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PubMed2005

Obesity and extreme obesity, manifest by ages 20-24 years, continuing through 32-41 years in women, should alert physicians to the diagnostic likelihood of polycystic ovary syndrome as a reversible underlying endocrinopathy.

OBJECTIVES: Document obesity-extreme obesity in most 20-24, 25-29, and 32-41 years old women with PCOS as a stimulus for physicians to consider the diagnosis of PCOS, an underlying reversible endocrinopathy. STUDY DESIGN: In matched age groups 20-24, 25-29, and 32-41 years, we compared BMI in 84, 129, and 188 Caucasian women with PCOS versus 956, 815, and 815 women in NHANES I (general population), and 25, 36, and 45 non-pregnant women (community obstetrics practice). RESULTS: At ages 20-24, 25-29, and 32-41 years, mean+/-S.D. BMIs in women with PCOS (35.3+/-7.7, 36.0+/-9.4, 36.7+/-8.2) were much greater than NHANES I (22.8+/-4.6, 23.3+/-5.0, 24.5+/-5.6; p < .0001), and community (26.1+/-6.8, 26.9+/-6.6, 25.2+/-5.2; p < .0001). Classifying BMI <25 (normal), > or =25-30 (overweight), > or =30-40 (obese), > or =40 (extremely obese), at ages 20-24, 25-29, and 32-41 years: 76, 73, and 78% of PCOS women were obese-extremely obese, versus 7, 11, and 14% of NHANES I, and 20, 28, and 15% of community women. At ages 20-24, 25-29, and 32-41 years, only 10, 12, and 7% PCOS women had BMIs <25, versus 78, 74, and 66% NHANES I, and 48, 47, and 58% of community women. CONCLUSIONS: Obesity-extreme obesity in women, manifest by ages 20-24 years, continuing through 32-41 years, should alert physicians to the likelihood of PCOS, an underlying, heritable, potentially reversible, insulin resistant endocrinopathy that promotes obesity.

Adult↗
PubMed2006

Staff views on the management of the extremely preterm infant.

OBJECTIVE: To explore the opinions of different healthcare professionals about the use of interventions and outcome in extremely preterm labour. STUDY DESIGN: This was a prospective questionnaire survey. A structured questionnaire was mailed to 142 obstetricians, neonatologists, midwives and neonatal nurses working at City Hospital and Queen's Medical Centre, Nottingham, UK. The current opinions of practice of the healthcare professionals in their antenatal and intrapartum management of a woman with an extremely preterm infant were sought. RESULTS: The overall response was 49% (n=69) after two mailings. Most respondents overestimated infant survival and underestimated intact infant survival rates. Neonatal staff were most likely to wish to use electronic fetal monitoring and administer corticosteroids at the lower extreme gestations. There was no consensus on when to use corticosteroids. Consultant obstetricians were expected to be responsible for counselling parents before delivery, when time allows, but their presence at delivery was not thought to be essential. Neonatal nurses would recommend in utero transfer for women more readily at lower gestations whereas midwives were more reluctant to accept these women as in utero transfers. There were no significant differences in the attitudes to resuscitation of the extremely preterm infant among the different professionals. The median birthweights at which active resuscitation should be commenced ranged from 400 g for neonatal nurses to 500 g for midwives. CONCLUSIONS: Different professional groups perceive outcome differently and this may affect willingness to use interventions at borderline viability. Generally, neonatal staff wished to be more interventional at 21-23 weeks of gestation.

Adrenal Cortex Hormones↗
PubMed2005

Major amputation for intractable extremity melanoma after failure of isolated limb perfusion.

AIM: The aim of this study was to analyse indications and results of amputation for intractable extremity melanoma after failure of isolated limb perfusion (ILP). METHODS: Between 1978 and 2001, 451 patients with loco-regional advanced extremity melanoma underwent 505 ILPs. Amputation of the affected extremity had to be carried out for intractable recurrent disease in 11 of these patients. RESULTS: The indications for amputation were uncontrollable pain (n=2), extensive loco-regional tumour progression (n=4), loss of ankle function due to local tumour growth (n=1), and ulcerating and fungating lesions, not responding to other treatments (n=4). Four patients developed stump recurrence after amputation. Ten patients died of melanoma metastases after a median of 11 months (range 2-110 months). Two patients survived more than 5 years after amputation. CONCLUSIONS: Major amputation is rarely indicated for intractable extremity melanoma but long-term survival can be achieved in selected patients.

Adult↗
PubMed2005

Resuming driving after a fracture of the lower extremity: a survey among Dutch (orthopaedic) surgeons.

BACKGROUND: Patients with a fracture of the lower extremity often ask their physician during their rehabilitation when they can resume driving. Since no guidelines exist and only scarce literature is available with varying advices the physician has to rely on his own clinical experience and judgment. The Dutch legislation also fails to provide rules when driving can be resumed after a temporary invalidity, it relies on the physician to judge when driving can be assumed to be safe. With this study, we investigated the need for specific guidelines concerning driving after fractures of the lower extremity among Dutch (orthopaedic) surgeons. METHODS: A survey was conducted among Dutch (orthopaedic) surgeons consisting of four parts; the first part contains questions about how the physician handles with patients who suffered from a lower extremity fracture. The second part of the survey is about which criteria are used to judge whether driving can be resumed. The third part contains true/false/do not know questions about the legal context on participation in motorized traffic with a (temporary) disability. The fourth and last part is a series of examples of fractures with a description of how the fracture was treated in which we asked how long it should normally take before a patient can resume driving again safely per case. A final question is about the need for specific guidelines on this topic. RESULTS: One third of the surgeons do not advise their patients regarding driving. A wide range of criteria is used to consider whether driving is safe, however the possibility of full weight bearing is considered the most important. The legal knowledge of the surgeons on this subject is poor; up to 10% believe that driving with a plaster on the right leg is allowed. Seventy-nine percent of the questioned surgeons believe that guidelines concerning driving after a fracture should be developed. CONCLUSIONS: Our study shows that there is a great demand for guidelines concerning car driving after a fracture of the lower extremity.

Attitude of Health Personnel↗
PubMed2005

Differences in risk factors for lower extremity arterial occlusive disease.

BACKGROUND: Patients undergoing lower extremity revascularization have associated cardiovascular risks: smoking, hypertension, dyslipidemia, and diabetes. This study evaluated the impact of cardiovascular risk factors on proximal versus distal arterial occlusive disease in patients undergoing lower extremity revascularization as adjusted to a control group without vascular disease. STUDY DESIGN: We performed a retrospective, case-control study that included 151 patients undergoing lower extremity revascularization and 229 patients undergoing knee and hip replacement (controls). Risk factors were determined for each of three separate groups undergoing revascularization for different levels of occlusive disease: aortoiliac, superficial femoral, and popliteal-tibial. Comparisons to controls were tested using t-tests or chi-square tests and multiple logistic regression. RESULTS: Dyslipidemia was associated with a significant risk of aortoiliac (odds ratio [OR]=3.4; p=0.0006) and superficial femoral occlusion (OR=2.8; p=0.01) but was less strongly associated with popliteal-tibial occlusion (OR=2.1; p=0.09). Smoking was strongly associated with aortoiliac (OR=4.5; p=0.004) and superficial femoral disease (OR=4.6; p=0.0007) but not popliteal-tibial disease (OR=1.3; p=0.53). In contrast, diabetes mellitus and chronic renal insufficiency were strong risk factors for popliteal-tibial occlusion (OR=5.4, p=0.0002; OR=3.9, p=0.01, respectively), but were not significant risk factors for aortoiliac or superficial femoral occlusion. CONCLUSIONS: These data, which use revascularization level as a surrogate marker for lower extremity arterial disease, suggest that the risk factor profile for proximal disease differs from that of distal disease. These findings may reflect differences in the biology of disease and indicate that different risk factors have various anatomic influences on arterial disease formation.

Arterial Occlusive Diseases↗
PubMed2005

Early extreme contradictory estimates may appear in published research: the Proteus phenomenon in molecular genetics research and randomized trials.

BACKGROUND AND OBJECTIVE: Divergent results on the same scientific question generate controversy. We hypothesized that controversial data are attractive to investigators and editors, and thus the most extreme, opposite results would appear very early rather than late, as data accumulate, provided data can be generated rapidly. METHODS: We used data from MEDLINE-indexed meta-analyses of case-control studies on genetic associations (retrospective, hypothesis-generating research with usually rapid turnaround) and meta-analyses of randomized trials of health care interventions (prospective, targeted research that usually takes longer) sampled from the Cochrane Library. Using cumulative meta-analysis, we evaluated how the between-study variance for studies on the same question changed over time and at what point the studies with the most extreme results ever observed had been published. RESULTS: The maximal between-study variance was more likely to be recorded early in the 44 eligible meta-analyses of genetic associations than in the 37 meta-analyses of health care interventions (P = .013). At the time of the first heterogeneity assessment, the most favorable-ever result in support of a specific association was more likely to appear than the least favorable-ever result (22 vs. 10, P = .017); the opposite was seen at the second heterogeneity assessment (15 vs. 5, P = .031). Such a sequence of extreme opposite results was not seen in the clinical trials meta-analyses. The estimated between-study variance decreased over time in genetic association studies (P = .010), but not in clinical trials (P = .30). CONCLUSION: In contrast to prospective trials, a rapid early sequence of extreme, opposite results is frequent in retrospective hypothesis-generating molecular research.

Case-Control Studies↗
PubMed2005

Use of the anterolateral thigh free flap for upper-extremity reconstruction.

PURPOSE: The anterolateral thigh free flap (ALTF) first was reported in 1984 and has been used in large series with success for a multitude of clinical purposes. We describe our results with the ALTF in upper-extremity and hand reconstruction. METHODS: From 1996 to 2003 there were 15 patients who had reconstruction of the hand and upper extremity using the ALTF. The parameters used to assess the outcome of our series included the success rate of the flap as measured by flap survival rate and adequacy of skin coverage, ability to close the donor site primarily or necessity of a skin graft, complications associated with the flap, donor site, and non-flap-related complications such as pulmonary embolism. RESULTS: Of the 15 patients with an ALTF, 3 (20%) had a musculocutaneous perforator and 12 (80%) had a septocutaneous perforator. Two patients had a neurotized ALTF reconstruction. There were 4 complications related to the flap with 1 complete flap failure. The overall flap survival rate was 93%. The donor site was closed primarily in 8 patients (53%) and with a skin graft in 7 patients (47%). One donor site breakdown occurred. CONCLUSIONS: Our results show many advantages of the ALTF for upper-extremity reconstruction. Because of its versatility the ALTF is suited ideally for upper-extremity reconstruction and should be considered as part of the reconstructive ladder.

Adolescent↗
PubMed2006

Grades I-II intraventricular hemorrhage in extremely low birth weight infants: effects on neurodevelopment.

OBJECTIVE: To quantify the effect of grades I-II intraventricular hemorrhage (IVH) on the neurosensory and cognitive outcomes of extremely low birth weight infants. STUDY DESIGN: Of 706 extremely low birth weight infants without major malformations admitted to our center from 1992 to 2000, 537 survived to 20 months' corrected age (CA) and had cranial ultrasound studies performed, of whom 490 (91%) had complete neurodevelopmental assessments. Infants with severe cranial ultrasound abnormalities or meningitis were excluded, leaving a population of 362 infants, 258 of whom had a normal cranial ultrasound and 104 had an isolated grade I-II IVH. The groups had similar birth weight (808 vs 801 grams) and gestational age (26.5 vs 26.3 weeks). Outcomes of infants with normal cranial ultrasound were compared with those with grades I-II IVH at 20 months' CA. Outcomes included the Bayley Scales of Infant Development Mental Developmental Index (MDI) and major neurosensory abnormality. Logistic regression was used to assess the effect of grades I-II IVH on outcomes while adjusting for other risk factors. RESULTS: Extremely low birth weight infants with grades I-II IVH had a significantly lower mean MDI score than infants with normal cranial ultrasound (74 +/- 16 vs 79 +/- 14, P = .006). They had higher rates of MDI <<70 (45% vs 25%; OR, 2.00; 95% CI, 1.20 to 3.30; P = .008), major neurologic abnormality (13% vs 5%; OR, 2.60; 95% CI, 1.06 to 6.36; P = .036), and neurodevelopmental impairment (47% vs 28%; OR, 1.83; 95% CI, 1.11 to 3.03; P = .018) at 20 months' CA, even when adjusting for confounding factors. CONCLUSIONS: Extremely low birth weight infants with grades I-II IVH have poorer neurodevelopmental outcomes at 20 months' CA than infants with normal cranial ultrasound. Advanced radiologic imaging may indicate additional brain injury associated with grade I-II IVH, which could explain these outcomes.

Brain↗
PubMed2006

Operative and nonoperative management of children aged 13 years or younger with arterial trauma of the extremities.

BACKGROUND: Previous studies have suggested that open repair of arterial injuries in very young children often leads to less satisfactory outcomes. The aim of this study is to describe a decade's experience in the management of pediatric arterial trauma of the limbs, with an additional specific objective to evaluate the long-term outcome of arterial traumas in preschool children treated conservatively. METHODS: Hospital charts were reviewed for all children aged < or =13 years with arterial trauma of the extremities who underwent operative or nonoperative treatment. Twenty-three children were located who had arterial traumas equally divided between the upper extremity (13) and lower extremity (10). RESULTS: The method of treatment was either open surgical repair or medical treatment consisting of systematic heparin administration. In 11 of 12 school-aged children (>6 years; mean age, 10 years), open surgical repair was performed. In six of 11 preschool children (< or =6 years; mean, 3.2 years) medical treatment was offered. Open repair was deferred in all children <2.5 years. Autologous vein interposition grafting was the most common surgical procedure and was performed in 10 patients. There were no deaths, and 87% limb salvage (21/23) was achieved. Two patients, both in the surgical arm, underwent lower limb amputation. The long-term outcome of those treated conservatively was excellent in all but one child, in whom minor limb-length discrepancy was detected. CONCLUSION: Surgical repair can be performed in school-aged children as in adults. Surgical treatment of arterial injuries in neonates, infants, and those children <2.5 years old might best be deferred in ischemic but nonthreatened limbs. In a nonthreatened ischemic extremity in this age group, systemic heparinization is an alternative safe method of management. Limb loss is rare if distal Doppler signals are present; but as children grow, limb shortening is a threat. In preschool children, the risks of an open surgical repair must be weighed against any potential benefits.

Arm↗
PubMed2007

The adverse effects of race, insurance status, and low income on the rate of amputation in patients presenting with lower extremity ischemia.

OBJECTIVES: A consequence of delay in the diagnosis of peripheral vascular disease limb loss. This study was undertaken to determine the correlation of low socioeconomic status and race on the severity of ischemic presentation and the subsequent amputation rate. METHODS: Data from the Nationwide Inpatient Sample (NIS) from 1998 to 2002 on patients from urban hospitals with the diagnosis of lower extremity ischemia were evaluated. The population was divided into two groups: the amputation group (AMP) and lower extremity revascularization group (LER). Comorbidities, age, gender, race, ischemic gangrene at presentation, insurance status (no/noncommercial or commercial), and income status at admission were determined. These variables were compared using multivariate logistic regression analyses of the data for risk adjustment. RESULTS: Of 691,833 patients presenting with lower extremity ischemia, 363,193 underwent revascularization (66.3%) or amputation (33.7%). Univariate analysis correlated a statistically significant (P < .0001) higher rate of amputation and multivariate analysis associated significantly higher odds of amputation with the following variables: nonwhites (1.91, 95% confidence interval [CI], 1.65, 2.20), low-income bracket (1.41, 95% CI, 1.18, 1.60), and Medicare & Medicaid (1.81, 95% CI, 1.66, 1.97). Adjusting for other variables of statistical significance, multivariate regression analysis showed a statistically significant risk for amputation based on the nonteaching status of the institution (odds ratio [OR], 1.17, 95% CI, 1.08, 1.30). CONCLUSIONS: Primary amputation was performed with a higher frequency on patients with lower extremity ischemia who were nonwhite, low income, and without commercial insurance. The observed advanced ischemia among these economically disadvantaged patients suggests a delayed diagnosis of peripheral vascular disease, probably due to lack of access to adequate primary care or vascular surgery providers, or both. Better education of the general population and primary care providers to the symptoms and consequences of PVD may reduce the amputation rate in this group.

Aged↗
PubMed2004

Apoptosis may contribute to false-positive results in the in vitro micronucleus test performed in extreme osmolality, ionic strength and pH conditions.

Conditions in which clastogens produce positive responses have been increasingly challenged, and several situations have been described in which clastogenic responses would be considered not to be relevant. For example, extreme culture conditions lead to high variations of pH, osmolality or ionic strength. Apoptosis is induced in extreme culture conditions and contributes to false-positive results in the in vitro micronucleus test performed with CTLL-2 cells. These cells can enter apoptosis when exposed to apoptosis stimuli or after IL-2 deprivation, whereas the CTLL-2 Bcl2 cell line is protected from apoptosis due to the over-expression of the apoptosis inhibitor Bcl2 in bcl2-transfected CTLL-2 cells. The two cell lines were treated in extreme culture conditions of either pH or osmolality or were submitted to high ionic strength. The apoptosis level was measured in parallel with the in vitro micronucleus test using the annexin V-FITC method. Data obtained in the two cell lines suggested that apoptosis caused by extreme culture condition induces the formation of micronucleated cells, which leads to false-positive results in the in vitro micronucleus test.

Animals↗
PubMed2006

The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center.

OBJECTIVES: To describe the incidence of symptomatic postoperative lower-extremity lymphedema in women treated for uterine corpus cancer, and to evaluate its relationship to regional lymph node removal and postoperative therapy. METHODS: A retrospective chart review of all patients with uterine corpus cancer managed over a 12-year period (1/93-12/04). All patients had a hysterectomy as part of their therapy. We identified patients with leg lymphedema - as described by the physician or reported by the patient - through medical records. We excluded cases of leg edema that developed secondary to medical conditions such as cardiovascular and renal disease, venous thrombosis, and end-stage recurrent malignancy. Lymphedema dermal changes and related fibrosis were graded using the common terminology criteria for adverse events. RESULTS: In all, 1,289 patients with uterine corpus malignancy were evaluated. We excluded other chronic lower-extremity edema that was related to a variety of medical conditions in 74 patients (5.7%). With a median follow-up of 3 years (interquartile range, 1.1-5.4 years), new symptomatic post-treatment lower-extremity lymphedema was noted in 16 patients. Patients who had lymph nodes removed at initial surgery had a higher rate of developing lymphedema (16/670, 2.4%) than those who did not (0/619, 0%) (P = 0.0001). Furthermore, symptomatic lymphedema was limited to patients who had 10 or more regional lymph nodes removed 16/469 (3.4%). Lymphedema was noted at a median of 5.3 months after surgery (range, 1-32 months). Lymphedema was unilateral in 11 patients (69%) and bilateral in 5 (31%); moreover, it was considered grade 1 in 12 patients (75%) and grade 2 in 4 (25%). Age, weight, stage, type of hysterectomy, and type of postoperative adjuvant therapy were not associated with lymphedema. CONCLUSIONS: To date, this is the largest series evaluating symptomatic lower-extremity lymphedema in women with uterine corpus cancer. Patients who had 10 or more regional lymph nodes removed at initial surgery appeared to be at higher risk for developing new symptomatic leg lymphedema. Patients undergoing surgery with lymphadenectomy for uterine corpus malignancy should be informed about the possibility of postoperative new symptomatic leg lymphedema. A prospective evaluation of leg lymphedema is needed to accurately determine the incidence, severity, and risk factors of this complication.

Adult↗
PubMed2001

Predicting ambulatory function following lower extremity trauma using the functional capacity index.

This study evaluated the accuracy of experts' predictions of ambulatory function following lower extremity trauma using the Functional capacity index (FCI). Data from three orthopedic trauma studies designed to determine long-term function following specific types of lower extremity injuries were used to examine the extent of agreement between the reported and predicted ambulatory function of 921 subjects. Functional limitations reported by the cohort using a generalized health status measure and more detailed questions on lower extremity function were compared with those predicted by experts based on the injuries sustained. The overall agreement between predicted and self-reported FCI function for ambulation was relatively low (31%). In the majority of cases (80%), the disagreement differed by one functional level. Subjects were more likely to report worse function than predicted by the experts. Multivariate modeling identified different injuries, combinations of injuries, and patient characteristics that significantly influenced agreement. For example, subjects who sustained both a tibia and a femur fracture were three times more likely than subjects who did not sustain either fracture type to report poorer ambulatory function than predicted. Many challenges are faced in predicting long-term function following trauma. More empirical data are needed to inform the process. These data suggest that until the FCI can more accurately predict long-term ambulatory function following different lower extremity injuries, it should not be used for this purpose.

Activities of Daily Living↗
PubMed1998

Diagnosis and outcome of 100 consecutive patients with extreme granulocytic leukocytosis.

PURPOSE: To determine the clinical features, causes, and prognostic significance of extreme leukocytosis in adults. PATIENTS AND METHODS: Medical records of 100 consecutive patients who presented at the Minneapolis Veterans Affairs Medical Center between March 1993 and January 1994 with more than 25,000 leukocytes/microL blood and with more than 50% granulocytes were reviewed. Demographic, clinical, and outcome information was recorded, and a cause of extreme leukocytosis was sought in each case. RESULTS: Extreme leukocytosis was attributed to infection in 48 cases, advanced malignancy in 13 cases, hemorrhage in 9 cases, glucocorticoids in 8 cases, and other causes in 22 cases. Four patients had previously diagnosed conditions resulting in chronic leukocytosis. Higher leukocyte counts were associated with malignancy (chi2 for trend=12.5, P <0.002). Fever was more common in patients with infection (weighted rate ratio=3.7, 95% Confidence interval [CI]=2.2 to 6.2). Mortality was high overall (31%), and was greater in patients with noninfectious diagnoses compared with infected patients, an association which persisted after stratification by leukocyte count (weighted rate ratio=2.5, 95% CI=1.2 to 4.9). CONCLUSION: Clinicians should be aware that extreme leukocytosis with a predominance of granulocytes is associated with infection in only 48% of cases. The presence of fever increases the likelihood that infection is the cause. Mortality is high, particularly in patients without infection.

Adult↗
PubMed1998

Limb salvage for streptococcal gangrene of the extremity.

BACKGROUND: Extremity soft tissue infections from group A, beta-hemolytic streptococcus frequently culminate in amputation. This study compares our protocol for limb salvage with expected results. METHODS: Patients with extremity streptococcal gangrene treated from 1989 to 1995 were reviewed. The management protocol mandated immediate, radical excision of involved skin and subcutaneous tissue, with preservation of fascia. Patients were managed in the burn unit, and wounds were covered with split-thickness skin grafts. Amputation rate and mortality were measured. RESULTS: Fourteen cases of extremity streptococcal gangrene were identified. Delay to surgical referral was 5 days. Eleven (79%) patients were septic. Ten (71%) were managed with a single debridement before grafting. Limb salvage was 93% (13 of 14). One patient (7%) died on day 150 from acute myelogenous leukemia. CONCLUSIONS: Delay in referral of extremity streptococcal gangrene is common, contributing to a high incidence of sepsis. Our management protocol of a single, radical debridement with preservation of fascia maximizes limb salvage and survival.

Adult↗
PubMed1978

Moderate and extreme hemodilution in open-heart surgery: fluid balance and acid-base studies.

Two groups of patients underwent aortic valve replacement. Fifteen patients received moderate hemodilution (mean hematocrit, 27%) with 40% donor blood in the priming solution. Extreme hemodilution was used in 14 patients (mean hematocrit, 18%) with a nonhemic prime and withdrawal of blood at the start of operation. Both groups were given more than 7 liters of fluid during operation; donor blood was primarily used in the moderately diluted patients, and Ringer's acetate was primarily given to the other group. The diuretic response to this fluid load was much more pronounced in the extreme than in the moderate hemodilution group. Eighteen hours postoperatively, patients in the moderate and extreme hemodilution groups had an excess of about 2 and 1.5 liters of water, respectively. In the patients who had moderate dilution an average of 1,000 ml of erythrocytes disappeared from circulation; no such disappearance could be found in the other group. The moderate group showed significantly lower arterial PO2 postoperatively than the extreme group. There were, however, no differences between the two groups in mixed venous PO2 during perfusion or in acid-base and osmolality values.

Acid-Base Equilibrium↗
PubMed1998

Surgical indication for congenital heart disease with extremely thickened media of small pulmonary arteries.

BACKGROUND: Nineteen patients (mean age, 7.6 months) with a percent wall thickness of more than 33% in the small pulmonary arteries were found to have extremely thickened media. Based on our findings, a criterion of operative indication is proposed. METHODS: The percentage of extremely thickened media of small pulmonary arteries for all pulmonary arteries was determined on microscopic lung sections and was introduced as an index for operative indication. RESULTS: Operative repair was performed in 16 patients: 9 died intraoperatively and 7 survived more than 12 months. In 4 of 5 patients that had pulmonary artery banding, medial hypertrophy remained despite pulmonary artery banding. Operative repair also had no positive effect. In operative and late deaths and in survivors without a decrease of pulmonary arterial pressure, the percentage of extremely thickened media of small pulmonary arteries was shown to be more than 10%, whereas in 5 survivors and 1 operative death with a significant postoperative decrease of pulmonary arterial pressure, the value was less than 7%. CONCLUSIONS: If a patient has less than 7% of small pulmonary arteries with extremely thickened media, operative repair is likely to be effective. When the value is higher than 10%, not only operative repair but also pulmonary artery banding cannot be recommended because of ineffectiveness and hazard.

Blood Pressure↗
PubMed2000

Postural sway characteristics in women with lower extremity arthritis before and after an aquatic exercise intervention.

OBJECTIVE: To examine the reliability of postural sway assessment in women with lower extremity arthritis and to ascertain the effects of an aquatic exercise intervention program on these measures. DESIGN: The reliability of postural sway measures was analyzed by within-subjects (Subject times Trial) analysis of variance (ANOVA). The effects of aquatic exercise were analyzed by repeated measures ANOVA using a planned comparison approach with an independent 2 x 2 (Group times Test) design. SETTING: Testing in a motor control research laboratory; aquatic exercise in a warm water pool at an area YMCA. PARTICIPANTS: Volunteer sample, 24 women with lower extremity arthritis (rheumatoid [RA] n = 11, osteo [OA] n = 13) randomly assigned into an aquatic exercise group (n = 14) or control group (n = 10). INTERVENTION: Postural sway measures under a two-legged stance test on two separate test days: day 1, pretest; day 2, posttest, administered after a 6-week aquatic exercise program. RESULTS: Reliability correlation coefficients for postural sway measures ranged from .64 to .94 for both subject groups. Aquatic exercise subjects significantly reduced lateral sway and total sway area scores (by 18% to 30%) under both visual conditions after the 6-week intervention. Postural sway scores were significantly higher under the no-vision condition than under the vision condition in each group for both test sessions. Both OA and RA groups had normal sagittal/lateral ratio scores. CONCLUSION: Women with lower extremity arthritis can be reliably assessed on postural sway measures on a stable two-legged stance test. Although they had normal sagittal/lateral sway ratio scores (ie, scores typical for nonarthritic peers), vision played an important role in their postural stability for this balance task. Aquatic exercise reduced postural sway in women with lower extremity arthritis, as demonstrated by a two-legged stance test, and this exercise program appears to be a viable treatment for increasing postural stability in this population.

Analysis of Variance↗