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At least 1,153 records · Page 64Linked to original sources
PubMed1989

[Usefulness of thermographic examination in the diagnosis of early peripheral ischemia of the extremities in patients with diabetes mellitus].

Vascular damage is the main complication of diabetes. An early sign of this complication is damage to the arterial and capillary vessels in the lower extremities with later impairment of peripheral blood flow. The aim of the present study was evaluation of the usefulness of thermography in the detection of early circulatory disturbances in the lower extremities during diabetes, and comparison of its results with those obtained in oscillometry. The study comprised 28 patients with type I diabetes aged from 16 to 57 years and 27 patients with type II diabetes aged from 35 to 65 years. The control group included 10 clinically health subjects in similar age group. It was found that thermographic changes were much more frequent than pains in the extremities and abnormal values of oscillometric++ index in diabetes type I and II. Nearly half the patients with evident thermographic disturbances had no oscillometric changes, and 2/3 of the patients felt no pains in the extremities.

Adolescent↗
PubMed1989

[Correlation of arteriosclerosis obliterans of the lower extremity with coronary artery disease].

To ascertain the correlation between arteriosclerosis obliterans (ASO) of the lower extremities and coronary artery disease (CAD), 69 patients with lower extremity ASO were observed. Based on clinical symptoms, the patients were categorized as group A: 52 with intermittent claudication and group B: 17 with angina pectoris. All patients underwent angiography of both lower extremities and the heart. Results were as follows: 1. In group A, 33 patients had significant coronary stenosis with single (16 cases), double (12 cases) and triple (five cases) vessel disease. Sixteen patients had histories of myocardial infarction and two had vasospastic angina. In group B, 15 patients had significant coronary stenosis with single (five cases), double (six cases) and triple (four cases) vessel disease including two cases involving the left main trunk. Six patients had histories of myocardial infarction and two had vasospastic angina. 2. Electrocardiography revealed that 37 patients in group A and 14 patients in group B had abnormal ECGs as abnormal Q waves and ST-T changes. However, 10 patients in group A and three patients in group B had significant coronary stenosis despite their normal ECGs. 3. According to the sites of stenotic lesions, all 69 patients with ASO were classified in four types; as diffuse, pelvic, ilio-femoral and femoral. The incidence of CAD did not differ among these four types. 4. In group A, 38 patients experienced revascularization of ASO; 36 cases by bypass grafting, and two by percutaneous transluminal angioplasty (PTA). Ten patients received cardiac revascularization including three cases with coronary artery bypass graft (CABG) and seven cases with percutaneous transluminal coronary angioplasty (PTCA). In group B, 13 patients received revascularization of ASO with bypass grafting. Eleven patients had coronary revascularization including seven cases with CABG and four cases with PTCA. 5. Fourteen of the 69 patients received revascularization for both ASO and CAD. In conclusion, there is a highly significant coincidence of CAD in patients with ASO, and CAD is often silent. These data indicate that routine coronary angiography is necessary for detecting and preventing CAD in all patients with ASO. Coronary artery revascularization, especially PTCA, can be indicated prior to lower extremity revascularization.

Aged↗
PubMed1989

Gangrene of the upper extremity in diabetic patients.

Twenty-two patients who had diabetes mellitus and had needed an amputation for gangrene in an upper extremity at an average age of fifty-one years were identified and followed. The five patients who were still living at the latest follow-up had been followed for an average of 50.6 months. The other seventeen patients survived for an average of only 20.6 months after the amputation. All of the patients were in poor health; eighteen had needed an amputation in a lower extremity, and sixteen received hemodialysis. The results of amputation in an upper extremity were unsatisfactory; the site of the initial amputation healed in only two of the twenty-two patients. In the remaining twenty patients, a total of sixty-three additional operations were performed on an upper extremity, and five of the twenty patients died before the wound had healed.

Adult↗
PubMed1988

Upper extremity function in multiple sclerosis: improving assessment sensitivity with box-and-block and nine-hole peg tests.

The need for standardized operational definitions, as well as a more sensitive, easily applied, and reproducible upper extremity functional assessment for following patients in multiple sclerosis clinical trials is evident. Experience with the use of two upper extremity functional assessment instruments--the nine-hole peg test (9HPT) and the box-and-block test (BBT)--is described. The patients, who were followed for six months, experienced subjective change in functional status but failed to show significant change on the pyramidal, cerebellar, or visual functional scores of the Kurtzke Expanded Disability Status Scale (EDSS). The prevalence of upper extremity dysfunction in multiple sclerosis, as measured by the 9HPT and the BBT, is higher than previously appreciated. The 9HPT and BBT are more sensitive in detecting upper extremity functional status change than the EDSS and should prove helpful in following patients in clinical trials.

Adult↗
PubMed1988

Effect of exercise on the vascular pattern in the bone extremities of broiler fowl.

The vascular morphology of the proximal femur, tibiotarsus and tarsometatarsus was studied in growing broiler chicks. A carousel was used to exercise one group of 24 birds for four periods of 15 minutes each day. A second group (controls) were not exercised. Some birds were killed during the course of the experiment, and the remainder after 25 days of exercise when they were 33 days old. After killing the limbs were perfused and the bone extremities cleared. The bone extremities were then cut into 1 mm thick slabs and examined. There were abnormalities of the physis and physeal vasculature in 18 (25 per cent) of the bone extremities from the exercised birds and in 24 (40 per cent) of the bone extremities from the unexercised (control) birds. The low level of activity in the unexercised fowls of the present study appeared to contribute to these abnormalities.

Animals↗
PubMed1987

Extremity tissue expansion.

The gradual mechanical distention of tissues in the extremities using inflatable balloons allows elimination of local defects or expansion of known extremity donor sites to facilitate other reconstructive requirements. Complication rate are higher for extremity tissue expansion, and proper caution must be adopted if this concept is to be valuable for applications in the extremities.

Adolescent↗
PubMed1988

Congenital venous valvular aplasia of the lower extremities.

A 10-year-old girl had bilateral, symmetrical swelling of the lower extremities, which had been present since the age of 1 year. Noninvasive vascular laboratory measurements of the ambulatory venous pressure, venous recovery time, and maximum venous outflow revealed profound bilateral lower extremity venous valvular incompetence. Duplex imaging of the veins of the lower extremities demonstrated no evidence of thrombosis, and no venous valves could be imaged. On phlebography, the patient was found to have no venous valves in the superficial and deep systems of the leg. We conclude that congenital absence of the venous valves of the lower extremities is almost certainly underdiagnosed and that the vascular laboratory can accurately and easily differentiate between lymphedema and venous valvular imcompetence. Such differentiation may have therapeutic implications.

Child↗
PubMed1988

Fasciotomy for severe, blunt and penetrating trauma of the extremity.

Blunt or penetrating injuries to the extremity with vascular or severe soft tissue and skeletal trauma frequently require fasciotomy. Long term follow-up studies of these patients are rare. From 1976 to 1983, 85 patients underwent 39 fasciotomies upon the upper extremities and 57 upon the lower. Amputations were required in 11 patients; four due to primary vascular compromise, six to severe crush injury and one to electric burn with myonecrosis. The fasciotomy was not etiologically related to limb loss in any of these patients. Osteomyelitis occurred in two patients. Long term follow-up data was obtained by telephone and mail survey from 23 of the 61 patients five to 11 years after injury. Pain, weakness and paresthesia were major determinants of long term morbidity. Chronic edema was present in two patients. Seven of the patients interviewed were unemployed due to the injuries they received to the extremities. Most symptoms were believed to be due to the severity of the injury, and none were directly attributed to the fasciotomy. When fasciotomy is indicated, it is a safe adjunctive procedure in limb salvage and contributes very little to the long term morbidity of patients with severe trauma to the extremity.

Amputation, Surgical↗
PubMed1988

Late complications of the weight-bearing upper extremity in the paraplegic patient.

Paraplegic patients rely almost exclusively on their upper extremities for weight-bearing activities such as transfers and wheelchair propulsion. Eighty-four paraplegic patients whose injury level was T2 or below and who were at least one year from spinal cord injury were screened for upper extremity complaints. Fifty-seven (67.8%) had complaints of pain in one or more areas of their upper extremities. The most common complaints were shoulder pain and/or pain relating to carpal tunnel syndrome. Twenty-five (30%) complained of shoulder pain during transfer activities. Symptoms were found to increase with time from injury. As the long-term survival of spinal cord injured patients continues to improve, an increased awareness of the complications of the weight-bearing upper extremity is necessary to keep these patients functioning in society.

Arm↗
PubMed1986

On assessment of shoulder exercise and load-elicited pain in the cervical spine. Biomechanical analysis of load--EMG--methodological studies of pain provoked by extreme position.

Biomechanical analyses of load on locomotor structures are essential parts of physical therapy. Load moments of force, compressive and shear joint forces are associated with the risk of eliciting pain or causing excessive load during work and leisure activities as well as during rehabilitative training exercises. Two common therapeutic exercise movements were analysed with special emphasis on the effects of patient positioning on the load relations. Resistance was provided by an ordinary pulley apparatus. A computerized static model was developed, where positioning angle, pulley cord force and pulley distance could be varied. The best adaptation between the curves for induced load moment about the shoulder joint and maximum isometric muscle moment through joint angles was obtained when the subject during internal rotation exercises sat with the pulley located 40 degrees anterior to, and during external rotation exercises 20 degrees posterior to, a frontal plane through the shoulders at a distance of 1.3 m from the joint. EMG was recorded from the pectoralis major, latissimus dorsi and anterior deltoid muscles during internal rotation exercises, and from infraspinatus, deltoid and trapezius during external rotation. Pectoralis major and infraspinatus were the most active muscles during internal and external rotation respectively. Two methodological studies were made concerning pain provoked by loading joints in maintained extreme positions (i.e. positions at the limit of the motion sector). Sensations of discomfort/pain from healthy elbow and knee joints maintained in an extreme position increased with duration of provocation and decreased slowly after removal of loading weight. Using such joint loadings, a comparison of the Visual Analogue Scale with Borg's category-ratio scale showed that both be can be used for reliable assessments of load-elicited pain intensity. In one study cervical spine extreme position was found to be associated with sitting work postures where the thoraco-lumbar spine was slightly inclined backwards or where the whole spine was flexed. Healthy subjects participated in an experimental study in which a position involving extreme flexion of the lower-cervical-upper-thoracic spine (similar to a common work posture) was maintained. Pain was experienced by all ten subjects within 15 minutes, disappeared 15 minutes after the end of provocation, but was again experienced by nine subjects the same evening or the next morning and lasted up to four days. Neck extensor muscle activity was low.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1978

[Change in the oxygen regimen in the skin of the extremities after the subcutaneous administration of nitrous oxide].

The work deals with the study of the skin oxygen rate in obliterating diseases of the lower extremities. In 40 patients the skin oxygen tension was studied in the first web space of the foot. 19 of these patients were the control group. In the main group (21 patients) nitrous oxide was injected in the subcutaneous fat of the lower extremities within the complex of the conservative treatment. In obliterating arterial diseases of the lower extremities the disorders of the tissue oxygen rate, particularly pronounced in the late stages of the pathological process, were found. The subcutaneous injections of nitrous oxide improved the regional blood flow in the low extremities.

Arterial Occlusive Diseases↗
PubMed1986

Upper extremity sensory feedback therapy in chronic cerebrovascular accident patients with impaired expressive aphasia and auditory comprehension.

Electromyographic (EMG) sensory feedback therapy (SFT) was used in the neuromuscular retraining of the nonfunctional upper extremity in five chronic left cerebrovascular accident (CVA) patients with impaired expressive and auditory comprehension. Speech diagnoses included global, moderate-to-severe Broca, and Wernicke aphasias. These patients had experienced increased despondency associated with previous therapy failures and often had indicated that they wished to have their involved extremity amputated, so that it would no longer be in the way. In this study, specific behavioral training strategies to increase patient involvement were used, including: general relaxation, modified SFT instruction, and home exercises, which were supported by family and/or friends. After an average of 50 therapy sessions, all patients were successfully retrained to use their right upper extremity at the gross-assist level. This resulted in feelings of increased self-esteem to the extent that amputation was no longer requested. It is concluded that EMG SFT can be beneficial in the neuromuscular reeducation of paretic upper extremity muscles of CVA patients with expressive aphasia and (impaired) auditory comprehension.

Aphasia, Broca↗
PubMed1987

Use of insulation to reduce extremity temperature nonuniformity during whole body hyperthermia in dogs.

Previously we have shown in dogs that tibial bone marrow and s.c. tissue temperatures are lower than rectal temperature during the plateau phase of whole body hyperthermia with the use of a radiant heating device. In an attempt to increase thermal dose to these sites during whole body hyperthermia, we applied insulation to an extremity prior to the plateau phase of heating. We found that extremity insulation during whole body hyperthermia resulted in increased s.c. tissue and tibial bone marrow temperatures. With insulation, tibial bone marrow and rectal temperature were nearly equal but s.c. tissue temperature, although greater than without insulation, remained lower than rectal temperature. High efficiency extremity insulation or supplemental heating techniques may be necessary during whole body hyperthermia with the use of the radiant heat device in order to assure that extremities receive the prescribed thermal dose.

Animals↗
PubMed1986

Contralateral therapy in upper extremity rehabilitation.

Evaluation of upper extremity function after an elective surgery with emphasis on the possible effect of contralateral therapy was done in 20 patients. This study was designed to test the postulate that range of motion exercises and work to muscle groups of one upper extremity has a beneficial effect on the analogous muscle groups in an immobilized, post-surgical contralateral extremity. Analysis of results show a small, but consistent, effect on range of motion measurements. However, strength measurements were shown to be markedly increased in the group receiving contralateral therapy to the normal extremity, as compared to the normal control group. Significant indirect training occurs by a cross-over phenomenon. Rehabilitation programs can be individually designed to enhance recovery of specific motor groups by utilizing contralateral therapy and cross-education principles. Further work is now underway to further elucidate specific clinical applications.

Adult↗
PubMed1986

Amputation alternatives in the lower limb, stressing combined management of the traumatized extremity.

A methods approach for the care of the traumatic lower extremity amputee is presented, emphasizing joint surgical approach, specifics of management, ideal amputation levels, and functional rehabilitation. The role of the plastic surgeon with an interest in free flaps is ever increasing and has elevated the level and quality of traumatic extremity amputation. Therefore, an understanding by the plastic surgeon of the orthopedic, prosthetic, functional, and rehabilitation principles becomes as important as the orthopedic surgeon's appreciation of current microvascular reconstruction potential. Fortunately, large numbers of traumatic amputees are not available for study in the civilian population. With better-quality extremity salvage by free flap coverage, this number is decreasing. However, the problem will never be eliminated and efforts to produce the best possible amputation must be expended by the best techniques and personnel. Prosthetic management continues to develop with exciting innovations on the horizon. Currently, the modular concept of prosthetic design (Fig. 26) is a practical, cosmetic standard. Newer space-age materials and design changes should facilitate the functional potential of the traumatic amputee. Characteristics of traumatic lower extremity amputees are youth, immaturity, arrogance, and psychological instability, but they are usually cooperative following the initial shock and reality of the situation. These young people deserve our best efforts to allow them to become integrated into society and continue an active life, albeit passive or active (Fig. 27).

Amputation, Surgical↗
PubMed1986

Soft-tissue infection in lower extremity trauma.

Soft-tissue infection following lower extremity trauma has not been studied in detail in light of recent data on 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↗
PubMed1979

[Metabolic activity of the gastrocnemius muscles in atherosclerotic lesion of the abdominal aorta and arteries of the extremities].

The histochemical investigation of the oxidizing-reducing enzymes in the gastrocnemius muscle was carried out on the material of 42 patients with atherosclerotic lesions of the abdominal aorta and the extremity arteries. The results obtained were compared with the muscle blood flow value and the level of the partial strain of oxygen in the gastrocnemius muscle. A conclusion is made that it is expedient to investigate the level of metabolic activity of muscles of the injured extremity for the estimation of the vitability of muscles which is very important for solving the question about the possible revascularization of the extremity in severe ischemia due to chronic occlusing process in the extremity arteries.

Aged↗
PubMedDate not supplied

Isolated extremity perfusion with DTIC. An experimental and clinical study.

Dacarbazine (DTIC) was used for isolated perfusion of extremities in dogs and man. In the animal experiment perfusions with DTIC at dosages up to 100 mg per kg of extremity weight were well tolerated. The concentration of DTIC in the perfusate ranged from 70 to 400 micrograms/ml without evidence for formation of metabolites. Electron microscopy, performed 14 days later, revealed a decrease of glycogen in striated muscle cells. Vascular damage was not observed. Five patients with advanced malignant melanoma or soft tissue sarcoma of the extremities were treated by isolation perfusion with 75 to 133 mg DTIC per kg of extremity at 40 degrees C for 60 minutes. A tumor regression of at least 30% was observed.

Animals↗