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PubMed2006

Effect of brisk walking in 1 or 2 daily bouts and moderate resistance training on lower-extremity muscle strength, balance, and walking performance in women who recently went through menopause: a randomized, controlled trial.

BACKGROUND AND PURPOSE: Menopause may induce a phase of rapid decreases in bone mineral density, aerobic fitness, muscle strength, and balance, especially in sedentary women. The purpose of this study was to examine the effects and feasibility of an exercise program of 1 or 2 bouts of walking and resistance training on lower-extremity muscle strength (the force-generating capacity of muscle), balance, and walking performance in women who recently went through menopause. SUBJECTS AND METHODS: The subjects were 134 women who recently went through menopause. The study was a 15-week, randomized, controlled trial with continuous and fractionated exercise groups. The outcomes assessed were lower-extremity muscle strength, balance, and walking time over 2 km. Feasibility was assessed by questionnaires, interviews, and training logs. RESULTS: One hundred twenty-eight women completed the study. Adherence to the study protocol was 92%. Both continuous and fractionated exercise groups improved equally in lower-extremity muscle strength and walking time but not in balance. Almost 70% of the subjects considered the program to be feasible. Two daily walking sessions caused fewer lower-extremity problems than did continuous walking. DISCUSSION AND CONCLUSION: Brisk walking combined with moderate resistance training is feasible and effective. Fractionating the walking into 2 daily sessions is more feasible than continuous walking.

Exercise↗
PubMed2006

Extreme jobs: the dangerous allure of the 70-hour workweek.

Today's overachieving professionals labor longer, take on more responsibility, and earn more than the workaholics of yore. They hold what Hewlett and Luce call "extreme jobs", which entail workweeks of 60 or more hours and have at least five often characteristics-such as tight deadlines and lots of travel--culled from the authors' research on this work model. A project of the Hidden Brain Drain Task Force, a private-sector initiative, this research consists of two large surveys (one of high earners across various professions in the United States and the other of high-earning managers in large multinational corporations) that map the shape and scope of such jobs, as well as focus groups and in-depth interviews that get at extreme workers' attitudes and motivations. In this article, Hewlett and Luce consider their data in relation to increasing competitive pressures, vastly improved communication technology, cultural shifts, and other sweeping changes that have made high-stakes employment more prominent. What emerges is a complex picture of the all-consuming career-rewarding in many ways, but not without danger to individuals and to society. By and large, extreme professionals don't feel exploited; they feel exalted. A strong majority of them in the United States-66%-say they love their jobs, and in the global companies survey, this figure rises to 76%. The authors' research suggests, however, that women are at a disadvantage. Although they don't shirk the pressure or responsibility of extreme work, they are not matching the hours logged by their male colleagues. This constitutes a barrier for ambitious women, but it also means that employers face a real opportunity: They can find better ways to tap the talents of women who will commit to hard work and responsibility but cannot put in over-long days.

Data Collection↗
PubMed1991

Soft-tissue expansion in lower extremity reconstruction.

Soft-tissue expansion in the lower extremities is typically well tolerated. The more proximal one is--that is, the closer to the thigh and buttocks--the easier and less complication prone the expansion will be. It is another valuable technique for resurfacing the lower extremity and for reconstructing defects in contour and in skin character. There are limitations to this technique, which generally is most useful in late reconstructions. Intraoperative expansion has no place in lower extremity reconstruction. Soft-tissue expansion may be limited by an unsuitable geometry or the sheer size of defects. It should not be used next to open wounds. Soft-tissue expansion offers significant advantage in that the coverage of a defect will be replaced with tissue like that lost. Seldom does one see necrosis of advanced flaps, so that there is little risk of tissue loss in using this modality. There is an excellent vascularity to the flaps and an excellent character to the skin. In addition, in this cost-conscious era, soft-tissue expansion is quite cost effective, and in many cases the procedures can be conducted on an outpatient basis with a minimum of hospitalization, if any. With care to select patients properly, design carefully, and conduct expansion in a leisurely fashion, soft-tissue expansion offers a valuable means of reconstructing both large and small lower extremity defects.

Adult↗
PubMed1991

Bone marrow and peripheral blood findings in patients with extreme thrombocytosis. A report of 63 cases.

Sixty-three bone marrow (BM) and peripheral blood specimens from patients with platelet counts of 1000 x 10(9)/L or greater were examined in an attempt to determine if any BM or peripheral blood findings could be used reliably to distinguish primary thrombocythemia from other myeloproliferative disorders and extreme examples of reactive thrombocytosis. Our results indicated that the BM findings in primary thrombocythemia were quite similar to those in polycythemia vera and chronic granulocytic leukemia with associated extreme thrombocytosis. However, statistically significant differences between the BM findings in myeloproliferative disorders and extreme reactive thrombocytosis were found in the numbers of megakaryocytes, presence or absence of megakaryocyte clusters, stainable iron, cellularity, and reticulin content. We concluded that BM examination is a useful procedure as an aid in determining the cause of extreme thrombocytosis.

Bone Marrow↗
PubMed1990

Soft-tissue infection in lower-extremity trauma.

Soft-tissue infection after lower-extremity trauma has not been studied in detail in light of recent data on the biology of infection. This article examines specific problems in lower-extremity trauma that allow the wound to become susceptible to wound infection. It also illustrates the various principles of wound management in lower-extremity trauma that serve to prevent infection. Two case examples are used to illustrate principles of management. Other wound problems in lower-extremity trauma are also discussed, such as rabies, necrotizing soft-tissue infection, tetanus, and diabetic foot infections.

Adult↗
PubMed1990

[A case of flexion myelopathy presenting juvenile segmental muscular atrophy of upper extremities--a successful treatment by cervical spine immobilization].

A 24-year-old man was well until 1982, when he noticed weakness and atrophy of right arm especially those of biceps muscles. These symptoms did not progress until 1988. In 1988 weakness of left elbow flexion appeared and he was admitted to our hospital. On examination, he had weakness and atrophy of both upper extremities. Fasciculation was noticed in the proximal part of right arm. When his head was bent forward, dysesthesia appeared around radial side of his arm. There were no long tract sign or objective sensory loss. EMG showed neurogenic change over both his upper extremities. In plain cervical roentgenogram there existed abnormal kyphosis of cervical vertebrae. In MRI imaged with his neck flexed, cervical cord was compressed by the posterior surface of 4th cervical vertebral body, which corresponded to the top of cervical kyphosis. Based on these signs and examinations, a diagnosis of flexion myelopathy was made. Spinal immobilization by wiring and bone graft implantation ranging from C2 to C6 was performed to limit the range of anterior nuchal flexion. After this operation, improvement of muscle strength along with the disappearance of dysesthesia on neck flexion was observed. Clinically, this case closely resembles to juvenile type of distal and segmental muscular atrophy of upper extremities (Hirayama type). From our study, pathomechanism of this case seems to be a flexion myelopathy at C4 level. This view is supported also by the good recovery after the operation. This case suggests that nonprogressive atrophy of upper extremities due to flexion myelopathy can be successfully treated by cervical spine immobilization.

Adult↗
PubMed1990

[Duration of anoxia during replantation of large segments of the extremities].

Experience in 155 replantations of large segments of the extremities is discussed. The results of treatment are analysed from the standpoint of anoxia of the separated segments of the extremities. A case of replantation of the lower extremity (shin) with 42-hour anoxia is described. It is concluded that increased risk of replantation of large segments of extremities is determined in the first place by traumatic and hemorrhagic shock and not by the so-called transplantation toxicosis.

Adult↗
PubMed1990

Evaluation of quantitative measures of upper extremity speed and coordination in healthy persons and in three patient populations.

Upper extremity tracking tests have been used extensively in clinical studies in patients with neurologic disorders. We evaluated several new measures of upper extremity performance derived from step-response and phase-plane analysis techniques; both techniques are founded in automatic control theory. Using a computer-based tracking test, a visual step function stimulus was applied in 15 healthy subjects and 45 patients from multiple sclerosis, myasthenia gravis, and Parkinson disease populations. The upper extremity response of the subject was analyzed to find the reliability and discriminating power measures that quantify speed, coordination, and steadiness of the upper extremity response during the tracking task. Results show that reliability of the measures, although variable across the populations tested, is generally high (greater than 0.7). The speed and coordination measures derived from phase-plane analysis are more discriminating than the measures of step-response analysis for the populations tested. Some of the measures may be useful for monitoring patient performance, the other measures can be potentially helpful in diagnosis of the disorders.

Arm↗
PubMed1990

Increased limb salvage. Distal tibial/peroneal artery thrombectomy/embolectomy in acute lower extremity ischemia.

Fifty-five acutely ischemic lower extremities, in 35 patients, which remained ischemic after standard thrombectomy/embolectomy techniques were further treated with distal tibial/peroneal thrombectomy/embolectomy by ankle level arteriotomy to increase limb salvage. A total of 84 infrapopliteal arteries were explored and thromboembolectomy performed in 79. The precipitating ischemic event was arterial embolus in 38 per cent, arterial thrombus in 60 per cent, and trauma in 2 per cent of the cases. There were 16 female and 19 male patients. Additional bypass grafting was used in 18 per cent of extremities. The limb salvage rate was 91 per cent in this select "tibial/peroneal" group. This technique salvaged 50 limbs that otherwise would have required major amputation. The addition of this technique changed the potential limb salvage rate from 76 per cent of the entire 199 lower extremities treated during this period to an actual limb salvage rate of 97 per cent. Operative mortality was 16 per cent in this selected group with an overall mortality of 6 per cent for all patients with acutely ischemic lower limbs. A mean patient follow-up of 32 months (range 12 to 72 months) identified only three late amputations, demonstrating that distal tibial/peroneal thrombectomy/embolectomy is a durable procedure. It is a technically easy means of promoting limb salvage in the acutely ischemic limb which either 1) remains ischemic after standard transinguinal iliofemoral thromboembolectomy, or 2) is secondary to infrapopliteal artery occlusion. It allows successful thromboembolectomy of acutely occluded infrapopliteal arteries without distal popliteal arteriotomy. These techniques should be within the armamentarium of all surgeons dealing with acute lower extremity ischemia.

Adult↗
PubMedDate not supplied

[Kidney involvement in acute occlusion of the bifurcation of the aorta and the major arteries of the lower extremities].

A total of 162 patients with acute thromboses and embolism of bifurcation of the aorta and the major vessels of the extremities were studied for renal performance before and after the corrective surgery. In this line the values of central hemodynamics, electrolytic balance, acid-base composition of blood and the hemostatic system were investigated. The author established the relation between the renal dysfunction and the character of the underlying disease which was the cause of thromboses or embolism, the level of occlusion and the degree of ischemic lesions in the extremity mainly. It was revealed that in case of an increase in the ischemic lesion of the extremity, the kidney performance decreased. In patients with recovered blood flow in the extremities, the failure of the renal function was developing due to the inclusion syndrome. The author distinguished three stages of the syndrome severity and related functional disorders of the kidneys. Renal dysfunction should be corrected even in case of mild ischemic lesions. The authors presented the principles of their correction as well. Acute renal failure can be regarded as a death cause only in 7.7% of expired persons who had acute thromboses of arterial embolism. The author came to the conclusion that in patients with the recovered blood flow pathological changes in the morphology and functioning of the kidneys were mainly associated with the disorders in renal hemodynamics, the mechanical blockage of tubules by myoglobin degradation products, decompensated metabolic acidosis, disseminated intravascular coagulation syndrome and immediate exposure of the renal parenchyma to toxins of protein nature.

Acute Disease↗
PubMed1989

Lower extremity peripheral neuropathy and ischemic ulcers associated with giant cell arteritis.

A patient with previously treated, temporal artery biopsy proven, giant cell arteritis (GCA) developed lower extremity ulcers and sensory neuropathy. Sural nerve biopsy showed epineural vessels with focal mild chronic inflammation. The lower extremity skin and nerve abnormalities improved after retreatment with prednisone. The rare manifestations of lower extremity skin and peripheral nervous system involvement associated with GCA are discussed. GCA must be considered in lower extremity ischemic processes of the skin and peripheral nervous system.

Foot Diseases↗
PubMed1989

[A roentogenographical study on the alignment of the lower extremities in secondary coxarthrosis].

Alignment of the lower extremities in secondary coxarthrosis (273 lower extremities) and controls (240 normal lower extremities) were studied using roentogenograms of whole lower extremities including the pelvis taken in the standing position with both legs. Secondary coxarthrosis, which is caused by congenital dislocation of the hip joint, was classified into four groups: unreduced dislocation, high dislocation, incomplete dislocation, and dysplasia of the acetabulum. Comparative studies were conducted using statistical data on measured items, obtained from secondary coxarthrosis cases and controls. In controls, the femoro-tibial angle (FTA) was 175.5 +/- 2.08 degrees and the mechanical axis passed through the medial side to the middle of the knee. It has been noted that a tendency for bow-legs was seen after the age of 50. In coxarthrosis with high dislocation, the most marked knock-knees were observed (FTA of 172.5 +/- 3.88 degrees), while in coxarthrosis with incomplete dislocation and dysplasia of the acetabulum, there was a tendency to coxa valga but no tendency toward knock-knees was evident. Cases of total hip replacement revealed that it is possible to improve knock-knees by installing a socket in the primary acetabulum as much as possible, correcting the difference between the length of the legs and elimating adduction contracture. It was also possible to study factors contributing to bow-legs and knock-knees by means of multivariate analysis.

Adolescent↗
PubMed1989

[Surgical treatment of primary varices of the lower extremities using the I.K.E.M. method].

This report reviews our two years experience of the surgical treatment of the lower extremities primary varix by I.K.E.M.- method. Since March 1985 to September 1988., 75 patients have been operated upon at our surgical clinic. Sexual ratio was 4:1 in favour of female sex. The operations on both lower extremities were performed in one stage on 2/3 of patients. Operation indication were based on clinical research and a generally known tests. No phlebography has been done as it is considered unnecessary for diagnoses on the lower extremities primary varix. Main tactics and technology for this method is retrograded saphenectomy against application of Klapp's and Smetanas knite for varix elimination. Operation period is approximately 45 for both extremities. It is recommended for patients to get up early in the morning. Average staying at the hospital was two days. Occasional wearing of elastic bandages is for six weeks.

Female↗
PubMed1989

[Personal experience with lower extremity lengthening].

The authors submit results of surgical treatment of unequal extremities in 10 patients. In nine cases by gradual distraction the affected lower extremity was extended, in one female patient the upper extremity. Ilizarov-type fixation devices proved useful. The maximum attainable increment is 8-9 cm, in the described group a prolongation by 2-8.5 cm was achieved, the mean period of distraction being three months. Up to 4 cm the distraction was made at a rate of 1 mm per day. When extending the leg by more than 4 cm, also the Achilles tendon must be extended and a tibiofibular syndesmosis by means of a screw must be made. Indications for surgical prolongation of the extremities must be carefully contemplated.

Adolescent↗
PubMed1989

[Late results of replantation of the upper extremity].

The authors present the long-term results observed in 82 patients after replantations of various segments of the upper extremity which were performed at centres of microsurgery of in Italy. A number of tests of prac- four towns tical importance aimed at the evaluation of the recovery of the extremity and the fingers sensitivity has been used during the examination. The authors have come to the conclusion that the success of the operations of replantation of various moments of the extremities is determined not only by the technical aspect of the surgery, but to a greater degree by correct implementation of the system of rehabilitation treatment aimed at the extremity sensitivity recovery.

Adolescent↗
PubMed1989

Influence of appropriate lower extremity orthotic management on ambulation, pain, and fatigue in a postpolio population.

A major functional problem for the postpolio patient is the loss of ambulation ability. A retrospective study of lower extremity orthotic management for ambulation was made of 104 subjects with histories of paralytic poliomyelitis who received treatment and evaluation in a postpolio clinic. Thirty-six patients (35%) had a remote history of a surgical arthrodesis of the ankle. Fifty-six subjects (54%) reported using lower extremity orthoses after the onset of their polio. At initial postpolio clinic evaluation 19 subjects (18%) were using lower extremity orthoses, and all of these patients had a remote history of orthotic use. After clinical evaluation, a new lower extremity orthosis was recommended for 37 subjects (36%). Nine of these patients had never used orthotic devices. New orthoses for a previously braced limb or an additional orthosis for a previously unbraced limb were prescribed more frequently in previously braced patients (28 of 56 vs 9 of 48, p less than 0.02). Seventy-two percent of subjects with ankle fusion required new orthoses; 19% of those without fusion required one (p less than 0.001). A questionnaire returned by 81 subjects (78%) indicated that appropriate orthotic prescription significantly improved the ability to walk, increased perceived walking safety, and reduced knee and overall pain (p = 0.04 to 0.008).

Adult↗
PubMedDate not supplied

[Physical work capacity of Alpinists under conditions of extremely low pO2 in inspired air].

It is shown that high-trained Alpinists retain relatively high working capacity under conditions of extremely low piO2. Maximal oxygen uptake with extremely low piO2 decreases in high-trained Alpinists less than the working capacity which under conditions of extremely low piO2, is, mainly, limited by decreased potentiality to utilize oxygen by cardiac and skeletal muscles because of paO2 and pvO2 fall below critical values. Low paO2 promotes a decrease in the rate of oxygen diffusion from blood of capillaries into cells, fall of oxygen tension in tissues and lowering of the oxidative processes' rate. Changes in the working capacity of high-trained Alpinists under conditions of extremely low piO2 depend on individual peculiarities of the organism, alpinist length of training which promote high reactivity of the respiration in response to low piO2, economization of the respiration function, development of adaptation mechanisms to low pO2 in the cerebral tissues, skeletal muscles and heart.

Adult↗
PubMed1989

[Acute arterial occlusion of the extremities. Rate of success following simple embolectomy and following combined procedures].

Acute arterial obstruction of the extremities represents the most common emergency in vascular surgery. Diagnosis is based on the typical history and clinical symptoms. Emboli in vessels without atherosclerotic changes can be removed by simple embolectomy. In atherosclerotic arteries or in cases of acute thrombotic occlusion preoperative angiography is recommended in order to perform extensive reconstructive procedures. 400 arterial reconstructions for acute obstruction of the extremities were analysed. 46 operations were done in the upper extremities. In the majority of the cases simple embolectomy was successful. Limb salvage was 100% although one embolectomy and one bypass procedure failed to restore full revascularization. Complication and mortality rate was low. 354 lower limbs were operated. 274 extremities could be saved (77.4%). Among 80 poor results 48 major amputations had to be done (13.5%). Perioperative mortality was 12.4%. Death was mainly attributed to myocardial infarction.

Acute Disease↗