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PubMed1986

Impact of glucose ingestion on hepatic and peripheral glucose metabolism in man: an analysis based on simultaneous use of the forearm and double isotope techniques.

The metabolic response to glucose ingestion was studied in 10 normal men (aged 21-23 yr) by the simultaneous application of the forearm and double isotope techniques. The latter consisted of a primed constant infusion of [3-3H]glucose, followed by the administration of an oral glucose load (mean +/- SE, 90.7 +/- 0.7 g) containing [1-14C]glucose. Most (80.6 +/- 8.1%) of the ingested glucose appeared systemically within 270 min, suggesting that initial splanchnic glucose extraction accounted for 19.4 +/- 3.1% (17.7 +/- 2.8 g) of the oral load. Basal hepatic glucose output (2.22 +/- 0.12 mg/kg X min) was reduced (P less than 0.005) within 30 min after glucose loading and remained suppressed throughout the study; its mean reduction from 0-270 min was 54.9 +/- 9.9%, thereby accounting for the conservation of 26.5 +/- 4.9 g glucose. Suprabasal glucose appearance from 0-270 min was 46.6 +/- 4.3 g. Forearm glucose uptake rose 8.5-fold to 0.664 +/- 0.083 mg/100 ml forearm X min at 45 min, but basal forearm oxygen uptake (6.1 +/- 0.4 mumol/100 ml forearm X min) did not change. The increment in glucose disappearance from 0-270 min was 46.4 +/- 3.8 g, of which increased glucose uptake by muscle, determined from the forearm glucose uptake data, accounted for 37.7 +/- 5.1 g (81%). If uptake of the remaining 8.7 g was shared equally by the liver and peripheral tissues, the splanchnic bed and periphery would account, respectively, for 47.1 g (52%) and 43.5 g (48%) of the ingested load. We conclude that splanchnic and peripheral tissues contribute almost equally to the total homeostatic response; in kinetic terms, decreased hepatic glucose output and increased glucose uptake (splanchnic plus peripheral) constitute 29% and 71% of the total response, respectively; restoration of basal glucose kinetics after glucose ingestion requires more than 270 min; and increased peripheral oxygen uptake is not the mechanism of glucose-induced thermogenesis which, instead, may reflect increased splanchnic oxygen consumption.

Administration, Oral↗
PubMed2004

Cadmium exposure and distal forearm fractures.

UNLABELLED: The aim of this study was to analyze the relationship between low-level cadmium exposure and distal forearm fractures. Altogether, 1021 men and women exposed to cadmium in Sweden were included. The study indicates that cadmium exposure is associated with increased risk of forearm fractures in people over the age of 50. INTRODUCTION: Very few studies have been performed on environmental risk factors for fractures. Cadmium is known to cause damage to the kidneys and in high doses to the bone. The aim of this study was to analyze the relationship between low-level cadmium exposure and distal forearm fractures. MATERIALS AND METHODS: A total of 479 men and 542 women, 16-81 years of age, that were environmentally or occupationally exposed to cadmium were examined in 1997. Cadmium in urine was used to estimate dose, and information about previous fractures and risk factors for fractures was obtained from questionnaires. Fractures were validated using medical records. The association between cadmium dose and risk of forearm fracture was evaluated using Cox proportional hazard regression analysis. RESULTS AND CONCLUSION: The mean urinary cadmium in the study population was 0.74 nmol cadmium/mmol creatinine (10% and 90% percentiles are 0.19 and 1.42, respectively). For fractures occurring after the age of 50 years (n = 558, 32 forearm fractures), the fracture hazard ratio, adjusted for gender and other relevant co-variates, increased by 18% (95% CI, 1.0-38%) per unit urinary cadmium (nmol cadmium/mmol creatinine). When subjects were grouped in exposure categories, the hazard ratio reached 3.5 (90% CI, 1.1, 11) in the group of subjects with urinary cadmium between 2 and 4 nmol/mmol creatinine and 8.8 (90% CI, 2.6, 30) in the group of subjects with > or = 4 nmol/mmol creatinine. Associations between cadmium and fracture risk were absent before the age of 50. Cadmium exposure is associated with increased risk of forearm fractures in people over 50 years of age.

Adolescent↗
PubMed2004

Comparison of the homeostasis model assessment and quantitative insulin sensitivity check index with data from forearm metabolic studies for the in vivo assessment of insulin sensitivity.

The present study was designed to compare the homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI) with data from forearm metabolic studies of healthy individuals and of subjects in various pathological states. Fifty-five healthy individuals and 112 patients in various pathological states, including type 2 diabetes mellitus, essential hypertension and others, were studied after an overnight fast and for 3 h after ingestion of 75 g of glucose, by HOMA, QUICKI and the forearm technique to estimate muscle uptake of glucose combined with indirect calorimetry (oxidative and non-oxidative glucose metabolism). The patients showed increased HOMA (1.88 +/- 0.14 vs 1.13 +/- 0.10 pmol/l x mmol/l) and insulin/glucose (I/G) index (1.058.9 +/- 340.9 vs 518.6 +/- 70.7 pmol/l x (mg/100 ml forearm)-1), and decreased QUICKI (0.36 +/- 0.004 vs 0.39 +/- 0.006 ( microU/ml + mg/dl)-1) compared with the healthy individuals. Analysis of the data for the group as a whole (patients and healthy individuals) showed that the estimate of insulin resistance by HOMA was correlated with data obtained in the forearm metabolic studies (glucose uptake: r = -0.16, P = 0.04; non-oxidative glucose metabolism: r = -0.20. P = 0.01, and I/G index: r = 0.17, P = 0.03). The comparison of QUICKI with data of the forearm metabolic studies showed significant correlation between QUICKI and non-oxidative glucose metabolism (r = 0.17, P = 0.03) or I/G index (r = -0.37, P < 0.0001). The HOMA and QUICKI are good estimates of insulin sensitivity as data derived from forearm metabolic studies involving direct measurements of insulin action on muscle glucose metabolism.

Blood Glucose↗
PubMed1987

Is there a place for forearm osteodensitometry in clinical screening studies?

In order to evaluate forearm osteodensitometry for its potential to detect subjects with a low spinal mineral content and/or vertebral fractures, single-photon absorptiometry of the forearm and estimations of spinal mineral content by computed tomography were performed in 124 normal and abnormal subjects. Eighty-one per cent (22/27) of patients with vertebral crush fractures had a low spinal mineral content. In contrast, among 64 apparently normal individuals, six patients (four women, two men; 9.4%) had a low spinal mineral content. Forearm osteodensitometry showed a significant positive correlation with spinal mineral content. A forearm value in women in excess of 35 arbitrary units was associated with a spinal value of 75.1-mg equivalent dipotassium phosphate (K2HPO4) or above in 29/31 cases. A forearm value in women of 28.5 arbitrary units or lower was associated with a spinal value of 75-mg equivalent K2HPO4 or less in 20/24 subjects. While of no predictive value for the spine in patients with intermediate readings, forearm osteodensitometry is nevertheless considered a useful screening procedure for spinal osteoporosis.

Adult↗
PubMed2001

The accuracy of bone mineral density at distal radius on non-forearm osteoporosis identification.

The accuracy of BMD at distal radius was evaluated in terms of sensitivity, specificity, false negative, false positive, predictive value of a positive (osteoporosis) and a negative (normal) test for non-forearm osteoporosis. 278 women (150 osteoporotic and 128 normal) were measured for both distal radius bone mineral density (BMD) using Panasonic (DXA-70) dual energy X-ray absorptiometry (DEXA) and non-forearm BMD using Hologic (QDR-4500) DEXA on the same day. The results showed that mean age, menopause age, height and weight in the osteoporotic group were not different from the healthy group (p=0.168, 0.091, 0.274 and 0.097, respectively). Mean BMD of both distal radius and lumbar spine in the normal women was significantly higher than that in the osteoporotic group (p<0.001, = 0.002, <0.001, respectively). While mean BMD of the hip, femoral neck and Ward's triangle in both groups was not different (p = 0.330, 0.874, 0.847, respectively). The sensitivity of BMD of the right radius was very high (90.00-95.45%) and specificity was moderately high (53.85-73.68%). While false negative (4.55-10.00%) was less than false positive (26.32-46.15%). The accuracy of right radius BMD when compared with spine, hip, femoral neck and Ward's triangle was 82.35, 66.66, 80.00 and 86.49 per cent, respectively. The sensitivity (85.00-96.67%), specificity (57.69-81.58%), false negative (3.33-15.00%) and false positive (18.42-42.31%) of left radius BMD had the same trend as right radius BMD. Accuracy of the left radius when compared with non-forearm BMD was 88.24, 66.67, 75.71 and 86,49 per cent, respectively. The predictive value of right radius osteoporosis was 73.68, 47.37, 77.78 and 89.66 per cent for detecting osteoporosis at spine, hip, femoral neck and Ward's triangle, respectively. The predictive value of normal right radius BMD was 93.33, 92.86, 87.50 and 75.00 per cent, respectively for normal non-forearm BMD. Moreover, the predictive value of left radius osteoporosis for identifying spinal, hip, femoral neck and Ward's triangle osteoporosis was (80.56, 47.22, 77.55 and 91.07%, respectively) and the predictive value of normal left radius BMD for identifying normal BMD at non-forearm sites (96.88, 90.00, 71.43 and 72.22%, respectively) was revealed. It indicated that forearm DEXA provides adequate accuracy for in vivo determination of spinal, femoral neck and Ward's triangle osteoporosis. However, there was inadequate accuracy and very low predictive ability for identifying hip osteoporosis.

Absorptiometry, Photon↗
PubMed1991

Effect of low-concentration sodium lauryl sulfate on human vulvar and forearm skin. Age-related differences.

The reactivity of forearm and vulvar skin to low-concentration sodium lauryl sulfate (SLS) was studied in 20 healthy women, 10 before and 10 after menopause. SLS at concentrations of 0.1%, 0.5% and 1.0% was applied to the forearm and labium majus for 24 hours. Skin changes were monitored with transepidermal water loss (TEWL), capacitance (CAP) (as an indicator of stratum corneum hydration) and visual scoring (VS). In forearm skin, irritant dermatitis developed in most subjects, as indicated by a VS and TEWL increase, with the reaction in premenopausal women significantly more intense than in postmenopausal women. In vulvar skin, however, irritant reactions were not observed. CAP increased significantly in the forearm of premenopausal but not postmenopausal women, whereas it decreased significantly in postmenopausal vulvar skin. Thus, vulvar skin was less reactive to SLS at low concentrations than was forearm skin. However, SLS did affect vulvar skin stratum corneum hydration. The irritant response in the forearm decreased with age for all parameters studied, whereas in vulvar skin age-related differences in irritant reaction were limited to stratum corneum hydration.

Adult↗
PubMed1983

[Mechanical strain in the forearm bones].

Knowledge of the physiologic distribution of strain in bone is essential for a successful osteosynthesis by means of compression plate. This method guarantees optimum stability if the plate acts as a tension band. If the side of tensile stresses varies within the bone, strain may not only occur on the side of the plate but also on the opposite cortex. In such cases the distribution of pressure in the fracture gap is of special importance. For determining the distribution of strain on the radius, it is necessary to examine the forces caused by the flexor- and extensor muscles of the wrist and fingers. Additional forces come also from flexor- and extensor muscles of the elbow. The frame formed by the bow-shaped radius and the ulna is of further importance for the distribution of strain. Kind and amount of tension is fundamentally influenced by forearm rotation. Anatomic studies on post-mortem specimens showed how the direction of muscle action to wrist and fingers changed in relation to the position of a plate fixed to the proximal shaft of the radius. This already demonstrates possible variations in the bending forces caused by forearm rotation. An analysis of the distribution of strain in the forearm bones was carried out on a biomechanical model using strain gauges. This method allows the simulation of strain to the skeleton caused by muscle force and the influence of load. The distribution of strain can be studied on the same model in various different positions of elbow and forearm. Six muscles and two muscle groups were simulated by means of wire pulls with calibrated strain gauges; these muscles and muscle groups act, on account of the physiological cross section and their position, as bending forces to the forearm bones in a dorsovolar plane. The tensile force on radius and ulna were each controlled by three strain gauges in four sections. The characteristic quantities of these sections were determined by evaluation of the appropriate computertomograms. With the aid of three strain gauges per section it was possible to assess the strain at any one desired point. Distribution of strain was determined by pull to each "muscle" in the extreme position of forearm rotation and three different positions of flexion to the elbow. The tensile force was expressed on graphs as muscle tension of 2 kp/cm2 per cross section (ill. 6 to 12).(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1998

Similarity of bone mass measurement among hip, spines and distal forearm.

From January-December 1995, bone mineral density (BMD) of lumbar spine, hip and distal forearm were studied in 325 healthy women visiting the menopause clinic, Chulalongkorn Hospital. This retrospective analysis was conducted to assess the correlation of BMD among various measurement sites. Bone mass measurement at hip and spine were performed utilizing dual energy X-ray absorptiometer (DEXA), Hologic QDR 2000 and at distal forearm by single energy X-ray absorptiometer (SEXA), Hologic DTX 100. By canoconical correlation, the results revealed a significant correlation of BMD of distal and ultra-distal part of forearm with various sites of hip (r = 0.602, p < 0.001). There was also significant correlation of distal and ultra-distal part of forearm with various sites of spines (r = 0.619, p < 0.001). Though there is some heterogeneity of bone mass density among different measurement sites, practically with this fairly good level of correlation, bone mass measurement of distal forearm might be used to predict the BMD of hip and spine in Thai women. The accuracy of predicting the BMD of hip and spine by BMD of distal forearm in the mass screening programme in Thailand is now going on. The results will be followed.

Absorptiometry, Photon↗
PubMed1998

[Modified Krukenberg-plasty with callus distraction of the stump and complete skin closure of both forearm branches].

In 1917, Hermann Krukenberg first reported on the conversion of a forearm stump into tongs by separating the ulna and radius in a bilateral forearm amputee. Up to now, this technique still has its indication in patients with bilateral loss of the hand or forearm. The main problem is still the coverage of both forearm branches with sensitive skin, especially when the muscles are preserved for surface management and strength. The two case reports of bilateral amputation injuries of the upper extremities illustrate our modification of the Krukenberg procedure. First, callus distraction of the short forearm stump by an external fixator was used in one case. After implantation of tissue expanders, enough sensitive skin was gained to resurface both arms of the Krukenberg forearm during a second procedure in both patients nearly completely.

Adult↗
PubMed2006

The "muscular hernia sign": an original ultrasonographic sign to detect lesions of the forearm's interosseous membrane.

The total disruption of the forearm's interosseous membrane can lead to an Essex-Lopresti syndrome. The diagnosis must be done early for a better prognostic. Incomplete lesions can aggravate and an early diagnosis of incomplete lesions is a challenging problem. Magnetic resonance imaging is the gold standard but remains expensive, and is hard to obtain in an emergency. On the contrary, ultrasonography is cheap, accessible in an emergency, and dynamical tests can be performed easily. Twelve fresh frozen forearms were randomized in four groups. The membrane was divided into three parts (proximal, middle, and distal thirds). Each group was prepared with variable patterns of lesions. Two radiologists performed an ultrasonographic (US) examination of these forearms. They were blinded with respect to the lesional status of the forearms. Each examination consisted of two stages: static and dynamic. During the dynamic examination, the radiologist looked for the "muscular hernia sign". The results of their examinations were compared with the real lesional status. The static examination was very efficient in the proximal and middle parts of the membrane, and less reliable in the distal third. With the dynamical examination, no mistake occurred at the proximal and middle parts of the forearm, and there was only one at the distal part. The US examination of the interosseous membrane is very efficient to detect incomplete lesions, mostly, if dynamical tests are performed looking for a "muscular hernia sign".

Cadaver↗
PubMed2002

Computer simulation of forearm rotation in angular deformities: a new therapeutic approach.

A new computer-assisted simulation of forearm rotation based on orthogonal radiographs of the forearm is introduced. A new computer program called STOOPS was developed based on a new kinematic model describing motion of the radius and ulna in regards to forearm rotation. The computer program allows simulation of angular deformities of the forearm and can predict subsequent rotational impairment. To validate the program, the authors compared the actual pronation of 21 patients with angular deformities with the predicted pronation by STOOPS. The mean difference between the simulated and clinically measured pronation was 5.6 degrees (S.D. 9.4 degrees ). There was no statistically significant difference between the measured and simulated values. Using the computer-assisted simulation may help predict impairment of pronation due to angular deformities. If clinical impairment differs from the computed one, other causes such as lesions to the interosseous membrane or the adjacent joints have to be excluded. If values are similar, correction of the angular deformities should result in improvement of forearm pronation.

Adolescent↗
PubMed1995

Clinical results of the one-bone forearm.

Between 1973 and 1991, 19 patients underwent creation of a one-bone forearm at our institution as treatment for radioulnar instability secondary to trauma ("type 1" patients) or tumor resection or congenital deformity ("type 2" patients). Seventeen had failed previous reconstruction attempts. Ten one-bone forearms were constructed in neutral rotation, and nine in varying pronation (mean, 24 degrees). The distal ulna was absent or excised at the time of surgery in nine patients, partially excised in two, and shortened in one. At a mean follow-up interval of 42 months, the primary union rate was 68%, and the secondary rate was 74%. Using a rating scale devised for this study, 37% excellent, 32% good, 26% fair, and 5% poor results were noted. Poor results were statistically associated with previous trauma (type 1 patients), infection, severe nerve injury, and multiple previous surgical procedures. This is a retrospective study, and because of the limitations of such studies, no correlation of results with forearm rotational position, preoperative wrist or elbow dysfunction, fusion location, distal ulna excision or synostosis union was noted. Significant complications were noted in 10 patients, with a higher rate in type 1 patients. Although one-bone forearm construction remains a viable salvage option for forearm instability in selected patients, results may be less predictable than previously reported.

Adult↗
PubMed1982

The forearm flap.

We present our experimental and clinical experiences with the free neurovascular forearm flap. The flap is based on the radial artery, one of the great veins of the forearm (cephalic, basilic, or interconnecting vein), and one or two cutaneous forearm nerves (ulnar, median, or lateral). Because of the standard anatomy, the large caliber of blood vessels, the good sensory supply, the quality and quantity of the forearm skin, and the thin layer of subcutaneous fat, the free forearm flap is a technically easy and safe flap for reconstruction of soft-tissue defects, especially those in the head and neck and those areas of the extremities where sensitive skin is desired.

Adult↗
PubMed1999

Assessment of donor-site functional morbidity from radial forearm fasciocutaneous free flap harvest.

OBJECTIVE: To quantitate the functional morbidity to the hand and wrist following harvest of a radial forearm fasciocutaneous free flap. DESIGN: Prospective case-control study, with each patient providing his or her internal control, comparing preoperative and postoperative operated to nonoperated forearms. SETTING: Tertiary care hospital in large metropolitan area. PATIENTS: A consecutive sample of 11 patients who underwent a radial forearm free flap reconstruction of the head and neck from April 1997 to May 1998. MAIN OUTCOME MEASURES: Range of motion of the wrist (flexion and extension, ulnar and radial deviation), grip and pinch strength, and sharp and dull sensation in the distribution of the radial, ulnar, and median nerves. RESULTS: Statistically significant differences (P<.05) were measured in wrist flexion, pinch strength, and sharp sensation in the anatomical snuffbox of the operated forearm. No subjective complaints of loss of function were reported by any patient. CONCLUSIONS: Donor-site functional morbidity associated with harvest of the radial forearm fasciocutaneous free flap is measurable. The statistical differences found do not translate into subjective patient complaints of everyday functional morbidity.

Adult↗
PubMed1997

Functional outcome in soft palate reconstruction using a radial forearm free flap in conjunction with a superiorly based pharyngeal flap.

BACKGROUND: Speech and swallowing problems due to velopharyngeal incompetence may follow soft palate resection and reconstruction. Over the past 3 years, we have developed the use of a superiorly based pharyngeal flap in conjunction with a radial forearm flap for soft palate reconstruction. METHODS: This paper describes the technique in detail and compares the functional results in a study with patients undergoing soft palate resection for squamous cell carcinoma treated with or without a pharyngeal flap as an adjunct to a radial forearm free flap for soft palate reconstruction. Seven patients had one quarter or one half soft palate defects reconstructed with a radial forearm flap alone. Of the 11 patients undergoing three quarter or total soft palate resections, all were reconstructed with a radial forearm flap, but 5 were treated with an additional superiorly based pharyngeal flap. The functional outcome for all the patients was analyzed and compared. RESULTS: Our results show that the addition of the superiorly based pharyngeal to the radical forearm flap in soft palate reconstruction results in improved speech and swallowing. We recommend the use of the additional flap in resections in which more than one quarter of the soft palate is included.

Adult↗
PubMed2001

Telemetered electromyography of the supinators and pronators of the forearm in gibbons and chimpanzees: implications for the fundamental positional adaptation of hominoids.

Extant apes are similar to one another, and different from monkeys, in features granting them greater range of forearm rotation and greater size of the muscles that produce this motion. Although these traits may have been independently acquired by the various apes, the possibility arises that such features reflect adaptation to the stem behavior of the hominoid lineage. Anticipating that knowledge of forearm rotatory muscle recruitment during brachiation, vertical climbing, arm-hanging during feeding, and voluntary reaching might point to this stem behavior, we undertook telemetered electromyographic experiments on the supinator, pronator quadratus, ulnar head of pronator teres, and a variety of other upper limb muscles in two gibbons and four chimpanzees. The primary rotator muscles of the hominoid forearm were recruited at high levels in a variety of behaviors. As had been suspected by previous researchers, the supinator is usually active during the support phase of armswinging, but we observed numerous instances of this behavior during which the muscle was inactive. No other muscle took over its role. Kinetic analyses are required to determine how apes can execute body rotation of armswinging without active muscular effort. The one behavior that is common to most extant apes, is rare in monkeys, and which places a consistently great demand on the primary forearm rotatory muscles, is hang-feeding. The muscles of the supporting limb are essential to properly position the body; those of the free limb are essential for grasping food. Since the greater range of forearm rotation characterizing apes is also best explained by adaptation to this behavior, we join previous authors who assert that it lies at the very origin of the Hominoidea.

Adaptation, Physiological↗
PubMedDate not supplied

Intraoral and oropharyngeal reconstruction using a de-epithelialized forearm flap.

We have used free forearm flaps for closure of various intraoral and oropharyngeal defects after radical ablation of tumors. A problem remained, however, in that split-thickness skin grafts required to close the forearm defect had to be obtained from other areas. To avoid this disadvantage, we de-epithelialized forearm flaps and the donor defects were closed with the split-thickness skin obtained from flap de-epithelialization. As a result of this procedure, unnecessary scarring has been avoided and postoperative management has been simplified. Such complications as flap loss, fistulae, or scar contracture have not occurred with greater frequency than is seen in normal circumstances. The de-epithelialized forearm flap procedure is explained. Histological findings concerning the de-epithelialized forearm flap are described, and the advantages of this method stated.

Adult↗
PubMedDate not supplied

Folded free radial forearm flap for reconstruction of full-thickness defects of the cheek.

BACKGROUND: Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full-thickness defects of the cheek. METHODS: The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent fill-thickness excision of the cheek. RESULTS: Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks. CONCLUSION: Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity.

Adult↗