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[Closure of the procurement zone of a latissimus dorsi flap].
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[A case report of aortic and mitral regurgitation combined with ankylosing spondylosis].
The purpose of this communication is to present a successful case of surgical treatment of aortic and mitral valve regurgitation associated with ankylosing spondylosis. A 48-year-old male was admitted with symptoms of palpitation and shortness of breath. His heart murmur had been pointed out for 4 months prior to this admission. His previous history did not show any evidence of rheumatic heart disease. Retrograde aortography showed moderate to severe aortic valvular regurgitation and echocardiography revealed mitral valve regurgitation with minor degree. At the same time he complained of rigidity of neck muscle as well as back pain for last 15 years. He underwent aortic valve replacement and mitral valve was left alone. His postoperative course was uneventful. In Japan, aortic valve regurgitation associated with ankylosing spondylosis has been reported to be very rare compared to the European or American people. Several important features in the diagnosis and operative treatment for this combination of diseases have been also discussed.
Managing low back pain--a comparison of the beliefs and behaviors of family physicians and chiropractors.
Random samples of 605 family physicians and 299 chiropractors in Washington were surveyed to determine their beliefs about back pain and how they would respond to three hypothetic patients with back pain. With 79% of the family physicians and 70% of the chiropractors responding, family physicians and chiropractors differed greatly not only in their technical approaches to back pain--such as drug therapy versus spinal manipulation--but also in their underlying beliefs and attitudes. Family physicians think that most back pain is caused by muscle strain, that lumbosacral radiographs are rarely useful, that appropriate therapy does not depend on a precise diagnosis, and that back pain will usually resolve within a few weeks without professional help. Family physicians were more likely than chiropractors to feel frustrated by patients with back pain, less likely to think they can help patients prevent future episodes of back pain, and less confident that their patients are satisfied with their care. Studies are needed to determine whether the different perspectives of family physicians and chiropractors are associated with differences in the costs and outcomes of care.
Reversal of paralysis in nerve-muscle preparations isolated from animals with hereditary motor endplate disease.
Motor endplate disease (med) in the mouse is an hereditary disorder of the skeletal neuromuscular system. Affected animals suffer a 'functional denervation' of skeletal muscle (Duchen & Stefani, 1971). Muscle fibres do not respond to indirect excitation, but motor nerve terminals release transmitter spontaneously. Spontaneous transmitter release can be enhanced by raising [K+]o or by exposing muscles to red-back spider venom and functional transmission following indirect stimulation may be restored by 4-aminopyridine.
Diagnosis of aluminum-related bone disease and treatment of aluminum toxicity with deferoxamine.
Bone disease related to aluminum toxicity (aluminum-related bone disease) presents with variable clinical and biochemical findings in patients with renal failure. Bone pain and muscle weakness are common, although afflicted patients can be asymptomatic. Bone pain can be generalized or localized to the hips, back, feet, or ankles; proximal muscle weakness is common. Most cases in the United States arise from the ingestion of aluminum-containing gels by patients on long-term dialysis treatment. Patients at increased risk for developing aluminum-related bone disease include those with earlier parathyroidectomy, failed renal transplant, previous bilateral nephrectomy, and diabetes mellitus. Biochemical features that are common with aluminum-related bone disease include plasma aluminum levels greater than 100 to 150 micrograms/L, serum parathyroid hormone (PTH) levels equal to or lower than those in dialysis patients without bone disease, and normal or slightly elevated serum calcium levels. Plasma alkaline phosphatase levels are often elevated. In our experience, microcytic anemia has been uncommon. An increase in plasma aluminum levels greater than 200 micrograms/L 24 to 48 hours after the infusion of the chelating agent deferoxamine (DFO) correlates with an increased bone aluminum content, and an increment greater than 400 micrograms/L suggests marked aluminum accumulation. Radiographs are usually nonspecific. When results from indirect diagnostic procedures are equivocal, a bone biopsy is necessary. After a diagnosis of aluminum-related bone disease is established, therapy with DFO may be useful. DFO increases both the total plasma aluminum level and its ultrafilterable fraction. After an infusion of DFO, the removal of aluminum increases from 50 to 300 micrograms to 4 to 8 mg per dialysis session. Aluminum removal is similar during continuous ambulatory peritoneal dialysis after either intravenous (IV) or intraperitoneal (IP) administration of DFO. Usually, 2 to 4 g of DFO is administered once weekly, but the optimal dose and duration of therapy have not been determined. Symptoms usually improve after 4 to 12 weeks, and bone biopsies show improvement after treatment for 6 to 12 months. Further experience with DFO is needed, both to identify the optimal dosage and to clarify the risks of long-term therapy in patients with renal failure.
[A case of an abnormal bundle from the anterior margin of the right and left trapezius and an abnormality in the right omohyoid appearance in a cadaver].
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Dynamic peroneus tendon transfer for repair of the unstable ankle.
The author considers the anatomic basis and indications for a dynamic peroneus brevis tendon transfer to treat ankle instability and pain caused by rupture of the lateral fibular ligaments. He describes the surgical technique. The peroneus brevis tendon is passed through a tunnel in the distal fibula and cuboid bone, proximally and deep to the belly of the short toe extensor muscle and is looped back and sutured to itself. Thirty-two patients with ankle instability and pain of 10 years' duration or acute ligamentous rupture underwent dynamic peroneus brevis tendon transfer in a prospective study between Nov. 1, 1976 and Oct. 31, 1981. Twenty-five of the 32 patients were available for follow-up, which ranged from 15 to 57 months. The operation resulted in improved activity in 80% and relief of pain in 76%. There were three complications: causalgia, infection and numbness in one patient each. The author believes this procedure is worthwhile in active individuals who have long-standing ankle pain and weakness due to rupture of the lateral ankle ligaments.
[Muscular tensions of the back studied with telethermography: changes induced with static measures and auricular acupuncture. Preliminary report].
Thirty-six cases affected with scoliosis or scoliotic attitudes secondary to static trouble were examined. On all these cases a telethermography of the back was carried out demonstrating the presence of thermic asymmetry as regards to a normal map presenting hot areas on the side of the curve's concavity. The dysmorphosis secondary to static trouble cases was treated with millimetric rise whilst idiopathic scoliosis was treated with auricle therapy and precisely with the penetration of semipermanent steelplated needles of the bilateral external anthelis face. The exact point of penetration was determined by making use of the F frequency. All the cases treated have undergone long-term controls which document a return towards a normal telethermography. In the case of idiopathic scoliosis a significant modification in the thermography already after fifteen seconds of needle penetration was observed.
[Lumbago disclosing muscular metastasis].
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Trunk strength testing with iso-machines. Part 1: Review of a decade of scientific evidence.
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Trunk strength testing with iso-machines. Part 1: Review of a decade of scientific evidence.
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"Twin-pedicled" scapular and latissimus dorsi free flaps.
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[Giant-cell temporal arteritis. Anatomo-clinical study of 2 cases].
The Authors describe two cases of giant cell arteritis in male and elderly patients 72 and 82 years old. In both cases the early symptoms and signs of disease (headache, fever, weight loss and sedimentation rate raised) were associated to classical histology of temporal arteritis (granulomatous inflammation with giant cells). In case 1 there was impaired vision, while in case 2 coexisted polymialgia rheumatica (pain and stiffness in the muscles of the neck, back and proximal portions of the limbs).
Isolated lumbar strengthening in the rehabilitation of chronic low back pain.
OBJECTIVE: To discuss the effects of an active care protocol that includes isolated lumbar spine strengthening on a chronic low back pain patient. CLINICAL FEATURES: A 20-yr-old female college basketball player suffered from a 7-month history of debilitating low back and left leg pain. Four previous independent physicians expressed diagnostic and therapeutic uncertainty. Bone scan, MRI, nerve conduction study, electromyography, CT, discogram and laboratory evaluation had all failed to identify the etiology of the problem. The patient was forced to discontinue basketball and drop out of college as a result of her spinal problem. Treatment by her prior physicians consisted of analgesics and prolonged bedrest. INTERVENTION AND OUTCOMES: The patient underwent a functional restoration program consisting of isolated lumbar extensor progressive resistance exercise (PRE) on a MedX lumbar instrument, PRE to ancillary musculature, progressive aerobic exercise, static stretching and proprioceptive exercises. She showed a 368% increase in average lumbar isometric strength, 41% increase in isolated lumbar sagittal plane range of motion and decrease in pain. The patient returned to school after 8 wk of care; at 18-month check-up, she remained asymptomatic. CONCLUSION: Functional restoration, even with uncertain diagnosis, can be effective in the resolution of chronic low back pain.
[Relaxation and release of spasms].
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