Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Extremities”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 523 records · Page 29Linked to original sources
PubMed1995

Deep vein thrombosis associated with lower extremity amputation.

PURPOSE: Patients undergoing lower extremity amputation are perceived to be at high risk for deep vein thrombosis (DVT). Limited data are available, however, to confirm this impression. The purpose of this study is to prospectively document the incidence of DVT complicating lower extremity amputation. METHODS: During a recent 28-month period, 72 patients (71 men, 1 woman; mean age 68 years) undergoing major lower extremity amputation (31 above-knee and 41 below-knee) were prospectively evaluated with perioperative duplex scanning for DVT. RESULTS: DVT was documented in nine (12.5%) patients (one bilateral, four ipsilateral, and four contralateral to amputation). Patients with a history of venous disease were at significantly higher risk for development of DVT (p = 0.02). Thrombi were located at or proximal to the popliteal vein in eight patients and were isolated to the tibial veins in one patient. DVT was identified before operation in six patients and after operation in three. Patients with DVT were treated with heparin anticoagulation, with no patient experiencing clinical symptoms compatible with pulmonary embolism. CONCLUSIONS: In our recent experience, lower extremity amputation is associated with DVT at or proximal to the popliteal vein in 11% of patients. Documentation of DVT prevalence is essential to assist surgeons in planning a management strategy for prevention, diagnosis, and treatment of DVT associated with lower extremity amputation.

Aged↗
PubMed1994

The nature of lower extremity venous insufficiency in patients with primary varicose veins.

The purpose of this study was to investigate the distribution of vein incompetence and the nature of venous haemodynamics accompanying the development of lower extremity primary varicose veins (LEPVV). The entire venous circulation of 77 lower extremities in 55 patients (pts) with LEPVV was evaluated, by using Duplex colour Doppler ultrasonography. The greater and lesser saphenous veins (GSV, LSV) and their branches were thoroughly scanned. The valvular integrity of the deep venous system was determined in the areas of common and superficial femoral vein, saphenofemoral junction, popliteal vein, saphenopopliteal junction, and perforating veins. Demonstration of bidirectional flow signified venous incompetence. Quantitation of venous reflux was estimated after manual calf compression with pts in a standing position. All the symptomatic legs had branch venous disease, 60% had GSV incompetence, 3% had LSV incompetence, 10% showed concurrent GSV and LSV incompetence, while 27% demonstrated no evidence of GSV, and LSV disease. Thirty per cent and 50% of the symptomatic legs demonstrated deep and perforating vein incompetence, respectively. Furthermore, 30% of the asymptomatic lower extremities had insufficiency of saphenofemoral (nine pts) and saphenopopliteal (one pt) junction. The median peak venous reflux in the incompetent GSV and popliteal vein was 0.74 ml/s (range 0.2 to 2.5 ml/s) and 3.5 ml/s (range 2.5 to 8 ml/s), respectively. In conclusion, the observed heterogeneity in anatomic and functional distribution of lower extremity venous insufficiency in pts with LEPVV support the hypothesis that this condition is probably a part of another entity that might be called "lower extremity primary venous insufficiency" whose treatment should be highly individualised. To this end, colour Doppler imaging can help.

Female↗
PubMed2003

Effect of high sensitivity in a computerized scheme for detecting extremely subtle solitary pulmonary nodules in chest radiographs: observer performance study.

RATIONALES AND OBJECTIVES: This study investigated the effect of a high sensitivity in computer-aided diagnosis (CAD) for detecting lung nodules in chest radiographs when extremely subtle cases were presented to radiologists. MATERIAL AND METHODS: The chest radiographs used in this study consisted of 36 normal images and 54 abnormals containing solitary lung nodules, of which 25 were extremely subtle and 29 were very subtle. Receiver operating characteristic analysis for detecting lung nodules was performed without and with CAD. The levels of CAD output were simulated with a hypothetical ideal performance of 100% sensitivity, but with three or four false positives per image. Six radiologists participated in an observer study in which cases were interpreted first without and then with the use of CAD. RESULTS: The average A(z) values for radiologists without and with CAD were 0.682 and 0.808, respectively. The performance of radiologists was improved significantly when high sensitivity was used (P = .0003). However, the radiologists were not able to recognize some extremely subtle nodules (5 of 54 nodules by all radiologists), even with the correct CAD output; these nodules were then considered as non-actionable. None of 306 computer-false positives was incorrectly regarded as a nodule by all radiologists, but 63 false positives were incorrectly identified by one or more radiologists. CONCLUSION: The accuracy of radiologists in the detection of some extremely subtle solitary pulmonary nodules can be improved significantly when the sensitivity of a CAD scheme can be made to be at an extremely high level. However, all of the six radiologists failed to identify some nodules (about 10%), even with the correct output of the CAD.

Humans↗
PubMed2001

Breast cancer survival and in vitro tumor response in the extreme drug resistance assay.

PURPOSE: To determine whether in vitro extreme drug resistance (EDR) assay results for patients with breast carcinoma were associated with clinical outcome after chemotherapy. PATIENTS AND METHODS: EDR assays were performed on tumor tissue obtained from 103 newly diagnosed breast cancer cases. EDR scores of 2 for low, 1 for intermediate, or 0 for extreme drug resistance were determined for each agent tested. In vitro EDR scores for 4-hydroxycyclophosphamide (4HC) and doxorubicin were summed for patients treated with AC, or for 4HC and 5-FU for patients treated with CMF. Treatment selection was blinded to assay results. RESULTS: Median time to progression was significantly shorter for patients with extreme or intermediate in vitro resistance (n = 55, 48 months), compared to patients with low in vitro resistance, (n = 41, 100 months, p = 0.022). Patients demonstrating extreme to intermediate drug resistance also showed poorer survival than the low resistance group (49.5 months vs. not reached, median follow-up 48 months, p =0.011). Summed EDR scores, stage, and number of lymph nodes were significantly associated with survival in univariate and multivariate analysis. Compared to EDR scores of 4, summed EDR scores of 0-1 and summed EDR scores of 2-3 were associated with a relative risk of death of 3.09 (95%, CI 1.05-9.06, Cox proportional hazards model, p = 0.040) and 2.35 (95%, CI 1.07-5.15, Cox proportional hazards model, p = 0.033), respectively. CONCLUSION: Extreme drug resistance testing identified patients with individual patterns of drug resistance prior to therapy. In this cohort of breast cancer patients treated with chemotherapy, summed EDR scores were significantly associated with time to tumor progression and overall survival. EDR results may offer a method for optimizing treatment selection.

Adult↗
PubMed1997

Development of a criteria set and a structured interview for disorders of extreme stress (SIDES).

Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.

Adolescent↗
PubMed1976

Variation in a natural population of Schizophyllum commune. Variation within the extreme isolates for growth rate.

Two extreme dikaryotic idolates chosen from a large sample of a localised population of Schizophyllum commune exhibited a considerable amount of genetical variation for growth rate at the near ambient temperature of 20 degrees C and at the higher temperature of 30 degrees C. The potential variation within these extreme isolates were greater than the variation observed in the whole sample. Regression analysis of the variation in growth rate of the dikaryotic progeny of the extreme isolates on that of their component monokaryons showed that the nature of gene action was not the same in these two stages of the life cycle. The simple additive-dominance model of gene action was adequate to explain the variation in growth rate in both of the extreme isolates at both of the temperatures. The small deviations from this model could be accounted for by unequal gene frequencies due to small sample size although a low incidence of non-allelic interactions could not be rule out. Directional dominance for growth rate was detected in both isolates at the more normal temperature and it was opposing in direction in the two isolates. In the slow growing isolate the dominance was for faster growth and in the fast growing isolate it was for slower growth. This is expected for a character which displays overall ambi-directional dominance if isolates with more extreme growth rates than those recovered in the population sample are eliminated by stabilising selection. The dominance is temperature dependent being ambi-directional in both isolates at the higher temperature. Environmental heterogeneity, the buffering effects of directional dominance and genotype-environment interactions and opposing selective forces operating on the monokaryotic and dikaryotic stages of the life cycle are possible contributory factors to the considerable free and potential variability displayed in this small, localised population.

Agaricales↗
PubMed2006

Validity of an alternative anthropometric trait as cardiovascular diseases risk factor: example from individuals with traumatic lower extremity amputation.

BACKGROUND: Published studies reveal that individuals with lower extremity amputation are vulnerable to cardiovascular diseases (CVD) because of poor physical activity level. Many cardiovascular risk assessment studies have utilized anthropometric traits (primarily body mass index and waist circumference) as cardiovascular risk factor. However, some studies emphasized the technical limitations of measuring waist circumference for studying cardiovascular risk, and so it is difficult to obtain correct measurement from the individuals with lower extremity amputation. OBJECTIVES: The objectives of the present article are to study the prevalence of CVD risk factors among the individuals with traumatic lower extremity amputation and to test the validity of upper arm circumference (UAC) as an alternative anthropometric measurement for screening the CVD risk condition. SUBJECTS AND SETTING: Anthropometric data and other cardiovascular traits data have been collected from unilateral traumatic lower extremity amputated adult males (n = 85) residing in Calcutta and adjoining areas. RESULTS: Results show higher prevalence of cardiovascular risk factor among individuals with above-knee amputation than below-knee amputation. The receiver operating characteristics curve analysis shows significant ability of upper arm circumference to diagnose cardiovascular risk condition. The cutoff value of UAC > 26.6 cm show maximum sensitivity and specificity for the diagnosis of cardiovascular risk condition. Although, binomial tests for equality of proportion does not show any significant difference, however, agreement statistics reveal better diagnostic ability of cutoff value of UAC than the existing cutoff value of waist circumference. CONCLUSIONS: Therefore, UAC provides a better assessment of cardiovascular risk condition than does waist circumference especially for individuals with lower extremity amputation. SPONSORSHIP: Indian Statistical Institute, Kolkata.

Adult↗
PubMed1997

Familial risk ratios for extreme obesity: implications for mapping human obesity genes.

OBJECTIVE: To determine familial risk ratios for extreme obesity to aid in the design of obesity linkage studies. DESIGN: Family study of obesity. SUBJECTS: 2349 first-degree relatives (parents and siblings) of 840 probands who are members of the National Association to Advance Fat Acceptance (NAAFA) and 5851 participants of the first phase of the National Health and Nutrition Examination Survey III. METHODS: Computed age-gender standardized risk ratios (SRRs) for obesity in relatives categorized by the level of obesity in the index case (proband). MEASUREMENT: Body mass index (BMI) (kg/m2). RESULTS: The risk of extreme obesity (BMI > or = 40) in relatives of extremely obese women (BMI > or = 40) was more than five times greater than in the population; furthermore, the risk of obesity in relatives was approximately linearly associated with the degree of obesity in the proband. The risk of thinness in relatives of obese individuals was substantially lower than in the general population. CONCLUSION: Because the familial risk ratio for extreme obesity is higher than for moderate levels of obesity, the number of families required to achieve adequate statistical power in gene mapping studies of obesity can be reduced substantially by focusing on family members of extremely obese individuals (BMI > or = 40).

Adult↗
PubMed1998

Obesity related phenotypes in families selected for extreme obesity and leanness.

BACKGROUND: Obesity is a multigenic trait, and special methods and sampling designs are needed for gene identification. OBJECTIVE: To describe characteristics of families selected to increase information for genetic linkage studies of obesity. DESIGN: Families having extremely obese siblings with a lean parent and sibling. SUBJECTS: 594 members of 94 Caucasian families. MEASUREMENTS: Measured height and weight, bioelectric impedance, skinfolds, circumferences and questionnaires. RESULTS: Families have an extreme range of obesity phenotypes, which are bimodally distributed. The obese individuals are predominantly women with an onset of obesity early in life. Obesity onset age was negatively correlated with level of obesity, and onset ages were correlated among family members. Individual obesity measures were highly correlated. The extreme range of phenotypes within families increases family variability and presumably gene segregation. CONCLUSION: Sampling families through extremely obese sibling pairs with a lean parent and sibling results in families with an extreme range of obesity and leanness. The large within-family variance and early age of onset should make these families highly informative for gene mapping and gene identification studies.

Adolescent↗
PubMed2002

Binge eating disorder in extreme obesity.

OBJECTIVE: To determine whether extremely obese binge eating disorder (BED) subjects (BED defined by the Eating Disorder Examination) differ from their extremely obese non-BED counterparts in terms of their eating disturbances, psychiatric morbidity and health status. DESIGN: Prospective clinical comparison of BED and non-BED subjects undergoing gastric bypass surgery (GBP). SUBJECTS: Thirty seven extremely obese (defined as BMI > or = 40 kg/m(2)) subjects (31 women, six men), aged 22-58 y. MEASUREMENTS: Eating Disorder Examination 12th Edition (EDE), Three Factor Eating Questionnaire (TFEQ), Structured Clinical Interview for the Diagnostic and Statistical Manual-IV (SCID-IV), Short-Form Health Status Survey (SF-36), and 24 h Feeding Paradigm. RESULTS: Twenty-five percent of subjects were classified as BED (11% met full and 14% partial BED criteria) and 75% of subjects were classified as non-BED. BED (full and partial) subjects had higher eating disturbance in terms of eating concern and shape concern (as found by the EDE), higher disinhibition (as found by the TFEQ), and they consumed more liquid meal during the 24 h feeding paradigm. No difference was found in psychiatric morbidity between BED and non-BED in terms of DSM-IV Axis I diagnosis. The health status scores of both BED and non-BED subjects were significantly lower than US norms on all subscales of the SF-36, particularly the BED group. CONCLUSION: Our findings support the validity of the category of BED within a population of extremely obese individuals before undergoing GBP. BED subjects differed from their non-BED counterparts in that they had a greater disturbance in eating attitudes and behavior, a poorer physical and mental health status, and a suggestion of impaired hunger/satiety control. However, in this population of extremely obese subjects, the stability of BED warrants further study.

Adult↗
PubMed2001

Intrathecal baclofen in tetraplegia of spinal origin: efficacy for upper extremity hypertonia.

STUDY DESIGN: Retrospective analysis. OBJECTIVES: To evaluate the efficacy of intrathecal baclofen (ITB) for upper extremity spastic hypertonia in tetraplegia of spinal origin. SETTING: University of Alabama at Birmingham hospital. METHODS: The medical records of 14 individuals with tetraplegia of spinal origin who underwent intrathecal baclofen pump placement were reviewed. The effects of intrathecal baclofen on spasm frequency, deep tendon reflexes, and tone (Ashworth scale) were assessed for the upper and lower extremities for a 1-year follow-up period. RESULTS: There were statistically significant declines in upper extremity spasm scores (1.8 points, P=0.012), reflex scores (1.4 points, P<0.0001) and Ashworth scores (0.6 points, P<0.0001) for the 1-year follow-up period. For the lower extremities, all decreases were significant (P<0.0001). There was also a statistically significant (P<0.0001) increase in intrathecal baclofen dosage requirements during the 1-year follow-up period to maintain the reductions in spasm frequency, reflexes and tone. CONCLUSIONS: Intrathecal baclofen is a safe and effective intervention for treating upper extremity hypertonia of spinal origin. In addition, the level of intrathecal catheter placement is felt to be of importance.

Adult↗
PubMed1999

Maximal strength and power characteristics in isometric and dynamic actions of the upper and lower extremities in middle-aged and older men.

Muscle cross-sectional area of the quadriceps femoris (CSAQF), maximal isometric strength (handgrip test and unilateral knee extension/flexion), the shape of isometric force-time curves, and power-load curves during concentric and stretch-shortening cycle (SSC) actions with loads ranging from 15 to 70% of one repetition maximum half-squat (1RMHS) and bench-press (1RMBP) were examined in 26 middle-aged men in the 40-year-old (M40) (mean age 42, range 35-46) and 21 elderly men in the 65-year-old age group (M65) (mean age 65, range 60-74). Maximal bilateral concentric (1RMHS and 1RMBP), unilateral knee extension (isometric; MIFKE and concentric; 1RMKE) strength and muscle CSA in M65 were lower (P < 0.001) than in M40. The individual values of the CSAQF correlated with the individual values of maximal concentric 1RMHS, 1RMKE and MIFKE in M65, while the corresponding correlations were lower in M40. The maximal MIFKE value per CSA of 4.54 +/- 0.7 N m cm-2 in M40 was greater (P < 0. 05-0.01) than that of 4.02 +/- 0.7 N m cm-2 recorded in M65. The maximal rate of force development of the knee extensors and flexors in M65 was lower (P < 0.01-0.001) and the heights in squat and counter-movement jumps as much as 27-29% lower (P < 0.001) than those recorded in M40. M65 showed lower (P < 0.001) concentric power values for both upper and lower extremity performances than those recorded for M40. Maximal power output was maximized at the 30-45% loads for the upper extremity and at the 60-70% loads for the lower extremity extensors in both age groups. Muscle activation of the antagonists was significantly higher (P < 0.01-0.001) during the isometric and dynamic knee extension actions in M65 than in M40. The present results support a general concept that parallel declines in muscle mass and maximal strength take place with increasing age, although loss of strength may vary in both lower and upper extremity muscles in relation to the type of action and that ageing may also lead to a decrease in voluntary neural drive to the muscles. Explosive strength and power seem to decrease with increasing age even more than maximal isometric strength in both actions but power was maximized at the 30-45% loads for the upper and at the 60-70% loads for the lower extremity action in both age groups. High antagonist muscle activity may limit the full movement efficiency depending on the type of muscle action, testing conditions and the velocity and/or the time duration of the action, especially in the elderly.

Adult↗
PubMed2002

Educational outcome at 8 years for children who were born extremely prematurely: a controlled study.

OBJECTIVE: To assess the educational outcome and utilization of special education resources at age 8 years in children who were born extremely prematurely, and to compare this outcome with a matched cohort of children born full-term. METHODS: All children with gestational age less than 28 weeks or birthweight of less than 1000 g, born at Royal North Shore Hospital from July 1985 through June 1990 were enrolled in a study of long-term outcome. A cohort of full-term children matched for age, sex and school with non-disabled extremely premature children was enrolled at age 8 years. Children were assessed using standardized measures of cognitive and academic achievement. Information was obtained from teachers regarding educational support and academic progress. RESULTS: Of 82 extremely premature children assessed at age 8 years, 8 (10%) had a severe disability, 13 (16%) had a mild or moderate disability and 61 (74%) were non-disabled (IQ > or = 85, no neurosensory disability). Thirty-five (43%) required special education support, 22 (27%) were below grade level in reading or mathematics and 25 (30%) were performing at grade level without support. Compared with controls, non-disabled extremely premature children had lower scores on standardized measures of academic achievement and were more likely to be reported by teachers as falling below grade level in reading (48% vs 13%; P < 0.001), mathematics (48% vs 10%; P < 0.001) and spelling (48% vs 17%; P < 0.002), and to require special education support (25% vs 4%; P = 0.004). CONCLUSION: Parents and professionals caring for extremely premature children need to be alert to the additional support that these children may require at school.

Analysis of Variance↗
PubMed2002

Test-retest reliability of isokinetic muscle strength of the lower extremities in patients with stroke.

OBJECTIVE: To i the test-retest reliability of isokinetic strength measurements of 3 muscle groups of the lower extremities in stroke patients. DESIGN: Isokineth tests of bilateral hip flexors, knee extensors, and ankle plantarflexors at 2 angular velocities, performed during 2 sessions scheduled 1 week apart for each subject. SETTING: Outpatilitation clinic of a local hospital in Taiwan. PARTICIPANTS: Nts with mild spastic hemiparesis secondary to stroke and with poststroke onset time of at least 6 months. All subjects could communicate and voluntarily move the affected lower extremity. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The maximal peak torque, total work, and average power of the 3 muscle groups on the affected side examined during each test were quantified by using the normalization and the deficit methods. The normalization method divides the measured strength value by the patient's body weight, whereas the deficit method divides the difference between the strengths of the unaffected and affected extremities by the strength of the unaffected extremity. RESULTS: The normalized strength measures for muscles on the affected side showed good to excellent test-retest reliability (intraclass correlation coefficient [ICC] range,.62-.94; P<.05), whereas the deficit strength measures did not always show good reliability (ICC range,.13-.91). The knee extensors and ankle plantarflexors, but not the hip flexors, on the affected side showed better test-retest reliability of isokinetic strength generated at faster velocity (ICC range,.73-.94) than that generated at slower velocity (ICC range,.62-.88). The normalized peak torque (ICC range,.76-.94) and total work (ICC range,.83-.91) were more reliable than the normalized average power (ICC range,.62-.90) for all 3 muscle groups on the affected side. CONCLUSIONS: Quantitative assessment of muscle strength of the affected lower extremity in patients with mild spastic hemiparesis secondary to stroke is feasible using isokinetic testing. However, the test-retest reliability of isokinetic strength measures is affected by the quantifying method, testing velocity, and strength measures.

Adult↗
PubMed2002

Upper-extremity torque production in men with paraplegia who use wheelchairs.

OBJECTIVES: To study maximal upper-extremity torque values and agonist/antagonist torque ratios in a sample of individuals with paraplegia and to compare these values with a sample of age-, gender-, and weight-matched able-bodied individuals. DESIGN: Cross-sectional, case-control study. SETTING: A biomechanics laboratory. PARTICIPANTS: A convenience sample of 15 men with complete (American Spinal Injury Association class A) T5-L2 paraplegia and 15 able-bodied control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Maximal isometric torques of 12 upper-extremity muscle groups (shoulder, elbow, and wrist flexion and extension; shoulder abduction and adduction; shoulder internal and external rotation; elbow pronation and supination) were measured with custom dynamometers. RESULTS: Maximal torque values and agonist/antagonist torque ratios for the shoulder, elbow, and wrist functions did not differ between the control subjects and those with complete paraplegia, with the exception of the supination/pronation torque ratio, which was significantly higher in the able-bodied control group. CONCLUSION: Wheelchair propulsion and other functional activities, such as transfers, do not significantly affect maximum torque production of the upper extremities in individuals with paraplegia. On the basis of these findings, arguments that upper-extremity muscle imbalances are important contributory factors to upper-extremity pain and dysfunction in this group may be too simplistic.

Adult↗
PubMed2001

The outcome of extreme prematurity.

Significant advances in perinatology and neonatology in the last decade have resulted in increased survival of extremely premature infants. Survival rates for infants born in tertiary perinatal and neonatal care centers in the United States in the 1990s increase with each week of gestational age from 22 through 26 weeks. Reported survival rates at 22 weeks range from 0% to 21% in the few reporting studies. Reported survival rates at 23 and 24 weeks range from 5% to 46% and from 40% to 59%, respectively. These may not be the maximum survival rates possible because at these gestational ages information is either insufficient to determine that obstetric and neonatal intensive care strategies to maximize neonatal survival were used or it is specified that such strategies were not used. Reported survival rates at 25 and 26 weeks range from 60% to 82% and from from 75% to 93%, respectively. The literature regarding the prevalence of major neurodevelopmental disabilities among extremely premature survivors in the last 25 years is heteogeneous, and the reported prevalances of major disability vary much more than do survival rates. However, the majority of extremely premature infants who survive will be free of major disability. Overall, approximately one fifth to one quarter of survivors have at least one major disability-impaired mental development, cerebral palsy, blindness, or deafness. Impaired mental development is the most prevalent disability (17%-21% [95% CI] of survivors affected), followed by cerebral palsy (12%-15% of survivors affected). Blindness and deafness are less common (5% to 8% and 3% to 5% of survivors affected, respectively). Approximately one half of disabled survivors have more than one major disability. Based on studies of infants less than 750 to 1,000 grams birth weight, it can be anticipated that approximately another half of all extremely premature survivors will have one or more subtle neurodevelopmental disabilities in the school and teenage years. There is little evidence to suggest that long-term neurodevelopmental outcome has changed from the late 1970s to the early 1990s or with increasing survival. Survival of individual extremely premature infants cannot be accurately predicted in the immediate perinatal period. Major disability cannot be accurately predicted for individual survivors during the course in the newborn intensive care unit.

Blindness↗
PubMed2006

[Vacuum assisted closure (V.A.C.) therapy is an essential tool for treatment of complex defect injuries of the upper extremity].

INTRODUCTION: Complex injuries of the upper extremity remain a therapeutic challenge. The prognosis of the damaged extremity is often limited by soft tissue defects. Vacuum Assisted Closure (V.A.C.) therapy facilitates temporary coverage of soft tissue defects prior to surgical reconstruction. METHODS: In a retrospective study all patients with complex defect injuries of the upper extremity that were treated by V.A.C. prior to reconstruction between August 2003 and September 2005 were analyzed. RESULTS: 7 patients (6 male, 1 female, 14-70 years) were included in the study. The patients suffered from subtotal upper arm (n = 1) and forearm (n = 1) amputation, complex multilevel amputation injury of the forearm (n = 1), slash wound of the forearm with skin defect and discontinuity of all volar structures (n = 1), complex open forearm fractures with skin and soft tissue defects (n = 2), and almost complete necrosis of the flexor compartment following distal radius and proximal ulnar fracture and compartment syndrome (n = 1). Stabile defect coverage was achieved in all patients following V.A.C. therapy by myocutaneous free flaps (n = 2), split thickness skin grafts (STSG) (n = 2), sequential secondary suture (n = 1), and STSG + secondary suture (n = 2). Wound conditions improved significantly under V.A.C. therapy. 5 patients reported pain relief following induction of V.A.C. therapy. Due to reduction of tissue oedema secondary suture was facilitated in 3 patients. DISCUSSION: V.A.C. therapy represents an essential tool for treatment of complex injuries of the upper extremity with extended soft tissue defects. Decreased frequency of dressing changes as well as reduced tissue oedema considerably improved patient's comfort. Posttraumatic compartment syndrome or skin necrosis, which are often associated with macro amputations of the upper extremity, are efficiently treated with V.A.C., and secondary sutures may be performed despite initial skin defects.

Adolescent↗
PubMed1986

Deterioration of venous function in normal lower extremities during daily activity.

The change in venous function during the course of the day was studied noninvasively in 50 normal lower extremities of 25 physically active normal subjects. Venous refilling time, measured by photoplethysmography, was significantly shorter (p less than 0.0001), and venous capacitance, measured by impedance plethysmography, was significantly reduced (p less than 0.04) after 5 hours or more of daily activities performed in the upright position. Abnormally short venous refilling time (less than 18 seconds) developed in 21% of the extremities, which had a normal venous refilling time earlier in the same day. Lower extremity symptoms of ache, pain, or swelling were reported more frequently in extremities that developed an abnormal venous refilling time. There was a trend toward a greater change in venous refilling time during the day in symptomatic lower extremities than in asymptomatic limbs (p = 0.07).

Adult↗