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PubMed1985

Beta adrenergic-mediated vasodilator response to insulin in the human forearm.

Insulin, in doses sufficient to cause systemic hypoglycemia, decreases vascular resistance; however, a vasoactive effect of insulin in humans, in the absence of hypoglycemia, is unknown. Venous occlusion strain gauge plethysmography was utilized to determine forearm blood flow (FBF) and forearm vascular resistance (FVR) during incremental intra-arterial infusion of insulin (0.1, 0.5 and 1.0 mU/kg/min) in seven normal subjects. With the increasing doses of insulin, FBF increased 55, 76 and 145% and FVR decreased 30, 42 and 58%, respectively. Systemic glucose concentration decreased only during the highest dose insulin infusion. In eight subjects who received insulin during euglycemic glucose clamping, FVR also decreased. Therefore, it was demonstrated that insulin dilates the forearm vasculature in the absence of hypoglycemia. In order to determine whether the vasodilatory effect of insulin was mediated by the sympathetic nervous system, plasma levels of epinephrine and norepinephrine were measured. During the incremental insulin infusions, norepinephrine levels did not change, but epinephrine concentration increased during the 1.0 mU/kg/min infusion when hypoglycemia developed. Furthermore, 21 subjects were pretreated with intra-arterial phentolamine, propranolol or the combination of phentolamine and propranolol. Phentolamine did not potentiate the fall in FVR during insulin administration; however, propranolol attenuated or completely inhibited the changes in FBF and FVR. During combined alpha and beta adrenergic blockade, insulin increased FBF and decreased FVR only during the higher dose insulin infusions. It is concluded that insulin causes forearm vasodilation primarily via a beta adrenergic mechanism. In addition, at the higher doses used in this study, insulin may decrease FVR directly or by a mechanism other than adrenergic stimulation.

Adult↗
PubMed1986

The influence of the renin-angiotensin system on adrenergic vasoconstrictor responses in the forearm and splanchnic region in sodium deplete man.

In sodium deplete subjects forearm (FBF) and splanchnic (SBF) blood flows were measured at rest and during lower body negative pressure (LBNP) before and during angiotensin II (ANG II) blockade. Both FBF and SBF were reduced by LBNP. Forearm blood flow and forearm vascular resistance were unaffected by ANG II blockade (intra-arterial saralasin, n = 6; i.v. enalapril, n = 9) both at rest and during LBNP. In contrast, resting SBF increased and splanchnic vascular resistance decreased after i.v. enalapril (n = 10). The low resistance was completely unchanged during the following LBNP. It is concluded that acute ANG II blockade has no influence on the vascular resistance in the human forearm, but increases basal SBF in sodium depleted subjects and 'paralyses' the vasoconstrictor response to LBNP.

Angiotensin II↗
PubMed1987

Treatment of forearm bone fractures by an integrated method of traditional Chinese and Western medicine.

Of 2221 forearm fractures (1300 left, 921 right) in adults (1167 men, 1043 women) treated from January, 1972, to December, 1982, 2117 were closed and 104 open fractures. The fractures are classified as follows: fracture of both radius and ulna, 1161 cases (52.3%); fracture of the ulna alone, 343 (15.4%); Monteggia fracture, 259 (11.7%); fracture of the radius alone, 222 (10%); and Galeazzi fracture, 236 (10.6%). For each type, the treatment consisted of closed reduction by manipulation, immobilization, and functional exercises. A total of 1054 cases of forearm fracture were followed for 0.5-6.5 years (average, 2.5 years). The results were excellent in 735 cases (69.7%); good, 153 (14.5%); fair, 79 (7.5%); and poor, 87 (8.3%). The time of bone union was from 21-258 days. Nonunion occurred in three cases. Anatomic observations were carried out in specimens of adult forearms, which showed that: the interosseous membrane is an important factor in maintaining the stability of the radius and ulna and is the anatomic basis for manipulative reduction by bone separation; the use of bone separator pads can maintain the normal tension of the interosseous membrane and the physiologic space between the radius and ulna. Stress analysis of the bone separator pads and splint immobilization suggests that treatment of forearm fracture by integrated traditional Chinese medicine and western medicine is simple, economical, relatively painless, and effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

The control of blood flow through human forearm muscles following brief isometric contractions.

1. The blood flow through the forearm was measured 2 sec after single, brief isometric hand-grip contractions. The tension and duration of those contractions varied from 10 to 100% of the maximal voluntary contraction (m.v.c.) and from 2 to 12 sec, respectively. 2. The blood flow increased linearly with tension up to about 60% m.v.c. but further increases in tension, up to 100% m.v.c., did not elicit higher blood flows than were found at 60% m.v.c. The same relationship between tension and the resultant blood flow held for all durations of contractions, from 2 to 12 sec. The blood flow immediately after (2 sec) contractions at a given tension increased linearly with the duration of the contraction, from 2 to 12 sec. Maximal exercise blood flow was approached only in response to the longest contractions (12 sec) at tensions of 60% m.v.c. or higher. 3. Brief alterations (2--5 sec) of transmural pressure across blood vessels did not result in a significant change of blood flow, either in the resting forearm or when the vessels were dilated by brief, isometric contractions. When the tension was applied or released either rapidly or gradually ('ramp' contractions) there was no correlation between the rate of change of stretch on arterial vessels and the resultant blood flow. However, there was a direct relationship between a force--time integral (duration of contraction x peak tension) and blood flow. All these results make it clear that changes in blood flow in the forearm elicited by brief isometric contractions are not the result of a myogenic reflex but are metabolically induced. 4. Successive contractions exerted at 60% m.v.c. for 4 sec induced a blood flow of 21.2 +/- 1.6 ml.min-1.100 ml.-1 when a rest interval of 8 sec was allowed between the contractions. Blood flows remained constant at this submaximal level, even when muscular fatigue was induced, and when there was an accompanying large increase in blood pressure. 5. Isometric muscular activity by the contralateral arm which resulted in fatigue, associated with a large increase in mean blood pressure, did not alter the level of vasodilation that was induced by brief, isometric contractions in the 'test' arm. 6. It is suggested that the vasodilatation in response to intermittent isometric contractions is the result of metabolic vasodilatation of distal segments and continued sympathetic vasoconstriction of the proximal segments of the forearm vascular bed.

Blood Pressure↗
PubMed1983

Effects of postoperative infusion of branched chain amino acids on nitrogen balance and forearm muscle substrate flux.

A branched chain amino acid (45% BCAA)--enriched solution was compared with a standard amino acid (25% BCAA) solution in a randomized blinded study in eight patients undergoing cystectomy and ileal loop diversion. Solution administration rates were designed to provide 20 kcal/kg/day and 0.26 gm nitrogen/kg/day postoperatively from days 1 to 8. Daily urine creatinine and nitrogen levels were measured. On day 4 during infusion, forearm blood flow was measured by capacitance plethysmography. Arterial and antecubital deep venous blood samples were drawn simultaneously for determinations of glucose, lactate, pyruvate, and amino acids; substrate flux was calculated (mumol/ml/min, uptake = +, release = -). The mean total amino acid flux was significantly improved In the 45% BCAA group (+1.7 +/- 0.4) versus the 25% BCAA group (-0.03 +/- 0.2, P less than 0.05). The mean total BCAA flux was significantly improved in the 45% BCAA group (+1.1 +/- 0.4) compared with the 25% BCAA group (-0.03 +/- 0.2) (P less than 0.02). There were no significant differences between groups in alanine, glutamine, glucose, lactate, or pyruvate forearm flux. The cumulative adjusted 7-day nitrogen balance was -1.4 +/- 7 gm in the 45% BCAA group and -14.2 +/- 4 gm in the 25% BCAA group (NS). the 45% BCAA solution resulted in significant uptake of total amino acid and BCAA into forearm muscle, which was not significantly demonstrated in whole body nitrogen balance studies. Sixty-six percent of the increase in total amino acid forearm flux with use of the 45% BCAA solution was due to the uptake of BCAA even though less leucine was given compared with the 25% BCAA solution.

Adult↗
PubMed1983

Intracompartmental forearm pressure during rest and exercise.

To investigate whether effort-related dorsal forearm pain could be due to an increase of the intracompartmental pressure (ICP) in the dorsal forearm compartment, the normal range of the ICP at rest and during exercise was first determined in 11 volunteers using a wick catheter. The ICP at rest was 6 mm Hg (range, 2-11 mm Hg), and during exercise the pressure rose to about six times the resting level. Fourteen patients with pain in the dorsal forearm during exercise were similarly examined. In six patients the pressure at rest and/or during exercise was more than twice that of the normal persons or that of the healthy forearm. After fasciotomy four of these six patients were relieved of pain within three weeks, which might suggest a relation between ICP and pain.

Adult↗
PubMed1982

The free forearm flap--a report of 25 cases.

In 25 cases using microvascular techniques, free forearm flaps were used for reconstruction of various tissue defects. 15 flaps were used for repair of hand injuries, 5 for facial defects, 1 for lower extremity deformity and 4 for total rhinoplasty. All flaps survived. The arterial blood supply of the forearm flap comes from the cutaneous branches of the radial artery while its venous drainage is via cephalic vein and the radial comitantes veins. The forearm flap has a thin layer of subcutaneous fatty tissue, can provide quite large area of soft tissue and the vascular pedicle is long with moderately large calibre vessels. The donor area, however, has to be skin grafted, leaving an unsightly scar over the forearm which is one of the shortcomings of this flap. Secondly it means sacrificing a major arterial supply to the hand on the donor side.

Adult↗
PubMed1980

Forearm fractures: treatment by rigid fixation with early motion.

Sixty-four adult patients with ninety-two acute diaphyseal fractures of the forearm were treated with plate-and-screw fixation. In these patients, we analyzed the effect of early active postoperative motion. Patients with open fractures and those with fractures of both bones of the forearm lost significantly more rotation of the forearm, irrespective of treatment, compared with the other groups of patients in our series. A program of early active motion without immobilization increased the range of motion of the forearm in patients with fractures of both bones. However, this was not the case in patients with single-bone (radial or ulnar) fractures.

Adolescent↗
PubMed1995

Use of hand-held Doppler to identify 'difficult' forearm veins for cannulation.

Intravenous cannulation is a necessary procedure in many hospital patients. Some patients are regarded as having 'impossible' veins that are invisible and impalpable despite venous tourniquet. We investigated the use of a hand-held Doppler to identify veins suitable for percutaneous cannulation in such patients. A total of 24 arms in 12 patient volunteers with invisible and impalpable forearm veins was studied by squeezing the ipsilateral hand and using a hand-held 8 MHz Doppler probe on the forearm. Each venous signal was noted and the loudest chosen. Classification as 'good' or 'poor' was made on signal strength. The best signal was then mapped and the direction was indicated by a line on the skin. Each forearm was examined using a colour-flow Duplex. All veins were noted and diameters measured with and without tourniquet. These results were compared with the best veins found by hand-held Doppler. In all, 23 (96%) arms had the largest vein correctly identified by the hand-held Doppler. All 19 (100%) described as 'good' on signal had a diameter of 2.0-4.2 mm (mean 3.2 mm). All 4 (100%) described as 'poor' on Doppler signal had diameters of 1.4-1.7 mm (mean 1.6 mm). Hand-held Doppler, used as described, can accurately identify forearm veins larger than 2.0 mm in diameter in patients with invisible and impalpable veins with venous tourinquet. These veins should be amenable to percutaneous cannulation.

Catheterization, Peripheral↗
PubMed1994

In vivo release of tissue-type plasminogen activator across the human forearm during mental stress.

We have previously shown that plasma levels of endothelium-derived tissue-type plasminogen activator (t-PA) increase during mental stress. The aim of the study was to investigate in vivo release in an intact human muscle vascular bed. Eleven healthy young males (22-36 yrs) were studied at rest and during 10 min of mental stress (forced arithmetic). Net release or uptake were assessed by arterio-venous (AV) concentration gradients across the forearm of t-PA antigen and t-PA activity, and plasminogen activator inhibitor antigen type 1 (PAI-1). Forearm blood flow was measured by venous occlusion plethysmography. At rest, there was a positive AV-difference of t-PA activity across the forearm indicating a net release of t-PA activity of approximately 3.7 fmol x min-1 x 100 ml-1 (Wilcoxon's signed rank test vs 0, p = 0.01). However, t-PA antigen showed a variable release pattern. On the average, there was a net release of 0.17 ng x min-1 x 100 ml-1 after 60 min of rest (Wilcoxon vs 0, p = 0.07). PAI-1 antigen showed net release at rest. In response to stress, forearm blood flow increased from 1.9 to 2.9 ml x min-1 x 100 ml-1 (ANOVA, p = 0.007), and net release of t-PA activity increased to 9.8 fmol x min-1 x 100 ml-1 (ANOVA, p = 0.01 compared with rest). Arterial and venous plasma t-PA levels also increased significantly during stress (ANOVA, p < 0.01). t-PA antigen showed a similar but less pronounced release pattern during stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Effects of retained diaphyseal plates on forearm bone density and grip strength.

Numerous complications have been attributed to elective plate removal following successful treatment of both bone diaphyseal forearm fractures, yet the effects of retained implants are not known. Fourteen patients were reviewed for residual forearm grip strength (FGS) and bone mineral density (BMD) following uneventful union. Patients were analyzed in two groups based upon time from fixation: group I, > 2 years but < or = 5 years, and group II, > 5 years. In group I, mean 2.6 years follow-up (n = 6), mean FGS ratios (patient values/age matched general population means) were 0.65 and 0.77, respectively, for plated and normal limbs (p = 0.08). The mean BMD ratios of plated/normal sides adjacent to the plate were 0.99 (ulna) and 1.02 (radius); these values were not significantly different from more proximal forearm BMD ratios (p = 0.92 ulna; p = 0.44, radius). In group II, mean 8.4 years (n = 8), mean FGS ratios were 0.97 and 1.09, respectively, for plated and normal limbs (p > 0.05). The BMD ratio was 1.04 adjacent to the plate; this was not significantly different from the ratios measured away from the plate (p > 0.4). We conclude that retained forearm plates can be well tolerated and that their routine removal is not indicated based on FGS or BMD.

Adolescent↗
PubMed1995

Systemic hemodynamic, forearm vascular, renal, and humoral responses to sustained cardiopulmonary baroreceptor deactivation in well-compensated cirrhosis.

The aim of this study was to assess baroreceptor function in well-compensated cirrhosis by determining the forearm vascular, renal, and humoral responses to sustained baroreceptor deactivation. The effect of sodium status on baroreceptor function was also assessed. Eight cirrhotic patients and 10 age- and sex-matched controls were studied twice after a 20 mmol and 200 mmol of sodium/d diet for 7 days. Systemic and renal hemodynamics, renal sodium handling, forearm blood flow, and neurohumoral factors were assessed before, during, and after the application of lower body negative pressure (LBNP) for 1 hour. Controls and cirrhotic patients had similar baseline mean arterial pressure, heart rate, forearm and renal hemodynamics. High-sodium intake resulted in suppression of sympathetic nervous activity in the controls (plasma norepinephrine, 1.06 +/- 0.11 nmol/L on low vs. 0.76 +/- 0.08 nmol/L on high sodium; P = 0.01) but not in the cirrhotic patients (1.35 +/- 0.22 nmol/L on low vs. 1.26 +/- 0.11 nmol/L on high sodium; P > 0.05). Both groups responded to LBNP with significant further increases in plasma norepinephrine, resulting in significant decreases in forearm blood flow on both sodium diets. Controls also responded with a significant worsening of renal hemodynamics on low-sodium diet only, but this was not observed in the cirrhotic patients on either diet. Therefore, in well-compensated cirrhotic patients: (1) sympathetic activation occurs despite an adequate, effective arterial filling, and this may contribute to sodium retention; and (2) baroreceptor function is normal. Apparent end organ unresponsiveness within the renal circulation may account for the lack of renal hemodynamic changes to reflex sympathetic stimulation.

Adult↗
PubMed1996

Percutaneous absorption of hydrocortisone and testosterone on the vulva and forearm: effect of the menopause and site.

The percutaneous absorption of hydrocortisone and testosterone was studied following their application to the vulvar and ventral forearm regions of pre- and post-menopausal women. Percutaneous absorption of hydrocortisone was significantly greater in vulvar skin than forearm skin in both pre- and post-menopausal women (P < 0.05, respectively), whereas the percutaneous absorption of testosterone was significantly increased (P < 0.01) on the vulva compared with the arm only in post-menopausal women. The effect of age on the percutaneous absorption of hydrocortisone and testosterone was evaluated by using the menopause as a biological chronometric end point. It is a common misconception that older skin has a diminished barrier capacity, and that percutaneous absorption is therefore greater. Our studies showed that absorption of hydrocortisone vulval skin of pre-menopausal women was significantly greater (P < 0.01) than in post-menopausal women. The ventral forearm skin of pre-menopausal women tended to show increased absorption compared with post-menopausal women, but statistical significance was not reached. No significant differences (P > 0.05) in the percutaneous absorption of testosterone in vulval or forearm skin were observed between the two age groups.

Administration, Topical↗
PubMed1995

Hydrochlorothiazide exerts no direct vasoactivity in the human forearm.

BACKGROUND: Recently, hydrochlorothiazide has been shown to relax vascular smooth muscle in vitro in clinically relevant concentrations by the opening of calcium-activated potassium channels, leading to hyperpolarization and consequent closing of voltage-operated calcium channels. Long-term administration of hydrochlorothiazide reduces peripheral vascular resistance in vivo in man. These results indicate that hydrochlorothiazide has hemodynamic activity, and we therefore examined the direct vascular action of this drug in vivo. SUBJECTS AND METHODS: Forearm vasodilator responses to the infusion of a placebo and five increasing doses of hydrochlorothiazide into the brachial artery were recorded by venous occlusion strain-gauge plethysmography (perfused forearm technique) in eight normotensive male volunteers. Venous samples were taken from an ipsilateral antecubital vein at the end of each infusion period to measure the hydrochlorothiazide concentration. RESULTS AND DISCUSSION: Plasma concentrations of hydrochlorothiazide averaged 3.5 +/- 0.3 mu g/ml at the highest infusion rate. This concentration leads to a 60 +/- 10% relaxation in vitro and is more than 10 times the therapeutic plasma concentration. Despite these supratherapeutic levels, we were unable to demonstrate a change in forearm blood flow and vascular resistance. Also, no significant changes were observed in blood pressure and heart rate. CONCLUSION: In contrast to in vitro results, hydrochlorothiazide does not exert any direct vasoactivity in the forearm vascular bed of healthy normotensive male volunteers at (supra)therapeutic plasma concentrations.

Antihypertensive Agents↗
PubMedDate not supplied

Factors affecting fracture position at cast removal after pediatric forearm fracture.

The outcome of a pediatric forearm fracture is related to the angulation of that fracture at the time of union. We discuss the factors affecting the position of the fracture at union. Three hundred forty-six children with 369 reductions of forearm fractures were reviewed retrospectively. Quality of reduction at the time of operation and loss of reduction during the period of cast immobilization were assessed using axis deviation. Loss of reduction had a greater influence on the final position of the fracture at union than did the position of the fracture at initial reduction. To ensure a satisfactory outcome, all pediatric forearm fractures should be monitored with radiologic review and remanipulation if their axis deviation is > 5 in younger patients or > 3 in patients with fractures close to or after growth-plate closure. Right forearm fractures in boys were identified as a subgroup at greater risk for redisplacement.

Analysis of Variance↗
PubMedDate not supplied

Management of forearm deformity in multiple hereditary osteochondromatosis.

The records of 97 patients with multiple hereditary osteochondromatosis were retrospectively reviewed. Seventy-eight patients had one or more osteochondroma(s) of one or both forearm(s). Fifty-three operations were performed, of which 41 were excisions of symptomatic osteochondromas or dislocated radial heads. All forearm, wrist, and elbow radiographs were reviewed. Four common radiographic parameters were measured: radial articular angle, carpal slip, relative ulnar shortening, and forearm-third metacarpal angle. Thirty-seven of these 78 patients were contacted by telephone questionnaire. The results indicated that skeletally mature patients do well on a functional basis and are comfortable with their appearance, despite deformity. Surgery can improve aesthetic appearance and provide pain relief when done before or after skeletal maturity. Because of these results, we are less aggressive in the early treatment of forearm deformities.

Adolescent↗
PubMed1998

Once-daily nifedipine sustained release (nifelan) on forearm vascular resistance and regression of left ventricular hypertrophy in patients with mild to moderate essential hypertension.

BACKGROUND: Nifelan, a sustained-release formulation of nifedipine, is a new antihypertensive agent. However, its effect on peripheral vascular resistance and left ventricular mass is still controversial. METHODS: We evaluated the antihypertensive efficacy and safety of nifelan in 20 patients with mild to moderate essential hypertension. After 2 weeks of a placebo-qualifying phase, the eligible patients were entered into an 8-week active treatment period in which nifelan was given 10-40 mg once-daily with gradual titration. RESULTS: Seventeen patients (8 men, 9 women; age range 43-72 years, mean 52 years) completed the entire study. The mean sitting systolic and diastolic blood pressures were significantly reduced (p < 0.0001) by 13.8 mmHg and 9.6 mmHg, respectively, with a mean nifelan dose of 27.1 +/- 2.7 mg per day, while the heart rate remained unchanged (75.9 +/- 1.3 vs. 73.6 +/- 0.9 beats per minute, p = NS). Four patients (20%) reported side effects necessitating termination of nifelan treatment in 2 patients because of intolerance. One patient was found to be poorly compliant and withdrew prematurely from the study for unknown reasons without complaints of adverse effects. Echocardiographic left ventricular mass index was significantly reduced from 104.2 +/- 4.6 g/m2 to 96.6 +/- 5.2 g/m2 (p < 0.05), and the left ventricular diastolic function evaluated by E/A ratio showed a trend toward improvement from 0.97 +/- 0.06 to 1.10 +/- 0.07 (p = 0.06). Both forearm hemodynamic parameters showed favorable changes from baseline to the end of the study (forearm blood flow, 3.39 +/- 0.28 vs. 4.04 +/- 0.31 ml/100 ml/min, p < 0.05; forearm vascular resistance, 37.75 +/- 4.95 vs. 28.73 +/- 3.34 mmHg/ml/100 ml/min, p < 0.05). The lipid profiles followed trends toward favorable changes after treatment (high density lipoprotein, 51.8 +/- 3.0 vs. 54.4 +/- 3.3 mg/dl, p = NS; low density lipoprotein, 146.1 +/- 8.8 vs. 139.9 +/- 10.6 mg/dl, p = NS). Hematological and biochemical parameters did not change at the end of treatment. CONCLUSION: Once-daily nifelan as monotherapy was safe and effective in Chinese patients with mild to moderate essential hypertension. Regression of left ventricular mass and reversal of unfavorable forearm hemodynamics were observed in these patients after short-term therapy.

Adult↗
PubMed1998

Use of toenail fluoride levels as an indicator for the risk of hip and forearm fractures in women.

The relation between fluoride intake and risk of osteoporotic fractures remains unclear. The lack of individual measures of long-term fluoride intake has limited epidemiologic studies. We used toenail fluoride in this study as a measure of long-term intake to evaluate the relation between fluoride intake and subsequent risk of hip and distal forearm fractures. Between 1982 and 1984, we collected toenail clippings from 62,641 women in the Nurses' Health Study who were free from cancer, heart disease, stroke, and previous hip or forearm fracture. We identified fracture cases (53 proximal femur and 188 distal forearm) through subsequent biennial mailed questionnaires and matched controls to cases on year of birth. The odds ratio of hip fracture among women in the highest quartile of toenail fluoride [ > 5.50 parts per million (ppm)], compared with those in the lowest quartile (> 2.00 ppm), was 0.8 (95% confidence interval = 0.2-4.0), with adjustment for menopausal status, postmenopausal hormone use, caffeine intake, and alcohol consumption. The corresponding adjusted odds ratio for forearm fracture was 1.6 (95% confidence interval = 0.8-3.1). Further adjustment for body mass index, smoking status, and calcium and vitamin D intake did not alter these results.

Adult↗