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At least 757 records · Page 42Linked to original sources
PubMed2007

Improved neurodevelopmental outcomes for extremely low birth weight infants in 2000-2002.

BACKGROUND: Neurodevelopmental impairment of extremely low birth weight infants increased in the 1990s. Modern therapeutic changes may have influenced more recent neonatal outcomes. OBJECTIVE: We sought to compare neonatal therapies and outcomes among all extremely low birth weight infants born in 2000-2002 (period III) to 2 previous periods: 1982-1989 (period I) and 1990-1999 (period II). METHODS: The population included 496 extremely low birth weight infants born at our perinatal center during period I, 749 during period II, and 233 during period III. Therapies, rates of death, and survival with and without impairment at 20 months' corrected age were compared. RESULTS: Between periods I and II, survival increased from 49% to 68% as did neonatal morbidity. This resulted in increased survival without impairment but also increased survival with impairment. Changes in therapy during period III included an increase in antenatal steroid use and a decrease in postnatal steroid use, although the rate of chronic lung disease did not change. Sepsis decreased, as did severe intraventricular hemorrhage. On follow-up, the rate of cerebral palsy decreased from 13% to 5%, resulting in a decrease in neurodevelopmental impairment from 35% to 23%. As a result, during period III versus II, survival without impairment increased, whereas survival with impairment decreased. CONCLUSION: Since 2000, neurodevelopmental impairment has decreased among extremely low birth weight infants. A variety of perinatal and neonatal factors were associated with the improved outcomes including increased antenatal steroid use and cesarean section delivery, as well as decreased sepsis, severe cranial ultrasound abnormalities, and postnatal steroid use despite no change in the rate of chronic lung disease.

Cerebral Palsy↗
PubMed2007

No improvement in outcome of nationwide extremely low birth weight infant populations between 1996-1997 and 1999-2000.

OBJECTIVE: Our goal was to investigate whether outcome in extremely low birth weight infants changes over time in Finland. PATIENTS AND METHODS: All infants with a birth weight <1000 g born in Finland in 1996-1997 and 1999-2000 were included in the study. Perinatal and follow-up data were collected in a national extremely low birth weight infant research register. Data concerning cerebral palsy and visual impairment were obtained from hospitals, the national discharge, and visual impairment registers. RESULTS: A total of 529 and 511 extremely low birth weight infants were born during 1996-1997 and 1999-2000. No changes were detected in prenatal, perinatal, neonatal, and postneonatal mortality rates between the periods. The survival rates including stillborn infants were 40% and 44%. The incidence of respiratory distress syndrome and septicemia increased from 1996-1997 to 1999-2000 (75% vs 83% and 23% vs 31%). The overall incidence of intraventricular hemorrhage increased (29% vs 37%), but the incidence of intraventricular hemorrhage grades 3 through 4 did not (16% vs 17%). The rates of oxygen dependency at the age corresponding with 36 gestational weeks, retinopathy of prematurity stages 3 to 5, cerebral palsy, and severe visual impairment did not change. Mortality remained higher in 1 university hospital area during both periods compared with the other 4 areas, but no regional differences in morbidity were detected during the later period. CONCLUSIONS: No significant changes were detected in birth or mortality rate in extremely low birth weight infants born in Finland during the late 1990s, but some neonatal morbidities seemed to increase. Regional differences in mortality were detected in both cohorts. Repeated long-term follow-up studies on geographically defined very preterm infant cohorts are needed for establishing reliable outcome data of current perinatal care. Regional differences warrant thorough audits to assess causalities.

Cerebral Palsy↗
PubMed2004

[Lower extremity amputations in diabetic patients: a case-control study].

OBJECTIVE: Lower extremity amputation is an increasing problem among diabetic patients and an important public health problem. The study purpose was to identify factors associated with lower extremity amputation. METHODS: A matched case-control study was carried out among diabetic patients. Cases were selected in public health programs of the city of São Paulo, Brazil. One hundred and seventeen cases of diabetics with lower extremity amputation were compared to 234 controls of diabetics without amputation, matched by sex, age, and duration of disease. Sociodemographic variables, life habits (smoking and alcohol drinking), clinical aspects, and health education in diabetes were included. Univariate analyses and conditional logistic regression method were applied to data. RESULTS: Data showed evidence of association for: smoking, last glucose test > or = 200 mg/dl, presence of peripheral somatic neuropathy and vibratory perception (tuning fork 128 Hz), and peripheral vascular disease. Diabetes treatment and attending nursing appointments for diabetes education were important factors for preventing lower extremity amputation in diabetic patients. CONCLUSIONS: The knowledge of determinants and intervening factors for this condition will lead to cost reduction and better quality of care delivered in public health services.

Aged↗
PubMed2006

Star Excursion Balance Test as a predictor of lower extremity injury in high school basketball players.

STUDY DESIGN: Prospective cohort. OBJECTIVE: To determine if Star Excursion Balance Test (SEBT) reach distance was associated with risk of lower extremity injury among high school basketball players. BACKGROUND: Although balance has been proposed as a risk factor for sports-related injury, few researchers have used a dynamic balance test to examine this relationship. METHODS AND MEASURES: Prior to the 2004 basketball season, the anterior, posteromedial, and posterolateral SEBT reach distances and limb lengths of 235 high school basketball players were measured bilaterally. The Athletic Health Care System Daily Injury Report was used to document time loss injuries. After normalizing for lower limb length, each reach distance, right/left reach distance difference, and composite reach distance were examined using odds ratio and logistic regression analyses. RESULTS: The reliability of the SEBT components ranged from 0.82 to 0.87 (ICC3,1) and was 0.99 for the measurement of limb length. Logistic regression models indicated that players with an anterior right/left reach distance difference greater than 4 cm were 2.5 times more likely to sustain a lower extremity injury (P<.05). Girls with a composite reach distance less than 94.0% of their limb length were 6.5 times more likely to have a lower extremity injury (P<.05). CONCLUSIONS: We found components of the SEBT to be reliable and predictive measures of lower extremity injury in high school basketball players. Our results suggest that the SEBT can be incorporated into preparticipation physical examinations to identify basketball players who are at increased risk for injury.

Adolescent↗
PubMed2006

Gait symmetry and walking speed analysis following lower-extremity trauma.

BACKGROUND AND PURPOSE: Gait has been shown to be a major determining factor of function following limb-salvage surgery. However, little is known regarding the measures associated with gait recovery for this patient population. The purpose of this study was to identify clinical measures associated with impaired walking speed and gait asymmetry in patients with lower-extremity reconstruction. SUBJECTS: Study subjects were 381 patients from the Lower Extremity Assessment Project (LEAP) who had undergone reconstruction following severe lower-extremity trauma. METHODS: The LEAP study was a longitudinal study of outcomes following lower-extremity reconstruction. The present study used 24-month clinical follow-up data. A combined outcome measure of reduced walking speed and gait deviation was chosen to provide a comprehensive measure of impaired physical mobility. RESULTS: The most significant clinical factors associated with decreased walking speed and gait deviation were impaired ankle plantar-flexion range of motion, knee flexion strength, and a nonreciprocal stair-climbing pattern. DISCUSSION AND CONCLUSION: The findings provide clinicians with specific clinical measures associated with functional recovery in patients with lower-limb reconstruction. These measures, in turn, can be considered to inform treatment decision making and to prioritize interventions.

Adolescent↗
PubMed2005

Sonographic evaluation of upper extremity deep venous thrombosis.

OBJECTIVE: The purpose of this presentation is to review the techniques of performing an upper extremity Doppler examination, in addition to illustrating the sonographic appearances of acute and chronic upper extremity deep venous thrombosis (UEDVT). METHODS: The risk factors and complications of UEDVT are discussed, and the anatomy of the upper extremity deep venous system as well as examination techniques are described. Cases of acute and chronic deep venous thrombosis were also chosen to illustrate the spectrum of sonographic appearances. RESULTS: Color Doppler sonography is accurate in the diagnosis of UEDVT. However, in cases of equivocal Doppler findings, or when the sonographic findings are normal but clinical suspicion for central venous thrombosis is high, magnetic resonance or contrast venography is necessary for further evaluation. CONCLUSIONS: Color Doppler sonography is a rapid and noninvasive technique in the evaluation of venous disease in the upper extremity and is the modality of choice in screening for UEDVT.

Chronic Disease↗
PubMed2000

Investigation of trunk and extremity movement associated with passive head turning in newborns.

BACKGROUND AND PURPOSE: Physical therapist examination of pediatric clients or clients with neurological conditions often includes the observation of stereotypical movement patterns such as the asymmetrical tonic neck reflex and righting reactions. The purpose of this study was to investigate whether extremity and trunk responses to passive head turning could be documented in newborn infants. SUBJECTS AND METHODS: Forty-two newborns with no known medical problems were videotaped within 5 days of birth while an investigator turned their heads left and right. Videotapes were stopped at 5-second intervals to record the direction of head turn with the rest of the body obscured. A second investigator recorded trunk and extremity position with the head obscured. RESULTS: The direction of head turning affected upper- and lower-extremity position, with extension stronger on the face side. The direction of trunk convexity was also affected by head position, with the trunk convex to the side to which the face was turned. CONCLUSION AND DISCUSSION: Extremity responses and trunk responses to passive head turning can be documented corresponding to patterns reported for the asymmetrical tonic neck reflex and righting reflexes in neonates with no known medical problems more frequently than would occur by chance.

Back↗
PubMed1999

[A study of color Doppler ultrasound on arteries of the extremities in patients with type 2 diabetes].

To investigate the changes of the arteries in extremities in patients with type 2 diabetes(DM2), fifty patients with DM2(35 women and 15 men, mean aged 57.54 +/- 14.19 years old, time of DM2 diagnosed one week-26 years, without the histories of hypertension and smoking) were studied. Radial, finger, anterior tibial and dorsum pedis arteries of all subjects were examined using color Doppler Ultrasonography, 30 of 50 patients had the symptoms of extremities (e.g., numbness, coldness and pain). The Doppler examination revealed: 1. In the patient group, arterial wall became thick, rough and rigid. The atherosclerotic plaques were found inside vascular cavities in 14/50 in patient group with one patient being asymptomatic of extremities. 2. The vascular cavities in patients remarkably narrowed compared with the control group (P < 0.05). The vascular lesion worsened along with the development of the symptoms. 3. Doppler spectra in the majority of patients displayed single-peak, whereas it displayed three peaks in normal subjects with significant differences (P < 0.05). 4. The peak flow velocities in the patients increased, and this increase was related to the development of the symptoms, but no significant differences were found. Color Doppler Ultrasound examination is valuable in the evaluation of the arterial lesion of the extremities, especially at the early stage of artery diseases in patients with DM2.

Adult↗
PubMed2002

Compartment syndrome in multiple uninjured extremities: a case report.

Compartment syndrome is a common problem in trauma patients. It can occur within any space bound by a dense fascial layer, such as the extremities or abdomen. It exists when increased tissue pressure within the limited anatomic space compromises perfusion. Failure to decompress the compartment leads to a self-perpetuating ischemia-edema process and resultant irreversible tissue damage. In the extremities, it typically arises from a vascular injury in that same extremity. Herein is reported a case of the unexpected development of compartment syndrome in multiple uninjured extremities in a trauma patient with hypotension requiring systemic vasopressors.

Abdominal Injuries↗
PubMed2002

[The application of tourniquet in burn patients during tangential excision on the extremities].

OBJECTIVE: To investigate the application of tourniquet in burn patients during tangential excision on the extremities. METHODS: Seventy - nine burn patients who were arranged to receive tangential excision and skin grafting on the extremities were randomly divided into A and B groups. The patients in A group (n = 41) underwent the operation with the tourniquet applied continuously throughout the operation, while those in B group (n = 38), only with tourniquet applied during tangential excision. The amounts of blood loss and blood transfusion, the operation time and the take rate of grafted skin and the incidence of complications were investigated and recorded. RESULTS: The amounts of blood loss and blood transfusion during operation in A group were 42% and 50% less than those in B group, respectively (P < 0.001). Moreover, the operation time on the upper and lower extremities in A group was much shorter (for 41% and 37%, respectively) than those in B group (P < 0.001). In addition, there was no difference of the take rate of skin graft and the incidence of subcutaneous hematoma between the two groups (P > 0.05). CONCLUSION: Continuous tourniquet application during tangential excision on the extremities in burn patients was proved to be effective in reducing operational blood loss, blood transfusion and in shortening operation time.

Adult↗
PubMed2003

[Surgical treatment of acute embolism of the upper extremity].

OBJECTIVE: To study the methods of surgical treatment and the prognosis of acute embolism of the upper extremity. METHODS: Balloon catheter embolectomy through the brachial artery was performed in 18 patients with acute embolism of the upper extremity. RESULTS: Both the pulse of the radial and ulnar artery could be palpated in 8 patients, either the pulse of the radial or ulner artery could be palpated in 9 patients. The temperature of the upper extremity was increased in the patient whose embolectomy was performed in the 6th day after onset of the illness. Three patients died postoperatively. CONCLUSIONS: Embolectomy through the brachial artery is an effective method to treat acute embolism of the upper extremity. Elderly and heart and pulmonary diseases are the high risk factors for postoperative death.

Acute Disease↗
PubMedDate not supplied

[Relationship between metabolic changes in regional blood and tissues in ischemia of the extremities].

The authors examined 56 patients with obliterating diseases (OD) of arteries of the lower extremities and conducted experiments on 97 male albino rats. In patients with OD the lactate content in the regional venous blood of the involved extremity increases proportionally to the severity of ischemia. No essential changes occur in the concentration of ATP and glucose. In rats with transitory ischemia of the extremities the lactate level in venous blood increases in the absence of changes of the ATP and glucose content; reduced concentration of ATP and glycogen was encountered in the ischemic muscles of the extremities. The mechanisms and significance of the disorders of metabolic parameters in ischemia are discussed.

Adult↗
PubMed2003

[Alignment of lower extremity in rheumatoid arthritis patients with a history of both total hip replacement and total knee replacement].

OBJECTIVE: The following is a retrospective study on lower extremity alignment of rheumatoid arthritis (RA) patients with a history of both Total Hip Replacement (THR) and Total Knee Replacement (TKR). METHODS: From 1992 to 2000, our department had 26 rheumatoid arthritis patients who underwent both THR and TKR. We classified these patients into three groups based on radiographic alignment of the lower extremities in the standing position: Knock-knee (valgus deformity of the knees), Bowleg (varus deformity of the knees) and Windswept Deformity (one knee in severe varus alignment with the other in severe valgus alignment). Furthermore, we identified dominant weight bearing points of the hip as classified by the following new criteria: Central Shift, Lateral Shift, and Upward Shift. Mal-alignment was then evaluated based on these two classification systems. RESULTS: Of the 26 patients, 22 patients met our criteria and 4 did not. In mal-alignment, we had 11 cases in the knock-knee group, 5 cases in the bowleg group, and 6 cases in the Windswept deformity. Using the new criteria, central shift had 6 cases; lateral shift had 6 cases; and upward shift had 10 cases. The groups of Lateral shift and Central shift demonstrated deformities of the lower extremities were influenced by moving weight bearing points, pelvis obliquity, and adduction contractures of the hip joint. In upward shift, weight bearing lines did not change. Consequently, destruction of the joint in this group progressed symmetrically. Windswept deformity was asymmetric and had severe destruction on the other side of the knee and forefoot. DISCUSSION: Moving of weight bearing point, pelvis obliquity, and adduction contractures of the hip joint affected the severity of mal-alignment of the lower extremities.

Adult↗
PubMed2003

[Some features of orthostatic venous hemodynamics of the lower extremities in healthy, subjects and patients with varicose disease according to duplex scanning data].

Duplex scanning of the subcutaneous, deep and perforating veins was performed to examine venous return and to establish the diagnosis of valvular venous insufficiency of the lower extremities in 32 clinically healthy subjects (64 extremities) and 38 patients suffering from varicose disease (VD), when the patient was in the horizontal and vertical position. It has been established that in VD patients, the diameter of the deep and subcutaneous veins is greater than that in healthy subjects. When the patient is in the vertical position, the venous lumen expands 1.5-fold on the average (1.6-fold in healthy subjects and 1.4-fold in VD patients) under the influence of orthoshtatic venous pressure (,the sum of hydrodynamic and hydrostatic pressure). The growth of the total venous pressure up to the design values in the distal segments of the lower extremities is removed not only by musculovenous pump (MVP) motion but also by the MVP of free standing (maintenance of body balance) as well as by the action of the arteriovenous pump (AVP). The frequency of recording the retrograde blood runoff at functional exerelse in healthy subjects when they are in the orthostatic position is dramatically reduced. This phenomenon may be related to the orthostatic dilatation of the great veins and tension of the cusps of the unchanged valves, which should be regarded as a functional component of the closing mechanism of the MVP, In YD patients when they are in the orthostatic position, the frequency of revealing the design valvular insufficiency (according to the duration of retrograde runoff) decreases in the deep and rises in the subcutaneous veins. Valvular insufficiency of the perforating veins of the leg was primarily recorded in the veins of Cockett. The data obtained indicate that examination of venous function of the lower extremities is desirable when the patients are in both horizontal and vertical position.

Female↗
PubMed2004

[The potential of conservative therapy and surgical treatment of microcirculatory distress in chronic venous insufficiency of the lower extremities in a stage of trophic disorders].

The present work describes the results of an all-round examination and treatment of 120 patients suffering from different forms of chronic venous insufficiency (CVI) of the lower extremities with trophic disorders of soft tissues. Of these, varicosis was present in 91 (75.8%) patients and postthrombotic disease - in 29 (24.2%), patients. Hemomicrocireulation was examined by laser Doppler flow-metry. Assessment was made of the functional activity of neutrophilic granulocytes of the microcirculatory bed. The data were obtained indicating the decrease of skin perfusion and activation of neutrophils in the hemomicrocirculatory bed of the involved extremity at venous outflow decompensation. Of the 120 persons, conservative treatment was provided to 23 patients, in 45 patients, the conservative measures represented a stage in the preoperative preparation. Ninety-seven patients were operated on. The studies of hemomicrocirculation carried out at different times after treatment have demonstrated that conservative treatment produces a beneficial effect on hemomicrocirculatory disorders in the lower extremities of patients with CVI. However, the effects of conservative therapy are unstable and not long-lasting. Surgical correction of the venous outflow in patients with decompensated forms of CVI of the lower extremities leads to a stable improvement of the functional parameters of microcirculation.

Adult↗
PubMed2004

Upper extremity musculoskeletal symptoms and functional impairment associated with computer use among college students.

PURPOSE: Occupational computer use has been associated with upper extremity musculoskeletal disorders among working-age adults, but little is known about computer-related musculoskeletal problems among college students. We carried out a descriptive epidemiological study of computer use-associated symptoms, functional limitations, and medication and health care utilization in this population. SUBJECTS AND METHODS: Cross-sectional survey of 240 undergraduates in the second through fourth years at a residential dormitory at a four-year college with random housing assignments. RESULTS: 194 students returned useable surveys (81% response rate). 42% reported upper extremity pain or discomfort when using a computer in the preceding two weeks. 41% said this pain or discomfort caused functional limitation and 9% said that these symptoms hindered academic or extracurricular performance. 23% reported taking medications for upper extremity pain related to computing (4% regularly) and 16% had seen a health care provider for computer-related symptoms. Female students, students of racial/ethnic minority groups, and students who experienced symptoms with < or = 1 hour of computer use were more likely to report symptom-related functional limitation than others. CONCLUSION: College students report high rates of computer use-associated upper extremity musculoskeletal symptoms and symptom-related functional limitation. Future studies should more closely examine exposure, demographic, and ergonomic correlates of these symptoms and outcomes.

Adult↗
PubMed2004

[Neurolyses of the brachial plexus and peripheral nerves of the extremities].

AIM: This study presents the results of the brachial plexus and the peripheral extremities nerves neurolyses conducted in our clinic for 18 years from 1985 to 2003. SUBJECTS AND METHODOLOGY: 92 patients were treated surgically using neurolyses. Out of this number, 10 of them concerned brachial plexi, 49 nerves of the upper extremities and 33 nerves of the lower extremities. Out of the total patient number, 67 were males and 25 females, aged 30 years on average. The average time gap between the injury and the surgical procedure was 6.9 months. An extremely long time gap (over 12 months) was recorded in 5 cases. The operations were conducted in patients who suffered from a complete or persisting neurological deficits. In 92 patients, external neurolysis was conducted, out of them in 7 cases also internal neurolysis was conducted. Cases which required resection of the fascicles and reconstruction using autotransplants, as well as cases which had already undergone reconstruction procedures, have not been included in this study. The results analysis has been conducted with respect to the time gap between the surgical procedure and the injury, to the patient's age, to the type of the injured nerve and to the peroperatively detected degree of fibrotic changes. RESULTS: The best results were observed in patients under 20 years of age, in cases of early treatment, in distal injuries and in neurolyses of the tibial and radial nerves. CONCLUSION: When indicated, the early surgical treatment is the main factor determining the results of the surgical procedures.

Adult↗
PubMed2005

Golf injuries of the upper extremity.

Golf has demonstrated increasing popularity and with this heightened enthusiasm has come an increased awareness of the significant number of injuries associated with playing golf. While back injuries represent the most commonly injured specific body part, upper extremity injuries are most frequent overall and the most likely to result in loss of play. Patterns of injury differ based on level of play and time spent playing or practicing golf. Among golf professionals, the hand/wrist is the most commonly injured upper extremity structure. Among amateurs, the elbow is most commonly injured. The vast majority of upper extremity injuries are due to overuse. Age, ability, equipment, and swing mechanics also play contributing roles. Most upper extremity golf injuries can be successfully treated with appropriate cessation or modification of play, anti-inflammatory modalities, and rehabilitation. Surgical treatment is rarely required, but if needed can prove successful in a high percentage of patients.

Carpal Bones↗