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PubMed2000

Changes in cold-induced vasodilatation, pain and cold sensation in fingers caused by repeated finger cooling in a cool environment.

To examine how repeated cooling of fingers with a rest pause schedule at work affects cold-induced vasodilatation (CIVD), pain and cold sensation in fingers, six healthy men aged 21 to 23 years immersed their left index fingers six times in stirred water at 10 degrees C for 10 minutes. After each cold-water immersion of the fingers, 5-minute rest pause was taken to observe the recovery process of the indicators. This cold-water immersion/rest pause test was carried out in a range of three ambient temperature conditions: 30 degrees C (warm), 25 degrees C (thermoneutral), and 20 degrees C (cool) as experienced in daily life. At the ambient temperatures of 30 degrees C and 25 degrees C, marked CIVD response occurred and the CIVD reactivity did not significantly change upon repetition of cold-water immersion. The lowered finger skin temperature also tended to recover quickly to the pre-immersion level during each post-immersion rest period. At the ambient temperature of 20 degrees C, however, the CIVD response weakened continuously upon repetition of immersion and almost disappeared during the final immersion. The recovery of finger skin temperature during each post-immersion rest was gradually delayed upon repetition of immersion. At every ambient temperature, finger pain and cold sensation induced by each cold-water immersion significantly decreased upon repetition of immersion and completely disappeared during each post-immersion rest period. Oral temperature during the experiment showed no significant change at the ambient temperatures of 25 degrees C and 30 degrees C, but it decreased significantly at the ambient temperature of 20 degrees C. These results suggest that in a cool work environment where the body core temperature is liable to decrease, repeated finger cooling may weaken CIVD reactivity and delay the recovery of finger temperature during post-immersion rest periods. In such lower ambient temperature work conditions, subjective judgements such as the decrease in finger pain and cold sensation during repeated finger cooling and the absence of them during post-immersion rest may not be reliable indicators for monitoring the risk of progressive tissue cooling and frostbite formation.

Adult↗
PubMed1996

Statistical analysis of amputations and trends in Korea.

Epidemiological research on amputees is being continued extensively world wide, but there are different epidemiologic reports from country to country. This study undertakes an epidemiologic report of the medical records of amputees in Korea which has developed very rapidly, when compared with other countries. This study included 4258 amputees who either had an amputation and/or received prosthetic training at Yonsei University College of Medicine, Severance Hospital from January 1970 to June 1994. The most common cause of amputation was trauma (66.7%), and the second most common cause was peripheral vascular disease. While amputations due to infection or trauma were the most common in the 1950's, amputations due to peripheral vascular disease have gradually increased until they now make up 23.5% of all amputations in the 1990's. Lower limb amputation, more common than upper limb amputation, accounted for 68.7% of all amputation. Multiple amputation accounted for 9.3% of all amputations, and the occurrence rate of multiple amputation was relatively higher in cases of burn injuries, train accidents, frostbite, and Buerger's disease than in cases brought about by other causes. The various amputation causes change according to the circumstances of the times, as can be seen in this study.

Adolescent↗
PubMed2006

Brief interventions to reduce harmful alcohol use among military personnel: lessons learned from the civilian experience.

Unhealthy alcohol use is among the leading causes of morbidity and mortality in the United States. Among military personnel, service members between the ages 18 and 25 had a 27.3% prevalence of heavy drinking in the previous 30 days, compared to 15.3% among civilians in the same age group. In the civilian world, > 100 million patients are treated in U.S. emergency departments (ED) annually; 7.9% of these visits are alcohol related. Alcohol is associated with a broad range of health consequences that may ultimately present in the ED setting: traumatic injuries (e.g., motor vehicle crashes, intentional violence, falls); environmental injuries (e.g., frostbite); cardiovascular problems (e.g., hypertension, dilated cardiomyopathy); gastrointestinal disorders (e.g., hepatitis, pancreatitis, gastrointestinal bleeding); neurological problems (e.g., encephalopathy, alcohol withdrawal, withdrawal seizures), as well as psychological problems (e.g., depression, suicide). Seminal work has been done to create behavioral interventions for at-risk drinkers. These motivational interventions have been found to be successful in encouraging clients to change their risky behaviors. We present such a technique, called the Brief Negotiated Interview as performed in a civilian ED setting, in hopes of adapting it for use in the military context. Military health care providers could easily adapt this technique to help reduce risky levels of alcohol consumption among service members, retirees, or military dependents.

Adolescent↗
PubMed1999

[The clinico-pharmacological activity of Agapurin].

Data from published literature are generalized together with results of the authors' studies on clinical pharmacology of the metabolite drug agapurin (pentoxifulline). It is shown to be of high therapeutic efficacy in postinsult syndrome, varicose ulcers, gangrene, frostbite, paresthesias, acrocyanosis, Raynaud's disease, cerebral circulatory ischemic disorders, postischemic/hemorrhagic insult states, circulation disorders in the vessels of the eye, of the internal ear, in male sterility.

Contraindications↗
PubMed2000

Adverse effects of low-flow oxygen therapy.

Exposure to oxygen at a high FIO2 can result in substantial damage to several organ systems. In contrast, low-flow oxygen is generally quite safe. Although there have been reports of lung tissue injury with low-flow oxygen, the benefits of this therapy in appropriately selected individuals clearly outweighs the small risks. Elevations in PaCO2 occur in some COPD patients receiving low-flow oxygen and appear to be related to changes in ventilation-perfusion matching in the lung and carbon dioxide transport in the blood stream rather than to reductions in respiratory drive as previously thought. The effect is generally small in magnitude and is not progressive in response to oxygen therapy alone. Nonmedical hazards such as frostbite and fire related to oxygen equipment have been described but are unusual. Minor problems such as skin rash or nasal irritation in those using low-flow oxygen are usually easily handled with topical treatments. Social and psychological problems, resulting from a perceived stigma of wearing oxygen may lead to social isolation of the patient and should be addressed with appropriate counseling and education.

Accident Prevention↗
PubMed2000

[Ischemic disease of the lower extremity and lumbar sympathectomy].

We consider lumbar sympathectomy (LSE) to be the last attempt to improve the condition of the limb. Though being aware of inconsistent opinions on LSE, we are not opponents of this method, particularly if it is carried out in a selected group of patients, that is in case of: 1) treatment of frostbites, 2) treatment of patients at an early stage of advanced ischemia whose main symptom is moderate night pain at rest, 3) desiccation of chronically moist ulcerations between the toes, 4) treatment of patients with reflex symptomatic dystrophy (causalgia), 5) Buerger's disease.

Female↗
PubMedDate not supplied

Cryosurgery for colorectal liver metastases.

Destructive therapy for liver tumors has been available for some time and a number of options have been used. These include alcohol injection, heating therapy with laser and, more recently, radiofrequency ablation and cryosurgery. The principle of cryosurgery is to destroy tissue by freezing and causing expansion of intracellular water. The effect of this treatment is to cause disruption of the cell membrane as the ice expands, thereby killing the cells and, secondly, releasing intracellular antigen into the circulation to promote an immune response. Lastly, there is a "frostbite" effect with thrombophlebitis of vessels feeding the tumor because of the freezing. A number of trials have evaluated destructive therapy, but none have shown definite benefit over chemotherapy alone. This review examines the data as it currently stands.

Colorectal Neoplasms↗
PubMed2001

[Usefulness of epidural infusion of ketamine for relief of localized superficial pain].

Three patients with localized superficial pain had their pain alleviated by single epidural infusion with low dose ketamine. The patients are as follows: a 62-year-old female with herpetic neuralgia on her right sixth thoracic nerve area; a 52-year-old male whose left shoulder, anterior chest and abdomen had been burned by acetylene gas; and a 49-year-old male whose bilateral hands suffering from frostbite by propane gas. Epidural tube insertion to administer a single dose of 10 mg ketamine with lidocaine or bupibacaine was performed in all the three patients. They were administered single epidural infusion of 10 mg ketamine with lidocaine or bupibacaine everyday and they continued to receive epidural block with lidocaine or bupivacaine including buprenorphine or morphine. Therefore, we suspect that single epidural infusion of ketamine, an antagonist for N-methyl-D-aspartic acid receptor, could be an effective and useful alternative treatment in patients with various refractory localized superficial pain of either acute or chronic nature.

Analgesia, Epidural↗
PubMed2001

Toe-to-finger transfer for post-traumatic reconstruction of the fingerless hand.

OBJECTIVE: To assess the utility of toe-to-finger transfers (TFTs) for post-traumatic reconstruction of the fingerless hand. DESIGN: A case series. SETTING: A regional trauma centre. PATIENTS: Eight men, mean age was 36 years (range from 25-59 yr), who had lost all the fingers from a hand due to a crush-degloving injury (6 patients), frostbite (1 patient) or a burn injury (1 patient). INTERVENTION: TFT. Twelve TFTs were cone and the mean time from injury to reconstruction was 17.2 months. MAIN OUTCOME MEASURES: Objective (range of motion, moving 2-point discrimination, grip strength, key pinch, Jebsen-Taylor hand assessment, return to work) and subjective (activities of daily living and a questionnaire) measures. RESULTS: Eleven of the 12 transfers survived. Six of the 7 in whom the transfer was successful were available for follow-up (mean 45 mo). Range of motion was 10 degrees at the distal interphalangeal joint, 18 degrees at the proximal interphalangeal joint and 59 degrees at the metacarpophalangeal joint. Sensation was protective in all. Grip strength and key pinch were 26.1% and 70.2% of the contralateral hand respectively. Jebsen-Taylor assessment indicated that basic activities were possible but slowed. All 6 patients returned to work and could perform 92.6% of the activities of daily living unassisted. Hand and foot symptoms were mild. Two-thirds were appearance conscious, 5 of the 6 went on to altered vocations and all reported overall satisfaction as high. CONCLUSION: This study supports TFT for reconstruction of the fingerless hand in that, although transferred toe function may be poorer than a normal finger, the hand is restored to a useful, sensate and versatile functional unit, such that global hand and patient function, as well as patient satisfaction, are very good.

Adult↗
PubMedDate not supplied

Thrombosis as a complication of extended stay at high altitude.

BACKGROUND: There is limited knowledge about the medical problems of long term stay at high (> 3000 m) and extreme (> 5000 m) altitudes, as these areas are generally considered uninhabitable. METHODS: Prospectively collected clinical records of all patients hospitalized at Command Hospital, Western Command between November 1998 and February 2000 were reviewed to identify thrombotic complications among patients from high and extreme altitude areas as well as those from non-high altitude areas who were < 45 years of age. RESULTS: Of 20,257 hospital admissions during the study period, 1692 were from high and extreme altitude areas. Forty-six patients from these areas had thrombosis-related diseases compared to 17 from non-high altitude areas (odds ratio: 30.49; 95% CI: 17.06-51.67; p < 0.001). The mean (SD) age of all patients with thrombotic complications was 32 (8) years and all were men. The mean duration of stay at high and extreme altitudes of such patients was 10.2 (5.6) months. Only 25 were smokers (mean 5.2 pack-years) and 39 consumed alcohol (mean 54 ml/day). Apart from frostbite in 5, no other medical condition was noted in these patients. The vascular events were deep vein thrombosis (20), pulmonary thromboembolism (6), stroke (15), thrombosis of the abdominal veins (8), and retinal artery and peripheral arterial thrombosis (1 each). The presenting complaint in all patients with thrombosis of the abdominal veins was poorly localized pain in the upper abdomen followed by ascites (6/8). Five of these patients also had a large spontaneous splenic haematoma. None of the patients investigated was found to have a procoagulant disorder. CONCLUSION: Long term stay at high and extreme altitudes is associated with a 30 times higher risk of spontaneous vascular thrombosis. Veins are common sites of such thrombotic events. We also encountered thrombosis of the portal, splenic and superior mesenteric veins in our patients who had stayed at high and extreme altitudes.

Adult↗
PubMed2001

[Repair and reconstruction of massively damaged wounds].

OBJECTIVE: To report repair and reconstruction of massively damaged wound under unusual condition. METHODS: One hundred and forty-seven patients with deep tissue defects were admitted from January 1993 to December 2000, among them, 96 cases suffered from electrical injury, 18 cases with hot press injury, 18 cases with deep burns as a result of CO poisoning or epileptic seizure, 6 cases caused by chemical producing necrosis and wound infection, 3 cases with radiation injuries, 2 cases with chemical burn, 2 cases with explosive injury, 2 cases with frostbite. One hundred and seventy five wounds in 147 patients were repaired by transfer of local flap, forearm conversal island skin flap, pectoralis major myocutaneous flap, delto-pectoral skin flap, latissimus dorsi skin flap, gastroecnemius myocutaneous flap, anterior and posterior tibial artery island skin flap, and so on. The wound defect ranged from 1 cm x 1 cm to 20 cm x 28 cm, and the flaps were 1.5 cm x 2.0 cm to 22 cm x 30 cm. The necrotic tendon was replaced with acellular allogenic tendon simultaneously in 7 cases. RESULTS: One hundred and sixty-nine flaps were survival with first intention, while necrosis of the tip of flap occurred in 6 cases. The transplantation of acellular allogenic tendon in all cases were survival. The function and configuration in 28 cases were satisfactory after 4 months to 8 years follow-up. CONCLUSION: Various types of flaps are choosen according to the position, defect range and degree of wound, which is an ideal method to restore the function and to improve patients' living condition.

Adolescent↗
PubMed2002

Factors affecting breeding soundness classification of beef bulls examined at the Western College of Veterinary Medicine.

Breeding soundness evaluation records from 2110 beef bulls, for the period of 1986 to 1999, were analyzed to determine the prevalence and importance of factors affecting breeding soundness classification. The percentage of all bulls classified as satisfactory ranged from 49.0% in January to 73.3% in May. The percentage of physically normal bulls with satisfactory semen quality ranged from 65.7% in January to 87.5% in June. Poor body condition or excessive body condition, below average or below the recommended minimum scrotal circumference, lameness, and severe scrotal frostbite significantly reduced the probability of a satisfactory breeding soundness classification. The percentage of sperm with midpiece defects declined significantly and the percentage of sperm with head defects increased significantly with the approach of summer. Photoperiod, cold stress, poor or excessive body condition, and reduced feed quality may interact to reduce semen quality in the winter months.

Aging↗
PubMed2002

Simulated parachute descent in the cold: thermal responses and manual performance.

BACKGROUND: Ejection from a fighter aircraft can expose the pilot to extreme cold and windy conditions. Knowledge of the effects of such conditions on thermal responses and performance of the pilot is scarce. HYPOTHESIS: It is expected that the temperature of bare skin and fingers may decrease to the level where health and/or performance are hampered. METHODS: Seven fighter pilots performed a simulated parachute descent (SPD) at ambient temperature (Ta) of -35 degrees C and wind velocity of 10 m x s(-1). The 8-min SPD was followed by a 60-min cold exposure (CE) at Ta of -20 degrees C. Flight garments with or without immersion suit were used. During SPD the subjects performed basic survival tasks. Rectal and skin temperatures were measured and manual performance was tested. RESULTS: Thermal responses did not significantly differ between the clothing ensembles. Mean skin temperature was 28 degrees C and 27 degrees C at the end of SPD and CE, respectively. The cheek temperature was 9 degrees C (range 3.2-13.8 degrees C) at the end of SPD. Finger skin temperature was 7 degrees C and 9 degrees C at the end of SPD and CE, respectively. The subjects could perform the defined tasks during SPD while manual performance was slightly impaired during CE. CONCLUSIONS: Subjects could tolerate the 8-min SPD and the following CE in the studied conditions without a loss of vital performance in basic survival actions. However, the risk of frostbite on the uncovered skin area as well as numbness of the fingers may jeopardize pilots' health and performance during parachuting.

Adaptation, Physiological↗
PubMed1991

Cognitive and physiological feedback on cold pain tolerance.

Results supported the relevancy of cognitive information effects on pain tolerance, in that subjects who were given a rational and accurate explanation of what to expect showed greater tolerance than those who received irrelevant information. Accurate monitoring of hand temperature did not seem necessarily advantagous as an influence on pain tolerance. It appears merely watching a monitor, regardless of the specific contents of the screen, resulted in longer hand immersion times when compared to no monitor. The monitors seem to serve as distractors and specificity of physiological information was not particularly useful. However, neither information nor physiological monitoring emerged as the primary influence on pain tolerance in this study. Instead, the strongest predictors found were motivation and self-efficacy. The subject's own self prediction of anticipated performance with cold induced pain was closely consistent with actual performance. Although these results alone may not generalize to extended field situations, this study does reinforce the general findings of previous research: namely Bandura's (10) evidence on self-efficacy. While it is obvious cold temperatures have measurable physiological consequences, the experience of pain is also psychologically mediated. Pain associated with cold injury and frostbite in hospital studies show personality correlates are significantly related to the frequency, severity and tragedy of subsequent results (15). A replication of this study will include male subjects even though it is anticipated that findings will be consistent, with perhaps longer immersion times. Future research may want to develop training strategies aimed at teaching self-efficacy and realistic expectations of potential consequences in cold environments rather than scare tactics regarding physiological and psychological cold pain tolerance.

Biofeedback, Psychology↗
PubMed2003

Recognition and prevention of inhalant abuse.

Inhalant abuse is a prevalent and often overlooked form of substance abuse in adolescents. Survey results consistently show that nearly 20 percent of children in middle school and high school have experimented with inhaled substances. The method of delivery is inhalation of a solvent from its container, a soaked rag, or a bag. Solvents include almost any household cleaning agent or propellant, paint thinner, glue, and lighter fluid. Inhalant abuse typically can cause a euphoric feeling and can become addictive. Acute effects include sudden sniffing death syndrome, asphyxia, and serious injuries (e.g., falls, burns, frostbite). Chronic inhalant abuse can damage cardiac, renal, hepatic, and neurologic systems. Inhalant abuse during pregnancy can cause fetal abnormalities. Diagnosis of inhalant abuse is difficult and relies almost entirely on a thorough history and a high index of suspicion. No specific laboratory tests confirm solvent inhalation. Treatment is generally supportive, because there are no reversal agents for inhalant intoxication. Education of young persons and their parents is essential to decrease experimentation with inhalants.

Administration, Inhalation↗
PubMedDate not supplied

[Etiological argument about the Trench Foot].

The Trench Foot was described during the Napoleon's wars but its clinical picture dates from 1915. As a result of soldiers' life in trenches, it was recognized as a neurological, circulatory and infectious disease which struck thousands of fighters (chiefly French and English). At the beginning it was considered as a simple "frostbite" and troublesome for the military physicians who did know know how to cure this supposedly dermatological disease. More than 200 papers were published about the Trench Foot and the numerous individual inventions to protect the soldier's foot from mud, rain, cold and compression. As this issue is found in most testimonies of the fighters that proves it was a real and further suffering in the trenches.

Disease↗
PubMed1992

[Free transfer of the latissimus dorsi flap to sites with decompensated regional blood flow in burn and vascular surgery].

In the experiment, a sluggish wound of an extremity against the background of chronic ischemia was modelled in white rats. Then, a scapular muscle was transferred onto a wound defect. Free transfer of the latissimus dorsi flap (LDF) aimed at closure of the extensive wound defect and revascularization of the tissue ischemia area was performed in 29 patients: for high-voltage electric burn (12 cases), frostbite (5), radiation ulcer (4) and obliterative diseases of the lower extremities (8). Complications--partial, or total necrosis of a flap--occurred in 11 patients. Risk of free LDF transfer is justified because of absence of the other methods for prevention of amputation of the extremities.

Animals↗
PubMed2004

The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner.

Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculoskeletal injuries. Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Through a better understanding of these modalities, clinicians can optimize their present treatment strategies. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Continuous low-level cryotherapy and thermotherapy are newer concepts in therapeutic modalities. Both modalities provide significant pain relief with a low side-effect profile. Contrast therapy, which alternates between hot and cold treatment modalities, provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone. Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing. With thermotherapy, skin burns may occur, especially in patients with diabetes mellitus, multiple sclerosis, poor circulation, and spinal cord injuries. In individuals with rheumatoid arthritis, deep-heating modalities should be used with caution because increased inflammation may occur. Whirlpool and other types of hydrotherapy have caused infections of the skin, urogenital, and pulmonary systems. Additionally, ultrasound should not be used in patients with joint prostheses.

Journal Article↗