SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A method of continuous brachial plexus blockade by an epidural catheter is reported. This kind of postoperative analgesia was applied to 10 patients over a period of 2-3 days after hyperthermic melanoma perfusion of the upper extremities. A sufficient analgetic effect was obtained by intermittent injection of local anesthetics.
Breast cancer presently affects one in nine women in the United States. Women receiving radiation and surgical resection of axial lymph nodes are at risk for development of lymphedema of the ipsilateral upper extremity. Mental health consultation and intervention can be an important part of rehabilitative efforts aimed at improving both lymphedema itself and the overall psychosocial adjustment of the patient. Such consultation begins with a careful consideration of possible psychiatric diagnosis but must necessarily depart from standard psychiatric considerations to include an assessment of psychosexual and social factors. Additionally, the consultant must gauge the degree of success the patient has had in adjustment to lifestyle changes brought on by lymphedema. This paper discusses the psychological problems posed by lymphedema and offers case examples. These cases illustrate the nature of psychiatric and psychological factors encountered in this population and the interventions that can help improve both compliance with rehabilitative efforts and psychological adjustment.
BACKGROUND: The purpose of this study was to evaluate the feasibility, safety, and potential role of gadoterate meglumine (Gd-DOTA) as a contrast agent for upper extremity venography before the creation of an arteriovenous fistula (AVF) for nondialyzed renal insufficiency patients. METHODS: Over a 16-month period, 50 venographies were performed on end-stage renal insufficiency patients, using Gd-DOTA as a contrast agent on a high-resolution digital subtraction angiography system. Three sequences were performed on forearm, arm, and chest at 3 mL/sec for a total of 35 mL of Gd-DOTA. Examinations were reviewed by two radiologists for diagnostic and opacification quality. Tolerance was evaluated on the evolution of serum creatinine levels and occurrence of pain during injection. RESULTS: Good interobserver correlation was obtained in evaluating the feasibility of AVF creation by vein segment (0.64 < kappa < 0.88) and in relationship to opacification quality (0.62 to 0.87). No deterioration in renal function (creatinine level before and after) or pain was observed. Twenty-six patients underwent surgical creation of brachiobasilic (N = 8), brachiocephalic (N = 8), radiocephalic (N = 8), and cubitocephalic (N = 1) fistulas or insertion of a polytetrafluoroethylene (PTFE) graft (N = 1). Seventeen were awaiting AVF or were on peritoneal dialysis. Two died before surgery for reasons unconnected with the venography. CONCLUSIONS: Venography with Gd-DOTA is an effective and safe technique in planning AVFs for renal insufficiency patients.
Sensory disturbances (hypoaesthesia in fingertips and tenderness) and movement disorders (tremor, dystonia, muscle spasms, abnormal postures and inability in initiating of movement) were investigated in 80 patients with post-traumatic reflex sympathetic dystrophy (RSD) of the upper extremity. Sensory disturbances were found in 67 patients (84%): most frequently hypoaesthesia in fingertips--in 49, and tenderness of the dorsal aspect of the hand in 24; in six patients both these signs were present simultaneously. Movement disorders were found less frequently: tremor was observed in 12 patients, spasms of the flexor muscles of the forearm and hand in two, postural dystonia in one, and inability initiating of movement in the other one. Sympathetic interruptions reduced movement disturbances in two patients. Dystonia was resistant to various treatment approaches including botulinum toxin injections. Certain hypothesis explaining pathogenic background of motor and sensory disorders in RSD are discussed. The results of this study show that sensory disturbances are frequently observed in RSD, however, they usually disappear after successful treatment of the condition; movement disorders are less frequent, but much more difficult to control. Neurologists are not frequently faced with the problem of neurological disorders after trauma of the limb. Inclusion of RSD in differential diagnosis may improve recognition of the disorder and result in its faster and proper management.
The results of necrectomy in 26 burned cases are described. There were 9 unilateral cases, the rest were bilateral with the involvement of other parts of the body. The indications for necrectomy on the upper extremities are established.
As a part of the Gerontological and Geriatric Population Study of 70-year-old people in Gothenburg 75 men and 101 women were subjected to tests of upper extremity function. Twenty men and 22 women were healthy without any locomotor disorders. The investigation included tests of muscular co-ordination, static strength in key-grip, transversal volar grip, elbow flexion and submaximal endurance in handgrip. Results in healthy subjects were compared with results in a reference group of young subjects aged 20-30 years. Seventy-year-old healthy subjects did not differ significantly from young subjects regarding strength in key-grip and endurance in transversal volar grip. The largest decrease in function was seen in healthy 70-year-old subjects in the test of muscular co-ordination and in strength in the transversal volar grip. In general healthy 70-year-old women showed a slighter decrease in function than men. Significant correlations were found between strength in key-grip and transversal volar grip and between strength in elbow extension and flexion of 70-year-old subjects. A slight correlation was found between strength in elbow extension and static knee extension at 90 degrees knee angle in 70-year-old healthy subjects.
Compartment syndrome is a potentially devastating entity associated with a great variety of injuries, but to the authors' knowledge there are no known reports of infection documented as a cause. A retrospective review of 263 patients with upper extremity infections admitted to the orthopaedic infection ward during 1992 was conducted to identify patients with compartment syndrome directly associated with infection. Four patients' clinical presentations fulfilled the criteria: two presented with infection and compartment syndrome, and two developed compartment syndrome 2-12 hours after admission. All four had beta-hemolytic streptococci on initial culture; three of four grew Group A streptococcus. Fasciotomies and serial debridements were necessary. One patient ultimately underwent amputation through the elbow.
Health care costs for inpatient care have been escalating. Homeless and indigent patients may be unable to have access to clean toilet facilities to perform adequate wound care. Evaluation of delayed primary closure of upper extremity soft tissue infections after incision and drainage in 34 patients was done. Patients were discharged at an average of 8.3 days (range, 5-21 days). This is 11 days less than the reported average granulation time for wounds to heal. No patient required readmission for surgery, wound care, or intravenous antibiotics. The authors' institution charges a rate of $2800 per patient day. A potential savings of $1,047,200 was realized.
BACKGROUND AND AIMS: Hand function weakens with age in both men and women, especially after the age of 65. As the number of older people increases, more older adults may have sensorimotor impairment, which affects upper extremity (UE) performance and thus independence in the activities of daily life. The purpose of this study was to detect and evaluate the impact of age on pressure pain threshold (PPT), touch/pressure threshold and grip strength in the decades after the age of 60. METHODS: The study was carried out with the participation of older adults living in the Izmir Geriatric Centre. Older adults were subdivided into three age groups and 128 subjects (47 male, 81 female) were selected systematically as one out of every three individuals in each group (group 1: 60 to 69; group 2: 70 to 79; group 3: 80 or over). Touch/pressure threshold test, pressure pain threshold (PPT) test and grip strength measurement were performed on dominant and non-dominant hands. RESULTS: It was found out that touch/pressure thresholds increased with age, but the change was not statistically significant between the three age groups. PPT and grip strength of dominant and non-dominant hands decreased from groups 1 to 3, but analysis indicated that these declines were not statistically significant. CONCLUSIONS: Despite the fact that age-related sensorimotor changes are not statistically significant, a reduction is seen in sensorimotor parameters after the age of 60.
Zygomycosis is a rare fungal infection that may present as a necrotizing soft tissue infection in the neonate. This report illustrates the typical presentation of a premature, infant with a rapidly progressive soft tissue necrotizing infection of his upper extremity at an intravenous site. Early diagnosis with tissue biopsy confirmed the diagnosis of Zygomycosis. Successful treatment required systemic amphotercin B and aggressive debridement requiring through-the-elbow amputation for survival.
Golfers are athletes, for golf is a sport. To play it well, one must have athletic ability, strength, agility, coordination, and endurance. The golf swing is physically demanding and has contributed to overuse injuries in the upper extremity. The wrist, elbow, and shoulder are the most frequently injured joints.
Anatomy favorable to the application of regional blockade, the capacity to decrease latency and prolong blockade, and the opportunity to facilitate recovery and decrease costs create a constellation of factors that have the potential to make upper extremity blockade a tremendously rewarding application of modern regional anesthetic technique. These rewards can be realized by the motivated anesthesiologist and shared with patients, surgical colleagues, and hospital administrators.
This report, part 2 of a two-part case report on the clinical use of neuromuscular electrical stimulation (NMES) for children with cerebral palsy, documents the functional changes that occurred with the application of NMES to the upper extremity of two children, 1.6 and 6.7 years of age, with hemiplegia due to cerebral palsy. The NMES was used as an adjunct to a dynamic-systems, task-oriented physical therapy program. The youngest child showed immediate improvement in the ability to crawl and use both hands together. The older child demonstrated increased sensory awareness and use of the nonfunctional hand. Preliminary findings suggest that NMES may be a useful physical therapy tool for enhancing muscle strength increasing sensory awareness, and assisting motor learning and coordination.
A significant number of patients infected with Mycobacterium marinum have been treated at the Curtis National Hand Center in Baltimore, Maryland. The purpose of this study was to review the authors' experience with M. marinum infections of the upper extremity. Twenty-nine patients were identified and their charts were reviewed for all factors related to diagnosis and treatment. The most common presenting symptoms were swelling (n = 25) and pain (n = 14). Only 69 percent of patients could correlate their injury with aquatic activities. The mean time from injury to diagnosis was 5.2 months. Acid-fast bacilli stains were positive in only 22 percent of specimens. The mean number of procedures was 1.75, with the majority being tenosynovectomy. The mean duration of antibiotic therapy was 6 months. Clinical history, pathological evaluation, and a high clinical suspicion can lead to early diagnosis and introduction of antibiotics. The authors' patients were successfully treated with 6 months of antibiotic therapy and early surgical intervention.
The velocimetric examination by Doppler effect of arteries and veins of the arm, forearm and hands, performed in an indifferent position, then during dynamic exercises, provides sometimes determining factors in the etiology of some vascular disorders of the upper extremities. Requiring learning, experience, time and patience, this examination is debatable, but, in our experience, absolutely necessary to the work-up of these disorders.
Among the non-traumatic lesions of peripheral nerves the compression syndromes occupy a numerically leading position. After mentioning the common characteristics the individual compression syndromes of the brachial plexus and peripheral nerves of the upper extremity are described: the compression of the brachial plexus in the posterior triangle of the neck, in the costoclavicular passage and on hyperabduction. The suprascapular notch syndrome ist mentioned. The distal compression syndrome of the median nerve, the carpal tunnel syndrome is described in detail as the most common of the compression syndromes. The proximal compression syndrome of the ulnar nerve, the cubital tunnel syndrome, ist also described as are the distal compression syndrome of this nerve, Guyon's recess syndrome and the ramus profundus nervi ulnaris lesion. The supinator recess syndrome of the radial nerve is briefly mentioned.
Immobilization of fractures associated with instability and comminution by an external skeletal device facilitates wound care, skin coverage, and ultimate reconstructive surgery. External skeletal fixation was applied in 20 patients who sustained complex open injuries of the upper extremity. All injuries were associated with extensive soft tissue and skin defects. Associated neurovascular injuries included 14 nerve injuries and five major vascular injuries. The Hoffman fixation device was used in the majority of cases. Skin coverage was obtained in all patients by an appropriate method of skin grafts, pedicle flaps, and a free myocutaneous flap. Primary bone union was achieved in five of 16 patients. Ten of 16 patients required secondary procedure to obtain union in cases of delayed union or nonunion, and one case remained with a nonunion. Pin tract infection in three patients and osteomyelitis in two patients were effectively treated with antibiotics and appropriate surgery. The initial treatment goals of limb salvage, skin coverage, and bone stabilization without drainage or persistent osteomyelitis can be accomplished by the use of external skeletal fixation devices.
Our objective was to assess the inter-observer and intra-observer agreement in the interpretation of digital subtraction venography (DSV) in patients with suspected deep vein thrombosis of the upper extremity (DVTUE). Prospectively, 62 consecutive DSV studies in 54 patients with clinically suspected DVTUE were included. Hard copies were presented without demographic data or original report. All venograms were read twice, at 3-month intervals, by an interventional vascular radiologist (observer 1) and an experienced general radiologist (observer 2). Consensus reading took place in the presence of a third experienced interventional radiologist. Inter-observer and intra-observer agreement were assessed using kappa statistics. Initial reading in 62 venograms showed an inter-observer agreement of 71% (kappa 0.48). The inter-observer agreement of the second reading was 83% (kappa 0.71). The agreement with the consensus report ranged from 76 to 94%. The intra-observer agreement for the first and second observer was 94% (kappa 0.89) and 76% (kappa 0.56), respectively ( p<0.01). Digital subtraction venography has moderate to excellent intra- and inter-observer agreement, suggesting that digital subtraction venography is reliable for the diagnosis of DVTUE.