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Sample records for bones of lower extremity

  1. Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting.

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    Niu, Yunfei; Bai, Yushu; Xu, Shuogui; Liu, Xinwei; Wang, Panfeng; Wu, Dajiang; Zhang, Chuncai; Li, Ming

    2011-07-01

    Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects. Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted. The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain. The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.

  2. Quality of Life Following Amputation or Limb Preservation in Patients with Lower Extremity Bone Sarcoma

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    Gary E Mason

    2013-08-01

    Full Text Available PURPOSE: Although functional differences have been described between patients with lower extremity bone sarcoma with amputation and limb preservation surgery, differences have not clearly been shown between the two groups related to quality of life. The aim of the study was to determine if there is a difference in overall quality of life in lower extremity bone sarcoma survivors related to whether they had an amputation or a limb preservation procedure. PATIENTS AND METHODS: Eighty-two long-term survivors of lower extremity bone sarcoma were studied to make a comparison of the overall quality of life, pain assessment and psychological evaluations in limb preservation and amputation patients. Forty-eight patients with limb preservation and thirty-four patients with amputations were enrolled in the study. Validated psychometric measures including the Quality of Life Questionnaire, the Minnesota Multiphasic Personality Inventory and visual analog scales were utilized.RESULTS: The overall quality of life of patients with limb preservation was significantly higher than patients with amputation (p-value < 0.01. Significant differences were noted in the categories of material well being, job satisfiers and occupational relations. CONCLUSION: The overall quality of life of patients with limb preservation appears to be better than for those patients with amputation based on the quality of life questionnaire in patients surviving lower extremity bone sarcoma. Further analysis needs to verify the results and focus on the categories that significantly affect the overall quality of life.

  3. [The laboratory evaluation of pathogenic factors under retarded consolidation of fractures of bones of lower extremities].

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    Stogov, V M; Kireeva, E A; Karasev, A G

    2014-12-01

    The study was carried out to comparatively analyze metabolic profile and content of growth factors in blood serum of patients with retarded consolidation of fractures of bones of lower extremities. The evaluation was applied to concentration of metabolites, growth factors and enzyme activity of blood serum in 13 patients with retarded consolidation of fractures of thigh and shank bones (main group). The comparative group included 14 patients with solid fractures of thigh and shank bones. The analysis established that as compared to patients with solid fractures of bones, in patients with retarded consolidation of fractures blood serum contained reliably higher concentration of triglycerides, products of glycolysis, epidermal growth factor and transforming growth factors TGF-α and TGF-β2. The content of vitamin E and insullin-like growth factor (IGF-1) was decreased The given markers can be labeled as potential markers of diagnostic and prognosis of development of retarded consolidation of fractures.

  4. Management of Lower Extremity Long-bone Fractures in Spinal Cord Injury Patients.

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    Schulte, Leah M; Scully, Ryan D; Kappa, Jason E

    2017-09-01

    The AO classification system, used as a guide for modern fracture care and fixation, follows a basic philosophy of care that emphasizes early mobility and return to function. Lower extremity long-bone fractures in patients with spinal cord injury often are pathologic injuries that present unique challenges, to which the AO principles may not be entirely applicable. Optimal treatment achieves healing without affecting the functional level of the patient. These injuries often result from low-energy mechanisms in nonambulatory patients with osteopenic bone and a thin, insensate soft-tissue envelope. The complication rate can be high, and the outcomes can be catastrophic without proper care. Satisfactory results can be obtained through various methods of immobilization. Less frequently, internal fixation is applied. In certain cases, after discussion with the patient, amputation may be suitable. Prevention strategies aim to minimize bone loss and muscle atrophy.

  5. Physiological uptake values of 18F-FDG in long bones of the lower extremity on PET/CT imaging

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    van Vliet, Kirsten E.; van Eck-Smit, Berthe L. F.; de Jong, Vincent M.; Goslings, J. Carel; Schep, Niels W. L.; Termaat, M. Frank

    2016-01-01

    Fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) has proven to be a valuable imaging modality with high diagnostic accuracy for the detection of bone infections. However, the physiological uptake values for F-FDG in the long bones of the lower extremity have not been established

  6. Sexual function in adolescent and young adult survivors of lower extremity bone tumors.

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    Barrera, Maru; Teall, Tanya; Barr, Ronald; Silva, Mariana; Greenberg, Mark

    2010-12-15

    Improving survival rates and new surgical options have led to increased interest regarding late effects and quality of life in adolescent and young adult survivors of bone cancers, including their sexual functioning. This study investigated sexual functioning in adolescent and young adult survivors of lower limb bone tumors, in relation to surgical treatments, gender differences, depressive symptoms, global self worth, and physical disability. Twenty-eight participants (age range 18-32 years) completed measures of gender specific sexual function, depressive symptoms, global self worth, and physical disability. For analysis, surgical intervention was grouped into limb sparing surgeries (LS; allograft fusion and endoprosthesis) and amputation or Van Nes rotationplasty (AMP). Male survivors reported significantly higher scores than females on total sexual function scores (P = 0.050), sexual drive (P = 0.002), and frequency of sexual thoughts, fantasies or erotic dreams (P = 0.021). Men also reported significantly better physical functioning scores than women (P = 0.012). LS scored significantly lower on frequency of sexual thoughts, fantasies and erotic dreams (P = 0.048) and frequency of sexual experiences (P = 0.016) compared with AMP. In addition, LS reported significantly more depressive symptoms scores (P = 0.004) and lower self worth scores (P = 0.037), than AMP. These results suggest that male survivors of lower extremity bone tumors experience better sexual functioning than women. Survivors of limb sparing surgeries struggle with sexual function, depressive symptoms, and poor self-perception compared to Van Nes rotationplasty and amputation survivors. Copyright © 2010 Wiley-Liss, Inc.

  7. Diagnostic accuracy of ultrasound in upper and lower extremity long bone fractures of emergency department trauma patients.

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    Frouzan, Arash; Masoumi, Kambiz; Delirroyfard, Ali; Mazdaie, Behnaz; Bagherzadegan, Elnaz

    2017-08-01

    Long bone fractures are common injuries caused by trauma. Some studies have demonstrated that ultrasound has a high sensitivity and specificity in the diagnosis of upper and lower extremity long bone fractures. The aim of this study was to determine the accuracy of ultrasound compared with plain radiography in diagnosis of upper and lower extremity long bone fractures in traumatic patients. This cross-sectional study assessed 100 patients admitted to the emergency department of Imam Khomeini Hospital, Ahvaz, Iran with trauma to the upper and lower extremities, from September 2014 through October 2015. In all patients, first ultrasound and then standard plain radiography for the upper and lower limb was performed. Data were analyzed by SPSS version 21 to determine the specificity and sensitivity. The mean age of patients with upper and lower limb trauma were 31.43±12.32 years and 29.63±5.89 years, respectively. Radius fracture was the most frequent compared to other fractures (27%). Sensitivity, specificity, positive predicted value, and negative predicted value of ultrasound compared with plain radiography in the diagnosis of upper extremity long bones were 95.3%, 87.7%, 87.2% and 96.2%, respectively, and the highest accuracy was observed in left arm fractures (100%). Tibia and fibula fractures were the most frequent types compared to other fractures (89.2%). Sensitivity, specificity, PPV and NPV of ultrasound compared with plain radiography in the diagnosis of upper extremity long bone fractures were 98.6%, 83%, 65.4% and 87.1%, respectively, and the highest accuracy was observed in men, lower ages and femoral fractures. The results of this study showed that ultrasound compared with plain radiography has a high accuracy in the diagnosis of upper and lower extremity long bone fractures.

  8. QUALITY-OF-LIFE IN BONE-TUMOR PATIENTS COMPARING LIMB SALVAGE AND AMPUTATION OF THE LOWER-EXTREMITY

    NARCIS (Netherlands)

    POSTMA, A; KINGMA, A; DERUITER, JH; KOOPS, HS; VETH, RPH; GOEKEN, LNH; KAMPS, WA

    In 33 long-term survivors of lower extremity bone cancer quality-of-life data were studied following limb salvage compared to amputation. Self-report questionnaires, semistructured interviews and visual analog scales were used to measure psychoneurotic and somatical distress, activities of daily

  9. Loading modalities and bone structures at nonweight-bearing upper extremity and weight-bearing lower extremity: a pQCT study of adult female athletes.

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    Nikander, Riku; Sievänen, Harri; Uusi-Rasi, Kirsti; Heinonen, Ari; Kannus, Pekka

    2006-10-01

    This cross-sectional study of adult female athletes assessed whether the apparent loading-related differences in bone structure are primarily associated with the loading type or the muscle performance-related joint moments. Several structural variables at shaft sites of the tibia, radius and humerus, and distal sites of the tibia and radius were measured with peripheral quantitative computed tomography (pQCT) among 113 female national level athletes (representing hurdling, volleyball, soccer, racket-sports and swimming) and their 30 nonathletic referents. For the weight-bearing lower extremities, the loading modalities of the above sports were classified into high-impact (hurdling, volleyball), odd-impact (soccer, racket-sports) and repetitive, nonimpact (swimming) loadings; and for the nonweight-bearing upper extremities into high magnitude (functional weightlifting in hurdling and soccer), impact (volleyball, racket-sports) and repetitive, nonimpact (swimming) loadings. As expected, athletes' bone mass was substantially higher at loaded bone sites compared with the nonathletic referents, but more pertinently to the locomotive perspective, the loading-induced additional bone mass seemed to be used to build mechanically strong and appropriate bone structures. Compared with controls, the weight-bearing bone structures of female athletes (swimmers excluded) were characterized by larger diaphysis, thicker cortices and somewhat denser trabecular bone. The athletes' bones at the nonweight-bearing upper extremity were generally larger in cross-sectional area. The estimated indices of joint moment (muscle force x estimated lever arm) were explained from 29% to 50%, and the loading modalities from 8% to 25%, of the variance in most bone variables (P features of loading seemed to govern the skeletal adaptation at the upper and lower extremity.

  10. Evaluation of remote results of treatment of children with long-bone fractures of the lower extremities

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    Aleksander A Patlatov

    2016-09-01

    Full Text Available Background. Evaluation of the effectiveness of treatment of long-bone fractures of the lower extremities should be comprehensive and include both subjective and objective indicators. In the developed countires, it is standard to assess the quality of life related to children’s health after trauma. According to the Russian literature, such assessment has not been studied. The aim of our study was to assess the quality of life in children, with long-bone fractures of the lower extremities, and to compare the results with data from the Lower Extremity Functional Scale (LEFS and assessment system according to N.B. Duysenov. Materials and methods. We examined 70 patients (age range, 8–18 years with long-bone fractures of the lower extremities. Forty patients had a history of tibia fracture, and 30 patients had a history of femoral fracture. We determined the severity of the fractures using pediatric comprehensive classification of long-bone fractures (PCCF. We assessed the quality of life of the children using the Pediatric Questionnaire for Quality of Life  (PedsQLTM 4.0. Results. Trauma had a significant impact on the quality of life in children. The children evaluated their quality of life after injury more objectively; on all scales, their scores had the highest correlation with LEFS and assessment system according to N.B Duysenov. In most cases, parents underestimated the mental and physical burden of their child’s condition after injury. The values for the “physical functioning” assessment in children with severe trauma was the lowest, and was not significantly different between parents and children. Parents who were aware of the severity of the injury gave their child more attention, which positively affected the child’s psychological and social functioning. Children with severe trauma had higher values on the emotional, social and role functioning scale, compared to children with minor  injuries. Conclusions. The results of

  11. Lymphoscintigraphy of the lower extremity

    International Nuclear Information System (INIS)

    Abbasi, N.Z.

    1990-01-01

    Fifty one lower extremities of 26 normal healthy volunteers and 26 extremities of 13 patients with oedema have been studied. Dynamic quantitative lymphoscintigraphy using 99Tc-m antimony sulphide colloid during passive exercise as well as before and after active exercise was performed. parameters of lymphatic function including percentage of radioactivity cleared from the injection site, the percentage uptake by the inguinal lymph nodes, the time of arrival of activity at the regional lymph nodes and the lymphatic reserve index have been evaluated. The percentage clearance of activity from the injection site was found technically difficult to standardize and proved to be an unreliable parameter of lymphatic function. However, the quantitation of nodal uptake, the lymphatic transit time and the lymphatic reserve capacity accurately depicted the lymphatic functional status of an individual. The physiologic parameters of lymphatic function of the contralateral lower extremities were compared and a physiologic difference in the lymphatic capacity of the two limbs was scintigraphically documented. (author)

  12. MR angiography of lower extremity

    International Nuclear Information System (INIS)

    Fujikawa, Takao

    1991-01-01

    MR angiography by ECG-gated 2D rephase-dephase subtraction method was performed in normal volunteers (n=14) and patients with arterial or venous vascular disease of lower extremities (n=36). Results were compared to digital subtraction angiography or conventional film angiography. In normal cases, superficial femoral and popliteal arteries were well demonstrated by angiography whereas visualization of intrapelvic portion of the arteries was often impaired by mortion artifacts from bowel loops. Diagnostic results of MR angiography and digital or conventional angiography were in agreement in 92.3% of obstructive arteriosclerotic disease, 87.0% of post by-pass graft surgery, and 85.7% of cases in which deep vein thrombosis was clinically suspected. Considering its virtually noninvasive nature, MR angiography can be a valuable screening method in vascular diseases of lower extremities and also in post operative evaluation of by-pass graft surgery. Further technical advancements are expected. (author)

  13. MR angiography of lower extremity

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    Fujikawa, Takao (Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine)

    1991-02-01

    MR angiography by ECG-gated 2D rephase-dephase subtraction method was performed in normal volunteers (n=14) and patients with arterial or venous vascular disease of lower extremities (n=36). Results were compared to digital subtraction angiography or conventional film angiography. In normal cases, superficial femoral and popliteal arteries were well demonstrated by angiography whereas visualization of intrapelvic portion of the arteries was often impaired by mortion artifacts from bowel loops. Diagnostic results of MR angiography and digital or conventional angiography were in agreement in 92.3% of obstructive arteriosclerotic disease, 87.0% of post by-pass graft surgery, and 85.7% of cases in which deep vein thrombosis was clinically suspected. Considering its virtually noninvasive nature, MR angiography can be a valuable screening method in vascular diseases of lower extremities and also in post operative evaluation of by-pass graft surgery. Further technical advancements are expected. (author).

  14. Quantitative bone scintigraphy in the evaluation of angular deformity of the lower extremity

    International Nuclear Information System (INIS)

    Harcke, H.T.; Zapf, S.E.; Mandell, G.A.; Sharkey, C.A.; Cooley, L.A.

    1986-01-01

    A technique for quantitative analysis of growth plates in varus or valgus deformity about the knee has been developed. Computer-generated regions of interest are placed on magnification scintigraphs to divide distal femoral and proximal tibial physes into four equal segments. The ratio of counts in the medial half to counts in the lateral half was studied in 31 children (22 normal, 9 with angular deformity). Normal ratios were 0.74 to 0.98 for femora and 0.98 to 1.20 for tibias. In eight of nine patients with deformity, the ratio was abnormal; in two patients the ratio returned to normal when the deformity ceased to progress

  15. The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities

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    Tekin Ali Çağrı

    2016-01-01

    Full Text Available Aim: To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame in patients with lower extremity shortness and deformity. Materials and methods: The study comprised 17 patients (14 male, 3 female who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure’s level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. Results: The mean age of the patients was 24.58 years (range, 5–51 years. The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6–31 months from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1–6 cm. The mean duration of fixator application was 202.7 days (range, 104–300 days. The mean External Fixator Index was 98 days/cm (range, 42–265 days/cm. The mean Distraction Index was 10.49 days/cm (range, 10–14 days/cm. Conclusion: The computer-assisted external fixator system (spider frame achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

  16. The results of bone deformity correction using a spider frame with web-based software for lower extremity long bone deformities.

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    Tekin, Ali Çağrı; Çabuk, Haluk; Dedeoğlu, Süleyman Semih; Saygılı, Mehmet Selçuk; Adaş, Müjdat; Esenyel, Cem Zeki; Büyükkurt, Cem Dinçay; Tonbul, Murat

    2016-03-22

    To present the functional and radiological results and evaluate the effectiveness of a computer-assisted external fixator (spider frame) in patients with lower extremity shortness and deformity. The study comprised 17 patients (14 male, 3 female) who were treated for lower extremity long bone deformity and shortness between 2012 and 2015 using a spider frame. The procedure's level of difficulty was determined preoperatively using the Paley Scale. Postoperatively, the results for the patients who underwent tibial operations were evaluated using the Paley criteria modified by ASAMI, and the results for the patients who underwent femoral operations were evaluated according to the Paley scoring system. The evaluations were made by calculating the External Fixator and Distraction indexes. The mean age of the patients was 24.58 years (range, 5-51 years). The spider frame was applied to the femur in 10 patients and to the tibia in seven. The mean follow-up period was 15 months (range, 6-31 months) from the operation day, and the mean amount of lengthening was 3.0 cm (range, 1-6 cm). The mean duration of fixator application was 202.7 days (range, 104-300 days). The mean External Fixator Index was 98 days/cm (range, 42-265 days/cm). The mean Distraction Index was 10.49 days/cm (range, 10-14 days/cm). The computer-assisted external fixator system (spider frame) achieves single-stage correction in cases of both deformity and shortness. The system can be applied easily, and because of its high-tech software, it offers the possibility of postoperative treatment of the deformity.

  17. Prevention of Lower Extremity Injuries in Basketball

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    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlle...

  18. The structure of long tubular bones fractures of lower extremity by the data of the regional bureau of forensic-medical examination

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    Savka I.H.

    2013-10-01

    Full Text Available The main purpose of the research is carrying out forensic-medical analysis of cases from expert’s practice with fractures of the long bones based on the findings of the Regional Bureau of Forensic-Medical Examination over 2009-2012 years period. The research has been carried out using methods of statistical and comparative analysis. Their distribution by gender, age, localization, character and type of external influence, the conditions of their occurrence and participation of other persons has been outlined. Fractures of lower extremity bones make up from 15,8 to 22,5% of all the cases of mechanical trauma with lethal outcomes. Therewith male persons suffer more often from injury of the left extremity at different day time and season. The principal mechanism of their origin is injury resulting from road accidents in the countryside with the participation of other persons.

  19. Interlimb differences in lower extremity bone mineral density following anterior cruciate ligament reconstruction.

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    Reiman, Michael P; Rogers, Michael E; Manske, Robert C

    2006-11-01

    Prospective descriptive study. To determine the extent of bone mineral density (BMD) interlimb differences at several hip locations in the involved versus noninvolved lower extremity following anterior cruciate ligament (ACL) surgery. Disuse following ACL reconstruction can be extensive. This disuse not only affects the soft tissue, but may also affect the skeletal structure. The extent of this disuse specific to the proximal femur has not been previously determined. BMD was assessed in 15 subjects, 17 to 51 years old, who were between 6 and 32 months post-ACL reconstruction surgery. Bone mineral content (BMC) and BMD of the femoral neck, trochanteric region, intertrochanteric region, and entire hip were measured as a primary emphasis of this study. BMD and BMC of the entire lower extremities were also measured bilaterally. BMD was significantly less in the involved lower extremity compared to noninvolved lower extremity at several hip sites: 6.6% less (Phip, and 3.4% less (P = .004) for the intertrochanteric region. No significant differences were noted comparing the entire lower extremities for either BMD (0.9%, P = .48) or BMC (3.7%, P= .09). BMD differences at the hip are significant in patient's postoperative ACL reconstruction, especially in the trochanteric region.

  20. Sports nuclear medicine. Bone imaging for lower extremity pain in athletes

    International Nuclear Information System (INIS)

    Brill, D.R.

    1983-01-01

    Increased participation in sports by the general public has led to an increase in sports-induced injuries, including stress fractures, shin splints, arthritis, and a host of musculotendinous maladies. Bone scintigraphy with Tc-99m MDP has been used with increasing frequency in detecting stress fractures, but this study can miss certain important conditions and detect other lesions of lesser clinical significance. This paper demonstrates the spectrum of findings on bone scanning in nonacute sports trauma and offers suggestions for the optimal use of Tc-99m MDP for detecting the causes of lower extremity pain in athletes

  1. Curettage with cement augmentation of large bone defects in giant cell tumors with pathological fractures in lower-extremity long bones.

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    Gupta, Som P; Garg, Gaurav

    2016-09-01

    Thorough curettage and cement augmentation is the procedure of choice for treating giant cell tumor lesions, particularly those associated with large defects. Its association with pathological fractures has not been studied to a great extent, although a pathological fracture following a giant cell tumor is not a contraindication to treatment by curettage and cementation. We present our experience of bone cementation following intralesional curettage for treatment of giant cell tumors of the long bones of lower limbs with associated pathological fractures. A total of 38 patients who had undergone a procedure in the weight-bearing long bones of lower limbs were included in the study. The age of the patients ranged from 18-79 years with a mean age of 38.57 years. The average follow-up was 102.42 months (8.5 years) ranging from 60-186 months (5-15.5 years). Results were based on serial radiographs showing consolidation of the lesion along with a subjective clinical examination and Enneking functional evaluation noted in the patient's records. Approximately 76 % of the lesions occurred around the knee. The results were graded as excellent (72 %), good (12.82 %) fair (10.25 %) and poor (5.12 %). Four cases developed a recurrence. Apart from a few documented complications, the lesions showed good consolidation and healed well. Giant cell tumors of the long bones of lower limbs with an associated pathological fracture at diagnosis can be managed with thorough curettage and cement augmentation of the bone defect with a satisfactory outcome. Level IV.

  2. Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula

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    Koichi Ogura

    2015-01-01

    Full Text Available Introduction. Although several intercalary reconstructions after resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograft and a vascularized fibula graft composite. Materials and Methods. We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years undergoing reconstruction using a devitalized autograft (pasteurization (n=6, deep freezing (n=5 and a vascularized fibula graft composite for lower extremity malignant bone tumors (femur (n=10, tibia (n=1. Results. The mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograft, 1 frozen autograft and 1 fracture and 1 implant failure (both in pasteurized autografts. Graft removal was required in 2 patients with infections. The mean MSTS score was 81% at last follow-up. Conclusions. Although some complications were noted in early cases involving a pasteurized autograft, our novel method involving a combination of a frozen autograft with a vascularized fibula graft and rigid fixation with a locking plate may offer better outcomes than previously reported allografts or devitalized autografts.

  3. Reconstruction of Lower Extremity Primary Malignant and Metastatic ...

    African Journals Online (AJOL)

    Introduction: This study is aimed to assess the functional results of cases with lower extremity malignant and metastatic bone tumours that were treated with modular tumour resection prostheses. Materials and Methods: 49 patients were retrospectively examined. 27 (55.1%) patients had a primary bone tumour, and 22 ...

  4. Prevention of Lower Extremity Injuries in Basketball

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    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Terry, Lauren N.; Hegedus, Eric J.

    2015-01-01

    Context: Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. Objective: To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. Data Sources: PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Study Selection: Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Study Design: Systematic review and meta-analysis. Level of Evidence: Level 2. Data Extraction: Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Results: Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P basketball athletes. Conclusion: In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. PMID:26502412

  5. Botulinum toxin treatment of lower extremity spasticity

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    S. E. Khat’kova

    2017-01-01

    Full Text Available The article reviews the current concept of lower extremity spasticity, which is a frequent disabling consequence of stroke. Gait biomechanics, step cycle and main pathologic patterns of lower extremity are described (hip adduction, knee flexion, knee extension, foot plantar flexion, equinovarus foot position, toes flexion, hallux extension, including muscles involved in the pathological process. Additionally the article contains detailed information on pathologic principles of lower extremity spasticity development. Special focus is given to sarcomeregenesis as an essential element of the development of potential conditions for muscle tissue adaptation to a new state and restoration of muscle length and strength. At present Botulinum toxin A (BTA is used in a complex spasticity management programs. The results of clinical studies performed in the last decade supporting the efficacy of Botox® (Onabotulinumtoxin A in the treatment of spasticity are reviewed. Effective BTA doses are proposed. Authors came to the conclusion that BTA as a part of complex rehabilitation in patients with poststroke spasticity of lower extremity promotes treatment efficacy due to a decrease of muscle tone and increase of range of movements in the joints. BTA should be regarded as an essential part of standard rehabilitation programs. Further studies to define optimal muscles for intervention, BTA doses and rehabilitation schemes are still needed. 

  6. Clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans

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    Moon, Il Bong; Dong, Kyung Rae [Dept. Radiological Technology, Gwangju Health University, Gwangju (Korea, Republic of); Goo, Eun Hoe [Dept. Radiological Science, Cheongju University, Cheongju (Korea, Republic of)

    2016-11-15

    The purpose of this study was to assess clinical application of lower extremity CTA and lower extremity perfusion CT as a method of diagnostic for lower extremity atherosclerotic obliterans. From January to July 2016, 30 patients (mean age, 68) were studied with lower extremity CTA and lower extremity perfusion CT. 128 channel multi-detector row CT scans were acquired with a CT scanner (SOMATOM Definition Flash, Siemens medical solution, Germany) of lower extremity perfusion CT and lower extremity CTA. Acquired images were reconstructed with 3D workstation (Leonardo, Siemens, Germany). Site of lower extremity arterial occlusive and stenosis lesions were detected superficial femoral artery 36.6%, popliteal artery 23.4%, external iliac artery 16.7%, common femoral artery 13.3%, peroneal artery 10%. The mean total DLP comparison of lower extremity perfusion CT and lower extremity CTA, 650 mGy-cm and 675 mGy-cm, respectively. Lower extremity perfusion CT and lower extremity CTA were realized that were never be two examination that were exactly the same legions. Future through the development of lower extremity perfusion CT soft ware programs suggest possible clinical applications.

  7. Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study

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    Ellen A. Almirol

    2016-09-01

    Conclusions: In this randomized, pilot study, brief administration of TPTD showed anabolic effects that TPTD may help hasten fracture healing in premenopausal women with lower-extremity stress fractures. Larger prospective studies are warranted to determine the effects of TPTD treatment on stress fracture healing in premenopausal women.

  8. Reliability of the mangled extremity severity score in combat-related upper and lower extremity injuries.

    Science.gov (United States)

    Ege, Tolga; Unlu, Aytekin; Tas, Huseyin; Bek, Dogan; Turkan, Selim; Cetinkaya, Aytac

    2015-01-01

    Decision of limb salvage or amputation is generally aided with several trauma scoring systems such as the mangled extremity severity score (MESS). However, the reliability of the injury scores in the settling of open fractures due to explosives and missiles is challenging. Mortality and morbidity of the extremity trauma due to firearms are generally associated with time delay in revascularization, injury mechanism, anatomy of the injured site, associated injuries, age and the environmental circumstance. The purpose of the retrospective study was to evaluate the extent of extremity injuries due to ballistic missiles and to detect the reliability of mangled extremity severity score (MESS) in both upper and lower extremities. Between 2004 and 2014, 139 Gustillo Anderson Type III open fractures of both the upper and lower extremities were enrolled in the study. Data for patient age, fire arm type, transporting time from the field to the hospital (and the method), injury severity scores, MESS scores, fracture types, amputation levels, bone fixation methods and postoperative infections and complications retrieved from the two level-2 trauma center's data base. Sensitivity, specificity, positive and negative predictive values of the MESS were calculated to detect the ability in deciding amputation in the mangled limb. Amputation was performed in 39 extremities and limb salvage attempted in 100 extremities. The mean followup time was 14.6 months (range 6-32 months). In the amputated group, the mean MESS scores for upper and lower extremity were 8.8 (range 6-11) and 9.24 (range 6-11), respectively. In the limb salvage group, the mean MESS scores for upper and lower extremities were 5.29 (range 4-7) and 5.19 (range 3-8), respectively. Sensitivity of MESS in upper and lower extremities were calculated as 80% and 79.4% and positive predictive values detected as 55.55% and 83.3%, respectively. Specificity of MESS score for upper and lower extremities was 84% and 86.6%; negative

  9. Powering of lower extremities in fitness centre

    OpenAIRE

    Zavičák, Ondřej

    2011-01-01

    Title: Strengthening of the lower limbs in fitness center. Objectives: The aim of thesis is to create an overview for strengthening the legs in fitness and for people who have decided to devote this strengthening. Methods: The paper has been used the literature analysis and interviews. Target group interviews were 20 women and 20 men who attend fitness center. Results: In this work it was found that women strengthen the lower limbs more often and longer than men. The lower limbs are overwhelm...

  10. Ultrasonography of the hip and lower extremity.

    Science.gov (United States)

    Malanga, Gerard A; Dentico, Richard; Halperin, Jonathan S

    2010-08-01

    Musculoskeletal ultrasonographic evaluation of the proximal lower limb includes the evaluation of the soft tissue structures, including tendons, ligaments, or muscles, and the bony structures of this region, include the hip, pubic symphysis, and sacroiliac joints. The evaluation of the hip or proximal lower limb region can be performed in an efficient and systematic manner. Ultrasonography of the lateral hip, intra-articular hip, medial thigh, and posterior thigh are discussed in the article. Copyright 2010 Elsevier Inc. All rights reserved.

  11. Acute lower extremity ischaemia

    African Journals Online (AJOL)

    often defined as a sudden loss of perfusion to the lower extremity/extremities of less than 14 days' duration, ... Femoral arteries palpated Soft, tender. Hard, calcified. Dystrophic limb features Absent. Present. Cardiac abnormalities Present. Generally absent. Iliac/femoral bruits Absent. May be present. History of claudication ...

  12. Ultrasonography of the lower extremity veins: anatomy and basic approach

    Directory of Open Access Journals (Sweden)

    Dong-Kyu Lee

    2017-04-01

    Full Text Available Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography.

  13. Ultrasonography of the lower extremity veins: Anatomy and basic approach

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Kyu; Ahn, Kyung Sik; Kang, Chang Ho; Cho, Sung Bum [Dept. of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Ultrasonography is an imaging modality widely used to evaluate venous diseases of the lower extremities. It is important to understand the normal venous anatomy of the lower extremities, which has deep, superficial, and perforating venous components, in order to determine the pathophysiology of venous disease. This review provides a basic description of the anatomy of the lower extremity veins and useful techniques for approaching each vein via ultrasonography.

  14. The rotational profile of the lower extremities of Nigerian children ...

    African Journals Online (AJOL)

    The rotational profile of the lower extremities of Nigerian children. B Omota, PFA Umebese, A Bafor. Abstract. Lower extremity rotational problems are common findings in children worldwide. The approach to treatment of such problems requires knowledge of the normal rotational profile of the children in any particular ...

  15. On the Limit Distribution of Lower Extreme Generalized Order Statistics

    Indian Academy of Sciences (India)

    In a wide subclass of generalized order statistics ( g O s ) , which contains most of the known and important models of ordered random variables, weak convergence of lower extremes are developed. A recent result of extreme value theory of m − g O s (as well as the classical extreme value theory of ordinary order statistics) ...

  16. Bone transport and compression-distraction in the treatment of bone loss of the lower limbs.

    Science.gov (United States)

    Lavini, Franco; Dall'Oca, Carlo; Bartolozzi, Pietro

    2010-11-01

    A clinical series of 17 adult patients operated due to significant by bone loss of the long bones of the lower extremity (3 femurs and 11 tibias), is presented. Their management consisted of 6 bone transports (6 tibias) and 11 compression distraction procedures (3 femurs and 8 tibiae) using monolateral external fixators. Bone loss ranged from 3.9 cm to 14.7 cm. Mean healing time was 301 days with a mean healing index of 45.6 days for cm of lengthening achieved. The clinical and radiological results were excellent in 9, good in 6 and fair in 2 patients according to the utilised criteria of assessment. Consolidation was achieved in all but one patient who developed an aseptic stiff non-union. Two patients developed residual limb-length discrepancy less than 1.5 cm, three tibias ended up with less than 5° of valgus deviation. In two cases the half-pins were re-inserted due to early loosening. In two cases reoperation was needed for late bending of the callus after fixator removal. Three cases of bone transport and 1 case of compression distraction needed bone grafting at the docking site. Bone transport and compression-distraction are effective methods for treating bone loss in the lower extremity. It is suggested that the compression-distraction technique is preferable, since this is associated with a lower incidence of complications than bone transport procedures. The deciding factor, however, is the actual extent of the bone loss. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. The Bt-DUX: Development of a subjective measure of health-related quality of life in patients who underwent surgery for lower extremity malignant bone tumor

    NARCIS (Netherlands)

    W.P. Bekkering (Peter); T.P.M. Vliet Vlieland (Theodora); H.M. Koopman (Hendrik); G.R. Schaap (Gerard); H.W.B. Schreuder; A. Beishuizen (Auke); W.J.E. Tissing (Wim); P.M. Hoogerbrugge (Peter); J.K. Anninga (Jacob); A.H.M. Taminiau (Antonie)

    2009-01-01

    textabstractBackground. To examine the practical applicability, internal consistency, and validity of the Bt-DUX, a disease-specific Health Related Quality of Life (HRQoL) instrument. The Bt-Dux was developed to examine patients' individual values of their life after a malignant bone tumor of the

  18. Administrative Algorithms to identify Avascular necrosis of bone among patients undergoing upper or lower extremity magnetic resonance imaging: a validation study.

    Science.gov (United States)

    Barbhaiya, Medha; Dong, Yan; Sparks, Jeffrey A; Losina, Elena; Costenbader, Karen H; Katz, Jeffrey N

    2017-06-19

    Studies of the epidemiology and outcomes of avascular necrosis (AVN) require accurate case-finding methods. The aim of this study was to evaluate performance characteristics of a claims-based algorithm designed to identify AVN cases in administrative data. Using a centralized patient registry from a US academic medical center, we identified all adults aged ≥18 years who underwent magnetic resonance imaging (MRI) of an upper/lower extremity joint during the 1.5 year study period. A radiologist report confirming AVN on MRI served as the gold standard. We examined the sensitivity, specificity, positive predictive value (PPV) and positive likelihood ratio (LR + ) of four algorithms (A-D) using International Classification of Diseases, 9th edition (ICD-9) codes for AVN. The algorithms ranged from least stringent (Algorithm A, requiring ≥1 ICD-9 code for AVN [733.4X]) to most stringent (Algorithm D, requiring ≥3 ICD-9 codes, each at least 30 days apart). Among 8200 patients who underwent MRI, 83 (1.0% [95% CI 0.78-1.22]) had AVN by gold standard. Algorithm A yielded the highest sensitivity (81.9%, 95% CI 72.0-89.5), with PPV of 66.0% (95% CI 56.0-75.1). The PPV of algorithm D increased to 82.2% (95% CI 67.9-92.0), although sensitivity decreased to 44.6% (95% CI 33.7-55.9). All four algorithms had specificities >99%. An algorithm that uses a single billing code to screen for AVN among those who had MRI has the highest sensitivity and is best suited for studies in which further medical record review confirming AVN is feasible. Algorithms using multiple billing codes are recommended for use in administrative databases when further AVN validation is not feasible.

  19. Lower Extremity Paralysis.

    Science.gov (United States)

    Glancy, D Luke; Subramaniam, Pramilla N; Rodriguez, Juan F

    2016-11-15

    Severe hypokalemia in the absence of other electrolyte abnormalities, the result of diarrhea, caused striking electrocardiographic changes, generalized weakness, flaccid paralysis of the lower extremities, and biochemical evidence of mild skeletal and cardiac rhabdomyolysis in a 33-year-old man. Repletion of potassium reversed all abnormalities in 24 hours. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Prediction of Lower Extremity Movement by Cyclograms

    Directory of Open Access Journals (Sweden)

    P. Kutilek

    2012-01-01

    Full Text Available Human gait is nowadays undergoing extensive analysis. Predictions of leg movements can be used for orthosis and prosthesis programming, and also for rehabilitation. Our work focuses on predicting human gait with the use of angle-angle diagrams, also called cyclograms. In conjunction with artificial intelligence, cyclograms offer a wide area of medical applications. We have identified cyclogram characteristics such as the slope and the area of the cyclogram for a neural network learning algorithm. Neural networks learned by cyclograms offer wide applications in prosthesis control systems.

  1. Effect of anterior cruciate ligament injury of the knee on bone mineral density of the spine and affected lower extremity: a prospective one-year follow-Up study.

    Science.gov (United States)

    Leppälä, J; Kannus, P; Natri, A; Pasanen, M; Sievänen, H; Vuori, I; Järvinen, M

    1999-04-01

    The objective of this 1-year prospective follow-up study was to assess, with dual-energy X-ray absorptiometry (DXA), the effect of an anterior cruciate ligament (ACL) injury of the knee on areal bone mineral density (BMD) of the injured extremity and lumbar spine in two separate patient groups: 21 surgically treated patients (group A) and 12 conservatively treated patients (group B). Clinical and functional status of the patients and BMD of the spine (L2-L4), dominant distal radius, femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities were determined at the time of the injury and after 4, 8, and 12 months. A surgically treated, complete ACL rupture (group A) resulted in considerable and statistically significant bone loss to the affected knee (distal femur 21%, patella 17%, proximal tibia 14%; P < 0.001 in each), whereas the other sites were clearly less affected. Patients with a conservatively treated, complete or partial ACL injury (group B) had only a small but statistically significant bone loss at the patella (-3%; P = 0.005) and proximal tibia (-2%; P = 0.022) of the injured knee, and the other sites remained unchanged. The obvious differences between the groups A and B in the severity of the injury itself (complete or partial tear), its treatment (surgical or conservative), and subsequent rehabilitation (longer nonweight-bearing times in group A) explain these different BMD results, and the forthcoming years will show whether the considerable posttraumatic osteoporosis in the affected knee of group A patients will finally recover, and if so, to what extent.

  2. Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget’s disease of bone

    Directory of Open Access Journals (Sweden)

    Al Kaissi, Ali

    2014-09-01

    Full Text Available [english] We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget’s disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget’s disease of the bone.

  3. The deep venous system of the lower extremity: new nomenclature.

    Science.gov (United States)

    Kachlik, D; Pechacek, V; Musil, V; Baca, V

    2012-03-01

    The correct and precise nomenclature of the veins of the lower extremity is a necessary tool for communication. Three important changes have been done over the last 13 years. Terminologia Anatomica, the latest version of the Latin anatomical nomenclature, was published in 1998, extended in the area of the lower extremity veins with two consensus documents, in 2001, during the 14th World Congress of the International Union of Phlebology and in 2004 during the 21st World Congress of the International Union of Angiology. This article is a free continuation of two previous articles, reviewing the detailed anatomy and correct nomenclature of the superficial veins of the lower extremities and veins of pelvis. Now, it is concentrated on the deep venous system, in which 15 new terms have been added in both Latin and English languages.

  4. Malignant bone tumors of the pelvis and of the extremities

    International Nuclear Information System (INIS)

    Gullotta, U.; Reiser, M.; Feuerbach, S.; Biehl, T.; Technische Univ. Muenchen

    1981-01-01

    Bone tumors of the extremities are usually diagnosed by conventional radiography. A good angiogram may render information not only about intra- and extraosseous extension of the tumor, but often also about the biological dignity. CT is usually not necessary, especially since it is sometimes difficult to define the extraosseous borders of these extremity tumors with this method. In bone tumors of the pelvis, however, neither conventional radiography nor angiography render reliable information about the extent of the tumor, which CT is very well able to do. Therefore CT is primarily indicated for evaluation of bone tumors in this region. Angiography is done only for preoperative evaluation of the vascular architecture or for potential therapeutic embolisation. (orig.) [de

  5. Radiotherapy for Soft Tissue Sarcoma of the Proximal Lower Extremity

    Directory of Open Access Journals (Sweden)

    Brendan Prendergast

    2010-01-01

    Full Text Available Soft-tissue sarcoma (STS is a histopathologically diverse group of tumors accounting for approximately 10,000 new malignancies in the US each year. The proximal lower extremity is the most common site for STS, accounting for approximately one-third of all cases. Coordinated multimodality management in the form of surgery and radiation is often critical to local control, limb preservation, and functional outcome. Based on a review of currently available Medline literature and professional experience, this paper provides an overview of the treatment of STS of the lower extremity with a particular focus on the modern role of radiotherapy.

  6. Management of mixed arterial venous lower extremity ulceration: A review.

    Science.gov (United States)

    Hedayati, Nasim; Carson, John G; Chi, Yung-Wei; Link, Daniel

    2015-10-01

    Mixed arterial venous disease is estimated to affect up to 26% of patients with lower extremity ulcerations. However, its clinical significance and pathophysiology are incompletely understood. Furthermore, there is no consensus on the optimal treatment modality, whether conservative or operative. In this review paper, we describe the current understanding of the pathophysiology of mixed arterial venous lower extremity ulcers. Guidelines for diagnostic tests for patients with mixed arterial venous diseases are discussed. We review some of the newer biological skin substitutes for conservative wound care. Finally, we propose a treatment algorithm based on current available data. © The Author(s) 2015.

  7. [Osteoid osteoma in the lower extremity of the radius: about a case, rare location and review of the literature].

    Science.gov (United States)

    Abdelhafid, Derfoufi; Moncef, Erraji; Abdessamad, Kharraji; Najib, Abdeljaouad; Hicham, Yacoubi

    2016-01-01

    Osteoid osteoma is a benign but painful bone tumor whose treatment involves complete surgical resection. We report the case of a young patient with osteoid osteoma in the lower extremity of the radius.

  8. Reliability of a New Lower-Extremity Motor Coordination Test

    Directory of Open Access Journals (Sweden)

    Antosiak-Cyrak Katarzyna

    2015-12-01

    Full Text Available Introduction. Motor coordination is a basic motor ability necessary for daily life, which also allows athletes to win a sports rivalry and patients to assess their recovery progress after therapy and rehabilitation. The aim of the present study was to assess the reliability of a new lower-extremity rate of movements test and testing apparatus.

  9. Reconstruction of Lower Extremity Primary Malignant and Metastatic ...

    African Journals Online (AJOL)

    2017-10-26

    Oct 26, 2017 ... Lower extremity tumors and endoprosthesis. 1130. Nigerian Journal of Clinical Practice ¦ Volume 20 ¦ Issue 9 ¦ September 2017 renal failure, and the other patients died due to advanced metastatic disease. None of our patients who received radiotherapy and chemotherapy died due to oncologic treatment.

  10. Progress in Finite Element Modeling of the Lower Extremities

    Science.gov (United States)

    2015-06-01

    an assembly architecture that is currently under development. 15. SUBJECT TERMS  lower extremities, FEM , accelerative loading, biological...is on lower-leg injuries due to an underbody blast event beneath a vehicle. During such an event, the explosive gases and soil impart momentum to the...parsed by an external finite element method ( FEM ) solver. The program is written in C++ and heavily makes use of operator overloading, function

  11. Roentgenoendovascular dilatation and recanalization of vessels of lower extremities

    International Nuclear Information System (INIS)

    Rabkin, I.Kh.; Matevosov, A.L.; Gotman, L.N.

    1987-01-01

    Advantages and disadvantages of using roentgenoendovascular dilatation (RED) of vessels of lower extremities are presented. RED is recommended in treating patients with short segmented stenoses of common and external illiac arteries and also with the similar damages of surficial femoral arteries. Dilatation is a success when there is permeability in at least one of the three central crus arteries. Success of delayed results of vessel dilatation is to a certain degree in inverse proportion to time and length of occlusion

  12. US evaluation of deep venous thrombosis of the lower extremity

    International Nuclear Information System (INIS)

    Vogel, P.; Laing, F.C.; Jeffrey, R.B.; Wing, V.W.

    1986-01-01

    The sensitivity of US for detecting lower extremity deep venous thrombosis (DVT) was prospectively compared with contrast venography in 53 patients. Sonographically visible thrombi and abnormal vein compressibility were 91% sensitive for DVT of the common femoral vein and 94% sensitive for DVT of the superficial femoral or popliteal veins, with no false-positive examinations. Abnormal Doppler US findings and an abnormal response of the common femoral vein to the Valsalva maneuver were only indicative of thrombi in the common femoral and iliac veins. Combined data allowed accurate diagnoses in all patients with DVT proximal to the deep calf veins. These results suggest that US is a sensitive screening modality for lower extremity DVT

  13. Treatment of lower extremity arterial occlusive through retrograde access

    International Nuclear Information System (INIS)

    Liu Xueqiang; Guo Pingfan; Zhang Jinchi; Cai Fanggang

    2012-01-01

    Objective: To explore the clinical significance of retrograde access for the interventional treatment of lower extremity arterial occlusive diseases when the occluded segment of lower extremity artery could not be reached through antegrade access. Methods: Twenty-seven cases (male 17, female 10; age range 32-89 years) were retrospectively investigated, including 18 with lower limb arteriosclerosis obliterans, 7 with diabetic foot and 2 with thromboangiitis obliterans. According to the Fontaine staging, 6 cases were classified as Fontaine Ⅱ, 11 were classified as Fontaine Ⅲ and 10 were classified as Fontaine Ⅳ. All cases underwent endovascular operation through antegrade access first with an attempt to cross the occlusive segment, but in vain. So retrograde access was tried via puncture of pedis dorsalis or posterior tibial artery or exposure of lateral branches of posterior tibial artery, peroneal artery or dorsal artery by open surgery,which followed by Percutaneous transluminal angiography and (or) stenting. Results: The operation through retrograde access was successful in all cases with obvious improvement of ischemic symptoms. Hematoma at the puncture site occurred in 3 patients, and paresthesia of toes occurred in 1 after dorsalis pedis arteriotomy. No severe perioperative complication occurred. The average ankle brachial index increased from 0.37 ± 0.11 preoperatively to 0.85 ± 0.12 postoperatively. Conclusions: Retrograde access could be used as an alternative strategy in lower extremity arterial occlusive diseases when the occluded segment could not reach through antegrade access. (authors)

  14. Progression of disease preceding lower extremity amputation in Denmark

    DEFF Research Database (Denmark)

    Jensen, Pia Søe; Petersen, Janne; Kirketerp-Møller, Klaus

    2017-01-01

    OBJECTIVES: Patients with non-traumatic lower extremity amputation are characterised by high age, multi-morbidity and polypharmacy and long-term complications of atherosclerosis and diabetes. To ensure early identification of patients at risk of amputation, we need to gain knowledge about....... Data were retrieved from 14 years before until 1 year after the amputation. Descriptive statistics were used to describe the progression of diseases and use of medication and healthcare services. PARTICIPANTS: An unselected cohort of patients (≥50 years; n=2883) subjected to a primary non-traumatic......, 64% had been in contact with the hospital or outpatient clinics within the last 3 years, and 29% received a prescription of opioids 3 years prior to the amputation. CONCLUSION: Among patients with non-traumatic lower extremity amputation, one-third live with undiagnosed and untreated atherosclerosis...

  15. Assessment of lower extremity ischemia using smartphone thermographic imaging

    Directory of Open Access Journals (Sweden)

    Peter H. Lin, MD

    2017-12-01

    Full Text Available Conventional diagnostic modalities for assessing arterial circulation or tissue perfusion include blood pressure measurement, ultrasound evaluation, and contrast-based angiographic assessment. An infrared thermal camera can detect infrared radiation energy from the human body, which generates a thermographic image to allow tissue perfusion analysis. We describe a smartphone-based miniature thermal imaging system that can be used as an adjunctive imaging modality to assess tissue perfusion. This smartphone-based camera device is noninvasive, simple to use, and cost-effective in assessing patients with lower extremity tissue perfusion. Assessment of patients with lower extremity arterial ischemia can be performed by a variety of diagnostic modalities, including ankle-brachial index, absolute systolic ankle or toe pressure, transcutaneous oximetry, arterial Doppler waveform, arterial duplex ultrasound, computed tomography scan, arterial angiography, and thermal imaging. We herein describe a noninvasive imaging modality using smartphone-based infrared thermography.

  16. CRPS of the upper or lower extremity: surgical treatment outcomes

    Directory of Open Access Journals (Sweden)

    Rosson Gedge D

    2009-02-01

    Full Text Available Abstract The hypothesis is explored that CRPS I (the "new" RSD persists due to undiagnosed injured joint afferents, and/or cutaneous neuromas, and/or nerve compressions, and is, therefore, a misdiagnosed form of CRPS II (the "new" causalgia. An IRB-approved, retrospective chart review on a series of 100 consecutive patients with "RSD" identified 40 upper and 30 lower extremity patients for surgery based upon their history, physical examination, neurosensory testing, and nerve blocks. Based upon decreased pain medication usage and recovery of function, outcome in the upper extremity, at a mean of 27.9 months follow-up (range of 9 to 81 months, gave results that were excellent in 40% (16 of 40 patients, good in 40% (16 of 40 patients and failure 20% (8 of 40 patients. In the lower extremity, at a mean of 23.0 months follow-up (range of 9 to 69 months the results were excellent in 47% (14 of 30 patients, good in 33% (10 of 30 patients and failure 20% (6 of 30 patients. It is concluded that most patients referred with a diagnosis of CRPS I have continuing pain input from injured joint or cutaneous afferents, and/or nerve compressions, and, therefore, similar to a patient with CRPS II, they can be treated successfully with an appropriate peripheral nerve surgical strategy.

  17. MR imaging findings of fatigue fractures of lower extremity in young soldiers

    Energy Technology Data Exchange (ETDEWEB)

    Mo, Jong Hyun; Moon, Sung Hee; Kim, Young Bok; Park, Yang Hee [National Police Hospital, Seoul (Korea, Republic of); Park, Jin Kyoon [Chonnam National Medical School, Kwangju (Korea, Republic of)

    1999-04-01

    To evaluate the MR imaging findings of fatigue fractures of the lower extremity in young soldiers. In 22 cases of fatigue fractures of the lower extremity in young soldiers proven by clinical findings and radiological follow up, the MRI findings were retrospectively evalvated. All patients were male and aged between 19 and 21 years. As seen on MRI, the bone marrow edema, intramedullary low signal intensity band, cortical fracture line, periosteal reaction, surrounding soft tissue edema, and enhancement pattern were analyzed and the site of involvement was determined in the axial plane. The locations of fatigue fractures of the lower extremity were the tibia (n=12), fibula (n=8), femur (n=1) and second metatarsus (n=1). All occurred in diaphyses: the junction of the proximal and middle (n=10), middle (n=9), proximal (n=2), and distal shaft (n=1). The sites of involvement were the posteromedial (n=6) and medial side (n=6) of the tibia, and the entire portion of the fibula(n=5) in the axial plane. MRI findings were bone marrow edema in 20 cases, intramedullary low signal intensity band in 14 (which were continuous with the cortex or cortical fracture line), cortical fracture line in 13, and periosteal reaction and surrounding soft tissue edema in all. On gadolinium-enhanced images, enhancement was seen in the bone marrow in 19 cases, in the subperiosteal region in 18, and in the surrounding soft tissue in 22. In fatigue fractures of the lower extremity in young soldiers, the main locations were the tibia and fibula, and characteristic MR imaging findings were intramedullary low signal intensity bands, which were continuous with the cortex or cortical fracture line and often accompanied by bone marrow edema, periosteal reaction, and surrounding soft tissue edema.

  18. Unusual cause of lower extremity wounds: Cobb syndrome.

    Science.gov (United States)

    Abtahi-Naeini, Bahareh; Saffaei, Ali; Pourazizi, Mohsen

    2016-10-01

    Cobb syndrome (Cutaneomeningospinal Angiomatosis) is a rare segmental neurocutaneous syndrome associated with metameric cutaneous and spinal cord arteriovenous malformations (AVMs). In this syndrome, capillary malformation or angiokeratoma-like lesions are formed in a dermatomal distribution, with an AVM in the corresponding segment of the spinal cord. The spinal cord lesions can cause neurological disorder and paraplegia, which typically develop during young adulthood. We report a 32-year-old male with the Cobb syndrome associated with lower extremity painful wounds and acute-onset paraplegia due to metameric vascular malformations. © 2015 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  19. Wound size measurement of lower extremity ulcers using segmentation algorithms

    Science.gov (United States)

    Dadkhah, Arash; Pang, Xing; Solis, Elizabeth; Fang, Ruogu; Godavarty, Anuradha

    2016-03-01

    Lower extremity ulcers are one of the most common complications that not only affect many people around the world but also have huge impact on economy since a large amount of resources are spent for treatment and prevention of the diseases. Clinical studies have shown that reduction in the wound size of 40% within 4 weeks is an acceptable progress in the healing process. Quantification of the wound size plays a crucial role in assessing the extent of healing and determining the treatment process. To date, wound healing is visually inspected and the wound size is measured from surface images. The extent of wound healing internally may vary from the surface. A near-infrared (NIR) optical imaging approach has been developed for non-contact imaging of wounds internally and differentiating healing from non-healing wounds. Herein, quantitative wound size measurements from NIR and white light images are estimated using a graph cuts and region growing image segmentation algorithms. The extent of the wound healing from NIR imaging of lower extremity ulcers in diabetic subjects are quantified and compared across NIR and white light images. NIR imaging and wound size measurements can play a significant role in potentially predicting the extent of internal healing, thus allowing better treatment plans when implemented for periodic imaging in future.

  20. ["Depletion" in the treatment of lymphedema of the lower extremities].

    Science.gov (United States)

    Bilancini, S; Lucchi, M

    1987-01-01

    The treatment of lymphedemas consists of two phases: reduction of the edema-prevention of its recurrence. The second phase is invariably linked to the use of a strong contention by means of a stocking. In order to reduce the edema, opinions do not all occur. Some advocate pressotherapy, manual lymphatic drainage, wrapping and immersion in mercury. The authors propose another form of treatment which has the merit to be simple and well tolerated. Their study is based on 187 cases of moderate lymphedema of the lower extremities and, they observed favorable results in 179 patients. For 8 patients, there were partial results, but the treatment prescribed had not been perfectly followed by the patients.

  1. Early Ambulation After Microsurgical Reconstruction of the Lower Extremity.

    Science.gov (United States)

    Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel

    2018-02-02

    Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

  2. Analysis of muscle activation in lower extremity for static balance.

    Science.gov (United States)

    Chakravarty, Kingshuk; Chatterjee, Debatri; Das, Rajat Kumar; Tripathy, Soumya Ranjan; Sinha, Aniruddha

    2017-07-01

    Balance plays an important role for human bipedal locomotion. Degeneration of balance control is prominent in stroke patients, elderly adults and even for majority of obese people. Design of personalized balance training program, in order to strengthen muscles, requires the analysis of muscle activation during an activity. In this paper we have proposed an affordable and portable approach to analyze the relationship between the static balance strategy and activation of various lower extremity muscles. To do that we have considered Microsoft Kinect XBox 360 as a motion sensing device and Wii balance board for measuring external force information. For analyzing the muscle activation pattern related to static balance, participants are asked to do the single limb stance (SLS) exercise on the balance board and in front of the Kinect. Static optimization to minimize the overall muscle activation pattern is carried out using OpenSim, which is an open-source musculoskeletal simulation software. The study is done on ten normal and ten obese people, grouped according to body mass index (BMI). Results suggest that the lower extremity muscles like biceps femoris, psoas major, sartorius, iliacus play the major role for both maintaining the balance using one limb as well as maintaining the flexion of the other limb during SLS. Further investigations reveal that the higher muscle activations of the flexed leg for normal group demonstrate higher strength. Moreover, the lower muscle activation of the standing leg for normal group demonstrate more headroom for the biceps femoris-short-head and psoas major to withstand the load and hence have better static balance control.

  3. The superficial venous system of the lower extremity: new nomenclature.

    Science.gov (United States)

    Kachlik, D; Pechacek, V; Baca, V; Musil, V

    2010-06-01

    The phlebology in the area of lower limbs is the only medical field in which the terminological needs of clinicians were met. Ten years ago, the latest revision of the Latin anatomical nomenclature, Terminologia Anatomica (TA), was issued. But almost none of the chapters reflected the clinicians' need to be a relevant theoretical base for correct diagnostics and appropriate treatment. In 2001, during the 14th World Congress of the International Union of Phlebology, a consensus document (under the auspices of Federative International Committee on Anatomical Terminology and International Federation of Associations of Anatomists) was laid to expand the nomenclature of the lower extremity venous system. Some terms have been changed and several new have been added, corresponding to their clinical significance and anatomical positions. Sixteen new terms have been added in both Latin and English languages in the chapter concerning the superficial veins of the lower limb. This consensus document will be incorporated into the next version of the TA. The international anatomical nomenclature serves as a communication base for research, diagnostic, therapy and information exchange in phlebological sciences.

  4. Normal venous anatomy and physiology of the lower extremity.

    Science.gov (United States)

    Notowitz, L B

    1993-06-01

    Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

  5. On the limit distribution of lower extreme generalized order statistics

    Indian Academy of Sciences (India)

    m−gOs (as well as the classical extreme value theory of ordinary order statistics) yields three types of limit distributions that are possible in case of linear normalization. In this paper a similar classification of limit distributions holds for extreme gOs, where the parameters γj , j = 1,..., n, are assumed to be pairwise different.

  6. Quality of clinical practice guidelines of lower extremity venous ulcers.

    Science.gov (United States)

    Rumbo-Prieto, José María; Arantón-Areosa, Luis; Palomar-Llatas, Federico; Romero-Martín, Manuel

    The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted. It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II. After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  7. Bone characteristics of late-term embryonic and hatchling broilers: bone development under extreme growth rate.

    Science.gov (United States)

    Yair, R; Uni, Z; Shahar, R

    2012-10-01

    The development of broilers is an extreme example of rapid growth, increasing in weight from 40 g at hatch to 2,000 g 5 to 6 wk later. Such rapid growth requires a correspondingly fast development of the skeleton. Bone development is a genetically programmed process that is modified by epigenetic factors, mainly muscle-induced stresses and strains. In this study, we describe the temporal changes in bone morphology and material properties during the prehatch period [embryonic day (E) 14, E17, E19, E21] and posthatch d 3 and 7. The bones were examined for their weight, length, ash content, mechanical properties, and cortical structure. We show that the cross-sectional shape of the tibia and femur changes during the examination period from circular to elliptical. Additionally, the changes in bone properties are time-dependent and nonuniform: from E14 to E17 and from d 3 to 7, fast bone growth was noted, with major increases in both mechanical properties (stiffness, ultimate load, and energy to fracture) and geometric properties (cross-sectional area and thickness, medullary area, and moment of inertia). On the other hand, during the last days of incubation, most mechanical and geometric properties remain unchanged or even decrease. The reasons for this finding may relate to the hatching process but also to mineral shortage during the last days of incubation. This study leads to better understanding of bone development in ovo and posthatch in fast-growing broilers.

  8. The treatment of venous ulcers of the lower extremities

    Science.gov (United States)

    2007-01-01

    Venous hypertension from failure of proper venous valve function in the veins of thelower extremities causes changes over time in the microcirculation of the skin of the distal extremity. These changes set the stage for the development of a chronic nonhealing ulceration, which typically occurs at the ankle. The mainstay of treatment has been conservative, with compression dressings and elevation of the extremity. However, results have been less than satisfactory because of delay in healing and high recurrence rates after successful healing. Elimination of the venous hypertension should be the goal of therapy using more recent minimally invasive surgical techniques, including ablation of incompetent truncal veins with laser or radiofrequency energy and use of ultrasound-guided foam sclerosant injections to close incompetent perforator veins that are frequently found in or near the ulcer bed. This approach will shorten ulcer healing time and reduce recurrence rates as well as patient suffering and expense. PMID:17948110

  9. Biomechanical considerations in intramedullary fixation of lower-extremity fracture.

    Science.gov (United States)

    Inhofe, P D

    1992-08-01

    Since Gerhard Kuntscher's first cloverleaf design was introduced in the early 1940s, intramedullary nail geometry has become increasingly complex. Many design changes have been introduced, and these have had profound effects upon the mechanical performance of intramedullary devices, making them more versatile. The subset of long-bone fractures amenable to intramedullary fixation is expanding, largely because of these advancements in nail design. Selection of the appropriate nail and bone-nail construct for each fracture configuration requires a knowledge of basic biomechanical principles behind nail design and the implant-host interface. Appropriate clinical application of this knowledge not only ensures the best possible intramedullary fixation of long-bone fractures, but it also aids in avoiding some of the complications that may occur.

  10. Epidemiological characteristics of lower extremity cellulitis after a typhoon flood.

    Directory of Open Access Journals (Sweden)

    Pei-Chen Lin

    Full Text Available The flood after a typhoon may lead to increase in patients with cellulitis of lower limbs. However, the microbiological features of these cases are rarely reported. We conducted a study of patients with lower extremity cellulitis after a typhoon followed in southern Taiwan to study the risk factors of cellulitis and the bacteriological features of the patients.We reviewed all the medical records of cellulitis at emergency departments of two teaching hospitals in southern Taiwan 30 days before and after the landing of Typhoon Morakot and collected data on the demographic and bacteriological characteristics. In addition, we evaluated the relationship between the daily number of patients and the rainfall in the Tainan area.The number of cellulitis patients increased from 183 to 344 during the 30-day period after the typhoon. The number peaked in the third and fourth days and lasted for 3 weeks. The proportion of patients with water immersion of the affected limb was higher after the typhoon (6% vs. 37%, odds ratio [OR]: 9.0, 95% Confidence interval [CI]: 4.7-17.2. We found cultures from the infected limbs with immersion had more polymicrobial (73% vs. 26%, OR: 7.8, 95% CI: 3.2-19.2 and Gram-negative bacilli infection (86% vs. 34%, OR: 11.8, 95% CI: 4.1-34.5.Flood arose from Typhoon Morakot caused increases in cellulitis patients, which lasted for 3 weeks. Antibiotic treatment that were effective to both Gram-positive cocci and Gram-negative bacilli are recommended for patients with limbs emerged in the water.

  11. Implant and limb survival after resection of primary bone tumors of the lower extremities and reconstruction with mega-prostheses fifty patients followed for a mean of forteen years.

    Science.gov (United States)

    Holm, Christina Enciso; Bardram, Christian; Riecke, Anja Falk; Horstmann, Peter; Petersen, Michael Mørk

    2018-03-12

    Previous studies reported variable outcome and failure rates after mega-prosthetic reconstructions in the lower extremities. The purpose of this study was to make a long-term single-center evaluation of patients treated with limb-sparing surgery and reconstruction with mega-prostheses in the lower extremities. We identified 50 patients (osteosarcoma (n = 30), chondrosarcoma (n = 9), osteoclastoma (n = 6), Ewing sarcoma (n = 4), angiosarcoma (n = 1)), who underwent limb-sparing reconstruction of the lower extremities (proximal femur (n = 9), distal femur (n = 29), proximal tibia (n = 9), and the entire femur (n = 3)) between 1985 and 2005. Surviving patients not lost to follow-up were evaluated using the MSTS score. Causes of failure were classified according to the Henderson classification. Kaplan-Meier survival analysis was used for evaluation of patient, prosthesis, and limb survival. Twenty-eight patients were alive at follow-up. Fifty-four percent had revision surgery (n = 27). The ten year patient survival was 60% (95%CI 46-74%); the ten year implant survival was 24% (95%CI 9-41%), and the ten year limb survival rate was 83% (95%CI 65-96%). Type 1 failure occurred in 9%, type 2 in 16%, type 3 in 28%, type 4 in 18%, and type 5 in 3%. Mean MSTS score was 21 (range, 6-30), representing a median score of 71%. Our long-term results with mega-prostheses justify the use of limb-salvage surgery and prosthetic reconstruction. Our results are fully comparable with other findings, with regard to limb and prosthesis survival, but also with regard to functional outcome.

  12. High-resolution Sonographic Measurements of Lower Extremity Bursae in Chinese Healthy Young Men

    Directory of Open Access Journals (Sweden)

    Yong-Yan Gao

    2016-01-01

    Conclusions: Using HR-US imaging, we were able to analyze lower extremity bursae with high detection rates in healthy young men. The normal ranges of lower extremity bursa dimensions in healthy young men measured by HR-US in this study could be used as reference values for evaluation of bursa abnormalities in the lower extremity.

  13. Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity.

    Science.gov (United States)

    Pellikaan, P; van der Krogt, M M; Carbone, V; Fluit, R; Vigneron, L M; Van Deun, J; Verdonschot, N; Koopman, H F J M

    2014-03-21

    To generate subject-specific musculoskeletal models for clinical use, the location of muscle attachment sites needs to be estimated with accurate, fast and preferably automated tools. For this purpose, an automatic method was used to estimate the muscle attachment sites of the lower extremity, based on the assumption of a relation between the bone geometry and the location of muscle attachment sites. The aim of this study was to evaluate the accuracy of this morphing based method. Two cadaver dissections were performed to measure the contours of 72 muscle attachment sites on the pelvis, femur, tibia and calcaneus. The geometry of the bones including the muscle attachment sites was morphed from one cadaver to the other and vice versa. For 69% of the muscle attachment sites, the mean distance between the measured and morphed muscle attachment sites was smaller than 15 mm. Furthermore, the muscle attachment sites that had relatively large distances had shown low sensitivity to these deviations. Therefore, this morphing based method is a promising tool for estimating subject-specific muscle attachment sites in the lower extremity in a fast and automated manner. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Evaluation of pediatric lower extremity fractures managed with external fixation: outcomes in a deployed environment.

    Science.gov (United States)

    Eichinger, Josef K; McKenzie, Colin S; Devine, John G

    2012-01-01

    External fixation of pediatric lower extremity fractures is usually reserved for severe, open fractures in polytraumatized patients, but it is often the only available treatment option for deployed military surgeons. We analyzed the outcomes and complications of 17 consecutive pediatric long bone fractures treated with external fixation at a Forward Surgical Team facility in an austere environment during Operation Enduring Freedom in Afghanistan during a 12-month period. Treatment consisted of uniplanar external fixation for 12 femoral shaft fractures (11 closed), 4 tibial shaft fractures (all open), and 1 subtrochanteric fracture (closed) in 14 males and 3 females with an average age of 7.4 years. All 17 fractures went on to union with no incidences of refracture. Complications included 1 broken pin and 3 pin site infections treated with wound care and oral antibiotics. In a deployed environment, external fixation is the treatment method of choice for lower extremity fractures by virtue of patient, environment, equipment, and mission factors. This case series validates the usage of a simple, uniplanar external fixator for a variety of open and closed pediatric long bone fractures as evidenced by the successful union rate and low number of complications.

  15. Effect of landing height on frontal plane kinematics, kinetics and energy dissipation at lower extremity joints.

    Science.gov (United States)

    Yeow, C H; Lee, P V S; Goh, J C H

    2009-08-25

    Lack of the necessary magnitude of energy dissipation by lower extremity joint muscles may be implicated in elevated impact stresses present during landing from greater heights. These increased stresses are experienced by supporting tissues like cartilage, ligaments and bones, thus aggravating injury risk. This study sought to investigate frontal plane kinematics, kinetics and energetics of lower extremity joints during landing from different heights. Eighteen male recreational athletes were instructed to perform drop-landing tasks from 0.3- to 0.6-m heights. Force plates and motion-capture system were used to capture ground reaction force and kinematics data, respectively. Joint moment was calculated using inverse dynamics. Joint power was computed as a product of joint moment and angular velocity. Work was defined as joint power integrated over time. Hip and knee joints delivered significantly greater joint power and eccentric work (phip joint in response to increasing landing height. Knee and hip joints acted as key contributors to total energy dissipation in the frontal plane with increase in peak ground reaction force (GRF). The hip joint was the top contributor to energy absorption, which indicated a hip-dominant strategy in the frontal plane in response to peak GRF during landing. Future studies should investigate joint motions that can maximize energy dissipation or reduce the need for energy dissipation in the frontal plane at the various joints, and to evaluate their effects on the attenuation of lower extremity injury risk during landing.

  16. Approach to Lower Extremity Edema.

    Science.gov (United States)

    Ratchford, Elizabeth V; Evans, Natalie S

    2017-03-01

    Lower extremity edema is extremely common among patients seen across multiple specialties. The differential diagnosis is broad and ranges from simple dependent edema to more complex conditions such as chronic venous disease and lymphedema. Several key features from the history and physical exam can assist with the diagnosis. Imaging is rarely necessary at the initial visit unless venous thromboembolism is suspected. Treatment is specific to the etiology of the edema, but compression stockings, elevation, exercise, and weight loss remain the cornerstone in most cases.

  17. [Localized Scleroderma of Lower Extremities:Clinical and Magnetic Resonance Imaging Features].

    Science.gov (United States)

    Wang, Feng-dan; Wang, Hong-wei; Wu, Zhi-hong; Hou, Bo; Jiang, Bo; Zhang, Yan; Feng, Feng; Jin, Zheng-yu; Yuan, Xie

    2015-08-01

    To evaluate the clinical and musculoskeletal characteristics of localized scleroderma with lower extremities affected. All the localized scleroderma patients,who received magnetic resonance (MR ) examinations of affected lower extremities at Peking Union Medical College Hospital from April 2013 to June 2014,were retrospectively reviewed. Their clinical data and laboratory results of antinuclear antibody,anti-double stranded-DNA antibody, and anti-extractable nuclear antigen antibody were collected and analyzed. All the MR examinations were non-contrast imaging using Siemens Skyra 3.0T MR scanner. There were 16 localized scleroderma patients with lower extremities affected, 11 of whom were linear scleroderma, 4 generalized morphea, and 1 deep morphea. Female to male ratio was 1:2.2. The mean age was 22.5 years. The mean time span was 7.4 years. Four of the 14 patients (28.6%) who received antinuclear antibody test were positive. All the 10 patients who received anti-double stranded-DNA antibody test and the 7 patients who received anti-extractable nuclear antigen antibody test were negative. The most common musculoskeletal MR features were subcutaneous septal thickening (16/16) and fascial thickening (11/16). The thickened speta and fascia could either be hypointenstiy or hyperintensity on turbo inversion recovery magnitude/proton density weighted imaging. Other MR manifestations were intramuscular speta thickening (3/16), muscular abnormal signals (1/16), and bone marrow abnormal signals (2/16). Musculoskeletal manifestations of the lower extremities with localized scleroderma can be well revealed using MR imaging.

  18. Use of the spider limb positioner in oncologic lower extremity surgery.

    Science.gov (United States)

    Henderson, Eric R; Prioreschi, Brandon; Mata-Fink, Ana; Bell, John-Erik

    2014-11-01

    Orthopedic extremity surgery presents a unique set of restraints and difficulties relative to other surgical specialties. Among these is the positioning of heavy limbs in sometimes awkward positions for long periods of time. Ideal positioning of an extremity allows accurate and precise surgery to occur at otherwise difficult to access joints and proximal bones and soft tissues. Numerous solutions to this problem have been proposed, one such solution is the Smith and Nephew Spider Limb Positioning System. The table-mounted pneumatic arm features three fully articulating joints and a simple repositioning mechanism. Classic uses of the Spider Limb Positioner System include shoulder and elbow surgery, total knee replacement and ankle procedures. In our institution, the Spider Limb Positioner is used primarily for shoulder arthroscopy and total shoulder arthroplasty. In addition, we have had success using the system for orthopedic oncology cases. This manuscript addresses the conventional as well as unconventional uses implemented at our institution. Limb positioning in orthopedics provides a unique challenge for prepping, draping and surgery. The use of positioning aids can improve exposure, decrease contamination and reduce the risk of surgeon strain. Our institution has developed a solution to positioning of heavy lower limbs for hip disarticulation via the Smith and Nephew 'Spider'. This pneumatic, full articulating device used primarily for shoulder surgery can be modified to allow lower extremity use in the setting of hip disarticulation. This paper describes the standard and novel use of this device.

  19. SOFT TISSUE RECONSTRUCTION OF THE LOWER EXTREMITY: EVALUATION OF SURGICAL RESULTS IN 15 PATIENTS

    Directory of Open Access Journals (Sweden)

    M.J FATEMI

    2003-03-01

    Full Text Available Introduction: There are general guidelines for reconstruction of complex wounds of the Lower extremity. The goal in treatment of these wounds is to preserve a limb that will be more functional than an amputation. Material & Methods: In this study, we evaluate our results in 15 patients with extensive wounds in lower extremities (April - 1998 to march - 2001. Results: The average age of the patients was 31.20 with an age range between 9 to 61 years. Majority of the patients were victims of motor vehicle accident, except two, which developed wounds due to war injury. Distal third of leg was the most common site of trauma and 7 patients had bone fractures, mostly Gustillo III-B. Wound coverage was the most common indication for surgery and free tissue transplantation performed for majority of the patients. Transfer of latissimus dorsi muscle or myocutaneous flap was the most common procedure. One free flap and one fasciocutaneous flap necrosed due to infection and poor technique respectively. Discussion: Our results revealed that the options for reconstruction of significant soft tissue wounds of the upper and lower thigh are included skin graft, local flap and rarely free tissue transfer. The gastrocnemius muscle or myocutaneous flap serve well for supra-patellar, knee and proximal tibial wounds. The soleus muscle flape is probably the most useful flap in middle tibia However, frequently; wounds of this part are best satisfied by micro vascular tissue transplantation. Soft tissue reconstruction in distal tibia and foot is viewed by many as the most challenging of all lower extremity areas. The vast majority of these wounds are best satisfied by micro vascular tissue transfer. Meanwhile, in cases with a modest skin defect, there is the opportunity to utilize either proximally or distally based fasciocutaneous flaps.

  20. Delayed reconstruction of mangled lower extremities: soft tissue management

    OpenAIRE

    Tiftikçioğlu, Yiğit Özer; Erçin, Burak Sercan; Erdem, Mehmet; Biçer, Ahmet; Özkayın, Nadir; Özek, Cüneyt

    2018-01-01

    Objectives: This study aims to propose a new, practical and versatile algorithm for the management of traumatic lower limb soft tissue wounds for patients who did not undergo early reconstruction.Materials and methods: A total of 81 patients (54 males, 27 females; mean age 37.1 years; range 11 to 64 years) managed due to complex lower limb injuries at our institution between January 2008 and December 2012 were analyzed retrospectively in this study. Age and gender of the patients, type of tra...

  1. Hemolymphangioma of the lower extremities in children: two case reports

    Directory of Open Access Journals (Sweden)

    Kosmidis Ilias

    2010-08-01

    Full Text Available Abstract Background and purpose Hemo-lymphangiomas are rare benign tumors that arise from congenital malformation of the vascular system. They are usually diagnosed at birth or early in childhood. The management of hemo-lymphangiomas in children remains challenging because complete resection is often difficult to be achieved and recurrences are common. Methods We present the case of two children with a mass on their left tibia. Imaging modalities, plain radiograph, Ultrasonography and Magnetic Resonance were used to investigate the nature of the mass, the anatomical relationship to the neighboring tissues and help planning the surgical resection. The dominant diagnosis was hemo-lymphangioma. Both lesions increased in size in a short period of follow-up thus we decided to proceed to surgical excision. The diagnosis of hemo-lymphangioma was confirmed by histological examination of the surgical specimen. Post-operatively, seroma was formed to the first patient, managed by placing a drainage and immobilizing the limb on a splint. The second patient experienced no complications post-operatively. After 12 months of follow-up both patients had no complications or recurrence. Conclusions Very few cases of hemo-lymphangiomas of the extremities have been reported in the literature. Those tumors can grow slowly and remain asymptomatic for a long period of time or may become aggressive and enlarge rapidly, without invasive ability though. Radical resection is the choice of treatment offering the lowest recurrence rates. Other therapeutic methods are: aspiration and drainage, cryotherapy, injection of sclerotic agents and radiotherapy; although none of those offers better results that the surgical excision.

  2. Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

    Energy Technology Data Exchange (ETDEWEB)

    Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K. [Toolo Trauma Center, Helsinki University Central Hospital, Topeliuksenkatu 5, 00029, Helsinki (Finland); Stahls, Anders; Bohling, Tom [Department of Pathology, Haartman Institute, University of Helsinki, 00014, Helsinki (Finland); Kivioja, Aarne [Department of Orthopedics and Traumatology, Helsinki University Central Hospital, 00029, Helsinki (Finland)

    2004-08-01

    Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

  3. Radicular lower extremity pain as the first symptom of primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Mustonen, Antti O.T.; Kiuru, Martti J.; Koskinen, Seppo K.; Stahls, Anders; Bohling, Tom; Kivioja, Aarne

    2004-01-01

    Clinical symptoms of hyperparathyroidism are generally nausea, vomiting, fatigue, constipation, and hypotonicity of the muscles and ligaments; bone pain and tenderness are also seen but are more common in secondary hyperparathyroidism. We report a histologically confirmed case of a 28-year-old man whose sole symptom of primary hyperparathyroidism was lower extremity radicular pain due to a vertebral brown tumor. Magnetic resonance imaging demonstrated brown tumor to be hyperintense on T2-weighted and slightly hypointense on T1-weighted sequences; it showed intense contrast enhancement with gadolinium. Because brown tumors usually contain hemosiderin a short T2 should have been expected, but this was not seen in our case. Healing resulted in decreasing contrast enhancement on T1-weighted sequences and increasingly short T2. To our knowledge, this is the first report of a lumbar vertebral brown tumor associated with primary hyperparathyroidism. (orig.)

  4. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

    DEFF Research Database (Denmark)

    Pickwell, Kirsty; Siersma, Volkert; Kars, Marleen

    2015-01-01

    of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries......OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation....... RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity...

  5. Basal Cell Carcinoma Of The Lower Extremities - A Report Of Two Cases

    Directory of Open Access Journals (Sweden)

    Nada Ritambhra

    2001-01-01

    Full Text Available The most common malignancy of the skin is basal cell carcinoma (BCC, usually occurring in the head and neck. It can occur elsewhere as also in the lower extremity. We describe two patients with BCC in the lower extremities, which were nodular type and without any predisposing factors.

  6. The effect of field condition and shoe type on lower extremity injuries in American Football.

    Science.gov (United States)

    Iacovelli, Jaclyn Nicole; Yang, Jingzhen; Thomas, Geb; Wu, Hongqian; Schiltz, Trisha; Foster, Danny T

    2013-08-01

    Considerable improvement has been made in football field surfaces and types of shoe, yet relatively few epidemiological studies have investigated their roles in the risk of football injuries. This study examined the effects of field surface, surface condition and shoe type on the likelihood of lower extremity football injuries. Deidentified data from 188 players from one division I university football team during the 2007-2010 seasons were analysed. Lower extremity injury rate and rate ratio, along with 95% confidence limits, were calculated by football activity, playing surface condition and shoe type. A total of 130 lower extremity injuries were sustained, with an overall lower extremity injury rate of 33.5/10 000 athlete-sessions. The lower extremity injury rate was 2.61 times higher when the surface condition was abnormal compared with when the surface condition was normal. During games, the risk for lower extremity injury was 3.34 times higher (95% CI 1.70 to 6.56) on artificial turf compared with natural grass. However, this trend was not statistically significant in practice sessions. Furthermore, neither the number of shoe cleats nor the height of the shoe top was statistically associated with risk of lower extremity injuries. Football players who played on artificial turf or when the surface condition was abnormal were susceptible to lower extremity injuries. Evidence from this study suggests that further research into playing surfaces and shoe types may provide fruitful opportunities to reduce injuries to collegiate football players.

  7. Therapeutic ultrasound to promote healing of lower extremity venous ulcers: CAT

    Directory of Open Access Journals (Sweden)

    Raúl Alberto Aguilera Eguía

    2013-10-01

    Full Text Available Purpose. The aim of this CAT (Critically Appraised Topic was to check the validity of the results and applicability regarding the effectiveness of therapeutic ultrasound in increasing healing of lower extremity ulcers and to answer the question: In subjects that have lower extremity venous ulcers, does high-frequency therapeutic ultrasound improve healing rate compared to placebo? Method. We conducted an analysis of the article "Therapeutic Ultrasound for lower extremity venous ulcers, Cochrane Systematic Review" of Cullum, et al (2010. Results. The application of high-frequency therapeutic ultrasound could increase healing in patients with lower extremity venous ulcers, RR = 1.40 (95% CI 1.00 to 1.96. Conclusion. The use of therapeutic ultrasound to promote healing in lower extremity venous ulcers is neither endorsed nor discouraged.

  8. The Effects of Load Carriage and Muscle Fatigue on Lower-Extremity Joint Mechanics

    Science.gov (United States)

    Wang, He; Frame, Jeff; Ozimek, Elicia; Leib, Daniel; Dugan, Eric L.

    2013-01-01

    Military personnel are commonly afflicted by lower-extremity overuse injuries. Load carriage and muscular fatigue are major stressors during military basic training. Purpose: To examine effects of load carriage and muscular fatigue on lower-extremity joint mechanics during walking. Method: Eighteen men performed the following tasks: unloaded…

  9. Multiple Eccrine Syringofibroadenoma of Mascaro of the Lower Extremity.

    Science.gov (United States)

    Lowell, Danae L; Salvo, Nichol L; Weily, William J; Swiatek, Michael; Sahli, Hannah

    2016-11-01

    Eccrine syringofibroadenoma (ESFA) is a rare benign lesion of ductal and secretory differentiation exhibiting multiple cutaneous polymorphic presentations with an unknown etiology. We present a case of ESFA that uniquely exhibited large, thick, verrucous-like hyperplastic growths as well as superficial shiny mosaic plaques and deep ulcerations in three different anatomical locations in the same patient. The diagnosis of ESFA was confirmed histologically after biopsies were performed on all of the affected areas. In addition to a case report and literature review, we also present classification, clinical, and histologic aspects of ESFA.

  10. Determination of functional strength imbalance of the lower extremities.

    Science.gov (United States)

    Newton, Robert U; Gerber, Aimee; Nimphius, Sophia; Shim, Jae K; Doan, Brandon K; Robertson, Mike; Pearson, David R; Craig, Bruce W; Häkkinen, Keijo; Kraemer, William J

    2006-11-01

    The purposes of this study were (a) to determine whether a significant strength imbalance existed between the left and right or dominant (D) and nondominant (ND) legs and (b) to investigate possible correlations among various unilateral and bilateral closed kinetic chain tests, including a field test, and traditional isokinetic dynamometry used to determine strength imbalance. Fourteen Division I collegiate women softball players (20.2 +/- 1.4 years) volunteered to undergo measures of average peak torque for isokinetic flexion and extension at 60 degrees .s(-1) and 240 degrees .s(-1); in addition, measures of peak and average force of each leg during parallel back squat, 2-legged vertical jump, and single-leg vertical jump and performance in a 5-hop test were examined. Significant differences of between 4.2% and 16.0% were evident for all measures except for average force during single-leg vertical jump between the D and ND limbs, thus revealing a significant strength imbalance. The 5-hop test revealed a significant difference between D and ND limbs and showed a moderate correlation with more sophisticated laboratory tests, suggesting a potential use as a field test for the identification of strength imbalance. The results of this study indicate that a significant strength imbalance can exist even in collegiate level athletes, and future research should be conducted to determine how detrimental these imbalances could be in terms of peak performance for athletes, as well as the implications for injury risk.

  11. Diseases of the veins of the lower extremities

    International Nuclear Information System (INIS)

    Roth, F.J.; Koppers, B.

    1988-01-01

    The vena saphena magna is the most important arterial vascular substitute in today's vascular surgery. That is why modern varicose vein surgery is performed very carefully and cautiously with an aim to preserve the vessels as much as possible. This can be done only if the radiologist visualises both the healthy and the diseased superficial and deep venous systems as completely and a easily appreciable as possible when diagnosing varicosis. It is not enough to merely produce contrast images of the deep venous system when attempting to clarify varicosis via phlebography. The conditions obtaining at the points where the great saphenous vein and the small saphenous vein open into the femoral and popliteal veins, respectively, must be clearly visible. The maximum possible number of insufficient venae perforantes must be shown and the side branches of the great saphenous vein that have undergone varicose changes, must be visualised. It goes without saying that the deep venous system must be shown in a manner that it can be safely assessed. An extended thrombosis of the deep veins of the leg and pelvis does not present any diagnostic pitfalls when assessing the phlebogram. On the other hand, a beginning deep leg thrombosis is easily overlooked. Phlebographically it is quite difficult to clarify a relapsing thrombosis. This requires detailed knowledge of the patterns of signs in deep leg vein thrombosis. (orig.) [de

  12. Diseases of the veins of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Roth, F.J.; Koppers, B.

    1988-07-01

    The vena saphena magna is the most important arterial vascular substitute in today's vascular surgery. That is why modern varicose vein surgery is performed very carefully and cautiously with an aim to preserve the vessels as much as possible. This can be done only if the radiologist visualises both the healthy and the diseased superficial and deep venous systems as completely and a easily appreciable as possible when diagnosing varicosis. It is not enough to merely produce contrast images of the deep venous system when attempting to clarify varicosis via phlebography. The conditions obtaining at the points where the great saphenous vein and the small saphenous vein open into the femoral and popliteal veins, respectively, must be clearly visible. The maximum possible number of insufficient venae perforantes must be shown and the side branches of the great saphenous vein that have undergone varicose changes, must be visualised. It goes without saying that the deep venous system must be shown in a manner that it can be safely assessed. An extended thrombosis of the deep veins of the leg and pelvis does not present any diagnostic pitfalls when assessing the phlebogram. On the other hand, a beginning deep leg thrombosis is easily overlooked. Phlebographically it is quite difficult to clarify a relapsing thrombosis. This requires detailed knowledge of the patterns of signs in deep leg vein thrombosis.

  13. Two-dimensional phase contrast MR angiography of the venous system of lower extremities

    International Nuclear Information System (INIS)

    Hashimoto, Hiromi; Nakatsuka, Haruki; Tsubakimoto, Mitsuo

    1994-01-01

    Two-dimensional phase contrast MR angiography (MRA) was performed in 10 healthy volunteers and 14 patients in whom deep venous occlusion was clinically suspected. In all volunteers, MRA demonstrated bilateral great saphenous veins, superficial femoral veins and popliteal veins. Deep veins in the calves were visualized in only 3 of 20 legs (15%) examined, but after applying tourniquets above the knee, they were visualized in 6 of 8 legs (75%). In 5 of 8 patients whose lower extremities were swollen, deep vein occlusions were diagnosed by MRA and in 4 patients deep vein thrombosis was confirmed by computed tomography or conventional venography. In the other 3 patients whose lower extremities were swollen and in 6 patients whose lower extremities were not swollen but who had varicose veins, MRA demonstrated patency of the deep veins. It is concluded that MRA is a non-invasive useful diagnostic technique for evaluating patency of the deep venous system of the lower extremities. (author)

  14. Two-dimensional phase contrast MR angiography of the venous system of lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Hiromi; Nakatsuka, Haruki; Tsubakimoto, Mitsuo (Itami City Hospital, Hyogo (Japan)) (and others)

    1994-01-01

    Two-dimensional phase contrast MR angiography (MRA) was performed in 10 healthy volunteers and 14 patients in whom deep venous occlusion was clinically suspected. In all volunteers, MRA demonstrated bilateral great saphenous veins, superficial femoral veins and popliteal veins. Deep veins in the calves were visualized in only 3 of 20 legs (15%) examined, but after applying tourniquets above the knee, they were visualized in 6 of 8 legs (75%). In 5 of 8 patients whose lower extremities were swollen, deep vein occlusions were diagnosed by MRA and in 4 patients deep vein thrombosis was confirmed by computed tomography or conventional venography. In the other 3 patients whose lower extremities were swollen and in 6 patients whose lower extremities were not swollen but who had varicose veins, MRA demonstrated patency of the deep veins. It is concluded that MRA is a non-invasive useful diagnostic technique for evaluating patency of the deep venous system of the lower extremities. (author).

  15. Doppler ultrasonography of the lower extremity arteries: anatomy and scanning guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Ji Young [Dept. of Radiology, Ewha Womans University School of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Doppler ultrasonography of the lower extremity arteries is a valuable technique, although it is less frequently indicated for peripheral arterial disease than for deep vein thrombosis or varicose veins. Ultrasonography can diagnose stenosis through the direct visualization of plaques and through the analysis of the Doppler waveforms in stenotic and poststenotic arteries. To perform Doppler ultrasonography of the lower extremity arteries, the operator should be familiar with the arterial anatomy of the lower extremities, basic scanning techniques, and the parameters used in color and pulsed-wave Doppler ultrasonography.

  16. Infection in the ischemic lower extremity.

    Science.gov (United States)

    Fry, D E; Marek, J M; Langsfeld, M

    1998-06-01

    Infections in the lower extremity of the patient with ischemia can cover a broad spectrum of different diseases. An understanding of the particular pathophysiologic circumstances in the ischemic extremity can be of great value in understanding the natural history of the disease and the potential complications that may occur. Optimizing blood flow to the extremity by using revascularization techniques is important for any patient with an ischemic lower extremity complicated by infection or ulceration. Infections in the ischemic lower extremity require local débridement and systemic antibiotics. For severe infections, such as necrotizing fasciitis or the fetid foot, more extensive local débridement and even amputation may be required. Fundamentals of managing prosthetic graft infection require removing the infected prosthesis, local wound débridement, and systemic antibiotics while attempting to preserve viability of the lower extremity using autogenous graft reconstruction.

  17. Tail-like congenital duplication of lower extremity (extra leg or ...

    African Journals Online (AJOL)

    Background: Congenital duplication of lower extremity, either complete or incomplete is extremely rare. Only 26 cases had been reported till 2010, of which only 5 cases had feature of complete duplication. Theories have been proposed that the cause of this abnormality includes maternal factors like diabetes and usage of ...

  18. On the limit distribution of lower extreme generalized order statistics

    Indian Academy of Sciences (India)

    Author Affiliations. H M Barakat1 Magdy E El-Adll2. Department of Mathematics, Faculty of Science, Zagazig University, Zagazig, Egypt; Department of Mathematics, Faculty of Science, Helwan University, Ain Helwan, Cairo, Egypt ...

  19. On the limit distribution of lower extreme generalized order statistics

    Indian Academy of Sciences (India)

    In testing the strength of materials, reliability analysis, lifetime studies, etc., the real- izations of experiments arise in nondecreasing order and therefore we need to consider several models of ascendingly ordered rv's. Theoretically, many of these models are con- tained in the gOs model, such as ordinary order statistics ...

  20. Post-thrombotic syndrome of the lower extremities

    International Nuclear Information System (INIS)

    Bosnjakovic, S.; Gerhard, U.; Buck, J.

    1980-01-01

    The postthrombotic syndrome with chronic venous insufficiency develops either gradually over a number of years or after a latent period of varying length. The clinical manifestations correlate with morphological and functional phlebographic findings of the superficial and deep veins. The conservative therapy of the post-thrombotic syndrome, consisting of anti-coagulant therapy, compression dressing or active physical exercise, must be consistently enforced. Indication of vascular surgical intervention should be carefully noted. Optimal examination of the patho-anatomical findings in the phlebogram is imperative as an important aid in decision-making. (orig.) [de

  1. Indications Level and Outcome of Lower Extremity Amputations in ...

    African Journals Online (AJOL)

    Wound dehiscence occurred in 8 patients and flap necrosis in 4. A reamputation rate of 16.7% was recorded for below knee amputations. The mortality rate was 15.2%. None of the patients acquired any prosthesis during convalescence. The below knee amputation is the commonest amputation level here and it reflects the ...

  2. A Rare Cause of Lower Extremity Ulcers: Prolidase Deficiency.

    Science.gov (United States)

    Adışen, Esra; Erduran, Funda Bapur; Ezgü, Fatih Süheyl; Kasapkara, Çiğdem Seher; Besio, Roberta; Forlino, Antonella; Gürer, Mehmet Ali

    2016-03-01

    Prolidase deficiency is an autosomal recessive disorder, which is associated with chronic skin ulcers, a characteristic facial appearance, mental retardation, and recurrent infections. This study describes 4 patients with recurrent leg ulcerations and abnormal facies who were first clinically suspected of prolidase deficiency and then biochemically confirmed. Two siblings and 2 other patients were admitted to our clinic at different times, and they had some common features such as chronic leg and foot ulcers recalcitrant to treatment, consanguineous parents, facial dysmorphism, mental retardation, and widespread telangiectasias. Physical examination and detection of low prolidase level in blood finally led us to the diagnose of ulcers secondary to prolidase deficiency. Prolidase deficiency is a rare genodermatosis and must be considered in the differential diagnosis of recurrent leg and foot ulcers that develop at an early age. © The Author(s) 2015.

  3. Skeletal muscle CT of lower extremities in myotonic dystrophy

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Ryosuke; Imai, Terukuni; Sadashima, Hiromichi; Matsumoto, Sadayuki; Yamamoto, Toru; Kusaka, Hirofumi; Yamasaki, Masahiro; Maya, Kiyomi; Tanabe, Masaya

    1988-02-01

    We evaluated the leg and thigh muscles of 4 control subjects and 10 patients with myotonic dystrophy using computed tomography. Taking previous reports about the skeletal muscle CT of myotonic dystrophy into account, we concluded that the following 5 features are characteristic of myotonic dystrophy: 1. The main change is the appearance of low-density areas in muscles; these areas reflect fat tissue. In addition, the muscle mass decreases in size. 2. The leg is more severely affected than the thigh. 3. In the thigh, although the m. quadriceps femoris, especially the vastus muscles, tends to be affected, the m. adductor longus and magnus tend to be preserved. 4. In the leg, although the m. tibialis anterior and m. triceps surae tend to be affected, the m. peroneus longus, brevis, and m. tibialis posterior tend to be preserved. 5. Compensatory hypertrophy is often observed in the m. rectus femoris, m. adductor longus, m. adductor magnus, m. peroneus longus, and m. peroneus brevis, accompanied by the involvement of their agonist muscles.

  4. Stress fractures in the lower extremity

    International Nuclear Information System (INIS)

    Berger, Ferco H.; Jonge, Milko C. de; Maas, Mario

    2007-01-01

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely

  5. Stress fractures in the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Berger, Ferco H. [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Jonge, Milko C. de [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Maas, Mario [Academic Medical Center, University of Amsterdam, Department of Radiology, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)]. E-mail: m.maas@amc.uva.nl

    2007-04-15

    Stress fractures are fatigue injuries of bone usually caused by changes in training regimen in the population of military recruits and both professional and recreational athletes. Raised levels of sporting activity in today's population and refined imaging technologies have caused a rise in reported incidence of stress fractures in the past decades, now making up more than 10% of cases in a typical sports medicine practice. Background information (including etiology, epidemiology, clinical presentation and treatment and prevention) as well as state of the art imaging of stress fractures will be discussed to increase awareness amongst radiologists, providing the tools to play an important role in diagnosis and prognosis of stress fractures. Specific fracture sites in the lower extremity will be addressed, covering the far majority of stress fracture incidence. Proper communication between treating physician, physical therapist and radiologist is needed to obtain a high index of suspicion for this easily overlooked entity. Radiographs are not reliable for detection of stress fractures and radiologist should not falsely be comforted by them, which could result in delayed diagnosis and possibly permanent consequences for the patient. Although radiographs are mandatory to rule out differentials, they should be followed through when negative, preferably by magnetic resonance imaging (MRI), as this technique has proven to be superior to bone scintigraphy. CT can be beneficial in a limited number of patients, but should not be used routinely.

  6. Prevention of Lower Extremity Injuries in Basketball: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Taylor, Jeffrey B; Ford, Kevin R; Nguyen, Anh-Dung; Terry, Lauren N; Hegedus, Eric J

    2015-01-01

    Lower extremity injuries are common in basketball, yet it is unclear how prophylactic interventions affect lower extremity injury incidence rates. To analyze the effectiveness of current lower extremity injury prevention programs in basketball athletes, focusing on injury rates of (1) general lower extremity injuries, (2) ankle sprains, and (3) anterior cruciate ligament (ACL) tears. PubMed, MEDLINE, CINAHL, SPORTDiscus, and the Cochrane Register of Controlled Trials were searched in January 2015. Studies were included if they were randomized controlled or prospective cohort trials, contained a population of competitive basketball athletes, and reported lower extremity injury incidence rates specific to basketball players. In total, 426 individual studies were identified. Of these, 9 met the inclusion criteria. One other study was found during a hand search of the literature, resulting in 10 total studies included in this meta-analysis. Systematic review and meta-analysis. Level 2. Details of the intervention (eg, neuromuscular vs external support), size of control and intervention groups, and number of injuries in each group were extracted from each study. Injury data were classified into 3 groups based on the anatomic diagnosis reported (general lower extremity injury, ankle sprain, ACL rupture). Meta-analyses were performed independently for each injury classification. Results indicate that prophylactic programs significantly reduced the incidence of general lower extremity injuries (odds ratio [OR], 0.69; 95% CI, 0.57-0.85; P ankle sprains (OR, 0.45; 95% CI, 0.29-0.69; P basketball athletes. In basketball players, prophylactic programs may be effective in reducing the risk of general lower extremity injuries and ankle sprains, yet not ACL injuries. © 2015 The Author(s).

  7. Influence of trunk control and lower extremity impairments on gait capacity in children with cerebral palsy.

    Science.gov (United States)

    Balzer, Julia; Marsico, Petra; Mitteregger, Elena; van der Linden, Marietta L; Mercer, Thomas H; van Hedel, Hubertus J A

    2017-09-24

    We investigated the combined impact of trunk control and lower extremities impairments on predicting gait capacity in children with cerebral palsy (CP) and evaluated relationships between trunk control and lower extremities impairments. Data of 52 children with CP [29 boys, mean age 11 years 9 months (±4 years 6 months)] were included in this observational study. Gait capacity was measured by the "modified Time Up and Go test". Experienced therapists performed the "Modified Ashworth Scale", "Manual Muscle Test", the "Selective Control Assessment of the Lower Extremity", and the "Trunk Control Measurement Scale". We calculated Spearman correlations coefficients (ρ) and performed regression analyses. Trunk control was the strongest predictor (β = -0.624, p capacity and remained in the model together with spasticity (R 2  = 0.67). Muscle strength and selectivity correlated moderately to strongly with the trunk control and gait capacity (-0.68 ≤ ρ ≤ -0.78), but correlations for the spasticity were low (ρcapacity in children with CP was shown. It indicates the significance of these impairments in gait assessment and, potentially, rehabilitation. Implications for Rehabilitation Trunk control was the strongest predictor for gait capacity in a regression model with lower extremity spasticity, muscle strength and selectivity and age as independent variables. Lower extremity muscle strength, selectivity, and trunk control explained a similar amount of gait capacity variance which is higher than that explained by lower extremity spasticity. Lower extremity muscle strength and selectivity correlated strongly with trunk control. Therefore, we cautiously suggest that a combined trunk control and lower extremity training might be promising for improving gait capacity in children with CP (Gross Motor Function Classification System level I-III), which needed to be tested in future intervention-studies.

  8. Are levels of bone turnover related to lower bone mass of adolescents previously fed a macrobiotic diet?

    NARCIS (Netherlands)

    Parsons, T.J.; Dusseldorp, van M.; Seibel, M.J.; Staveren, van W.A.

    2001-01-01

    Dutch adolescents who consumed a macrobiotic (vegan-type) diet in early life, demonstrate a lower relative bone mass than their omnivorous counterparts. We investigated whether subjects from the macrobiotic group showed signs of catching up with controls in terms of relative bone mass, reflected by

  9. Prevalence and risk factor analysis of lower extremity abnormal alignment characteristics among rice farmers

    Directory of Open Access Journals (Sweden)

    Karukunchit U

    2015-06-01

    Full Text Available Usa Karukunchit,1,2 Rungthip Puntumetakul,1,3 Manida Swangnetr,1,4 Rose Boucaut5 1Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 2Faculty of Associated Medical Sciences, Khon Kaen University, 3School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, 4Department of Production Technology, Faculty of Technology, Khon Kaen University, Khon Kaen, Thailand; 5School of Health Sciences (Physiotherapy, iCAHE (International Centre for Allied Health Evidence, Sansom Institute for Health Research, University of South Australia, Adelaide, SA, Australia Background: Rice farming activities involve prolonged manual work and human–machine interaction. Prolonged farming risk-exposure may result in lower limb malalignment. This malalignment may increase the risk of lower extremity injury and physical disabilities. However, the prevalence and factors associated with lower extremity malalignment have not yet been reported. This study aimed to investigate the prevalence and risk factors of lower extremity malalignment among rice farmers.Methods: A cross-sectional survey was conducted with 249 rice farmers. Lower extremity alignment assessment included: pelvic tilt angle, limb length equality, femoral torsion, quadriceps (Q angle, tibiofemoral angle, genu recurvatum, rearfoot angle, and medial longitudinal arch angle. Descriptive statistics were used to analyze participant characteristics and prevalence of lower extremity malalignment. Logistic regression analysis was used to identify risk factors.Results: The highest prevalence of lower extremity malalignment was foot pronation (36.14%, followed by the abnormal Q angle (34.94%, tibiofemoral angle (31.73%, pelvic tilt angle (30.52%, femoral antetorsion (28.11%, limb length inequality (22.49%, tibial torsion (21.29%, and genu recurvatum (11.24%. In females, the risk factors were abnormal Q angle, tibiofemoral angle, and genu recurvatum. Being overweight

  10. Effects of wobble board training on weight distribution on the lower extremities of sedentary subjects.

    Science.gov (United States)

    Adedoyin, Rufus A; Olaogun, Matthew O B; Omotayo, Kehinde; Olawale, Olajide A; Egwu, Michael O

    2008-01-01

    Inequality of weight distribution on the lower extremities affects the posture and gait performance of an individual. The effect of wobble board training on weight distribution on the lower extremities is presently unknown. The purpose of this study was to investigate the effects of a six week wobble board exercise training program on the weight distribution in the lower extremities. Subjects (n = 16) in the wobble board group were trained three times a week for the period of six weeks. The subjects in the control group (n = 13) did not receive any training. Weight distribution symmetry scores improved by 9% and 2% in the wobble board and control groups, respectively, no significant difference was found between the two groups' pre-training weight distribution on the lower extremities. The two-ways repeated analysis of variance revealed a significant F ratio between the two groups (P board group, while no significant improvement was recorded within the control group. Our findings implied that the wobble board exercise program could be used to improve the symmetry of weight distribution on the lower extremities in sedentary subjects.

  11. Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography

    DEFF Research Database (Denmark)

    Duer-Jensen, A.; Vestergaard, A.; Dohn, U.M.

    2008-01-01

    Objectives: To compare the ability of two different dedicated extremity MRI (E-MRI) units and conventional radiography (CR) for identifying bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) and wrist joints. Methods: CR and two MRI examinations (using 0.2 T Esaote Artoscan and 0.2...... T portable MagneVu MV1000 units) of 418 bones in the dominant wrist and second to fifth MCP joints of 15 patients with RA and 4 healthy controls were performed and evaluated blindly for bones being visible and for erosions. Results: In MCP joints, MagneVu visualised 18.5% of bones entirely and 71...... was particularly more sensitive than CR for metacarpal heads and carpal bones. MagneVu MRI and CR detected 100% and 89%, respectively, of large erosions (Outcome Measures in Rheumatoid Arthritis Clinical Trials-Rheumatoid Arthritis MRI Scoring System (OMERACT-RAMRIS) score >1 on Artoscan) in MCP joints and 69...

  12. Crossover replantation of the foot after bilateral traumatic lower extremity amputation.

    Science.gov (United States)

    Cinar, Can; Arslan, Hakan; Ogur, Simin; Pilanci, Ozgur; Yucel, Akin; Cetinkale, Oguz

    2007-06-01

    Bilateral traumatic amputation and limb-threatening injury of the lower extremities is more challenging than the unilateral amputation. Successful replantation of both lower extremities has been reported previously. However, orthotopic implantations may not be possible when amputation of both lower limbs with different levels of section and degrees of damage to surrounding tissues occurs. It was reported that the crossover replanted foot in combination with prosthetic limb is better than 2 artificial limbs. Hence, crossover replantation should be considered when anatomic replantation of both lower extremities is not possible as a result of bilateral total or subtotal amputation. To our knowledge, there are few reports about the crossover replantation of the lower extremity in the literature. A 30-year-old engineer being run over by the train had crushed the bilateral lower limbs in different anatomic levels. We decided to perform the crossover replantation of the right foot to the stump of the left leg to provide the patient with at least 1 weight-bearing sensate extremity. At the latest follow-up examination, 30 months after the operation, he had mild pain, especially in toes of the replanted foot. There was no ulceration in both the replanted extremity and the right amputation stump. The sole has maintained complete protective sensation. The patient described the functional result of the reimplanted leg as satisfying and better than the prosthesis that has caused much more problems than the replanted extremity. He had no complaint about the cosmetic result. He stated that he would have the crossover replantation again under the same condition. He was able to return to his previous job. Moreover, he affirmed that he is able to carry on his all social activities as he had done before the accident except for playing football. In conclusion, the possibility of the crossover replantation should be considered while evaluating the patient with bilateral lower limb

  13. Effect of mirror use on lower extremity muscle strength of patients with chronic stroke.

    Science.gov (United States)

    Kim, Myoung-Kwon; Choe, Yu-Won; Shin, Young-Jun; Peng, Cheng; Choi, Eun-Hong

    2018-02-01

    [Purpose] This study examines the effect on muscle strength of lower extremity muscle strength exercise while using a mirror on the non-paretic side in patients with chronic stroke. [Subjects and Methods] Subjects were randomly assigned to a non-mirror lower extremity exercise group (n=10), a mirror lower extremity exercise group (n=10), or a mirror lower extremity muscle strength exercise group (n=10). Subjects were asked to do the exercise assigned to their group (5 sets 30 times a day, 5 times weekly for 4 weeks) with general physical therapy in the hospital. Muscle strength in the knee extensor and flexor of paretic and non-paretic side were measured using electrical muscle testing device before and after the intervention. [Results] Muscle strength significantly increased within each group after intervention. No significant differences were found among the three groups. [Conclusion] This study showed that the lower extremity muscle strength exercise of the non-paretic side using a mirror has a positive effect on muscle strength in patient with chronic stroke.

  14. Associations of Foot Posture and Function to Lower Extremity Pain: The Framingham Foot Study

    Science.gov (United States)

    Riskowski, JL; Dufour, AB; Hagedorn, TJ; Hillstrom, Howard; Casey, VA; Hannan, MT

    2014-01-01

    Objective Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Methods Participants were members of the Framingham Foot Study. lower extremity joint pain was determined by the response to the NHANES-type question, “On most days do you have pain, aching or stiffness in your [hips, knees, ankles, or feet]?” Modified Arch Index (MAI) classified participants as having planus, rectus (referent) or cavus foot posture. Center of Pressure Excursion Index (CPEI) classified participants as having over-pronated, normal (referent) or over-supinated foot function. Crude and adjusted (age, gender, BMI) logistic regression determined associations of foot posture and function to lower extremity pain. Results Participants with planus structure had higher odds of knee (1.57, 95% CI: 1.24– 1.99) or ankle (1.47, 95% CI: 1.05–2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (7.56, 95% CI: 1.99–28.8) and pain at one lower extremity site (1.37, 95% CI: 1.04–1.80). Associations between foot function and lower extremity joint pain were not statistically significant, except for a reduced risk of hip pain in those with an over-supinated foot function (0.69, 95% CI: 0.51–0.93). Conclusions These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. PMID:24591410

  15. Nursing care of catheter-directed thrombolysis therapy for acute arterial embolism of lower extremities

    International Nuclear Information System (INIS)

    Li Yan; Ge Jingping; Gu Jianping

    2011-01-01

    Objective: To discuss the clinical effect of nursing intervention for interventional catheter-directed thrombolysis therapy in patients with acute arterial embolism of lower extremities. Methods: The experience of nursing care for 48 cases with acute arterial embolism of lower extremities which was treated with interventional catheter-directed thrombolysis was retrospectively analyzed. Results: With the help of active nursing care and rational treatment the occluded arteries were completely reopened in 40 cases and partially reopened in 8 cases. Complete relief from the clinical symptoms was obtained in 42 cases and partial remission was seen in 6 cases. Conclusion: For getting a complete recovery and improving living quality after catheter-directed thrombolysis in patients with acute arterial embolism of lower extremities, the key points are sufficient preoperative preparation, perioperative painstaking nursing care as well as postoperative correct guidance of exercise program. (authors)

  16. MR imaging findings of lower extremity sepsis caused by vibro vulnificus: A report of three cases

    International Nuclear Information System (INIS)

    Kim, Jihyun; Koh, Sung Hye; Min, Soo Kee; Lee, Jeong A; Lee, Kwan Seop

    2017-01-01

    Lower extremity infection caused by Vibrio vulnificus sepsis is a rapidly progressing fatal condition. Prompt diagnosis followed by early and aggressive treatment with antibiotics and fasciotomy is crucial. In this report, we described lower extremity magnetic resonance (MR) images of three patients with Vibrio vulnificus sepsis. In our cases, MR imaging of lower extremity with Vibrio vulnificus sepsis showed three common findings. First, the MR signal abnormalities appeared simultaneously in all layers, including skin, subcutaneous fat, muscles, and deep fasciae. Second, the inflammation showed symmetry on both legs. Third, none of our cases was accompanied by abscess formation. These imaging features may represent rapid progression of Vibrio vulnificus sepsis and could be helpful for accurate diagnosis, and prompt and aggressive treatment

  17. MR imaging findings of lower extremity sepsis caused by vibro vulnificus: A report of three cases

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jihyun; Koh, Sung Hye; Min, Soo Kee; Lee, Jeong A; Lee, Kwan Seop [Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang (Korea, Republic of)

    2017-01-15

    Lower extremity infection caused by Vibrio vulnificus sepsis is a rapidly progressing fatal condition. Prompt diagnosis followed by early and aggressive treatment with antibiotics and fasciotomy is crucial. In this report, we described lower extremity magnetic resonance (MR) images of three patients with Vibrio vulnificus sepsis. In our cases, MR imaging of lower extremity with Vibrio vulnificus sepsis showed three common findings. First, the MR signal abnormalities appeared simultaneously in all layers, including skin, subcutaneous fat, muscles, and deep fasciae. Second, the inflammation showed symmetry on both legs. Third, none of our cases was accompanied by abscess formation. These imaging features may represent rapid progression of Vibrio vulnificus sepsis and could be helpful for accurate diagnosis, and prompt and aggressive treatment.

  18. Attitudes regarding lower extremity allotransplantation among lower extremity amputees.

    Science.gov (United States)

    Carty, Matthew J; Duclos, Antoine; Talbot, Simon G; Tullius, Stefan G; Pribaz, Julian J; Pomahac, Bohdan

    2014-12-01

    Lower limb allotransplantation is garnering increasing attention in the vascularized composite allotransplantation community as a potential treatment modality for those suffering from lower limb amputations. Little is known, however, about the level of interest among lower limb amputees regarding this procedure. An online survey regarding lower limb allotransplantation was designed in conjunction with and distributed by the Amputee Coalition to lower limb amputees in the United States. Responses from the survey were blinded, tabulated, and analyzed for significance using chi-square or Fisher's exact test. A total of 770 respondents completed the online survey. Forty-three percent of respondents stated they would be interested in being evaluated for lower limb transplantation, 36 percent declined, and 21 percent were uncertain. Those respondents who expressed an interest in allotransplantation tended to be significantly younger, better educated, more recently amputated, and less satisfied with prosthetic outcomes than those who were not interested. The most important criterion for transplantation to be considered a success by respondents was restoration of meaningful knee/ankle joint function, followed by restoration of limb sensibility. If immunosuppression were not required, 32 percent of those who initially declined and 88 percent of those who were uncertain would choose to undergo evaluation for lower limb allotransplantation. A significant proportion of lower limb amputees would be interested in undergoing evaluation for lower limb allotransplantation.

  19. Treatment of postoperative lower extremity wounds using human fibroblast-derived dermis: a retrospective analysis.

    Science.gov (United States)

    Carlson, Russell M; Smith, Nicholas C; Dux, Katherine; Stuck, Rodney M

    2014-04-01

    Human fibroblast-derived dermis skin substitute is a well-studied treatment for diabetic foot ulcers; however, no case series currently exist for its use in healing postoperative wounds of the lower extremity. A retrospective analysis was conducted on 32 lower extremity postoperative wounds treated weekly with human fibroblast-derived dermis skin substitute. Postoperative wounds were defined as a wound resulting from an open partial foot amputation, surgical wound dehiscence, or nonhealing surgical wound of the lower extremity. Wound surface area was calculated at 4 and 12 weeks or until wound closure if prior to 12 weeks. Postoperative wounds treated with weekly applications showed mean improvement in surface area reduction of 63.6% at 4 weeks and 96.1% at 12 weeks. More than 56% of all wounds healed prior to the 12-week endpoint. Additionally, only one adverse event was noted in this group. This retrospective review supports the use of human fibroblast-derived dermis skin substitute in the treatment of postoperative lower extremity wounds. This advanced wound care therapy aids in decreased total healing time and increased rate of healing for not only diabetic foot wounds but also postoperative wounds of the lower extremity, as demonstrated by this retrospective review.

  20. A finite element lower extremity and pelvis model for predicting bone injuries due to knee bolster loading

    NARCIS (Netherlands)

    Rooij, L. van; Hoof, J. van; Barbir, A.; Made, R. van der; Slaats, P.M.A.; McCann, M.J.; Ridella, S.A.; Rupp, J.D.

    2004-01-01

    Injuries to the knee-thigh-hip (KTH) complex in frontal motor vehicle crashes are of substantial concern because of their frequency and potential to result in long-term disability. Current frontal impact Anthropometric Test Dummies (ATDs) have been shown to respond differently than human cadavers

  1. Evaluation of the Plastic Surgery In-Service Training Exam: Lower Extremity Questions.

    Science.gov (United States)

    Silvestre, Jason; Basta, Marten N; Serletti, Joseph M; Chang, Benjamin

    2015-01-01

    To facilitate the training of plastic surgery residents, we analyzed a knowledge-based curriculum for plastic and reconstructive surgery of the lower extremity. The Plastic Surgery In-Service Training Exam (PSITE) is a commonly used tool to assess medical knowledge in plastic surgery. We reviewed the lower extremity content on 6 consecutive score keys (2008-2013). Questions were classified by taxonomy, anatomy, and subject. Answer references were quantified by source and relative year of publication. Totally, 107 questions related to the lower extremity (9.1% of all questions) and 14 questions had an associated image (13.1%). Questions required decision making (49%) over interpretation (36%) and direct recall (15%) skills (p Plastic Surgery by Mathes et al. was the most referenced textbook (21.9%). These data establish a benchmark for lower extremity training during plastic surgery residency. Study efforts focused on the most common topics and references will enhance trainee preparation for lower extremity PSITE questions. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  2. Rare imaging of a known entity: fat embolism seen on CT in lower extremity vein after trauma

    Directory of Open Access Journals (Sweden)

    Varun Chowdhary, MD

    2017-09-01

    Full Text Available Fat embolism occurs in the vast majority of patients who have had trauma (approximately 90%. The most common occurrence is after long bone fracture. It has also been noted in cases after orthopedic surgery. Fat embolism is most often diagnosed when the clinical manifestations of fat embolism syndrome become apparent. Reported cases of fat emboli in transit are unusual. In our case, we present the rare finding of fat embolism seen on computed tomography in the lower extremity after a trauma.

  3. Eccrine porocarcinoma of the lower extremity: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Asarian Armand

    2011-08-01

    Full Text Available Abstract Eccrine porocarcinoma is a rare malignancy of the eccrine sweat gland. It is usually found frequently on the lower extremities, and it affects both sexes equally usually in the sixth to seventh decade. In our case, we present a 42-year-old male patient with a recurring exophytic tumor on the right lower extremity without local extension. The initial tumor was biopsied, excised and diagnosed as an eccrine poroma. The tumor then recurred 6 years later, was re-excised, reconstructed with a soleus muscle flap and diagnosed as an eccrine porocarcinoma.

  4. Validity and interobserver agreement of lower extremity local tissue water measurements in healthy women using tissue dielectric constant

    DEFF Research Database (Denmark)

    Jensen, Mads R; Birkballe, Susanne; Nørregaard, Susan

    2012-01-01

    Tissue dielectric constant (TDC) measurement may become an important tool in the clinical evaluation of chronic lower extremity swelling in women; however, several factors are known to influence TDC measurements, and comparative data on healthy lower extremities are few.......Tissue dielectric constant (TDC) measurement may become an important tool in the clinical evaluation of chronic lower extremity swelling in women; however, several factors are known to influence TDC measurements, and comparative data on healthy lower extremities are few....

  5. The use of mechanotherapy means in basketball players recovery after the injuries of the lower extremities

    Directory of Open Access Journals (Sweden)

    Zheleznyj O.D.

    2013-05-01

    Full Text Available The aim is to develop methods of physical rehabilitation of basketball players with injuries of the lower extremities. Summarizes the experience of use of mechanical therapy for the recovery of athletes with injuries to the lower extremities. Analyzed the nature of lower extremity injuries and their consequences. The methods of application of mechanical therapy using a simulator developed universal and local fatty clay as a means of physical therapy. It is proved that the method developed by the authors provided a mechanotherapy achieve the required level of mobility in the joints and improve range of body functions. Found that in the process of applying the developed program of rehabilitation basketball players with injuries of the lower extremities most effective in complex physical rehabilitation was value: therapeutic physical training with mechanotherapy + physical therapy with curative mud + therapeutic massage. Technique introduced to the work of medical and health-improving establishments and educational institutions of Ukraine Ministry of Education and Science of Ukraine.

  6. Evaluation of a morphing based method to estimate muscle attachment sites of the lower extremity

    NARCIS (Netherlands)

    Pellikaan, P.; van der Krogt, Marjolein; Carbone, Vincenzo; Fluit, René; Vigneron, L.M.; van Deun, J.; Verdonschot, Nicolaas Jacobus Joseph; Koopman, Hubertus F.J.M.

    2014-01-01

    To generate subject-specific musculoskeletal models for clinical use, the location of muscle attachment sites needs to be estimated with accurate, fast and preferably automated tools. For this purpose, an automatic method was used to estimate the muscle attachment sites of the lower extremity, based

  7. 3D Modeling of Lower Extremities With Biplanar Radiographs: Reliability of Measures on Subsequent Examinations.

    Science.gov (United States)

    Westberry, David E; Carpenter, Ashley M

    2017-08-02

    Biplanar radiography with 3-dimensional (3D) modeling (EOS) provides a comprehensive assessment of lower limb alignment in an upright weight-bearing position with less radiation than conventional radiography. A study was performed to assess the consistency and reliability of 2 lower extremity 3D biplanar radiograph models created at least 1 year apart in a pediatric population. All patients who had 2 lower extremity radiographic evaluations with EOS performed at visits a minimum of 1 year apart were reviewed. Digital radiographs, of lower extremities in both frontal and sagittal planes, were acquired simultaneously, using the EOS system. The 3D reconstruction of the images was achieved utilizing the SterEOS software. Pelvic position, femoral and tibial anatomy, and the torsional profile were evaluated and compared using t tests. In total, 53 patients with a mean age of 11.7 years (range, 6.1 to 18.9 y) met inclusion criteria. When comparing 3D models between visits, minimal differences were noted in proximal femoral anatomy and pelvic alignment (pelvic incidence, sacral slope, sagittal tilt, neck shaft angle). Expected differences in femoral and tibial length corresponded with normal longitudinal growth between visits. Sagittal plane knee position varied widely between examinations. Femoral and/or tibial rotational osteotomies were performed in 37% of extremities between examinations. After femoral derotational osteotomy, a significant difference in femoral anteversion was appreciated when comparing preoperative and postoperative 3D models. However, this difference was less than the expected difference based on the anatomic correction achieved intraoperatively. No differences were noted in tibial torsion measures after tibial derotational osteotomy. The 3D modeling based on biplanar radiographs provides consistent and reliable measures of pelvic and hip joint anatomy of the lower extremity. Patient positioning may influence the reproducibility of knee alignment

  8. Establishing the Turkish version of the SIGAM mobility scale, and determining its validity and reliability in lower extremity amputees.

    Science.gov (United States)

    Yilmaz, Hülya; Gafuroğlu, Ümit; Ryall, Nicola; Yüksel, Selcen

    2018-02-01

    The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees. Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test-retest reliability. Structural validity was tested using the "scale validity" method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman's correlation test. Cronbach's alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A-F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales. In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees. Implications for Rehabilitation Amputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body. Loss of a lower extremity is one of the most important conditions that cause functional disability. The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees. Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their

  9. Angiographic distribution of lower extremity atherosclerosis in patients with and without diabetes

    NARCIS (Netherlands)

    van der Feen, C; Neijens, FS; Kanters, SDJM; Mali, WRTM; Stolk, RP; Banga, JD

    Aims To determine differences in the anatomic site of atherosclerosis in the lower extremity between patients with and patients without diabetes. Design Cross-sectional study of patients who underwent angiography of both legs because of symptoms of intermittent claudication, rest and/or night pain,

  10. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer.

    Science.gov (United States)

    Pickwell, Kristy; Siersma, Volkert; Kars, Marleen; Apelqvist, Jan; Bakker, Karel; Edmonds, Michael; Holstein, Per; Jirkovská, Alexandra; Jude, Edward; Mauricio, Didac; Piaggesi, Alberto; Ragnarson Tennvall, Gunnel; Reike, Heinrich; Spraul, Maximilian; Uccioli, Luigi; Urbancic, Vilma; van Acker, Kristien; van Baal, Jeff; Schaper, Nicolaas

    2015-05-01

    Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts. © 2015 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered.

  11. [Digital model of human lower extremity musculature based on CT & MRI].

    Science.gov (United States)

    Shang, Peng; Ye, Ming; Wang, Chengtao; Wang, Li

    2004-10-01

    A new method to reconstruct comparatively complete muscle model of human lower limb from CT and MRI data is presented. Topological structure of more than fourteen muscles is built and the coordinates of origin and insertion points are given. Based on this model, straight-line model and centroid-line muscle model are acquired. Muscle force prediction is discussed according to the model reconstructed, and a multi-objective optimization method is put forward for evaluating muscle forces of human lower extremity.

  12. Intra-arterial Ultra-low-Dose CT Angiography of Lower Extremity in Diabetic Patients

    Energy Technology Data Exchange (ETDEWEB)

    Özgen, Ali, E-mail: draliozgen@hotmail.com [Yeditepe University Hospital, Department of Radiology (Turkey); Sanioğlu, Soner [Yeditepe University Hospital, Department of Cardiovascular Surgery (Turkey); Bingöl, Uğur Anıl [Yeditepe University Hospital, Department of Plastic Surgery (Turkey)

    2016-08-15

    PurposeTo image lower extremity arteries by CT angiography using a very low-dose intra-arterial contrast medium in patients with high risk of developing contrast-induced nephropathy (CIN).Materials and MethodsThree cases with long-standing diabetes mellitus and signs of lower extremity atherosclerotic disease were evaluated by CT angiography using 0.1 ml/kg of the body weight of contrast medium given via 10-cm-long 4F introducer by puncturing the CFA. Images were evaluated by an interventional radiologist and a cardiovascular surgeon. Density values of the lower extremity arteries were also calculated. Findings in two cases were compared with digital subtraction angiography images performed for percutaneous revascularization. Blood creatinine levels were followed for possible CIN.ResultsIntra-arterial CT angiography images were considered diagnostic in all patients and optimal in one patient. No patient developed CIN after intra-arterial CT angiography, while one patient developed CIN after percutaneous intervention.ConclusionIntra-arterial CT angiography of lower extremity might be performed in selected patients with high risk of developing CIN. Our limited experience suggests that as low as of 0.1 ml/kg of the body weight of contrast medium may result in adequate diagnostic imaging.

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

    NARCIS (Netherlands)

    Klein Horsman, M.D.; Koopman, Hubertus F.J.M.; van der Helm, F.C.T.; Poliacu Prosé, L.; Veeger, H.E.J.

    2007-01-01

    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

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

    NARCIS (Netherlands)

    Klein Horsman, M.D.; Koopman, H.F.; van der Helm, F.C.T.; Prose, L.P.; Veeger, H.E.J.

    2007-01-01

    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

  15. Lower extremity finite element model for crash simulation

    Energy Technology Data Exchange (ETDEWEB)

    Schauer, D.A.; Perfect, S.A.

    1996-03-01

    A lower extremity model has been developed to study occupant injury mechanisms of the major bones and ligamentous soft tissues resulting from vehicle collisions. The model is based on anatomically correct digitized bone surfaces of the pelvis, femur, patella and the tibia. Many muscles, tendons and ligaments were incrementally added to the basic bone model. We have simulated two types of occupant loading that occur in a crash environment using a non-linear large deformation finite element code. The modeling approach assumed that the leg was passive during its response to the excitation, that is, no active muscular contraction and therefore no active change in limb stiffness. The approach recognized that the most important contributions of the muscles to the lower extremity response are their ability to define and modify the impedance of the limb. When nonlinear material behavior in a component of the leg model was deemed important to response, a nonlinear constitutive model was incorporated. The accuracy of these assumptions can be verified only through a review of analysis results and careful comparison with test data. As currently defined, the model meets the objective for which it was created. Much work remains to be done, both from modeling and analysis perspectives, before the model can be considered complete. The model implements a modeling philosophy that can accurately capture both kinematic and kinetic response of the lower limb. We have demonstrated that the lower extremity model is a valuable tool for understanding the injury processes and mechanisms. We are now in a position to extend the computer simulation to investigate the clinical fracture patterns observed in actual crashes. Additional experience with this model will enable us to make a statement on what measures are needed to significantly reduce lower extremity injuries in vehicle crashes. 6 refs.

  16. Effects of prosthetic limb prescription on 3-year mortality among lower extremity veteran amputees

    Science.gov (United States)

    Kurichi, Jibby E.; Kwong, Pui; Vogel, W. Bruce; Xie, Dawei; Ripley, Diane Cowper; Bates, Barbara E.

    2015-01-01

    Our objective was to determine the relationship between receipt of a prescription for a prosthetic limb and three-year mortality post-surgery among veterans with lower extremity amputation. We conducted a retrospective observational study that included 4,578 veterans hospitalized for lower extremity amputation and discharged in Fiscal Years 2003 and 2004. The outcome was time to all-cause mortality from the amputation surgical date up to the 3-year anniversary of the surgical date. There were 1,300 (28.4%) veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation. About 46% (n=2086) died within three-years of the surgical anniversary. Among those who received a prescription for a prosthetic limb, only 25.2% died within 3 years of the surgical anniversary. After adjustment, veterans who received a prescription for a prosthetic limb were less likely to die after the surgery than veterans without a prescription with a hazard ratio of 0.68 (95% CI, 0.60-0.77). Findings demonstrated that veterans with lower extremity amputations who received a prescription for a prosthetic limb within a year after the surgical amputation were less likely to die within three years of the surgical amputation after controlling for patient-, treatment-, and facility-level characteristics. PMID:26348602

  17. A Retrospective Review from 2006 to 2011 of Lower Extremity Injuries in Badminton in New Zealand

    Directory of Open Access Journals (Sweden)

    Joanna Reeves

    2015-06-01

    Full Text Available Aim: To describe lower extremity injuries for badminton in New Zealand. Methods: Lower limb badminton injuries that resulted in claims accepted by the national insurance company Accident Compensation Corporation (ACC in New Zealand between 2006 and 2011 were reviewed. Results: The estimated national injury incidence for badminton injuries in New Zealand from 2006 to 2011 was 0.66%. There were 1909 lower limb badminton injury claims which cost NZ$2,014,337 (NZ$ value over 2006 to 2011. The age-bands frequently injured were 10–19 (22%, 40–49 (22%, 30–39 (14% and 50–59 (13% years. Sixty five percent of lower limb injuries were knee ligament sprains/tears. Males sustained more cruciate ligament sprains than females (75 vs. 39. Movements involving turning, changing direction, shifting weight, pivoting or twisting were responsible for 34% of lower extremity injuries. Conclusion: The knee was most frequently injured which could be due to multi-planar loading. Turning or cutting movements typically involve motion in the frontal and transverse planes that may place the knee at greater risk of injury than movement in the sagittal plane alone. Further research on badminton specific movements is warranted to better understand the mechanisms of lower extremity injuries in the sport. Sports medicine and support personnel should take into account the susceptibility of the knee to injury when designing training and injury prevention programmes given the large number of change of direction movements during badminton.

  18. Overweight and health problems of the lower extremities: osteoarthritis, pain and disability

    NARCIS (Netherlands)

    Tukker, A.; Visscher, T.L.S.; Picavet, H.S.

    2009-01-01

    Aim: To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability. Methods: Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the

  19. Reliability of a Scoring System for Qualitative Evaluation of Lymphoscintigraphy of the Lower Extremities.

    Science.gov (United States)

    Ebrahim, Mojgan; Savitcheva, Irina; Axelsson, Rimma

    2017-09-01

    Lymphoscintigraphy is an imaging technique to diagnose and characterize the severity of edema in the upper and lower extremities. In lymphoscintigraphy, a scoring system can increase the ability to differentiate between diagnoses, but the use of any scoring system requires sufficient reliability. Our aim was to determine the inter- and intraobserver reliability of a proposed scoring system for visual interpretation of lymphoscintigrams of the lower extremities. Methods: The lymphoscintigrams of 81 persons were randomly selected from our database for retrospective evaluation. Two nuclear medicine physicians scored these scans according to the 8 criteria of a proposed scoring system for visual interpretation of lymphoscintigrams of the lower extremities. Each scan was scored twice 3 mo apart. The total score was the sum of the scores for all criteria, with a potential range of 0 (normal lymphatic drainage) to 58 (severe lymphatic impairment). The intra- and interobserver reliability of the scoring system was determined using the Wilcoxon signed-rank test, percentage of agreement, weighted κ, and intraclass correlation coefficient with 95% confidence interval. In addition, for 7 categories, differences in total scores between and within observers were determined. Results: We found some insignificant differences between observers. Percentage agreement was high or very high, at 82.7%-99.4% between observers and 84.6%-99.4% within observers. For each criterion of the scoring system, the κ-correlations showed moderate to very good inter- or intraobserver reliability. The total scores for all criteria had good inter- and intraobserver reliability. Regarding the interobserver comparison, 66% and 64% of the difference in total scores were within ±1 scale point (-1, +1), and regarding the intraobserver comparison, 68% and 72% of the difference in total scores were within ±1 scale point. Conclusion: The proposed scoring system is a reliable tool for visual qualitative

  20. Use of platelet-rich plasma in the healing of chronic ulcers of the lower extremity.

    Science.gov (United States)

    Salazar-Álvarez, A E; Riera-del-Moral, L F; García-Arranz, M; Alvarez-García, J; Concepción-Rodriguez, N A; Riera-de-Cubas, L

    2014-01-01

    Platelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing. We prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment. There was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P<.05) and a significant improvement in the physical and mental components of the SF-12 (P<.05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed. The local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief. Copyright © 2013 Elsevier España, S.L. and AEDV. All rights reserved.

  1. The non-compressibility ratio for accurate diagnosis of lower extremity deep vein thrombosis

    Directory of Open Access Journals (Sweden)

    Caecilia Marliana

    2014-08-01

    Full Text Available Background Accurate identification of patients with deep vein thrombosis (DVT is critical, as untreated cases can be fatal. It is well established that the specificity of the clinical signs and symptoms of DVT is low. Therefore, clinicians rely on additional tests to make this diagnosis. There are three modalities for DVT diagnosis; clinical scoring, laboratory investigations, and radiology. The objective of this study was to determine the correlation of plasma D-dimer concentration with the ultrasonographic non-compressibility ratio in patients with DVT in the lower extremities. Methods This research was a cross-sectional observational study. The sample comprised 25 subjects over 30 years of age with clinically diagnosed DVT in the lower extremities. In all subjects, D-dimer determination using latex enhanced turbidimetric test was performed, as well as ultrasonographic non-compressibility ratio assessment of the lower extremities. Data were analyzed using Pearson’s correlation at significance level of 0.05. Results Mean plasma D-dimer concentration was 2953.00 ± 2054.44 mg/L. The highest mean non-compressibility ratio (59.96 ± 35.98% was found in the superficial femoral vein and the lowest mean non-compressibility ratio (42.68 ± 33.71% in the common femoral vein. There was a moderately significant correlation between plasma D-dimer level and non-compressibility ratio in the popliteal vein (r=0.582; p=0.037. In the other veins of the lower extremities, no significant correlation was found. Conclusion The sonographic non-compressibility ratio is an objective test for quick and accurate diagnosis of lower extremity DVT and for evaluation of DVT severity.

  2. Overweight and health problems of the lower extremities: osteoarthritis, pain and disability.

    Science.gov (United States)

    Tukker, A; Visscher, T L S; Picavet, H S J

    2009-03-01

    To examine the association between overweight and health problems of the lower extremities, i.e. osteoarthritis (OA), pain and disability. Cross-sectional data from the Dutch population-based Musculoskeletal Conditions & Consequences Cohort (DMC3), comprising a random sample from the Dutch population aged >25 years (n 3664), were analysed using multivariate logistic regression. Overweight was defined as BMI > or = 25.0 kg/m2, moderate overweight as 25.0 kg/m2 or = 30.0 kg/m2. Health problems of the lower extremities were: (i) self-reported OA of the hip or knee as told by a doctor; (ii) presence of self-reported chronic pain (>3 months) of the lower extremities; and (iii) disabilities in mobility as measured by the Euroqol questionnaire (EQ-5D). Moderate overweight was associated with self-reported OA of the hip or knee (OR = 1.7; 95 % CI 1.4, 2.1), chronic pain of the lower extremities at one or more location(s) (OR = 1.6; 95 % CI 1.3, 1.9) and disability in mobility (OR = 1.7; 95 % CI 1.4, 2.0). For obesity these odds were higher: 2.8 (95 % CI 2.1, 3.7), 2.5 (95 % CI 1.9, 3.2) and 3.0 (95 % CI 2.3, 3.9), respectively. Also, among those with OA, moderate overweight and obesity were associated with disability in mobility. There is a strong association between overweight/obesity and health problems of the lower extremities, i.e. OA, pain and disability. The increasing prevalence of overweight and obesity worldwide urges for public health action not only for diabetes and heart disease, but also OA.

  3. Lower Extremity Permanent Dialysis Vascular Access.

    Science.gov (United States)

    Parekh, Vishal B; Niyyar, Vandana D; Vachharajani, Tushar J

    2016-09-07

    Hemodialysis remains the most commonly used RRT option around the world. Technological advances, superior access to care, and better quality of care have led to overall improvement in survival of patients on long-term hemodialysis. Maintaining a functioning upper extremity vascular access for a prolonged duration continues to remain a challenge for dialysis providers. Frequently encountered difficulties in clinical practice include (1) a high incidence of central venous catheter-related central vein stenosis and (2) limited options for creating a functioning upper extremity permanent arteriovenous access. Lack of surgical skills, fear of complications, and limited involvement of the treating nephrologists in the decision-making process are some of the reasons why lower extremity permanent dialysis access remains an infrequently used option. Similar to upper extremity vascular access options, lower extremity arteriovenous fistula remains a preferred access over arteriovenous synthetic graft. The use of femoral tunneled catheter as a long-term access should be avoided as far as possible, especially with the availability of newer graft-catheter hybrid devices. Our review provides a summary of clinical evidence published in surgical, radiology, and nephrology literature highlighting the pros and cons of different types of lower extremity permanent dialysis access. Copyright © 2016 by the American Society of Nephrology.

  4. The potential for functional recovery of upper extremity function following cervical spinal cord injury without major bone injury.

    Science.gov (United States)

    Hayashi, T; Kawano, O; Sakai, H; Ideta, R; Ueta, T; Maeda, T; Mori, E; Yugue, I; Takao, T; Masuda, M; Morishita, Y; Shiba, K

    2013-11-01

    This was a retrospective observational study. The objectives were to describe the prognosis of upper extremity function following cervical spinal cord injury (CSCI), and to identify prognostic factors for functional recovery. Spinal Injuries Center, Japan. Sixty patients with C3-4 CSCI without major bone injury participated in the study. Patients were treated nonsurgically and evaluated using the American Spinal Injury Association (ASIA) scales for the upper and lower extremities, their residual cervical motor functions, the modified Frankel grade and an upper extremity function scale. We compared the findings for the upper extremity function scale at 6 months with those for the residual cervical motor functions and modified Frankel grade obtained 3 days after injury. Most patients with CSCI who could flex their hip and knee from a supine position (95%) or who showed some active elbow extension (86%) 3 days after their injury could use a spoon at 6 months. We compared patients who used their fingers at 6 months to those who could not, and observed significant differences in age and ASIA scores for the upper and lower extremities obtained 3 days after injury. A strong correlation was observed between the initial motor scores and the extent of functional recovery at 6 months. Hip and knee flexion from the supine position and elbow extension 3 days after injury significantly predicted a positive prognosis for upper extremity function. Younger age and higher ASIA motor scores obtained 3 days after injury were factors associated with neurological recovery.

  5. Pathologic features of lower extremity arterial lesions in diabetes mellitus:an analysis of 162 patients

    International Nuclear Information System (INIS)

    Guo Xiangjiang; Zhang Jiwei

    2010-01-01

    Objective: To investigate the angiographic manifestations of lower extremity atherosclerotic occlusion in patients with diabetes mellitus. Methods: The angiographic findings of lower extremity in 162 patients with diabetes mellitus were retrospectively analyzed. (1) The arteries of lower extremity were divided into the following four segments: iliac, femoral, popliteal and crural artery. The involvements of these arteries were documented. (2) Based on the lesion's number, location, nature (stricture or occlusion) and length ( 5 cm), the diabetic arterial diseases were categorized. Results: (1) Of 162 diabetic lower limbs, multiple segmental lesions were seen in 131, superficial femoral arterial lesions in 130, and crural arterial lesions in 139, of which 130 arterial lesions had at least two below-the-knee arteries being involved. (2) Based on segmental angiographic classification, a total of 660 vascular lesions were detected, including stricture lesions (33.8%) and occlusive lesions (66.2%). Of the 437 occlusions, 70.5% were located in below-the-knee arteries, and most of which were longer than 10 cm and located in anterior and posterior tibial arteries, while only a few peroneal arteries were involved (P < 0.0001). One hundred and fifty-two lesions were detected in superficial femoral arteries, of which 49 (31.2%) were located at the origin of the superficial femoral artery and 56 (35.7) were in the adductor canal hiatus. Conclusion: The main feature of peripheral arterial disease of lower extremity caused by diabetes mellitus is multi-level atherosclerotic occlusion, the superficial femoral and the crural arteries are most likely to be involved. The lesions of superficial femoral artery are often located at the arterial origin and in the adductor canal hiatus, while the deep femoral artery and the femoral artery are less involved. Long occlusive lesions are more prevalent in crural arteries, especially in anterior and posterior tibial arteries. (J Intervent

  6. Detection of rheumatoid arthritis bone erosions by 2 different dedicated extremity MRI units and conventional radiography

    DEFF Research Database (Denmark)

    Duer, Anne; Vestergaard, Aage; Døhn, Uffe Møller

    2008-01-01

    OBJECTIVES: To compare the ability of 2 different dedicated extremity magnetic resonance imaging (E-MRI) units and conventional radiography (CR) for identifying bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) and wrist joints. METHODS: CR and 2 MRI-examinations (on 0.2T Esaote...... Artoscan and 0.2T portable MagneVu MV1000 units) of 418 bones in the dominant wrist and 2.-5. MCP-joints of 15 RA patients and 4 healthy controls were performed and blindedly evaluated for bones being visible and for erosions. RESULTS: In MCP-joints, MagneVu visualized 18.5% of bones entirely and 71....... With the previously validated Artoscan-unit as standard reference, MagneVu and CR had sensitivities of 0.82 and 0.55, respectively, in MCP-joint bones and 0.41 and 0.14 in wrist bones. Specificities of CR and MagneVu were comparable (0.82-0.99). MagneVu was particularly more sensitive than CR in metacarpal heads...

  7. Comparison of effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy.

    Science.gov (United States)

    Caliskan Uckun, Asli; Celik, Canan; Ucan, Halil; Ordu Gokkaya, Nilufer Kutay

    2014-12-01

    The aim of the study was to compare the effects of lower extremity orthoses on energy expenditure in patients with cerebral palsy (CP). We included 48 children with CP using lower extremity orthosis. Energy expenditures determined based on heart rate, yielded an energy expenditure index (EEI) with and without orthosis during walking. RESULTS were compared statistically between orthosis groups (solid polyethylene ankle foot orthosis (PAFO), articulated PAFO, ground reaction foot orthosis (GRAFO), plastic and metallic knee-ankle-foot-orthosis (KAFO), and metallic AFO). It was found that an advancement in energy expenditure was seen with plastic orthoses which is more prominent by solid PAFO (p = 0.008). It was concluded that especially solid PAFO can be more beneficial in terms of energy consumption in CP patients. In rehabilitation phase, the EEI measurement was seen to be a useful and practical method for choosing the proper orthosis type.

  8. LOWER EXTREMITY MANIFESTATIONS OF PERIPHERAL ARTERY DISEASE: THE PATHOPHYSIOLOGIC AND FUNCTIONAL IMPLICATIONS OF LEG ISCHEMIA

    Science.gov (United States)

    McDermott, Mary McGrae

    2015-01-01

    Lower extremity peripheral artery disease (PAD) is frequently under-diagnosed, in part because of the wide variety of leg symptoms manifested by patients with PAD and in part because of the high prevalence of asymptomatic PAD. In primary care medical practices, 30% to 60% of PAD patients report no exertional leg symptoms and approximately 45–50% report exertional leg symptoms that are not consistent with classic intermittent claudication. The prevalence and extent of functional impairment and functional decline in PAD may also be underappreciated. Functional impairment and functional decline is common in PAD, even among those who are asymptomatic. Lower extremity ischemia is also associated with pathophysiologic changes in calf skeletal muscle including smaller calf muscle area, increased calf muscle fat content, impaired leg strength, and impaired metabolic function. People with severe PAD have poorer peroneal nerve conduction velocity compared to people with mild PAD or no PAD. The degree of ischemia-related pathophysiologic changes in lower extremity muscles and peripheral nerves of people with PAD are associated with the degree of functional impairment. New interventions are needed to improve functional performance and prevent mobility loss in the large number of PAD patients, including in those who are asymptomatic or who have exertional leg symptoms other than claudication. PMID:25908727

  9. Estimates of effective dose for CT scans of the lower extremities.

    Science.gov (United States)

    Saltybaeva, Natalia; Jafari, Mary Ellen; Hupfer, Martin; Kalender, Willi A

    2014-10-01

    To determine the dose-length product (DLP)-effective dose (ED) (DLP/ED) conversion coefficient (k) tables for the lower extremities that can be used for calculating ED. Dose calculations were performed on standard phantoms using a validated Monte Carlo calculation tool. Calculations were performed to obtain ED values for tube voltages from 80 kV to 140 kV in steps of 20 kV for the following examinations: hip (femur), knee, ankle, and computed tomographic (CT) angiography of the lower extremities. Values of the DLP were calculated by multiplying measured CT dose index values by the scan length; k values resulted as the quotients of the ED and DLP values. DLP/ED coefficients averaged over the range of voltage values and their standard deviations were determined for the given lower-extremity CT examinations for all age groups and for both sexes. Coefficients depend strongly on the phantom age and size, but little on the kilovolt value. In the case of the newborn, for example, k values were 0.0612, 0.0046, 0.0014, and 0.047 for hip, knee, ankle, and CT angiography, respectively, while in the case of the adult, these respective values were 0.0110, 0.0004, 0.0002, and 0.0062. A substantial difference up to 20% between coefficients in male and female phantoms was observed for CT angiographic examination. DLP/ED conversion coefficients are provided for lower extremities and allow estimation of ED for commonly used clinical musculoskeletal CT and CT angiographic protocols. © RSNA, 2014.

  10. Peroneal island flap for wound coverage in complex injuries of the lower extremity

    Directory of Open Access Journals (Sweden)

    Fazal A

    2012-01-01

    Full Text Available Akil Fazal1, Haroon-ur-Rashid1, Tahseen Cheema21Section of Orthopedics, Department of Surgery, Aga Khan University, Karachi, Pakistan; 2Department of Orthopedics and Rehabilitation, University of New Mexico, Albuquerque, NM, USABackground: Complex injuries of the lower extremity pose a therapeutic challenge owing to limited availability of local soft tissue for coverage. One option in this region is the pedicled fasciocutaneous flap based on perforators of the peroneal artery. In this case series, we present our experience of the peroneal island pedicled flap for reconstruction of lower extremity wounds.Methods: Records of 18 cases of peroneal island flap admitted consecutively to the Section of Orthopedics at Aga Khan University Hospital from January 1996 to December of 2009 were studied and their outcomes determined.Results: The most common indication for coverage was open wounds due to a road traffic accident (n = 10, followed by burns (n = 3. The most common area exposed was the lower third of the leg followed by the middle third. The tibia was exposed in 11 patients. The flaps ranged in size from 35 cm2 to over 200 cm2. In 13 patients, the flaps healed uneventfully, while in the remaining five there was partial flap necrosis. In four of the latter patients, the residual wound healed with conservative measures only, but the fifth patient required further surgery to achieve acceptable coverage.Conclusion: The peroneal artery flap appears to be a simple, useful, and reliable flap in the armamentarium of the surgeon when planning soft tissue coverage of the lower extremity.Keywords: leg injuries, surgical flaps, lower extremity

  11. Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-07-15

    To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease.

  12. Characteristics of lower extremity work during the impact phase of jumping and weightlifting.

    Science.gov (United States)

    Moolyk, Amy N; Carey, Jason P; Chiu, Loren Z F

    2013-12-01

    Jumping and weightlifting tasks involve impact phases, where work is performed by the lower extremity to absorb energies present at contact. This study compared the lower extremity kinematic and kinetic strategies to absorb energy during the impact phase of jumping and weightlifting activities. Ten women experienced in jumping and weightlifting performed 4 tasks (landing from a jump, drop landing, clean, and power clean) in a motion analysis laboratory. Work performed at the hip, knee, and ankle were calculated during the landing and receiving phases of jumping and weightlifting tasks, respectively. Additionally, segment and joint kinematics and net joint moments were determined. The most lower extremity work was performed in the clean and drop landing, followed by landing from a jump, and the least work was performed in the power clean (p 0.05) but greater in the drop landing and clean (p weightlifting tasks is a large contribution of knee extensor work. Further, the correspondence in kinematics between impact phases of jumping and weightlifting tasks suggests that similar muscular strategies are used to perform both types of activities. Weightlifting tasks, particularly the clean, may be important exercises to develop the muscular strength required for impact actions due to their large knee extensor net joint moments.

  13. Sensitivity to change of mobility measures in musculoskeletal conditions on lower extremities in outpatient rehabilitation settings.

    Science.gov (United States)

    Navarro-Pujalte, Esther; Gacto-Sánchez, Mariano; Montilla-Herrador, Joaquina; Escolar-Reina, Pilar; Ángeles Franco-Sierra, María; Medina-Mirapeix, Francesc

    2018-01-12

    Prospective longitudinal study. To examine the sensitivity of the Mobility Activities Measure for lower extremities and to compare it to the sensitivity of the Physical Functioning Scale (PF-10) and the Patient-Specific Functional Scale (PSFS) at week 4 and week 8 post-hospitalization in outpatient rehabilitation settings. Mobility Activities Measure is a set of short mobility measures to track outpatient rehabilitation progress: its scales have shown good properties but its sensitivity to change has not been reported. Patients with musculoskeletal conditions were recruited at admission in three outpatient rehabilitation settings in Spain. Data were collected at admission, week 4 and week 8 from an initial sample of 236 patients (mean age ± SD = 36.7 ± 11.1). Mobility Activities Measure scales for lower extremity; PF-10; and PSFS. All the Mobility Activities Measure scales were sensitive to both positive and negative changes (the Standardized Response Means (SRMs) ranged between 1.05 and 1.53 at week 4, and between 0.63 and 1.47 at week 8). The summary measure encompassing the three Mobility Activities Measure scales detected a higher proportion of participants who had improved beyond the minimal detectable change (MDC) than detected by the PSFS and the PF-10 both at week 4 (86.64% vs. 69.81% and 42.23%, respectively) and week 8 (71.14% vs. 55.65% and 60.81%, respectively). The three Mobility Activities Measure scales assessing the lower extremity can be used across outpatient rehabilitation settings to provide consistent and sensitive measures of changes in patients' mobility. Implications for rehabilitation All the scales of the Mobility Activities Measure for the lower extremity were sensitive to both positive and negative change across the follow-up periods. Overall, the summary measure encompassing the three Mobility Activities Measure scales for the lower extremity appeared more sensitive to positive changes than the Physical Functioning Scale

  14. MR manifestation of lower extremity rhabdomyolysis caused by crush injury in earthquake

    International Nuclear Information System (INIS)

    Li Zhengyan; Zou Ling; Song Bin; Liu Chang; Sun Jiayu; Zhang Weiwei; Zhang Cuiping

    2008-01-01

    Objective: Rhabdomyolysis (RM) is a common disorder resulting from a large variety of causes. Acute injury is one of the main reasons. The purpose is to describe the MRI manifestations of rhabdomyolysis caused by 5.12 Wenchuan earthquake in Sichuan province and to discuss their importance in diagnosis and treatment of rhabdomyolysison in clinic practice. Methods: Three patients with rhabdomyolysis caused by earthquake were studied via 1.5 T MRI. In all the patients, T 1 and T 2 weighted sequences with and without fat suppression, and short time inversion recovery (STIR) of both lower extremities were obtained in axial, coronal and sagittal planes. All patients were given contrast material during imaging, and MRA (magnetic resonance angiography) of both lower extremity vessels were performed. The MRI characteristics of damaged extremities in 3 cases were studied. Results: MRI showed swelling of the affected muscles and subcutaneous fat tissue on both T 1 and T 2 weighted images. The margins of involved muscles were blurred. On T 1 weighted images, swollen muscles showed equal or slightly decreased intensity with small patterns of increased intensity in some local areas. On T 2 weighted and STIR sequences, the affected muscles showed inhomogeneous increased signal intensity with clearer margin. Slight fluid collection in spatium intermusculare was observed. Contrast-enhanced scanning showed nonhomologous intensification of damaged muscles, the enhancement inside the muscles was decreased when compared with normal muscles. The locations of all these abnormal intensity were correlated with the injury history and clinic physical examinations. MRA showed no lower extremity vessels were affected. Conclusion: MRI has very high sensitivity in detecting the injury of muscles. It's very useful in evaluating the extent and severity of muscles affected in rhabdomyolysis caused by trauma. Also it's very valuable to evaluate the condition of blood vessels in involved extremity

  15. Distribution of lower extremity work during clean variations performed with different effort.

    Science.gov (United States)

    Dæhlin, Torstein E; Krosshaug, Tron; Chiu, Loren Z F

    2018-03-08

    The purpose of this research was to investigate how lower extremity work was distributed during the pull of cleans performed lifting the barbell to the minimum height required to receive it in a full squat (minimal height clean); or with maximum effort to elevate the barbell as high as possible and receiving it in either a full (maximal effort clean) or partial (power clean) squat. Eight weightlifters screened for proficient technique performed these clean variations at 80% of one repetition maximum. Work performed on the barbell and by the lower extremity net joint moments (NJM) was computed from marker trajectories and ground reaction forces. Total barbell work, lower extremity NJM work, knee extensor work, and knee joint excursion during the second pull was lower in the minimal height clean than the maximal effort and power cleans (P < 0.05). This research demonstrates that more knee extensor work is performed in the second pull of maximal effort and power cleans compared to the minimal height clean. The larger knee extensor work performed is due to larger knee joint excursion during the second pull of the maximal effort and power cleans, but not larger knee extensor NJM.

  16. Diagnosis of deep vein thrombosis in the lower extremities. Phlebography versus Doppler sonography

    Energy Technology Data Exchange (ETDEWEB)

    Maurer, H.J.

    1986-02-01

    In this retrospective study, the results of Doppler sonography and phlebography are compared. In about 30% cases the diagnosis of thrombosis made by Doppler sonography could not be confirmed. Agreement was better in patients with acute thrombosis or following pulmonary emboli than in those with a longer history of swelling of the lower extremities. These results agree with the findings of other authors using impedance plethysmography; this also shows lack of agreement in about 30% of the cases.

  17. Validation of the SF-6D Health State Utilities Measure in Lower Extremity Sarcoma

    Directory of Open Access Journals (Sweden)

    Kenneth R. Gundle

    2014-01-01

    Full Text Available Aim. Health state utilities measures are preference-weighted patient-reported outcome (PRO instruments that facilitate comparative effectiveness research. One such measure, the SF-6D, is generated from the Short Form 36 (SF-36. This report describes a psychometric evaluation of the SF-6D in a cross-sectional population of lower extremity sarcoma patients. Methods. Patients with lower extremity sarcoma from a prospective database who had completed the SF-36 and Toronto Extremity Salvage Score (TESS were eligible for inclusion. Computed SF-6D health states were given preference weights based on a prior valuation. The primary outcome was correlation between the SF-6D and TESS. Results. In 63 pairs of surveys in a lower extremity sarcoma population, the mean preference-weighted SF-6D score was 0.59 (95% CI 0.4–0.81. The distribution of SF-6D scores approximated a normal curve (skewness = 0.11. There was a positive correlation between the SF-6D and TESS (r=0.75, P<0.01. Respondents who reported walking aid use had lower SF-6D scores (0.53 versus 0.61, P=0.03. Five respondents underwent amputation, with lower SF-6D scores that approached significance (0.48 versus 0.6, P=0.06. Conclusions. The SF-6D health state utilities measure demonstrated convergent validity without evidence of ceiling or floor effects. The SF-6D is a health state utilities measure suitable for further research in sarcoma patients.

  18. The Effect of Sport Specialization on Lower Extremity Injury Rates in High School Athletes

    OpenAIRE

    McGuine, Timothy A.; Bell, David; Brooks, Margaret Alison; Hetzel, Scott; Pfaller, Adam; Post, Eric

    2017-01-01

    Objectives: Sport specialization has been shown to be associated with increased risk of musculoskeletal lower extremity injuries (LEI) in adolescent athletes presenting in clinical settings. However, the association of sport specialization and incidence of LEI has not been studied prospectively in a large population of adolescent athletes. The objective of this study was to compare the incidence of LEI in high school athletes identified as having low (LOW), moderate (MOD) or high (HIGH) level...

  19. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review

    Science.gov (United States)

    van Gent, R N; Siem, D; van Middelkoop, M; van Os, A G; Bierma‐Zeinstra, S M A; Koes, B W

    2007-01-01

    The purpose of this study was to present a systematic overview of published reports on the incidence and associated potential risk factors of lower extremity running injuries in long distance runners. An electronic database search was conducted using the PubMed–Medline database. Two observers independently assessed the quality of the studies and a best evidence synthesis was used to summarise the results. The incidence of lower extremity running injuries ranged from 19.4% to 79.3%. The predominant site of these injuries was the knee. There was strong evidence that a long training distance per week in male runners and a history of previous injuries were risk factors for injuries, and that an increase in training distance per week was a protective factor for knee injuries. PMID:17473005

  20. Virtual anatomy and movement of lower extremities using virtual reality modeling language

    OpenAIRE

    Kim, D. O.; Kang, H. S.; Kim, J. H.; Min, B. G.

    2000-01-01

    In medical imaging, the use of three-dimensional image is increasing for both educational and diagnostic purposes. With the advent of techniques for browsing a three-dimensional object, it became possible to display three-dimensional images on a personal computer via the Internet. This report describes the construction of a three-dimensional virtual model of human lower extremities that was linked with the data acquired from gait analysis in order to perform threedimensional gait analysis.

  1. Subject-specific musculoskeletal modeling of the lower extremities in persons with unilateral cerebral palsy

    OpenAIRE

    Klets, Olesya

    2011-01-01

    The computational musculoskeletal models that are used to study muscle moment-generating capacities of persons with movement disorders and planning treatment options must be accurate, and take into account the inter-individual variability of musculoskeletal geometry. In Paper I the methods of creating the subject-specific musculoskeletal model of the lower extremities from magnetic resonance images (MRIs) were developed. The subject-specific model was used to analyze hip, knee and ankle muscl...

  2. The Effect of the Weight of Equipment on Muscle Activity of the Lower Extremity in Soldiers

    Directory of Open Access Journals (Sweden)

    Tobias Lindner

    2012-01-01

    Full Text Available Due to their profession and the tasks it entails, soldiers are exposed to high levels of physical activity and strain. This can result in overexertion and pain in the locomotor system, partly caused by carrying items of equipment. The aim of this study was to analyse the extent of muscle activity in the lower extremities caused by carrying specific items of equipment. For this purpose, the activity of selected groups of muscles caused by different items of equipment (helmet, carrying strap, backpack, and rifle in the upper and lower leg was measured by recording dynamic surface electromyograms. Electrogoniometers were also used to measure the angle of the knee over the entire gait cycle. In addition to measuring muscle activity, the study also aimed to determine out what influence increasing weight load has on the range of motion (ROM of the knee joint during walking. The activity of recorded muscles of the lower extremity, that is, the tibialis anterior, peroneus longus, gastrocnemius lateralis, gastrocnemius medialis, rectus femoris, and biceps femoris, was found to depend on the weight of the items of equipment. There was no evidence, however, that items of equipment weighing a maximum of 34% of their carrier’s body weight had an effect on the ROM of the knee joint.

  3. New Methods of Treatment for Trophic Lesions of the Lower Extremities in Patients with Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    S.V. Bolgarska

    2016-08-01

    Full Text Available Introduction. Complications in the form of trophic ulcers of the lower extremities are one of the serious consequences of diabetes mellitus (DM, as they often lead to severe health and social problems, up to high amputations. The aim of the study was the development and clinical testing of diagnostic and therapeutic algorithm for the comprehensive treatment of trophic ulcers of the lower extremities in patients with DM. Materials and methods. Here are presented the results of treatment of 63 patients (42 women and 21 men with neuropathic type of trophic lesions of the lower limbs or postoperative defects at the stage of granulation. Of them, 32 patients (study group received local intradermal injections of hyaluronic acid preparations and sodium succinate (Lacerta into the extracellular matrix. Patients of the comparison group were treated with hydrocolloid materials (hydrocoll, granuflex. The level of glycated hemoglobin, the degree of circulatory disorders (using ankle brachial index, before and after the test with a load and neuropathic disorders (on a scale for the evaluation of neurologic dysfunctions — NDS were assessed in patients. Results. The results of treatment were assessed by the rate of defect healing during 2 or more months. In the study group, 24 patients showed complete healing of the defect (75 %, while in the control group the healing was observed in 16 patients (51.6 %. During the year, relapses occurred in 22.2 % of cases in the study group, and in 46.9 % — in the control one (p < 0.05. Conclusion. The developed method of treatment using Lacerta allowed to increase the effectiveness of therapy, to speed recovery, to decrease a number of complications in patients with DM and trophic ulcers of the lower extremities.

  4. The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review.

    Science.gov (United States)

    Ashrafi, Mohammed; Alonso-Rasgado, Teresa; Baguneid, Mohamed; Bayat, Ardeshir

    2017-02-01

    Current gold standard lower extremity cutaneous wound management is not always effective. Cutaneous wounds generate a "current of injury" which is directly involved in wound healing processes. Application of exogenous electrical stimulation has been hypothesised to imitate the natural electric current that occurs in cutaneous wounds. The aim of this extensive review was to provide a detailed update on the variety of electrical stimulation modalities used in the management of lower extremity wounds. Several different waveforms and delivery methods of electrical stimulation have been used. Pulsed current appears superior to other electrical modalities available. The majority of studies support the beneficial effects of pulsed current over conservative management of lower extremity cutaneous wounds. Although it appears to have no benefit over causal surgical intervention, it is a treatment option which could be utilised in those patients unsuitable for surgery. Other waveforms and modalities appear promising; however, they still lack large trial data to recommend a firm conclusion with regards to their use. Current studies also vary in quantity, quality and protocol across the different modalities. The ideal electrical stimulation device needs to be non-invasive, portable and cost-effective and provides minimal interference with patients' daily life. Further studies are necessary to establish the ideal electrical stimulation modality, parameters, method of delivery and duration of treatment. The development and implementation of newer devices in the management of acute and chronic wounds provides an exciting direction in the field of electrotherapy. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  5. Training Shoes do not Decrease the Negative Work of the Lower Extremity Joints.

    Science.gov (United States)

    Hashizume, Satoru; Murai, Akihiko; Hobara, Hiroaki; Kobayashi, Yoshiyuki; Tada, Mitsunori; Mochimaru, Masaaki

    2017-11-01

    Different types of running shoes may have different influence on the negative work of each lower extremity joint. Clarifying this influence can reduce the potential risk of muscle injury. The present study examined the difference in the negative work and associated kinetic and kinematic parameters of the lower extremity joints between training shoes and racing flats during the contact phase of running. Participants were asked to run on a runway at a speed of 3.0 m·s -1 for both training shoes and racing flats. The negative work and associated kinetic and kinematic parameters of each lower extremity joint were calculated. No difference was found in the negative work of the hip and ankle joints between the two types of running shoes. Meanwhile, the negative work of the knee joint was significantly greater for training shoes than for racing flats. This aspect was related to a longer duration of the negative power of the knee joint with the invariant amplitude of the negative power, moment, and angular velocity. These results suggest a higher potential risk of muscle injury around the knee joint for training shoes than for racing flats. © Georg Thieme Verlag KG Stuttgart · New York.

  6. The effects of band exercise using proprioceptive neuromuscular facilitation on muscular strength in lower extremity.

    Science.gov (United States)

    Rhyu, Hyun-Seung; Kim, Su-Hyun; Park, Hye-Sang

    2015-02-01

    The purpose of this study was to examine whether a six-week elastic band exercise program using proprioceptive neuromuscular facilitation (PNF) can increase isotonic strength of abductor muscles in the lower extremity. Twenty-eight healthy students from S university were divided into an experimental group and control group. Each group was participated in pre and post-measurement in isotonic strength using an isotonic analyzer, En-treeM. Experimental group performed elastic band exercise using PNF pattern for a six-weeks, in contrast, control group did not take any exercise. In the results of this study, isotonic strength measurements of abductor muscles in lower extremity in experimental group were significantly different after exercise, but control group did not show any significant changes. Therefore, we hope that resistive exercise would be very valuable for healthy people as well as the old people with weakened muscle strength.

  7. Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity

    OpenAIRE

    Peters, Heather T.; Dunning, Kari; Belagaje, Samir; Kissela, Brett M.; Ying, Jun; Laine, Jarmo; Page, Stephen J.

    2017-01-01

    Objectives. (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the a...

  8. Validity of the lower extremity functional movement screen in patients with chronic ankle instability

    OpenAIRE

    Choi, Ho-Suk; Shin, Won-Seob

    2015-01-01

    [Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen includ...

  9. Attribution of extreme precipitation in the lower reaches of the Yangtze River during May 2016

    Science.gov (United States)

    Li, Chunxiang; Tian, Qinhua; Yu, Rong; Zhou, Baiquan; Xia, Jiangjiang; Burke, Claire; Dong, Buwen; Tett, Simon F. B.; Freychet, Nicolas; Lott, Fraser; Ciavarella, Andrew

    2018-01-01

    May 2016 was the third wettest May on record since 1961 over central eastern China based on station observations, with total monthly rainfall 40% more than the climatological mean for 1961–2013. Accompanying disasters such as waterlogging, landslides and debris flow struck part of the lower reaches of the Yangtze River. Causal influence of anthropogenic forcings on this event is investigated using the newly updated Met Office Hadley Centre system for attribution of extreme weather and climate events. Results indicate that there is a significant increase in May 2016 rainfall in model simulations relative to the climatological period, but this increase is largely attributable to natural variability. El Niño years have been found to be correlated with extreme rainfall in the Yangtze River region in previous studies—the strong El Niño of 2015–2016 may account for the extreme precipitation event in 2016. However, on smaller spatial scales we find that anthropogenic forcing has likely played a role in increasing the risk of extreme rainfall to the north of the Yangtze and decreasing it to the south.

  10. Comparison of Intact Knee Cartilage Thickness in Patients with Traumatic Lower Extremity Amputation and Nonimpaired Individuals.

    Science.gov (United States)

    Kesikburun, Serdar; Köroğlu, Özlem; Yaşar, Evren; Güzelküçük, Ümüt; Yazcoğlu, Kamil; Tan, Arif Kenan

    2015-08-01

    The aim of this study was to assess the femoral articular cartilage thickness of the intact knee in patients with traumatic lower extremity amputation compared with nonimpaired individuals. A total of 30 male patients with traumatic lower extremity amputation (mean [SD] age, 31.2 [6.3] yrs) and a random sample of 53 age-matched and body mass index-matched male nonimpaired individuals (mean [SD] age, 29.8 [6.3] yrs) participated in the study. Exclusion criteria were age younger than 18 yrs, history of significant knee injury, previous knee surgery, or rheumatic disease. The femoral articular cartilage thickness was measured using ultrasound at the midpoints of the medial condyle, the intercondylar notch, and the lateral condyle. Ultrasonographic cartilage measurement was performed on the intact side of the patients with amputation and on both sides of the nonimpaired individuals. The femoral articular cartilage thickness of the intact knees of the patients with amputation was significantly decreased at the lateral and medial condyles compared with the nonimpaired individuals (P amputation and the nonimpaired individuals (P > 0.05). There was a premature cartilage loss in the intact limb knee of the patients with traumatic amputation. This result supports the view that patients with traumatic lower extremity amputation are at increased risk for developing knee osteoarthritis in the intact limb.

  11. Lower extremity necrotizing fasciitis: A unique initial presentation of Crohn's disease

    Directory of Open Access Journals (Sweden)

    Anna Weiss

    2015-09-01

    Full Text Available Crohn's disease is a disease of the bowel, typically presenting with diarrhea, weight loss, and abdominal pain. Complications such as abscesses, fistulas, and strictures may require surgical intervention. We would like to report a patient with Crohn's disease who presented for the first time with left lower extremity necrotizing fasciitis. There are very few reports of necrotizing fasciitis in Crohn's disease as the initial presentation.

  12. Changes of the intensity of morphogenetic process in the bone skeleton under lowering of gravitational loading

    Science.gov (United States)

    Vasilievna Rodionova, Natalia; Zolotova-Haidamaka, Nadezhda

    The development of long skeleton bones and reconstruction of bone structures in ontogenesis during adaptive remodeling are performed due to a combination of the bone apposition and bone resorption processes. With the use of radioactive markers of specific biosyntheses -3H- thymidine and 3H-glycine we studied the dynamics and peculiarities of these processes under modeling microgravity conditions by unloading the hind limbs of young white rats (tail suspension method) during 28 days. The radionuclides were administered in a single dose at the end of the experiment and the biomaterial was taken 1, 24, 48, 120 and 192 h. after injection. In histoautographs the counts were made of a nuclei labeling index (3H-thymidine), of the number of silver grains over the cells and in the forming bone matrix in growth and remodeling zones of the femoral bone (3H-glycine). The tendency for a reduction of a labeling index in the 3H-thymidine-labeled osteogenic cells in the periost and endost has been established. The dynamics of labeled cells following various intervals after 3H-thymidine injection testifies to a delay in the rates of osteoblasts' differentiation and their transformation to osteocytes in the experiment animals. 3H-glycine is assimilated by osteogenic cells 30 min after the radionuclide injection and following 24 h. it is already incorporated into the forming bone matrix. As a result an appositional bone addition by 192 h. the silver grains are registered in the bone matrix as "labeling lines". A lower 3H-glycine uptake by the osteogenic cells and bone matrix as compared with a control is indicative of a decrease of the osteoplastic process under hypokinesia, particulary in the periost. At the same time the resorption and remodeling bone zones reveal regions of an intensive 3H-glycine uptake after 1 and 24 h. We associate this latter fact with an activation of collagen proteins in the differentiating fibroblasts (instead of osteoblasts) in these locations. This is

  13. Lower Extremity Arterial Calcification as a Predictor of Coronary Atherosclerosis in Patients with Peripheral Arterial Disease

    International Nuclear Information System (INIS)

    Shin, Hwa Seon; Jung Park, Mi; Nyeo Jeon, Kyung; Min Cho, Jae; Soo Bae, Kyung; Seob Choi, Dae; Boem Na, Jae; Cheol Choi, Ho; Young Choi, Hye; Eun Kim, Ji; Bueum Cho, Soo; Eun Park, Sung

    2016-01-01

    Until now, there has been no study on the relationship between the calcification of the lower extremity arteries and significant coronary arterial disease (CAD). To evaluate whether lower extremity calcium scores (LECS) are associated with CAD and whether this can predict multivessel-CAD in patients with peripheral arterial disease (PAD). We retrospectively enrolled 103 PAD patients without cardiac symptoms or known CAD. All patients underwent cardiac computed tomography (CT) and lower extremity CT within 1 month and were categorized as nonsignificant CAD, single-CAD, or multivessel-CAD. The coronary calcium scores (CCS) were quantitatively measured according to the Agatston method and LECS were semi-quantitatively measured according to the presence of lower extremity calcification in the segment. The extent of CAD was evaluated according to the presence of ≥ 50% luminal diameter stenosis in the segment of CAD. LECS in multivessel-CAD were significantly higher than those in nonsignificant CAD (10.0 ± 5.8 versus 4.0 ± 3.1, P < 0.001). LECS significantly correlated with CCS (r = 0.831, P < 0.001) and the extent of CAD (r = 0.631, P < 0.001). Multivariate regression analysis demonstrated LECS and log-transformed CCS were independent predictors for multivessel-CAD. In receiver operating characteristic curve analysis, the diagnostic performance of LECS was 0.807 (95% confidence interval = 0.724-0.891, P < 0.001) for predicting multivessel-CAD. Peripheral arterial calcification is significantly correlated with CAD extent in patients with PAD. Peripheral arterial calcification can be a useful marker for predicting multivessel-CAD

  14. Enhanced MR angiography of the lower extremities with synergy spine coil

    International Nuclear Information System (INIS)

    Takashima, Hiroyuki; Watanabe, Naoki

    2002-01-01

    A synergy spine coil is a phased-array coil designed for spine imaging. The coil's sensitive area is narrow in both the x-axis and y-axis directions but very wide in the z-axis direction. It is therefore suitable for using in long parts of the body, such as the spine. We used the coil for enhanced MR angiography in the lower extremities, which requires a very long field of view on the z-axis direction. Using on the NEMA (National Electrical Manufacturers Association) standard test for special-purpose coils, the sensitive volume of the synergy spine coil was first measured by using a phantom. It was found that the sensitive lengths along x-axis and y-axis were 300 mm and 120 mm, respectively, while that along z-axis could set at any length required for the examination by modifying the element number. The above area was confirmed to be sufficient for obtaining enhanced MR angiograms of the lower extremities. The results of this study showed the use of the synergy spine coil in enhanced MR angiography of the lower extremities is superior to the use of a conventional whole body coil for obtaining good MR angiograms with a good single-to-noise ratio (SNR). (author)

  15. Clinical and functional outcomes of acute lower extremity compartment syndrome at a Major Trauma Hospital.

    Science.gov (United States)

    Lollo, Loreto; Grabinsky, Andreas

    2016-01-01

    Acute lower extremity compartment syndrome (CS) is a condition that untreated causes irreversible nerve and muscle ischemia. Treatment by decompression fasciotomy without delay prevents permanent disability. The use of intracompartmental pressure (iCP) measurement in uncertain situations aids in diagnosis of severe leg pain. As an infrequent complication of lower extremity trauma, consequences of CS include chronic pain, nerve injury, and contractures. The purpose of this study was to observe the clinical and functional outcomes for patients with lower extremity CS after fasciotomy. Retrospective chart analysis for patients with a discharge diagnosis of CS was performed. Physical demographics, employment status, activity at time of injury, injury severity score, fracture types, pain scores, hours to fasciotomy, iCP, serum creatine kinase levels, wound treatment regimen, length of hospital stay, and discharge facility were collected. Lower extremity neurologic examination, pain scores, orthopedic complications, and employment status at 30 days and 12 months after discharge were noted. One hundred twenty-four patients were enrolled in this study. One hundred and eight patients were assessed at 12 months. Eighty-one percent were male. Motorized vehicles caused 51% of injuries in males. Forty-one percent of injuries were tibia fractures. Acute kidney injury occurred in 2.4%. Mean peak serum creatine kinase levels were 58,600 units/ml. Gauze dressing was used in 78.9% of nonfracture patients and negative pressure wound vacuum therapy in 78.2% of fracture patients. About 21.6% of patients with CS had prior surgery. Nearly 12.9% of patients required leg amputation. Around 81.8% of amputees were male. Sixty-seven percent of amputees had associated vascular injuries. Foot numbness occurred in 20.5% of patients and drop foot palsy in 18.2%. Osteomyelitis developed in 10.2% of patients and fracture nonunion in 6.8%. About 14.7% of patients underwent further orthopedic surgery

  16. Primary chronic venous insufficiency of the lower extremities: preoperative color duplex Doppler ultrasound study

    International Nuclear Information System (INIS)

    Selfa, S.; Diago, T.; Ricart, M.; Chulia, R.; Martin, F.

    2000-01-01

    To asses the role of color duplex Doppler ultrasound (CDU) in the preoperative study of patients with varicose veins in lower extremities. We employed CDU to examine varicose veins in 342 lower limbs, assessing reflux in saphenous veins (SV), deep venous system (DVS) and perforating veins (PV). We analyzed the relationship between the anatomical extent of the reflux and the clinical findings. Insufficiency of the superficial venous system alone was uncommon, occurring in only 10.8% of the limbs examined. Reflux was observed in SV and PV in 48.2% of the legs. It was detected in all three systems in 29.2% of cases. The presence of reflux in more than one system and more than one value was associated with increased clinical severity. The site of venous reflux in lower extremities with varicose veins varies. Greater clinical severity is observed in the presence of more marked reflux in the DVS and PV. CDU provides anatomic and functional data on the three venous systems of the lower limbs, allowing an individualized therapeutic surgery. Preoperative localization of incompetent PV by means of CDU facilities their ligation. CDU is the technique of choice for the preoperative examination of the venous systems of patients with varicose veins. (Author)

  17. Early versus delayed amputation in the setting of severe lower extremity trauma.

    Science.gov (United States)

    Williams, Zachary F; Bools, Lindsay M; Adams, Ashley; Clancy, Thomas V; Hope, William W

    2015-06-01

    Leg-threatening injuries present patients and clinicians with the difficult decision to pursue primary amputation or attempt limb salvage. The effects of delayed amputation after failed limb salvage on outcomes, such as prosthetic use and hospital deposition, are unclear. We evaluated the timing of amputations and its effects on outcomes. We retrospectively reviewed all trauma patients undergoing lower extremity amputation from January 1, 2000 through December 31, 2010 at a Level 2 trauma center. Patients undergoing early amputation (amputation within 48 hours of admission) were compared with patients undergoing late amputation (amputations >48 hours after admission). Patient demographics, injury specifics, operative characteristics, and outcomes were documented. During the 11-year study period, 43 patients had a lower extremity amputation and 21 had early amputations. The two groups were similar except for a slightly higher Mangled Extremity Severity Score in the early amputation group. Total hospital length of stay significantly differed between groups, with the late amputation group length of stay being nearly twice as long. The late amputation group had significantly more ipsilateral leg complications than the early group (77% vs 15%). There was a trend toward more prosthetic use in the early group (93%vs 57%, P = 0.07). Traumatic lower extremity injuries requiring amputation are rare at our institution (0.3% incidence). Regardless of the amputation timing, most patients were able to obtain a prosthetic. Although the late group had a longer length of hospital stay and more local limb complications, attempted limb salvage still appears to be a viable option for appropriately selected trauma patients.

  18. Clinical characteristics and survival of patients with diabetes mellitus following non-traumatic lower extremity amputation.

    Science.gov (United States)

    Wiessman, Maya Paryente; Liberty, Idit F; Segev, Renana Wilkof; Katz, Tiberiu; Abu Tailakh, Muhammad; Novack, Victor

    2015-03-01

    Diabetes mellitus-related lower extremity amputation is a major complication severely affecting patient survival and quality of life. To analyze epidemiological and clinical trends in the incidence and survival of lower extremity amputations among diabetes patients. We conducted a retrospective observational cohort study of 565 consecutive diabetes patients who underwent their first non-traumatic lower extremity amputation between January 2002 and December 2009. Major amputations were performed in 316 (55.9%) patients: 142 above the knee (25.1%) and 174 below (30.8%); 249 (44.1%) had a minor amputation. The incidence rates of amputations decreased from 2.9 to 2.1 per 1000 diabetes patients. Kaplan-Meier survival analysis showed that first year mortality rates were lower among patients with minor amputations (31.7% vs. 39.6%, P = 0.569). First year mortality rates following below-knee amputation were somewhat lower than above-knee amputation (33.1 vs. 45.1%, respectively). Cox regression model of survival at 1 year after the procedure found that age (HR 1.06 per year, 95% CI 1.04-1.07, P amputation (HR 1.36, 95% CI 1.01-1.83, P = 0.045) and ischemic heart disease (HR 1.68, 95% CI 1.26-2.24, P traumatic amputations in diabetes patients between January 2002 and December 2009 decreased slightly. However, one year mortality rates after the surgery did not decline and remained high, stressing the need for a multidisciplinary effort to prevent amputations in diabetes patients.

  19. Complication of venous thrombosis of the lower extremities with pulmonary embolism

    International Nuclear Information System (INIS)

    Suzuki, Teruyasu; Morita, Rikushi

    1993-01-01

    We studied the relationship between the complication of the pulmonary embolism and the localization of the venous thrombus in the lower extremities using Tc-99m macroaggregated albumin (MAA) venography. Tc-99m MAA venography clearly demonstrated most of the deep and superficial veins from the leg to the pelvis and the abdomen. The incidence of venous thrombosis was highest in the pelvic veins (28.8%), and second in the superficial leg veins (10.9%). The complication of pulmonary embolism was highest in the pelvic venous thrombosis (20.4%), and second in the femoral venous thrombosis (16.0%). (author)

  20. Effects of repetitive transcranial magnetic stimulation on lower extremity spasticity and motor function in stroke patients.

    Science.gov (United States)

    Rastgoo, Maryam; Naghdi, Sofia; Nakhostin Ansari, Noureddin; Olyaei, Gholamreza; Jalaei, Shohreh; Forogh, Bijan; Najari, Hamidreza

    2016-09-01

    To investigate the effect of low-frequency repetitive transcranial magnetic stimulation (rTMS) on lower extremity (LE) spasticity, motor function and motor neurone excitability in chronic stroke patients. This study was a randomised sham-controlled cross-over trial with 1-week follow-up. A total of 20 post-stroke patients were randomised to receive active (n = 10) or sham (n = 10) rTMS. Fourteen of them (7 in each group) crossed over to the sham or active rTMS after a washout period of 1 month. Interventions consist of five consecutive daily sessions of active or sham rTMS to the unaffected lower extremity motor area (1000 pulses; 1 Hz; 90% of the tibialis anterior motor threshold). Outcome measures were modified modified ashworth scale (MMAS), the H-reflex, lower extremity section of Fugl-Mayer assessment (LE-FMA) and timed UP and GO (TUG) test. All outcomes were measured at three levels in each intervention period: pre- and post-intervention and 1-week follow-up. Friedman's test revealed significant improvement in MMAS score only after active rTMS. This improvement lasted for one week after the active rTMS. Repeated measure analysis of variance (ANOVA) showed significant time*intervention interaction for LE-FMA. There are no differences between groups for the MMAS and LE-FMA. No significant change in Hmax/Mmax ratio and TUG test was noted. Low-frequency rTMS over the LE motor area can improve clinical measures of muscle spasticity and motor function. More studies are needed to clarify the changes underlying this improvement in spasticity. Implications for Rehabilitation Spasticity is a common disorder and one of the causes of long-term disability after stroke. Physical therapy modalities, oral medications, focal intervention and surgical procedures have been used for spasticity reduction. Beneficial effect of the repetitive transcranial magnetic stimulation (rTMS) for post-stroke upper extremity spasticity reduction and motor function improvement was

  1. The usefulness of color doppler ultrasound in diagnosing venous diseases of lower extremity: a comparison with DSA

    International Nuclear Information System (INIS)

    Zhang Yamei; Wang Shuzhi; Gu Jianpig; Chen Songwang; Huang Yan

    2009-01-01

    Objective: To evaluate the color Doppler ultrasound in diagnosing venous diseases of lower extremity, and to compare it with DSA.Methods: By using color Doppler ultrasound (CDUS) apparatus, two-dimensional spectrum, color Doppler flow image, pulse wave Doppler and Valsalva examination were performed in 48 patients with suspected venous diseases of lower extremity. The CDUS findings were compared with DSA findings. Results: Of 48 cases with suspected lower extremity venous diseases, deep vein thrombosis formation was confirmed in 27, among them 15 were accompanied with lower extremity deep venous valvular incompetence, 8 were complicated by lower extremity varicosity and 2 were associated with both conditions. Another one had cyst in the left popliteal fossa and popliteal venous thrombosis. Decreased blood flow in iliac veins was found in some cases. Pure lower extremity venous valvular incompetence was seen in 5 cases and pure lower extremity superficial varicosity in 6 cases. Six cases suffered both valvular incompetence and superficial varicosity. CDUS showed normal findings in 4 cases, of them DSA demonstrated compressed iliac vein in 2. When taking DSA as golden standard, the accuracy of CDUS was 95.83%. By using the uniformity test, Kappa value was 0.65. Conclusion: CDUS is of great clinical usefulness in diagnosing venous diseases of lower extremity as well as in evaluating the therapeutic effect. (authors)

  2. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    Science.gov (United States)

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  3. The effects of anesthetic technique and ambient temperature on thermoregulation in lower extremity surgery.

    Science.gov (United States)

    Ozer, Ayse B; Tosun, Fadime; Demirel, Ismail; Unlu, Serap; Bayar, Mustafa K; Erhan, Omer L

    2013-08-01

    The purpose of our study was to determine the effects of anesthetic technique and ambient temperature on thermoregulation for patients undergoing lower extremity surgery. Our study included 90 male patients aged 18-60 years in American Society of Anesthesiologists Physical Status groups I or II who were scheduled for lower extremity surgery. Patients were randomly divided into three groups according to anesthetic technique: general anesthesia (GA), epidural anesthesia (EA), and femoral-sciatic block (FS). These groups were divided into subgroups according to room temperature: the temperature for group I was 20-22 °C and that for group II was 23-25 °C. Therefore, we labeled the groups as follows: GA I, GA II, EA I, EA II, FS I, and FS II. Probes for measuring tympanic membrane and peripheral temperature were placed in and on the patients, and mean skin temperature (MST) and mean body temperature (MBT) were assessed. Postoperative shivering scores were recorded. During anesthesia, tympanic temperature and MBT decreased whereas MST increased for all patients. There was no significant difference between tympanic temperatures in either the room temperature or anesthetic method groups. MST was lower in group GA I than in group GA II after 5, 10, 15, 20, 60 and 90 min whereas MBT was significantly lower at the basal level (p temperature affected thermoregulation in Group GA.

  4. A review of the risk factors for lower extremity overuse injuries in young elite female ballet dancers.

    Science.gov (United States)

    Bowerman, Erin Anne; Whatman, Chris; Harris, Nigel; Bradshaw, Elizabeth

    2015-06-01

    The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.

  5. Beckwith-Wiedemann Syndrome and Primary Lymphedema of the Lower Extremity.

    Science.gov (United States)

    Beijnen, Usha E A; Maclellan, Reid A; Goss, Jeremy A; Couto, Javier A; Konczyk, Dennis J; Greene, Arin K

    2017-01-01

    Beckwith-Wiedemann syndrome is the most common genetic overgrowth syndrome. Patients with Beckwith-Wiedemann syndrome may have hemihypertrophy, but their lymphatic vasculature is intact. We present a child with Beckwith-Wiedemann syndrome and lower extremity enlargement thought to be due to hemihypertrophy that was instead diagnosed with primary lymphedema. There are many causes of leg overgrowth in the pediatric population and misdiagnosis is common. While extremity enlargement secondary to hemihypertrophy may occur in 15% of patients with Beckwith-Wiedemann syndrome, progression and pitting edema only occur in primary lymphedema. This report highlights the importance of ensuring an accurate diagnosis so that patients are managed appropriately. © 2016 Wiley Periodicals, Inc.

  6. Inter-rater reliability for measurement of passive physiological movements in lower extremity joints is generally low: a systematic review.

    NARCIS (Netherlands)

    Trijffel, E. van; Pol, R.J. van de; Oostendorp, R.A.B.; Lucas, C.

    2010-01-01

    QUESTION: What is the inter-rater reliability for measurements of passive physiological or accessory movements in lower extremity joints? DESIGN: Systematic review of studies of inter-rater reliability. PARTICIPANTS: Individuals with and without lower extremity disorders. OUTCOME MEASURES: Range of

  7. Catheter-directed thrombolysis of below-knee deep venous thrombosis of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk; Sohn, Young Jun; Heo, Eun A; Cho, Hyun Sun; Park, Seong Hoon; Lee, Young Hwan [Wonkwang University Hospital, Iksan (Korea, Republic of)

    2008-02-15

    To evaluate the technical feasibility and clinical efficacy of the use of local thrombolysis for below-knee deep vein thrombosis (DVT). From a population of 41 patients with a lower extremity DVT, the prospective clinical trial included 11 patients (7 female, 4 male, average age 61.4 years) treated with catheter-directed thrombolysis with urokinase for below-knee DVT. After removal of the proximal ilofemoral DVT, additional interventional procedures to remove the residual thrombosis and restore the venous flow from the below-knee vein were performed in cases of continuous occlusion of venous flow from the popliteal and tibial veins. Under ultrasound (US) guidance, catheter-directed thrombolysis with urokinase was performed through the ipsilateral popliteal vein. After administration of oral anticoagulation therapy, CT and venography were performed to identify patency and the presence of a recurrent thrombosis. Successful removal of the thrombus and restoration of venous flow were achieved in all of the patients (100%). Restoration of flow with a residual thrombus occurred in one case. Focal venous stenosis was discovered in four cases. The duration of urokinase infusion was 1-4 days (average 2.36 days), which was considered long. For 15.2 months, the venous lumen of all cases was preserved without a recurrent thrombosis. Catheter-directed thrombolysis is an effective procedure for recanalization of below-knee DVT in patients with a lower extremity DVT.

  8. [Methicillin resistant Staphylococcus aureus infection postoperatory complications and prognosis of patients with lower extremity amputations].

    Science.gov (United States)

    del Río-Solá, M Lourdes; San Norberto-García, Enrique; González-Fajardo, José A; Carrera-Díaz, Santiago; Gutiérrez-Alonso, Vicente; Vaquero-Puerta, Carlos

    2006-02-04

    Methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increasing morbimortality when compared with other microorganisms. The aim of this study was to examine the complications and prognosis of the presence of MRSA in vascular patients with amputation of lower limbs. We included patients who had lower extremity amputation in our department in 2004 and displayed positive surgical wounds cultures. We compared patients with MRSA positive cultures with other microrganisms. We evaluated general characteristics, operative indications, surgical wounds microbiology, reamputations, morbimortality and mean time of stay in hospital. 117 patients (median age 73, 68% male) underwent lower extremity amputation. 82 of them had positive cultures and MRSA were isolated in 30% cases. Two two groups were comparable and no statistical differences were found in relation to reamputation rate, morbimortality and mean time of stay in hospital. Presence of MRSA does not represent an additional risk of reamputation or an increase of postoperative complications. Careful wound surveillance, through wound debridement and optimal administration of antibiotics must be applied to all patients, regardless of the bacterial flora.

  9. FDG-PET imaging of lower extremity muscular activity during level walking

    Energy Technology Data Exchange (ETDEWEB)

    Oi, Naoyuki; Iwaya, Tsutomu; Tobimatsu, Yoshiko; Fujimoto, Toshihiko [Tohoku Univ., Sendai (Japan). Graduate School of Medicine; Itoh, Masatoshi; Yamaguchi, Keiichiro [Tohoku Univ., Sendai (Japan). Cyclotron and Radioisotope Center

    2003-07-01

    We analyzed muscular activity of the lower extremities during level walking using positron emission tomography (PET) with {sup 18}F-fluorodeoxyglucose ({sup 18}F-FDG). We examined 17 healthy male subjects; 11 were assigned to a walking group and 6 to a resting group. After {sup 18}F-FDG injection, the walking group subjects walked at a free speed for 15 min. A whole-body image was then obtained by a PET camera, and the standardized uptake ratio (SUR) was computed for each muscle. The SUR for each muscle of the walking group was compared with that for the corresponding muscles in the resting group. The level of muscular activity of all the muscles we examined were higher during level walking than when resting. The activity of the lower leg muscles was higher than that of the thigh muscles during level walking. The muscular activity of the soleus was highest among all the muscles examined. Among the gluteal muscles, the muscular activity of the gluteus minimus was higher than that of the gluteus maximus and gluteus medius. The concurrent validity of measuring muscular activity of the lower extremity during level walking by the PET method using {sup 18}F-FDG was demonstrated. (author)

  10. Standardization of care in patients with lower extremity ulcers venous etiology

    Directory of Open Access Journals (Sweden)

    Diego López Muñoz

    2012-11-01

    Full Text Available The ulcer of the lower extremity is a common chronic disease process in daily practice, in which there is wide variability in treatment. Venous ulcers account for 70% of all vascular ulcers. They occur mainly as there is a valve dysfunction as a result of venous incompetence in the lower limbs. Due to the impact they pose is necessary to apply a corrective treatment and also to demonstrate effectiveness in repairing these ulcers. Our goals are to unify and standardize criteria for action by nursing language records and all perform a standardization of care for these patients. This has been an analysis of the needs of care in patients with ulcers of the lower extremity venous etiology methodology by applying nurse. The patient assessment is made by functional health patterns of M. Gordon, for the diagnosis, interventions and outcome criteria necessary use the NNN taxonomy (NANDA-NIC-NOC. We obtained a total of 3 major diagnostic labels, encoded according to NANDA taxonomy for nursing care quality required 13 interventions. Plant 5 outcome criteria to evaluate the effectiveness and quality of nurse activity. Standardized care plans are a valuable tool. Its use ensures that share a common language, unified performance criteria, achieved quality care for our patients.

  11. [The influence of ozone therapy on endothelial damage markers in patients with atherosclerosis of lower extremities].

    Science.gov (United States)

    Rość, D; Ponikowska, I; Paczuski, R; Włodarczyk, K; Zastawna, E; Michalski, A

    1999-03-01

    The aim of study was to evaluate the influence of the treatment with oxygen-ozone mixture on the blood plasma antigen concentration of tissue plasminogen activator (t-PA) and von Willebrand factor (vWF) in patients suffering from atherosclerotic disease of lower extremities. The study was performed in the group of 28 (M/F 22/6) patients means aged 64.1 years with atherosclerotic diseases of lower extremities, in whom 2 weeks therapy with oxygen-ozone mixture was used. The control group consisted of 30 healthy volunteers in mean age 51.0 years. In the blood plasma obtained from the patients before and after treatment with oxygen-ozone mixture and from the control group determinations of t-PA and vWF antigen using ELISA were done. Both parameters were significantly increased in the patients before the treatment in comparison to the healthy controls. The treatment with oxygen-ozone therapy caused in patients slight statistically not significant raise of t-PA and vWF antigen showing the endothelial stimulation but not the destruction of vascular endothelium.

  12. Lower Extremity Muscle Activation and Kinematics of Catchers When Throwing Using Various Squatting and Throwing Postures

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    Yi-Chien Peng, Kuo-Cheng Lo, Lin-Hwa Wang

    2015-09-01

    Full Text Available This study investigated the differences in joint motions and muscle activities of the lower extremities involved in various squatting postures. The motion capture system with thirty-one reflective markers attached on participants was used for motion data collection. The electromyography system was applied over the quadriceps, biceps femoris, tibialis anterior, and gastrocnemius muscles of the pivot and stride leg. The joint extension and flexion in wide squatting are greater than in general squatting (p = 0.005. Knee joint extension and flexion in general squatting are significantly greater than in wide squatting (p = 0.001. The adduction and abduction of the hip joint in stride passing are significantly greater than in step squatting (p = 0.000. Furthermore, the adduction and abduction of the knee joint in stride passing are also significantly greater than in step squatting (p = 0.000. When stride passing is performed, the muscle activation of the hamstring of the pivot foot in general squatting is significantly greater than in wide squatting (p < 0.05, and this difference continues to the stride period. Most catchers use a general or wide squatting width, exclusive of a narrow one. Therefore, the training design for strengthening the lower extremity muscles should consider the appropriateness of the common squat width to enhance squat-up performance. For lower limb muscle activation, wide squatting requires more active gastrocnemius and tibialis anterior muscles. Baseball players should extend the knee angle of the pivot foot before catching the ball.

  13. Bilateral lower extremity hyperkeratotic plaques: a case report of ichthyosis vulgaris

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    Leight H

    2015-09-01

    Full Text Available Hayley Leight, Zachary Zinn, Omid JalaliDepartment of Dermatology, West Virginia University, Morgantown, WV, USA Abstract: Here, we report a case of a middle-aged woman presenting with severe, long-standing, hyperkeratotic plaques of the lower extremities unrelieved by over-the-counter medications. Initial history and clinical findings were suggestive of an inherited ichthyosis. Ichthyoses are genetic disorders characterized by dry scaly skin and altered skin-barrier function. A diagnosis of ichthyosis vulgaris was confirmed by histopathology. Etiology, prevalence, and treatment options are discussed. Keywords: filaggrin gene, FLG, profilaggrin, keratohyalin granules, hyperkeratosis

  14. Sports-related muscle injuries of the lower extremity: MR imaging appearances

    International Nuclear Information System (INIS)

    Sanchez-Marquez, A.; Gil-Garcia, M.; Valls, C.; Narvaez-Garcia, J.; Andia-Navarro, E.; Pozuelo-Segura, O.; Portabella-Blavia, F.

    1999-01-01

    Sports-related injuries of the lower extremity are frequent. Before magnetic resonance (MR) imaging was available, ultrasound, radionuclide scintigraphy and computed tomography were used to evaluate muscle trauma. Although relatively inexpensive, these imaging modalities are limited by their low specificity. The high degree of soft tissue contrast and multiplanar capability of MR imaging, allow direct visualization as well as characterization of traumatic muscle lesions. This pictorial review highlights the spectrum of traumatic muscle lesions on MRI, with emphasis on its typical appearances. (orig.)

  15. Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed?

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, S.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of); Oh, J.H. [Department of Radiology, Kyung Hee University Medical Center, Seoul (Korea, Republic of)], E-mail: radkwon@dreamwiz.com; Seo, T.-S. [Department of Radiology, Korea University Guro Hospital, Seoul (Korea, Republic of); Ahn, H.J.; Park, H.C. [Department of Surgery, Kyung Hee University Medical Center, Seoul (Korea, Republic of)

    2009-05-15

    Aim: To assess the technical feasibility and initial success of aspiration thrombectomy as a potential alternative to lytic therapy in initial endovascular management of acute lower extremity deep vein thrombosis (DVT). Materials and Methods: From July 2004 to October 2007, a retrospective analysis of 27 patients (male:female 5:22; mean age 59 years) with acute iliofemoral or femoropopliteal DVT of less than 2 weeks was performed. All patients underwent sonography of the lower extremities, and 13 patients underwent computed tomography (CT) venography. All patients received an inferior vena cava (IVC) filter and were initially treated with aspiration thrombectomy using the pullback technique with or without basket thrombus fragmentation. If persistent stenotic portions (>50% luminal narrowing) were noted, balloon angioplasty or stent placement was performed. Successful recanalization was defined as successful restoration of antegrade flow in the treated vein with elimination of any underlying obstructive lesion. Results: The mean procedure time was 65 min (range 40-100 min). Successful initial recanalization was achieved in 24 patients (88.9%) without complications. Urokinase was required for three patients (11.1%) due to a hard thrombus remaining in the iliac vein. Of the 27 patients, 23 had residual venous stenosis in the common iliac vein or external iliac vein. Therefore, balloon angioplasty (n = 23) and stent placement (n = 22) was performed. The remaining four patients were treated using only aspiration thrombectomy without angioplasty or stent placement. Conclusion: Aspiration thrombectomy without catheter-directed thrombolysis is a safe and effective treatment for acute DVT of the lower extremities, and minimizes the risk of haemorrhagic complications.

  16. Percutaneous aspiration thrombectomy for the treatment of acute lower extremity deep vein thrombosis: is thrombolysis needed?

    International Nuclear Information System (INIS)

    Kwon, S.H.; Oh, J.H.; Seo, T.-S.; Ahn, H.J.; Park, H.C.

    2009-01-01

    Aim: To assess the technical feasibility and initial success of aspiration thrombectomy as a potential alternative to lytic therapy in initial endovascular management of acute lower extremity deep vein thrombosis (DVT). Materials and Methods: From July 2004 to October 2007, a retrospective analysis of 27 patients (male:female 5:22; mean age 59 years) with acute iliofemoral or femoropopliteal DVT of less than 2 weeks was performed. All patients underwent sonography of the lower extremities, and 13 patients underwent computed tomography (CT) venography. All patients received an inferior vena cava (IVC) filter and were initially treated with aspiration thrombectomy using the pullback technique with or without basket thrombus fragmentation. If persistent stenotic portions (>50% luminal narrowing) were noted, balloon angioplasty or stent placement was performed. Successful recanalization was defined as successful restoration of antegrade flow in the treated vein with elimination of any underlying obstructive lesion. Results: The mean procedure time was 65 min (range 40-100 min). Successful initial recanalization was achieved in 24 patients (88.9%) without complications. Urokinase was required for three patients (11.1%) due to a hard thrombus remaining in the iliac vein. Of the 27 patients, 23 had residual venous stenosis in the common iliac vein or external iliac vein. Therefore, balloon angioplasty (n = 23) and stent placement (n = 22) was performed. The remaining four patients were treated using only aspiration thrombectomy without angioplasty or stent placement. Conclusion: Aspiration thrombectomy without catheter-directed thrombolysis is a safe and effective treatment for acute DVT of the lower extremities, and minimizes the risk of haemorrhagic complications.

  17. Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.

    Science.gov (United States)

    Wrigley, Clinton W; Vance, Ansar; Niesen, Timothy; Grilli, Christopher; Velez, J Daniel; Agriantonis, Demetrios J; Kimbiris, George; Garcia, Mark J; Leung, Daniel A

    2014-09-01

    To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts. Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication. The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively. Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  18. Does pediatric body mass index affect surgical outcomes of lower-extremity external fixation?

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    Fedorak, Graham T; Cuomo, Anna V; Otsuka, Norman Y

    2015-06-01

    Obese patients are highly prevalent in the pediatric orthopaedic surgeon's practice and obesity is an increasing issue in the United States. Increased body mass index (BMI) has been associated with increased complications in pediatric orthopaedic patients, but no study has looked specifically at external fixation. The purpose of this study was to determine whether obesity is a risk factor for increased complications in lower-extremity procedures requiring external fixation. A retrospective chart review was conducted of pediatric patients who underwent external fixation as definitive operative treatment for any condition at a tertiary care hospital over a 15-year period. Patients were grouped into normal weight, overweight, and obese based on Centers for Disease Control definitions. All orthopaedic complications were recorded. A total of 208 patients with a mean age of 11.2 years were identified. Ninety-four children were obese at the 95th percentile BMI or higher, 22 were overweight and 93 were normal weight. External fixation was applied to the tibia in 82 cases, to the femur in 77 and to both in 49. Mean duration of fixation was 160 days (range, 31 to 570 d) and patients were followed for a mean of 3.9 years (range, 1.0 to 12.0 y). There was no statistically significant difference in the rate of complications between the 3 groups (P=0.61). In the obese group complications occurred in 68.1% versus 66.7% in the overweight group and 61.3% in normal weight. In the setting of external fixator use for lower-extremity pathology in pediatric patients, there is no association between an increase in complications and obesity as defined by BMI. Complication rates are high when external fixation is utilized for the lower extremity, however, patients and families should not be counseled that increased BMI will add to the burden of orthopaedic complications in this situation. Level II-prognostic.

  19. An extremely sensitive species-specific ARMs PCR test for the presence of tiger bone DNA.

    Science.gov (United States)

    Wetton, Jon H; Tsang, Carol S F; Roney, Chris A; Spriggs, Adrian C

    2004-02-10

    The survival of the tiger (Panthera tigris) is seriously threatened by poaching to provide raw materials for Traditional Chinese Medicines (TCMs). Most highly prized are the tiger's bones, which are used in combination with other animal and plant derivatives in pills and plasters for the treatment of rheumatism and other ailments. Hundreds of patent remedies have been produced which claim to contain tiger bone, but proof of its presence is needed, if legislation prohibiting the trade in endangered species is to be enforced. A highly sensitive tiger-specific real-time PCR assay has been developed to address this problem. Using primers specific to the tiger mitochondrial cytochrome b gene, successful amplification has been reliably achieved from blood, hair and bone as well as from a range of TCMs spiked with 0.5% tiger bone. Although capable of detecting fewer than 10 substrate molecules, the seven varieties of TCM pills and plasters tested showed no detectable trace of tiger DNA before spiking. Furthermore, sequencing several "tiger bone" fragments seized from TCM shops has shown that they actually originated from cattle and pigs. The potential effects of traditional bone preparation methods, evidence that much lower concentrations are used than alleged on TCM packaging, and substitution of bones from other species all suggest a low likelihood of detecting tiger DNA in patent medicines. Despite this, the basic methods have been thoroughly proven and can be readily applied to derivatives from other CITES protected species providing a rapid and highly sensitive forensic test for species of origin. Potential applications to the monitoring of wild populations are demonstrated by the successful identification of shed hairs and faecal samples.

  20. Comparison of Lower Extremity Kinematics and Hip Muscle Activation During Rehabilitation Tasks Between Sexes

    Science.gov (United States)

    Dwyer, Maureen K.; Boudreau, Samantha N.; Mattacola, Carl G.; Uhl, Timothy L.; Lattermann, Christian

    2010-01-01

    Abstract Context: Closed kinetic chain exercises are an integral part of rehabilitation programs after lower extremity injury. Sex differences in lower extremity kinematics have been reported during landing and cutting; however, less is known about sex differences in movement patterns and activation of the hip musculature during common lower extremity rehabilitation exercises. Objective: To determine whether lower extremity kinematics and muscle activation levels differ between sexes during closed kinetic chain rehabilitation exercises. Design: Cross-sectional with 1 between-subjects factor (sex) and 1 within-subjects factor (exercise). Setting: Research laboratory. Patients or Other Participants: Participants included 21 women (age  =  23 ± 5.8 years, height  =  167.6 ± 5.1 cm, mass  =  63.7 ± 5.9 kg) and 21 men (age  =  23 ± 4.0 years, height  =  181.4 ± 7.4 cm, mass  =  85.6 ± 16.5 kg). Intervention(s): In 1 testing session, participants performed 3 trials each of single-leg squat, lunge, and step-up-and-over exercises. Main Outcome Measure(s): We recorded the peak joint angles (degrees) of knee flexion and valgus and hip flexion, extension, adduction, and external rotation for each exercise. We also recorded the electromyographic activity of the gluteus maximus, rectus femoris, adductor longus, and bilateral gluteus medius muscles for the concentric and eccentric phases of each exercise. Results: Peak knee flexion angles were smaller and peak hip extension angles were larger for women than for men across all tasks. Peak hip flexion angles during the single-leg squat were smaller for women than for men. Mean root-mean-square amplitudes for the gluteus maximus and rectus femoris muscles in both the concentric and eccentric phases of the 3 exercises were greater for women than for men. Conclusions: Sex differences were observed in sagittal-plane movement patterns during the rehabilitation exercises. Because of the sex differences

  1. Rotational profile of the lower extremity in achondroplasia: computed tomographic examination of 25 patients

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    Song, Hae-Ryong; Suh, Seung-Woo [Korea University Guro Hospital, Department of Orthopaedic Surgery, Rare Diseases Institute, Seoul (Korea); Choonia, Abi-Turab [Laud Clinic, Department of Orthopaedic Surgery, Mumbai (India); Hong, Suk Joo; Cha, In Ho [Korea University Guro Hospital, Department of Radiology, Seoul (Korea); Lee, Seok-Hyun [Dongguk University Ilsan Buddist Hospital, Department of Orthopaedic Surgery, Goyang (Korea); Park, Jong-Tae [Korea University Ansan Hospital, Department of Occupational and Enviornmental Medicine, Ansan (Korea)

    2006-12-15

    To evaluate lower-extremity rotational abnormalities in subjects with achondroplasia using computed tomography (CT) scans. CT scans were performed in 25 subjects with achondroplasia (13 skeletally immature, mean age 8.7 years; 12 skeletally mature, mean age 17.6 years). In a total of 50 bilateral limbs, CT images were used to measure the angles of acetabular anteversion, femoral anteversion, and tibial external torion. Measurement was performed by three examiners and then repeated by one examiner. Inter- and intraobserver agreements were analyzed, and results were compared with previously reported normal values. Mean values for skeletally immature and skeletally mature subjects were 13.6{+-}7.5 and 21.5{+-}6.4 respectively for acetabular anteversion, 27.1{+-}20.8 and 30.5{+-}20.1 for femoral torsion, and 21.6{+-}10.6 and 22.5{+-}10.8 for tibial torsion. Intra- and interobserver agreements were good to excellent. Acetabular anteversion and femoral anteversion in skeletally mature subjects were greater than normal values in previous studies. Both skeletally immature and mature subjects with achondroplasia had decreased tibial torsion compared to normal skeletally immature and mature subjects. Lower-extremity rotational abnormalities in subjects with achondroplasia include decreased tibial external torsion in both skeletally immature and mature subjects, as well as increased femoral and acetabular anteversion in skeletally mature subjects. (orig.)

  2. The Effect of Extremely Low Frequency Magnetic Field and Manganese on Bone Mineral Content and Density

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    Veysi Akpolat

    2008-12-01

    Full Text Available The aim of this study was to investigate the effect of extremely low frequency magnetic field (ELF MF on bone that exposed us in our daily life. In our study, sixty four male Wistar-Albino rats were used. The rats were exposed to ELF MF (50Hz, 1.5mT during 4 hours/day for 45 days. The experimental rats were divided into eight groups (n=8 per group. The groups were as follows; only ELF MF was exposed to 1.group, the ELF MF was exposed to the 2., 3. and 4.groups with the doses manganese (Mn of 3.75 mg/kg, 15mg/kg and 60mg/kg respectively, the 5., 6. and 7.groups received Mn with the doses of 3.75 mg/kg, 15mg/kg and 60mg/kg respectively and lastly the 8.group was used as a control group (cage control. Total bone mineral content (TBMC and total bone mineral density (TBMD of rats were determined by dual-energy X-ray absorptiometry (DXA. Measurements were recorded for all groups and the levels were compared with the control group. The levels of TBMC increased significantly in 3., 4. and 7. groups compare to control group (p<0.05. However, significant differences was not found in relation to the levels of TBMD between groups. The following results could be derived for this study; i an additive effect of EMF was observed in increasing of bone mineral content for the groups with manganese ii EMF stimulates the increasing of TBMD iii manganese has a positive effect on bone tissue.

  3. [Lower extremity amputation rates in diabetic patients].

    Science.gov (United States)

    Cisneros-González, Nelly; Ascencio-Montiel, Iván Jesús; Libreros-Bango, Vita Norma; Rodríguez-Vázquez, Héctor; Campos-Hernández, Ángel; Dávila-Torres, Javier; Kumate-Rodríguez, Jesús; Borja-Aburto, Víctor Hugo

    2016-01-01

    The lower extremity amputations diminish the quality of life of patients with Diabetes Mellitus (DM). The aim of this study was to describe the lower extremity amputation rates in subjects with DM in the Mexican Social Security Institute (IMSS), comparing 2004 and 2013. A comparative cross-sectional study was done. Amputations were identified from the hospital records of System of Medical Statistics (DataMart). The DM patient census was obtained from the System of Integral Attention to Health. Major and minor amputations rates were expressed per 100,000 DM patients. We observed 2 334 340 and 3 416 643 DM patients during 2004 and 2013, respectively. The average age at the time of the amputation was similar in 2004 and 2013 (61.7 and 65.6 years old for minor and major amputations respectively). The major amputations rates were 100.9 and 111.1 per 100 000 subjects with DM in during 2004 and 2013 (p = 0.001); while minor amputations rates were 168.8 and 162.5 per 100 000 subjects with DM in during 2004 and 2013 respectively (p = 0.069). The lower extremity amputations rates at IMSS are very high compared with that reported in developed countries. The major amputations rate increased in 2013 compared with 2004.

  4. The Effect of Fatigue in Proxmal and Distal Muscles of Lower Extremity on Postural Control

    Directory of Open Access Journals (Sweden)

    Mozhgan Moghadam

    2003-07-01

    Full Text Available Objective: Several studies have shown the effects of muscular fatigue on proprioception and neuromuscular control. However all available researches have studied just the effect of local fatigue in ankle joint muscles on postural control, and no study have found about the effect of fatigue in proximal muscles of the lower extremity on postural control. To compare changes in postural control parameters after isokinetic fatigue of proximal and distal muscles of lower extremity. Materials & Methods: Subjects were twenty healthy men (age: 22.6±2.4 years, height: 173.7± 3.6 cm, weight: 63.3±7.9kg. There were 4 test sessions, with a randomized order according to site and plane of fatigue. During each session one of these muscle groups was fatigued using a Biodex isokinetic dynamometer: ankle plantar / dorsi flexors, ankle evertor / inventors, hip flexor / extensors and hip abductor/adductors. The biodex stability system was used to perform dynamic balance test before and after muscle fatigue in each session. Overall, anterior / posterior, and medial/lateral stability indices were recorded. The higher the stability indices, the lower the balancing skill. Results: Analysis of pre-and post fatigue balance results of all sessions, demonstrated significant increase (P<0.05 in all stability indices. Repeated measures ANOVA performed on the rate of changes in stability indices during each session revealed that hip muscle fatigue caused much more increase in stability indices than ankle muscle fatigue (P<0.05. Conclusion: Isokinetic fatigue of both ankle and hip muscles significantly decreases postural control ability in healthy young men. In addition, our findings suggest that the hip joint musculature plays a more prominent role in postural control.

  5. Reliability of 4-meter and 10-meter walk tests after lower extremity surgery.

    Science.gov (United States)

    Unver, Bayram; Baris, Refik Hilmi; Yuksel, Ertugrul; Cekmece, Senol; Kalkan, Serpil; Karatosun, Vasfi

    2017-12-01

    To investigate the test-retest reliability of the 4-meter walk test (4 MWT) and 10-meter walk test (10 MWT) in patients undergoing lower extremity surgery during inpatient rehabilitation. In all, 102 patients with total hip arthroplasty (THA), total knee arthroplasty (TKA), lower extremity fracture (LEF) and soft tissue operation were recruited. Patients performed two 4 MWT and two 10 MWT trials on the same day. The same researcher performed all the measurements to avoid inter-rater variability. The 4 MWT and 10 MWT were shown to have excellent test-retest reliability. The ICCs for the 4 MWT and 10 MWT were found as 0.94 and 0.95, respectively. The SEMs for the 4 MWT and 10 MWT were 2.0 and 5.5 seconds, respectively. The smallest real difference at the 95% confidence level (SRD95) was 5.5 seconds for the 4 MWT and 12.2 seconds for 10 MWT and SRD95 percentage was 31.2 for the 4 MWT and 28.5 for the 10 MWT. Both the 4 MWT and the 10 MWT have excellent reliability in patients undergoing lower extremity surgery such as TKA, THA, LEF and soft tissue operation during inpatient rehabilitation. Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status, represent a real clinical change in rehabilitation process. Implications for Rehabilitation The 4 MWT and the 10 MWT are simple methods and were also shown to be reliable measurement methods in many patient groups. This study illustrates that the test-retest reliability of the 4 MWT and 10 MWT are excellent in patients undergoing lower extremity surgery during inpatient rehabilitation (ICC: 0.94 for 4 MWT, ICC: 0.95 for 10 MWT). Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status represent a real clinical change in rehabilitation process.

  6. Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity

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    Heather T. Peters

    2017-01-01

    Full Text Available Objectives. (a To determine associations among motor evoked potential (MEP amplitude, MEP latency, lower extremity (LE impairment, and gait velocity and (b determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method. 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM, and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA and soleus (SO. Results. MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking. Conclusion. MEP latency appears to be an indicator of LE impairment and gait. Significance. Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.

  7. Navigated Transcranial Magnetic Stimulation: A Biologically Based Assay of Lower Extremity Impairment and Gait Velocity.

    Science.gov (United States)

    Peters, Heather T; Dunning, Kari; Belagaje, Samir; Kissela, Brett M; Ying, Jun; Laine, Jarmo; Page, Stephen J

    2017-01-01

    Objectives . (a) To determine associations among motor evoked potential (MEP) amplitude, MEP latency, lower extremity (LE) impairment, and gait velocity and (b) determine the association between the presence of a detectable MEP signal with LE impairment and with gait velocity. Method . 35 subjects with chronic, stable LE hemiparesis were undergone TMS, the LE section of the Fugl-Meyer Impairment Scale (LE FM), and 10-meter walk test. We recorded presence, amplitude, and latency of MEPs in the affected tibialis anterior (TA) and soleus (SO). Results . MEP presence was associated with higher LEFM scores in both the TA and SO. MEP latency was larger in subjects with lower LEFM and difficulty walking. Conclusion . MEP latency appears to be an indicator of LE impairment and gait. Significance . Our results support the precept of using TMS, particularly MEP latency, as an adjunctive LE outcome measurement and prognostic technique.

  8. Neuropathic Pain Medication Use Does Not Alter Outcomes of Spinal Cord Stimulation for Lower Extremity Pain.

    Science.gov (United States)

    Maher, Dermot P; Martins, Yuri Chaves; Doshi, Tina; Bicket, Mark; Zhang, Kui; Hanna, George; Ahmed, Shihab

    2018-01-01

    Spinal cord stimulation (SCS) for the treatment of lower extremity pain is believed to the result of increased activity in the descending inhibitory and decreased activity in the ascending excitatory tracts. Evidence suggests that the analgesia afforded by SCS may be altered using certain neuropathic pain medications that also modulate neurotransmitters in these sensory tracts. We hypothesize that neuropathic pain medications may alter the response to SCS therapy. One hundred and fifteen subjects undergoing SCS therapy for lower extremity pain were retrospectively examined. The pharmacologic profile, including stable use of neuropathic and opioid medications, were recorded. Three separate logistic regression models examined the odds ratio of primary outcomes; a successful SCS trial, a 50% decrease in pain or a 50% reduction in opioid use one year after implant. Neither the use of opioids or neuropathic pain medications were associated with changes in the odds of a successful SCS trial or a 50% pain reduction. A higher dose of chronic opioids use prior to a trial was associated with greater odds of having a 50% reduction in opioid use following implant. OR 1.02, 95% CI 1.01-1.02, p-value neuropathic pain medications did not change the odds of either a successful SCS trial, or of experiencing a 50% reduction in pain at one year. The association between higher opioid doses and greater odds of a 50% reduction in opioid use may be the reflective of SCS's ability to reduce opioid reliance in chronic pain patients. © 2017 International Neuromodulation Society.

  9. Incidence and Risk Factors of Lower Extremity Lymphedema After Gynecologic Surgery in Ovarian Cancer.

    Science.gov (United States)

    Ki, Eun Young; Park, Jong Sup; Lee, Keun Ho; Hur, Soo Young

    2016-09-01

    There is no standard method to establish an early diagnosis of lower extremity lymphedema (LEL). Lower extremity lymphedema can be diagnosed by physical examination and laboratory tests when patients complain of typical clinical symptoms. The objective of this study was to investigate the incidence and risk factors of LEL in patients with ovarian cancer. The medical records were reviewed retrospectively in patients with ovarian cancer treated at Seoul St. Mary's Hospital from January 2000 to July 2014. A total of 413 patients with epithelial ovarian cancer were analyzed. Forty-six patients (11.1%) developed LEL, and 67.4% of these patients had LEL within 1 year after surgery. The mean number of resected lymph nodes (LNs) was larger in patients with LEL (43.1 ± 16.7; range, 12-80) than in those without (32.3 ± 19.8; range, 0-99) (P < 0.0001). The number of resected LNs was significantly associated with the occurrence of LEL (odds ratio, 1.025; 95% confidence interval, 1.005-1.045; P < 0.05). A significant proportion of patients with ovarian cancer could develop LEL after surgery. This study suggests that the occurrence of LEL is associated with the number of resected LNs.

  10. EFFECTS OF A BAND LOOP ON LOWER EXTREMITY MUSCLE ACTIVITY AND KINEMATICS DURING THE BARBELL SQUAT.

    Science.gov (United States)

    Foley, Ryan C A; Bulbrook, Brittany D; Button, Duane C; Holmes, Michael W R

    2017-08-01

    Medial knee collapse can signal an underlying movement issue that, if uncorrected, can lead to a variety of knee injuries. Placing a band around the distal thigh may act as a proprioceptive aid to minimize medial collapse of the knee during squats; however, little is known about EMG and biomechanics in trained and untrained individuals during the squat with an elastic band added. To investigate the effects of the TheraBand® Band Loop on kinematics and muscle activity of the lower extremity during a standard barbell back squat at different intensities in both trained and untrained individuals. Cross-sectional, repeated measures. Sixteen healthy, male, university aged-participants were split into two groups of eight, consisting of a trained and untrained group. Participants performed both a 3-repetition maximum (3-RM) and a bodyweight load squat for repetitions to failure. Lower extremity kinematics and surface electromyography of four muscles were measured bilaterally over two sessions, an unaided squat and a band session (band loop placed around distal thighs). Medial knee collapse, measured as a knee width index, and maximum muscle activity were calculated. During the 3-RM, squat weight was unaffected by band loop intervention (p = 0.486) and the trained group lifted more weight than the untrained group (pbarbell squat strength by increasing activation of agonist muscles more than traditional, un-banded squats. Greater maximal muscle activity in most muscles during band loop sessions may provide enhanced knee stability via increased activation of stabilizing muscles. 3.

  11. Kinematic and kinetic synergies of the lower extremities during the pull in olympic weightlifting.

    Science.gov (United States)

    Kipp, Kristof; Redden, Josh; Sabick, Michelle; Harris, Chad

    2012-07-01

    The purpose of this study was to identify multijoint lower extremity kinematic and kinetic synergies in weightlifting and compare these synergies between joints and across different external loads. Subjects completed sets of the clean exercise at loads equal to 65, 75, and 85% of their estimated 1-RM. Functional data analysis was used to extract principal component functions (PCF's) for hip, knee, and ankle joint angles and moments of force during the pull phase of the clean at all loads. The PCF scores were then compared between joints and across loads to determine how much of each PCF was present at each joint and how it differed across loads. The analyses extracted two kinematic and four kinetic PCF's. The statistical comparisons indicated that all kinematic and two of the four kinetic PCF's did not differ across load, but scaled according to joint function. The PCF's captured a set of joint- and load-specific synergies that quantified biomechanical function of the lower extremity during Olympic weightlifting and revealed important technical characteristics that should be considered in sports training and future research.

  12. Lower extremity physical performance and hip bone mineral density in elderly black and white men and women : cross-sectional associations in the Health ABC Study

    NARCIS (Netherlands)

    Taaffe, Dennis R; Simonsick, Eleanor M; Visser, Marjolein; Volpato, Stefano; Nevitt, Michael C; Cauley, Jane A; Tylavsky, Frances A; Harris, Tamara B

    2003-01-01

    BACKGROUND: Aging is characterized by declines in physical capacity and bone mineral density (BMD), both of which contribute to increased risk for fracture. However, it is unclear if these factors coexist or are independent in elderly people, and if a relationship does exist, whether it varies by

  13. Ultrasound and review of evidence for lower extremity peripheral nerve blocks.

    Science.gov (United States)

    Salinas, Francis V

    2010-01-01

    This qualitative systematic review summarizes existing evidence from randomized controlled trials (RCTs) comparing ultrasound (US) to alternative techniques for lower extremity peripheral nerve block. There were 11 RCTs of sufficient quality for inclusion. Jadad scores ranged from 1 to 4 with a median of 3. For femoral nerve blocks, US provided shorter onset and improved quality of sensory and motor block, as well as a decrease in local anesthetic requirements. For sciatic nerve blocks, US resulted in a higher percentage of patients with complete sensory and motor block, as well as decreased local anesthetic requirements. In 2 of the studies for sciatic nerve block, US resulted in a shorter time to successfully complete the procedure. No study was powered to detect a difference in surgical block success. Overall, there was significant heterogeneity in the definitions of successful sensory and motor block. In 2 studies, the optimal peripheral nerve stimulation technique may have not been used, resulting in a potential bias. No RCT reported US as inferior to alternative techniques in any outcome. There is level Ib evidence to make a grade A recommendation that US guidance provides improvements in onset and success of sensory block, a decrease in local anesthetic requirements, and decreased time to perform lower extremity peripheral nerve blocks.

  14. Sequence comparison for non-enhanced MRA of the lower extremity arteries at 7 Tesla.

    Directory of Open Access Journals (Sweden)

    Sören Johst

    Full Text Available In this study three sequences for non-contrast-enhanced MRA of the lower extremity arteries at 7T were compared. Cardiac triggering was used with the aim to reduce signal variations in the arteries. Two fast single-shot 2D sequences, a modified Ultrafast Spoiled Gradient Echo (UGRE sequence and a variant of the Quiescent-Interval Single-Shot (QISS sequence were triggered via phonocardiogram and compared in volunteer examinations to a non-triggered 2D gradient echo (GRE sequence. For image acquisition, a 16-channel transmit/receive coil and a manually positionable AngioSURF table were used. To tackle B1 inhomogeneities at 7T, Time-Interleaved Acquisition of Modes (TIAMO was integrated in GRE and UGRE. To compare the three sequences quantitatively, a vessel-to-background ratio (VBR was measured in all volunteers and stations. In conclusion, cardiac triggering was able to suppress flow artifacts satisfactorily. The modified UGRE showed only moderate image artifacts. Averaged over all volunteers and stations, GRE reached a VBR of 4.18±0.05, UGRE 5.20±0.06, and QISS 2.72±0.03. Using cardiac triggering and TIAMO imaging technique was essential to perform non-enhanced MRA of the lower extremities vessels at 7T. The modified UGRE performed best, as observed artifacts were only moderate and the highest average VBR was reached.

  15. Endovascular management of deep venous thrombotic diseases of the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk [School of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

    2004-07-01

    Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

  16. Alignment of the lower extremity mechanical axis by computer-aided design and application in total knee arthroplasty.

    Science.gov (United States)

    Zhang, Yuan Z; Lu, Sheng; Zhang, Hui Q; Jin, Zhong M; Zhao, Jian M; Huang, Jian; Zhang, Zhi F

    2016-10-01

    The success of total knee arthroplasty (TKA) depends on many factors. The position of a prosthesis is vitally important. The purpose of the present study was to evaluate the value of a computer-aided establishing lower extremity mechanical axis in TKA using digital technology. A total of 36 cases of patients with TKA were randomly divided into the computer-aided design of navigation template group (NT) and conventional intramedullary positioning group (CIP). Three-dimensional (3D) CT scanning images of the hip, knee, and ankle were obtained in NT group. X-ray images and CT scans were transferred into the 3D reconstruction software. A 3D bone model of the hip, knee, ankle, as well as the modified loading, was reconstructed and saved in a stereolithographic format. In the 3D reconstruction model, the mechanical axis of the lower limb was determined, and the navigational templates produced an accurate model using a rapid prototyping technique. The THA in CIP group was performed according to a routine operation. CT scans were performed postoperatively to evaluate the accuracy of the two TKA methods. The averaged operative time of the NT group procedures was [Formula: see text] min shorter than those of the conventional procedures ([Formula: see text]  min). The coronal femoral angle, coronal tibial angle, posterior tibial slope were [Formula: see text], [Formula: see text], [Formula: see text] in NT group and [Formula: see text], [Formula: see text], [Formula: see text] in CIP group, respectively. Statistically significant group differences were found. The navigation template produced through mechanical axis of lower extremity may provide a relative accurate and simple method for TKA.

  17. MR imaging appearances of soft tissue flaps following reconstructive surgery of the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Magerkurth, Olaf [Dept. of Radiology, Hospital Baden, Baden (Switzerland); Girish, Gandikota; Jacobson, Jon A.; Kim, Sung Moon; Brigido, Monica; Dong, Qian; Jamadar, David A. [Dept. of Radiology, University of Michigan Hospitals, Ann Arbor (United States)

    2015-02-15

    MR imaging appearances of different types of reconstructive muscle flaps following reconstructive surgery of the lower extremity with associated post-surgical changes due to altered anatomy, radiation, and potential complications, can be challenging. A multidisciplinary therapeutic approach to tumors allows for limb salvage therapy in a majority of the patients. Decision-making for specific types of soft tissue reconstruction is based on the body region affected, as well as the size and complexity of the defect. Hematomas and infections are early complications that can jeopardize flap viability. The local recurrence of a tumor within six months after a complete resection with confirmed tumor-free margins and adjuvant radiation therapy is rare. Identification of a new lesion similar to the initial tumor favors a finding of tumor recurrence.

  18. State-of-the-art ultrasonographic findings in lower extremity sports injuries.

    Science.gov (United States)

    Suzue, Naoto; Matsuura, Tetsuya; Iwame, Toshiyuki; Higashino, Kosaku; Sakai, Toshinori; Hamada, Daisuke; Goto, Tomohiro; Takata, Yoichiro; Nishisho, Toshihiko; Goda, Yuichiro; Tsutsui, Takahiko; Tonogai, Ichiro; Miyagi, Ryo; Abe, Mitsunobu; Morimoto, Masatoshi; Mineta, Kazuaki; Kimura, Tetsuya; Nitta, Akihiro; Higuchi, Tadahiro; Hama, Shingo; C Jha, Subash; Takahashi, Rui; Fukuta, Shoji; Sairyo, Koichi

    2015-01-01

    Athletes sometimes experience overuse injuries. To diagnose these injuries, ultrasonography is often more useful than plain radiography, computed tomography (CT), or magnetic resonance imaging (MRI). Ultrasonography can show both bone and soft tissue from various angles as needed, providing great detail in many cases. In conditions such as osteochondrosis or enthesopathies such as Osgood-Schlatter disease, Sinding-Larsen-Johansson disease, bipartite patella, osteochondritis dissecans of the knee, painful accessory navicular,and jumper's knee, ultrasonography can reveal certain types of bony irregularities or neovascularization of the surrounding tissue. In patients of enthesopathy, ultrasonography can show the degenerative changes at the insertion of the tendon. Given its usefulness in treatment, ultrasonography is expected to become essential in the management of overuse injuries affecting the lower limb in athletes. J. Med. Invest. 62: 109-113, August, 2015.

  19. The Effect of Elevation on Volumetric Measurements of the Lower Extremity

    Directory of Open Access Journals (Sweden)

    Cordial M. Gillette

    2017-07-01

    Full Text Available Background: The empirical evidence for the use of RICE (rest, ice, compression, elevation has been questioned regarding its   clinical effectiveness. The component of RICE that has the least literature regarding its effectiveness is elevation. Objective: The objective of this study was to determine if various positions of elevation result in volumetric changes of the lower extremity. Methodology: A randomized crossover design was used to determine the effects of the four following conditions on volumetric changes of the lower extremity: seated at the end of a table (seated, lying supine (flat, lying supine with the foot elevated 12 inches off the table (elevated, and lying prone with the knees bent to 90 degrees (prone. The conditions were randomized using a Latin Square. Each subject completed all conditions with at least 24 hours between each session. Pre and post volumetric measurements were taken using a volumetric tank. The subject was placed in one of the four described testing positions for 30 minutes. The change in weight of the displaced water was the main outcome measure. The data was analyzed using an ANOVA of the pre and post measurements with a Bonferroni post hoc analysis. The level of significance was set at P<.05 for all analyses. Results: The only statistically significant difference was between the gravity dependent position (seated and all other positions (p <.001. There was no significant difference between lying supine (flat, on a bolster (elevated, or prone with the knees flexed to 90 degrees (prone. Conclusions: From these results, the extent of elevation does not appear to have an effect on changes in low leg volume. Elevation above the heart did not significantly improve reduction in limb volume, but removing the limb from a gravity dependent position might be beneficial.

  20. The application of comprehensive nursing measures in interventional therapy for deep vein thrombosis of lower extremities

    International Nuclear Information System (INIS)

    Huang Linfen; Guo Yanxue; Nan Yi; Pan Xiaohui

    2009-01-01

    Objective: To discuss the effective nursing measures in interventional therapy for deep vein thrombosis (DVT) of lower extremities in order to improve the successful rate of the procedure and to decrease the occurrence of complications. Methods: Comprehensive nursing measures, including general nursing care, specific nursing care and emergency nursing care, were employed in 63 DVT patients receiving interventional therapy. Clinical response and complications were observed. Results: After the treatment, the disorder was cured in 31 cases, while excellent result was seen in 26 cases and obvious improvement in 6 cases. During the procedure, bleeding at puncture site occurred in 16 cases, pulmonary embolism in 2 cases and cerebral hemorrhage in one case. No death occurred. Conclusion: Comprehensive nursing measures can effectively prevent or reduce the occurrence of complications, decrease the mortality rate. Therefore, Comprehensive nursing measures are the most helpful nursing care for DVT patients receiving interventional therapy. (authors)

  1. Joint Torque and Mechanical Power of Lower Extremity and Its Relevance to Hamstring Strain during Sprint Running

    Directory of Open Access Journals (Sweden)

    Yunjian Zhong

    2017-01-01

    Full Text Available The aim of this study was to quantify the contributions of lower extremity joint torques and the mechanical power of lower extremity muscle groups to further elucidate the loadings on hamstring and the mechanics of its injury. Eight national-level male sprinters performed maximum-velocity sprint running on a synthetic track. The 3D kinematic data and ground reaction force (GRF were collected synchronously. Intersegmental dynamics approach was used to analyze the lower extremity joint torques and power changes in the lower extremity joint muscle groups. During sprinting, the GRF during the stance phase and the motion-dependent torques (MDT during the swing phase had a major effect on the lower extremity movements and muscle groups. Specifically, during the stance phase, torque produced and work performed by the hip and knee muscles were generally used to counteract the GRF. During the swing phase, the role of the muscle torque changed to mainly counteract the effect of MDT to control the movement direction of the lower extremity. Meanwhile, during the initial stance and late swing phases, the passive torques, namely, the ground reaction torques and MDT produced by the GRF and the inertial movement of the segments of the lower extremity, applied greater stress to the hamstring muscles.

  2. Evaluation of disabilities and activities of daily living of war-related bilateral lower extremity amputees.

    Science.gov (United States)

    Ebrahimzadeh, Mohammad H; Moradi, Ali; Bozorgnia, Shahram; Hallaj-Moghaddam, Mohammad

    2016-02-01

    Long-term consequences and the activities of daily living of bilateral lower limb amputation are not well documented. The aims of our study were to identify the long-term effects of bilateral lower extremity amputations on daily activities and understand how these amputees cope with their mobility assistive devices. Cross-sectional study. A total of 291 veterans with war bilateral lower limb amputations accepted to participate in a cross-sectional study. The average of follow-up was 25.4 years. A total of 152 amputees (54%) were involved in sports averagely 6.7 h per week. Bilateral amputees walk 10 m by the average of 15 ± 33 s, and they could walk continuously with their prosthesis 315 ± 295 m. They wore their prosthesis 6.8 ± 1.7 days per week and 7.9 ± 8.1 h per day. Of these, 6.7% of bilateral lower limb amputees needed help to wear their prosthesis; 88.3% of amputees used assistant device for walking. According to this survey, 73 (42%) prostheses in right limb were appropriate, 95 (54.6%) needed to be replaced, and 6 (3.4) needed to be fixed. On the left side, it was 76 (42%), 92 (52.0%), and 9 (5.1%), respectively. A total of 203 (74.9%) amputees reported limitations in at least one domain of the activities of daily living. The most common single item that affected the patients was ascending and descending stairs by the score of 66% of normal population. Veterans with bilateral lower limb amputations suffering from vast categories of daily problems. This study and its results confirm that bilateral lower limb amputees have major progressive disabilities in daily activities and their social performance. This should attract the attention of amputees' administrative organizations, social workers, health-care providers and caregiver providers. © The International Society for Prosthetics and Orthotics 2014.

  3. FREQUENCY AND RISK FACTORS FOR OVERUSE INJURIES OF LOWER EXTREMITY IN SLOVENIAN RECREATIVE RUNNERS

    Directory of Open Access Journals (Sweden)

    Branko Škof

    2012-09-01

    Full Text Available Running is probably the most frequent form of regular physical activity in the general population. Unfortunatelly the running related injuries are also quite frequent and different authors are reporting the injury rates between 19,4 % to 79,3 % (Knobloch, Yoon, & Vogt, 2008. The purpose of our cross-sectional study was to evalute the injury rates and anatomical distribution of lower extremity injuries in slovenian runners of different gender, age and training level. Unique injury report form was used to evaluate data of 1.323 recreative runners (50.3 % females and 49.7 % males, average age 37.8 ± 10.9 let. The results have shown that: - During the previous year 53.5 % of runners had experienced at least one running related injury that caused them to miss from regular running for at least one week. - The proportion of uninjured female runners during the previous year was significantly lower when compared to male runners (59.1 % females vs. 40.9 % males, Chi square = 0.000 - The age and the running training volume were not related with injury rates. - The injury rates were related with the training level (Chi square = 0.024, which means that well trained runners had less injuries compared with less trained counterparts. Same was surprisingly true for young still unexperienced runners. - The injuries were of acute nature in 59.3 % cases while 28.9 % runners reported overuse injuries - The rate of overuse injuries is increasing with age of the runner as with the over 50y old runners the prevalence of overuse injuries was 40.9 %, while in the below 35y runners the prevalence was only 26.4 % (Chi square = 0.014. The running related overuse injuries of lower extremity are in many cases related to inappropriate training approach (too qucikly, too much; too quickly, too fast.

  4. Can new passenger cars reduce pedestrian lower extremity injury? A review of geometrical changes of front-end design before and after regulatory efforts.

    Science.gov (United States)

    Nie, Bingbing; Zhou, Qing

    2016-10-02

    Pedestrian lower extremity represents the most frequently injured body region in car-to-pedestrian accidents. The European Directive concerning pedestrian safety was established in 2003 for evaluating pedestrian protection performance of car models. However, design changes have not been quantified since then. The goal of this study was to investigate front-end profiles of representative passenger car models and the potential influence on pedestrian lower extremity injury risk. The front-end styling of sedans and sport utility vehicles (SUV) released from 2008 to 2011 was characterized by the geometrical parameters related to pedestrian safety and compared to representative car models before 2003. The influence of geometrical design change on the resultant risk of injury to pedestrian lower extremity-that is, knee ligament rupture and long bone fracture-was estimated by a previously developed assessment tool assuming identical structural stiffness. Based on response surface generated from simulation results of a human body model (HBM), the tool provided kinematic and kinetic responses of pedestrian lower extremity resulted from a given car's front-end design. Newer passenger cars exhibited a "flatter" front-end design. The median value of the sedan models provided 87.5 mm less bottom depth, and the SUV models exhibited 94.7 mm less bottom depth. In the lateral impact configuration similar to that in the regulatory test methods, these geometrical changes tend to reduce the injury risk of human knee ligament rupture by 36.6 and 39.6% based on computational approximation. The geometrical changes did not significantly influence the long bone fracture risk. The present study reviewed the geometrical changes in car front-ends along with regulatory concerns regarding pedestrian safety. A preliminary quantitative benefit of the lower extremity injury reduction was estimated based on these geometrical features. Further investigation is recommended on the structural changes

  5. Color duplex-Doppler ultrasonography of lower extremities veins. Types of findings

    International Nuclear Information System (INIS)

    Brkljacic, B.; Hebrang, A.; Sebecic, B.; Grga, A.; Patrlj, L.

    2001-01-01

    Background. The types of ultrasonographic findings observed in patients referred for color duplex Doppler ultrasonography (CDD-US) of veins of lower extremities are presented in this paper. Patients and methods. During 27 months, 934 patients were examined. Among these, 663 were women (71 %) and 271 men (29 %), with the age range 19-86 (mean 58.4) years. Color Doppler scanners Acuson 128 XP 10, ATL HDI 5000 and Siemens Sonoline Elegra were used, with the transducers in the frequency range from 2.5-12 MHz. The types of findings were classified as: (a) deep venous thrombosis (DVT), (b) pathology related to veins without DVT, (c) pathology of adjacent structures, (d) normal findings. Results. DVT was observed in 210 patients (22.5%) - acute or chronic in 129 patients, and 81 patients were examined in the follow-up of the DVT treatment. Postthrombotic syndrome, varicose veins, superficial thrombophlebitis and popliteal venous aneurysms were seen in 415 patients (44.4 %). The pathology unrelated to veins was observed in 117 patients (12.5 %). Muscular hematomas and popliteal cysts were most common in this group, but very rare pathology was noted, as well. In 192 patients (20.6 %) CDD-US was normal. Conclusions. In patients referred for CDD-US examination of lower extremities veins, a high number of findings unrelated to veins, in addition to well-known findings of various venous pathologies, can be observed on CDD-US. The lesions that clinically mimic DVT should be recognized with US in order to avoid erroneous medical treatment. (author)

  6. Effect of Reduced Stiffness Dance Flooring on Lower Extremity Joint Angular Trajectories During a Ballet Jump.

    Science.gov (United States)

    Hackney, James; Brummel, Sara; Newman, Mary; Scott, Shannon; Reinagel, Matthew; Smith, Jennifer

    2015-09-01

    We carried out a study to investigate how low stiffness flooring may help prevent overuse injuries of the lower extremity in dancers. It was hypothesized that performing a ballet jump (sauté) on a reduced stiffness dance floor would decrease maximum joint flexion angles and negative angular velocities at the hips, knees, or ankles compared to performing the same jump on a harder floor. The participants were 15 young adult female dancers (age range 18 to 28, mean = 20.89 ± 2.93 years) with at least 5 years of continuous ballet experience and without history of serious lower body injury, surgery, or recent pain. They performed sautés on a (low stiffness) Harlequin ® WoodSpring Floor and on a vinyl-covered hardwood on concrete floor. Maximum joint flexion angles and negative velocities at bilateral hips, knees, and ankles were measured with the "Ariel Performance Analysis System" (APAS). Paired one-tailed t-tests yielded significant decreases in maximum knee angle (average decrease = 3.4° ± 4.2°, p = 0.026) and angular negative velocity of the ankles (average decrease = 18.7°/sec ± 27.9°/sec, p = 0.009) with low stiffness flooring. If the knee angle is less acute, then the length of the external knee flexion moment arm will also be shorter and result in a smaller external knee flexion moment, given an equal landing force. Also, high velocities of eccentric muscle contraction, which are necessary to control negative angular velocity of the ankle joint, are associated with higher risk of musculotendinous injury. Hence, our findings indicate that reduced floor stiffness may indeed help decrease the likelihood of lower extremity injuries.

  7. MRI Findings of Causalgia of the Lower Extremity Following Transsphenoidal Resection of Pituitary Tumor

    Directory of Open Access Journals (Sweden)

    D. Ryan Ormond

    2012-01-01

    Full Text Available Background. Causalgia is continuing pain, allodynia, or hyperalgesia after nerve injury with edema, changes in skin blood flow, or abnormal sudomotor activity. Here we report a case of lower extremity causalgia following elective transsphenoidal resection of a pituitary tumor in a young man. Clinical Presentation. A 33-year-old man with acromegaly underwent elective sublabial transsphenoidal resection of his pituitary tumor. During the three-hour surgery, the lower limbs were kept in a supine, neutral position with a pillow under the knees. The right thigh was slightly internally rotated with a tape to expose fascia lata, which was harvested to repair the sella. Postoperatively, he developed causalgia in a distal sciatic and common peroneal nerve distribution. Pain was refractory to several interventions. Finally, phenoxybenzamine improved his pain significantly. Conclusions. Malpositioning in the operating room resulted in causalgia in this young man. Phenoxybenzamine improved, and ultimately resolved, his symptoms. Improvement in his pain symptoms correlated with resolution of imaging changes in the distal sciatic and peroneal nerves on the side of injury.

  8. Lower extremity venous thrombosis in patients younger than 50 years of age

    Directory of Open Access Journals (Sweden)

    Kreidy R

    2012-03-01

    Full Text Available Raghid Kreidy1, Pascale Salameh2, Mirna Waked31Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, 2Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, 3Department of Pulmonary Medicine, Saint George Hospital, University Medical Center, University of Balamand, Beirut, LebanonAim: Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients.Methods: From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years. The control group included 217 patients (86 males and 131 females older than 50 years (range: 50–96 years; mean 72.9 years.Results: The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001, pregnancy (18.2% compared with 0.5%; P < 0.001, treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001, and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084.Conclusion: Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia

  9. Common Patterns of Congenital Lower Extremity Shortening: Diagnosis, Classification, and Follow-up.

    Science.gov (United States)

    Bedoya, Maria A; Chauvin, Nancy A; Jaramillo, Diego; Davidson, Richard; Horn, B David; Ho-Fung, Victor

    2015-01-01

    Congenital lower limb shortening is a group of relatively rare, heterogeneous disorders. Proximal focal femoral deficiency (PFFD) and fibular hemimelia (FH) are the most common pathologic entities in this disease spectrum. PFFD is characterized by variable degrees of shortening or absence of the femoral head, with associated dysplasia of the acetabulum and femoral shaft. FH ranges from mild hypoplasia to complete absence of the fibula with variable shortening of the tibia. The development of the lower limb requires complex and precise gene interactions. Although the etiologies of PFFD and FH remain unknown, there is a strong association between the two disorders. Associated congenital defects in the lower extremity are found in more than 50% of patients with PFFD, ipsilateral FH being the most common. FH also has a strong association with shortening and bowing of the tibia and with foot deformities such as absence of the lateral rays of the foot. Early diagnosis and radiologic classification of these abnormalities are imperative for appropriate management and surgical planning. Plain radiography remains the main diagnostic imaging modality for both PFFD and FH, and appropriate description of the osseous abnormalities seen on radiographs allows accurate classification, prognostic evaluation, and surgical planning. Minor malformations may commonly be misdiagnosed. ©RSNA, 2015.

  10. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome: An Observational Study.

    Science.gov (United States)

    Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

    2015-11-01

    Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes.All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed.Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS.Lower-extremity vein thrombosis

  11. Clinical and Ultrasonographic Evaluation of Lower-extremity Vein Thrombosis in Behcet Syndrome

    Science.gov (United States)

    Seyahi, Emire; Cakmak, Osman Serdal; Tutar, Burcin; Arslan, Caner; Dikici, Atilla Suleyman; Sut, Necdet; Kantarci, Fatih; Tuzun, Hasan; Melikoglu, Melike; Yazici, Hasan

    2015-01-01

    Abstract Vascular involvement can be seen in up to 40% of patients with Behcet syndrome (BS), the lower-extremity vein thrombosis (LEVT) being the most common type. The aim of the current study was to compare venous Doppler findings and clinical features between BS patients with LEVT and control patients diagnosed as having LEVT due to other causes. All consecutive 78 patients (71 men, 7 women; mean age 38.6 ± 10.3 years) with LEVT due to BS and 50 control patients (29 men, 21 women; mean age 42.0 ± 12.5 years) who had LEVT due to other causes, or idiopathic, were studied with the help of a Doppler ultrasonography after a detailed clinical examination. Patterns of venous disease were identified by cluster analyses. Clinical features of chronic venous disease were assessed using 2 classification systems. Venous claudication was also assessed. Patients with BS were more likely to be men, had significantly earlier age of onset of thrombosis, and were treated mainly with immunosuppressives and less frequently with anticoagulants. Furthermore, they had significantly more bilateral involvement, less complete recanalization, and more frequent collateral formation. While control patients had a disorganized pattern of venous involvement, BS patients had a contiguous and symmetric pattern, involving all deep and superficial veins of the lower extremities, with less affinity for crural veins. Clinical assessment, as measured by the 2 classification systems, also indicated a more severe disease among the BS patients. In line, 51% of the BS patients suffered from severe post-thrombotic syndrome (PTS) and 32% from venous claudication, whereas these were present in 8% and 12%, respectively, among the controls. Among BS patients, a longer duration of thrombosis, bilateral femoral vein involvement, and using no anticoagulation along with immunosuppressive treatment when first diagnosed were found to be associated independently with severe PTS. Lower-extremity vein

  12. Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial.

    Science.gov (United States)

    Dennis, Douglas A; Kittelson, Andrew J; Yang, Charlie C; Miner, Todd M; Kim, Raymond H; Stevens-Lapsley, Jennifer E

    2016-01-01

    Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss. Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquet-assisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the identical posterior-stabilized TKA design were used by all four fellowship-trained knee surgeons involved. Isometric quadriceps strength, hamstring strength, voluntary quadriceps activation, and unilateral balance were assessed preoperatively, 3 weeks, and 3 months after bilateral knee arthroplasty. Other factors, including pain, range of motion, and lower extremity girth, were assessed for descriptive purposes at each of these time points as well as on the second postoperative day. Quadriceps strength was

  13. Upper Extremity Assessment in Tetraplegia: The Importance of Differentiating Between Upper and Lower Motor Neuron Paralysis.

    Science.gov (United States)

    Bryden, Anne M; Hoyen, Harry A; Keith, Michael W; Mejia, Melvin; Kilgore, Kevin L; Nemunaitis, Gregory A

    2016-06-01

    Scientific advances are increasing the options for improved upper limb function in people with cervical level spinal cord injury (SCI). Some of these interventions rely on identifying an aspect of paralysis that is not uniformly assessed in SCI: the integrity of the lower motor neuron (LMN). SCI can damage both the upper motor neuron and LMN causing muscle paralysis. Differentiation between these causes of paralysis is not typically believed to be important during SCI rehabilitation because, regardless of the cause, the muscles are no longer under voluntary control by the patient. Emerging treatments designed to restore upper extremity function (eg, rescue microsurgical nerve transfers, motor learning-based interventions, functional electrical stimulation) all require knowledge of LMN status. The LMN is easily evaluated using surface electrical stimulation and does not add significant time to the standard clinical assessment of SCI. This noninvasive evaluation yields information that contributes to the development of a lifetime upper extremity care plan for maximizing function and quality of life. Given the relative simplicity of this assessment and the far-reaching implications for treatment and function, we propose that this assessment should be adopted as standard practice for acute cervical SCI. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Malignant Hidradenocarcinoma in the Lower Extremity: A Case Report of a Rare Tumor.

    Science.gov (United States)

    Kane, Brendan; Adler, Evan; Bhandari, Tarun; Rose, Michael; DiGuglielmo, Nicola; Sun, Xiu

    2018-02-19

    Malignant hidradenocarcinomas are rare soft tissue tumors of sweat gland origin. We present the case of a soft tissue, fungating tumor of 15 years' duration of the medial ankle in an 85-year-old male that exhibited malignant features clinically and radiographically. Subsequent punch biopsy revealed a diagnosis of malignant hidradenocarcinoma. Given the risk of recurrence and the poor radiation and chemotherapy options, the patient initially decided to leave the lesion untreated. However, he soon developed lower extremity cellulitis from the exposed lesion and decided to have the tumor excised, eliminating the source of the infection. In the present case study, we discuss the etiology, clinical and radiographic characteristics, and treatment options for this rare lesion. At the 18-month follow-up visit, he had had no recurrence of the lesion. Copyright © 2017 The American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  15. The Tarsal Bone Test: A Basic Test of Health Sciences Students' Knowledge of Lower Limb Anatomy

    Directory of Open Access Journals (Sweden)

    José Manuel Castillo-López

    2014-01-01

    Full Text Available Objectives. The aim of the present study was to design an easy-to-use tool, the tarsal bone test (TBT, to provide a snapshot of podiatry students’ basic anatomical knowledge of the bones of the lower limb. Methods. The study included 254 podiatry students from three different universities, 145 of them were first-year students and 109 were in their fourth and final years. The TBT was administered without prior notice to the participants and was to be completed in 5 minutes. Results. The results show that 97.2% of the subjects (n=247 correctly labelled all tarsal bones, while the other 2.8% (n=7 incorrectly labelled at least one bone, that was either the cuboid (7 times or the navicular (6 times. Although only one fourth-year student inaccurately identified one bone, no significant differences in the distribution of the correct and incorrect responses were found between first and fourth-year students. Conclusions. The TBT seems to be a straightforward and easy-to-apply instrument, and provides an objective view of the level of knowledge acquired at different stages of podiatry studies.

  16. Chronopharmacodynamics of Intrathecal Co-injection of Sufentanyl and Bupivacaine in Orthopedic Surgery of Lower Extremities

    Directory of Open Access Journals (Sweden)

    B Sadri

    2012-05-01

    Full Text Available  

    Background and objectives: In chronopharmacology the biological rhythm variations caused by drug administration is assessed. Evaluation of the time of drug administration and the qualitative and quantitative effects of reactions to drugs is called chronopharmacodynamics. In this study, we assessed the chronopharmacodynamics of intrathecal co-administration of sufentanyl and bupivacaine in surgical operations of lower extremities.  

    Methods: In 2006, patients aged 20-50 with ASA physical status of I and II, who underwent surgical operation of lower extremities were entered into this prospective study. The patients received a slow intrathecal injection of 10 μg sufentanyl and 15 mg bupivacaine into subarachnoid of third and fourth lumbar spaces in 30 seconds. After the operation, the time of first pain sensation and the visual analogue scale (VAS score, as the measure of severity of pain, were recorded.  

    Results: 115 patients were studied in this project. The pain-free interval was considered as the time between injection and patient’s demand for pain relief. This interval was 746 (± 322 minutes. The average score of pain severity on VAS at the time of demand for pain relief was 24.7 (± 9.3. The average pain-free duration in patients injected about noon or at midnight was significantly longer than the pain-free interval of other patients. 

    Conclusion: The results show that intrathecal co-administration of sufentanyl and bupivacaine at noon or midnight (conforming to the circadian rhythm causes better pain-relief with longer duration in comparison with other times of the day or night. 

  17. Uncontacted tire explosion causing trauma to bilateral lower extremities: A case report

    Directory of Open Access Journals (Sweden)

    Ming-Yang Yu

    2017-06-01

    Full Text Available It is uncommon for tire explosion related injuries on the lower extremity. The bilateral lower extremities were injured by tire explosion when the patient was seated in a bus. She sustained an open fracture with partial bone loss in the right calcaneus (a comminuted fracture in the right ankle joint and a closed comminuted fracture in the left tibia and fibula. This damage was caused by uncontacted tire explosion, thanks to a thick floor between the exploded tire and the patient's feet. This type of injury on lower extremity caused by uncontacted tire explosion was uncommon.

  18. Lower extremity amputation: a contemporary series.

    Science.gov (United States)

    Stone, Patrick A; Flaherty, Sarah K; Hayes, J David; AbuRahma, Ali F

    2007-01-01

    We sought to identify the results achieved with lower extremity amputations performed by both community and university-based surgeons as well as from multiple disciplines (orthopedic/general/vascular surgeons) serving a predominantly nonurban population. A review of 411 consecutive patients undergoing 508 non-traumatic lower extremity amputations at Charleston Area Medical Center from January 1999 to December 2003 was conducted. Amputations were performed most frequently at the below knee level (50.9%). Perioperative mortality (30-day) for the cohort was 11%. Mortality increased with more proximal level of initial amputations: 1.6% for transmetatarsal, 3.6% for below knee, 17.6% for above knee and 100% of those requiring hip disarticulation. Stump failure requiring conversion to a more proximal level was seen in 34.5% of TMA's, 12% of BKA, 6% of AKA during the follow-up period. Twenty-one percent of patients required bilateral amputations by the end of the follow-up period. Non-wound related morbidity for all procedures (i.e. pneumonia, stroke, renal failure) was 29%. Rehabilitation documentation was available for 55% of the cohort, of whom only 27% (N=61) were fitted for, and ambulating with a prosthesis during the follow-up period. Survival at 6 months, 1 year and 2 years was 59%, 47% and 23% respectively. Patients requiring major lower extremity amputation represent the peak of high-risk patients undergoing vascular surgery. Significant perioperative morbidity and limited survival is seen in this cohort. Early vascular surgery referral may reduce more proximal amputations and improve functional outcome in a group with poor longevity and limited functional capacity with amputation at the transtibial level and proximal.

  19. Accuracy and consequences of 3D-fluoroscopy in upper and lower extremity fracture treatment: A systematic review

    International Nuclear Information System (INIS)

    Beerekamp, M.S.H.; Sulkers, George S.I.; Ubbink, Dirk T.; Maas, Mario; Schep, Niels W.L.; Goslings, J. Carel

    2012-01-01

    Objectives: The aim of this systematic review was to compare the diagnostic accuracy, subjective image quality and clinical consequences of 3D-fluoroscopy with standard imaging modalities (2D-fluoroscopy, X-ray or CT) during reduction and fixation of intra-articular upper and lower extremity fractures. Methods: A systematic literature search was performed in MEDLINE, EMBASE and the Cochrane library. In total 673 articles were identified (up to March 2012). The 19 included studies described patients/cadavers with intra-articular upper/lower extremity fractures and compared 3D-fluoroscopy to standard imaging. The study was performed in accordance with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines. Diagnostic accuracy was defined by the quality of fracture reduction or implant position and, if possible, expressed as sensitivity and specificity; subjective image quality was determined by the quality of depiction of bone or implants; clinical consequences were defined as corrections in reduction or implant position following 3D-fluoroscopy. Results: Ten cadaver- and nine clinical studies were included. A meta-analysis was not possible, because studies used different scoring protocols to express diagnostic accuracy and reported incomplete data. Based on the individual studies, diagnostic accuracy of 3D-fluoroscopy was better than 2D-fluoroscopy and X-ray, but similar to CT-scanning. Subjective image quality of 3D-fluoroscopy was inferior compared to all other imaging modalities. In 11–40% of the operations additional corrections were performed after 3D-fluoroscopy, while the necessity for these corrections were not recognized based on 2D-fluoroscopic images. Conclusions: Although subjective image quality is rated inferior compared to other imaging modalities, intra-operative use of 3D-fluoroscopy is a helpful diagnostic tool for improving the quality of reduction and implant position in intra-articular fractures.

  20. [Recent Knowledge of Smoking and Peripheral Arterial Disease in Lower Extremities].

    Science.gov (United States)

    Sotoda, Yoko; Hirooka, Shigeki; Orita, Hiroyuki; Wakabayashi, Ichiro

    2015-01-01

    Peripheral arterial disease (PAD) is an atherosclerotic obstructive disease of the arteries in lower extremities. Patients with PAD show high rates of mortality from coronary artery disease (CAD) and stroke. Smoking as well as diabetes is an important risk factor for PAD. A lesion of PAD in the lower extremities tends to be more proximal in smokers than in nonsmokers and to be more distal in patients with diabetes than in nondiabetics. By a systematic review, the odds ratio for PAD of smokers vs nonsmokers has been reported to be in the range of 1.7-7.4. Previous epidemiological studies suggest a stronger association of smoking with PAD than that with CAD. Nitric oxide (NO) is an important molecule suppressing the progression of atherosclerosis, but this function is compromised by smoking. Smoking decreases the bioactivity of NO and the expression level of NO synthase. In addition, smoking results in deteriorations of risk factors for atherosclerosis such as decreases in blood HDL (high-density lipoprotein) cholesterol and tissue plasminogen activator levels and increases in the levels of blood triglycerides, LDL (low-density lipoprotein) cholesterol, fibrinogen and the von Willebrand factor. Thus, smoking increases blood coagulability and deteriorates the blood lipid profile, resulting in thrombogenetic proneness and dyslipidemia. Smoking also increases the generation of atherogenic oxidized LDL in blood and decreases antiatherogenic prostacyclin production in the vascular endothelium. Smoking cessation is important for the prevention and therapy of PAD, and to this end, counseling by physicians and nicotine replacement therapy are useful and strongly recommended for patients with PAD.

  1. An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system.

    Science.gov (United States)

    Cull, David L; Manos, Ginger; Hartley, Michael C; Taylor, Spence M; Langan, Eugene M; Eidt, John F; Johnson, Brent L

    2014-12-01

    The Society for Vascular Surgery (SVS) recently established the Lower Extremity Threatened Limb Classification System, a staging system using Wound characteristic, Ischemia, and foot Infection (WIfI) to stratify the risk for limb amputation at 1 year. Although intuitive in nature, this new system has not been validated. The purpose of the following study was to determine whether the WIfI system is predictive of limb amputation and wound healing. Between 2007 and 2010, we prospectively obtained data related to wound characteristics, extent of infection, and degree of postrevascularization ischemia in 139 patients with foot wounds who presented for lower extremity revascularization (158 revascularization procedures). After adapting those data to the WIfI classifications, we analyzed the influence of wound characteristics, extent of infection, and degree of ischemia on time to wound healing; empirical Kaplan-Meier survival curves were compared with theoretical outcomes predicted by WIfI expert consensus opinion. Of the 158 foot wounds, 125 (79%) healed. The median time to wound healing was 2.7 months (range, 1-18 months). Factors associated with wound healing included presence of diabetes mellitus (P = .013), wound location (P = .049), wound size (P = .007), wound depth (P = .004), and degree of ischemia (P WIfI clinical stage was predictive of 1-year limb amputation (stage 1, 3%; stage 2, 10%; stage 3, 23%; stage 4, 40%) and wound nonhealing (stage 1, 8%; stage 2, 10%; stage 3, 23%; stage 4, 40%) and correlated with the theoretical outcome estimated by the SVS expert panel. The theoretical framework for risk stratification among patients with critical limb ischemia provided by the SVS expert panel appears valid. Further validation of the WIfI classification system with multicenter data is justified. Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  2. Body schema and midline sensation influenced by unilateral manual stimulation of lower extremity

    DEFF Research Database (Denmark)

    Læssøe, Uffe; Barth, Lasse; Skeie, Sindre

    Relevance: Clinical experience advocates manual stimulation in order to increase the sensation of the body and adjust the body schema. Unilateral treatment may affect the midline sensation and weight distribution in a standing position, but little evidence is available to support this procedure....... Purpose: The aim of the present study was to evaluate whether one-sided manual stimulation of one leg would influence the midline perception and weight distribution in standing position. Methods/analysis: Twenty-one healthy young people received unilateral manual stimulation of the lower extremities...... alignment was seen as a response to unilateral massage. It may be suggested, that the manipulated midline sensation and weight distribution reflects a state in which the participant's attention to a greater extent has been directed towards a specific body part due to the manual sensory stimulation. Impact...

  3. Temporal Characteristics of Lower Extremity Moment Generation in Children with Cerebral Palsy

    Science.gov (United States)

    Downing, Andrea L.; Ganley, Kathleen J.; Fay, Deanne R.; Abbas, James J.

    2009-01-01

    Lower extremity weakness has been documented in children with cerebral palsy (CP). However, the temporal characteristics of moment generation have not been characterized, and they may be important to function. This study tested ankle, knee, and hip flexion and extension moment generation capabilities in children with CP and in able-bodied children. Maximum voluntary isometric contractions (MVIC), the maximum rates of moment development and relaxation, and the time to produce and reduce the moments were quantified. Relationships between the temporal measures, Gross Motor Function Measure-66 (GMFM-66), and MVICs were also examined. Children with CP had significantly reduced MVICs, maximum development and relaxation rates, and increased times to produce and reduce moments. The maximum rates of moment development and relaxation at some joints were correlated with the GMFM-66 and MVICs. These results suggest that both the magnitude and temporal characteristics of moment generation need to be targeted during therapeutic interventions for children with CP. PMID:19260049

  4. Stenting for peripheral artery disease of the lower extremities: an evidence-based analysis.

    Science.gov (United States)

    2010-01-01

    In January 2010, the Medical Advisory Secretariat received an application from University Health Network to provide an evidentiary platform on stenting as a treatment management for peripheral artery disease. The purpose of this health technology assessment is to examine the effectiveness of primary stenting as a treatment management for peripheral artery disease of the lower extremities. CONDITION AND TARGET POPULATION Peripheral artery disease (PAD) is a progressive disease occurring as a result of plaque accumulation (atherosclerosis) in the arterial system that carries blood to the extremities (arms and legs) as well as vital organs. The vessels that are most affected by PAD are the arteries of the lower extremities, the aorta, the visceral arterial branches, the carotid arteries and the arteries of the upper limbs. In the lower extremities, PAD affects three major arterial segments i) aortic-iliac, ii) femoro-popliteal (FP) and iii) infra-popliteal (primarily tibial) arteries. The disease is commonly classified clinically as asymptomatic claudication, rest pain and critical ischemia. Although the prevalence of PAD in Canada is not known, it is estimated that 800,000 Canadians have PAD. The 2007 Trans Atlantic Intersociety Consensus (TASC) II Working Group for the Management of Peripheral Disease estimated that the prevalence of PAD in Europe and North America to be 27 million, of whom 88,000 are hospitalizations involving lower extremities. A higher prevalence of PAD among elderly individuals has been reported to range from 12% to 29%. The National Health and Nutrition Examination Survey (NHANES) estimated that the prevalence of PAD is 14.5% among individuals 70 years of age and over. Modifiable and non-modifiable risk factors associated with PAD include advanced age, male gender, family history, smoking, diabetes, hypertension and hyperlipidemia. PAD is a strong predictor of myocardial infarction (MI), stroke and cardiovascular death. Annually, approximately

  5. Effectiveness of Occupational Therapy Interventions for Lower-Extremity Musculoskeletal Disorders: A Systematic Review.

    Science.gov (United States)

    Dorsey, Julie; Bradshaw, Michelle

    Lower-extremity (LE) musculoskeletal disorders (MSDs) can have a major impact on the ability to carry out daily activities. The effectiveness of interventions must be examined to enable occupational therapy practitioners to deliver the most appropriate services. This systematic review examined the literature published between 1995 and July 2014 that investigated the effectiveness of occupational therapy interventions for LE MSDs. Forty-three articles met the criteria and were reviewed. Occupational therapy interventions varied on the basis of population subgroup: hip fracture, LE joint replacement, LE amputation or limb loss, and nonsurgical osteoarthritis and pain. The results indicate an overall strong role for occupational therapy in treating clients with LE MSDs. Activity pacing is an effective intervention for nonsurgical LE MSDs, and multidisciplinary rehabilitation is effective for LE joint replacement and amputation. Further research on specific occupational therapy interventions in this important area is needed. Copyright © 2017 by the American Occupational Therapy Association, Inc.

  6. Surgical Treatment of Classic Kaposi’s Sarcoma in the Lower Extremity

    Directory of Open Access Journals (Sweden)

    Adem Topkara

    2017-03-01

    Full Text Available Objective: Classic Kaposi’s sarcoma is an indolent, angioproliferative tumor that is usually observed in the lower extremities of elderly men. Depending on their stages, skin lesions are maculonodular or vegetative ulcerated masses. Visceral organ or lymph node involvement may rarely occur. There is no gold standard treatment for local diseases. Surgical excision, radiotherapy, chemotherapy, and cryotherapy can be performed. This retrospective study aimed to evaluate the long-term results of surgical excision and skin graft repair of stage I and II classic Kaposi’s sarcoma skin lesions around the foot and ankle. Material and Methods: Eleven patients were included. The patients’ age and gender, location of lesion, surgical treatment, follow-up period, and recurrence were evaluated by retrospectively examining patient records. For the surgical treatment, the lesion was excised with a 0.5-cm safe skin margin. The defect area was repaired with full-thickness skin grafts that were obtained from the inguinal region in all patients. Results: Eight of the patients were male and three were female. The average age of the patients was 69 (54–84 years. All patients were completely cured. The average follow-up period was 1.8 (1–3 years. No recurrence was observed in any of the patients at the end of the follow-up period. Conclusion: Classic Kaposi’s sarcoma skin lesions in the lower extremity can be completely cured by surgical excision, with no recurrence risk. After surgical excision, using a full-thickness skin graft for repairing primary cutaneous defects, particularly those in the soles, is a simple and reliable method.

  7. Effect of initial projectile speed on contamination distribution in a lower extremity surrogate "wound track".

    Science.gov (United States)

    Krebsbach, Meaghen A; Muci-Küchler, Karim Heinz; Hinz, Brandon J

    2012-05-01

    This article presents an experimental study that examines the relationship between initial projectile speed and bacterial distribution along a wound track due to surface contamination. A ballistic gelatin cylinder was used as a lower extremity surrogate, and surface contamination was simulated using circular filter paper moistened with a solution containing Escherichia coli strain K-12 that was previously transformed to express green fluorescent protein and be resistant to ampicillin. An 11.43-mm caliber round-nose lead projectile was shot through the contaminated area and into the extremity surrogate at firing velocities ranging from 61 to 199 m/s. The "wound track" was extracted and cut into 10 evenly spaced slices. Then, the permanent cavity was removed from each slice using a biopsy punch, liquefied, and grown on selective agar containing ampicillin. Direct and normalized bacterial colony counts and normalized extents of area covered by bacteria colonies were used to compare the differences between distribution trends corresponding to different projectile speeds. The results obtained showed that, for the cases considered, an increase in projectile speed resulted in a significant shift in the percentage of contamination from the "wound" entrance region to the "wound" exit region.

  8. Effect of ankle braces on lower extremity joint energetics in single-leg landings.

    Science.gov (United States)

    Gardner, Jacob K; McCaw, Steven T; Laudner, Kevin G; Smith, Peter J; Stafford, Lindsay N

    2012-06-01

    Ankle sprains are one of the most common injuries in competitive and recreational athletics. Studies have shown that the use of prophylactic ankle braces effectively reduces the frequency of ankle sprains in athletes. However, although it is generally accepted that the ankle braces are effective at reducing frontal plane motion, some researchers report that the design of the brace may also reduce ankle sagittal plane motion. The purpose of this study was to quantify lower extremity joint contributions to energy absorption during single-legged drop landings in three ankle brace conditions (no brace, boot brace, and hinged brace). Eleven physically active females experienced in landing and free of lower extremity injury (age = 22.3 ± 1.7 yr, height = 1.66 ± 0.04 m, mass = 58.43 ± 5.83 kg) performed 10 single-leg drop landings in three conditions (one unbraced, two braced) from a 0.33-m height. Measurements taken were hip, knee, and ankle joint impulse; hip, knee, ankle, and total work; and hip, knee, and ankle joint relative work. Total energy absorption remained consistent across the braced conditions (P = 0.057). Wearing the boot brace reduced relative ankle work (P = 0.04, Cohen d = 0.43) but did not change relative knee (P = 0.08, Cohen d = 0.32) or hip (P = 0.14, Cohen d = 0.20) work compared with the no-brace condition. In an ankle-braced condition, ankle, knee, and hip energetics may be altered depending on the design of the brace.

  9. Outcomes of Foam Sclerotherapy plus Ligation versus Foam Sclerotherapy Alone for Venous Ulcers in Lower Extremities.

    Science.gov (United States)

    Li, Xin; Fan, Lin; Ren, Shiyan; Li, Xianlun

    2017-11-01

    Foam sclerotherapy (FS) is a safe and effective approach for managing patients with varicose veins and venous ulcers in lower extremities. But, recanalization of the ablated varicose veins and phlebitis are common postoperative complications that jeopardize its clinical effects. We hypothesize that ligation of the ablated varicose veins after FS will improve the outcomes of patients with varicose veins and venous ulcer. This study was aimed to evaluate the clinical efficacy of ligation after FS in comparison with FS alone for the management of patients with varicose veins and venous ulcers in lower extremities. Eighteen patients underwent FS plus ligation (FSL) and 15 patients received FS alone. Aberdeen varicose veins questionnaire (AVVQ) and the revised venous clinical severity score (rVCSS), venous disability scores (VDSs), duplex sonography, ulcer healing rate, and ulcer healing time were documented to compare the outcomes in both groups. The ulcer healing time in patients treated with FSL was shorter than that in patients who received FS (P = 0.022; log-rank test). The average healing time was significantly shorter in FSL group than in FS group (35.67 ± 24.62 days vs. 62.86 ± 47.43, P = 0.042). The mean rVCSS, VDS, and AVVQ at 3 months after treatment in both groups decreased significantly in comparison with baseline, respectively. There were no severe complications or side effects in both groups. Ligation of the treated varicose veins after FS can improve the outcomes of patients with venous ulcers in comparison with FS alone. FSL is a safe, effective, and technically feasible procedure and can be used as a day surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Repeatability testing of a new Hybrid III 6-year-old ATD lower extremity.

    Science.gov (United States)

    Boucher, Laura C; Ryu, Yeonsu; Kang, Yun-Seok; Bolte, John H

    2017-05-29

    Vehicle safety is improving, thus decreasing the number of life-threatening injuries and increasing the need for research in other areas of the body. The current child anthropomorphic test device (ATD) does not have the capabilities or instrumentation to measure many of the potential interactions between the lower extremity and the vehicle interior. A prototype Hybrid III 6-year-old ATD lower extremity (ATD-LE) was developed and contains a tibia load cell and a more biofidelic ankle. The repeatability of the device has not yet been assessed; thus, the objective was to evaluate the repeatability of the ATD-LE. Additionally, a dynamic assessment was conducted to quantify injury threshold values. A pneumatic ram impactor was used at 2 velocities to evaluate repeatability. The ATD-LE was fixed to a table and impacted on the plantar aspect of the forefoot. Three repeated trials at 1.3 and 2.3 m/s without shoes and 2.3 m/s with shoes were conducted. The consistency of tibia force (N), bending moment (Nm), ankle range of motion (ROM, °), and stiffness (Nm/°) were quantified. A dynamic assessment using knee bolster airbag (KBA) tests was also conducted. The ATD-LE was positioned to mimic 3 worst-case scenarios: toes touching the mid-dashboard, touching the lower dashboard, and flat on the floor prior to airbag deployment. The impact responses in the femur and tibia were directly collected and compared with published injury threshold values. Ram impact testing indicated primarily excellent repeatability for the variables tested. For all 3 conditions the coefficients of variance (CV) were as follows: tibia force, 1.9-2.7%; tibia moment, 1.0-2.2%; ROM, 1.3-1.4%; ankle stiffness, 4.8-15.6%. The shoe-on condition resulted in a 25% reduction in tibia force and a 56% reduction in tibia bending moment. The KBA tests indicate that the highest injury risk may be when the toes touch the lower dashboard, due to the high bending moments recorded in the tibia at 76.2 Nm, which was

  11. Use of angiotensin-converting enzyme inhibitors and freedom from amputation after lower extremity revascularization

    Directory of Open Access Journals (Sweden)

    Kray JE

    2017-07-01

    Full Text Available Jared E Kray,1 Viktor Y Dombrovskiy,2 Todd R Vogel1 1Department of Surgery, Division of Vascular Surgery, School of Medicine, University of Missouri, Columbia, MO, 2Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA Objective: Angiotensin-converting enzyme inhibitors (ACEIs have not been well evaluated in conjunction with lower extremity revascularization (LER. This study evaluated freedom from amputation in patients who underwent either an open (OPEN or endovascular (ENDO revascularization with and without utilization of an ACEI.Materials and methods: Patients who underwent LER were identified from 2007–2008 Medicare Provider Analysis and Review files. Demographics, comorbidities, and disease severity were obtained. Post-procedural use of an ACEI was confirmed using combining them with National Drug Codes and Part D Files. Outcomes were analyzed using chi-square analysis, Kaplan–Meier test, and Cox regression.Results: We identified 22,954 patients who underwent LER: 8,128 (35.4% patients with claudication, 3,056 (13.3% with rest pain, and 11,770 (51.3% with ulceration or gangrene. More patients underwent ENDO (14,353 than OPEN (8,601 revascularization and 38% of the cohort was taking an ACEI. Overall, ACEI utilization compared to patients not taking ACEI was not associated with lower amputation rates at 30 days (13.5% vs. 12.6%, 90 days (17.7% vs. 17.1%, or 1 year (23.9% vs. 22.8% (P>0.05 for all. After adjustment for comorbidities, ACEI utilization was associated with higher amputation rates for patients with rest pain (hazard ratio: 1.4; 95% confidence interval: 1.1–1.8. Conclusion: ACEI utilization was not associated with overall improved rates of amputation-free survival or overall survival in the vascular surgery population. However, an important finding of this study was that patients presenting with a diagnosis of rest pain and taking an ACEI who underwent a LER had statistically higher

  12. [Fractures of the lower extremity in skiing - the influence of ski boots and injury pattern].

    Science.gov (United States)

    Bürkner, A; Simmen, H P

    2008-12-01

    Though the injury patterns of the lower extremities in skiing have changed since 1970, tibial fractures remain daily work of hospitals near ski slopes. A lot of medical studies have analysed the relevance of well adjusted bindings of the common lesions of the knee joint ligaments. However the influence of the flexibility of the ski boot and the injury pattern has been neglected. 49 tibial fractures have been analysed in a hospital near a large ski resort in the alpes. All fractures occurred during alpine skiing. The type of the fracture, according to the AO-classification and the injury pattern have been documented. Also demographic data, ski experience and specification concerning the ski boot have been questioned. The type of the ski boot and the grade of flexibility, have been documented if possible. It has also been recorded whether the binding opened. In contrast to other studies our patients are represented in widely spread age-groups with a large share of elderly and experienced persons. Young or unexperienced sportsmen suffer primarily from fractures of the tibial diaphysis. With increasing skiing experience the injury pattern is widening on the whole leg. 62 % of all fractures are caused by rotation traumas. Compression, dorsal forces and direct collisions are the other causes. In 59 % of all accidents the binding failed to open. There is an increased risk of complex fractures in the proximal or distal epiphysis if the binding has not opened. 23 % of all fractures occurred with rented ski boots. Only 16 % of all ski boots are labelled with a flexibility index. There is no standardized value for the flexibility of ski boots. The trend can be derived that rigid ski boots with a high flexibility index cause above all fractures of the diaphysis. 10 % of all fractures happened to patients wearing "snowblades". These short skis without safety bindings contributed a considerable share to tibial fractures, even though there is no big leverage. Tibial fractures are

  13. Modified Ashworth scale reliability for measurement of lower extremity spasticity among patients with SCI.

    Science.gov (United States)

    Craven, B C; Morris, A R

    2010-03-01

    Observational study. To report the intra-rater (one rater), inter-rater (two raters) and inter-session (one subject, sessions 1-5) reliability of lower extremity modified Ashworth scale (MAS) scores among patients with chronic spinal cord injury (SCI). Tertiary Academic Rehab Centre in Toronto, Canada. MAS scores of 20 subjects with chronic SCI (C5-T10 AIS A-D>12 months) were recorded for the hip abductors and adductors, knee flexors and extensors, and ankle plantar and dorsiflexors. MAS scores were assessed by two blinded raters (A and B) at the same time of day, weekly for 5 weeks using standardized test positions, a one-cycle per second metronome, with ratings recorded on the second cycle. MAS score reproducibility [intra-rater, inter-rater] were calculated using Cohen's Kappa. Intraclass correlation coefficients (ICCs) were calculated to determine inter-session (trials 1-5) reliability; Kappa values >or=0.81 and ICC values >or=0.75 were desired. Intra-rater reliability was fair to almost perfect (0.2lower extremity spasticity between raters (inter-rater) or over time (inter-session). It is recommended that the rehabilitation science community seek alternative measures for quantifying spasticity.

  14. An Epidemiological and Etiological Report on Lower Extremity Amputation in Northwest of Iran

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    Alireza Rouhani

    2013-12-01

    Full Text Available Background: Lower extremity amputation has different etiologies and the purpose of the study was to describe the demographics and etiologies of amputations. This study was designed to evaluate amputations performed in the province of Eastern Azerbaijan (north-west of Iran and to       determine specific causes of amputations associated with geographical and cultural characteristics of the region.   Methods: We have done this retrospective and descriptive study from June 1st, 2005 to June 1st, 2010 in Tabriz Shohada Hospital (Tabriz, Iran. The patients were evaluated with respect to age, sex, etiology, side and level of amputations, prevalence of amputations among the sexes at different ages and surgical interventions performed. Results: One-hundred-sixty files were identified with a diagnosis of lower limb amputation. Trauma was the most frequent cause in 67 cases (46%, followed by vascular disease in 61 cases (42%, and then infection in 18 cases (12%. Eighty percent of patients were male and 20% were female. Conclusion: This investigation shows that trauma (especially due to car accidents is the most common cause of amputations in our region, followed by vascular problems.

  15. Association between superficial vein thrombosis and deep vein thrombosis of the lower extremities.

    Science.gov (United States)

    Binder, Barbara; Lackner, Helmut Karl; Salmhofer, Wolfgang; Kroemer, Susanne; Custovic, Jasmina; Hofmann-Wellenhof, Rainer

    2009-07-01

    To evaluate the occurrence of deep vein thrombosis (DVT) in patients with superficial vein thrombosis (SVT). A prospective study in patients with sonographically proven SVT. Outpatient department of the Department of Dermatology, Medical University of Graz. Patients Forty-six consecutive patients with superficial vein thrombosis were enrolled. Intervention Every patient underwent color-coded duplex sonography of both lower extremities at the beginning of the study. Important risk factors (eg, history of thromboembolic events, recent immobilization, active malignant disease, and the use of oral contraceptives) were investigated. In 24% of our patients, a concomitant, mostly asymptomatic DVT was found. In 73% of these patients, the DVT occurred in the affected leg, in 9% in the contralateral leg, and in 18% in both legs. The calf muscle veins were most commonly involved. In all patients with DVT, the SVT was located on the lower leg and the D-dimer findings were positive. Superficial vein thrombosis is not a life-threatening disease, but the risk of concomitant DVT cannot be ignored. Color-coded duplex sonography should be performed in patients with SVT to rule out DVT.

  16. Frequency of superficial and deep vein thrombosis in patients with variations of superficial veins of lower extremities.

    Science.gov (United States)

    Lovic, Svetlana; Delic, Jasmin; Ljuca, Farid; Mujanovic, Emir; Custendil-Delic, Sunita; Zabic, Aida; Suljkanovic-Mahmutovic, Ahida

    2012-01-01

    Anatomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. THE AIM of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form ofv. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.

  17. Local changes in bone marrow at MRI after treatment of extremity soft tissue sarcoma

    International Nuclear Information System (INIS)

    Hwang, Sinchun; Lefkowitz, Robert; Landa, Jonathan; Akin, Oguz; Schwartz, Lawrence H.; Cassie, Conrad; Panicek, David M.; Healey, John H.; Alektiar, Kaled M.

    2009-01-01

    To determine the prevalence and appearance of magnetic resonance imaging (MRI) signal changes that occur in local bone marrow after radiation therapy (RT) and/or chemotherapy for extremity soft tissue sarcoma (STS). Seventy patients with primary STS at the level of a long bone who also had undergone pretreatment MRI and at least one post-treatment MRI of the tumor bed were identified. MRIs of each patient were retrospectively reviewed for new changes in marrow signal in the region of the tumor bed and for the morphology, relative signal intensities, heterogeneity, and progression or regression of changes over time. Focal signal changes in marrow were observed in 26/70 patients (37%) at a median of 9.5 months after RT and/or chemotherapy and diffuse changes in seven (10%) at a median of 8 months. Patients who received neither RT nor chemotherapy did not develop marrow changes. Mean RT doses in patients with changes and those without were 5,867 and 6,076 cGy, respectively. In most patients with focal changes, changes were seen in all sequences and were linear-curvilinear, patchy, or mixed at the level of the tumor bed. Predominant signal intensity of changes was between muscle and fat at T1WI and between muscle and fluid at fat-saturated T2WI or short tau inversion recovery. Most focal changes enhanced heterogeneously and increased or fluctuated in size over time. Changes in MRI appearance of long bone marrow frequently are evident after combined RT and chemotherapy for STS and most commonly increase or fluctuate in size over time. These changes have various non-mass-like configurations and often show signal intensities similar to those of red marrow and thus should not be mistaken for metastases. The marrow changes might represent an early stage of gelatinous transformation of marrow. (orig.)

  18. A Longitudinal Study of Social Participation After Dysvascular Lower Extremity Amputation.

    Science.gov (United States)

    Roepke, Ann Marie; Williams, Rhonda M; Turner, Aaron P; Henderson, Alison W; Norvell, Daniel C; Henson, Helene; Hakimi, Kevin N; Czerniecki, Joseph M

    2017-10-01

    This study examined patterns of social participation among individuals experiencing their first dysvascular lower extremity amputation. We identified the types of social participation valued by this population and explored factors that were associated with individuals' levels of participation and their subjective satisfaction with participation. A prospective cohort was recruited from four Veterans Administration Medical Centers and followed for 1 yr after amputation. Social participation was measured with a modified version of the Community Integration Questionnaire. Potential correlates included the Patient Health Questionnaire-9, Modified Social Support Survey, Locomotor Capability Index 5, Short Portable Mental Status Questionnaire, and self-rated health. At 1-yr postamputation, participants indicated that the most valued aspects of social participation were maintaining close friendships, visiting loved ones, and managing finances. Levels of social participation and satisfaction with participation were modest at 1-yr postamputation. Higher levels of social participation at 1 yr were related to better baseline mental status, better premorbid mobility, and lower amputation level. Higher satisfaction with participation was related to greater baseline social support. Individuals' social participation may be influenced by physical and cognitive factors, whereas their satisfaction with participation may be influenced by psychosocial factors. Rehabilitation specialists are encouraged to address both aspects of social participation when formulating and pursuing rehabilitation goals.

  19. The Effect of Adolescent Idiopathic Scoliosis on the Occurrence of Varicose Veins on Lower Extremities

    Science.gov (United States)

    Talic, Goran; Talic, Luka; Stevanovic-Papica, Djurdjica; Nozica-Radulovic, Tatjana; Novakovic-Bursac, Snjezana

    2017-01-01

    Introduction: Scoliosis is a complex three-dimensional spine deformity with the frontal plane deflexion (side-shift) of the series of vertebra from the midline and with torque deformity of vertebra, ribs, and the entire trunk towards the apex of curve. Chronic venous diseases present a group of pathological conditions caused by the increased venous pressure. The venous pressure may be increased due to genetics, ligament laxity, general obesity, injuries, and changes in biomechanics of spine and lower extremities, etc. Aim: The aim of the study is to evaluate the frequency of the varicose veins in women previously treated for the adolescent idiopathic scoliosis. Material and methods: In the period August 1, 2015 - December 30, 2015 the Team for scoliosis in the Institute for the Physical medicine and Rehabilitation „Dr Miroslav Zotović” in Banja Luka in study program has clinically assessed 89 women previously treated for the adolescent idiopathic scoliosis (AIS) and the control group of 87 women without history of scoliosis. Results: Results of the study led to conclusion that occurrence of the varicose veins was more frequent in the group of women who were treated for the AIS (23/89 or 25.8%) in comparison with control group with no history of AIS (7/87 or 8.1%). Conclusion: This might relate AIS with some other connective tissue disorder, like venous varices, for instance. PMID:28790540

  20. Autosomal dominant spinal muscular atrophy with lower extremity predominance: A recognizable phenotype of BICD2 mutations.

    Science.gov (United States)

    Rudnik-Schöneborn, Sabine; Deden, Florian; Eggermann, Katja; Eggermann, Thomas; Wieczorek, Dagmar; Sellhaus, Bernd; Yamoah, Alfred; Goswami, Anand; Claeys, Kristl G; Weis, Joachim; Zerres, Klaus

    2016-09-01

    Heterozygous BICD2 gene mutations cause a form of autosomal dominant spinal muscular atrophy with lower extremity predominance (SMALED). We analyzed the BICD2 gene in a selected group of 25 index patients with neurogenic muscle atrophy. We identified 2 new BICD2 missense mutations, c.2515G>A, p.Gly839Arg, in a family with autosomal dominant inheritance, and c.2202G>T, p.Lys734Asn, as a de novo mutation in an isolated patient with similar phenotype. The patients had congenital foot contractures, muscle atrophy of the legs, and slowly progressive weakness of the shoulder girdle. There was no apparent sensory or brain dysfunction. One patient died of unrelated reasons at age 52 years. Autopsy revealed no upper motor neuron and only moderate lower motor neuron loss, but there was distal corticospinal tract degeneration and marked neurogenic muscular atrophy. These findings give further insight into the clinical and pathoanatomical consequences of BICD2 mutations. Muscle Nerve 54: 496-500, 2016. © 2016 Wiley Periodicals, Inc.

  1. Epidemiology of lower extremity injuries among U.S. high school athletes.

    Science.gov (United States)

    Fernandez, William G; Yard, Ellen E; Comstock, R Dawn

    2007-07-01

    Despite the health benefits of organized sports, high school athletes are at risk for lower extremity sports-related injuries (LESRIs). The authors documented the epidemiology of LESRIs among U.S. high school athletes. Via two-stage sampling, 100 U.S. high schools were randomly selected. During the 2005 school year, LESRIs in nine sports were reported: boys' baseball, football, and wrestling; girls' softball and volleyball; and boys' and girls' basketball and soccer. The authors calculated rates as the ratio of LESRIs to the number of athlete exposures. National estimates were generated by assigning injuries a sample weight based on the inverse probability of the school's selection into the study. Among high school athletes in 2005, 2,298 of 4,350 injuries (52.8%) were LESRIs. This represents an estimated 807,222 LESRIs in U.S. high school athletes in nine sports (1.33/1,000 athlete exposures). Football had the highest LESRI rate for boys (2.01/1,000) and soccer the highest for girls (1.59/1,000). Leading diagnoses were sprains (50%), strains (17%), contusions (12%), and fractures (5%). The ankle (40%), knee (25%), and thigh (14%) were most frequently injured. Fractures occurred most often in the ankle (42%), lower leg (29%), or foot (18%). Girls with ligamentous knee injuries required surgery twice as often as boys (67% vs. 35%; p injuries. To optimize prevention strategies, ongoing surveillance is needed.

  2. Bone graft substitutes for the treatment of traumatic fractures of the extremities.

    Science.gov (United States)

    Hagen, Anja; Gorenoi, Vitali; Schönermark, Matthias P

    2012-01-01

    HEALTH POLITICAL AND SCIENTIFIC BACKGROUND: Bone graft substitutes are increasingly being used as supplements to standard care or as alternative to bone grafts in the treatment of traumatic fractures. The efficacy and cost-effectiveness of bone graft substitutes for the treatment of traumatic fractures as well as the ethical, social and legal implications of their use are the main research questions addressed. A systematic literature search was conducted in electronic medical databases (MEDLINE, EMBASE etc.) in December 2009. Randomised controlled trials (RCT), where applicable also containing relevant health economic evaluations and publications addressing the ethical, social and legal aspects of using bone graft substitutes for fracture treatment were included in the analysis. After assessment of study quality the information synthesis of the medical data was performed using metaanalysis, the synthesis of the health economic data was performed descriptively. 14 RCT were included in the medical analysis, and two in the heath economic evaluation. No relevant publications on the ethical, social and legal implications of the bone graft substitute use were found. In the RCT on fracture treatment with bone morphogenetic protein-2 (BMP-2) versus standard care without bone grafting (RCT with an elevated high risk of bias) there was a significant difference in favour of BMP-2 for several outcome measures. The RCT of calcium phosphate (CaP) cement and bone marrow-based composite materials versus autogenous bone grafts (RCT with a high risk of bias) revealed significant differences in favour of bone graft substitutes for some outcome measures. Regarding the other bone graft substitutes, almost all comparisons demonstrated no significant difference. The use of BMP-2 in addition to standard care without bone grafting led in the study to increased treatment costs considering all patients with traumatic open fractures. However, cost savings through the additional use of BMP-2

  3. Imaging of Sports-related Injuries of the Lower Extremity in Pediatric Patients.

    Science.gov (United States)

    O'Dell, M Cody; Jaramillo, Diego; Bancroft, Laura; Varich, Laura; Logsdon, Gregory; Servaes, Sabah

    2016-10-01

    With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports. However, some injuries that occur almost exclusively in high-level athletes (eg, athletic pubalgia) are reviewed to increase awareness and understanding of these entities among pediatric radiologists who may not be familiar with them and thus may not look for them. Injuries are described according to their location (ie, hip, knee, or foot and ankle) and pathologic process (eg, apophysitis, osteochondritis dissecans). Examples of abnormalities and normal variants of the anatomy that are often misdiagnosed are provided. The injuries reviewed represent a common and growing subset of pathologic processes about which all pediatric and musculoskeletal radiologists should be knowledgeable. Understanding physeal injury is especially important because missed diagnoses can lead to premature physeal closure and osteoarthritis. © RSNA, 2016.

  4. Tedizolid and Linezolid for Treatment of Acute Bacterial Skin and Skin Structure Infections of the Lower Extremity versus Non-Lower-Extremity InfectionsPooled Analysis of Two Phase 3 Trials.

    Science.gov (United States)

    Joseph, Warren S; Culshaw, Darren; Anuskiewicz, Steven; De Anda, Carisa; Prokocimer, Philippe

    2017-07-01

    Tedizolid phosphate, the prodrug of the oxazolidinone tedizolid, has been approved in a number of countries, including the United States, those in the European Union, and Canada, for treatment of patients with acute bacterial skin and skin structure infections (ABSSSI). Two phase 3 trials demonstrated the noninferior efficacy of tedizolid (200 mg once daily for 6 days) to linezolid (600 mg twice daily for 10 days) in patients with ABSSSI. Because of the challenges of treating lower-extremity ABSSSI, the efficacy and safety of tedizolid and linezolid for treating lower-extremity versus non-lower-extremity infections were compared. This was a post hoc analysis of pooled data from patients with lower-extremity infections enrolled in two phase 3 studies, ESTABLISH-1 (NCT01170221) and ESTABLISH-2 (NCT01421511), comparing tedizolid to linezolid in patients with ABSSSI. Lower-extremity ABSSSI were present in 40.7% of tedizolid-treated and 42.2% of linezolid-treated patients. Methicillin-resistant Staphylococcus aureus (MRSA) was present in 34.7% of all patients with a baseline causative pathogen. Early clinical responses at 48 to 72 hours and investigator-assessed responses at the post-therapy evaluation were similar between tedizolid and linezolid, regardless of ABSSSI type. With both treatments, the early clinical response was slightly higher in patients with non-lower-extremity infection than in those with lower-extremity ABSSSI (tedizolid, 84.8% versus 77.0%; linezolid, 81.4% versus 76.6%, respectively); however, by the post-therapy evaluation visit, response rates were similar (tedizolid, 87.1% versus 86.3%; linezolid, 86.6% versus 87.2%, respectively). Gastrointestinal adverse events and low platelet counts were observed more frequently with linezolid treatment. Post-therapy evaluations showed that the clinical response of lower-extremity ABSSSI to tedizolid and linezolid was comparable to that of ABSSSI in other locations. A short 6-day course of once

  5. Assessment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in patients with diabetic angiopathy

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    Čizmić Milica

    2011-01-01

    Full Text Available Background/Aim. Tibial perfusion in diabetic microangiopathy is considered to be a diagnostic problem. A special place in quantifying muscle microcirculatory perfusion belongs to thallium 201 muscle perfusion scintigraphy (201Tl PS. Thallium, showing the characteristics of potassium (K+, enters a cell by means of active cell transportation and follows erythrocyte up to the tissue. The aim of this study was to determine if 201Tl PS of lower extremities (LE is a good method for estimating muscle microcirculatory perfusion in diabetic microangiopathy. Methods. The study included 32 patients of an average age 66.1 ± 14.9 years with signs of LE ischemia befalling into III and IV stage of ischemic disease according to the Lariche-Fontain classification. Out of that number there were 27 of the patients with non-insulin-dependent diabetes mellitus (NIDDM, while 5 of the patients were with Burger's disease and Raynand's disorder. Lower extremities PS was performed after 3 min of tibial loading by the use of dorsoplantar foot flexion and intravenous 74 MBq 201Tl as a 10-minute dynamic study. A 10 minute static scintigraphy was carried out of the gluteal region, femurs, tibias and feet per a position and repeated after 3 h at rest in the same projections. The results were interpreted visually and by the semiquantitive method using a program for calculating the number of pulses per pixel in the corresponding region over 1-, 2- and 10-minute dynamic study, thus obtaining numerical data for estimating perfusion. Binding ratio in both legs was estimated visually as low (1, medium (2 and significant (3 difference in both legs. The results were compared with doppler hemodynamic indices (PI and RI. Results. Regardless the group, 201Tl binding intensity rising was significantly 2 min after application, as compared to 1 min, and the obtained level of binding was maintained even after 10 min. In the group Fontain III the majority of the patients showed a medium

  6. [Assesment of lower extremities ischemic disease by thallium 201 perfusion scintigraphy in patients with diabetic angiopathy].

    Science.gov (United States)

    Cizmić, Milica; Pucar, Dragan; Zoranović, Uros

    2011-02-01

    Tibial perfusion in diabetic microangiopathy is considered to be a diagnostic problem. A special place in quantifying muscle microcirculatory perfusion belongs to thallium 201 muscle perfusion scintigraphy (201T1 PS). Thallium, showing the characteristics of potassium (K+), enters a cell by means of active cell transportation and follows erythrocyte up to the tissue. The aim of this study was to determine if T1 PS of lower extremities (LE) is a good method for estimating muscle microcirculatory perfusion in diabetic microangiopathy. The study included 32 patients of an average age 66.1 +/- 14.9 years with signs of LE ischemia befalling into III and IV stage of ischemic disease according to the Lariche-Fontain classification. Out of that number there were 27 of the patients with non-insulin-dependent diabetes mellitus (NIDDM), while 5 of the patients were with Burger's disease and Raynand's disorder. Lower extremities PS was performed after 3 min of tibial loading by the use of dorsoplantar foot flexion and intravenous 74 MBq 201T1 as a 10-minute dynamic study. A 10 minute static scintigraphy was carried out of the gluteal region, femurs, tibias and feet per a position and repeated after 3 h at rest in the same projections. The results were interpreted visually and by the semiquantitive method using a program for calculating the number of pulses per pixel in the corresponding region over 1-, 2- and 10-minute dynamic study, thus obtaining numerical data for estimating perfusion. Binding ratio in both legs was estimated visually as low (1), medium (2) and significant (3) difference in both legs. The results were compared with doppler hemodynamic indices (PI and RI). Regardless the group, 201T1 binding intensity rising was significantly 2 min after application, as compared to 1 min, and the obtained level of binding was maintained even after 10 min. In the group Fontain III the majority of the patients showed a medium difference in binding 201T1 (2) in regard to the

  7. Effect of Tai Chi on muscle strength of the lower extremities in the elderly.

    Science.gov (United States)

    Zhou, Ming; Peng, Nan; Dai, Qiang; Li, Hong-Wei; Shi, Rong-Guang; Huang, Wei

    2016-11-01

    Aging is associated with a progressive decline in muscle strength, muscle mass and impaired physical function, which reduces mobility and impairs quality of life in the elderly population. The 6-12 months of exercise can enhance the muscle strength, but these improvements can only be maintained for a short period. In this study, we investigated the effects of long-term Tai Chi (TC) exercise on muscle strength of lower extremities. A cross-sectional study was conducted in 205 long-term TC practitioners (age: 60-89 years) and 205 age and gentle matched controls who did not practice TC. Each of the activity group was further divided into three distinct age groups: G1, 60-69 years; G2, 70-79 years; and G3, 80-89 years. Hand-held dynamometery was used to measure the maximum isometric strength of iliopsoas, quadriceps femoris, tibialis anterior and hamstrings in both sides of the participants. Unpaired t tests were performed to compare the difference of strength between the TC and non-Tai Chi (NTC) groups. Multivariate analysis of variance (MANOVA) was used to compare the lower muscle strengths among the different age groups in the TC and NTC groups. Pearson's correlations were used to quantify the linear relationship between the months of TC practice and lower limbs muscle strength. The inter-rater reliabilities of iliopsoas, quadriceps femoris, tibialis anterior and hamstrings were intraclass correlation coeffificient (ICC) (1,1) = 0.895 (0.862-0.920), ICC (2,2) = 0.905 (0.874-0.928), ICC (3,3) = 0.922 (0.898-0.941) and ICC (4,4) = 0.930 (0.908-0.947). The strength of the muscles in the TC group did not differ among different age groups (P>0.05). The strength of iliopsoas, quadriceps femoris, tibialis anterior and hamstrings in TC group was higher than that in the NTC group (Pstrength and extension of the exercise period was positive (Pstrength loss with aging. TC might be a good form to slow down the trend of age-related decline in muscle strength in community

  8. Immediate application of vacuum assisted closure dressing over free muscle flaps in the lower extremity does not compromise flap survival and results in decreased flap thickness

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    Harvey Chim

    2018-01-01

    Full Text Available Background Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC dressing after a free muscle flap to the lower extremity. Methods Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival. Immediate application of a VAC dressing was performed in 9 patients, while the flap was left exposed for monitoring in 8 patients. Results There was no statistically significant difference in flap survival between both cohorts. Mean flap thickness at postoperative day 5 for the VAC group was 6.4±6.4 mm, while flap thickness for the exposed flap group was 29.6±13.5 mm. Flap thickness was significantly decreased at postoperative day 5 for the VAC dressing group. Conclusions Immediate application of VAC dressing following free muscle flaps to the lower extremity does not compromise flap survival or outcomes and results in decreased flap thickness and a better aesthetic outcome.

  9. Premature Epiphyseal Closure of the Lower Extremities Contributing to Short Stature after cis-Retinoic Acid Therapy in Medulloblastoma: A Case Report.

    Science.gov (United States)

    Noyes, Jessica J; Levine, Michael A; Belasco, Jean B; Mostoufi-Moab, Sogol

    2016-01-01

    Prolonged cis-retinoic acid (RA) exposure contributes to premature epiphyseal closure. cis-RA is administered in various treatment regimens for pediatric cancers, thus increasing the risk for bone deformities and compromised growth. We present a case of premature epiphyseal closure in a 9-year-old female with a history of medulloblastoma and treatment with a multimodal regimen including cis-RA. She was subsequently diagnosed with radiation-induced endocrine late effects including hypothyroidism and growth hormone deficiency (GHD). Seven months after initiation of GH therapy, an increased prominence of the wrists and knees combined with a deceleration in growth velocity prompted further evaluation; radiographs revealed bilateral premature closure of the distal femur and proximal tibia growth plates despite normal left wrist bone age. High doses of vitamin A and its analogs are linked to premature closure of the lower-extremity growth plates in animals and children. Pediatric brain tumor patients are at increased risk of growth failure due to concurrent radiation-induced GHD, damage to the spinal bones, and cis-RA-associated premature closure of the lower-extremity growth plates, with significant reduction in adult stature. A better appreciation of the detrimental effect of cis-RA on the growing skeleton is needed to monitor at-risk patients and to provide timely interventions. © 2015 S. Karger AG, Basel.

  10. Design and characterization of a magneto-rheological series elastic actuator for a lower extremity exoskeleton

    Science.gov (United States)

    Chen, Bing; Zhao, Xuan; Ma, Hao; Qin, Ling; Liao, Wei-Hsin

    2017-10-01

    In this paper, an innovative actuator named magneto-rheological series elastic actuator (MRSEA) is designed for the knee joints of a lower extremity exoskeleton CUHK-EXO. MRSEA is designed to reduce the mechanical impedance of the exoskeleton and filter out unwanted collisions. It can also provide large controllable braking torque with low power, and hence improve the system energy efficiency. A description of CUHK-EXO developed to help paraplegic patients regain the mobility to stand up, sit down and walk is firstly introduced, followed by the mechanical design of MRSEA and simulation of the torsion spring pack (TSP) and magneto-rheological (MR) brake of MRSEA. Prototype of MRSEA is fabricated. Preliminary tests are performed to investigate the characteristics of the TSP and MR brake, and walking experiments with a paraplegic patient are performed to evaluate the performance of MRSEA. Experimental results of MRSEA match the modeling and simulation. As compared with the electric motor, the energy efficiency of the innovative MRSEA is improved by 52.8% during a gait cycle.

  11. Muscle injuries of the lower extremity: a comparison between young and old male elite soccer players.

    Science.gov (United States)

    Svensson, Kjell; Alricsson, Marie; Karnebäck, Gustav; Magounakis, Theo; Werner, Suzanne

    2016-07-01

    The aim of this study was to make a comparison between players in two age groups in an elite male soccer team regarding injury localisation within the muscle-tendon unit, injury size and muscle group in terms of muscle injuries of the lower extremity. Cohort study based on data collected from a Swedish elite male soccer team during the seasons 2007-2012. In total, 145 muscle injuries were included. Injury localisation to the tendon or muscle, the size of haematoma and the affected muscle group were assessed using ultrasound. Age comparison was made between younger players (≤23 years) and older players (>23 years). No difference regarding injury localisation to either the tendon or the muscle, or the size of haematoma between the two age groups was found. However, the older group of players suffered a significantly higher number of injuries to the triceps surae than the younger players (p = 0.012). In a Swedish team of male soccer players at elite level, there was no difference between players 23 years or younger and players older than 23 years, in terms of injury distribution to muscles or tendons. Players older than 23 years sustained more injuries to triceps surae when compared with players 23 years or younger. The clinical relevance is to pay attention to muscle function of triceps surae in older players and to screen those players who may need an injury prevention programme. II.

  12. Evaluation, management and prevention of lower extremity youth ice hockey injuries

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    Popkin CA

    2016-11-01

    Full Text Available Charles A Popkin,1 Brian M Schulz,2 Caroline N Park,1 Thomas S Bottiglieri,1 T Sean Lynch1 1Department of Orthopedic Surgery, Center for Shoulder, Elbow and Sports Medicine at Columbia University, New York, NY, 2Kerlan‑Jobe Orthopedic Clinic, Los Angeles, CA, USA Abstract: Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13–14 years (Bantam level from 11–12 years (Pee Wee. Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries. Keywords: youth hockey, body checking, injury prevention, femoroacetabular impingement, apophyseal avulsions

  13. Effects of Varus Orthotics on Lower Extremity Kinematics During the Pedal Cycle

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    Sinclair Jonathan

    2014-12-01

    Full Text Available Purpose. Cycling has been shown to be associated with a high incidence of chronic pathologies. Foot orthoses are frequently used by cyclists in order to reduce the incidence of chronic injuries. The aim of the current investigation was to examine the influence of different varus orthotic inclines on the three-dimensional kinematics of the lower extremities during the pedal cycle. Methods. Kinematic information was obtained from ten male cyclists using an eight-camera optoelectronic 3-D motion capture system operating at 250 Hz. Participants cycled with and without orthotic intervention at three different cadences (70, 90 and 110 RPM. The orthotic device was adjustable and four different wedge conditions (0 mm - no orthotic, 1.5 mm, 3.0 mm and 4.5 mm were examined. Two-way repeated measures ANOVAs were used to compare the kinematic parameters obtained as a function of orthotic inclination and cadence. Participants were also asked to subjectively rate their comfort in cycling using each of the four orthotic devices on a 10-point Likert scale. Results. The kinematic analysis indicated that the orthotic device had no significant influence at any of the three cadences. Analysis of subjective preferences showed a clear preference for the 0 mm, no orthotic, condition. Conclusions. This study suggests that foot orthoses do not provide any protection from skeletal malalignment issues associated with the aetiology of chronic cycling injuries.

  14. Perioperative Complications of Orthopedic Surgery for Lower Extremity in Patients with Cerebral Palsy

    Science.gov (United States)

    2015-01-01

    Because complications are more common in patients with cerebral palsy (CP), surgeons and anesthesiologists must be aware of perioperative morbidity and be prepared to recognize and treat perioperative complications. This study aimed to determine the incidence of and risk factors for perioperative complications of orthopedic surgery on the lower extremities in patients with CP. We reviewed the medical records of consecutive CP patients undergoing orthopedic surgery. Medical history, anesthesia emergence time, intraoperative body temperature, heart rate, blood pressure, immediate postoperative complications, Gross Motor Function Classification System (GMFCS) level, Cormack-Lehane classification, and American Society of Anesthesiologists physical status classification were analyzed. A total of 868 patients was included. Mean age at first surgery was 11.8 (7.6) yr. The incidences of intraoperative hypothermia, absolute hypotension, and absolute bradycardia were 26.2%, 4.4%, and 20.0%, respectively. Twenty (2.3%) patients had major complications, and 35 (4.0%) patients had minor complications postoperatively. The incidences of intraoperative hypothermia, absolute hypotension, and major postoperative complications were significantly higher in patients at GMFCS levels IV and V compared with patients at GMFCS levels I to III (P<0.001). History of pneumonia was associated with intraoperative absolute hypotension and major postoperative complications (P<0.001). These results revealed that GMFCS level, patient age, hip reconstructive surgery, and history of pneumonia are associated with adverse effects on intraoperative body temperature, the cardiovascular system, and immediate postoperative complications. PMID:25829819

  15. Associations of foot posture and function to lower extremity pain: results from a population-based foot study.

    Science.gov (United States)

    Riskowski, Jody L; Dufour, Alyssa B; Hagedorn, Thomas J; Hillstrom, Howard J; Casey, Virginia A; Hannan, Marian T

    2013-11-01

    Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Participants were members of the Framingham Foot Study. Lower extremity joint pain was determined by the response to the National Health and Nutrition Examination Survey-type question, "On most days do you have pain, aching or stiffness in your (hips, knees, ankles, or feet)?" The Modified Arch Index classified participants as having planus, rectus (referent), or cavus foot posture. The Center of Pressure Excursion Index classified participants as having overpronated, normal (referent), or oversupinated foot function. Crude and adjusted (age, sex, and body mass index) logistic regression determined associations of foot posture and function to lower extremity pain. Participants with planus structure had higher odds of knee (odds ratio [OR] 1.57, 95% confidence interval [95% CI] 1.24-1.99) or ankle (OR 1.47, 95% CI 1.05-2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (OR 7.56, 95% CI 1.99-28.8) and pain at 1 lower extremity site (OR 1.37, 95% CI 1.04-1.80). Associations between foot function and lower extremity joint pain were not statistically significant except for a reduced risk of hip pain in those with an oversupinated foot function (OR 0.69, 95% CI 0.51-0.93). These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. Copyright © 2013 by the American College of Rheumatology.

  16. Evaluation, management and prevention of lower extremity youth ice hockey injuries

    Science.gov (United States)

    Popkin, Charles A; Schulz, Brian M; Park, Caroline N; Bottiglieri, Thomas S; Lynch, T Sean

    2016-01-01

    Ice hockey is a fast-paced sport played by increasing numbers of children and adolescents in North America and around the world. Requiring a unique blend of skill, finesse, power and teamwork, ice hockey can become a lifelong recreational activity. Despite the rising popularity of the sport, there is ongoing concern about the high frequency of musculoskeletal injury associated with participation in ice hockey. Injury rates in ice hockey are among the highest in all competitive sports. Numerous research studies have been implemented to better understand the risks of injury. As a result, rule changes were adopted by the USA Hockey and Hockey Canada to raise the minimum age at which body checking is permitted to 13–14 years (Bantam level) from 11–12 years (Pee Wee). Continuing the education of coaches, parents and players on rules of safe play, and emphasizing the standards for proper equipment use are other strategies being implemented to make the game safer to play. The objective of this article was to review the evaluation, management and prevention of common lower extremity youth hockey injuries. PMID:27920584

  17. Treatment-related fractures after combined modality therapy for soft tissue sarcomas of the proximal lower extremity: Can the risk be mitigated?

    Science.gov (United States)

    Bishop, Andrew J; Zagars, Gunar K; Allen, Pamela K; Moon, Bryan S; Lin, Patrick P; Lewis, Valerae O; Guadagnolo, B Ashleigh

    2016-01-01

    The purpose of this study was to investigate the incidence of and risk factors associated with femur fracture after combined modality therapy for soft tissue sarcomas (STS) of the proximal lower extremity. We reviewed the records of 596 patients with STS of the proximal lower extremity consecutively treated with surgery and radiation therapy (RT) from 1966 to 2012. One hundred ninety-seven patients (33%) received 50 Gy to the entire femur circumference (n = 197, 33%); 265 patients (45%) received perioperative chemotherapy, and during surgery, 155 patients (26%) had bone exposure, whereas 82 patients (14%) had the periosteum stripped. The Kaplan-Meier method was used to estimate actuarial outcome rates, and both Cox regression modeling and competing risk analyses using the method of Fine and Gray were performed. Median follow-up time was 110 months (range, 6-470 months). The actuarial 10-year local control and overall survival rates were 88% (95% confidence interval [CI], 84%-90%) and 62% (95% CI, 57%-66%). Twelve patients had pathologic fractures, which were associated with 50 Gy to the entire bone circumference (P modalities contributes to the overall risk, and a multidisciplinary approach to mitigating fracture risk is needed. Although avoiding circumferential bone coverage with the 50-Gy isodose line may be a valuable dosimetric parameter, more rigorous dosimetric studies are required. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  18. The Incidence of Giacomini Vein and Its Association with Lower Extremity venous Insufficiency: An Ultrasonographic Study

    International Nuclear Information System (INIS)

    Park, Soon Chan; Kwon, Se Hwan; Oh, Joo Hyeong; Ryu, Kyung Nam; Ahn, Hyung Joon; Park, Ho Chul

    2009-01-01

    We wanted to evaluate the incidence of Giacomini vein and its association with lower extremity venous insufficiency by performing US. From September 2006 to July 2007, 173 patients (58 males and 115 females, mean age: 52.7 years, age range: 22-72 years) who had been diagnosed with unilateral/bilateral varicose veins or telangiectasias were evaluated with duplex Doppler ultrasonography. The presence of Giacomini vein, superficial/deep vein reflux, the anatomical sites of the venous reflux and the abnormal perforating veins was investigated in 346 legs. Giacomini veins were found in 33 limbs (9.5%) of 21 patients (12.1%). Bilateral Giacomini veins were found in 12 patients. Of the 33 limbs that had Giacomini veins, 20 limbs had great saphenous vein (GSV) reflux and 4 limbs had small saphenous vein (SSV) reflux. The patients with Giacomini veins were classified into two groups according to the presence of Giacomini vein. There was no significant difference of the GSV reflux (p = 0.155), the SSV reflux (p = 0.760) and the mean velocity of the GSV reflux or the SSV reflux (p = 0.685, p = 0.431, respectively) between the two groups. Our results indicated that Giacomini vein is not associated with either GSV or SSV reflux, and this is contrary to conventional belief

  19. To evaluate the differences of risk factors in patients with lower extremity venous disease

    International Nuclear Information System (INIS)

    Sadikoglu, G.; Ozcakir, A.; Ercan, I.; Ozkaya, G.; Sadikoglu, Y.M.

    2007-01-01

    To determine whether there is difference between risk factors in patients diagnosed to have clinically documented lower extremity venous disease after confirming the diagnosis radiologically by ultrasonographic and venographic evaluation. This study was performed from January 2002 to January 2005 in Bursa, the fourth biggest city of Turkey situated in the west of country in the Marmara region. The study center is a private imaging center working in conjunction with the Department of Health, which performs diagnostic and therapeutic vascular protocols in the region. Five hundred and fifty-three cases with clinically and radiologically documented diagnoses were evaluated with Multi-Variate Statistical Package 3.13 for the presence of pre-defined clusters of 14 different variables. Other statistical analyses were performed by the Statistical Package for Social sciences, version 13.0. Three different clusters were defined. The variables used to define the clusters were: age, gender, educational level, presence of smoking, amount of smoking (pack/per year), disease symptoms, presence of heart disease and radiologically documented diagnosis. Chronic venous insufficiency and varicose veins are venous system diseases that are most commonly present in association with more than one concomitant risk factors. (author)

  20. Residual impairment after lower extremity fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D

    1998-01-01

    In a prospective follow-up study of 158 consecutive patients 18 to 64 years old with unilateral lower extremity fracture, our aim was to disclose the impairment and disability 6 months after the injury. The patients were interviewed within 1 week after the trauma, and all patients returned...... the functional status before the injury. Additionally, three major aspects of impairments were measured 6 months after the fractures: range of motion, muscle strength, and pain. Most patients had a significantly higher SIP score 6 months after the fracture(s) than pretraumatically. The mean overall SIP score...... was 2.7 pretraumatically and 8.7 6 months posttraumatically. Major deficits in range of motion was observed, especially in the ankle joint. Additionally, loss of muscle strength was observed in the thigh and calf muscles in one fourth of the patients. Only low levels of residual pain were reported after...

  1. Standards of the Polish Ultrasound Society – update. Sonography of the lower extremity veins

    Directory of Open Access Journals (Sweden)

    Grzegorz Małek

    2014-09-01

    Full Text Available This article has been prepared on the basis of the Ultrasonography Standards of the Polish Ultrasound Society (2011 and updated based on the latest findings and reports. Ultrasound examination of the lower extremity veins is relatively easy and commonly used to confirm or rule out venous thrombosis. However, a relatively easy compression test frequently requires experience, particularly in situations when imaging is difficult (due to lymphedema, dressing or thick tissues. The technique is time-consuming and requires assessment of each deep vein every 1 cm. Lesions in the deep veins cannot be ruled out when the vessels are assessed in only 2–3 points – a full examination is needed. The value of the method is the highest when the proximal section is assessed and the lowest when crural veins are evaluated. Doppler sonography is the basic method used when patients are prepared for a surgery of varicose veins. The assessment of the superficial veins prior to this procedure is tedious and requires knowledge of anatomy together with numerous variants. A considerable challenge is posed by re-assessment of recurrent varicose veins following a previous surgery. The Standards include anatomic nomenclature proposed by the Polish Society for Vascular Surgery and Polish Society of Phlebology, which should facilitate communication with clinicians. The most beneficial patient positions have been thoroughly discussed in terms of safety and effectiveness of the examination. Sometimes during such an examination, no venous pathology is found, but other changes with symptoms that suggest deep thrombophlebitis are detected. In such a situation, it is necessary to conduct an initial (or complete, if possible assessment of lesions as well as provide recommendations connected with further, more detailed diagnosis.

  2. Standards of the Polish Ultrasound Society – update. Sonography of the lower extremity veins

    Science.gov (United States)

    Nowicki, Andrzej

    2014-01-01

    This article has been prepared on the basis of the Ultrasonography Standards of the Polish Ultrasound Society (2011) and updated based on the latest findings and reports. Ultrasound examination of the lower extremity veins is relatively easy and commonly used to confirm or rule out venous thrombosis. However, a relatively easy compression test frequently requires experience, particularly in situations when imaging is difficult (due to lymphedema, dressing or thick tissues). The technique is time-consuming and requires assessment of each deep vein every 1 cm. Lesions in the deep veins cannot be ruled out when the vessels are assessed in only 2–3 points – a full examination is needed. The value of the method is the highest when the proximal section is assessed and the lowest when crural veins are evaluated. Doppler sonography is the basic method used when patients are prepared for a surgery of varicose veins. The assessment of the superficial veins prior to this procedure is tedious and requires knowledge of anatomy together with numerous variants. A considerable challenge is posed by re-assessment of recurrent varicose veins following a previous surgery. The Standards include anatomic nomenclature proposed by the Polish Society for Vascular Surgery and Polish Society of Phlebology, which should facilitate communication with clinicians. The most beneficial patient positions have been thoroughly discussed in terms of safety and effectiveness of the examination. Sometimes during such an examination, no venous pathology is found, but other changes with symptoms that suggest deep thrombophlebitis are detected. In such a situation, it is necessary to conduct an initial (or complete, if possible) assessment of lesions as well as provide recommendations connected with further, more detailed diagnosis. PMID:26675992

  3. The effect of increase in baggage weight on elderly women's lower extremity muscle activation during gait.

    Science.gov (United States)

    Kim, Seong-Gil; Nam, Chan-Woo; Yong, Min-Sik

    2014-01-01

    The aim of the present study was to examine the effect of increased baggage weight on the muscle activation of elderly women's lower extremities during gait. A total of 24 elderly women who were residing in communities in Daegu, South Korea aged 79.6±6.2, 149.7±7.0cm in height, and 53.5±7.2kg in weight participated in this study. The muscle activation of each muscle was measured three times at 2kg, 3kg, and 4kg of baggage weight while the subjects were conducting treadmill walking wearing backpacks. Electrodes were placed on four muscles: the quadriceps muscle (rectus femoris), the hamstring muscle (semitendinosus), the tibialis anterior muscle, and the soleus muscle. The results show that the rates of increase in muscle activation in the tibialis anterior and soleus muscles according to baggage weight increase were higher than those in the quadriceps and hamstring muscles (elderly people should be instructed not to carry heavy objects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Effect of exercise therapy on lower extremity deep venous thrombosis after total knee arthoplasty

    Directory of Open Access Journals (Sweden)

    Zhong-Wu Huang

    2016-11-01

    Full Text Available Objective: To explore the effect of exercise therapy in preventing the lower extremity deep venous thrombosis (DVT after total knee arthoplasty (TKA. Methods: A total of 153 patients with osteoarthritis who were admitted in our hospital for TKA were included in the study and randomized into the observation group and the control group. The patients in the observation group were given continuous passive motion (CPM in combined with exercise therapy, while the patients in the control group were only given CPM. After 2-week treatment, the related coagulation indicators and femoral venous blood flow in the two groups were detected and compared. The occurrence rate of DVT in the two groups was calculated. Results: PT and APTT from 2 weeks to 2 months after operation in the two groups were shortened first and extended later when compared with before operation, while FIB and D-D contents were elevated first and reduced later, and the coagulation indicator levels 2 months after treatment in the two groups were significantly different from those before operation. The femoral venous blood flow peak and average velocity 1 week after operation in the two groups were significantly elevated when compared with before operation. The femoral venous blood flow peak and average velocity 1 week after operation in the observation group were significantly higher than those in the control group. The occurrence rate of DVT in the observation group was significantly lower than that in the control group. Conclusions: CPM in combined with exercise therapy for patients after TKA can effectively prevent the formation of DVT, with a significant effect.

  5. Noninvasive measurement of lower extremity muscle oxygen extraction fraction under cuff compression paradigm.

    Science.gov (United States)

    Wang, Chengyan; Zhang, Rui; Zhang, Xiaodong; Wang, He; Zhao, Kai; Jin, Lixin; Zhang, Jue; Wang, Xiaoying; Fang, Jing

    2016-05-01

    To demonstrate the feasibility of using a susceptibility-based MRI technique with asymmetric spin-echo (ASE) sequence to assess the lower extremity muscle oxygen extraction fraction (OEF) alternations under cuff compression paradigm. Approved by the local institutional human study committee, nine healthy young volunteers participated in this study. All the ASE scans were conducted using a 3 Tesla clinical MRI scanner during resting state (pre), 1-3 min (post1) and 3-5 min (post2) after a pressure of 50 mmHg above individual systolic blood pressure imposed on the thigh. Moreover, near-infrared spectroscopy (NIRS) measurements were performed on the same day under the same cuff compression protocol to verify the accuracy of this susceptibility-based method. In all volunteers, the mean MRI based OEF in gastrocnemius (GAS) muscle increased significantly from 0.28 ± 0.02 (pre) to 0.31 ± 0.03 (post1, P measured 1-%HbO2 (percentage of deoxyhemoglobin concentration within total hemoglobin) in GAS rose significantly from 0.29 ± 0.03 (pre) to 0.31 ± 0.04 (post1, P measuring skeletal muscle oxygenation. © 2015 Wiley Periodicals, Inc.

  6. Comparative diagnosis of venous occlusive diseases of lower extremity through multi-slice CT angiography and DSA

    International Nuclear Information System (INIS)

    Wu Gang; Gu Jianping; Wang Shuzhi; Yin Xinxao; Lu Lingquan

    2008-01-01

    Objective: To assess the clinical application value of multi-slice CT angiography(MSCTA) in the diagnosis of venous occlusive diseases of lower extremity. Methods: Thirty-two suspected patients with venous occlusive diseases of lower extremity underwent 16-slice MSCTA and DSA simultaneously. The MSCTA technique and its diagnostic value were analyzed with clinical data. Results: Thirty-two cases of suspected lower extremity venous occlusive diseases were diagnosed by MSCTA, including 19 cases of iliac vein compression syndrome (left iliac vein in 16 cases, right iliac vein 3 cases). Nine cases of deep vein thrombosis (2 on left side, 5 on right and another 2 bilaterally). The left external iliac vein was compressed by a cyst in left inguinal region in one case and another case showed simple varicosis of superficial veins of the left lower limb. The results were similar demonstrated by DSA and MSCTA in above thirty cases. The right femoral and popliteal venous dilatations were diagnosed by MSCTA in one case and no abnormality in the other. The two cases were found to be valvular functional defect of deep veins of lower limb by DSA. Conclusion: MSCTA possesses rather high application value in the diagnosis of venous occlusive diseases of lower extremity. (authors)

  7. Cigarette Smoking Is Associated with a Lower Concentration of CD105+ Bone Marrow Progenitor Cells

    Directory of Open Access Journals (Sweden)

    Shaul Beyth

    2015-01-01

    Full Text Available Cigarette smoking is associated with musculoskeletal degenerative disorders, delayed fracture healing, and nonunion. Bone marrow progenitor cells (BMPCs, known to express CD105, are important in local trophic and immunomodulatory activity and central to musculoskeletal healing/regeneration. We hypothesized that smoking is associated with lower levels of BMPC. Iliac bone marrow samples were collected from individuals aged 18–65 years during the first steps of pelvic surgery, under IRB approval with informed consent. Patients with active infectious or neoplastic disease, a history of cytotoxic or radiation therapy, primary or secondary metabolic bone disease, or bone marrow dysfunction were excluded. Separation process purity and the number of BMPCs recovered were assessed with FACS. BMPC populations in self-reported smokers and nonsmokers were compared using the two-tailed t-test. 13 smokers and 13 nonsmokers of comparable age and gender were included. The average concentration of BMPCs was 3.52 × 105/mL ± 2.45 × 105/mL for nonsmokers versus 1.31 × 105/mL ± 1.61 × 105/mL for smokers (t= 3.2, P=0.004. This suggests that cigarette smoking is linked to a significant decrease in the concentration of BMPCs, which may contribute to the reduced regenerative capacity of smokers, with implications for musculoskeletal maintenance and repair.

  8. Development and validation of a self-report lower-extremity lymphedema screening questionnaire in women.

    Science.gov (United States)

    Yost, Kathleen J; Cheville, Andrea L; Weaver, Amy L; Al Hilli, Mariam; Dowdy, Sean C

    2013-05-01

    Patient-reported signs and symptoms are often the first indication of clinically relevant lymphedema. The purpose of this study was to develop and assess the diagnostic accuracy of a screening questionnaire to detect lower-extremity lymphedema (LEL) among normal-weight women and women with obesity. This was a cross-sectional survey study. The authors reviewed existing questionnaires assessing upper-extremity lymphedema (UEL) for potential questions and worked with content experts to generate new items. A draft questionnaire with 59 items was reviewed by 5 physicians and 5 physical therapists who specialized in lymphedema management and 5 female patients with clinically confirmed secondary LEL. A revised questionnaire with 45 items was administered by mail to 186 women with clinically confirmed LEL (n=116) or UEL (n=70). A total of 99 women (53.2% of 186) completed the mailed survey, and 28 women with lymphedema who were recruited directly in a lymphedema clinic waiting area also completed the survey. A parsimonious subset of items that best discriminated patients with and without LEL was identified using chi-square tests and logistic regression. Sensitivity and specificity for detecting LEL and positive and negative likelihood ratios (LR+, LR-) were estimated for the entire sample and for subsamples defined by obesity (body mass index ≥30 versus UEL group, n=39). A sum of 13 items (score range=0-52) was the most discriminating. Using a cutoff score of ≥5 points, the sensitivity and specificity for detecting LEL among all participants were 95.5% and 86.5%, respectively (LR+=7.1, LR-=0.05), and 94.8% and 76.5%, respectively (LR+=4.0, LR-=0.07), for participants who were obese. By enumerating a sample with a high prevalence of LEL, a spectrum bias may have been introduced, which may have affected the accuracy of the screening questionnaire. The brief, 13-item self-report questionnaire is a sensitive and specific tool for detecting clinically relevant LEL among

  9. Intrarater reliability of hand held dynamometry in measuring lower extremity isometric strength using a portable stabilization device.

    Science.gov (United States)

    Jackson, Steven M; Cheng, M Samuel; Smith, A Russell; Kolber, Morey J

    2017-02-01

    Hand held dynamometry (HHD) is a more objective way to quantify muscle force production (MP) compared to traditional manual muscle testing. HHD reliability can be negatively impacted by both the strength of the tester and the subject particularly in the lower extremities due to larger muscle groups. The primary aim of this investigation was to assess intrarater reliability of HHD with use of a portable stabilization device for lower extremity MP in an athletic population. Isometric lower extremity strength was measured for bilateral lower extremities including hip abductors, external rotators, adductors, knee extensors, and ankle plantar flexors was measured in a sample of healthy recreational runners (8 male, 7 females, = 30 limbs) training for a marathon. These measurements were assessed using an intrasession intrarater reliability design. Intraclass correlation coefficients (ICC) were calculated using 3,1 model based on the single rater design. The standard error of measurement (SEM) for each muscle group was also calculated. ICC were excellent ranging from ICC (3,1) = 0.93-0.98 with standard error of measurements ranging from 0.58 to 17.2 N. This study establishes the use of a HHD with a portable stabilization device as demonstrating good reliability within testers for measuring lower extremity muscle performance in an active healthy population. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Prognostic value of biochemical variables for survival after surgery for metastatic bone disease of the extremities.

    Science.gov (United States)

    Sørensen, Michala Skovlund; Hovgaard, Thea Bechman; Hindsø, Klaus; Petersen, Michael Mørk

    2017-03-01

    Prediction of survival in patients having surgery for metastatic bone disease in the extremities (MBDex) has been of interest in more than two decades. Hitherto no consensus on the value of biochemical variables has been achieved. Our purpose was (1) to investigate if standard biochemical variables have independent prognostic value for survival after surgery for MBDex and (2) to identify optimal prognostic cut off values for survival of biochemical variables. In a consecutive cohort of 270 patients having surgery for MBDex, we measured preoperative biochemical variables: hemoglobin, alkaline phosphatase, C-reactive protein and absolute, neutrophil and lymphocyte count. ROC curve analyses were performed to identify optimal cut off levels. Independent prognostic factors for variables were addressed with multiple Cox regression analyses. Optimal cut off levels were identified as: hemoglobin 7.45 mmol/L, absolute lymphocyte count 8.5 × 10 9 /L, neutrophil 5.68 × 10 9 /L, lymphocyte 1.37 × 10 9 /L, C-reactive protein 22.5 mg/L, and alkaline phosphatase 129 U/L. Regression analyses found alkaline phosphatase (HR 2.49) and neutrophil count (HR 2.49) to be independent prognostic factors. We found neutrophil count and alkaline phosphatase to be independent prognostic variables in predicting survival in patients after surgery for MBDex. © 2016 Wiley Periodicals, Inc.

  11. An evidence-based review of hip-focused neuromuscular exercise interventions to address dynamic lower extremity valgus

    Directory of Open Access Journals (Sweden)

    Ford KR

    2015-08-01

    Full Text Available Kevin R Ford,1 Anh-Dung Nguyen,2 Steven L Dischiavi,1 Eric J Hegedus,1 Emma F Zuk,2 Jeffrey B Taylor11Department of Physical Therapy, High Point University, High Point, NC, USA; 2Department of Athletic Training, School of Health Sciences, High Point University, High Point, NC, USAAbstract: Deficits in proximal hip strength or neuromuscular control may lead to dynamic lower extremity valgus. Measures of dynamic lower extremity valgus have been previously shown to relate to increased risk of several knee pathologies, specifically anterior cruciate ligament ruptures and patellofemoral pain. Therefore, hip-focused interventions have gained considerable attention and been successful in addressing these knee pathologies. The purpose of the review was to identify and discuss hip-focused exercise interventions that aim to address dynamic lower extremity valgus. Previous electromyography, kinematics, and kinetics research support the use of targeted hip exercises with non-weight-bearing, controlled weight-bearing, functional exercise, and, to a lesser extent, dynamic exercises in reducing dynamic lower extremity valgus. Further studies should be developed to identify and understand the mechanistic relationship between optimized biomechanics during sports and hip-focused neuromuscular exercise interventions.Keywords: dynamic lower extremity valgus, hip neuromuscular control, ACL injury rehabilitation, patellofemoral pain, hip muscular activation

  12. Trocar injury of the retroperitoneal vessels followed by life-threatening postischemic compartment syndrome of both lower extremities.

    Science.gov (United States)

    Hauser, Joerg; Lehnhardt, Marcus; Steinau, Hans-Ulrich; Homann, Heinz-Herbert

    2008-04-01

    Lesions of the intra-abdominal organs and vessels caused by trocars and Verres needles are rare but serious complications during laparoscopic surgery. We report an unusual case of left common iliac artery and inferior vena cava injury during laparoscopy. This lesion was followed by a bilateral postischemic compartment syndrome of the lower extremities. The patient sustained massive rhabdomyolysis, renal failure, peroneal nerve palsy, and functional loss of the lower extremities. Postischemic tissue swelling should be recognized as early as possible because it is a life-threatening condition that necessitates immediate treatment.

  13. An evolutionary algorithm for the segmentation of muscles and bones of the lower limb.

    Science.gov (United States)

    Lpez, Marco A.; Braidot, A.; Sattler, Anbal; Schira, Claudia; Uriburu, E.

    2016-04-01

    In the field of medical image segmentation, muscles segmentation is a problem that has not been fully resolved yet. This is due to the fact that the basic assumption of image segmentation, which asserts that a visual distinction should ex- ist between the different structures to be identified, is infringed. As the tissue composition of two different muscles is the same, it becomes extremely difficult to distinguish one another if they are near. We have developed an evolutionary algorithm which selects the set and the sequence of morphological operators that better segments muscles and bones from an MRI image. The achieved results shows that the developed algorithm presents average sensitivity values close to 75% in the segmentation of the different processed muscles and bones. It also presents average specificity values close to 93% for the same structures. Furthermore, the algorithm can identify muscles that are closely located through the path from their origin point to their insertions, with very low error values (below 7%) .

  14. Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation; a qualitative study

    DEFF Research Database (Denmark)

    Jensen, P S; Green, S M; Petersen, J

    2018-01-01

    INTRODUCTION: Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables......-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the COREQ guideline. FINDINGS: Three themes emerged; Responsible for own dietary intake, Diet based on preferences...

  15. Ectopic major transplantation for salvage of upper and lower extremity amputations

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram

    2013-12-01

    Full Text Available 【Abstract】Objective: Ectopic tissue transplanta- tion is not a new idea. Godina and his colleagues pioneered this method in the 1980s. This method is a last resort method of preserving an amputated body part, which consists of banking the amputated segment in an ectopic area and re- turning it to its native place at a later date. In this article we present our experience with this demanding procedure. Methods: Debridement was the mainstay of this procedure. The stump and amputated part are carefully de- brided and the stump was either closed primarily or covered by a flap. The amputated part was transplanted to one of several banking sites in the body and at a later date it will be transferred to its native site in an elective setting. Results: Seven patients meeting the set criteria for ectopic transplantation were enrolled in this study. The over- all success rate was about 70%, lower than expected but these are cases of severe crush injury. Although the func- tional recovery of these patients are very low, all of the successful cases except one could find a job as a janitor or light manual worker. No patient could return to his previous job. Conclusion: Ectopic transplantation of body parts is an accepted method of treatment of severely crushed ex- tremity or finger injuries. In our country an amputee has very little chance of finding a job instead a disabled person can. In addition in Iran cultures amputation is seen as pu- nishment of either the God or the society, so it is not well accepted and many patients persist on saving the limb even with no functional recovery. None of our successful cases could return to his previous occupation but almost all of them could find a job as janitors or light manual workers. Key words: Replantation; Transplantation; Extremities; Amputation, traumatic

  16. Prediction of core and lower extremity strains and sprains in collegiate football players: a preliminary study.

    Science.gov (United States)

    Wilkerson, Gary B; Giles, Jessica L; Seibel, Dustin K

    2012-01-01

    Poor core stability is believed to increase vulnerability to uncontrolled joint displacements throughout the kinetic chain between the foot and the lumbar spine. To assess the value of preparticipation measurements as predictors of core or lower extremity strains or sprains in collegiate football players. Cohort study. National Collegiate Athletic Association Division I Football Championship Subdivision football program. All team members who were present for a mandatory physical examination on the day before preseason practice sessions began (n = 83). Preparticipation administration of surveys to assess low back, knee, and ankle function; documentation of knee and ankle injury history; determination of body mass index; 4 different assessments of core muscle endurance; and measurement of step-test recovery heart rate. All injuries were documented throughout the preseason practice period and 11-game season. Receiver operating characteristic analysis and logistic regression analysis were used to identify dichotomized predictive factors that best discriminated injured from uninjured status. The 75th and 50th percentiles were evaluated as alternative cutpoints for dichotomization of injury predictors. Players with ≥2 of 3 potentially modifiable risk factors related to core function had 2 times greater risk for injury than those with <2 factors (95% confidence interval = 1.27, 4.22), and adding a high level of exposure to game conditions increased the injury risk to 3 times greater (95% confidence interval = 1.95, 4.98). Prediction models that used the 75th and 50th percentile cutpoints yielded results that were very similar to those for the model that used receiver operating characteristic-derived cutpoints. Low back dysfunction and suboptimal endurance of the core musculature appear to be important modifiable football injury risk factors that can be identified on preparticipation screening. These predictors need to be assessed in a prospective manner with a larger

  17. CT angiography in the diagnosis of lower extremity arteriosclerosis obliterans: a Meta analysis

    International Nuclear Information System (INIS)

    Chang Zhihui; Liu Zhaoyu; Zheng Jiahe; Lu Zaiming; Guo Qiyong

    2010-01-01

    Objective: To systematically assess the diagnostic performance of CTA for lower extremity peripheral arterial disease (PAD) using a Meta analysis method. Methods: Studies were located through electronic searching of the PubMed, EBSCO, Springer, Ovid, CNKI, Cochrane library (from the date of establishment of the databases to October 2009). Bibliographies of the retrieved articles were also checked. All the studies concerning the diagnosis of PAD using CTA had been searched and reviewed, and the studies with the DSA as the gold standard were adopted as eligible. Subsequently, the characteristics of the included articles were appraised and extracted. Data on accuracy of included studies were extracted for further heterogeneity exploring, statistical pooling and SROC (summary receiver operating characteristics) analyzing using the Meta Disc 1.4 software. Results: Totally 24 studies met the inclusion criteria with a total of 1096 patients. The heterogeneity was found in these studies. The pooled accuracy indicators like sensitivity, specificity, and diagnostic odds ratio (DOR) were 0.95 (95% CI: 0.94-0.95), 0.96 (95% CI: 0.95-0.96), and 471.13 (95% CI: 242.92-913.71), respectively. The area under of SROC curve was 0.9888 and the Q index was 0.9555. Subgroup analysis demonstrated significant difference on diagnostic performance for various CT slices (P<0.05). Conclusion: CTA can be regarded as an effective and feasible method for PAD diagnosis and screening, based on the results of this systematic review. However, more rigorous evaluations of CTA in patients with critical limb ischemia are needed. (authors)

  18. Reducing major lower extremity amputations after the introduction of a multidisciplinary team for the diabetic foot.

    Science.gov (United States)

    Rubio, José Antonio; Aragón-Sánchez, Javier; Jiménez, Sara; Guadalix, Gregorio; Albarracín, Agustín; Salido, Carmen; Sanz-Moreno, José; Ruiz-Grande, Fernando; Gil-Fournier, Nuria; Álvarez, Julia

    2014-03-01

    We analyzed the incidence of lower extremity amputations (LEAs) in the 3rd Health Care Area of Madrid before and after the March 2008 introduction of a multidisciplinary team for managing diabetic foot disease. We compared the amputation rates in people with and without diabetes during 2 periods: before (2001-2007) and after (2008-2011) the introduction of a Multidisciplinary Diabetic Foot Unit (MDFU). We also analyzed the trend of the amputation rates by joinpoint regression analysis and measured the annual percentage change (APC). During the study period, 514 nontraumatic LEAs were performed, 374 (73%) in people with diabetes and 140 (27%) in people without the disease. The incidence of LEAs showed a significant reduction in major amputations in people with diabetes, from 6.1 per 100 000 per year (95% confidence interval [CI] = 4.9 to 7.2), in the 2001 to 2007 period, to 4.0 per 100 000 per year (95% CI = 2.6 to 5.5) in the 2008 to 2011 period (P = .020). There were no changes in incidence of minor or total amputations in the diabetic population or in amputations in the nondiabetic population during the study period. Joinpoint regression analysis showed a significant reduction in the incidence of major LEAs in diabetic population with an APC of -6.6% (95% CI = -10.2 to -2.8; P = .003), but there were no other significant changes. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the incidence of major amputations in patients with diabetes.

  19. Systemic inflammation as a predictor of clinical outcomes after lower extremity angioplasty/stenting.

    Science.gov (United States)

    DeSart, Kenneth; O'Malley, Kerri; Schmit, Bradley; Lopez, Maria-Cecilia; Moldawer, Lyle; Baker, Henry; Berceli, Scott; Nelson, Peter

    2016-09-01

    The activation state of the systemic inflammatory milieu has been proposed as a critical regulator of vascular repair after injury. We evaluated the early inflammatory response after endovascular intervention for symptomatic peripheral arterial disease to determine its association with clinical success or failure. Blood samples were obtained from 14 patients undergoing lower extremity angioplasty/stenting and analyzed using high-throughput gene arrays, multiplex serum protein analyses, and flow cytometry. Time-dependent plasma protein and monocyte phenotype analyses demonstrated endovascular revascularization had a modest influence on the overall activation state of the systemic inflammatory system, with baseline variability exceeding the perturbations induced by the intervention. In contrast, specific time-dependent changes in the monocyte genome are evident in the initial 28 days, predominately in those genes associated with leukocyte extravasation. Investigating the relationship between inflammation and the 1-year success or failure of the intervention showed no single plasma protein was correlated with outcome, but a more comprehensive cluster analysis revealed a clear pattern of protein expression that was closely related to the clinical phenotype. Corresponding examination of the monocyte genome identified a gene subset at 1 day postprocedure that was predictive of clinical outcome, with most of these genes active in cell-cycle signaling. Although the global influence of angioplasty/stenting on systemic inflammation was modest, circulating cytokine and monocyte genome analyses support a pattern of early inflammation that is associated with ultimate intervention success vs failure. Molecular profiles incorporating genes involved in monocyte cell-cycle progression and homing, or proinflammatory cytokines, or both, offer the most promise for the development of class prediction tools for clinical application. Published by Elsevier Inc.

  20. Timing of Lower Extremity Injuries in Competition and Practice in High School Sports.

    Science.gov (United States)

    Nagle, Kyle; Johnson, Bernadette; Brou, Lina; Landman, Tyler; Sochanska, Ada; Comstock, R Dawn

    Laboratory-based experiments demonstrate that fatigue may contribute to lower extremity injury (LEI). Few studies have examined the timing of LEIs during competition and practice, specifically in high school athletes across multiple sports, to consider the possible relationship between fatigue and LEIs during sport events. The purpose of this study was to describe the timing of LEIs in high school athletes within games and practices across multiple sports, with a hypothesis that more and severe injuries occur later in games and practices. Descriptive epidemiologic study. Level 4. Using the National High School RIO (Reporting Information Online) sport injury surveillance system, LEI severity and time of occurrence data during practice and competition were extracted for 9 high school sports. During the school years 2005-2006 through 2013-2014, 16,967,702 athlete exposures and 19,676 total LEIs were examined. In all sports surveyed, there was a higher LEI rate, relative risk for LEI, and LEI requiring surgery during competition than practice. During practice, the majority of LEIs occurred over an hour into practice in all sports. In quarter-based competition, more LEIs occurred in the second (31% to 32%) and third quarters (30% to 35%) than in the first (11% to 15%) and fourth quarters (22% to 26%). In games with halves, the majority (53% to 66%) of LEIs occurred in the second half. The greater severity LEIs tended to occur earlier in games. Fatigue may play a role in the predominance of injuries in the second half of games, though various factors may be involved. Greater severity of injuries earlier in games may be because of higher energy injuries when athletes are not fatigued. These findings can help prepare sports medicine personnel and guide further related research to prevent LEIs.

  1. [The application of impulse magnetic therapy for the treatment of the patients presenting with lymphedema of the lower extremities].

    Science.gov (United States)

    Kulchitskaya, D B; Gerasimenko, M Yu; Aphanova, T V; Konchugova, T V

    The principal objective of the present work was to evaluate the influence of impulse magnetic therapy on the state of the microcirculatory system in the patients presenting with lymphedema of the lower extremities. The study included 59 patients with stage of 1 and 2 lymphedema who were divided into two groups. Those comprising the first group had impulse magnetic therapy applied to their lower extremities while the patients making up the second group served as controls. All the patients were examined with the use of the laser Doppler flowmetry (LDF) that revealed the initially present pathological changes in the microcirculatory system of their lower extremities. The study has demonstrated that the application of impulse magnetic therapy produced a positive effect on all the constituent components of the microcirculatory blood stream of the patients suffering from lymphedema of the lower extremities. Specifically, the initially increased arteriolar tonus was decreased, the blood flow in the capillary vessels was improved, and congestive phenomena in the venular segments of the microcirculation blood stream were markedly reduced. The results of the LDF examination in the control group gave no evidence of significant changes in the patients' microcirculatory system. The results of the LDF examination of the patients of the control group suggested the absence of any appreciable changes in the microcirculatory system. The present study has demonstrated the advisability of the application of impulse magnetic therapy for the treatment of the patients presenting with lymphedema of the lower extremities as a minimally invasive technique for the evaluation of the condition of the microcirculatory system and the objective assessment of the effectiveness of the outcomes of physiotherapy in the patients with vascular pathology.

  2. An important Norwegian contribution to the study of the bursae of the upper and lower extremities

    Science.gov (United States)

    2010-01-01

    We present a critical analysis of the monograph of A.S.D. Synnestvedt (1869) “En anatomisk beskrivelse af de paa over- og underestremiteterne forekommende Bursae mucosae”. The analysis was completed using anatomical information from the historically oldest publications dealing with the bursae of the extremities: Albinus (1734), Monro (1788), Rosenmüller (1799). We are of the opinion that Synnestvedt's publication is important, not only historically but also as a source of information for recent medical practitioners. Synnestvedt's monograph has a wealth of literary citations, unambiguous opinions of seasoned anatomists regarding the structure and function of the synovial membrane, and detailed descriptions of dissections he performed on fetal and adult cadavers. The information in this publication may enhance the diagnosis of bursopathies and enthesopathies of the extremities. PMID:20860444

  3. [Intermittent pneumatic compression of the lower extremity muscles in complex prophylactics of postoperative venous thromboses in elderly and senile patients].

    Science.gov (United States)

    Glushkov, N I; Openchenko, S V

    2009-01-01

    An analysis of frequency of venous thrombitic complications after different operations on 69 patients aged from 69 through 87 was made. The greatest number of venous thromboses was noted after amputations of the femur. Intermittent pneumatic compression of the lower extremities in addition to standard methods of prophylactics reduced the number of postoperative thromboses from 12.8% to 3.3%.

  4. PRE-ACTIVITY MODULATION OF LOWER EXTREMITY MUSCLES WITHIN DIFFERENT TYPES AND HEIGHTS OF DEEP JUMP

    Directory of Open Access Journals (Sweden)

    Vladimir Mrdakovic

    2008-06-01

    Full Text Available The purpose of this study was to determine modulation of pre- activity related to different types and heights of deep jump. Sixteen male soccer players without experience in deep jumps training (the national competition; 15.0 ± 0.5yrs; weight 61.9 ± 6.1kg; height 1.77 ± 0.07m, who participated in the study, performed three types of deep jump (bounce landing, counter landing, and bounce drop jump from three different heights (40cm, 60cm, and 80cm. Surface EMG device (1000Hz was used to estimate muscle activity (maximal amplitude of EMG - AmaxEMG; integral EMG signal - iEMG of five muscles (mm.gastrocnemii, m.soleus, m.tibialis anterior, m.vastus lateralis within 150ms before touchdown. All the muscles, except m. gastrocnemius medialis, showed systematic increase in pre-activity when platform height was raised. For most of the lower extremity muscles, the most significant differences were between values of pre-activity obtained for 40 cm and 80 cm platforms. While the amount of muscle pre-activity in deep jumps from the heights above and beneath the optimal one did not differ significantly from that generated in deep jumps from the optimal drop height of 60 cm, the patterns of muscle pre-activity obtained for the heights above the optimal one did differ from those obtained for the optimal drop height. That suggests that deep jumps from the heights above the optimal one do not seem to be an adequate exercise for adjusting muscle activity for the impact. Muscle pre-activity in bounce drop jumps differed significantly from that in counter landing and bounce landing respectively, which should indicate that a higher amount of pre-activity generated during bounce drop jumps was used for performing take-offs. As this study included the subjects who were not familiar with deep jumps training, the prospective studies should reveal the results of athletes with previous experience

  5. Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection.

    Science.gov (United States)

    Mandell, Jacob C; Khurana, Bharti; Smith, Jeremy T; Czuczman, Gregory J; Ghazikhanian, Varand; Smith, Stacy E

    2018-04-01

    Osteomyelitis is inflammation of the bone caused by an infectious organism, and is a difficult clinical problem. The pathophysiology, imaging, and classification of osteomyelitis are challenging, varying with the age of the patient (child versus adult), the chronicity of the infection (acute versus chronic), and the route of spread (hematogenous versus contiguous focus), as well as the immune and vascular status of the patient and affected region. The two most common classification schemes are those of Lew and Waldvogel, and Cierny and Mader. Brodie's abscess is seen in subacute osteomyelitis, while sequestrum, involucrum, and cloaca are inter-related entities of chronic osteomyelitis. Imaging workup of suspected osteomyelitis should begin with radiographs, although MRI is the most accurate imaging test. Three patterns of T1 signal change have been described in the setting of suspected osteomyelitis including confluent intramedullary, hazy reticular, and subcortical. The confluent intramedullary pattern is most associated with osteomyelitis, while hazy reticular is rarely associated with hematogenous osteomyelitis, and subcortical is not associated with osteomyelitis. It can be challenging to differentiate neuropathic arthropathy from osteomyelitis. Osteomyelitis tends to involve a single bone subjacent to an ulcer or sinus tract. In contrast, neuropathic arthropathy tends to involve multiple bones of the midfoot. Subchondral cystic change, thin rim enhancement of a joint effusion, and the presence of intra-articular bodies are more indicative of a neuropathic joint without infection. Biopsy can play an important role in diagnosis and treatment of osteomyelitis.

  6. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population: a cross sectional study.

    Science.gov (United States)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-13

    Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van Mechelen prevention model is to determine the extent of the problem. The primary aim of this study was to determine the incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population. The secondary aim was to investigate possible associated factors. A cross-sectional study was performed in a Dutch general practice. Using International Classification of Primary Care codes, the electronic patient files were searched to identify cases of adductor tendinopathy, greater trochanteric pain syndrome, jumper's knee, Achilles tendinopathy, and plantar fasciopathy in 2012. The tendinopathy patients were compared to the general practice population regarding age, gender, use of medication, and comorbidity using 95% confidence intervals. The prevalence and incidence rates of lower extremity tendinopathy found in this study were 11.83 and 10.52 per 1000 person-years. Lower extremity tendinopathy was more prevalent among older patients. No differences between tendinopathy patients and the general practice population were found regarding gender, use of medication, or comorbidity. In this cross-sectional study in a Dutch general practice, the prevalence and incidence rates of lower extremity tendinopathy were 11.83 and 10.52 per 1000 person-years. Lower extremity tendinopathy deserves a higher place in locomotor system research to develop preventive interventions.

  7. Perioperative Optimization of Geriatric Lower Extremity Bypass in the Era of Increased Performance Accountability.

    Science.gov (United States)

    Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Lagoo, Sandhya; Shortell, Cynthia K; Mureebe, Leila

    2017-01-01

    The initiation of bundled payment for care improvement by Centers for Medicare and Medicaid Services (CMS) has led to increased financial and performance accountability. As most vascular surgery patients are elderly and reimbursed via CMS, improving their outcomes will be critical for durable financial stability. As a first step in forming a multidisciplinary pathway for the elderly vascular patients, we sought to identify modifiable perioperative variables in geriatric patients undergoing lower extremity bypass (LEB). The 2011-2013 LEB-targeted American College of Surgeons National Surgical Quality Improvement Program database was used for this analysis (n = 5316). Patients were stratified by age <65 (n = 2171), 65-74 (n = 1858), 75-84 (n = 1190), and ≥85 (n = 394) years. Comparisons of patient- and procedure-related characteristics and 30-day postoperative outcomes stratified by age groups were performed with Pearson χ 2 tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. During the study period, 5316 total patients were identified. There were 2171 patients aged <65 years, 1858 patients in the 65-74 years age group, 1190 patients in the 75-84 years age group, and 394 patients in the ≥85 years age group. Increasing age was associated with an increased frequency of cardiopulmonary disease (P < 0.001) and a decreased frequency of diabetes, tobacco use, and prior surgical intervention (P < 0.001). Only 79% and 68% of all patients were on antiplatelet and statin therapies, respectively. Critical limb ischemia occurred more frequently in older patients (P < 0.001). Length of hospital stay, transfusion requirements, and discharge to a skilled nursing facility increased with age (P < 0.001). Thirty-day amputation rates did not differ significantly with age (P = 0.12). Geriatric patients undergoing LEB have unique and potentially modifiable perioperative factors that may improve postoperative outcomes. These

  8. Determination of bone mineral density of the distal extremity of the radio in Rottweiller, by radiographic optic densitometry

    International Nuclear Information System (INIS)

    Alves, Jefferson Douglas Soares; Sterman, Franklin de Almeida

    2010-01-01

    This study allowed the standardization of the bone mineral density (BMD) of the distal extremity of the radio of 36 dogs adults in Rottweiler breed by radiographic optic densitometry. The limbs of the animals were radiographed with scale of aluminum that served as a reference. The radiographs images were digitalized and analyzed by a computer program for comparison of gray tones between the standard image and the image of the reference scale radiographed with the bone. Afterwards the values of density were expressed in millimeters of aluminum. Also studied the correlations between BMD and the sex, weight and external measures as the length of spine, height of the animal and circumference the distal extremity of the limb in study. The mean values and standard deviations of the bone mineral density of the distal extremity of the radio were: for the metaphyseal region the average of BMD of 7,88±0,89 mmAl, the diaphyseal region 1 the average of BMD of 8,58±0,80 mmAl and for diaphyseal region 2 of BMD of 9,00±0,74 mmAl. (author)

  9. Opposing Extremes of Zygomatic Bone Morphology: Australopithecus Boisei versus Homo Neanderthalensis.

    Science.gov (United States)

    Rak, Yoel; Marom, Assaf

    2017-01-01

    The lateral margin of the zygomatic bone of Australopithecus boisei flares both anteriorly and laterally. As a result, the bone loses the suspensory bracing of the facial frame and is transformed into a visor-like structure that supports itself and gains its rigidity from its shape. The coronally oriented bony plates and the outline of the facial mask help the A. boisei face resist the effect of the visor-like structure, which tends to pull the bone plates of the face away from the midline. On the other hand, the nearly sagittal orientation of the zygomatic bone in Homo neanderthalensis helps the face resist torque and bending forces, which themselves stem from the positioning of the bite point on the anterior teeth. Although the zygomatic bones of these two taxa are highly specialized, they differ fundamentally from each other. Anat Rec, 300:152-159, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. Tail-like Congenital Duplication of Lower Extremity (Extra Leg or ...

    African Journals Online (AJOL)

    2018-01-01

    Jan 1, 2018 ... done successfully.This type of case is unusual. It is the rarest type of lower limb duplication. KEYWORD: congenital duplication of lower limb, vestigial parasitic twin, pseudo tail. INTRODUCTION. Human limbs started to develop from the 4thweeks of post- fertilization. the lower limb buds appears 2 days after ...

  11. Real-time screening tests for functional alignment of the trunk and lower extremities in adolescent – a systematic review

    DEFF Research Database (Denmark)

    Junge, Tina; Wedderkopp, N; Juul-Kristensen, B

    on functional alignment of the trunk and lower extremities. Methods An electronic database search was performed accessing Pub- Med and Embase from 2000 to 2011. Eligible studies assessing functional alignment screening of trunk and lower extremities in children or adolescents (10-18 years old) were included....... Hand searching of all reference lists of the included studies was performed. Laboratory settings were included as reference tests, but studies with the primary test requiring force plate, 3D analysis or other technical device were excluded. The QUADAS score (Whiting, 2006) was used to evaluate...

  12. Electromyographic evaluation of high-intensity elastic resistance exercises for lower extremity muscles during bed rest

    DEFF Research Database (Denmark)

    Vinstrup, Jonas; Skals, Sebastian; Calatayud, Joaquin

    2017-01-01

    extremity muscles and normalized to the maximal EMG (nEMG). Likewise, exercise satisfaction was evaluated by a questionnaire. RESULTS: All participants were able to perform all exercises without discomfort and generally rated them satisfactory. High levels of muscle activity were observed for all prime...

  13. Bilateral Fibular Graft: Biological Reconstruction after Resection of Primary Malignant Bone Tumors of the Lower Limb

    Directory of Open Access Journals (Sweden)

    Maya Niethard

    2013-01-01

    Full Text Available This paper deals with bilateral vascularized fibular grafts (BVFG as a method for reconstruction of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors of the lower limb. This reconstructional technique was used in 11 patients undergoing metadiaphyseal resection of lower limb malignant bone tumors. All patients with Ewing’s sarcoma and osteosarcoma had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median FU was 63 months. None of the patients experienced local recurrence during FU. 2 patients died due to distant disease during FU. Full weight- bearing was permitted after a mean of 8 months. The median MSTS score was 87%. Complications occurred in five patients. None of the complications led to failure of the biological reconstruction or to amputation. Biological reconstruction of osseous defects is always desirable when possible and aims at a permanent solution. Good functional and durable results can be obtained by using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia. Radiotherapy in the multimodal setting increases the risk for graft or fixation failure.

  14. The clinical efficacy observation of fluoroscopy-guided foam sclerotherapy with lauromacrogol for varicose veins of the lower extremities

    International Nuclear Information System (INIS)

    Zhu Yongqiang; Xu Jingxuan; Chen Junying; Wu Yan; Zhang Chuanhong; Li Liang

    2012-01-01

    Objective: To assess the clinical efficacy of foam sclerotherapy with lauromacrogol for varicose veins of the lower extremities. Methods: During the period from February to July 2011, we retrospectively analyzed 20 patients with varicose veins of the lower extremities, who were treated with lauromacrogol foam sclerosing agent injected directly at varicose veins, and in 5 extremities injected at the great saphenous vein (GSV) through a catheter at the same time. Elastic bandages were applied at the site of the injected varicosities after the therapy. The clogging of the varicose veins, the improvement of the clinical symptoms and the adverse reaction were observed. Results: Lauromacrogol foam sclerosing agent was successfully injected under the guidance of fluoroscopy in 20 patients with 28 affected extremities. The average volume of foam sclerosing agent in each affected extremity was 7.8 ml. All patients presented self limiting minor complications, including swelling and pain, which was obviously alleviated by the externally applied Mucopolysaccharide Polysulfate Cream. Two patients presented cough that was relieved after inhaling oxygen. Most of treated varicosities demonstrated pigmentation after the first week, which gradually disappeared after the four-month use of vitamin E capsule. A second foam sclerotherapy was carried out for 3 affected extremities of 3 patients two months after the first therapy. Two cases of leg venous ulcer were healed within a few weeks. All patients could walk immediately with no deep vein thrombosis, pulmonary embolism, anaphylaxis, or transient visual disturbance. Obvious abnormal varicose veins as well as the soreness and fatigue of the lower extremities disappeared in all patients at the 10th-month follow-up. The grading of the disease was significantly improved by the treatment (Z=5.103, P<0.01). Conclusions: The efficacy of lauromacrogol foam sclerosing agent in the treatment of varicose veins of the lower extremities is

  15. Fast gaze reorientations by combined movements of the eye, head, trunk and lower extremities.

    Science.gov (United States)

    Anastasopoulos, Dimitri; Naushahi, J; Sklavos, Sokratis; Bronstein, Adolfo M

    2015-05-01

    Large reorientations of the line of sight, involving combined rotations of the eyes, head, trunk and lower extremities, are executed either as fast single-step or as slow multiple-step gaze transfers. In order to obtain more insight into the mechanisms of gaze and multisegmental movement control, we have investigated time-optimal gaze shifts (i.e. with the instruction to move as fast as possible) during voluntary whole-body rotations to remembered targets up to 180° eccentricity performed by standing healthy humans in darkness. Fast, accurate, single-step movement patterns occurred in approximately 70 % of trials, i.e. considerably more frequently than in previous studies with the instruction to turn at freely chosen speed (30 %). Head-in-space velocity in these cases was significantly higher than during multiple-step transfers and displayed a conspicuously regular bell-shaped profile, increasing smoothly to a peak and then decreasing slowly until realignment with the target. Head-in-space acceleration was on average not different during reorientations to the different target eccentricities. In contrast, head-in-space velocity increased with target eccentricity due to the longer duration of the acceleration phase implemented during trials to more distant targets. Eye saccade amplitude approached the eye-in-orbit mechanical limit and was unrelated to eye/head velocity, duration or target eccentricity. Overall, the combined movement was stereotyped such that the first two principal components accounted for data variance almost up to gaze shift end, suggesting that the three mechanical degrees of freedom under consideration (eye-in-orbit, head-on-trunk and trunk-in-space) are on average reduced to two kinematic degrees of freedom (i.e. eye, head-in-space). Synchronous EMG activity in the anterior tibial and gastrocnemius muscles preceded the onset of eye rotation. Since the magnitude and timing of peak head-in-space velocity were scaled with target eccentricity and

  16. Association of Lower Quarter Y-Balance Test with lower extremity injury in NCAA Division 1 athletes: an independent validation study.

    Science.gov (United States)

    Wright, Alexis A; Dischiavi, Steven L; Smoliga, James M; Taylor, Jeffrey B; Hegedus, Eric J

    2017-06-01

    To determine if the Lower Quarter Y-Balance Test (LQYBT) is predictive of lower extremity injury in NCAA Division 1 athletes. Prospective cohort, therapy. One hundred eighty-nine NCAA Division 1 athletes participated in the study and underwent a preparticipation screen that included the LQYBT. Maximal reach distances were recorded in each direction and normalized to leg length. A composite score was calculated by summing the three normalized reach distances and dividing by three times leg length. Side to side asymmetry was calculated as the lesser of the two composite scores, divided by the greater of the two composite scores, multiplied by 100. Injuries for the following season were tracked and recorded; LQYBT scores were compared between injured and non-injured athletes. In our sample, 90 [59 female, 31 male] of the 189 athletes participating suffered a lower extremity injury. No significant differences were found between injured and non-injured athletes for reach distance, normalized reach distance, normalized composite reach distance, or normalized composite percent score (P>0.05). The LQYBT does not appear to predict general lower extremity injury in a diverse population of NCAA D1 athletes. These results are in direct conflict with previous findings suggesting the LQYBT is predictive of injury suggesting its utility as an injury risk screening tool in a general collegiate athletic population should continue to be questioned. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  17. Perceptions and experiences of nutritional care following the overwhelming experience of lower extremity amputation: A qualitative study.

    Science.gov (United States)

    Jensen, Pia Søe; Green, Sue M; Petersen, Janne; Andersen, Ove; Poulsen, Ingrid

    2017-11-29

    Good nutritional care of people following major lower extremity amputation is essential as poor nutritional status can lead to delayed wound healing. Working with patients to identify their perspectives on food, views on nutritional care and the need for dietary counselling enables the development of optimised nutritional care. To explore hospital patients' perspectives on food, dietary counselling and their experiences of nutritional care following lower extremity amputation. A qualitative, explorative study design was employed. An inductive content analysis of semi-structured interviews with a purposive sample of 17 people over 50 years of age, who had recently undergone major lower extremity amputation, was undertaken. The study was reported according to the consolidated criteria for reporting qualitative research guideline. Three themes emerged: responsible for own dietary intake, diet based on preferences and experiences with dietary counselling and feeling overwhelmed. The participants expressed motivation to ensure their nutritional needs were met but described feeling emotionally overwhelmed by the experience of amputation. They appeared not to expect nursing staff to focus on nutritional issues as they expressed belief that they themselves were solely responsible for their dietary intake. They described being motivated to receive nutritional counselling but indicated advice should be compatible with their lifestyle and eating habits. Lower extremity amputation can be an overwhelming experience which affects nutritional intake. People appear to consider themselves responsible for their nutritional care and describe not experiencing or expecting nursing staff to engage in this aspect of care. Dietary counselling by nurses who respect and incorporate patient preferences and experiences following amputation has the potential to enhance nutritional care. This study illustrates that nurses caring for people who undergo lower extremity amputation need to

  18. Outcomes of infrageniculate retrograde versus transfemoral access for endovascular intervention for chronic lower extremity ischemia.

    Science.gov (United States)

    Taha, Ashraf G; Abou Ali, Adham N; Al-Khoury, George; Singh, Michael J; Makaroun, Michel S; Avgerinos, Efthymios D; Chaer, Rabih A

    2018-03-31

    Retrograde infrageniculate access is an alternative treatment strategy for patients who have failed to respond to antegrade endovascular intervention. This study compares the outcomes of infrageniculate retrograde arterial access with the conventional transfemoral access for the endovascular management of chronic lower extremity ischemia. This was a retrospective single-center review of retrograde endovascular intervention (REI) from 2012 to 2016. Indications for intervention, comorbidities, complications, procedural success, limb outcomes, and mortality were analyzed. Technical failure was defined as the inability to complete the procedure because of failed access or unsuccessful recanalization. Infrageniculate access and transfemoral access were obtained with ultrasound or angiographic roadmap guidance. Patency rates were calculated for technically successful interventions. There were 47 patients (85% presenting with critical limb ischemia) who underwent sheathless REI after failed antegrade recanalization of TransAtlantic Inter-Society Consensus class D infrainguinal lesions, whereas 93 patients (83% with critical limb ischemia) underwent standard transfemoral access. There were 16 (34%) femoropopliteal, 14 (30%) tibial, and 17 (36%) multilevel interventions in the retrograde group compared with 41 (41%) femoropopliteal, 20 (20%) tibial, and 39 (39%) multilevel interventions in the transfemoral group. Access sites for the retrograde group included the dorsalis pedis (26%), midcalf peroneal (24%), anterior tibial (22%), posterior tibial (26%), and popliteal (2%) arteries. Overall technical success was achieved in 57% of the retrograde group compared with 78% of the transfemoral group. Mean follow-up was 20 months (range, 1-45 months). There were no significant differences in the primary patency rates between the two groups at 1 year and 2 years. The primary assisted patency rates were significantly better in the transfemoral group at 1 year (66% vs 46%; P

  19. Digital subtraction angiography for lower extremity phlebography

    International Nuclear Information System (INIS)

    Yokoyama, Kunihiko; Nakashima, Noriko; Takata, Yasunori; Hashimoto, Shozo.

    1989-01-01

    DSA was applied to the lower extremity phlebography on 21 cases (36 legs). The patient lay in the supine position and a tourniquet was placed around the ankle. Forty ml of contrast medium, diluted to 25% of the original concentration with normal saline, was injected into the dorsal vein of the foot. The anterior tibial vein, posterior tibial vein, peroneal vein and muscular vein of the calf were identified in 24(63.2%), 36(94.7%), 37(97.4%) and 7 legs (18.4%), respectively. The poor opacification of the anterior tibial vein was attributed partly to the compression effect of the tourniquet. The abnormal findings were deep vein thrombosis (5 legs), reflux from the deep to the superficial vein (14 legs) and irregularity of the vein wall (16 legs). The superficial varicose veins were not demonstrated in DSA phlebography. The examination was comfortable because the patient position was supine and the dilute contrast medium caused no burning sensation. We believe that DSA phelobography is a safe and useful method for diagnosing the deep venous system disorders. (author)

  20. Digital subtraction angiography for lower extremity phlebography

    Energy Technology Data Exchange (ETDEWEB)

    Yokoyama, Kunihiko; Nakashima, Noriko; Takata, Yasunori; Hashimoto, Shozo.

    1989-04-01

    DSA was applied to the lower extremity phlebography on 21 cases (36 legs). The patient lay in the supine position and a tourniquet was placed around the ankle. Forty ml of contrast medium, diluted to 25% of the original concentration with normal saline, was injected into the dorsal vein of the foot. The anterior tibial vein, posterior tibial vein, peroneal vein and muscular vein of the calf were identified in 24(63.2%), 36(94.7%), 37(97.4%) and 7 legs (18.4%), respectively. The poor opacification of the anterior tibial vein was attributed partly to the compression effect of the tourniquet. The abnormal findings were deep vein thrombosis (5 legs), reflux from the deep to the superficial vein (14 legs) and irregularity of the vein wall (16 legs). The superficial varicose veins were not demonstrated in DSA phlebography. The examination was comfortable because the patient position was supine and the dilute contrast medium caused no burning sensation. We believe that DSA phelobography is a safe and useful method for diagnosing the deep venous system disorders. (author).

  1. Transradial approach to lower extremity interventions

    Directory of Open Access Journals (Sweden)

    Ravikiran Korabathina

    2010-07-01

    Full Text Available Ravikiran Korabathina1, Sidharth S Yadav1, John T Coppola2, Cezar S Staniloae21Department of Cardiovascular Medicine, Saint Vincents Catholic Medical Center, New York, NY, USA; 2Cardiac and Vascular Institute, New York University Medical Center, New York, NY, USAAbstract: Percutaneous interventions of the coronary and peripheral vessels have historically been performed using a femoral artery approach. There has been increasing recognition of postprocedural bleeding complications and its impact on short- and long-term mortality. Because of its now recognized safety, the transradial approach has recently emerged as a preferred method compared to the transfemoral approach. The limitations associated with the distance from the puncture site to the lesion location are being addressed as new tools are developed for the endovascular treatment of peripheral arterial disease. In this review, we discuss the many facets of the transradial approach to lower extremity endovascular interventions, highlighting its safety and efficacy. Approaches to special populations including individuals with prior surgical bypass, Leriche’s syndrome, and those committed to chronic anticoagulation are also reviewed.Keywords: peripheral arterial disease, endovascular interventions, transradial interventions, aorto-iliac angioplasty

  2. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Rehabilitation process and prosthetics. Part 2.

    Science.gov (United States)

    Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Duijzentkunst, Rob Smit; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

    2015-10-01

    A structured, multidisciplinary approach in the rehabilitation process after amputation is needed that includes a greater focus on the involvement of both (para)medics and prosthetists. There is considerable variation in prosthetic prescription concerning the moment of initial prosthesis fitting and the use of replacement parts. To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 2 focuses on rehabilitation process and prosthetics. Systematic literature design. Literature search in five databases and quality assessment on the basis of evidence-based guideline development. An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for treatment and reintegration of patients undergoing amputation of a lower extremity and can be used to provide patient information. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. © The International Society for Prosthetics and Orthotics 2014.

  3. Dutch evidence-based guidelines for amputation and prosthetics of the lower extremity: Amputation surgery and postoperative management. Part 1.

    Science.gov (United States)

    Geertzen, Jan; van der Linde, Harmen; Rosenbrand, Kitty; Conradi, Marcel; Deckers, Jos; Koning, Jan; Rietman, Hans S; van der Schaaf, Dick; van der Ploeg, Rein; Schapendonk, Johannes; Schrier, Ernst; Smit Duijzentkunst, Rob; Spruit-van Eijk, Monica; Versteegen, Gerbrig; Voesten, Harrie

    2015-10-01

    Surgeons still use a range of criteria to determine whether amputation is indicated. In addition, there is considerable debate regarding immediate postoperative management, especially concerning the use of 'immediate/delayed fitting' versus conservative elastic bandaging. To produce an evidence-based guideline for the amputation and prosthetics of the lower extremities. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. Part 1 focuses on amputation surgery and postoperative management. Systematic literature design. Literature search in five databases. Quality assessment on the basis of evidence-based guideline development. An evidence-based multidisciplinary guideline on amputation and prosthetics of the lower extremity. The best care (in general) for patients undergoing amputation of a lower extremity is presented and discussed. This part of the guideline provides recommendations for diagnosis, referral, assessment, and undergoing amputation of a lower extremity and can be used to provide patient information. This guideline provides recommendations in support of daily practice and is based on the results of scientific research and further discussions focussed on establishing good medical practice. © The International Society for Prosthetics and Orthotics 2014.

  4. Incidence and prevalence of lower extremity tendinopathy in a Dutch general practice population : a cross sectional study

    NARCIS (Netherlands)

    Albers, Iris Sophie; Zwerver, Johannes; Diercks, Ronald Leo; Dekker, Janny Hendrika; Van den Akker-Scheek, Inge

    2016-01-01

    Background: Lower extremity tendinopathy is a common sports injury, but it can also affect non-athletes. Because tendinopathy is difficult to treat and has negative effects on the ability to work and quality of life, development of preventive interventions is important. The first step in the Van

  5. Concussion Increases Odds of Sustaining a Lower Extremity Musculoskeletal Injury After Return to Play Among Collegiate Athletes.

    Science.gov (United States)

    Brooks, M Alison; Peterson, Kaitlin; Biese, Kevin; Sanfilippo, Jennifer; Heiderscheit, Bryan C; Bell, David R

    2016-03-01

    Previous studies have identified abnormalities in brain and motor functioning after concussion that persist well beyond observed clinical recovery. Recent work suggests subtle deficits in neurocognition may impair neuromuscular control and thus potentially increase risk of lower extremity musculoskeletal injury after concussion. To determine the odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play from concussion in a cohort of National Collegiate Athletic Association (NCAA) Division I collegiate athletes. Cohort study; Level of evidence, 3. Included in this study were 87 cases of concussion among 75 athletes (58 men; 17 women) participating in NCAA Division I football, soccer, hockey, softball, basketball, wrestling, or volleyball at a single institution from 2011 to 2014. The 90-day period after return to play for each case of concussion was reviewed for acute noncontact lower extremity musculoskeletal injury. Each 90-day period after return to play was matched to the same 90-day period in up to 3 controls. Control athletes without a history of concussion in the previous year were matched to concussed athletes by sport team/sex, games played, and position. A total of 182 control (136 men; 46 women) 90-day periods were reviewed for acute injury. Conditional logistic regression was used to assess the association between concussion and subsequent risk of acute lower extremity musculoskeletal injury. The incidence of acute lower extremity musculoskeletal injury was higher among recently concussed athletes (15/87; 17%) compared with matched controls (17/182; 9%). The odds of sustaining an acute lower extremity musculoskeletal injury during the 90-day period after return to play were 2.48 times higher in concussed athletes than controls during the same 90-day period (odds ratio, 2.48; 95% CI, 1.04-5.91; P = .04). Concussed athletes have increased odds of sustaining an acute lower extremity musculoskeletal

  6. THE COMPARISON OF HYPERBARIC BUPIVACAINE AND ROPIVACAINE USAGE IN SPINAL ANESTHESIA AT HIP AND LOWER EXTREMITY SURGERY

    Directory of Open Access Journals (Sweden)

    Aynur sahin

    2013-03-01

    Conclusion: Ropivacaine and bupivacaine usage in hip and lower extremity surgery may provide hemodynamic stability, therefore we suggest that ropivacaine and bupivacaine are safe to use in spinal anesthesia for this kind of processes. [J Contemp Med 2013; 3(1.000: 36-41

  7. Potential predictors of lower extremity impairments in motor coordination of stroke survivors.

    Science.gov (United States)

    Menezes, Kenia K; Scianni, Aline A; Faria-Fortini, Iza; Avelino, Patrick R; Carvalho, Augusto C; Faria, Christina D; Teixeira-Salmela, Luci F

    2016-06-01

    It is well recognized that the negative motor impairments following upper motor neuron damage, e.g., loss of strength and dexterity (motor coordination), mostly contribute to disability. Many factors may predict impairments in motor coordination (MC) and the identifications of these factors could help rehabilitation professionals to select variables to be considered in the evaluation and interventions aimed at improving MC of the lower limbs after stroke. To investigate the potential predictors of motor coordination (MC) of the paretic lower limb with stroke subjects, as assessed by the Lower Limb Motor Coordination Test (LEMOCOT). Cross-sectional, observational study. University laboratory. One hundred and six stroke subjects. The selected potential predictors of the LEMOCOT scores were age, gender, motor recovery and sensation of the lower limb, tonus of the knee extensor and plantar flexor muscles, and strength of the hip flexor and knee flexor/extensor muscles. Step-wise multiple regression was employed for analysis. Only motor recovery, tonus of the plantar flexor muscles, and age reached significance (PMotor recovery alone was able to explain 46% (F=89.0, Pmotor recovery was positively associated with the LEMOCOT scores, whereas the tonus of the plantar flexor muscles and age were negatively correlated. Motor recovery of the lower limb, tonus of the plantar flexor muscles, and age were significant predictors of MC of the paretic lower limb. These findings could help rehabilitation professionals to evaluate MC deficits and plan interventions aimed at improving MC of the lower limbs for stroke subjects, based upon the knowledge of the possible factors that could contribute to MC impairments.

  8. Complete decongestive physical therapy in a patient with secondary lymphedema due to orthopedic trauma and surgery of the lower extremity.

    Science.gov (United States)

    Cohen, Meryl D

    2011-11-01

    This case report describes a patient who developed lower-extremity lymphedema secondary to orthopedic trauma and surgery and reports the response to complete decongestive physical therapy (CDP), with 8 treatment sessions over 3 months. The patient was a 56-year-old man who sustained a right ankle displaced fibular fracture, underwent open reduction internal fixation surgery 12 days later, and developed lymphedema 4 months postinjury. The patient's impairments of the right lower extremity included increased girth, decreased ankle range of motion, and increased pain. Due to these impairments and the inability to fit into normal footwear, the patient limited activities such as ambulating long distances and climbing stairs. This limited activity restricted him from participating in his normal lifestyle activities such as walking his dog in the community and performing all necessary work duties. Using the truncated cone formula to measure limb volume, the limb volume of the right (involved) lower extremity decreased 368 mL as a result of CDP. The percentage of difference in limb volume between the right and left lower extremities at the initial examination was 9%, and it was reduced to less than 1% at discharge. He was independent with his home program in order to maintain the results of therapy. Physical therapist management of secondary lymphedema due to orthopedic trauma and surgery of the lower extremity was effective in decreasing circumferential girth measurements and decreasing limb volume, thereby improving gait and allowing the patient to fit into his work and leisure shoes. The patient reported improvement in his ability to perform all work activities, and he returned to his prior level of participation in the community.

  9. [Possibilities of endoscopic surgery in treatment of chronic venous insufficiency of the lower extremities].

    Science.gov (United States)

    Lazarenko, V A; Okhotnikov, O I; Prokopov, V A; Kopeĭko, I L; Bobrovskaia, E A; Es'kov, V P; Tulupova, L N

    2005-01-01

    The authors present their experiences with endoscopic dissection of perforating veins in patients with severe forms of chronic venous insufficiency with special reference to the peculiarities of blood supply of the extremity superficial tissue. The generalized morphological description of the perforating arteriovenous structures of the leg is presented as a vascular formation including the arteries and veins put in the general connective-tissue vagina and beginning from the profound or/and muscular veins and arteries. Operations were made on 56 patients aged 25-76 years, 40 of them had postthrombotic disease, 16 - varicose disease. The endoscopic subfascial dissection of the perforating veins was conducted using the standard set of tools for laparoscopic surgery of K. Storz Company. During the surgical procedure the perforating vascular bunch in the subfascial space was isolated, the veins were intersected electrosurgically, the other parts of the vascular bunch were preserved. On the average, the patients were in the hospital for 7+/-2 days. Trophic ulcers healed up during 7-30 days. Long-term results were good in 30%, satisfactory in 64%, unsatisfactory - in 6%. So, the selective endoscopical dissection of perforating veins is thought to be a radical, minimally invasive, anatomically and functionally reasonable method of elimination of the horizontal venous blood regurgitation. This technique resulted in a considerably decreased number of postoperative complications and less time of hospital treatment.

  10. Changes of maximal muscle torque and maximal power output of lower extremities in male judoists during training

    OpenAIRE

    Buśko, Krzysztof; Nowak, Anna

    2008-01-01

    Purpose. The aim of the study was to follow changes of the maximal muscle torque and maximal power output of lower extremities in male judoists during pre-competition training (PCT). The original hypothesis assumed that different training loads would cause changes of the maximal muscle torque and maximal power output of legs in male judoists during pre-competition training, but not changes of the topography of the maximal muscle torque in all muscle groups. Basic procedures. The study sample ...

  11. Lower Extremity Disorders among Men and Women in Army Basic Training and Effects of Two Types of Boots

    Science.gov (United States)

    1983-01-01

    the calcaneus .! 5,16 Stress fractures of the femur, tibia, and fibula, while not as frequent, have been reported as occurring among Army, Navy, and...R. G. MacDonald. Early diagnosis and treatment of stress fractures of the calcaneus . Journal of the American Podiatry Association, 56, 533-536, 1966...men than women had previously sustained ankle fractures or sprains. 3. Disorders Exclusive to Each Sex. Of 27 types of lower extremity disorders

  12. Computed tomography angiography of lower extremities in the emergency room for evaluation of patients with gunshot wounds

    Energy Technology Data Exchange (ETDEWEB)

    Adibi, Ali; Plotnik, Adam N.; Mohajer, Kiyarash; Arellano, Cesar; Ruehm, Stefan G. [University of California, Diagnostic Cardiovascular Imaging, Department of Radiological Sciences, Los Angeles, CA (United States); Krishnam, Mayil S.; Dissanayake, Sumudu [University of California, Cardiovascular and Thoracic Imaging, Department of Radiology, Irvine, CA (United States)

    2014-07-15

    To assess the role of CT angiography in the evaluation of patients with lower extremity gunshot wounds in the emergency room. Eighty patients (73 male, 7 female, mean age 26 years) underwent CT angiography for the evaluation of lower extremity gunshot injuries. Imaging was conducted on the basis of standardized protocols utilizing 16-slice and 64-slice multidetector systems and images were qualitatively graded and assessed for various forms of arterial injury. CT angiography findings indicative of arterial injury were observed in 24 patients (30 %) and a total of 43 arterial injuries were noted; the most common form was focal narrowing/spasm (n = 16, 37.2 %); the most common artery involved was the superficial femoral artery (n = 12, 50 %). In qualitative assessment of images based on a 4-point grading system, both readers considered CT angiography diagnostically excellent (grade 4) in most cases. Surgical findings were consistent with CT angiography and follow-up of patients' medical records showed no arterial injuries in patients with normal findings on initial imaging. Our findings demonstrate that CT angiography is an effective imaging modality for evaluation of lower extremity gunshot wounds and could help limit more invasive procedures such as catheter angiography to a select group of patients. (orig.)

  13. Doppler spectrum of superficial femoral artery in patients with occlusive arterial disease of lower extremity: Comparison with angiography

    International Nuclear Information System (INIS)

    Jae, Hwan Jun; Koh, Young Hwan; Kim, Kyoung Won; Kim, Hyun Boem; Jung, Jin Wook; Park, Jae Hyung

    2000-01-01

    To compare Doppler waveform of superficial femoral artery (SFA) with the angiographic findings according to the location and severity of occlusive arterial disease of lower extremity. We examined 32 lower extremities in 20 patients (M:F=18:2, Age: 37-86, Mean age:62) with the occlusive arterial disease of lower extremity using Doppler sonography and angiography. We classified them into 6 groups according to the location and severity of arterial stenosis or occlusion on angiography; stenosis 50% proximal to SFA (n=5), total occlusion proximal to (n=5), stenosis>50% or occlusion in the distal SFA or popliteal artery (n=8), stenosis>50% or occlusion below trifurcation (n=4), stenosis>50% or occlusion i the proximal to SFA (n=6). The Doppler waveforms SFA were retrospectively analyzed tot he 6 groups classified by the angiographic findings. Normal triphasic pattern (3/4) of SFA was preserved in case with stenosis 50% or occlusion in the distal SFA or popliteal artery. Triphasic (2/4) or biphasic pattern with absent diastolic flow (2/4) was detected in stenosis>50% or occlusion in the lover than trifurcation. The waveform was variable in the cases with stenosis>50% or occlusion in the proximal and distal lesion. The Doppler waveform of SFA in the occlusive arterial disease of the lower extremity was variable. However, it tends to show pulsus tardus et parvus pattern in the total occlusion proximal to SFA and high resistive pattern with absent early diastolic reversal in stenosis>50% or occlusion in the distal SFA or popliteal artery.

  14. Lower trabecular volumetric BMD at metaphyseal regions of weight-bearing bones is associated with prior fracture in young girls.

    Science.gov (United States)

    Farr, Joshua N; Tomás, Rita; Chen, Zhao; Lisse, Jeffrey R; Lohman, Timothy G; Going, Scott B

    2011-02-01

    Understanding the etiology of skeletal fragility during growth is critical for the development of treatments and prevention strategies aimed at reducing the burden of childhood fractures. Thus we evaluated the relationship between prior fracture and bone parameters in young girls. Data from 465 girls aged 8 to 13 years from the Jump-In: Building Better Bones study were analyzed. Bone parameters were assessed at metaphyseal and diaphyseal sites of the nondominant femur and tibia using peripheral quantitative computed tomography (pQCT). Dual-energy X-ray absorptiometry (DXA) was used to assess femur, tibia, lumbar spine, and total body less head bone mineral content. Binary logistic regression was used to evaluate the relationship between prior fracture and bone parameters, controlling for maturity, body mass, leg length, ethnicity, and physical activity. Associations between prior fracture and all DXA and pQCT bone parameters at diaphyseal sites were nonsignificant. In contrast, lower trabecular volumetric BMD (vBMD) at distal metaphyseal sites of the femur and tibia was significantly associated with prior fracture. After adjustment for covariates, every SD decrease in trabecular vBMD at metaphyseal sites of the distal femur and tibia was associated with 1.4 (1.1-1.9) and 1.3 (1.0-1.7) times higher fracture prevalence, respectively. Prior fracture was not associated with metaphyseal bone size (ie, periosteal circumference). In conclusion, fractures in girls are associated with lower trabecular vBMD, but not bone size, at metaphyseal sites of the femur and tibia. Lower trabecular vBMD at metaphyseal sites of long bones may be an early marker of skeletal fragility in girls. Copyright © 2011 American Society for Bone and Mineral Research.

  15. The influence of a foot orthotic on lower extremity transverse plane kinematics in collegiate female athletes with pes planus.

    Science.gov (United States)

    Christopher, R Carcia; Drouin, Joshua M; Houglum, Peggy A

    2006-01-01

    Non-contact anterior cruciate ligament (ACL) injuries in female athletes remain prevalent. Athletes with excessive foot pronation have been identified to be at greater risk for non-contact ACL injury. Excessive foot pronation has been linked to increased medial tibial rotation. Increased medial tibial rotation heightens ACL strain and has been observed at or near the time of ACL injury. Foot orthotics have been shown to decrease medial tibial rotation during walking and running tasks. The effect of a foot orthotic on activities that simulate a non-contact ACL injury mechanism (i.e. landing) however is unknown. Therefore, the objective of this study was to determine whether a foot orthotic was capable of altering transverse plane lower extremity kinematics in female athletes during landing. Twenty uninjured collegiate female athletes participating in the sports of basketball, soccer or volleyball with pes planus volunteered. Utilizing a repeated measures counterbalanced design, subjects completed two landing tasks with and without a foot orthotic using standardized footwear. The prefabricated orthotic had a rigid shell and a 6 extrinsic rear-foot varus post. Dependent measures included initial contact angle, peak angle, excursion and time to peak angle for both the tibia and femur. Statistical analysis suggested that the selected foot orthosis had little influence over lower extremity transverse plane kinematics. Several factors including: the limitation of a static measure to predict dynamic movement, inter-subject variability and the physical characteristics of the orthotic device likely account for the results. Future research should examine the influence of different types of foot orthotics not only on lower extremity kinematics but also tibiofemoral kinetics. Key PointsLower extremity transverse plane kinematics in female athletes during a landing task exhibit substantial variability.A rigid prefabricated foot orthotic does not significantly alter transverse

  16. Incomplete palmar fracture of the proximal extremity of the third metacarpal bone in horses: ten cases (1981-1986)

    International Nuclear Information System (INIS)

    Lloyd, K.C.K.; Koblik, P.; Ragle, C.; Wheat, J.D.; Lakritz, J.

    1988-01-01

    In 4 adult horses, simple, non displaced, incomplete fracture of the proximal extremity of the third metacarpal bone (MC3) was identified radiographically only on the dorsopalmar projection. Lameness was slight to moderate. Although nerve blocks of the foot and fetlock did not alter the lameness, high palmar regional nerve block improved the gait in 1 of the 2 horses on which it was performed. Pain on palpation or swollen distal accessory (inferior check) ligament, flexor tendons, and suspensory ligament were not found in any horse. The fracture was localized to the palmar surface of the proximal extremity of the MC3 on the basis of the intense uptake of radiopharmaceutical (99MTc-labeled sodium medronate) observed in that area during the soft tissue and delayed bone phases of a nuclear scintigraphic examination (nuclear scan) performed concurrently with radiography. Of 4 horses evaluated 6 months after the initial diagnosis, 3 had medullary sclerosis without radiographic evidence of fracture; results of follow-up nuclear scintigraphy performed in one of these horses at the same time were normal. Incomplete fracture also was suspected in another 6 adult horses with clinical lameness referable to the proximal extremity of the MC3. Although a fracture line could not be seen radiographically, trabecular hypertrophy and/or medullary sclerosis of the proximal extremity of the MC3 were detected on the dorsopalmar projection. Further, during nuclear scintigraphy, an intense uptake of the radiopharmaceutical was observed on the palmar aspect of the proximal extremity of the MC3 in all 6 horses

  17. [Symmetrical phlebothrombosis of lower extremities resulting from congenital malformation of vena cava inferior].

    Science.gov (United States)

    Halcín, A; Kovácová, E; Mikla, F; Reptová, A; Bedeová, J

    2009-12-01

    Agenesis/atresia ofvena cava inferior is a rare congenital anomaly, caused by an aberrance of embryonal venous system development. This is in most cases asymptomatic, because of well developed collateral venous circulation. However, in some cases, it can be manifested with occurence of deep thrombosis in area of pelvis and lower limbs. In this case report, we repon a 21 year old male with painful swelling of both lower limbs. Ultrasonographic examination revealed a bilateral thrombosis in deep venous system of lower limbs and pelvis. Subsequent CT angiography showed atresia ofinfrarenal segment ofvena cava inferior. According to the CT image thrombotic proces affected also collateral venous system, that joined mostly to vena azygos and hemiazygos. Examination of coagulation system didn't reveal a procuring cause ofthrombotic occurrence. We realized a systemic trombolysis with streptokinase during 5 days. Starting from the fifth day we administered a low molecular weight heparin in anticoagulant dose. This treatment showed a good clinical effect. Pacient was discharged with a long-term oral warfarin therapy in combination with acetylsalicylic acid. In next four months of taking recommended therapy no relapse of thrombotic process nor evolvement of bleeding complication was observed.

  18. Epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia: a systematic review protocol

    OpenAIRE

    van Netten, Jaap J.; Baba, Mendel; Lazzarini, Peter A.

    2017-01-01

    Background Diabetic foot disease is associated with major morbidity, mortality, costs, and reduction of a person?s quality of life. Investigating the epidemiology of diabetic foot disease is the backbone of diabetic foot research and clinical practice, yet the full burden of diabetic foot disease in Australia is unknown. This study aims to describe the protocol for a systematic review of the epidemiology of diabetic foot disease and diabetes-related lower-extremity amputation in Australia. Me...

  19. Risk factors for lower extremity fatigue among assembly plant workers.

    Science.gov (United States)

    Gell, Nancy; Werner, Robert A; Hartigan, Anne; Wiggermann, Neal; Keyserling, W Monroe

    2011-03-01

    Work-related fatigue of the lower extremities is a known cause of lost productivity and significant employer costs. Common workplace solutions to reduce fatigue levels include anti-fatigue matting, shoe orthoses, or sit/stand work stations. However, assessment of these anti-fatigue measures within the workplace has been limited. This was a cross sectional study in an automotive assembly plant on employees with at least 6 months tenure. Subject data were collected via questionnaires including Likert-scale questions to define fatigue severity. Jobs were evaluated for lower extremity ergonomic exposures via videotaping, pedometers, interviews, and industrial engineering records. Lower extremity fatigue at the end of the work day was associated with a higher prevalence of smoking, rheumatoid arthritis, job dissatisfaction, use of shoes with firmer outsoles, and increased time on the job spent standing or walking. Supervisor support and increased time spent on carpet were protective. Lower extremity fatigue that interfered with activities outside of work had additional risk factors including higher BMI, prior diagnosis of osteoarthritis, and increased hours per week spent working. While these results identify carpet as being protective against lower extremity fatigue, no similar relationship was identified for anti-fatigue mats. No adverse relationship was found between hard surfaces such as concrete and lower extremity fatigue. Given the high costs associated with work-related fatigue, future areas for potential intervention include smoking cessation, specific shoe recommendations, and enhancing psychosocial aspects of work such as supervisor support. Copyright © 2010 Wiley-Liss, Inc.

  20. Comparative measurements of mineral salt concentrations in the calcaneus by 125I γ-absorption measurement in the course of fractures of the lower extremities

    International Nuclear Information System (INIS)

    Mehrlich, P.

    1979-01-01

    In a group of 52 patients aged between 16 and 78 years, all with fractures of the lower extremities, BMC concentrations were determined in a period from 10 weeks to 50 month after the accident in both calcaneal bones and the right ulna. The gamma absorption measurements were carried out in a single-isotope technique in a water bath, using a 125 I source as radionuclides. The results were evaluated by planimetrisation of the absorption curve. The patients were divided in groups according to clinically complicated, clinically uncomplicated, radiologically demineralized, and radiologically and clinically uncomplicated healing. In 11 patients, up to 4 measurements were also carried out as course control measures. The results differed in dependence of the patients' age. The localisation of the fracture had no effect on the degree of demineralisation. (orig./MG) [de

  1. Comparative measurements of mineral salt concentrations in the calcaneus by /sup 125/I. gamma. -absorption measurement in the course of fractures of the lower extremities

    Energy Technology Data Exchange (ETDEWEB)

    Mehrlich, P.

    1979-01-01

    In a group of 52 patients aged between 16 and 78 years, all with fractures of the lower extremities, BMC concentrations were determined in a period from 10 weeks to 50 month after the accident in both calcaneal bones and the right ulna. The gamma absorption measurements were carried out in a single-isotope technique in a water bath, using a /sup 125/I source as radionuclides. The results were evaluated by planimetrisation of the absorption curve. The patients were divided in groups according to clinically complicated, clinically uncomplicated, radiologically demineralized, and radiologically and clinically uncomplicated healing. In 11 patients, up to 4 measurements were also carried out as course control measures. The results differed in dependence of the patients' age. The localisation of the fracture had no effect on the degree of demineralisation.

  2. Pyogenic Arthritis of the Ankle Joint Following a High-Voltage Electrical Burn in the Lower Extremity: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kuk Seon; Lee, Gyung Kyu; Kang, Ik Won; Hwang, Dae Hyun; Lee, Eil Seong; Min, Seon Jung; Han, You Mie [Dept. of Radiology, Hangang Scared Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of); Lee, Eil Seong [Dept.of Radiology, Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju (Korea, Republic of)

    2011-04-15

    A high-voltage electrical burn caused extensive deep muscle injuries beneath a relatively small skin wound at the contact point. Hidden, undetected deep muscle injuries have a tendency for progressive tissue necrosis, which can lead to major amputations or sepsis. The radiologic features of this rare, sometimes life-threatening injury have occasionally been described in the literature. However, to the best of our knowledge, there have been no reports on a case of pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity. We report a case of the pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity.

  3. Pyogenic Arthritis of the Ankle Joint Following a High-Voltage Electrical Burn in the Lower Extremity: A Case Report

    International Nuclear Information System (INIS)

    Kim, Kuk Seon; Lee, Gyung Kyu; Kang, Ik Won; Hwang, Dae Hyun; Lee, Eil Seong; Min, Seon Jung; Han, You Mie; Lee, Eil Seong

    2011-01-01

    A high-voltage electrical burn caused extensive deep muscle injuries beneath a relatively small skin wound at the contact point. Hidden, undetected deep muscle injuries have a tendency for progressive tissue necrosis, which can lead to major amputations or sepsis. The radiologic features of this rare, sometimes life-threatening injury have occasionally been described in the literature. However, to the best of our knowledge, there have been no reports on a case of pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity. We report a case of the pyogenic arthritis of the ankle joint following a high-voltage electrical burn involving the lower extremity.

  4. Reliability and validity of a low load endurance strength test for upper and lower extremities in patients with fibromyalgia.

    Science.gov (United States)

    Munguía-Izquierdo, Diego; Legaz-Arrese, Alejandro

    2012-11-01

    To evaluate the reliability, standard error of the mean (SEM), clinical significant change, and known group validity of 2 assessments of endurance strength to low loads in patients with fibromyalgia syndrome (FS). Cross-sectional reliability and comparative study. University Pablo de Olavide, Seville, Spain. Middle-aged women with FS (n=95) and healthy women (n=64) matched for age, weight, and body mass index (BMI) were recruited for the study. Not applicable. The endurance strength to low loads tests of the upper and lower extremities and anthropometric measures (BMI) were used for the evaluations. The differences between the readings (tests 1 and 2) and the SDs of the differences, intraclass correlation coefficient (ICC) model (2,1), 95% confidence interval for the ICC, coefficient of repeatability, intrapatient SD, SEM, Wilcoxon signed-rank test, and Bland-Altman plots were used to examine reliability. A Mann-Whitney U test was used to analyze the differences in test values between the patient group and the control group. We hypothesized that patients with FS would have an endurance strength to low loads performance in lower and upper extremities at least twice as low as that of the healthy controls. Satisfactory test-retest reliability and SEMs were found for the lower extremity, dominant arm, and nondominant arm tests (ICC=.973-.979; Ptest and retest were lower than the SEM for all performed tests, varying from -.10 to .29 repetitions. No significant differences were found between the test and retest (P>.05 for all). The Bland-Altman plots showed 95% limits of agreement for the lower extremity (4.7 to -4.5), dominant arm (3.8 to -4.4), and nondominant arm (3.9 to -4.1) tests. The endurance strength to low loads test scores for the patients with FS were 4-fold lower than for the controls in all performed tests (Pstrength to low loads tests showed good reliability and known group validity and can be recommended for evaluating endurance strength to low loads in

  5. Lower-extremity musculoskeletal geometry affects the calculation of patellofemoral forces in vertical jumping and weightlifting.

    Science.gov (United States)

    Cleather, D I; Bull, A M J

    2010-01-01

    The calculation of the patellofemoral joint contact force using three-dimensional (3D) modelling techniques requires a description of the musculoskeletal geometry of the lower limb. In this study, the influence of the complexity of the muscle model was studied by considering two different muscle models, the Delp and Horsman models. Both models were used to calculate the patellofemoral force during standing, vertical jumping, and Olympic-style weightlifting. The patellofemoral forces predicted by the Horsman model were markedly lower than those predicted by the Delp model in all activities and represented more realistic values when compared with previous work. This was found to be a result of a lower level of redundancy in the Delp model, which forced a higher level of muscular activation in order to allow a viable solution. The higher level of complexity in the Horsman model resulted in a greater degree of redundancy and consequently lower activation and patellofemoral forces. The results of this work demonstrate that a well-posed muscle model must have an adequate degree of complexity to create a sufficient independence, variability, and number of moment arms in order to ensure adequate redundancy of the force-sharing problem such that muscle forces are not overstated.

  6. A new concept for evaluating muscle function in the lower extremities in cases of low back pain syndrome in anamnesis

    Directory of Open Access Journals (Sweden)

    Przemysław Lisiński

    2014-06-01

    Full Text Available introduction. There are difficulties in objective evaluation of activity of the muscles in the lower extremities of patients after successful treatment of sciatica and pseudosciatica, when no clear clinical symptoms are detected. However, the existence of some muscle dysfunction can be hypothesised and its detection was the aim of the study. objective. Recordings from chosen lower extremity muscles during standing were performed as supplementary differential diagnosis in evaluation of these patients. EMG in standing positions constitutes a new methodological approach not described in detail. methods. Twenty patients (11 after sciatica and 9 after sciatica-like episodes were enrolled into the study. On the day of examination, clinical and electroneurographical (ENG; M and F waves tests studies showed no pathology. The percentage of maximal voluntary contraction (MVC defined muscle activity during standing. Mean amplitude and number of changes in muscle activity (fluctuations were measured in surface electromyography recordings (sEMG during normal standing and tandem positions. results and conclusions. Activity of proximal lower extremity muscles expressed as percentage of MVC was bilaterally increased in patients after sciatica in normal standing position, compared with results from the group of healthy volunteers (N=9. Patients after sciatica were also characterized with a significant increase of mean sEMG amplitude, recorded especially in distal muscles on the affected side during tandem position. This pathological change was related to decrease in ‘fluctuations’ frequency in patients after sciatica (P<0.001 more than after pseudosciatica (P<0.01 groups in both standing positions, compared to parameters of healthy volunteers. Sciatica and pseudosciatica in anamnesis cause different abnormal patterns of lower extremity muscle activity during standing positions when recorded with surface EMG.

  7. Evaluation of elastic bands for lower extremity resistance training in adults with and without musculo-skeletal pain

    DEFF Research Database (Denmark)

    Sundstrup, E; Jakobsen, M D; Andersen, C H

    2014-01-01

    Therapists commonly use elastic bands in resistance exercises during rehabilitation of smaller muscles, such as in the shoulder. However, the effectiveness has not yet been investigated for larger muscle groups. This study investigates muscle activity during lower extremity exercises. Electromyog......Therapists commonly use elastic bands in resistance exercises during rehabilitation of smaller muscles, such as in the shoulder. However, the effectiveness has not yet been investigated for larger muscle groups. This study investigates muscle activity during lower extremity exercises....... Electromyographic (EMG) activity of 10 muscles was measured in 24 women and 18 men during lunges with elastic resistance, lunges with dumbbells, and unilateral leg press in machine using 10 repetition maximum loadings, and normalized to maximal voluntary isometric contraction EMG. Lunges with dumbbells and leg...... press showed higher activity than lunges with elastic resistance for the vasti and rectus femoris (P resistance showed higher activity of gluteus maximus, hamstrings, and erector spinae (P 

  8. The application of DSA bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus

    International Nuclear Information System (INIS)

    Ren Chongyang; Di Zhenhai; Mao Xuequn; Zou Rong; Zhang Jian; Wang Meirong; Li Quan

    2010-01-01

    Objective: To retrospectively evaluate the digital subtraction angiography (DSA) bolus chase technology in diagnosing the vascular disorders of lower extremities due to diabetes mellitus. Methods: From January 2004 to March 2010, DSA was performed in forty-five diabetes patients with suspicious vascular diseases of lower extremities. Among them, 24 cases (31 lower limbs)were examined with DSA bolus chase technology and the remaining 21 cases (21 lower limbs)were examined with traditional segmentational technique. The contrast dosage used in angiography, the total exposure time, the examination time and the imaging value for making diagnosis were analyzed and compared between two techniques. Results: For DSA bolus chase technology group, the contrast dosage used in angiography, the total exposure time and the examination time were 25.26 ml, 13.23 s and 37.26 min, respectively,with an average exposure of 101.65 pictures. For traditional segmentational technique group, the contrast dosage used in angiography, the total exposure time and the examination time were 130.00 ml, 52.38 s and 50.48 min, respectively, with an average exposure of 118.33 pictures. The percentage of high quality images in bolus chase technology group and in traditional segmentational technique group were 90.3% and 90.5%, respectively. All the images could meet the requirements for making a reliable diagnosis. Conclusion: Digital subtraction angiography by using bolus-chase technology can well demonstrate the vascular pathology of lower extremities caused by diabetes mellitus, obtain sufficient imaging information necessary for making a reliable diagnosis. DSA bolus chase technology is superior to traditional segmentational technique in shortening procedure time, reducing contrast medium dosage and decreasing radiation dose. (authors)

  9. Permissive weight bearing in trauma patients with fracture of the lower extremities: prospective multicenter comparative cohort study.

    Science.gov (United States)

    Kalmet, Pishtiwan H S; Meys, Guido; V Horn, Yvette Y; Evers, Silvia M A A; Seelen, Henk A M; Hustinx, Paul; Janzing, Heinrich; Vd Veen, Alexander; Jaspars, Coen; Sintenie, Jan Bernard; Blokhuis, Taco J; Poeze, Martijn; Brink, Peter R G

    2018-02-02

    The standard aftercare treatment in surgically treated trauma patients with fractures around or in a joint, known as (peri)- or intra-articular fractures of the lower extremities, is either non-weight bearing or partial weight bearing. We have developed an early permissive weight bearing post-surgery rehabilitation protocol in surgically treated patients with fractures of the lower extremities. In this proposal we want to compare our early permissive weight bearing protocol to the existing current non-weight bearing guidelines in a prospective comparative cohort study. The study is a prospective multicenter comparative cohort study in which two rehabilitation aftercare treatments will be contrasted, i.e. permissive weight bearing and non-weight bearing according to the AO-guideline. The study population consists of patients with a surgically treated fracture of the pelvis/acetabulum or a surgically treated (peri)- or intra-articular fracture of the lower extremities. The inclusion period is 12 months. The duration of follow up is 6 months, with measurements taken at baseline, 2,6,12 and 26 weeks post-surgery. ADL with Lower Extremity Functional Scale. Outcome variables for compliance, as measured with an insole pressure measurement system, encompass peak load and step duration. This study will investigate the (cost-) effectiveness of a permissive weight bearing aftercare protocol. The results will provide evidence whether a permissive weight bearing protocol is more effective than the current non-weight bearing protocol. The study is registered in the Dutch Trial Register ( NTR6077 ). Date of registration: 01-09-2016.

  10. Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries.

    Science.gov (United States)

    Sluys, Kerstin Prignitz; Shults, Justine; Richmond, Therese S

    2016-04-01

    To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give

  11. Manipulating the fidelity of lower extremity visual feedback to identify obstacle negotiation strategies in immersive virtual reality.

    Science.gov (United States)

    Kim, Aram; Zhou, Zixuan; Kretch, Kari S; Finley, James M

    2017-07-01

    The ability to successfully navigate obstacles in our environment requires integration of visual information about the environment with estimates of our body's state. Previous studies have used partial occlusion of the visual field to explore how information about the body and impending obstacles are integrated to mediate a successful clearance strategy. However, because these manipulations often remove information about both the body and obstacle, it remains to be seen how information about the lower extremities alone is utilized during obstacle crossing. Here, we used an immersive virtual reality (VR) interface to explore how visual feedback of the lower extremities influences obstacle crossing performance. Participants wore a head-mounted display while walking on treadmill and were instructed to step over obstacles in a virtual corridor in four different feedback trials. The trials involved: (1) No visual feedback of the lower extremities, (2) an endpoint-only model, (3) a link-segment model, and (4) a volumetric multi-segment model. We found that the volumetric model improved success rate, placed their trailing foot before crossing and leading foot after crossing more consistently, and placed their leading foot closer to the obstacle after crossing compared to no model. This knowledge is critical for the design of obstacle negotiation tasks in immersive virtual environments as it may provide information about the fidelity necessary to reproduce ecologically valid practice environments.

  12. Cross-cultural adaptation and validation of the Japanese version of the Toronto Extremity Salvage Score (TESS) for patients with malignant musculoskeletal tumors in the lower extremities.

    Science.gov (United States)

    Ogura, Koichi; Uehara, Kosuke; Akiyama, Toru; Iwata, Shintaro; Shinoda, Yusuke; Kobayashi, Eisuke; Saita, Kazuo; Yonemoto, Tsukasa; Kawano, Hirotaka; Chuman, Hirokazu; Davis, Aileen M; Kawai, Akira

    2015-11-01

    Before this work a Japanese version of the Toronto Extremity Salvage Score (TESS), a disease-specific patient-completed questionnaire widely used to assess the physical function of patients with musculoskeletal tumors, had not been developed. The purpose of this study was cross-cultural adaptation and validation of the English-language version of the TESS to facilitate international comparisons of treatment results. The TESS was translated into Japanese, back-translated into English, and reviewed by a committee to develop a consensus Japanese version of the TESS. One hundred and two patients were assessed by use of this Japanese version to examine its reliability and validity. Test-retest reliability and internal consistency determined by using the intraclass correlation coefficient (0.941) and Cronbach's alpha test (0.978), respectively, were excellent. Factor analysis showed that the structure consisted of a three-item cluster; the Akaike information criterion (AIC) network also demonstrated that the items could be divided into three domains in accordance with their content. The Japanese version of the TESS correlated with the Musculoskeletal Tumor Society rating scale (r = 0.811; P TESS is a reliable and valid instrument for measuring patient-reported functional outcome for patients with lower extremity sarcoma, and that it enables international comparisons of treatment results. The spatial association of each item demonstrated by using the AIC network also suggested that the underlying structure of the TESS reflected its coverage of a wide range of physical functions.

  13. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    Energy Technology Data Exchange (ETDEWEB)

    Ganguli, Suvranu, E-mail: sganguli@partners.org; Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil [Massachusetts General Hospital and Harvard Medical School, Division of Vascular Imaging and Intervention, Department of Imaging (United States); Grabowski, Eric F. [Massachusetts General Hospital and Harvard Medical School, Division of Hematology and Oncology, Department of Pediatrics (United States); Wicky, Stephan [Massachusetts General Hospital and Harvard Medical School, Division of Vascular Imaging and Intervention, Department of Imaging (United States)

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  14. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    International Nuclear Information System (INIS)

    Ganguli, Suvranu; Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil; Grabowski, Eric F.; Wicky, Stephan

    2012-01-01

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12–72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 ± 20.2 months (range 3.8–54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  15. Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps.

    Science.gov (United States)

    Jennissen, Charles A; Koos, Maggie; Denning, Gerene

    2018-04-10

    The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries. Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed. Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3-5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person's lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0-58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7-77.4). Decreasing age was associated with a higher likelihood of being identified as sliding down on another person's lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler's fracture of

  16. Quantification of axial alignment of the lower extremity on conventional and digital total leg radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, J.; Scharitzer, M.; Peloschek, P.; Imhof, H.; Grampp, S. [Medizinische Fakultaet der Universitaet Wien, Univ. Klinik fuer Radiodiagnostik, Abteilung Osteoradiologie, Vienna (Austria); Giurea, A. [Medizinische Fakultaet der Universitaet Wien, Univ. Klinik fuer Orthopaedie, Vienna (Austria)

    2005-01-01

    The purpose was to assess axial alignment of the lower limb using mechanical axis measurements on conventional and digital radiographs. Total-leg radiographs of 24 patients, 8 male and 16 female, with a mean age of 68.6{+-}10.2 years, were performed in a standardized anterior-posterior projection and standing position using a conventional and digital phosphor storage film screen radiography system. Knee joint angulation was assessed by measuring the angle between a line drawn from the center of the femoral head to the middle of the femoral condyles and a line drawn from the middle of the tibial condyles to the midpoint of the malleolus. On conventional leg radiographs, line drawing and angle measurement were performed manually with a transparent goniometer. Angle measurement on digital leg radiographs was performed on a PACS workstation using computer-assisted measurement software (IMPAX, AGFA-GEVAERT, Belgium). Evaluation time for both measurements was recorded. We diagnosed 14 varus and 10 valgus angulations of the knee joint. The mean individual difference between axis deviation of conventional digital leg radiographs was 0.93+0.6 (min 0 , max 2 ), the mean difference in varus angulation was 1.13{+-}0.45 (min 0.3 , max 2 ), and the mean difference in valgus angulation was 0.65{+-}0.71 (min 0 , max 2 ). Angle measurements on conventional and digital radiographs did not show any statistically significant difference. Mean time exposure was 4.9 min/patient for manual and 1.08 min/patient for computer-assisted angle measurement (P<0.001). Computer-assisted angle measurement on digital total-leg radiographs represents a reliable method with no significant angle differences compared to conventional radiographic systems and offers a significantly lower evaluation time. (orig.)

  17. Physiotherapy in the physical rehabilitation of patients with sequelae of injuries of the lower extremities in Zhitomir of rehabilitation facilities

    Directory of Open Access Journals (Sweden)

    Zhelezniy O.D.

    2015-02-01

    Full Text Available Purpose : to study the physical properties and therapeutic effect of mechanical factors in the pathogenetic treatment in traumatology. Material : 622 patients were studied with the consequences of injuries of the lower extremities (age 18-64 years. Observations carried out since 2005 in hospitals and medical health institutions of Zhitomir. Selected physiotherapy factors that are mainly used for the physical rehabilitation of patients in trauma. Results : identified the factors that were intended to eliminate the consequences of injuries of the lower extremities. Analyzed their effect in the author's method of complex rehabilitation of patients. Performed systematization selected physiotherapy factors in a table to read and understand forms. In the medical health institutions in the city of Zhytomyr investigated and established the effectiveness of the recommendations. Conclusions : physical factors cause the body general, non-specific and specific response to each type of impact. This allows you to selectively influence the pathogenic elements of the disease. Should strictly adhere to the indications and contraindications to the use of physiotherapy factor. It is necessary to take into account age, sex, and comorbidity.

  18. Composition and Making of Lower Extremity Movement by Using Action Unit

    Science.gov (United States)

    Nishida, Satoshi; Kamata, Mitsunobu; Sugiura, Akihiko

    Recently, various medias (film, TV, computer, and so on) are changing from analog to digital, and capturing human motion in computer graphics has attracted public attention. Therefore, we suggest a new human model for computer graphics. We use a muscle-based model “action unit”, and produce a software package. Present system can produce movements and compositions of the lower part of the body. We suggest a new composition method using muscles of human body movement, and suggest a new storage method of movement information for the field of human body animation of VRML. Furthermore, we confirmed effectiveness of present method by experiments on the basis of usability engineering.

  19. Association Between Concussion and Lower Extremity Injuries in Collegiate Athletes.

    Science.gov (United States)

    Gilbert, Frances C; Burdette, G Trey; Joyner, A Barry; Llewellyn, Tracy A; Buckley, Thomas A

    Concussions have been associated with elevated musculoskeletal injury risk; however, the influence of unreported and unrecognized concussions has not been investigated. The purpose of this study was to examine the association between concussion and lower extremity musculoskeletal injury rates across a diverse array of sports among collegiate student-athletes at the conclusion of their athletic career. The hypothesis was that there will be a positive association between athletes who reported a history of concussions and higher rates of lower extremity injuries. Cross-sectional study. Level 3. Student-athletes (N = 335; 62.1% women; mean age, 21.2 ± 1.4 years) from 13 sports completed a reliable injury history questionnaire. Respondents indicated the total number of reported, unreported, and potentially unrecognized concussions as well as lower extremity injuries including ankle sprains, knee injuries, and muscle strains. Chi-square analyses were performed to identify the association between concussion and lower extremity injuries. There were significant associations between concussion and lateral ankle sprain ( P = 0.012), knee injury ( P = 0.002), and lower extremity muscle strain ( P = 0.031). There were also significant associations between reported concussions and knee injury ( P = 0.003), unreported concussions and knee injury ( P = 0.002), and unrecognized concussions and lateral ankle sprain ( P = 0.001) and lower extremity muscle strains ( P = 0.006), with odds ratios ranging from 1.6 to 2.9. There was a positive association between concussion history and lower extremity injuries (odds ratios, 1.6-2.9 elevated risk) among student-athletes at the conclusion of their intercollegiate athletic careers. Clinicians should be aware of these elevated risks when making return-to-participation decisions and should incorporate injury prevention protocols.

  20. Prevention and nursing care of the complications occurred in interventional therapy for arteriosclerosis obliterans of lower extremity

    International Nuclear Information System (INIS)

    Xu Yang; Qi Yuchun; Wang Hua; Han Yajun; Fu Wenli; Fan Rui; Lv Xiaoying

    2009-01-01

    Objective: To discuss the prevention and nursing care of the perioperative complications occurred in interventional therapy for arteriosclerosis obliterans of lower extremity. Methods: During the period of July 2006 to June 2009, interventional treatment for the arteriosclerosis obliterans of lower extremity was performed in 380 cases. The clinical data and complications were reviewed and analyzed, and the prevention and nursing care of the complications were summarized. Results: Complications occurred in 41 cases. During the surgery, vascular rupture or arterial dissection occurred in 5 cases, hypoglycemia reaction in 3 cases and elevation of blood pressure in 2 cases. The complications,which occurred after the treatment,included acute arterial thrombosis (n=3), deep vein thrombosis (n=2), bleeding of different tissues or organs (n=17), acute myocardial infarction (n=2), pseudoaneurysm (n=2), excessive lower limb perfusion syndrome (n=4) and compression sores (n=1). Conclusion: Detailed information of medical history, careful observation of clinical condition, intensive care of patient, adequate preparation of medical materials, seriously handing over the duty to the next shift and taking one's turn on duty, etc. are all the effective measures to prevent and to reduce the occurrence of complications. (authors)

  1. Deletions of 5' HOXC genes are associated with lower extremity malformations, including clubfoot and vertical talus.

    Science.gov (United States)

    Alvarado, David M; McCall, Kevin; Hecht, Jacqueline T; Dobbs, Matthew B; Gurnett, Christina A

    2016-04-01

    Deletions of the HOXC gene cluster result in variable phenotypes in mice, but have been rarely described in humans. To report chromosome 12q13.13 microdeletions ranging from 13 to 175 kb and involving the 5' HOXC genes in four families, segregating congenital lower limb malformations, including clubfoot, vertical talus and hip dysplasia. Probands (N=253) with clubfoot or vertical talus were screened for point mutations and copy number variants using multiplexed direct genomic selection, a pooled BAC targeted capture approach. SNP genotyping included 1178 probands with clubfoot or vertical talus and 1775 controls. The microdeletions share a minimal non-coding region overlap upstream of HOXC13, with variable phenotypes depending upon HOXC13, HOXC12 or the HOTAIR lncRNA inclusion. SNP analysis revealed HOXC11 p.Ser191Phe segregating with clubfoot in a small family and enrichment of HOXC12 p.Asn176Lys in patients with clubfoot or vertical talus (rs189468720, p=0.0057, OR=3.8). Defects in limb morphogenesis include shortened and overlapping toes, as well as peroneus muscle hypoplasia. Finally, HOXC and HOXD gene expression is reduced in fibroblasts from a patient with a 5' HOXC deletion, consistent with previous studies demonstrating that dosage of lncRNAs alters expression of HOXD genes in trans. Because HOXD10 has been implicated in the aetiology of congenital vertical talus, variation in its expression may contribute to the lower limb phenotypes occurring with 5' HOXC microdeletions. Identification of 5' HOXC microdeletions highlights the importance of transcriptional regulators in the aetiology of severe lower limb malformations and will improve their diagnosis and management. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  2. Easily Missed Fractures in the Lower Extremity.

    Science.gov (United States)

    Yu, Joseph S

    2015-07-01

    As long as radiography remains cheap and provides value in patient care, it will continue to be widely used as a front-line imaging technique. There are limitations to what a radiograph can depict, however. It is imperative to understand the limitations of radiography to avoid pitfalls owing to the overlap of numerous osseous structures. This article reminds the reader of the association between certain radiographic abnormalities and the anatomic relevance in the patient. Although interpretive errors occur in fast-paced, high-volume emergency settings, meticulous attention to changes in the cortex and medullary bone may help to keep errors to a minimum. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Older women with dementia can perform fast alternating forearm movements and performance is correlated with tests of lower extremity function

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    Bramell-Risberg E

    2013-02-01

    Full Text Available Eva Bramell-Risberg,1 Gun-Britt Jarnlo,2 Sölve Elmståhl11Division of Geriatric Medicine, 2Division of Physiotherapy, Department of Health Sciences, Lund University, Lund, SwedenBackground: The purpose of this work was to study the performance and reliability of a test of fast alternating forearm movements and its relationship with measures of lower extremity function in older women with dementia.Methods: Fast alternating movements was studied in 26 female patients (mean age 81.7 ± 5.9 years with dementia and 34 controls (mean age 87.5 ± 4.7 years. Subgroup analyses for those aged 80–89 years were performed due to significant differences in the mean ages of the study groups. Test–retest reliability for alternating forearm movements was studied in 11 patients (mean age 80.3 ± 6.7 years and 10 controls (mean age 87.4 ± 1.6 years. Pulses generated were transformed to an analog signal shown on a modified electrocardiogram. Numbers of cycles at 10 and 15 seconds were calculated for the right and left hand. Walking 2 × 15 m and the Get-Up-and Go (GUG test were performed at self-selected and maximal speed. Associations between tests of upper and lower extremity function were sought in eight patients (mean age 85 ± 2.7 years and 16 controls (mean age 85.1 ± 2.8 years and also according to types of dementia in nine patients with probable Alzheimer's disease and 10 patients with other types of dementia.Results: Patients with dementia could perform the test and had significantly fewer cycles (P = 0.02–0.006 at both 10 and 15 seconds compared with controls after age adjustment. A higher number of cycles was associated with higher self-selected walking speeds in patients (r = -0.79. Test–retest reliability for alternating forearm movements was high for both patients (intraclass correlation 0.88–0.94 and controls (intraclass correlation 0.74–0.94.Conclusion: Alternating forearm movements at fast speed can be used as a reliable test in both

  4. Fixed-site high-frequency transcutaneous electrical nerve stimulation for treatment of chronic low back and lower extremity pain

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    Gozani SN

    2016-06-01

    Full Text Available Shai N Gozani NeuroMetrix, Inc., Waltham, MA, USA Objective: The objective of this study was to determine if fixed-site high-frequency transcutaneous electrical nerve stimulation (FS-TENS is effective in treating chronic low back and lower extremity pain. Background: Transcutaneous electrical nerve stimulation is widely used for treatment of chronic pain. General-purpose transcutaneous electrical nerve stimulation devices are designed for stimulation anywhere on the body and often cannot be used while the user is active or sleeping. FS-TENS devices are designed for placement at a pre-determined location, which enables development of a wearable device for use over extended time periods. Methods: Study participants with chronic low back and/or lower extremity pain self-administered an FS-TENS device for 60 days. Baseline, 30-, and 60-day follow-up data were obtained through an online questionnaire. The primary outcome measure was the patient global impression of change. Pain intensity and interference were assessed using the Brief Pain Inventory. Changes in use of concomitant pain medications were evaluated with a single-item global self-rating. Results: One hundred and thirty participants were enrolled, with 88 completing the 60-day follow-up questionnaire. Most participants (73.9% were 50 years of age or older. At baseline, low back pain was identified by 85.3%, lower extremity pain by 71.6%, and upper extremity pain by 62.5%. Participants reported widespread pain, at baseline, with a mean of 3.4 (standard deviation 1.1 pain sites. At the 60-day follow-up, 80.7% of participants reported that their chronic pain had improved and they were classified as responders. Baseline characteristics did not differentiate non-responders from responders. There were numerical trends toward reduced pain interference with walking ability and sleep, and greater pain relief in responders. There was a large difference in use of concomitant pain medications, with 80

  5. Effect of programmed strength training on explosive strength of lower extremities in children aged 11 to 14 years

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    Atanasković Andrija

    2014-01-01

    Full Text Available Vertical jumps are an integral part of many sport activities. There are several factors that affect the athlete's jumping ability: strength, force and acceleration that occur when we jump. The jump is a complex and more articulated activity that requires not only strength, but great power as well. The main types of training to increase explosive strength are plyometric training and myogenic training with weight load on the lower extremities. The aim of this study was to determine the effect of myogenic training with weight load on explosive strength of the lower extremities. The first group is the control group (K, while the second group is an experimental group (E, each consisting of eighteen respondents. By Using the Myotest and performing the squat jump (SJ, the Height, Power, Force and Velocity were determined. The programme of power lasted for six weeks, twice a week for up to 60 minutes. We conclude that there is a statistically significant difference between the final and initial measurements in the experimental group, the multivariate level sig = 0.000. Increase in jump height ΔHeight = 3.28 in cm, force ΔForce = 4.68 in N/kg, the strength ΔPower = 6.18 in W/kg, the acceleration ΔVelocity = 21.8 in cm/s. The results of this study show that myogenic training with weight load has a positive impact on the explosive power of the lower extremities. This research was carried out against children aged 11 to 14 years, so we cannot say with certainty that this type of programme can have identical effects on athletes.

  6. Anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries

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    Seyed Hamid Reza Faiz

    2012-01-01

    Full Text Available Background: Regional anesthesia is widely used to perform different surgical procedures including those performed on the extremities. In this study, the anesthetic effects of adding intrathecal neostigmine or magnesium sulphate to bupivacaine in patients under lower extremities surgeries were assessed. Materials and Methods: In this double-blind randomized clinical trial, 90 patients, candidate for lower extremities surgeries in a training hospital, were recruited. The patients with ASA class I and II aging from 20 to 65 years between 2009 and 2010 were evaluated. The selected patients were randomly assigned to receive either bupivacaine alone (Group A, n=30, or bupivacaine plus magnesium sulphate 50% (Group B, n=30, or bupivacaine plus neostigmine (Group C, n=30. Then sensory and motor onset and complete block and the time of recovery were measured. Results: The sensory block onset time were 3.03 ± 0.981 in group A, 3.90 ± 2.71 in group B and 3.7 ± 1.08 in group C and knee flexion time were not significantly different among the three groups (P > 0.05, whereas the time to complete motor block was significantly longer in group C and motor recovery time were significantly different between groups (P=0.001. Conclusions: According to the obtained results, it may be concluded that magnesium sulphate is a safe and effective adjuvant for increasing the onset time of motor block.

  7. X-ray morphology of the joints and the bones of the extremities of aged people

    International Nuclear Information System (INIS)

    Olah, J.

    1978-01-01

    The radiograms of the healthy extremities of aged people are analyzed and the normal formations, typical at higher age, are differentiated from the pathological phenomena. The ''physiological'' decalcification can cause the following symptoms: trabecular microfractures, areas without structure, pseudoforamena, discrete spicules at the edges of the joints, periostoses, fibrous structure of the compacta. The deformations occurring in the different joints are detailed. The relationship between high age and arthrosis is also investigated. It is concluded that the occurrence of arthrosis is not inevitable and it is not seriously influenced neither by the weight nor by the profession of the patient. The thesis contains 49 radiograms. (L.E.)

  8. Measurement properties of visual rating of postural orientation errors of the lower extremity - A systematic review and meta-analysis.

    Science.gov (United States)

    Nae, Jenny; Creaby, Mark W; Cronström, Anna; Ageberg, Eva

    2017-09-01

    To systematically review measurement properties of visual assessment and rating of Postural Orientation Errors (POEs) in participants with or without lower extremity musculoskeletal disorders. A systematic review according to the PRISMA guidelines was conducted. The search was performed in Medline (Pubmed), CINAHL and EMBASE (OVID) databases until August 2016. Studies reporting measurement properties for visual rating of postural orientation during the performance of weight-bearing functional tasks were included. No limits were placed on participant age, sex or whether they had a musculoskeletal disorder affecting the lower extremity. Twenty-eight articles were included, 5 of which included populations with a musculoskeletal disorder. Visual rating of the knee-medial-to-foot position (KMFP) was reliable within and between raters, and meta-analyses showed that this POE was valid against 2D and 3D kinematics in asymptomatic populations. Other segment-specific POEs showed either poor to moderate reliability or there were too few studies to permit synthesis. Intra-rater reliability was at least moderate for POEs within a task whereas inter-rater reliability was at most moderate. Visual rating of KMFP appears to be valid and reliable in asymptomatic adult populations. Measurement properties remain to be determined for POEs other than KMPF. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. An Extremely Rare Case of Lower Urinary Tract Symptoms: Floating Benign Mesenchymal Mass in Abdomen

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    Bulent Kati

    2017-01-01

    Full Text Available A 48-year-old man admitted to the urology outpatient clinic with major symptoms of right-side pain and intermittent lower urinary tract symptoms (LUTSs such as low urine flow rate, dysuria, and frequency. Uroflowmetry showed low urine flow, and laboratory tests revealed no pathology. Ultrasound (US showed a 7 cm calcific mass above the bladder and a kidney cyst with a diameter of 5.3 cm in the upper pole of the right kidney. Enhanced computed tomography confirmed the US findings. Laparoscopic transperitoneal renal cyst decortication was performed. There was no sign of additional tumors. An independent mass in the abdomen was diagnosed, and the mass was removed. Based on the pathology, the diagnosis was a benign mesenchymal calcific mass. This is the first report of LUTSs due to a free benign mesenchymal mass in the published literature.

  10. Effectiveness of digital infrared thermal imaging in detecting lower extremity deep venous thrombosis.

    Science.gov (United States)

    Deng, Fangge; Tang, Qing; Zeng, Guangqiao; Wu, Hua; Zhang, Nuofu; Zhong, Nanshan

    2015-05-01

    The authors aimed to determine the effectiveness of infrared thermal imaging (IRTI) as a novel, noninvasive technique in adjunctive diagnostic screening for lower limb deep venous thrombosis (DVT). The authors used an infrared thermal imaging sensor to examine the lower limbs of 64 DVT patients and 64 healthy volunteers. The DVT patients had been definitively diagnosed with either Doppler vascular compression ultrasonography or angiography. The mean area temperature (T_area) and mean linear temperature (T_line) in the region of interest were determined with infrared thermal imaging. Images were evaluated with qualitative pseudocolor analysis to verify specific color-temperature responses and with quantitative temperature analysis. Differences in T_area and T_line between the DVT limb and the nonaffected limb in each DVT patient and temperature differences (TDs) in T_area (TDarea) and T_line (TDline) between DVT patients and non-DVT volunteers were compared. Qualitative pseudocolor analysis revealed visible asymmetry between the DVT side and non-DVT side in the presentation and distribution characteristics (PDCs) of infrared thermal images. The DVT limbs had areas of abnormally high temperature, indicating the presence of DVT. Of the 64 confirmed DVT patients, 62 (96.88%) were positive by IRTI detection. Among these 62 IRTI-positive cases, 53 (82.81%) showed PDCs that agreed with the DVT regions detected by Doppler vascular compression ultrasonography or angiography. In nine patients (14.06%), IRTI PDCs did not definitively agree with the DVT regions established with other testing methods, but still correctly indicated the DVT-affected limb. There was a highly significant difference between DVT and non-DVT sides in DVT patients (P Infrared thermal imaging can be effectively used in DVT detection and adjunctive diagnostic screening because of its specific infrared PDCs and TDs values.

  11. A clinical study on chronic arterial occlusive diseases of the lower extremities by scintiangiography of the foot

    International Nuclear Information System (INIS)

    Oya, Yoshitaro

    1981-01-01

    Scintiangiography of the foot was performed on 210 limbs with peripheral vascular diseases of the lower extremities in comparison with 12 normal limbs. After an intravenous bolus of 10 to 20 mCi of sup(99m)Tc-human serum albumin, the arrival and distribution of activity in foot during reactive hyperemia were observed and photographed on the monitor scope of the gamma camera and recorded on video tape. The activity curve was obtained for several regions of interest and analysed to obtain the arrival time of activity Ta, the maximum counts time Tmax and the perfusion index. Those results were compared with angiography and the pressure index. The gamma camera image provided approximately the state of the peripheral circulation, and the defect or delay of the image was obtained on 93 per cent of the ischemic extremities. The pattern of the activity curves were classified into three types, I: rapid appearance with high activity peak, II: relatively rapid appearance with low activity peak, III: delayed appearance with the absence of the activity peak. In normal subjects and good run-off patients, the typical pattern of the activity curve was mainly observed being to I type, on the other hand, the pattern was generally being to III type in patients with ulcerated or cyanotic foot. The difference between the arrival time of activity of foot and toe under conditions of reactive hyperemia was longer evidently according to degree of arterial occlusion. The perfusion index was well correlated to the pressure index on foot and toe. In conclusion, scintiangiography of the foot is a simple and harmless procedure to evaluate the hemodynamic state of the lower extremities and is applicable for screening the peripheral vascular diseases and postoperative study. (author)

  12. Instrumentation for surveying the lower part of the atmosphere in extremes conditions

    Science.gov (United States)

    Gobinddass, Marie-Line; Molinie, Jack; Richard, Sandrine; Jean-Louis, Sabrina

    To observe atmospheric phenomena such as clouds, precipitation and wind in order to understand how they form and evolve meteorologists use few instruments which allows to measure parameters as temperature, pressure and humidity. In the specific case of Kourou region where the French Space Agency is located the environment and safeguard group works on protecting biodiversity in and around the center. By considering a few scientific challenges in atmospheric science one of the main topics of this work consists on the understanding of the fluctuation of the atmosphere due to natural or industrials perturbations. We have considered a few experiences with many instruments in a large space of more than 1200 km per square. To differentiate and try to quantify industrial cloud from natural cloud or from natural atmosphere, the idea of using a drone has been experimented. The ratio of the cost of such experimentation with the relevance of the results which can be obtained will be discussed here. It is necessary to take into account the turbulence in the atmosphere due to industrial acid cloud or hot cloud. Finally, instead of taking the risk of having airbone measurements with a pilot we have thought of the tetherball due to it lower cost and for security reason. The technical experiment and few type of results will be presented here.

  13. Effect of cause of iliac vein stenosis and extent of thrombus in the lower extremity on patency of iliac venous stent placed after catheter-directed thrombolysis of acute deep venous thrombosis in the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Sung Il; Choi, Young Ho; Yoon, Chang Jin; Lee, Min Woo; Chung, Jin Wook; Park, Jae Hyung [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2003-10-01

    To assess the CT findings of acute deep venous thrombosis (DVT) in a lower extremity prior to catheter-directed thrombolysis, and to evaluate their relevance to the patency of an iliac venous stent placed with the help of CT after catheter-directed thrombolysis of DVT. Fourteen patients [M:F=3:11; age, 33-68 (mean, 50.1) years] with acute symptomatic DVD of a lower extremity underwent CT before and after catheter-directed thrombolysis using an iliac venous stent. The mean duration of clinical symptoms was 5.0 (range, 1-14 days. The CT findings prior to thrombolysis were evaluated in terms of their anatomic cause and the extent of the thrombus, and in all patients, the patency of the iliac venous stent was assessed at CT performed during a follow-up period lasting 6-31 (mean, 18.9) months. All patients were assigned to the patent stent group (n=9) or the occluded stent group (n=5). In the former, the anatomic cause of patency included typical iliac vein compression (May-Thurner syndrome) (n=9), and a relatively short segmental thrombus occurring between the common iliac and the popliteal vein (n=8). Thrombi occurred in the iliac vein (n=3), between the common iliac and the femoral vein (n=3), and between the common iliac and the popliteal vein (n=2). In one case, a relatively long segmental thrombus occurred between the common iliac vein and the calf vein. In the occluded stent group, anatomic causes included atypical iliac vein compression (n=3) and a relatively long segmental thrombus between the common iliac and the calf vein (n=4). Typical iliac vein compression (May-Thurner syndrome) occurred in two cases, and a relatively short segmental thrombus between the external iliac and the common femoral vein in one. Factors which can affect the patency of an iliac venous stent positioned after catheter-directed thrombolysis are the anatomic cause of the stenosis, and the extent of a thrombus revealed at CT of acute DVT and occurring in a lower extremity prior to

  14. The usefulness of three-dimensional gadolinium-enhanced MR venography for the evaluation of varices in lower-extremities

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Myong Kwan; Lee, Hee; Kang, Sung Gwon; Choi, Jeong Yeol; Byun, Ju Nam; Jang, Jeong Hwan; Lim, Chae Ha [Chosun Univ. College of Medicine, Kwangju (Korea, Republic of); Kim, Young Cheol [Yeong Gwang Christian Hospital, Yeong Gwang (Korea, Republic of)

    2001-11-01

    To assess the performance of contrast-enhanced three-dimensional(3-D) magnetic resonance venography (MRV) of the pelvis and lower extremities in patients with varicose veins. Ascending and MR venography were performed in seven legs of seven patients, and duplex Doppler sonography and MR venography in 15 legs of 12 patients, all referred for evaluation of varicose veins. For analysis, the venous system as revealed by ascending and MR venographic images was divided into 13 segments. For detection of reflux to the great saphenous vein, duplex Doppler sonography and MRV were performed. In ascending venography and MRV, 91 venous segments were potentially visible; both modalities depicted 78 of these, but failed to detect four. Ascending venography and MRV detected 17 and 19 varices, respectively. When two tourniquets were placed around the ankle and knee using the Valsalva maneuver, MRV and duplex Doppler sonography detected reflux in 8 or 11 and 13 or 15 legs, respectively. Contrast-enhanced 3-D MRV comprehensively displays the venous system of the lower extremities and permits assessment of varicose veins. MRV using the Valsalva maneuver allows assessment of reflux to the great saphenous vein.

  15. [Fractures of the lower extremity in the emergency room. Analysis of a new immobilization and x-ray splint].

    Science.gov (United States)

    Kraus, T M; Kirchhoff, C; Martetschläger, F; Braun, K F; Siebenlist, S; Ganslmeier, A; Stöckle, U; Freude, T

    2013-03-01

    Fractures of the lower extremity are a common reason for presentation to an emergency room. The aim of this study was to evaluate a new immobilization and x-ray splint (Andante®, ForMed) in the emergency room. From April 2010 to August 2010 all patients presenting with a fracture of the lower extremity were included in the study. Pain perception (visual analog scale; VAS) was measured before and after splint application. The handling of the splint during radiography was assessed and the quality of the diagnostic x-ray was evaluated. The study comprised 61 patients. Subjective pain perception was reduced significantly (3.96±1.9 vs. 6.38±2.2; p<0.001). The handling of the splint was graded at 1.73±0.96 (1, very good; 5, poor). There was no difference in the diagnostic quality of the x-rays between the Andante® and the control group; however, significantly poorer results were found for x-rays of ankle fractures (p<0.038). The Andante® splint is a useful tool in the emergency room that combines simple handling and pain relief due to immobilization. However, the quality of the diagnostic x-rays was not better compared with the control group.

  16. THE INFLUENCE OF A FOOT ORTHOTIC ON LOWER EXTREMITY TRANSVERSE PLANE KINEMATICS IN COLLEGIATE FEMALE ATHLETES WITH PES PLANUS

    Directory of Open Access Journals (Sweden)

    Christopher R. Carcia

    2006-12-01

    Full Text Available Non-contact anterior cruciate ligament (ACL injuries in female athletes remain prevalent. Athletes with excessive foot pronation have been identified to be at greater risk for non-contact ACL injury. Excessive foot pronation has been linked to increased medial tibial rotation. Increased medial tibial rotation heightens ACL strain and has been observed at or near the time of ACL injury. Foot orthotics have been shown to decrease medial tibial rotation during walking and running tasks. The effect of a foot orthotic on activities that simulate a non-contact ACL injury mechanism (i.e. landing however is unknown. Therefore, the objective of this study was to determine whether a foot orthotic was capable of altering transverse plane lower extremity kinematics in female athletes during landing. Twenty uninjured collegiate female athletes participating in the sports of basketball, soccer or volleyball with pes planus volunteered. Utilizing a repeated measures counterbalanced design, subjects completed two landing tasks with and without a foot orthotic using standardized footwear. The prefabricated orthotic had a rigid shell and a 6 extrinsic rear-foot varus post. Dependent measures included initial contact angle, peak angle, excursion and time to peak angle for both the tibia and femur. Statistical analysis suggested that the selected foot orthosis had little influence over lower extremity transverse plane kinematics. Several factors including: the limitation of a static measure to predict dynamic movement, inter-subject variability and the physical characteristics of the orthotic device likely account for the results. Future research should examine the influence of different types of foot orthotics not only on lower extremity kinematics but also tibiofemoral kinetics

  17. Intrathecal Bupivacaine Monotherapy with a Retrograde Catheter for the Management of Complex Regional Pain Syndrome of the Lower Extremity.

    Science.gov (United States)

    McRoberts, W Porter; Apostol, Catalina; Haleem, Abdul

    2016-01-01

    Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity. The patient, a 57-year-old woman with a history of failed foot surgery, was seen in our office after 2 years of ineffective treatments with local blocks and neurolytic procedures. We advanced therapy to moderately invasive procedures with an emphasis on neuromodulation. A combined central and peripheral stimulation technique that initially provided 75% pain relief, failed to provide lasting analgesia. We proceeded with an intrathecal pump implant. Based on the results of dorsal root ganglion (DRG) mapping, L5-S1 was identified as the optimal target for therapy and a retrograde catheter was placed at this level. Various intrathecal medications were tested individually. An intrathecal morphine trial was ineffective (visual analog scale [VAS] 7), while intrathecal clonidine provided excellent pain relief (VAS 0) that was limited by severe side effects. Bupivacaine provided 100% analgesia with tolerable side effects (lower extremity weakness and minor bladder incontinence) and was selected for intrathecal infusion. After 14 months, bupivacaine treatment continued to control pain exacerbations. We conclude that CRPS patients benefit from early identification of the predominant underlying symptoms and a targeted treatment with moderately invasive techniques when less invasive techniques fail. Intrathecal bupivacaine, bupivacaine monotherapy, retrograde catheter, complex regional pain syndrome (CRPS), dual stimulation, dosal root ganglion (DRG) testing.

  18. Human limb-specific and non-limb-specific brain representations during kinesthetic illusory movements of the upper and lower extremities.

    Science.gov (United States)

    Naito, Eiichi; Nakashima, Tokuro; Kito, Tomonori; Aramaki, Yu; Okada, Tomohisa; Sadato, Norihiro

    2007-06-01

    Sensing movements of the upper and lower extremities is important in controlling whole-body movements. We have shown that kinesthetic illusory hand movements activate motor areas and right-sided fronto-parietal cortices. We investigated whether illusions for the upper and lower extremities, i.e. right or left hand or foot, activate the somatotopical sections of motor areas, and if an illusion for each limb engages the right-sided cortices. We scanned the brain activity of 19 blindfolded right-handed participants using functional magnetic resonance imaging (fMRI) while they experienced an illusion for each limb elicited by vibrating its tendon at 110 Hz (ILLUSION). As a control, we applied identical stimuli to the skin over a nearby bone, which does not elicit illusions (VIBRATION). The illusory movement (ILLUSION vs. VIBRATION) of each immobile limb activated limb-specific sections of the contralateral motor cortex (along with somatosensory area 3a), dorsal premotor cortex (PMD), supplementary motor area (SMA), cingulate motor area (CMA), and the ipsilateral cerebellum, which normally participate in execution of movements of the corresponding limb. We found complex non-limb-specific representations in rostral parts of the bilateral SMA and CMA, and illusions for all limbs consistently engaged concentrated regions in right-sided fronto-parietal cortices and basal ganglia. This study demonstrated complete sets of brain representations related to kinesthetic processing of single-joint movements of the four human extremities. The kinesthetic function of motor areas suggests their importance in somatic perception of limb movement, and the non-limb-specific representations indicate high-order kinesthetic processing related to human somatic perception of one's own body.

  19. Mortality following operations for lower extremity peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Tracie C Collins

    2010-05-01

    Full Text Available Tracie C Collins1,2, David Nelson3, Jasjit S Ahluwalia1,21Department of Medicine, Division of General Internal Medicine, University of Minnesota Minneapolis, MN, USA; 2Center for Health Equity, University of Minnesota Medical School, Minneapolis, MN, USA; 3Minneapolis VA Medical Center, Center for Chronic Disease Outcomes Research, University of Minnesota, Minneapolis, MN, USABackground: We sought to identify risk factors associated with mortality following surgery for peripheral arterial disease (PAD.Methods: We evaluated the association between levels of control of atherosclerotic risk factors and time to mortality following either lower extremity bypass surgery or lower extremity amputation using Cox proportional hazards regression.Results: Among 796 patients with PAD (defined by an ankle-brachial index [ABI] < 0.9, 230 (28.9% underwent an operation for PAD (136, lower-extremity bypasses; 111, lower-extremity amputations. Participants were followed for up to six years after their diagnosis of PAD. A total of 107 (46.5% of the 230 died during the period of follow-up. Factors associated with mortality following lower extremity bypass surgery included age 70 years and older hazard ratio [HR] 1.88; 95% confidence interval [CI]: 1.01–3.51 and of African American race (HR 1.94; 95% CI: 1.04–3.62. Renal insufficiency was significantly associated with mortality following lower extremity amputation (HR 2.19; 95% CI: 1.16–4.13. Conclusion: Our data provide information on preoperative risk variables to consider when assessing long-term mortality in persons with PAD who are undergoing surgery for PAD.Keywords: risk factors, mortality, bypass surgery, ankle-brachial index

  20. Correction of psycho-emotional state of athletes playing sports with the consequences of injuries of the lower extremities

    Directory of Open Access Journals (Sweden)

    O.D. Zheleznuy

    2014-12-01

    Full Text Available Purpose : development of techniques for using factors of psychological support for the recovery of athletes playing sports after injuries of the lower extremities. Material : The study involved 44 sportsmen. During 2008 - 2013 years was recorded 558 injuries. Results : The results psychodiagnosis injured athletes procedure K. Leonhard additions to copyright. Recommended approaches such psychological rehabilitation: gaining an understanding of real prospects athlete restore lost functions; mobilization will athlete to actively participate in the rehabilitation process; help in facing traumatized and need opportunities to participate in training-competitive process. Conclusions : The proposed package of measures for psychological support provided athletes decrease recovery times for 1 - 3 weeks and return to training-competitive process.

  1. A child presented with bilateral congenital constriction ring in lower extremity: a case report.

    Science.gov (United States)

    Jaiman, Richa; Gangopadhyay, Ajay N; Gupta, Dinesh K; Srivastava, Punit; Upadhyaya, Vijay D; Sharma, Shiv P; Kumar, Vijayendra

    2009-07-23

    The congenital constriction ring of lower extremity is very uncommon and rare condition. The actual incidence in general population is not known. In English literature, very few cases are reported time to time as congenital constriction band syndrome associated with musculoskeletal disorder like congenital talipes equino varus. The lesion can involve skin only or goes to deeper structure up to bone, which can lead to gangrene of foot or auto amputation. We are presenting a case of bilateral congenital constriction ring in lower limb who presented at age of 4 year without any other associated congenital anomaly, simply managed by Z-plasty, which improves quality of life after physiotherapy. Congenital constriction ring of lower limb is extremely rare condition in children. Early diagnosis and management is mandatory, either in single stage or by stage procedure, to prevent auto-amputation of limb and to improve quality of life on feet.

  2. Prognosis of complicated clinical course of varicose veins of lower extremities on the basis of analysis of phenotypic characteristics of connective tissue dysplasia

    Directory of Open Access Journals (Sweden)

    Tsarev О.А.

    2015-12-01

    Full Text Available Aim: to identify the phenotypic characteristics of indeterminate connective tissue dysplasia, which help to predict the progression of varicose veins of lower extremities and disease recurrence after surgery. Material and Methods. The long-term results of surgical treatment of 60 patients with varicose veins of lower extremities in a 5-year period after phlebectomy were analyzed. The phenotypic characteristics of indeterminate connective tissue dysplasia were researched. 24 patients had recurrence of varicose veins of lower extremities associated with disease progression; 36 patients did not have recurrence of varicose veins of lower extremities. Results. All the patients demonstrated the signs of indeterminate connective tissue dysplasia, whereas their frequency was different. There were specified nine phenotypic characteristics of indeterminate connective tissue dysplasia, which were significantly more frequent for patients with recurrence of varicose vein disease of lower extremities: 1 postural abnormality, 2 flat foot, 3 skin pallor, 4 hyperextension of skin, 5 positive "wrist test", 6 positive "pollex test", 7 diastasis recti abdominis, 8 myopia, 9 hematomas which form quickly. Conclusion. The determined sum of phenotypic characters of indeterminate connective tissue dysplasia allows to predict progression of varicose vein disease of lower extremities, and offers new opportunities for improving the results of surgical treatment via developing special therapeutic measures aimed at improving lifestyle and dysplasia treatment.

  3. Sympathetic reflex control of resistance in collateral arteries in the lower extremities in patients with diabetes mellitus

    DEFF Research Database (Denmark)

    Agerskov, K; Tønnesen, K H

    1982-01-01

    The vascular response in the lower extremities to 40 degrees head-up tilt was studied in 5 patients with occlusion of the superficial femoral artery and maturity onset diabetes mellitus with symptoms suggesting autonomic neuropathy. The pressure measurements were performed via catheters placed...... in the brachial artery, femoral artery and vein and popliteal artery and vein. Relative blood flow was calculated as the relative change in arterio-venous oxygen saturation. Absolute blood flow in the common femoral artery was measured by an indicator dilution technique. Resistance of the collateral arteries...

  4. Is prescribed lower extremity weight-bearing status after geriatric lower extremity trauma associated with increased mortality?

    Science.gov (United States)

    Gitajn, Ida Leah; Connelly, Daniel; Mascarenhas, Daniel; Breazeale, Stephen; Berger, Peter; Schoonover, Carrie; Martin, Brook; O'Toole, Robert V; Pensy, Raymond; Sciadini, Marcus

    2018-02-01

    Evaluate whether mortality after discharge is elevated in geriatric fracture patients whose lower extremity weight-bearing is restricted. Retrospective cohort study SETTING: Urban Level 1 trauma center PATIENTS/PARTICIPANTS: 1746 patients >65 years of age INTERVENTION: Post-operative lower extremity weight-bearing status MAIN OUTCOME MEASURE: Mortality, as determined by the Social Security Death Index RESULTS: Univariate analysis demonstrated that patients who were weight-bearing as tolerated on bilateral lower extremities (BLE) had significantly higher 5-year mortality compared to patients with restricted weight-bearing on one lower extremity and restricted weight-bearing on BLE (30%, 21% and 22% respectively, p bearing as tolerated on BLE, restricted weight-bearing on one lower extremity had a hazard ratio (HR) of 0.97 (95% confidence interval 0.78 to 1.20, p = 0.76) and restricted weight-bearing in BLE had a HR of 0.91 (95% confidence interval 0.60 to 1.36, p = 0.73). In geriatric patients, prescribed weight-bearing status did not have a statistically significant association with mortality after discharge, when controlling for age, sex, body mass index, medical comorbidities, Injury Severity Scale (ISS), mechanism of injury, nonoperative treatment and admission GCS. This remained true in when the analysis was restricted to operative injuries only. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Rehabilitation Trends After Lower Extremity Amputations in Canada.

    Science.gov (United States)

    Kayssi, Ahmed; Dilkas, Steven; Dance, Derry L; de Mestral, Charles; Forbes, Thomas L; Roche-Nagle, Graham

    2017-05-01

    The heterogeneity of medical complications that lead to amputation has resulted in a diverse patient population with differing rehabilitation needs; however, the rehabilitation trends for patients with lower extremity amputations across Canada have not been studied previously. To describe trends in rehabilitation after lower extremity amputations and the factors affecting rehabilitation length of stay in Canada. Retrospective cohort analysis. Canadian inpatient rehabilitation facilities that received persons with lower extremity amputations discharged from academic or community hospitals. Patients underwent lower extremity amputations between 2006 and 2009 for nontraumatic indications and were then discharged to a rehabilitation facility. Patients were identified from the Canadian Institute for Health Information's Discharge Abstract Database that includes hospital admissions across Canada except Quebec. Inpatient rehabilitation after lower extremity amputations. Length of stay, discharge destination, and change in total and motor function scores. The analysis included 5342 persons who underwent lower extremity amputations, 1904 of whom were transferred to a rehabilitation facility (36%). Patients most commonly underwent single below-knee (74%) and above-knee (17%) amputations. The duration of rehabilitation varied by whether the amputation was performed by a vascular (median = 36 days), orthopedic (median = 38 days), or general surgeon (median = 35 days). The overall median length of stay was 36 days. Most patients (72%) subsequently were discharged home and 9% were readmitted to hospital. Predictors of longer rehabilitation included amputation by an orthopedic surgeon (beta = 5.0, P ≤ .01), older age (beta = 0.2, P ≤ .01), and a history of ischemic heart disease (beta = 3.8, P = .03) or congestive heart failure (beta = 5, P = .04). Patients who spent Canada after lower extremity amputation varies by the type of surgeon performing the amputation. Advanced age

  6. Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

    International Nuclear Information System (INIS)

    Yamagami, Takuji; Kato, Takeharu; Iida, Shigeharu; Hirota, Tatsuya; Nishimura, Tsunehiko

    2005-01-01

    Purpose. To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity. Methods. We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology. Results. Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 ± 8.3 days (mean ± SD, range 4-37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment. Conclusion. The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary

  7. The relationship between lower limb muscle strength and lower extremity function in HIV disease

    Directory of Open Access Journals (Sweden)

    Peter C. Mhariwa

    2017-02-01

    Full Text Available Background: Human immunodeficiency virus (HIV negatively impacts muscle strength and function. This study aimed to establish the relationship between lower limb muscle strength and lower extremity function in HIV disease.Method: A cross-sectional study was undertaken with a sample of 113 HIV-positive participants. Lower limb muscle strength and self-reported function were established using dynamometry and the Lower Extremity Functional Scale (LEFS, respectively. Muscle strength and functional status were established in a subset of 30 HIV-negative participants to determine normative values.Results: Muscle strength for participants with HIV ranged from an ankle dorsiflexion mean of 9.33 kg/m2 to 15.79 kg/m2 in hip extensors. In the HIV-negative group, ankle dorsiflexors recorded 11.17 kg/m2, whereas hip extensors were the strongest, generating 17.68 kg/m2. In the HIV-positive group, linear regression showed a positive relationship between lower limb muscle strength and lower extremity function (r = 0.71, p = 0.00. Fifty per cent of the changes in lower extremity function were attributable to lower limb muscle strength. A simple linear regression model showed that lower limb ankle plantar flexors contributed the most to lower extremity function in this cohort, contrary to the literature which states that hip and trunk muscles are the most active in lower limb functional activities.Conclusion: Lower extremity strength impacts perceived function in individuals stabilised on antiretroviral therapy for HIV disease. These findings demonstrate that ankle plantar flexors produce more force over hip flexors. Careful attention should be paid to the implications for strength training in this population.

  8. Guideline for the management of wounds in patients with lower-extremity venous disease: an executive summary.

    Science.gov (United States)

    Kelechi, Teresa J; Johnson, Jan J

    2012-01-01

    This article provides an executive summary of the lower extremity venous disease (LEVD) evidence-based guideline produced by the WOCN Wound Guidelines Task Force. The target audience for this guideline is health care professionals who specialize in, direct, or provide wound care for patients at risk for or with lower-extremity venous disease. The full guideline opens with an overview of definitions of LEVD, its prevalence, clinical relevance, etiology, related physiology and pathophysiology, and overall management goals for patients at risk for developing venous leg ulcers. A detailed assessment section describes how to conduct a full clinical history and physical examination. Two approaches to interventions are provided: one addresses prevention strategies to reduce the risk of developing LEVD with ulcers. Methods to prevent ulcer recurrence are summarized including compression therapy, adjunctive therapies, medications, and patient education. A second approach presents treatment interventions including wound cleansing, debridement, infection control, antibiotic use, along with management of the periwound skin, nutrition, pain, and edema. This section also discusses limb elevation, surgical options, adjunctive therapies, patient education, and health care provider follow-up. A comprehensive reference list, glossary of terms, and appendices on cellulitis and venous eczema, types of edema, and compression therapy are available at the end of the guideline. This article provides an executive summary of the essential features of the guideline.

  9. Life after lower extremity amputation in diabetics.

    Science.gov (United States)

    Cox, P St L; Williams, S K P; Weaver, S R

    2011-10-01

    Lower limb amputees typically have reduced mobility which affects their ability to perform daily tasks and to successfully reintegrate into community life. A major goal of rehabilitation for amputees is to improve quality of life (QOL). This study therefore focussed on QOL and functional independence for persons with lower limb amputations secondary to diabetes. To determine the QOL and functional independence of lower limb diabetic amputees one to three years post amputation, using variables such as age, gender and amputation level. A total of 87 participants were selected from the 2006-2009 physiotherapy records at the St Ann's Bay Hospital. These participants completed the World Health Organization Quality of Life Scale (WHO QOL-BREF) and the Functional Independence Measure (FIM). Data were analysed using SPSS (version 12) and the mean values for QOL and functional independence were calculated. Relationships between the variables: age, gender and level of amputation with QOL and functional independence were analysed using descriptive and inferential statistical techniques. Among the 35 males and 52 females participating in the study, below knee amputees recorded higher scores for QOL (p quality of life of all participants. The results showed that below knee amputees functioned better than those with above knee amputations and that females were more likely to cope and function with the disability than males.

  10. Comparison of joint angles and electromyographic activity of the lower extremities during standing with wearing standard and revised high-heeled shoes: A pilot study.

    Science.gov (United States)

    Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min

    2016-04-29

    Revised high-heeled shoes (HHSs) were designed to improve the shortcomings of standard HHSs. This study was conducted to compare revised and standard HHSs with regard to joint angles and electromyographic (EMG) activity of the lower extremities during standing. The participants were five healthy young women. Data regarding joint angles and EMG activity of the lower extremities were obtained under three conditions: barefoot, when wearing revised HHSs, and when wearing standard HHSs. Lower extremity joint angles in the three dimensional plane were confirmed using a VICON motion capture system. EMG activity of the lower extremities was measured using active bipolar surface EMG. Kruskal-Wallis one-way analysis of variance by rank applied to analyze differences during three standing conditions. Compared with the barefoot condition, the standard HHSs condition was more different than the revised HHSs condition with regard to lower extremity joint angles during standing. EMG activity of the lower extremities was different for the revised HHSs condition, but the differences among the three conditions were not significant. Wearing revised HHSs may positively impact joint angles and EMG activity of the lower extremities by improving body alignment while standing.

  11. THE EFFECTS OF TAI CHI CHUAN COMBINED WITH VIBRATION TRAINING ON BALANCE CONTROL AND LOWER EXTREMITY MUSCLE POWER

    Directory of Open Access Journals (Sweden)

    Pao-Hung Chung

    2013-03-01

    Full Text Available The aim of this study was to determine whether performing Tai Chi Chuan on a customized vibration platform could enhance balance control and lower extremity muscle power more efficiently than Tai Chi Chuan alone in an untrained young population. Forty-eight healthy young adults were randomly assigned to the following three groups: a Tai Chi Chuan combined with vibration training group (TCV, a Tai Chi Chuan group (TCC or a control group. The TCV group underwent 30 minutes of a reformed Tai Chi Chuan program on a customized vibration platform (32 Hz, 1 mm three times a week for eight weeks, whereas the TCC group was trained without vibration stimuli. A force platform was used to measure the moving area of a static single leg stance and the heights of two consecutive countermovement jumps. The activation of the knee extensor and flexor was also measured synchronously by surface electromyography in all tests. The results showed that the moving area in the TCV group was significantly decreased by 15.3%. The second jump height in the TCV group was significantly increased by 8.14%, and the activation of the knee extensor/flexor was significantly decreased in the first jump. In conclusion, Tai Chi Chuan combined with vibration training can more efficiently improve balance control, and the positive training effect on the lower extremity muscle power induced by vibration stimuli still remains significant because there is no cross-interaction between the two different types of training methods.

  12. Lower extremity nerve decompression in painful diabetic polyneuropathy

    NARCIS (Netherlands)

    Macare van Maurik, A.F.

    2014-01-01

    The aim of the study was to evaluate the effect of surgical decompression of nerves in the lower extremity in patients with painful diabetic polyneuropathy (DPN). Influences on pain, tactile sensation, anatomical aspects of the tibial nerve and thickness of the flexor retinaculum, use of pain

  13. The Effects of Whole Body Vibration Training and Creatine Supplementation on Lower Extremity Performance and Balance in Elderly Males

    Directory of Open Access Journals (Sweden)

    Mostafa Rahimi

    2011-04-01

    Full Text Available Objectives: The purpose of this study was to investigate the effects of whole body vibration training (WBVT and creatine (Cr supplementation on lower extremity performance and balance in elderly males. Methods & Materials: In this semi-experimental study, twenty two eligible males from the members of an elderly daycare center with more than 60 years of age were enrolled and were divided into three groups randomly, WBVT+Cr(n=7, WBVT+Pgroup (n=7, and control group (n=8. In WBVT+Cr and WBVT+P groups exercises were performed on the whole body vibration device for 10 days with 30-35 Hz intensity and 5 mm amplitude. The WBVT+Cr group consumed 20g/day Crsupplement for the first 5 days followed by 5g/days for the next 5 days of protocol. The WBVT+P group consumed dexterous. The control group neither did any exercise nor consumed any supplement during the protocol. Static balance by standing time on one leg, dynamic balance by TUG test and lower extremity performance by 30-meter walking test, sit and stand test and tandem gait test weremeasured. Paired sample t-test and one way ANOVAwere used for data analysis (α=0.05. Results: Our results showed that dynamic balance, lower body performance in 30- meter walking and tandem gait improved in experimental groups. However, ANOVA did not show any significant increase in static balance (P=0.514, dynamic balance (P=0.153, lower body performance in 30-meter walking test (P=0.339, sit and stand test (P=0.578 and tandem gait (P=0.151. Conclusion: In conclusion, it seems that WBVT plus Cr supplementation improves some of the motor fitness factors in elderly males during a short time.

  14. Reliability of digital photography for assessing lower extremity alignment in individuals with flatfeet and normal feet types.

    Science.gov (United States)

    Ashnagar, Zinat; Hadian, Mohammad Reza; Olyaei, Gholamreza; Talebian Moghadam, Saeed; Rezasoltani, Asghar; Saeedi, Hassan; Yekaninejad, Mir Saeed; Mahmoodi, Rahimeh

    2017-07-01

    The aim of this study was to investigate the intratester reliability of digital photographic method for quantifying static lower extremity alignment in individuals with flatfeet and normal feet types. Thirteen females with flexible flatfeet and nine females with normal feet types were recruited from university communities. Reflective markers were attached over the participant's body landmarks. Frontal and sagittal plane photographs were taken while the participants were in a standardized standing position. The markers were removed and after 30 min the same procedure was repeated. Pelvic angle, quadriceps angle, tibiofemoral angle, genu recurvatum, femur length and tibia length were measured from photographs using the Image j software. All measured variables demonstrated good to excellent intratester reliability using digital photography in both flatfeet (ICC: 0.79-0.93) and normal feet type (ICC: 0.84-0.97) groups. The findings of the current study indicate that digital photography is a highly reliable method of measurement for assessing lower extremity alignment in both flatfeet and normal feet type groups. Copyright © 2016. Published by Elsevier Ltd.

  15. Long bone histology of sauropterygia from the lower Muschelkalk of the Germanic basin provides unexpected implications for phylogeny.

    Directory of Open Access Journals (Sweden)

    Nicole Klein

    Full Text Available BACKGROUND: Sauropterygia is an abundant and successful group of Triassic marine reptiles. Phylogenetic relationships of Triassic Sauropterygia have always been unstable and recently questioned. Although specimens occur in high numbers, the main problems are rareness of diagnostic material from the Germanic Basin and uniformity of postcranial morphology of eosauropterygians. In the current paper, morphotypes of humeri along with their corresponding bone histologies for Lower to Middle Muschelkalk sauropterygians are described and interpreted for the first time in a phylogenetic context. METHODOLOGY/PRINCIPAL FINDINGS: Nothosaurus shows a typical plesiomorphic lamellar-zonal bone type, but varying growth patterns and the occurrence of a new humerus morphotype point to a higher taxonomic diversity than was known. In contrast to the enormous morphological variability of eosauropterygian humeri not assigned to Nothosaurus, their long bone histology is relatively uniform and can be divided into two histotypes. Unexpectedly, both of these histotypes reveal abundant fibrolamellar bone throughout the cortex. This pushes the origin of fibrolamellar bone in Sauropterygia back from the Cretaceous to the early Middle Triassic (early Anisian. Histotype A is assigned to Cymatosaurus, a basal member of the Pistosauroidea, which includes the plesiosaurs as derived members. Histotype B is related to the pachypleurosaur Anarosaurus. Contrary to these new finds, the stratigraphically younger pachypleurosaur Neusticosaurus shows the plesiomorphic lamellar-zonal bone type and an incomplete endochondral ossification, like Nothosaurus. CONCLUSIONS/SIGNIFICANCE: Histological results hypothetically discussed in a phylogenetical context have a large impact on the current phylogenetic hypothesis of Sauropterygia, leaving the pachypleurosaurs polyphyletic. On the basis of histological data, Neusticosaurus would be related to Nothosaurus, whereas Anarosaurus would follow

  16. Upper Extremity Length Equalization

    OpenAIRE

    DeCoster, Thomas A.; Ritterbusch, John; Crawford, Mark

    1992-01-01

    Significant upper extremity length inequality is uncommon but can cause major functional problems. The ability to position and use the hand may be impaired by shortness of any of the long bones of the upper extremity. In many respects upper and lower extremity length problems are similar. They most commonly occur after injury to a growing bone and the treatment modalities utilized in the lower extremity may be applied to the upper extremity. These treatment options include epiphysiodesis, sho...

  17. [Comparative study of performance of lower extremities blocks under ultrasonography and nerve stimulator guidance].

    Science.gov (United States)

    Bubnov, R V; Strokan', A M; Abdullaiev, R Ia

    2011-01-01

    The aim of the study was to conduct a comparative analysis of regional anesthesia under neurostimulator, ultrasound guidance, and under combined guidance of the neurostimulator and ultrasound to ensure the safe and effective control of regional anesthesia with minimal discomfort for the patient. Ultrasound allows to gain significantly higher quality scores of local anesthesia than nerve stimulator control, to significantly reduce the number of needle extra insertions, needling cases, transposition, addition of general anesthesia, the number of unsuccessful blocks, reduce needle manipulation, significantly increase the occurrence of cases of complete blockade (sensitive and motor) on 30 min., causes less discomfort for patients. The use of ultrasound does not exclude the use of nerve stimulator as an additional means of verification of correct needle placement, particularly in the early stages of mastering the technique. The research combined use of ultrasound and nerve stimulator significantly decrease unsuccessful blockade and transposition need for a needle during manipulation. However, the difference between some indicators of quality of regional anesthesia is statistically unreliable; it requires further randomized and double blind studies on large patient groups, for different blockages.

  18. Duplex scanning in the diagnosis of acute deep vein thrombosis of the lower extremity

    NARCIS (Netherlands)

    van Ramshorst, B.; Legemate, D. A.; Verzijlbergen, J. F.; Hoeneveld, H.; Eikelboom, B. C.; de Valois, J. C.; Meuwissen, O. J.

    1991-01-01

    In a prospective study the value of duplex scanning in the diagnosis of acute femoro-popliteal thrombosis was compared to conventional contrast venography (CV) as a gold standard. A total of 126 legs in 117 patients suspected of having deep vein thrombosis (DVT) or pulmonary embolism (PE) were

  19. Vacuum therapy of trophic ulcer of lower extremities, presented in patients with DFS

    Directory of Open Access Journals (Sweden)

    Yurkova R.A.

    2017-01-01

    Full Text Available the article has analyzed the results of treatment of 67 patients with diabetic foot syndrome (DFS, complicated by feet trophic ulcers, using the vacuum bandages. Patients were divided into 2 groups: the control group had a traditional treatment and the studied one had vacuum bandages applied to the trophic ulcers. The results confirmed an assured decrease in the duration of patients’ treatment and hospitalization in the hospital.

  20. Multimodality treatment of a multifocal osteoblastoma-like tumor of the lower extremity.

    Science.gov (United States)

    Mait, Jeffrey E; Perino, Giorgio; Unnanuntana, Aasis; Chang, Tai-Li; Doty, Stephen; Schneider, Robert; Lane, Joseph M

    2012-09-01

    Osteoblastoma-like tumor is a rare condition with limited information on its orthopedic management in the current medical literature. The tumor histologically resembles an osteoblastoma, although the radiographic features are similar to those observed in primary vascular lesions. The treatment in the previously reported cases involved aggressive procedures including amputation, en bloc resection, and chemotherapy because of the uncertainty regarding the biological behavior of the tumor. We present a case of this entity that was successfully treated by a combination therapy including intralesional curettage with adjuvant cryotherapy, in situ and intravenous administration of bisphosphonates and radioablation.

  1. Lower extremity angle measurement with accelerometers - error and sensitivity analysis

    NARCIS (Netherlands)

    Willemsen, A.T.M.; Willemsen, Antoon Th.M.; Frigo, Carlo; Boom, H.B.K.

    1991-01-01

    The use of accelerometers for angle assessment of the lower extremities is investigated. This method is evaluated by an error-and-sensitivity analysis using healthy subject data. Of three potential error sources (the reference system, the accelerometers, and the model assumptions) the last is found

  2. Magnetic resonance imaging findings of vascular malformations of the lower extremity

    NARCIS (Netherlands)

    Breugem, C. C.; Maas, M.; van der Horst, C. M.

    2001-01-01

    Vascular malformations are congenital lesions resulting from a defect during embryogenesis. Magnetic resonance imaging (MRI) is a very effective method for demonstrating detailed information regarding involved structures, extent, and flow characteristics of vascular malformations. In previous MRI

  3. Necrotizing fasciitis of the lower extremity: a case report and current concept of diagnosis and management.

    LENUS (Irish Health Repository)

    Naqvi, G A

    2012-02-01

    Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries high mortality rate and require prompt diagnosis and urgent treatment with radical debridement and antibiotics. We describe a case of 21-year old man who presented with the history of trivial injury to the knee. Initially he was admitted and treated for septic arthritis but later was diagnosed as necrotizing fasciitis which was successfully treated with no ill effects what so ever from this devastating condition. This rare condition has been reported in literature but still early diagnosis, which is a key for successful treatment, remains a challenge.

  4. Relation of selective voluntary motor control of the lower extremity and extensor strength of the knee joint in children with spastic diplegia.

    Science.gov (United States)

    Kusumoto, Yasuaki; Takaki, Kenji; Matsuda, Tadamitsu; Nitta, Osamu

    2016-06-01

    [Purpose] The aim of this study was to investigate differences in selective voluntary motor control of the lower extremities by objective assessment and determine the relationship between selective voluntary motor control and knee extensor strength in children with spastic diplegia. [Subjects and Methods] Forty individuals who had spastic cerebral palsy, with Gross Motor Function Classification System levels ranging from I to III, were assessed using the Selective Control Assessment of the Lower Extremity and by testing the maximum knee extensor strength. The unaffected side was defined as the lower limb with the higher score, and the affected side was defined as the lower limb with the lower score. [Results] The Selective Control Assessment of the Lower Extremity score on the affected side had a lower average than that on the unaffected side. The scores showed a significant inverse correlation with the maximum knee extensor strength. [Conclusion] There was bilateral difference in the selective voluntary motor control of the lower extremities in children with spastic diplegia, and the selective voluntary motor control of the lower extremity was related to maximum knee extensor strength.

  5. Comparative analysis of lower extremities tissue perfusion by the use of perfusion scintigraphy method after hyperbaric oxygenation and lumbar sympathectomy

    Directory of Open Access Journals (Sweden)

    Zoranović Uroš

    2009-01-01

    Full Text Available Background/Aim. Lumbar syphatectomy (LS increases pheripheral blood flow primarily by the arteriolar vasodilatation within the skin vascular net. Increase in tissue nutrition takes place only in the distal blood vessels of the skin. Nevertheless, in some patients sympathectomy brings about improvement in ischemic ulcerations healing. Hyperbaric oxigenation (HBO is a medical treatment in which a patient breathes 100% oxygen under pressure higher than atmospheric implemented in special units allowing the whole body be in a chamber. The aim of the study was to determine efficacy of the applied therapies for the treatment of inoperable occlusive lower extremities (LE arteries diseases according to the obtained results. Methods. The study included 30 patients divided into two groups (15 patients each in which stenosis level of the lower extremities arteries had been determined using aortography due to further treatment with HBO and LS. All the patients were clinically examined, their objective condition evaluation based on claudication distance, pain in rest, skin and skin adnexa atrophy, and temperature and LE functionality, as well as exposed to perfusion scintigraphy prior to the treatment and within 30 days after the treatment finishing. Results. Analyzing patients' status prior to and after the treatments applied the number of patients with obvious improvement was higher in those treated by HBO than those treated by LS. Measuring claudication distance revealed significantly greater changes in patients treated by HBO (from 178.57 m to 754.76 m than in those treated by LS (from 229 m to 253 m. Other clinical symptoms, such as parasthesia, status of the skin adnexes (hair, nails, skin colour and temperature were also improved after the treatment by HBO. Conclusion. The results obatined in this study confirm the advantages of HBO over LS in therapy of inoperable occlusive LE disease, so LS could be definitely abandoned as a choice for treating such

  6. Regeneration of Cystic Bone Cavities and Bone Defects With Bioactive Glass S53P4 in the Upper and Lower Jaws.

    Science.gov (United States)

    Stoor, Patricia; Apajalahti, Satu; Kontio, Risto

    2017-07-01

    Cysts and tumors are common lesions in the jaws. To be able to retain a good volume of the alveolar ridge during healing as well as strengthening the angle and body of the mandible and provide an instant improved support for adjacent teeth, reliable long-term bone regeneration is needed. The purpose of this prospective study was to promote bone regeneration by filling bony defects in the upper or lower jaw with granules of the bioactive glass S53P4 (BAG), which have osteostimulative and antimicrobial properties.The authors treated 20 patients (21 defects) surgically; benign tumors, cysts, or infection related to impacted teeth in the maxilla or mandible. The tumor or cyst was removed or enucleated and thorough cleaning of the infected area was performed. The bone cavity was filled with granules of the BAG S53P4 despite signs of chronic infection in the area at the time of surgery. The patients were followed up for an average of 34 months clinically and with cone beam computerized tomography for 28 months. In 20 defects the final outcome was successful. Despite infection at the time of surgery in 65% of the patients, no material associated infection was seen during the follow-up. The BAG S53P4 granules were radiologically remodeled into bone after 2 years follow-up. The use of granules of the BAG S53P4 in the treatment of large bone defects provides infection-free reliable bone regeneration despite chronic infection at the time of surgery, which improves the prognosis of adjacent teeth.

  7. The efficacy of negative pressure wound therapy in the management of lower extremity trauma: review of clinical evidence.

    Science.gov (United States)

    Kanakaris, N K; Thanasas, C; Keramaris, N; Kontakis, G; Granick, Mark S; Giannoudis, P V

    2007-12-01

    A large number of aids have been conceived and introduced into clinical practice (nutritional supplements, local dressings, technical innovations) aimed at facilitating and optimising wound healing in both acute and chronic wound settings. Among these advances, negative pressure wound therapy (NPWT) has been introduced during the last 30 years, and has been analysed in over 400 manuscripts of the English, Russian and German literature. Until very recently, vacuum assisted closure (VAC) (KCI, TX, USA) has been the only readily available commercial device that provides localised negative pressure to the wound and is the predominant agent used to deliver NPWT featured in this review. We conducted a comprehensive review of the existing clinical evidence of the English literature on the applications of NPWT in the acute setting of trauma and burns of the lower extremity. Overall, 16 clinical studies have been evaluated and scrutinised as to the safety and the efficacy of this adjunct therapy in the specific environment of trauma. Effectiveness was comparable to the standard dressing and wound coverage methods. The existing clinical evidence justifies its application in lower limb injuries associated with soft tissue trauma.

  8. Upper Extremity Sports Injury : Risk Factors in Comparison to Lower Extremity Injury in More Than 25 000 Cases

    NARCIS (Netherlands)

    Sytema, Renee; Dekker, Rienk; Dijkstra, Pieter U.; ten Duis, Hendrik J.; van der Sluis, Corry K.

    Objective: To analyze differences in sports injury characteristics of the upper and lower extremity and to identify factors that contribute to the risk of sustaining an upper extremity injury compared with the risk of sustaining a lower extremity injury. Design: Retrospective cohort study. Setting:

  9. OBSERVER RATING VERSUS THREE-DIMENSIONAL MOTION ANALYSIS OF LOWER EXTREMITY KINEMATICS DURING FUNCTIONAL SCREENING TESTS: A SYSTEMATIC REVIEW.

    Science.gov (United States)

    Maclachlan, Liam; White, Steven G; Reid, Duncan

    2015-08-01

    Functional assessments are conducted in both clinical and athletic settings in an attempt to identify those individuals who exhibit movement patterns that may increase their risk of non-contact injury. In place of highly sophisticated three-dimensional motion analysis, functional testing can be completed through observation. To evaluate the validity of movement observation assessments by summarizing the results of articles comparing human observation in real-time or video play-back and three-dimensional motion analysis of lower extremity kinematics during functional screening tests. Systematic review. A computerized systematic search was conducted through Medline, SPORTSdiscus, Scopus, Cinhal, and Cochrane health databases between February and April of 2014. Validity studies comparing human observation (real-time or video play-back) to three-dimensional motion analysis of functional tasks were selected. Only studies comprising uninjured, healthy subjects conducting lower extremity functional assessments were appropriate for review. Eligible observers were certified health practitioners or qualified members of sports and athletic training teams that conduct athlete screening. The Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) was used to appraise the literature. Results are presented in terms of functional tasks. Six studies met the inclusion criteria. Across these studies, two-legged squats, single-leg squats, drop-jumps, and running and cutting manoeuvres were the functional tasks analysed. When compared to three-dimensional motion analysis, observer ratings of lower extremity kinematics, such as knee position in relation to the foot, demonstrated mixed results. Single-leg squats achieved target sensitivity values (≥ 80%) but not specificity values (≥ 50%>%). Drop-jump task agreement ranged from poor ( 80%). Two-legged squats achieved 88% sensitivity and 85% specificity. Mean underestimations as large as 198 (peak knee flexion) were found in

  10. Prospective, randomized, multi-institutional clinical trial of a silver alginate dressing to reduce lower extremity vascular surgery wound complications.

    Science.gov (United States)

    Ozaki, C Keith; Hamdan, Allen D; Barshes, Neal R; Wyers, Mark; Hevelone, Nathanael D; Belkin, Michael; Nguyen, Louis L

    2015-02-01

    Wound complications negatively affect outcomes of lower extremity arterial reconstruction. By way of an investigator initiated clinical trial, we tested the hypothesis that a silver-eluting alginate topical surgical dressing would lower wound complication rates in patients undergoing open arterial procedures in the lower extremity. The study block-randomized 500 patients at three institutions to standard gauze or silver alginate dressings placed over incisions after leg arterial surgery. This original operating room dressing remained until gross soiling, clinical need to remove, or postoperative day 3, whichever was first. Subsequent care was at the provider's discretion. The primary end point was 30-day wound complication incidence generally based on National Surgical Quality Improvement Program guidelines. Demographic, clinical, quality of life, and economic end points were also collected. Wound closure was at the surgeon's discretion. Participants (72% male) were 84% white, 45% were diabetic, 41% had critical limb ischemia, and 32% had claudication (with aneurysm, bypass revision, other). The overall 30-day wound complication incidence was 30%, with superficial surgical site infection as the most common. In intent-to-treat analysis, silver alginate had no effect on wound complications. Multivariable analysis showed that Coumadin (Bristol-Myers Squibb, Princeton, NJ; odds ratio [OR], 1.72; 95% confidence interval [CI], 1.03-2.87; P = .03), higher body mass index (OR, 1.05; 95% CI, 1.01-1.09; P = .01), and the use of no conduit/material (OR, 0.12; 95% CI, 0.82-3.59; P silver-eluting alginate dressing showed no effect on the incidence of wound complications. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  11. Incidence of ipsilateral postoperative deep venous thrombosis in the amputated lower extremity of patients with peripheral obstructive arterial disease.

    Science.gov (United States)

    Matielo, Marcelo Fernando; Presti, Calógero; Casella, Ivan Benaduce; Netto, Baptista Muraco; Puech-Leão, Pedro

    2008-12-01

    Patients undergoing amputation of the lower limb due to peripheral arterial disease (PAD) are at risk of developing deep venous thrombosis (DVT). Few studies in the research literature report the incidence of DVT during the early postoperative period or the risk factors for the development of DVT in the amputation stump. This prospective study evaluated the incidence of DVT during the first 35 postoperative days in patients who had undergone amputation of the lower extremity due to PAD and its relation to comorbidities and death. Between September 2004 and March 2006, 56 patients (29 men), with a mean age of 67.25 years, underwent 62 amputations, comprising 36 below knee amputations (BKA) and 26 above knee amputations (AKA). Echo-Doppler scanning was performed preoperatively and on postoperative days 7 and 31 (approximately). All patients received acetylsalicylic acid (100 mg daily) preoperatively and postoperatively, but none received prophylactic anticoagulation. DVT occurred in 25.8% of extremities with amputations (10 AKA and 6 BKA). The cumulative incidence in the 35-day postoperative period was 28% (Kaplan-Meier). There was a significant difference (P = .04) in the incidence of DVT between AKA (37.5%) and BKA (21.2%). Age >or=70 years (48.9% vs 16.8%, P = .021) was also a risk factor for DVT in the univariate analysis. Of the 16 cases, 14 (87.5%) were diagnosed during outpatient care. The time to discharge after amputation was averaged 6.11 days in-hospital stay (range, 1-56 days). One symptomatic nonfatal pulmonary embolism occurred in a patient already diagnosed with DVT. There was no relation between other comorbidities and DVT. The multivariate analysis showed no association between risk factors and the occurrence of DVT in the amputated extremity. DVT ipsilateral to the amputation did not influence the mortality rate (9.7%). The incidence of DVT in the early postoperative period (or=70 years and for AKA. Patients with PAD who have recently undergone

  12. Intra-arterial Autologous Bone Marrow Cell Transplantation in a Patient with Upper-extremity Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Madaric, Juraj, E-mail: jurmad@hotmail.com [National Institute of Cardiovascular Diseases (NUSCH) and Slovak Medical University, Department of Cardiology and Angiology (Slovakia); Klepanec, Andrej [National Institute of Cardiovascular Diseases, Department of Diagnostic and Interventional Radiology (Slovakia); Mistrik, Martin [Clinic of Hematology and Transfusiology, Faculty Hospital (Slovakia); Altaner, Cestmir [Slovak Academy of Science, Institute of Experimental Oncology (Slovakia); Vulev, Ivan [National Institute of Cardiovascular Diseases, Department of Diagnostic and Interventional Radiology (Slovakia)

    2013-04-15

    Induction of therapeutic angiogenesis by autologous bone marrow mononuclear cell transplantation has been identified as a potential new option in patients with advanced lower-limb ischemia. There is little evidence of the benefit of intra-arterial cell application in upper-limb critical ischemia. We describe a patient with upper-extremity critical limb ischemia with digital gangrene resulting from hypothenar hammer syndrome successfully treated by intra-arterial autologous bone marrow mononuclear cell transplantation.

  13. Psychometric properties of the Dutch Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a fracture of the upper or lower extremity

    NARCIS (Netherlands)

    M.A.C. van Son; B.L. den Oudsten (Brenda); J.A. Roukema; T. Gosens; M.H.J. Verhofstad (Michiel); J. de Vries (Jolanda)

    2013-01-01

    textabstractPurpose: This prospective study examined the psychometric properties of the adapted Dutch translation of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with isolated unilateral lower fracture (LEF) or upper extremity fracture (UEF). Methods: Patients

  14. Clinimetric properties of hip abduction strength measurements obtained using a handheld dynamometer in individuals with a lower extremity amputation.

    Directory of Open Access Journals (Sweden)

    Ruud A Leijendekkers

    Full Text Available Suitable handheld dynamometer (HHD-techniques to test hip abduction strength in individuals with a lower extremity amputation, irrespective of their amputation level are absent. The aim of this study was to optimise a HHD-technique and to test its reproducibility and validity.This study involved three phases, in which two techniques were evaluated. Both HHD-techniques used a lever-arm of 22 centimetre. HHD-technique 1 used a break-technique. After obtaining within-session test-retest reproducibility (phase 1 we optimised the HHD-technique by adding a fixation-belt and using a make-technique (HHD-technique 2. We tested the within-session test-retest and inter-rater reproducibility (phase 2 and the validity (phase 3 of HHD-technique 2 using an isokinetic dynamometer. New cohorts of participants were recruited for each phase.Phase 1: we tested HHD-technique 1 in 26 participants with a lower extremity amputation. It was test-retest reproducible (ICC3.1agreement: 0.80-0.92, standard error of measurement (SEM: 3.1-4.4 Nm and smallest detectable change (SDC: 8.6-12.3 Nm. There were questions regarding the validity of the measurement, because the mean muscle torque of the residual limb and sound limb were similar, which is uncommon. Phase 2: reproducibility of HHD-technique 2 was tested in 44 participants with a lower extremity amputation. It was test-retest reproducible (ICC3.1agreement: 0.96-0.97, SEM: 3.9-4.7 Nm and SDC: 10.9-12.9 Nm but not inter-rater reproducible despite having good reliability (ICC3.1agreement: 0.92, SEM: 6.9-7.6 Nm and SDC: 19.2-21.2 Nm. Systematic bias and bias related to the magnitude of the muscle torque was suspected. Phase 3: the concurrent validity was established in 30 healthy participants (r = 0.84. Systematic bias in measurement error was present, including a consistent overestimation of the muscle torque of 28% using the HHD.HHD-technique 2 is a test-retest reproducible and valid measuring technique The technique may

  15. Reducing major lower extremity amputations after the introduction of a multidisciplinary team in patient with diabetes foot ulcer.

    Science.gov (United States)

    Wang, Chuan; Mai, Lifang; Yang, Chuan; Liu, Dan; Sun, Kan; Song, Weidong; Luo, Baoming; Li, Yan; Xu, Mingtong; Zhang, Shaoling; Li, Fangping; Ren, Meng; Yan, Li

    2016-07-07

    Diabetic foot ulceration is receiving more attention because of its high amputation and mortality rate. It is essential to establish the frequency of amputations in people with diabetes after any change to the management of diabetic foot care. The present study aim to compare the frequency of lower-extremity amputations in patients with diabetes foot ulcer over a ten-year period. Six hundred forty eight patients with diabetes foot ulcer were retrospectively studied from 2004 to 2013. The clinical features, laboratory results and the lower-extremity amputations were recorded. Major amputation was defined as amputations above the ankle while minor amputation was amputations below the ankle in the present study. Patients with diabetic foot ulcer were old (age 66.96 ± 11.96 years), with a long duration of diabetes (10.30 ± 6.94 years), high HbA1c (9.19 ± 2.62 %), SBP (144.05 ± 24.18 mmHg), DBP (79.53 ± 11.88 mmHg), LDL-C (2.71 ± 0.93 mmol/L) and had great frequency of neuropathy (62.7 %), retinopathy (45.0 %), nephropathy (39.5 %) and PAD (33.2 %). From 2004 to 2013, the frequency of all lower-extremity amputations is 12.0 % (5.2 % major amputation, 6.8 % minor amputation). The frequency of major amputations decreased from 9.5 % in 2004 and 14.5 % in 2005 to less than 5.0 % after 2006. In particular, there was a significant decline in major amputations of diabetic foot patient with Wagner 3 to 4 wounds. The frequency rate of major amputations in diabetic foot patient with Wagner 3 to 4 wounds fell from 35.7 % in 2004 to 4.4 % after 2007. The change in frequency of minor amputations was fluctuation. This study demonstrates that the introduction of a multidisciplinary team, coordinated by an endocrinologist and a podiatrist, for managing diabetic foot disease is associated with a reduction in the frequency of major amputations in patients with diabetes.

  16. Comparing the Effects of Dual-Task Gait Testing in New and Established Ambulators With Lower Extremity Amputations.

    Science.gov (United States)

    Frengopoulos, Courtney; Payne, Michael W C; Holmes, Jeffrey D; Viana, Ricardo; Hunter, Susan W

    2018-04-05

    Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm. To investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations. Cross-sectional study. Outpatient and inpatient amputee clinics at an academic rehabilitation hospital. Sixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas). Not applicable. Time to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs. Gait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many

  17. [Function of prosthesis components in lower limb amputees with bone-anchored percutaneous implants : Biomechanical aspects].

    Science.gov (United States)

    Blumentritt, S

    2017-05-01

    Bone anchorage of an artificial limb has been proven to be an alternative intervention for amputees when prosthesis use is seriously reduced because of stump problems. Little is known about how prosthesis components interact with bone and joints and which potential the optimum use provides with respect to quality of treatment of leg amputees. Does osseointegration influence the motor activity of residual limbs differently compared with socket prostheses? How should prosthesis components be aligned? What type of prosthetic knee joints should be preferred in transfemoral amputees? Transfer of biomechanical knowledge of socket prosthetics to bone-anchored prostheses. Pilot studies with a limited number of amputees. Force transmission at the interface between the prosthesis and residual limb stump is completely different for osseointegrated fixation and socket design; however, the number of muscles available for control remains unchanged. Because the iliotibial tract is missing, bending moments of the femur are expected to be greater. Prosthetic alignment is very critical for gait pattern and the basic rules seem to be the same as for socket design. The foot position determines the knee function for below-knee amputees. The position of the femur influences the gait pattern of above-knee amputees. The lowest risk of falls and best functional properties are shown by microprocessor controlled knee joints. Osseointegrated leg prostheses have some biomechanical advantages over the socket design. Since rehabilitation quality is clearly affected the prosthetic alignment has to be done carefully and precisely. As a rule microprocessor controlled knee joints are indicated.

  18. Strategies for Managing Massive Defects of the Foot in High-Energy Combat Injuries of the Lower Extremity

    Science.gov (United States)

    2010-01-01

    fracture Calcaneus fracture Midfoot fracture Segmental bone loss Bone graft Foot Ankle Clin N Am 15 (2010) 139 149 doi:10.1016/j.fcl...reliable reconstruction of the plantar fat pad.29 Plantar soft tissue wounds are known to predict poor outcomes for open calcaneus fracture .5 A 21-year...old marine sustained an open type-IIIB calcaneus fracture with severe plantar soft tissue disruption necessitating amputation (Fig. 6). It is unclear