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At least 613 records · Page 34Linked to original sources
PubMed2001

Clinical outcome and diseases associated with extreme neutrophilic leukocytosis in cats: 104 cases (1991-1999).

OBJECTIVE: To describe diseases, prognosis, and clinical outcomes associated with extreme neutrophilic leukocytosis in cats. DESIGN: Retrospective study. ANIMALS: 104 cats with extreme neutrophilic leukocytosis. PROCEDURE: Medical records from 1991 to 1999 were examined to identify cats that had > or =50,000 WBC/microl with > or =50% neutrophils. Signalment, absolute and differential WBC counts, rectal temperature, clinical or pathologic diagnosis, duration and cost of hospitalization, and survival time were reviewed. RESULTS: Mean age of cats was 8.3 years, mean WBC count was 73,055 cells/microl, and mean absolute neutrophil count was 59,046 cells/microl. Mean duration of hospitalization was 5.9 days, and mean cost of hospitalization was $2,010. Twenty-nine (28%) cats were febrile, and 63 (61%) cats died. Overall median survival time was 30 days. Cats with neoplasia were nearly 14 times as likely to die unexpectedly as cats with other diseases. CONCLUSIONS AND CLINICAL RELEVANCE: Extreme neutrophilic leukocytosis was associated with a high mortality rate. The prognostic importance of extreme neutrophilic leukocytosis should not be overlooked. Cats and dogs have similar diseases, mortality rates, and treatment costs associated with extreme neutrophilic leukocytosis.

Animals↗
PubMed1996

The relationship between static lower extremity measurements and rearfoot motion during walking.

Despite the fact that clinicians regularly perform static lower extremity measurements on their patients, to date, little research has been published supporting their ability to predict dynamic rearfoot motion. The abilities of static measurements to predict dynamic foot motion could have important implications considering the fact that excessive rearfoot motion has been associated with various injuries of the lower extremity. The purpose of this study, therefore, was to determine if static lower extremity measurements could be used to predict the magnitude of rearfoot motion during walking. Rearfoot motion of each lower extremity was measured from videotape in 27 healthy young adult subjects with a mean age of 26.1 years. In addition, 17 static measurements were measured and recorded bilaterally for each subject. The results of a multiple regression analysis indicated that the only variable that was able to predict maximum rearfoot pronation was the "difference in navicular height" (r2 = .17). None of the 17 measurements were found to predict time to maximum pronation. These results indicate that static measurements of the lower extremity and foot are poor predictors of dynamic rearfoot motion as measured by maximum pronation or time to maximum pronation in healthy individuals without severe foot deformities.

Adult↗
PubMed2006

Interlimb differences in lower extremity bone mineral density following anterior cruciate ligament reconstruction.

STUDY DESIGN: Prospective descriptive study. OBJECTIVE: To determine the extent of bone mineral density (BMD) interlimb differences at several hip locations in the involved versus noninvolved lower extremity following anterior cruciate ligament (ACL) surgery. BACKGROUND: Disuse following ACL reconstruction can be extensive. This disuse not only affects the soft tissue, but may also affect the skeletal structure. The extent of this disuse specific to the proximal femur has not been previously determined. METHODS AND MEASURES: BMD was assessed in 15 subjects, 17 to 51 years old, who were between 6 and 32 months post-ACL reconstruction surgery. Bone mineral content (BMC) and BMD of the femoral neck, trochanteric region, intertrochanteric region, and entire hip were measured as a primary emphasis of this study. BMD and BMC of the entire lower extremities were also measured bilaterally. RESULTS: BMD was significantly less in the involved lower extremity compared to noninvolved lower extremity at several hip sites: 6.6% less (P<.001) for the trochanteric region, 4.0% less (P<.001) for the entire hip, and 3.4% less (P = .004) for the intertrochanteric region. No significant differences were noted comparing the entire lower extremities for either BMD (0.9%, P = .48) or BMC (3.7%, P= .09). CONCLUSION: BMD differences at the hip are significant in patient's postoperative ACL reconstruction, especially in the trochanteric region.

Adolescent↗
PubMed1993

The relationship between body height extremes and the conditioned patellar tendon reflex response.

The purpose of this study was to determine the effects of extreme body heights on the conditioned patellar tendon reflex response in an attempt to differentiate between the contributions of supraspinal and spinal mechanisms on long-latency reflex facilitation. Unilateral and conditioned right patellar tendon reflexes were assessed in 10 extremely short males and females and 10 extremely tall males and females. The conditioning stimulus was a contralateral patellar tendon tap and the conditioning intervals were 10, 15, 25, 50, 60, 75, 100, 150, and 300 ms. There was a long-latency facilitation of quadriceps excitability beginning at the 75 ms conditioning interval regardless of the height of the subject. It is hypothesized that the similar conditioned patellar tendon recovery profiles in the extremely short subjects and the extremely tall subjects reflects the activation of a spinal polysynaptic pathway as the predominant mechanism for our long-latency reflex facilitation.

Adolescent↗
PubMed1997

[A case of polymyalgia rheumatica with swelling and pitting edema of the distal lower extremities].

We report a case of an 82-year-old woman with polymyalgia rheumatica (PMR) associated with swelling and pitting edema of the lower extremities. The patient had been previously admitted because of PMR in 1990, but there was no history of swollen extremities. In July 1996, at another hospital, she was again diagnosed as having PMR on the basis of pain in the neck, shoulders and lower back. Administration of prednisolone was followed by improvement of the symptoms. Four months later, similar pain recurred and swelling of the lower extremities was noted. On admission, the erythrocyte sedimentation rate was 86 mm/h, and C-reactive protein was 15.5 mg/dl. Reviewing the previous treatment, it was ascertained that her clinical deterioration was due to premature reduction of the steroid dosage. The cause of the swelling of the lower extremities was unlikely to be heart, liver, kidney or endocrine disease. Prednisolone was increased from 2.5 mg to 10 mg daily with marked improvement in all the symptoms including the swelling and pitting edema. In 1996, a study reported distal extremity swelling with pitting edema as a manifestation of PMR, which mostly developed concurrently with proximal symptoms or during relapses of PMR. The swelling responded poorly to non-steroidal antiinflammatory drugs but promptly to corticosteroids. The distal swelling was reported to be tenosynovitis and synovitis of the surrounding structures. The present case appears similar to that report. More studies of PMR need to be done.

Aged↗
PubMed2004

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Journal Article↗
PubMedDate not supplied

Forced use of the upper extremity in cerebral palsy: a single-case design.

OBJECTIVE: Muscle imbalance and poor control of movement can have an impact on the daily occupational functioning of children with cerebral palsy. When one side of the body functions better than the other, children will often prefer to use the less-involved upper extremity for completion of play and self-care activities because they have learned that the other hand does not function as effectively. This study examined a method purported to overcome this learned nonuse of the affected upper extremity by directing the child's attention to this extremity and increasing his or her motivation to use it. The research hypothesis was that restriction of the less-involved hand with a resting splint would result in increased use of the more-involved hand in a child with spastic cerebral palsy. METHOD: Initially, two children with cerebral palsy participated in this single-subject, ABA design study, but only one subject complied with the splint-wearing schedule and completed the study. This subject was a 2-year-old girl with greater involvement of the right side than the left. During the experimental phase, she wore a resting splint on her less-involved hand for most of the waking hours of the day to restrict its use. Data were collected over a 7-week period (2 weeks presplinting, 3 weeks splinting, 2 weeks postsplinting) and at a 6-month follow-up. Use of the more-involved extremity was measured through analysis of her performance during 15-min videotaped sessions of free play, administration of items from the Peabody Developmental Fine Motor Scales, and completion of a daily finger-feeding task. RESULTS: An improvement in quality, quantity, and variety of use of the more-involved extremity after splinting, with some continuing improvement evident at follow-up, was found. The subject had increased voluntary control of her more-involved arm and hand and used them more spontaneously for completion of daily occupations. CONCLUSIONS: Although the results of this single-case design are encouraging, further research with a randomized, controlled design is necessary to determine the effectiveness of the forced-use technique with a larger population.

Cerebral Palsy↗
PubMedDate not supplied

Extremity fractures in the patient with a traumatic brain injury.

Extremity fractures are common in patients with traumatic brain injuries (TBIs). These injuries are often inadequately treated and occasionally are completely missed due to the unique problems inherent to the TBI patient. However, appropriate evaluation of the TBI patient allows prompt diagnosis and optimal treatment of extremity fractures. The increased survival rate of these patients has resulted in a greater emphasis on minimizing dysfunction and disability, especially that due to concomitant orthopaedic trauma. Advances in anesthestic technique permit earlier operative fixation of extremity fractures. Most injuries, particularly those in the lower extremity, require operative stabilization to allow early mobilization and rehabilitation. Upper extremity fractures are often associated with peripheral nerve injuries. Heterotopic ossification is common, especially about the elbow and hip. Contrary to prevalent belief, fracture healing is not necessarily accelerated in the TBI patient; hypertrophic callus, myositis ossificans, and heterotopic ossification occur frequently and are often misperceived as accelerated healing.

Adult↗
PubMedDate not supplied

Lower-extremity overuse injury and use of foot orthotic devices in women's basketball.

One hundred thirty-two female basketball players were observed for lower-extremity overuse injury between 1993 and 2004. Athletes studied between 1993 and 1996 did not receive foot orthotic devices and composed the control group. The treatment group comprised athletes studied between 1996 and 2004. Athletes in the treatment group were given a foot orthotic device before participation in basketball. Data analysis included lower-extremity overuse injury rates and the effect of foot orthotic devices on lower-extremity overuse injury rates by means of an incidence density ratio. The control group had a lower-extremity overuse injury rate of 5.37 per 1,000 exposures, and the treatment group had a rate of 6.44 per 1,000 exposures. The incidence density ratio was not significant (P = .44). This study rejects the concept that foot orthotic devices may assist in prevention of lower-extremity overuse injury in female basketball players.

Adult↗
PubMed1999

Multifactorial analysis of the survival of patients with distant metastasis arising from primary extremity sarcoma.

BACKGROUND: Despite optimal multimodality limb-sparing therapy for extremity soft tissue sarcoma (STS), a significant number of patients develop distant metastasis. The objective of this study was to analyze patterns of metastatic disease and define prognostic factors for survival in a large group of patients followed prospectively at a single institution. METHODS: Between July 1, 1982, and June 30, 1996, all adult patients admitted to the Memorial Sloan-Kettering Cancer Center with primary extremity sarcoma were treated and prospectively followed. Patients who developed distant metastases constituted the study group. Prognostic factors were analyzed for postmetastasis survival. These included both factors related to the primary tumor and factors related to the pattern of metastasis. Postmetastasis survival was modeled using the Kaplan-Meier method. Statistical significance was evaluated using the log rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis. RESULTS: During the study period, the authors admitted and treated 994 patients with primary extremity STS. The median follow-up was 33 months. Distant metastasis developed in 230 patients (23%). Median survival after distant metastasis was 11.6 months. The lungs were the first metastatic site in 169 patients (73%). Other first sites of metastasis included the skin and soft tissues of the head and neck, trunk, and extremities. There was no statistically significant difference in survival between patients with pulmonary and those with nonpulmonary metastatic disease. In multivariate analysis, resection of metastatic disease, the length of the disease free interval, the presence of a preceding local recurrence, and patient age > 50 years all were significant predictors of postmetastasis survival. Other factors that defined the primary tumor, including histologic grade, depth, and microscopic margins, were not associated with postmetastasis survival. CONCLUSIONS: Despite optimal multimodality therapy, 23% of the patients in this series with primary extremity sarcoma developed distant metastasis. Median survival after metastasis was approximately 1 year. After metastasis, the independent favorable factors that are associated with patient survival include resection of the metastases, a long disease free interval, the absence of preceding local recurrence, and patient age < 50 years. Although a definitive conclusion regarding the benefit of resection can be made only with a randomized clinical trial, these data suggest that resection of metastatic STS may contribute to patient survival, which in some cases may be long term.

Adolescent↗
PubMed2000

Performance of ordered-subset reconstruction algorithms under conditions of extreme attenuation and truncation in myocardial SPECT.

UNLABELLED: We studied the bias and variance characteristics of the ordered-subset expectation maximization (OSEM) and rescaled block-iterative EM (RBIEM) iterative reconstruction algorithms in myocardial SPECT under extreme, but realistic, conditions. METHOD: We used the 2-dimensional mathematic cardiac torso phantom to simulate 2 patient anatomies: a large male with a raised diaphragm and a female with large breast size, approximating extreme cases of attenuation conditions found in the clinic. For each anatomy, realistic 201Tl projection data were simulated for a 180 degrees acquisition arc. Three cases of truncation for a 90 degrees-configured dual detector system were simulated: no truncation, moderate truncation, and extreme truncation. For each case, an ensemble of 250 noise simulations was generated, and each noisy dataset was reconstructed with the OSEM and RBIEM algorithms. The reconstructions modeled only the effects of nonuniform attenuation and used a range of subset configurations. Over the ensemble, we computed means and variances of activity in 8 regions of interest (ROIs) in the heart as a function of iteration. RESULTS: Under conditions of no truncation and moderate truncation, the results from OSEM and RBIEM were very close to those from maximum-likelihood EM (MLEM); in all cases, the difference in ROI means was <2.5%. For extreme truncation, the errors increased to as much as 11% with OSEM, but these were no greater than the errors for MLEM under the same conditions. The OSEM algorithm with 2 views per subset was found to result in much higher variance of ROI estimates for the same bias as compared with RBIEM or OSEM with 4 or more views per subset. CONCLUSION: The OSEM and RBIEM algorithms are at least as robust to highly attenuating patients and truncation as MLEM algorithm and can be adequate substitutes for MLEM, even in extreme cases. Clinical users should apply the smallest number of subsets that can be accommodated by allowable processing time to reduce image noise and variance in quantitative estimates.

Algorithms↗
PubMed2000

Hyperbaric oxygen in the treatment of delayed radiation injuries of the extremities.

Hyperbaric oxygen (HBO2) is used as an adjunct in the treatment of radiation injury at many sites, including the mandible, larynx, chest wall, bladder, and rectum. In these disorders, HBO2 is effective in stimulating neovascularization and reducing fibrosis. No previous publications report the application of HBO2 to radiation injuries of the extremities. From 1979 until 1997, 17 patients were treated at the Southwest Texas Methodist and Nix Hospitals for nonhealing necrotic wounds of the extremities within previously irradiated fields. All but one wound involved a lower extremity. Most of the patients had been irradiated for soft tissue sarcomas or skin cancers. The rest were irradiated for a variety of malignancies. HBO2 was delivered in a multiplace chamber at 2.4 atm abs daily for 90 min of 100% oxygen at pressure. This report is a retrospective, uncontrolled review of these patients. Eleven patients (65%) healed completely whereas five (29%) failed to heal and one (6%) was lost to follow-up. Three (60%) of those who failed were found to have local or distant recurrence of their tumor early in their course of hyperbaric treatment and were discontinued from therapy at that time. When last seen in the clinic, the wound of the patient who was lost to follow-up was improved but not completely healed. Four of those who failed (including the two with local tumor recurrence) required amputation. If we exclude those with active cancer and the patient lost to follow-up, the success rate was 11 of 13 or 85%. HBO2 was applied successfully with complete wound healing and the avoidance of amputation in a majority of these patients. The consequences of failure in patients suffering from radiation necrosis of the extremities (some complicated by the presence of tumor) are significant, with 80% of the five failures requiring amputation. In radiation injuries of the extremities as in delayed radiation injury at other sites, HBO2 is a useful adjunct and should be part of the overall management.

Adult↗
PubMed2000

Mycobacterial infection of the upper extremities.

BACKGROUND AND PURPOSE: Mycobacterial infection of the upper extremities is extremely rare. To make an early accurate diagnosis is often difficult, and the treatment is, therefore, frequently delayed in clinical practice. This paper describes the diagnosis and treatment of mycoabacterial infection of the upper extremities in a series of patients treated at National Taiwan University Hospital. METHODS: The medical records of 15 patients with mycobacterial infection of the upper extremities treated between 1985 and 1998 were retrospectively analyzed. The diagnosis of mycobacterial infection was established by positive culture results, the presence of acid-fast bacilli, or characteristic histopathologic findings. RESULTS: Mycobacterial infection was suspected on initial examination in only two patients. The duration between the onset of symptoms and correct diagnosis averaged 37.5 months (range, 3 wk to 209 mo). The involved sites of mycobacterial infection included the wrist in nine patients, the elbow in two, the hand in two, the humerus in two, the forearm in one, and the shoulder in one. Three patients suffered from multifocal musculoskeletal mycobacterial infection. Microbiologic studies identified Mycobacterium tuberculosis in four patients and nontuberculous mycobacteria (NTM) in four. Characteristic histopathologic findings of mycobacterial infection including caseation, granulomatous inflammation, eosinophilic epithelioid cells, Langhan's giant cells, and lymphocytic aggregates were noted in all 15 patients. All patients received chemotherapy and 14 patients underwent surgical treatment. The mean duration of follow-up was 46 months (range, 15-97 months). Treatment failed in two of the patients with multifocal NTM infection and in one patient whose mycobacterial infection was identified by histopathology. CONCLUSIONS: Mycobacterial infection should be included in the differential diagnosis of infection of the upper extremities. Treatment failures are more frequent in patients with multifocal NTM infection.

Adolescent↗
PubMed2000

[A case of antiphospholipid antibody syndrome with cerebral infarction showing slowly progressive pure motor monoparesis in unilateral upper extremity].

We reported a 68-year-old man with anti-phospholipid antibody syndrome who presented slowly progressive pure motor monoparesis(PMM) in left upper extremity as a sign of cerebral infarction. He had history of hypertension and hyperlipidemia. He first noticed clumsiness in left fingers, then weakness of left fingers with drop hand developing gradually in 2 to 6 weeks. He began to feel difficulty in raising left upper arm in 8 weeks and was admitted to our hospital. On admission, he exhibited severe weakness in distal portion and moderate weakness in proximal portion of left upper extremity. Deep tendon reflexes were slightly hyperactive in left side. Muscle strength of right upper extremity and bilateral lower extremities were normal. There was no sensory and autonomic abnormality. Laboratory examination revealed high titer of anti-cardiolipin IgM antibody. Brain MRI demonstrated a small cortical infarction in the right precentral gyrus. Cerebral angiography revealed severe stenosis in right common carotid artery. Other examinations including EMG were unremarkable. PMM in left upper extremity was considered to be caused by the ischemic lesion in the precentral motor cortex. Slowly progressive course might be explained by the hypovolemic factor due to the marked stenosis in right common carotid artery, poor collateral circulation, and abnormal coagulation caused by anti-phospholipid antibody syndrome.

Aged↗
PubMed2001

Changes of blood circulation of the extremity after external fixation for tibia shaft defect: an experimental study.

OBJECTIVE: To assess and compare two approaches, end to end compression with lengthening (EECL) and segmental bone transport by lengthening (STBL), for long tubular bone defect and nonunion. METHODS: Ten goats were used to establish the bone defect model of the mid-tibia. The bone defect ends were shortened step by step with a sulcated half-ring external fixator. Changes of the blood flow of the distal extremity were measured with pulse-Doppler monitor and angiography. RESULTS: The blood flow in the distal extremity was not affected when bone defect was less than 15% of the original length. Blood circulatory disorder would appear in the distal extremity when bone defect ranged 15%-20% of the original length. The necrosis would appear in the extremity because of the blood circulatory obstacle when bone defect was more than 20% of the original length. CONCLUSIONS: EECL is an appropriate alternative of treatments if bone defect is less than 15%; while SBTL may be feasible if bone defect is over 20% of the original length. When bone defect ranges between 15% and 20%, EECL should be applied with great care on condition of keeping watch on the extremity circulation with pulse-Doppler monitor.

Angiography↗
PubMed1975

Postprandial rest pain and claudication of the lower extremity: A case report.

Postprandial rest pain and claudication in the lower extremities may occur in arteriosclerotic aortic occlusion when mesenteric and systemic collateral pathways provide inadequate blood flow to the extremity. The symptoms occur as a result of vasodilation of the distal mesenteric vascular bed with a concomitant increase in mesenteric blood flow which leads to a decrease in mesenteric artery to extremity collateral blood flow. This normal physiologic phenomenon, increase in mesenteric blood flow, causes the extremity pain. Such symptoms indicate a quite significant decrease in blood flow to the extremity, and prompt surgical correction is indicated. Aortofemoral reconstruction yields total reflief of the symptom complex.

Aortic Diseases↗
PubMed2002

Regional frequency analysis of extreme rainfalls.

This study proposes two alternative methods for estimating the distribution of extreme rainfalls for sites where rainfall data are available (gaged sites) and for locations without data (ungaged sites). The first method deals with the estimation of short-duration rainfall extremes from available rainfall data for longer durations using the "scale-invariance" concept to account for the relationship between statistical properties of extreme rainfall processes for different time scales. The second method is concerned with the estimation of extreme rainfalls for ungaged sites. This method relies on a new definition of homogeneous sites. Results of the numerical application using data from a network of 10 recording rain gauges in Quebec (Canada) indicate that the proposed methods are able to provide extreme rainfall estimates that are comparable with those based on observed at-site rainfall data.

Calibration↗
PubMed1975

[The dynamics of morphofunctional changes in the microcirculation of the pelvic extremity after modeling the chief stages of its replantation].

Under study was the effect of autotransplantation in its "pure form" upon the morpho-functional reconstruction and structural mechanisms of adaptation of the blood and lymphatic links of the microcirculatory bed of extremities during early postoperation period up to 10 days. The pathophysiological state of the extremity sufficiently close to its autotransplantation was obtained by means of circular transection of soft tissues of the medial third of the femur together with the nerves and deep collecting lymphatic vessels. It was found that after modeling the main stages of replantation in the fascia and periosteum of the operated extremity there developed a spasm of the arteriolar link and dilatation of the venular and lymphatic links of the microcirculatory bed. The areas of leukocytic infiltration with the phenomena of diapedesis and microhemorrhages were revealed along the course of postcapillaries and venules in the paravasal connective tissue. The amount of functioning arteriole-venular anastomoses was increased. Against the background of pronounced oedema of soft tissues of the operated extremity the venous pressure increased and the rate of the capillary bloodflow in the skin and muscles decreased. The above changes tend to be reduced by the 10th day after modelling the main stages of replantation of the extremity.

Animals↗