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At least 1,171 records · Page 65Linked to original sources
PubMed1984

Nerve entrapment syndromes in the upper extremity contralateral to amputation.

Five cases are reported of upper extremity amputation with no metabolic disease. Patients experienced pain, paresthesia and weakness in the intact extremity associated with electrophysiologic evidence of entrapment neuropathies. All patients did heavy manual work, and all had carpal tunnel syndrome. One patient also had cubital tunnel syndrome and compression of the medial cord of the brachial plexus in the axilla, and another patient had cubital tunnel syndrome and axillary neuropathy. Surgery did not relieve symptoms of carpal tunnel and cubital tunnel syndromes for prosthesis users until the figure-8 harness was changed. Patients who did not use a prosthesis felt relief of symptoms following surgical release. Possible mechanisms which produce nerve entrapment syndromes in patients with upper extremity amputations are use of one limb for heavy manual work over prolonged periods, direct compression of neural structures from the axilla loop of a figure-8 harness, and compression of neural structures in the axilla resulting in entrapment at a distal site. Changing the figure-8 harness should be considered prior to surgical decompression for patients who have upper extremity amputations with entrapment syndromes.

Adult↗
PubMedDate not supplied

[Vascular changes in the lower extremities and their significance for tissue oxygen supply in middle and old age].

The studies involved practically healthy subjects aged 20-102. The oscillogram and rheogram were recorded in the upper and lower extremities. Measurements on the pulse wave progagation velocity and the skin capillary blood circulation were taken. The oxygen tension in subcutaneous cellular tissue was determined by the polarographic method. It was found that the values of systolic pressure, pulse pressure, and mean dynamic pressure increased, whereas the oscillographic index decreased with aging. In older people the rheogram was characterized by a slow elevation, rounded peak, frequently arch-shaped, flattening or absence of diastolic wave, shortening of Q-X-interval, and decrease of rheographic index. These age-associated changes reflecting decrease in elasticity and increase in rigidity of peripheral arteries as well as decrease in blood filling of tissues were more pronounced in the lower extremities. In older people the oxygen supply and the intensity of tissue respiration in subcutaneous cell tissue of legs were lower as compared with the upper extremities. In young adults no differences were found in oscillographic, rheographic, and polarographic values as well as in capillaroscopic pictures between upper and lower extremities.

Adult↗
PubMed1983

Upper and lower extremity EMG correlations during normal human gait.

The purpose of the present study was to determine whether diagonal intersegmental interactions are present during normal human gait. The demonstration of consistently synchronous phasing would indicate the feasibility of utilizing an electromyographic (EMG) signal to control functional electrical stimulation to a paralyzed lower extremity muscle during gait. The EMG activity of several muscles of the upper extremity and of the tibialis anterior (TA) were monitored with surface electrodes in 8 women. Variability in both the frequency of occurrence and duration of EMG activity was found in all muscles of the upper extremity. No single arm muscle common to all subjects was phased similarly to TA. However, 6 subjects demonstrated at least 1 muscle of the upper extremity that was working at the same time as TA. It is postulated that differences in upper limb kinematics may mask the existence of intersegmental interactions during gait.

Adult↗
PubMed1982

Prognostic and therapeutic implications of extreme serum aminotransferase elevation in chronic active hepatitis.

Extreme elevation of the serum aspartate aminotransferase level typically suggests acute hepatocellular necrosis and may militate against the diagnosis of chronic active hepatitis. However, we found that 26 of 160 patients (16%) with chronic active hepatitis had aminotransferase elevations of more than 1,000 IU/liter. These patients were younger and more often jaundiced than the others, but they exhibited signs of chronic liver disease as often. In only 2 of 26 patients with extreme aminotransferase abnormality were features of chronic disease absent. Patients with extreme enzyme elevation had histologic findings of confluent necrosis (P greater than 0.005) and features associated with acute viral infection (P greater than 0.005) more often than others, but they as often had cirrhosis on biopsy specimens. Virologic markers did not distinguish the patients or correlate with viral features in liver tissue. Corticosteroids improved immediate survival (P greater than 0.005) and the likelihood of remission (P greater than 0.005). Although chronic active hepatitis may present with extreme aminotransferase elevation and histologic features associated with acute viral infection, ancillary features of chronic disease facilitate the correct diagnosis and the initiation of appropriate therapy.

Adult↗
PubMed1982

Diagnosis of upper extremity deep venous thrombosis using noninvasive technique.

Forty-two patients suspected of having unilateral upper extremity deep venous thrombosis (DVT) were evaluated with Doppler ultrasonography and phleborheography (PRG). Venography was performed on 23 upper extremities (54%). Doppler ultrasonography and PRG produced similar accuracy (82%) in detecting upper extremity DVT when compared with venography. The accuracy improved to 91% when the results of both tests were considered together. It is concluded that Doppler ultrasonography and PRG, when used together, are useful, rapid, and accurate techniques for diagnosing upper extremity DVT.

Adult↗
PubMedDate not supplied

A new revascularization procedure for extensive arterial occlusions of lower extremity. A.V shunt procedure.

A revascularization procedure for extensive arterial occlusive lesions of the lower extremity, namely "A-V shunt procedure" was devised. The occluded popliteal artery is recanalized by open endarterectomy in association with E-PTFE bypass for occlusion of the superficial femoral artery, and the patency of reconstructed arterial segments is ensured by an arterio-venous shunt created at the distal end of the recanalized tibio-peroneal trunk. The branches of the genicular arterial network are also reopened by a technique of thrombectomy. Numerous collaterals develop through the reopened genicular network increasing blood flow to the ischemic distal areas. From 1967 to 1980, 63 extremities in 57 patients, which had extensive arterial occlusions of lower extremities with impending ulcer and/or severe rest pain in their feet or toes, underwent this procedure. Remarkable improvement of ischemic symptoms resulted in 76.2% of extremities at the time of the hospital discharge and 57.1% in follow-up.

Adult↗
PubMed1982

Upper extremity prone position exercise as aerobic capacity indicator.

Peak oxygen uptake of prone upper extremity exercise (VO2peak arm) compared with maximal oxygen uptake of upright lower extremity cycling (VO2max leg) was examined in an unselected young healthy male population (n = 21). The large standard deviation of the mean value of VO2peak arm expressed as a percentage of VO2max leg (60.48% +/- 11.84%) discourages use of a maximal upper extremity exercise test to predict total body aerobic capacity (r = 0.595 p = 0.002). However, the relationship between VO2peak arm and VO2max leg was influenced by the individual's cardiorespiratory fitness and capacity to perform either arm or leg work. When the population was divided into subgroups according to cardiorespiratory fitness or when subjects previously trained for either arm or leg work were excluded from analysis, the predictive power of VO2peak arm improved. (r = 0.946 p less than 0.001). Study results suggest that with careful analysis of subjects' fitness prior to upper extremity exercise testing, such exercise in a prone position can indicate aerobic capacity and may be used for fitness training when lower limb disabilities exist.

Adult↗
PubMedDate not supplied

[Composition and metabolism of extremely low-density lipoproteins in normal rabbits of different age and under experimental atherosclerosis].

The lipid composition and protein content in extremely low-density lipoproteids. lipoproteid-lypase activity and breakdown dynamics of the mentioned [3H]cholesterol-labelled lipoproteids are studied in blood of young and old rabbits in norm and under experimental atherosclerosis. It is shown that in normal animals the content of all lipid components and protein decreases with ageing in the fraction of extremely low-density lipoproteids isolated from blood serum. The activity of lipoproteid lypase and breakdown of intravenously injected labelled extremely low-density lipoproteids are lowered in old animals as well. Under experimental atherosclerosis in extremely low-density lipoproteids there occurs accumulation of cholesterol esters in considerable amounts, the breakdown of the class lipoproteids is slown down. The enzymic activity manifests no significant changes in comparison with the norm. Disturbances in the composition of lipoproteids and their metabolism with the studied pathology are more pronounced in old rabbits than in young ones.

Aging↗
PubMed1981

[Evolutionary dispositon of the thoracic extremities and the fate of the coracoids and scapulae in vertebrates].

It is of general opinion that the mammalian coracoid bone reduced during the evolutional process and remained as a small tubercle on the distal part of the scapula. The cause of the caracoid bone reduction is supposed to result from certain changes in position of the free thoracic extremity from the segmental (as in reptiles) plane into the sagittal one, while the position of the shoulder girdle remained unchanged. However, this view does not coincide to the paleontological data which state that already in the Dinosauria and Theriodontia the thoracic extremities were situated in the parasagittal plane and, nevertheless their caracoids were well developed. There is also no agreement with numerous embryological, comparative-anatomical and electromyographic data concerning the osseous-muscular system of the thoracic extremities and the evolutional transformation of the brachial plexus. Owing to these data, it is possible to suggest that in the process of the mammalian evolution, the thoracic extremity together with the shoulder girdle made a turn around its longitudinal axis and, as a consequence, the caracoid with its musculature, moved from its abdominal position forward and upward on the lateral and spinal surface, and the scapula, correspondingly, in the caudoventral direction and gradually reduced.

Amphibians↗
PubMed1980

Patients complaining of extreme pain.

Some patients chronic pain say that their pain is both constant and extreme. A graphic rating scale was used to identify 35 patients in a pain management program who complained of extreme pain. They were compared with 31 subjects who rated their pain as low. The patients with extreme pain were older, were more often female, had a longer history of pain, were disabled longer, had had more surgical procedures and hospitalizations, were more dependent on drugs, had higher ratings of bodily and facial pain behavior, and responded less well to treatment than the patients in the low-pain group. A rating of extreme pain remained a rather fixed presentation. It did not correlate with orthopedic or neurologic diagnoses. Possible explanations of the complaint are discussed, and illustrative case material is presented.

Adult↗
PubMed1980

Hyperthermic perfusion of recurrent malignant melanoma on the extremities.

Twenty-one patients with recurrent malignant melanoma on the extremities were treated by regional hyperthermic perfusion with melphalan (Alkeran). Four patients had a second perfusion. The recurrence site was on the foot in one patient, on the lower part of the leg in 13 patients, below the mid-thigh in 6 patients and on the elbow in one patient. The temperature of the extremities was registered continuously during the perfusion. Perfusion was performed under hyperthermic conditions with a temperature of 40-41.0 degrees C i.m. The perfusion time was 2 hours. Alkeran was given in a dose of 0.9 mg/kg bodyweight for lower extremity perfusion and 0.45 mg/kg for upper extremity perfusion. Complete tumour regression or more than 50% tumour regression was registered in 8 out of the 10 patients with manifest tumour. As the first sign of recurrence after perfusion, 4 patients had local recurrence and 10 had systemic recurrence. Altogether one-third of the patients had local recurrences and half of the patients systemic recurrences. Local recurrences occurred after a median time of 8 months and systemic recurrences after a median time of 7 months. Nine patients are still alive after an observation time of 5.5 months to 44 months. Three patients are without any signs of recurrent disease.

Aged↗
PubMed1995

Upper extremity replantation at a regional medical center: a six-year review.

Trauma to the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Traumatic amputation can be particularly devastating, but many of these extremities can be saved by replanatation of the amputated parts. We reviewed the upper extremity replantations performed at the Medical Center of Central Georgia in the 6-year period from September 1987 to August 1993. A total of 48 replantations in 39 patients (33 male, six female) were studied: 36 fingers, seven thumbs, two transmetacarpals, one wrist, one forearm, and one brachium. Average patient age was 32.7 years, with a range of 4 to 69 years. All seven thumbs, two transmetacarpals, and three proximal replants survived. Viability of replanted fingers was 56 per cent; however, sharp injuries fared better than crush injuries (62% vs 50%). The success rate improved with experience of the surgeon (85% after 1990). Leeches were used effectively for venous congestion in nine of 13 cases (70%). Results were comparable with those of large academic medical institutions. Replantation of traumatic amputations can be performed with reasonable success at a regional medical center if a qualified surgeon and appropriate ancillary care are available. Results improve with experience of the surgeon and careful patient selection. Successful replantation significantly reduces the morbidity of upper extremity amputations and will continue to be important in the management of the trauma patient.

Adolescent↗
PubMed1995

[Unification of extreme levels of exposure to flight factors of different energy nature].

The factors of a various energetic nature the extreme levels of which both directly (via special receptors) and mediately influence and change the functions of nervous system are studied. Empirical data suggest conclusively that the general biological regularities of the effects of an "intensity-time" type is also valid on the organism level if the central nervous system is thought of as an irritable object. In all cases the initial cause of the disturbed cerebral activity is an external energetic irritative action. It is demonstrated that the character of human response to the extreme effects of some flight factors corresponds to general biological regularity of the reaction toward irritating stimulus. In this case the general mechanism of such reactions of the nervous system is an exhaustion of the energetic brain resources. There have been derived the equalities which define the quantitative relationships among the equivalent levels of extreme flight factor effects and the common unit of their measurement is introduced. On the basis of general biological regularities of the body response to irritating stimulus, the method for estimating and predicting useful consciousness time of the pilot in case of a combined effect of the flight factors under extreme conditions is suggested. For some flight factors (altitude, flight accelerations, noise, ionizing radiation) there have been obtained the qualitative indices enabling one to apply this method to solve the practical tasks. The set algorithm can be fed in personal computers and extended to other flight factors.

Acceleration↗
PubMed1994

[The use of continuous plasmapheresis and extracorporeal laser irradiation of the blood in treating diabetic angiopathies of the lower extremities].

The plasmapheresis (PP) with the help of the PP-05 apparatus was applied in the treatment of 70 patients with the low extremities diabetic angiopathy. The optimal plasma exfusion dose is from 600 to 1100 ml. Under the PP influence the blood glucose level reduced proportionally to the excreted plasma quantity, the rheovasographic index on the low extremities increased from 0.41 +/- 0.15 to 0.64 +/- 0.6; the bloodflow velocity in the peripheral arteries of low extremities have got the 2.2-fold rise according to the dopplerography data. In comparison with a control group of patients the exarticulation conduction frequency decreased from 20 to 8, and extremities amputation--from 14 to 5.

Blood↗
PubMed1994

[The psychophysiological characteristics and correction of extreme states of an informational-semantic origin].

The article deals with the general characteristics of extreme states influence. The authors systematize the factors which may be considered as extreme ones. The article shows that the development of different extreme states frequently is predetermined by informative-semantic nature. The following types of extreme states of informative-semantic genesis were studied: emotional tension, anxiety, fear, affective excitement, inhibition, depersonalization. There are psychophysiological characteristics of these states and basic methods of its correction.

Aerospace Medicine↗
PubMed1994

The mangled lower extremity: can salvage be predicted?

The ability to predict amputation following combined orthopedic, vascular and soft tissue trauma to an extremity could eliminate prolonged attempts at salvage of a doomed limb. We reviewed our experience with 48 mangled lower extremities in 46 patients. Twenty-one penetrating wounds and 25 blunt injuries occurred in 37 men and nine women ranging in age from 3 to 59 years. Severity of injuries to muscle, skin, and major nerves were strongly interrelated (r = 0.49 to 0.74, P < 0.001), but there were no correlations between injuries to these tissues and severity of bone injury (r < 0.19, P > 0.20). Twenty-four limbs were salvaged, and 24 were amputated. Increased severity of soft tissue injury was associated with a greater probability of limb loss (P < 0.001), but limb salvage or amputation could not be predicted accurately by any variable or group of variables such as age, mechanism of injury, Injury Severity Score, presence of shock, level of injury, venous injury or repair, sequence of repair (vascular vs skeletal), time of fasciotomy, arteriography, blood requirement, or duration of ischemia. Amputation was best predicted by severity of injury to the sciatic or tibial nerves (P < 0.001), and by failure of arterial repair (P < 0.01). Severe extremity injuries require a coordinated approach and decisions regarding amputation require careful judgement. These decisions cannot always be made at the time of presentation or during the initial operation. If after revascularization and skeletal stabilization the extremity is clearly nonviable or remains insensate, then delayed amputation can be performed under more controlled circumstances.

Adolescent↗
PubMed1993

Lower extremity revascularization.

Atherosclerotic occlusive disease of the lower extremity in patients exhibiting severe rest pain, ulceration, or tissue necrosis represents a serious threat to extremities. In the past two decades the surgical approach in the treatment of lower extremity ischemia has changed significantly due to better understanding of segmental disease and infrapopliteal disease. Also, better visualization of leg and foot arteries due to improved angiographic and surgical techniques aided by magnification have all significantly contributed to increased limb salvage. Vein, when available, is the ideal graft material both for supra and infrapopliteal reconstruction. Availability of vein as a conduit can be increased when ectopic veins such as cephalic etc., are used and also when short segments of veins are used with unconventional distal inflow sites such as SFA, distal deep femoral artery, and popliteal artery. However, when vein is unavailable, PTFE graft is a good option particularly in patients with life expectancy of less than three years. Better understanding of graft failure has lead to better graft surveillance with PVR, ABI and Duplex scanning. Timely intervention with either PTA or surgery has lead to better secondary patency of grafts. Veith et al. looked at amputation rates during the period of changing therapeutic approach and found both a decrease in primary and secondary amputation rate implying the effectiveness of an aggressive therapeutic approach. Not all aspects of lower extremity disease are understood. However, infrapopliteal disease has now been addressed and new, innovative therapeutic approaches have made significant advances in limb salvage.

Amputation, Surgical↗
PubMed1993

Sonography of peripheral nerves of the extremities.

High-resolution sonography can visualize segments of the major nerve trunks in the extremities, with nerves displaying a characteristic hyperechoic appearance. Sonography can also establish the diagnosis of nerve sheath tumors when the normal nerve is visualized. Other abnormalities that can be demonstrated by sonography include traumatic and Morton's neuromas and inflammatory changes. High-frequency probes up to 20.0 MHz are used. Both longitudinal and tranverse scans must be performed, strictly parallel and perpendicular to the nerve axis. In the upper extremities US demonstrates better than CT and MRI the radial and ulnar nerves in the elbow, the median nerve in the forearm and the carpal tunnel; in the lower extremities the sciatic, the tibial, the popliteal nerves are visualized, while both the deep and the superficial nerves are poorly demonstrated. Our experience leads us to the conclusion that the examination of nerves in the extremities is a promising new application of high resolution US. Indeed, the method can play a significant role in the diagnosis of pathologic conditions of nerves, particularly nerve sheath tumors, at a lower cost than MRI. However, the latter will remain the diagnostic procedure in areas of complex anatomy.

Humans↗