that cervical p-syn deposits displayed a uniform distribution between both sides not following the motor dysfunction in unilateral patients, and skin nerve p-syn deposits demonstrated a spine gradient with the cervical site expressing the highest positivity. © 2017 American Association of Neuropathologists, Inc. All rights reserved.

Bilateral changes in forearm oxygen consumption at rest and after exercise in patients with unilateral repetitive strain injury: a case-control study.

PubMed

Brunnekreef, Jaap J J; Thijssen, Dick H J; Oosterhof, Jan; Hopman, Maria T E

2012-04-01

Case-control study. To investigate whether oxygen consumption and blood flow at rest and after exercise are lower in the affected arm of patients with repetitive strain injury (RSI) compared to controls, and lower in the healthy nonaffected forearm within patients with unilateral RSI. RSI is considered an upper extremity overuse injury. Despite the local presentation of complaints, RSI may be represented by systemic adaptations. Insight into the pathophysiology of RSI is important to better understand the development of RSI complaints and to develop effective treatment and prevention strategies. Twenty patients with unilateral RSI and 20 gender-matched control subjects participated in this study. Forearm muscle blood flow and oxygen consumption were measured using near-infrared spectroscopy at baseline and immediately after isometric handgrip exercises at 10%, 20%, and 40% of the individual maximal voluntary contraction. Unilateral RSI resulted in a lower oxygen consumption and blood flow in the affected forearm at baseline and lower oxygen consumption after incremental handgrip exercises compared to controls (P<.05). In addition, exercise-induced blood flow and oxygen consumption in the nonaffected forearm in patients with RSI were similarly reduced. Blood flow and oxygen consumption after exercise are similarly attenuated in the affected and nonaffected arms of patients with unilateral RSI. Our findings suggest that, despite the unilateral character in clinical symptoms, RSI demonstrates systemic adaptations in forearm blood flow and oxygen consumption at rest and after exercise.

Postrenal acute kidney injury in a patient with unilateral ureteral obstruction caused by urolithiasis: A case report.

PubMed

Kazama, Itsuro; Nakajima, Toshiyuki

2017-10-01

In patients with bilateral ureteral obstruction, the serum creatinine levels are often elevated, sometimes causing postrenal acute kidney injury (AKI). In contrast, those with unilateral ureteral obstruction present normal serum creatinine levels, as long as their contralateral kidneys are preserved intact. However, the unilateral obstruction of the ureter could affect the renal function, as it humorally influences the renal hemodynamics. A 66-year-old man with a past medical history of hypertension and diabetes mellitus came to our outpatient clinic because of right abdominal dullness. Unilateral ureteral obstruction caused by a radio-opaque calculus in the right upper ureter and a secondary renal dysfunction. As oral hydration and the use of calcium antagonists failed to allow the spontaneous stone passage, extracorporeal shock wave lithotripsy (ESWL) was performed. Immediately after the passage of the stone, the number of red blood cells in the urine was dramatically decreased and the serum creatinine level almost returned to the normal range with the significant increase in glomerular filtration rate. Unilateral ureteral obstruction by the calculus, which caused reflex vascular constriction and ureteral spasm in the contralateral kidney, was thought to be responsible for the deteriorating renal function.

Comparison of EMG activity on abdominal muscles during plank exercise with unilateral and bilateral additional isometric hip adduction.

PubMed

Kim, Soo-Yong; Kang, Min-Hyeok; Kim, Eui-Ryong; Jung, In-Gui; Seo, Eun-Young; Oh, Jae-Seop

2016-10-01

The aim of this study was to investigate the effects of additional isometric hip adduction during the plank exercise on the abdominal muscles. Twenty healthy young men participated in this study. Surface electromyography (EMG) was used to monitor the activity of the bilateral rectus abdominis (RA), the internal oblique (IO), and the external oblique (EO) muscles. The participants performed three types of plank exercise; the standard plank exercise, the plank exercise with bilateral isometric hip adduction, and the plank exercise with unilateral isometric hip adduction. All abdominal muscle activity was significantly increased during the plank exercise combined with the bilateral and unilateral isometric hip adduction compared with the standard plank exercise (p<0.05). Bilateral IO, EO, and left RA muscle activity was significantly increased during the unilateral isometric hip adduction compared with the bilateral isometric hip adduction (p<0.05). These findings suggest that additional isometric hip adduction during the plank exercise could be a useful method to enhance abdominal muscle activity. In particular, the unilateral isometric hip adduction is a more beneficial exercise than the bilateral isometric hip adduction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enlarged thalamostriate vein causing unilateral Monro foramen obstruction. Case report.

PubMed

Leonardo, Jody; Grand, Walter

2009-06-01

Causes of unilateral hydrocephalus resulting from an obstruction at the Monro foramen include foraminal atresia, tumors, gliosis, contralateral shunting, and infectious and inflammatory conditions. However, few reports in the literature cite vascular lesions as the cause of the obstruction. To their knowledge, the authors present the first report of unilateral hydrocephalus occurring due to an abnormally enlarged thalamostriate vein independent of an arteriovenous malformation or developmental venous angioma. The condition was treated successfully by endoscopic septum pellucidum fenestration. A 28-year-old man was referred for evaluation due to a 10-year history of chronic headaches that worsened in severity over the past year. A CT scan of the head revealed unilateral right ventricular dilation. Cranial MR imaging with and without contrast administration showed a dilated right thalamostriate-internal vein complex without any evidence of associated arteriovenous malformation or venous angioma. Endoscopic exploration of the right lateral ventricle showed an enlarged subependymal thalamostriate vein obstructing the Monro foramen. An endoscopic fenestration of the septum pellucidum was performed, resulting in alleviation of the patient's symptoms. Abnormally enlarged venous structures may cause obstructive unilateral hydrocephalus and can be a rare cause of chronic, intermittent headaches in adults. Endoscopic fenestration of the septum pellucidum is an effective treatment.

Gait asymmetries in unilateral symptomatic hip osteoarthritis and their association with radiographic severity and pain.

PubMed

Farkas, Gary J; Schlink, Bryan R; Fogg, Louis F; Foucher, Kharma C; Wimmer, Markus A; Shakoor, Najia

2018-05-01

Little is known about the loading patterns in unilateral hip osteoarthritis (OA) and their relationship to radiographic severity and pain. We aimed to examine the loading patterns at the hips of those with unilateral symptomatic hip OA and identify associations between radiographic severity and pain with loading alterations. Sixty-one subjects with symptomatic unilateral hip OA underwent gait analyses and evaluation for radiographic severity (Kellgren-Lawrence [KL]-grade) and pain (visual analogue scale) at bilateral hips. Hip OA subjects had greater range of motion and higher hip flexion, adduction, internal and external rotation moments at the contralateral, asymptomatic hip compared to the ipsilateral hip ( p < 0.05). Correlations were noted between increasing KL-grade and increasing asymmetry of contralateral to ipsilateral hip loading ( p < 0.05). There were no relationships with pain and loading asymmetry. Unilateral symptomatic hip OA subjects demonstrate asymmetry in loading between the hips, with relatively greater loads at the contralateral hip. These loading asymmetries were directly related to the radiographic severity of symptomatic hip OA and not with pain. Additional research is needed to determine the role of gait asymmetries in disease progression.

Emotional Perception of Music in Children With Bimodal Fitting and Unilateral Cochlear Implant.

PubMed

Shirvani, Sareh; Jafari, Zahra; Motasaddi Zarandi, Masoud; Jalaie, Shohre; Mohagheghi, Hamed; Tale, Mohammad Reza

2016-06-01

Biological, structural, and acoustical constraints faced by cochlear implant (CI) users can alter the perception of music. Bimodal fitting not only provides bilateral hearing but can also improve auditory skills. This study was conducted to assess the impact of this amplification style on the emotional perception of music among children with hearing loss (HL). Twenty-five children with congenital severe to profound HL and unilateral CIs, 20 children with bimodal fitting, and 30 children with normal hearing participated in this study. Their emotional perceptions of music were measured using a method where children indicated happy or sad feelings induced by music by pointing to pictures of faces showing these emotions. Children with bimodal fitting obtained significantly higher mean scores than children with unilateral CIs for both happy and sad music items and in overall test scores (P < .001). Both groups with HL obtained significantly lower scores than children with normal hearing (P < .001). Bimodal fitting results in a better emotional perception of music compared to unilateral CI. Given the influence of music in neurological and linguistic development and social interactions, it is important to evaluate the possible benefits of bimodal fitting prescriptions for individuals with unilateral CIs. © The Author(s) 2015.

Hypothalamic network for thermoregulatory shivering.

PubMed

Kanosue, K; Zhang, Y H; Yanase-Fujiwara, M; Hosono, T

1994-07-01

Warming one side of a rat's preoptic area and anterior hypothalamus (POAH) suppresses shivering on both sides of the body, and the present study evaluated the extent to which signals mediating this suppression cross the midline within and below the POAH. Hind paw shivering during unilateral POAH thermal stimulation was measured for rats in which the POAH had been midsagittally transected and for rats in which one side of the hypothalamus had been coronally transected just caudal to the POAH. In midsagittally transected rats, unilateral warming on either side of the POAH suppressed shivering equally on both sides of the body. In unilaterally transected rats, POAH warming on the transected side did not affect shivering, but warming the intact side suppressed shivering equally on both sides of the body. When a unilateral transection of only the lateral part of the hypothalamus included the medial forebrain bundle, the effect was the same as that of a unilateral transection of the whole hypothalamus. These results indicate that no information controlling shivering is exchanged between the left and right POAH and that efferent signals from the POAH, descending through the medial forebrain bundle, cross the midline somewhere below the hypothalamus to innervate both sides of the body equally.

Parkinsonian gait improves with bilateral subthalamic nucleus deep brain stimulation during cognitive multi-tasking.

PubMed

Chenji, Gaurav; Wright, Melissa L; Chou, Kelvin L; Seidler, Rachael D; Patil, Parag G

2017-05-01

Gait impairment in Parkinson's disease reduces mobility and increases fall risk, particularly during cognitive multi-tasking. Studies suggest that bilateral subthalamic deep brain stimulation, a common surgical therapy, degrades motor performance under cognitive dual-task conditions, compared to unilateral stimulation. To measure the impact of bilateral versus unilateral subthalamic deep brain stimulation on walking kinematics with and without cognitive dual-tasking. Gait kinematics of seventeen patients with advanced Parkinson's disease who had undergone bilateral subthalamic deep brain stimulation were examined off medication under three stimulation states (bilateral, unilateral left, unilateral right) with and without a cognitive challenge, using an instrumented walkway system. Consistent with earlier studies, gait performance declined for all six measured parameters under cognitive dual-task conditions, independent of stimulation state. However, bilateral stimulation produced greater improvements in step length and double-limb support time than unilateral stimulation, and achieved similar performance for other gait parameters. Contrary to expectations from earlier studies of dual-task motor performance, bilateral subthalamic deep brain stimulation may assist in maintaining temporal and spatial gait performance under cognitive dual-task conditions. Copyright © 2017 Elsevier Ltd. All rights reserved.

Temporo-mandibular joint condylectomy and its effect over occlusion in cats: cadaveric study.

PubMed

El-Warrak, A O; Ferrer, G A; Lanthier, T; Loureiro Silva, B; El-Warrak, L O

2011-03-01

To determine the effect of unilateral condylectomy on dental occlusion in cats. Twelve feline cadaver heads were randomly submitted to either a right or left unilateral condylectomy of the temporo-mandibular joint. The distance between the mandibular and maxillary canine tooth was measured before (B0) and after the unilateral condylectomy (P0). A right or left latero--lateral standardised force (4 N) was applied to the mandibular mentus area before and after the surgical procedure. These measurements were analysed with a linear model for repeated measures. The comparative analysis between pre- and postsurgical values indicated no significant variation in teeth displacement following condylectomy between B0 and P0 measurements. Statistically significant differences were detected after either left or right condylectomy with respect to all measurements after application of the standardised forces. Occlusion changes are significant when comparing bites before and after surgery. Unilateral condylectomy causes a significant increase in latero-lateral amplitude of jaw movement which might clinically affect feline dental occlusion. Clinical studies are required to determine the effect of unilateral condylectomies on mastication and dental occlusion in feline patients. © 2011 British Small Animal Veterinary Association.

Recurrent Unilateral Vulval Elephantiasis: A Case Report

PubMed Central

G., Sampath Kumar; Venkatesh, Shreedhar

2014-01-01

Genital elephantiasis is caused by a variety of infective and non infective causes leading to blockage of lymphatic. We are presenting a rare case of recurrent unilateral vulval elephantiasis which has recurred after initial reconstructive surgery. A 38 year old female presented with vulval swelling and on examination there was gross unilateral vulval enlargement. FNAC (Fine needle aspiration cytology) and biopsy were contributory for diagnosis. Patient was started with antibiotics and daily dressing was done till the infection was subsided and the patient was planned for reconstructive surgery. PMID:24971141

Human cortical activity related to unilateral movements. A high resolution EEG study.

PubMed

Urbano, A; Babiloni, C; Onorati, P; Babiloni, F

1996-12-20

In the present study a modern high resolution electroencephalography (EEG) technique was used to investigate the dynamic functional topography of human cortical activity related to simple unilateral internally triggered finger movements. The sensorimotor area (M1-S1) contralateral to the movement as well as the supplementary motor area (SMA) and to a lesser extent the ipsilateral M1-S1 were active during the preparation and execution of these movements. These findings suggest that both hemispheres may cooperate in both planning and production of simple unilateral volitional acts.

Cold shivering activity after unilateral destruction of the vestibular apparatus

NASA Technical Reports Server (NTRS)

Kuzmina, G. I.

1980-01-01

The bioelectric activity of muscles (flexors and extensors of the forelimbs and hindlimbs) during cold shivering after unilateral destruction of the vestibular apparatus. It was found, that unilateral delabyrinthing produces bilateral facilitation of cold shivering in the flexor extremities more pronounced on the ipsilateral side. In the extensor muscles there was an absence of bioelectric activity both before and after delabyrinthing. Enhancement of cold shivering in the flexor extremities following intervention was evidently conditioned by removal of the inhibiting effect of the vestibulary apparatus on the function of special centers.

Case report: Unilateral conduction hearing loss due to central venous occlusion.

PubMed

Ribeiro, Phillip; Patel, Swetal; Qazi, Rizwan A

2016-05-07

Central venous stenosis is a well-known complication in patients with vascular access for hemodialysis. We report two cases involving patients on hemodialysis with arteriovenous fistulas who developed reversible unilateral conductive hearing loss secondary to critical stenosis of central veins draining the arteriovenous dialysis access. A proposed mechanism for the patients' reversible unilateral hearing loss is pterygoid venous plexus congestion leading to decreased Eustachian tube patency. Endovascular therapy was conducted to treat the stenosis and the hearing loss of both patients was returned to near normal after successful central venous angioplasty.

Unilateral purpura annularis telangiectodes of majocchi in an elderly male: an atypical presentation.

PubMed

Wang, Apphia; Shuja, Fareesa; Chan, Audrey; Wasko, Carina

2013-08-15

Purpura annularis telangiectodes (PAT), also known as Majocchi purpura, is a rare form of pigmented purpuric dermatosis characterized by non-palpable red-brown, occasionally pruritic patches which progress to hyperpigmented halos. Purpura annularis telangiectodes usually presents in female adolescents as benign symmetric lesions with a predilection for the lower extremities. We present an atypical case of unilateral PAT in an elderly male. To our knowledge, our patient at 85-years-old is the oldest PAT and first unilateral purpura annularis telangiectodes case described in the literature.

Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire.

PubMed

Dolas, Siddhesh Gajanan; Chitko, Shrikant Shrinivas; Kerudi, Veerendra Virupaxappa; Patil, Harshal Ashok; Bonde, Prasad Vasudeo

2016-03-01

Unilateral scissor bite is a relatively rare malocclusion. However, its correction is often difficult and a challenge for the clinician. This article presents simple and efficient technique for the correction of severe unilateral scissor bite in a 14 year old boy, using 0.020 S.S. A. J. Wilcock wire (premium plus) out of the spool, with minimal adjustments and placed in mandibular arch. After about six weeks time, good amount of correction was seen in the lower arch and the lower molar had been relieved of scissor bite.

Unilateral basal-ganglia involvement likely due to valproate-induced hyperammonemic encephalopathy.

PubMed

Joardar, Swarnali; Das, Shubhadeep; Chatterjee, Rita; Guha, Gautam; Hasmi, M A

2012-08-01

A male child suffering from generalized tonic clonic epilepsy, on treatment with valproate, developed fulminant hepatic failure, hyperammonemia and encephalopathy due to drug toxicity. The most extraordinary feature was his MRI (FLAIR image) of brain which showed unilateral hyperintensities in right putamen and caudate nucleus. The patient recovered on withdrawal of valproate with mild residual left sided athetotic movements during remission. Repeat investigation confirmed an improved MRI imaging and normalised blood ammonia levels. The case report is unique because of unilateral involvement of basal ganglia due to valproate-induced encephalopathy.

Paralabral rupture of the proximal biceps tendon from light weightlifting.

PubMed

Miller, Kyle E; Solomon, Daniel J

2008-12-01

Rupture of the long head of the biceps is usually seen in older adults, in conjunction with rotator cuff tears or tenosynovitis secondary to chronic subacromial impingement; it is rarely seen as a result of trauma. We present the case of a young active patient who denied prodromal symptoms but ruptured the long head of the biceps brachii tendon (LHB) while performing 25-pound biceps curls. Upon examination, the patient was noted to have a readily apparent biceps defect and decreased strength. He was brought to the operating room, where open subpectoral tenodesis of the LHB was performed. At the 6-week follow-up evaluation, the patient had regained full range of motion. By 6 months, he had regained his previous strength. This case demonstrates an unusual presentation of a LHB rupture in a young healthy man with no prodromal symptoms.

Rotator cuff disorders: How to write a surgically relevant magnetic resonance imaging report?

PubMed Central

Tawfik, Ahmed M; El-Morsy, Ahmad; Badran, Mohamed Aboelnour

2014-01-01

Evaluation of rotator cuff is a common indication for magnetic resonance imaging (MRI) scanning of the shoulder. Conventional MRI is the most commonly used technique, while magnetic resonance (MR) arthrography is reserved for certain cases. Rotator cuff disorders are thought to be caused by a combination of internal and external mechanisms. A well-structured MRI report should comment on the relevant anatomic structures including the acromial type and orientation, the presence of os acromiale, acromio-clavicular degenerative spurs and fluid in the subacromial subdeltoid bursa. In addition, specific injuries of the rotator cuff tendons and the condition of the long head of biceps should be accurately reported. The size and extent of tendon tears, tendon retraction and fatty degeneration or atrophy of the muscles are all essential components of a surgically relevant MRI report. PMID:24976930

Type IIIb Endoleak and Relining: A Mathematical Model of Distraction Forces.

PubMed

Swaelens, Charles; Poole, Robert J; Torella, Francesco; McWilliams, Richard G; England, Andrew; Fisher, Robert K

2016-04-01

To examine the changes in distraction force following relining of a conventional abdominal aortic stent-graft with a type IIIb endoleak using the Nellix endovascular sealing device compared to a unilateral stent-graft. Relining is often used to repair type IIIb endoleaks, but the consequences to graft stability are unknown. A mathematical model was constructed based on pressure and volume flow through the stent-grafts, incorporating recognized distraction force equations. Steady flow was presumed at peak systolic pressures to calculate the maximum distraction force, with gravity ignored. Distraction forces for 28- to 36-mm-diameter stent-graft bodies with 16-mm limbs were calculated and compared to forces following relining with single and double Nellix devices or the Renu unilateral device. Distraction forces for the 28-, 32-, and 36-mm stent-grafts prior to relining were 5.99, 10.21, and 14.99 N, respectively. Similar forces were reported after relining with bilateral Nellix devices (5.86, 10.08, and 14.86 N, respectively). However, use of a unilateral Nellix increased the distraction forces to 9.92, 14.14, and 18.92 N, respectively. These were comparable to the increase observed after relining with a Renu unilateral stent-graft (9.87, 14.09, and 18.86 N, respectively). The proportional increase in distraction force for a unilateral relining ranged from 26% to 66%, with the greatest increase noted in the smaller diameter main bodies. Relining a stent-graft with a type IIIb endoleak using bilateral Nellix devices does not increase the distraction force. However, a unilateral Nellix device or the Renu system could theoretically increase the distraction force by up to 66%, potentially risking migration and type Ia endoleak. In clinical practice, these results suggest that a relining with bilateral Nellix may have benefits over the Renu unilateral stent-graft. © The Author(s) 2016.

Pain-evoked trunk muscle activity changes during fatigue and DOMS.

PubMed

Larsen, L H; Hirata, R P; Graven-Nielsen, T

2017-05-01

Muscle pain may reorganize trunk muscle activity but interactions with exercise-related muscle fatigue and delayed onset muscle soreness (DOMS) is to be clarified. In 19 healthy participants, the trunk muscle activity during 20 multi-directional unpredictable surface perturbations were recorded after bilateral isotonic saline injections (control) and during unilateral and bilateral hypertonic saline-induced low back pain (LBP) in conditions of back muscle fatigue (Day-1) and DOMS (Day-2). Pain intensity and distribution were assessed by visual analogue scale (VAS) scores and pain drawings. The degree of fatigue and DOMS were assessed by Likert scale scores. Root-mean-square electromyographic (RMS-EMG) signals were recorded post-perturbation from six bilateral trunk muscles and the difference from baseline conditions (Delta-RMS-EMG) was extracted and averaged across abdominal and back muscles. In DOMS, peak VAS scores were higher during bilateral control and bilateral saline-induced pain than fatigue (p < 0.001) and during bilateral compared with unilateral pain (p < 0.001). The saline-induced pain areas were larger during DOMS than fatigue (p < 0.01). In response to surface perturbations during fatigue and DOMS, the back muscle Delta-RMS-EMG increased during bilateral compared with unilateral pain and control injections (p < 0.001) and decreased during unilateral pain compared with control injections (p < 0.04). In DOMS compared with fatigue, the post-perturbation Delta-RMS-EMG in back muscles was higher during bilateral pain and lower during unilateral pain (p < 0.001). The abdominal Delta-RMS-EMG was not significantly affected. Facilitated and attenuated back muscle responses to surface perturbations in bilateral and unilateral LBP, respectively, was more expressed during exercise-induced back muscle soreness compared with fatigue. Back muscle activity decreased during unilateral and increased during bilateral pain after unpredictable surface perturbations during muscle fatigue and DOMS. Accumulation effects of DOMS on pain intensity and spreading and trunk muscle activity after pain-induction. © 2017 European Pain Federation - EFIC®.

Comparison of Hemodynamic Changes in Unilateral Spinal Anesthesia Versus Epidural Anesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial

PubMed Central

Kiasari, Alieh Zamani; Babaei, Anahita; Alipour, Abbas; Motevalli, Shima; Baradari, Afshin Gholipour

2017-01-01

Background: Unilateral spinal anesthesia is used to limit the spread of block. The aim of the present study was to compare hemodynamic changes and complications in unilateral spinal anesthesia and epidural anesthesia below the T10 sensory level in unilateral surgeries. Materials and Methods: In this double-blind randomized clinical trial in total 120 patients were randomly divided into a unilateral spinal anesthesia group (Group S) and an epidural anesthesia group (Group E). Systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rates were measured before and immediately after the administration of spinal or epidural anesthesia and then at 5-, 10-, 15-, 20-, 25-, and 30-min intervals. The rates of prescribed ephedrine and intraoperative respiratory arrest were recorded, in addition to postoperative nausea and vomiting, puncture headaches, and back pain during the first 24 h after the surgery. Results: SBP, DBP, and MAP values initially showed a statistically significant downward trend in both groups (p = 0.001). The prevalence of hypotension in Group S was lower than in Group E, and the observed difference was statistically significant (p < 0.0001). The mean heart rate change in Group E was greater than in Group S, although the difference was not statistically significant (p = 0.68). The incidence of prescribed ephedrine in response to a critical hemodynamic situation was 5.1% (n = 3) and 75% (n = 42) in Group S and Group E, respectively (p = 0.0001). The incidence of headaches, back pain, and nausea/vomiting was 15.3%, 15.3%, and 10.2% in Group S and 1.8%, 30.4%, and 5.4% in Group E (p = 0.017, 0.07, and 0.49, respectively). Conclusion: Hemodynamic stability, reduced administration of ephedrine, a simple, low-cost technique, and adequate sensory and motor block are major advantages of unilateral spinal anesthesia. PMID:28974849

Cochlear implantation in adults: a systematic review and meta-analysis.

PubMed

Gaylor, James M; Raman, Gowri; Chung, Mei; Lee, Jounghee; Rao, Madhumathi; Lau, Joseph; Poe, Dennis S

2013-03-01

Sensorineural hearing loss is the third leading cause of years lived with disability worldwide. Cochlear implants may provide a viable alternative to hearing aids for this type of hearing loss. The Coverage and Analysis Group at the Centers for Medicare & Medicaid Services was interested in an evaluation of recently published literature on this topic. In addition, this meta-analysis is to our knowledge the first to evaluate quality-of-life (QOL) outcomes in adults with cochlear implants. To evaluate the communication-related outcomes and health-related QOL outcomes after unilateral or bilateral cochlear implantation in adults with sensorineural hearing loss. MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and previous reports from January 1, 2004, through May 31, 2012. Published studies of adult patients undergoing unilateral or bilateral procedures with multichannel cochlear implants and assessments using open-set sentence tests, multisyllable word tests, or QOL measures. Five researchers extracted information on population characteristics, outcomes of interest, and study design and assessed the studies for risk of bias. Discrepancies were resolved by consensus. A total of 42 studies met the inclusion criteria. Most unilateral implant studies showed a statistically significant improvement in mean speech scores as measured by open-set sentence or multisyllable word tests; meta-analysis revealed a significant improvement in QOL after unilateral implantation. Results from studies assessing bilateral implantation showed improvement in communication-related outcomes compared with unilateral implantation and additional improvements in sound localization compared with unilateral device use or implantation only. Based on a few studies, the QOL outcomes varied across tests after bilateral implantation. Unilateral cochlear implants provide improved hearing and significantly improve QOL, and improvements in sound localization are noted for bilateral implantation. Future studies of longer duration, higher-quality reporting, and large databases or registries of patients with long-term follow-up data are needed to yield stronger evidence.

Pattern analysis of patients with temporomandibular disorders resulting from unilateral mastication due to chronic periodontitis

PubMed Central

2017-01-01

Purpose The purpose of the present study was to perform a pattern analysis in patients with temporomandibular disorder (TMD) resulting from unilateral mastication due to chronic periodontitis. Methods Thirty participants with signs or symptoms of TMD who engaged in unilateral mastication due to periodontitis-related discomfort (test group) were selected. Another 30 subjects exhibiting signs or symptoms of TMD resulting from unilateral mastication not due to chronic periodontitis (control group) were also recruited. An interview-based questionnaire was administered, and an examination of the temporomandibular joint (TMJ) with determination of periodontal status was performed. Results The duration of unilateral mastication was significantly longer in the control group than in the test group. There was a significant negative correlation between the duration of unilateral mastication and the Community Periodontal Index score. Using the Research Diagnostic Criteria for TMD (RDC/TMD) axis I algorithms, all the subjects were assigned to 3 main groups. The test group exhibited significantly a higher diagnostic distribution of group III (arthralgia, osteoarthritis, or osteoarthrosis), and in both the test and control groups, the number of diagnoses was larger for the non-chewing side. The control group showed a significantly higher diagnostic distribution of group I (myofacial pain), and in both the test and control groups, the number of diagnoses was larger for the chewing side. Conclusions The results of the present study indicate that unilateral mastication due to chronic periodontitis could induce not only pain but also structural TMJ changes if adequate treatment is not administered and supported within a short time from the onset of the condition. Therefore, immediate treatment of chronic periodontitis is recommended to prevent not only the primary progress of periodontal disease, but also secondary TMJ-related problems. Furthermore, subjects who have suffered chronic long-term periodontitis without treatment should be urged to undergo a TMJ examination. PMID:28861285

The V-Y flap technique in complicated and recurrent pilonidal sinus disease.

PubMed

Koca, Yavuz Savas; Yıldız, Ihsan; Ugur, Mustafa; Barut, Ibrahim

2018-01-01

This study presents early and long term (5 years) outcome of 61 complicated pilonidal sinus disease cases undergoing V-Y advancement flap method together with the literature data. Data of 336 patients undergoing surgery for pilonidal sinus disease between 2008 and 2012 were retrospectively analyzed. Patients with defect size ≥ 10 cm, and more than one subcutaneous sinus tunnels were assumed to have complicated pilonidal sinus disease. A total of 61 patients were included in the study. Age, gender, type of surgery, duration of hospitalization, time of drain removal, pre-operative complications, and relapse rates at post-operative 5th year were analyzed. Of the 66 patients, 51 underwent unilateral V-Y advancement and 10 patients had bilateral V-Y plasty. Mean duration of operations was 66.87±18.37 minutes for total, 61.02±12.30 minutes for unilateral V-Y plasty, and 96.70±15.04 minutes for bilateral V-Y plasty. Hemovac drains were removed at 5.59±1.91 days averagely, 5.16±1.37 in unilateral group, and 7.80±2.74 in bilateral V-Y plasty group. Of the 4 patients who developed wound site infection, 2 had unilateral and 2 had bilateral V-Y flap advancement. Postoperative hematomas developed in 2 patients with unilateral flap and one patient with bilateral flapss. Seroma occurred in 2 patients with unilateral flap and one patient with bilateral flaps. Dehiscence developed two patients, one patient from each group. The mean duration of hosptalization was 5.98±2.21 days; 5.49±1.52 in unilateral group, and 8.50±3.34 in bilateral group. Early or late relapse was not seen in any groups. V-Y advancement flap technique can be applied as an efficient method in the treatment of complicated pilonidal sinus disease due to low relapse and complication rates. Advancement flap, Complicated pilonidal sinus, Pilonidal sinus, V-Y flap.

A Case of Generalized Auditory Agnosia with Unilateral Subcortical Brain Lesion

PubMed Central

Suh, Hyee; Kim, Soo Yeon; Kim, Sook Hee; Chang, Jae Hyeok; Shin, Yong Beom; Ko, Hyun-Yoon

2012-01-01

The mechanisms and functional anatomy underlying the early stages of speech perception are still not well understood. Auditory agnosia is a deficit of auditory object processing defined as a disability to recognize spoken languages and/or nonverbal environmental sounds and music despite adequate hearing while spontaneous speech, reading and writing are preserved. Usually, either the bilateral or unilateral temporal lobe, especially the transverse gyral lesions, are responsible for auditory agnosia. Subcortical lesions without cortical damage rarely causes auditory agnosia. We present a 73-year-old right-handed male with generalized auditory agnosia caused by a unilateral subcortical lesion. He was not able to repeat or dictate but to perform fluent and comprehensible speech. He could understand and read written words and phrases. His auditory brainstem evoked potential and audiometry were intact. This case suggested that the subcortical lesion involving unilateral acoustic radiation could cause generalized auditory agnosia. PMID:23342322

Facial soft-tissue asymmetry in three-dimensional cone-beam computed tomography images of children with surgically corrected unilateral clefts.

PubMed

Starbuck, John Marlow; Ghoneima, Ahmed; Kula, Katherine

2014-03-01

Cleft lip with or without cleft palate (CL/P) is a relatively common craniofacial malformation involving bony and soft-tissue disruptions of the nasolabial and dentoalveolar regions. The combination of CL/P and subsequent craniofacial surgeries to close the cleft and improve appearance of the cutaneous upper lip and nose can cause scarring and muscle pull, possibly resulting in soft-tissue depth asymmetries across the face. We tested the hypothesis that tissue depths in children with unilateral CL/P exhibit differences in symmetry across the sides of the face. Twenty-eight tissue depths were measured on cone-beam computed tomography images of children with unilateral CL/P (n = 55), aged 7 to 17 years, using Dolphin software (version 11.5). Significant differences in tissue depth symmetry were found around the cutaneous upper lip and nose in patients with unilateral CL/P.

Unilateral proptosis as the initial manifestation of malignancy.

PubMed

Rakul Nambiar, K; Ajith, P S; Arjunan, Asha

2017-09-01

Proptosis, a common sign with a broad differential diagnosis, is defined as anterior displacement and protrusion of one or both orbital globes. Patients can present with varying degrees of chronicity, visual loss and associated symptoms. The etiology of acquired unilateral proptosis is diverse, ranging from benign to life-threatening. The causes of unilateral proptosis include traumatic, vascular, endocrine, inflammatory, infective and malignant. Breast carcinoma is the most common metastatic cause of proptosis; however, proptosis has never been reported as the initial manifestation of breast carcinoma. Our patient presented with unilateral proptosis secondary to an intraorbital lesion and histopathology of orbital lesion was suggestive of metastatic breast adenocarcinoma. She was later diagnosed to have primary breast carcinoma. We present this unusual case of a 56-year-old woman who presented with proptosis as the initial manifestation of a metastatic breast malignancy. Copyright © 2017 National Cancer Institute, Cairo University. Production and hosting by Elsevier B.V. All rights reserved.

Hyperventilation-induced nystagmus in vestibular schwannoma and unilateral sensorineural hearing loss.

PubMed

Mandalà, Marco; Giannuzzi, Annalisa; Astore, Serena; Trabalzini, Franco; Nuti, Daniele

2013-07-01

We evaluated the incidence and characteristics of hyperventilation-induced nystagmus (HVN) in 49 patients with gadolinium-enhanced magnetic resonance imaging evidence of vestibular schwannoma and 53 patients with idiopathic unilateral sensorineural hearing loss and normal radiological findings. The sensitivity and specificity of the hyperventilation test were compared with other audio-vestibular diagnostic tests (bedside examination of eye movements, caloric test, auditory brainstem responses) in the two groups of patients. The hyperventilation test scored the highest diagnostic efficiency (sensitivity 65.3 %; specificity 98.1 %) of the four tests in the differential diagnosis of vestibular schwannoma and idiopathic unilateral sensorineural hearing loss. Small tumors with a normal caloric response or caloric paresis were associated with ipsilateral HVN and larger tumors and severe caloric deficits with contralateral HVN. These results confirm that the hyperventilation test is a useful diagnostic test for predicting vestibular schwannoma in patients with unilateral sensorineural hearing loss.

Clock-drawing test and unilateral spatial neglect.

PubMed

Ishiai, S; Sugishita, M; Ichikawa, T; Gono, S; Watabiki, S

1993-01-01

We investigated the ability of 25 patients with left unilateral spatial neglect to make a clock face by putting numbers inside a printed circle. Impairment seen in this clock-drawing test did not parallel neglect severity as judged by results of the line-cancellation and line-bisection tests, as well as the copying of a daisy. The score for clock drawing correlated highly with the verbal WAIS score. Most neglect patients with a verbal IQ of 87 or more could draw a clock face fairly well and used planning in placing the numbers 12, 3, 6, and 9 before the others. In clock drawing, verbal intelligence may compensate for left unilateral spatial neglect. We therefore recommend use of the line-cancellation and line-bisection tests, as well as the copying test, but do not recommend use of the clock-drawing test in the diagnosis of left unilateral spatial neglect.

Health-related quality of life in pediatric patients with long-standing pancreatitis.

PubMed

Pohl, John F; Limbers, Christine A; Kay, Marie; Harman, Annette; Rollins, Michael; Varni, James W

2012-05-01

There are limited data on health-related quality of life (HRQOL) in pediatric patients with long-standing pancreatitis (including acute relapsing and chronic pancreatitis) using age-appropriate measurement instruments. We evaluated HRQOL in children with long-standing pancreatitis using the PedsQL 4.0 Generic Core Scales by patient self-report as well as parent proxy report. Additionally, patient self-reports and parent proxy reports were completed for the PedsQL Multidimensional Fatigue Scale. Across all of the dimensions, significantly impaired HRQOL and higher fatigue were noted for both pediatric patient self-report and parent proxy report in comparison with the matched healthy children samples. Higher fatigue was associated with lower HRQOL. There was moderate to good agreement between patient self-reports and parent proxy reports. Given the impaired HRQOL and fatigue documented in the present study, future studies are needed to determine whether specific factors can modify HRQOL and fatigue in this patient population.

[The use of Piezosurgery osteotomy in treatment of long-standing maxillary fractures: report of 12 consecutive patients].

PubMed

Guo, Zhao-Zhong; Liu, Xue; Li, Yan; Deng, Yan-Fang; Wang, Yang

2007-02-01

To evaluate the clinical applicability of Piezosurgery osteotomy: a new safe technique in managing long standing maxillary fractures. 12 patients with long-standing maxillary fractures were surgically treated using Le Fort I osteotomy. During operation, Piezosurgery osteotomy was used for bone cutting and splitting. After repositioning, the bone segments were rigidly fixed with micro Ti-plate, Ti-mesh. All the patients were followed up for 6 to 12 months, and the functional and esthetic results were evaluated. Ultrasonic microvibrations allow accurate bone cutting without oscillating injuries to the soft tissue. All the wounds healed primarily without complications. The postoperative occlusion and appearance were satisfactory. Maximal recovery of mastication and appearance can be achieved by using Piezosurgery osteotomy with fixation materials such as Ti-plates and Ti-meshes in selected patients with long-standing maxillary fractures.

Lateralizing value of unilateral relative ictal immobility in patients with refractory focal seizures--Looking beyond unilateral automatisms.

PubMed

Agarwal, Priya; Kaul, Bhavna; Shukla, Garima; Srivastava, Achal; Singh, Mamta Bhushan; Goyal, Vinay; Behari, Madhuri; Suri, Ashish; Gupta, Aditya; Garg, Ajay; Gaikwad, Shailesh; Bal, C S

2015-12-01

Ictal motor phenomena play a crucial role in the localization of seizure focus in the management of refractory focal epilepsy. While the importance of unilateral automatisms is well established, little attention is paid to the contralateral relatively immobile limb. In cases where automatisms mimic clonic or dystonic movements and in the absence of previously well-established signs, unilateral relative ictal immobility (RII) is potentially useful as a lateralizing sign. This study was carried out to examine the lateralizing value of this sign and to define its characteristics among patients of refractory focal epilepsy. VEEGs of 69 consecutive patients of refractory focal epilepsy who had undergone epilepsy surgery at our center over last four years were reviewed and analyzed for the presence of RII. Unilateral RII was defined as a paucity of movement in one limb lasting for at least 10s while the contralateral limb showed purposive or semi-purposive movements (in the absence of tonic or dystonic posturing or clonic movements in the involved limb). The findings were seen in the light of VEEG, radiological and nuclear imaging data, and with post-surgical outcome. Unilateral RII as a lateralizing sign was found in 24 of 69 patients (34.78%), consisting of both temporal and extra temporal epilepsy, with 100% concordance with VEEG and MRI data. All patients demonstrating this sign had a good post-surgical outcome. RII, when well characterized is a frequent and reliable lateralizing sign in patients of refractory focal epilepsy. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Modified animal model and computer-assisted approach for dentoalveolar distraction osteogenesis to reconstruct unilateral maxillectomy defect.

PubMed

Feng, Zhihong; Zhao, Jinlong; Zhou, Libin; Dong, Yan; Zhao, Yimin

2009-10-01

The purpose of this report is to show the establishment of an animal model with a unilateral maxilla defect, application of virtual reality and rapid prototyping in the surgical planning for dentoalveolar distraction osteogenesis (DO). Two adult dogs were used to develop an animal model with a unilateral maxillary defect. The 3-dimensional model of the canine craniofacial skeleton was reconstructed with computed tomography data using the software Mimics, version 12.0 (Materialise Group, Leuven, Belgium). A virtual individual distractor was designed and transferred onto the model with the defect, and the osteotomies and distraction processes were simulated. A precise casting technique and numeric control technology were applied to produce the titanium distraction device, which was installed on the physical model with the defect, which was generated using Selective Laser Sintering technology, and the in vitro simulation of osteotomies and DO was done. The 2 dogs survived the operation and were lively. The osteotomies and distraction process were simulated successfully whether on the virtual or the physical model. The bone transport could be distracted to the desired position both in the virtual environment and on the physical model. The novel method to develop an animal model with a unilateral maxillary defect was feasible, and the animal model was suitable to develop the reconstruction method for unilateral maxillary defect cases with dentoalveolar DO. Computer-assisted surgical planning and simulation improved the reliability of the maxillofacial surgery, especially for the complex cases. The novel idea to reconstruct the unilateral maxillary defect with dentoalveolar DO was proved through the model experiment.

Practical Repair Method for Unilateral Cleft Lips: Straight-Line Advanced Release Technique.

PubMed

Baek, Rong-Min; Choi, Jun-Ho; Kim, Baek-Kyu

2016-04-01

Straight-line closure repair of unilateral cleft lips was first introduced in the 1840s, and since then, many different techniques have been attempted for cleft repair. However, these methods have several disadvantages and are difficult to adopt. In this study, we describe our novel technique, known as Straight-Line Advanced Release Technique (StART), and its application in treating several cases of unilateral cleft lip. The preoperative design of the surgical method is drawn on the skin, the vermilion, and the oral mucosa. A total of 13 points are marked (points 0-12). The A flap, B flap, triangular flap, M (medial mucosal) flap, and L (lateral mucosal) flap are designed. After completion of the preoperative marking, the wide dissection is performed to separate the orbicularis oris muscle completely from the abnormally inserted bony structure and the enveloped skin-mucosal flap. The freed orbicularis oris muscle is then reconstructed with full width. After all planes of the lip wound are closed, a straight vertical skin suture line is achieved without any unnecessary transverse scar. Unilateral cleft lip repair using StART was conducted in 145 patients between 1993 and 2012. Cases of microform cleft lip were excluded. A total of 21 patients (14%) required a secondary operation on the lip after the first unilateral cheiloplasty. In all patients, satisfactory surgical outcomes were obtained with an indistinct straight-lined scar and a well-aligned lip contour. To acquire a natural and balanced shape in unilateral cleft lip repair, we recommend the novel StART.

Combined metopic and unilateral coronal synostoses: a phenotypic conundrum.

PubMed

Sauerhammer, Tina M; Patel, Kamlesh; Oh, Albert K; Proctor, Mark R; Mulliken, John B; Rogers, Gary F

2014-03-01

Most types of craniosynostosis cause predictable changes in cranial shape. However, the phenotype of combined metopic and unilateral coronal synostoses is anomalous. The purpose of this observational study was to better clarify the clinical and radiographic features of this rare entity. A retrospective review of a craniofacial database was performed. Patients with combined metopic and unilateral coronal synostoses were included in this study. Data collected included demographic information, physical and radiographic findings, genetic evaluation, treatment, and operative outcomes. Of 687 patients treated between 1989 and 2010, only 3 patients had combined metopic and unilateral coronal synostoses. All patients were diagnosed through computed tomography on the first day of life. Phenotypic features included the following: (1) narrowed forehead with a prominent midline ridge, (2) severe bilateral brow retrusion with an acute indentation on the side of the patient coronal suture, (3) facial and nasal angulation similar to isolated unilateral coronal synostosis, and (4) anterior displacement of the ear on the fused side. In addition, the cranial vertex was deviated toward the side of the open coronal suture. Two patients had a head circumference below the 25th percentile; 2 of the 3 had a TWIST gene mutation consistent with Saethre-Chotzen syndrome. One patient was managed through fronto-orbital advancement and required a revision. The other 2 patients had early endoscopic release, followed by postoperative helmet therapy; one improved but still required open cranial remodeling. The other has near-normal phenotype, and no further surgery is planned. Combined metopic and unilateral coronal synostoses present a rare and unusual phenotype. Although early intervention improves the deformity, revisional procedures are usually required.

Unilateral and bilateral dental transpositions in the maxilla-dental and skeletal findings in 63 individuals.

PubMed

Danielsen, J C; Karimian, K; Ciarlantini, R; Melsen, B; Kjær, I

2015-12-01

This was to elucidate dental and skeletal findings in individuals with unilateral and bilateral maxillary dental transpositions. The sample comprised of radiographic materials from 63 individuals with maxillary dental transpositions from the Departments of Odontology at the Universities of Copenhagen and Aarhus and by the Danish municipal orthodontic service. The cases were divided into three groups: unilateral transposition of the canine and first premolar (Type 1U), bilateral transposition of canine and first premolar (Type 1B), and unilateral transposition of canine and lateral incisor (Type 2). The dentitions were analysed regarding agenesis and dental morphological anomalies on panoramic radiographs, and craniofacial aspects were cephalometrically analysed on profile images The results were statistically evaluated. All groups demonstrated increased occurrences of agenesis (Type 1U and Type 1B: 31 agenesis in 15 patients; and Type 2 three agenesis in three patients). Taurodontic root morphology was most dominant in Type 1U. Peg-shaped lateral incisors showed an increased occurrence, though not in Type 1U. Skeletally, Type 1B and Type 1U demonstrated maxillary retrognathia (more pronounced in Type 1B). Type 2 showed a significant posterior inclination of the maxilla. Transpositions of maxillary canines involve dental and skeletal deviations. Dental deviations were predominantly taurodontic root morphology and agenesis. Regarding skeletal deviations, bilateral transpositions of the canines and the first premolars are associated with skeletal changes. Unilateral transpositions are possibly a localised deviation with minor or no skeletal involvements. The results indicate a possible difference in the aetiologies of unilateral and bilateral transpositions.

Evaluation of muscle hyperactivity of the grimacing muscles by unilateral tight eyelid closure and stapedius muscle tone.

PubMed

Shiba, Masato; Matsuo, Kiyoshi; Ban, Ryokuya; Nagai, Fumio

2012-10-01

Muscle hyperactivity of grimacing muscles, including the orbicularis oculi and corrugator supercilii muscles that cause crow's feet and a glabellar frown line with ageing, cannot be accurately evaluated by surface observation. In 71 subjects, this study investigated the extent to which grimacing muscles are innervated by the bilateral motor cortices, whether the corticofacial projection to the grimacing muscles affects the facially innervated stapedius muscle tone by measuring static compliance of the tympanic membrane, and whether unilateral tight eyelid closure with contraction of the grimacing muscles changes static compliance. Unilateral tight eyelid closure and its subsequent change in the contralateral vertical medial eyebrow position revealed that motor neurons of the orbicularis oculi and corrugator supercilii muscles were innervated by the bilateral motor cortices with weak-to-strong contralateral dominance. The orbicularis oculi, corrugator supercilii, and stapedius muscles innervated by the bilateral motor cortices had increased muscle hyperactivity, which lowered the vertical medial eyebrow position and decreased the static compliance of the tympanic membrane more than those innervated by the unilateral motor cortex. Unilateral enhanced tight eyelid closure with contraction of the grimacing muscles in certain subjects ipsilaterally decreased the static compliance with increased contraction of the stapedius muscle, which probably occurs to immobilise the tympanic membrane and protect the inner ear from loud sound. Evaluation of unilateral tight eyelid closure and the subsequent change in the contralateral vertical medial eyebrow position as well as a measurement of the static compliance for the stapedius muscle tone has revealed muscle hyperactivity of grimacing muscles.

Comparative cross-sectional study of masticatory performance and mastication predominance for patients with missing posterior teeth.

PubMed

Iwashita, Hayato; Tsukiyama, Yoshihiro; Kori, Hidehiro; Kuwatsuru, Rika; Yamasaki, Yo; Koyano, Kiyoshi

2014-10-01

Missing posterior teeth can decrease masticatory function and cause horizontal mastication deviation, i.e., mastication predominance. Mastication predominance may lead to abnormal tooth attrition and temporomandibular disorders. This study evaluated masticatory performance and mastication predominance in patients with missing posterior teeth to investigate effects of missing posterior teeth on masticatory performance and mastication predominance. Thirty volunteers with normal dentition (control group), 30 patients with unilateral missing posterior teeth (unilateral group), and 23 patients with bilateral missing posterior teeth (bilateral group) participated. Gummy jellies were used to evaluate participants' masticatory performance, and electromyography was used to assess the degree of mastication predominance. Chewing gums, gummy jellies, and peanuts were used as foods of various hardnesses for evaluating mastication predominance. Compared with the control group, masticatory performance did not differ in the unilateral group but was significantly decreased in the bilateral group. With chewing gum and gummy jellies, the degree of mastication predominance was significantly increased in both unilateral and bilateral groups than the control group. With peanuts, the degree of mastication predominance was significantly increased in the unilateral group than the control group. Although masticatory performance was not decreased in the unilateral group, the degree of mastication predominance was increased. Decreased masticatory performance was observed in the bilateral group, and for foods with normal hardness and soft foods, the degree of mastication predominance was increased. These results suggested that mastication predominance should be considered in the recovery of masticatory performance in patients with missing posterior teeth. Copyright © 2014 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Changes in the Flow-Volume Curve According to the Degree of Stenosis in Patients With Unilateral Main Bronchial Stenosis

PubMed Central

Yoo, Jung-Geun; Yi, Chin A; Lee, Kyung Soo; Jeon, Kyeongman; Um, Sang-Won; Koh, Won-Jung; Suh, Gee Young; Chung, Man Pyo; Kwon, O Jung

2015-01-01

Objectives The shape of the flow-volume (F-V) curve is known to change to showing a prominent plateau as stenosis progresses in patients with tracheal stenosis. However, no study has evaluated changes in the F-V curve according to the degree of bronchial stenosis in patients with unilateral main bronchial stenosis. Methods We performed an analysis of F-V curves in 29 patients with unilateral bronchial stenosis with the aid of a graphic digitizer between January 2005 and December 2011. Results The primary diseases causing unilateral main bronchial stenosis were endobronchial tuberculosis (86%), followed by benign bronchial tumor (10%), and carcinoid (3%). All unilateral main bronchial stenoses were classified into one of five grades (I, ≤25%; II, 26%-50%; III, 51%-75%; IV, 76%-90%; V, >90% to near-complete obstruction without ipsilateral lung collapse). A monophasic F-V curve was observed in patients with grade I stenosis and biphasic curves were observed for grade II-IV stenosis. Both monophasic (81%) and biphasic shapes (18%) were observed in grade V stenosis. After standardization of the biphasic shape of the F-V curve, the breakpoints of the biphasic curve moved in the direction of high volume (x-axis) and low flow (y-axis) according to the progression of stenosis. Conclusion In unilateral bronchial stenosis, a biphasic F-V curve appeared when bronchial stenosis was >25% and disappeared when obstruction was near complete. In addition, the breakpoint moved in the direction of high volume and low flow with the progression of stenosis. PMID:26045916

Hydrocephalus caused by unilateral foramen of Monro obstruction: A review on terminology

PubMed Central

Nigri, Flavio; Gobbi, Gabriel Neffa; da Costa Ferreira Pinto, Pedro Henrique; Simões, Elington Lannes; Caparelli-Daquer, Egas Moniz

2016-01-01

Background: Hydrocephalus caused by unilateral foramen of Monro (FM) obstruction has been referred to in literature by many different terminologies. Precise terminology describing hydrocephalus confined to just one lateral ventricle has a very important prognostic value and determines whether or not the patient can be shunt free after an endoscopic procedure. Methods: Aiming to define the best term for unilateral FM obstruction, 19 terms were employed on PubMed database (http://www.ncbi.nlm.nih.gov/pubmed) as quoted phrases. Results: A total of 194 articles were found. Four patterns of hydrocephalus were discriminated as a result of our research term query and were divided by types for didactic purpose. Type A - partial dilation of the lateral ventricle; Type B - pure unilateral obstruction of the FM; Type C - previously shunted patients with secondary obstruction of the FM; and Type D - asymmetric lateral ventricles with patent FM. Conclusion: In unilateral FM obstruction hydrocephalus, an in-depth review on terminology application is critical to avoid mistakes that may compromise comparisons among different series. This terminology review suggests that Type B hydrocephalus, i.e., the hydrocephalus confined to just one lateral ventricle with no other sites of cerebrospinal fluid circulation blockage, are best described by the terms unilateral hydrocephalus (UH) and monoventricular hydrocephalus, the first being by far the most popular. Type A hydrocephalus is best represented in the literature by the terms uniloculated hydrocephalus and loculated ventricle; Type C hydrocephalus by the terms isolated lateral ventricle and isolated UH; and Type D hydrocephalus by the term asymmetric hydrocephalus. PMID:27274402

A martial arts injury: karate induced unilateral haematoma of the adrenal gland.

PubMed

Ortu, M; Vaccarezza, M; Trovati, S; Galli, M; Gervasoni, C; Vella, A

2006-08-01

Adrenal gland haematoma is often a complication of traumatic events. The case is reported of a 45 year old man with unilateral non-symptomatic adrenal gland haematoma caused by a trauma during martial arts practice.

A martial arts injury: karate induced unilateral haematoma of the adrenal gland

PubMed Central

Ortu, M; Vaccarezza, M; Trovati, S; Galli, M; Gervasoni, C

2006-01-01

Adrenal gland haematoma is often a complication of traumatic events. The case is reported of a 45 year old man with unilateral non‐symptomatic adrenal gland haematoma caused by a trauma during martial arts practice. PMID:16723403

British Nuclear Policymaking,

DTIC Science & Technology

1984-01-01

policy hut much less so than in the United States. TRADE UNIONS Drawing a distinction between political parties and a pressure group such as trade...policy issues. The Campaign for Democratic Socialism, a pressure group against unilateral disarmament, was set up to counter unionist unilateral

Thyrotoxicosis Presenting as Unilateral Drop Foot

PubMed Central

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot. PMID:28768980

Thyrotoxicosis Presenting as Unilateral Drop Foot.

PubMed

Hara, Kenju; Miyata, Hajime; Motegi, Takahide; Shibano, Ken; Ishiguro, Hideaki

2017-01-01

Neuromuscular disorders associated with hyperthyroidism have several variations in their clinical phenotype, such as ophthalmopathy, periodic paralysis, and thyrotoxic myopathy. We herein report an unusual case of thyrotoxic myopathy presenting as unilateral drop foot. Histopathological examinations of the left tibialis anterior muscle showed marked variation in the fiber size, mild inflammatory cell infiltration, and necrotic and regenerated muscle fibers with predominantly type 1 fiber atrophy. Medical treatment with propylthiouracil resulted in complete improvement of the left drop foot. This case expands the phenotype of thyrotoxicosis and suggests that thyrotoxicosis be considered as a possible cause of unilateral drop foot.

Complete dorsal pancreatic agenesis and unilateral renal agenesis.

PubMed

Moreira, Adriana; Carvalho, André; Portugal, Inês; Jesus, José Miguel

2018-02-01

Dorsal pancreatic agenesis is a very rare congenital anomaly. Unilateral renal agenesis, on the other hand, is a relatively common congenital anomaly, although its etiology is not fully understood. Renal and pancreatic embryologic development appears to be nonrelated. We report a case of a 34-year-old man who was referred to our hospital for evaluation of cholestasis and microalbuminuria. Ultrasound and magnetic resonance imaging examinations showed empty right renal fossa and absence of the pancreatic neck, body, and tail. Our case report is the second case of a dorsal pancreatic agenesis and unilateral renal agenesis in a young male patient.

Unilateral or "side-locked" migrainous headache with autonomic symptoms linked to night guard use.

PubMed

Strahlendorf, Jean; Schiffer, Randolph; Strahlendorf, Howard

2008-01-01

Night guards are commonly prescribed as a palliative measure for bruxism, temporomandibular joint symptoms, and associated disorders. We describe a patient with a 10- to 12-year history of night guard use with concurrent unilateral side-locked migrainous headaches with autonomic symptoms characteristic of trigeminal autonomic cephalgia. These headaches were refractory to numerous pharmacological interventions. Upon self-initiated cessation of night guard use, there was complete remission of headaches. We believe the headaches were initiated by night guard-initiated irritation of the trigeminal nerve and a trigeminal autonomic reflex resulting in unilateral migrainous headache with autonomic signs.

Rare encounter of unilateral facial nerve palsy in an adolescent with Guillain-Barré syndrome

PubMed Central

Iqbal, Mehtab; Sharma, Parnika; Charadva, Creana; Prasad, Manish

2016-01-01

Unilateral facial nerve palsy is rarely encountered in Guillain-Barré syndrome (GBS). We report a case of an adolescent girl who presented with peripheral ascending weakness, preceded by Campylobacter jejuni infection. After treatment with intravenous immunoglobulin, the peripheral weakness improved. Electro-diagnostic testing confirmed axonal dysfunction and the patient was positive for antiganglioside antibodies. However, the patient developed unilateral left-sided facial weakness. She was managed with further intravenous immunoglobulin and intensive physiotherapy. The outcome for facial palsy was very good, with almost complete resolution after 2 weeks. PMID:26823357

Simple and Efficient Technique for Correction of Unilateral Scissor Bite Using Straight Wire

PubMed Central

Dolas, Siddhesh Gajanan; Chitko, Shrikant Shrinivas; Kerudi, Veerendra Virupaxappa; Bonde, Prasad Vasudeo

2016-01-01

Unilateral scissor bite is a relatively rare malocclusion. However, its correction is often difficult and a challenge for the clinician. This article presents simple and efficient technique for the correction of severe unilateral scissor bite in a 14 year old boy, using 0.020 S.S. A. J. Wilcock wire (premium plus) out of the spool, with minimal adjustments and placed in mandibular arch. After about six weeks time, good amount of correction was seen in the lower arch and the lower molar had been relieved of scissor bite. PMID:27231682

Bilateral and Unilateral Cochlear Implant Users Compared on Speech Perception in Noise

PubMed Central

Dunn, Camille C.; Noble, William; Tyler, Richard S.; Kordus, Monika; Gantz, Bruce J.; Ji, Haihong

2009-01-01

Objective Compare speech performance in noise with matched bilateral (CICI) and unilateral (CI-Only) cochlear implant users. Design Thirty CICI and 30 CI-Only subjects were tested on a battery of speech perception tests in noise that utilize an 8-loudspeaker array. Results On average, CICI subject's performance with speech in noise was significantly better than the CI-Only subjects. Conclusion The CICI group showed significantly better performance on speech perception in noise compared to the CI-Only subjects, supporting the hypothesis that bilateral cochlear implantation is more beneficial than unilateral implantation. PMID:19858720

A cone beam computed tomographic evaluation of the size of the sella turcica in patients with cleft lip and palate.

PubMed

Paknahad, Maryam; Shahidi, Shoaleh; Khaleghi, Iman

2017-09-01

Changes in the size of the sella turcica are frequently related to pathologies and syndromes. The aim of this was to compare the sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate and non-cleft subjects. Cone beam computed tomography (CBCT) images of three groups consisted of 20 patients with unilateral cleft lip and palate; 20 patients with bilateral cleft lip and palate and a control group consisting of 20 non-cleft subjects were the research population in this pilot study. The sella turcica linear dimensions in terms of length, depth and diameter were measured for all subjects. One-way ANOVA test was used to determine any significant differences among the three groups for the measured parameters. The length, depth and diameter of sella turcica were found to be significantly smaller in the unilateral and bilateral groups compared with the normal age and gender matched group. No significant differences were found in the measured variables between the unilateral and bilateral cleft patients. CBCT images showed a greater likelihood of abnormal sella turcica dimensions in patients with unilateral and bilateral cleft lip and palate. Therefore, the sella turcica dimensions may have an intrinsic relationship to the cleft condition.

Mechanisms of Gait Asymmetry Due to Push-off Deficiency in Unilateral Amputees

PubMed Central

Adamczyk, Peter Gabriel; Kuo, Arthur D.

2015-01-01

Unilateral lower-limb amputees exhibit asymmetry in many gait features, such as ground force, step time, step length, and joint mechanics. Although these asymmetries result from weak prosthetic-side push-off, there is no proven mechanistic explanation of how that impairment propagates to the rest of the body. We used a simple dynamic walking model to explore possible consequences of a unilateral impairment similar to that of a transtibial amputee. The model compensates for reduced push-off work from one leg by performing more work elsewhere, for example during the middle of stance by either or both legs. The model predicts several gait abnormalities, including slower forward velocity of the body center-of-mass (COM) during intact-side stance, greater energy dissipation in the intact side, and more positive work overall. We tested these predictions with data from unilateral transtibial amputees (N = 11) and non-amputee control subjects (N = 10) walking on an instrumented treadmill. We observed several predicted asymmetries, including forward velocity during stance phases and energy dissipation from the two limbs, as well as greater work overall. Secondary adaptations, such as to reduce discomfort, may exacerbate asymmetry, but these simple principles suggest that some asymmetry may be unavoidable in cases of unilateral limb loss. PMID:25222950

Mechanisms of Gait Asymmetry Due to Push-Off Deficiency in Unilateral Amputees.

PubMed

Adamczyk, Peter Gabriel; Kuo, Arthur D

2015-09-01

Unilateral lower-limb amputees exhibit asymmetry in many gait features, such as ground force, step time, step length, and joint mechanics. Although these asymmetries result from weak prosthetic-side push-off, there is no proven mechanistic explanation of how that impairment propagates to the rest of the body. We used a simple dynamic walking model to explore possible consequences of a unilateral impairment similar to that of a transtibial amputee. The model compensates for reduced push-off work from one leg by performing more work elsewhere, for example during the middle of stance by either or both legs. The model predicts several gait abnormalities, including slower forward velocity of the body center-of-mass during intact-side stance, greater energy dissipation in the intact side, and more positive work overall. We tested these predictions with data from unilateral transtibial amputees (N = 11) and nonamputee control subjects (N = 10) walking on an instrumented treadmill. We observed several predicted asymmetries, including forward velocity during stance phases and energy dissipation from the two limbs, as well as greater work overall. Secondary adaptations, such as to reduce discomfort, may exacerbate asymmetry, but these simple principles suggest that some asymmetry may be unavoidable in cases of unilateral limb loss.

Individuals with chronic ankle instability exhibit dynamic postural stability deficits and altered unilateral landing biomechanics: A systematic review.

PubMed

Simpson, Jeffrey D; Stewart, Ethan M; Macias, David M; Chander, Harish; Knight, Adam C

2018-06-13

To evaluate the literature regarding unilateral landing biomechanics and dynamic postural stability in individuals with and without chronic ankle instability (CAI). Four online databases (PubMed, ScienceDirect, Scopus, and SportDiscus) were searched from the earliest records to 31 January 2018, as well as reference sections of related journal articles, to complete the systematic search. Studies investigating the influence of CAI on unilateral landing biomechanics and dynamic postural stability were systematically reviewed and evaluated. Twenty articles met the criteria and were included in the systematic review. Individuals with CAI were found to have deficits in dynamic postural stability on the affected limb with medium to large effect sizes and altered lower extremity kinematics, most notably in the ankle and knee, with medium to large effect sizes. Additionally, greater loading rates and peak ground reaction forces, in addition to reductions in ankle muscle activity were also found in individuals with CAI during unilateral jump-landing tasks. Individuals with CAI demonstrate dynamic postural stability deficits, lower extremity kinematic alterations, and reduced neuromuscular control during unilateral jump-landings. These are likely factors that contribute recurrent lateral ankle sprain injuries during dynamic activity in individuals with CAI. Copyright © 2018 Elsevier Ltd. All rights reserved.

Side-to-side difference in dynamic unilateral balance ability and pitching performance in Japanese collegiate baseball pitchers.

PubMed

Yanagisawa, Osamu; Futatsubashi, Genki; Taniguchi, Hidenori

2018-01-01

[Purpose] To evaluate the side-to-side difference in dynamic unilateral balance ability and to determine the correlation of the balance ability with pitching performance in collegiate baseball pitchers. [Subjects and Methods] Twenty-five Japanese collegiate baseball pitchers participated in this study. Dynamic balance ability during a unilateral stance was bilaterally evaluated using the star excursion balance test (SEBT). The pitchers threw 20 fastballs at an official pitching distance; the maximal ball velocity and pitching accuracy (the number of strike/20 pitches × 100) were assessed. Side-to-side difference in scores of SEBT was assessed using a paired t-test. Correlations between SEBT scores and pitching performance were evaluated for both legs using a Pearson's correlation analysis. [Results] The pivot side showed significantly higher score of the SEBT in the anteromedial direction than the stride side. On the other hand, the SEBT scores in the pivot and stride legs did not have significant correlations with maximal ball velocity and pitching accuracy. [Conclusion] These findings suggest that marked side-to-side difference does not exist in the dynamic unilateral balance ability of collegiate baseball pitchers and that the dynamic unilateral balance ability of each leg is not directly related to maximal ball velocity and pitching accuracy.

Spanish Transcultural Adaptation and Validity of the Behavioral Inattention Test

PubMed Central

Sánchez-Cabeza, Ángel; Huertas-Hoyas, Elisabet; Máximo-Bocanegra, Nuria; Rosa María Martínez-Piédrola; Pérez-de-Heredia-Torres, Marta

2017-01-01

Objective To adapt, validate, and translate the Behavioral Inattention Test as an assessment tool for Spanish individuals with unilateral spatial neglect. Design A cross-sectional descriptive study. Setting University laboratories. Participants A sample of 75 Spanish stroke patients and 18 healthy control subjects. Interventions Not applicable. Main Outcome Measures The Behavioral Inattention Test. Results The Spanish version of the Behavioral Inattention Test shows a high degree of reliability both in the complete test (α = .90) and in the conventional (α = .93) and behavioral subtests (α = .75). The concurrent validity between the total conventional and behavioral scores was high (r = −.80; p < 0.001). Significant differences were found between patients with and without unilateral spatial neglect (p < 0.001). In the comparison between right and left damaged sides, differences were found in all items, except for article reading (p = 0.156) and card sorting (p = 0.117). Conclusions This measure is a useful tool for evaluating unilateral spatial neglect as it provides information on everyday problems. The BIT discriminates between stroke patients with and without unilateral spatial neglect. This measure constitutes a reliable tool for the diagnosis, planning, performance, and design of specific treatment programs intended to improve the functionality and quality of life of people with unilateral spatial neglect. PMID:29097959

[Aetiology and treatment of vocal fold paralysis: retrospective study of 108 patients].

PubMed

Bothe, Carolina; López, Montserrat; Quer, Miquel; León, Xavier; García, Jacinto; Lop, Joan

2014-01-01

To review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. Retrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. Of the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. The aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

Neurosteroid allopregnanolone reduces ipsilateral visual cortex potentiation following unilateral optic nerve injury.

PubMed

Sergeeva, Elena G; Espinosa-Garcia, Claudia; Atif, Fahim; Pardue, Machelle T; Stein, Donald G

2018-05-02

In adult mice with unilateral optic nerve crush injury (ONC), we studied visual response plasticity in the visual cortex following stimulation with sinusoidal grating. We examined visually evoked potentials (VEP) in the primary visual cortex ipsilateral and contralateral to the crushed nerve. We found that unilateral ONC induces enhancement of visual response on the side ipsilateral to the injury that is evoked by visual stimulation to the intact eye. This enhancement was associated with supranormal spatial frequency thresholds in the intact eye when tested using optomotor response. To probe whether injury-induced disinhibition caused the potentiation, we treated animals with the neurosteroid allopregnanolone, a potent agonist of the GABA A receptor, one hour after crush and on post-injury days 3, 8, 13, and 18. Allopregnanolone diminished enhancement of the VEP and this effect was associated with the upregulated synthesis of the δ-subunit of the GABA A receptor. Our study shows a new aspect of experience-dependent plasticity following unilateral ONC. This hyper-activity in the ipsilateral visual cortex is prevented by upregulation of GABA inhibition with allopregnanolone. Our findings suggest the therapeutic potential of allopregnanolone for modulation of plasticity in certain eye and brain disorders and a possible role for disinhibition in ipsilateral hyper-activity following unilateral ONC. Copyright © 2018. Published by Elsevier Inc.

Children with optic nerve hypoplasia face a high risk of neurodevelopmental disorders.

PubMed

Dahl, Sara; Wickström, Ronny; Ek, Ulla; Teär Fahnehjelm, Kristina

2018-03-01

Optic nerve hypoplasia (ONH) is a congenital ocular malformation that has been associated with neurodevelopmental disorders, but the prevalence in unilateral disease and less severe visual impairment is unknown. We studied intellectual disability and autism spectrum disorders (ASDs) in patients with ONH. This was a population-based cross-sectional cohort study of 65 patients (33 female) with ONH below 20 years of age, living in Stockholm in December 2009, with data analysed in January 2016. Of these 35 were bilateral and 30 were unilateral. Neurodevelopmental disorders were diagnosed or confirmed by neurological assessments, the Five to Fifteen parent questionnaire and reviewing previous neuropsychological investigations or conducting neuropsychological tests. Bilateral ONH patients had lower mean full scale intelligence quotient scores than unilateral patients (84.4 and 99.4, respectively, p = 0.049). We assessed intellectual disability in 55 eligible patients, and it was more common in patients with bilateral ONH (18 of 32, 56%) than unilateral ONH (two of 23, 9%, p < 0.001). ASDs were diagnosed in seven of 42 (17%) patients. Children with bilateral ONH had a high risk of neurodevelopmental disorders, especially intellectual disability. The risk was lower in unilateral ONH, but the levels of neurodevelopmental disorders warrant screening of both groups. ©2017 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Unilateral endonasal transcribriform approach with septal transposition for olfactory groove meningioma: can olfaction be preserved?

PubMed

Youssef, A Samy; Sampath, Raghuram; Freeman, Jacob L; Mattingly, Jameson K; Ramakrishnan, Vijay R

2016-10-01

Loss of olfaction has been considered inevitable in endoscopic endonasal resection of olfactory groove meningiomas. Olfaction preservation may be feasible through an endonasal unilateral transcribriform approach, with the option for expansion using septal transposition and contralateral preservation of the olfactory apparatus. An expanded unilateral endonasal transcribriform approach with septal transposition was performed in five cadaver heads. The approach was applied in a surgical case of a 24 × 26-mm olfactory groove meningioma originating from the right cribriform plate with partially intact olfaction. The surgical approach offered adequate exposure to the anterior skull base bilaterally. The nasal/septal mucosa was preserved on the contralateral side. Gross total resection of the meningioma was achieved with the successful preservation of the contralateral olfactory apparatus and preoperative olfaction. Six months later, the left nasal cavity showed no disruption of the mucosal lining and the right side was at the appropriate stage of healing for a harvested nasoseptal flap. One year later, the preoperative olfactory function was intact and favorably viewed by the patient. Objective testing of olfaction showed microsomia. Olfaction preservation may be feasible in the endoscopic endonasal resection of a unilateral olfactory groove meningioma through a unilateral transcribriform approach with septal transposition and preservation of the contralateral olfactory apparatus.

First molar cross-bite is more closely associated with a reverse chewing cycle than anterior or pre-molar cross-bite during mastication.

PubMed

Tomonari, H; Ikemori, T; Kubota, T; Uehara, S; Miyawaki, S

2014-12-01

A posterior cross-bite is defined as an abnormal bucco-lingual relationship between opposing molars, pre-molars or both in centric occlusion. Although it has been reported that patients with unilateral posterior cross-bite often show unique chewing patterns, the relationship between the form of cross-bite and masticatory jaw movement remains unclear in adult patients. The objective of this study was to investigate masticatory jaw movement among different forms of cross-bite. One hundred and one adults were recruited in this study: 27 had unilateral first molar cross-bite (MC group); 28, unilateral pre-molar cross-bite (PC group); 23, anterior cross-bite (AC group); and 23, normal occlusion (control group). Masticatory jaw movement of the lower incisor point was recorded with six degrees of freedom jaw-tracking system during unilateral mastication. Our results showed that the reverse chewing ratio during deliberate unilateral mastication was significantly larger in the MC group than in the PA (P < 0.001), AC (P < 0.001) and control (P < 0.001) groups. These findings suggest that compared to the anterior or pre-molar cross-bite, the first molar cross-bite is more closely associated with a higher prevalence of a reverse chewing cycle. © 2014 John Wiley & Sons Ltd.

ARE UNILATERAL AND BILATERAL KNEE OSTEOARTHRITIS PATIENTS UNIQUE SUBSETS OF KNEE OSTEOARTHRITIS? A BIOMECHANICAL PERSPECTIVE

PubMed Central

Messier, Stephen P.; Beavers, Daniel P.; Herman, Cassandra; Hunter, David J.; DeVita, Paul

2016-01-01

Objective To compare the gait of adults with unilateral and bilateral symptomatic and radiographic knee osteoarthritis (OA) to determine whether these subgroups can be treated similarly in the clinic and when recruiting for randomized clinical trials, and to use these data to generate future hypotheses regarding gait in these subsets of knee OA patients. Methods Cross-sectional investigation of patients with unilateral and bilateral knee OA on gait mechanics using 136 older adults (age ≥ 55 yrs.; 27 kg.m−2 ≥ BMI ≤ 41 kg.m−2; 82% female) with radiographic knee OA. Comparisons were made between the most affected side of the bilateral group (Bi) and the affected side of the unilateral group (Uni), and between symmetry indices of each group. Results There were no significant differences in any temporal, kinematic, or kinetic measures between the Uni and Bi cohorts. Comparison of symmetry indices between groups also revealed no significant differences. Conclusion The similarity in lower extremity mechanics between unilateral and bilateral knee OA patients is sufficiently robust to consider both subsets as a single cohort. We hypothesize that biomechanical adaptations to knee OA are at least partially systemic in origin and not based solely on the physiological characteristics of an affected knee joint. PMID:26706699

Confined anterior cerebral artery infarction manifesting as isolated unilateral axial weakness.

PubMed

Honig, Asaf; Eliahou, Ruth; Auriel, Eitan

2017-02-15

We describe isolated unilateral axial weakness in three patients eventually diagnosed with anterior cerebral artery infarction (ACAI), a new clinical observation. Files of three ACAI patients (2 females, 1 male, ages 55-80) were retrospectively reviewed. All three presented to the ED with sudden unsteadiness. On initial neurological examination, all three patients manifested unilateral truncal deviation to the side contralateral to the weakness, even while seated. There was significant unilateral hypotonia due to substantial paravertebral weakness. None had pyramidal signs or increased limb tone. Speech, language, and cognitive performance were intact during admission examination. In all three patients, initial diffusion-weighted imaging (DWI) MRI showed small confined regions of restriction involving the posterolateral border of ACA territory; CT angiography was normal in one patient with a newly diagnosed atrial fibrillation but showed atherosclerotic vasculature with severe narrowing of the A3 segment of the ACA in two. Awareness of ACAI presenting as unilateral axial weakness is warranted. We suggest that optimal diagnostic management should include examination of axial tone. Ischemic involvement of distal ACA branches may herald a more extensive ACAI. Prompt diagnosis may enable thrombolysis or endovascular treatment, and blood pressure maintenance may allow adequate perfusion to damaged tissue. Copyright © 2016 Elsevier B.V. All rights reserved.

REDUCED CHORIOCAPILLARIS FLOW IN EYES WITH TYPE 3 NEOVASCULARIZATION AND AGE-RELATED MACULAR DEGENERATION.

PubMed

Borrelli, Enrico; Souied, Eric H; Freund, K Bailey; Querques, Giuseppe; Miere, Alexandra; Gal-Or, Orly; Sacconi, Riccardo; Sadda, SriniVas R; Sarraf, David

2018-04-30

To study choriocapillaris (CC) flow in eyes with Type 3 neovascularization (NV) and age-related macular degeneration, using optical coherence tomography angiography analysis. In this multicenter, retrospective, observational study, we collected data from 21 patients with unilateral Type 3 NV and age-related macular degeneration, based on clinical examination, structural optical coherence tomography, and fluorescein angiography when available. An additional group of 20 nonneovascular age-related macular degeneration eyes with unilateral Type 1 or Type 2 NV due to age-related macular degeneration was included for comparison. En face optical coherence tomography angiography imaging (3 × 3 mm scans) with quantitative microvascular analysis of the CC was performed. Main outcome measures were: 1) the percent nonperfused choriocapillaris area; and 2) the average CC signal void size. We included 21 patients with unilateral Type 3 NV (15 female, 71.5%) and 20 patients with unilateral Type 1 or 2 NV (9 female, 45.0% P = 0.118). Mean ± SD age was 82.1 ± 7.4 years in the unilateral Type 3 patients and 78.3 ± 8.1 in unilateral Type 1/2 NV subjects (P = 0.392). The percent nonperfused choriocapillaris area was 56.3 ± 8.1% in eyes with Type 3 NV and 51.9 ± 4.3% in the fellow eyes (P = 0.016). The average signal void size was also increased in those eyes with Type 3 NV (939.9 ± 680.9 μm), compared with the fellow eyes (616.3 ± 304.2 μm, P = 0.039). The number of signal voids was reduced in the Type 3 NV eyes (604.5 ± 282.9 vs. 747.3 ± 195.8, P = 0.046). The subfoveal choroidal thickness was 135.9 ± 54.2 μm in eyes with Type 3 NV and 167.2 ± 65.4 μm in the fellow eyes (P = 0.003). In addition, the fellow eyes of patients with unilateral Type 3 NV displayed more significant CC flow abnormalities versus the fellow eyes with unilateral Type 1/2 NV (percent nonperfused choriocapillaris area = 51.9 ± 4.3% vs. 46.0 ± 2.1%, respectively, P < 0.0001; and average signal void size 616.3 ± 304.2 μm versus 351.4 ± 65.5 μm, respectively, P < 0.0001; and number of signal voids 747.3 ± 195.8 vs. 998.5 ± 147.3, respectively, P < 0.0001). Eyes with unilateral Type 3 NV illustrated increased CC nonperfusion versus fellow nonneovascular eyes. These results suggest that choroidal ischemia may play an important role in the development of Type 3 NV.

Psychological characteristics of patients with asthma.

PubMed

Bulcun, Emel; Turkel, Yakup; Oguztürk, Omer; Dag, Ersel; Visal Buturak, S; Ekici, Aydanur; Ekici, Mehmet

2018-01-01

Psychological distress of patients with asthma may be reduced when they learned to live with their illness. Asthma can change the psychological and personality characteristics. We aim to investigate the psychological and personality characteristics of patients with asthma using MMPI (Minnesota Multiphasic Personality Inventory). Thirty-three adult patients with asthma (23 female and 10 male) and 20 healthy controls (14 females and 6 males) were enrolled in this study. Psychometric evaluation was made with the Turkish version of the MMPI. The patients were separated into two groups according to the duration of symptoms (recent-onset asthma < 10 years, long-standing asthma ≥10 years). Patients with asthma compared with control group had significantly higher the rate of clinical elevation on depression, hysteria, psychasthenia and social introversion. Patients with recent-onset asthma compared with long-standing asthma have significantly higher the rate of clinical elevation on depression, hysteria, psychopathic deviate, psychasthenia and social introversion. MMPI mean t score in patients with recent-onset asthma was higher than patients with long-standing asthma. MMPI mean t score in patients with asthma was negatively associated with the symptom duration in multivariate model. Patients with asthma have relatively more inactivity, anergia, guilt, pessimism, nonspecific physical complaints, irrational fears and introvert. Patients with long-standing asthma have less psychological distress, suggesting that learned to cope with his illness. © 2016 John Wiley & Sons Ltd.

Identification of Left Atrial Appendage Thrombi in Patients With Persistent and Long-Standing Persistent Atrial Fibrillation Using Intra-Cardiac Echocardiography and Cardiac Computed Tomography.

PubMed

Ikegami, Yukinori; Tanimoto, Kojiro; Inagawa, Kohei; Shiraishi, Yasuyuki; Fuse, Jun; Sakamoto, Munehisa; Momiyama, Yukihiko; Takatsuki, Seiji

2017-12-25

Intracardiac echocardiography (ICE) and cardiac computed tomography (CCT), in addition to standard transesophageal echocardiography (TEE), have been used to identify left atrial (LA) thrombi prior to ablation for atrial fibrillation (AF). The clinical advantages of this, however, remain unclear. This study therefore investigated the advantages of additional pre-procedural LA appendage (LAA) thrombus evaluation using ICE and the clinical value of CCT in persistent and long-standing persistent AF.Methods and Results:We analyzed data from 108 consecutive patients with persistent and long-standing persistent AF who were scheduled to undergo AF ablation. TEE was performed within 24 h prior to ablation. ICE was performed for 97 patients in whom a thrombus was not detected on TEE. CCT was performed in 95 patients. Thrombus or sludge was detected on TEE in 11 patients (10.3%), for whom ablation was cancelled. Four additional patients were diagnosed with LAA thrombus on ICE. When TEE and ICE were used as the reference for thrombus detection, the sensitivity, specificity, positive predictive value, and negative predictive value of CCT for identifying contrast defects in the LAA were 100%, 81.0%, 40.7%, and 100%, respectively. ICE combined with TEE increased the detection rate of LAA thrombi in patients with persistent and long-standing persistent AF. Moreover, CCT had high sensitivity and negative predictive value for LAA thrombus detection.

Ocular Toxocariasis: Clinical Features and Long-term Visual Outcomes in Adult Patients.

PubMed

Despreaux, Raphaelle; Fardeau, Christine; Touhami, Sara; Brasnu, Emmanuelle; Champion, Emmanuelle; Paris, Luc; Touitou, Valérie; Bodaghi, Bahram; Lehoang, Phuc

2016-06-01

To investigate clinical characteristics and treatment outcomes of proven ocular toxocariasis (OT) in adult patients. Retrospective, consecutive, interventional case series. setting: Institutional. Consecutive OT patients with positive serum serology and positive western blot (WB) on ocular sample. Clinical features, optical coherence tomography (OCT), and treatment outcomes. Best-corrected visual acuity (BCVA) and OCT central foveal thickness (CFT). Fourteen patients were included between 2011 and 2013. Mean age at diagnosis was 45.6 years. Mean duration between the first symptoms and diagnosis was 15.1 months. Uveitis was unilateral in all cases and all patients displayed vitreous inflammation. The main baseline findings were presence of ≥1 peripheral granulomas (57.1%), vasculitis (57.1%), vitreoretinal traction (57.1%), and chronic macular edema (ME) (71.4%). Delayed diagnosis (>8 months) seemed to be associated with higher rate of ME. All patients received albendazole. Systemic (n = 5) and/or local corticosteroids (CS) (n = 7) were administered in case of ME and/or posterior segment inflammation. Vitrectomy was performed when vitreous inflammation was severe and persistent despite CS or in case of threatening traction or visually significant epimacular membrane (28.6%). Overall, this regimen allowed significant decrease of CFT (P = .01). In the vitrectomy subgroup, mean BCVA increased (P = .01) and CFT decreased (P = .017). While some features such as granuloma are typical signs of OT, atypical features can delay the diagnosis. In doubtful situations, WB on ocular samples seems to be more specific than serum antibodies alone. ME seems to be a common complication of longstanding OT in the adult. Copyright © 2016 Elsevier Inc. All rights reserved.

Bilateral uveitis and Usher syndrome: a case report.

PubMed

Benson, Matthew D; MacDonald, Ian M

2015-03-15

Usher syndrome is a genetically heterogeneous condition and represents the most common cause of inherited combined vision and hearing loss. Deficits manifest as sensorineural hearing loss that typically develops at a young age and retinitis pigmentosa that can lead to peripheral vision loss and night blindness. As a result, this syndrome can have a significant impact on a patient's quality of life. Previous studies have described an association between Usher syndrome and Fuchs' heterochromic iridocyclitis, a form of non-granulomatous uveitis that generally presents in a unilateral manner. We present a rare finding of bilateral uveitis and, to the best of our knowledge, the first report of granulomatous uveitis as a feature in a patient with Usher syndrome. A 45-year-old Caucasian woman with a known history of retinitis pigmentosa presented to our clinic with suspected Usher syndrome, given her report of long-standing hearing loss. Aside from a mild loss in visual acuity, our patient was otherwise asymptomatic. Visual field testing, audiology and electroretinography findings supported the diagnosis of Usher syndrome. With slit lamp examination she was found to have bilateral keratic precipitates, with large, greasy-white, mutton-fat keratic precipitates on the endothelial surface of her left eye. A thorough work-up that included blood tests and imaging was negative for an alternative cause of her uveitis. We present a rare finding of bilateral uveitis and what we believe to be the first reported instance of mutton-fat keratic precipitates and granulomatous uveitis as a feature in a patient with Usher syndrome. By identifying atypical presentations of the disease, we hope to contribute to the range of ophthalmic conditions that may be seen in association with Usher syndrome.

Differential impact of partial cortical blindness on gaze strategies when sitting and walking - an immersive virtual reality study

PubMed Central

Iorizzo, Dana B.; Riley, Meghan E.; Hayhoe, Mary; Huxlin, Krystel R.

2011-01-01

The present experiments aimed to characterize the visual performance of subjects with long-standing, unilateral cortical blindness when walking in a naturalistic, virtual environment. Under static, seated testing conditions, cortically blind subjects are known to exhibit compensatory eye movement strategies. However, they still complain of significant impairment in visual detection during navigation. To assess whether this is due to a change in compensatory eye movement strategy between sitting and walking, we measured eye and head movements in subjects asked to detect peripherally-presented, moving basketballs. When seated, cortically blind subjects detected ~80% of balls, while controls detected almost all balls. Seated blind subjects did not make larger head movements than controls, but they consistently biased their fixation distribution towards their blind hemifield. When walking, head movements were similar in the two groups, but the fixation bias decreased to the point that fixation distribution in cortically blind subjects became similar to that in controls - with one major exception: at the time of basketball appearance, walking controls looked primarily at the far ground, in upper quadrants of the virtual field of view; cortically blind subjects looked significantly more at the near ground, in lower quadrants of the virtual field. Cortically blind subjects detected only 58% of the balls when walking while controls detected ~90%. Thus, the adaptive gaze strategies adopted by cortically blind individuals as a compensation for their visual loss are strongest and most effective when seated and stationary. Walking significantly alters these gaze strategies in a way that seems to favor walking performance, but impairs peripheral target detection. It is possible that this impairment underlies the experienced difficulty of those with cortical blindness when navigating in real life. PMID:21414339

Differential impact of partial cortical blindness on gaze strategies when sitting and walking - an immersive virtual reality study.

PubMed

Iorizzo, Dana B; Riley, Meghan E; Hayhoe, Mary; Huxlin, Krystel R

2011-05-25

The present experiments aimed to characterize the visual performance of subjects with long-standing, unilateral cortical blindness when walking in a naturalistic, virtual environment. Under static, seated testing conditions, cortically blind subjects are known to exhibit compensatory eye movement strategies. However, they still complain of significant impairment in visual detection during navigation. To assess whether this is due to a change in compensatory eye movement strategy between sitting and walking, we measured eye and head movements in subjects asked to detect peripherally-presented, moving basketballs. When seated, cortically blind subjects detected ∼80% of balls, while controls detected almost all balls. Seated blind subjects did not make larger head movements than controls, but they consistently biased their fixation distribution towards their blind hemifield. When walking, head movements were similar in the two groups, but the fixation bias decreased to the point that fixation distribution in cortically blind subjects became similar to that in controls - with one major exception: at the time of basketball appearance, walking controls looked primarily at the far ground, in upper quadrants of the virtual field of view; cortically blind subjects looked significantly more at the near ground, in lower quadrants of the virtual field. Cortically blind subjects detected only 58% of the balls when walking while controls detected ∼90%. Thus, the adaptive gaze strategies adopted by cortically blind individuals as a compensation for their visual loss are strongest and most effective when seated and stationary. Walking significantly alters these gaze strategies in a way that seems to favor walking performance, but impairs peripheral target detection. It is possible that this impairment underlies the experienced difficulty of those with cortical blindness when navigating in real life. Copyright © 2011 Elsevier Ltd. All rights reserved.

A case of bilateral aldosterone-producing adenomas differentiated by segmental adrenal venous sampling for bilateral adrenal sparing surgery

PubMed Central

Morimoto, R; Satani, N; Iwakura, Y; Ono, Y; Kudo, M; Nezu, M; Omata, K; Tezuka, Y; Seiji, K; Ota, H; Kawasaki, Y; Ishidoya, S; Nakamura, Y; Arai, Y; Takase, K; Sasano, H; Ito, S; Satoh, F

2016-01-01

Primary aldosteronism due to unilateral aldosterone-producing adenoma (APA) is a surgically curable form of hypertension. Bilateral APA can also be surgically curable in theory but few successful cases can be found in the literature. It has been reported that even using successful adrenal venous sampling (AVS) via bilateral adrenal central veins, it is extremely difficult to differentiate bilateral APA from bilateral idiopathic hyperaldosteronism (IHA) harbouring computed tomography (CT)-detectable bilateral adrenocortical nodules. We report a case of bilateral APA diagnosed by segmental AVS (S-AVS) and blood sampling via intra-adrenal first-degree tributary veins to localize the sites of intra-adrenal hormone production. A 36-year-old man with marked long-standing hypertension was referred to us with a clinical diagnosis of bilateral APA. He had typical clinical and laboratory profiles of marked hypertension, hypokalaemia, elevated plasma aldosterone concentration (PAC) of 45.1 ng dl−1 and aldosterone renin activity ratio of 90.2 (ng dl−1 per ng ml−1 h−1), which was still high after 50 mg-captopril loading. CT revealed bilateral adrenocortical tumours of 10 and 12 mm in diameter on the right and left sides, respectively. S-AVS confirmed excess aldosterone secretion from a tumour segment vein and suppressed secretion from a non-tumour segment vein bilaterally, leading to the diagnosis of bilateral APA. The patient underwent simultaneous bilateral sparing adrenalectomy. Histopathological analysis of the resected adrenals together with decreased blood pressure and PAC of 5.2 ng dl−1 confirmed the removal of bilateral APA. S-AVS was reliable to differentiate bilateral APA from IHA by direct evaluation of intra-adrenal hormone production. PMID:26538381

The influence of unilateral saccular impairment on functional balance performance and self-report dizziness.

PubMed

McCaslin, Devin L; Jacobson, Gary P; Grantham, Sarah L; Piker, Erin G; Verghese, Susha

2011-09-01

Postural stability in humans is largely maintained by vestibular, visual, and somatosensory inputs to the central nervous system. Recent clinical advances in the assessment of otolith function (e.g., cervical and ocular vestibular evoked myogenic potentials [cVEMPs and oVEMPs], subjective visual vertical [SVV] during eccentric rotation) have enabled investigators to identify patients with unilateral otolith impairments. This research has suggested that patients with unilateral otolith impairments perform worse than normal healthy controls on measures of postural stability. It is not yet known if patients with unilateral impairments of the saccule and/or inferior vestibular nerve (i.e., unilaterally abnormal cVEMP) perform differently on measures of postural stability than patients with unilateral impairments of the horizontal SCC (semicircular canal) and/or superior vestibular nerve (i.e., unilateral caloric weakness). Further, it is not known what relationship exists, if any, between otolith system impairment and self-report dizziness handicap. The purpose of this investigation was to determine the extent to which saccular impairments (defined by a unilaterally absent cVEMP) and impairments of the horizontal semicircular canal (as measured by the results of caloric testing) affect vestibulospinal function as measured through the Sensory Organization Test (SOT) of the computerized dynamic posturography (CDP). A secondary objective of this investigation was to measure the effects, if any, that saccular impairment has on a modality-specific measure of health-related quality of life. A retrospective cohort study. Subjects were assigned to one of four groups based on results from balance function testing: Group 1 (abnormal cVEMP response only), Group 2 (abnormal caloric response only), Group 3 (abnormal cVEMP and abnormal caloric response), and Group 4 (normal control group). Subjects were 92 adult patients: 62 were seen for balance function testing due to complaints of dizziness, vertigo, or unsteadiness, and 30 served as controls. All subjects underwent videonystagmography or electronystagmography (VNG/ENG), vestibular evoked myogenic potentials (VEMPs), self-report measures of self-perceived dizziness disability/handicap (Dizziness Handicap Inventory), and tests of postural control (Neurocom Equitest). Subjects were categorized into one of four groups based on balance function test results. All variables were subjected to a multifactor analysis of variance (ANOVA). The Dizziness Handicap Inventory (DHI) total scores and equilibrium scores served as the dependent variables. Results showed that patients with abnormal unilateral saccular or inferior vestibular nerve function (i.e., abnormal cVEMP) demonstrated significantly impaired postural control when compared to normal participants. However, this group demonstrated significantly better postural stability when compared to the group with abnormal caloric responses alone and the group with abnormal caloric responses and abnormal cVEMP results. Patients with an abnormal cVEMP did not differ significantly on the DHI compared to the other two impaired groups. We interpret these findings as evidence that a significantly asymmetrical cVEMP in isolation negatively impacts performance on measures of postural control compared to normal subjects but not compared to patients with significant caloric weaknesses. However, patients with a unilaterally abnormal cVEMP do not differ from patients with significant caloric weaknesses in regard to self-perceived dizziness handicap. American Academy of Audiology.

Post-traumatic unilateral plantar hyperhidrosis.

PubMed

Eren, Y; Yavasoglu, N G; Comoglu, S S

2016-02-01

Localized unilateral hyperhidrosis is rare and poorly understood, sometimes stemming from trauma. Feet, quite vulnerable to trauma are affected by disease-mediated plantar hyperhidrosis, usually bilaterally. This report describes partial hyperhidrosis developing post-traumatically on the left plantar region of a 52-year-old male.

Minimally invasive thoracoscopic repair of unilateral pectus carinatum.

PubMed

Kim, Sunghoon; Idowu, Olajire

2009-02-01

Thoracoscopic repair of pectus excavatum as described by Nuss has become a well established method of repair. However, minimally invasive intrathoracic repair of pectus carinatum has not been reported in literature. We report a case of successful thoracoscopic repair of unilateral pectus carinatum.

Primary aldosteronism: results of adrenalectomy for nonsingle adenoma.

PubMed

Quillo, Amy R; Grant, Clive S; Thompson, Geoffrey B; Farley, David R; Richards, Melanie L; Young, William F

2011-07-01

Historically, treatment of confirmed primary aldosteronism has been adrenalectomy for unilateral adenoma; bilateral hypersecretion is treated medically. Increasingly, we use adrenal venous sampling (AVS) to define unilateral hypersecretion. Histology of glands resected based on AVS often reveals multiple nodules or hyperplasia. The aim of this study was to compare patients with multiple nodules or hyperplasia with those with single adenoma with regard to cure, preoperative imaging, AVS ratio, and biochemical evaluation to determine if a nonsingle adenoma (NSA) process could be predicted to impact extent of adrenalectomy. This was a retrospective study reviewing a single-institutional surgical experience at a tertiary academic center from 1993 to 2008, during which 215 patients with primary aldosteronism underwent unilateral adrenalectomy based on imaging of a single adenoma (normal contralateral gland) or AVS ratios. Histology included single adenoma versus NSA; cure was defined as normal immediate postoperative plasma or urine aldosterone level, normal aldosterone:renin ratio, or normotension without antihypertensive medications. Follow-up (mean 13 months, range 0 to 185 months) was available for 167 patients: 132 (79%) single adenoma and 35 (21%) NSA. All 35 patients with NSA and 128 patients (97%) with single adenoma were cured. Imaging studies correctly predicted NSA in 29% and 57% when combined with AVS. Identifying patients with NSA preoperatively was impossible biochemically: mean serum and urinary aldosterone levels and AVS ratios were not different than those of the single adenoma group. Twenty-one percent of patients had NSA, all cured by unilateral adrenalectomy. No preoperative evaluation reliably predicted NSA. Therefore, total unilateral adrenalectomy was safest given the potential for incomplete resection with partial adrenalectomy. Accurate AVS is highly predictive of cure irrespective of the unilateral adrenal histology. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Multivariate analysis on unilateral cleft lip and palate treatment outcome by EUROCRAN index: A retrospective study.

PubMed

Yew, Ching Ching; Alam, Mohammad Khursheed; Rahman, Shaifulizan Abdul

2016-10-01

This study is to evaluate the dental arch relationship and palatal morphology of unilateral cleft lip and palate patients by using EUROCRAN index, and to assess the factors that affect them using multivariate statistical analysis. A total of one hundred and seven patients from age five to twelve years old with non-syndromic unilateral cleft lip and palate were included in the study. These patients have received cheiloplasty and one stage palatoplasty surgery but yet to receive alveolar bone grafting procedure. Five assessors trained in the use of the EUROCRAN index underwent calibration exercise and ranked the dental arch relationships and palatal morphology of the patients' study models. For intra-rater agreement, the examiners scored the models twice, with two weeks interval in between sessions. Variable factors of the patients were collected and they included gender, site, type and, family history of unilateral cleft lip and palate; absence of lateral incisor on cleft side, cheiloplasty and palatoplasty technique used. Associations between various factors and dental arch relationships were assessed using logistic regression analysis. Dental arch relationship among unilateral cleft lip and palate in local population had relatively worse scoring than other parts of the world. Crude logistics regression analysis did not demonstrate any significant associations among the various socio-demographic factors, cheiloplasty and palatoplasty techniques used with the dental arch relationship outcome. This study has limitations that might have affected the results, example: having multiple operators performing the surgeries and the inability to access the influence of underlying genetic predisposed cranio-facial variability. These may have substantial influence on the treatment outcome. The factors that can affect unilateral cleft lip and palate treatment outcome is multifactorial in nature and remained controversial in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Does unilateral basal ganglia activity functionally influence the contralateral side? What we can learn from STN stimulation in patients with Parkinson's disease.

PubMed

Brun, Yohann; Karachi, Carine; Fernandez-Vidal, Sara; Jodoin, Nicolas; Grabli, David; Bardinet, Eric; Mallet, Luc; Agid, Yves; Yelnik, Jerome; Welter, Marie-Laure

2012-09-01

In humans, the control of voluntary movement, in which the corticobasal ganglia (BG) circuitry participates, is mainly lateralized. However, several studies have suggested that both the contralateral and ipsilateral BG systems are implicated during unilateral movement. Bilateral improvement of motor signs in patients with Parkinson's disease (PD) has been reported with unilateral lesion or high-frequency stimulation (HFS) of the internal part of the globus pallidus or the subthalamic nucleus (STN-HFS). To decipher the mechanisms of production of ipsilateral movements induced by the modulation of unilateral BG circuitry activity, we recorded left STN neuronal activity during right STN-HFS in PD patients operated for bilateral deep brain stimulation. Left STN single cells were recorded in the operating room during right STN-HFS while patients experienced, or did not experience, right stimulation-induced dyskinesias. Most of the left-side STN neurons (64%) associated with the presence of right dyskinesias were inhibited, with a significant decrease in burst and intraburst frequencies. In contrast, left STN neurons not associated with right dyskinesias were mainly activated (48%), with a predominant increase 4-5 ms after the stimulation pulse and a decrease in oscillatory activity. This suggests that unilateral neuronal STN modulation is associated with changes in the activity of the contralateral STN. The fact that one side of the BG system can influence the functioning of the other could explain the occurrence of bilateral dyskinesias and motor improvement observed in PD patients during unilateral STN-HFS, as a result of a bilateral disruption of the pathological activity in the corticosubcortical circuitry.

Comparison of two spinal needle types to achieve a unilateral spinal block.

PubMed

Kuusniemi, Kristiina; Leino, Kari; Lertola, Kaarlo; Pihlajamäki, Kalevi; Pitkänen, Mikko

2013-04-01

Unilateral spinal anesthesia is beneficial in patients undergoing unilateral leg surgery. The direction and the shape of the spinal needle are thought to influence the unilateral distribution of the local anesthetic in the intrathecal space. Therefore, to study the effects of different spinal needles we compared the effects of the Whitacre and Quincke spinal needles. This was a prospective, randomized, double-blind study of 60 consecutive outpatients scheduled for unilateral lower-limb surgery. The patients were randomized to receive spinal anesthesia with 1.2 ml of 0.5 % plain bupivacaine using either a 27-G Whitacre or a Quincke needle. One half of the local anesthetic was injected towards the nondependent side and the other half was directed cranially. The spread of spinal anesthesia, both sensory and motor blocks, was defined as the primary endpoint and was recorded at 10, 20, and 30 min after the spinal injection, at the end of the operation, 2 h after the spinal injection, and every 30 min thereafter until there was no motor block. Secondary endpoints included patient satisfaction and adverse effects. There was no difference in the spread of sensory or motor blocks between the Whitacre and the Quincke groups. However, the sensory and motor blocks on the operated and the nonoperated sides were significantly different at all testing times, as expected. There was no difference in the incidence of adverse effects or patient satisfaction scores between the Whitacre and the Quincke groups. Unilateral spinal block for outpatient surgery can be achieved with both pencil-point (Whitacre) and Quincke needles using 6.0 mg of plain bupivacaine. Neither the spread of sensory and motor blocks nor the corresponding recovery times appeared to be different between the groups. Nor was there any difference in patient satisfaction.

Is mandibular asymmetry more frequent and severe with unilateral disc displacement?

PubMed

Xie, Qianyang; Yang, Chi; He, Dongmei; Cai, Xieyi; Ma, Zhigui

2015-01-01

To investigate the prevalence of mandibular asymmetry (MA) within the symptomatic unilateral anterior disc displacement (ADD) patients, and analyze the influence TMJ factors of the MA severity. Patients aged under 20 years old with symptomatic unilateral ADD and asymptomatic volunteers with normal disc-condyle relationship diagnosed by magnetic resonance imaging (MRI) were included in this study. Posteroanterior cephalometric radiographs were taken to measure MA. Condylar height, disc length and disc displacement were measured by MRI. The prevalence and severity of MA were compared between the ADD and the control groups. The correlation between the severity of MA with the amount of condylar height shortage, disc deformity and distance of disc displacement were also evaluated within the ADD group. There were 165 cases in the unilateral ADD group, and 156 cases in the control group. One hundred and nineteen cases had MA which accounted 72.12% (119/165) in the ADD group; while in the control group, only 25.64% (40/156) exhibited MA. The mean horizontal menton deviation and condylar height shortage in the unilateral ADD group were significantly larger than that in the control group (5.62 mm vs. 4.19 mm; 3.14 mm vs. 1.32 mm, p < 0.01). The severity of MA was significantly correlated with the amount of disc displacement, disc deformity and condylar height shortage (correlation coefficient: 0.80, 0.70, and 0.82). MA is much more common and severe in young unilateral ADD patients. The severity of MA is correlated with the height of condyle and the status of the disc. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Growing Use of Contralateral Prophylactic Mastectomy Despite no Improvement in Long-term Survival for Invasive Breast Cancer.

PubMed

Wong, Stephanie M; Freedman, Rachel A; Sagara, Yasuaki; Aydogan, Fatih; Barry, William T; Golshan, Mehra

2017-03-01

To update and examine national temporal trends in contralateral prophylactic mastectomy (CPM) and determine whether survival differed for invasive breast cancer patients based on hormone receptor (HR) status and age. We identified women diagnosed with unilateral stage I to III breast cancer between 1998 and 2012 within the Surveillance, Epidemiology, and End Results registry. We compared characteristics and temporal trends between patients undergoing breast-conserving surgery, unilateral mastectomy, and CPM. We then performed Cox proportional-hazards regression to examine breast cancer-specific survival (BCSS) and overall survival (OS) in women diagnosed between 1998 and 2007, who underwent breast-conserving surgery with radiation (breast-conserving therapy), unilateral mastectomy, or CPM, with subsequent subgroup analysis stratifying by age and HR status. Of 496,488 women diagnosed with unilateral invasive breast cancer, 59.6% underwent breast-conserving surgery, 33.4% underwent unilateral mastectomy, and 7.0% underwent CPM. Overall, the proportion of women undergoing CPM increased from 3.9% in 2002 to 12.7% in 2012 (P < 0.001). Reconstructive surgery was performed in 48.3% of CPM patients compared with only 16.0% of unilateral mastectomy patients, with rates of reconstruction with CPM rising from 35.3% in 2002 to 55.4% in 2012 (P < 0.001). When compared with breast-conserving therapy, we found no significant improvement in BCSS or OS for women undergoing CPM (BCSS: HR 1.08, 95% confidence interval 1.01-1.16; OS: HR 1.08, 95% confidence interval 1.03-1.14), regardless of HR status or age. The use of CPM more than tripled during the study period despite evidence suggesting no survival benefit over breast conservation. Further examination on how to optimally counsel women about surgical options is warranted.

Effects of prefrontal tDCS on executive function: Methodological considerations revealed by meta-analysis.

PubMed

Imburgio, Michael J; Orr, Joseph M

2018-05-01

A meta-analysis of studies using single-session transcranial direct current stimulation (tDCS) to target the dorsolateral prefrontal cortex (DLPFC) was undertaken to examine the effect of stimulation on executive function (EF) in healthy samples. 27 studies were included in analyses, yielding 71 effect sizes. The most relevant measure for each task was determined a priori and used to calculate Hedge's g. Methodological characteristics of each study were examined individually as potential moderators of effect size. Stimulation effects on three domains of EF (inhibition of prepotent responses, mental set shifting, and information updating and monitoring) were analyzed separately. In line with previous work, the current study found no significant effect of anodal unilateral tDCS, cathodal unilateral tDCS, or bilateral tDCS on EF. Further moderator and subgroup analyses were only carried out for anodal unilateral montages due to the small number of studies using other montages. Subgroup analyses revealed a significant effect of anodal unilateral tDCS on updating tasks, but not on inhibition or set-shifting tasks. Cathode location significantly moderated the effect of anodal unilateral tDCS. Extracranial cathodes yielded a significant effect on EF while cranial cathodes yielded no effect. Anode size also significantly moderated effect of anodal unilateral tDCS, with smaller anodes being more effective than larger anodes. In summary, anodal DLPFC stimulation is more effective at improving updating ability than inhibition and set-shifting ability, but anodal stimulation can significantly improve general executive function when extracranial cathodes or small anodes are used. Future meta-analyses may examine how stimulation's effects on specific behavioral tasks, rather than broader domains, might be affected by methodological moderators. Copyright © 2018 Elsevier Ltd. All rights reserved.

Head-shaking nystagmus predicts greater disability in unilateral peripheral vestibulopathy.

PubMed

Angeli, Simon I; Velandia, Sandra; Snapp, Hillary

2011-01-01

The objective of this study was to determine the association of the bedside test of head-shaking nystagmus (HSN) with patients' self-perceived dizziness handicap as well as this test's sensitivity and specificity in unilateral peripheral vestibular hypofunction. A retrospective case-control study was performed. The study was held at an academic, tertiary referral center. Fifty-three adult patients with unilateral peripheral hypofunction defined by the caloric test of the videonystagmography with documented bedside HSN and who had completed questionnaires of self-perceived dizziness handicap were included. The sensitivity and specificity of the bedside HSN in patients and 10 healthy controls in diagnosing unilateral vestibular hypofunction defined by videonystagmographic caloric testing and by abnormal gain and symmetry of the vestibular-ocular reflex by rotary chair testing were determined. Scores of the screening test of the Dizziness Handicap Index and Functional Level Scale questionnaires were taken. When using the caloric irrigation test as the reference standard for unilateral vestibular hypofunction, the sensitivity, specificity, and positive predictive value of the bedside HSN were 31%, 96%, and 97%, respectively. When comparing with results of rotational chair testing (vestibular-ocular reflex gain and symmetry), the sensitivity of the HSN test increases to 71%. Patients with positive bedside HSN had higher scores (greater self-perceived dizziness handicap) of the Dizziness Handicap Index (P = .049) and higher (worse) scores of the Functional Level Scale (P = .0377) than those with negative bedside HSN (Wilcoxon rank test). Greater perceived handicap was correlated with a positive bedside HSN in patients with unilateral peripheral vestibulopathy. The HSN has sufficient sensitivity to be used as screening test of uncompensated vestibulopathy in this series. However, a negative HSN alone does not rule out the diagnosis of peripheral vestibular dysfunction. Copyright © 2011 Elsevier Inc. All rights reserved.

Association of surgical approach with complication rate, progression-free survival time, and disease-specific survival time in cats with mammary adenocarcinoma: 107 cases (1991-2014).

PubMed

Gemignani, Francesco; Mayhew, Philipp D; Giuffrida, Michelle A; Palaigos, Jason; Runge, Jeffrey J; Holt, David E; Robertson, Nicholas A; Seguin, Bernard; Walker, Meaghan; Singh, Ameet; Liptak, Julius M; Romanelli, Giorgio; Martano, Marina; Boston, Sarah E; Lux, Cassie; Busetto, Roberto; Culp, William T N; Skorupski, Katherine A; Burton, Jenna H

2018-06-01

OBJECTIVE To evaluate potential associations between surgical approach and complication rate, progression-free survival time, and disease-specific survival time in cats with mammary adenocarcinoma. DESIGN Retrospective case series. ANIMALS 107 client-owned cats. PROCEDURES Medical records of cats that underwent surgical excision of mammary adenocarcinoma by means of a unilateral or bilateral (staged or single-session) mastectomy at 9 hospitals between 1991 and 2014 were reviewed. Relevant clinicopathologic data and details of surgical and adjuvant treatments were recorded. Outcome data were obtained, including postoperative complications, progression-free survival time, and disease-specific survival time. RESULTS Complications occurred in 12 of 61 (19.7%) cats treated with unilateral mastectomy, 5 of 14 (35.7%) cats treated with staged bilateral mastectomy, and 13 of 32 (40.6%) cats treated with single-session bilateral mastectomy. Complications were significantly more likely to occur in cats undergoing bilateral versus unilateral mastectomy. Median progression-free survival time was longer for cats treated with bilateral mastectomy (542 days) than for cats treated with unilateral mastectomy (289 days). Significant risk factors for disease progression included unilateral mastectomy, tumor ulceration, lymph node metastasis, and tumors arising in the fourth mammary gland. Significant risk factors for disease-specific death included lymph node metastasis and development of regional or distant metastasis. Among cats that did not develop metastasis, unilateral mastectomy was a significant risk factor for disease-specific death. Treatment with chemotherapy was associated with a significantly decreased risk of disease-specific death. CONCLUSIONS AND CLINICAL RELEVANCE Results supported bilateral mastectomy for the treatment of mammary adenocarcinoma in cats to improve progression-free and disease-specific survival time. Performing bilateral mastectomy in a staged fashion may help to decrease the complication rate.

Bilateral movements increase sustained extensor force in the paretic arm.

PubMed

Kang, Nyeonju; Cauraugh, James H

2018-04-01

Muscle weakness in the extensors poststroke is a common motor impairment. Unfortunately, research is unclear on whether bilateral movements increase extensor force production in the paretic arm. This study investigated sustained force production while stroke individuals maximally extended their wrist and fingers on their paretic arm. Specifically, we determined isometric force production in three conditions: (a) unilateral paretic arm, (b) unilateral nonparetic arm, and (c) bilateral (both arms executing the same movement simultaneously). Seventeen chronic stroke patients produced isometric sustained force by executing wrist and fingers extension in unilateral and bilateral contraction conditions. Mean force, force variability (coefficient of variation), and signal-to-noise ratio were calculated for each contraction condition. Analysis of two-way (Arm × Type of Condition: 2 × 2; Paretic or Nonparetic Arm × Unilateral or Bilateral Conditions) within-subjects ANOVAs revealed that the bilateral condition increased sustained force in the paretic arm, but reduced sustained force in the nonparetic arm. Further, although the paretic arm exhibited more force variability and less signal-to-noise ratio than the nonparetic arm during a unilateral condition, there were no differences when participants simultaneously executed isometric contractions with both arms. Our unique findings indicate that bilateral contractions transiently increased extensor force in the paretic arm. Implications for Rehabilitation Bilateral movements increased isometric wrsit extensor force in paretic arms and redcued force in nonparetic arms versus unilateral movements. Both paretic and nonparetic arms produced similar force variability and signal-to-noise ratio during bilateral movements. Increased sustained force in the paretic arm during the bilateral condition indicates that rehabilitation protocols based on bilateral movements may be beneficial for functional recovery.

Assessing Muscle-Strength Asymmetry via a Unilateral-Stance Isometric Midthigh Pull.

PubMed

Dos'Santos, Thomas; Thomas, Christopher; Jones, Paul A; Comfort, Paul

2017-04-01

To investigate the within-session reliability of bilateral- and unilateral-stance isometric midthigh-pull (IMTP) force-time characteristics including peak force (PF), relative PF, and impulse at time bands (0-100, 0-200, 0-250, and 0-300 milliseconds) and to compare isometric force-time characteristics between right and left and dominant (D) and nondominant (ND) limbs. Professional male rugby league and multisport male college athletes (N = 54; age, 23.4 ± 4.2 y; height, 1.80 ± 0.05 m; mass, 88.9 ± 12.9 kg) performed 3 bilateral IMTP trials and 6 unilateral-stance IMTP trials (3 per leg) on a force plate sampling at 600 Hz. Intraclass correlation coefficients (ICCs) and coefficients of variation (CVs) demonstrated high within-session reliability for bilateral and unilateral IMTP PF (ICC = .94, CV = 4.7-5.5%). Lower reliability measures and greater variability were observed for bilateral and unilateral IMTP impulse at time bands (ICC = .81-.88, CV = 7.7-11.8%). Paired-sample t tests and Cohen d effect sizes revealed no significant differences for all isometric force-time characteristics between right and left limbs in male college athletes (P >.05, d ≤ 0.32) and professional rugby league players (P > .05, d ≤ 0.11); however, significant differences were found between D and ND limbs in male college athletes (P < .001, d = 0.43-0.91) and professional rugby league players (P < .001, d = 0.27-0.46). This study demonstrated high within-session reliability for unilateral-stance IMTP PF, revealing significant differences in isometric force-time characteristics between D and ND limbs in male athletes.

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy.

PubMed

Zielinski, Ingar Marie; Steenbergen, Bert; Baas, C Marjolein; Aarts, Pauline; Jongsma, Marijtje L A

2016-01-11

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Feasibility of translaminar screw placement in Korean population: morphometric analysis of cervical spine.

PubMed

Ji, Gyu Yeul; Oh, Chang Hyun; Park, Sang Hyuk; Kurniawan, Ferry; Lee, Junho; Jeon, Jae Kyun; Shin, Dong Ah; Kim, Keung Nyun

2015-01-01

To analyze the feasibility of unilateral and bilateral translaminar screw placement in Koran population, and compare the acceptance rate using previously reported data in American population. The translaminar lengths, thickness, heights, and sagittal-diagonal measurements were performed. The feasibility analysis was performed using unilateral and bilateral 3.5 mm cervical screw placement on the CT scans within 0.5 mm of safety margin. We also performed radiographic analysis of the morphometric dimensions and the feasibility of unilateral and bilateral translaminar screw placement at C3-C7. Korean population had similar or significantly shorter translaminar lengths and thickness (lengths and thickness in C7 among males; lengths in C6-C7 and thickness in C4 among females) than American population, but had similar or significantly longer translaminar heights and sagittal-diagonal measurements (heights in C3-C7 and sagittal-diagonal measurements in C3-C6 among males; heights in C7 and sagittal-diagonal measurements in C3-C7 among females). Unilaterally, translaminar screw acceptance rates in C3-C7 were similar between Korean and American male population, but the rates in C4-C6 were significantly smaller between Korean and American female population. Bilaterally, translaminar screw acceptance rates in C3 and C5-C6 were significantly larger between Korean and American male population, but the rates in C3-C7 were similar between Korean and American female population. The feasibility of unilateral and bilateral translaminar screw placement is different depending on different ethnics. Subaxial cervical unilateral translaminar screw placement among Korean male population and bilateral placement at C4-C7 among Korean female population are more acceptable than American population.

Children with unilateral hearing loss may have lower intelligence quotient scores: A meta-analysis.

PubMed

Purcell, Patricia L; Shinn, Justin R; Davis, Greg E; Sie, Kathleen C Y

2016-03-01

In this meta-analysis, we reviewed observational studies investigating differences in intelligence quotient (IQ) scores of children with unilateral hearing loss compared to children with normal hearing. PubMed Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO. A query identified all English-language studies related to pediatric unilateral hearing loss published between January 1980 and December 2014. Titles, abstracts, and articles were reviewed to identify observational studies reporting IQ scores. There were 261 unique titles, with 29 articles undergoing full review. Four articles were identified, which included 173 children with unilateral hearing loss and 202 children with normal hearing. Ages ranged from 6 to 18 years. Three studies were conducted in the United States and one in Mexico. All were of high quality. All studies reported full-scale IQ results; three reported verbal IQ results; and two reported performance IQ results. Children with unilateral hearing loss scored 6.3 points lower on full-scale IQ, 95% confidence interval (CI) [-9.1, -3.5], P value < 0.001; and 3.8 points lower on performance IQ, 95% CI [-7.3, -0.2], P value 0.04. When investigating verbal IQ, we detected substantial heterogeneity among studies; exclusion of the outlying study resulted in significant difference in verbal IQ of 4 points, 95% CI [-7.5, -0.4], P value 0.028. This meta-analysis suggests children with unilateral hearing loss have lower full-scale and performance IQ scores than children with normal hearing. There also may be disparity in verbal IQ scores. Laryngoscope, 126:746-754, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Reduction of Sample Size Requirements by Bilateral Versus Unilateral Research Designs in Animal Models for Cartilage Tissue Engineering

PubMed Central

Orth, Patrick; Zurakowski, David; Alini, Mauro; Cucchiarini, Magali

2013-01-01

Advanced tissue engineering approaches for articular cartilage repair in the knee joint rely on translational animal models. In these investigations, cartilage defects may be established either in one joint (unilateral design) or in both joints of the same animal (bilateral design). We hypothesized that a lower intraindividual variability following the bilateral strategy would reduce the number of required joints. Standardized osteochondral defects were created in the trochlear groove of 18 rabbits. In 12 animals, defects were produced unilaterally (unilateral design; n=12 defects), while defects were created bilaterally in 6 animals (bilateral design; n=12 defects). After 3 weeks, osteochondral repair was evaluated histologically applying an established grading system. Based on intra- and interindividual variabilities, required sample sizes for the detection of discrete differences in the histological score were determined for both study designs (α=0.05, β=0.20). Coefficients of variation (%CV) of the total histological score values were 1.9-fold increased following the unilateral design when compared with the bilateral approach (26 versus 14%CV). The resulting numbers of joints needed to treat were always higher for the unilateral design, resulting in an up to 3.9-fold increase in the required number of experimental animals. This effect was most pronounced for the detection of small-effect sizes and estimating large standard deviations. The data underline the possible benefit of bilateral study designs for the decrease of sample size requirements for certain investigations in articular cartilage research. These findings might also be transferred to other scoring systems, defect types, or translational animal models in the field of cartilage tissue engineering. PMID:23510128

Number and location of drainage catheter side holes: in vitro evaluation.

PubMed

Ballard, D H; Alexander, J S; Weisman, J A; Orchard, M A; Williams, J T; D'Agostino, H B

2015-09-01

To evaluate the influence of number and location of catheter shaft side holes regarding drainage efficiency in an in vitro model. Three different drainage catheter models were constructed: open-ended model with no side holes (one catheter), unilateral side hole model (six catheters with one to six unilateral side holes), and bilateral side hole model (six catheters with one to six bilateral side holes). Catheters were inserted into a drainage output-measuring device with a constant-pressure reservoir of water. The volume of water evacuated by each of the catheters at 10-second intervals was measured. A total of five trials were performed for each catheter. Data were analysed using one-way analysis of variance. The open-ended catheter had a mean drainage volume comparable to the unilateral model catheters with three, four, and five side holes. Unilateral model catheters had significant drainage volume increases up to three side holes; unilateral model catheters with more than three side holes had no significant improvement in drainage volume. All bilateral model catheters had significantly higher mean drainage volumes than their unilateral counterparts. There was no significant difference between the mean drainage volume with one, two, or three pairs of bilateral side holes. Further, there was no drainage improvement by adding additional bilateral side holes. The present in vitro study suggests that beyond a critical side hole number threshold, adding more distal side holes does not improve catheter drainage efficiency. These results may be used to enhance catheter design towards improving their drainage efficiency. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Ultrasonographic findings in dual kidney transplantation.

PubMed

Impedovo, Stefano Vittorio; Martino, Pasquale; Palazzo, Silvano; Ditonno, Pasquale; Tedeschi, Michele; Palumbo, Fabrizio; Tafa, Ardit; Matera, Matteo; Selvaggi, Francesco Paolo; Battaglia, Michele

2012-12-01

Organ shortage has led to using grafts from expanded criteria donors (ECD). Double kidney transplantation is an accepted strategy to increase the donor pool, using organs from an ECD which are not acceptable for single kidney transplantation (SKT). Aim of this retrospective study was to analyse the role of colour Doppler ultrasound (CDUS) in the diagnosis of major surgical complications in DKT, performed with unilateral or bilateral placement. From 2000 to 2011 we performed 54 DKT. Unilateral placement of both kidneys was done in 26 patients and bilateral DKT in 28, through two separate Gibson incisions (18) or one midline incision (10). Each patient underwent at least 3 CDUS before hospital discharge. The main surgical complications, discovered initially thanks to ultrasound (US), were hydronephrosis from ureteral obstruction, lymphocele and deep venous thrombosis (DVT). Mean follow-up was 42.7 months. Good postoperative renalfunction was demonstrated in 25 patients (46.3%), while delayed graft function occurred in 29 (53.7%). US showed ureteral obstruction requiring surgery in 5 unilateral DKT while no patient subjected to bilateral DKT developed severe hydronephrosis. Lymphoocele, surgically drained, was demonstrated in 6 bilateral DKT with a midline incision, 2 bilateral DKT with two separate incisions and 3 unilateral DKT. CDUS also enabled diagnosis of 2 cases of DVT in ipsilateral DKTs. CDUS provides useful information in patients with DKT, allowing the detection of clinically unsuspected unilateral diseases. US study of our patients demonstrated that unilateral DKTs are more susceptible to the development of DVT and ureteral stricture, while the incidence of voluminous lymphocele is more frequent in bilateral DKT through a single midline incision. In this scenario, all patients undergoing DKT should be carefully monitored by US after surgery.

Bitemporal v. high-dose right unilateral electroconvulsive therapy for depression: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Kolshus, E; Jelovac, A; McLoughlin, D M

2017-02-01

Brief-pulse electroconvulsive therapy (ECT) is the most acutely effective treatment for severe depression though concerns persist about cognitive side-effects. While bitemporal electrode placement is the most commonly used form worldwide, right unilateral ECT causes less cognitive side-effects though historically it has been deemed less effective. Several randomized trials have now compared high-dose (>5× seizure threshold) unilateral ECT with moderate-dose (1.0-2.5× seizure threshold) bitemporal ECT to investigate if it is as effective as bitemporal ECT but still has less cognitive side-effects. We aimed to systematically review these trials and meta-analyse clinical and cognitive outcomes where appropriate. We searched PubMed, PsycINFO, Web of Science, Cochrane Library and EMBASE for randomized trials comparing these forms of ECT using the terms 'electroconvulsive' OR 'electroshock' AND 'trial'. Seven trials (n = 792) met inclusion criteria. Bitemporal ECT did not differ from high-dose unilateral ECT on depression rating change scores [Hedges's g = -0.03, 95% confidence interval (CI) -0.17 to 0.11], remission (RR 1.06, 95% CI 0.93-1.20), or relapse at 12 months (RR 1.42, 95% CI 0.90-2.23). There was an advantage for unilateral ECT on reorientation time after individual ECT sessions (mean difference in minutes = -8.28, 95% CI -12.86 to -3.70) and retrograde autobiographical memory (Hedges's g = -0.46, 95% CI -0.87 to -0.04) after completing an ECT course. There were no differences for general cognition, category fluency and delayed visual and verbal memory. High-dose unilateral ECT does not differ from moderate-dose bitemporal ECT in antidepressant efficacy but has some cognitive advantages.

Unilateral incompatibility in Capsicum (Solanaceae): occurrence and taxonomic distribution.

PubMed

Onus, A Naci; Pickersgill, Barbara

2004-08-01

Unilateral incompatibility (UI) occurs when pollinations between species are successful in one direction but not in the other. Self-incompatible (SI) species frequently show UI with genetically related, self-compatible (SC) species, as pollen of SI species is compatible on the SC pistil, but not vice versa. Many examples of unilateral incompatibility, and all those which have been studied most intensively, are found in the Solanaceae, particularly Lycopersicon, Solanum, Nicotiana and Petunia. The genus Capsicum is evolutionarily somewhat distant from Lycopersicon and Solanum and even further removed from Nicotiana and Petunia. Unilateral incompatibility has also been reported in Capsicum; however, this is the first comprehensive study of crosses between all readily available species in the genus. All readily available (wild and domesticated) species in the genus are used as plant material, including the three genera from the Capsicum pubescens complex plus eight other species. Pollinations were made on pot-grown plants in a glasshouse. The number of pistils pollinated per cross varied (from five to 40 pistils per plant), depending on the numbers of flowers available. Pistils were collected 24 h after pollination and fixed for 3-24 h. After staining, pistils were mounted in a drop of stain, squashed gently under a cover slip and examined microscopically under ultra-violet light for pollen tube growth. Unilateral incompatibility is confirmed in the C. pubescens complex. Its direction conforms to that predominant in the Solanaceae and other families, i.e. pistils of self-incompatible species, or self-compatible taxa closely related to self-incompatible species, inhibit pollen tubes of self-compatible species. Unilateral incompatibility in Capsicum does not seem to have arisen to prevent introgression of self-compatibility into self-incompatible taxa, but as a by-product of divergence of the C. pubescens complex from the remainder of the genus.

Development of the Mini-Assisting Hand Assessment: evidence for content and internal scale validity.

PubMed

Greaves, Susan; Imms, Christine; Dodd, Karen; Krumlinde-Sundholm, Lena

2013-11-01

To describe the development of the Mini-Assisting Hand Assessment (Mini-AHA) for children with signs of unilateral cerebral palsy (CP) aged 8 to 18 months, and evaluate aspects of content and internal scale validity. The ability of the video-recorded Mini-AHA play session to provoke bimanual performance in children with unilateral CP and typical development was evaluated. Original AHA test items were examined for their suitability for younger children and possible new items were generated. Data from 108 assessments of children with unilateral CP (86 children, 53 males, 33 females; mean age 13 mo, SD 3 mo, range 8-18 mo) were entered into a Rasch measurement model analysis to evaluate internal scale validity. A Spearman's correlation analysis explored the relationship between age and ability measures for children with unilateral CP. The frequency of maximum scores in 40 children with typical development (22 males, 18 females; mean age 12 mo, SD 3 mo) was examined. The Mini-AHA play session provoked bimanual responses in typically developing children 99% of the time. Person and item fit criteria established 20 items for the scale. The resultant unidimensional scale also demonstrated excellent discriminative features through high separation reliability. The item calibration values covered the range of person ability measures well. Age was not related to the ability measures for children with unilateral CP (rs =0.178). All children with typical development achieved maximum scores. Accumulated evidence shows that the Mini-AHA validly measures use of the affected hand during bimanual performance for children with unilateral CP aged 8 to 18 months. The Mini-AHA has the potential to be a useful assessment to evaluate functional hand use and the effects of intervention in an age group when potential for change is high. © 2013 Mac Keith Press.

Observations on the elicitation of secondary and inverted primary nystagmus from the cat by unilateral caloric irrigation.

DOT National Transportation Integrated Search

1963-02-01

Vestibular stimulation by repeated unilateral caloric irrigation of cats occasioned the appearance of secondary, tertiary, and inverted primary nystagmus in some animals. These inverse responses were recorded with stimulus temperatures of 5, 23.5, an...

Midline shift and lateral guidance angle in adults with unilateral posterior crossbite.

PubMed

Rilo, Benito; da Silva, José Luis; Mora, María Jesús; Cadarso-Suárez, Carmen; Santana, Urbano

2008-06-01

Unilateral posterior crossbite is a malocclusion that, if not corrected during infancy, typically causes permanent asymmetry. Our aims in this study were to evaluate various occlusal parameters in a group of adults with uncorrected unilateral posterior crossbite and to compare findings with those obtained in a group of normal subjects. Midline shift at maximum intercuspation, midline shift at maximum aperture, and lateral guidance angle in the frontal plane were assessed in 25 adults (ages, 17-26 years; mean, 19.6 years) with crossbites. Midline shift at maximum intercuspation was zero (ie, centric midline) in 36% of the crossbite subjects; the remaining subjects had a shift toward the crossbite side. Midline shift at maximum aperture had no association with crossbite side. Lateral guidance angle was lower on the crossbite side than on the noncrossbite side. No parameter studied showed significant differences with respect to the normal subjects. Adults with unilateral posterior crossbite have adaptations that compensate for the crossbite and maintain normal function.

The effects of floor incline on lower extremity biomechanics during unilateral landing from a jump in dancers.

PubMed

Pappas, Evangelos; Orishimo, Karl F; Kremenic, Ian; Liederbach, Marijeanne; Hagins, Marshall

2012-05-01

Retrospective studies have suggested that dancers performing on inclined ("raked") stages have increased injury risk. One study suggests that biomechanical differences exist between flat and inclined surfaces during bilateral landings; however, no studies have examined whether such differences exist during unilateral landings. In addition, little is known regarding potential gender differences in landing mechanics of dancers. Professional dancers (N = 41; 14 male, 27 female) performed unilateral drop jumps from a 30 cm platform onto flat and inclined surfaces while extremity joint angles and moments were identified and analyzed. There were significant joint angle and moment effects due to the inclined flooring. Women had significantly decreased peak ankle dorsiflexion and hip adduction moment compared with men. Findings of the current study suggest that unilateral landings on inclined stages create measurable changes in lower extremity biomechanical variables. These findings provide a preliminary biomechanical rationale for differences in injury rates found in observational studies of raked stages.

Spinal hemianesthesia: Unilateral and posterior

PubMed Central

Imbelloni, Luiz Eduardo

2014-01-01

The injection of a non-isobaric local anesthetic should induce a unilateral spinal anesthesia in patients in a lateral decubitus position. The posterior spinal hemianesthesia only be obtained with hypobaric solutions injected in the jackknife position. The most important factors to be considered when performing a spinal hemianesthesia are: type and gauge of the needle, density of the local anesthetic relative to the CSF, position of the patient, speed of administration of the solution, time of stay in position, and dose/concentration/volume of the anesthetic solution. The distance between the spinal roots on the right-left sides and anterior-posterior is, approximately, 10-15 mm. This distance allows performing unilateral spinal anesthesia or posterior spinal anesthesia. The great advantage of obtaining spinal hemianesthesia is the reduction of cardiovascular changes. Likewise, both the dorsal and unilateral sensory block predominates in relation to the motor block. Because of the numerous advantages of producing spinal hemianesthesia, anesthesiologists should apply this technique more often. This review considers the factors which are relevant, plausible and proven to obtain spinal hemianesthesia. PMID:25886320

Design and experimental validation of Unilateral Linear Halbach magnet arrays for single-sided magnetic resonance.

PubMed

Bashyam, Ashvin; Li, Matthew; Cima, Michael J

2018-07-01

Single-sided NMR has the potential for broad utility and has found applications in healthcare, materials analysis, food quality assurance, and the oil and gas industry. These sensors require a remote, strong, uniform magnetic field to perform high sensitivity measurements. We demonstrate a new permanent magnet geometry, the Unilateral Linear Halbach, that combines design principles from "sweet-spot" and linear Halbach magnets to achieve this goal through more efficient use of magnetic flux. We perform sensitivity analysis using numerical simulations to produce a framework for Unilateral Linear Halbach design and assess tradeoffs between design parameters. Additionally, the use of hundreds of small, discrete magnets within the assembly allows for a tunable design, improved robustness to variability in magnetization strength, and increased safety during construction. Experimental validation using a prototype magnet shows close agreement with the simulated magnetic field. The Unilateral Linear Halbach magnet increases the sensitivity, portability, and versatility of single-sided NMR. Copyright © 2018 Elsevier Inc. All rights reserved.

Diagnosis of unilateral trapezius muscle palsy: 54 Cases.

PubMed

Seror, Paul; Stojkovic, Tanya; Lefevre-Colau, Marie Martine; Lenglet, Timothée

2017-08-01

We assessed medical and surgical causes of unilateral trapezius muscle (TM) palsy and/or wasting. Clinical and electrodiagnostic data were collected in 54 patients with TM impairment over 21 years. In total, 35 cases had a medical origin: neuralgic amyotrophy (NA, n = 22), idiopathic unilateral TM palsy (n = 5), regional neck radiotherapy for different conditions (n = 2), facioscapulohumeral dystrophy (FSH) (n = 4), abnormal loop of the jugular vein (n = 1), or basilar impression (n = 1). Other etiologies were neck surgery (n = 16), cervicofacial lift (n = 2), or trauma (n = 1). There were 5 main diagnostic findings in unilateral TM palsy: (1) dynamic examination of the scapula provides a new clinical sign; (2) NA is the most frequent medical cause; (3) in medical cases, partial preservation of the upper TM can offer good recovery; (4) FSH must be considered, especially in young patients; and (5) minor neck surgery can lead to severe TM palsy. Muscle Nerve 56: 215-223, 2017. © 2016 Wiley Periodicals, Inc.

En-bloc Transplantation: an Eligible Technique for Unilateral Dual Kidney Transplantation

PubMed Central

Salehipour, M.; Bahador, A.; Nikeghbalian, S.; Kazemi, K.; Shamsaeifar, A. R.; Ghaffaripour, S.; Sahmeddini, M. A.; Salahi, H.; Bahreini, A.; Janghorban, P.; Gholami, S.; Malek-Hosseini, S. A.

2012-01-01

Background: Kidney transplantation is the best available treatment for patients with end-stage renal disease. Objective: To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). Methods: From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. Results: Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2–6 months of post-operation follow up. Conclusion: Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time. PMID:25013633

En-bloc Transplantation: an Eligible Technique for Unilateral Dual Kidney Transplantation.

PubMed

Salehipour, M; Bahador, A; Nikeghbalian, S; Kazemi, K; Shamsaeifar, A R; Ghaffaripour, S; Sahmeddini, M A; Salahi, H; Bahreini, A; Janghorban, P; Gholami, S; Malek-Hosseini, S A

2012-01-01

Kidney transplantation is the best available treatment for patients with end-stage renal disease. To evaluate the en bloc anastomosis technique for unilateral dual kidney transplantation (DKT). From May to October 2011, 5 patients (4 women and 1 man) with mean age of 31.8 years underwent unilateral DKT with this technique in which distal end of the aorta and proximal end of inferior vena cava (IVC) were closed with running sutures. Then, proximal end of the aorta and distal end of the IVC were anastomosed to internal (or external) iliac artery and external iliac vein, respectively. Post-operative course was uneventful. No vascular and urologic complications developed; all patient had acceptable serum creatinine at discharge time and up of 2-6 months of post-operation follow up. Unilateral DKT is a safe method for performing DKT. The proposed en bloc anastomosis can improve the outcome of the graft by reducing the cold ischemia and the operation time.

Design and experimental validation of Unilateral Linear Halbach magnet arrays for single-sided magnetic resonance

NASA Astrophysics Data System (ADS)

Bashyam, Ashvin; Li, Matthew; Cima, Michael J.

2018-07-01

Single-sided NMR has the potential for broad utility and has found applications in healthcare, materials analysis, food quality assurance, and the oil and gas industry. These sensors require a remote, strong, uniform magnetic field to perform high sensitivity measurements. We demonstrate a new permanent magnet geometry, the Unilateral Linear Halbach, that combines design principles from "sweet-spot" and linear Halbach magnets to achieve this goal through more efficient use of magnetic flux. We perform sensitivity analysis using numerical simulations to produce a framework for Unilateral Linear Halbach design and assess tradeoffs between design parameters. Additionally, the use of hundreds of small, discrete magnets within the assembly allows for a tunable design, improved robustness to variability in magnetization strength, and increased safety during construction. Experimental validation using a prototype magnet shows close agreement with the simulated magnetic field. The Unilateral Linear Halbach magnet increases the sensitivity, portability, and versatility of single-sided NMR.

Unilateral lag screw fixation of isolated non-union atlas lateral mass fracture: a new technical note.

PubMed

Farrokhi, Majid Reza; Kiani, Arash; Rezaei, Hamid

2018-01-15

We describe a novel and new technique of posterior unilateral lag screw fixation of non-union atlas lateral mass fracture. A 46-year-old man presented with cervical pain and tenderness after a vehicle turn over accident and he was diagnosed to have left atlas lateral mass fracture. He was initially treated by immobilization using Minerva orthosis. About 2 months later, he developed severe neck pain and limitation of motion and thus he was scheduled for operation due to non-union atlas lateral mass fracture. A 28 mm lag screw was inserted under anterior-posterior and lateral fluoroscopic views. The entrance point was at the dorsal aspect of left atlas posterior arc at its junction to the lateral mass, and by using the trajectory of 10 degrees medial and 22 degrees cephalad fracture reduction was achieved. Unilateral lag screw fixation of atlas fractures is an appropriate, safe and effective surgical technique for the management of unilateral atlas fractures.

U.S. Department of Agriculture: Resolution of Discrimination Complaints Involving Farm Credit and Payment Programs

DTIC Science & Technology

2001-04-12

2There have also been long-standing concerns about USDA’s treatment of minority employees . As requested, however, this report focuses on program -related... program participants and employees . Form SF298 Citation Data Report Date ("DD MON YYYY") 00MAY2001 Report Type N/A Dates Covered (from... to) ("DD MON...Indianswho were denied benefits under the U.S. Department of Agricultures (USDA) farm assistance programs 1 have been a long-standing issue. Compounding

Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP

PubMed Central

2014-01-01

Background Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy (CP). Given the great plasticity of the young brain, possible interventions for infants at risk of unilateral CP deserve exploration. Constraint-induced movement therapy (CIMT) is known to be effective for older children with unilateral CP but is not systematically used for infants. The development of CIMT for infants (baby-CIMT) is described here, as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage. The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved hand faster than will infants receiving baby-massage in the first year of life. Method and design The study will be a randomised, controlled, prospective parallel-group trial. Invited infants will be to be randomised to either the baby-CIMT or the baby-massage group if they: 1) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2) have been referred to Astrid Lindgren Children’s Hospital due to asymmetric hand function. The inclusion criteria are age 3–8 months and established asymmetric hand use. Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause, for 12 weeks in total of treatment. The primary outcome measure will be the new Hand Assessment for Infants (HAI) for evaluating manual ability. In addition, the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used. Clinical neuroimaging will be utilized to characterise the brain lesion type. To compare outcomes between treatment groups generalised linear models will be used. Discussion The model of early intensive intervention for hand function, baby-CIMT evaluated by the Hand Assessment for Infants (HAI) will have the potential to significantly increase our understanding of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured. Trial registration SFO-V4072/2012, 05/22/2013 PMID:24903062

Topography and Higher Order Corneal Aberrations of the Fellow Eye in Unilateral Keratoconus.

PubMed

Aksoy, Sibel; Akkaya, Sezen; Özkurt, Yelda; Kurna, Sevda; Açıkalın, Banu; Şengör, Tomris

2017-10-01

Comparison of topography and corneal higher order aberrations (HOA) data of fellow normal eyes of unilateral keratoconus patients with keratoconus eyes and control group. The records of 196 patients with keratoconus were reviewed. Twenty patients were identified as unilateral keratoconus. The best corrected visual acuity (BCVA), topography and aberration data of the unilateral keratoconus patients' normal eyes were compared with their contralateral keratoconus eyes and with control group eyes. For statistical analysis, flat and steep keratometry values, average corneal power, cylindrical power, surface regularity index (SRI), surface asymmetry index (SAI), inferior-superior ratio (I-S), keratoconus prediction index, and elevation-depression power (EDP) and diameter (EDD) topography indices were selected. Mean age of the unilateral keratoconus patients was 26.05±4.73 years and that of the control group was 23.6±8.53 years (p>0.05). There was no statistical difference in BCVA between normal and control eyes (p=0.108), whereas BCVA values were significantly lower in eyes with keratoconus (p=0.001). Comparison of quantitative topographic indices between the groups showed that all indices except the I-S ratio were significantly higher in the normal group than in the control group (p<0.05). The most obvious differences were in the SRI, SAI, EDP, and EDD values. All topographic indices were higher in the keratoconus eyes compared to the normal fellow eyes. There was no difference between normal eyes and the control group in terms of spherical aberration, while coma, trefoil, irregular astigmatism, and total HOA values were higher in the normal eyes of unilateral keratoconus patients (p<0.05). All HOA values were higher in keratoconus eyes than in the control group. According to our study, SRI, SAI, EDP, EDD values, and HOA other than spherical aberration were higher in the clinically and topographically normal fellow eyes of unilateral keratoconus patients when compared to a control group. This finding may be due to the mild asymmetric and morphologic changes in the subclinical stage of keratoconus leading to deterioration in the indicators of corneal irregularity and elevation changes. Therefore, these eyes may be exhibiting the early form of the disease.

Specific Changes in Young Soccer Player's Fitness After Traditional Bilateral vs. Unilateral Combined Strength and Plyometric Training

PubMed Central

Ramirez-Campillo, Rodrigo; Sanchez-Sanchez, Javier; Gonzalo-Skok, Oliver; Rodríguez-Fernandez, Alejandro; Carretero, Manuel; Nakamura, Fabio Y.

2018-01-01

The aim of this study was to compare changes in young soccer player's fitness after traditional bilateral vs. unilateral combined plyometric and strength training. Male athletes were randomly divided in two groups; both received the same training, including strength training for knee extensors and flexors, in addition to horizontal plyometric training drills. The only difference between groups was the mode of drills technique: unilateral (UG; n = 9; age, 17.3 ± 1.1 years) vs. bilateral (TG; n = 9; age, 17.6 ± 0.5 years). One repetition maximum bilateral strength of knee muscle extensors (1RM_KE) and flexors (1RM_KF), change of direction ability (COD), horizontal and vertical jump ability with one (unilateral) and two (bilateral) legs, and limb symmetry index were measured before and after an 8-week in-season intervention period. Some regular soccer drills were replaced by combination of plyometric and strength training drills. Magnitude-based inference statistics were used for between-group and within-group comparisons. Beneficial effects (p < 0.05) in 1RM_KE, COD, and several test of jumping performance were found in both groups in comparison to pre-test values. The limb symmetry index was not affected in either group. The beneficial changes in 1RM_KE (8.1%; p = 0.074) and 1RM_KF (6.7%; p = 0.004), COD (3.1%; p = 0.149), and bilateral jump performance (from 2.7% [p = 0.535] to 10.5% [p = 0.002]) were possible to most likely beneficial in the TG than in the UG. However, unilateral jump performance measures achieved likely to most likely beneficial changes in the UG compared to the TG (from 4.5% [p = 0.090] to 8.6% [p = 0.018]). The improvements in jumping ability were specific to the type of jump performed, with greater improvements in unilateral jump performance in the UG and bilateral jump performance in the TG. Therefore, bilateral strength and plyometric training should be complemented with unilateral drills, in order to maximize adaptations. PMID:29623049

Assessment of the structural brain network reveals altered connectivity in children with unilateral cerebral palsy due to periventricular white matter lesions.

PubMed

Pannek, Kerstin; Boyd, Roslyn N; Fiori, Simona; Guzzetta, Andrea; Rose, Stephen E

2014-01-01

Cerebral palsy (CP) is a term to describe the spectrum of disorders of impaired motor and sensory function caused by a brain lesion occurring early during development. Diffusion MRI and tractography have been shown to be useful in the study of white matter (WM) microstructure in tracts likely to be impacted by the static brain lesion. The purpose of this study was to identify WM pathways with altered connectivity in children with unilateral CP caused by periventricular white matter lesions using a whole-brain connectivity approach. Data of 50 children with unilateral CP caused by periventricular white matter lesions (5-17 years; manual ability classification system [MACS] I = 25/II = 25) and 17 children with typical development (CTD; 7-16 years) were analysed. Structural and High Angular Resolution Diffusion weighted Images (HARDI; 64 directions, b = 3000 s/mm(2)) were acquired at 3 T. Connectomes were calculated using whole-brain probabilistic tractography in combination with structural parcellation of the cortex and subcortical structures. Connections with altered fractional anisotropy (FA) in children with unilateral CP compared to CTD were identified using network-based statistics (NBS). The relationship between FA and performance of the impaired hand in bimanual tasks (Assisting Hand Assessment-AHA) was assessed in connections that showed significant differences in FA compared to CTD. FA was reduced in children with unilateral CP compared to CTD. Seven pathways, including the corticospinal, thalamocortical, and fronto-parietal association pathways were identified simultaneously in children with left and right unilateral CP. There was a positive relationship between performance of the impaired hand in bimanual tasks and FA within the cortico-spinal and thalamo-cortical pathways (r(2) = 0.16-0.44; p < 0.05). This study shows that network-based analysis of structural connectivity can identify alterations in FA in unilateral CP, and that these alterations in FA are related to clinical function. Application of this connectome-based analysis to investigate alterations in connectivity following treatment may elucidate the neurological correlates of improved functioning due to intervention.

Specific Changes in Young Soccer Player's Fitness After Traditional Bilateral vs. Unilateral Combined Strength and Plyometric Training.

PubMed

Ramirez-Campillo, Rodrigo; Sanchez-Sanchez, Javier; Gonzalo-Skok, Oliver; Rodríguez-Fernandez, Alejandro; Carretero, Manuel; Nakamura, Fabio Y

2018-01-01

The aim of this study was to compare changes in young soccer player's fitness after traditional bilateral vs. unilateral combined plyometric and strength training. Male athletes were randomly divided in two groups; both received the same training, including strength training for knee extensors and flexors, in addition to horizontal plyometric training drills. The only difference between groups was the mode of drills technique: unilateral (UG; n = 9; age, 17.3 ± 1.1 years) vs. bilateral (TG; n = 9; age, 17.6 ± 0.5 years). One repetition maximum bilateral strength of knee muscle extensors (1RM_KE) and flexors (1RM_KF), change of direction ability (COD), horizontal and vertical jump ability with one (unilateral) and two (bilateral) legs, and limb symmetry index were measured before and after an 8-week in-season intervention period. Some regular soccer drills were replaced by combination of plyometric and strength training drills. Magnitude-based inference statistics were used for between-group and within-group comparisons. Beneficial effects ( p < 0.05) in 1RM_KE, COD, and several test of jumping performance were found in both groups in comparison to pre-test values. The limb symmetry index was not affected in either group. The beneficial changes in 1RM_KE (8.1%; p = 0.074) and 1RM_KF (6.7%; p = 0.004), COD (3.1%; p = 0.149), and bilateral jump performance (from 2.7% [ p = 0.535] to 10.5% [ p = 0.002]) were possible to most likely beneficial in the TG than in the UG. However, unilateral jump performance measures achieved likely to most likely beneficial changes in the UG compared to the TG (from 4.5% [ p = 0.090] to 8.6% [ p = 0.018]). The improvements in jumping ability were specific to the type of jump performed, with greater improvements in unilateral jump performance in the UG and bilateral jump performance in the TG. Therefore, bilateral strength and plyometric training should be complemented with unilateral drills, in order to maximize adaptations.

A New Classification System for Unilateral Cleft Lip and Palate Infants to assist Presurgical Infant Orthopedics.

PubMed

Daigavane, P S; Hazarey, P V; Niranjane, P; Vasudevan, S D; Thombare, B R; Daigavane, S

2015-01-01

The proposed advantages of pre-surgical naso-alveolar moulding (PNAM) are easy primary lip repair which heals under minimum tension reducing the scar formation and improving the aesthetic results in addition to reshaping of alar cartilage and improvement of nasal symmetry.However, the anatomy and alveolar morphology varies for each cleft child; the procedure for PNAM differs accordingly. In an attempt to categorize unilateral cleft lip and palate cases as per anatomical variations, a new classification system has been proposed. This classification aims to give an insight in unilateral cleft morphology based on which modification in PNAM procedure could be done.

Ambiguous genitalia in a fertile, unilaterally cryptorchid male miniature schnauzer dog.

PubMed

Breshears, M A; Peters, J L

2011-09-01

A 7-year-old male miniature schnauzer dog with unilateral cryptorchidism was presented for elective orchiectomy. Surgery to remove the cryptorchid testis revealed a fully formed uterus with horns attached to both testis and the body and cervix terminating at the prostate gland. The gross and microscopic diagnosis for the genital tract was persistent Müllerian duct syndrome with unilateral cryptorchidism. Additional associated lesions included cystic endometrial hyperplasia and a solitary, intratubular seminoma within the undescended testis. Persistent Müllerian duct syndrome is rare among domestic animals but is more common in miniature schnauzer dogs because of inheritance as an autosomal recessive trait.

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.

Hemisphere division and its effect on selective attention: a generality examination of Lavie's load theory.

PubMed

Nishimura, Ritsuko; Yoshizaki, Kazuhito; Kato, Kimiko; Hatta, Takeshi

2009-01-01

The present study examined the role of visual presentation mode (unilateral vs. bilateral visual fields) on attentional modulation. We examined whether or not the presentation mode affects the compatibility effect, using a paradigm involving two task-relevant letter arrays. Sixteen participants identified a target letter among task-relevant letters while ignoring either a compatible or incompatible distracter letter that was presented to both hemispheres. Two letters arrays were presented to visual fields, either unilaterally or bilaterally. Results indicated that the compatibility effect was greater in bilateral than in unilateral visual field conditions. Findings support the assumption that the two hemispheres have separate attentional resources.

Management of Unilateral Masseter Hypertrophy and Hypertrophic Scar—A Case Report

PubMed Central

Shetty, Naresh; Malaviya, Rajanikanth K.; Gupta, M. K.

2012-01-01

Masseter muscle hypertrophy is a rare condition of idiopathic cause. It clinically presents as an enlargement of one or both masseter muscles. Most patients complain of facial asymmetry; however, symptoms such as trismus, protrusion, and bruxism may also occur. Several treatment options reported for masseter hypertrophy are present, which range from simple pharmacotherapy to more invasive surgical reduction. Keloid scar with unilateral masseter hypertrophy is a rarely seen in clinical practice. This paper reports a case of unilateral masseter hypertrophy with keloid scar in the angle of the mandible for which surgical treatment was rendered to the patient by using a single approach. PMID:22844620

Shortlasting Unilateral Neuralgiform Conjunctival Injection and Tearing Syndrome: The Term and New View Points

PubMed Central

Antonaci, Fabio; Fredriksen, Torbjørn; Pareja, Juan A.; Sjaastad, Ottar

2018-01-01

A solitary patient with symptoms similar to those of shortlasting unilateral neuralgiform conjunctival injection and tearing (SUNCT) was first mentioned in 1978. The term SUNCT was first used in 1991. SUNCT is an acronym; the “S” signifies “Shortlasting”; the “U” symbolizes “Unilateral”; “N” stands for “Neuralgiform”; the “C” for “Conjunctival injection”; and “T” for “Tearing.” The term short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms were marketed in 2004. The terminology and new view points are discussed and nosography proposal for SUNCT is presented. PMID:29740387

Decreased shoulder function and pain common in recreational badminton players.

PubMed

Fahlström, M; Söderman, K

2007-06-01

The aim of this study was to describe the prevalence and consequences of painful conditions in the shoulder region in recreational badminton players. A questionnaire study was performed on 99 players, of whom 57 were also assessed with Constant score. Previous or present pain in the dominant shoulder was reported by 52% of the players. Sixteen percent of the players had on-going shoulder pain associated with badminton play. A majority of these players reported that their training habits were affected by the pain. Total Constant score was lower in the painful shoulders. Furthermore, range of active pain-free shoulder abduction was decreased. However, isometric shoulder strength test showed no differences when compared with pain-free shoulders. Even though the pain caused functional problems, the players were still playing with on-going symptoms. The diagnoses were mostly unknown, although history and clinical tests indicate problems resembling subacromial impingement.

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder.

PubMed

Roy, Elizabeth A; Cheyne, Ian; Andrews, Gordon T; Forster, Bruce B

2016-02-01

Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified. © RSNA, 2016.

[Reconstruction of an iatrogenic acromial pseudarthrosis: a case report].

PubMed

Liodakis, E; Kenawey, M; Petri, M; Liodaki, E; Hankemeier, S; Krettek, C; Jagodzinski, M

2011-06-01

Acromial fractures are rare but severe complications which can occur during subacromial decompression. We report a case of acromial pseudarthrosis which was discovered belatedly due to persistent pain after several operations. The pseudarthrosis was successfully treated by osteosynthesis with a distal radius plate and implantation of a monocortical bone graft from the iliac crest. Two years after surgery, the fracture has healed and the patient's pain improved significantly. In the constant score the patient achieved postoperatively 58 points compared to 25 points before surgery and 65 points compared to 25 points preoperatively in the subjective shoulder rating system (SSRS). Postoperatively, the patient had a better range of motion with active abduction/adduction of 50/0/25º (30/0/20° preoperatively), outward rotation/inward rotation of 35/0/45º (30/0/30° preoperatively) and anteversion/retroversion of 60/0/35° (35/0/20° preoperatively).

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique.

PubMed

Mook, William R; Greenspoon, Joshua A; Millett, Peter J

2016-01-01

Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

PubMed Central

Mook, William R.; Greenspoon, Joshua A.; Millett, Peter J.

2016-01-01

Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results: The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion: Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears. PMID:27733881

DTI-based response-driven modeling of mTLE laterality.

PubMed

Nazem-Zadeh, Mohammad-Reza; Elisevich, Kost; Air, Ellen L; Schwalb, Jason M; Divine, George; Kaur, Manpreet; Wasade, Vibhangini S; Mahmoudi, Fariborz; Shokri, Saeed; Bagher-Ebadian, Hassan; Soltanian-Zadeh, Hamid

2016-01-01

To develop lateralization models for distinguishing between unilateral and bilateral mesial temporal lobe epilepsy (mTLE) and determining laterality in cases of unilateral mTLE. mTLE is the most common form of medically refractory focal epilepsy. Many mTLE patients fail to demonstrate an unambiguous unilateral ictal onset. Intracranial EEG (icEEG) monitoring can be performed to establish whether the ictal origin is unilateral or truly bilateral with independent bitemporal ictal origin. However, because of the expense and risk of intracranial electrode placement, much research has been done to determine if the need for icEEG can be obviated with noninvasive neuroimaging methods, such as diffusion tensor imaging (DTI). Fractional anisotropy (FA) was used to quantify microstructural changes reflected in the diffusivity properties of the corpus callosum, cingulum, and fornix, in a retrospective cohort of 31 patients confirmed to have unilateral (n = 24) or bilateral (n = 7) mTLE. All unilateral mTLE patients underwent resection with an Engel class I outcome. Eleven were reported to have hippocampal sclerosis on pathological analysis; nine had undergone prior icEEG. The bilateral mTLE patients had undergone icEEG demonstrating independent epileptiform activity in both right and left hemispheres. Twenty-three nonepileptic subjects were included as controls. In cases of right mTLE, FA showed significant differences from control in all callosal subregions, in both left and right superior cingulate subregions, and in forniceal crura. Comparison of right and left mTLE cases showed significant differences in FA of callosal genu, rostral body, and splenium and the right posteroinferior and superior cingulate subregions. In cases of left mTLE, FA showed significant differences from control only in the callosal isthmus. Significant differences in FA were identified when cases of right mTLE were compared with bilateral mTLE cases in the rostral and midbody callosal subregions and isthmus. Based on 11 FA measurements in the cingulate, callosal and forniceal subregions, a response-driven lateralization model successfully differentiated all cases (n = 54) into groups of unilateral right (n = 12), unilateral left (n = 12), and bilateral mTLE (n = 7), and nonepileptic control (23). The proposed response-driven DTI biomarker is intended to lessen diagnostic ambiguity of laterality in cases of mTLE and help optimize selection of surgical candidates. Application of this model shows promise in reducing the need for invasive icEEG in prospective cases.

Oral strength in subjects with a unilateral cleft lip and palate.

PubMed

Van Lierde, Kristiane M; Bettens, Kim; Luyten, Anke; Plettinck, Janne; Bonte, Katrien; Vermeersch, Hubert; Roche, Nathalie

2014-08-01

Facial appearance and speech outcome may affect psychosocial functioning in girls and boys. Several studies reported dissatisfaction with facial appearance and more specifically the lip and mouth profile in children with cleft lip and palate (CLP). The purpose of this controlled study was to measure the tongue and lip strength and endurance in boys and girls with CLP. Twenty-five subjects (mean age: 10.6 years) with a unilateral CLP and a gender- and age- matched control group were selected. All subjects with an unilateral CLP consulted the same craniofacial team and had undergone an identical surgical procedure. Surgical procedure of the lip was performed using a modified Millard technique without primary nose correction at an average age of 5.5 months. The Iowa Oral Performance instrument was used to measure lip and tongue strength and tongue endurance. The results of the Iowa Oral Performance measurement showed no significant differences between the subjects with an unilateral cleft lip and palate and the age and gender matched control group without a cleft lip and palate. There is no significant differences regarding oral strength more specifically the lip and tongue strength and endurance between subjects with and without an unilateral cleft lip and palate. ENT specialists and speech pathologists must be aware of this aspect of the normal lip and tongue functions. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Cone Beam Computed Tomographic Evaluation of Mandibular Asymmetry in Patients with Cleft Lip and Palate.

PubMed

Paknahad, Maryam; Shahidi, Shoaleh; Bahrampour, Ehsan; Beladi, Amir Saied; Khojastepour, Leila

2018-01-01

Objective The purpose of the present study was to compare mandibular vertical asymmetry in patients with unilateral and bilateral cleft lip and palate and subjects with normal occlusion. Materials and Methods Cone beam computed tomography scans of three groups consisting of 20 patients with unilateral cleft lip and palate, 20 patients affected by bilateral cleft lip and palate, and a control group of 20 subjects with normal occlusion were analyzed for this study. Condylar, ramal, and condylar plus ramal asymmetry indices were measured for all subjects using the method of Habets et al. Kruskal-Wallis and Mann-Whitney tests were used to determine any significant differences between the groups for all indices at the 95% level of confidence. Results There were no significant differences regarding sex for all mandibular asymmetry indices in all three groups. All Asymmetry indices (condylar, ramal, and condylar plus ramal asymmetry) were significantly higher in the unilateral cleft group compared with the other two groups. Conclusion Cone beam computed tomography images showed that patients with cleft lip and palate suffered from mandibular asymmetry. Subjects with unilateral cleft lip and palate had a more asymmetric mandible compared with the bilateral cleft lip and palate and control groups. Therefore, the mandible appears to be the leading factor in facial asymmetry in subjects with unilateral cleft lip and palate.

Temporal lobe developmental malformations and epilepsy: dual pathology and bilateral hippocampal abnormalities.

PubMed

Ho, S S; Kuzniecky, R I; Gilliam, F; Faught, E; Morawetz, R

1998-03-01

Temporal lobe developmental malformations (TLDM) with focal cortical dysplasia and balloon cells may coexist with mesial temporal sclerosis. The true incidence of this dual pathology is unknown. Our aim was to assess the frequency of amygdala (AM)-hippocampal abnormality in a homogeneous population with this specific developmental malformation. MRI-based volumetry of the AM and hippocampal formation (HF) in 30 patients with unilateral TLDM and intractable partial epilepsy was performed. A volume normalization process defined a normal range of HF and AM volumes in control subjects, and enabled the detection of bilateral volume loss. Normalized volumes detected HF atrophy in 26 patients (nine unilateral and 17 bilateral) and AM atrophy in 18 patients (three unilateral and 15 bilateral). Visual analysis detected unilateral HF abnormality in 21 patients and bilateral abnormality in two. When compared with a group of patients with temporal lobe epilepsy and pure hippocampal sclerosis (N = 92), where volumetry revealed bilateral HF atrophy in 18%, a significant difference in the frequency of bilateral HF atrophy was found (p < 0.0001). Dual pathology is frequent in patients with TLDM (87%), and the AM-HF abnormality is often bilateral (57%). Our data suggest that more widespread and potentially epileptogenic lesions coexist with visibly detectable unilateral TLDM. This has implications for the selection of patients for temporal lobe surgery and may influence surgical strategies.

Unilateral maxillary molar distalization with zygoma-gear appliance.

PubMed

Kilkis, Dogan; Bayram, Mehmet; Celikoglu, Mevlut; Nur, Metin

2012-08-01

The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3°. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (-0.5 mm) and maxillary incisor inclination (-1°), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 × 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Double transverse myocutaneous gracilis free flaps for unilateral breast reconstruction.

PubMed

Werdin, Frank; Haug, Daniel M; Amr, Amro; Schoeller, Thomas

2016-10-01

In cases were the deep inferior epigastric perforator flap (DIEP flap) is not available and unilateral transverse myocutaneous gracilis flap (TMG flap) is not sufficient for breast reconstruction, we perform double TMG flaps as a reconstructive method. In this report, we present our results of the use of double TMG free-flap-transfer for unilateral breast reconstruction. Between August 2004 and June 2012 we performed 58 TMG flaps in 29 patients for unilateral breast reconstruction. Patient data were analyzed and operative outcome (operation time, complication rate and aesthetic results) were investigated. Aesthetic outcome was evaluated retrospectively via photo documentation by an independent plastic surgeon. The results were classified in;unsatisfactory, satisfactory, good and very good. The average operating time was 6 hours 55 minutes (295 - 650 minutes). Of 58 TMG flaps, 57 (98.3%) were successful. Thrombosis occurred in seven (12%) cases (1 arterial, 6 venous). Flap salvage was successful in six cases and flap failure occurred in one (1.7%) case. The results of 25 patients were graded as good and very good. Three patients showed satisfying and one patient unsatisfying results. Double TMG flaps in unilateral breast reconstruction could lead to good operative results. This method further expands the range of options with autologous tissue in reconstructive breast surgery. © 2015 Wiley Periodicals, Inc. Microsurgery 36:539-545, 2016. © 2015 Wiley Periodicals, Inc.

Functional-structural reorganisation of the neuronal network for auditory perception in subjects with unilateral hearing loss: Review of neuroimaging studies.

PubMed

Heggdal, Peder O Laugen; Brännström, Jonas; Aarstad, Hans Jørgen; Vassbotn, Flemming S; Specht, Karsten

2016-02-01

This paper aims to provide a review of studies using neuroimaging to measure functional-structural reorganisation of the neuronal network for auditory perception after unilateral hearing loss. A literature search was performed in PubMed. Search criterions were peer reviewed original research papers in English completed by the 11th of March 2015. Twelve studies were found to use neuroimaging in subjects with unilateral hearing loss. An additional five papers not identified by the literature search were provided by a reviewer. Thus, a total of 17 studies were included in the review. Four different neuroimaging methods were used in these studies: Functional magnetic resonance imaging (fMRI) (n = 11), diffusion tensor imaging (DTI) (n = 4), T1/T2 volumetric images (n = 2), magnetic resonance spectroscopy (MRS) (n = 1). One study utilized two imaging methods (fMRI and T1 volumetric images). Neuroimaging techniques could provide valuable information regarding the effects of unilateral hearing loss on both auditory and non-auditory performance. fMRI-studies showing a bilateral BOLD-response in patients with unilateral hearing loss have not yet been followed by DTI studies confirming their microstructural correlates. In addition, the review shows that an auditory modality-specific deficit could affect multi-modal brain regions and their connections. Copyright © 2015 Elsevier B.V. All rights reserved.

Masticatory motion after surgical or nonsurgical treatment for unilateral fractures of the mandibular condylar process.

PubMed

Throckmorton, Gaylord S; Ellis, Edward; Hayasaki, Haruaki

2004-02-01

We sought to compare mandibular motion during mastication in patients treated in either an open or a closed fashion for unilateral fractures of the mandibular condylar process. Eighty-one male patients with unilateral condylar process fractures were treated either with (n = 37) or without (n = 44) surgical reduction and rigid fixation of their condylar process fractures. At 6 weeks, 6 months, 1 year, and 2 years after treatment, the subjects' chewing cycles were recorded using a magnetic sensor array (Sirognathograph; Siemens Corp, Bensheim, Germany) while chewing Gummi-Bears (HARIBO, Bonn, Germany) unilaterally on the same side as the fracture and on the opposite side. The chewing cycles were analyzed using a custom computer program, and the duration, excursive ranges, and 3-dimensional cycle shape were compared between the 2 treatment groups at each time interval using multilevel linear modeling statistics. The 2 treatment groups did not differ significantly for any measure of cycle duration or any excursive range (except lateral excursions at 1 year post-treatment) at any of the time intervals. However, the 3-dimensional cycle shapes of the 2 groups did differ significantly at all time intervals. Surgical correction of unilateral condylar process fractures has relatively little effect on the more standard measures (duration and excursive ranges) of masticatory function. However, surgical correction better normalizes opening incisor pathways during mastication on the side opposite the fracture.

Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid.

PubMed

Andersen, Henrik Terkel; Schrøder, Stine Attrup; Bonding, Per

2006-09-01

To evaluate the subjective hearing handicap in patients with unilateral deafness after acoustic neuroma surgery and the effect of the Bone-anchored Hearing Aid (BAHA) on test band. Fifty-nine consecutive patients with unilateral deafness after translabyrintine removal of an acoustic neuroma, treated in Denmark in 2001 and 2002, were included. The patients were asked to complete a questionnaire, which addressed the subjective handicap of unilateral deafness; 90% responded. These patients were invited to test the BAHA on test band, and the subjective and objective effects were recorded. Eighty percent of the patients thought that they had a subjective hearing handicap of some significance. However, only 50% accepted the invitation to test the BAHA. The overall subjective effect was positive, and a significant improvement in speech discrimination in noise with the BAHA was demonstrated. After the test, however, only about 50%, that is, 25% of all patients wished implantation for BAHA treatment. This study shows that unilateral deafness after acoustic neuroma surgery is thought as a handicap in most of the patients and confirms that treatment with the BAHA has positive subjective effects and improves speech discrimination in noise. However, only 25% of the patients wished implantation for BAHA treatment. The implications of these findings are discussed. Data from centers that perform simultaneous acoustic neuroma surgery and implantation for BAHA are necessary for firm conclusions.

Cranial thoracic vertebral canal stenosis in three juvenile large-breed brachycephalic dogs treated by unilateral hemilaminectomy.

PubMed

Miller, Amanda; Marchevsky, Andrew

2017-05-22

To describe the surgical treatment and outcome for juvenile dogs with cranial thoracic vertebral canal stenosis treated by unilateral hemilaminectomy. Case series. Three large-breed brachycephalic dogs of various breeds (Dogue de Bordeaux, Australian Bulldog, Boerboel) with neurological signs consistent with a myelopathy of the third thoracic (T) to third lumbar (L) spinal cord segment. Information on clinical presentation, diagnostic imaging, surgical procedures, postoperative complications, recovery and outcome is described. Neurological signs were present and progressive for two to four weeks prior to surgery and ranged from mild ataxia to paralysis. Cranial thoracic vertebral canal stenosis was diagnosed with computed tomography imaging. Lateral and dorsolateral spinal cord compression was present at multiple sites between T2 and T6. Alternating left and right-sided compressions were common. Surgical treatment was by unilateral, continuous hemilaminectomy over three to six vertebral spaces. Postoperative morbidity was minimal and return of independent ambulation was rapid (median: 13.5 days, range: 2-29 days). Neurological status in one dog worsened four months after surgery due to reoccurrence of osseous compression; unilateral hemilaminectomy was repeated in this dog. Long-term follow-up ranged from six to 10 months; neurological signs had completely resolved in one dog and substantially improved in the other two dogs. Unilateral hemilaminectomy was associated with rapid return of independent ambulation and substantial improvement in neurological scores.

Exercise dependence score in patients with longstanding eating disorders and controls: the importance of affect regulation and physical activity intensity.

PubMed

Bratland-Sanda, Solfrid; Martinsen, Egil W; Rosenvinge, Jan H; Rø, Oyvind; Hoffart, Asle; Sundgot-Borgen, Jorunn

2011-01-01

To examine associations among exercise dependence score, amount of physical activity and eating disorder (ED) symptoms in patients with longstanding ED and non-clinical controls. Adult female inpatients (n = 59) and 53 age-matched controls participated in this cross sectional study. Assessments included the eating disorders examination, eating disorders inventory, exercise dependence scale, reasons for exercise inventory, and MTI Actigraph accelerometer. Positive associations were found among vigorous, not moderate, physical activity, exercise dependence score and ED symptoms in patients. In the controls, ED symptoms were negatively associated with vigorous physical activity and not correlated with exercise dependence score. Exercise for negative affect regulation, not weight/appearance, and amount of vigorous physical activity were explanatory variables for exercise dependence score in both groups. The positive associations among exercise dependence score, vigorous physical activity and ED symptoms need proper attention in the treatment of longstanding ED. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Sensitive period in stereopsis: random dot stereopsis after long-standing strabismus.

PubMed

Hatch, S W; Laudon, R

1993-12-01

Bifoveal fixation is a requirement for random dot stereopsis. It is believed that random dot stereopsis is not possible after treatment of long-standing strabismus because binocular cortical cells are permanently damaged when strabismus is present during the sensitive period. Although the sensitive period for amblyopia has been clearly documented, the sensitive period for stereopsis is uncertain. We present a case we have followed from age 22 months to 10 years. This patient had intermittent esotropia until approximately age 3 years 4 months; he then had constant esotropia from about age 3 years 4 months to age 9 years 7 months. After orthoptic treatment at age 9 years, the patient returned to intermittent esotropia. He subsequently developed bifoveal fixation as measured by 30 sec arc of contour stereopsis and 250 to 500 sec arc of random dot stereopsis. This patient demonstrates that bifoveal fixation can be obtained after long-standing strabismus. We suggest that the sensitive period for stereopsis development, for this patient, was from birth to age 3 years.

The Course and Outcome of Unilateral Intracranial Arteriopathy in 79 Children with Ischaemic Stroke

ERIC Educational Resources Information Center

Braun, K. P. J.; Bulder, M. M. M.; Chabrier, S.; Kirkham, F. J.; Uiterwaal, C. S. P.; Tardieu, M.; Sebire, G.

2009-01-01

Arteriopathies are the commonest cause of arterial ischaemic stroke (AIS) in children. Repeated vascular imaging in children with AIS demonstrated the existence of a "transient cerebral arteriopathy" (TCA), characterized by lenticulostriate infarction due to non-progressive unilateral arterial disease affecting the supraclinoid internal…

36 CFR 223.236 - Unilateral termination.

Code of Federal Regulations, 2010 CFR

2010-07-01

....236 Section 223.236 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE SALE... sale or free use of special forest products for any of the following reasons: (1) Any of the reasons...) No compensation shall be provided if the unilateral termination is due in whole or in part to the...

Midlife personality and risk of Alzheimer disease and distress: a 38-year follow-up.

PubMed

Johansson, Lena; Guo, Xinxin; Duberstein, Paul R; Hällström, Tore; Waern, Margda; Ostling, Svante; Skoog, Ingmar

2014-10-21

To study the association between midlife neuroticism and extraversion and development of late-life dementia and long-standing distress in a sample of women followed for 38 years. A population-based sample of 800 women, aged 38 to 54 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, 2000, and 2005. Neuroticism and extraversion were assessed using the Eysenck Personality Inventory at baseline. Distress was measured according to a standardized question at each study wave. Dementia was diagnosed according to DSM-III-R criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. During the 38-year follow-up, 153 women developed dementia; Alzheimer disease (AD) dementia was diagnosed in 104 of these. A higher degree of neuroticism in midlife was associated with increased risk of AD dementia and long-standing distress over 38 years. The association between neuroticism and AD dementia diminished after adjusting for long-standing distress. Extraversion was associated with a lower degree of long-standing distress, but had no impact on AD dementia. When the 2 personality dimensions were combined, high neuroticism/low extraversion showed the highest risk of AD dementia. Our study suggests that midlife neuroticism is associated with increased risk of AD dementia, and that distress mediates this association. The results have clinical implications because a group of women at risk of AD dementia is identified. © 2014 American Academy of Neurology.

Anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in residual poliomyelitis.

PubMed

Sung, Ki Hyuk; Chung, Chin Youb; Lee, Kyoung Min; Lee, Seung Yeol; Park, Moon Seok

2013-09-01

This study was performed to investigate anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity in patients with residual poliomyelitis and to investigate whether the severity of preoperative equinus deformity affected the occurrence of symptomatic anterior impingement. Twenty-seven consecutive patients (mean age, 43.8 ± 9.4 years) with residual poliomyelitis who underwent tendo-Achilles lengthening for equinus foot deformity were included. On lateral foot-ankle weight-bearing radiographs, the tibiocalcaneal angle, plantigrade angle, and McDermott grade were measured and the presence of anterior blocking spur was evaluated. Eleven patients (40.7%) had anterior ankle impingement on radiographic findings preoperatively and 24 patients (88.9%) at latest follow-up. There was a significant difference in McDermott grade between preoperative and latest follow-up (P < .001). There were significant differences in tibiocalcaneal angle and plantigrade angle between the patients with anterior ankle pain and without anterior ankle pain (P = .006 and .011, respectively) and between the patients with anterior blocking spur and without anterior blocking spur (P = .005 and .010, respectively). Most patients with residual poliomyelitis had anterior ankle impingement after tendo-Achilles lengthening for long-standing equinus deformity, and the presence of symptomatic anterior ankle impingement was significantly associated with the severity of the equinus deformity. Therefore, for residual poliomyelitis patients with severe long-standing equinus deformity, surgeons should consider the possibility of a subsequent anterior procedure for anterior impingement after tendo-Achilles lengthening. Level IV, retrospective case series.

Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis

PubMed Central

Daniero, James J.; Garrett, C. Gaelyn; Francis, David O.

2014-01-01

Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239

A unilateral optic perineuritis in a teenager - A case report.

PubMed

Ameilia, Ahmad; Shatriah, Ismail; Wan-Hitam, Wan Hazabbah; Yunus, Rohaizan

2015-06-01

Optic perineuritis is an uncommon inflammatory disorder that involves optic nerve sheath. Numerous case reports have been published on optic perineuritis in adults, the majority of whom had bilateral presentation. There are limited data on optic perineuritis occurring in pediatric patients. We report a teenager who presented with a unilateral sign that mimicked the presentation of optic neuritis. The orbit and brain magnetic resonance imaging confirmed features of unilateral optic perineuritis. She was treated with a high dose of corticosteroids for 2weeks, and her final visual outcome was satisfactory. No signs of relapse were noted during follow-up visits. Copyright © 2014 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

Isolated cochlear neuritis from varicella reactivation mimicking a vestibular schwannoma.

PubMed

Goodale, Adam D; Golub, Justin S; Cornelius, Rebecca S; Samy, Ravi N

2016-09-01

We present a case of a patient with progressive unilateral sensorineural hearing loss and tinnitus with internal auditory canal enhancement on magnetic resonance imaging (MRI) secondary to isolated cochlear neuritis from varicella reactivation. MRI following antiviral treatment showed resolution of enhancement. Varicella reactivation is commonly seen in the form of Ramsay Hunt syndrome, which is known to produce abnormal MRI enhancement from facial and vestibulocochlear neuritis; however, its characteristic clinical signs aid the diagnosis. This case is unique in that the only manifestation of varicella infection was unilateral hearing loss. This case outlines the importance of maintaining a broad differential diagnosis in the evaluation of unilateral hearing loss as well as recognizing the limited specificity of MRI.

A case of unilateral, systematized linear hair follicle nevi associated with epidermal nevus-like lesions.

PubMed

Ikeda, Shigaku; Kawada, Juri; Yaguchi, Hitoshi; Ogawa, Hideoki

2003-01-01

Multiple hair follicle nevi are an extremely rare condition. In 1998, a case of unilateral multiple hair follicle nevi, ipsilateral alopecia and ipsilateral leptomeningeal angiomatosis of the brain was first reported from Japan. Very recently, hair follicle nevus in a distribution following Blaschko's lines has also been reported. In this paper, we observed a congenital case of unilateral, systematized linear hair follicle nevi associated with congenital, ipsilateral, multiple plaque lesions resembling epidermal nevi but lacking leptomeningeal angiomatosis of the brain. These cases implicate the possibility of a novel neurocutaneous syndrome. Additional cases should be sought in order to determine whether this condition is pathophysiologically distinct. Copyright 2003 S. Karger AG, Basel

Effect of unilateral exercises on low back pain in an urban driver

PubMed Central

Yoo, Won-gyu

2016-01-01

[Purpose] This study aimed to develop unilateral exercises for urban drivers and investigate the effect of these exercises on low back pain (LBP). [Subject and Methods] A 40-year-old male driver, who complained of LBP on the left side at L3–5 levels, participated in this study. A two-session program was conducted, and LBP, pelvic tilt angle, and trunk range of motion were measured after each session. [Results] After the unilateral exercises, the anterior pelvic tilt angle was improved and the visual analog scale score of back pain decreased. [Conclusion] Analyzing car features and performing individual approaches are necessary in providing treatment for urban drivers with LBP. PMID:27942161

Unilateral glaucoma in Sotos syndrome (cerebral gigantism).

PubMed

Yen, M T; Gedde, S J; Flynn, J T

2000-12-01

To report a patient with unilateral glaucoma associated with Sotos syndrome. Sotos syndrome (cerebral gigantism) is a disorder of growth and development with characteristic facial changes and normal endocrine function. Ocular manifestations may also include megalocornea, iris hypoplasia, cataracts, megalophthalmos, strabismus, nystagmus, and retinal dystrophy. Case report. A 50 year-old man with the clinical features of Sotos syndrome presented with complaints of decreased vision in the left eye. Ophthalmologic examination revealed bilateral megalocornea, megalophthalmos, iris hypoplasia and transillumination defects, cataracts, and unilateral glaucoma. Intraocular pressure was lowered, and visual field loss was stabilized with topical medications. Sotos syndrome patients should be examined routinely to allow for early detection and treatment of potential ocular problems, including glaucoma.

Structural-metabolic organization of field 4 of the cat brain in normal conditions and after unilateral enucleation of the eye.

PubMed

Zykin, P A

2005-01-01

Comparative data on the structural-metabolic organization of field 4 of the cat brain in normal conditions and after unilateral enucleation of the eye are presented. Cytochrome oxidase was detected histochemically. Data were processed by a computerized method using an original video capture system. Data were obtained demonstrating the uneven distribution of enzyme along sublayer IlIb of field 4 in animals with unilateral enucleation. A hypothesis based on published data is suggested whereby the alternation of high- and low-reactive areas is evidence for the ordering of the retinal representations of the right and left eyes in the sensorimotor cortex.

Ocular Lyme borreliosis as a rare presentation of unilateral vision loss.

PubMed

Patterson-Fortin, Jeffrey; Kohli, Anita; Suarez, Maria J; Miller, P Elliott

2016-04-25

Ocular Lyme borreliosis is a rare manifestation of Lyme disease. We describe a case of an 80-year-old woman who presented with a 1-month history of unilateral painless central vision loss. Based on a temporal artery biopsy, she was initially diagnosed with giant cell arteritis and treated with a 3-day course of high-dose intravenous steroids. A more detailed history uncovered multiple previous treatments for Lyme disease and residence in an endemic Lyme area. The patient was subsequently diagnosed with ocular Lyme borreliosis and treated with intravenous antibiotics. After 5 weeks of treatment, unilateral vision loss did not progress and optic disc oedema resolved. 2016 BMJ Publishing Group Ltd.

[Complications of treatment of acromioclavicular joint dislocation and unstable distal clavicular fracture with clavicular hook plate].

PubMed

Zhu, Yi-Yong; Cui, Heng-Yan; Jiang, Pan-Qiang; Wang, Jian-Liang

2013-11-01

To investigate the causes and prevention of the complications about treatment of acromioclavicular joint dislocation (Tossy III) and unstable distal clavicular fracture (Neer II) with clavicular hook plate. From January 2001 to December 2011, 246 patients with acromioclavicular joint dislocation (Tossy III) and 222 patients with unstable distal clavicular fracture (Neer II) were treated with acromioclvicular hook plate fixation,including 348 males and 120 females with an average age of 45.4 years old ranging from 21 to 80 years old. The mean time from injury to operation was 30.8 hours (ranged from 1 h to 15 d). All patients had normal shoulder function before injury. According to Karlsson evaluation standard, the cases with excellent and good function of the shoulder joint were regarded as the normal group, and the cases with poor function of shoulder joint as the abnormal group. The comparison of the range of forward flexion,backward stretch, adduction, abduction and elevation of shoulder joints between two groups was performed. The data of impingement, subacromial osteolysis, acromioclavicular arthritis, clavicular stress fracture, downward acromioclavicular joint subluxation, hook cut-out and hook break were summarized. All patients were followed up from 8 to 48 months with an average of 12.5 months. The results were excellent in 308 cases,good in 76,and poor in 84 according to Karlsson evaluation. The excellent and good rate was 82.1%. The difference of the range of forward flexion, backward stretch, adduction, abduction and elevation of shoulder joints between two groups had a statistically significant difference (P < 0.01). Among 84 poor cases, there were 41 (8.76%) in acromial impingement or inadequate place of plate hook, 12 (2.56%) with subacromial osteolysis or/and bursitis, 10 (2.14%) with acromioclavicular arthritis or painful shoulder caused by delayed dirigation,7 (1.50%) with clavicular stress fracture or interal plate upward, 6 (1.28%) with downward acromioclavicular joint subluxation, 5 (1.07%) with hook cut -out and 3 (0.64%) in hook break. The clavicular hook plate is useful for the treatment of acromioclavicular joint dislocation (Tossy III) and unstable distal clavicular fracture (Neer II). The correct place and suitable preflex of plate hook,the restoration of fiber structure around the acromioclavicular joint and the advisable dirigation contribute to the modified rate of complications.

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians.

PubMed

Skedros, John G; Hunt, Kenneth J; Pitts, Todd C

2007-07-06

Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1) fluorinated vs. non-fluorinated corticosteroids, 2) acetate vs. phosphate types, 3) patient age, and 4) adjustments for special considerations including young athletes and diabetics. 169 (64% response rate, RR) surveys were returned: 105/163 orthopaedic surgeons (64%RR), 44/77 PCSMs/PMRs (57%RR), 20/24 rheumatologists (83%RR). Although corticosteroid doses do not differ significantly between specialties (p > 0.3), anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol(R) (methylprednisolone acetate) and Kenalog(R) (triamcinolone acetonide) are most commonly used. More rheumatologists (80%) were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76%) and orthopaedists (60%). However, relatively fewer rheumatologists (25%) than PCSMs/PMRs (32%) or orthopaedists (32%) knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37% orthopaedists. Nearly 85% use the same non-fluorinated corticosteroid for all injections; <10% make adjustments for diabetic patients. Variations between specialists in anesthetic doses suggest that surgeons (who use significantly larger volumes) emphasize determining the percentage of pain attributable to the injected region. Alternatively, this might reflect a more profound knowledge that non-surgeons specialists have of the potentially adverse cardiovascular effects of these agents. Variations between these specialists in corticosteroid/anesthetic doses and/or types, and their use in some special situations (e.g., diabetics), bespeak the need for additional investigations aimed at establishing uniform injection guidelines, and for identifying knowledge deficiencies that warrant advanced education.

Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

PubMed Central

Skedros, John G; Hunt, Kenneth J; Pitts, Todd C

2007-01-01

Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1) fluorinated vs. non-fluorinated corticosteroids, 2) acetate vs. phosphate types, 3) patient age, and 4) adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR) surveys were returned: 105/163 orthopaedic surgeons (64%RR), 44/77 PCSMs/PMRs (57%RR), 20/24 rheumatologists (83%RR). Although corticosteroid doses do not differ significantly between specialties (p > 0.3), anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate) and Kenalog® (triamcinolone acetonide) are most commonly used. More rheumatologists (80%) were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76%) and orthopaedists (60%). However, relatively fewer rheumatologists (25%) than PCSMs/PMRs (32%) or orthopaedists (32%) knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37% orthopaedists. Nearly 85% use the same non-fluorinated corticosteroid for all injections; <10% make adjustments for diabetic patients. Conclusion Variations between specialists in anesthetic doses suggest that surgeons (who use significantly larger volumes) emphasize determining the percentage of pain attributable to the injected region. Alternatively, this might reflect a more profound knowledge that non-surgeons specialists have of the potentially adverse cardiovascular effects of these agents. Variations between these specialists in corticosteroid/anesthetic doses and/or types, and their use in some special situations (e.g., diabetics), bespeak the need for additional investigations aimed at establishing uniform injection guidelines, and for identifying knowledge deficiencies that warrant advanced education. PMID:17617900

Tumors masquerading in patients with thyroid eye disease.

PubMed

Griepentrog, Gregory J; Burkat, Cat N; Kikkawa, Don O; Lucarelli, Mark J

2013-08-01

Thyroid eye disease (TED) is the most common cause of proptosis in adults. The external manifestations of TED are characteristic and the diagnosis is typically made without imaging. Although there are multiple descriptions of primary and secondary orbital tumors initially mistaken for TED in the literature, there are limited reports detailing the findings of patients with long-standing TED whom developed an orbital tumor at a later date. Herein, we present a 6-year retrospective multi-center report of three patients with long-standing TED who developed an initially unsuspected orbital or cavernous sinus tumor.

Alpha-thalassemia genetic testing: an important anemia diagnostic tool in patients of African heritage.

PubMed

Dasanu, Constantin A

2010-01-01

Inherited alpha-thalassemia genotypes have been shown to have a rather high prevalence in some patient populations of African heritage. These genotypes lead to mild anemia with microcytic indices and a normal hemoglobin electrophoresis. In our outpatient department, we analyzed 54 consecutive patients of African descent with longstanding microcytic anemia, but no evidence of iron deficiency. We detected alpha-thalassemia gene deletions in 94 percent of these patients. Alpha-thalassemia genetic testing appears cost-effective in an otherwise unexplained, longstanding microcytic anemia in patients of African origin.

Right Hemispatial Neglect: Frequency and Characterization Following Acute Left Hemisphere Stroke

ERIC Educational Resources Information Center

Kleinman, Jonathan T.; Newhart, Melissa; Davis, Cameron; Heidler-Gary, Jennifer; Gottesman, Rebecca F.; Hillis, Argye E.

2007-01-01

The frequency of various types of unilateral spatial neglect and associated areas of neural dysfunction after left hemisphere stroke are not well characterized. Unilateral spatial neglect (USN) in distinct spatial reference frames have been identified after acute right, but not left hemisphere stroke. We studied 47 consecutive right handed…

Sports Adaptations for Unilateral and Bilateral Upper-Limb Amputees: Archery/Badminton/Baseball/Softball/Bowling/Golf/Table Tennis.

ERIC Educational Resources Information Center

Cowart, Jim

1979-01-01

The booklet discusses sports adaptations for unilateral and bilateral upper limb amputees. Designs for adapted equipment are illustrated and information on adaptations are described for archery (including an archery release aid and a stationary bow holder); badminton (serving tray); baseball/softball (adaptations for catching, throwing, and…

36 CFR 223.236 - Unilateral termination.

Code of Federal Regulations, 2013 CFR

2013-07-01

....236 Section 223.236 Parks, Forests, and Public Property FOREST SERVICE, DEPARTMENT OF AGRICULTURE SALE..., permit, or other instrument authorizing the sale or free use of special forest products for any of the... if the unilateral termination is due in whole or in part to the reasons set forth at § 223.236(a)(2...

Sex Differences in the Effects of Unilateral Brain Damage on Intelligence

NASA Astrophysics Data System (ADS)

Inglis, James; Lawson, J. S.

1981-05-01

A sexual dimorphism in the functional asymmetry of the damaged human brain is reflected in a test-specific laterality effect in male but not in female patients. This sex difference explains some contradictions concerning the effects of unilateral brain damage on intelligence in studies in which the influence of sex was overlooked.

Comparison of the Electromyographic Activation Level and Unilateral Selectivity of Erector Spinae during Different Selected Movements

ERIC Educational Resources Information Center

Guo, Lan-Yuen; Wang, Yu-Lin; Huang, Yu-Han; Yang, Chich-Haung; Hou, Yi-You; Harn, Hans I-Chen; You, Yu-Lin

2012-01-01

For patients with scoliosis, core stabilization exercises may be beneficial in improving muscle strength and trunk dynamic control. However, few studies have examined whether the erector spinae (ES) activation status during unilateral spinal extensor strengthening meets the guideline for patients with spinal scoliosis. To determine ES activation…

Traumatic glaucoma with features of unilateral pigment dispersion.

PubMed

Bowler, Gordon; Ellul, Antony; Gouws, Pieter

2014-01-01

We report a patient with traumatic glaucoma with features of unilateral pigment dispersion. This rare form of secondary glaucoma has only been reported twice previously, with both patients demonstrating angle recession, indicating associated damage to the trabecular meshwork. To our knowledge, this is the first such case reported in which angle recession was absent.

12 CFR 950.11 - Capital stock requirements; unilateral redemption of excess stock.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Capital stock requirements; unilateral redemption of excess stock. 950.11 Section 950.11 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL... affairs of the Bank shall be administered fairly and impartially and without discrimination in favor of or...

Coupling of FM Systems to Individuals with Unilateral Hearing Loss.

ERIC Educational Resources Information Center

Kopun, Judy G.; And Others

1992-01-01

This study examined the attenuation characteristics of 5 Frequency Modulation system sound delivery options for 25 adults and children (ages 5-13). Degree of ear canal occlusion was a major factor in degree of attenuation. For children with unilateral hearing impairments, the most acoustically appropriate option was the tube-fitting. (Author/JDD)

A case of Todd's Palsy following unilateral electroconvulsive therapy

PubMed Central

Bell, Christine; Lepping, Peter; Clifford, John; Gardner-Thorpe, Catherine

2012-01-01

This case describes a woman undergoing unilateral electroconvulsive therapy (ECT) who developed a Todd's Palsy following the treatment, and which resolved when converted to bilateral ECT. We go on to hypothesize that this rare side effect may be an indication of the need to switch laterality during a course of ECT. PMID:22988330

Informational Masking and Spatial Hearing in Listeners with and without Unilateral Hearing Loss

ERIC Educational Resources Information Center

Rothpletz, Ann M.; Wightman, Frederic L.; Kistler, Doris J.

2012-01-01

Purpose: This study assessed selective listening for speech in individuals with and without unilateral hearing loss (UHL) and the potential relationship between spatial release from informational masking and localization ability in listeners with UHL. Method: Twelve adults with UHL and 12 normal-hearing controls completed a series of monaural and…

Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

ERIC Educational Resources Information Center

Croake, Daniel J.; Andreatta, Richard D.; Stemple, Joseph C.

2018-01-01

Purpose: The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that…

A case-control analysis and laboratory study of the two feet-one hand syndrome in two dermatology hospitals in China.

PubMed

Zhan, P; Ge, Y P; Lu, X L; She, X D; Li, Z H; Liu, W D

2010-07-01

Two feet-one hand syndrome (bilateral plantar tinea pedis with coexistent unilateral tinea manuum) is commonly seen in dermatology clinics, but the cause of the unilateral hand involvement remains unresolved. To investigate the unilateral hand involvement in this syndrome. This was a case-control study. The experimental group comprised 113 patients with bilateral tinea pedis and unilateral tinea manuum and the control group comprised 44 patients with tinea pedis only, without tinea manuum. Clinical data were recorded and pathogens were identified by fungal examination. The predominant pathogen, Trichophyton rubrum, was genotyped by PCR amplification of tandem repeat elements from the ribosomal DNA nontranscribed spacer region. Scratching habits were significantly different between the groups, and there was a significant relationship between tinea manuum and the hand reportedly used to scratch the feet. In analysis of isolates from the feet and the involved hand, 94.5% of pairs were of the same species, and 80% of pairs had the same genotypes. Contact between hands and feet probably results in the transmission of dermatophytes from the feet to the scratching hand.

Symptoms, disability and handicap in unilateral peripheral vestibular disorders. Effects of early presentation and initiation of balance exercises.

PubMed

Bamiou, D E; Davies, R A; McKee, M; Luxon, L M

2000-01-01

The aim of this study was to obtain a profile of disability and handicap in patients with unilateral peripheral vestibular disorders presenting to a specialist tertiary care unit. Two validated questionnaires were sent to patients who had a unilateral peripheral vestibular disorder as defined by strict criteria. Some patients still suffered moderate handicap and disability 5 years after the initial symptoms related to a unilateral vestibular disorder, although the duration of symptoms (onset to questionnaire completion) did not correlate with severity of disability and handicap, as judged by questionnaire scores. However, patients presenting to the unit within 6 months of onset of vertigo commenced balance exercises significantly earlier and had significantly lower disability scores than patients presenting later. A high proportion of non-compliance with, and delay in initiation of, vestibular rehabilitation exercises was noted in the total patient sample, while compliance with, and early initiation of, Cooksey Cawthorne exercises were significantly correlated with low disability and questionnaire scores. These findings suggest that early referral to a specialist balance unit for patients with persistent dizziness is associated with better outcome.

Subtype Diagnosis of Primary Aldosteronism: Is Adrenal Vein Sampling Always Necessary?

PubMed Central

Buffolo, Fabrizio; Monticone, Silvia; Williams, Tracy A.; Rossato, Denis; Burrello, Jacopo; Tetti, Martina; Veglio, Franco; Mulatero, Paolo

2017-01-01

Aldosterone producing adenoma and bilateral adrenal hyperplasia are the two most common subtypes of primary aldosteronism (PA) that require targeted and distinct therapeutic approaches: unilateral adrenalectomy or lifelong medical therapy with mineralocorticoid receptor antagonists. According to the 2016 Endocrine Society Guideline, adrenal venous sampling (AVS) is the gold standard test to distinguish between unilateral and bilateral aldosterone overproduction and therefore, to safely refer patients with PA to surgery. Despite significant advances in the optimization of the AVS procedure and the interpretation of hormonal data, a standardized protocol across centers is still lacking. Alternative methods are sought to either localize an aldosterone producing adenoma or to predict the presence of unilateral disease and thereby substantially reduce the number of patients with PA who proceed to AVS. In this review, we summarize the recent advances in subtyping PA for the diagnosis of unilateral and bilateral disease. We focus on the developments in the AVS procedure, the interpretation criteria, and comparisons of the performance of AVS with the alternative methods that are currently available. PMID:28420172

Unilateral lung transplantation for pulmonary fibrosis.

PubMed

1986-05-01

Improvements in immunosuppression and surgical techniques have made unilateral lung transplantation feasible in selected patients with end-stage interstitial lung disease. We report two cases of successful unilateral lung transplantation for end-stage respiratory failure due to pulmonary fibrosis. The patients, both oxygen-dependent, had progressive disease refractory to all treatment, with an anticipated life expectancy of less than one year on the basis of the rate of progression of the disease. Both patients were discharged six weeks after transplantation and returned to normal life. They are alive and well at 26 months and 14 months after the procedure. Pulmonary-function studies have shown substantial improvement in their lung volumes and diffusing capacities. For both patients, arterial oxygen tension is now normal and there is no arterial oxygen desaturation with exercise. This experience shows that unilateral lung transplantation, for selected patients with end-stage interstitial lung disease, provides a good functional result. Moreover, it avoids the necessity for cardiac transplantation, as required by the combined heart-lung procedure, and permits the use of the donor heart for another recipient.

Everyday psychological functioning in children with unilateral cerebral palsy: does executive functioning play a role?

PubMed

Whittingham, Koa; Bodimeade, Harriet L; Lloyd, Owen; Boyd, Roslyn N

2014-06-01

To identify whether executive functioning mediates the effect of having unilateral cerebral palsy (CP) on executive functioning in everyday life, psychological functioning, and social functioning. A cross-sectional cohort of 46 children with unilateral CP (25 males, 21 females; mean age 11y 1mo, SD 2y 5mo; 24 right-sided, 22 left-sided) and 20 children with typical development (nine males, 11 females; mean age 10y 10mo, SD 2y 4mo). Cognitive executive functioning was tested using a neuropsychological battery. Executive functioning in everyday life was measured with the Behavior Rating Inventory of Executive Function (BRIEF; teacher and parent reports) and psychological and social functioning by the Strengths and Difficulties Questionnaire (SDQ). Analysis included analysis of covariance and bootstrapping. Children with unilateral CP were found to have significantly decreased functioning, compared with children with typical development, on the BRIEF Behavioral Regulation Index, the BRIEF Metacognition Index, and on the SDQ emotion, conduct, hyperactivity, and peer problems subscales. Group differences were mediated by cognitive executive functioning for the BRIEF Metacognition Index (teacher and parent report), the BRIEF Behavioral Regulation Index (parent report only), the SDQ conduct subscale, and the SDQ hyperactivity subscale. This study suggests that the increased risk of children with unilateral CP experiencing executive functioning difficulties in everyday life, conduct problems, and hyperactivity can be partly explained by decreased cognitive executive functioning abilities relative to children with typical development. © 2014 Mac Keith Press.

Unilateral Sympathectomy for Primary Palmar Hyperhidrosis.

PubMed

Ravari, Hassan; Rajabnejad, Ataollah

2015-12-01

Primary palmar hyperhidrosis that arises mostly during puberty and early adolescence has a tremendous impact on the quality of life in patients. This study aimed to investigate the effectiveness of unilateral video-assisted thoracic sympathectomy for dominant hand in these patients. From July 2010 to June 2013, 52 patients with primary palmar hyperhidrosis underwent unilateral video-assisted thoracoscopic sympathectomy for dominant hand. We analyzed the outcomes regarding the resolution of symptoms, occurrence of complications, recurrence rate, and compensatory hyperhidrosis, and need of operation for opposite side. All patients were followed up from 6 to 42 months. Palmar hyperhidrosis was completely alleviated and absolute dryness was achieved in all patients at the same hand after the operation. Palmar hyperhidrosis in the opposite hand was cured to a complete dryness in 24 (46.15%) patients. No change happened in the opposite hand in 22 (42.3%) patients, but an increase was seen in 6 (11.53%) patients. Only seven (13.46%) patients needed to undergo contralateral sympathectomy. Compensatory hyperhidrosis occurred in 13 patients (25%) after unilateral sympathectomy. Another five patients (totally 18, 34.6%) were involved with compensatory hyperhidrosis after contralateral sympathectomy. It was mainly on the trunk in all 18 patients. Unilateral dominant side thoracoscopic sympathectomy for patients with primary palmar hyperhidrosis is an effective, safe, and minimally invasive procedure. Only a small number of patients will eventually require a contralateral sympathectomy in nondominant hand. Georg Thieme Verlag KG Stuttgart · New York.

Cost minimisation analysis of using acellular dermal matrix (Strattice™) for breast reconstruction compared with standard techniques.

PubMed

Johnson, R K; Wright, C K; Gandhi, A; Charny, M C; Barr, L

2013-03-01

We performed a cost analysis (using UK 2011/12 NHS tariffs as a proxy for cost) comparing immediate breast reconstruction using the new one-stage technique of acellular dermal matrix (Strattice™) with implant versus the standard alternative techniques of tissue expander (TE)/implant as a two-stage procedure and latissimus dorsi (LD) flap reconstruction. Clinical report data were collected for operative time, length of stay, outpatient procedures, and number of elective and emergency admissions in our first consecutive 24 patients undergoing one-stage Strattice reconstruction. Total cost to the NHS based on tariff, assuming top-up payments to cover Strattice acquisition costs, was assessed and compared to the two historical control groups matched on key variables. Eleven patients having unilateral Strattice reconstruction were compared to 10 having TE/implant reconstruction and 10 having LD flap and implant reconstruction. Thirteen patients having bilateral Strattice reconstruction were compared to 12 having bilateral TE/implant reconstruction. Total costs were: unilateral Strattice, £3685; unilateral TE, £4985; unilateral LD and implant, £6321; bilateral TE, £5478; and bilateral Strattice, £6771. The cost analysis shows a financial advantage of using acellular dermal matrix (Strattice) in unilateral breast reconstruction versus alternative procedures. The reimbursement system in England (Payment by Results) is based on disease-related groups similar to that of many countries across Europe and tariffs are based on reported hospital costs, making this analysis of relevance in other countries. Copyright © 2013 Elsevier Ltd. All rights reserved.

Vestibular evoked myogenic potentials (VEMP) can detect asymptomatic saccular hydrops.

PubMed

Lin, Ming-Yee; Timmer, Ferdinand C A; Oriel, Brad S; Zhou, Guangwei; Guinan, John J; Kujawa, Sharon G; Herrmann, Barbara S; Merchant, Saumil N; Rauch, Steven D

2006-06-01

The objective of this study was to explore the useful of vestibular evoked myogenic potential (VEMP) testing for detecting endolymphatic hydrops, especially in the second ear of patients with unilateral Ménière disease (MD). This study was performed at a tertiary care academic medical center. Part I consisted of postmortem temporal bone specimens from the temporal bone collection of the Massachusetts Eye & Ear Infirmary; part II consisted of consecutive consenting adult patients (n = 82) with unilateral MD by American Academy of Otolaryngology-Head and Neck Surgery criteria case histories. Outcome measures consisted of VEMP thresholds in patients and histologic saccular endolymphatic hydrops in postmortem temporal bones. Saccular hydrops was observed in the asymptomatic ear in six of 17 (35%) of temporal bones from donors with unilateral MD. Clinic patients with unilateral MD showed elevated mean VEMP thresholds and altered VEMP tuning in their symptomatic ears and, to a lesser degree, in their asymptomatic ears. Specific VEMP frequency and tuning criteria were used to define a "Ménière-like" response. This "Ménière-like" response was seen in 27% of asymptomatic ears of our patients with unilateral MD. Bilateral involvement is seen in approximately one third of MD cases. Saccular hydrops appears to precede symptoms in bilateral MD. Changes in VEMP threshold and tuning appear to be sensitive to these structural changes in the saccule. If so, then VEMP may be useful as a detector of asymptomatic saccular hydrops and as a predictor of evolving bilateral MD.