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PubMed1969

Base sequence homology and renaturation studies of the deoxyribonucleic acid of extremely halophilic bacteria.

The genetic relatedness among various strains of halophilic bacteria has been assessed by deoxyribonucleic acid-deoxyribonucleic acid (DNA-DNA) duplex formation and ribosomal ribonucleic acid (RNA) hybridization. All of the strains of extremely halophilic rods are closely related, and the extent of divergence of base sequence is similar for the major and minor DNA components. Parallel experiments with ribosomal RNA revealed a relationship between the extremely halophilic rods and cocci and a more distant relationship to moderate halophiles and to a photosynthetic extreme halophile. Renaturation studies of halophile DNA exclude the possibility that the satellite DNA represents multiple copies of a small episomal element. The kinetics of DNA renaturation show that the genome size of the extreme and moderate halophiles is similar to that of Escherichia coli.

Adenine↗
PubMed2005

The incidences of and consultation rate for lower extremity complaints in general practice.

OBJECTIVE: To estimate the incidence and consultation rate of lower extremity complaints in general practice. METHODS: Data were obtained from the Second Dutch National Survey of General Practice, in which 195 general practitioners (GPs) in 104 practices recorded all contacts with patients during 12 consecutive months in computerised patient records. GPs classified the symptoms and diagnosis for each patient at each consultation according to the International Classification of Primary Care (ICPC). Incidence densities and consultation rates for different complaints were calculated. RESULTS: During the registration period 63.2 GP consultations per 1000 person-years were attributable to a new complaint of the lower extremities. Highest incidence densities were seen for knee complaints: 21.4 per 1000 person-years for women and 22.8 per 1000 person-years for men. The incidence of most lower extremity complaints was higher for women than for men and higher in older age. CONCLUSIONS: Both incidences of and consultation rates for lower extremity complaints are substantial in general practice. This implies a considerable impact on the workload of the GP.

Adolescent↗
PubMed2004

Impact of musculoskeletal co-morbidity of neck and upper extremities on healthcare utilisation and sickness absence for low back pain.

AIMS: To describe the presence of musculoskeletal co-morbidity of the neck and upper extremities among industrial workers with low back pain, and to examine whether it has an impact on healthcare utilisation and sickness absence for low back pain. METHODS: A self administered questionnaire was used to collect data from 505 industrial workers (response 86%). RESULTS: The 12 month prevalence of low back pain was 50%. Among subjects with low back pain the 12 month prevalence of musculoskeletal co-morbidity of the neck and upper extremities was 68%. Among workers with low back pain, subjects with high pain intensity or disabling low back pain were more likely to have musculoskeletal co-morbidity. In comparison to the subjects who report back pain only, subjects with co-morbidity showed worse general health and health related quality of life. No impact of upper extremity co-morbidity was found on healthcare utilisation, and sickness absence due to low back pain. CONCLUSIONS: This study provides no evidence that musculoskeletal co-morbidity of the neck and upper extremities influences the choice to seek care or take sick leave due to low back pain among industrial manual workers. For occupational health practitioners the finding of a high co-morbidity is important to consider when implementing workplace interventions aimed at the reduction of specific musculoskeletal complaints, since the controls for one musculoskeletal complaint may impact adversely on another musculoskeletal complaint. Researchers who perform low back pain intervention studies using generic health measures, should take into account the impact of musculoskeletal co-morbidity on these measures.

Absenteeism↗
PubMed2001

Multi-detector row CT angiography of lower extremity arterial inflow and runoff: initial experience.

PURPOSE: To assess the patterns of lower extremity arterial inflow and runoff opacification with four-channel multi-detector row computed tomographic (CT) angiography in a cohort of patients with disease warranting imaging of the lower extremity arterial system. MATERIALS AND METHODS: Twenty-four patients with symptomatic lower extremity arterial occlusive or aneurysmal disease underwent imaging with four-channel multi-detector row CT from the supraceliac abdominal aorta through the feet. Transverse sections were acquired with a 2.5-mm nominal detector width and pitch of 6.0 (3.2-mm effective section thickness) following intravenous injection of 174-185 mL of iodinated contrast medium (300 mg iodine per milliliter). In each patient, attenuation measurements were recorded in 16 arterial and 16 venous locations. In 18 patients, two radiologists assessed the detectability and stenosis degree of 21 arterial segments per patient relative to these features at conventional angiography. RESULTS: A mean scanning time of 66 seconds was required to cover a mean of 1,233 mm, resulting in a mean of 908 transverse reconstructions. All 504 arterial segments were depicted and analyzable. Mean arterial attenuation ranged from 253 HU in the midabdominal aorta to 357 HU in the popliteal artery and 253 HU in the dorsalis pedis or posterior tibial artery measured inferior to the tibiotalar joint. Maximum mean venous enhancement (99 HU) was observed in the saphenous vein at the ankle, with all other venous stations measuring less than 74 HU. CONCLUSION: The arteries of lower extremity inflow and runoff can be reliably depicted with minimal venous enhancement by using multi-detector row CT.

Adult↗
PubMed1988

Lower-extremity venous thrombosis: comparison of venography, impedance plethysmography, and intravenous manometry.

This study was undertaken to compare impedance plethysmography with lower-extremity venography and venous manometry in the diagnosis of acute deep venous thrombosis (DVT) of the lower extremity. Ninety-six extremities were studied. In this population, in which the prevalence of acute DVT was 43.8%, plethysmography had a sensitivity of 86.8% and a specificity of 72.0%. The predictive value of abnormal findings at plethysmography was 70.2%, and the predictive value of normal findings at plethysmography was 87.8%. Venous manometry was performed successfully in 89 extremities. A statistically significant difference was shown in the mean intravenous pressure between patients with and without acute DVT. However, there was considerable overlap between the two populations, limiting the predictive value of impedance plethysmography in any given patient.

Adult↗
PubMed1998

Distal lower extremity arteries: evaluation with two-dimensional MR digital subtraction angiography.

PURPOSE: To test the hypothesis that magnetic resonance (MR) digital subtraction angiography is superior to two-dimensional time-of-flight (TOF) MR angiography for demonstration of patent arteries in the distal lower extremity. MATERIALS AND METHODS: Thirty-seven lower extremities in 23 consecutive patients were imaged with two-dimensional TOF MR angiography and two-dimensional MR digital subtraction angiography. Images were interpreted in a randomized and blinded manner. Each lower extremity was subdivided into seven potential arterial segments. The number of digital arteries visualized was also determined. Overall image quality of MR digital subtraction and TOF angiograms was compared. The relative ability of MR digital subtraction angiography and TOF MR angiography to demonstrate patent arterial segments was assessed. RESULTS: MR digital subtraction angiography was significantly superior to TOF MR angiography for demonstration of patent arterial segments and digital arteries (P < .001). MR digital subtraction angiographic images were qualitatively superior to TOF images (P < .001). CONCLUSION: Two-dimensional MR digital subtraction angiography is superior to two-dimensional TOF MR angiography for help in identifying patent segments in the distal lower extremity.

Adult↗
PubMed1999

Acute upper extremity deep venous thrombosis: safety and effectiveness of superior vena caval filters.

PURPOSE: To evaluate the safety and effectiveness of percutaneous filter placement in the superior vena cava for prevention of pulmonary embolism (PE) due to acute upper extremity deep venous thrombosis (DVT) in patients with contraindications to or unsuccessful anticoagulation. MATERIALS AND METHODS: Forty-one patients with acute upper extremity DVT and contraindications to or unsuccessful anticoagulation underwent percutaneous placement of a superior vena caval filter for prevention of PE. Four types of filters were used. Follow-up chest radiographs were used to detect filter migration, dislodgment, and fracture. Placements of central venous and Swan-Ganz catheters after filter insertion were recorded. Patients were followed up clinically for evidence of superior vena cava syndrome and PE. Kaplan-Meier survival rates were determined. Follow-up was 1 day to 221 weeks. RESULTS: No complications such as filter migration, dislodgment, or fracture occurred (median follow-up, 12 weeks). No patients developed clinical evidence of PE due to upper extremity thrombosis or superior vena cava syndrome (median follow-up, 15 weeks). Catheters were placed subsequent to filter placement in 23 patients (56%) without complication. CONCLUSION: Percutaneous filter placement in the superior vena cava is a safe and effective method for preventing symptomatic PE due to acute upper extremity DVT in patients in whom therapeutic anticoagulation has failed or is contraindicated.

Acute Disease↗
PubMed1999

Aortoiliac and lower extremity arteries: comparison of three-dimensional dynamic contrast-enhanced subtraction MR angiography and conventional angiography.

PURPOSE: To determine the clinical feasibility of three-dimensional dynamic contrast agent-enhanced subtraction magnetic resonance (MR) angiography in patients with symptoms of lower extremity ischemia. MATERIALS AND METHODS: Twenty-three patients suspected of having lower extremity ischemia underwent three-dimensional dynamic contrast-enhanced subtraction MR angiography of the aortoiliac arteries and arteries of the lower extremity. As the reference standard, conventional angiography was also performed. For data analysis, the arterial system was divided into 10 segments. Each segment was classified as normal, mildly stenosed, moderately stenosed, severely stenosed, or occluded. RESULTS: At conventional angiography, 83 stenosed segments (14 mildly stenosed, 16 moderately stenosed, 14 severely stenosed, and 39 occluded) were identified in a total of 423 segments. For the segments with more than mild stenosis, MR angiography was 97.1% sensitive and 99.2% specific. CONCLUSION: Three-dimensional dynamic contrast-enhanced subtraction MR angiography has high sensitivity and specificity. This technique is a noninvasive alternative to conventional angiography for screening patients suspected of having lower extremity ischemia.

Aged↗
PubMed1999

Clinically suspected pulmonary embolism: use of bilateral lower extremity US as the initial examination--a prospective study.

PURPOSE: To determine the prevalence of deep venous thrombosis (DVT) and evaluate the use of symptoms and risk factors as selection criteria in the patient population undergoing lower extremity ultrasonography (US) as an initial examination for suspected pulmonary embolism (PE). MATERIALS AND METHODS: One hundred eighty-two consecutive patients referred for bilateral lower extremity US as the first examination for suspected PE were evaluated prospectively for predisposing factors and symptoms of DVT. Patients were placed into four groups: group 1, no symptoms or risk factors; group 2, both symptoms and risk factors; group 3, only risk factors; group 4, only symptoms. The prevalence of DVT detected at lower extremity US in each group was determined. RESULTS: There were 89 patients in group 1, 12 in group 2, 43 in group 3, and 38 in group 4, with a DVT prevalence of 0%, 25%, 14%, and 24%, respectively. There was no significant difference in DVT prevalence between groups with symptoms or risk factors but a significant difference between these groups and the group lacking both symptoms and risk factors. CONCLUSION: Lower extremity US as the initial examination in patients suspected of having PE should be used only in those patients who have symptoms or risk factors for DVT. This would substantially decrease the number of examinations performed without a decline in DVT detection.

Adolescent↗
PubMed2005

Diagnosing traumatic arterial injury in the extremities with CT angiography: pearls and pitfalls.

Computed tomographic (CT) angiography is a reliable and convenient imaging modality for diagnosing arterial injuries after blunt and penetrating trauma to the extremities. It is a noninvasive modality that could replace conventional arteriography as the initial diagnostic study for arterial injuries after trauma to the extremities. The technique requires scanning with multidetector helical CT after rapid intravenous injection of iodinated contrast material. The CT angiographic signs of arterial injuries in the extremities are active extravasation of contrast material, pseudoaneurysm formation, abrupt narrowing of an artery, loss of opacification of a segment of artery, and arteriovenous fistula formation. Metallic streak artifact, motion artifact, and inadequate arterial opacification may render a CT angiogram nondiagnostic. Studies have shown the sensitivity of CT angiography to be 90%-95.1% and its specificity 98.7%-100% for detecting arterial injury to the extremities after trauma.

Angiography↗
PubMed2004

Impaired plasma fatty acid oxidation in extremely obese women.

Skeletal muscle from extremely obese individuals exhibits decreased lipid oxidation compared with muscle from lean controls. It is unknown whether this effect is observed in vivo or whether the phenotype is preserved after massive weight loss. The objective of this study was to compare free fatty acid (FFA) oxidation during rest and exercise in female subjects who were either lean [n = 7; body mass index (BMI) = 22.6 +/- 2.2 kg/m(2)] or extremely obese (n = 10; BMI = 40.8 +/- 5.4 kg/m(2)) or postgastric bypass patients who had lost >45 kg (weight reduced) (n = 6; BMI = 33.7 +/- 9.9 kg/m(2)) with the use of tracer ([(13)C]palmitate and [(14)C]acetate) methodology and indirect calorimetry. The lean group oxidized significantly more plasma FFA, as measured by percent fatty acid uptake oxidized, than the extremely obese or weight-reduced group during rest (66.6 +/- 14.9 vs. 41.5 +/- 16.4 vs. 39.9 +/- 15.3%) and exercise (86.3 +/- 11.9 vs. 56.3 +/- 22.1 vs. 57.3 +/- 20.3%, respectively). BMI significantly correlated with percent uptake oxidized during both rest (r = -0.455) and exercise (r = -0.459). In conclusion, extremely obese women and weight-reduced women both possess inherent defects in plasma FFA oxidation, which may play a role in massive weight gain and associated comorbidities.

Adult↗
PubMed1982

Man at extreme altitude.

The history of man's attempts to learn more about the physiology of extreme altitudes is briefly reviewed. The earliest exploits were by balloonists who were often exposed to very severe hypoxia, sometimes with fatal consequences. A turning point was the work by Paul Bert using low-pressure chambers; he was able to prove that the deleterious effects of low barometric pressures were caused by the low PO2, though other explanations for mountain sickness such as a low aterial PCO2 continued to be promoted for some time. Many early physiologists believed that active secretion of oxygen by the lungs was necessary to explain man's tolerance of extreme altitudes. Indeed, Haldane championed this view until his death in 1936, though strong evidence to the contrary had accumulated since the work of Krogh and others in the first decade of the century. High climbs by mountaineers have stimulated much interest in the physiology of severe hypoxia. Norton reached over 8,500 m on Mt. Everest in 1924, but the summit was not attained without supplementary oxygen until 1978--the last 300 m took 54 years! This suggests that the summit, altitude 8,848 m, is very near the limit of human tolerance, and predictions based on maximal work levels measured at lower altitudes are consistent with this. The American Medical Research Expedition to Everest, 1981, was specifically planned to obtain data on human physiology at extreme altitudes, and a number of measurements were made over 8,000 m, including some on the summit itself. It is apparent that the mountain can be climbed without supplementary oxygen only because the barometric pressure at the summit is not as low as has often been predicted, and because of the extreme hyperventilation that man develops under these conditions.

Altitude↗
PubMedDate not supplied

Exclusive lower extremity mirror movements and diastematomyelia.

Mirror movements usually seen in the Klippel-Feil syndrome are most commonly appreciated in the upper extremities. Lower extremity involvement is seen rarely and when observed, is found in conjunction with upper extremity mirror movements. We report what we believe to be the first case of mirror movements found exclusively in the lower extremities in a female patient presenting with tethered cord syndrome. Our hopes are that this report will help elucidate mechanisms involved with these anomalous movements, as currently there is no commonly accepted etiology.

Adolescent↗
PubMed1995

Effects of continuous intrathecal baclofen infusion and selective posterior rhizotomy on upper extremity spasticity.

This study was performed to compare the effects of continuous intrathecal baclofen infusion (CIBI) and selective posterior rhizotomy (SPR) on upper extremity (UE) spasticity and range of motion in children with cerebral palsy. Spasticity was assessed with the Ashworth scale of muscle tone and range of motion was evaluated. Thirty-eight patients who had been treated with CIBI for at least 6 months were paired, according to pretreatment UE muscle tone and functional status, with 38 patients who had undergone SPR. The CIBI dosage had been titrated to reduce over lower extremity spasticity and improve lower extremity function, rather than to improve UE tone. The pretreatment muscle tone in the two groups was virtually identical. The UE tone of children treated with CIBI decreased from 2.07 prior to treatment to 1.66 after 1 year (p < 0.01). The tone of children treated with SPR decreased from 2.03 to 1.70 after 1 year (p = 0.005). In that group, the likelihood of a clinically significant reduction in muscle tone (one point or greater) was greater in children with a higher pretreatment UE muscle tone. There was no correlation between the percentage of posterior lumbar roots divided in SPR and the subsequent reduction in UE tone. There were no significant changes in the range of motion in any UE joint, at either 6 or 12 months, after either CIBI or SPR. We conclude that both CIBI and SPR significantly reduce UE spasticity, in addition to the previously documented reduction in lower extremity spasticity.

Arm↗
PubMed1994

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

High-resolution B-mode ultrasonography of the carotid arteries is used to investigate the signs of early atherosclerotic vessel wall disease. To assess whether carotid artery findings reflect atherosclerosis elsewhere, we studied the association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study. The Rotterdam Study is a single-center population-based prospective follow-up study of 7983 subjects, > or = 55 years old. Baseline measurements include ultrasound imaging of intima-media thickness of the distal common carotid artery and determination of the ankle-to-arm systolic blood pressure index. Lower extremity arterial disease was defined as an ankle-arm index < 0.90 in at least one leg. An increase of 0.1 mm in common carotid artery intima-media thickness was associated with an age- and sex-adjusted reduction of the ankle-arm index of 0.026 (95% confidence interval [CI]: 0.018 to 0.034). The age- and sex-adjusted odds ratio of lower extremity arterial disease for subjects with an intima-media thickness > or = 0.89 mm (upper quintile) to that of subjects with an intima-media thickness < 0.89 mm was 3.4 (95% CI: 2.2 to 5.2). Analysis among subjects free from symptomatic cardiovascular disease yielded a reduction in ankle-arm index per 0.1 mm increase in intima-media thickness of 0.018 (95% CI: 0.008 to 0.28) and an odds ratio for lower extremity arterial disease of 3.0 (95% CI: 1.7 to 5.1). Adjustments for differences in serum lipids, hypertension, and current smoking status only slightly attenuated the results.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.

BACKGROUND: Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. METHODS AND RESULTS: To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non-CVC-associated UEDVT patients were younger (59.2+/-18.2 versus 64.2+/-16.9 years old; P<0.0001), less often white (65% versus 73%; P<0.01), leaner (body mass index [BMI] 26.8+/-7.1 versus 28.5+/-7.3 kg/m2; P<0.001), and more likely to smoke (19% versus 13%; P=0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of <67 years, a BMI of <25 kg/m2, and hospitalization were the independent predictors of non-CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis. CONCLUSIONS: UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.

Adolescent↗
PubMed1979

Deep venous thrombosis of the upper extremity: a reappraisal.

Deep venous thrombosis (DVT) of the upper extremity is an unusual thrombotic event (1-2% of all DVT) which can be conveniently divided into two categories, traumatic (including "stress") and spontaneous. The spontaneous form is not reported as often in the literature, but occurs more commonly than the traumatic form. There is an increased left-sided predominance in spontaneous DVT compared with the traumatic form, where a right-sided predominance exists. Possible anatomical and physiological explanations are offered for the left-sided predominance in spontaneous DVT of the upper extremity. The thrombogenesis of DVT of the upper extremity is compared with DVT of the lower extremity. An analysis of responses to therapy and considerations for other therapeutic approaches are offered.

Adult↗
PubMed1996

Nocturnal fall of blood pressure and silent cerebrovascular damage in elderly hypertensive patients. Advanced silent cerebrovascular damage in extreme dippers.

To study the relation between diurnal blood pressure variations and silent cerebrovascular damage, we performed both 24-hour ambulatory blood pressure monitoring and brain magnetic resonance imaging in 131 elderly asymptomatic hypertensive patients. Silent cerebrovascular damage was identified by the magnetic resonance imaging findings of lacunae (low intensity in T1-weighted images and high intensity in T2-weighted images) and advanced periventricular hyperintense lesions (on T2-weighted images). The frequency of silent cerebrovascular damage in the 100 patients with sustained hypertension was greater than that in the 31 patients with white coat hypertension. We further classified the former group into nondippers (nocturnal reduction of systolic pressure by < 10% of awake systolic pressure; n = 46), dippers (reduction by > or = 10% to < 20%; n = 38), and extreme dippers (reduction by > or = 20%; n = 16). The extent of silent cerebrovascular damage was least severe in the dipper group (P < .05). This J-shaped relation was not found either with the cardiac hypertrophy detected by electrocardiography or with the renal damage assessed by urinary albumin excretion. More than half of the extreme dippers were patients with isolated systolic hypertension, and this prevalence was significantly greater than that in dippers or in nondippers (21% and 30%, respectively). Extreme dippers also had greater variability of pressure (standard deviation of awake systolic pressure) than dippers. Our results indicate that in addition to nondipping, extreme dipping (marked nocturnal fall of blood pressure) should be considered a type of abnormal diurnal blood pressure variation in elderly patients with hypertension who are likely to have advanced silent cerebrovascular damage.

Aged↗