Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Extremities”

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.

At least 1,531 records · Page 85Linked to original sources
PubMed2005

Dermatologic conditions associated with use of a lower-extremity prosthesis.

OBJECTIVES: To document the frequency of skin problems among lower-limb prosthesis users and to assess for factors associated with skin problems among patients using a prosthesis. DESIGN: Six-year retrospective chart review. SETTING: An outpatient amputee clinic at a regional, referral rehabilitation hospital in Canada. PARTICIPANTS: Seven hundred forty-five subjects with a total of 828 lower-extremity amputations participated. Subjects were included if they had a lower-extremity amputation and used a prosthesis for ambulation or transfers. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The presence or absence of a skin problem. Descriptive and nonparametric statistics were used to analyze data. RESULTS: Three hundred thirty-seven residual limbs (40.7%) had at least 1 skin problem. Adjusted odds ratios showed that amputation level, being employed, type of walking aid, and absence of peripheral vascular disease (as a comorbidity) were independently associated with the presence of at least 1 skin problem ( P <.05). CONCLUSIONS; Dermatologic conditions are a frequent complication for the lower-extremity amputee who uses a prosthesis. The results suggest that more active amputees have an increased risk for developing skin problems. Further study in this area is warranted.

Aged↗
PubMed2005

Use and perceived need of physical therapy following severe lower-extremity trauma.

OBJECTIVE: To examine the utilization of physical therapy (PT), the level of perceived need for PT, and the proportion of patients with perceived need receiving no PT in a cohort of severe lower-extremity trauma patients treated at level I trauma centers. DESIGN: Longitudinal, observational study of severe lower-extremity trauma patients. Patients were interviewed by a research coordinator and examined by an orthopedic surgeon and a physical therapist during initial admission, and at 3, 6, 12, and 24 months postdischarge. SETTING: Eight level I trauma centers. PARTICIPANTS: Of 601 patients age 18 to 65 enrolled in the parent study over a 40-month period, 550 with unilateral study injuries and followed up at least once over the 2-year study period were included in this analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Patient reported number of PT visits at each follow-up time point, inpatient rehabilitation admissions, and their perceived need for PT. Perceived need for PT was also assessed by an orthopedic surgeon and a physical therapist. Overall, concordance between physician, physical therapist, and patient's assessment of need for PT was low, with kappa statistics ranging between .12 and .41. RESULTS: Amputation and reconstruction patients used comparable amounts of PT services. Regardless of the criteria used to evaluate need, the proportion of patients with perceived need for PT receiving no PT services increased over the course of the follow-up, from 23% to 46% at first follow-up to over 68% by 2 years. Factors associated with increased risk for having a perceived need but receiving no therapy included lack of private insurance, pain, lower levels of education, lower fitness levels at time of injury, being a smoker, and having severe muscle injury. CONCLUSIONS: The results suggest a significant proportion of patients in the severe lower-extremity trauma population have perceived need for PT, yet receive no PT services.

Adolescent↗
PubMed2005

Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home.

OBJECTIVE: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of secondary and tertiary care centers. PARTICIPANTS: Patients (N=759; 47% men; mean age +/- standard deviation, 60.7+/-15.2y) living at home, with lower-extremity disorders resulting from stroke, poliomyelitis, osteoarthritis, amputation, and complex regional pain syndrome type I. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: (1) Unidimensionality, indicating that items assess only a single construct; (2) fit with the one-parameter logistic model (OPLM), yielding information about patient and item location parameters; (3) intratest reliability, indicating consistency of patients' item scores; and (4) content validity, indicating completeness with which the items cover the important aspects of the construct that they are attempting to represent. RESULTS: Thirty-nine of 42 items: (1) loaded on 1 component (variance explained, 59%; item component loadings, >or=.51), (2) showed good fit with the OPLM (P=.15), (3) had a good intratest reliability (Cronbach alpha=.96), and (4) had a good content validity (all important aspects represented). CONCLUSIONS: A unidimensional scale that fits with the OPLM has been developed for measuring activity limitations in R&S in patients with lower-extremity disorders who live at home.

Activities of Daily Living↗
PubMed2006

Upper-extremity pain disorders in breast cancer.

UNLABELLED: Upper-extremity pain is a common and debilitating problem for patients with breast cancer. Although there is considerable literature describing symptoms, little is available on the specific disorders responsible for pain and debility in these patients. Cervical radiculopathy, brachial plexopathy, neuropathy, rotator cuff tendonitis, adhesive capsulitis, epicondylitis, postmastectomy syndrome, swelling, and bone metastases are among the common disorders responsible for upper-extremity pain in breast cancer patients. OVERALL ARTICLE OBJECTIVE: To discuss common upper-extremity pain disorders in patients with breast cancer.

Breast Neoplasms↗
PubMed2006

Prevalence of in vitro extreme chemotherapy resistance in resected nonsmall-cell lung cancer.

BACKGROUND: Recent clinical trials suggest that adjuvant chemotherapy provides a survival advantage for patients with completely resected nonsmall-cell lung cancer (NSCLC) yet many patients receive chemotherapy without benefit. Tumor in vitro resistance to antineoplastic agents is highly predictive of clinical unresponsiveness to chemotherapy for some cancers; however, little is known of the prevalence of extreme chemotherapy drug resistance for human NSCLC tumors. Chemoresistance testing may be a way to predict treatment failure, choose alternative agents, and to avoid unnecessary chemotherapy toxicity. This study describes the prevalence of in vitro chemotherapy resistance in NSCLC patient tumor cultures. METHODS: A total of 3,042 NSCLC specimens were cultured in a proliferation assay and tested for resistance to carboplatin, cisplatin, doxorubicin, etoposide, gemcitabine, navelbine, paclitaxel, taxotere, or topotecan. The percentage of cell-growth inhibition measured by 3H-Thymidine uptake was used to determine extreme drug resistance, intermediate drug resistance, or low drug resistance. RESULTS: Extreme drug resistance or intermediate drug resistance to carboplatin was found in 1,056 of 1,565 NSCLC cultures (68%), to cisplatin in 1,409 of 2,227 (63%), to doxorubicin in 1,101 of 1,471 (75%), to etoposide in 1,581 of 2,505 (63%), to gemcitabine in 594 of 823 (72%), to navelbine in 603 of 1,444 (42%), to paclitaxel in 689 of 1,706 (40%), to taxotere in 273 of 521 (52%), and to topotecan in 280 of 896 (31%). CONCLUSIONS: Chemotherapy resistance is prevalent among NSCLC clinical cell cultures. This may account for the small survival seen with empiric adjuvant chemotherapy. The use of viable tumor culture for in vitro chemoresistance testing should be considered when formulating a plan of adjuvant therapy for resected NSCLC. Future trials comparing patient survival after tailored versus empiric adjuvant therapy appear justified.

Antineoplastic Agents↗
PubMed2005

Adaptation to extreme environments: macromolecular dynamics in complex systems.

What we previously thought of as insurmountable physical and chemical barriers to life, we now see as yet another niche harbouring 'extremophiles'. Extremophiles and their macromolecules had to develop molecular mechanisms of adaptation to extreme physico-chemical conditions. Using neutron spectroscopy, we have demonstrated that molecular dynamics represents one of these molecular mechanisms of adaptation. To which extent do hyper-saline conditions and extreme temperatures influence molecular dynamics? First, molecular dynamics were analysed for halophilic malate dehydrogenase from Haloarcula marismortui (Hm MalDH) under different molar solvent salt concentration conditions influencing its stability. Secondly, mean macromolecular motions were measured in-vivo in psychrophile (Aquaspirillum arcticum), mesophile (Escherichia coli and Proteus mirabilis), thermophile (Thermus thermophilus), and hyperthermophile (Aquifex pyrofilus) bacteria. The mean constant force of Hm MalDH increases progessively with increasing stability. The results show that the molecular adaptation of Hm MalDH to hyper-saline conditions is achieved through an increasing resilience of its structure dominated by enthalpic mechanisms. The study of bacteria has provided tools to quantify the macromolecular adaptation to extreme temperatures in the naturally crowded environment of the cell. The macromolecular resilience of bacteria increases with adaptation to high temperatures.

Adaptation, Biological↗
PubMed2005

A prospective study of pressures from parents, peers, and the media on extreme weight change behaviors among adolescent boys and girls.

The current study was designed to evaluate the role of sociocultural influences over a 16 month period on strategies to lose weight, extreme weight loss strategies, and strategies to increase muscles among adolescent boys (n=344) and girls (n=246). All participants completed measures of body dissatisfaction, body image importance, strategies to lose weight, extreme weight loss strategies, and strategies to increase muscles. Measures of perceived pressure to lose weight or increase muscles from mother, father, best male friend, best female friend and the media were also evaluated. Data were gathered on three occasions, 8 months apart. The results demonstrated that boys showed a decrease in strategies to lose weight and increase muscles over time, whereas girls showed an increase. Both boys and girls showed an increase in extreme weight loss strategies with girls demonstrating a greater increase than boys. The sociocultural influences generally were perceived by girls to relate to messages to lose weight, whereas for boys they were perceived to relate to increasing muscles. Messages from parents, particularly fathers, were strong predictors of both strategies to lose weight and increase muscles among boys, with the media and best male friend playing a limited role. For girls, the strongest influences were mothers and best female friends, with few influences from fathers or the media. The results of this study are discussed in terms of the importance of the various sociocultural influences in shaping body change strategies among young adolescent boys and girls, and the implications of these findings for intervention programs for adolescents.

Adolescent↗
PubMed2006

Hyperhomocysteinemia is associated with deep venous thrombosis of the lower extremities in Tunisian patients.

OBJECTIVES: To test the association between hyperhomocysteinemia (HHC) and deep venous thrombosis (DVT) of lower extremities in Tunisians. DESIGN AND METHODS: This case-control study included 90 patients with DVT of the lower extremities and 160 healthy controls. Plasma homocysteine, vitamin B(12) and folate were determined using immunoenzymatic methods. Logistic regression models were performed to test whether the association between HHC and DVT is independent and to precise determinants of HHC in DVT patients. RESULTS: Plasma total homocysteine concentrations were significantly higher in patients with DVT (17.4+/-11.5 micromol/L) and in patients with idiopathic DVT (15.2+/-6.4 micromol/L) as compared to controls (11.5+/-3.3 micromol/L). HHC was significantly associated (p<0.001) with all DVT (OR, 8.82; 95% CI, 3.96-19.6) as well as idiopathic DVT (OR, 7.40; 95% CI, 3.01-10.8). These associations persisted after adjustment for several thrombosis risk factors. In patients with DVT, HHC was related to folate and vitamin B(12) concentrations, but neither to the type of occurrence nor to the recurrence of DVT. CONCLUSION: HHC is independently associated with first DVT of lower extremities in Tunisians. Homocysteine should be assessed in patients with DVT and the effect of vitamin B supplementation should be tested among them.

Adolescent↗
PubMed2004

Alterations in lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis.

OBJECTIVE: The purpose of this study was to investigate lower extremity movement and muscle activation patterns in individuals with knee osteoarthritis and healthy age- and gender-matched control subjects. DESIGN: This study utilized a non-randomized case-control design to compare 24 subjects with unilateral symptomatic knee osteoarthritis to 24 age- and gender-matched control subjects without knee osteoarthritis. BACKGROUND: It is hypothesized that knee osteoarthritis is associated with altered lower extremity movement and muscle activation patterns. METHODS: A gait analysis was performed to determine the lower extremity movement and muscle activation patterns when walking on a level surface at 1.12 to 1.34 m/s and while descending a 20 cm step. Paired t-tests were used to compare the average of five trials between the groups. RESULTS: Subjects with knee osteoarthritis demonstrated less excursion of the knee in the sagittal plane from heelstrike to peak flexion before midstance (i.e. during loading). Subjects with knee osteoarthritis also demonstrated reduced peak vertical ground reaction forces relative to body weight. The muscle activity patterns were also different between the groups. The vastus lateralis, medial hamstrings, tibialis anterior and medial gastrocnemius were on approximately 1.5 times longer than the same muscles in the control subjects. Additionally, significant increases in muscle co-activation were also observed in individuals with knee osteoarthritis during walking. Similar findings were observed when the subject descended a 20 cm step.

Aged↗
PubMed2006

Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity.

BACKGROUND: To assist in the treatment of gait disorders, an inverse and forward 3D musculoskeletal model of the lower extremity will be useful that allows to evaluate if-then scenarios. Currently available anatomical datasets do not comprise sufficiently accurate and complete information to construct such a model. The aim of this paper is to present a complete and consistent anatomical dataset, containing the orientations of joints (hip, knee, ankle and subtalar joints), muscle parameters (optimum length, physiological cross sectional area), and geometrical parameters (attachment sites, 'via' points). METHODS: One lower extremity, taken from a male embalmed specimen, was studied. Position and geometry were measured with a 3D-digitizer. Optotrak was used for measurement of rotation axes of joints. Sarcomere length was measured by laser diffraction. FINDINGS: A total of 38 muscles were measured. Each muscle was divided in different muscle lines of action based on muscle morphology. 14 Ligaments of the hip, knee and ankle were included. INTERPRETATION: The presented anatomical dataset embraces all necessary data for state of the art musculoskeletal modelling of the lower extremity. Implementation of these data into an (existing) model is likely to significantly improve the estimation of muscle forces and will thus make the use of the model as a clinical tool more feasible.

Aged↗
PubMed2006

Ergonomic considerations in work-related upper extremity disorders.

Correctly applied, an ergonomics approach can reduce the likelihood of work-induced disorders and can assist in accommodating individuals who have work-related disorders, but it cannot eliminate disorders that have been mistakenly attributed to work by social processes. A contextual model of work-related upper extremity disorders is proposed that explicitly acknowledges that factors extrinsic to work can shape perceptions of upper extremity disorders and influence the process of somatic interpretation and health outcomes. Experiences in the United Kingdom of ergonomic regulations associated with computer use and the media coverage of work-related upper extremity disorders are used to illustrate this model.

Arm Injuries↗
PubMed2006

A controlled trial of skin-to-skin contact in extremely preterm infants.

BACKGROUND: Extremely preterm birth, even in the absence of significant neurological impairment, is associated with altered pain responses and impaired memory and behaviour. Preterm birth increases the risk of maternal depression and may impede the development of the mother-infant relationship, factors that in turn are also associated with impaired infant outcome. Mother-infant skin-to-skin contact has been recommended as a simple means of ameliorating these effects. METHODS: We conducted a pragmatic, prospective, controlled, intention-to-treat trial in two neonatal intensive care units. Infants born below 32 weeks gestation were recruited within the first week after birth and assigned to a control group receiving standard care, or an intervention group in which mothers were encouraged to provide a session of skin-to-skin contact once daily for 4 weeks. We assessed infant behaviour at time of discharge from hospital, responses to immunisation at 4 and 12 months of age, and memory, behaviour and development at 1 year corrected (postmenstrual) age. Indices of maternal depression, stress, anxiety, lactation performance and infant interaction were assessed at time of infant discharge, 4 months and 1 year. RESULTS: No significant difference was identified in any infant or maternal measure at any time point. CONCLUSIONS: Mother-infant skin-to-skin contact after extremely preterm birth results in neither benefit nor adverse consequences. Although there is no reason to dissuade mothers who wish to provide STS contact, we are unable to recommend resource allocation for the implementation of STS programmes for extremely preterm infants in a neonatal intensive care unit setting.

Adult↗
PubMed2006

Microbial activity in an acid resin deposit: biodegradation potential and ecotoxicology in an extremely acidic hydrocarbon contamination.

Acid resins are residues produced in a recycling process for used oils that was in use in the forties and fifties of the last century. The resin-like material is highly contaminated with mineral oil hydrocarbons, extremely acidic and co-contaminated with substituted and aromatic hydrocarbons, and heavy metals. To determine the potential for microbial biodegradation the acid resin deposit and its surroundings were screened for microbial activity by soil respiration measurements. No microbial activity was found in the core deposit. However, biodegradation of hydrocarbons was possible in zones with a lower degree of contamination surrounding the deposit. An extreme acidophilic microbial community was detected close to the core deposit. With a simple ecotoxicological approach it could be shown that the pure acid resin that formed the major part of the core deposit, was toxic to the indigenous microflora due to its extremely low pH of 0-1.

Biodegradation, Environmental↗
PubMed2004

Soft tissue sarcoma of the upper extremity.

Soft tissue sarcomas of the upper extremities are rare and hand surgeons typically encounter only one or two undiagnosed soft tissue sarcomas during their careers. It is incumbent on the physician to review repeatedly the characteristics of these tumors and remain suspicious, because these lesions typically are misdiagnosed and treatment is delayed. The most common soft tissue sarcomas of the upper extremity are the epithelioid sarcoma, synovial cell sarcoma, and malignant fibrous histiocytoma. Limb salvage surgery is the treatment of choice for soft tissue sarcomas to preserve upper extremity function. Following wide tumor resection, adjuvant therapies such as chemotherapy, external beam radiation therapy, and brachytherapy may lessen local recurrence rates, but their effect on overall survival remains unclear.

Arm↗
PubMed2004

Closed versus partially ventilated endotracheal suction in extremely preterm neonates: physiologic consequences.

This randomized cross over study aimed to compare the severity and incidences of desaturation and bradycardia between the partially ventilated endotracheal suction method (PVETS) and closed tracheal suction system (CTSS) in extremely preterm neonates. Fifteen intubated and ventilated extremely low birth weight preterm infants (mean birth weight 689g) randomly underwent both suction techniques within a 12-h period to obtain a paired reading group. The process was repeated 24-48h apart until three pairs of reading groups were collected. Changes in oxygen saturation measured with pulse oximetry and heart rate changes measured with electrocardiogram were recorded using Hewlett-Packard m240A monitor trending software. The mean of each parameter's variation from baseline was obtained using SPSS descriptive statistics and analyzed using SPSS repeated measures ANOVA. Fisher Exact Test was used to analyze the incidence of desaturation and bradycardia. The closed tracheal suction system reported a significantly smaller degree of oxygen saturation fall (P<0.005) and significantly fewer incidences of desaturation. There was also a significantly smaller degree of heart rate reduction although episodes of bradycardia were not significantly different between the two methods. Oxygen saturation and heart rate were significantly more stable during the use of CTSS compared to PVETS in the extremely low birth weight preterm population.

Analysis of Variance↗
PubMed2005

Relationship of lower extremity skin blood flow to the ankle brachial index in patients with peripheral arterial disease and normal volunteers.

Changes in posture of the lower extremities induce changes in skin blood flow, known as veno-arteriolar response (VAR). We investigated the relationship between ankle brachial index (ABI) and VAR in patients (ABI<0.9) with peripheral arterial disease (PAD) and age-matched normal controls (ABI>1). We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change (extended-flexed/extended) in blood flow (VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure (PVAR) at which the VAR was similar to that in the flexed position was recorded. Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients (95.8% vs. 4.3%, p=0.001). VAR and PVAR were significantly lower in patients than controls (0.42+/-0.16 vs. 0.65+/-0.11 flux/min, p=0.001 and 29+/-8 vs. 48+/-9 mm Hg, p=0.001, respectively). There was significant correlation between ABI-post and VAR (r=0.6, p=0.01) and between the VAR and PVAR (r=0.8, p=0.001). VAR<0.3 flux/min was 100% sensitive, 80% specific, and area under curve of 0.88, p=0.001 for detecting PAD as defined by ABI<0.9. Similarly, PVAR of 22 mm Hg was 100% sensitive, 85% specific, and area under curve of 0.94, p=0.001 for detecting PAD. Skin blood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis.

Adult↗
PubMed2005

Extremity vascular trauma in civilian population: a seven-year review from North India.

This is a retrospective study of the experience with extremity vascular trauma at a tertiary level referral centre in North India where the majority of the population lives in villages and the incidence of high-speed automobile accidents and civilian violence is low. The aim was to study the aetiology, pattern of injuries and the mortality and morbidity rates due to vascular trauma in our population. Data relating to 148 patients presenting with vascular trauma requiring surgical intervention other than amputation between January 1996 and December 2002 were collected retrospectively. There were 132 males and 16 females with a mean age of 39 years presenting to the casualty with a median delay of 9.3 h after injury. Blunt trauma accounted for 84% of the injuries with extremities involved in 88%. The brachial artery was the most common artery injured with the femoral next most common. Repair without graft interposition was done in 74% and autogenous vein grafts were used in 23% of cases. Comparison of our results with those that would have been obtained, had the recommendations of Mangled Extremity Severity Score (MESS) been followed, showed that this scoring system had low sensitivity and specificity for prediction of salvageability of limbs. Eight percent patients died due to associated visceral organ injuries. Complications occurred in 32% patients and amputation was required in 6% of patients after an initial surgical repair mainly due to inadequate functional recovery. Eighty-eight percent of the survivors with salvaged limbs were able to achieve full functional recovery. Judicious selection and appropriate intervention can result in satisfactory limb salvage with good functional outcomes even with delayed presentations.

Adolescent↗
PubMed2005

Gunshot injuries to the extremities: experience of a U.K. trauma centre.

BACKGROUND: The Metropolitan Police figures suggest an increase in the incidence of injuries related to gun crime. We conducted a retrospective analysis of extremity gunshot injuries over a five-year period. Our aim is to report on our (1) incidence, (2) complications and (3) experience in treating these injuries. METHODS: Over a five-year period (1998-2002), 70 extremity gunshot injuries in 61 patients were identified from a trauma register and case notes reviewed retrospectively. The following were identified and analysed: type of injury (low or high-energy transfer), treatment (early/late), complications, patient demographics and compliance. RESULTS: There was a four-fold increase in incidence. Our incidence correlated well with The Metropolitan Police figures (r = 0.93). One-third of our injuries were managed non-operatively and on an outpatient basis. Complications were as follows: eight wound infections, one fracture non-union, one compartment syndrome, one vascular injury and five nerve injuries. Compliance was excellent for high-energy transfer injuries. CONCLUSION: Extremity gunshot injuries are on an increase in the United Kingdom highlighting the need for trauma surgeons' knowledge of the management of these injuries. Complications can be reduced to a minimum if the basic principles of management are strictly adhered to.

Adolescent↗