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PubMed2001

Back and upper extremity disorders among enlisted U.S. Marines: burden and individual risk factors.

Although musculoskeletal disorders of the low back and upper extremities can affect military readiness, little is known about their extent and risk factors in the U.S. Marine Corps. Using the Defense Medical Epidemiology and Defense Medical Surveillance System databases, back and upper extremity diagnostic categories were among the top four sources of outpatient visits and duty limitation among enlisted Marines. Back disorders were also found to be the fifth most common cause for lost time. Subsequently, high-risk occupations were identified, age-related trends for clinic visit rates were determined, and rate ratios were computed for the top 15 low back and upper extremity diagnoses among enlisted Marines from 1997 through 1998. Occupational categories with the highest rates of musculoskeletal-related outpatient visits included image interpretation, auditing and accounting, disturbsing, surveillance/target acquisition, and aircraft launch equipment. Significantly increasing linear trends in rates across age groups were found for most diagnoses. For 1998, age-specific rate ratios indicated significantly higher rates for most low back and upper extremity disorders for females; lower rank (i.e., E1-E4) was also a risk, but for fewer diagnoses. The findings emphasize the need to identify modifiable (e.g., work-related, individual) risk factors and to develop focused primary and secondary prevention programs for musculoskeletal disorders in the Marine Corps. Subsequently, these efforts can assist in reducing associated effects, maximizing resource utilization, and enhancing operational readiness.

Adult↗
PubMed1998

[Management of true extremity aneurysms: experience in 23 patients].

OBJECTIVE: To explore the etiologic feature and specificity of diagnosis and treatment in true aneurysms of the extremities. METHOD: 23 patients with true aneurysms of the extremities from January 1984 to September 1997 were retrospectively reviewed. RESULT: Of 30 true aneurysms of the extremities, multiple aneurysms were found in 7 patients (30.4%). The multiple aneurysms were diagnosed in the same time or in different time. 21 patients were treated by exclusion of aneurysm and replacement with autogenous saphenous vein or graft. CONCLUSION: Early diagnosis and treatment are recommended to prevent complications which can cause limb loss, and multiple aneurysms must be taken into account. Importance of arteriography should be stressed in the diagnosis of multiple aneurysms. Exclusion of aneurysm and autogenous saphenous vein reconstruction is the first choice of treatment, circulation of the operated extremities should be noticed and close follow-up is imperative to pay attention to the development of new aneurysms.

Adolescent↗
PubMedDate not supplied

[Influence of social inequality, social unrest and extreme poverty on tuberculosis morbidity in the City of Barcelona].

BACKGROUND: The main purpose of this study was to analyse inequalities between tuberculosis/intravenous drug user and tuberculosis/not intravenous drug user among the different neighbourhoods of Barcelona and the relationship to socioeconomic indicators and social/material deprivation indicators throughout the 1990-1995 period. METHODS: An ecological study which included all cases of tuberculosis among residents of Barcelona, the analysis unit being the neighbourhood. Intravenous drug users within the 15-49 age range and non-intravenous drug users over age 14 were included. The mean annual incidence rate standardized by age was used. The social indicators considered were the inner city areas, unemployment, less than primary education, overcrowding, social unrest and extreme poverty. In the bivariate analysis, the relationship between tuberculosis incidence and the social indicators was studied by means of the Spearman correlation coefficient, and the multivariate analysis by means of the Poisson regression. RESULTS: The incidence rates were higher in the inner city neighbourhoods, followed by the newer outlying working class neighbourhoods in both groups studied, and in other older outlying districts for the non-users of intravenous drugs. Among the intravenous drug user group, the variables related to a greater risk of tuberculosis were: man (RR = 7.42, confidence interval at 95% ICI95%-: 6.16-8.93), age (RR = 61.51, CI95%: 34.64-109.20), unemployment (RR = 1.68, CI95%: 1.51-1.88), social unrest (RR = 1.29, CI 95%: 1.04-1.58), overcrowding (RR = 1.36, CI 95%: 1.19-1.55) and inner city areas (RR = 1.92, CI 95% 1.48-2.50). Among the male non-users of intravenous drugs, no interaction between unemployment and age was found. Neighbourhoods with extreme poverty and inner city neighbourhoods showed a higher risk of tuberculosis (RR = 1.11, CI 95% 1.08-1.135 and RR = 1.80, CI95%: 1.51-2.14). Among the female non-users of intravenous drugs, a relationship was found in those of lesser age (RR = 1.29, CI 95%: 1.05-1.57), unemployment (RR = 1.18, CI 95%: 1.09-1.26), extreme poverty (RR = 1.95, CI 95%: 1.56-2.45) and inner city areas (RR = 1.72, CI 95%: 1.35-2.19). CONCLUSION: Inequalities in tuberculosis are related to different social indicators such as unemployment and inner city areas. A difference exists between the two groups studied. Tuberculosis is related with social unrest and overcrowding among intravenous drug users and with extreme poverty among non-users of intravenous drugs.

Adolescent↗
PubMedDate not supplied

Mangled extremity severity score in children.

Treatment of the severely traumatized or mangled lower extremity poses significant challenges. The Mangled Extremity Severity Score (MESS) is a scale that uses objective criteria to assist with acute management decisions. Most research on the MESS has been in adults or combined series with few children. The study was performed to investigate the MESS in children exclusively. The MESS was applied retrospectively to 36 patients with grades IIIB and IIIC open lower extremity fractures collected from two level 1 pediatric trauma centers. Patients were divided into limb salvage and primary amputation groups based on the decision of the treating surgeon. In the salvage group there were 18 grade IIIB fractures and 10 grade IIIC fractures. The MESS prediction was accurate in 93% of the injured limbs. In the amputation group eight limbs met the inclusion criteria; the MESS agreed with the treating surgeon in 63% of cases. These findings suggest the MESS should be considered when managing a child with severe lower extremity trauma.

Amputation, Surgical↗
PubMed1968

Resistance of organisms to extreme influences in relation to some exobiological problems.

The conditions to which organisms have not been able to adapt in the process of evolution are called extreme influences or extreme conditions. The experiments show that organisms and cells have a potential for resistance; among animals, there are forms that are able to stand extremely low temperatures (from -80 to -269 degrees) when the water content of their tissues is large enough. Some species of protozoa can tolerate ionizing radiation in doses (500-1800 kr) of many orders exceeding those existing on the Earth and out in space. There are different ways of obtaining "protection" against ultraviolet (UV) shortwave sun radiation detained by the ozone layers of the Earth's atmosphere (photoreactivation, biological screens non-permeable for UV light, etc.). Many insects, especially alpine species, do not require as much oxygen as is contained in lower layers of the Earth's atmosphere. Hence, earth organisms possess some "margins of safety", enabling us to suggest the existence of similar biological systems in conditions different from the Earth's. The resistance to the action of extreme factors is probably connected with the resistance of biopolymers, protein complexes of cells and also with the capability of the organism to recover from damage.

Animals↗
PubMed2001

[Range of motion in the joints of the upper extremity at different stages of sympathetic reflex dystrophy (SRD)].

Sympathetic reflex dystrophy of the upper extremity is among the most serious complications of trauma injuries. The aim of this paper was to assess the effectiveness of mobilization treatment, augmented by cryogenic temperatures of post trauma SRD of the upper extremity. The material comprised 113 patients treated at the Orthopedic Outpatient Clinic of the J. Babiński Hospital in Breslau during the years 1987-1995. All patients underwent conservative treatment because of post trauma SRD. The effectiveness of cryo-therapy was based on pre- and post-therapy ROM examination. These results were compared to the ROM of the healthy extremity and the degree of ROM limitation was hence calculated. Limitation of ROM was found in all joints of the upper extremity regardless to the stage of the disease. The greatest limitations were found in the joints directly adjacent to the area were the disease was most pronounced. The applied therapy in these cases was found to increase ROM in all patients, with the greatest increase of ROM during stage I and II of the disease.

Arm Injuries↗
PubMed2000

Physical impairment and functional outcome in patients having lower extremity fractures after age 65.

The purpose of this study was to evaluate physical impairment and functional outcome in a group of patients who had a fracture of a lower extremity after age 65. The 30 subjects participating were treated between January 1992 and February 1998, for a unilateral fracture of the lower extremity. At the return examination, the patients' lower extremities were evaluated for range of motion (ROM) and strength. The participants also completed the Short Form 36 (SF-36) questionnaire, and their scores were compared with those of age-matched controls to determine relative disability. There were no statistically significant differences in ROM or muscle strength of the injured versus noninjured extremities, except in the case of knee flexion. The Mental Component Score (MCS) of the SF-36 in our study population was statistically different from that of controls, and there was no statistical difference in the Physical Component Score (PCS). A moderate correlation was found between the PCS and physical impairment.

Aged↗
PubMed2000

The impact of seating and positioning on the development of repetitive strain injuries of the upper extremity in wheelchair athletes.

The population of people who use wheelchairs has been increasing due to technological advances. With this increase, there has also been an increase in participation in wheelchair sports. The incidence of upper extremity injury in wheelchair users has been reported to be between 31 and 73% [2,13,23,26,29]. Wheelchair athletes may be at an increased risk for upper extremity injury due to increased upper extremity use with sport. The purpose of this paper is to ascertain whether proper seating and positioning have an impact on the prevention of repetitive strain injuries (RSI) of the soft tissues, including peripheral nerve entrapments and muscle injury, of the upper extremity in wheelchair athletes. A review of current research on wheelchair propulsion and RSI revealed several hazards for wheelchair athletes to develop RSI's. These include duration of impairment, muscle imbalance, awkward positioning, inadequate rest breaks, repetition of muscle use in daily activities and in sport participation, the degree of force needed for propulsion, and fatigue. Current research does not provide conclusive information on optimal seating. Suggestions of preventative measures are given including suggestions with regard to positioning in the wheelchair.

Journal Article↗
PubMed1977

Morphology of extremely heat-resistant spores from Bacillus sp. ATCC 27380 by scanning and transmission electron microscopy.

Bacillus sp. ATCC 27380 is a recently discovered aerobic mesophile, isolated from surface soil, that produces spores with extreme resistance to dry heat: the length of time to 90% kill is 139 hr at 125 degrees C and 13-17 hr at 138 degrees C. Values for spores from other known species range from 5 to 100 min. The molecular basis for this extreme heat resistance is unknown. We report a structural analysis of the internal and external mature spore morphology obtained by both scanning and transmission electron microscopy. Both modes of microscopy delineate a morel-like structure characterized by irregular, but distinct, polygonal ridges suggestive of extreme dehydration. Some spores also possess an appendage resembling the bun of a brioche. This bun-like body is possibly unique to this species. In cross section the spore exhibits a many-layered structure, each layer with a characteristic fine structure. These morphological characters do not suffice to explain the observed resistance to dry heat at extreme temperatures. They do form a basis for the chemical characterizations which will be necessary to understand this heat resistance at the molecular level. The concept of "solid state spore" is put forward as a generalization that may be useful towards understanding this resistance.

Bacillus↗
PubMed2003

Diagnosis of occlusive lesions of upper extremity arteries in patients with thromboangiitis obliterans.

The study accrued 84 patients suffering from thromboangiitis obliterans (TO) examined and treated at the A.V. Vishnevsky Institute of Surgery, RAMS, over the period 1988 to 2002. Based on the complaints on the part of the upper extremities the patients were distributed into four groups. Sixteen (19.1%) TO patients did not make any complaints on the part of the arms (degree I ischemia). Thirty-eight (45.2%) patients complained of numbness and paresthesia, chiefly of the tips of the fingers on both hands (degree II ischemia). Six (7.1%) persons complained of pains in the hands at physical exercise (decree III ischemia). Ulcers and necroses of the fingers were present in 24 (28.6%) patients (degree IV ischemia). The diagnostic procedures for arterial lesion of the upper extremities included laboratory investigations, duplex scanning of the great arteries, of the arteries of the hands, fingers and nail matrix, wide-field capillaroscopy, oxygen tension measurements, and angiography as well. Comparison of the clinical manifestations of arterial lesion of the upper extremities in TO patients to the data supplied by different research methods has revealed a direct correlation between the degree of ischemia and the pathomorphological as well as functional changes which increased as the ischemic syndrome was aggravated. As a result of the present work, there have been studied and systematized the criteria for the diagnosis of the degree of arterial lesion of the upper extremities in TO patients, based on the data, supplied by duplex scanning, capillaroscopy, measurements of transcutaneous oxygen tension and angiography. In addition, there has been studied the role of the humoral component of immunity in the delineation of inflammatory activity in patients with TO.

Adult↗
PubMed1992

[Analysis of factors influencing on the surgical results of arterial embolism in the lower extremities].

130 patients with arterial embolism in the lower extremities underwent surgical treatment. The curative rate was 66.9%, amputation rate-19.2% and the mortality rate-13.8%. Statistical study showed that sex, age and recurrent embolism had few effects on the surgical results (P < 0.05). One of the influencing factors was the ischemic time of the lower extremities. The mortality rate was 33.3% in the distal abdomen with aortic embolism and 8.7% in the lower extremities (P < 0.005). The mortality rate and amputation rate were significantly higher in embolic patients with atherosclerotic stenosis and occlusion (9% and 17%). The mortality rate and amputation rate were 2.3% and 3.4% in patients with good blood flow and were 42.1% and 57.9% in patients without good blood flow uspectively. Reembolectomies showed no satisfactory effect. The results indicated that embolectomy combined with other necessary operations did not increase the mortality rate and amputation rate (P < 0.05). Postoperative anticoagulation therapy is extremely important.

Adolescent↗
PubMed2003

Using a Y-shaped vein graft with drain-out branches to provide additional arterial sources for free flap reconstruction in injured lower extremities.

BACKGROUND: Reconstruction of the distal lower extremity with poor arterial circulation is a challenge for reconstructive surgeons, especially when a microsurgical free tissue transfer is necessary. One may face the problem of having no suitable recipient artery to be used except the main one. To overcome this difficult situation, utilization of a Y-shaped vein graft (YVG) was developed. METHODS: We report on 3 successful reconstructions of the lower extremities with free flaps using YVG to supply the arterial inflow and in which the distal circulation of the lower extremity was preserved at the same time. The therapeutic goals, design, surgical technique, and outcomes are clarified. The indications, advantages, and disadvantages are also discussed. RESULTS: All 3 patients achieved successful reconstruction of the affected limbs with uneventful surgery. Special microsurgical skills are unnecessary in this method. It can provide an additional arterial source, which is useful and reliable for revascularizing various kinds of free tissue. Utmost care must be taken to examine the direction of flow during harvesting since only the drainout branches can serve as an ideal YVG. CONCLUSION: We concluded that Y-shaped vein grafting is a good alternative technique to achieve free flap reconstruction of a distal lower extremity with simultaneous preservation of the distal circulation in selected difficult cases.

Ankle Injuries↗
PubMedDate not supplied

An experience with free scapular flap for reconstruction of lower extremity defects at Aga Khan University Hospital Karachi.

BACKGROUND: Reconstruction of large composite tissue defects with exposed vital structures and weight bearing surfaces are extremely difficult for reconstructive surgeons. Coverage of such difficult defects can be achieved with free tissue transfer provided microsurgical expertise is available. This study was carried out to determine the outcome of free scapular flaps performed for lower extremity defects. METHODS: Clinical records of the patients were reviewed and important variables included demographic data, etiology of soft tissue defects, site and size of defect, complications and percentage of wound coverage by flap. Patient satisfaction and objective assessment of flap coverage and motion of involved joints was made. RESULTS: There were 13 male patients with mean age of 30.46 years. The causes of tissue defects were road traffic accident in 8 cases, industrial accidents in 2 and 3 cases had bomb blast, gunshot and gas gangrene one in each case respectively. Nine scapular flaps were performed to reconstruct the defects around the foot, ankle and lower leg; two flaps for amputation stumps and two flaps for defects around the knee and popliteal fossa. Post flap surgery, 3 cases had vascular compromise which required urgent exploration of anastomosis. Two cases were revived and one flap did not survive. With respect to cosmetic appearance, coverage of required defect, performance of activities of daily living and functional range of motion of involved joints, 6 cases were graded excellent and 7 cases were good. CONCLUSION: In our cases of lower extremities defects, scapular flap helped to salvage the limb. In conclusion scapular flap is a versatile flap which can be used for lower extremity defects.

Accidents, Occupational↗
PubMed1992

Deep-venous thrombosis of the upper extremity after traumatic brain injury.

Deep-venous thrombosis (DVT) of the lower extremity occurs frequently in a variety of patients, including those with traumatic brain injury (TBI), during their rehabilitation. Thrombosis of the major veins of the upper extremity is believed to be relatively rare, although it has increased in recent years due to the routine use of indwelling percutaneous central venous catheters. Upper extremity pain and swelling in a TBI patient is commonly attributed to heterotopic ossification, reflex sympathetic dystrophy, or occult fracture. Clinicians may not consider DVT in the differential diagnosis. No longer regarded as a benign disorder, we report the successful outcome in a 27-year-old with TBI who developed an upper extremity DVT after subclavian catheterization. The diagnostic findings, as well as treatment recommendations are reviewed.

Adult↗
PubMed2004

Neuro-orthopedic management of the dysfunctional extremity in upper motor neuron syndromes.

Orthopedic surgery can help restore extremity function to many patients with upper motor neuron syndromes (UMN). Impairments are divided into those that cause problems with the active function of the extremity versus those that impede passive function. Limb deformities commonly result from both dynamic (spastic) and static (contractural) components. Clinical examination supplemented with dynamic electromyographic studies provides the optimal information for planning the most effective surgical procedures. In the upper extremity, selective lengthening of the shoulder adductors and extensors combined with elbow flexor lengthening can improve forward reach. Lengthening of the forearm pronators and finger flexors will improve hand use. In the lower extremity, standing balance is improved with widening the base of support by correcting hip adduction contractures and equinovarus foot deformities. Improvement of knee flexion during swing phase by a rectus femoris to gracilis transfer will enhance the fluidity and efficiency of walking. Correction of hip and knee flexion contractures will allow a upright posture and dramatically decrease the energy requirement of walking.

Journal Article↗
PubMed2005

[Vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity].

OBJECTIVE: To study the role of transplantation of the vascularized pedicle iliac crest for the repair of bone and soft tissue defect of lower extremity. METHODS: The vascularized pedicle iliac crest was designed for the repair of bone and soft tissue defect of lower extremity according to anatomic feature of leg and foot. Skin graft was used for coverage of the iliac flap. RESULTS: Skin survival could demonstrate the survival of the vascularized pedicle iliac crest indirectly one week postoperatively. Skin survived completely in 4 cases and partly in 3 cases. Callus was seen at the transplantation site one month postoperatively, and K-wires were removed 4 months later in the cases of metatarsal defect. The external fixators were removed in the cases of tibia defect 6 to 8 months postoperatively. The functions of lower extremities were restored in 2 to 4 months. The bone and soft tissue defects were repaired, and ultimate function and cosmetic effects were satisfied after the mean follow up of 10 months (ranged from 6 to 15 months). CONCLUSION: Transplantation of the vascularized pedicle iliac crest is an ideal method for the repair of bone and soft tissue defect of lower extremity. The operation can be performed in one stage. The functions and cosmetic effects are better than the traditional methods.

Adult↗
PubMed1992

[Microwave therapy of frostbite of the extremities].

In the experiment, frostbite of the hind legs in rabbits was induced for 3 hours. The extremities of 12 animals of the experimental group were influenced with UHF-field with a wavelength of 12.6 cm of nonthermal intensity (3 W) for 10 minutes one time after termination of cold influence. The extremities of 18 rabbits of the control group were warmed in a natural way. The milder course of cold trauma in animals of the experimental group manifesting itself in higher temperature of a skin of the damaged extremity, more rapid disappearance of edema and lesser spreading of cyanosis, tissue necrosis of an extremity--(7.6 +/- 2.5) and (11.7 +/- 1.2) cm, respectively--was noted. The authors consider that microwave therapy can be included into the complex of measures at the early period of treatment of local cold trauma.

Animals↗
PubMed1994

Upper extremity proprioceptive training.

Proprioception following lower extremity injuries is commonly recommended, but there is little information on proprioception training following upper extremity injuries. No studies have evaluated whether proprioception programs for athletes in open kinetic chain activities (throwing, shot putting) should be different than programs for athletes in closed kinetic chain activities (gymnastics, swimming, kayaking, or rowing). In this paper, we provide a rationale for proprioception training for upper extremity injuries in athletes and the importance of analyzing the athlete's sport and activity for specificity of proprioception exercises. We then discuss one popular proprioception exercise, rhythmic stabilization, and propose several additional upper extremity proprioception exercises, along with instructions for the athletic trainer on how to direct the athlete through these exercises.

Journal Article↗