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At least 505 records · Page 28Linked to original sources
PubMed2004

Prevalence of coronary artery disease, lower extremity peripheral arterial disease, and cerebrovascular disease in 110 men with an abdominal aortic aneurysm.

Of 110 men (mean age 66 years) with an abdominal aortic aneurysm, 78 (71%) had coronary artery disease (CAD), 50 (46%) had lower extremity peripheral arterial disease (PAD), and 30 (27%) had cerebrovascular disease. Twenty-four percent of the patients with an abdominal aortic aneurysm had CAD plus lower extremity PAD plus cerebrovascular disease, 22% had CAD plus lower extremity PAD and no cerebrovascular disease, 22% had only CAD, 4% had CAD plus cerebrovascular disease and no lower extremity PAD, and 29% had no CAD, lower extremity PAD, or cerebrovascular disease.

Adult↗
PubMed2006

Return to driving after lower-extremity amputation.

OBJECTIVES: To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation. DESIGN: A cross-sectional study. SETTING: Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001. PARTICIPANTS: A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4+/-12.1 years and were on average 6.8+/-8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Driving habits after lower-extremity amputation. RESULTS: Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02-.34), age of 60 years or greater (OR=.16; 95% CI, .03-.74), right-sided amputation (OR=.13; 95% CI, .03-.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05-.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions. CONCLUSIONS: The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.

Aged↗
PubMed2005

Malignant fibrous histiocytoma: outcome of tumours in the head and neck compared with those in the trunk and extremities.

Malignant fibrous histiocytoma is one of the commonest soft tissue sarcomas in adults, affecting, in order of frequency, the extremities, trunk and head and neck. We treated 131 patients with malignant fibrous histiocytoma by radical, wide, or marginal resection. Their mean age was 43 years, and there were 54 in the head and neck and 77 in the trunk and extremities. The extent of clearance of the tumour, local recurrence, and 5-year survival were studied in these two groups. In the head and neck group, local recurrences developed in 86% after marginal resection, 66% after wide resection and 27% after radical resection. The comparative figures in the trunk and extremities group were 75, 71 and 18%, respectively. The overall 5-year survival was 48% in the head and neck group and 77% in the trunk and extremities group (p=0.03). Repeat operations for recurrences of tumour offered a 'cure rate' of 23% in the head and neck group and 61% in the trunk and extremities group. Inadequate resection of the sarcoma in the head and neck was associated with a high incidence of local recurrence and a poor prognosis. Therefore, we suggest that the initial operation for sarcoma in the head and neck should be as radical as possible to reduce the chance of local recurrence and to improve the outcome.

Adolescent↗
PubMed2004

Quality of life in patients with vascular malformations of the lower extremity.

With the exception of capillary malformations (port-wine stains), the adverse psychosocial effects of vascular malformations have not received much attention in the medical literature. We, therefore, studied health related quality of life of patients with vascular malformations located primarily on the lower extremity, who presented to us over a 10-year period. Patient's self-assessment of quality of life was measured by the Multiple Outcomes Study (MOS) Short Form Health Survey Questionnaire (SF-36). Several possible predictors were also examined. Eighty-one patients (33 male, 48 female), aged 14-61 years, completed the SF-36. Seventy-one patients (88%) had a low flow lesion. Twenty-three patients (28%) had hypertrophy of the lower extremity, while 11 patients (14%) had hypotrophy. Sixty-nine patients (85%) had the vascular malformation located only on the lower extremity. Six (7%) also had their upper extremity (hand) involved, and 20 patients (24.7%) had >10% TBSA affected. Eight patients (10%) needed special shoes. Fifty-one patients (63%) had a previously performed MRI, of which 62.7% (32/51) had muscle involvement. Fifty-one patients (63%) had been operated on. Of the 34 patients wearing elastic compression stockings, 25 patients (74%) indicated that they were satisfied with the stockings. Compared to the general population sample, the SF-36 questionnaire indicated that our vascular malformation patients reported impaired vitality and higher levels of pain, while no differences were seen regarding the other dimensions of quality of life. Demographic, clinical and therapy characteristics could explain quality of life only to a limited extent. Explained variability of the SF-36 dimensions ranged from 0% for mental health to 34.5% for role functioning physical. To our surprise, this study suggests that patients with vascular malformations located primarily on the lower extremity do not have a greatly decreased quality of life when compared to the general Dutch population.

Adolescent↗
PubMed2006

Is extreme obesity a risk factor for cardiac surgery? An analysis of patients with a BMI > or = 40.

BACKGROUND: The increasing prevalence of obesity is a public health concern and perceived as a potential risk factor in open heart surgery. We critically appraised the literature available regarding postoperative complications in obese patients. METHODS: A single-center retrospective evaluation of complication rates (1999-2004) in cardiac surgical patients categorized by body mass index (BMI) was conducted. The overall incidence of complications (CX), renal failure (RF), hemodialysis (HD), atrial fibrillation (AF), cardiac arrest (CA), infections (INF), stroke (CVA and TIA), prolonged ventilation (VENT), and pulmonary embolism (PE) were observed. Patients with normal BMI (20-30) served for comparison, obesity and extreme obesity (ExtOb) were defined as BMI 30-40 and > or =40, respectively. RESULTS: In our institutional review of 1920 patients, 1780 met the inclusion criteria with BMI<20 (n=53), 20-30 (n=1056), 30-40 (n=592), and > or =40 (n=79) based on National Health and Nutrition Examination Survey (NHANES) criteria. Significant increase in complications (STS database guideline definitions) were observed with a BMI> or =40, 58% versus 47% (p=0.04). Extremely obese patients (ExtOb) had increased length of stay (LOS) (11.4 days vs 9.6 days; p< or =0.01), rate of renal failure (14.3% vs 5%; p< or =0.01) and prolonged ventilation (39%; p=0.01) compared to non-obese patients. Extremely obese had no significant increase in hemodialysis (7.3% vs 3.2%; p=0.11) or stroke (5.2% vs 2.9%; p=0.29). Obese patients (Ob) had increased LOS (10 days vs 9.6 days; p=0.04) and prolonged ventilation (28.3% vs 23.5%; p=0.03). CONCLUSIONS: Cardiac surgery can be performed without significant increase in perioperative and 30-day mortality in obese and extremely obese patients. Overall complication rates and LOS in patients with BMI> or =40 is increased and demands attention. We provide evidence that rates of few specific complications increase with extreme obesity. For risk stratification in the setting of an obesity epidemic, we advocate an interdisciplinary approach in obese patients undergoing elective cardiac surgery.

Acute Kidney Injury↗
PubMed2005

Outcome instruments for the assessment of the upper extremity following trauma: a review.

Orthopaedic injuries are common among trauma patients and can result in long-term problems. Considerable data are available regarding functional outcomes following lower extremity trauma. There is, however, a paucity of data available for upper extremity trauma patients. Whilst currently available instruments appear to assess outcomes of relevance in trauma populations, the reliability, validity and responsiveness of these instruments have not been evaluated in the upper extremity trauma population. This paper reviews instruments designed for patient self-evaluation of musculoskeletal disorders of the upper extremity, and instruments used in an orthopaedic trauma population to assess functional recovery following injury. The Musculoskeletal Functional Assessment (MFA), Short Musculoskeletal Functional Assessment (SMFA), Disabilities of the Arm, Shoulder, and Hand (DASH), American Shoulder and Elbow Surgeons Shoulder Scale (ASES-s), American Shoulder and Elbow Surgeons Elbow Scale (ASES-e), Patient Rated Elbow Evaluation (PREE), and the Patient Rated Wrist Evaluation (PRWE) were reviewed. Until research is published outlining the evaluation of assessment instruments in upper extremity orthopaedic populations, authors will need to conduct their own validation studies before investigating outcomes in specific trauma populations.

Arm Injuries↗
PubMed2004

Leg strength in peripheral arterial disease: associations with disease severity and lower-extremity performance.

OBJECTIVE: The purpose of this study was to determine relationships between lower-extremity arterial obstruction, leg strength, and lower-extremity functioning. DESIGN: The study design was cross-sectional. A total of 514 outpatients (269 with ankle-brachial index [ABI] <0.90), aged 55 and older, were identified from three Chicago-area hospitals. Individuals with history of lower-extremity revascularization were excluded. Main outcome measures Strength in each leg, 6-minute walk, 4-meter walking velocity, accelerometer-measured physical activity, and a summary performance score were measured. The summary performance score is a composite measure of lower-extremity functioning, ranging from 0 to 12 (12 = best). The leg with the lower ABI was defined as the "index" leg, and the leg with higher ABI was defined as the "contralateral" leg. RESULTS: Index leg ABI levels were associated linearly and significantly with strength for hip extension (P <.001), hip flexion (P <.001), knee extension (P =.066), and knee flexion (P =.003), adjusting for known and potential confounders. In adjusted analyses, the index ABI was also associated linearly and significantly with strength in the contralateral leg. Adjusting for confounders, including ABI, knee extension strength, was associated independently with functional measures. CONCLUSION: Among patients without prior leg revascularization, strength in each leg is highly correlated with the lower-leg ABI. Leg strength is associated independently with functional performance. Further study is needed to determine whether lower-extremity resistance training improves functioning in patients with peripheral arterial disease.

Aged↗
PubMed2004

Does a standardization tool to direct invasive therapy for symptomatic lower extremity peripheral arterial disease improve outcomes?

OBJECTIVES: While decision analysis and treatment algorithms have repeatedly been shown to improve quality of care in many areas of medicine, no such algorithm has emerged for the invasive management of lower extremity peripheral arterial disease. Using the best available evidence-based outcomes data, our group designed a standardization tool, the Lower Extremity Grading System (LEGS) score, which consistently directs limbs to a specific treatment on the basis of presentation. The purpose of this study was to examine whether use of such a tool improves outcomes by directing treatment of lower extremity peripheral arterial disease. METHODS: Over 18 months (July 2001-December 2002) our group intervened in 673 limbs (angioplasty, open surgery, primary limb amputation) with lower extremity peripheral arterial disease. During this time we developed the LEGS score, and implemented its prospective use for the final 362 limbs. For the purpose of this study, all 673 limbs were retrospectively scored with the LEGS score to determine the LEGS recommended best treatment. Of the 673 limbs, 551 (81.9%) received the same treatment as recommended with LEGS and 122 (18.1%) received treatment contrary to LEGS. Limbs treated contrary to LEGS (cases) were then compared with matched control limbs (treated according to LEGS), with similar angiographic findings, clinical presentation, preoperative functional status, comorbid conditions and operative technical factors. Outcomes measured at 6 months included arterial reconstruction patency, limb salvage, survival, and maintenance of ambulatory status and independent living status. Kaplan-Meier curves were used to assess patency, limb salvage, and survival; associated survival curves were compared with the log-rank test. Functional outcomes were compared with the Fisher exact test. RESULTS: After matching case limbs with control limbs, 9 limbs had no control match. Thus 113 limbs in 100 patients treated contrary to LEGS were compared with 113 limbs in 100 patients treated according to LEGS. Limbs treated contrary to LEGS resulted in significantly inferior outcomes at 6 months for measures of primary patency (57.5% vs 84.3%; P < .001), secondary patency (73.2% vs 96.2%; P < .001), limb salvage (89.7% vs 97.2%; P = .04), and maintenance of ambulatory status (78% vs 92%; P = .02). As an additional finding, 29.6% (92 of 311) of interventions performed before implementation of the algorithm were treated contrary to LEGS, and thus contrary to objectively determined best therapy, compared with 8.3% (30 of 362) after LEGS implementation (P < .001). CONCLUSIONS: Limbs treated according to our standardization tool resulted in better outcomes compared with limbs treated contrary to the algorithm. These data suggest that routine use of an appropriately validated treatment standardization algorithm is capable of improving overall results for invasive treatment of lower extremity peripheral arterial disease.

Amputation, Surgical↗
PubMed1996

Outcome and utility of scoring systems in the management of the mangled extremity.

BACKGROUND: The role of scoring systems as predictors of amputation and functional outcome in severe blunt extremity trauma was examined. METHODS: All severe extremity injuries treated over a 10-year period were scored retrospectively using four scoring systems: Mangled Extremity Syndrome Index (MESI), Mangled Extremity Severity Score (MESS), Predictive Salvage Index (PSI), and Limb Salvage Index (LSI). RESULTS: Twenty-three upper (UE) and 51 lower extremity (LE) injuries were evaluated. Sensitivity and specificity, respectively, were MESI 100% and 50%, MESS 79% and 83%, PSI 96% and 50%, and LSI 83% and 83%. For each system, there were no differences between patients with good and poor functional outcomes. CONCLUSION: All of the scoring systems were able to identify the majority of patients who required amputation. However, prediction in individual patients was problematic. None of the scoring systems were able to predict functional outcome.

Adult↗
PubMed2002

The risks of moderate and extreme obesity for coronary artery bypass grafting outcomes: a study from the Society of Thoracic Surgeons' database.

BACKGROUND: Obesity is epidemic in the United States and afflicts 97 million adults. Prior single center studies have been contradictory as to obese patients having higher risks with coronary artery bypass operations. Our objective was to assess the independent effect of both moderate (body mass index [BMI], 35 to 39.9) and extreme (BMI > or = 40) obesity on bypass operation outcomes using the Society of Thoracic Surgeons National Cardiac Database. METHODS: The study population consisted of 559,004 patients from the Society of Thoracic Surgeons database who underwent first-time, isolated coronary artery bypass grafting between January 1997 and December 2000. We compared 42,060 moderately obese patients (BMI, 35 to 39.9) and 18,735 extremely obese patients (BMI > or = 40) with 498,209 normal or mildly obese patients (BMI, 18.5 to 34.9). Multivariable logistic regression was used to determine whether BMI subgroups were independent predictors of operative risk after adjusting for other preoperative factors. RESULTS: Compared with normal or mildly obese patients (BMI, 18.5 to 34.9), moderate and severely obese patients were younger and more likely to be diabetic and hypertensive. After adjusting for these and other known preoperative risk factors, moderate obesity slightly elevated patients' operative risk (adjusted odds ratio, 1.21; confidence interval, 1.13 to 1.29). In contrast, extremely obese patients had marked higher risk for operative mortality (adjusted odds ratio, 1.58; confidence interval, 1.45 to 1.73). Major perioperative complications, particularly deep sternal wound infection, renal failure, and prolonged postoperative hospital stay also increased for extremely obese patients. CONCLUSIONS: Extreme obesity (body mass index > or = 40) is a significant independent predictor for adverse outcomes and prolonged hospitalization after coronary artery bypass operation.

Body Mass Index↗
PubMed1997

Extreme bilateral molar rotation in Monodelphis domestica (Marsupialia: Didelphidae).

Rotation of a tooth around an axis perpendicular to the occlusal plane through angles approaching 180 degrees is a rare anomaly found in the mammalian dentition. A specimen of Monodelphis domestica was found to show such extreme rotation of both lower last molars, with consequent disruption of normal occlusion and wear. A review of the literature discovered 41 other reported cases of extreme rotation, from four different orders of mammals. The distribution of extreme rotation within the dentition can be summarized as follows. It is found only in isolated teeth or in contralateral pairs of teeth. Bilateral rotation is far more common than would be expected based on the chance of the independent occurrence of two rotations. Extreme rotation has a significantly higher frequency in upper rather than lower teeth, in premolars rather than other teeth, and on the left- rather than the right--hand side. The incidence of extreme rotation across mammals was estimated to be approx. 1 in 5850.

Animal Diseases↗
PubMed2003

Critical evaluation of mangled extremity severity scoring system in Indian patients.

Amputation of a mangled extremity is repugnant to the patient and the surgeon. However, prolonged unsuccessful attempts at salvage are costly, highly morbid and sometimes lethal. Much discussion has taken place regarding which criteria predict successful salvage, and predictive indices have been proposed in an attempt to identify limbs for which attempted salvage is unlikely to succeed. The mangled extremity severity score, or MESS system is the most thoroughly validated of the various classification systems, but at present there is no predictive scale that can be used with confidence to determine whether to amputate or attempt to salvage a mangled lower extremity. MESS system based on four significant criteria (with increasing points with worsening prognosis) i.e. skeletal injury, limb ischaemia, shock and patient age, has become a standard method to determine which one of the mangled extremities will eventually undergo amputation or salvage. Keeping in view the paucity of studies on Indian patients, a prospective trial of MESS was done in 50 patients who had 56 mangled extremities during the last 3 years. A significant difference between the MESS value of salvaged limbs (4.7) and amputated limbs (8.6) was found. MESS value of more than 7 was most specific and was found to have a positive predictive value of 100%. The results have been compared with Western literature and authors suggest that nerve injuries and irreparable soft tissue loss should be given an extra point each. In bilateral cases, the MESS value of each limb should be properly assessed (especially when patient is in shock), as the score may increase because of the other injured limb.

Adult↗
PubMed2001

Use of continuous water quality records for hydrograph separation and to assess short-term variability and extremes in acidity and dissolved carbon dioxide for the River Dee, Scotland.

A combination of continuous (15-min) pH, conductivity and temperature measurements and fortnightly spot-sampled water quality data were used to examine temporal variability and extremes in river water quality in an upland Scottish river: the River Dee at Mar Lodge. An empirical relationship was established for Gran-alkalinity by multiple regression against flow and conductivity for the fortnightly data. Applying this relationship to the continuous data, an estimate of continuous Gran-alkalinity was calculated. The continuous Gran-alkalinity record was used as (1) a conservative tracer in a simple two-component mixing model to determine the relative proportions of near-surface runoff and deeper groundwater contributing to stream flow; (2) to deconvolute the contribution of weathering and sea-salt contributions to stream conductivity; and (3) to calculate the excess partial pressure of carbon dioxide in stream water. The episodic variations in pH, weathering and sea-salt conductivity and excess partial pressures of carbon dioxide (EpCO2) associated with high flow events in the River Dee suggest that hydrological pathways play an important role in determining stream chemistry. The results of the hydrograph separation indicate that groundwater provides an important contribution to stream flow, and that there are large and hydrologically active stores of groundwater within the upper River Dee catchment. Sea-salts have an important influence on stream conductivity, particularly with the onset of storm runoff following summer drought periods. This suggests that sea-salts are concentrated in the upper soil horizons by dry deposition and/or evapotranspiration. EpCO2 behaves non-conservatively and shows marked diurnal variability under low-flow conditions during summer, inducing diurnal pH variations, and indicating the importance of within-river biological processes. This study emphasises the very intermittent nature of water quality extremes with stream spates and the diurnal nature of biologically-induced responses. Fortnightly sampling programmes do not capture the range of high flow extremes, and with sampling undertaken during the working day, biological extremes occurring at night are also missed, introducing bias. This study shows the value of continuous measurements for infilling aspects of these intermittent extremes. However, it is also noted that the relatively simple patterns of response observed from the continuous measurements may well belie a much more varied response at the sub-catchment and hillslope scales, as local chemical and hydrological heterogeneities do occur. Thus, the two-component mixing model used is, in practice, based on catchment integrated values for a range of soil water and groundwater endmembers.

Carbon Dioxide↗
PubMed1997

Retroperitoneoscopic renal biopsy in extremely obese patients.

OBJECTIVES: Retroperitoneoscopic renal biopsy can be technically challenging in extremely obese patients because of loss of surgical landmarks and difficulty in identifying the kidney within retroperitoneal adipose tissue. We present our experience with retroperitoneoscopic renal biopsy in extremely obese patients and describe our surgical technique. METHODS: We performed retroperitoneoscopic renal biopsies on 8 extremely obese patients (body mass index greater than 40). Mean patient weight was 144.3 kg. Three patients presented with acute renal failure and 5 presented with nephrotic range proteinuria. Retroperitoneoscopic renal biopsy was indicated based on extreme obesity alone in 3 patients, 2 patients had failed previous attempts at percutaneous biopsy, 1 patient had a solitary kidney, 1 patient required chronic anticoagulation, and 1 patient was a Jehovah's Witness. Intraoperative ultrasonography and an anatomic approach facilitated the dissection and identification of the kidney. RESULTS: All eight retroperitoneoscopic renal biopsies were completed successfully without complication and all patients were discharged within 24 hours of the procedure. Sufficient tissue for pathologic diagnosis was obtained in all cases. Mean operating room time was 153 minutes and mean estimated blood loss was 71 mL. The patients returned to normal activity at a mean of 1.8 weeks. CONCLUSIONS: With the use of intraoperative ultrasonography and a systematic, anatomic approach, retroperitoneoscopic renal biopsy can be successfully completed in extremely obese patients. This procedure can be reliably performed on an outpatient basis with minimal morbidity and should be considered a viable alternative to open renal biopsy.

Adult↗
PubMed2000

Survival of the extremely preterm infant in North America in the 1990s.

Survival of extremely premature infants has been significantly higher in the last decade than previously, and may well have improved during this time. The majority of infants greater than or equal to 25 weeks' gestation survive today. Survival of infants 23 and 24 weeks' gestation is significantly lower, but is by no means negligible. Reports of survival of infants less than 23 weeks or less than 500-g birth weight are not unique. Moreover, the maximum survival of infants less than or equal to 25 weeks possible with current state-of-the-art care is not known. Currently available data do not allow survival of the individual extremely low-birth weight or extremely premature infant to be predicted with clinically acceptable accuracy. The concept of a limit of viability is vague and clinically and ethically simplistic. The provision of neonatal intensive care is not necessarily beneficial or justified merely because it affords some minimal chance of survival. This phrase should not be used to summarize the complex issues involved in balancing maternal and neonatal risks and benefits of intrapartum and neonatal care of the extremely low-birth weight or the extremely premature fetus and infant, the suffering of the infant and family, parental values and autonomy, and consumption of limited communal resources. It should be deleted from our vocabulary.

Ethics, Medical↗
PubMedDate not supplied

Costs and duration of care for lower extremity ulcers in patients with diabetes.

Medical and pharmaceutical insurance claims associated with lower extremity diabetic ulcers were examined retrospectively to better understand the costs and duration of treatment in clinical practice. The study population consisted of working-age individuals (18 to 64 years old) with health care benefits provided through private employer-sponsored insurance plans. Diagnostic information contained in the claims database was used to identify the severity of the ulcers, and the charges associated with treatment were based on claims data. Claims for lower extremity ulcers were found in 5.1% of individuals with diabetes. Although many lower extremity ulcers heal with standard treatment, some are more resistant to treatment and require costly ongoing medical care. Almost half of these cases were associated with deep infection, osteomyelitis, or amputation. Total payments for treatment of lower extremity ulcers in this population averaged $2687 per patient per year, or $4595 per ulcer episode, with inpatient expenditures accounting for more than 80% of these costs. Costs were significantly higher for patients with more severe ulcers or with inadequate vascular status in the affected limb. We concluded that lower extremity ulcers occur in a large number of working-age people with diabetes and contribute significantly to the morbidity associated with this disease. The high cost of treating diabetic foot ulcers suggested by this analysis argues for the development of better treatment strategies and outcomes assessments for these patients.

Adolescent↗
PubMed1998

The application of video image processing to quantitative analysis of extremity tremor in humans.

A new method for the detection and quantification of extremity tremor is described, based on video image processing. A single CCD camera recorded the movement of the extremity. A passive marker in the shape of a black annulus was placed on the forearm and the movement of the annulus analysed. The framestore digitised the video signal at a sample rate of 10 Hz. The time period of the movement analysis was delta t = 6.4 s. A total of 32 adults with alcoholism and 22 controls participated in this study. The movement of the extremity was recorded during the usual neurological test (sitting posture, feet together, upper extremities directly in front of subject) for both extremities. In this study, it was assumed that the probability density function f(d) of some variable D is characteristic of the tremor. This function is formed by a finite mixture of bivariate continuous distributions. The results suggest that f(d) characterises patients with alcoholism and distinguishes them from control subjects with only physiological tremor. The results demonstrate the capacity of the measuring system based on video imaging to quantifying motor impairments in clinical neurology.

Forearm↗
PubMed2002

The relationship between clinical measurements of lower extremity posture and tibial translation.

OBJECTIVE: The purpose of this investigation was to determine if postures of the lower extremity were related to the amount of anterior tibial translation. DESIGN: Regression model of lower extremity postural measures used to predict the amount of tibial translation for a sample of convenience. BACKGROUND: Retrospective studies have indicated a link between certain lower extremity postures and prediction of anterior cruciate ligament injury status. What is not clear is whether these lower extremity postures cause, or occur as a result of anterior cruciate ligament injury. METHODS: Genu recurvatum, the thigh-foot angle, and navicular drop measures were obtained from the right leg of 43 uninjured college-aged subjects. Tibial translation was determined using a KT-1000 arthrometer. Gender related differences were determined with independent t-tests. Step-wise regression was performed to assess the relationship between postural measures and subject gender, and tibial translation. RESULTS: Very good to excellent inter- and intra-rater reliability was found for the postural measures. There was greater tibial translation (P=0.01) in females. The final regression model indicated a moderate relationship between sex of the subject, navicular drop and tibial translation (r=0.551). Genu recurvatum and thigh-foot angle were not significant predictors of tibial translation. CONCLUSIONS; We concluded that foot pronation has a greater impact on the amount of tibial translation than genu recurvatum and torsion of the lower leg in anterior cruciate intact subjects. RELEVANCE: Static clinical measures of lower extremity posture are commonly taken as predictors of outcome (both performance and injury). There may be little association between these static measures and dynamic performance.

Adult↗