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PubMed1982

Massive upper extremity edema with arteriovenous fistula for hemodialysis. A complication of previous pacemaker insertion.

A 50-year-old patient with chronic renal insufficiency developed massive edema of the left upper extremity following placement of an elective radial artery-cephalic vein fistula for future hemodialysis. Subclavian vein thrombosis was diagnosed by radionuclide venography and was undoubtedly caused by prior transvenous pacemaker insertion. Ablation of that fistula relieved the edema. Investigation of the circulation of extremities used for previous pacemaker insertion is advised prior to their employment as vascular access for hemodialysis.

Arm↗
PubMed1995

Major amputation of the upper extremity. Functional results after replantation/revascularization in 47 cases.

Over a 7 year period, 47 patients underwent replantation of complete (19) and revascularization of incomplete nonviable (28) amputations of the upper extremity. Revascularization of incomplete nonviable amputations had a success rate of 100 percent, where as replantation of complete amputations had a success rate of 74 percent. 37 of the 42 patients with successful replantations had satisfactory functional use of the replanted extremity.

Activities of Daily Living↗
PubMed1997

The Bi-Digital O-Ring Test used in the successful diagnosis & treatment (with antibiotic, anti-viral agents & oriental herbal medicine) of a patient suffering from pain & weakness of an upper extremity & Barré-Liéou syndrome appearing after whiplash injury. A case report.

A patient with a whiplash injury suffering from prolonged symptoms, including pain and weakness of the right upper extremity and the symptoms of Barré-Liéou syndrome, was diagnosed and treated with the Bi-Digital O-Ring Test as a supplement to standard medical examinations. Radiological findings showed spondylotic canal stenosis with osteophytes and disc protrusions. The Bi-Digital O-Ring Test indicated a strong abnormal response around the right side of his neck and right shoulder, including the area of the vertebral artery and at acupuncture point GB 21, where positive resonant responses to Cytomegalovirus and Streptococcus faecalis were detected. Antibiotic and anti-viral agents, as well as Ku-Oketsu-Zai, a type of Oriental herbal medicine for overcoming blood stagnation or stasis, were administered according to the drug compatibility test using the Bi-Digital O-ring Test and the following clinical results were obtained. Infection at the site of the vertebral artery and the peri-arterial sympathetic nerve plexus was considered as a cause of the prolongation of the symptoms including Barré-Liéou syndrome, in this case. In addition we especially noted, in this clinical case, that the patient's impaired grasping force dramatically improved from 8 kg to 52 kg in a very short periods of time when the patient held suitable medicine selected with the Bi-Digital O-Ring Test drug compatibility test. We assume that the drug action was transferred electromagnetically, by which the pathological electromagnetic oscillations caused by trauma and following infections were scavenged. This effect might lead to an improvement in the coordination of the neuromuscular system.

Anti-Bacterial Agents↗
PubMed2002

Long-term consequences of upper extremity peripheral neuropathy in former Vietnam prisoners of war.

BACKGROUND: At the time of repatriation in 1973, a substantial number of Vietnam prisoners of war (POWs) were diagnosed with upper extremity peripheral neuropathy (UEPN). OBJECTIVE: To assess the long-term functional consequences of UEPN among former Vietnam POWs diagnosed with UEPN at repatriation. SUBJECTS: Former POWs with an International Classification of Diseases, Eighth Revision, code of peripheral neuropathy identified from a central database registry. METHODS: Cross-sectional survey. Standardized survey instruments and the SF-12 questionnaire were mailed to all subjects. A subsample of subjects completing the mailed survey was contacted by telephone to complete a semistructured questionnaire on current symptoms and physical limitations attributable to peripheral neuropathy. RESULTS: Seventy-nine percent of POWs diagnosed with peripheral neuropathy at repatriation currently experience some numbness or tingling more than 25 years after repatriation, and 63% currently experience pain in one or both hands. Although the average severity rating for numbness and pain was mild, 23% of the POWs still have moderate to severe pain. Ulnar neuropathy was present in more than 30% of the POWs. SF-12 physical composite scores were substantially lower among this group of POWs compared with an age-matched group from the Medical Outcomes Study. CONCLUSIONS: For those POWs diagnosed with UEPN at repatriation, nearly 80% continue to experience symptoms of numbness, tingling, and pain, with nearly 25% reporting a moderate or greater degree of symptoms. The low physical function scores of this cohort are particularly troubling. More research concerning physical symptoms and conditions among former POWs is needed, and this research should also investigate what causes are responsible for the significantly lower physical functional status.

Aged↗
PubMed1998

Bilateral percutaneous balloon angioplasty of the axillary arteries in a patient with giant cell arteritis and upper extremity ischemic symptoms not responsive to corticosteroids.

Giant cell arteritis (GCA) is well known to present with protean manifestations. We describe a 68-year-old woman with persistent upper extremity ischemic symptoms despite adequate treatment for GCA. She underwent successful balloon angioplasty of bilateral axillary artery stenosis. To our knowledge this is the first case utilizing this technique in GCA. Our case highlights the rare but important circumstances under which interventional techniques both surgical and nonsurgical need to be considered in cases of GCA with arterial occlusion not responsive to corticosteroid therapy.

Adrenal Cortex Hormones↗
PubMed2002

Reconstruction of the upper extremity with a compound rib-latissimus dorsi osteomusculocutaneous flap.

The reliability and versatility of the pedicled latissimus dorsi muscle or osteomusculocutaneous flap make it our first choice in the management of upper arm injuries and we have treated three such patients in this way. They had severe skeletonising, crushing injuries of an upper extremity with humeral defects that were treated with latissimus dorsi musculocutaneous flaps and segments taken from the ribs. All the flaps survived completely with no injury of the pleura at the donor site. The reconstructed humerus was strong enough for the patients to participate in all activities of daily living. We think that this technique is suitable for the upper arm defects with humeral loss because of its simplicity and minimal morbidity.

Adolescent↗
PubMed2006

Enlargement of cervical spinal cord correlates with improvement of motor function in upper extremities after laminoplasty for cervical myelopathy.

OBJECTIVE: The correlation between postoperative spinal cord enlargement at the most compressive disc level and clinical outcome is controversial. The relationship between spinal cord enlargement at neurologically symptomatic disc level and clinical recovery has not been explored. The purpose of this study was to clarify the relationship between postoperative spinal cord enlargement at neurologically symptomatic disc level and neurologic outcome. METHODS: We studied 55 consecutive patients between 1995 and 2002. All patients underwent preoperative neurologic examination to determine the neurologically symptomatic disc level of the spinal cord and computed tomographic myelography twice before and 4 weeks after laminoplasty. The cross-sectional areas of both spinal cord and dural sac from C3/4 to C7/T1 disc levels were measured on computed tomographic myelography images. The Japanese Orthopedic Association scoring system was used for clinical evaluation before and 1 year after surgery. RESULTS: Total score improved significantly from 10.2+/-2.8 (SD) to 13.0+/-3.0 after operation. Motor and sensory function scores of upper and lower extremities also improved significantly. The enlargement of spinal cord area at the neurologically symptomatic disc level correlated significantly with improvement in motor function scores of upper extremities (rs=0.421 P=0.0052). However, there were no significant relationships between the enlargement of the spinal cord at the most compressive disc level or that at the dural sac and any categories of Japanese Orthopedic Association scoring system. CONCLUSION: Postsurgical enlargement of the cervical spinal cord at the neurologically symptomatic disc level at 4 weeks postoperatively correlated with recovery of motor function of the upper extremities at 1 year.

Cervical Vertebrae↗
PubMed1994

Long-term results of arterial reconstruction of the upper extremity.

Arterial reconstructive surgery for upper limb ischaemia of non-traumatic non-embolic origin is uncommon in comparison to that of the lower extremities and long-term follow-ups are rare. Forty-eight patients (27 females, 21 males) with a median age of 58 years (range 22-88) were retrospectively analysed for risk factors, survival and patency rates. Seventy-three per cent were smokers, 42% had hypertension and 33% had had previous vascular interventions. Diabetes was only seen in 4% of the cases. Effort fatigue was the dominant cause for surgery followed by micro-embolism and rest pain or gangrene. The left side was more frequently affected with 30 procedures compared to 18 on the right. Bypass with either Dacron, ePTFE or autologous vein was the most frequent procedure in 56% of the cases followed by thrombendarterectomy (23%) and subclavio-carotid transposition (11%). Arm-arm index rose from 0.63 (SD 0.28) preoperatively to 1.02 (SD 0.12) after 1 month and at the end of follow-up (median 75 months) it was 0.96 (SD 0.15). Cumulative survival rates were at 1 month 98%, 1 year 91%, 5 years 81% and at 10 years 73%. Cumulative primary patency rates at the same intervals were 96, 96, 88 and 80%, respectively. Thus the survival rate and patency rate are favourable in comparison with arterial surgical procedures of the lower extremity.

Adult↗
PubMed1999

Motor neuron disease with predominantly upper extremity involvement: a clinicopathological study.

We report two autopsy cases of motor neuron disease (MND) patients with an unusual type of muscular atrophy predominantly affecting the shoulder girdle and the upper extremities with proximal dominance. Both patients are considered to be clinically categorized into the El Escorial suspected form of amyotrophic lateral sclerosis (ALS). At autopsy, they showed marked loss of spinal anterior horn cells accompanied by astrogliosis positively immunostained with anti-glial fibrillary acidic protein antibody at the cervical level. At the lumbosacral level, anterior horn neurons were relatively well preserved and Bunina bodies, ubiquitin-positive skein-like inclusions and Lewy body-like inclusions were observed in the remaining neurons. In one patient, brain stem motor neurons (nerves V, VII, XII) and motor cortex, including Betz cells, were also affected and the corticospinal tracts were degenerated at the level of the thoracic and lumbar spinal cord. Pathological findings of this patient are consistent with those of ALS. In the other patient, the motor cortex, brain stem motor nuclei and the corticospinal tracts were well preserved, which is pathologically compatible with progressive spinal muscular atrophy. These patients with such a peculiar pattern of progressive muscular atrophy should be placed in a subgroup of ALS.

Aged↗
PubMed2000

Upper extremity deep venous thrombosis: an underrecognized manifestation of a hypercoagulable state.

Although lower extremity deep venous thrombosis (LEDVT) has been associated with a hypercoagulable state, there are scant data available for patients presenting with upper extremity deep venous thrombosis (UEDVT). Therefore, we conducted a prospective study to determine whether such an association exists for UEDVT. Fifty-two patients who presented with UEDVT at our institution from August 1996 to June 1997 underwent a hematological profile consisting of activated protein C (APC) resistance, antithrombin III (ATIII) level and activity, factor V mutation (arginine 506 to glycine), protein C level and activity, protein S level and activity, factors II and X activity, lupus anticoagulant, and cardiolipin antibody. This represented 68% (52/76) of the total number of patients in whom the diagnosis of UEDVT was made by duplex ultrasonography during this time period. The ages ranged from 9 to 97 (mean 63 +/- 23 years). There were 22 males and 30 females. Twenty-five patients (48%) had a central venous line in place, 4 patients (8%) had a pacemaker, 14 patients (27%) had a history of neoplasm, and 7 patients (13%) had concomitant LEDVT. The results of our study showed that a hypercoagulable state may be an underappreciated contributing factor in the development of UEDVT. Contrary to prior belief that three sets of tests are needed to confirm the presence of a hypercoagulable state, these data also suggest that only two tests may be needed.

Adolescent↗
PubMed2003

Upper extremity deep vein thrombosis associated with indwelling peripheral venous catheters in gynecology oncology patients.

OBJECTIVE: The goal of this study was to review the clinical presentation, management, and outcome of upper extremity deep vein thrombosis (UEDVT) in women with gynecologic malignancies who had indwelling peripheral venous access catheters. METHODS: From a retrospective review of medical records, we identified 13 patients with various gynecologic malignancies who were diagnosed with UEDVT during their disease course. We obtained tumor data, detailed information regarding the indwelling catheters used, and the diagnosis and management of UEDVT. RESULTS: Two hundred sixty-four women with gynecologic malignancies underwent insertion of an indwelling peripheral catheter by interventional radiology over a 5-year period. A total of 325 catheters were placed in these patients. Thirteen patients developed UEDVTs, and all had a catheter in situ at the time of DVT diagnosis. Eleven of thirteen patients had Peripheral Access System (PAS) Ports and two had peripheral indwelling central catheters (PICCs). The mean age of the patients was 53 years (range, 32-70). At the time of UEDVT diagnosis patients had the following: progressive cancer (n = 8), stable disease (n = 1), no evaluable disease (n = 4), and actively receiving chemotherapy (n = 7). Clinical signs/symptoms at the time of diagnosis included: catheter occlusion (n = 2), arm swelling and pain (n = 10), and superior vena cava syndrome (n = 1). Diagnosis of thrombosis was confirmed using Doppler ultrasound (n = 4), venography (n = 5), and both modalities (n = 4). Management of UEDVT consisted of anticoagulation with warfarin (2-6 months) (n = 9), urokinase infusion (n = 2), intravenous antibiotics for 21 days and heparin for 10 days (n = 1), arm elevation only (n = 1), Lovenox for 60 days (n = 1), and no therapy (n = 1). There were no complications associated with anticoagulation. No patient had a pulmonary embolism. The incidence of UEDVT among our patients with indwelling venous catheters was 5.7%. CONCLUSION: Symptomatic UEDVT is an uncommon complication of indwelling peripheral venous catheters in women with gynecologic malignancies. The risk of pulmonary embolism is low in this patient population.

Adult↗
PubMed1999

Competitive water polo. Upper extremity injuries.

Water polo is a contact sport combining the skills of swimming, swim conditioning, throwing and, occasionally, the elements of wrestling and boxing. As such, the athletes frequently sustain upper extremity injuries involving the shoulder, the elbow, or the hand and fingers; moreover, injuries may result from either overuse or acute trauma. Successful treatment of these injuries requires an understanding of the peculiarities of the game and the likely mechanisms of injury, and the experience to properly recognize when they occur.

Arm Injuries↗
PubMed2004

Magnetic resonance venography in consecutive patients with suspected deep vein thrombosis of the upper extremity: initial experience.

PURPOSE: To assess the feasibility and accuracy of two magnetic resonance (MR) venography methods in a consecutive series of patients with suspected deep vein thrombosis of the upper extremity (DVTUE). MATERIAL AND METHODS: Consecutive in- and outpatients who were referred for imaging of suspected DVTUE in a large teaching hospital during the period April 2001 to October 2002 were eligible for inclusion. All patients were scheduled to undergo contrast venography with the intention to perform additional MR venography. Both time-of-flight and gadolinium-enhanced 3D MR venography were scheduled. All MR imaging were interpreted independently by consensus of two experienced radiologists, who were blinded for contrast venography outcome. Patients were managed based on contrast venography only. RESULTS: A total of 44 patients were eligible for inclusion. Thirteen patients were excluded (5 refused consent, 2 inability to gain venous access, 2 renal failure, 4 logistic reasons). Contrast venography was performed in 31 patients, and demonstrated DVTUE in 11 patients. MR imaging was not feasible in 10 patients (4 unable to lie flat, 3 claustrophobia, 1 too large for MR scanner, 1 osteosynthesis of shoulder, 1 pacemaker). The sensitivity and specificity of TOF MRV versus Gadolinium 3D MRV was 71% and 89% versus 50% and 80%, respectively. CONCLUSION: A high number of patients were unable to undergo MR venography in this setting. Contrast-enhanced MRV did not improve diagnostic accuracy. The clinical utility of MR venography in the setting of suspected DVTUE seems disappointing.

Adult↗
PubMed1997

Ergonomic risk exposure and upper-extremity cumulative trauma disorders in a maquiladora medical devices manufacturing plant.

Workers at a Nogales, Mexico, maquiladora plant that assembles medical devices were studied to determine the prevalence of upper-extremity cumulative trauma disorders (CTD). Subjects included production workers employed 6 months or longer; of the 148 eligible workers, 145 (98%) participated. Subjects had a mean age of 24.6 years (SD = 5.2; range, 17 to 45) and the mean length of employment was 3.5 years (SD = 2.5; range, 0.5 to 14). Job tasks were videotaped and analyzed for ergonomic risk factors, using pre-defined criteria. All jobs performed by study subjects were found to involve one or more ergonomic risk factors associated with the development of CTD. A CTD questionnaire and screening physical examination format, similar to that used by the National Institute of Occupational Safety and Health (NIOSH) in a chicken processing plant study, were administered. Period prevalence of CTD within the previous year, as reported on the questionnaire, was 28%. Prevalence of CTD was 17%, using data from the screening physical examination. Point prevalence (current pain data from the questionnaire plus positive symptoms on the screening physical examination) was 15%. CTD was reported more frequently in women than men (46% and 25%, respectively; P < 0.05) and in subjects who had worked at the plant less than one year (50%; P < 0.05). Workforce turnover (3% monthly) may have resulted in those affected by CTD leaving employment, reducing the apparent CTD rate in experienced workers.

Adolescent↗
PubMed1994

Results after replantation and revascularization in the upper extremity in children.

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after seventy-three replantations and eighty-nine revascularizations in the upper extremity in 120 children. All operations were performed between January 1974 and December 1988 after partial and complete amputations at various levels. The ages of the patients ranged from three days to sixteen years. The average duration of follow-up was thirty-six months (range, fourteen months to seven years) for the patients who had had a replantation and thirty months (range, fourteen months to eight years) for the patients who had had a revascularization. The rate of survival of the amputated part was significantly higher (p < 0.0002) after revascularization (seventy-eight parts [88 per cent]) than after replantation (forty-six parts [63 per cent]). There was no association, for either group, between survival and the preoperative duration of ischemia, the level of the injury, the digit that had been injured, the number of arteries that had been repaired, or the use of venous grafts. The rate of survival after replantation of completely amputated parts was 72 per cent (twenty-eight of thirty-nine parts) when the amputation had resulted from a laceration injury and 53 per cent (eighteen of thirty-four parts) when the amputation had resulted from a crush or an avulsion injury. The rate of survival after revascularization of incompletely amputated parts was 100 per cent (all forty-five parts) when the injury had been the result of a laceration and 75 per cent (thirty-three of forty-four parts) when it had been the result of a crush or an avulsion. We did not find any relationship between the age of the patient and the rate of survival of the amputated part after revascularization; however, there was a significantly higher rate of survival (p , 0.02) after replantation in children who were less than nine years old (77 per cent [twenty-four of thirty-one parts]) compared with the rate in those who were nine to sixteen years old (52 per cent [twenty-two of forty-two parts]). The viability of the digit was in jeopardy after twenty-nine (40 per cent) of the seventy-three replantations and nineteen (21 per cent) of the eighty-nine revascularizations. Immediate reoperation resulted in the salvage of only two of the twenty-one replanted parts and six of the twelve revascularized parts that had a reoperation.(ABSTRACT TRUNCATED AT 400 WORDS)

Activities of Daily Living↗
PubMed1992

Assessment of acute and old deep venous thrombosis in upper extremity by venous strain gauge plethysmography.

The purposes of this study were to evaluate the efficiency of occlusion strain gauge plethysmography in the diagnosis of symptomatic deep venous thrombosis in upper extremities, to compare early (one month) and late clinical evolution (many years) to plethysmography data and, finally, to set up normal and pathological values. Four groups of patients were tested. Sixteen patients with confirmed acute thrombosis, 6 patients with unconfirmed thrombosis, 15 with an old thrombosis (mean follow-up: 7 years) as well as 15 healthy volunteers. The outflows measurements were significantly lowered (p less than 0.05) in the arms with acute thrombosis compared to the contralateral arms, to the affected arms of patients with thrombosis excluded and to both volunteers' arms. Pathological values for the different outflow parameters could be defined as follows: Maximum venous output less than 110 ml/100 ml/minute, Outflow after 3 seconds less than 1.2 ml/100 ml, Strandness index less than 0.16. On month after the acute episode we found a good correlation between the usually favourable clinical evolution and venous haemodynamics assessed by plethysmography. The mild late post-thrombotic syndrome of most patients with an old thrombosis was not well demonstrated by plethysmography.

Adult↗
PubMed1986

Upper extremity function in hemiplegia. A cross-validation study of two assessment methods.

The methods devised by DeSouza et al. and by Fugl-Meyer et al. for description of upper extremity function after stroke were compared by parallel assessments in a consecutive series of 50 patients with hemimotor deficit. Very close positive associations between both methods indicated a high degree of cross-validity. As both methods appear to be externally valid, have good inter-rater reliability and as the time needed for assessing the arm function of a hemiplegic or hemiparetic patient rarely exceeds 10 min, it appears that the two methods possess about equal descriptive power.

Arm↗
PubMed1979

[Comparative characteristics of the number of axillary lymph nodes in the right and left upper extremities of adult humans].

The aim of the work was to deside whether there exists any regular difference in the number of axillary lymph nodes in the right and left upper extremities of the adult person depending on sex and age. Right and left axillary lymph nodes were studied in 32 female and 34 male corpses at the age of 28--90 years according to age periods suggested by V. V. Bunak (1965). It was stated that there were no statistically important sex and age differences.

Adult↗