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At least 1,243 records · Page 69Linked to original sources
PubMed2006

Upper extremity compartmental anatomy: clinical relevance to radiologists.

Malignant tumors of the upper extremity are uncommon, and their care should be referred to specialized facilities with experience treating these lesions. The Musculoskeletal Tumor Society (MSTS) staging system is used by the surgeon to determine appropriate surgical management, assess prognosis, and communicate with other healthcare providers. Magnetic resonance imaging (MRI) is employed pre-operatively to identify a lesion's compartment of origin, determine extent of spread, and plan biopsy and resection approaches. Involvement of neurovascular structures may result in devastating loss of upper extremity function, requiring amputation. Violation of high-resistance compartmental barriers necessitates more extensive surgical resection. Biopsy may be performed by the radiologist using imaging guidance. Knowledge of compartmental anatomy allows the radiologist or surgeon to use an easily excisable biopsy approach and prevent iatrogenic spread to unaffected compartments. Case examples are presented to illustrate the importance of compartmental anatomy in the management of benign and malignant upper extremity tumors.

Bone Neoplasms↗
PubMed2001

Contrast-enhanced three-dimensional helical CT for soft tissue tumors in the extremities.

OBJECTIVE: To evaluate the ability of contrast-enhanced three-dimensional (3D) helical computed tomography (CT) to image soft tissue tumors in the extremities. DESIGN AND PATIENTS: Forty-five consecutive patients with soft tissue tumors in the extremities were examined (mean age 46.2 years; 24 females, 21 males). Twenty-five patients had benign lesions and 20 had malignant lesions. All the patients underwent contrast-enhanced 3DCT scanning and magnetic resonance (MR) imaging preoperatively. All patients were surgically treated. Spiral CT scanning was performed with intravenous contrast enhancement. 3D reconstruction images were produced after thresholding, using Active-Windows (version 2.0, General Electric, Milwaukee, WI) software. 3DCT findings were compared in a masked fashion with the MR imaging and surgical findings regarding bone and major vessel invasion by the tumors. RESULTS: Forty-four of 45 tumors were satisfactorily imaged for the interpretation of their size, location and relationship to the skeleton and major vessels. One malignant tumor was judged on 3DCT to invade the major vessel, but the vessel proved to be normal at surgery. CONCLUSIONS: Contrast-enhanced 3D helical CT can be used for the evaluation of soft tissue tumors in the extremities, for preoperative surgical planning.

Adolescent↗
PubMedDate not supplied

Complications of lower-extremity outpatient arteriography via low brachial artery.

We retrospectively evaluated low brachial artery puncture for arteriography and its complications as an alternative approach route for bilateral lower extremity run-off. Using the Seldinger technique and catheterization with a sheathless 4-F multiple side-hole pigtail catheter, we performed 2250 low brachial artery punctures in outpatients. The right brachial artery (RBA) was successfully punctured in 2039 patients; the left brachial artery (LBA) in 200. The transfemoral approach was used in 11 patients when catheterizing either of brachial arteries failed. Ten major or moderate complications (2 pseudoaneurysms, 2 thrombosis, 1 dissection and 5 hematomas) were encountered. Surgical intervention was necessary in three cases. There were no transient ischemic attacks. Twenty-one patients suffered temporary loss of radial pulse which returned spontaneously in less than 1 hour. One patient demonstrated prolonged loss of pulse which required heparin. Low brachial artery puncture and catheterization at the antecubital fossa is a very safe and cost-effective alternative to the femoral artery approach for lower extremity intra-arterial arteriography in the hands of experienced operators. The success rate in catheterizing one of the brachial arteries was 99.52% with a low significant complications rate of 0.44%. The transbrachial approach should be used as a standard method for lower extremity IA-DSA in an outpatient setting.

Adolescent↗
PubMed2003

High prevalence of asymptomatically poor muscle perfusion of lower extremities measured in systemic lupus erythematosus patients with abnormal myocardial perfusion.

Patients with systemic lupus erythematosus (SLE) may develop premature atherosclerosis, notably peripheral vascular disease (PVD) presenting with intermittent claudication or gangrene. Therefore, it is important to investigate if high prevalence of poor muscle perfusion of lower extremities in SLE patients with abnormal myocardial perfusion is related to more cardiovascular risk factors. We used a well-established and noninvasive radionuclide method (xenon 133 muscle washout) to evaluate objectively the anterior tibial muscle perfusion of 34 SLE female patients without symptoms/signs of PVD in the lower extremities. The patients were separated into two groups according to myocardial perfusion imaging results. Meanwhile, 30 normal female controls with matched age distribution were also included for comparison. The muscle perfusion differed significantly ( P <0.05) between patients (1.90+/-0.41 ml/100 g per min) and controls (2.91+/-0.50 ml/100 g per min), as well as between 18 SLE patients with abnormal myocardial perfusion (1.33+/-0.43 ml/100 g per min) and 16 with normal myocardial perfusion (2.26+/-0.45 ml/100 g per min). Based on the xenon 133 muscle washout method, we conclude that muscle perfusion in the lower extremities of SLE patients without symptoms/signs of PVD is significantly decreased and related to abnormal myocardial perfusion.

Adult↗
PubMed2002

A novel vacuum device for extremity immobilisation during digital angiography: preliminary clinical experiences.

Our objective was to develop and evaluate a non-invasive device for rigid immobilisation during extremity angiography. The patented BodyFix immobilisation device (Medical Intelligence, Schwabmünchen, Germany) consists of a vacuum pump connected to special cushions and a plastic foil that covers the body part to be immobilised. First, the patient's extremity is covered by a thin plastic bag and then wrapped in one of the cushions, placed on the top of the therapy couch, and covered with the plastic foil. The air is evacuated from the cushion under the covering foil by the vacuum pump, resulting a hardening of the cushion and thus immobilisation of the patient's extremity. The rigid immobilisation resulted in a complete absence of motion artefacts in the majority of patients. No pixeling of the images was required in any of the 100 patients vs 32% in the control group. Repetition of series could be avoided in all cases and a substantial increase in the quality of the images was obtained. Setup of the device takes an additional 1-2 min. Vacuum immobilisation allows for comfortable, effective immobilisation during digital subtraction angiography, eliminating motion artefacts. This device has become an indispensable tool in daily clinical routine at our department.

Adult↗
PubMed2006

Role of magnetic resonance imaging in entrapment and compressive neuropathy--what, where, and how to see the peripheral nerves on the musculoskeletal magnetic resonance image: part 2. Upper extremity.

The diagnosis of nerve entrapment and compressive neuropathy has been traditionally based on the clinical and electrodiagnostic examinations. As a result of improvements in the magnetic resonance (MR) imaging modality, it plays not only a fundamental role in the detection of space-occupying lesions, but also a compensatory role in clinically and electrodiagnostically inconclusive cases. Although ultrasound has undergone further development in the past decades and shows high resolution capabilities, it has inherent limitations due to its operator dependency. We review the course of normal peripheral nerves, as well as various clinical demonstrations and pathological features of compressed and entrapped nerves in the upper extremities on MR imaging, according to the nerves involved. The common sites of nerve entrapment of the upper extremity are as follows: the brachial plexus of the thoracic outlet; axillary nerve of the quadrilateral space; radial nerve of the radial tunnel; ulnar nerve of the cubital tunnel and Guyon's canal; median nerve of the pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. Although MR imaging can depict the peripheral nerves in the extremities effectively, radiologists should be familiar with nerve pathways, common sites of nerve compression, and common space-occupying lesions resulting in nerve compression in MR imaging.

Brachial Plexus Neuropathies↗
PubMed2003

Lower extremity spasticity as an early marker of ambulatory recovery following traumatic brain injury.

METHODS: A consecutive series of 107 children and young persons with traumatic brain injury (TBI) admitted to a hospital-based inpatient rehabilitation program was assessed to determine whether lower extremity spasticity could be utilized as an early clinical marker for recovery of ambulation. Presence of spasticity was determined by clinical examination at admission, and the ability to ambulate safely indoors (15.24 m) was evaluated at discharge. Sensitivity, specificity and positive and negative predictive values for spasticity were calculated. RESULTS: Lower extremity spasticity is a sensitive (71.4%) and specific (81.5%) predictor of the inability to ambulate at discharge. The absence of lower extremity spasticity, however, was a better predictor of ambulation recovery than the presence of spasticity was a predictor of nonambulatory status at hospital discharge. DISCUSSION: Implications for spasticity assessment and prognosis in terms of ambulation and recovery are discussed.

Adolescent↗
PubMed1999

Strength training for 1h in humans: effect on the motor performance of normal upper extremities.

It has been found that one session of intense muscle strength training decreases muscle strength temporarily and causes neuromuscular fatigue in the trained muscles, but little attention has been given to the effects of neuromuscular fatigue on the other components of motor performance. The purpose of this study was to examine in normal healthy volunteers the effects of a 1-h strength training session on the motor performance of the upper extremity, including reaction time, speed of movement, tapping speed and coordination. Group of 30 healthy female volunteers, aged 29-47 years, were randomly divided into sub-groups, (A and B, n = 15 per group). Both groups first completed a set of motor performance tests on 3 consecutive days. On the 4th day, group A carried out a 1-h muscle strength training session of the upper extremities. Isometric muscle strengths and electromyogram (EMG) data were recorded before the training session. Immediately after the training session the same recordings were repeated, and additional motor performance tests were also performed. Group B carried out only the motor performance tests. The groups exchanged programmes the following week. The 1-h strength training session decreased the isometric muscle strength of wrist flexion by 18% (P < 0.001) and extension by 18% (P < 0.001) in group A, while in group B flexion strength decreased by 19% (P < 0.001) and extension strength by 17% (P < 0.001). All the measured EMG activations also decreased in both groups. There were no statistically significant differences in the results of the motor performance tests between the mean values of the three baseline measurements and the values recorded after the training session. The result was surprising, but straightforward; neuromuscular fatigue induced by a 1-h strength training session of the upper extremities had no effect on the motor performance functions of the hand, as indicated by reaction times, speed of movement, tapping speed and coordination, in these normal healthy female volunteers.

Adult↗
PubMed2003

Arteriovenous PTFE dialysis access in the lower extremity: a new approach.

Advances in hemodialysis technology have allowed application of this treatment modality to an ever-increasing number of patients. Maintaining patients on dialysis for more than a decade is not unusual and the treatment of such patients may be limited primarily by the availability of vascular access. The aim of this study was to assess the efficacy and safety of a PTFE bridge graft between the superficial femoral artery and vein when more conventional arteriovenous fistulas cannot be accomplished. Use of the lower extremity had previously been avoided because of a greatly increased risk of infection. Over the period October 1, 1992 to March 31,1997, we performed 14 of these grafts in 11 patients (6 men and 5 women) whose median age was 56 (range 34-85) years. The patients were on long-term hemodialysis and vascular access in the upper extremity was not possible. The median time from start of hemodialysis to receiving a suprapatellary bridge graft was 8 months (range 0-67). The suprapatellary graft was performed on two patients who were just starting on hemodialysis. Six patients received PTFE prosthetic implants in both arms and the other three patients underwent both native arteriovenous fistulas and PTFE prosthetic implants in the arm before the thigh was used. Only one patient had diabetes mellitus. Primary patency at 1 year was 54% and at 2 years, 18%. Secondary patency at 1 year was 64% and at 2 years, 18%. A PTFE bridge graft between the superficial femoral artery and vein for hemodialysis is a promising alternative when upper extremity arteriovenous fistulas cannot be constructed. The procedure is easily and rapidly performed with good access, and the patient clientele is easily selected. The technique has not been described previously.

Adult↗
PubMed2004

A comparison of magnetic resonance angiography, contrast arteriography, and duplex arteriography for patients undergoing lower extremity revascularization.

The objective of this study was to compare magnetic resonance angiography (MRA), contrast arteriography (CA), and duplex arteriography (DA) for defining anatomic features relevant to performing lower extremity revascularizations. From March 1, 2001 to August 1, 2001, 33 consecutive inpatients with chronic lower extremity ischemia underwent CA, MRA, and DA before undergoing lower extremity revascularization procedures. The reports of these tests were compared prospectively and the differences in the aortoiliac segment, femoral-popliteal, and infrapopliteal segments were noted. The vessels were classified as mild disease (<50%), moderate disease (50-70%), severe disease (71-99%), and occluded. These studies and treatment plans based on these data were compared. During this time period, 11 patients were not able to undergo MRA and therefore were excluded from the study. Thirty-three patients were included in this study. These patients underwent 35 procedures, as 2 patients underwent bilateral procedures. The mean age of the 33 patients was 76+/-10 years (SD). Indications for the procedures included gangrene (20), ischemic ulcer (8), rest pain (4), and severe claudication (1). Patients' medical history included diabetes mellitus (25), hypertension (20), and end-stage renal disease (5). No differences were noted between intraoperative findings and CA in this series. Two of the three differences between DA and CA were felt to be clinically significant whereas 9 of the 12 differences between MRA and CA were felt to be clinically significant. On the basis of these data in this series, MRA does not yet seem to be able to obtain adequate data on infrapopliteal segments, at least not for this highly selected population. When severe tibial calcification or very low flow states are identified, CA may be necessary for patients undergoing DA.

Aged↗
PubMed2006

An international comparison of lower extremity amputation rates.

The purpose of this report was to compare lower extremity amputation rates between areas of the United States and areas outside the United States using a standard format. Twelve U.S. counties similar in size, income, and land use were selected. The rate of amputation for each county was developed following the method and definitions described by the Global Lower Extremity Amputation Study (GLEAS). The data were compared to rates of amputation for non-U.S. areas that participated in the GLEAS. The U.S. counties generally had higher amputation rates than the non-U.S. areas in this standardized comparison. The United States suffers a high number of lower extremity amputations in comparison to other developed countries. The effectiveness of prevention strategies in the United States needs to be reevaluated and new strategies explored.

Amputation, Surgical↗
PubMed2004

Sarcoidosis with high serum levels of vascular endothelial growth factor (VEGF), showing RS3PE-like symptoms in extremities.

We report a patient with sarcoidosis who showed edema in the distal portion of all extremities, particularly the legs, as seen in remitting seronegative symmetrical synovitis with pitting edema (RS3PE). Magnetic resonance imaging demonstrated diffuse abnormal intensity in subcutaneous tissues of both legs, and skin biopsy led to a diagnosis of sarcoidosis. Vascular endothelial growth factor (VEGF) showed a high serum level, which decreased soon after starting oral prednisolone, in parallel with an improvement in the limb edema. In this patient VEGF as well as infiltration by sarcoid granuloma in the skin might have played an important role in the pathogenesis of RS3PE-like symptoms in the extremities. When painful pitting edema is seen predominantly in the distal portion of all extremities, sarcoidosis as well as RS3PE should be considered as a possible diagnosis.

Edema↗
PubMedDate not supplied

Primary extremity sarcoma: what is the appropriate follow-up?

BACKGROUND: Our objective was to evaluate the effectiveness of follow-up tests for detecting first local and distant recurrences in patients with primary extremity soft tissue sarcoma. METHODS: We retrospectively analyzed all adult cases of primary extremity soft tissue sarcoma (n = 174) treated between 1982 and 1992. Patients were observed every 3 months for 2 years, every 4 months the third year, every 6 months the next 2 years, and annually, thereafter. Each visit consisted of taking the patient's history, a physical examination, a complete blood count, a blood chemistry panel, and a chest x-ray. For high-grade tumors, the primary site was imaged annually when clinically appropriate. RESULTS: Of 141 patients who were assessable, 29 patients developed local recurrence and 57 developed distant recurrence. All but one of the local recurrences was detected on the basis of an abnormal physical examination. Of the 29 patients who developed local recurrence, 25 were resected. Distant metastases were detected because of symptoms in 21 cases. Of the 36 asymptomatic lung recurrences, 30 were detected by follow-up chest x-ray. Of the 36 asymptomatic lung recurrences, 24 patients underwent metastasectomy. The positive and negative predictive values of surveillance chest x-ray were 92% and 97%, respectively. Laboratory testing never led to the detection of recurrence. CONCLUSIONS: Close surveillance by clinical assessment and chest x-ray is appropriate for follow-up observation of patients with primary extremity soft tissue sarcoma.

Extremities↗
PubMed2006

Restricted upper extremity range of motion in mucopolysaccharidosis type I: no response to one year of enzyme replacement therapy.

BACKGROUND: Mucopolysaccharidosis type I (MPS I) results from deficiency of the lysosomal enzyme alpha-L: -iduronidase (IDUA). Glycosaminoglycans (GAGs) accumulate in multiple organs and the storage in connective tissues results in restricted mobility. Previous studies provided evidence of an improvement in range of motion (ROM), as measured by goniometry, after supplementation of recombinant enzyme (ERT). AIM: The aim of the study was to evaluate the efficacy of ERT in improving ROM in patients with MPS I, using a blinded three-dimensional (3D) video analysis of unrestricted movements of the upper extremities. METHODS: In 6 patients with the attenuated phenotype of MPS I, the longitudinal changes in the upper extremity ROM were analysed by 3D video analysis during one year of ERT. RESULTS: At baseline, all studied movements except for elbow flexion were restricted. No significant improvement of the restricted upper extremity ROM was observed after one year of ERT. CONCLUSION: Long-standing restrictions in ROM probably cannot be reversed by ERT. Early initiation of treatment might be essential to prevent irreversible functional defects.

Child↗
PubMed2005

Preliminary evaluation of the generalized work distress scale in patients with work-related upper extremity disorders.

This study evaluated the reliability and construct validity of the Generalized Work Distress Scale in 207 patients attending a specialty clinic with work-related upper extremity disorders. Factor analyses were conducted and compared to the original developmental study confirming a two-factor solution: an internal factor related to Work-Related Dysphoria and an external factor related to Work-Related Support. Reliability (internal consistency) of factors was high (Cronbach's alpha = 0.87 and 0.89). The Work-Related Dysphoria factor was more related to self-reported global depressed mood and self-reported upper extremity functional disability, than was Work-Related Support. This study provided preliminary support for the use of this scale in patients with work-related upper extremity disorders and consideration to depressive symptoms in these patients. Further investigation of the psychometric properties of this scale and its predictive validity are required.

Cohort Studies↗
PubMed2006

Adjuvant therapy for extremity sarcomas.

Extremity soft tissue sarcomas (STS) represent a rare, heterogeneous malignancy. Surgery is the primary treatment for patients with no evidence of metastatic disease, and for small low-grade superficial tumors in which adequate margins can be obtained, it may be the only therapy indicated. For large, deep tumors or tumors that are close to important neurovascular structures or bone, the addition of radiotherapy to resection has improved local control and increased limb salvage without affecting overall survival. Adjuvant chemotherapy has been an issue of considerable debate. Because 50% of patients with high-risk tumors will develop metastatic disease, effective systemic treatment with chemotherapy is needed. Unfortunately, studies have shown minimal improvement in overall survival when chemotherapy is added to the local treatment of high-risk extremity STS. More recently, a few trials of neoadjuvant chemotherapy consisting of mesna, doxorubicin, ifosfamide, and dacarbazine and high-dose doxorubicin and ifosfamide have shown some early promising results, but at the price of increased toxicity. Targeted therapy has shown some of its best results with gastrointestinal stromal tumors, but so far there has been little success in treating extremity STS. At this time, high-dose adjuvant or neoadjuvant chemotherapy should be given in the setting of a clinical trial to patients with high-risk tumors who can tolerate a potentially toxic chemotherapeutic regimen. The goal of these trials should be to assess new combination therapies, possibly including targeted therapies, for the management of large high-grade, high-risk soft tissue sarcomas.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1975

Soft tissue sarcomas of the extremity. Multidisciplinary therapy employing hyperthermic perfusion.

Cultured human sarcomatous cells that have been tested in our laboratory are more sensitive to the lethal effects of heat than are the normal cells from which they are derived. During an eight year period from March 1967 to March 1975, thirty-seven patients with soft tissue sarcomas of the extremities were treated with hyperthermic perfusion and, when possible, radiation therapy and radical local excision. Despite the fact that these tumors arise on the extremity, diagnosis was often delayed. With meticulous attention to all details, hyperthermic perfusion was performed with a minimum of morbidity and mortality. The combined use of hyperthermic perfusion, radiation therapy, and delayed excision has greatly reduced the necessity for amputation. Many useful limbs, heretofore not considered salvageable, can be saved with this method of treatment. Also, the possibility exists that destruction of tumor within the extremity followed by delayed excision enhances the immune response of the patient.

Adolescent↗
PubMed1985

Limb-sparing surgery for extremity sarcomas after preoperative intraarterial doxorubicin and radiation therapy.

Complete local control of 25 extremity bone and soft tissue sarcomas was obtained by combined preoperative intraarterial doxorubicin and radiation therapy, followed by limb-sparing resection with reconstruction and adjuvant chemotherapy. At a 32 month median follow-up, there are no local tumor recurrences. Functional limbs were salvaged in 21 patients (84 percent). Fifteen patients (60 percent) were continuously disease-free and overall survival was 80 percent. After the extensive combined modality therapy, extremity complications, including delays in wound healing, occurred in 10 patients. Nevertheless, most complications were resolved with salvage of functional limbs. These results support an aggressive multimodality limb-sparing approach to high-grade extremity sarcomas.

Adult↗