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Sample records for chronic sacral pressure

  1. Development of Marjolin's ulcer following successful surgical treatment of chronic sacral pressure sore

    DEFF Research Database (Denmark)

    Knudsen, M.A.; Biering-Sørensen, Fin

    2008-01-01

    STUDY DESIGN: Case report. OBJECTIVE: Report of an unusual case, where a Marjolin's ulcer that developed 2.5 years after surgical excision and successful closure. SETTING: Department of Plastic and Reconstructive Surgery and Burn Unit and the Clinic for Spinal Cord Injuries, Copenhagen University...... tomography, and magnetic resonance imaging scans revealed a soft tissue process over the sacral and coccygeal bones and massive destruction of these bony structures. The patient died 11 months later, despite surgical and radiation treatment. CONCLUSION: The present case is unusual because, in spite...... of surgical excision and successful closure of the wound, the patient developed Marjolin's ulcer 2.5 years later. Yet it illustrates the primary importance of preventing the development pressure sores, of aggressive (surgical) therapy with healing when they do arise and of taking frequent biopsies...

  2. A comparative, descriptive study of systemic factors and survival in elderly patients with sacral pressure ulcers.

    Science.gov (United States)

    Jaul, Efraim; Menczel, Jacob

    2015-03-01

    Sacral pressure ulcers (PUs) are a serious complication in frail elderly patients. Thin tissue in the sacral area, low body mass index, and anatomical location contribute to the development of sacral PUs. A comparative, descriptive study was conducted to identify patient systemic factors associated with sacral PUs and to compare survival time in patients with and without PU. All consecutive patients with PUs (n = 77) and without sacral PUs (n = 53) admitted to the skilled nursing department of a geriatric hospital in Jerusalem, Israel between July 1, 2008 and December 31, 2011 were eligible to participate. Charts of previously admitted patients were abstracted and patients were prospectively followed until discharge, death, or the end of the study. Patient demographics, comorbidities, nutritional status, physical and cognitive function (measured using the Reisberg's Functional Assessment Staging Tool [FAST], Stages of Dementia of Alzheimer Scale, and the Glasgow Coma Scale), PU status, number of courses of antibiotic treatment during admission, length of hospitalization, and mortality were compared between patients admitted with and without a sacral PU using descriptive and univariate statistics. Logistic regression models were used to estimate the odds ratio (OR) and 95% confidence intervals (CI) for sacral PU versus without PU by study covariate. The association between sacral PU and survival time was assessed using Kaplan-Meier models. Patients with a sacral PU were significantly older (average age 81.60 ±10.78 versus 77.06±11.19 years old, P = 0.02) and had a higher prevalence of dementia (70% versus 30%, P = 0.007), Parkinson's disease (92.3% versus 7.7%, P = 0.03), and anemia (67.7% versus 32.3%, P = 0.06) than patients admitted without a PU. Patients with a sacral PU also had a lower body mass index (23.1 versus 25.4, P = 0.04), and lower hemoglobin (10.54 versus 11.11, P = 0.03), albumin (26.2 versus 29.7, P = 0.002), and total protein levels (61.3 versus

  3. Treatment of intractable chronic pelvic pain syndrome by injecting a compound of Bupivacaine and Fentanyl into sacral spinal space

    Institute of Scientific and Technical Information of China (English)

    ZHOU Zhan-song; SONG Bo; NIE Fa-chuan; CHEN Jin-mei

    2006-01-01

    Objective:To investigate the effect of injecting a compound of Bupivacaine and Fentanyl into sacral spinal space to treat chronic pelvic pain syndrome (CPPS). Methods: A total of 36 men with recalcitrant CPPS refractory to multiple prior therapies were treated with the injection of a compound of Bupivacaine and Fentanyl (10 ml of 0. 125% upivacaine, .05 mg Fentanyl, 5 mg Dexamethasone, 100 mg Vitamin B1 and 1 mg Vitamin B12) into sacral space once a week for 4 weeks. The National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI), maximum and average flow rate were performed at the start and the end of 4 weeks' therapy. Results :Mean NIH-CPSI total score was decreased from 26.5±.6 to 13.4±2.0 (P<0. 001). Significant improvement was seen in each subscore domain. A total of 32 patients (89%) had at least 25% improvement on NIH-CPSI and 22 (61%) had at least 50% improvement. Maximal and average flow rate were increased from 19. 5±3.8 to 23. 6±4. 2 and 10. 9±2.6 to 14.3± 2.4 respectively. Conclusion: Injection of this compound of Bupivacaine, Fentanyl and Dexamethasone into sacral spinal space is an effective and safe approach for recalcitrant CPPS. Further study of the mechanisms and prospective placebo controlled trials are warranted.

  4. Acoustic pressure wound therapy to facilitate granulation tissue in sacral pressure ulcers in patients with compromised mobility: a case series.

    Science.gov (United States)

    Schmuckler, Jo

    2008-08-01

    Electrical stimulation and other modalities are recommended for treatment of pressure ulcers in spinal cord injury patients but their use may be limited by clinical contraindications such as necrosis and infection. Acoustic pressure wound therapy can be used to address infection and has no known contraindications related to wound status. A retrospective nonconsecutive study was conducted involving five inpatients with sacral pressure ulcers and compromised mobility (spinal cord injury, ventilator/mobility dependency, or persistent vegetative state) treated with acoustic pressure wound therapy three times per week, 4 to 6 minutes per session, for 5 weeks to 5.5 months. Acoustic pressure wound therapy was administered until necrotic tissue was removed, granulation was complete, drainage resolved to moderate levels, and wound size was compatible with indications for high-voltage electrical stimulation. Within 1 to 4 weeks of starting acoustic pressure wound therapy, four out of five wounds with substantial yellow slough or eschar demonstrated 100% granulation tissue and wound area and volume decreased 71% to 97% and 75% to 99%, respectively. Subsequent treatments included electrical stimulation alone (three patients) or in conjunction with negative pressure wound therapy (one patient), and silver foam (one patient). Acoustic pressure wound therapy was found to be an effective option in preparing wounds for subsequent therapy. PMID:18716342

  5. Inferior Gluteal Artery Perforator Flap for Sacral Pressure Ulcer Reconstruction: A Retrospective Case Study of 11 Patients.

    Science.gov (United States)

    Lin, Chin-Ta; Ou, Kuang-Wen; Chiao, Hao-Yu; Wang, Chi-Yu; Chou, Chang-Yi; Chen, Shyi-Gen; Lee, Tzu-Peng

    2016-01-01

    Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon. The flap from the gluteal crease derives blood supply from the inferior gluteal artery perforator (IGAP) and reliably preserves the entire contralateral side as a donor site. To incorporate the IGAP in the reconstruction of sacral pressure ulcers, a skin paddle over the gluteal crease was created and implemented by the authors. Data from 11 patients (8 men, 3 women; mean age 67 [range 44-85] years old) whose sacral ulcers were closed with an IGAP flap between June 2006 and May 2012 were retrieved and reviewed. All patients were bedridden; 1 patient in a vegetative state with a diagnosis of carbon monoxide intoxication was referred from a local clinic, 2 patients had Parkinson's disease, and 8 patients had a history of stroke. The average defect size was 120 cm(2) (range 88-144 cm(2)). The average flap size was 85.8 cm(2) (range 56-121 cm(2)). Only 1 flap failure occurred during surgery and was converted into V-Y advancement flap; 10 of the 11 flaps survived. After surgery, the patients' position was changed every 2 hours; patients remained prone or on their side for approximately 2 weeks until the flap was healed. After healing was confirmed, patients were discharged. Complications were relatively minor and included 1 donor site wound dehiscence that required wound reapproximation. No surgery-related mortality was noted; the longest follow-up period was 24 months. In this case series, flaps from the gluteal crease were successfully used for surgical closure of sacral pressure ulcers. This flap design should be used with caution in patients with hip contractures. Studies with larger sample sizes are needed to ascertain which type of flap is best suited to surgically manage extensive pressure ulcers in a variety of patient populations. PMID:26779702

  6. Use of a sacral silicone border foam dressing as one component of a pressure ulcer prevention program in an intensive care unit setting.

    Science.gov (United States)

    Walsh, Nancy S; Blanck, Alyson W; Smith, Lisa; Cross, Maribeth; Andersson, Liane; Polito, Carol

    2012-01-01

    In 2008, patients in the intensive care unit (ICU) at Danbury Hospital, Danbury, Connecticut, experienced 79 pressure ulcers. As a result, pressure ulcer-prevention interventions were standardized in critical care and medical-surgical units and education was provided to all direct patient care staff about principles of skin care and prevention. Following these efforts, 53 ICU patients developed pressure ulcers in the sacral area in fiscal year 2009, representing a 12.5% incidence for the ICU as compared to a 3.4% overall pressure ulcer incidence for the total hospital. In order to achieve additional reduction in pressure ulcer incidence, we replicated an initiative that called for application of a silicone foam dressing every 3 days to determine its effect on sacral pressure ulcer incidence in the ICU. We found that the use of the dressing further diminished the incidence of sacral pressure ulcers in our patients.

  7. SACRAL FRACTURES

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. To delineate the clinical spectrum and treatment choice of sacral fractures.Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis′ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurological deficits were present in seven patients. Thirty seven patients were treated conservatively and two underwent surgical management.Results.Thirty eight patients were followed up for three months to 19 years. Thirty three have recovered, four improved, and one remained disabled.Conclusion.The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture reduction and stability reconstruction. When the patients with pelvic fracture are complicated with neurological deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.

  8. Sacral nerve stimulation.

    Science.gov (United States)

    Matzel, K E; Stadelmaier, U; Besendörfer, M

    2004-01-01

    The current concept of recruiting residual function of an inadequate pelvic organ by electrostimulation involves stimulation of the sacral spinal nerves at the level of the sacral canal. The rationale for applying SNS to fecal incontinence was based on clinical observations of its effect on bowel habits and anorectal continence function in urologic patients (increased anorectal angulation and anal canal closure pressure) and on anatomic considerations: dissection demonstrated a dual peripheral nerve supply of the striated pelvic floor muscles that govern these functions. Because the sacral spinal nerve site is the most distal common location of this dual nerve supply, stimulating here can elicit both functions. Since the first application of SNS in fecal incontinence in 1994, this technique has been improved, the patient selection process modified, and the spectrum of indications expanded. At present SNS has been applied in more than 1300 patients with fecal incontinence limited.

  9. Management of pelvic heterotopic ossification post-myocutaneous flap reconstruction of a sacral pressure ulcer

    OpenAIRE

    McInnes, Colin W; Reynolds, Richard AK; Arneja, Jugpal S.

    2011-01-01

    Heterotopic ossification (HO) is a process whereby lamellar bone forms in the soft tissues surrounding a joint. The most common type of HO is traumatic myositis ossificans, which develops following traumatic injuries, burns or arthroplasty. A variety of other forms of HO also exist, such as those associated with central nervous system injury and systemic forms that can manifest at other joints simultaneously. Clinically, patients can present with decreased range of motion, pressure ulcers, ne...

  10. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD - Results of a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Søren Ventegodt

    2004-01-01

    Full Text Available The chronic state of whiplash-associated disorder (WAD might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6 to 10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy, followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22–49, median 37 years and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 1848, median 38. Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation, 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality

  11. Sacral fatigue fractures in children with sacral spina bifida occulta.

    Science.gov (United States)

    Hama, Shingo; Takata, Yoichiro; Sakai, Toshinori; Higashino, Kosaku; Abe, Mitsunobu; Nagamachi, Akihiro; Sairyo, Koichi

    2016-05-01

    In this report, we present two cases of 9-year-old children with spina bifida occulta (SBO) of the sacrum, who were diagnosed with sacral fatigue fractures. In both patients, MRI showed a linear signal void and high signal in sacral ala on the short tau inversion recovery sequence. Sacral SBO at the same level of the sacral fracture was observed in each patient on computed tomography images. These lesions healed with rest. This is the first literature reporting cases with sacral stress fractures who had SBO at the same level of fracture. PMID:26196371

  12. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  13. 一次性负压封闭引流器治疗骶部压疮的护理研究%Nursing research of one-time closed negative pressure drainage treatment department of sacral pressure sores

    Institute of Scientific and Technical Information of China (English)

    岳阳

    2014-01-01

    目的:研究评价一次性负压封闭引流装置对压疮患者的治疗效果。方法选取收治的56例压疮患者,随机分为观察组和对照组。观察组采用自行设计的一次性负压封闭引流器治疗骶部压疮,对照组应用VSD装置治疗骶部压疮,然后观察对比两组的创面缩小面积、治疗时间、创面处理费用、睡眠指数等指标。结果观察组与对照组创面缩小面积,、治疗时间无显著性差异,两组治疗压疮疗效相当。观察组与对照组睡眠指数、创面处理费用有明显差异,观察组花费明显小于对照组,且睡眠质量明显优于对照组。结论一次性负压封闭引流器结构简单,操作简便,治疗骶部压疮安全有效,舒适,且价格低廉,适合临床推广使用。%Objective To study the evaluation of disposable vacuum sealing drainage treatment device for patients with bedsore.56 patients Methods In our hospital,were randomly divided into observation group and control group.The observation group was treated with disposable negative pressure self designed closed drainage treatment of sacral pressure sores,the control group used VSD device in the treat-ment of sacral pressure sores,then to observe the wound area reduced,compared two groups of treatment time,wound treatment costs,the sleep index.Results The observation group and the control group,the treatment time of wound area reduced,there was no significant differ-ence in curative effect in the treatment of pressure sore,a two group.The observation group and the control group of sleep index,wound treatment charges have obvious differences,the observation group spent significantly less than control group,and the sleep quality was signifi-cantly better than the control group.Conclusion The disposable vacuum sealing drainage device has the advantages of simple structure, convenient operation,treatment of sacral pressure sore is effective and safe,comfortable,and inexpensive

  14. Two cases of sacral agenesis

    Energy Technology Data Exchange (ETDEWEB)

    Choi, J. Y.; Bae, Y. K.; Hahm, C. K.; Kang, S. R. [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    1979-06-15

    Sacral agenesis is a central component in the spectrum of anomalies comprising the caudal regression syndrome. Sacral agenesis occurs more frequently in an infant born to mother of diabetes, rubella infection in first trimester than normal mothers. In a patient of sacral agenesis, it is important to recognize the neurologic deficit, neurogenic bladder dysfunction and other congenital anomalies. A case of partial sacral agenesis of 10 years old girl and another case of complete total agenesis associated with multiple anomalies in autopsied newborn are reported.

  15. Study of the morphology and biomechanics of sacral fracture

    Institute of Scientific and Technical Information of China (English)

    QUAN Ren-fu; YANG Di-sheng; WANG Yi-jin

    2006-01-01

    Objective: To observe the morphological characteristics of sacral fracture under different impact loads.Method: Ten fresh pelvic specimens were loaded in dynamic or static state. A series of mechanical parameters including the pressure strain and velocity were recorded.Morphological characteristics were observed under scanning electron microscope.Results: The form of sacral fracture was related to the impact energy. Under low-energy impact loads, ilium fracture, acetabulum fracture and crista iliaca fracture were found. Under high-energy impact loads, three types of sacral fracture occurred according to the classification of Denis: sacral ala fracture, Type Ⅰ fracture; sacral foramen cataclasm fracture, Type Ⅱ fracture; central vertebral canal fracture, Type Ⅲ fracture. Nerve injury of one or two sides was involved in all three types of sacral fracture.The fracture mechanism of sacrum between the dynamic impact and static compression was significantly different.When the impact energy was above 25 J, sacral foramen cataclasm fracture occurred, involving nerve root injury.When it was below 20 J, ilium and sacral fracture was most likely to occur. When it was 20 ~ 25 J, Type Ⅰ fracture would occur. While in the static test, most of the fracture belonged to ilium or acetabulum fracture. The cross section of sacrum was crackly and the bone board of Haversian system was brittle, which could lead to separation of bone boards and malposition of a few of cross bone boards.Conclusions: In dynamic state, sacrum fracture mostly belongs to Type Ⅰ and Type Ⅱ, and usually involves the nerve roots. Sacrum fracture is relevant to the microstructures, the distribution of the bone trabecula, the osseous lacuna and the Haversian system of sacrum. The fracture of ilium and acetabulum more frequently appears in static state, with slight wound of peripheral tissues.

  16. Clinical significance of sacral and pudendal nerve anatomy.

    Science.gov (United States)

    Juenemann, K P; Lue, T F; Schmidt, R A; Tanagho, E A

    1988-01-01

    The neuroanatomy and neurophysiology of the external urethral closure mechanisms still are under debate because the motor fibers that emanate from the sacral plexus and pudendal nerve to supply this segment have not been traced, nor has their functional interrelationship been established. Therefore, we dissected 3 male human cadavers (aged 31 to 69 years) by tracing the entire sacral plexus, particularly the pudendal nerve, from the cauda equina throughout the branching of the nerves to their final destination. The dissection demonstrated that the extrinsic urethral sphincter, formed by the rhabdosphincter around the membranous urethra as well as the levator ani muscle and pelvic floor (especially the transversus perinei muscle), is innervated by somatic nerve fibers that emanate primarily from sacral roots S2 and S3. In 5 patients with neurogenic lower urinary tract dysfunction electrostimulation of the sacral root and pudendal nerve markedly increased intraurethral closure pressures. Stimulation of the pudendal nerve or its transversus perinei branch alone resulted in an increase in intraurethral closure pressure to 60 to 70 cm. water--an increase similar to that produced by stimulation of the sacral root without neurotomy. By means of neurotomy and/or neural blockade with lidocaine we were able to differentiate between the contributions of each muscular element to the external sphincteric mechanism. Almost 70 per cent of the closure pressure of the external urethral sphincter is induced by stimulation of the S3 ventral root, while the other 30 per cent derives from S2 and S4 neuronal impulses.

  17. Pneumorrhachis Secondary to a Sacral Decubitus Ulcer.

    Science.gov (United States)

    Moayedi, Siamak; Babin, Lisa

    2016-07-01

    An elderly woman with a chronic decubitus sacral ulcer presented to the emergency department with sepsis. A computed tomography of her abdomen showed diffuse gas extending throughout the thoracolumbar spinal canal. Pneumorrhachis is a rare radiographic finding defined as gas within the spinal canal. There are many causes of pneumorrhachis ranging from trauma to infection. In this case the pneumorrhachis was caused by direct spread of gas-forming organisms from vertebral osteomyelitis. Emergency physicians should know about the implication of gas in the spinal canal in the setting of sepsis. PMID:27429699

  18. Sacral Rachipagus Parasite: A Case Report.

    Science.gov (United States)

    Rattan, Kamal Nain; Singh, Jasbir; Dalal, Poonam; Sonika, Pallavi; Rattan, Ananta

    2016-01-01

    We are reporting a case of sacral rachipagus parasite which was vaginally delivered as a large irregular mass attached to the sacral region by a vascular pedicle. This case was managed successfully by surgical excision of parasite.

  19. Sacral Rachipagus Parasite: A Case Report

    Directory of Open Access Journals (Sweden)

    Kamal Nain Rattan

    2016-03-01

    Full Text Available We are reporting a case of sacral rachipagus parasite which was vaginally delivered as a large irregular mass attached to the sacral region by a vascular pedicle. This case was managed successfully by surgical excision of parasite.

  20. Osteolytic extra-axial sacral myxopapillary ependymoma

    Energy Technology Data Exchange (ETDEWEB)

    Biagini, R.; Demitri, S.; Orsini, U. [Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna (Italy); Bibiloni, J. [Medical Sciences Campus San Juan, University of Puerto Rico (Puerto Rico); Briccoli, A. [Istituto di Patologia Chirurgica, University of Modena (Italy); Bertoni, F. [Servizio di Anatomia Patologica, Istituto Ortopedico Rizzoli Bologna (Italy)

    1999-10-01

    The authors report an unusual case of sacral osteolytic myxopapillary ependymoma treated with curettage and radiotherapy. There is no evidence of recurrence 8 years after treatment. A review of the literature is presented on sacral ependymomas presenting with an osteolytic radiographic appearance (24 cases in 18 reports). The differential diagnosis with other sacral neoplasms is discussed. (orig.)

  1. Pancreatic tissue fluid pressure during drainage operations for chronic pancreatitis

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Madsen, P;

    1990-01-01

    Pancreatic tissue fluid pressure was measured in 10 patients undergoing drainage operations for painful chronic pancreatitis. The pressure was measured by the needle technique in the three anatomic regions of the pancreas before and at different stages of the drainage procedure, and the results...... a decrease in pancreatic tissue fluid pressure during drainage operations for pain in chronic pancreatitis. Regional pressure decrease were apparently unrelated to ERCP findings....

  2. Postpartal sacral fracture without osteoporosis.

    Science.gov (United States)

    Rousière, M; Kahan, A; Job-Deslandre, C

    2001-02-01

    Stress fractures of the sacrum during pregnancy or the postpartum seem uncommon. We report a new case of nontrauma-related postpartal sacral fracture. Only four similar cases have been reported to date. The patient was 36 years of age and her fracture was diagnosed four weeks after her first delivery. Vitamin D levels were low, but there was no osteomalacia. Other standard laboratory tests were normal, as were absorptiometry measurements at the lumbar spine and femur. Rheumatologists should consider sacral fracture in pregnant or nursing patients with buttock pain. Magnetic resonance imaging is the diagnostic investigation of choice.

  3. The clinical analysis of sacral pressure ulcers utilizing perforator flaps%臀部穿支皮瓣治疗骶尾部褥疮100例临床分析

    Institute of Scientific and Technical Information of China (English)

    杜丽平; 傅荣; 游晓波

    2012-01-01

    Objective To explore the clinical effects of various types Perforator Flap in the Reconstruction of Sacral Pressure Ulcers. Complications were analyzed. Methods A retrospective study from 100 operated cases using the superior gluteal artery perforator (SGAP) for sacral pressure ulcer is reported. According to defect parts and size, the patients are divided into two groups, which were designed with pure pedicle or island flaps respectively. Results The defect areas ranged from 4cmX5cm-10cmX12cm and 84 cases of 100 were healed primarily. We analyze two group's Complications and assess their risk factors. There is a statistical difference between the two groups. Conclusion The perforator flaps is an ideal method for the treatment of Ischia-sacral pressure ulcer. The pure pedicle flap operation is simple with low risk, but has low mobility, which is applicable to smaller defects. The island flap is a relatively complicated operation and has high mobility! The operation is applicable to ulcer bigger defect.%目的 探讨应用各种类型臀部穿支动脉皮瓣修复骶尾部褥疮的手术方法及临床效果.方法 对应用穿支皮瓣修复治疗骶尾部褥疮的100例病例按皮瓣类别分组进行分析.根据缺损部位及大小分为两组,分别设计单纯带蒂穿支皮瓣(旋转或移位皮瓣)、岛状穿支皮辨(推进或移位)修复骶尾部褥疮,并对其治愈率、并发症发生率和复发率等进行分析.结果 100例病例中84例皮瓣全部成活,伤口均一期愈合.随访1~7年,皮瓣质地优良,外形满意,溃疡无复发.结论 穿支蒂皮辩设计灵活,切取方便,血供可靠,不损伤臀部肌肉,供区无需植皮,是修复臀骶部褥疮的理想方法;旋转或移位皮瓣手术操作较简单,成功率高,但移动性差,仅适用于皮肤缺损小的褥疮;岛状皮瓣移动性高,操作相对复杂,手术风险大,适用于皮肤缺损较大或周围瘢痕较多的褥疮.

  4. A combination of gestalt therapy, Rosen Body Work, and Cranio Sacral therapy did not help in chronic whiplash-associated disorders (WAD)--results of a randomized clinical trial.

    Science.gov (United States)

    Ventegodt, Søren; Merrick, Joav; Andersen, Niels Jørgen; Bendix, Tom

    2004-01-01

    The chronic state of whiplash-associated disorder (WAD) might be understood as a somatization of existential pain. Intervention aimed to improve quality of life (QOL) seemed to be a solution for such situations. The basic idea behind the intervention was holistic, restoring quality of life and relationship with self, in order to diminish tension in the locomotion system, especially the neck. A psychosomatic theory for WAD is proposed. Our treatment was a short 2-day course with teachings in philosophy of life, followed by 6-10 individual sessions in gestalt psychotherapy and body therapy (Rosen therapy and Cranio Sacral therapy), followed by a 1-day course approximately 2 months later, closing the intervention. Two independent institutions did the intervention and the assessments. In a randomized, clinically controlled setting, 87 chronic WAD patients were included with a median duration of 37 months from their whiplash accidents. One patient never started. Forty-three had the above intervention (female/male = 36/7, ages 22-49, median 37 years) and another 43 were assigned to a nontreated control group (female/male = 35/8, ages 18-48, median 38). Six had disability pension and 27 had pending medicolegal issues in each group. Effect variables were pain in neck, arm, and/or head; measures of quality of life and daily activities; as well as general physical or mental health. Wilcoxon test for between-groups comparisons with intention-to-treat analyses was conducted; the square curve paradigm testing for immediate improvements of health and quality of life was also used. The groups were comparable at baseline. From the intervention group, 11 dropped out during the intervention (4 of those later joined the follow-up investigation), 22 of the remaining 32 graduated the course, and 35 of the 43 controls did as well. Approximately 3 months later, we found no clinically relevant or significant increase in any effect measure. The above version of a quality of life

  5. Is Lumbo-Sacral Angle Related to Plantar Loading Patterns in Patients with Ankylosing Spondylitis?

    Directory of Open Access Journals (Sweden)

    Elif Aydın

    2016-08-01

    Full Text Available Objective: Loss of lumbar lordosis is a clinical feature of ankylosing spondylitis (AS. Pedobarographic analysis assesses the interaction between the foot and the supporting surface. Postural abnormalities can reflect as pressure distribution deviations on pedobarography. The objective of the present study was to assess whether loss of lumbar lordosis detected with lumbo-sacral angle measurement is related to postural control assessed by plantar loading distribution in patients with AS. Materials and Methods: Thirty-two patients (two female, 30 male, mean age: 43.06±7.8 years with the diagnosis of AS, who already had a lateral lumbo-sacral X-ray performed within the past one year, were included in the study. Static and dynamic pedobarographic analyses of the patients were performed. The radiographic measurement of lumbo-sacral angle was done from lateral lumbo-sacral X-rays of the patients. Results: The static pedobarographic measurement revealed that lumbo-sacral angle was significantly correlated with forefoot plantar pressure (p=0.042; r=0.361. In the dynamic assessment, the maximum pressures were lower under the first metatarsal area in patients with lower lumbo-sacral angle (p=0.352; r=0.048. Conclusion: These findings suggest that foot joints may contribute to the compensation mechanism against the postural changes in patients with AS, statically and dynamically.

  6. Evaluation of sacral neuromodulation in treating 34 cases of chronic voiding-defecation dysfunction%骶神经调节测试治疗慢性功能性尿便障

    Institute of Scientific and Technical Information of China (English)

    卫中庆; Ernest Weil; 易超然; 宋涛; 于洪波; 文伟; 孙则禹; Philip Van Kerrebroeck

    2009-01-01

    Objective To explore the effectiveness and security of temporary lead and tined lead in evaluation of sacral neuromodulation. Methods Thirty four cases with chronic voiding-defecation dysfunction, in which 4 cases were refractory urgent incontinence. 8 cases were refractory urinary urgency-frequency, 8 cases(6 cases with constipation) were chronic un-obstructive urinary retention, 4 cases were chronic pelvic pain syndrome or IC, 10 cases neurogenic bladder (3 and 7 cases resulted from spinal cord injury and Spina bifida respectively) . Temporary test electrodes and tined-lead were implanted into 16 and 18 cases respectively. And then the temporary stimulation tests were performed in a period of 5 ~ 14 days, recorded the daily times and volume of voiding and the related urodynamic parameters. And comparing the effectiveness of the two groups was performed. Results In patients with urgent incontinence and urinary urgency-frequency syndrome their improvements were 43 % and 35 % respectively. About 10% were cured completely. In chronic voiding-defecation dysfunction, there were 32.3 % and 38.2 % improvement respectively in temporary and tined lead group with significant difference. There were 23.7 % and 28.3 % improvement of IC respectively in temporary lead and tined lead group in the respects of volume voiding and pain amelioration. In temporary lead and tined lead group shifting of electrode position occurred in 4 cases and 1 case respectively. Conclusion Sacral neuromodulation is a secure, minimally invasive, effective method for chronic voiding dysfunction; tined lead electrode has the superiorities of minimally invasive, prevents the shift position of the electrode, and raised the effective rate.%目的 探讨骶神经调节测试评估阶段临时电极及自固定倒齿状电极(Tined Lead)的疗效及安全性.方法 34例慢性尿便功能障碍患者,其中难治性急迫性尿失禁4例,难治性尿频、尿急综合症8例,非梗阻性慢性尿潴留8

  7. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Directory of Open Access Journals (Sweden)

    Korambayil Pradeoth

    2010-01-01

    Full Text Available The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18% suffered complications.

  8. Perforator propeller flaps for sacral and ischial soft tissue reconstruction

    Science.gov (United States)

    Korambayil, Pradeoth M.; Allalasundaram, KV; Balakrishnan, TM

    2010-01-01

    The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications. PMID:21217972

  9. 34例慢性盆底功能障碍骶神经调节治疗的测试结果观察%Test results of sacral neuromodulation in 34 patients with chronic pelvic floor dysfunction

    Institute of Scientific and Technical Information of China (English)

    卫中庆; 沈百欣; 丁留成; 易超然; 丁曙晴; 于洪波; 文伟; 孙则禹; PhilipVanKerrebroeck

    2012-01-01

    Objective To investigate the therapeutic effect and safety of temporary electrode and Tined Lead electrode in Bacral neuromodulation evaluation. Methods Thirty-four patients with chronic pelvic floor dysfunction were divided into temporary electrode group (n = 16) and Tined Lead electrode group (n = 18), and temporary stimulation tests were performed after electrode placement. The conditions of voiding and defecation were recorded every day, and related urodynamic parameters were measured. Results The symptoms improved in 43% patients with urgent incontinence and 35% patients with urinary frequency and urgency, and 10% patients with urgent incontinence or urinary frequency and urgency were cured. There were significant differences in the rates of self-perceived improvement of voiding and defecation between temporary electrode group and Tined Lead electrode group (32.2% vs 38. 2% , P 0.0S) . Electrode shift took place in 4 patients in temporary electrode group and in 1 patient in Tined Lead electrode group. Conclusion Sacral neuromodulation is a safe, minimally invasive and effective method for treatment of chronic pelvic floor dysfunction, and Tined Lead electrode may prevent the electrode shift, increase the rate of success, and improve the therapeutic effect.%目的 探讨骶神经调节测试评估阶段临时电极及自固定例齿状( Tined Lead)电极的疗效及安全性.方法 将34例慢性盆底功能障碍患者按电极置入方法不同分为临时电极组(n=16)和自固定Tined Lead电极组(n=18),并进行术后两种电极临时刺激测试.在测试期记录排尿排便日记,进行相关尿动力学参数测定.结果 急迫性尿失禁患者中,有43%症状改善;尿频尿急患者中有35%症状改善;10%的急迫性尿失禁/尿频尿急患者治愈.临时电极组患者排尿排便自我感觉的改善率为32.2%,自固定Tined Lead电极组为38.2%,两组差异有统计学意义(P<0.05).盆底疼痛综合征/间质性膀胱

  10. Anatomical Study of Sacral Hiatus for Caudal Epidural Block

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    Dhananjay S Patil

    2012-06-01

    Full Text Available Introduction: Anatomy of the sacral hiatus is having clinical importance during caudal epidural block. Present study is aimed at determining anatomy of sacrum specially sacral hiatus for caudal epidural block, with the help of morphometric measurements of the sacrum in relation to sacral hiatus in dry sacral bones. Material & method: Total 103 complete and undamaged adult, dry sacral bones were measured with Vernier caliper (accuracy 0.1 mm and anatomical measurements were obtained. Results: Three bones were excluded because of total posterior closure defect. Agenesis of the sacral hiatus was detected in three sacral bones. Right and left superolateral sacral crests of the sacrum were taken as two points on dorsal surface of sacrum (forming the base of a triangle because posterior superior iliac spines impose on the superolateral sacral crests. The distance between the two superolateral sacral crests (base of a triangle, the distances between the right and left superolateral sacral crest and the sacral apex were on average 60.61(SD 6.71, 61.95 (11.71 and 61.4 (11.98 mm respectively.. Summary: An equilateral triangle formed between the apex of the sacral hiatus and right and left superolateral sacral crests. This equilateral triangle will help in determining the location of the sacral hiatus during caudal epidural block. [National J of Med Res 2012; 2(3.000: 272-275

  11. Sacral neuromodulation: No more skiing?

    Science.gov (United States)

    Wöllner, Jens; Pannek, Jürgen

    2016-01-01

    Patients with spinal cord injury (SCI) commonly suffer from neurogenic lower urinary tract dysfunction (NLUTD). Sacral neuromodulation (SNM) offers an alternative in the treatment of detrusor overactivity in patients with NLUTD. We report the cases of three patients with NLUTD due to SCI who received SNM. Due to treatment success, all patients could resume skiing. All suffered from skiing accidents, leading to a decreased effectiveness of SNM. Subsequent evaluation revealed a defect of the impulse generator (IPG) and/or dislocation of the electrodes. Reprogramming or replacement of the IPG or the electrodes resulted in restoration of SNM function. Trauma due to skiing is a potential risk factor for the integrity of SNM. Patients with SNM should be informed about the potential risk of SNM damage by falls and accidents. PMID:26754577

  12. U-shaped sacral fractures: Surgical treatment and quality of life

    NARCIS (Netherlands)

    A.J.G. Gribnau; P. Boele van Hensbroek; R. Haverlag; K.J. Ponsen; H.D. Been; J.C. Goslings

    2009-01-01

    Background: U-shaped sacral fractures are rare and highly unstable pelvic ring fractures. They are not recognised in the standard classification systems of these fractures. The fracture pattern is associated with significant neurological injury and can lead to progressive deformity and chronic pain

  13. Lateral sacral lipomyelomeningocele : a rare anomaly.

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    Shetty D

    2002-04-01

    Full Text Available Lateral sacral lipomyelomeningocele is a rare spinal developmental anomaly. In the case under report, the fat attached to the neural placode was blending with the gluteal fat externally. The cord was tethered at this level. Multiple bony anomalies and diastematomyelia were associated findings. A case of lateral sacral lipomyelomeningocele with excellent imaging detail provided by the multiplanar magnetic resonance (MR scan is reported.

  14. Jogger's fracture and other stress fractures of the lumbo-sacral spine

    International Nuclear Information System (INIS)

    The posterior rings of the lower lumbo-sacral vertebrae are subject to stress fractures at any part - pedicle, pars, or lamina. The site of fracture is apparently determined by the axis of weight bearing. The three illustrative clinical examples cited include a jogger with a laminar fracture, a ballet dancer with pedicle fractures, and a nine-year-old boy with fractures of pars and lamina. Chronic low back pain is the typical complaint with stress fractures of the lower lumbo-sacral spine. Special imaging techniques are usually needed to demonstrate these lesions, including vertebral arch views, multi-directional tomography, and computed tomography (CT). (orig.)

  15. Aggressive blood pressure control for chronic kidney disease unmasks moyamoya!

    OpenAIRE

    Davis, T. Keefe; Halabi, Carmen M.; Siefken, Philp; Karmarkar, Swati; Leonard, Jeffrey

    2013-01-01

    Hypertensive crises in children or adolescents are rare, but chronic kidney disease (CKD) is a major risk factor for occurrence. Vesicoureteral reflux nephropathy is a common cause of pediatric renal failure and is associated with hypertension. Aggressive blood pressure (BP) control has been shown to delay progression of CKD and treatment is targeted for the 50th percentile for height when compared with a target below the 90th percentile for the general pediatric hypertensive patient. We pres...

  16. Balancing food and predator pressure induces chronic stress in songbirds.

    OpenAIRE

    Clinchy, Michael; Zanette, Liana; Boonstra, Rudy; Wingfield, John C.; Smith, James N. M.

    2004-01-01

    The never-ending tension between finding food and avoiding predators may be the most universal natural stressor wild animals experience. The 'chronic stress' hypothesis predicts: (i) an animal's stress profile will be a simultaneous function of food and predator pressures given the aforesaid tension; and (ii) these inseparable effects on physiology will produce inseparable effects on demography because of the resulting adverse health effects. This hypothesis was originally proposed to explain...

  17. Central Blood Pressure and Chronic Kidney Disease Progression

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    Debbie L. Cohen

    2011-01-01

    Full Text Available Hypertension, diabetes, and proteinuria are well-recognized risk factors for progressive kidney function loss. However, despite excellent antihypertensive and antidiabetic drug therapies, which also often lower urinary protein excretion, there remains a significant reservoir of patients with chronic kidney disease who are at high risk for progression to end-stage kidney disease. This has led to the search for less traditional cardiovascular risk factors that will help stratify patients at risk for more rapid kidney disease progression. Among these are noninvasive estimates of vascular structure and function. Arterial stiffness, manifested by the pulse wave velocity in the aorta, has been established in a number of studies as a significant risk factor for kidney disease progression and cardiovascular endpoints. Much less well studied in chronic kidney disease are measures of central arterial pressures. In this paper we cover the physiology behind the generation of the central pulse wave contour and the studies available using these approaches and conclude with some speculations on the rationale for why measurements of central pressure may be informative for the study of chronic kidney disease progression.

  18. Intensity-Modulated Radiotherapy of Sacral Chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Thilmann, Christoph; Schulz-Ertner, Daniela; Zabel, Angelika; Herfarth, Klaus K.; Wannenmacher, Michael; Debus, Juergen [German Cancer Research Center, Heidelberg (Germany)

    2002-08-01

    In a case of partially resected sacral chordoma, the planning target volume (PTV) received 60 Gy and the gross target volume (GTV) 72 Gy using inversely planned, intensity-modulated, radiation therapy (IMRT). IMRT was compared with 3D-conformal radiotherapy (CRT). With IMRT, it was found that dose distribution is more homogeneous within the PTV outside the GTV and allows simultaneous dose escalation within the GTV. The volume of bowel receiving a dose higher than 40 Gy was reduced from 400cc with CRT to 220cc with IMRT. If particle therapy is not available, IMRT seems to be a promising alternative in the treatment of sacral chordomas.

  19. Sacral-neuromodulation CT-guided

    International Nuclear Information System (INIS)

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  20. Case series of abdominal sacral colpopexy

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    Vandana Dhama

    2016-06-01

    Conclusions: Abdominal sacral colpopexy with polypropylene mesh is a safe, effective treatment in patients having post hysterectomy vaginal vault proplase. When done by experienced gynecologist, major post-operative complications seem to be very few in patients having normal BMI and no major systemic illnesses. [Int J Reprod Contracept Obstet Gynecol 2016; 5(6.000: 1992-1995

  1. Morphometric study of the sacral hiatus in Nigerian dry human sacral bones

    Directory of Open Access Journals (Sweden)

    Ukoha Ukoha U, Okafor Joseph I, Anyabolu Arthur E, Ndukwe Godwin U, Eteudo Albert N, Okwudiba Nchedo J

    2014-03-01

    Full Text Available Background: The sacrum is a large triangular bone formed by the fusion of the five sacral vertebrae and forms the caudal region of the vertebral column. Aims: This was aimed at studying the morphometry of the sacral hiatus noting its anatomical variations that is useful in caudal epidural anaesthesia. Materials and Methods: Eighty three intact adult sacra of unknown sex were measured with vernier callipers and the various shapes of the sacral hiatus were also noted. Results: The findings revealed that inverted U (48.2% was the most predominant shape; followed by inverted V (34.9%, dumbbell (4.8%, bifid (4.8% and irregular (4.8%. The mean anteroposterior diameter at the apex was 5.52 ± 1.89mm. The mean length of the sacral hiatus was 20.05 ± 9.22mm and the transverse width at base of hiatus was 12.35 ± 3.12mm. There was complete spina bifida in 1.2% and absence of sacral hiatus in another 1.2%. Conclusion: The knowledge of anatomical variations of sacral hiatus is important in the administration of caudal epidural anaesthesia in the studied population and may help to reduce its failure rate.

  2. Morphometrical study of sacral hiatus in dry human sacra

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    Rajapur Parashuram

    2015-07-01

    Results: Various shapes of sacral hiatus were observed which included Inverted-U (50%, Inverted-V (27.5%, Irregular (15.5%, Dumb bell (2%, and Bifid (2%. The mean anteroposterior depth of sacral canal at the level of apex of sacral hiatus was 4.25mm. The mean length of sacral hiatus was 19.63 mm and the mean transverse width of sacral hiatus at the level of base was 11.42 mm. There was complete spina bifida in 4 (2% and absence of sacral hiatus in 2 (1% cases. Conclusion: The sacral hiatus has anatomical variations. Understanding of these variations may improve the reliability of caudal epidural anaesthesia. [Int J Res Med Sci 2015; 3(7.000: 1726-1733

  3. Sacrality and worldmaking: new categorial perspectives

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    William E. Paden

    1999-01-01

    Full Text Available The category of the sacred in particular and the role of transcultural concept-formation in general have undergone an obvious crisis. For the most part, "the sacred," if not an empty label, has been linked with theologism, and transcultural concepts have been condemned for their general non-comparability and colonialist intent. The author approaches the matter of transcultural templates through an analysis of certain concepts of sacrality. With some exceptions, the discourse of sacrality has indeed been dominated by a single model, where "the sacred" became a reified noun—a substantive term for a supernatural reality, a label for the transcendent, or even an epithet for divinity, mystery, the wholly other. As such, the expression has functioned to bestow a sense of unity to the diversity of cultures, link that unity with a transcendent reality, and offer a simple way of making sense of otherwise foreign beliefs and practices by giving them a familiar, generic referent.

  4. Sacral arcuate lines: Anatomy and pathologic conditions

    International Nuclear Information System (INIS)

    The sacrum is one of the most commonly radiographed bones of the human body as part of abdominal and pelvic radiologic examinations. This paper describes the radiologic anatomy of the sacral arcuate lines and presents a systematic approach to identifying pathologic conditions, for example, primary and metastatic malignancies, traumatic and osteoporotic fractures, vascular erosions from aneurysms, changes from neural tumors, and changes following radiation therapy

  5. Synovial Cyst Mimicking an Intraspinal Sacral Mass

    Directory of Open Access Journals (Sweden)

    Jason Hoover

    2014-01-01

    Full Text Available A 68-year-old female had a three-week history of severe low back pain radiating down the posterior left buttocks and left leg exacerbated by standing and walking. Lumbar spine MRI revealed cystic mass with similar intensity to cerebrospinal fluid located on dorsolateral left side of the sacral spinal canal inferior to the S1 pedicle. There was compression of left exiting S1 and traversing S2 nerve roots. Neurosurgery consult was requested to evaluate the cystic mass in the sacral spinal canal. After clinical evaluation, an unusually located synovial cyst was thought possible. Cyst contents were heterogeneous, suggestive of small hemorrhage and acute clinical history seemed reasonable. Left S1 and partial left S2 hemilaminectomy was performed and an epidural, partially hemorrhagic cyst was removed. There was no obvious connection to the ipsilateral L5-S1 facet joint. Pathology revealed synovial cyst, and the patient’s leg pain was improved postoperatively. This synovial cyst was unusual as it had no connection with the facet joint intraoperatively and its location in the sacral canal was uncommon.

  6. Traditional and New Tendencies to Outdoor Sacral Spaces in Lithuania

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    Linas Krūgelis

    2011-03-01

    Full Text Available The article describes some features and traditions of outdoor sacral spaces in Lithuania, includes a historical analysis and various features of different historical periods and explains the new tendencies and possibilities of future development in contemporary Lithuania. By analysing the phenomenon of outdoor sacral spaces, some archaeological and historical data is used to identify the principles of creating such sacral space.Article in Lithuanian

  7. Morphometric data of canine sacral nerve roots with reference to electrical sacral root stimulation.

    Science.gov (United States)

    Rijkhoff, N J; Koldewijn, E L; d'Hollosy, W; Debruyne, F M; Wijkstra, H

    1996-01-01

    Experiments to investigate restoration of lower urinary tract control by electrical stimulation of the sacral nerve roots are mostly performed on dogs, yet little morphometric data (such as canine root and fiber diameter distributions) are available. The aim of this study was to acquire morphometric data of the intradural canine sacral dorsal and ventral roots (S1-S3). Cross-sections of sacral roots of two beagle dogs were analyzed using a light microscope and image processing software. The cross-sectional area of each root was measured. The diameters of the fibers and the axons in the cross-sections of the S2 and S3 roots were measured and used to construct nerve fiber diameter frequency distribution histograms. The results show a unimodal diameter distribution for the dorsal roots and a bimodal distribution for the ventral roots. In addition the average ratio g of the axon diameter to fiber diameter was calculated for each root. PMID:8732990

  8. Malignant fibrous histiocytoma developing in irradiated sacral chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Halpern, J.; Kopolovic, J.; Catane, R.

    1984-06-15

    Malignant fibrous histiocytoma (MFH), arising at the site of a sacral chordoma 8 years after massive radiotherapy, is described. Initially, the patient received 7000 rad to the sacral area and, on recurrence, 5 years later, an additional 4000 rad. Two years later, a sacral mass was noted again. Biopsy then revealed MFH; chest x-ray showed multiple lung metastases. A combination chemotherapy, consisting of cyclophosphamide, vincristine, adriamycin (doxorubicin), and DTIC, resulted in a 6 month partial response. Subsequently, the patient died because of progressive metastatic disease. At autopsy, 8 years after diagnosis, both the sacral lesion and the lung metastases proved to be MFH, and no residual chordoma was found.

  9. Implantable wireless battery recharging system for bladder pressure chronic monitoring.

    Science.gov (United States)

    Young, Darrin J; Cong, Peng; Suster, Michael A; Damaser, Margot

    2015-11-21

    This paper presents an implantable wireless battery recharging system design for bladder pressure chronic monitoring. The wireless recharging system consists of an external 15 cm-diameter 6-turn powering coil and a silicone-encapsulated implantable rectangular coil with a dimension of 7 mm × 17 mm × 2.5 mm and 18 turns, which further encloses a 3 mm-diameter and 12 mm-long rechargeable battery, two ferrite rods, an ASIC, and a tuning capacitor. For a constant recharging current of 100 μA, an RF power of 700 μW needs to be coupled into the implantable module through the tuned coils. Analyses and experiments confirm that with the two coils aligned coaxially or with a 6 cm axial offset and a tilting angle of 30°, an external power of 3.5 W or 10 W is required, respectively, at an optimal frequency of 3 MHz to cover a large implant depth of 20 cm.

  10. An unusual case of unilateral limb hypertrophy: Lipoma of sacral roots

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    Archana B Netto

    2012-01-01

    Full Text Available We report an unusual case of unilateral limb pseudo hypertrophy in a 21-year-old lady who developed progressive enlargement of the right calf followed by thigh in association with chronic leg pain. Magnetic resonance imaging (MRI of the affected limb confirmed enlargement of various muscles. Electromyography revealed neurogenic features consistent with S1 radiculopathy. MRI of the lumbosacral spine showed tethered cord with a lipoma infiltrating multiple sacral roots. Our case illustrates that muscular pseudo hypertrophy may follow chronic denervation as a consequence of spinal neural compressive disease. The various mechanisms postulated for this distinct condition are outlined.

  11. Hand metastasis from a sacral chordoma

    Science.gov (United States)

    Kaya, M; Sugita, S; Soma, T; Sasaki, M; Yamashita, T

    2014-01-01

    Chordomas are rare, low grade, malignant tumours derived from the ectopic remnants of the notochord that line the axial skeleton. They are characterised by their slow growth, long disease course and propensity for local relapse. Furthermore, up to 40% of non-cranial chordomas metastasise. We describe the first reported case of a hand metastasis arising from a conventional sacral chordoma after carbon ion radiotherapy. The common occurrence of distant metastasis with chordomas makes it important to perform a systemic examination, in part because their resection might improve patient prognosis. PMID:25350167

  12. Vacuum sealing drainage with perforator flap repair in the reconstruction of sacral pressure sore%负压封闭引流技术在臀部穿支皮瓣治疗骶尾部褥疮中的应用

    Institute of Scientific and Technical Information of China (English)

    傅荣; 游晓波

    2011-01-01

    Objective To study the effect of vacuum sealing drainage (VSD)on pressure sore. Methods A retrospective study of 20 patients with pressure sore were admitted in our hospital from 2009 to 2010. After debridement, wounds of patients were dealt with VSD for 7 ~ 14 days. Systemic treatments such as infection control and nutritional support were carried out at the same time. Wound healing was observed. Results Local inflammatory response of the patients reduced after VSD, which provided a good condition for the second stage surgery. All cases were healed primarily. Conclusions VSD can effectively reduce the infection and exudation of pressure sore, improve the success rate of surery, reduce treatment cost, which is an ideal method for ischia-sacral pressure ulcer.%目的 探讨负压封闭引流(VSD)技术在骶尾部褥疮治疗中的应用.方法 2009~2010年在四川省人民医院住院治疗的20例骶尾部褥疮患者,一期实施清创手术后进行持续负压吸引7~14天,同时进行控制感染、营养支持等全身治疗,观察创面的愈合情况.结果 20例患者局部炎性反应明显减轻,创面明显缩小,为二期手术提供了良好条件,再行穿支皮瓣修复,伤口均一期愈合.随访1年,褥疮无复发.结论 VSD技术可有效减少褥疮感染和渗出,提高穿支皮瓣手术成功率以及减少治疗费用,值得推广应用.

  13. Comparison of salbutamol given by intermittent positive-pressure breathing and pressure-packed aerosol in chronic asthma.

    OpenAIRE

    Anderson, P. B.; Goude, A; Peake, M D

    1982-01-01

    A double-blind crossover study was performed to compare 4 . 8 mg salbutamol given by pressure-packed aerosol and intermittent positive-pressure breathing nebulization in chronic asthmatic patients. The two delivery techniques produced similar changes in respiratory function and pulse rates. Given equal effect, a high-dose pressure-packed aerosol would have advantages in cost and convenience over nebulization techniques.

  14. Postpartum Sacral Stress Fracture: An Atypical Case Report

    Directory of Open Access Journals (Sweden)

    Andrea Speziali

    2015-01-01

    Full Text Available Sacral stress fractures are common in elderly people. However, sacral stress fracture should be always screened in the differential diagnoses of low back pain during the postpartum period. We present a case of sacral fracture in a thirty-six-year-old woman with low back pain and severe right buttock pain two days after cesarean section delivery of a 3.9 Kg baby. The diagnosis was confirmed by MRI and CT scan, while X-ray was unable to detect the fracture. Contribution of mechanical factors during the cesarean section is not a reasonable cause of sacral fracture. Pregnancy and lactation could be risk factors for sacral stress fracture even in atraumatic delivery such as cesarean section. Our patient had no risk factors for osteoporosis except for pregnancy and lactation. Transient or focal osteoporosis is challenging to assess and it cannot be ruled out even if serum test and mineral density are within the normal range.

  15. Evaluation of pancreatic tissue fluid pressure and pain in chronic pancreatitis. A longitudinal study

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Bülow, J;

    1990-01-01

    Pancreatic tissue fluid pressure and pain were compared in a longitudinal study in nine patients undergoing drainage operations for pain in chronic pancreatitis. Pressure measurements were performed percutaneously before the operation, intraoperatively before and after the drainage procedure, and...... duration of the pain-free period was significantly related to the size of the intraoperative pressure decrease (R = 0.79, p less than 0.03). These results further suggest that there is a causal relationship between pancreatic tissue fluid pressure and pain in chronic pancreatitis and that the success of...... the drainage procedure may be predicted by intraoperative pancreatic tissue fluid pressure measurements....

  16. Central Pulse Pressure in Chronic Kidney Disease: A CRIC Ancillary Study

    Science.gov (United States)

    Townsend, Raymond R.; Chirinos, Julio A.; Parsa, Afshin; Weir, Matthew A.; Sozio, Stephen M.; Lash, James P.; Chen, Jing; Steigerwalt, Susan P.; Go, Alan S.; Hsu, Chi-yuan; Rafey, Mohammed; Wright, Jackson T.; Duckworth, Mark J.; Gadegbeku, Crystal A.; Joffe, Marshall P.

    2010-01-01

    Central pulse pressure can be non-invasively derived using the radial artery tonometric methods. Knowledge of central pressure profiles has predicted cardiovascular morbidity and mortality in several populations of patients, particularly those with known coronary artery disease and those receiving dialysis. Few data exist characterizing central pressure profiles in patients with mild-moderate chronic kidney disease who are not on dialysis. We measured central pulse pressure cross-sectionally in 2531 participants in the Chronic Renal Insufficiency Cohort study to determine correlates of the magnitude of central pulse pressure in the setting of chronic kidney disease. Tertiles of central pulse pressure (CPP) were 51 mmHg with an overall mean (± S.D.) of 46 ± 19 mmHg. Multivariable regression identified the following independent correlates of central pulse pressure: age, gender, diabetes mellitus, heart rate (negatively correlated), glycosylated hemoglobin, hemoglobin, glucose and PTH concentrations. Additional adjustment for brachial mean arterial pressure and brachial pulse pressure showed associations for age, gender, diabetes, weight and heart rate. Discrete intervals of brachial pulse pressure stratification showed substantial overlap within the associated central pulse pressure values. The large size of this unique chronic kidney disease cohort provides an ideal situation to study the role of brachial and central pressure measurements in kidney disease progression and cardiovascular disease incidence. PMID:20660819

  17. Pancreatic tissue fluid pressure and pain in chronic pancreatitis

    DEFF Research Database (Denmark)

    Ebbehøj, N

    1992-01-01

    A casual relation between pancreatic pressure and pain has been searched for decades but lack of appropriate methods for pressure measurements has hindered progress. During the 1980's the needle method has been used for direct intraoperative pancreatic tissue fluid pressure measurements and later...... for percutaneous sonographically-guided pressure measurements. Clinical and experimental evaluation of the method showed comparable results at intraoperative and percutaneous measurements and little week-to-week variation. Furthermore, comparable pressures in duct and adjacent pancreatic tissue were found, i.......e. the needle pressure mirrors the intraductal pressure. Comparisons of pain registrations, morphological and functional parameters with pancreatic tissue fluid pressure measurements have revealed a relation between pressure and pain which probably is causal. In patients with pain the high pressures previously...

  18. Sacral-neuromodulation CT-guided; Nuova tecnica di centraggio TC-assistista nella neuromodulazione sacrale

    Energy Technology Data Exchange (ETDEWEB)

    Amoroso, Lamberto; Ricci, Stefano [INRCA, Ancona (Italy). Dipartimento di radiologia e medicina nucleare; Pelliccioni, Giuseppe; Scarpino, Osvaldo [INRCA, Ancona (Italy). Unita' operativa di radiologia; Ghiselli, Roberto; Saba, Vittorio [INRCA, Ancona (Italy). Dipartimento di chirurgia

    2005-04-01

    Purpose: Sacral neuromodulation is a new treatment for refractory voiding disorders such as urge incontinence, urinary retention, frequency-urgency syndromes and faecal incontinence. The current approach to sacral nerve stimulation consists of a two-stage procedure. The first is a PNE test (Percutaneous Nerve Evaluation) by a provisional electrically stimulated spinal needle, placed percutaneously in the S3 foramina for four of ten days. If successful, the second stage, permanent implantation, is carried out. The PNE test is performed under fluoroscopic control using the palpable bony sacral foramina as referral points. This technique can show some limitations, such as operator Rx exposure, poor visualization of sacral foramina because of bowel gas artefacts or sacral malformation. In order to reduce these inconveniences and to improve efficiency of the test we tried an alternative technique. The purpose of our study was to test the use of CT as an alternative technique in order to evaluate its advantages and possible routine use. Materials and methods: We tested 30 patients with the PNE test under CT guidance (16 males and 14 females) suffering from serious pelvic disorders and not responding to the normal therapeutic regime. Twenty-seven patient showed relative anatomical integrity of the pelvis and the sacrum, the remaining 3 patients presented morphological anormalities of the sacral foramina. With the patient in the prone position the sacral foramina were identified with CT volumetric scanning using a spiral CT scanner equipped with a second console for the three-dimensional reconstructions. Having identified the location of the S3 foramina, a sterile field was prepared and the spiral needle introduced checking correct positioning with a CT control scan. An electrode was inserted after having checked correct muscular contractile response and the precise position with a further CT scan. Results: Thirty patients were subjected to PNE under CT guidance for a

  19. Features of ambulatory blood pressure in 540 patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    王成

    2013-01-01

    Objective To explore the features and influencing factors of ambulatory blood pressure in chronic kidney disease(CKD)patients.Methods A total of 540 CKD patients from May 2010 to May 2012 in our department

  20. Circadian variation of blood pressure in patients with chronic renal failure on continuous ambulatory peritoneal dialysis

    DEFF Research Database (Denmark)

    Clausen, P; Feldt-Rasmussen, B; Ladefoged, Jens

    1995-01-01

    The circadian pattern of blood pressure variation was investigated in 10 patients with advanced chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) and in an age-matched group of controls without renal disease with similar office blood pressure level. Monitoring was done using....... In patients with chronic renal failure undergoing CAPD, an otherwise unnoticed 24-h hypertension and nocturnal blood pressure elevation can be discovered by use of 24-h blood pressure monitoring and this may indicate a need of earlier start of antihypertensive treatment in CAPD patients with borderline...

  1. Women with chronic and episodic migraine exhibit similar widespread pressure pain sensitivity

    DEFF Research Database (Denmark)

    Palacios, Maria; Lima Florencio, Lidiane; Natália Ferracini, Gabriela;

    2016-01-01

    OBJECTIVE: To investigate widespread pressure hyperalgesia in the trigemino-cervical and extra-trigeminal (distant pain-free) regions in women with episodic and chronic migraine. METHODS: Fifty-one women with episodic migraine, 52 women with chronic migraine, and 52 healthy women without headache...

  2. Non-invasive positive pressure ventilation (NIPPV) in stable patients with chronic obstructive pulmonary disease (COPD)

    NARCIS (Netherlands)

    Wijkstra, PJ

    2003-01-01

    While non-invasive positive pressure ventilation (NIPPV) has become an accepted management approach for patients with acute hypercapnia, it remains unclear whether it can also be beneficial in stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure. Randomised c

  3. The effect of chronic peripheral nesfatin-1 application on blood pressure in normal and chronic restraint stressed rats: related with circulating level of blood pressure regulators.

    Science.gov (United States)

    Ayada, Ceylan; Turgut, Günfer; Turgut, Sebahat; Güçlü, Zuhal

    2015-01-01

    Nesfatin is a peptide secreted by peripheral tissues, central and peripheral nervous system. It is involved in the regulation of homeostasis. Although the effects of nesfatin-1 on nutrition have been studied widely in the literature, the mechanisms of nesfatin-1 action and also relations with other physiological parameters are still not clarified well. We aimed to investigate the effect of peripheral chronic nesfatin-1 application on blood pressure regulation in normal and in rats exposed to restraint immobilization stress. In our study, three month-old male Wistar rats were used. Rats were divided into 4 groups as Control, Stress, Control+Nesfatin-1, Nesfatin-1+Stress. Angiotensinogen, angiotensin converting enzyme 2, angiotensin II, endothelin-1, endothelial nitric oxide synthase, aldosterone, cortisol, nesfatin-1 levels were determined in plasma samples by ELISA. Our results have shown that chronic peripheral nesfatin-1 administration increases blood pressure in normal and in rats exposed to chronic restraint stress. Effect of nesfatin-1 on circulating level of angiotensinogen, angiotensin converting enzyme 2, angiotensin II, endothelin-1, endothelial nitric oxide synthase, aldosterone and cortisol has been identified. We can conclude that elevated high blood pressure after chronic peripheral nesfatin-1 administration in rats exposed to chronic restraint stress may be related to decreased plasma level of endothelial nitric oxide synthase concentration. PMID:25504061

  4. Recurrent meningitis in a case of congenital anterior sacral meningocele and agenesis of sacral and coccygeal vertebrae Meningite recorrente em um paciente com meningocele sacral anterior e agenesia sacral e coccigea

    Directory of Open Access Journals (Sweden)

    Carolina A. R. Funayama

    1995-12-01

    Full Text Available A rare case of recurrent meningitis due to congenital anterior sacral meningocele and agenesis of the sacral and coccygeal vertebrae is described. An autosomal dominant inheritance is demonstrated for lower cord malformation, and environmental factors (chromic acid or fumes are discussed.Um caso raro de meningite recorrente devido a meningocele sacral anterior e agenesia das vértebras sacras coccígeas é descrito. Herança autossômica dominante para malformação medular caudal é demonstrada e, possíveis fatores ambientais (ligados ao cromo, são discutidos.

  5. Primary atypical sacral meningioma- not always benign

    Energy Technology Data Exchange (ETDEWEB)

    Bhadra, A.K.; Casey, A.T.H.; Saifuddin, A.; Briggs, T.W. [Royal National Orthopaedic Hospital, Stanmore, London (United Kingdom)

    2007-06-15

    We present a case of an atypical recurrent meningioma of the sacrum with pulmonary metastasis in a 31-year-old man. He presented with deep-seated buttock pain and urinary hesitancy for 3 months. MRI revealed a lesion occupying the central and left side of the sacral canal at the S1-S2 level. Surgical excision of the lesion via a posterior approach was undertaken, and the patient became symptom-free post-operatively. Histology confirmed atypical meningioma. Eight months later he re-presented with similar symptoms, and MRI confirmed local recurrence. The patient underwent left hemisacrectomy. Six months later he again presented with low back pain and MRI confirmed a second local recurrence. A CT scan of the chest showed multiple lung metastases. The patient died of a severe chest infection 18 months later. (orig.)

  6. Pancreatic tissue fluid pressure in chronic pancreatitis. Relation to pain, morphology, and function

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Bülow, J;

    1990-01-01

    The relation between pancreatic tissue fluid pressure and pain, morphology, and function was studied in a cross-sectional investigation. Pressure measurements were performed by percutaneous fine-needle puncture. Thirty-nine patients with chronic pancreatitis were included, 25 with pain and 14 wit...

  7. Sacral Chordoma and Single Stage Combined Anteroposterior High Sacrectomy.

    Directory of Open Access Journals (Sweden)

    Vasu Reddy Challa

    2014-05-01

    Full Text Available Chordomas are locally aggressive tumors, most commonly seen in sacrum. We present a case of sacral chordoma who presented with urinary retention and treated with single stage combined anteroposterior high sacrectomy.

  8. Lumbosacral Osteomyelitis and Discitis with Phlegmon Following Laparoscopic Sacral Colpopexy.

    Science.gov (United States)

    Jenson M D, Amanda V; Scranton, Robert; Antosh, Danielle D; Simpson, Richard K

    2016-01-01

    Lumbosacral osteomyelitis and discitis are usually a result of hematogenous spread; rarely it can result from direct inoculation during a surgical procedure. Bacteria may also track along implanted devices to a different location. This is a rare complication seen from pelvic organ prolapse surgery with sacral colpopexy. A 67-year-old female developed increasing lower back pain four months following a laparoscopic sacral colpopexy. Imaging revealed lumbar 5-sacral 1 (L5-S1) osteomyelitis and discitis with associated phlegmon confirmed by percutaneous biopsy and culture. The patient was treated conservatively with antibiotics, but required laparoscopic removal of the pelvic and vaginal mesh followed by twelve weeks of intravenous antibiotics. The patient has experienced clinical improvement of her back pain. This is an uncommon complication of sacral colpopexy, but physicians must be vigilant and manage aggressively to avoid more serious complications and permanent deficit. PMID:27551651

  9. Sacral Fracture Causing Neurogenic Bladder: A Case Report

    Directory of Open Access Journals (Sweden)

    Tatsuro Sasaji

    2012-01-01

    Full Text Available A 76-year-old man presented with a Denis Zone III sacral fracture after a traffic accident. He also developed urinary retention and perineal numbness. The patient was diagnosed with neurogenic bladder dysfunction caused by the sacral fracture. A computed tomogram (CT revealed that third sacral lamina was fractured and displaced into the spinal canal, but vertebral body did not displace. The fracture lines began at the center of lamina and extended bilateraly. The fracture pattern was unique. The sacrum was osteoporosis, and this fracture may be based on osteoporosis. We performed laminectomy to decompress sacral nerve roots. One month after surgery, the patient was able to urinate. Three months after surgery, his bladder function recovered normally. One year after surgery, he returned to a normal daily life and had no complaints regarding urination. One-year postoperative CT showed the decompressed third sacrum without displacement.

  10. Is determination between complete and incomplete traumatic spinal cord injury clinically relevant? Validation of the ASIA sacral sparing criteria in a prospective cohort of 432 patients.

    NARCIS (Netherlands)

    Middendorp, J.J. van; Hosman, A.J.F.; Pouw, M.H.; Meent, H. van de

    2009-01-01

    STUDY DESIGN: Prospective multicenter longitudinal cohort study. OBJECTIVE: To validate the prognostic value of the acute phase sacral sparing measurements with regard to chronic phase-independent ambulation in patients with traumatic spinal cord injury (SCI). SETTING: European Multicenter Study of

  11. Blood pressure 2 years after a chronic disease management intervention study

    OpenAIRE

    Tobe, Sheldon; Vincent, Lloyd; Wentworth, Joan; Hildebrandt, Denise; Kiss, Alexander; Perkins, Nancy; Hartman, Susan; Ironstand, Laurie; Hoppe, Jacquie; Hunter, Katie; Pylypchuk, George

    2012-01-01

    Objectives. To follow blood pressure change over time in participants who had participated in a 1- year chronic disease management program focused on blood pressure reduction. The expectation was that blood pressure would return back to the baseline once the study was completed. Study design. Prospective, single-arm observational study. Methods. Study participants were Status Indians living on-reserve with type 2 diabetes and persistent hypertension who had participated in the DREAM3 study. B...

  12. A sacral lesion resembling osteochondrosis in the German Shepherd dog

    International Nuclear Information System (INIS)

    More than 30% (21 of 65) of German Shepherd dogs with clinical signs of cauda equina compression had radiographic and pathologic abnormalities compatible with osteochondrosis of the sacral endplate. Most of these dogs had a defect in the dorsal part of the sacral endplate and a detached bone fragment in the vertebral canal. Similar lesions were also found in growing and young adult dogs without clinical signs. The dogs with clinical signs of cauda equina compression also had severe degenerative disc disease with protrusion of the lumbosacral disc and compression of the cauda equina, suggesting that the signs of cauda equina compression more likely were related to the secondary degenerative changes (disc protrusions) rather than the primary disease. Clinically normal German Shepherds with sacral osteochondrosis usually were younger than 18 months, the dogs with cauda equina compression and sacral osteochondrosis older than 18 months (mean age 4.8 years). On the average, these dogs were two years younger as compared to dogs with cauda equina compression without sacral osteochondrosis. Male dogs are more often affected than females (5:1). There is a breed predisposition: in dogs other than German Shepherds, osteochondrosis of the sacral endplate seems to be extremely rare

  13. Indications for portal pressure measurement in chronic liver disease

    DEFF Research Database (Denmark)

    Hobolth, Lise; Bendtsen, Flemming; Møller, Søren

    2012-01-01

    Portal hypertension leads to development of serious complications such as esophageal varices, ascites, renal and cardiovascular dysfunction. The importance of the degree of portal hypertension has been substantiated within recent years. Measurement of the portal pressure is simple and safe...... and the hepatic venous pressure gradient (HVPG) independently predicts survival and development of complications such as ascites, HCC and bleeding from esophageal varices. Moreover, measurements of HVPG can be used to guide pharmacotherapy for primary and secondary prophylaxis for variceal bleeding. Assessment...

  14. Sacral anterior root stimulated defecation in spinal cord injuries: An experimental study in canine model

    Institute of Scientific and Technical Information of China (English)

    Shi-Min Chang; Guang-Rong Yu; Ying-Min Diao; Meng-Jie Zhang; Shi-Bo Wang; Chun-Lin Hou

    2005-01-01

    AIM: To investigate whether there was a dominant sacral root for the motive function of rectum and anal sphincter,and to provide an experimental basis for sacral root electrically stimulated defecation in spinal cord injuries.METHODS: Eleven spinal cord injured mongrel dogs were included in the study. After L4-L7 laminectomy, the bilateral L7-S3 roots were electrostimulated separately and rectal and sphincter pressure were recorded synchronously. Four animals were implanted electrodes on bilateral S2 roots.RESULTS: For rectal motorial innervation, S2 was the most dominant (mean 15.2 kPa, 37.7% of total pressure),S1 (11.3kPa, 27.6%) and S3 (10.9 kPa, 26.7%) contributed to a smaller part. For external anal sphincter, S3 (mean 17.2 kPa, 33.7%) was the most dominant, S2 (16.2 kPa,31.6%) and S1 (14.3 kPa, 27.9%) contributed to a lesser but still a significant part. Above 85% L7 roots provided some functional contribution to rectum and anal sphincter.For both rectum and sphincter, the dght sacral roots provided more contribution than the left roots. Postoperatively, the 4 dogs had electrically stimulated defecation and micturition under the control of the neuroprosthetic device.CONCLUSION: S2 root is the most dominant contributor to rectal pressure in dogs. Stimulation of bilateral S2 with implanted electrodes contributes to good micturition and defecation in dogs.

  15. Stan scheller: the forerunner of clinical studies on using propolis for poor and chronic nonhealing wounds.

    Science.gov (United States)

    Kucharzewski, M; Kubacka, S; Urbanek, T; Wilemska-Kucharzewska, K; Morawiec, T

    2013-01-01

    For hundreds of years poor and chronic nonhealing wounds have constituted a serious problem to medicine. What is more, treating such wounds is an expensive let alone a long-lasting process. The following paper describes Professor Scheller's achievements in using propolis for poor and chronic non-healing wounds. The authors' intention was to present the results connected with the use of the ethanolic extract propolis, in the treatment of patients suffering from burns, venous crural ulceration, local sacral bone pressure ulcers, suppurative osteitis and arthritis, suppurative postoperative local wound complications, and infected traumatic wounds.

  16. Sacral Insufficiency Fractures Mimicking Lumbar Spine Pathology.

    Science.gov (United States)

    Sudhir, G; K L, Kalra; Acharya, Shankar; Chahal, Rupinder

    2016-06-01

    Sacral insufficiency fractures (SIFs) are a common cause of back pain in the elderly. SIFs mimic the symptoms of lumbar spine pathology and so are commonly missed or underdiagnosed. Here we present four cases of missed SIFs that were subsequently identified and treated. One patient was treated as mechanical lower back ache, another patient underwent root block and two patients underwent surgery for lumbar canal stenosis. None experienced relief of their symptoms after these procedures. Retrospective analysis of X-ray and magnetic resonance imaging data revealed SIFs that were confirmed by computed tomography scans. All four patients were treated for underlying osteoporosis. Two patients who underwent surgery were treated conservatively and other two were treated by sacroplasty involving injection of cement into the fracture. Sacroplasty produced immediate pain relief and early mobilization compared to the conservative group. SIFs should always be considered in the differential diagnosis of an elderly patient presenting with low back symptoms. Sacroplasty can be considered for immediate pain relief and rapid mobilization. PMID:27340538

  17. Chronic changes of hematocrit value alter blood pressure and glomerular filtration in spontaneously hypertensive rats

    Directory of Open Access Journals (Sweden)

    Milanović S.

    2012-01-01

    Full Text Available Many studies in hypertensive humans and animals have shown that increased blood viscosity is in direct relation with essential hypertension. The aim of our studies was to investigate the effects of chronic hematocrit value changes on arterial blood pressure and kidney function in genetically induced hypertension. To this end, we studied the effects of several interventions, designed to increase/decrease hematocrit, on hemodynamic parameters, vascular reactivity, glomerular filtration and renal function curve in spontaneously hypertensive rats (SHR. Results of our study show that chronic hematocrit value elevation increases blood pressure and peripheral vascular resistance in SHR. On the other hand, chronic hematocrit lowering elucidates blood pressure and peripheral vascular resistance decrease followed by cardiac output rising. Both hematocrit value changes significantly reduce vasodilatory vascular response. Hematocrit lowering induces acute renal failure. Sodium excretion is shifted to higher blood pressure values in high hematocrit value animals and opposite - lower blood pressure values in low hematocrit value animals. Repeated transfusions develop salt sensitive malignant hypertension in SHR. Further studies are necessary to evaluate the degree of kidney damage after chronic hematocrit value changes in SHR.

  18. Cauda equina syndrome presentation of sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Muthukumar, T.; Butt, S.H.; Cassar-Pullicino, V.N.; McCall, I.W. [The Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2007-04-15

    Sacral insufficiency fractures are a well recognised cause for low back, buttock and groin pain in the elderly. However, over a 4 year period, four patients have presented with symptoms of cauda equina syndrome, who were found on investigation to have acute sacral insufficiency fracture without any other aetiological spinal abnormality. Four patients who presented to the spinal surgeons of our institution with symptoms of cauda equina syndrome were referred for spinal MR. Sagittal and axial T1 and T2 weighted turbo spin echo sequences of the lower thoracic and lumbar spine were performed on all patients. Subsequent studies included MR of the sacrum supplemented where appropriate by CT and technetium MDP bone scintigraphy. No evidence of a compressive lesion of the lower thoracic or lumbar spine was present in any of the four patients. Dedicated MR examination of the sacrum in these patients revealed unilateral acute insufficiency fractures involving zone 1 from S1 to S3 extending from the sacro-iliac joint to the lateral margin of the sacral foramen. There was no evidence of compression of the sacral nerve roots. The possible mechanism for the symptomatic presentation is discussed. Sacral insufficiency fractures should be excluded in elderly or osteoporotic patients presenting with cauda equina syndrome who have no evidence of compression in the thoraco-lumbar MR studies. (orig.)

  19. Elevated systolic pressure following chronic low-level cadmiun feeding.

    Science.gov (United States)

    Perry, H M; Erlanger, M; Perry, E F

    1977-02-01

    Groups of 16 female Long-Evans rats received 0, 1, 2.5, 5, 10, 25, and 50 mg cadmium/liter dringking water (parts per million (ppm)), from the time they were weaned until they were 30 mo old. Systolic pressure was measured indirectly in triplicate at 6-mo intervals. Both 2.5 and 5 ppm cadmium consistently induced significant elevations in mean systolic pressure, ranging from 13 to 33 mmHg. At 6 mo, 10 and 25 ppm cadmium also induced significant elevations, whereas at 12 mo and subsequently 1 ppm cadmium induced significant elevations. With 10 ppm cadmium or less weight gain was normal and there was no evidence of cadmium toxicity. With 25 and 50 ppm cadmium weight gain was diminished, suggesting toxicity. Five rats with each level of exposure were sacrificed every 6 mo from a second population of similarly handled rats in order to determine renal cadmium concetrations. Cadmium intakes that had induced hypertension were associated with mean renal cadmium concentrations ranging from 5 to 50 mug/g kidney.

  20. Comparison of Pressure Support Ventilation and Proportional Assist Ventilation Modes in Chronic Obstructive Pulmonary Disease Exacerbation

    OpenAIRE

    ŞENGÜL, Aysun; Başyiğit, İlknur; Boyacı, Haşim; Yıldız, Füsun; Ilgazlı, Ahmet

    2013-01-01

    Objective: To compare the effectiveness of pressure support ventilation and proportional assist ventilation which is two modes of non-invasive mechanical ventilation used in the treatment of chronic obstructive pulmonary disease exacerbation. Material and Methods: Total of 20 patients was included in the study. Mean age was 63±7 years. Patients were randomized as proportional assist ventilation and pressure support ventilation groups. Non-invasive mechanical ventilation was per...

  1. Pubic and sacral insufficiency fractures: clinical course and radiologic findings

    International Nuclear Information System (INIS)

    Distinctive vertical insufficiency fractures of the pelvis were found in nine osteopenic patients. Each patient had subacute pelvic pain without antecedent trauma. The sacral fractures healed fairly quickly, but the pubic fractures often had a protracted course. All nine patients had skeletal demineralization due to metabolic bone disease, radiation therapy, or multiple myeloma. Recognition of the association between public and sacral insufficiently fractures should aid in recognizing the diffuse nature of the skeletal disease so that unnecessary biopsy of the fracture sites can be avoided. Plain films, tomographic scans, and radionuclide bone scans are reviewed

  2. Various sacral indices: role in study of sexual dimorphism

    Directory of Open Access Journals (Sweden)

    Uttama Umesh Joshi

    2016-03-01

    Results: The indices like sacral index, curvature index, corpobasal index and alar Index were found to be statistically significant with p value 0.05 and was statistically not significant. Conclusions: The most useful aspect of such studies was to determine appropriate indices of sexual dimorphism for sacral bone. The study concluded that no single index can identify sex of sacrum with 100% accuracy. So multiple indices should be used for determination of sex by sacrum with 100% accuracy. [Int J Res Med Sci 2016; 4(3.000: 841-846

  3. Cartilage contact pressure elevations in dysplastic hips: a chronic overload model

    Directory of Open Access Journals (Sweden)

    Grosland Nicole M

    2006-10-01

    Full Text Available Abstract Background Developmental dysplasia of the hip (DDH is a condition in which bone growth irregularities subject articular cartilage to higher mechanical stresses, increase susceptibility to subluxation, and elevate the risk of early osteoarthritis. Study objectives were to calculate three-dimensional cartilage contact stresses and to examine increases of accumulated pressure exposure over a gait cycle that may initiate the osteoarthritic process in the human hip, in the absence of trauma or surgical intervention. Methods Patient-specific, non-linear, contact finite element models, constructed from computed tomography arthrograms using a custom-built meshing program, were subjected to normal gait cycle loads. Results Peak contact pressures for dysplastic and asymptomatic hips ranged from 3.56 – 9.88 MPa. Spatially discriminatory cumulative contact pressures ranged from 2.45 – 6.62 MPa per gait cycle. Chronic over-pressure doses, for 2 million cycles per year over 20 years, ranged from 0.463 – 5.85 MPa-years using a 2-MPa damage threshold. Conclusion There were significant differences between the normal control and the asymptomatic hips, and a trend towards significance between the asymptomatic and symptomatic hips of patients afflicted with developmental dysplasia of the hip. The magnitudes of peak cumulative contact pressure differed between apposed articular surfaces. Bone irregularities caused localized pressure elevations and an upward trend between chronic over-pressure exposure and increasing Severin classification.

  4. A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Dursunoglu Nese

    2007-01-01

    Full Text Available The natural history of chronic obstructive pulmonary disease (COPD is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH. Noninvasive positive pressure ventilation (NPPV treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO2 and decrease PaCO2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment.

  5. Biochemical association of metabolic profile and microbiome in chronic pressure ulcer wounds.

    Directory of Open Access Journals (Sweden)

    Mary Cloud B Ammons

    Full Text Available Chronic, non-healing wounds contribute significantly to the suffering of patients with co-morbidities in the clinical population with mild to severely compromised immune systems. Normal wound healing proceeds through a well-described process. However, in chronic wounds this process seems to become dysregulated at the transition between resolution of inflammation and re-epithelialization. Bioburden in the form of colonizing bacteria is a major contributor to the delayed headlining in chronic wounds such as pressure ulcers. However how the microbiome influences the wound metabolic landscape is unknown. Here, we have used a Systems Biology approach to determine the biochemical associations between the taxonomic and metabolomic profiles of wounds colonized by bacteria. Pressure ulcer biopsies were harvested from primary chronic wounds and bisected into top and bottom sections prior to analysis of microbiome by pyrosequencing and analysis of metabolome using 1H nuclear magnetic resonance (NMR spectroscopy. Bacterial taxonomy revealed that wounds were colonized predominantly by three main phyla, but differed significantly at the genus level. While taxonomic profiles demonstrated significant variability between wounds, metabolic profiles shared significant similarity based on the depth of the wound biopsy. Biochemical association between taxonomy and metabolic landscape indicated significant wound-to-wound similarity in metabolite enrichment sets and metabolic pathway impacts, especially with regard to amino acid metabolism. To our knowledge, this is the first demonstration of a statistically robust correlation between bacterial colonization and metabolic landscape within the chronic wound environment.

  6. Acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure

    Directory of Open Access Journals (Sweden)

    Crivaldo Gomes Cardoso Jr

    2010-01-01

    Full Text Available Hypertension is a ubiquitous and serious disease. Regular exercise has been recommended as a strategy for the prevention and treatment of hypertension because of its effects in reducing clinical blood pressure; however, ambulatory blood pressure is a better predictor of target-organ damage than clinical blood pressure, and therefore studying the effects of exercise on ambulatory blood pressure is important as well. Moreover, different kinds of exercise might produce distinct effects that might differ between normotensive and hypertensive subjects. The aim of this study was to review the current literature on the acute and chronic effects of aerobic and resistance exercise on ambulatory blood pressure in normotensive and hypertensive subjects. It has been conclusively shown that a single episode of aerobic exercise reduces ambulatory blood pressure in hypertensive patients. Similarly, regular aerobic training also decreases ambulatory blood pressure in hypertensive individuals. In contrast, data on the effects of resistance exercise is both scarce and controversial. Nevertheless, studies suggest that resistance exercise might acutely decrease ambulatory blood pressure after exercise, and that this effect seems to be greater after low-intensity exercise and in patients receiving anti-hypertensive drugs. On the other hand, only two studies investigating resistance training in hypertensive patients have been conducted, and neither has demonstrated any hypotensive effect. Thus, based on current knowledge, aerobic training should be recommended to decrease ambulatory blood pressure in hypertensive individuals, while resistance exercise could be prescribed as a complementary strategy.

  7. Elevated pulse pressure is associated with hemolysis, proteinuria and chronic kidney disease in sickle cell disease.

    Directory of Open Access Journals (Sweden)

    Enrico M Novelli

    Full Text Available A seeming paradox of sickle cell disease is that patients do not suffer from a high prevalence of systemic hypertension in spite of endothelial dysfunction, chronic inflammation and vasculopathy. However, some patients do develop systolic hypertension and increased pulse pressure, an increasingly recognized major cardiovascular risk factor in other populations. Hence, we hypothesized that pulse pressure, unlike other blood pressure parameters, is independently associated with markers of hemolytic anemia and cardiovascular risk in sickle cell disease. We analyzed the correlates of pulse pressure in patients (n  =  661 enrolled in a multicenter international sickle cell trial. Markers of hemolysis were analyzed as independent variables and as a previously validated hemolytic index that includes multiple variables. We found that pulse pressure, not systolic, diastolic or mean arterial pressure, independently correlated with high reticulocyte count (beta  =  2.37, p  =  0.02 and high hemolytic index (beta  =  1.53, p = 0.002 in patients with homozygous sickle cell disease in two multiple linear regression models which include the markers of hemolysis as independent variables or the hemolytic index, respectively. Pulse pressure was also independently associated with elevated serum creatinine (beta  =  3.21, p  =  0.02, and with proteinuria (beta  =  2.52, p  =  0.04. These results from the largest sickle cell disease cohort to date since the Cooperative Study of Sickle Cell Disease show that pulse pressure is independently associated with hemolysis, proteinuria and chronic kidney disease. We propose that high pulse pressure may be a risk factor for clinical complications of vascular dysfunction in sickle cell disease. Longitudinal and mechanistic studies should be conducted to confirm these hypotheses.

  8. Sacral Nerve Stimulation for Constipation: Suboptimal Outcome and Adverse Events

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Lundby, Lilli; Buntzen, Steen;

    2010-01-01

    Sacral nerve stimulation is an emerging treatment for patients with severe constipation. There has been no substantial report to date on suboptimal outcomes and complications. We report our experience of more than 6 years by focusing on incidents and the management of reportable events....

  9. Tarenskeen's LUTHER : Allowing for new forms of sacrality

    NARCIS (Netherlands)

    Wijnia, L.; Klomp, Mirella

    2014-01-01

    This article explores the dynamics of sacrality in contemporary culture through the performance of LUTHER, a work by Dutch composer Boudewijn Tarenskeen. By means of reinterpreting the person and texts of Martin Luther, Tarenskeen created a performance in which different dynamics of the sacred were

  10. Preventing Ischial Pressure Ulcers: III. Clinical Pilot Study of Chronic Neuromuscular Electrical Stimulation

    Directory of Open Access Journals (Sweden)

    Hilton M. Kaplan

    2011-01-01

    Full Text Available Objective: BIONs™ (BIOnic Neurons are injectable, wireless microstimulators that make chronic BION Active Seating (BAS possible for pressure ulcer prevention (PUP. Neuromuscular electrical stimulation (NMES produces skeletal motion and activates trophic factors, counteracting three major etiological mechanisms leading to pressure ulcers (PUs: immobility, soft-tissue atrophy, and ischemia. Companion papers I and II reviewed prior experience with NMES for PUP, and analyzed the biomechanical considerations, respectively. This paper presents a treatment strategy derived from this analysis, and the clinical results of the first three cases.

  11. Combined use of non-invasive techniques to predict pulmonary arterial pressure in chronic respiratory disease.

    OpenAIRE

    Bishop, J M; Csukas, M

    1989-01-01

    The value of non-invasive procedures for predicting pulmonary arterial pressure was investigated in 370 patients with chronic obstructive lung diseases and in 73 with fibrosing alveolitis in a combined study at nine centres in six European countries. Measurements included forced expiratory volume in one second, arterial blood gas tensions, standard electrocardiogram, radiographic dimensions of pulmonary artery, right ventricle dimensions by M mode echocardiography, and myocardial scintigraphy...

  12. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  13. Combined Therapy for Distant Metastasis of Sacral Chordoma

    Science.gov (United States)

    Özkal, Birol; Yaldız, Can; Temiz, Peyker; Temiz, Cüneyt

    2015-01-01

    Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach. PMID:25649759

  14. Combined Therapy for Distant Metastasis of Sacral Chordoma

    Directory of Open Access Journals (Sweden)

    Birol Özkal

    2015-01-01

    Full Text Available Chordomas are known as rare primary malign tumours that have formed from primitive notochord remains. Sacral chordomas grow slowly but locally and aggressively. Chordomas are locally invasive and have low tendency to metastasis and have a poor prognosis in long-term follow-up. Metastasis may be seen in a rate of 5–40% of the chordomas. Metastasis of chordomas is common in liver, lung, lymph nodes, peritoneum, and brain. The treatment approaches, including surgery, have been discussed in the literature before. Susceptibility to radiotherapy and chemotherapy is controversial in these tumours. The success of surgical treatment affects survival directly. In this report, we will report a sacral chordoma case in which an intraperitoneal distant metastasis occurred and discuss the surgical approach.

  15. Spinal CT scan, 2. Lumbar and sacral spines

    Energy Technology Data Exchange (ETDEWEB)

    Nakagawa, Hiroshi (Aichi Medical Univ., Aichi (Japan))

    1982-08-01

    Plain CT described fairly accurately the anatomy and lesions of the lumbar and sacral spines on their transverse sections. Since hernia of the intervertebral disc could be directly diagnosed by CT, indications of myelography could be restricted. Spinal-canal stenosis of the lumbar spine occurs because of various factors, and CT not only demonstrated the accurate size and morphology of bony canals, but also elucidated thickening of the joints and yellow ligament. CT was also useful for the diagnosis of tumors in the lumbar and sacral spines, visualizing the images of bone changes and soft tissues on the trasverse sections. But the diagnosis of intradural tumors required myelography and metrizamide CT. CT has become important for the diagnosis of spinal and spinal-cord diseases and for selection of the route of surgical arrival.

  16. Esqueleto pré-sacral e sacral dos lagartos teiêdeos (Squamata, Teiidae Pressacral and sacral skeleton of teiids lizards (Squamata, Teiidae

    Directory of Open Access Journals (Sweden)

    Lauren Betina Veronese

    1997-01-01

    Full Text Available The morphology of the axial skeleton -pressacral and sacral regions - of the nine genera of Teiidae Boulenger, 1885 comprising Ameiva Meyer, 1795, Callopistes Gravenhorst, 1838, Cnemidophorus Wagler, 1830, Crocodilurus Spix, 1825, Dicrodon Duméril & Bibron, 1839, Dracaena Daudin, 1802, Kenlropyx Spix, 1825, Teius Merrem, 1820 and Tupinambis Daudin, 1803 is here analysed under a comparative approach. The study is in a generic levei, and the principal conclusions reter to differences on the total number of vertebrae and some aspects of the ribs, especially their insertion and presence.

  17. Sacral plexus injury after radiotherapy for carcinoma of cervix

    Energy Technology Data Exchange (ETDEWEB)

    Stryker, J.A.; Sommerville, K.; Perez, R.; Velkley, D.E. (Pennsylvania State Univ., Hershey (USA))

    1990-10-01

    A 42-year-old woman developed lower extremity weakness and sensory loss 1 year after external and intracavitary radiotherapy for Stage IB carcinoma of cervix. She has been followed for 5 years posttreatment, and the neurologic abnormalities have persisted, but no evidence of recurrent carcinoma has been found. We believe this to be a rare case of sacral plexus radiculopathy developing as a late complication after radiotherapy. Suggestions are made for improving the radiotherapy technique to prevent this complication in future cases.

  18. Fever, Sacral Pain, and Pregnancy: An Incarcerated Uterus

    OpenAIRE

    Sweigart, Amy N.; Matteucci, Michael J.

    2008-01-01

    Uterine incarceration is an uncommon but serious presentation in the emergency department that requires early recognition to improve maternal and fetal outcomes. Case: A 29-year-old female, at 12 weeks gestation, presented to the emergency department (ED) with complaints of fever, sacral pain and urgency. Based on history and physical examination, she was found to have a retroverted, incarcerated uterus. After a failed attempt at reduction in the ED, her uterus was successfully reduc...

  19. Computer Navigation-aided Resection of Sacral Chordomas

    Directory of Open Access Journals (Sweden)

    Yong-Kun Yang

    2016-01-01

    Full Text Available Background: Resection of sacral chordomas is challenging. The anatomy is complex, and there are often no bony landmarks to guide the resection. Achieving adequate surgical margins is, therefore, difficult, and the recurrence rate is high. Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection. The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas. Methods: Between 2007 and 2013, a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months. There were 21 primary cases and 5 recurrent cases, with a mean age of 55.8 years old (range: 35-84 years old. Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients. Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software. Tumors were resected via a posterior approach assisted by the computer navigation. Mean follow-up was 38.6 months (range: 18-84 months. Results: Mean operative time was 307 min. Mean intraoperative blood loss was 3065 ml. For computer navigation, the mean registration deviation during surgery was 1.7 mm. There were 18 wide resections, 4 marginal resections, and 4 intralesional resections. All patients were alive at the final follow-up, with 2 (7.7% exhibiting tumor recurrence. The other 24 patients were tumor-free. The mean Musculoskeletal Tumor Society Score was 27.3 (range: 19-30. Conclusions: Computer-assisted navigation can be safely applied to the resection of the sacral chordomas, allowing execution of preoperative plans, and achieving good oncological outcomes. Nevertheless, this needs to be accomplished by surgeons with adequate experience and skill.

  20. Intervention with Formulated Collagen Gel for Chronic Heel Pressure Ulcers in Older Adults with Diabetes.

    Science.gov (United States)

    Agosti, Jennifer K; Chandler, Lois A

    2015-11-01

    Chronic pressure ulcers (PrUs), ulcers that fail to progress through the expected phases of wound healing in a timely fashion, are not only a concern for the patients afflicted with them, but are also a significant burden for the long-term-care facilities in which patients reside. The heel is the second most common location for PrUs. Morbidity and mortality rates for heel PrUs, particularly in the diabetic population, are alarming. Therefore, a consistently effective, cost-conscious, and user-friendly topical treatment for heel ulcers would be welcomed by patients and clinicians. This article describes a marked and rapid improvement in wound granulation in 3 older adult patients following weekly treatment for 8 weeks of chronic (≥1-year duration) heel ulcers with an easy-to-use, cost-effective, topical, formulated collagen gel. PMID:26479694

  1. Ligament-induced sacral fractures of the pelvis are possible.

    Science.gov (United States)

    Steinke, Hanno; Hammer, Niels; Lingslebe, Uwe; Höch, Andreas; Klink, Thomas; Böhme, Jörg

    2014-07-01

    Pelvic ring stability is maintained passively by both the osseous and the ligamentous apparatus. Therapeutic approaches focus mainly on fracture patterns, so ligaments are often neglected. When they rupture along with the bone after pelvic ring fractures, disrupting stability, ligaments need to be considered during reconstruction and rehabilitation. Our aim was to determine the influence of ligaments on open-book injury using two experimental models with body donors. Mechanisms of bone avulsion related to open-book injury were investigated. Open-book injuries were induced in human pelves and subsequently investigated by anatomical dissection and endoscopy. The findings were compared to CT and MRI scans of open-book injuries. Relevant structures were further analyzed using plastinated cross-sections of the posterior pelvic ring. A fragment of the distal sacrum was observed, related to open-book injury. Two ligaments were found to be responsible for this avulsion phenomenon: the caudal portion of the anterior sacroiliac ligament and another ligament running along the ventral surface of the third sacral vertebra. The sacral fragment remained attached to the coxal bone by this second ligament after open-book injury. These results were validated using plastination and the structures were identified. Pelvic ligaments are probably involved in sacral avulsion caused by lateral traction. Therefore, ligaments should to be taken into account in diagnosis of open-book injury and subsequent therapy. PMID:24452928

  2. Sacral chordoma: a diagnosis not to be sat on?

    Science.gov (United States)

    Gibbins, Ruth; Evans, Guy; Grimer, Robert

    2007-01-01

    Sacral chordomas are rare, slow-growing tumours that are amenable to surgery, but unfortunately often diagnosed late. The aim of the study was to identify presenting symptoms, which may aid diagnosis and reduce the treatment time. Forty-four patients were identified with sacral chordoma between 1989 and 2006. Clinical and pathological records were reviewed retrospectively to elicit the symptoms recorded prior to diagnosis, duration of symptoms, surgical treatment, size of tumour and survival. Eleven patients were excluded, leaving 33 patients in the study group. Thirty-one patients had chordomas arising from the sacrum and two patients from the coccyx. The mean duration of symptoms prior to diagnosis was 120 weeks (2.3 years), with a median of length of 104 weeks (two years) and range of 26 to 416 weeks (0.5 to eight years). The mean maximum tumour size at resection was 8.3 cm, with a mean volume of 614 cm3 (range 9–2,113 cm3). Pain, typically dull and worse with sitting, was the most common presenting symptom in 85% of patients. The classic symptoms of cauda equina (saddle anaesthesia, bladder or bowel dysfunction) occurred in 70% patients (23 patients). Sacral chordoma should be considered in cases of back pain with coccydynia, especially with neurological symptoms. PMID:17205349

  3. STUDY OF SACRAL HIATUS IN DRY HUMAN SACRA IN NEPAL, PARSA REGION

    Directory of Open Access Journals (Sweden)

    Malarvani T

    2015-03-01

    Full Text Available Introduction: The sacrum is a large triangular bone, formed by the fusion of five sacral vertebrae. The opening at the caudal end of sacral canal is known as sacral hiatus. It is formed due to the failure of fusion of laminae of the fifth (occasionally fourth sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance because it may also leads to mechanical low back pain. Previous works on the morphometrical study on the sacral hiatus is limited, especially in Nepal, Parsa population. The present study was undertaken to help in filling this gap at least to a certain extent and also made an attempt to find out the variations of sacrum. Materials: One hundred dry human sacra were collected from the Department of Anatomy of National medical college & Teaching Hospital, Nepal. Methods & Observations: The morphometrical studies were done, and the parameters (Shape, length, Transverse width & Antero-posterior width of sacral hiatus and level of apex & base of sacral hiatus were measured with the help of divider, the observations were recorded, tabulated & analyzed. Result: The study showed a significant co-relation between anatomical variations of sacral hiatus with the previous studies.

  4. Home blood pressure monitor use in patients with chronic kidney disease.

    Science.gov (United States)

    Ye, Xiaojing; Shafi, Salman; Negrete, Andrea; Davis, William N; Sarac, Erdal; Negrete, Alejandro M; Negrete, Hilmer

    2016-10-01

    Home blood pressure monitoring (HBPM) is recommended in patients with chronic kidney disease (CKD) and hypertension (HTN). However, little is known about the use and pattern of HBPM in CKD patients. A cross-sectional study was conducted in an out-patient nephrology clinic. A total of 285 patients participated in the study. Of all patients, 66% reported using HBPM. Self-reported compliance with BP medications (93.9% vs. 85.1%, p 0.03), exercise >3 days/week (45.9 vs. 26.3%, p helpful in managing hypertension (85.4%). Most common reason for not using HBPM was lack of advice by a physician (43.4%). HBPM use is common in patients with CKD and HTN. HBPM users are more likely to follow life-style and dietary modifications for blood pressure control. PMID:27104796

  5. Update: Non-Invasive Positive Pressure Ventilation in Chronic Respiratory Failure Due to COPD.

    Science.gov (United States)

    Altintas, Nejat

    2016-01-01

    Long-term non-invasive positive pressure ventilation (NPPV) has widely been accepted to treat chronic hypercapnic respiratory failure arising from different etiologies. Although the survival benefits provided by long-term NPPV in individuals with restrictive thoracic disorders or stable, slowly-progressing neuromuscular disorders are overwhelming, the benefits provided by long-term NPPV in patients with chronic obstructive pulmonary disease (COPD) remain under question, due to a lack of convincing evidence in the literature. In addition, long-term NPPV reportedly failed in the classic trials to improve important physiological parameters such as arterial blood gases, which might serve as an explanation as to why long-term NPPV has not been shown to substantially impact on survival. However, high intensity NPPV (HI-NPPV) using controlled NPPV with the highest possible inspiratory pressures tolerated by the patient has recently been described as a new and promising approach that is well-tolerated and is also capable of improving important physiological parameters such as arterial blood gases and lung function. This clearly contrasts with the conventional approach of low-intensity NPPV (LI-NPPV) that uses considerably lower inspiratory pressures with assisted forms of NPPV. Importantly, HI-NPPV was very recently shown to be superior to LI-NPPV in terms of improved overnight blood gases, and was also better tolerated than LI-NPPV. Furthermore, HI-NPPV, but not LI-NPPV, improved dyspnea, lung function and disease-specific aspects of health-related quality of life. A recent study showed that long-term treatment with NPPV with increased ventilatory pressures that reduced hypercapnia was associated with significant and sustained improvements in overall mortality. Thus, long-term NPPV seems to offer important benefits in this patient group, but the treatment success might be dependent on effective ventilatory strategies. PMID:26418151

  6. Chronic effects of workplace noise on blood pressure and heart rate.

    Science.gov (United States)

    Lusk, Sally L; Hagerty, Bonnie M; Gillespie, Brenda; Caruso, Claire C

    2002-01-01

    Environmental noise levels in the United States are increasing, yet there are few studies in which the nonauditory effects of workplace noise are assessed. In the current study, the authors examined chronic effects of noise on blood pressure and heart rate in 374 workers at an automobile plant. Data were collected from subjects prior to the start of their workshift. Participants completed questionnaires about diet, alcohol use, lifestyle, noise annoyance, use of hearing protection, noise exposure outside of the work environment, personal and family health histories, and demographic information. Resting blood pressure, heart rate, and body mass index were obtained. Noise exposure levels were extracted retrospectively from company records for each participant for the past 5 yr. Summary statistics were generated for each variable, and the authors performed bivariate correlations to identify any unadjusted associations. The authors then completed statistical modeling to investigate the effects of noise on blood pressure and heart rate, after they controlled for other variables (e.g., gender, race, age). The authors controlled for confounding variables, after which use of hearing protection in high-noise areas was a significant predictor of a decrease in both systolic and diastolic blood pressures. The results suggested that the reduction of noise exposure by means of engineering controls or by consistent use of hearing protection by workers may positively affect health outcomes.

  7. Low-power wireless micromanometer system for acute and chronic bladder-pressure monitoring.

    Science.gov (United States)

    Majerus, Steve J A; Fletter, Paul C; Damaser, Margot S; Garverick, Steven L

    2011-03-01

    This letter describes the design, fabrication, and testing of a wireless bladder-pressure-sensing system for chronic, point-of-care applications, such as urodynamics or closed-loop neuromodulation. The system consists of a miniature implantable device and an external RF receiver and wireless battery charger. The implant is small enough to be cystoscopically implanted within the bladder wall, where it is securely held and shielded from the urine stream. The implant consists of a custom application-specific integrated circuit (ASIC), a pressure transducer, a rechargeable battery, and wireless telemetry and recharging antennas. The ASIC includes instrumentation, wireless transmission, and power-management circuitry, and on an average draws less than 9 μA from the 3.6-V battery. The battery charge can be wirelessly replenished with daily 6-h recharge periods that can occur during the periods of sleep. Acute in vivo evaluation of the pressure-sensing system in canine models has demonstrated that the system can accurately capture lumen pressure from a submucosal implant location.

  8. Negative pressure wound therapy technologies for chronic wound care in the home setting: A systematic review.

    Science.gov (United States)

    Rhee, Susan M; Valle, M Frances; Wilson, Lisa M; Lazarus, Gerald; Zenilman, Jonathan M; Robinson, Karen A

    2015-01-01

    The use of negative pressure wound therapy (NPWT) is increasing in both the inpatient and outpatient settings. We conducted a systematic review on the efficacy and safety of NPWT for the treatment of chronic wounds in the home setting. We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature, up to June 2014. Two independent reviewers screened search results. Seven studies met our criteria for inclusion. Six of the studies compared NPWT devices to other wound care methods and one study compared two different NPWT technologies. Data were limited by variability in the types of comparator groups, methodological limitations, and poor reporting of outcomes. We were unable to draw conclusions about the efficacy or safety of NPWT for the treatment of chronic wounds in the home setting due to the insufficient evidence. Consensus is needed on the methods of conducting and reporting wound care research so that future studies are able inform decisions about the use of NPWT in the home environment for chronic wounds.

  9. Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

    Directory of Open Access Journals (Sweden)

    Murat Api

    2014-08-01

    Full Text Available Objective The aim of the present study was to evaluate the safety and efficacy of a “Cravat’’ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh. Materials and Methods A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as ‘very satisfied’, ‘satisfied’ and ‘not satisfied’ at the 6th month postoperatively. Results Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy. Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months. Conclusions Laparoscopic sacral uteropexy with “Cravat technique” was found to be safe and simple procedure.

  10. Mulberry leaf extract restores arterial pressure in streptozotocin-induced chronic diabetic rats.

    Science.gov (United States)

    Naowaboot, Jarinyaporn; Pannangpetch, Patchareewan; Kukongviriyapan, Veerapol; Kukongviriyapan, Upa; Nakmareong, Saowanee; Itharat, Arunporn

    2009-08-01

    Free radical-induced vascular dysfunction plays a key role in the pathogenesis of vascular disease found in chronic diabetic patients. Morus alba (MA) leaf extract is promoted for good health especially in diabetic patients. Interestingly, antidiabetic and antioxidant activities of MA have been reported in experimental animals. Thus, the hypothesis of this study was that the long-term treatment with MA could improve vascular reactivity of chronic diabetic rats. To test this hypothesis, we examined the effect of long-term treatment with MA on the vascular responses to vasoactive agents in streptozotocin-induced chronic diabetic rats. The diabetic rats were either orally administered with distilled water, MA (0.25, 0.5 and 1 g/kg per day) or subcutaneously injected with insulin (4 U/kg per day) for 8 weeks. After each treatment, the fasting blood glucose, blood pressure, vascular responses to vasoactive agents and tissue malondialdehyde were examined. Morus alba at the doses of 0.5 and 1 g/kg, which significantly reduced blood glucose level, also significantly decreased the high blood pressure in diabetic rats. Vascular responses of the chronic diabetic rats to vasodilators, acetylcholine (3-30 nmol/kg) and sodium nitroprusside (1-10 nmol/kg) were significantly suppressed by 26% to 44% and 45% to 77% respectively, whereas those to vasoconstrictor, phenylephrine (0.01-0.1 micromol/kg) were significantly increased by 23% to 38% as compared to normal rats. Interestingly, the administration of 0.5 and 1 g/kg MA or 4 U/kg insulin significantly restored the vascular reactivities of diabetic rats. Moreover, 8 weeks of diabetes resulted in the elevation of malondialdehyde content in tissues (liver, kidney, heart, and aorta), and MA treatment significantly lessened this increase. These results provide the first evidence for the efficacy of MA in restoring the vascular reactivity of diabetic rats, the mechanism of which may associate with the alleviation of oxidative stress

  11. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Scheck, R.J. [Dept. of Radiology, Univ. Muenchen (Germany); Schramm, T. [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Gloning, K.P. [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany); Vogl, T. [Dept. of Radiology, Univ. Muenchen (Germany); Ostermayer, E. [Dept. of Gynaecology and Obstetrics, 1. Frauenklinik, Univ. Muenchen (Germany)

    1995-08-01

    Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

  12. Progressive bilateral anterior sacral meningoceles in Marfan syndrome

    International Nuclear Information System (INIS)

    Anterior sacral meningoceles (ASM) in Marfan syndrome are rare. They may cause constipation, urinary frequency, dysmenorrhoea, and low back pain or numbness. This report describes bilateral ASM at the level of S1, S2 and S3 in a woman with Marfan syndrome who was admitted to the gynaecology department for evaluation of left lower abdominal pain. The magnetic resonance appearance of the meningoceles is discussed and compared with findings from transvaginal ultrasound and CT. As MRI offers excellent delineation of spinal and pelvic structures, it is the most useful technique available in establishing the diagnosis and planning the treatment of ASM. (orig.)

  13. Computer Navigation-aided Resection of Sacral Chordomas

    Institute of Scientific and Technical Information of China (English)

    Yong-Kun Yang; Chung-Ming Chan; Qing Zhang; Hai-Rong Xu; Xiao-Hui Niu

    2016-01-01

    Background:Resection of sacral chordomas is challenging.The anatomy is complex,and there are often no bony landmarks to guide the resection.Achieving adequate surgical margins is,therefore,difficult,and the recurrence rate is high.Use of computer navigation may allow optimal preoperative planning and improve precision in tumor resection.The purpose of this study was to evaluate the safety and feasibility of computer navigation-aided resection of sacral chordomas.Methods:Between 2007 and 2013,a total of 26 patients with sacral chordoma underwent computer navigation-aided surgery were included and followed for a minimum of 18 months.There were 21 primary cases and 5 recurrent cases,with a mean age of 55.8 years old (range:35-84 years old).Tumors were located above the level of the S3 neural foramen in 23 patients and below the level of the S3 neural foramen in 3 patients.Three-dimensional images were reconstructed with a computed tomography-based navigation system combined with the magnetic resonance images using the navigation software.Tumors were resected via a posterior approach assisted by the computer navigation.Mean follow-up was 38.6 months (range:18-84 months).Results:Mean operative time was 307 min.Mean intraoperative blood loss was 3065 ml.For computer navigation,the mean registration deviation during surgery was 1.7 mm.There were 18 wide resections,4 marginal resections,and 4 intralesional resections.All patients were alive at the final follow-up,with 2 (7.7%) exhibiting tumor recurrence.The other 24 patients were tumor-free.The mean Musculoskeletal Tumor Society Score was 27.3 (range:19-30).Conclusions:Computer-assisted navigation can be safely applied to the resection of the sacral chordomas,allowing execution of preoperative plans,and achieving good oncological outcomes.Nevertheless,this needs to be accomplished by surgeons with adequate experience and skill.

  14. Rectal motility after sacral nerve stimulation for faecal incontinence

    DEFF Research Database (Denmark)

    Michelsen, H B; Worsøe, J; Krogh, K;

    2010-01-01

    Sacral nerve stimulation (SNS) is effective against faecal incontinence, but the mode of action is obscure. The aim of this study was to describe the effects of SNS on fasting and postprandial rectal motility. Sixteen patients, 14 women age 33-73 (mean 58), with faecal incontinence of various...... contractions, total time with cyclic rectal contractions, the number of aborally and orally propagating contractions, the number of anal sampling reflexes or rectal wall tension during contractions. Postprandial changes in rectal tone were significantly reduced during SNS (P

  15. Chronic cardiac pressure overload induces adrenal medulla hypertrophy and increased catecholamine synthesis.

    Science.gov (United States)

    Schneider, Johanna; Lother, Achim; Hein, Lutz; Gilsbach, Ralf

    2011-06-01

    Increased activity of the sympathetic system is an important feature contributing to the pathogenesis and progression of chronic heart failure. While the mechanisms and consequences of enhanced norepinephrine release from sympathetic nerves have been intensely studied, the role of the adrenal gland in the development of cardiac hypertrophy and progression of heart failure is less well known. Thus, the aim of the present study was to determine the effect of chronic cardiac pressure overload in mice on adrenal medulla structure and function. Cardiac hypertrophy was induced in wild-type mice by transverse aortic constriction (TAC) for 8 weeks. After TAC, the degree of cardiac hypertrophy correlated significantly with adrenal weight and adrenal catecholamine storage. In the medulla, TAC caused an increase in chromaffin cell size but did not result in chromaffin cell proliferation. Ablation of chromaffin α(2C)-adrenoceptors did not affect adrenal weight or epinephrine synthesis. However, unilateral denervation of the adrenal gland completely prevented adrenal hypertrophy and increased catecholamine synthesis. Transcriptome analysis of microdissected adrenal medulla identified 483 up- and 231 downregulated, well-annotated genes after TAC. Among these genes, G protein-coupled receptor kinases 2 (Grk2) and 6 and phenylethanolamine N-methyltransferase (Pnmt) were significantly upregulated by TAC. In vitro, acetylcholine-induced Pnmt and Grk2 expression as well as enhanced epinephrine content was prevented by inhibition of nicotinic acetylcholine receptors and Ca(2+)/calmodulin-dependent signaling. Thus, activation of preganglionic sympathetic nerves innervating the adrenal medulla plays an essential role in inducing adrenal hypertrophy, enhanced catecholamine synthesis and induction of Grk2 expression after cardiac pressure overload.

  16. The Effect of Chronic Administration of Saffron (Crocus sativus) Stigma Aqueous Extract on Systolic Blood Pressure in Rats

    OpenAIRE

    Imenshahidi, Mohsen; Razavi, Bibi Marjan; Faal, Ayyoob; Gholampoor, Ali; Mousavi, Seyed Mehran; Hosseinzadeh, Hossein

    2013-01-01

    Background Crocus sativus L. (saffron), which belongs to the Iridaceae family, is widely cultivated in Iran. Cardiovascular effects of saffron has been established in some studies but the effects of chronic administration of saffron (C. sativus) stigma aqueous extract on blood pressure has not been investigated. Objectives In this study the effects of saffron (C. sativus) stigma aqueous extract on blood pressure of normotensive and desoxycorticosterone acetate (DOCA)-salt induced hypertensive...

  17. A STUDY OF NEGATIVE PRESSURE WOUND THERAPY: VACUUM ASSISTED CLOSURE IN CHRONIC NON-HEALING ULCERS

    Directory of Open Access Journals (Sweden)

    Dhamotharan Senraman

    2016-06-01

    Full Text Available BACKGROUND This study evaluates the advantage of Negative Pressure Wound Therapy-Vacuum Assisted Closure over Conventional Dressing in the management of chronic non-healing ulcers. METHODS From June 2014 to June 2015, 50 patients were selected (25 cases and 25 controls. After wound debridement, VAC dressing is applied. Pre VAC and post VAC culture and sensitivity is taken. Dressing is given for 72 hours and intermittent suction is given for 10 mins. in an hour, daily for 12 hours with negative pressure ranging from 100 to 125 mmHg. Rest of the time drain of the VAC dressing is connected to the Romovac suction drain. Doppler study to assess the vascularity of the limb before the procedure and X-ray is taken to rule out osteomyelitis. Control group patients are given conventional dressings. RESULTS The gender, age and ulcer distributions were almost equal in the case and control groups and were found to be statistically insignificant. Duration of hospital stay in days was found to be statistically significant between groups. Majority (52% of cases left hospital within 3 weeks’ time, while a major chunk (88% of control population stayed more than 3 weeks. VAC dressing shows better results in patients with normal Doppler study. VAC dressing have better results in patients with 48% undergoing split skin grafting and less rate (8% of amputation as against none undergoing split skin grafting and 24% needing amputation in the control group. Patients with sterile pre-VAC culture were not turning unsterile after VAC, but 90% unsterile turns sterile after VAC. CONCLUSION NPWT is a novel technique for managing an open wound by submitting the wound either to intermittent or continuous subatmospheric pressure. Here, we did a study to study the advantage of vacuum assisted closure over conventional dressing in the management of chronic non-healing ulcers and concluded that VAC decreases hospital stay, improves pus culture sterility, has better result in

  18. Impact of chronic administration of anabolic androgenic steroids and taurine on blood pressure in rats.

    Science.gov (United States)

    Roşca, A E; Stoian, I; Badiu, C; Gaman, L; Popescu, B O; Iosif, L; Mirica, R; Tivig, I C; Stancu, C S; Căruntu, C; Voiculescu, S E; Zăgrean, L

    2016-01-01

    Supraphysiological administration of anabolic androgenic steroids has been linked to increased blood pressure. The widely distributed amino acid taurine seems to be an effective depressor agent in drug-induced hypertension. The purpose of this study was to assess the impact of chronic high dose administration of nandrolone decanoate (DECA) and taurine on blood pressure in rats and to verify the potentially involved mechanisms. The study was conducted in 4 groups of 8 adult male Wistar rats, aged 14 weeks, treated for 12 weeks with: DECA (A group); vehicle (C group); taurine (T group), or with both drugs (AT group). Systolic blood pressure (SBP) was measured at the beginning of the study (SBP1), 2 (SBP2) and 3 months (SBP3) later. Plasma angiotensin-converting enzyme (ACE) activity and plasma end products of nitric oxide metabolism (NOx) were also determined. SBP3 and SBP2 were significantly increased compared to SBP1 only in the A group (P<0.002 for both). SBP2, SBP3 and ACE activity showed a statistically significant increase in the A vs C (P<0.005), andvs AT groups (P<0.05), while NOx was significantly decreased in the A and AT groups vs controls (P=0.01). ACE activity was strongly correlated with SBP3 in the A group (r=0.71, P=0.04). These findings suggest that oral supplementation of taurine may prevent the increase in SBP induced by DECA, an effect potentially mediated by angiotensin-converting enzyme. PMID:27254659

  19. Computer-Assisted Navigation During an Anterior-Posterior En Bloc Resection of a Sacral Tumor.

    Science.gov (United States)

    Al Eissa, Sami; Al-Habib, Amro F; Jahangiri, Faisal R

    2015-11-04

    Previously, a computer-based navigation system has not been used routinely for en-bloc resection of sacral tumors. In order to improve the accuracy of tumor resection, O-arm navigation was used to join anterior and posterior osteotomies during an en-bloc resection of a sacral Ewing's sarcoma. This case study describes the technique for en-bloc resection of a sacral Ewing's sarcoma guided by O-arm computer navigation and intraoperative neurophysiological monitoring (IONM). An 18-year-old male presented with weakness in his left lower extremity. MRI of the patient's spine showed a sacral mass causing compression of left S1 and S2 roots. A surgical resection was planned with anterior and posterior approaches. An O-arm computer navigation system was used to assist in meeting anterior osteotomy cuts with the posterior cuts to ensure complete resection of the sacral tumor with a safe margin. Computer-assisted navigation was used along with IONM during this procedure to help guide the surgical team in an adequate tumor resection. There were no complications related to the use of the O-arm or the navigation system. Computer navigation guidance is both useful and safe in sacral tumor resections. It enhanced the accuracy of the en-bloc removal of a sacral tumor with safe margins while protecting neural function and minimizing recurrence.

  20. Specific Tips for General Controversies in Sacral Neuromodulation.

    Science.gov (United States)

    El-Azab, Ahmed S; Siegel, Steven W

    2016-11-01

    The field of Sacral Neuromodulation is continually evolving and still in its infancy. Common dilemmas experienced with this therapy will be discussed in this article, including ways to avoid and manage them. The focus will be on test evaluations performed with either peripheral nerve evaluation (PNE) or staged procedure, the clinical effectiveness and safety of unilateral versus bilateral test stimulation for both the PNE and staged procedures, and best methods to determine the success of the trial phase. We will also discuss how to deal with the problem of declining efficacy of the device over time. The article presents a discussion on future technological innovations to enhance techniques and mode of positioning and use of leads, which along with a refined understanding of how neuromodulation is effective for different problems, will lead to better outcomes.

  1. Fever, Sacral Pain, and Pregnancy: An Incarcerated Uterus

    Directory of Open Access Journals (Sweden)

    Sweigart, Amy N

    2008-11-01

    Full Text Available Uterine incarceration is an uncommon but serious presentation in the emergency department that requires early recognition to improve maternal and fetal outcomes.Case: A 29-year-old female, at 12 weeks gestation, presented to the emergency department (ED with complaints of fever, sacral pain and urgency. Based on history and physical examination, she was found to have a retroverted, incarcerated uterus. After a failed attempt at reduction in the ED, her uterus was successfully reduced under general anesthesia.Discussion: Pain and urinary difficulties, such as retention and hesitancy, are frequent in pregnancy, yet incarcerated uterus is an uncommon emergency department diagnosis that often presents with these symptoms. Clues to the diagnosis include a retroverted uterus, urinary retention, and pain in a patient presenting in the third to fourth months of gestation. Treatment is by manual reduction of the uterus. Complications range from spontaneous abortion to uterine rupture.[WestJEM. 2008;9:232-234.

  2. Cytogenetic telomere and telomerase studies in lumbo-sacral chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, H.S.; Dahir, G.A.; Miller, L.K. [Vanderbilt Univ., Nashville, TN (United States)] [and others

    1994-09-01

    Lumbo-sacral chordomas are rare skeletal sarcomas that originate from the remnant notochord. There are approximately 35 lumbo-sacral chordomas reported annually in the U.S.A. The understanding of this rare human cancer is limited to observations of its clinical behavior and embryonic link. We performed chromosome and molecular analyses from five surgically harvested chordomas in an effort to document genetic abnormalities and to further understand its tumor biology. Cytogenetically, four of five patients had entirely normal chromosomes. One patient had several abnormalities seen in one of 100 cells including a translocation with breakpoints at bands 5q13 and 7q22, loss of one X chromosome and an extra chromosome 14. There was no evidence of monosomy X or trisomy 14 seen with interphase in situ hybridization using biotin-labeled alpha satellite chromosome specific probes for chromosome 14/22 and X. Telomere integrity is required to protect termini from illegitimate recombination. Typically telomeric reduction occurs in senescent fibroblasts in vivo aging and several human solid tumors. A telomeric probe (TTAGGG){sub 50} was hybridized to genomic DNA isolated from chordoma cells and digested with Hinf I which allows the telomeric DNA to remain intact. The tumor DNA was paired with leukocyte DNA from age-matched controls and revealed telomere elongation in all four patients studied with molecular genetic techniques. Telomerase activity is required to maintain telomere integrity and is not present in normal somatic cells. It is determined by visualizing the sizes of the electrophoresis gel-separated radioactive telomeric fragments assembled during incubation of cytoplasmic extracts containing telomerase. Telomerase activity was detected when compared with HeLa cells, a positive control. In addition, no telomerase activity was detected from the chordoma patient`s fibroblasts.

  3. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly

    Directory of Open Access Journals (Sweden)

    Jaul E

    2014-05-01

    Full Text Available Efraim Jaul Skilled Geriatric Nursing Department, Herzog Memorial Hospital, Affiliated to the Hebrew University Hadassah Medical School, Jerusalem, Israel Abstract: The occurrence of pressure ulcers (PUs is common and poses serious problems for the frail elderly, with implications for functional disability and reduced quality of life. PUs are preventable in a majority of cases. The increase in PU occurrence, however, appears regardless of higher awareness in prevention and improvement through utilization of pressure relieving devices. Multiple changes in the elderly body systems occur over time including aging, multiple chronic conditions, and functional impairment, potentially culminating in the final pathways of geriatric syndrome, unless awareness to the development of PUs is reversible and prevented. The assumption is that the development of PUs is based on multifactorial causes (extrinsic and intrinsic factors; thus, the optimal management for elderly patients requires a comprehensive approach in all medical settings (community, hospital, and at the long term care [LTC] level. Comprehensiveness signifies looking beyond the wounds, assisting the patient through both local (wound and systemic (medical condition treatment, using a strategy of prevention and supporting quality of life. Within the multidisciplinary involvement team approach, each professional discipline contributes its own task in coordination with other disciplines to address PU prevention, assessment, and treatment. The entire medical staff and the multidisciplinary team work together and communicate frequently in order to prevent, halt at an early stage, and provide healing in a timely fashion. Limiting the formation of PUs is facilitated through early identification, treating contributing causes, eliminating all unnecessary medications, instituting supportive interventions which include the family. Understanding the relationship between the formation of PUs and the

  4. Garre's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy.

    LENUS (Irish Health Repository)

    Nasir, N

    2012-02-03

    Garre\\'s chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.

  5. The evaluation of relationship between blood pressure and dialysate Na concentration in chronic hemodialysis patients

    Science.gov (United States)

    Zahed, Narges Sadat; Gharooi, Omid; Gachkar, Latif; Nikbakht, Hajar

    2016-01-01

    Introduction: Hypertension is one of the traditional risk factors of cardiovascular disease (CVD). Extra cellular volume expansion and Na retention remain the main cause of hypertension. Objectives: The aim of this study was to investigate the relation between concentration of Na dialysate and blood pressure (BP) in chronic hemodialysis (HD) patient. Patients and Methods: This cross-sectional study was performed on 266 adult patients undergoing HD for at least three months. Pre-HD systolic BP (SBP) and post-HD SBP during 4 weeks were measured in relation to Na dialysate concentration. The other main factors affecting the post-dialysis BP, such as body mass index (BMI), pump speed, dialysis solution temperature, duration of dialysis and intradialysis weight gain (IDWG) were also considered. Mean of ΔSBP (post-HD SBP – pre-HD SBP) in each patient in 12 session of HD was measured and statistically analyzed in relation to dialysate Na with SPSS 21. Backward multivariable linear regression analysis and Pearson’s correlation coefficients were used to evaluate the correlation between sodium gradient and ΔSBP. Results: SBP was significantly changed before and after dialysis in relation to dialysate Na (Pcorrelation between ΔSBP with dialysate sodium and blood flow rate (pump speed) were statistically significant(P<0.05). Conclusion: We found that changes in SBP before and after dialysis is significantly associated with dialysate sodium concentration.

  6. The Application of Negative Pressure Wound Therapy in the Treatment of Chronic Venous Leg Ulceration: Authors Experience

    Directory of Open Access Journals (Sweden)

    Marek Kucharzewski

    2014-01-01

    Full Text Available The aim of the study was to use negative pressure wound therapy (NPWT in patients with chronic venous leg ulceration. The authors present their experience in treatment of 15 patients whose average ulceration surface area was 62.6 cm2. In 10 patients, the ulcers healed within 6 weeks and in the remaining patients within 20 weeks. Based on the results obtained, the authors imply that NPWT is an effective method in the treatment of chronic venous leg.

  7. Doença de Paget com acometimento sacral: relato de caso Paget's disease with sacral involvement: a case report

    Directory of Open Access Journals (Sweden)

    Fernanda Nogueira Holanda Ferreira Braga

    2010-10-01

    Full Text Available Os autores relatam o caso de um paciente do sexo masculino, 71 anos de idade, com diagnóstico de doença de Paget óssea sacral. Foi realizado estudo com radiografia, cintilografia, tomografia computadorizada e ressonância magnética, e o diagnóstico foi confirmado por análise histopatológica. O paciente evoluiu com boa resposta ao uso de ibandronato 150 mg, mensalmente, com redução significativa dos marcadores bioquímicos da doença.The authors report a case of a 71-year-old male patient diagnosed with Paget's disease of sacrum. Imaging study was performed with radiography, scintigraphy, computed tomography and magnetic resonance imaging, and the diagnosis was confirmed by biopsy. The patient progressed with a good response to monthly treatment with ibandronate 150 mg, presenting a significant reduction in biochemical markers of disease.

  8. Genetic influences on right ventricular systolic pressure (RVSP in chronic obstructive pulmonary disease (COPD

    Directory of Open Access Journals (Sweden)

    Shaw Janet G

    2012-06-01

    Full Text Available Abstract Background Pulmonary hypertension (PH is a complication of chronic obstructive pulmonary disease (COPD. This study examined genetic variations in mediators of vascular remodelling and their association with PH in patients with COPD. In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA. We tested for association with right ventricular systolic pressure (RVSP, spirometry and gas transfer, and hypoxemia. Methods In patients with COPD, we genotyped 7 SNPs in 6 candidate PH genes (NOS3, ACE, EDN1, PTGIS, SLC6A4, VEGFA. We tested for association with right ventricular systolic pressure (RVSP, spirometry and gas transfer, and hypoxemia. Results 580 COPD patients were recruited, 341 patients had a transthoracic echocardiogram, with RVSP measurable in 278 patients (mean age 69 years, mean FEV1 50% predicted, mean RVSP 44 mmHg, median history of 50 pack-years. Of the 7 tested SNPs, the NOS3-VNTR polymorphism was significantly associated with RVSP in a dose-dependent fashion for the risk allele: mean RVSP for a/a and a/b genotypes were 52.0 and 46.6 mmHg respectively, compared to 43.2 mmHg for b/b genotypes (P = 0.032. No associations were found between RVSP and other polymorphisms. ACE II or ID genotypes were associated with a lower FEV1% predicted than the ACE DD genotype (P = 0.028. The NOS3-298 TT genotype was associated with lower KCO % predicted than the NOS3-298 GG or GT genotype (P = 0.031. Conclusions The NOS3-VNTR polymorphism was associated with RVSP in patients with COPD, supporting its involvement in the pathogenesis of PH in COPD. ACE and NOS3 genotypes were associated with COPD disease severity, but not with the presence of PH. Further study of these genes could lead to the development of prognostic and screening tools for PH in COPD.

  9. Creation of an iliac arteriovenous shunt lowers blood pressure in chronic obstructive pulmonary disease patients with hypertension.

    LENUS (Irish Health Repository)

    Faul, John

    2014-01-28

    Vasodilators are used with caution in patients with chronic obstructive pulmonary disease (COPD). We have developed a device for percutaneous arteriovenous shunt creation in the iliac region to increase cardiac output and oxygen delivery for patients with COPD. Although this device does not cause significant blood pressure changes in normotensive patients with COPD, we hypothesized that arteriovenous shunt creation might cause vasodilator effects in hypertensive patients because of a reduction in vascular resistance.

  10. Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    SHI Jia-xin; XU Jin; SUN Wen-kui; SU Xin; ZHANG Yan; SHI Yi

    2013-01-01

    Background This meta-analysis evaluated the effect of noninvasive,positive pressure ventilation on severe,stable chronic obstructive pulmonary disease (COPD).Methods PUBMED,CNKI,Wanfang,EMBASE and the Cochrane trials databases were searched.Randomized controlled trials of patients with severe,stable COPD and receiving noninvasive positive pressure ventilation,compared with sham ventilation or no ventilation,were reviewed.The mortality,physiological and health related parameters were pooled to yield odds ratio (OR),weighted mean differences or standardized mean differences (SMD),with 95% confidence interval (C/).Results Eight parallel and three crossover randomized controlled trials met the inclusion criteria.Pooled analysis for parallel,randomized controlled trials showed noninvasive positive pressure ventilation:(1) Did not affect the 12-or 24-month mortality (OR 0.82,95% C/:0.48 to 1.41); (2) Improved the arterial carbon dioxide tension (SMD-0.88,95%C/:-1.43 to-0.34); (3) Did not improve forced expiratory volume in one second (SMD 0.20,95% C/:-0.06 to 0.46),maximal inspiratory pressure (SMD 0.01,95% C/:-0.28 to 0.29) or 6-minute walk distance (SMD 0.17,95% C/:-0.16 to 0.50); (4) Subgroup analysis showed noninvasive positive pressure ventilation improved the arterial carbon dioxide tension in hypercapnic patients.Pooled analysis for crossover randomized controlled trials did not show improvement in arterial blood gas or forced expiratory volume in one second with noninvasive positive pressure ventilation.Conclusions Noninvasive positive pressure ventilation improves the arterial carbon dioxide tension but does not improve the mortality,pulmonary function,or exercise tolerance and should be cautiously used in severe stable chronic obstructive pulmonary disease.

  11. Denomination of the Sacral Building, its Innerspaces and Liturgical Articles

    Directory of Open Access Journals (Sweden)

    Laimutė Kitkauskienė

    2011-04-01

    Full Text Available Basing upon the material collected the article aims at reviewing denomination of liturgical – ritual objects. As to their meaning names are divided into groups depending upon what they name – a sacral object or its parts, liturgical books or articles, ritual clothes, etc. Concerning their origin there are Lithuanian and non-Lithuanian words. The latters may come from one language or be received through languages – intermediates. The conclusion is made that Latin or other foreign words remain important in the Lithuanian language as there are no proper Lithuanian words to name liturgical objects. The article has both practical and theoretical value. The data presented can be used when studying general laws of term origin and building as well as explaining the adaptation of borrowings in the Lithuanian language. It is relevant to continue the studies of this subject in order to encourage the building of Lithuanian equivalents both in this field and in those which lack Lithuanian names.

  12. Changes of anabolic processes at the cellular and molecular level in chronic wounds under topical negative pressure can be revealed by transcriptome analysis

    OpenAIRE

    Leffler, Mareike; Derrick, Kathleen L.; McNulty, Amy; Malsiner, Caye; Dragu, Adrian; Horch, Raymund E.

    2011-01-01

    Abstract Chronic wounds – as defined by the World Union of Wound Healing Societies (WUWHS) – are a considerable worldwide health care expense and impair quality of life. In order for chronic wounds to heal, these wounds must be transformed to a more acute state to begin the healing process. Topical negative pressure (TNP) with reticulated open cell foam (ROCF) is known to promote healing in certain types of chronic wounds. However, little is known about changes at the cellular or molecular le...

  13. The effect of chronic reductions in the arterial partial pressure of oxygen on the radiation response of an experimental tumour

    International Nuclear Information System (INIS)

    A previous study by the same authors has reported the effect of acute reductions in the arterial partial pressure of oxygen (Pa02) on tumour response to radiation. The results have been extended in the present paper to investigate tumour response to radiation in animals in which the Pa02 is chronically reduced. The purpose of these experiments was to simulate the condition of cancer patients undergoing radiotherapy in the presence of chronically low Pa02 values as might be expected in patients with chronic respiratory disease. Mice bearing transplantable KHT sarcomas were kept in a 12% 02 environment prior to (10-16 days), during and following the radiation treatment of their tumours. During the period of low Pa02, (about 50 mm Hg) exposure, the mice were found to increase their haemoglobin (Hb) levels by approximately 50%. Because of this increase, the response, determined using a growth delay assay of the tumours irradiated at reduced Pa02 was found to be the same as that observed for tumours in mice breathing air throughout the experiment. In mice with reduced Pa02 levels maintained at normal Hb concentrations by periodic bleeding, tumour response was found to be similar to that of mice with acute Pa02 reductions. These results indicate that chronic Pa02 reductions in the absence of Hb compensation may have a detrimental effect on the success of a radiation treatment. (author)

  14. S3 Dorsal Root Ganglion/Nerve Root Stimulation for Refractory Postsurgical Perineal Pain: Technical Aspects of Anchorless Sacral Transforaminal Lead Placement

    Directory of Open Access Journals (Sweden)

    X. Zuidema

    2016-01-01

    Full Text Available Chronic perineal pain limits patients in physical and sexual activities, leading to social and psychological distress. In most cases, this pain develops after surgery in the urogenital area or as a consequence of trauma. Neuromodulation is one of the options in chronic postsurgical perineal pain treatment. We present a case of refractory perineal pain after right sided surgical resection of a Bartholin’s cyst which was treated with third sacral nerve root/dorsal root ganglion stimulation using the transforaminal approach. We describe a new anchorless lead placement technique using a unique curved lead delivery sheath. We postulate that this new posterior foraminal technique of lead placement is simple, safe, and reversible and may lower the occurrence of lead related complications.

  15. Image-guided percutaneous lipiodol-pingyangmycin suspension injection therapy for sacral chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Dexiao; Chen, Yong; Zeng, Qingie; Li, Yanhao [Dept. of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou (China); Wu, Renhua [Dept. of of Medical Imaging, the 2nd Affiliated Hospital, Medical College of Shantou University, Shantou (China)

    2013-10-15

    A 74-year-old man presented with a progressively worsening pain in sacrum and was diagnosed to have a sacral chordoma by biopsy in May, 2004. Percutaneous intratumoral injection with lipiodol-pingyangmycin suspension (LPS) was carried out under image guidance and repeated when the pain in sacrum recurred and the tumor increased. During a 6-year follow-up period, three sessions of this treatment were executed. CT imaging and Karnofsky Performance Score were used to evaluate the size of tumor and quality of life, respectively. The patient was free of pain after each procedure and had a high quality of life with a Karnofsky Performance Score above 80 points. The tumor lesion in sacral area was effectively controlled. No complications were observed. Percutaneous intratumoral injection with LPS under image guidance may be an effective and safe alternative for the patients with sacral chordoma.

  16. Dietary copper supplementation reverses hypertrophic cardiomyopathy induced by chronic pressure overload in mice

    Science.gov (United States)

    Sustained pressure overload causes cardiac hypertrophy and the transition to heart failure. We show here that dietary supplementation with physiologically relevant levels of copper (Cu) reverses pre-established hypertrophic cardiomyopathy in the presence of pressure overload induced by ascending aor...

  17. Sacral insufficiency fractures: an easily overlooked cause of back pain in the ED.

    LENUS (Irish Health Repository)

    Galbraith, John G

    2011-03-01

    Sacral insufficiency fractures are an important and treatable cause of severe back pain. Despite publication of several case reports since its original description in 1982, awareness of these injuries remains inadequate in emergency medicine. Most patients are elderly women presenting with intractable lower back pain. Postmenopausal osteoporosis is the most significant risk factor. Marked sacral tenderness is common. Neurologic impairment is rarely detectable. Routine radiography of the spine and pelvis is usually inconclusive. Computed tomography remains the diagnostic modality of choice. Treatment is usually conservative.

  18. Diffusion tensor MRI and fiber tractography of the sacral plexus in children with spina bifida

    DEFF Research Database (Denmark)

    Haakma, Wieke; Dik, Pieter; ten Haken, Bennie;

    2014-01-01

    anatomical and microstructural properties of the sacral plexus of patients with spina bifida using diffusion tensor imaging and fiber tractography. MATERIALS AND METHODS: Ten patients 8 to 16 years old with spina bifida underwent diffusion tensor imaging on a 3 Tesla magnetic resonance imaging system...... diffusivity values at S1-S3 were significantly lower in patients. CONCLUSIONS: To our knowledge this 3 Tesla magnetic resonance imaging study showed for the first time sacral plexus asymmetry and disorganization in 10 patients with spina bifida using diffusion tensor imaging and fiber tractography...

  19. Understanding the Resilience of Socio-Ecological Systems to the Impacts from Chronic Pressures

    Science.gov (United States)

    As understanding of the resilience of social-ecological systems to disasters has increased, a concurrent understanding of the resilience of those systems to chronic problems has not. To address this need, the U.S. Environmental Protection Agency is piloting a research effort to f...

  20. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, T.; Strandgaard, S.; Kamper, Anne-Lise

    2008-01-01

    /non-dipper status prospectively in a study on dosage of enalapril in progressive chronic kidney disease (CKD) stages 3-5. METHODS: In 34 patients, 24-h ambulatory BP (A&D TM2421) was measured at baseline and every 4 months for 1 year or until the need for renal replacement therapy. For each BP recording patients...

  1. Objective evaluation by reflectance spectrophotometry can be of clinical value for the verification of blanching/non blanching erythema in the sacral area.

    Science.gov (United States)

    Sterner, Eila; Fossum, Bjöörn; Berg, Elisabeth; Lindholm, Christina; Stark, André

    2014-08-01

    Early detection of non blanching erythema (pressure ulcer category I) is necessary to prevent any further skin damage. An objective method to discriminate between blanching/non blanching erythema is presently not available. The purpose of this investigation was to explore if a non invasive objective method could differentiate between blanching/non blanching erythema in the sacral area of patients undergoing hip fracture surgery. Seventy-eight patients were included. The sacral area of all patients was assessed using (i) conventional finger-press test and (ii) digital reading of the erythema index assessed with reflectance spectrophotometry. The patients were examined at admission and during 5 days postsurgery. Reflectance spectrophotometry measurements proved able to discriminate between blanching/non blanching erythema. The reliability, quantified by the intra-class correlation coefficient, was excellent between repeated measurements over the measurement period, varying between 0·82 and 0·96, and a significant change was recorded in the areas from day 1 to day 5 (P < 0·0001). The value from the reference point did not show any significant changes over the same period (P = 0·32). An objective method proven to identify early pressure damage to tissue can be a valuable tool in clinical practice.

  2. Evidence of viral adaptation to HLA class I-restricted immune pressure in chronic hepatitis C virus infection.

    Science.gov (United States)

    Gaudieri, Silvana; Rauch, Andri; Park, Lawrence P; Freitas, Elizabeth; Herrmann, Susan; Jeffrey, Gary; Cheng, Wendy; Pfafferott, Katja; Naidoo, Kiloshni; Chapman, Russell; Battegay, Manuel; Weber, Rainer; Telenti, Amalio; Furrer, Hansjakob; James, Ian; Lucas, Michaela; Mallal, Simon A

    2006-11-01

    Cellular immune responses are an important correlate of hepatitis C virus (HCV) infection outcome. These responses are governed by the host's human leukocyte antigen (HLA) type, and HLA-restricted viral escape mutants are a critical aspect of this host-virus interaction. We examined the driving forces of HCV evolution by characterizing the in vivo selective pressure(s) exerted on single amino acid residues within nonstructural protein 3 (NS3) by the HLA types present in two host populations. Associations between polymorphisms within NS3 and HLA class I alleles were assessed in 118 individuals from Western Australia and Switzerland with chronic hepatitis C infection, of whom 82 (69%) were coinfected with human immunodeficiency virus. The levels and locations of amino acid polymorphisms exhibited within NS3 were remarkably similar between the two cohorts and revealed regions under functional constraint and selective pressures. We identified specific HCV mutations within and flanking published epitopes with the correct HLA restriction and predicted escaped amino acid. Additional HLA-restricted mutations were identified that mark putative epitopes targeted by cell-mediated immune responses. This analysis of host-virus interaction reveals evidence of HCV adaptation to HLA class I-restricted immune pressure and identifies in vivo targets of cellular immune responses at the population level. PMID:17071929

  3. Overall anatomical features and clinical value of the sacral nerve in high resolution computed tomography reconstruction

    Institute of Scientific and Technical Information of China (English)

    LIN Jing-fu; WANG Yan-hua; JIANG Bao-guo; ZHANG Pei-xun; LI Yan-ying; ZHANG Dian-ying

    2010-01-01

    Background Sacral nerve injury is a common complication of pelvic or sacral fractures. As the sacral nerve courser within the sacrum and has a complex relationship with the surrounding tissues, different parts of the sacral plexus injury have similar clinical symptoms and signs. Since lack of specific imaging technique in the diagnosis of sacral nerve injury,especially on multi-segment, multi-site, how to determine the preoperative location and extent of the sacral nerve injury accurately becomes a concem of the general orthopaedic and images practitioners. This study was conducted to gain an insight into the overall anatomical features of the sacral nerve (SN) on the same slice in high resolution computed tomography (HRCT) reconstruction and to determine the value of this information for the clinical diagnosis of related diseases.Methods Fifty healthy volunteers and 30 patients (40 sides) with SN lesions confirmed by surgery were scanned using a 16-slice helical CT scanner (Light Speed, GE, USA). Among the patients, 6 with intervertebral disk hernia (6 sides), 8with spinal stenosis (12 sides), 11 with pelvic trauma (14 sides), 4 with pelvic malignancies (6 sides), and 1 with sacral vertebral tuberculosis (2 sides). The SN multiplanar reconstruction was performed using a UNIX-based SCD4.1workstation where the image was set on the same slice. All images were stored in the Digital Imaging and Communications in Medicine format. The display of nerves in different sections was analyzed using a five-graded scale with coordinate curves of each individual score. The overall anatomic features visible on the slice were analyzed and the abnormalities of the lesions were studied.Results The image of the same slice clearly revealed the shape, running direction, thickness, tension and adjacent anatomy of the S1-S4 nerves. The rank of display rates in different sections was: outward-rotated oblique sagittal >outward-rotated oblique coronal > oblique coronal plane > coronal

  4. High pressure versus high intensity noninvasive ventilation in stable hypercapnic chronic obstructive pulmonary disease: a randomized crossover trial

    Directory of Open Access Journals (Sweden)

    Murphy PB

    2012-12-01

    Full Text Available Patrick B Murphy,1,* Kate Brignall,1,* John Moxham,2 Michael I Polkey,3 A Craig Davidson,1,# Nicholas Hart1,4,#1Lane Fox Clinical Respiratory Physiology Group, Guy’s and St Thomas’ NHS Foundation Trust, 2Department of Thoracic Medicine, King’s College Hospital, 3Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust, 4Guy’s and St Thomas’ NHS Foundation Trust and Kings College London NIHR Comprehensive Biomedical Research Centre, London, UK*These authors contributed equally to the work #These senior authors contributed equally to the workBackground: High-intensity (high-pressure and high backup rate noninvasive ventilation has recently been advocated for the management of stable hypercapnic chronic obstructive pulmonary disease (COPD. However, the relative contributions of high inspiratory pressure and high backup rate to ventilator adherence and physiological outcome have not been investigated.Methods: Patients with stable hypercapnic COPD (daytime PaCO2 > 6 kPa and nocturnal hypoventilation were enrolled. Patients were randomly allocated to high-pressure and high backup rate (high-intensity and high-pressure and low backup rate (high-pressure for a 6-week period. At the end of the first treatment period, patients were switched to the alternative treatment. The primary outcome measure was mean nightly ventilator usage.Results: Twelve patients were recruited, with seven completing the 12-week trial protocol. The mean patient age was 71 ± 8 years, with a forced expiratory volume in one second (FEV1/forced vital capacity (FVC of 50% ± 13% and FEV1 of 32% ± 12%. The baseline PaCO2 and PaO2 were 8.6 ± 1.7 kPa and 7.3 ± 1.4 kPa, respectively. There was no significant difference demonstrated in mean nightly ventilator usage between the high-intensity and high-pressure groups (difference of 4 minutes; 95% confidence interval −45 to 53; P = 0.9. Furthermore, there were no differences in any of the secondary

  5. Evidence for effects of chronic lead exposure on blood pressure in experimental animals: an overview.

    OpenAIRE

    Victery, W

    1988-01-01

    Information obtained in a number of experimental studies conducted over the last 40 years on the effects of lead on blood pressure is reviewed. Differences in animal species, age at beginning of exposure, level of lead exposure, indices of lead burden, and blood pressure effects of each study are reported. In several of the high-dose experiments, hypertension was observed, but nephrotoxicity of lead may have contributed to its development. Moreover, in other high-dose experiments, no hyperten...

  6. Factors leading to poor outcome of noninvasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    Ashok Kumar; Anoop Kumar; Kelash Rai; Shaista Ghazal; Nadeem Rizvi; Sunil Kumar; Sadhna Notani

    2015-01-01

    Objective:To determine frequency of factors leading to poor outcome of non-invasive positive pressure ventilation in acute exacerbation of chronic obstructive pulmonary disease. Methods:This cross sectional study was conducted at our center between May 2012 and November 2012. A total of 195 diagnosed patients of acute exacerbation of chronic obstructive pulmonary disease meeting the inclusion criteria were selected from the ER department. At the time of admission age was inquired BP, respiratory rate and oxygen saturation will be noted and pedal edema was assessed and investigations were sent for pH assessment. Noninvasive positive pressure ventilation (NIPPV) using BiPAP was applied in spontaneous mode by the help of oronasal mask. Presence of respiratory rate (less than 12/min), systolic blood pressure140 bpm was taken as poor outcome. Results:The average age of the cases was 61.9±9.3 years with male to female ratio being 1.5:1. NIPPV was successful in 151 (77.4%) cases and 44 (22.6%) cases were underwent endotracheal intubation. About 38 (44.7%) of patients with oxygen saturation (82%-86%) had poor prognosis. A total of 40 (55.6%) of patients with pH range 7.20-7.26, required endotracheal intubation, 43 (66.2%) with pedal edema underwent endotracheal intubation. While 29 (24.16%) patients of age>60 years needed endotracheal intubation. Conclusions:In this study, NIPPV was successful in 77.4%cases and 22.6%cases were underwent endotracheal intubation. Pedal edema was the most common factor leading to poor outcomes while age>60 years was the least common factor, 66.2%and 24.2%respectively.

  7. Clinical Value of Interventional Embolization for Sacral Chordoma before Surgical Treatment

    Institute of Scientific and Technical Information of China (English)

    Zhihui CHANG; Zhaoyu LIU; Jiahe Zheng; Zaiming LU; Qiyong GUO

    2011-01-01

    Objetive:To evaluate the efficacy of preoperative transcatheter arterial embolization in the treatment of sacral chordoma,and to explore the choice of embolization timing. Methods:32 patients underwent the posterior approach after TAE of the main arteries that supplied the sacral chordoma. Intraoperative bleeding amount of each patient was recorded and compared between-group differences at different operation times. Results: After embolization, 12 patients were received resection within 24 hours (group A),that of 10 cases between 24 ~ 48h (group B), of another 10 cases between 48~ 72h (group C). All of the 32 tumors were removed intact with intraoperative bleeding about (894±199)ml, without any shock or death,nor injuries on abdominal organs such as rectum and ureter. There was no statistical significance in tumor size among group A,B and C (P>0.05). Data gave statistical significance in intraoperative blood loss between group A and B (P<0.01) ,there was no statistical differences between group B and C (P>0.05), in spite of group B slightly less than group C. Conclusion: Preoperative TAE for excising the sacral tumor can significantly decrease intraoperative blood loss, make the surgical field clear,and facilitate the maximal removal of the sacral chordoma. It would be best to select the embolization timing within 24 hours before surgical operation.

  8. STUDY OF SACRAL INDEX: COMPARISON BETWEEN DIFFERENT REGIONAL POPULATIONS OF INDIA AND ABROAD

    Directory of Open Access Journals (Sweden)

    Poornima Janipati

    2014-10-01

    Full Text Available Identification of sex by human skeletal remains is a critical problem and is very important in anthropological and medico legal works. Bones often survive the process of decay and therefore provide the major evidence of human age and sex after death. Over the years different authors had carried various types of measurements on human sacra of different races and regions. The present study carried out 81 sacra of unknown sex contains 45 male and 36 female sacra identified by physical characteristics. They were collected from Telangana and Andhra Pradesh region. India may be divided into four regions like North part, South part, West part, and East part for different study purpose on local population. In the present study mean sacral index in males is 104.08 and females are 115.72. The male mean sacral index value of present study is more than the values of Eastern part, north part, other worker of Southern part of India and western part except in Western part in Western Rajasthan population. The female mean sacral index value of present study is higher than the observation of Eastern part, other workers of Southern part of India, Varanasi and Jammu of north part of India and Saurashtra region of western region of India. Observations of the workers from remaining areas of Western part of India and Agra region of North India is higher than the present study. The studies on Indian population suggest that mean sacral index in females is higher than that of males.

  9. Progressive or degressive compression pressure profile in patients with chronic venous disorders of the lower limb

    Directory of Open Access Journals (Sweden)

    Giovanni Mosti

    2014-03-01

    Full Text Available Graduated compression devices are considered the standard care for management of venous and lymphatic disorders. Recently compression devices exerting a pressure over the calf higher than over the ankle have been proved to be more effective than traditional graduated devices in increasing the impaired ejection fraction (EF from the lower leg in patients with venous disease. Aim of this work is presenting an overview of the new concept on progressive compression, its potential benefits and limits. In different series of tests, the EF from the lower leg was assessed in 70 patients with severe reflux in the great saphenous vein (GSV. EF was measured by strain gauge plethysmography, in baseline conditions and after applying graduated compression devices or the new inversely graduated or progressive compression (PC devices. The interface pressure was recorded, simultaneously with the EF, both in the gaiter area (B1 point and at the calf (C point in order to assess the compression pressure profile. EF, severely impaired in patients with GSV reflux, was increased by compression. So called PC devices (both PC elastic stocking and PC inelastic bandages were significantly more effective than graduated compression in increasing the ejection fraction. The higher the pressure on the calf the higher the EF improvement. Maintaining the same strong pressure over the calf by means of two progressive stockings and increasing the pressure only over the calf to restore a graduated compression didn’t improve the EF. To improve venous pumping function in the ambulant patient stronger compression of the calf is more effective than graduated compression. This can be explained by the higher amount of blood volume pooled in the calf veins.

  10. The sacral networks and neural pathways used to elicit lumbar motor rhythm in the rodent spinal cord

    Directory of Open Access Journals (Sweden)

    Meir eCherniak

    2014-12-01

    Full Text Available Identification of neural networks and pathways involved in activation and modulation of spinal central pattern generators (CPGs in the absence of the descending control from the brain is important for further understanding of neural control of movement and for developing innovative therapeutic approaches to improve the mobility of spinal cord injury patients. Activation of the hindlimb innervating segments by sacrocaudal afferent input and by specific application of neurochemicals to the sacral networks is feasible in the isolated spinal cord preparation of the newborn rat. Here we review our recent studies of sacral relay neurons with lumbar projections and evaluate their role in linking the sacral and thoracolumbar networks during different motor behaviors. Our major findings show that: 1 Heterogeneous groups of dorsal, intermediate and ventral sacral-neurons with ventral and lateral ascending funicular projections mediate the activation of the locomotor central pattern generators through sacral sensory input, and 2 Rhythmic excitation of lumbar flexor motoneurons, produced by bath application of alpha-1 adrenoceptor agonists to the sacral segments is mediated exclusively by ventral clusters of sacral-neurons with lumbar projections through the ventral funiculus.

  11. Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    CHEN Hong; LIANG Bin-miao; XU Zhi-bo; TANG Yong-jiang; WANG Ke; XIAO Jun; YI Qun; SUN Jian; FENG Yu-lin

    2011-01-01

    Background The evidence for non-invasive positive pressure ventilation (NIPPV) used in patients with severe stable chronic obstructive pulmonary disease (COPD) is insufficient.The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change,lung function,health-related quality of life (HRQL),survival and mortality in severe stable COPD patients.Methods Randomized controlled trials (RCTs) and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010.Two reviewers independently assessed study quality.Data were combined using Review Manager 5.0.Both pooled effects and 95% confidence intervals were calculated.Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included.NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures.The weighted mean difference (WMD) for the partial pressure of carbon dioxide in artery (PaCO2) was -3.52 (-5.26,-1.77) mmHg and for the partial pressure of oxygen in artery (PaO2) 2.84 (0.23,5.44) mmHg.There were significant improvements in dyspnea and sleep quality,but gained no benefits on lung function.The standardized mean difference (SMD) for the forced expiratory volume in 1 second (FEV1)was 0.00 (0.29,0.29).And the benefits for exercise tolerance,mood,survival and mortality remained unclear.Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV,especially improvements in gas change,dyspnea and sleep quality.Studies of high methodological quality with large population,especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

  12. Effect of hemodialysis on visual acuity, intraocular pressure, and macular thickness in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Chelala E

    2015-01-01

    Full Text Available Elias Chelala,1,2,* Ali Dirani,1,2,* Ali Fadlallah,1,2 Elise Slim,1,2 Youssef Abdelmassih,1,2 Henry Fakhoury,3 Patrick Baz,1,2 Riad Bejjani1,2 1Faculty of Medicine, Saint-Joseph University, 2Hôtel-Dieu de France Hospital, Saint-Joseph University, 3Eye and Ear Hospital, Beirut, Lebanon *These two authors contributed equally to this work Background: The aim of this study was to evaluate the effects of hemodialysis (HD on visual acuity, intraocular pressure (IOP, and central foveal thickness (CFT in patients with chronic kidney disease.Materials and methods: Forty-nine eyes from 49 chronic kidney-disease patients were analyzed. Causes of chronic kidney disease included diabetes mellitus (n=9 patients, hypertensive nephrosclerosis (n=15 patients, and other causes (n=25 patients. All patients underwent HD in the Dialysis Unit of Hôtel-Dieu de France Hospital. Best-corrected visual acuity, CFT, and IOP were evaluated before and after HD. CFT was measured with spectral domain optical coherence tomography, and IOP was measured with Goldmann applanation tonometry.Results: Neither decimal best-corrected visual acuity (pre-HD 0.71±0.32, post-HD 0.72±0.31; P=0.877 nor CFT (pre-HD 251.39±39.29, post-HD 253.09±39.26; P=0.272 significantly changed after HD. However, mean IOP significantly decreased from 13.99±2.48 before HD to 12.65±2.41 mmHg after HD (P=0.001. IOP change was significantly correlated with serum albumin levels (P=0.008 and weight changes (P=0.047.Conclusion: HD can affect various ocular parameters. This is particularly true of IOP, which decreases significantly following HD. Keywords: chronic kidney disease, hemodialysis, visual acuity, central macular thickness, intraocular pressure

  13. Management of patients with pressure ulcers

    OpenAIRE

    Bora Ozel

    2014-01-01

    A pressure ulcer is an area of localized damage to the skin and underlying tissue caused by pressure or shear. Although these ulcers can occur anywhere on the body, they are often located in the ischial, trochanteric, sacral areas and. heel. These ulcers are primarily the products of a combination of pressure and decreased angiogenic response. Early intervention and comprehensive treatment should result in complete healing of ulcers. In this review, we tried to create a general perspective ab...

  14. Comparison of regional pancreatic tissue fluid pressure and endoscopic retrograde pancreatographic morphology in chronic pancreatitis

    DEFF Research Database (Denmark)

    Ebbehøj, N; Borly, L; Madsen, P;

    1990-01-01

    previous surgery. A stone, total obstruction, or major stenosis in the pancreatic duct at ERP was related to a downstream pressure gradient significantly higher than found in a non-obstructed pancreatic main duct, but the relation was not uniform. Generally, there was no significant relation between...

  15. Longitudinal observations on circadian blood pressure variation in chronic kidney disease stages 3-5

    DEFF Research Database (Denmark)

    Elung-Jensen, Thomas; Strandgaard, Svend; Kamper, Anne-Lise

    2008-01-01

    BACKGROUND: It has been suggested that status as a 'non-dipper' determined from 24-h blood pressure (BP) recordings is associated with increased risk of end-organ damage but little is known about the consistency of dipper status in renal patients. The present post hoc analysis evaluated dipper...

  16. The reduction of intraocular pressure after instillation of travoprost compared with timolol in chronic primary angle-closure glaucoma

    Directory of Open Access Journals (Sweden)

    Edi S. Affandi

    2006-12-01

    Full Text Available The objective of this study is to compare the reduction of intraocular pressure (IOP after instillation of Travoprost compared with timolol in chronic primary angle-closure glaucoma. A prospective randomized, crossover study was conducted from April 2005 to July 2005 at Department of Ophthalmology, National Central General Hospital (RSCM Jakarta on subjects with chronic primary angle-closure glaucoma. Subjects were randomly divided into 2 groups: those taking Travoprost once daily and those taking timolol twice daily. Two weeks after treatment with the first drug, the second drug was substituted. Intraocular pressure was recorded before therapy, at day 1, day 7, and day 14. There was a wash out period of three weeks prior to initial treatment and after the cross over. Sixteen subjects (32 eyes met the inclusion criteria and were included in this study. The mean baseline IOP in the Travoprost group was 25.38 ± 3.01 mmHg, while in the timolol group it was 25.88 ± 2.55 mmHg (p=0.354. At day 7, the IOP were consecutively 16.75 + 1.92 mmHg and 21.25 + 3.09 mmHg (p=0.001 and at day 14 IOP were 13.94 + 2.02 mmHg and 19.25 + 2.18 mmHg (p=000. This showed that Travoprost decreased the IOP faster and greater than timolol. The mean baseline IOP was 25.38 ± 3.01 mmHg was decreased to 11.44 ± 1.90 mmHg with Travoprost. In the timolol group, the mean baseline IOP of 25.88 ± 2.55 mmHg was decreased to 6.63 ± 2.25 mmHg. Statistically, Travoprost significantly reduced the IOP faster and greater than timolol (p<0.05. Travoprost eye drops reduced the IOP faster and greater than timolol. (Med J Indones 2006; 15:242-5Keywords: chronic primary angle closure glaucoma, intraocular pressure, Travoprost, timolol.

  17. Resistance Training Exercise Program for Intervention to Enhance Gait Function in Elderly Chronically Ill Patients: Multivariate Multiscale Entropy for Center of Pressure Signal Analysis

    OpenAIRE

    Ming-Shu Chen; Jiang, Bernard C.

    2014-01-01

    Falls are unpredictable accidents, and the resulting injuries can be serious in the elderly, particularly those with chronic diseases. Regular exercise is recommended to prevent and treat hypertension and other chronic diseases by reducing clinical blood pressure. The “complexity index” (CI), based on multiscale entropy (MSE) algorithm, has been applied in recent studies to show a person's adaptability to intrinsic and external perturbations and widely used measure of postural sway or stabili...

  18. Blood pressure response to conventional and low-dose enalapril in chronic renal failure

    DEFF Research Database (Denmark)

    Elung-Jensen, Thomas; Heisterberg, Jens; Kamper, Anne-Lise;

    2003-01-01

    ) glomerular filtration rate (GFR) at baseline was 18 (7.9) in the high enalaprilat concentration group and 17 (7.3) ml min(-1) 1.73 m(2) in the low concentration group (NS). Nine patients in each group were on treatment with enalapril at baseline with a median daily dose of 5 mg in both the high (5...... pressures in the two groups were 140 (110-200) and 133 (110-165), in the high and low enalaprilat concentration groups, respectively, and after 3 months they were 135 (105-170) and 130 (105-170) mmHg (NS). Median diastolic blood pressure was 80 mmHg in each group both at baseline (65-100) and at follow...

  19. Multidisciplinary and comprehensive approaches to optimal management of chronic pressure ulcers in the elderly

    OpenAIRE

    Jaul E

    2014-01-01

    Efraim Jaul Skilled Geriatric Nursing Department, Herzog Memorial Hospital, Affiliated to the Hebrew University Hadassah Medical School, Jerusalem, Israel Abstract: The occurrence of pressure ulcers (PUs) is common and poses serious problems for the frail elderly, with implications for functional disability and reduced quality of life. PUs are preventable in a majority of cases. The increase in PU occurrence, however, appears regardless of higher awareness in prevention and improvement throu...

  20. Total resection of the sacral chordoma through posterior approach; Calkowite usuniecie struniaka kosci krzyzowej z dojscia dolnego

    Energy Technology Data Exchange (ETDEWEB)

    Doniec, J.; Pasciak, M.; Folta, K. [Wojewodzki Szpital Chirurgii Urazowej, Piekary Slaskie (Poland)

    1993-12-31

    The case of the sacral chordoma with intrapelvic ingrowth was operated and treated with radiotherapy. Technic of total tumor resection through posterior approach was described. (author). 12 refs, 1 fig.

  1. The importance of trabecular hypertrophy in right ventricular adaptation to chronic pressure overload.

    Science.gov (United States)

    van de Veerdonk, Mariëlle C; Dusoswa, Sophie A; Marcus, J Tim; Bogaard, Harm-Jan; Spruijt, Onno; Kind, Taco; Westerhof, Nico; Vonk-Noordegraaf, Anton

    2014-02-01

    To assess the contribution of right ventricular (RV) trabeculae and papillary muscles (TPM) to RV mass and volumes in controls and patients with pulmonary arterial hypertension (PAH). Furthermore, to evaluate whether TPM shows a similar response as the RV free wall (RVFW) to changes in pulmonary artery pressure (PAP) during follow-up. 50 patients underwent cardiac magnetic resonance (CMR) and right heart catheterization at baseline and after one-year follow-up. Furthermore 20 controls underwent CMR. RV masses were assessed with and without TPM. TPM constituted a larger proportion of total RV mass and RV end-diastolic volume (RVEDV) in PAH than in controls (Mass: 35 ± 7 vs. 25 ± 5 %; p TPM mass was related to the RVFW mass in patients (baseline: R = 0.65; p TPM from the assessment resulted in altered RV mass, volumes and function than when included (all p TPM mass (β = 0.44; p = 0.004) but not the changes in RVFW mass (p = 0.095) were independently related to changes in PAP during follow-up. RV TPM showed a larger contribution to total RV mass in PAH (~35 %) compared to controls (~25 %). Inclusion of TPM in the analyses significantly influenced the magnitude of the RV volumes and mass. Furthermore, TPM mass was stronger related to changes in PAP than RVFW mass. Our results implicate that TPM are important contributors to RV adaptation during pressure overload and cannot be neglected from the RV assessment.

  2. Evaluation of Blood Pressure and Heart Rate in Patients with Hypertension Who Received Tapentadol Extended Release for Chronic Pain: A Post Hoc, Pooled Data Analysis

    OpenAIRE

    Biondi, David M.; Xiang, Jim; Etropolski, Mila; Moskovitz, Bruce

    2014-01-01

    Background and Objectives Hypertension is one of the most common co-existing conditions in patients with chronic pain, and the potential effects of an analgesic on heart rate and blood pressure are of particular concern for patients with hypertension. The purpose of this analysis was to evaluate changes in blood pressure and heart rate with tapentadol extended release (ER) treatment in patients with hypertension. Methods We performed a post hoc analysis of data pooled from three randomized, p...

  3. Time-updated systolic blood pressure and the progression of chronic kidney disease: Findings from the Chronic Renal Insufficiency Cohort (CRIC) Study

    Science.gov (United States)

    Anderson, Amanda H; Yang, Wei; Townsend, Raymond R; Pan, Qiang; Chertow, Glenn M; Kusek, John W; Charleston, Jeanne; He, Jiang; Kallem, RadhaKrishna; Lash, James P; Miller, Edgar R; Rahman, Mahboob; Steigerwalt, Susan; Weir, Matthew; Wright, Jackson T; Feldman, Harold I

    2015-01-01

    Background Blood pressure (BP) is often inadequately controlled in patients with chronic kidney disease (CKD). Previous reports of the longitudinal association between achieved level of BP and end-stage renal disease (ESRD) have not incorporated time-updated BP with appropriate adjustment for known confounders. Objective To assess the association between baseline and time-updated systolic BP (SBP) with the progression of CKD. Design Observational, prospective cohort study (ClinicalTrials.gov identifier: NCT00304148) Setting Seven US clinical centers Patients Participants of the Chronic Renal Insufficiency Cohort (CRIC) Study (N=3,708) followed for a median (25th, 75th percentiles) of 5.7 (4.6, 6.7) years Measurements The mean of three seated SBP measurements were used as the visit-specific SBP. SBP was time-updated as the mean of that visit and all prior visits. Outcomes were ESRD and the composite renal endpoint of ESRD (dialysis or transplantation) or halving of the estimated glomerular filtration rate (eGFR). Analyses investigating baseline and time-updated SBP utilized traditional Cox proportional hazards models and marginal structural models, respectively. Results SBP was ≥130 mmHg at all study visits in 19.2% of participants, and ≥140 mmHg in 10.6%. The hazard ratio (95% confidence interval) for ESRD among participants with SBP 130–139 mmHg, compared to SBP <120 mmHg, was 1.46 (1.13–1.88) using only baseline data, and was 2.37 (1.48–3.80) using all available time-updated data. Among those with SBP ≥140 mmHg, corresponding hazard ratios were 1.46 (1.18–1.88) and 3.37 (2.26–5.03), respectively. Limitations SBP was measured once annually, and the CRIC Study cohort is not a random sample. Conclusions Among participants in the CRIC Study, time-updated SBP over 130 mmHg was more strongly associated with progression of CKD than analyses based on baseline SBP. Funding The CRIC Study is funded under cooperative agreements from the National Institute of

  4. Comparison of silver sulfadiazine, povidone-iodine and physiologic saline in the treatment of chronic pressure ulcers.

    Science.gov (United States)

    Kucan, J O; Robson, M C; Heggers, J P; Ko, F

    1981-05-01

    The presence of bacteria and local infection is an important factor in the local management of chronic pressure ulcers. For successful closure of the ulcer, the bacterial count should be 10(5) or less per gram of tissue in the granulating wound. In a prospective randomized study of 45 (eventually 40) hospitalized patients, silver sulfadiazine (Silvadene) cream and povidone-iodine (Betadine) solution were compared to physiologic saline for effectiveness in preparing pressure ulcers for closure. Quantitative bacteriologic techniques on tissue biopsy specimens were used for objective evaluation. In 100 percent of the ulcers treated with silver sulfadiazine cream (15 patients) the bacterial counts were reduced to 10(5) or less per gram of tissue within the three-week test period, compared to 78.6 percent in those treated with saline (14 patients) and 63.6 percent in those treated with povidone-iodine solution (11 patients). Moreover, the ulcers treated with silver sulfadiazine cream responded more rapidly, with one-third showing bacterial levels of less than 10(5) within three days, and half within a week. PMID:7014694

  5. Introducing a New Risk Factor for Lumbar Disc Herniation in Females : Vertical Angle of the Sacral Curvature

    OpenAIRE

    Kanat, Ayhan; Yazar, Ugur; Kazdal, Hizir; Sonmez, Osman Fikret

    2012-01-01

    Objective To characterize the importance of the vertical angle of the sacral curvature (VASC) in lumbar disc herniations. Methods Morphological data derived from lumbar sagittal MRI imaging. The statistical significance of the findings are discussed. The angles of 60 female patients with lumbar disc herniations (LDH) were compared with the 34 female patients without LDH. Results 128 of the 185 patients met our inclusion criteria. The vertical angle of sacral curvature is statistically signifi...

  6. [Continuous positive airway pressure and high-frequency independent lung ventilation in patients with chronic obstructive lung diseases].

    Science.gov (United States)

    Fedorova, E A; Vyzhigina, M A; Gal'perin, Iu S; Zhukova, S G; Titov, V A; Godin, A V

    2004-01-01

    The original hypoxemia, hypercapnia, high pulmonary hypertension, high resistance of microcirculation vessels, right volumetric ventricular overload, persistent sub-edema of pulmonary intersticium as well as disparity of ventilation and perfusion between both lungs are the main problems in patients with chronic obstructive disease of the lungs (CODL). Such patients are, as a rule, intolerant to the independent lung collaboration or artificial single-stage ventilation (ASV). Patients with respiratory insufficiency, stages 2 and 3, and with a pronounced impaired type of ventilation have originally a deranged blood gas composition, like hypoxemia or hypercapnia. The application of volume-controllable bi-pulmonary ASV in such patients maintains an adequate gas exchange hemodynamics. However, ASV is accompanied by a significantly reduced gas-exchange function of the single ventilated lung and by essentially worsened intrapulmonary hemodynamics. Therefore, what is needed is to use alternative methods of independent lung ventilation in order to eliminate the gas-exchange impairments and to enable surgical interventions at thoracic organs in such patients (who are intolerant to ASV). A choice of a method and means of oxygen supply to the independent lung is of great importance. The possibility to avoid a high pressure in the airways, while maintaining, simultaneously, an adequate gas exchange, makes the method related with maintaining a constant positive pressure in the airways (CPPA) a priority one in case of CODL patients. The use of constant high-frequency ventilation in the independent lung in patients with obstructive pulmonary lesions does not improve the gas exchange or hemodynamics. Simultaneously, a growing total pulmonary resistance and an increasing pressure in the pulmonary artery are observed. Consequently, the discussed method must not be used for the ventilation support of the independent lung in patients with the obstructive type of the impaired external

  7. Effects of Inhaled Fenoterol and Positive End-Expiratory Pressure on the Respiratory Mechanics of Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Claude Guerin

    2005-01-01

    Full Text Available BACKGROUND: During acute ventilatory failure in patients with chronic obstructive pulmonary disease (COPD, applying external positive end-expiratory pressure (PEEPe will reopen small airways and, thus, may enhance peripheral deposition as well as the physiological effects of inhaled beta-2 agonists.

  8. Effects of Aerobic Exercise Training and Irbesartan on Blood Pressure and Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Karine Marquis

    2008-01-01

    Full Text Available BACKGROUND AND OBJECTIVES: The present pilot study was undertaken to evaluate the efficacy of an aerobic exercise training (AET program alone or combined with an antihypertensive agent (irbesartan to reduce blood pressure (BP and enhance heart rate variability (HRV in chronic obstructive pulmonary disease patients.

  9. First experience using navigation-guided radiofrequency kyphoplasty for sacroplasty in sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Klingler, J.H.; Kluge, P.; Sircar, R.; Kogias, E.; Scholz, C.; Krueger, M.T.; Scheiwe, C.; Hubbe, U. [Freiburg Univ. Medical Center, Freiburg (Germany). Dept. of Neurosurgery

    2013-08-15

    Purpose: To evaluate the efficacy and safety of navigation-guided radiofrequency kyphoplasty for sacroplasty in patients with sacral insufficiency fractures. Methods: In this single-center retrospective observational study, four consecutive patients with sacral insufficiency fractures were treated with navigation-guided radiofrequency kyphoplasty for sacroplasty between April 2010 and May 2012. Symptom characteristics, pain duration and pain intensity were recorded for each patient. Cement extravasation was evaluated in thin-sliced and triplanar reconstructed CT scans of the sacrum. Results: Four female patients with painful sacral insufficiency fractures and extensive osteopenic areas significantly improved from an average pre-treatment VAS score of 8.3 {+-} 0.5 to 2.3 {+-} 1.0 (p < 0.001) on the first postoperative day and to 1.3 {+-} 1.9 (p < 0.004) at follow-up (mean, 20.1 weeks). Slight cement extravasations were observed without evidence of being symptomatic. No major complications or procedure-related morbidity were noted. Conclusion: From the limited experience in four patients, navigation-guided radiofrequency kyphoplasty appears to be a safe and effective treatment option for sacral insufficiency fractures even though asymptomatic cement extravasation was noted. The use of navigation based on intraoperative 3 D images simplifies the positioning of the navigated bone needles via the long axis approach. The radiofrequency kyphoplasty system provides the possibility to administer a sufficient amount of bone cement with a well-defined viscosity over the entire period of the procedure leading to high security and low cement extravasation. Sacroplasty provides rapid and enduring pain relief and facilitates prompt mobilization. (orig.)

  10. EVALUATION OF SACRAL RATIO AS A PROGNOSTIC FACTOR IN PATIENTS WITH ANORECTAL MALFORMATIONS

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    J. Ahmadi

    2005-05-01

    Full Text Available Correlation between sacral ratio and bowel function as well as fecal continence has been well documented in patients with anorectal malformations (ARMs. One hundred and twenty children with ARMs were investigated in this study. Sacral ratio (SR was measured from pelvic X-rays of patients. Among these, 52 patients (43% had no pelvic X-ray and were excluded from this study. SR was measured by drawing three horizontal lines, through iliac crests (A, tip of coccyx (B and inferior point of sacroiliac joints (C. The SR was determined by dividing the distance between lines B and C to the distance between lines A and B. In the normal and well developed children, the average ratio is ≥0.74. The SR was higher than 0.70 in 12 (17.7% children and less than 0.69 in 56 children (82.3%. Among children with ARMs and abnormal SR, 38 cases (68% had SR of 0.50-0.69; 12 cases (21.5%had SR of 0.40-0.49 and 6 cases (10.5% had SR of 0-0.39. In children with ARMs and normal SR, the fecal incontinence was observed in 2 cases (16%. In contrast, 16 cases (29% with ARMs and abnormal SR had functional disturbance, either fecal incontinence or soiling (P < 0.12. When the patients had an absent sacrum, they had zero possibility for bowel control and frequently had major urinary problems. The sacral feature and SR appear to have a direct influence on the final functional outcome in ARMs. The abnormal SR < 0.7 correlates with poor bowel function. In patients with ARMs, sacral segment and SR are important factors in post operative bowel function disturbance.

  11. Low back pain during pregnancy caused by a sacral stress fracture: a case report

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    Pishnamaz Miguel

    2012-04-01

    Full Text Available Abstract Introduction Sacral stress fractures are a rare but well known cause of low back pain. This type of fracture has also been observed as a postpartum complication. To date, no cases of intrapartum sacral stress fractures have been described in the literature. Case presentation We report the case of a 26-year-old Caucasian European primigravid patient (30 weeks and two days of gestation who presented to our outpatient clinic with severe low back pain that had started after a downhill walk 14 days previously. She had no history of trauma. A magnetic resonance imaging scan revealed a non-displaced stress fracture of the right lateral mass of her sacrum. Following her decision to opt for non-operative treatment, our patient received an epidural catheter for pain control. The remaining course of her pregnancy was uneventful and our patient gave birth to a healthy child by normal vaginal delivery. Conclusions We conclude that a sacral stress fracture must be considered as a possible cause of low back pain during pregnancy.

  12. Tratamento de dor em paciente com tumor sacral inoperável: relato de caso Tratamiento de dolor en paciente con tumor sacral inoperable: relato de caso Management of pain in patient with inoperable sacral tumor: case report

    Directory of Open Access Journals (Sweden)

    Juliano Rodrigues Gasparini

    2004-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Diversas técnicas podem ser utilizadas no controle de dor em pacientes oncológicos. O objetivo deste relato é mostrar o uso de algumas medidas terapêuticas empregadas para tratar um paciente com quadro doloroso importante de difícil controle. RELATO DO CASO: Paciente do sexo masculino, 70 anos, com cordoma sacral e com possibilidade terapêutica muito difícil. Apresentava quadro de dor importante associado ao tumor. São relatadas diversas técnicas utilizadas no seu tratamento e os resultados obtidos. CONCLUSÕES: Os bloqueios neurolíticos, para o controle da dor em paciente com tumores cuja possibilidade terapêutica é difícil, constituem técnica eficaz quando bem indicados e realizados dentro de critérios estabelecidos.JUSTIFICATIVA Y OBJETIVOS: Diversas técnicas pueden ser utilizadas en el control de dolor en pacientes oncológicos. El objetivo de este relato es mostrar el uso de algunas medidas terapéuticas utilizadas para tratar un paciente con cuadro doloroso importante de difícil control. RELATO DE CASO: Paciente masculino, 70 años, con cordoma sacral y con posibilidad terapéutica muy difícil. Presentaba cuadro de dolor importante asociado al tumor. Se relatan diversas técnicas utilizadas en su tratamiento y los resultados obtenidos. CONCLUSIONES: Los bloqueos neurolíticos, para el control del dolor en paciente con tumores cuja posibilidad terapéutica es difícil, constituyen técnica eficaz cuando bien indicados y realizados dentro de criterios establecidos.BACKGROUND AND OBJECTIVES: Different techniques may be used to control cancer pain. This report aimed at describing some therapeutic measures used to treat a patient with a severe and bad responsive pain. CASE REPORT: A 70-year-old male patient a sacral chordoma of very difficult therapeutic. He referred major tumor-associated pain. Several techniques used to treat pain of this patient and results obtained are reported. CONCLUSIONS

  13. Use of the Draeger Apollo to Deliver Bilevel Positive Pressure Ventilation During Awake Frontal Craniotomy for a Patient with Severe Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Lee, Susie So-Hyun; Berman, Mitchell F

    2015-12-01

    In this case report, we describe the use of the Draeger Apollo anesthesia machine to deliver bilevel positive airway pressure (BiPAP) to a patient with severe chronic obstructive pulmonary disease and a history of lung resection undergoing frontal craniotomy for the removal of a brain tumor under moderate to deep sedation. BiPAP in the perioperative period has been described for purposes of preoxygenation and postextubation recruitment. Although its utility as a mode of ventilation during moderate to deep sedation has been demonstrated, it has not come into widespread use. We describe the intraoperative use of pressure support mode on the anesthesia machine to deliver noninvasive positive pressure ventilation through a standard anesthesia mask. Given its ease of access and effectiveness, it is our belief that intraoperative BiPAP may reduce hypoxemia and/or hypercarbia in patients with chronic obstructive pulmonary disease and obstructive sleep apnea undergoing moderate to deep sedation. PMID:26588034

  14. Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study

    Science.gov (United States)

    Wang, Cheng; Ye, Zengchun; Li, Yan; Zhang, Jun; Zhang, Qunzi; Ma, Xinxin; Peng, Hui; Lou, Tanqi

    2016-01-01

    The “reverse dipping” blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a “dipper”, “non-dipper” and “reverse dippers” was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis. PMID:27713498

  15. Systolic blood pressure and heart rate in cats with chronic kidney disease undergoing chemical restraint during hemodialysis

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    Karine Kleine Figueiredo dos Santos

    2016-04-01

    Full Text Available Dialysis is one of the used methods for treatment of Acute Renal Injury (ARI and Chronic Kidney Disease (CKD to replace the function of the kidneys when refers to blood depuration. Hemodialysis removes toxins accumulated in the body directly from the blood, being a useful alternative therapy for dogs and cats with CKD in advanced stages. Because of the difficulty on handling the patient feline, this procedure requires sedation. However, few studies have been conducted to assess the safety of anesthesia in dogs and cats with CKD undergoing dialysis. The present study aimed to evaluate two different protocols of chemical restraint in cats with CKD and the effect of these on systolic blood pressure (SBP and heart rate (HR, since the procedure of extracorporeal circulation leads the patient to a hypotensive frame. Twelve adult cats were used, with an average weight of 4 kg, CKD, underwent two anesthetic protocols: Group GP (n = 6 using propofol, and group GCM (n = 6 using ketamine-midazolam association for the implantation procedure of central venous catheter (CVC and hemodialysis. Cats in GP as well as the GCM group showed statistical difference in the change in SBP and HR only from baseline compared to the other time points evaluated. The two protocols maintained SBP and HR within physiological values.

  16. Positive outcome of average volume-assured pressure support mode of a Respironics V60 Ventilator in acute exacerbation of chronic obstructive pulmonary disease: a case report

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    Okuda Miyuki

    2012-09-01

    Full Text Available Abstract Introduction We were able to treat a patient with acute exacerbation of chronic obstructive pulmonary disease who also suffered from sleep-disordered breathing by using the average volume-assured pressure support mode of a Respironics V60 Ventilator (Philips Respironics: United States. This allows a target tidal volume to be set based on automatic changes in inspiratory positive airway pressure. This removed the need to change the noninvasive positive pressure ventilation settings during the day and during sleep. The Respironics V60 Ventilator, in the average volume-assured pressure support mode, was attached to our patient and improved and stabilized his sleep-related hypoventilation by automatically adjusting force to within an acceptable range. Case presentation Our patient was a 74-year-old Japanese man who was hospitalized for treatment due to worsening of dyspnea and hypoxemia. He was diagnosed with acute exacerbation of chronic obstructive pulmonary disease and full-time biphasic positive airway pressure support ventilation was initiated. Our patient was temporarily provided with portable noninvasive positive pressure ventilation at night-time following an improvement in his condition, but his chronic obstructive pulmonary disease again worsened due to the recurrence of a respiratory infection. During the initial exacerbation, his tidal volume was significantly lower during sleep (378.9 ± 72.9mL than while awake (446.5 ± 63.3mL. A ventilator that allows ventilation to be maintained by automatically adjusting the inspiratory force to within an acceptable range was attached in average volume-assured pressure support mode, improving his sleep-related hypoventilation, which is often associated with the use of the Respironics V60 Ventilator. Polysomnography performed while our patient was on noninvasive positive pressure ventilation revealed obstructive sleep apnea syndrome (apnea-hypopnea index = 14, suggesting that his chronic

  17. Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds

    DEFF Research Database (Denmark)

    Amris, Kirstine; Jespersen, Anders; Bliddal, Henning

    2010-01-01

    Widespread pain and pain hypersensitivity are the hallmark of fibromyalgia, a complex pain condition linked to central sensitization. In this study the painDETECT questionnaire (PDQ), validated to identify neuropathic pain and based on pain quality items, was applied in a cross-sectional sample...... of patients with chronic widespread pain (CWP). The aims of the study were to assess the patient-reported sensory neuropathic symptoms by PDQ and to correlate these with tender point (TP) count and pressure-pain thresholds. Eighty-one patients (75 F, 6 M) with CWP (ACR-criteria) filled in the PDQ. Manual TP...... examination was conducted according to ACR guidelines. Computerized cuff pressure algometry was used for the assessment of pressure-pain detection thresholds (PDT, unit: kPa) and pressure-pain tolerance thresholds (PTT, unit: kPa). Mean TP count was 14.32 (range: 2-18), mean PDQ score 22.75 (range: 5...

  18. Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study

    Directory of Open Access Journals (Sweden)

    Micalos PS

    2014-08-01

    Full Text Available Peter S Micalos,1 Mayuresh S Korgaonkar,2 Eric J Drinkwater,3 Jack Cannon,3 Frank E Marino3 1School of Biomedical Sciences, Charles Sturt University, Bathurst, 2Brain Dynamics Centre, Westmead Millennium Institute, University of Sydney Medical School, Sydney, 3School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia Objective: The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation before and after exercise rehabilitation in patients with chronic pain. Materials and methods: Eleven chronic pain patients and eight healthy pain-free controls completed 12 weeks of supervised aerobic exercise intervention. Perceptual rating of standardized somatic pressure stimulation (2 kg on the right anterior mid-thigh and brain responses during functional magnetic resonance imaging (fMRI were assessed at pre- and postexercise rehabilitation. Results: There was a significant difference in the perceptual rating of innocuous somatic pressure stimulation between the chronic pain and control groups (P=0.02 but no difference following exercise rehabilitation. Whole brain voxel-wise analysis with correction for multiple comparisons revealed trends for differences in fMRI responses between the chronic pain and control groups in the superior temporal gyrus (chronic pain > control, corrected P=0.30, thalamus, and caudate (control > chronic, corrected P=0.23. Repeated measures of the regions of interest (5 mm radius for blood oxygen level-dependent signal response revealed trend differences for superior temporal gyrus (P=0.06, thalamus (P=0.04, and caudate (P=0.21. Group-by-time interactions revealed trend differences in the caudate (P=0.10 and superior temporal gyrus (P=0.29. Conclusion: Augmented perceptual and brain responses to innocuous somatic pressure stimulation were shown in the chronic pain group compared to the control group; however, 12-weeks of exercise

  19. Chronic treatment with Vitamin D lowers arterial blood pressure and reduces endothelium-dependent contractions in the aorta of the SHR

    DEFF Research Database (Denmark)

    Wong, Michael S K; Delansorne, Remi; Svenningsen, Per;

    2010-01-01

    that chronic treatment with 1,25-dihydroxyvitamin D3 modulates vascular tone and this modulation is accompanied by a lowered blood pressure, reduced expression of COX-1 mRNA and protein and reduced ROS level in SHR. The reduction in endothelium-dependent contractions does not involve the surge in endothelial......Vitamin D has cardiovascular protective effects besides regulating calcium homeostasis. To examine the chronic in vivo effect of a physiological dose 1,25-dihydroxyvitamin D3 on the occurrence of endothelium-dependent contractions, spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY......) were treated with the vitamin D derivative for six weeks. The serum 1,25-dihydroxyvitamin D3 level of both treated WKY and SHR was significantly higher than in untreated rats while the mean arterial blood pressure of the treated SHR was significantly lower than that of control SHR. Aortic rings...

  20. Miso (Japanese soybean paste) soup attenuates salt-induced sympathoexcitation and left ventricular dysfunction in mice with chronic pressure overload.

    Science.gov (United States)

    Ito, Koji; Hirooka, Yoshitaka; Sunagawa, Kenji

    2014-02-01

    The hypothalamic mineralocorticoid receptor (MR)-angiotensin II type 1 receptor (AT1R) pathway is activated in mice with chronic pressure overload (CPO). When this activation is combined with high salt intake, it leads to sympathoexcitation, hypertension, and left ventricular (LV) dysfunction. Salt intake is thus an important factor that contributes to heart failure. Miso, a traditional Japanese food made from fermented soybeans, rice, wheat, or oats, can attenuate salt-induced hypertension in rats. However, its effects on CPO mice with salt-induced sympathoexcitation and LV dysfunction are unclear. Here, we investigated whether miso has protective effects in these mice. We also evaluated mechanisms associated with the hypothalamic MR-AT1R pathway. Aortic banding was used to produce CPO, and a sham operation was performed for controls. At 2 weeks after surgery, the mice were given water containing high NaCl levels (0.5%, 1.0%, and 1.5%) for 4 weeks. The high salt loading in CPO mice increased excretion of urinary norepinephrine (uNE), a marker of sympathetic activity, in an NaCl concentration-dependent manner; however, this was not observed in Sham mice. Subsequently, CPO mice were administered 1.0% NaCl water (CPO-H) or miso soup (1.0% NaCl equivalent, CPO-miso). The expression of hypothalamic MR, serum glucocorticoid-induced kinase-1 (SGK-1), and AT1R was higher in the CPO-H mice than in the Sham mice; however, the expression of these proteins was attenuated in the CPO-miso group. Although the CPO-miso mice had higher sodium intake, salt-induced sympathoexcitation was lower in these mice than in the CPO-H group. Our findings indicate that regular intake of miso soup attenuates salt-induced sympathoexcitation in CPO mice via inhibition of the hypothalamic MR-AT1R pathway. PMID:24908908

  1. Procalcitonin: Is it a predictor of noninvasive positive pressure ventilation necessity in acute chronic obstructive pulmonary disease exacerbation?

    Directory of Open Access Journals (Sweden)

    Ahmet Cemal Pazarli

    2012-01-01

    Full Text Available Background: Acute exacerbations of chronic obstructive pulmonary disease (AeCOPD are important causes of morbidity and mortality. In this study, we analyzed procalcitonin (PCT levels in AeCOPD and stable period of COPD in order to evaluate usage of PCT in the prediction of the severity of AeCOPD, and its value on the planing of noninvasive positive pressure ventilation (NPPV. Materials and Methods: In this cross sectional study (2009-2010 118 COPD patients were enrolled, 68 of them (58% were in acute exacerbations (case group. The others had stabile COPD and they were defined as control group. Results: In case group the mean levels of PCT (0.19 ± 0.02 C-Reactive Protein (44.7 ± 5.92, erythrocyte sedimentation rate (28.4 ± 2.65, white blood cell (9.4 ± 0.43 and %neutrophils (69.9 ± 1.22 were significantly higher than controls (P = 0.0001. There was no difference between PCT levels based on stages of COPD. There were significiant differences in mean PCT levels according to type and severity of AeCOPD. Mean PCT level in hospitalized patients receiving NPPV was 0.36 ng/ml, while it was 0.15 ng/ml for those treated without NPPV (P = 0.0001. PCT cut-off value for NPPV indication was determined to be 0.10 ng/ml. Conclusions: PCT levels were found to be higher in AeCOPD patients than in stable COPD patients, as expected. Also mean PCT levels increased especially in cases with severe AeCOPD and those receiving NPPV among them. In the present study, we determined a cut off value of PCT as 0.10 ng/ml as a predictor of necessity of NPPV in AeCOPD.

  2. Efficacy and Tolerability of Budesonide/Formoterol in One Hydrofluoroalkane Pressurized Metered-Dose Inhaler in Patients with Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Rennard, Stephen I; Tashkin, Donald P.; McElhattan, Jennifer; Goldman, Mitchell; Ramachandran, Sulabha; Martin, Ubaldo J.; Silkoff, Philip E.

    2012-01-01

    Background: Combination therapy with a long-acting bronchodilator and an inhaled corticosteroid (ICS) is recommended in patients with chronic obstructive pulmonary disease (COPD) who have frequent exacerbations. The efficacy and tolerability of the combination of budesonide/formoterol have been demonstrated in patients with COPD when administered via the dry powder inhaler (DPI) in a 1-year study and when administered via the hydrofluoroalkane (HFA) pressurized metered-dose inhaler (pMDI) in ...

  3. Relationship of daily arterial blood pressure monitoring readings and arterial stiffness profile in male patients with chronic obstructive pulmonary disease combined with arterial hypertension

    Directory of Open Access Journals (Sweden)

    Karoli N.A.

    2013-06-01

    Full Text Available The aim of the study was to determine correlation between arterial blood pressure daily rhythm and daily profile of arterial stiffness in male patients with chronic obstructive pulmonary disease (COPD and arterial hypertension. Materials et methods: Prospective investigation comprised 45 male patients with COPD and arterial hypertension. Individuals of 40 years younger and 80 years elder, patients with diabetes, stroke, angina pectoris, or heart infarction, vascular diseases, and exacerbation of chronic disease, bronchial and pulmonary diseases of other etiology were excluded from the analyses. Comparison group included 47 patients with essential arterial hypertension and without chronic respiratory diseases closely similar on general parameters with patients from main clinical series. Twenty-four-hour arterial blood pressure monitoring (ABPM and daily arterial stiffness monitoring were performed using BPLab® MnSDP-2 apparatus (Petr Telegin, Russian Federation. Results: Patients with COPD combined with arterial hypertension with raised arterial stiffness measures prevail over individuals in essential hypertension group. There is pathological alteration of the ABPM circadian rhythm and raised «Pressure load» values in raised arterial stiffness group. Conclusion: We found ABPM raised parameters in patients with COPD and arterial hypertension. It confirms necessity of ABPM in daily arterial stiffness assessment in patients with COPD.

  4. 骶椎隐球菌骨髓炎一例报告%Cryptococcus neoformans osteomyelitis of the sacral vertebrae:a case report

    Institute of Scientific and Technical Information of China (English)

    陈志源; 丁焕文; 涂强; 沈健坚; 刘辉亮; 王虹; 滕强; 贾军锋; 庾广文

    2014-01-01

    Objective To report a case of cryptococcus neoformans osteomyelitis of the sacral vertebrae and to analyze the cause of misdiagnosis. Methods The clinical data of a patient with cryptococcus neoformans osteomyelitis of the sacral vertebrae who was adopted in 2012 were retrospectively analyzed. Results Intermittent pain in the sacrum occurred to the patient without any obvious precipitating factors, which became worse at night. And meanwhile, the patient had low-grade fever. Whole body bone scan and single photon emission computed tomography ( SPECT )/CT showed abnormally active metabolism in the sacrum and bony defects and changes in the right margin. Therefore, bone tumors were considered. Sacral metastases was conifrmed using CT-guided needle aspiration biopsy. Debridement was performed after multidisciplinary consultation. The intraoperative frozen pathology presented fungal infections. The postoperative routine pathological examination showed pyogenic and inlfammatory granulomas and there were fungal spores in the histocytes. At last, sacral cryptococcus infections was diagnosed. Conclusions The partial performance of cryptococcus neoformans osteomyelitis of the sacral vertebrae is similar to that of malignant tumors of the sacral vertebrae. So clinical doctors should raise the awareness of the disease. It is necessary to ifrst rule out the possibility of cryptococcus neoformans osteomyelitis of the sacral vertebrae before making the diagnosis of malignant tumors of the sacral vertebrae.

  5. Modified lumbopelvic fixation for sacral and L5 fractures associated with spinopelvic instability: a case report and introduction of the surgical technique

    Institute of Scientific and Technical Information of China (English)

    YI Cheng-la; BAI Xiang-jun; SONG Xian-zhou; LI Zhan-fei; HU Dan

    2011-01-01

    Posterior lumbopelvic fixation with iliac screws is the most commonly used method for unstable spinopelvic injuries. It has certain limitations including inability to use distraction along the spinopelvic rod as an indirect reduction maneuver, need for complex 3-dimensional rod contouring and complications such as hardware prominence and soft tissue coverage. In the present case report,we described a surgical technique of lumbopelvic fixation with sacral alar screws for traumatic spinopelvic instability resulted from a unilateral Denis-Ⅲ comminuted sacral fracture and the L5 burst fracture. On the opposite side of the sacral fracture, caudal screws were implanted into the pedicle of the S1, whereas on the side of sacral fracture, two sacral alar screws were placed parallel to the superior sacral endplate as well as the plane of sacroiliac joint. In addition,horizontal stabilization was conducted with cross-link connections to maintain the longitudinal traction. For sacral fracture associated with traumatic spinopelvic instability,this modified lumbopelvic fixation technique using sacral alar screws makes longitudinal reduction easier, requires less rod contouring, and reduces hardware prominence without compromising the stability.

  6. Modified lumbopelvic fixation for sacral and L5 fractures associated with spinopelvic instability: a case report and introduction of the surgical technique

    Directory of Open Access Journals (Sweden)

    YI Cheng-la

    2012-02-01

    Full Text Available 【Abstract】Posterior lumbopelvic fixation with iliac screws is the most commonly used method for unstable spinopelvic injuries. It has certain limitations including inability to use distraction along the spinopelvic rod as an indirect reduction maneuver, need for complex 3-dimensional rod contouring and complications such as hardware prominence and soft tissue coverage. In the present case report, we described a surgical technique of lumbopelvic fixation with sacral alar screws for traumatic spinopelvic instability resulted from a unilateral Denis-III comminuted sacral fracture and the L5 burst fracture. On the opposite side of the sacral fracture, caudal screws were implanted into the pedicle of the S1, whereas on the side of sacral fracture, two sacral alar screws were placed parallel to the superior sacral endplate as well as the plane of sacroiliac joint. In addition, horizontal stabilization was conducted with cross-link connections to maintain the longitudinal traction. For sacral fracture associated with traumatic spinopelvic instability, this modified lumbopelvic fixation technique using sacral alar screws makes longitudinal reduction easier, requires less rod contouring, and reduces hardware prominence without compromising the stability. Key words: Sacrum; Lumbar vertebrae; Fracture fixation

  7. Low expression of PHLPP1 in sacral chordoma and its association with poor prognosis

    Science.gov (United States)

    Chen, Hao; Zhang, Kai; Wu, Guizhong; Song, Dawei; Chen, Kangwu; Yang, Huilin

    2015-01-01

    Sacral chordoma is a rare spine tumor with a high recurrence rate even after optimal therapy. Previous studies have demonstrated that the PI3K/AKT pathway plays a pivotal role in chordoma, and high expression of pAKT is associated with poor prognosis. Recently, PHLPP was recognized to be a tumor suppressor that targets AKT. We analyzed the expression of PHLPP1 and AKT2 in 37 chordoma samples and 11 fetal nucleus pulposus samples by immunohistochemical staining. Of the chordoma cases, 40.5% (15/37) showed strong cytoplasmic staining (score ≥3) for PHLPP1, which was significantly lower than the 90.9% (10/11) of fetal nucleus pulposus samples (P = 0.004). Conversely, strong immunohistochemical staining for AKT2 was observed in 75.7% (28/37) of chordoma samples, which was significantly higher than 36.4% (4/11) of fetal nucleus pulposus (P = 0.021). Kaplan-Meier survival curves and log-rank test showed that patients with high expression of PHLPP1 experienced longer progression free survival time than those with low PHLPP1 expression (P = 0.011). Further multivariate Cox regression analysis indicated that PHLPP1 expression level and surgical approaches were independent risk factors for chordoma recurrence (P = 0.023 and P = 0.022). However, PHLPP1 expression was not statistically related to patients’ total survival time. Conclusively, our results suggest that PHLPP1 plays a crucial role in sacral chordoma, and may be a promising biomarker for prognosis. Meanwhile, manipulation of PHLPP1 expression is also a potential therapeutic approach for the treatment of sacral chordoma. PMID:26823799

  8. Comparison of Therapeutic Effects Between Acupuncture plus Sacral Injection and Simple Acupuncture for Lumbar Intervertebral Disc Herniation

    Institute of Scientific and Technical Information of China (English)

    YAN Jie-ying; XU Yao

    2007-01-01

    To compare the therapeutic effects between acupuncture plus sacral injection and simple acupuncture for intervertebral disc hemia.Methods:The patients with lumbar intervertebral disc hernia at the age of 30-45 years old were divided into No.1-80 upon their visiting order,with odd number as Group A and even number as Group B.Group A was treated by acupuncture plus sacral injection,and Group B was treated by simple acupuncture.Results:The clinical effective rate was higher in Group A than in Group B,with significant difference (P<0.05).Conclusion:Acupuncture plus sacral injection had the better therapeutic effect than simple acupuncture in treating lumbar intervertebral disc hernia.

  9. MR imaging features of giant pre-sacral schwannomas: a report of four cases

    International Nuclear Information System (INIS)

    Benign giant sacral schwannoma is an uncommon cause of destruction of the sacrum. This report details four cases of a variant of this condition called giant presacral schwannoma (GPSS). On MR imaging the features are of a large, well-defined presacral soft tissue mass, arising just to one side of the midline with minor involvement of the bone. The typical MR features of a benign peripheral nerve sheath tumour are not seen. The tumours appear heterogeneous due to long-standing degeneration. Biopsy is advocated as the appearances of GPSS can be similar to a malignant peripheral nerve sheath tumour (malignant schwannoma). (orig.)

  10. Fatigue fracture of the sacral bone associated with septic arthritis of the symphysis pubis

    Energy Technology Data Exchange (ETDEWEB)

    Albertsen, A.M.B. [Department of Radiology, Odense University Hospital (Denmark); Egund, N. [Department of Radiology, Odense University Hospital (Denmark); Jurik, A.G. [Department of Radiology, Aarhus University Hospital (Denmark)

    1995-11-01

    Two women, aged 50 and 67 years, with septic arthritis of the symphysis pubis attended by severe low back pain, were followed with CT and MR imaging of the pelvis, as well as bone scintigraphy in one patient. In the first patient sacral fractures with severe displacement were revealed, prompting stabilizing symphysiodesis. In the second patient an undisplaced fatigue fracture was confirmed in the right half of the sacrum. In patients with pelvic laxity following arthritis of the symphysis and post-traumatic osteolysis associated with low back pain, displaced or occult fractures of the bones adjacent to the sacroiliac joints should be considered. (orig./MG)

  11. Bladder response to acute sacral neuromodulation while treating rats in different phases of complete spinal cord injury: a preliminary study

    Directory of Open Access Journals (Sweden)

    Ping Shi

    2015-12-01

    Full Text Available Background: Compared to conventional therapies, sacral neuromodulation (SNM may offer an alternative, non-destructive treatment for SCI patients with bladder dysfunction. Understanding bladder response to SNM treatment for SCI in different phases may yield new insights for innovative use of this promising technique. Materials and Methods: Female Sprague-Dawley rats were used in this study to examine the effects of acute SNM on bladder reflex in complete SCI rats. All rats were anesthetized and set up for continuous saline infusion. Acute SNM treatment was implemented for about 6 hours for each rat. Cystometric parameters, including time between contractions, contraction duration, bladder peak pressure, and number of uninhibited contractions, were analyzed and compared within rats before and after SNM treatment. Results: For the spinally transected rats during early phase (less than two weeks post spinalization, the time between contractions and contraction duration both increased after SNM treatments, yet the increased amplitude was about or less than 20%. For the spinally transected rats with a longer days survival (about two to four weeks post spinalization, the time between contractions and contraction duration substantially increased after SNM treatment and the changes for their average values were more than 90%. For the spinally transected rats with a much longer days survival (more than five weeks post spinalization, the time between contractions and contraction duration increased after SNM treatments, yet the magnitude of changes were less than 30%. Conclusion: The present study suggested that the significant effectiveness of SNM for complete SCI played its role after the spinal shock phase and prior to the development of detrusor overactivity. It indicated that the time point of SNM treatment is necessary to be paid attention.

  12. An open randomized controlled trial of noninvasive positive pressure ventilation in patients of acute on chronic hypercapnic respiratory failure in a general respiratory ward setting

    Directory of Open Access Journals (Sweden)

    Prasad R

    2007-01-01

    Full Text Available Objective : To compare the standard medical therapy (SMT and noninvasive posi-tive pressure ventilation (NPPV in acute on chronic hypercapnic respiratory fail-ure due to exacerbation of chronic obstructive pulmonary disease (COPD. Method : Between June 2002 and May 2003, 19 patients with acute on chronic hypercapnic respiratory failure were prospectively and randomly recruited to re-ceive either SMT (n=10 or NPPV plus SMT (n=9 in a general respiratory ward and followed up after 4 to 6 weeks after discharge. NPPV was given with a silicone cushioned nasal mask via a bilevel ventilator with initial pressure support of 5 cm of H 2 O. Results : At the time of randomization there was no significant difference in respiratory rate, PaO 2 , PaCO 2 , pH and HCO3 - , between the two groups. At 2 hours with SMT, there was significant improvement only in respiratory rate (p = 0.0000 and PaO 2 (p=0.0014. However with NPPV, respiratory rate (p=0.0000, PaO2 (p=0.0011, pH (0.0002, pulse rate (p=0.0329 and mean arterial pressure (p=0.0096 improved significantly at 2 hours while PaCO2 (p=0.0008 significantly improved at24 hours. Hospital stay was significantly shorter for NPPV group as compared to SMT group (9.63 + 1.4 days vs. 13.33 + 4.69 days, p < 0.05. There was 1 failure (12.5% in NPPV group as compared to 2 failures (20% in SMT group of which one was salvaged by NPPV. Conclusion : The study suggests that early application of NPPV in acute on chronic hypercapnic respiratory failure due to COPD facilitates improvement, favors early mobiliation and discharge from hospital.

  13. Combined ab interno trabeculotomy and lens extraction: a novel management option for combined uveitic and chronic narrow angle raised intraocular pressure.

    Science.gov (United States)

    Lin, Siying; Gupta, Bhaskar; Rossiter, Jonathan

    2016-02-01

    Minimally invasive glaucoma surgery is a developing area that has the potential to replace traditional glaucoma surgery, with its known risk profile, but at present there are no randomised controlled data to validate its use. We report on a case where sequential bilateral combined ab interno trabeculotomy and lens extraction surgery was performed on a 45-year-old woman with combined uveitic and chronic narrow angle raised intraocular pressure. Maximal medical management alone could not control the intraocular pressure. At 12-month follow-up, the patient had achieved stable intraocular pressure in both eyes on a combination of topical ocular antiglaucomatous and steroid therapies. This case demonstrates the effectiveness of trabecular meshwork ablation via ab interno trabeculotomy in a case of complex mixed mechanism glaucoma.

  14. Sacral chordoma in an adult showing an aggressive clinical course: A case report

    Science.gov (United States)

    ENDO, KOJI; YAMASHITA, HIDEKI; NAGASHIMA, HIDEKI; TESHIMA, RYOTA

    2014-01-01

    The current report presents a case of a 78-year-old male with sacral chordoma, showing an aggressive clinical course. The patient underwent sacral resection, however, nine months later, multiple metastases were detected by magnetic resonance imaging. The metastases progressed rapidly and 15 months following surgery the patient succumbed to respiratory dysfunction. An autopsy revealed multiple metastases of the lung, liver, heart, kidneys and vertebrae. Pathologically, the tumors did not show proliferation of anaplastic cells or dedifferentiation; however, the metastatic tumor cells were smaller than the primary tumor cells. The Ki-67 labeling indices were <5% in all of the patient’s tumors, therefore, the capacity for cellular proliferation of the tumors was considered to be low. Chordoma in adults are generally slow-growing tumors and are associated with a relatively prolonged course and frequent local recurrences. Therefore, it must be recognized that chordoma may grow rapidly and show an aggressive clinical course, even when the Ki-67 labeling index is low. PMID:24765153

  15. Ipsilateral Hip Dysplasia in Patients with Sacral Hemiagenesis: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Tadatsugu Morimoto

    2015-01-01

    Full Text Available Sacral agenesis (SA is a rare condition consisting of the imperfect development of any part of the sacrum. This paper describes two cases of the rare cooccurrence of ipsilateral SA and developmental dysplasia of the hip (DDH and analyzes possible contributory factors for SA and DDH. Each of a 16-year-old female and 13-year-old female visited our hospital for left hip pain and limping. The findings of physical examinations showed a lower limb length discrepancy (left side in both cases, as well as left hip pain without limitations of the range of motion or neurological deficits. Initial radiographs demonstrated left subluxation of the left hip with associated acetabular dysplasia and partial left sacral agenesis. MRI revealed a tethering cord with a fatty filum terminale, and periacetabular osteotomy combined with allogeneic bone grafting was performed. After the surgery, the patients experienced no further pain, with no leg length discrepancy and were able to walk without a limp, being neurologically normal with a normal left hip range of motion. The cooccurrence of SA and DDH suggests a plausible hypothesis to explain the embryogenic relationship between malformation of the sacrum and hip.

  16. Resistance Training Exercise Program for Intervention to Enhance Gait Function in Elderly Chronically Ill Patients: Multivariate Multiscale Entropy for Center of Pressure Signal Analysis

    Directory of Open Access Journals (Sweden)

    Ming-Shu Chen

    2014-01-01

    Full Text Available Falls are unpredictable accidents, and the resulting injuries can be serious in the elderly, particularly those with chronic diseases. Regular exercise is recommended to prevent and treat hypertension and other chronic diseases by reducing clinical blood pressure. The “complexity index” (CI, based on multiscale entropy (MSE algorithm, has been applied in recent studies to show a person’s adaptability to intrinsic and external perturbations and widely used measure of postural sway or stability. The multivariate multiscale entropy (MMSE was advanced algorithm used to calculate the complexity index (CI values of the center of pressure (COP data. In this study, we applied the MSE & MMSE to analyze gait function of 24 elderly, chronically ill patients (44% female; 56% male; mean age, 67.56±10.70 years with either cardiovascular disease, diabetes mellitus, or osteoporosis. After a 12-week training program, postural stability measurements showed significant improvements. Our results showed beneficial effects of resistance training, which can be used to improve postural stability in the elderly and indicated that MMSE algorithms to calculate CI of the COP data were superior to the multiscale entropy (MSE algorithm to identify the sense of balance in the elderly.

  17. Resistance training exercise program for intervention to enhance gait function in elderly chronically ill patients: multivariate multiscale entropy for center of pressure signal analysis.

    Science.gov (United States)

    Chen, Ming-Shu; Jiang, Bernard C

    2014-01-01

    Falls are unpredictable accidents, and the resulting injuries can be serious in the elderly, particularly those with chronic diseases. Regular exercise is recommended to prevent and treat hypertension and other chronic diseases by reducing clinical blood pressure. The "complexity index" (CI), based on multiscale entropy (MSE) algorithm, has been applied in recent studies to show a person's adaptability to intrinsic and external perturbations and widely used measure of postural sway or stability. The multivariate multiscale entropy (MMSE) was advanced algorithm used to calculate the complexity index (CI) values of the center of pressure (COP) data. In this study, we applied the MSE & MMSE to analyze gait function of 24 elderly, chronically ill patients (44% female; 56% male; mean age, 67.56 ± 10.70 years) with either cardiovascular disease, diabetes mellitus, or osteoporosis. After a 12-week training program, postural stability measurements showed significant improvements. Our results showed beneficial effects of resistance training, which can be used to improve postural stability in the elderly and indicated that MMSE algorithms to calculate CI of the COP data were superior to the multiscale entropy (MSE) algorithm to identify the sense of balance in the elderly. PMID:25295070

  18. Modified Kraske Procedure with Mid-Sacrectomy and Coccygectomy for En Bloc Excision of Sacral Giant Cell Tumors

    Directory of Open Access Journals (Sweden)

    Vítor M. Gonçalves

    2014-01-01

    Full Text Available Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.

  19. Neurons in the lateral sacral cord of the cat project to periaqueductal grey, but not to thalamus

    NARCIS (Netherlands)

    Klop, EM; Mouton, LJ; Kuipers, R; Holstege, G; Klop, [No Value

    2005-01-01

    Previous work of our laboratory has shown that neurons in the lateral sacral cord in cat project heavily to the periaqueductal grey (PAG), in all likelihood conveying information from bladder and genital organs. In humans this information usually does not reach consciousness, which raises the questi

  20. Sacral nerve stimulation increases activation of the primary somatosensory cortex by anal canal stimulation in an experimental model.

    LENUS (Irish Health Repository)

    Griffin, K M

    2011-08-01

    Sacral and posterior tibial nerve stimulation may be used to treat faecal incontinence; however, the mechanism of action is unknown. The aim of this study was to establish whether sensory activation of the cerebral cortex by anal canal stimulation was increased by peripheral neuromodulation.

  1. Ressecção de cordoma sacral com abaixamento de cólon: relato de caso Sacral chordoma resection with colo anal anastomosis: case report

    Directory of Open Access Journals (Sweden)

    Kanthya Arreguy de Sena

    2006-09-01

    Full Text Available O cordoma é uma lesão maligna da medula espinhal, que se origina nos remanescentes ectópicos de tecido notocordial. Trata-se de neoplasia rara e sua localização preferencial é o sacro. Tem crescimento lento, mas comportamento localmente agressivo. Relatamos um caso de ressecção de cordoma sacral com abaixamento de cólon. Para extirpação oncológica da lesão foi necessária a abordagem colorretal e ortopédica. Novas técnicas preconizando cirurgias mais agressivas melhoraram significativamente a expectativa de vida dos pacientes portadores de cordoma, bem como o tempo de vida livre de doença. Na busca dessa cirurgia oncológica ideal, a abordagem multidisciplinar é essencial.Chordoma is a rare malignant lesion of spinal cord originated from ectopic remnants of notocordial tissue. Its presentation is characterized by slow growth in spite of locally aggressive behaviour. We report a case of multidisciplinary oncologic resection with coloanal anastomosis. Extended and aggressive resections improved significantly the disease free survival in patients with chordoma. The multidisciplinary oncologic approach is essential in order to reach this goal.

  2. Sacral Herpes

    Science.gov (United States)

    ... to her newborn baby. HSV-2 is often spread through direct skin-to-skin contact with active lesions on another person. However, people who have ... important to take the following steps to prevent spread (transmission) of the virus ... or itching) and active phase (presence of blisters or sores) of HSV- ...

  3. SACRAL syndrome

    OpenAIRE

    Yadav, Devendra Kumar; Panda, Shasanka Shekhar; Teckchandani, Narinder; Bagga, Deepak

    2013-01-01

    Haemangiomas are the most common tumours of infancy and early childhood. They are usually present in the neonate in the first 2 weeks of life. Haemangioma usually involves the head and neck area but less commonly involves the lumbosacral and perineal areas. Involvement of lumbosacral, perineal and other areas with associated anomalies are very rare. We present a neonatal case with extensive superficial haemangioma from the perineum to the neck along with multiple congenital anomalies.

  4. Costs of topical treatment of pressure ulcer patients

    Directory of Open Access Journals (Sweden)

    Cynthia Carolina Duarte Andrade

    2016-04-01

    Full Text Available Abstract OBJECTIVE To evaluate the costs of a topical treatment of pressure ulcer (PU patients in a hospital unit for treatment of chronic patients in 2014. METHOD This is an activity-based costing study. This method encompasses the identification, measurement and pricing of physical and human resources consumed for dressings. RESULTS Procedure costs varied between BRL 16.41 and BRL 260.18. For PUs of the same category, of near areas and with the same type of barrier/adjuvant, the cost varied between 3.5% and 614.6%. For most dressings, the cost increased proportionally to the increase of the area and to the development of PU category. The primary barrier accounted for a high percentage of costs among all items required to the application of dressings (human and material resources. Dressings applied in sacral PUs had longer application times. CONCLUSION This study allowed us to understand the costs involved in the treatment of PUs, and it may support decision-makers and other cost-effectiveness studies.

  5. Chronic hypoxia increases arterial blood pressure and reduces adenosine and ATP induced vasodilatation in skeletal muscle in healthy humans

    DEFF Research Database (Denmark)

    Calbet, J A L; Boushel, Robert Christopher; Robach, P;

    2014-01-01

    AIMS: To determine the role played by adenosine, ATP and chemoreflex activation on the regulation of vascular conductance in chronic hypoxia. METHODS: The vascular conductance response to low and high doses of adenosine and ATP was assessed in ten healthy men. Vasodilators were infused into the f...

  6. Successful management of a giant anterior sacral meningocele with an endoscopic cutting stapler: case report.

    Science.gov (United States)

    Sunna, Tarek P; Westwick, Harrison J; Zairi, Fahed; Berania, Ilyes; Shedid, Daniel

    2016-05-01

    Anterior sacral meningoceles (ASMs) are rare defects in the sacrum with thecal sac herniations and symptoms that commonly include constipation, dysmenorrhea, and urinary disturbances. An ASM causing hydronephrosis and acute renal failure from compression of the lower portion of the urinary tract is a rare clinical entity. Only one other case has been reported. The authors present the case of a 37-year-old man admitted for obstructive renal failure and hydronephrosis due to a giant ASM that measured 25 × 12 × 18 cm and compressed the ureters and bladder. The ASM was successfully treated via an anterior transabdominal approach in which the authors used a novel technique for watertight closure of the meningocele pedicle with an endoscopic cutting stapler. The authors review the literature and discuss the surgical options for the treatment of ASMs, specifically the management of ASMs in the context of obstructive renal failure and hydronephrosis. PMID:26745349

  7. A CASE REPORT OF A VARIANT OF LUMBO-SACRAL TRANSITION VERTEBRAE: CASTELLVI TYPE IIA SACRALISATION

    Directory of Open Access Journals (Sweden)

    Subhendu Pandit

    2015-09-01

    Full Text Available Lumbosacral transitional vertebra (LSTV are congenital anomalies of the lumbosacral spine causing sacralisation or lumbarisation. Sacralisation has been defined as an abnormality where one of the transverse processes of L5 vertebra may articulate or fuse with the sacrum. The sacralisation has been studied for almost a century for its association with low back pain as “Bertolotti Syndrome”, but there are studies for and against its association. Castellvi in 1984 had propounded a radiographical classification identifying sacralisation in four sub types. Out of this, the Type IIA, is the least prevalent wherein there is a unilateral articulation of the L5 transverse process with the sacral ala. Inspite of the controversy, there is a high association of low back pain with disc degeneration, nerve root compression and degenerative facet joints observed with this condition. It is a widely researched vertebral anomaly for its anatomical, developmental and clinical ramifications.

  8. Trans-sacral screw fixation in the treatment of high dyplastic developmental spondylolisthesis.

    Science.gov (United States)

    Landi, Alessandro; Marotta, Nicola; Mancarella, Cristina; Tarantino, Roberto; Delfini, Roberto

    2013-06-16

    We describe the case of a 67-year-old woman with L5-S1 ontogenetic spondylolisthesis treated with pedicle fixation associated with interbody arthrodesis performed with S1-L5 trans-sacral screwing according to the technique of Bartolozzi. The procedure was followed by a wide decompressive laminectomy. The patient had a progressive improvement of the symptoms which gradually disappeared in 12 mo. The radiograph at 6 and 12 mo showed complete fusion system. The choice of treatment in L5-S1 ontogenetic spondylolithesis is related to a correct clinical and diagnostic planning (X-ray, computer tomography magnetic resonance imaging, Measurement). In particular, the severity index and the square of unstable zone, and the standard measurements already described in the literature, are important to understand and to plane the correct surgical strategy, that require, in most of the times, fusion and interbody artrodesis.

  9. Imaging appearances and clinical outcome following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Marianna; Davies, A.M.; James, Steven L.J. [Department of Radiology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Stirling, A.J.; Grainger, M. [Department of Spinal Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom); Grimer, R.J. [Department of Orthopaedic Oncology, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham (United Kingdom)

    2014-02-15

    Sacrectomy and ilio-lumbar reconstruction is an uncommonly performed complex surgical procedure for the treatment of sacral neoplasia. There are many challenges in the post-operative period including the potential for tumor recurrence, infection, and construct failure. We present our experience of this patient cohort and describe the complications and imaging appearances that can be encountered during the follow-up period. Retrospective review of our Orthopaedic Oncology database was undertaken which has been collected over a 30-year period to identify patients that had undergone sacrectomy and ilio-lumbar reconstruction. Pre and post-operative imaging including radiographs, CT, and MRI was reviewed. These were viewed by two experienced musculoskeletal radiologists with consensus opinion if there was disagreement over the imaging findings. Data regarding patient demographics, tumor type, and dimensions was collected. Serial review of radiographs, CT, and MRI was performed to assess implant position and integrity, strut graft position and union, and for the presence of recurrence within the surgical bed. Five male and two female patients (mean age 36 years, age range 15-54 years) were treated with this procedure. Histological diagnoses included chordoma, chondrosarcoma, osteosarcoma, and spindle cell sarcoma. Mean maximal tumor size on pre-operative imaging was 10.7 cm (range, 6-16 cm). Post-operative follow-up ranged from 10-46 months. A total of 76 imaging studies were reviewed. Commonly identified complications included vertical rod and cross-connector fracture and screw loosening. Fibula strut graft non-union and fracture was also evident on imaging review. Two patients demonstrated disease recurrence during the follow-up period. This study demonstrates the spectrum and frequency of complications that can occur following sacrectomy and ilio-lumbar reconstruction for sacral neoplasia. (orig.)

  10. The Unresolved Case of Sacral Chordoma: From Misdiagnosis to Challenging Surgery and Medical Therapy Resistance

    Science.gov (United States)

    Garofalo, Fabio; Christoforidis, Dimitrios; di Summa, Pietro G.; Gay, Béatrice; Cherix, Stéphane; Raffoul, Wassim; Matter, Maurice

    2014-01-01

    Purpose A sacral chordoma is a rare, slow-growing, primary bone tumor, arising from embryonic notochordal remnants. Radical surgery is the only hope for cure. The aim of our present study is to analyse our experience with the challenging treatment of this rare tumor, to review current treatment modalities and to assess the outcome based on R status. Methods Eight patients were treated in our institution between 2001 and 2011. All patients were discussed by a multidisciplinary tumor board, and an en bloc surgical resection by posterior perineal access only or by combined anterior/posterior accesses was planned based on tumor extension. Results Seven patients underwent radical surgery, and one was treated by using local cryotherapy alone due to low performance status. Three misdiagnosed patients had primary surgery at another hospital with R1 margins. Reresection margins in our institution were R1 in two and R0 in one, and all three recurred. Four patients were primarily operated on at our institution and had en bloc surgery with R0 resection margins. One had local recurrence after 18 months. The overall morbidity rate was 86% (6/7 patients) and was mostly related to the perineal wound. Overall, 3 out of 7 resected patients were disease-free at a median follow-up of 2.9 years (range, 1.6-8.0 years). Conclusion Our experience confirms the importance of early correct diagnosis and of an R0 resection for a sacral chordoma invading pelvic structures. It is a rare disease that requires a challenging multidisciplinary treatment, which should ideally be performed in a tertiary referral center. PMID:24999463

  11. Axons of sacral preganglionic neurons in the cat: II. Axon collaterals.

    Science.gov (United States)

    Morgan, C W

    2001-01-01

    Axon collaterals were identified in 21 of 24 preganglionic neurons in the lateral band of the sacral parasympathetic nucleus of the cat. Following the intracellular injection of HRP or neurobiotin the axons from 20 of these neurons were followed and 53 primary axon collaterals were found to originate from unmyelinated segments and from nodes of Ranvier. Detailed mapping done in the five best labeled cells showed bilateral axon collaterals distributions up to 25,000 microm in length with 950 varicosities and unilateral distributions up to 12,561 microm with 491 varicosities. The axon collaterals appeared to be unmyelinated, which was confirmed at EM, and were small in diameter (average 0.3 microm). Varicosities were located mostly in laminae I, V, VII, VIII and X and in the lateral funiculi. Most varicosities were not in contact with visible structures but some were seen in close apposition to Nissl stained somata and proximal dendrites. Varicosities had average minor diameters of 1.3 microm and major diameters of 2.3 microm. Most were boutons en passant while 10-20% were boutons termineaux. EM revealed axodendritic and axoaxonic synapses formed by varicosities and by the axons between varicosities. It is estimated that the most extensive of these axon collaterals systems may contact over 200 spinal neurons in multiple locations. These data lead to the conclusion that sacral preganglionic neurons have multiple functions within the spinal cord in addition to serving their target organ. As most preganglionic neurons in this location innervate the urinary bladder, it is possible that bladder preganglionic neurons have multiple functions.

  12. Noninvasive mechanical ventilation with average volume assured pressure support (AVAPS) in patients with chronic obstructive pulmonary disease and hypercapnic encephalopathy

    OpenAIRE

    Briones Claudett, Killen Harold; Briones Claudett, Monica; Chung Sang Wong, Miguel; Nuques Martinez, Alberto; Soto Espinoza, Ricardo; Montalvo, Mayra; Esquinas Rodriguez, Antonio; Gonzalez Diaz, Gumersindo; Grunauer Andrade, Michelle

    2013-01-01

    Background Non-invasive mechanical ventilation (NIV) in patients with acute respiratory failure has been traditionally determined based on clinical assessment and changes in blood gases, with NIV support pressures manually adjusted by an operator. Bilevel positive airway pressure-spontaneous/timed (BiPAP S/T) with average volume assured pressure support (AVAPS) uses a fixed tidal volume that automatically adjusts to a patient’s needs. Our study assessed the use of BiPAP S/T with AVAPS in pati...

  13. Negative Pressure Wound Therapy Literature Review of Efficacy, Cost Effectiveness, and Impact on Patients' Quality of Life in Chronic Wound Management and Its Implementation in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Diaa Othman

    2012-01-01

    Full Text Available This is a paper reviewing the National Health Service (NHS agenda in relation to the use of Negative Pressure Wound Therapy (NPWT in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients’ satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients’ satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

  14. Estudio clínico retrospectivo del uso de un sistema de hidrocirugía en pacientes lesionados medulares con úlceras por presión crónicas Retrospective clinical study of an hydrogurgery system on spinal cord injured patients with chronic pressure ulcers

    Directory of Open Access Journals (Sweden)

    J.M. Arévalo Velasco

    2011-03-01

    Full Text Available Realizamos un estudio clínico retrospectivo con pacientes lesionados medulares crónicos en el Hospital Nacional de Parapléjicos (Toledo, España, intervenidos quirúrgicamente por una o varias úlceras por presión de carácter crónico durante el año 2008. Revisamos 84 historias clínicas de pacientes a los cuales se realizaron 141 procedimientos quirúrgicos. Sólo en 8 casos se realizó una cirugía puramente de limpieza (bisturí más hidrocirugía sin realizar consecutivamente el tratamiento de cobertura de la lesión. Los restantes 133 procedimientos de limpieza más cobertura inmediata se distribuyeron en 2 grupos según el tipo de desbridamiento realizado: grupo I (n = 71, sólo desbridamiento quirúrgico con bisturí y grupo II (n = 62 desbridamiento con bisturí más uso posterior de un sistema de hidrocirugía de flujo continuo a alta presión. Según la localización, las lesiones ulcerosas tratadas fueron: isquiáticas 69 (48,94 %, sacras 49 (34,75 %, trocantéreas 15 (10,63 % y otras (talones y maléolos 8 (5,67%. Como conclusiones, establecemos que más del 54 % de los procedimientos llevados a cabo (72 de 133 curaron en la primera intervención y no necesitaron más cirugías; un 38% (51 de 133 fueron intervenciones realizadas en pacientes con úlceras muy evolucionadas y/o de difícil solución; la tasa de recidivas al año fue del 4,4 %; no encontramos diferencias significativas en cuanto a la tasa de curación entre los grupos I y II (p We carried out a retrospective study on spinal cord injured patients from the National Hospital for Paraplegics (Toledo, Spain, who were surgically treated during 2008 to alleviate the problems elicited by one or more pressure ulcers of chronic nature. We reviewed the clinical histories of 84 patients that received 141 surgical procedures, 8 were of radical nature (scalpel plus hidrosurgery without wound covering. The remaining 133 procedures of surgical cleaning and immediate wound

  15. Systolic blood pressure and heart rate in cats with chronic kidney disease undergoing chemical restraint during hemodialysis

    OpenAIRE

    Karine Kleine Figueiredo dos Santos; Daniel Paulino Junior; Julio César Cambraia Veado; Juliana de Abreu Pereira

    2016-01-01

    Dialysis is one of the used methods for treatment of Acute Renal Injury (ARI) and Chronic Kidney Disease (CKD) to replace the function of the kidneys when refers to blood depuration. Hemodialysis removes toxins accumulated in the body directly from the blood, being a useful alternative therapy for dogs and cats with CKD in advanced stages. Because of the difficulty on handling the patient feline, this procedure requires sedation. However, few studies have been conducted to assess the safety o...

  16. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    McGuire, S; Bhatia, S; Sun, W; Menda, Y; Ponto, L; Gross, B; Buatti, J [University Of Iowa, Iowa City, IA (United States)

    2015-06-15

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced.

  17. SU-E-J-125: A Novel IMRT Planning Technique to Spare Sacral Bone Marrow in Pelvic Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: Develop an IMRT planning technique that can preferentially spare sacral bone marrow for pelvic cancer patients. Methods: Six pelvic cancer patients (two each with anal, cervical, and rectal cancer) were enrolled in an IRB approved protocol to obtain FLT PET images at simulation, during, and post chemoradiation therapy. Initially, conventional IMRT plans were created to maintain target coverage and reduce dose to OARs such as bladder, bowel, rectum, and femoral heads. Simulation FLT PET images were used to create IMRT plans to spare bone marrow identified as regions with SUV of 2 or greater (IMRT-BMS) within the pelvic bones from top of L3 to 5mm below the greater trochanter without compromising PTV coverage or OAR sparing when compared to the initial IMRT plan. IMRT-BMS plans used 8–10 beam angles that surrounded the subject. These plans were used for treatment. Retrospectively, the same simulation FLT PET images were used to create IMRT plans that spared bone marrow located in the sacral pelvic bone region (IMRT-FAN) also without compromising PTV coverage or OAR sparing. IMRT-FAN plans used 16 beam angles every 12° anteriorly from 90° – 270°. Optimization objectives for the sacral bone marrow avoidance region were weighted to reduce ≥V10. Results: IMRT-FAN reduced dose to the sacral bone marrow for all six subjects. The average V5, V10, V20, and V30 differences from the IMRT-BMS plan were −2.2 ± 1.7%, −11.4 ± 3.6%, −17.6 ± 5.1%, and −19.1 ± 8.1% respectively. Average PTV coverage change was 0.5% ± 0.8% from the conventional IMRT plan. Conclusion: An IMRT planning technique that uses beams from the anterior and lateral directions reduced the volume of sacral bone marrow that receives ≤10Gy while maintaining PTV coverage and OAR sparing. Additionally, the volume of sacral bone marrow that received 20 or 30 Gy was also reduced

  18. Sindrome de currarino associada ao Tailgut Cyst: ressecção abdômino-sacral The Tailgut Cyst is na embryological remnant of the retrorectal (Presacral space that can be a part of the currarino syndrome

    Directory of Open Access Journals (Sweden)

    Cristiane Koizimi Martos Fernandes

    2007-12-01

    patient is characterized as carrying the Currarino Syndrome. Discussion: The syndrome is characterized by the malformation of the anorectal, sacral abnormalties and retrorectal mass. It has connection with a gene mutation of the HLXB9. The Tailgut Cyst is an embryological remnant of the hindgut, more common in young adult women (75-90%. The tailgut cyst related to the Currarino Syndrome is an uncommom lesion. Most patients are asymptomatic, however, they may present anorectal, perineo and sacrum symptoms. Imaging exams are useful for diagnostic definition and surgery programming. The complete surgery excision is recommended due to the risk of reestablishment, malignant degeneration and chronic infection, even in asymptomatic patients. The prognosis is uncertain.

  19. Imperfuração anal associada à agenesia parcial do sacro e lipoma pré-sacral: síndrome de Currarino Imperforate anus associated with partial sacral agenesis and presacral lipoma: Currarino syndrome

    Directory of Open Access Journals (Sweden)

    Paulo Ricardo G. Zen

    2010-09-01

    Full Text Available OBJETIVO: Relatar o caso de uma criança com síndrome de Currarino diagnosticada após avaliação por episódios recorrentes de infecção urinária. DESCRIÇÃO DE CASO: Menina branca de dois anos, única filha de pais hígidos e sem história familiar de defeitos congênitos. A criança nasceu com imperfuração anal e com fístula retovestibular diagnosticadas no primeiro dia de vida. Por volta dos sete meses, começou a apresentar episódios recorrentes de infecção urinária, estabelecendo-se o diagnóstico de bexiga neurogênica. Na mesma ocasião, foi constatada a presença de agenesia parcial do sacro. A avaliação pela tomografia computadorizada e ressonância nuclear magnética de coluna identificou presença de fístula coincidente com a fosseta da transição lombo-sacral, observada ao exame físico; amputação da porção inferior da medula, com diminuição do número de raízes nervosas da cauda equina e massa pré-sacral de aspecto lipomatoso. Esta foi confirmada durante a cirurgia de correção do ânus imperfurado. A criança não apresentava outras dismorfias e a avaliação radiológica dos pais não identificou anormalidades sacrais. COMENTÁRIOS: A síndrome de Currarino é uma doença genética autossômica, dominante e rara caracterizada pela tríade formada por atresia anal, agenesia parcial do sacro e tumoração pré-sacral. Inclui teratomas, meningoceles, cistos entéricos e lipomas, como observado em nossa paciente. Crianças apresentando anormalidades anorretais deveriam ser sempre cuidadosamente avaliadas quanto à presença da síndrome de Currarino. A agenesia parcial do sacro é um forte indicativo da doença.OBJECTIVE: To report a patient with Currarino syndrome diagnosed after evaluation for recurrent urinary infections. CASE DESCRIPTION: This is a Caucasian two-year-old girl, the only daughter of healthy unrelated parents with no family history of congenital defects. The patient was born with imperforate

  20. Subgroups based on thermal and pressure pain thresholds in women with chronic whiplash display differences in clinical presentation – an explorative study

    Directory of Open Access Journals (Sweden)

    Börsbo B

    2012-11-01

    Full Text Available Björn Börsbo,1,2 Gunilla M Liedberg,3 Mia Wallin,1,3 Björn Gerdle1,41Department of Medicine and Health Sciences, University of Linköping, Linköping, Sweden; 2Clinical Department of Rehabilitation Medicine, County Hospital Ryhov, Jönköping, Sweden; 3Department of Social and Welfare Studies, University of Linköping, Norrköping, Sweden; 4Pain and Rehabilitation Centre, UHL, Östergötland County Council, Linköping, SwedenPurpose: To investigate the presence of subgroups in chronic whiplash-associated disorders (WAD based on pain thresholds for pressure (PPT, cold (CPT, and heat (HPT and to compare these subgroups with respect to symptomatology, disability, and health aspects. Methods: Two groups of female subjects – patients with chronic WAD (n = 28 and healthy controls (CON; n = 29 – were investigated. Quantitative sensory testing (QST for thermal thresholds and algometry for PPT at four sites in the body (over the trapezius and tibialis anterior bilaterally were determined. Habitual pain intensities, psychological strain, disability, and health aspects were registered using a questionnaire.Results: A cluster analysis based on PPT, CPT, and HPT identified two subgroups of chronic WAD: one sensitive subgroup (s-WAD; n = 21, and one less sensitive subgroup (ls-WAD; n = 6. S-WAD displayed widespread hyperalgesia, whereas ls-WAD had localized hyperalgesia in the neck area, with tendencies to supernormal values in remote areas of the body. Generally, s-WAD had a significantly worse situation than the CON with respect to symptomatology, disability, and health aspects. The ls-WAD group was intermediary between s-WAD and CON in these aspects.Conclusion: Different explanations, eg, severity of the pain condition per se, etiological factors, and pre-trauma differences in pain sensitivity, may exist for the differences in pain thresholds between the two subgroups. Future research should investigate the role of pain thresholds in the chronic

  1. A Case of Apoplexy Attack-Like Neuropathy due to Hereditary Neuropathy with Liability to Pressure Palsies in a Patient Diagnosed with Chronic Cerebral Infarction.

    Science.gov (United States)

    Hachisuka, Akiko; Matsushima, Yasuyuki; Hachisuka, Kenji; Saeki, Satoru

    2016-06-01

    Hereditary neuropathy with liability to pressure palsies is an inherited disease associated with the loss of a copy of the PMP22 gene. The condition leads to mononeuropathy due to compression and easy strangulation during daily life activities, resulting in sudden muscle weakness and sensory disturbance, and displaying symptoms similar to cerebrovascular diseases. We report the case of an 80-year-old man with left paralysis due to chronic cerebral infarction. His medical history indicated remarkable recovery from about 4 months after the onset of left hemiplegia with predominant involvement of the fingers. Despite subsequent recurrent monoplegia of the upper or lower limbs, brain magnetic resonance imaging consistently revealed only previous cerebral infarction in the right corona radiata without new lesions. Medical examination showed reduced deep tendon reflexes in his extremities on both the healthy and hemiplegic sides. Nerve conduction studies showed delayed conduction at the bilateral carpal and cubital tunnels and near the right caput fibulae. Genetic analysis revealed loss of a copy of the PMP22 gene. Thus, he was diagnosed with a cerebral infarction complicated by hereditary neuropathy with liability to pressure palsies. Stroke patients develop sudden muscle weakness and sensory disturbance. However, if such patients have no hyperactive deep tendon reflexes and show atypical recovery of paralysis that does not correspond to findings of imaging modalities, nerve conduction studies and genetic analysis may be necessary, considering the complication of hereditary neuropathy with liability to pressure palsies. PMID:27080157

  2. A Novel Use for the Rigid Cystoscope: The Removal of Sacral Tacks after a Coloanal Anastamosis Dehiscence

    Directory of Open Access Journals (Sweden)

    W. Mahmalji

    2009-01-01

    Full Text Available A 69-year-old female presented as an emergency with atrial fibrillation, which was treated with warfarin. She subsequently developed fresh rectal bleeding and after further investigations a Dukes B adenocarcinoma of the rectum was found. She subsequently underwent a low anterior resection, coloanal anastamosis and a defunctioning ileostomy. Three sterile surgical metallic tacks (pins were inserted into the sacrum to stop brisk bleeding from the presacral venous plexus. Following discharge, she was readmitted with septic shock and a CT scan revealed a presacral fluid collection in the area surrounding the sacral tacks (pins and an anastamotic dehiscence. The patient was not fit for further pelvic surgery to remove the tacks, so an alternative minimally invasive cystoscopic procedure was performed. The sacral tacks (pins were removed by the urologist using a rigid cystoscope and cold cup biopsy forceps. To our knowledge, this is the first reported case in the literature.

  3. Clinical symptoms of right ventricular failure in experimental chronic pressure load are associated with progressive diastolic dysfunction

    NARCIS (Netherlands)

    Borgdorff, Marinus A. J.; Koop, Anne Marie C.; Bloks, Vincent W.; Dickinson, Michael G.; Steendijk, Paul; Sillje, Herman H. W.; van Wiechen, Maarten P. H.; Berger, Rolf M. F.; Bartelds, Beatrijs

    2015-01-01

    Background: Right ventricular failure (RVF) due to pressure load is a major cause of death in congenital heart diseases and pulmonary hypertension. The mechanisms of RVF are unknown. We used an experimental approach based upon clinical signs of RVF to delineate functional and biological processes as

  4. High blood pressure six weeks postpartum after hypertensive pregnancy disorders at term is associated with chronic hypertension

    NARCIS (Netherlands)

    Visser, V. S.; Hermes, W.; Franx, A.; Koopmans, C. M.; van Pampus, M. G.; Mol, B. W.; de Groot, C. J. M.

    2013-01-01

    Objectives: Hypertension in pregnancy is associated with cardiovascular disease (CVD) later in life. Blood pressure monitoring in women who experienced hypertension in pregnancy after puerperium has been suggested to be important for early detection and prevention of CVD. The aim of this study is to

  5. Particle therapy using carbon ions or protons as a definitive therapy for patients with primary sacral chordoma

    Science.gov (United States)

    Demizu, Y; Jin, D; Hashimoto, N; Takagi, M; Terashima, K; Fujii, O; Niwa, Y; Akagi, T; Daimon, T; Hishikawa, Y; Abe, M; Murakami, M; Sasaki, R; Fuwa, N

    2014-01-01

    Objective: This study retrospectively evaluated the efficacy and toxicity of particle therapy using carbon ions or protons for primary sacral chordomas. Methods: We evaluated 23 patients with primary sacral chordoma treated with carbon ion therapy (CIT) or proton therapy (PT) between July 2005 and June 2011 at the Hyogo Ion Beam Medical Center, Hyogo, Japan. The median patient age was 72 years. 14 patients were treated with 70.4 Gy equivalents (GyE) in 16 fractions and 9 were treated with 70.4 GyE in 32 fractions. CIT was used for 16 patients, and PT was used for 7 patients. Results: The median follow-up period was 38 months. At 3 years, local control (LC), overall survival (OS) and progression-free survival (PFS) for all patients were 94%, 83% and 68%, respectively. The log-rank test revealed that male sex was significantly related to better PFS ( p = 0.029). No other factors, including dose fractionation and ion type, were significant for LC, OS or PFS. In nine patients, ≥Grade 3 acute dermatitis was observed, and ≥Grade 3 late toxicities were observed in nine patients. The 32-fraction protocol reduced severe toxicities in both the acute and late phases compared with the 16-fraction protocol. Conclusion: Particle therapy for patients with sacral chordoma showed favourable LC and OS. Severe toxicities were successfully reduced by modifying the dose fractionation and treatment planning in the later treatment era. Thus, this therapeutic modality should be considered useful and safe. Advances in knowledge: This is the first study including both CIT and PT for sacral chordomas. PMID:24288399

  6. A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome

    OpenAIRE

    Fassov, Janne; Lundby, Lilli; Worsøe, Jonas; Buntzen, Steen; Laurberg, Søren; Krogh, Klaus

    2014-01-01

    Background Irritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide. In selected patients with severe diarrhoea-predominant or mixed IBS subtypes sacral nerve stimulation (SNS) alleviates IBS-specific symptoms and improves quality of life. The mode of action, however, remains unknown. The present study aimed to evaluate the effect of SNS on small intestinal motility in IBS patients. Methods Twenty patients treated with SNS for severe diarrhoea-predominant o...

  7. Postoperative Issues of Sacral Nerve Stimulation for Fecal Incontinence and Constipation: A Systematic Literature Review and Treatment Guideline

    DEFF Research Database (Denmark)

    Maeda, Yasuko; Matzel, Klaus; Lundby, Lilli;

    2011-01-01

    on a wider literature using the keywords “complication,” “adverse effect,” “treatment failure,” “equipment failure,” “infection,” “foreign-body migration,” “reoperation,” “pain,” and “algorithm.” STUDY SELECTION: Four hundred sixty-one titles were identified, and after a title and abstract review, 135 were......BACKGROUND: There is a lack of knowledge on the incidence and management of suboptimal therapeutic effect and the complications associated with sacral nerve stimulation for fecal incontinence and constipation. OBJECTIVE: This study aimed to review current literature on postoperative issues...... and to propose a treatment algorithm. DATA SOURCE: PubMed, MEDLINE, and EMBASE were searched using the keywords “sacral nerve stimulation,” “sacral neuromodulation,” “fecal incontinence,” and “constipation” for English-language articles published from January 1980 to August 2010. A further search was conducted...

  8. Cancer of the breast and anterior sacral meningeal in a patient with Marfan syndrome

    International Nuclear Information System (INIS)

    Introduction. Breast cancer is the most common malignancy of women in the world Western. It is rare below 30 years. Marfan syndrome (MS) is an entity clinically characterized by cardiovascular, ocular and skeletal genetic base. Its prevalence is estimated at 4-6 per 100,000 births. In the literature there are few reports of cancers diagnosed in association with SM, and after a thorough review, we found only two communications association with malformations such as dural sac meningocele. Objective. The aim of this study was to review the literature from communication A case report of a patient with SM in which the age of 24 he diagnosed with breast cancer and a previous sacral meningocele. Case. Female patient 24 years old, with SM, who consulted a tumor of right breast. Was studied with mammography and cytological puncture were positive for malignancy. Local treatment consisted of modified radical mastectomy and chest wall radiotherapy. The pathology corresponded to ductal carcinoma Infiltrating (CDI) NOS 27mm diameter greater final histologic grade II carcinoma in situ solid and cribriform intermediate grade without necrosis greater than 30%; 10 axillary lymph resected, all free of metastases. The dosage of hormone receptors was frankly positive for both estrogen and progesterone. In sum CDI NOS stage IIA. the chest radiograph and bone scan showed no abnormalities and abdominal ultrasound He requested postoperatively revealed an abdominopelvic image 13 x 16 cm. positron abdomen and pelvis confirmed a predominantly cystic mass in the pelvis and abdomen lower. Exploratory laparotomy revealed that the tumor corresponded to a meningocele before and proceeded to peritoneal cyst resection and closure of the sacral gap. At the time of writing, the patient is free and without neurological deficit disease, low adjuvant Tamoxifen for 3 years. Conclusions. The SM as breast cancer in younger women is uncommon. Few cancers have been reported in association with SM. Some of

  9. Self-reported somatosensory symptoms of neuropathic pain in fibromyalgia and chronic widespread pain correlate with tender point count and pressure-pain thresholds

    DEFF Research Database (Denmark)

    Amris, Kirstine; Jespersen, Anders; Bliddal, Henning

    2010-01-01

    of patients with chronic widespread pain (CWP). The aims of the study were to assess the patient-reported sensory neuropathic symptoms by PDQ and to correlate these with tender point (TP) count and pressure-pain thresholds. Eighty-one patients (75 F, 6 M) with CWP (ACR-criteria) filled in the PDQ. Manual TP......-37). Mean PDT was 8.8 kPa (range: 2-36) and mean PTT 30.9 kPa (range: 4-85). Deep-tissue hyperalgesia was the predominant somatosensory symptom reported in 83%, but other neuropathic symptoms were also frequent, e.g. burning 51% and prickling 47%. Statistically significant correlations were found between...

  10. Health Technology Assessment of the Negative Pressure Wound Therapy for the treatment of acute and chronic wounds: efficacy, safety, cost effectiveness, organizational and ethical impact

    Directory of Open Access Journals (Sweden)

    Paolo Giorgi Rossi

    2012-06-01

    Full Text Available

    Background: the aim of the study was to assess the safety, efficacy and cost-effectiveness of negative Pressure wound therapy (nPT for people with chronic and acute wounds.

    Methods: the scope and the final draft of the report have been submitted to the stakeholders (producers, payers and patients. safety issues were addressed through a systematic review of the meta-literature. efficacy was addressed through a systematic review and meta-analysis of randomized controlled trials (rcTs comparing nPT and other standard therapies in patients with chronic or acute lesions. cost-consequence was analyzed through a systematic review of the existing studies.

    Results: we retrieved 19 studies, 13 of which were included in the meta-analysis. Many studies had biases that may have resulted in a better performance for nPT. nPT showed: a slightly shorter healing time (-10.4 days, p=0.001, with no heterogeneity, apart from one small study with very positive results, and 40% more patients healed (p=0.002, no heterogeneity.We identified 15 original research papers on nPT costs and cost per outcome. The costs-per-patient- treated varied from +29% to -60%, with several studies reporting savings for nPT.

    Conclusions: despite serious methodological flaws, the body of evidence available was sufficient to prove some clinical benefit of nPT in severe chronic and acute wound treatment. There is a need for independent and contextualized cost analyses....

  11. Differential Impact of Stress Reduction Programs upon Ambulatory Blood Pressure among African American Adolescents: Influences of Endothelin-1 Gene and Chronic Stress Exposure

    Directory of Open Access Journals (Sweden)

    Mathew J. Gregoski

    2012-01-01

    Full Text Available Stress-activated gene × environment interactions may contribute to individual variability in blood pressure reductions from behavioral interventions. We investigated effects of endothelin-1 (ET-1 LYS198ASN SNP and discriminatory stress exposure upon impact of 12-week behavioral interventions upon ambulatory BP (ABP among 162 prehypertensive African American adolescents. Following genotyping, completion of questionnaire battery, and 24-hour ABP monitoring, participants were randomized to health education control (HEC, life skills training (LST, or breathing awareness meditation (BAM. Postintervention ABP was obtained. Significant three-way interactions on ABP changes indicated that among ET-1 SNP carriers, the only group to show reductions was BAM from low chronic stress environments. Among ET-1 SNP noncarriers, under low chronic stress exposure, all approaches worked, especially BAM. Among high stress exposure noncarriers, only BAM resulted in reductions. If these preliminary findings are replicated via ancillary analyses of archival databases and then via efficacy trials, selection of behavioral prescriptions for prehypertensives will be edging closer to being guided by individual's underlying genetic and environmental factors incorporating the healthcare model of personalized preventive medicine.

  12. Effective use of negative pressure wound therapy provides quick wound-bed preparation and complete graft take in the management of chronic venous ulcers.

    Science.gov (United States)

    Egemen, Onur; Ozkaya, Ozay; Ozturk, Muhammed Besir; Aksan, Tolga; Orman, Çağdaş; Akan, Mithat

    2012-04-01

    Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment. PMID:21992173

  13. Architectural configuration and microstructural properties of the sacral plexus: a diffusion tensor MRI and fiber tractography study.

    Science.gov (United States)

    van der Jagt, Pasquelle K N; Dik, Pieter; Froeling, Martijn; Kwee, Thomas C; Nievelstein, Rutger A J; ten Haken, Bennie; Leemans, Alexander

    2012-09-01

    The ability to investigate microstructural properties of the central nervous system with diffusion tensor imaging (DTI) has been shown in many studies. More recently, DTI is being applied outside the brain showing promising results, for instance, for investigating muscle tissue. In this work, we demonstrate the feasibility of diffusion tensor imaging (DTI) and fiber tractography to study the nerves of the sacral plexus in humans in vivo and to assess the architectural configuration and microstructural properties of these peripheral nerves. For this research goal we optimized the acquisition parameters of a DTI sequence and acquired data from 10 healthy adults and one 12-year patient having spina bifida and neurogenic bladder dysfunction. For the healthy volunteers, we estimated the fractional anisotropy (FA) and mean (MD), axial (AD), and radial diffusivities (RD) of the sacral plexus nerves which may serve as a baseline for future studies. We demonstrated that tractography of the sacral plexus on a 3 Tesla MR scanner is feasible, giving 3D insight in the general anatomy and organization of the nerves L4 to S3. In addition, branches to the pudendal nerve were also found in 4 volunteers. There were no significant differences in any of the estimated diffusion measures between the right and left sided nerves or between the nerves L4 to S3 on an intra-subject basis. Furthermore, clinical feasibility of DTI and tractography in a child having spina bifida and neurogenic bladder dysfunction is demonstrated. The architectural configuration of the child's sacral plexus was comparable with the healthy volunteers and no significant disrupted nerve fibers were observed. However, there are strong indications that abnormal diffusion characteristics are present at the level of the neural tube defect due to incomplete segments of the nerves that are close to the vertebrae. These findings are encouraging for using DTI as a means to investigate changes in microstructural properties

  14. Female SHR have greater blood pressure sensitivity and renal T cell infiltration following chronic NOS inhibition than males

    OpenAIRE

    Brinson, Krystal N.; Elmarakby, Ahmed A.; Tipton, Ashlee J.; Crislip, G. Ryan; Yamamoto, Tatsuo; Baban, Babak; Sullivan, Jennifer C.

    2013-01-01

    Nitric oxide is a critical regulator of blood pressure (BP) and inflammation, and female spontaneously hypertensive rats (SHR) have higher renal nitric oxide bioavailability than males. We hypothesize that female SHR will have a greater rise in BP and renal T cell infiltration in response to nitric oxide synthase (NOS) inhibition than males. Both male and female SHR displayed a dose-dependent increase in BP to the nonspecific NOS inhibitor NG-nitro-l-arginine methyl ester (l-NAME: 2, 5, and 7...

  15. Negative pressure wound therapy versus standard wound care in chronic diabetic foot wounds: study protocol for a randomized controlled trial

    OpenAIRE

    Seidel, Dörthe; Mathes, Tim; Lefering, Rolf; Storck, Martin; Lawall, Holger; Neugebauer, Edmund A. M.

    2014-01-01

    Background In August 2010, the Federal Joint Committee (G-BA) decided that negative pressure wound therapy (NPWT) would not be reimbursable in German ambulatory care. This decision was based on reports from the Institute for Quality and Efficiency in Health Care (IQWiG), which concluded that there is no convincing evidence in favor of NPWT. The aim of this diabetic foot study (DiaFu study) is to evaluate whether the clinical, safety and economic results of NPWT are superior to the results of ...

  16. Cytopathological Dilemma of Anaplastic Sacral Chordoma with Radiological and Histological Corroboration

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    Arghya BANDYOPADHYAY

    2011-05-01

    Full Text Available Chordoma is a relatively rare locally invasive and potentially malignant tumor of fetal notochord origin, affecting the axial skeleton. Cytopathological diagnosis of chordoma is favored by the presence of characteristic physaliphorous cells, bearing abundant foamy cytoplasm dispersed in a myxoid matrix. Anaplastic chordoma or dedifferentiated chordoma, an even rarer variant, can cause a diagnostic confusion with chondrosarcoma from the cytopathological point of view, with similar chondromyxoid matrix and atypical cells. Hence, chordoma bearing anaplastic features needs to be identified and should be distinguished from chondrosarcoma on aspiration cytopathology. We present a case of anaplastic sacral chordoma in a man 59 years of age, causing extensive destruction of sacrum and invading the paravertebral tissues as evidenced by radiology. Fine needle aspiration cytopathology revealed few large pleomorphic hyperchromatic cells, admixed with characteristic physaliphorous cells and myxoid matrix. The cytopathological diagnosis has been confirmed by histopathology and immunohistochemistry. Since anaplastic chordoma bears an unfavorable prognosis, it should be suspected on preoperative aspiration cytopathology. Clinicoradiological correlation along with histopathological and immunohistochemical confirmation is necessary subsequently.

  17. Disabling Orthostatic Headache after Penetrating Stonemason Pencil Injury to the Sacral Region

    Directory of Open Access Journals (Sweden)

    Carlo Brembilla

    2015-01-01

    Full Text Available Penetrating injuries to the spine, although less common than motor vehicle accidents and falls, are important causes of injury to the spinal cord. They are essentially of two varieties: gunshot or stab wounds. Gunshot injuries to the spine are more commonly described. Stab wounds are usually inflicted by knife or other sharp objects. Rarer objects causing incidental spinal injuries include glass fragments, wood pieces, chopsticks, nailguns, and injection needles. Just few cases of penetrating vertebral injuries caused by pencil are described. The current case concerns a 42-year-old man with an accidental penetrating stonemason pencil injury into the vertebral canal without neurological deficit. After the self-removal of the foreign object the patient complained of a disabling orthostatic headache. The early identification and treatment of the intracranial hypotension due to the posttraumatic cerebrospinal fluid (CSF sacral fistulae were mandatory to avoid further neurological complications. In the current literature acute pattern of intracranial hypotension immediately after a penetrating injury of the vertebral column has never been reported.

  18. The anesthesia for selective posterior rhizotomy at lumbar and sacral regions on juvenile cerebral palsy patients%小儿脑性瘫痪患者腰骶段选择性后根神经切断术的麻醉处理

    Institute of Scientific and Technical Information of China (English)

    王强; 王增春

    2002-01-01

    Objective To summarize the anesthesia techniques performed in the selective posterior rhizotomy(SPR) at lumbar and sacral regions( L& R) on juvenile cerebral palsy(CP) patients. Method 144 CP patients below 10 years were successfully erformed SPR at L& R under combined intravenous and inhalation anesthesia (CIIA) in prone position with threshold values of each nerve root being measured by means of nerve root electric stimulus (NRES). Result All patients were performed SPR and NRES successfully although blood pressure and heart rate increased significantly while NRES. Conclusion CIIA is safe and effective for juvenile CP patients to be performed SPR at L& R.

  19. Skull involvement in a pediatric case of chronic recurrent multifocal osteomyelitis

    OpenAIRE

    Watanabe, Toru; Ono, Hiroyuki; Morimoto, Yoshitaka; Otsuki, Yoshiro; Shirai, Masami; Endoh, Akira; Naito, Masaaki; Inoue, Yoshiya; Hongo, Teruaki

    2015-01-01

    ABSTRACT An 11-year-old boy was diagnosed with chronic recurrent multifocal osteomyelitis (CRMO) and presented with right sacro-femoral and occipital lesions. Initially, a tumor was suspected. However, the bone biopsy showed osteomyelitis with a negative bacterial culture. Bone scintigraphy revealed inflammatory changes on multiple bone lesions. The slight elevation in inflammatory markers such as C-reactive protein was of little clinical value. He was diagnosed with CRMO by sacral biopsy, an...

  20. 骶骨肿瘤术后并发症分析及处理%Analysis and treatment of postoperative complications of sacral tumor after surgery

    Institute of Scientific and Technical Information of China (English)

    董军; 孙成良; 李栋

    2012-01-01

    Objective To analyze the postoperative complications of sacral tumor and treatment strategy. Methods This retrospective study included 38 cases of sacral tumors surgically treated from December 2003 to December 2010. The age of patients ranged from 18 to 65 years (mean 34.5 years) , including of 22 male and 16 female. Record the most common postoperative complication of these patients, causes and relative treatments were analyzed. Results After surgery, 26 cases were followed up for an average period of 3.1 years ( longest 5 years, shortest 10 months). None of the patients died in surgery. The early complications after surgery included gastrointestinal dysfunction in 31 cases. Nonunion of the incision occurred in 2 cases caused by radiation, one case with S4 tumor died of chronic infection after 8 monthes in spite of half year dressing, and the other was delayed union of the incision and the wound healed by dressing with granulation promoting plaster after 3 monthes. Incisal effuscin with hyperpyrexia happened in 3 cases. Enterococcal infection was confirmed by germiculture. Body temperature restored normally after 5-10 d with a method of puncture drainage and the application of vancomycin. Urine retention occurred in 2 cased after surgery and catheter removed after 3 monthes. Internal fixation( iliac screw) loosened in 3 cases during follow-up phase. Conclusion Because of stimulating bowel with effuscin and operation,gastrointestinal dysfunction in patients with sacral tumor rate is higher, but alleviated commonly. Sacral tumor patients with a higher incidence of enterococcal infection caused by differential tissue coverage and near perineum. The treatment of enterococcal infection is difficult. Be cautious about operating on patients after radiation. Selective nerve root should be preserved to avoid urine retention.%目的 探讨骶骨肿瘤术后常见并发症及其处理方法.方法 2003年12月~2010年12月间手术治疗的38

  1. The response of right ventricular size, function, and pressure to supine exercise: A comparison of patients with chronic obstructive lung disease and normal subjects

    International Nuclear Information System (INIS)

    The response of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume (RVEDV) to exercise was studied in 11 patients with severe (FEV25sub(%)sub(-)75sub(%)=0.32+-0.13, mean+-SD) chronic obstructive pulmonary disease (COPD). Using gated radionuclide cardiac blood pool imaging techniques, the response of the patients with COPD was compared with that of 15 control subjects. Arterial blood gases, pulmonary arterial pressures, wedge pressure, and right ventricular pressures also were monitored in patients with COPD. The resting RVEF was lower and the resting RVEDV was higher in patients with COPD than in normals (both, P2). With exercise this cardiac index rose to 5.52+-1.7/min/m2(P<0.01) due to the increase in heart rate (83+-18 to 125+-25 beats/min; P<0.01) while stroke volume did not significantly change. During exercise, normal subjects showed an increase in RVEF while RVEDV did not change; in patients with COPD, the RVEF fell and the RVEDV increased. In the patients with COPD, mild resting arterial hypoxemia and hypercapnia were both exaggerated during exercise; and mild resting pulmonary arterial hypertension (PAm=24.3+-7.65 mm Hg) also worsened with exercise (PAm=41+-19 mm Hg, P<0.01). Correlation between change in RVEF and PAm was -0.58, and between change in RVEDV and PAm was 0.63. We conclude that patients with severe COPD often have right ventricular dilation at rest and commonly respond to supine exercise with a fall in FV ejection fraction and further dilation of the right ventricle. (orig.)

  2. Changes in blood pressure and dipsogenic responsiveness to angiotensin II during chronic exposure of rats to cold

    Energy Technology Data Exchange (ETDEWEB)

    Fregly, M.J.; Shechtman, O.; van Bergen, P.; Reeber, C.; Papanek, P.E. (Univ. of Florida, Gainesville (United States))

    1991-03-11

    To assess the role of the renin-angiotensin (RA) system in the development of cold-induced hypertension in rats, systolic blood pressure (SBP), plasma renin activity (PRA), and the dipsogenic responsiveness to s.c. administration of angiotensin II (AII) were measured weekly for 4 weeks. SBP increased significantly during the third week of exposure to cold (5C), compared to warm-adapted controls. A significant increase in SBP occurred during the third week of cold. In contrast, (PRA) increased within the first week of cold, and declined thereafter to reach the level of the control by the third week. By the fourth week, PRA decreased to a level significantly below that of control. The dipsogenic responsiveness to acute administration of AII increased significantly by the third week of cold and remained significantly elevated during the fourth week. There was a significant direct relationship between dipsogenic responsiveness to AII and SBP in the cold-treated but not the control group. There was also a significant indirect linear relationship between PRA and dipsogenic responsiveness to AII. Cold-treated rats had significant increases in urinary norepinephrine output and weights of heart, kidneys, adrenals, and brown adipose tissue. Thus, the results suggest, but do not prove, either that the elevation of blood pressure under these conditions may be induced by changes in the RA system. The results suggest further that the reduction in the drinking response to AII accompanying increases in PRA may be related to changes in the regulation of central receptors for AII.

  3. Live-dead agreement of benthic communities under pressure by chronic oil pollution in the Arabian Sea

    Science.gov (United States)

    Albano, Paolo G.; Tomašových, Adam; Stachowitsch, Michael; Filippova, Nadezhda; Steger, Jan; Zuschin, Martin

    2014-05-01

    Mismatch between the richness or species composition of a death assemblage (DA) and the local living assemblage (LA) is typically attributed to natural post-mortem processes, particularly preservational bias. Recent research, however, suggests that live-dead (LD) agreement is significantly lower in anthropogenically disturbed settings. This reflects the so-called "compositional inertia" of DAs to recent environmental change, i.e., DAs still capture earlier community states not affected by such disturbance. The inertia to changing ecological conditions should be particularly likely under conditions of anthropogenic modification because the rapidity of many human-driven changes is unprecedented in natural systems. Our research tests this hypothesis by evaluating the agreement between the LA and DA in benthic communities around the Zakum oil field in the Southern Arabian Sea, off the coast of the United Arab Emirates. This is an area of intense oil extraction, with almost 800 offshore oil and gas platforms and 25 major terminals, but no studies on the related impacts are widely available. This approach also sheds light on chronic pollution in tropical settings, an underrepresented topic in the literature. The size fraction between 2 and 5 mm was sorted for living molluscs and empty shells, which were then segregated to morphospecies and identified. The agreement was evaluated in terms of fidelity of species richness, evenness, and rank-order agreement. Compositional fidelity was also evaluated by multivariate analysis. The communities are dominated by bivalves. Polyplacophorans and scaphopods are occasionally present. Gastropod abundance is marginal compared to the bivalves, although their contribution is more significant when species diversity is taken into consideration. Moreover, the living assemblage in the studied size range was particularly poor in terms of species abundance.

  4. Prevalence of sacral dysmorphia in a prospective trauma population: Implications for a "safe" surgical corridor for sacro-iliac screw placement

    Directory of Open Access Journals (Sweden)

    Newman Justin T

    2011-05-01

    Full Text Available Abstract Background Percutaneous sacro-iliac (SI screw fixation represents a widely used technique in the management of unstable posterior pelvic ring injuries and sacral fractures. The misplacement of SI-screws under fluoroscopic guidance represents a critical complication for these patients. This study was designed to determine the prevalence of sacral dysmorphia and the radiographic anatomy of surgical S1 and S2 corridors in a representative trauma population. Methods Prospective observational cohort study on a consecutive series of 344 skeletally mature trauma patients of both genders enrolled between January 1, 2007, to September 30, 2007, at a single academic level 1 trauma center. Inclusion criteria included a pelvic CT scan as part of the initial diagnostic trauma work-up. The prevalence of sacral dysmorphia was determined by plain radiographic pelvic films and CT scan analysis. The anatomy of sacral corridors was analyzed on 3 mm reconstruction sections derived from multislice CT scan, in the axial, coronal, and sagittal plane. "Safe" potential surgical corridors at S1 and S2 were calculated based on these measurements. Results Radiographic evidence of sacral dysmorphia was detected in 49 patients (14.5%. The prevalence of sacral dysmorphia was not significantly different between male and female patients (12.2% vs. 19.2%; P = 0.069. In contrast, significant gender-related differences were detected with regard to radiographic analysis of surgical corridors for SI-screw placement, with female trauma patients (n = 99 having significantly narrower corridors at S1 and S2 in all evaluated planes (axial, coronal, sagittal, compared to male counterparts (n = 245; P P = 0.06, implying S2 as a safe surgical corridor of choice in patients with sacral dysmorphia. Conclusions These findings emphasize a high prevalence of sacral dysmorphia in a representative trauma population and imply a higher risk of SI-screw misplacement in female patients

  5. Sacral Theater, a code to simulate the propagation of the superconducting magnet LHC atlas barrel toroid transition; Sacral theater, un code pour simuler la propagation de la transition de l'aimant supraconducteur LHC atlas barrel toroid

    Energy Technology Data Exchange (ETDEWEB)

    Gastineau, B

    2000-06-01

    Sacral Theater has been developed for the toroid magnet Atlas of the CERN LHC project. This three dimensional calculations code calculates the propagation of the transition of a superconducting coil in 25 m long hippodrome. Procedures to study low currents have been included. This work is a part of the magnet safety system because the coils protection is made by warmers activating the quench propagation in case of default detection. This allows the complete dissipation of storage energy that can reach 1080 MJ on Atlas. (N.C.)

  6. Vascular endothelium derived endothelin-1 is required for normal heart function after chronic pressure overload in mice.

    Directory of Open Access Journals (Sweden)

    Susi Heiden

    Full Text Available BACKGROUND: Endothelin-1 participates in the pathophysiology of heart failure. The reasons for the lack of beneficial effect of endothelin antagonists in heart failure patients remain however speculative. The anti-apoptotic properties of ET-1 on cardiomyocytes could be a reasonable explanation. We therefore hypothesized that blocking the pro-apoptotic TNF-α pathway using pentoxifylline could prevent the deleterious effect of the lack of ET-1 in a model for heart failure. METHODS: We performed transaortic constriction (TAC in vascular endothelial cells specific ET-1 deficient (VEETKO and wild type (WT mice (n = 5-9 and treated them with pentoxifylline for twelve weeks. RESULTS: TAC induced a cardiac hypertrophy in VEETKO and WT mice but a reduction of fractional shortening could be detected by echocardiography in VEETKO mice only. Cardiomyocyte diameter was significantly increased by TAC in VEETKO mice only. Pentoxifylline treatment prevented cardiac hypertrophy and reduction of fractional shortening in VEETKO mice but decreased fractional shortening in WT mice. Collagen deposition and number of apoptotic cells remained stable between the groups as did TNF-α, caspase-3 and caspase-8 messenger RNA expression levels. TAC surgery enhanced ANP, BNP and bcl2 expression. Pentoxifylline treatment reduced expression levels of BNP, bcl2 and bax. CONCLUSIONS: Lack of endothelial ET-1 worsened the impact of TAC-induced pressure overload on cardiac function, indicating the crucial role of ET-1 for normal cardiac function under stress. Moreover, we put in light a TNF-α-independent beneficial effect of pentoxifylline in the VEETKO mice suggesting a therapeutic potential for pentoxifylline in a subpopulation of heart failure patients at higher risk.

  7. Re: Effect of Sacral Neuromodulation on Female Sexual Function and Quality of Life: Are They Correlated?

    Directory of Open Access Journals (Sweden)

    Mai Banakhar

    2015-06-01

    Full Text Available Sacral neuromodulation (SNM has become an established therapy for voiding dysfunction (VD. There have been published papers that documented improvement in bowel functions and bladder pain via SNM. However, improvement in female sexual function (FSF after SNM treatment remains unclear. Recently, Banakhar et al. evaluated the effects of SNM on FSF and its impact on quality of life (QoL and analyzed any correlation. They evaluated 33 female patients who were treated with SNM for VD. All patients completed the Female Sexual Function Index (FSFI, the 36-Item Short-Form Health Survey (SF-36, and incontinence questionnaires (the Urinary Distress Inventory [UDI-6] preoperatively and 4 months postoperatively. Ten patients were excluded from the study because they were not sexually active. The indications were: refractory overactive bladder in 19, frequency urgency syndrome in 2, and non-obstructive urinary retention in another 2 patients. SNM therapy significantly improved the total FSFI score (p=0.011. When the SF-36 and UDI-6 scores were compared, QoL showed significant improvement after SNM treatment. However, improvement in FSFI scores was not correlated with improvement in QoL. SNM therapy is an effective treatment modality in selected patient groups. In our country, SNM therapy has become a new option in the treatment of lower urinary tract problems. According to the results of this study, it is too early to conclude that SNM certainly improve FSF and QoL. The study just evaluated 23 cases. In order to have a more discrete conclusion, we need prospective trials with larger series

  8. Value of MRI in the diagnosis of non-clival, non-sacral chordoma

    Energy Technology Data Exchange (ETDEWEB)

    Smolders, D.; Wang, X.; Vanhoenacker, F.; De Schepper, A.M. [Department of Radiology, University Hospital Antwerp, Wilrijkstraat 10, 2650, Edegem (Belgium); Drevelengas, A. [Department of Radiology, University of Thessaloniki, Thessaloniki (Greece)

    2003-06-01

    To determine the MR features of non-sacral, non-clival chordoma and to describe a MR prototype of the lesion.Design and patients We reviewed the MR findings of 10 patients with a histologically proven chordoma (6 cervical spine, 1 thoracic spine, 3 lumbar spine). There were three female and seven male patients. Age ranged from 12 to 66 years with a mean age of 44.6 years. The MR images were reviewed for signal intensity (SI) and morphology. All lesions showed a soft tissue extension spanning several vertebral segments. Most of the lesions exhibited a so-called collar button appearance (sagittal images). Two cases of cervical chordoma displayed a ''dumbbell morphology'' (axial images) or ''mushroom'' appearance without bone involvement and with enlargement of the neuroforamen mimicking a neurogenic tumor. Although the region of the nucleus pulposus is the last part of the fetal notochord in the adult to involute, disks were surprisingly spared in all patients. Eight of 10 patients showed heterogeneous SI on all sequences. The overall SI of all lesions was isointense or slightly higher than that of muscle on T1-weighted images. All lesions exhibited high SI on T2-weighted images. After gadolinium contrast administration there was a moderate enhancement in most cases. Although the SI on MR imaging is not specific, chordoma should be considered when a destructive lesion of a vertebral body is associated with a soft tissue mass with a collar button or mushroom appearance and dumbbell morphology, spanning several vertebral segments and sparing the disk(s). (orig.)

  9. Magnetic resonance imaging analysis of surgical trans-sacral axial L5/S1 interbody fusion

    Institute of Scientific and Technical Information of China (English)

    YAN Ning; HE Shi-sheng; ZHANG Hai-long; GU Guang-fei; LIU Bi-feng; LIU Yan-bin; ZHANG Li-guo; GU Xin; DING Yue; GUO Cheng-bin

    2011-01-01

    Background Trans-sacral axial L5/S1 interbody fusion (AxiaLIF), a novel surgical procedure, recently adopted in clinical practice, has excellent clinical outcomes. However, there is inadequate data on the feasibility of the approach in all adult patients and the optimal surgical approach is currently unclear; therefore, further studies are required. In order to enhance the surgical approach for AxiaLIF, prospective anatomical imaging optimization is necessary. The objective of this study was to investigate the ability of magnetic resonance imaging (MRI) to achieve an optimal procedural setting.Methods The subjects (n=40) underwent lumbosacral MRI examination. The median sagittal MRI images were analyzed and four measurement markers were defined as follows: the center of the L5/S1 disc (A), the anterior margin of the S1/2 disc space (B), the sacrococcygeal junction (C), and the coccygeal tip (D). The measurement markers were connected to each other to produce five lines (AB, AC, AD, BC, and BD), as reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L5 and S1 vertebral bodies was measured to determine the safety of the respective approaches.Results In all patients, Lines AB and AC satisfied the imaging safety criteria. Line AB would result in a significant deviation from the median and was determined to be unsuitable for AxiaLIF. Line AD satisfied the imaging safety criteria in 39 patients. However, the anal proximity of the puncture point proved to be limiting. For lines BC and BD, the imaging safety criteria were satisfied in 70% and 45% of patients, respectively.Conclusions The AxiaLIF procedure is a safe technique for insertion of fusion implants in all subjects. Line AC is a favorable reference line for surgical approach and safe for all subjects, while line BC is not suitable for all subjects.

  10. Microsurgical treatment of sacral perineural (Tarlov) cysts: case series and review of the literature.

    Science.gov (United States)

    Burke, John F; Thawani, Jayesh P; Berger, Ian; Nayak, Nikhil R; Stephen, James H; Farkas, Tunde; Aschyan, Hovik John; Pierce, John; Kanchwala, Suhail; Long, Donlin M; Welch, William C

    2016-05-01

    OBJECTIVE Tarlov cysts (TCs) occur most commonly on extradural components of the sacral and coccygeal nerve roots. These lesions are often found incidentally, with an estimated prevalence of 4%-9%. Given the low estimated rates of symptomatic TC and the fact that symptoms can overlap with other common causes of low-back pain, optimal management of this entity is a matter of ongoing debate. Here, the authors investigate the effects of surgical intervention on symptomatic TCs and aim to solidify the surgical criteria for this disease process. METHODS The authors performed a retrospective review of data from consecutive patients who were surgically treated for symptomatic TCs from September 2011 to March 2013. Clinical evaluations and results from surveying pain and overall health were used. Univariate statistical analyses were performed. RESULTS Twenty-three adults (4 males, 19 females) who had been symptomatic for a mean of 47.4 months were treated with laminectomy, microsurgical exposure and/or imbrication, and paraspinous muscle flap closure. Eighteen patients (78.3%) had undergone prior interventions without sustained improvement. Thirteen patients (56.5%) underwent lumbar drainage for an average of 8.7 days following surgery. The mean follow-up was 14.4 months. Univariate analyses demonstrated that an advanced age (p = 0.045), the number of noted perineural cysts on preoperative imaging (p = 0.02), and the duration of preoperative symptoms (p = 0.03) were associated with a poor postoperative outcome. Although 47.8% of the patients were able to return to normal activities, 93.8% of those surveyed reported that they would undergo the operation again if given the choice. CONCLUSIONS This is one of the largest published studies on patients with TCs treated microsurgically. The data suggest that patients with symptomatic TCs may benefit from open microsurgical treatment. Although outcomes seem related to patient age, duration of symptoms, and extent of disease

  11. Administration-time-dependent effects of hypertension treatment on ambulatory blood pressure in patients with chronic kidney disease.

    Science.gov (United States)

    Crespo, Juan J; Piñeiro, Luis; Otero, Alfonso; Castiñeira, Carmen; Ríos, María T; Regueiro, Antonio; Mojón, Artemio; Lorenzo, Sonia; Ayala, Diana E; Hermida, Ramón C

    2013-03-01

    Many published prospective trials have reported clinically meaningful morning-evening, treatment-time differences in the blood pressure (BP)-lowering efficacy, duration of action, and safety of most classes of hypertension medications. Most important, it was recently documented that routine ingestion of the full daily dose of ≥1 hypertension medications at bedtime, compared with ingestion of all of them upon awakening, significantly reduces cardiovascular disease (CVD) events. Nocturnal hypertension and non-dipping (hypertension treatment time on the circadian BP pattern and degree of BP control of hypertensive patients with CKD evaluated by 48-h ABPM. This cross-sectional study evaluated 2659 such patients (1585 men/1074 women), 64.9 ± 13.2 (mean ± SD) yrs of age, enrolled in the Hygia Project, involving primary care centers of northwest Spain and designed to evaluate prospectively CVD risk by ABPM; 1446 were ingesting all BP-lowering medications upon awakening, whereas 1213 patients were ingesting ≥1 medications at bedtime. Among the latter, 359 patients were ingesting all medications at bedtime, whereas 854 were ingesting the full daily dose of some medications upon awakening and the others at bedtime. Those ingesting all medications upon awakening had significantly higher total cholesterol and low-density lipoprotein (LDL) cholesterol than those ingesting ≥1 medications at bedtime. Moreover, patients ingesting all medications at bedtime had the lowest fasting glucose, serum creatinine, and uric acid. Ingestion of ≥1 medications at bedtime was significantly associated with lower asleep systolic (SBP) and diastolic (DBP) BP means than treatment with all medications upon awakening. The sleep-time relative SBP decline was significantly attenuated in patients ingesting all medications upon awakening (p hypertension medications were ingested upon awakening (68.3%) than when ≥1 of them was ingested at bedtime (54.2%; p hypertension medications

  12. Chronic kidney disease, 24-h blood pressure and small vessel diseases are independently associated with cognitive impairment in lacunar infarct patients

    International Nuclear Information System (INIS)

    Although the relationships between chronic kidney disease (CKD) and cognitive impairment (CI) have been highlighted, the etiology of CI in CKD remains uncertain. Subjects comprised 224 consecutive patients with symptomatic lacunar infarction who underwent magnetic resonance imaging and ambulatory blood pressure monitoring (ABPM). Diurnal blood pressure (BP) patterns were categorized into three groups: dippers, non-dippers and risers. Lacunar infarcts (LIs), including both symptomatic and silent and diffuse white matter lesions (WMLs), were graded into three grades according to their degree. The results of kidney function were evaluated using estimated glomerular filtration rate (eGFR), categorized into three groups: stage 1, >60; stage 2, 30-60; and stage 3, -1 per 1.73 m2. There were 44 patients with CI. Confluent WMLs, including WML 2 and WML 3, were found in 36 patients (81.8%), and multiple lacunae including LI 2 and LI 3 were found in 30 patients (68.1%) with CI. Age >75 years (odds ratio (OR), 5.5; P-1 per 1.73 m2 (OR, 2.9; P-1 per 1.73 m2 (OR, 23.8; P75 years (OR, 4.1; P-1 per 1.73 m2 (OR, 3.7; P-1 per 1.73 m2 (OR, 8.7; P<0.05) were independently associated with WML grade 3. Extensive small vessel diseases, CKD and non-dipping status were independently associated with CI. CKD appears to mainly contribute to vascular CI, whereas possibilities of overlapping with other mechanisms such as degenerative CI cannot be excluded. Strict night time BP control and renoprotective treatment may be warranted to prevent CI. (author)

  13. The effect of lowering salt intake on ambulatory blood pressure to reduce cardiovascular risk in chronic kidney disease (LowSALT CKD study: protocol of a randomized trial

    Directory of Open Access Journals (Sweden)

    McMahon Emma J

    2012-10-01

    Full Text Available Abstract Background Despite evidence implicating dietary sodium in the pathogenesis of cardiovascular disease (CVD in chronic kidney disease (CKD, quality intervention trials in CKD patients are lacking. This study aims to investigate the effect of reducing sodium intake on blood pressure, risk factors for progression of CKD and other cardiovascular risk factors in CKD. Methods/design The LowSALT CKD study is a six week randomized-crossover trial assessing the effect of a moderate (180 mmol/day compared with a low (60 mmol/day sodium intake on cardiovascular risk factors and risk factors for kidney function decline in mild-moderate CKD (stage III-IV. The primary outcome of interest is 24-hour ambulatory blood pressure, with secondary outcomes including arterial stiffness (pulse wave velocity, proteinuria and fluid status. The randomized crossover trial (Phase 1 is supported by an ancillary trial (Phase 2 of longitudinal-observational design to assess the longer term effectiveness of sodium restriction. Phase 2 will continue measurement of outcomes as per Phase 1, with the addition of patient-centered outcomes, such as dietary adherence to sodium restriction (degree of adherence and barriers/enablers, quality of life and taste assessment. Discussion The LowSALT CKD study is an investigator-initiated study specifically designed to assess the proof-of-concept and efficacy of sodium restriction in patients with established CKD. Phase 2 will assess the longer term effectiveness of sodium restriction in the same participants, enhancing the translation of Phase 1 results into practice. This trial will provide much-needed insight into sodium restriction as a treatment option to reduce risk of CVD and CKD progression in CKD patients. Trial registration Universal Trial Number: U1111-1125-2149. Australian New Zealand Clinical Trials Registry Number: ACTRN12611001097932

  14. Introduction to Professor HUA Yan-ling's Acupuncture Experience: Ⅱ .Paravertebral Acupuncture, Sacroiliac Acupuncture and Sacral Acupuncture

    Institute of Scientific and Technical Information of China (English)

    QI Li-zhen; XIAO Yuan-chun

    2003-01-01

    @@ Pro. HUA had practiced traditional Chinese medicine and acupuncture for about 50 years, borne excellent medical skills and was then highly respected by his colleagues and patients. In his large amount of practice, he combined syndrome differentiation in Chinese medicine and disease differentiation in western medicine in order to work hard on acupuncture indications and some stubborn diseases. With the time going on and medical cases accumulating, some unique treatment styles had been formed, such as Jiaji (paravertebral) acupuncture, sacroiliac acupuncture and sacral acupuncture. They are briefly introduced as follows.

  15. Chronic pancreatitis

    Science.gov (United States)

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  16. Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated to hereditary neuropathy with liability to pressure palsies (HNPP) and revealed after influenza AH1N1 vaccination.

    Science.gov (United States)

    Remiche, Gauthier; Abramowicz, Marc; Mavroudakis, Nicolas

    2013-12-01

    Neurological complications of AH1N1 vaccination such as Guillain-Barré syndrome were described in the previous years. Several reports suggest that hereditary neuropathies may be a predisposing factor for immune-mediated neuropathies. We report the case of a 54-year-old female who developed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) 5 weeks after AH1N1 vaccination. She had no previous neurological history, but neurophysiological features led us to suspect an underlying hereditary neuropathy. PMP22 gene analysis showed a typical deletion, confirming the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP). We observed a significant clinical and neurophysiological improvement of the neuropathy after intravenous immunoglobulin treatment. This is, to our knowledge, the first reported case of CIDP potentially triggered by AH1N1 vaccination. This and previous observations suggest that genetic-determined neuropathies could predispose to the occurrence of immune-mediated neuropathies. One must recall the possibility of a superimposed hereditary neuropathy like HNPP in patients with a clinical presentation of CIDP, especially when positive family history or unexpected neurophysiological features are present.

  17. Influence of air pressure, humidity, solar radiation, temperature, and wind speed on ambulatory visits due to chronic obstructive pulmonary disease in Bavaria, Germany

    Science.gov (United States)

    Ferrari, Uta; Exner, Teresa; Wanka, Eva R.; Bergemann, Christoph; Meyer-Arnek, Julian; Hildenbrand, Beate; Tufman, Amanda; Heumann, Christian; Huber, Rudolf M.; Bittner, Michael; Fischer, Rainald

    2012-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most important causes of morbidity and mortality in the world. The disease is often aggravated by periods of increased symptoms requiring medical attention. Among the possible triggers for these exacerbations, meteorological factors are under consideration. The objective of this study was to assess the influence of various meteorological factors on the health status of patients with COPD. For this purpose, the daily number of ambulatory care visits due to COPD was analysed in Bavaria, Germany, for the years 2006 and 2007. The meteorological factors were provided by the model at the European Centre for Medium Range Weather Forecast (ECMWF). For the multivariate analysis, a generalised linear model was used. In Bavaria, an increase of 1% of daily consultations (about 103 visits per day) was found to be associated with a change of 0.72 K temperature, 209.55 of log air surface pressure in Pa, and a decrease of 1% of daily consultations with 1,453,763 Ws m2 of solar radiation. There also seem to be regional differences between north and south Bavaria; for instance, the effect of wind speed and specific humidity with a lag of 1 day were only significant in the north. This study could contribute to a tool for the prevention of exacerbations. It also serves as a model for the further evaluation of the impact of meteorological factors on health, and could easily be applied to other diseases or other regions.

  18. Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis.

    Science.gov (United States)

    Yoshitomi, Ryota; Nakayama, Masaru; Ura, Yoriko; Kuma, Kazuyoshi; Nishimoto, Hitomi; Fukui, Akiko; Ikeda, Hirofumi; Tsuchihashi, Takuya; Tsuruya, Kazuhiko; Kitazono, Takanari

    2014-12-01

    The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD. PMID:25056682

  19. Chronic exposure to broadband noise at moderate sound pressure levels spatially shifts tone-evoked responses in the rat auditory midbrain.

    Science.gov (United States)

    Lau, Condon; Pienkowski, Martin; Zhang, Jevin W; McPherson, Bradley; Wu, Ed X

    2015-11-15

    Noise-induced hearing disorders are a significant public health concern. One cause of such disorders is exposure to high sound pressure levels (SPLs) above 85 dBA for eight hours/day. High SPL exposures occur in occupational and recreational settings and affect a substantial proportion of the population. However, an even larger proportion is exposed to more moderate SPLs for longer durations. Therefore, there is significant need to better understand the impact of chronic, moderate SPL exposures on auditory processing, especially in the absence of hearing loss. In this study, we applied functional magnetic resonance imaging (fMRI) with tonal acoustic stimulation on an established broadband rat exposure model (65 dB SPL, 30 kHz low-pass, 60 days). The auditory midbrain response of exposed subjects to 7 kHz stimulation (within exposure bandwidth) shifts dorsolaterally to regions that typically respond to lower stimulation frequencies. This shift is quantified by a region of interest analysis that shows that fMRI signals are higher in the dorsolateral midbrain of exposed subjects and in the ventromedial midbrain of control subjects (pmidbrain regions above the exposure bandwidth spatially expand due to exposure. This expansion shifts lower frequency regions dorsolaterally. Similar observations have previously been made in the rat auditory cortex. Therefore, moderate SPL exposures affect auditory processing at multiple levels, from the auditory cortex to the midbrain.

  20. Transcutaneous oximetry but not arterial toe blood pressure or ankle-brachial index is related to macular thickness in patients with chronic diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Per Katzman

    2013-04-01

    Full Text Available Objectives: Diabetes related vascular complications of the lower extremity could be classified as micro- and macrovascular. Ankle-brachial index (ABI and toe blood pressure (TBP measurements evaluate macro-circulation, whereas transcutaneous oximetry (TcPO2 is considered to be a composite measure of vascular function, thereby also reflecting microcirculation. Microvascular disease in the eye involves abnormal capillary permeability and possibly thereby increased macular thickness. The aim of the present clinical study was to evaluate if microvascular disease in the eye was related to measures of foot ischemia in patients with diabetes mellitus. Methods: Twenty consecutive patients with diabetes and chronic full-thickness foot ulcers were included. Peripheral ischemia was diagnosed using TcPO2, TBP and ABI. Macular thickness was measured with optical coherence tomography technique. Results: Based on TcPO2, TBP and ABI measurements 14, 13 and 13 patients, respectively, were classified as ischemic. Patients with ischemic TcPO2 levels at the dorsum of the foot had significantly higher macular thicknesses. This was not the case in patients with ischemic TBP or ABI levels. Conclusion: TcPO2, unlike TBP and ABI, seems to be a clinically relevant measure of peripheral microvascular disease in patients with diabetes mellitus and may, if low, indicate an increased risk of macular edema. [J Exp Integr Med 2013; 3(2.000: 81-85

  1. Application of navigation template to fixation of sacral fracture using three-dimensional reconstruction and re-verse engineering technique

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yuan-zhi; LU Sheng; XU Yong-qing; SHI Ji-hong; LI Yan-bing; FENG Zi-liang

    2009-01-01

    Objective: To provide a new method in the fixation of sacral fracture by means of three-dimensional reconstruc-tion and reverse engineering technique.Methods: Pelvis image data were obtained from three-dimensional CT scan in patients with sacral fracture. The data were transferred into a computer workstation. The three-dimensional models of pelvis were reconstructed using Amira 3.1 software and saved in STL format. Then the three-dimensional fracture models were imported into Imageware 9.0 software. Different situations of reduction (total reduction, half reduction and non-reduction) were simulated using Imageware 9.0 software. The best direction and loca-tion of extract iliosacral lag screws were defined using re-verse engineering according to these three situations and navigation templates were designed according to the ana-tomic features of the postero-iliac part and the channel. The exact navigational template was made by rapid prototyping.Drill guides were sterilized and used intraoperatively to as-sist in surgical navigation and the placement of iliosacral lag screws.Results: Accurate screw placement was confirmed with postoperative X-ray and CT scanning. The navigation template was found to be highly accurate. Conclusion: The navigation template may be a useful method in minimal-invasive fixation of sacroiliac joint fracture.

  2. High incidence of persistence of sacral and coccygeal intervertebral discs in South Indians – a cadaveric study

    Science.gov (United States)

    Satheesha Nayak, B; Ashwini Aithal, P; Kumar, Naveen; George, Bincy M; Deepthinath, R; Shetty, Surekha D

    2016-01-01

    The sacrum, by virtue of its anatomic location plays a key role in providing stability and strength to the pelvis. Presence of intervertebral discs in sacrum and coccyx is rare. Knowledge of its variations is of utmost importance to surgeons and radiologists. The current study focused on the presence of intervertebral discs between the sacral and coccygeal vertebrae in south Indian cadaveric pelvises. We observed 56 adult pelvises of which, 34 (61%) pelvises showed the presence of intervertebral discs between the sacral vertebrae and between the coccygeal vertebrae, while 22 (39%) pelvises did not have the intervertebral discs either in the sacrum or the coccyx. We also found that most of the specimens had discs between S1 and S2 vertebrae (39%), followed by, between S4 and S5 (18%), between S2–S3 (14%) and least being between S3–S4 (13%). In the coccyx it was found that 7% of pelvises had disc between Co1-Co2, 4% of them had between Co2-Co3 and 4% had between Co3-Co4. Knowledge regarding such anatomic variations in the sacro-coccygeal region is important to note because they require alterations in various instrumentation procedures involving the sacrum. PMID:27385838

  3. Cost-Effectiveness Analysis in Comparing Alginate Silver Dressing with Silver Zinc Sulfadiazine Cream in the Treatment of Pressure Ulcers

    OpenAIRE

    Apirag Chuangsuwanich; Peerasak Chortrakarnkij; Jupaporn Kangwanpoom

    2013-01-01

    Background The treatment of pressure ulcers is complicated, given the various wound dressing products available. The cost of different treatments varies and the cost-effectiveness of each product has not been thoroughly evaluated. We compare two wound dressing protocols-alginate silver dressing (AlSD) and silver zinc sulfadiazine cream (AgZnSD) with regard to wound healing and cost-effectiveness. Methods Patients with grade III or IV sacral or trochanteric pressure ulcers were eligible for th...

  4. Aliskiren suppresses the renin–angiotensin–aldosterone system and reduces blood pressure and albuminuria in elderly chronic kidney disease patients with hypertension

    Directory of Open Access Journals (Sweden)

    Morishita Y

    2012-09-01

    Full Text Available Yoshiyuki Morishita,1 Toshihiro Yasui,2 Akihiko Numata,1 Akira Onishi,1 Kenichi Ishibashi,3 Eiji Kusano11Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan; 2National Health Insurance Yukawa Clinic, Niimi, Japan; 3Department of Medical Physiology, Meiji Pharmaceutical University, Tokyo, JapanBackground: We investigated the effects of aliskiren in terms of its inhibition of the renin–angiotensin–aldosterone system (RAAS as well as that on blood pressure (BP, and renal and cardiac protection in elderly chronic kidney disease (CKD patients with hypertension.Methods: Nineteen elderly CKD patients (nine males, ten females, aged 74.6 ± 5.8 years were assigned to receive 150 mg/day of aliskiren added to existing antihypertensives for 6 months. Changes in plasma renin activity (PRA, angiotensin I (Ang I, angiotensin II (Ang II, aldosterone (Ald, BP, estimated glomerular filtration rate (eGFR, urine albumin/creatinine ratio (UACR, left ventricular ejection fraction (LVEF, interventricular septum thickness (IVST, left ventricular posterior wall thickness (LVPWT, and plasma brain natriuretic peptide (BNP levels were evaluated.Results: Aliskiren suppressed the RAAS as follows: PRA 1.3 ± 1.0 to 0.3 ± 0.3 ng/mL/hour, P < 0.05; Ang I 59.5 ± 32.1 to 26.0 ± 17.3 pg/mL, P < 0.05; Ang II 58.4 ± 62.1 to 14.3 ± 9.0 pg/mL, P < 0.05; and Ald 86.1 ± 38.3 to 80.1 ± 52.6 pg/mL, not significant (NS. Aliskiren reduced BP (153.6/77.2 ± 14.9/10.4 to 130.9/72.2 ± 15.6/9.9 mmHg, P < 0.05. It also reduced UACR (747.1 ± 1121.4 to 409.6 ± 636.8 mg/g, P < 0.05, whereas it did not change eGFR (52.1 ± 29.2 to 51.2 ± 29.3 mL/min/1.73 m2, NS, LVEF (66.8 ± 7.9 to 66.5% ± 6.8%, NS, IVST (10.1 ± 1.8 to 9.9 ± 1.8 mm, NS, LVPWT (10.0 ± 1.6 mm to 10.0 ± 1.4 mm, NS, or BNP (48.2 ± 46.0 to 54.9 ± 41.1 pg/mL, NS.Conclusion: Aliskiren was effective for BP control and reduced UACR while maintaining eGFR and heart function in elderly CKD

  5. Estimated aortic blood pressure based on radial artery tonometry underestimates directly measured aortic blood pressure in patients with advancing chronic kidney disease staging and increasing arterial stiffness.

    Science.gov (United States)

    Carlsen, Rasmus K; Peters, Christian D; Khatir, Dinah S; Laugesen, Esben; Bøtker, Hans Erik; Winther, Simon; Buus, Niels H

    2016-10-01

    Central blood pressure (BP) can be assessed noninvasively based on radial tonometry and may potentially be a better predictor of clinical outcome than brachial BP. However, the validity of noninvasively obtained estimates has never been examined in patients with chronic kidney disease (CKD). Here we compared invasive aortic systolic BP (SBP) with estimated central SBP obtained by radial artery tonometry and examined the influence of renal function and arterial stiffness on this relationship. We evaluated 83 patients with stage 3 to 5 CKD (mean estimated glomerular filtration rate [eGFR] 30 ml/min/1.73 m(2)) and 41 controls without renal disease undergoing scheduled coronary angiography. BP in the ascending aorta was measured through the angiography catheter and simultaneously estimated using radial tonometry. The mean difference between estimated central and aortic SBP was -13.2 (95% confidence interval -14.9 to -11.4) mm Hg. Arterial stiffness was evaluated by carotid-femoral pulse wave velocity (cf-PWV) and was significantly increased in CKD patients compared with (versus) control patients (mean 10.7 vs. 9.3 m/s). The difference in BP significantly increased 1.0 mm Hg for every 10 ml/min decrease in eGFR and by 1.6 mm Hg per 1 m/s increase in cfPWV. Using multivariate regression analysis including both eGFR and cfPWV, the difference between estimated central and invasive aortic SBP was significantly increased by 0.7 mm Hg. For the entire cohort brachial SBP significantly better reflected invasive SBP than estimated SBP. Thus, tonometry-based estimates of central BP progressively underestimate invasive central SBP with decreasing renal function and increasing arterial stiffness in CKD patients.

  6. Altered pressure pain thresholds and increased wind-up in adult patients with chronic back pain with a history of childhood maltreatment: a quantitative sensory testing study.

    Science.gov (United States)

    Tesarz, Jonas; Eich, Wolfgang; Treede, Rolf-Detlef; Gerhardt, Andreas

    2016-08-01

    Childhood maltreatment (CM) has been associated with an increased risk of nonspecific chronic low back pain (nsCLBP). However, the mechanisms underlying this association are unclear. Therefore, this study considered whether distinct types of CM are accompanied by specific alterations in somatosensory function. A total of 176 subjects with nsCLBP and 27 pain-free controls (PCs) were included. The Childhood Trauma Questionnaire (CTQ) was used to categorize patients into 2 groups (abused/neglected vs nonabused/nonneglected) for 5 types of CM (emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect). The standardized quantitative sensory testing protocol of the "German Research Network on Neuropathic Pain" was performed to obtain comprehensive profiles on somatosensory function, including detection and pain thresholds, pain sensitivity, and assessments of temporal summation (wind-up). Between 17.7% and 51.4% of subjects with nsCLBP reported CM, depending on the type of CM. Childhood Trauma Questionnaire subscores for emotional and sexual abuse were significantly higher in subjects with nsCLBP than in PCs. Compared with PCs, subjects with CM showed reduced pressure pain thresholds (PPTs), irrespective of the type of CM. Regarding distinct types of CM, subjects with nsCLBP with emotional abuse reported significantly higher wind-up than those without, and sexual abuse was accompanied by enhanced touch sensitivity. Our findings suggest that CM is nonspecifically associated with a decreased PPT in nsCLBP. Emotional abuse apparently leads to enhanced spinal pain summation, and sexual abuse leads to enhanced touch sensitivity. These results emphasize the importance of emotional abuse in nsCLBP and suggest that CM can induce long-term changes in adult somatosensory function. PMID:27075429

  7. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2015-12-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  8. ASSESSMENT OF THE CHANGES IN BLOOD PRESSURE CIRCADIAN PROFILE AND VARIABILITY IN PATIENTS WITH CHRONIC HEART FAILURE AND ARTERIAL HYPERTENSION DURING COMBINED THERAPY INCLUDING IVABRADINE

    Directory of Open Access Journals (Sweden)

    M. V. Surovtseva

    2012-01-01

    Full Text Available Aim. To assess the changes in blood pressure (BP circadian profile and variability in patients with chronic heart failure (CHF of ischemic etiology and arterial hypertension (HT due to the complex therapy including ivabradine. Material and methods. Patients (n=90 with CHF class II–III NYHA associated with stable angina II-III class and HT were examined. The patients were randomized into 3 groups depending on received drugs: perindopril and ivabradine - group 1; perindopril, bisoprolol and ivabradine - group 2; perindopril and bisoprolol - group 3. The duration of therapy was 6 months. Ambulatory BP monitoring (ABPM was assessed at baseline and after treatment. Results. More significant reduction in average 24-hours systolic BP was found in groups 1 and 2 compared to group 3 (Δ%: -19.4±0,4; -21.1±0.4 and -11.8±0.6, respectively as well as diastolic BP (Δ%: -10.6±0.6; -12.9±0.4 and -4,3±0.3, respectively and other ABPM indicators. Improvement of BP circadian rhythm was found due to increase in the number of «Dipper» patients (p=0.016. More significant reduction in average daily and night systolic and diastolic BP (p=0.001, as well as daily and night BP variability (p=0.001 was also found in patients of group 2 compared to these of group 1. Conclusion. Moderate antihypertensive effect (in respect of both diastolic and systolic BP was shown when ivabradine was included into the complex therapy of patients with ischemic CHF and HT. The effect was more pronounced when ivabradine was combined with perindopril and bisoprolol. This was accompanied by reduction in high BP daily variability and improvement of the BP circadian rhythm. 

  9. Quantitative assessment of bone marrow attenuation values at MDCT: An objective tool for the detection of bone bruise related to occult sacral insufficiency fractures

    Energy Technology Data Exchange (ETDEWEB)

    Henes, F.O.; Groth, M.; Bley, T.A.; Regier, M.; Ittrich, H.; Adam, G.; Bannas, P. [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Nuechtern, J.V. [University Medical Center Hamburg-Eppendorf, Department of Trauma, Hand and Reconstructive Surgery, Hamburg (Germany); Treszl, A. [University Medical Center Hamburg-Eppendorf, Center for Experimental Medicine, Department of Medical Biometry and Epidemiology, Hamburg (Germany)

    2012-10-15

    To prove the feasibility of using Hounsfield attenuation values at MDCT to detect bone bruises related to sacral insufficiency fractures. Twenty-two patients with acute sacrum trauma and no fracture findings at MDCT were included in our prospective study. Two observers independently reviewed CTs regarding visual signs of bone bruises in 132 defined regions of the sacral alae. Interobserver agreement was tested by {kappa} statistics. Subsequently, HU values were obtained in the same regions, and attenuation differences between the two sides were calculated. Validity and reliability were assessed by intraclass correlation coefficient and Bland-Altman analysis. HU differences were subjected to ROC curve analysis to determine sensitivity, specificity, PPV and NPV. MRI served as standard reference. MRI revealed 19 regions with bone bruises and associated sacral insufficiency fractures. HU measurements demonstrated good validity and reliability (r = 0.989). ROC curve analysis exhibited an ideal cutoff value of 35.7 HU density difference between affected and non-affected regions. Visual evaluation revealed moderate agreement ({kappa} = 0.48); diagnostic accuracy was inferior to objective evaluation. Assessment of differences in bone marrow density by HU measurements is an objective and reliable tool for detection of bone bruises associated with occult sacral insufficiency fractures. (orig.)

  10. Chronic Diarrhea

    Science.gov (United States)

    ... infections that cause chronic diarrhea be prevented? Chronic Diarrhea What is chronic diarrhea? Diarrhea that lasts for more than 2-4 ... represent a life-threatening illness. What causes chronic diarrhea? Chronic diarrhea has many different causes; these causes ...

  11. Osteoporotic compression fracture of the thoracolumbar spine and sacral insufficiency fracture: incidence and analysis of the relationship according to the clinical factors

    Energy Technology Data Exchange (ETDEWEB)

    Kong, Jeong Hwa; Park, Ji Sun; Ryu, Kyung Nam [Kyunghee University Hospital, Seoul (Korea, Republic of)

    2006-11-15

    To evaluate the incidence of sacral insufficiency fracture in osteoporotic patient with compression fracture of the thoracolumbar (T-L) spine on magnetic resonance image (MRI), and to analyze the correlation of variable clinical factors and the incidence of sacral insufficiency fracture. We retrospectively reviewed 160 patients (27 men, 133 women; age range of 50 to 89 years) who underwent spinal MRI and had compression fracture of the T-L spine. Compression fractures due to trauma or tumor were excluded. We evaluated the incidence of sacral insufficiency fracture according to the patients' age, sex, number of compression fractures, and the existence of bone marrow edema pattern of compression fracture. During the same period, we evaluated the incidence of spinal compression fracture in the patients of pelvic insufficiency fracture. Out of the 160 patients who had compression fracture in the T-L spine, 17 (10.6%) had insufficiency fracture of the sacrum. Compression fracture occurred almost 5 times more frequently in women (27:133), but the incidence of sacral insufficiency fracture was 2/27 for men (7.4%) and 15/133 for women (11.3%), with no statistically significant difference ({rho} = 0.80). According to age, the ratio of insufficiency fracture to compression fracture was 0% (0/23) in the 50's, 10.6% (7/66) in the 60's, 12.5% (7/56) in the 70's, and 20.0% (3/15) in the 80's. In respect of single and multiple compression fracture, the incidence of sacral insufficiency fracture was 8/65 for men (12.3%) and 9/95 for women (9.5%), showing no significant difference ({rho} = 0.37). In the patients with and without compression fracture with bone marrow edema, insufficiency fracture occurred in 5/76 (6.6%) and 12/84 (14.3%), respectively. On the other hand, of the 67 patients who had pelvic insufficiency fracture, 27 (40.3%) also had spinal compression fracture. About 10% of the patients with osteoporotic compression fracture in the T/L spine

  12. Chronic Kidney Disease

    Science.gov (United States)

    You have two kidneys, each about the size of your fist. Their main job is to filter wastes and excess water out of ... help control blood pressure, and make hormones. Chronic kidney disease (CKD) means that your kidneys are damaged ...

  13. Clinical treatment of sacral chordoma%骶骨脊索瘤的临床病理分析

    Institute of Scientific and Technical Information of China (English)

    孙成良; 董军; 李栋

    2011-01-01

    为了探讨骶骨脊索瘤的临床特点、外科治疗方法与疗效,回顾性分析接受手术治疗的26例骶骨脊索瘤患者的临床资料.26例患者均无术中死亡,术后平均随访3.5年,7例患者局部复发,局部复发率26.9%,肺转移1例,死亡2例,术后病理检查可见典型的“Physaliphorous”细胞.初步研究结果提示,骶骨脊索瘤早期症状不典型,诊断应重视CT和MR检查.广泛手术切除是有效的治疗方式,结合术中化疗和术后局部辅助放疗可降低肿瘤的局部复发率,延长生存期,提高患者的生活质量.%The objective of this study was to analyze the clinical characteristics and surgical treatment results of patients with sacral chordoma. Twenty-six patients with surgical treatment were analyzed retrospectivly. No intraop-erative death occurred. After average 3. 5 years follow-up, 7 patients had recurred, with a recurrence rate of 26. 9%. The most recurrence was 4 times in one patients. One patient had pulmonary metastasis, and 2 patients died. The typical "Physaliphorous cell" could be found in the oncologic examination in all patients. In conclusion, the early clinical manifestation of sacral chordoma is not typical, so the CT and MR should be paid for more attention. Complete resection of tumor are an effective way to treat the sacral chordoma. Combine with intraoperative chemothery and postoperative adjuvant radiotherapy can reduce the tumor recurrence rate, prolong the survival time, and improve life quality of patients.

  14. ORANGE JUICE AND BLOOD PRESSURE

    OpenAIRE

    M. F. VALIM; Barros, S.

    2009-01-01

    Blood pressure is the force of blood against artery walls. It is measured in millimeters of mercury (mm Hg) and recorded as two numbers: systolic pressure (as the heart contracts) over diastolic pressure (as the heart relaxes between beats). High blood pressure (hypertension) is defined as chronically elevated high blood pressure, with systolic blood pressure (SBP) of 140 mm Hg or greater, and diastolic blood pressure (DBP) of 90 mm Hg or greater. High blood pressure ...

  15. Overexpression of Raf-1 and ERK1/2 in sacral chordoma and association with tumor recurrence

    Science.gov (United States)

    Zhang, Kai; Chen, Hao; Zhang, Bin; Sun, Jiajia; Lu, Jian; Chen, Kangwu; Yang, Huilin

    2015-01-01

    Chordoma is a rare and low-malignant neoplasm which is considered to arise from notochord remnants. Due to its large resistance to chemotherapy and radiotherapy, surgical resection so far is the prior treatment for chordoma. However, the recurrence rate is high even after complete surgical resection. Recently, targeted cancer therapy has been demonstrated to be effective in several other tumors, while the related research on chordoma is rare. Mitogen-activated protein kinase signaling pathway is acknowledged to participate in tumor development, in which Raf-1 and extracellular regulated protein kinase 1/2 (ERK1/2) play vital roles. In this study, we evaluated the expression of Raf-1 and ERK1/2 by immunohistochemical staining in 42 chordoma tissue and 16 distant normal tissue. Moreover, we also investigated the correlations of Raf-1 and ERK1/2 expression with clinical features in sacral chordoma. Expression of Raf-1 and ERK1/2 was both significantly higher in sacral chordoma tissue than distant normal tissue (P = 0.008, P = 0.019). Raf-1 positive expression was related to surrounding muscle invasion (P = 0.032) and chordoma recurrence (P = 0.002), but the results did not indicate any association with patients’ age, gender, tumor size and location. ERK1/2 was associated with tumor size (P = 0.044) instead of other clinical factors (P > 0.05). Spearman correlation test showed close relation between ERK1/2 and Raf-1 (P = 0.001, r = 0.518). Kaplan–Meier survival Curve and log-rank test showed that Raf-1 positive expression was associated with shorter continuous disease-free survival time (CDFS) (P = 0.001), while ERK1/2 had no relation to CDFS (P = 0.961). Conclusively, Raf-1 may be an important biomarker in predicting the prognosis of chordoma patients. PMID:25755752

  16. Early use of non-invasive positive pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease: a multicentre randomized controlled trial

    Institute of Scientific and Technical Information of China (English)

    Collaborative Research Group of Noninvasive Mechan

    2005-01-01

    Background Respiratory muscle fatigue plays an important role in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). In previous clinical studies, non-invasive positive pressure ventilation (NPPV) was proved to be successful only for AECOPD patients with severe respiratory failure. We hypothesized that, the outcomes of AECOPD would be improved if NPPV is early (within 24 to 48 hours of admission) administered in those patients with respiratory muscle fatigue and mild respiratory insufficiency, especially in patients without fulfilling the conventional criteria of mechanical ventilatory support. Methods A prospective multicentre randomized controlled trial was conducted in 19 hospitals in China over 16 months. Three hundred and forty-two AECOPD patients with pH≥7.25 and PaCO2>45 mmHg were recruited on general ward and randomly assigned to standard medical treatment (control group) or early administration of additional NPPV (NPPV group).Results The characteristics of two groups on admission were similar. The number of AECOPD patients requiring intubations in NPPV group was much fewer than that of the control group (8/171 vs 26/71, P=0.002). Subgroup analysis showed the needs for intubation in mildly (pH≥7.35) and severe (pH<7.30) acidotic patients in NPPV group were both decreased (9/80 vs 2/71, P=0.047 and 8/30 vs 3/43, P=0.048, respectively). The mortality in hospital was reduced slightly by NPPV but with no significant difference (7/171 vs 12/171, P=0.345). Respiratory rate (RR),scale for accessory muscle use and arterial pH improved rapidly at the first 2 hours only in patients of NPPV group. After 24 hours, the differences of pH, PaO2, scale for accessory muscle use and RR in NPPV group [(7.36±0.06) mmHg, (72±22) mmHg, (2.5±0.9)/min, (22±4)/min] were statistically significant compared with control group (7.37±0.05) mmHg, (85±34) mmHg, (2.3±1.1)/min, (21±4)/min, P<0.01 for all comparisons].Conclusions The early use of NPPV on

  17. 负压治疗技术在急、慢性骨感染中的应用%Treatment of acute and chronic osteomyelitis with negative pressure wound therapy

    Institute of Scientific and Technical Information of China (English)

    谭延斌; 李杭; 潘志军; 郑强; 李建兵; 冯钢

    2008-01-01

    Objective To investigate the treatment of acute and chronic osteomyelitis with negative pressure wound therapy.Method Thirty cases of acute and chronic osteomyelitis were treated with negative presage wound therapy,assisted with debridement,autodermoplasty and myo-cutaneous flap surgery.Results No evidence of relapse was found in all cases treated with negative pressure wound thempy.All the patients were followed up,range from 6 to 23 months,the average was 13.6 months.Condusion The negative pressure wound thempy maybe a simple,effective and inexpensive method,and could be one of the favorable therapy in the treatment of acute and chronic osteomyelitis.%目的 探讨负压治疗技术在治疗急、慢性骨感染中的价值.方法 采用负压治疗技术.即在一段时间内将伤口置于密闭强力负压状态,治疗急、慢性骨感染患者30例(33个部位),辅助清创手术,应用敏感抗生素,应用植皮、肌皮瓣转移等方法闭合创面.结果 29个部位通过1次负压治疗就可达到创面闭合条件.所有患者均获随访,随访时间6~23个月,平均13.6个月,感染无复发.结论 负压治疗技术能有效控制急、慢性骨感染,缩短治疗时间,在骨感染治疗中有较好的应用前景.

  18. Spatial segregation within the sacral parasympathetic nucleus of neurons innervating the bladder or the penis of the rat as revealed by three-dimensional reconstruction.

    Science.gov (United States)

    Banrezes, B; Andrey, P; Maschino, E; Schirar, A; Peytevin, J; Rampin, O; Maurin, Y

    2002-01-01

    The purpose of the present investigations was (1) to examine the spatial organization of preganglionic neurons of the sacral parasympathetic nucleus in the lumbosacral spinal cord of male adult rats and (2) to search, in this nucleus, for a possible segregation of sub-populations of neurons innervating the penis or the bladder, respectively. To estimate their spatial organization, neurons of the sacral parasympathetic nucleus were retrogradely labeled by wheat germ agglutinin coupled to horseradish peroxidase applied to the central end of the sectioned pelvic nerve. The sub-populations of lumbosacral neurons innervating the corpus cavernosum of the penis or the dome of the bladder were identified using transsynaptic retrograde labeling by pseudorabies virus injected into these organs in different rats. In both wheat germ agglutinin-labeled and pseudorabies virus-labeled rats, serial coronal sections were cut through the spinal L5-S1 segments. Labeled neurons were revealed by histochemistry (peroxidase experiments) or immunohistochemistry (pseudorabies virus experiments). By means of a three-dimensional reconstruction software developed in our laboratory, three-dimensional models were calculated from each spinal section image series. They revealed the spatial organization of (i) preganglionic neurons and (ii) neurons innervating the bladder or the penis. The different three-dimensional models were subsequently merged into a single one which revealed the segregation, within the sacral parasympathetic nucleus, of the sub-populations of neurons. Neurons labeled by virus injected into the penis extended predominantly from the rostral part of the L6 segment to the rostral part of the S1 segment while those labeled by bladder injections were distributed predominantly from the caudal part of the L6 segment to the caudal part of the S1 segment. These results support the hypothesis of a viscerotopic organization of sacral neurons providing the spinal control of pelvic organs.

  19. CT-guided screw fixation of vertical sacral fractures in local anaesthesia using a standard CT; CT-kontrollierte Schraubenosteosynthese von vertikalen Frakturen des hinteren Beckenringes in Lokalanaesthesie

    Energy Technology Data Exchange (ETDEWEB)

    Reuther, G.; Dehne, I. [Thueringen-Klinik, Saalfeld (Germany). Radiologische Klinik; Roehner, U.; Will, T.; Petereit, U. [Thueringen-Klinik, Saalfeld (Germany). Orthopaedics and Trauma Surgery

    2014-12-15

    To evaluate time efficiency, radiation dose, precision and complications of percutaneous iliosacral screw placement under CT-guidance in local anaesthesia. Retrospective analysis of 143 interventions in 135 patients during a period of 42 months. Implant failures could be evaluated in 85/182 screws and bony healing or refracturing in 46/182 screws. A total of 182 iliosacral screw placements in 179 vertical sacral fractures (105 unilateral, 37 bilateral) took place in 135 patients. 166/179 of the sacral fractures were detected in Denis zone 1, 10 in Denis zone 2 and 3 in Denis zone 3. No screw misplacements including the simultaneous bilateral procedures were noted. The average time for a unilateral screw placement was 23 minutes (range: 14-52 minutes) and 35 minutes (range: 21-60 minutes) for simultaneous bilateral screwing. The dose length product was 365 mGy x cm (range: 162-1014 mGy x cm) for the unilateral and 470 mGy x cm (range: 270-1271 mGy x cm) for the bilateral procedure. 1 gluteal bleeding occurred as the only acute minor complication (0.7%). Fracture healing was verified with follow-up CTs in 42/46 sacral fractures after screw placement. Backing out occurred in 12/85 screws between 6 and 69 days after intervention. In 8 patients contralateral stress fractures were detected after unilateral screw placement between day 10 and 127 (average: 48 days). CT-guided iliosacral screw placement in sacral fractures is a safe tool providing a very high precision. The radiation dose is in the order of a diagnostic CT of the pelvis for both unilateral and bilateral screws. Contralateral stress fractures in unilateral screw placements have to be considered during the first weeks after intervention.

  20. Outcome of long-axis percutaneous sacroplasty for the treatment of sacral insufficiency fractures with a radiofrequency-induced, high-viscosity bone cement

    Energy Technology Data Exchange (ETDEWEB)

    Eichler, Katrin [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); J. W. Goethe University of Frankfurt, Institute for Diagnostic and Interventional Radiology, Frankfurt (Germany); Zangos, Stephan; Vogl, Thomas J. [University of Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Mack, Martin G. [Radiology Munich, Munich (Germany); Marzi, Ingo [University of Frankfurt, Department of Trauma, Hand and Reconstructive Surgery, Frankfurt (Germany)

    2014-04-15

    Our goal was to assess the technical results in patients who underwent long-axis sacroplasty for the treatment of sacral insufficiency fractures (SIF) by radiofrequency-induced high-viscosity bone cement augmentation. Twelve patients with bilateral sacral fractures were treated by augmentation with radiofrequency-activated, high-viscosity polymethylmethacrylate (PMMA) bone cement under local anesthesia. CT-guided sacroplasty was performed by using a long-axis approach through a single entry point. Thirty-six vertebrae were treated in 12 sessions under a combination of CT and fluoroscopic guidance using a bilateral access and a cavity-creating osteotome prior to remote-controlled, hydraulically driven cement injection. The visual analogue scale (VAS) score before sacroplasty and at 1 and 3 months after the treatment was obtained. PMMA leaks were evaluated retrospectively using the post-interventional CT. The mean amount of high-viscosity PMMA injected per patient was 7.8 ml. No major adverse events were observed. In the first 4 days after the procedure, the mean VAS score decreased from 8.1 ± 1.9 to mean 3.1 ± 1.2 and was followed by a gradual but continuous decrease throughout the rest of the follow-up period at 24 weeks (mean 2.2 ± 1.1) and 48 weeks (mean 2.1 ± 1.4). CT fluoroscopy-guided sacral augmentation was safe and effective in all 12 patients with osteoporotic SIF. (orig.)

  1. 骶管麻醉与喉罩-七氟醚麻醉在小儿短小手术的对比研究%A comparision of sacral canal block and sevoflurane anaesthesia with LMA in children undergoing minor surgery

    Institute of Scientific and Technical Information of China (English)

    李建桥; 李秀泽; 谢东武; 袁玲

    2009-01-01

    Objective To compare the advantages and disadvantages of sacral canal block and sevoflurane anaesthesia with LMA in children undergoing minor surgery. Methods Sixty children aged 2~5 years,schedule to undergo minor surgical procedures, were divided into sacral canal block (group S) and sevoflurane anaesthesia with LMA (group L). Demographic data, heart rate, non-invasive blood pressure, pulse oximeter oxygen satutraion were recorded for each child. In addition, time from termination of surgery to emergence and duration of stay in the PACU, total dose of ketamine, side effects were recorded. Results The two groups were comparable with respect to demographic data, blood pressure and heart rate. The emergence time and du-ration of stay in the PACU of group S were significantly longer than those of group L. There were significantly more dose of ket-amine in the group S. The incidence of emergence agitation in the L group was significantly higher than that in the group S. Con-clusion The balanced anaesthesia of sacral canal block and intravenous anaesthesia, resulted in a lower incidence of emergence agitation, but there were significantly longer emergence time.%目的 观察骶管阻滞麻醉与喉罩-七氟醚麻醉在小儿短小手术中应用的优缺点.方法 2~5岁择期行斜疝或隐睾手术的患儿60例,随机分为静脉复合骶管麻醉组(S),喉罩-静吸麻醉组(L),每组30例.观察患儿术中生命体征、苏醒时间、PACU停留时间、氯胺酮用量、围术期并发症.结果 BP、HR和SpO2在两组间比较差异无统计学意义.S组麻醉苏醒时间、PACU停留时间明显长于L组(P<0.01),S组氯胺酮用量明显多于L组(P<0.01).S组术后躁动发生率明显低于L组(P<0.05).结论 两种方法都可以安全、有效地用于小儿短小手术麻醉,静脉复合骶管阻滞麻醉苏醒时间明较长,但是可以明显降低术后躁动发生丰.

  2. Nova técnica de cateterização de uso prolongado em canal peridural sacral de coelhos

    Directory of Open Access Journals (Sweden)

    Yüksel Erkin

    2013-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O objetivo deste estudo foi desenvolver uma técnica simples e prática para a cateterização crônica em canal peridural sacral de coelhos. MÉTODOS: O estudo incluiu dez coelhos com peso entre 2 e 2,5 kg. Após a anestesia e a analgesia, colocamos um cateter peridural através de uma incisão longitudinal de 2 cm na cauda acima da região do hiato sacral. Confirmamos a localização com a administração de lidocaína a 1% (nivelamento da perda sensorial e da função motora dos membros inferiores. O cateter foi introduzido através de um túnel subcutâneo até o pescoço, onde foi fixado. RESULTADOS: A implantação de cateter crônico peridural caudal foi bem-sucedida em todos os coelhos. Os cateteres permaneceram eficazmente no lugar por dez dias, sem intercorrências durante esse período. A localização do cateter foi reconfirmada por lidocaína a 1% no último dia. Após matar os animais, procedeu-se laminectomia para localização do cateter no espaço peridural. CONCLUSÕES: Há vários métodos de cateterização do espaço peridural em modelos animais na literatura. A cateterização do espaço peridural em coelhos pode ser feita através das vias atlanto-occipital, lombar ou caudal por amputação da cauda. As técnicas de cateterização intratecal e peridural descritas na literatura exigem perícia cirúrgica e conhecimento de procedimentos cirúrgicos, como laminectomia e amputação da cauda. A nossa técnica não requer grande habilidade cirúrgica, a integridade anatômica foi preservada e não houve mau posicionamento de cateter. Em conclusão, podemos sugerir que a nova técnica de cateterização peridural é simples, facilmente aplicável e pode ser usada em estudos experimentais de modelos animais.

  3. The influence of sacral morphology on the existence of secure S1 and S2 transverse bone corridors for iliosacroiliac screw fixation.

    Science.gov (United States)

    Mendel, T; Noser, H; Kuervers, J; Goehre, F; Hofmann, G O; Radetzki, F

    2013-12-01

    Sacroiliac (SI) screw fixation for unstable pelvic fractures stands out as the only minimally invasive method among all other ORIF procedures. A strictly transverse screw trajectory is needed for central or bilateral fracture patterns up to a complete iliosacroiliac fixation. However, secure screw insertion is aggravated by a narrow sacroiliac bone stock. This study investigates the influence of a highly variable sacral morphology to the existence of S1 and S2 transverse corridors. The analysis contained in this study is based on 125 CT datasets of intact human pelvises. First, sacral dysplasia was identified using the "lateral sacral triangle" method in a lateral 3-D semi-transparent pelvic view. Second, 3-D corridors for a 7.3mm screw in the upper two sacral levels were visualised using a proprietary IT workflow of custom-made programme scripts based on the Amira(®)-software. Shape-describing measurement variables were calculated as output variables. The results show a significant linear correlation between ratioT and the screw-limiting S1 isthmus height (Pearson coefficient of 0.84). A boundary ratio of 1.5 represented a positive predictive value of 96% for the existence of a transverse S1-corridor for at least one 7.3mm screw. In 100 out of 125 pelvises (80%), a sufficient S1 corridor existed, whereas in 124 specimens (99%), an S2 corridor was found. Statistics revealed significantly larger S1 and S2 corridors in males compared to females (pS1 and 1 screw in S2. The expanse of the S1 corridor is highly influenced by the dimensions of the dysplastic elevated upper sacrum, whereas the S2 corridor is not affected. Hence, in dysplastic pelvises, sacroiliac screw insertion should be recommended into the 2nd sacral segment. Our IT workflow for the automatic computation of 3-D corridors may assist in surgical pre-operative planning. Furthermore, the workflow could be implemented in computer-assisted surgery applications involving pelvic trauma.

  4. Evaluation of slow release nicardipine in essential hypertension by casual and ambulatory blood pressure measurements. Effects of acute versus chronic administration.

    Science.gov (United States)

    Bellet, M; Pagny, J Y; Chatellier, G; Corvol, P; Ménard, J

    1987-10-01

    We conducted a randomized placebo-controlled double-blind study in 40 hypertensive subjects to assess the antihypertensive effect of a new galenic form of nicardipine administered at a dosage of 50 mg twice daily for 3 weeks. Regardless of whether blood pressure was measured by standard mercury sphygmomanometer, non-ambulatory automatic oscillometry or a Remler ambulatory blood pressure recorder, it dropped by a significantly larger amount in the nicardipine group than in the placebo group. In the control group, a placebo effect was observed with the ambulatory diastolic blood pressure recording, whereas it was not observed with hospital blood pressure measurements, especially when using the serial measurements performed for 30 min by an automatic recorder. The fall in blood pressure measured with the Remler recorder was correlated with the fall measured 10-20 min during one acute intravenous nicardipine perfusion before the trial, although the correlation coefficients do not suggest clinically relevant predictability of nicardipine efficacy at the individual level. The present findings support the need for controlled double-blind trials with careful office blood pressure measurements. PMID:3429863

  5. Abscess formation in vertebral canal and presacral area following penetrating injury of rectum and sacral vertebra by a steel rod

    Institute of Scientific and Technical Information of China (English)

    TAN Hao; GUO Qing-shan; ZHANG Lian-yang; SUN Shi-jin; YAO Yuan-zhang; HUANG Xiao-ying

    2012-01-01

    Penetrating injury to the rectum,vertebral body and spinal cord by a steel rod is a rare condition.Treatment of this kind of injury is very challenging.Rectal injury requires repair and fecal diversion,while debridement of the spine is difficult,especially when the injury site is very long.Here we report a case of penetrating injury of rectum and sacral vertebra by a steel rod after falling onto the ground from 1 m height.The abscess cavity was irrigated with 3% hydrogen peroxide and physiological saline repeatedly.The bony canal was carefully debrided,curetted and bony fragments were removed.Spinal irrigation and drainage lasted for 2 months and sensitive antibiotic (amikacin sulfate) was given 7 days after surgery,but abscess was still formed in the vertebral canal.At 6-month follow-up,the patient was paralyzed without any neurological improvement,and the pain in low back and lower limb still continued.

  6. Deletion of Cyclooxygenase-2 in the mouse increases arterial blood pressure with no impairment in renal NO production in response to chronic high salt intake

    DEFF Research Database (Denmark)

    Staehr, Mette; Hansen, Pernille B L; Madsen, Kirsten;

    2013-01-01

    Experiments were designed to test the hypothesis that COX-2 activity attenuates the blood pressure increase during high NaCl intake by stimulation of eNOS-mediated NO synthesis in the kidney medulla. COX-2(-/-) (C57BL6) and (+/+) mice were fed a diet with 0.004% (LS) or 4% (HS) NaCl for 18 days....... Arterial blood pressure was recorded continuously using indwelling catheters. Food and water intake and diuresis were measured in metabolic cages. Urine osmolality and excretion of electrolytes, cGMP, cAMP and NOx were determined, as well as plasma NOx and cGMP. There was a significant dependence of blood...... pressure during high salt intake and COX-2 activity is not necessary for increased renal NO formation during elevated NaCl intake....

  7. Cerebral responses to innocuous somatic pressure stimulation following aerobic exercise rehabilitation in chronic pain patients: a functional magnetic resonance imaging study

    OpenAIRE

    Micalos PS; Korgaonkar MS; Drinkwater EJ; Cannon J; Marino FE

    2014-01-01

    Peter S Micalos,1 Mayuresh S Korgaonkar,2 Eric J Drinkwater,3 Jack Cannon,3 Frank E Marino3 1School of Biomedical Sciences, Charles Sturt University, Bathurst, 2Brain Dynamics Centre, Westmead Millennium Institute, University of Sydney Medical School, Sydney, 3School of Human Movement Studies, Charles Sturt University, Bathurst, NSW, Australia Objective: The purpose of this research was to assess the functional brain activity and perceptual rating of innocuous somatic pressure stimulation be...

  8. A Clinical Analysis of Non-Invasive Positive Pressure Ventilation in Treating Chronic Obstructive Pulmonary Diseases with Respiratory Failure%无创正压通气治疗COPD伴呼吸衰竭疗效的临床分析

    Institute of Scientific and Technical Information of China (English)

    杨建民; 贺明

    2006-01-01

    近几年,慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)病例逐年增多,且多为老年性伴呼吸衰竭的患者,经鼻或口鼻无创正压通气(non-invasive positive pressure ventilation,NIPPV)治疗慢性阻塞性肺气肿伴呼吸衰竭具有良好效果。现将近4年来我科收治的COPD合并呼吸衰竭患者行NIPPV治疗26例分析如下。

  9. An autopsy case of superficial siderosis of the central nervous system accompanied by anterior sacral polycystic meningocele in neurofibromatosis type 1.

    Science.gov (United States)

    Matsumoto, Arifumi; Suzuki, Hiroyoshi; Tobita, Muneshige; Hisanaga, Kinya

    2016-07-28

    A 74-year-old female patient, who was diagnosed with neurofibromatosis type 1 (NF1) at the age of 40, was admitted with complaints of flickering vision and gait disturbance for the last 2 years. On admission, neurological examination revealed mild bilateral hearing loss and ataxia in the limb and trunk. Laboratory tests revealed anti-hepatitis C virus (HCV) antibody positivity and elevated HCV RNA by real-time polymerase chain reaction. The cerebrospinal fluid examination revealed a slightly yellowish appearance with elevated total protein levels. Gradient echo T2*-weighted brain magnetic resonance imaging (MRI) demonstrated a rim of hypointense lesions surrounding the surface of the cerebellum, brainstem, frontal and temporal lobes, and thalamus, which was considered as hemosiderin depositions. From these MRI findings, she was diagnosed as having superficial siderosis of the central nervous system. Cerebral angiography revealed an aneurysm-like dilatation at the bifurcation of the right internal carotid-posterior communicating artery. (99m)Tc-ethyl cysteinate dimer single-photon emission computed tomography revealed hypoperfusion in the bilateral frontal and temporal lobes. Pelvic plain X-ray, pelvic computed tomography, and lumbosacral MRI revealed a sacral defect and an anterior sacral polycystic meningocele communicating with the spinal subarachnoid space. The patient's symptoms gradually worsened, and she died of septic shock because of pyelonephritis at the age of 77. An autopsy was performed; on pathological examination, we did not observe any findings associated with rupture of the aneurysm-like dilatation in the bifurcation of the right internal carotid-posterior communicating artery and cerebral amyloid angiopathy. Because duropathies-a new neurological disease concept-have been implicated as a cause of bleeding in the superficial siderosis, the anterior sacral polycystic meningocele, a type of duropathies, was presumed to be the most probable bleeding

  10. Should we prescribe blood pressure lowering drugs to every patient with advanced chronic kidney disease? A comment on two recent meta-analyses.

    Science.gov (United States)

    Gross, Peter; Schirutschke, Holger; Barnett, Kerstin

    2009-10-01

    Antihypertensive treatment is an essential, life-prolonging measure in primary hypertension. It prevents apoplexy, myocardial infarction, and hypertensive kidney failure. Chronic kidney failure is associated with hypertension and an accelerated form of arteriosclerosis. Demise from cardiovascular affliction is a leading cause of death in renal patients (chronic renal failure stages II-IV, renal failure requiring dialysis, renal transplantation). What, then, is the role of antihypertensive treatment in such patients, and, specifically, what is achieved by renin-angiotensin-aldosterone (RAA) system modifying agents? Two meta-analyses have recently investigated these issues. An article in The Lancet evaluated eight studies on dialysis patients (n = 1679). It concluded that antihypertensives are beneficial in reducing cardiovascular morbidity and mortality. However, we criticize these conclusions and show that the data are not convincingly in favor of antihypertensive treatment. A meta-analysis in the American Heart Journal assessed the role of antihypertensive agents and RAA system modifying drugs in 45,758 patients (from 25 studies), who were in stages I-III of renal failure, i.e., not (yet) requiring dialysis. The authors claim that angiotensin- -converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) significantly reduced cardiovascular outcomes. However, our analysis of the data is not consistent with their conclusions. It showed that the results were quite mixed, that the authors may have overemphasized the positive results, and that considering all the results, it should be concluded that antihypertensive treatments, including those with ACEI/ARB, may not be superior to placebo (sic!) in renal patients. Rather than doing meta-analyses, larger primary studies are needed to reveal the real role of antihypertensive treatments in renal patients.

  11. Imaging of sacral chordoma: comparison between MRI and CT; Bildgebende Diagnostik bei Chordomen des Beckens: Vergleich der Modalitaeten CT und MRT

    Energy Technology Data Exchange (ETDEWEB)

    Plathow, C.; Weber, M.-A.; Kauczor, H.-U. [Deutsches Krebsforschungszentrum (DKFZ) Heidelberg, Abteilung Radiologie (Germany); Debus, J. [Universitaet Heidelberg, Abteilung Strahlentherapie (Germany)

    2005-01-01

    Sacral chordoma is a primarily benign tumor with a high tendency to recur. A correct definition of tumor volume is a significant prognostic factor. We compared the value of CT and MRI in diagnosing a sacral chordoma. 31 patients with a histologically proven sacral chordoma were included in this study. Following parameters were analyzed by two independent radiologists: septation, signs of blood and ossification in the tumor tissue, contrast enhancement, maximal tumor diameter, infiltration of the soft tissue, the dural salc and the cauda equina and multifocality. In CT all chordomas showed a hypodensity to the normal tissue and in MRI a hyperintensity on T2w images with a low level of contrast enhancement. On the basis of the more precise soft tissue contrast of MRI compared with CT, MRI was significantly more accurate in all tested parameters (p <0.05) besides in detecting tumor ossification. In CT tumor volume was frequently underestimated. MRI in sacral chordoma is an essential tool in the pretherapeutic diagnostic regimen and in a state of relapse. (orig.) [German] Das sakrale Chordom ist ein primaer gutartiger Tumor des Knochenskeletts. Eine korrekte und ausreichende Tumorvolumendefinition zur Therapieplanung ist ein entscheidender Prognoseparameter aufgrund der hohen Rate an Rezidiven. Wir untersuchten die Wertigkeit der CT und MRT in der Diagnostik des sakralen Chordoms. Mittels CT und MRT wurden bei 31 Patienten mit histologisch gesichertem sakralem Chordom Septierung, Ossifikation, Zeichen einer Einblutung, die Kontrastmittelaufnahme des Tumors, die maximale axiale Tumorausdehnung, Weichteilinfiltration, Infiltration des Duralsackes, der Cauda equina und eine Multifokalitaet durch 2 unabhaengige Radiologen untersucht und bewertet. Alle Chordome zeigten in der CT nativ ein hypodenses und in der MRT ein T2w-hyperintenses Verhalten mit nur maessiger Kontrastmittelaufnahme. Unter Zugrundelegung des besseren Weichteilkontrastes der MRT gegenueber der CT erwies

  12. Local control of recurrent clival and sacral chordoma after interstitial irradiation with iodine-125: new techniques for treatment of recurrent or unresectable chordomas

    Energy Technology Data Exchange (ETDEWEB)

    Kumar, P.P.; Good, R.R.; Skultety, F.M.; Leibrock, L.G.

    1988-03-01

    Using new /sup 125/I brachytherapy techniques, we were able to deliver safely a tumor volume dose of 16,000 rads to a previous irradiated, large, recurrent sacral chordoma by means of the intraoperative interstitial implantation of 229 low activity /sup 125/I seeds and 40,000 rads to a previously irradiated, small, recurrent clival chordoma by means of the transnasal needle implantation of two high activity /sup 125/I seeds. Iodine-125 brachytherapy was followed by regression of tumor, lessening of symptoms, and bony recalcification in both cases.

  13. Inter rater reliability of Pressure Ulcer Scale for Healing (PUSH in patients with chronic leg ulcers Confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH en pacientes con úlceras crónicas en la pierna Confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em pacientes com úlceras crônicas de perna

    Directory of Open Access Journals (Sweden)

    Vera Lúcia Conceição de Gouveia Santos

    2007-06-01

    Full Text Available This study aimed to evaluate the inter rater reliability of the Pressure Ulcer Scale for Healing (PUSH, in its version adapted to the Portuguese language, in patients with chronic leg ulcers. Kappa index was used for the analysis. After accomplishing ethical issues, 41 patients with ulcers were examined. A total of 49% of the ulcers were located in the right leg and 36% of them were venous ulcers. The Kappa indices (0.97 to 1.00 obtained in the comparison between the observations of the clinical nurses and the stomal therapists for all sub-scales and for total score, confirmed the tool inter rater reliability, with statistical significance (pEl objetivo del estúdio fue probar la confiabilidad inter-observadores del Pressure Ulcer Scale for Healing (PUSH, en su versión adaptada al portugués, en pacientes con úlceras crónicas en la pierna. Para el análisis de concordancia se utilizó el Indice Kappa. Posterior a la aprobación del Comité de Ética, 41 pacientes con úlcera fueron examinados, siendo que 49% de las úlceras se localizaron a la derecha y 36% eran de etiología venosa. Los indices Kappa obtenidos (0,97 a 1,00, con un nivel significativo de pTestar a confiabilidade interobservadores do Pressure Ulcer Scale for Healing (PUSH, em sua versão adaptada para o português, em pacientes com úlceras crônicas de perna foi o objetivo deste estudo. Para a análise de concordância, utilizou-se o índice Kappa. Após aprovação pelo Comitê de Ética, pacientes com úlceras (41 úlceras foram examinados, sendo que 49% das úlceras localizavam-se à direita e 36% eram de etiologia venosa. Os índices Kappa obtidos (0,97 a 1,00, com significância estatística (p<0,001, ratificaram a confiabilidade interobservadores, ao ser obtida concordância de muito boa a total entre as observações de enfermeiros clínicos e especialistas em estomaterapia (padrão-ouro, para todas as subescalas do PUSH, como para o escore total. Esses resultados

  14. 维持性血液透析患者血浆容量与血压关系的研究%Clinical study on relationship between plasma volume and blood pressure in patients undergoing chronic hemodialysis

    Institute of Scientific and Technical Information of China (English)

    方燕; 张伟明; 严玉澄; 陆任华; 王咏梅; 朱铭力; 倪兆慧; 钱家麒

    2011-01-01

    目的 探讨维持性血液透析患者透析过程中血浆容量变化与血压的关系.方法 36例维持性血液透析患者根据透析前血压水平分为正常血压组(n=16)和高血压组(n=20).记录透析前后患者的血压和体质量,检测血清总蛋白水平并计算血浆容量变化值(△Pv).所有数据采用SPSS 13.0软件进行统计学分析.结果 在正常血压组,透析前后收缩压分别为(123.3±19.9) mmHg(1 mmHg=0.133 kPa)和(122.3±27.0) mmHg,舒张压分别为(69.6+9.2) mmHg和(70.9+17.0) mmHg,透析前后收缩压和舒张压比较差异均无统计学意义(P>0.05);透析过程中,体质量变化值为(2.7±1.4)kg,△PV为(14.7±10.8)%.在高血压组,透析前后收缩压分别为(162.6±16.2) mmHg和(148.2±31.1) mmHg,透析前后舒张压分别为(86.6±9.6) mmHg和(82.1±14.4) mmHg,透析后收缩压较透析前显著下降(P<0.05),而透析前后舒张压比较差异无统计学意义(P>0.05);透析过程中,体质量变化值为(3.2±1.3)kg,△PV为(20.4±14.4)%.相关性分析结果显示:正常血压组和高血压组患者透析前后血压与透析过程中的△PV和体质量变化均无显著相关性(P>0.05).结论 透析过程中,血浆容量改变未对患者透析前后血压变化产生显著影响;体质量下降尚不足以确切反映患者血浆容量状态,且用于预示透析前后血压变化的作用有限.%Objective To explore the association between plasma volume and blood pressure during hemodialysis in patients undergoing chronic hemodialysis. Methods Thirty-six patients undergoing chronic hemodialysis were divided into normotensive group (n = 16) and hypertensive group (n = 20) according to blood pressure before hemodialysis. The blood pressure and body weight before hemodialysis and after hemodialysis were recorded, and serum total protein concentrations were measured to determine the changes of plasma volumes ( APV). Statistical analysis was performed with SPSS 13. 0

  15. Clinical efficacy and safety of sacral block combined with general anesthesia in pediatric laparoscopic operation: A meta-analysis%骶管阻滞复合全麻在小儿腹腔镜手术中的临床效果和不良反应的Meta分析

    Institute of Scientific and Technical Information of China (English)

    沈孜颖; 夏中元; 赵博; 冷燕; 刘敏; 侯家保

    2015-01-01

    Objective To evaluate the clinical effects and adverse reactions of sacral block combined with general anesthesia in pediatric laparoscopic operation. Methods Articles have been retrieved in PubMed, Embase, Cochrane Library, Chinese HowNet database, VIP, from database built to October 2014, and handled in inclusion and exclusion criteria for data extraction and quality assessment, using RevMan 5.1.5 software for Meta-analysis. Results A total of 9 randomized controlled trials were included, with a total of 528 patients. Compared with general anesthesia, heart rate in sacral block combined tracheal intubation was more stable, with statistically significant differ-ence between the two groups before tracheal intubation, 15 min after pneumoperitoneum and after extubation. The par-tial pressure of end-tidal carbon dioxide (PETCO2) in sacral block combined tracheal intubation was more stable, with significant difference 15 min after pneumoperitoneum; The induction time, wake-up time and extubation time were shorter, with statistically significant difference. The postoperative adverse reactions were significantly less, with signif-icant difference in restlessness, nausea, vomiting and balderdash. Conclusion In pediatric laparoscopic operation, sacral block combined with tracheal intubation results in more stable circular and respiratory function, shorter time of induction, wake-up and extubation, and lower incidence of adverse reactions, compared with simple general anesthesia.%目的 采用Meta分析的方法系统评价骶管阻滞复合气管插管全麻在小儿腹腔镜手术中的临床效果和不良反应.方法 计算机检索PubMed、Embase、Cochrane Library、中国知网、维普、万方数据库从建库至2014年10月的文献,对符合纳入与排除标准的研究进行资料提取和文献质量评价,并采用RevMan 5.1.5软件进行Meta分析.结果 最终纳入9个随机对照实验,共计患者528例.Meta分析结果显示,与单纯全麻比较,骶

  16. 脊神经前根对大鼠排尿和勃起功能的选择性支配机制%Selective innervation of sacral anterior rootlets to micturition and erection function in rats

    Institute of Scientific and Technical Information of China (English)

    王文婷; 周谋望; 黄红拾; 陈亚平; 杨延砚; 曾凡硕

    2010-01-01

    Objective To investigate the selective innervation of sacral anterior rootlets to micturition and erection function in SD rats. Methods Forty male SD rats of clean grade, aged 6 weeks old, were selected. Ten rats received a retrograde nerve tract tracing study. Thirty rats were chosen for an electro-physiological study. The L6, S1 spinal cord segment anterior rootlets of anesthetic rats were electrostimulated respectively. The intravesical pressure, urethral perfusion pressure and intracarvernerous pressure were recorded simultaneously and innervation effectiveness was analyzed. Results CB-HRP labeled neurons were observed mainly in L6 and S1 spinal cords. When some anterior rootlets of L6 and S1were electrostimulated, the intravesical pressure rose gradually, but the urethral perfusion pressure and the intracavernous pressure curve changed slightly; when other rootlets of the same anterior root were stimulated,the urethral perfusion pressure could reach the peak; while others were stimulated, the intracavernours pressure rose quickly, but there were no great changes in intravesical pressure and urethral perfusion pressure. Some other rootlets might lead to the simultaneous changes of 2 or 3 above-mentioned pressures.Conclusion The innervations of L6 and S1 anterior rootlets to rats' bladder detrusor, external urethral sphincter and penile cavernous body are significantly distinct. Different rootlets may be distinguished by microanatomy and electrostimulation.%目的 探讨脊神经前根小束对SD大鼠膀胱和勃起功能的选择性支配机制.方法 成年雄性SD大鼠40只,10只行逆行神经示踪,30只行电生理研究:分别刺激大鼠排尿及勃起反射中枢所在脊髓节段的脊神经前根神经小束,同时记录膀胱内压、尿道灌注压和阴茎海绵体内压的变化.结果 SD大鼠排尿和勃起功能的低级中枢主要位于L6、S1脊髓节段,电刺激L6、S1脊神经前根某些小束分别引起膀胱内压、尿道灌注压

  17. Neuron counting and the changes of section size after chronic pressure on cervical spinal cord in rabbit%兔颈脊髓慢性受压后神经元计数及截面积的变化

    Institute of Scientific and Technical Information of China (English)

    陈锋; 黄有荣; 韦贵康; 李寿斌

    2005-01-01

    neurocyte and neurocyte damage. DESIGN: A randomized controlled observational study using experimental animals as study subjects.MATERIALS: The study was conducted in the Central Laboratory of Ruikang Hospital affiliated to Guangxi Traditional Chinese Medical University from December 2002 to August 2003.SUBJECTS: Fourty-eight male New Zealand rabbits with a bodymass of (2.45 ± 0. 28) kg were randomly divided into control group, mild pressure group and severe pressure group with 16 rabbits in each group.METHODS: Animal models with mild and severe cervical spinal cord chronic pressure were established in rabbits. Control group was pseudo-operation group. Spinal cord observation under optical microscope and electron microscope, neurocyte apoptosis analysis (TUNEL method), neuron counting, and the section size of the neuron were analyzed respectively.MAIN OUTCOME MEASURES: Main results: observational results under optical microscope of each group. Subordinate results: ① observational results under electron microscope of each group; ② neurocyte apoptosis analysis RESULTS: After chronic pressure in the spinal cord of rabbits, phenomena like neuron atrophy,loss,reduced section size,and neuron and neurocyte apoptosis appeared. The morphology of neurons in control group was normal and the quantity was quite a lot, which was (40 ± 2), and the neuron section size was(41.24 ± 15.61) μm2.The number of neuron of mild pressurc group was(27 ± 2), and the neuron section size was(20. 82 ± 6.57) μm2. The number of neurons of severe pressure group was (22± 2), and the neuron section size was( 17. 96 ± 9.03 ) μm2. The difference between mild, severe pressure group and control group was significant( P < 0.01),while the difference between mild and severe pressure groups was insignificant(P > 0. 05 ). The ultrastructural changes of neurons after chronic pressure were reduced volume of soma, unclear nucleolus and reduced rough endoplasmic reticulum. The lamellar structure of

  18. 持续腰椎穿刺引流治疗高位骶骨肿瘤术后脑脊液漏%Continuous lumbar puncture drainage in the treatment of cerebrospinal fluid leakage after superior sacral tumor resection

    Institute of Scientific and Technical Information of China (English)

    熊燕; 杨红胜; 屠重棋; 张斌; 任程; 闵理; 段宏

    2013-01-01

    was conducted to review 72 patients who underwent superior sacral tumor resection and had complete medical records from January 1998 to August 2011. The inclusive criteria were that the patients with dural injuries during sacrum tumor resection had CSF leakage postoperatively, meanwhile excluding those who had contraindications after continuous lumbar puncture CSF drainage such as brain hernia, intracranial pressure increased obviously, skin or soft tissue infection in puncture position, systemic inflammatory response syndrome ( SIRS ) to severe sepsis or septic shock, not cooperating puncture, CSF circulation channel obstruction above L3 etc. 11 patients were in accordance with the inclusive criteria ifnally. 5 patients with CSF leakage after sacrum tumor resection who underwent single drainage using a tube beside the wound before March 2005 were taken as the control group. While the other 6 patients who had CSF leakage after sacrum tumor resection after March 2005 were taken as the continuous lumbar puncture drainage group. The healing time of CSF leakage, the general condition of patients and related complications were compared between the 2 groups. Results No retrograde intracranial infection occurred in both groups, while 1 patient in the control group had local infection of operative incision. The healing time of the patients in the continuous lumbar puncture drainage group was at a median of 14.5 days ( range;12-18 days ), while 25 days ( range;23-36 days ) in the control group, and there were statistically signiifcant differences between them ( P=0.004 ). Less oozing or swelling appeared in the operative incision of the sacrococcygeal region of the continuous lumbar puncture drainage group during the treatment than that of the control group. At the same time, self-feelings of patients in the continuous lumbar puncture drainage group, such as wound pain, dizziness symptoms and so on, were lighter than that of the control group. No patients in both groups had

  19. US Pilot Study of Lumbar to Sacral Nerve Rerouting to Restore Voiding and Bowel Function in Spina Bifida: 3-Year Experience

    Directory of Open Access Journals (Sweden)

    Kenneth M. Peters

    2014-01-01

    Full Text Available Objective. To report our experience with creating a skin-central nervous system-bladder reflex arc with intradural lumbar to sacral motor root microanastomosis to restore bladder/bowel function in spina bifida patients. Methods. Urinary/bowel changes from baseline to three years were evaluated with questionnaires, voiding diaries, urodynamics (UDS, and renal function studies. Treatment response was defined as CIC ≤ once/day with stable renal function, voiding efficiency > 50%, and no worsening of motor function. Results. Of 13 subjects (9 female, median age 8 years, 3 voided small amounts at baseline, one voided 200 cc (voiding efficiency 32%, 4/13 reported normal bowels, and 2/13 were continent of stool. Postoperatively, all had transient lower extremity weakness; one developed permanent foot drop. Over three years, renal function remained stable and mean maximum cystometric capacity (MCC increased (P=0.0135. In the 10 that returned at 3 years, 7 were treatment responders and 9 had discontinued antimuscarinics, but most still leaked urine. Only 2/8 with baseline neurogenic detrusor overactivity (NDO still had NDO, all 3 with compliance <10 mL/cm H2O had normalized, 7/10 considered their bowels normal, 5/10 were continent of stool, and 8/10 would undergo the procedure again. Conclusion. Lumbar to sacral nerve rerouting can improve elimination in spina bifida patients. This trial is registered with ClinicalTrials.gov NCT00378664.

  20. Dynamics of indicators of a metabolic exchange and condition of blood circulation of the bottom extremities after traction extension at patients with lumbar and sacral dorsopathy

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

    Full Text Available Aim: to study influence of traction therapy in a pulse mode in a complex with electrotherapy on a condition of blood circulation of the bottom extremities and level of a metabolic exchange. Material and methods. There had been examined 120 patients with a lumbar and sacral dorsopathy aged from 22 to 69 years (middle age of 49,5 years with prescription of a disease from 1 to 5 years, among them men of 34,2%, women of 65,8%. Results. The analysis of effects of various medical methods on a condition of local blood circulation in the bottom extremities showed that the most expressed its compensation is noted at complex application of mechanical pulse traction influence and electrotherapy for patients with a dorsopathy of lumbar and sacral department of a backbone that is confirmed by restoration to normal values of all indicators rheovasogramm. Conclusion. High clinical results of application of the combined medical and rehabilitation complex are based on compensation of local blood circulation that is shown in elimination of deficiency of blood supply due to improvement of a tone of arterial vessels and elimination of venous stagnation, and also due to increase of linear speed of a blood-groove and development of collateral blood circulation. Application of electrical impulse and mechanical traction influences, more at their combination promotes fermentative activity of the systems responsible for a protein exchange that is important for prevention of degenerate and dystrophic process progressing.

  1. What Are the Signs, Symptoms, and Complications of High Blood Pressure?

    Science.gov (United States)

    ... What Are the Signs, Symptoms, and Complications of High Blood Pressure? Because diagnosis is based on blood pressure readings, ... damaged from chronic high blood pressure. Complications of High Blood Pressure When blood pressure stays high over time, it ...

  2. Preeclampsia and High Blood Pressure During Pregnancy

    Science.gov (United States)

    ... AQ FREQUENTLY ASKED QUESTIONS FAQ034 PREGNANCY Preeclampsia and High Blood Pressure During Pregnancy • What is high blood pressure? • What is chronic hypertension? • What is gestational hypertension? • ...

  3. 青少年慢性疼痛与学习压力的相关性分析%Relationship between the incidence of chronic pain and academic pressure in high school students

    Institute of Scientific and Technical Information of China (English)

    赵庆华; 张永兴; 邓国英; 蒋文斌; 张琳娜; 狄黎卿; 栗扬阳; 杜小宇; 吴欣菀

    2014-01-01

    目的 分析高中生头痛、腹痛、颈肩痛和腰背痛等慢性疼痛发病情况及其与青少年学习压力之间的关系.方法 2011至2012学年度第二学期,就相关问题,随机问卷调查上海市全日制普通高中3 000名学生,对结果进行多因素Logistic回归模型分析.结果 完成问卷的学生2 849名,重测信度在0.69 ~ 0.81之间,头痛、腹痛、颈肩痛和腰背痛的整体发病率分别为30.3%、20.9%、32.8%和41.1%,女生均高于男生(头痛为35.00%比24.60%,腹痛为21.50%比18.50%,颈肩痛为44.10%比36.80%,腰背痛为35.40%比29.00%),差异有统计学意义(P<0.05);而且普遍存在着学习负担重、压力大、睡眠不足等现象,与4种慢性疼痛密切相关.结论 慢性疼痛为青少年常见疾病,女生高于男生,与学习压力密切相关.%Objective To explore the incidence of four types of chronic pain,i.e.headache,abdominal pain,neck & shoulder pain (NSP) and low back pain (LBP) and examine the relationship between the incidence of chronic pain and academic pressure in high school students.Methods A total of 3 000 high school students were randomly surveyed with a questionnaire on related issues.And the results were analyzed with a multivariate Logistic regression model.Results Among them,2 849 completed the questionnaire.And the overall incident rates of headache,abdominal pain,NSP,and LBP were 30.3%,20.9%,32.8% and 41.1% respectively.The students generally experienced a heavy burden of learning,a high level of stress and sleep deprivation closely related to four types of chronic pain.Conclusion As a common condition in Chinese adolescents,chronic pain is closely correlated with academic pressure.

  4. The Effect of Chronic Aerobic Exercise on Blood Pressure in Mice%运动训练对自发性高血压大鼠血压的影响

    Institute of Scientific and Technical Information of China (English)

    蔡弘扬; 王晋

    2015-01-01

    Objective To analysis the effect of chronic aerobic exercise on blood pressure.Methods 24 male 16–weeks-old rats were used in this study. 12 spontaneously hypertensive rats and 12 normal rats were randomly divided into normal quiet group (sedentary, Sed) and exercise training (ExT) groups, respectively. Quiet control group, exercise control group, quiet group of hypertension, exercise group of hypertension, n=6.Results After exercise training, the blood pressure of normal rats had no apparent change. But the blood pressure of exercise group of hypertension decreased by 17 mm Hg (P<0.05) and decreased by 11 mm Hg as compared with that of quiet group of hypertension rats (P<0.05).Conclusion The mechanism that exercise training signiifcantly reduced blood pressure in spontaneously hypertensive rats may be improve arterial barorelfex function.%目的研究运动训练对自发性高血压大鼠血压的影响。方法24只16周龄雄性大鼠用于实验,其中正常对照大鼠12只,自发性高血压大鼠12只;各类大鼠再随机分为安静组和运动训练组,每组6只。结果运动训练结束后,正常大鼠血压没有明显变化。但高血压运动组大鼠与运动前相比血压降低17 mm Hg(P<0.05);与高血压安静组大鼠相比降低了11 mm Hg(P<0.05)。结论运动训练对自发性高血压大鼠的降压机制可能是通过改善动脉压力反射功能。

  5. Lumbopelvic fixation for unstable U-shaped sacral fractures:4 cases report%髂腰内固定治疗不稳定型骶骨U型骨折四例报道

    Institute of Scientific and Technical Information of China (English)

    邓超华; 蔡林

    2013-01-01

    U-shaped sacral fractures usually occur in multiply injured patients after falling from height. However, it is often missed or delayed in diagnosis because of other severe associated injuries. Due to its low incidence, the experience of the diagnosis and treatment of U-shaped sacral fractures is very limited. In this article, the treatment outcomes of lumbopelvic fixation for unstable U-shaped sacral fractures were retrospectively studied. From 2008 to the present, 4 patients with U-shaped sacral fractures were treated by lumbopelvic fixation, among whom there were 3 males and 1 female, with an average age of 30 years old (range;20-45 years). According to the Roy-Camille system, there were 2 cases of Type 2 and 2 cases of Type 3. All patients underwent the bone chip removal, sacral canal decompression and lumbopelvic pedicle screw fixation. 3 patients with cauda equina injuries underwent cauda equina release after decompression. All patients were followed up with a mean period of 2 years and 6 months (range;2-4 years). In 2 patients, the bladder and bowel function was restored about 3 months postoperatively, with gradually normal ambulation 6 months postoperatively. Only paresthesia or numbness remained in some areas in lower limbs 2 years postoperatively. In 1 patient, the bladder and bowel function was restored 1 month postoperatively, with gradually normal ambulation and improved muscle weakness 3 months postoperatively. He entirely got recovered 2 years postoperatively. 1 patient with U-shaped sacrum fractures, combined with no neurological damage could gradually move around 1 month postoperatively, and the sensory-motor of lower limbs was completely normal during the 4-year follow-up. In summary, for patients with U-shaped sacral fractures, combined with obvious fracture displacement and neurological damage, lumbopelvic pedicle screw fixation can significantly correct the displaced and deformed fractures during the surgery and is in favor of adequate nerve

  6. Assessment of sacrococcygeal pressure ulcers using diffuse correlation spectroscopy

    Science.gov (United States)

    Diaz, David; Lafontant, Alec; Neidrauer, Michael; Weingarten, Michael S.; DiMaria-Ghalili, Rose Ann; Fried, Guy W.; Rece, Julianne; Lewin, Peter A.; Zubkov, Leonid

    2016-03-01

    Microcirculation is essential for proper supply of oxygen and nutritive substances to the biological tissue and the removal of waste products of metabolism. The determination of microcirculatory blood flow (mBF) is therefore of substantial interest to clinicians for assessing tissue health; particularly in pressure ulceration and suspected deep tissue injury. The goal of this pilot clinical study was to assess deep-tissue pressure ulceration by non-invasively measuring mBF using Diffuse Correlation Spectroscopy (DCS). DCS provides information about the flow of red blood cells in the capillary network by measuring the temporal autocorrelation function of scattering light intensity. A novel optical probe was developed in order to obtain measurements under the load of the subject's body as pressure is applied (ischemia) and then released (reperfusion) on sacrococcygeal tissue in a hospital bed. Prior to loading measurements, baseline readings of the sacral region were obtained by measuring the subjects in a side-lying position. DCS measurements from the sacral region of twenty healthy volunteers have been compared to those of two patients who initially had similar non-blanchable redness. The temporal autocorrelation function of scattering light intensity of the patient whose redness later disappeared was similar to that of the average healthy subject. The second patient, whose redness developed into an advanced pressure ulcer two weeks later, had a substantial decrease in blood flow while under the loading position compared to healthy subjects. Preliminary results suggest the developed system may potentially predict whether non-blanchable redness will manifest itself as advanced ulceration or dissipate over time.

  7. Sacralizing Reality Digitally

    DEFF Research Database (Denmark)

    Damgaard, Mads

    2014-01-01

    Marshalling scientific arguments and methods for religious ends is certainly not a new trend in religious expressions, but new modes of writing scientifically legitimated myths has developed online. Computer-mediated communication provides new tools for such a fusing of religion and science......, and the present article asks what this entails for categories of religious authority and authenticity. Taking online expressions of the Neo-Pagan faith called Asatrú, a 9,500 year-old skeleton and an associated modern North American conspiracy theory as the starting points, a configuration of religious...... authenticity derived from scientific sources is analysed. The case is made that through hyperlinks, YouTube videos and discussion forums, religious communities such as the online Asatrú groups strategically assemble religious authority on a foundation of science, tapping into non-religious ecologies...

  8. Effectiveness and safety of noninvasive positive-pressure ventilation for severe hypercapnic encephalopathy due to acute exacerbation of chronic obstructive pulmonary disease:a prospective case-control study

    Institute of Scientific and Technical Information of China (English)

    ZHU Guang-fa; ZHANG Wei; ZONG Hua; XU Qiu-fen; LIANG Ying

    2007-01-01

    Background Although severe encephalopathy has been proposed as a possible contraindication to the use of noninvasive positive-pressure ventilation(NPPV),increasing clinical reports showed it was effective in patients with impaired consciousness and even coma secondary to acute respiratory failure,especially hypercapnic acute respiratory failure(HARF).To further evaluate the effectiveness and safety of NPPV for severe hypercapnic encephalopathy,a prospective case-control study was conducted at a university respiratory intensive care unit(RICU)in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)during the past 3 years.Methods Forty-three of 68 consecutive AECOPD patients requiring ventilatory support for HARF were divided into 2 groups,which were carefully matched for age,sex,COPD course,tobacco use and previous hospitalization history,according to the severity of encephalopathy,22 patients with Glasgow coma scale(GCS)0.05),but group A needed an average of 7 cmH2O higher of maximal pressure support during NPPV,and 4,4 and 7 days longer of NPPV time,RICU stay and hospital stay respectively than group B(P<0.05 or P<0.01).NPPV therapy failed in 12 patients(6 in each group)because of excessive airway secretions(7 patients),hemodynamic instability(2),worsening of dyspnea and deterioration of gas exchange(2),and gastric content aspiration(1).Conclusions Selected patients with severe hypercapnic encephalopathy secondary to HARF can be treated as effectively and safely with NPPV as awake patients with HARF due to AECOPD;a trial of NPPV should be instituted to reduce the need of endotracheal intubation in patients with severe hypercapnic encephalopathy who are otherwise good candidates for NPPV due to AECOPD.

  9. The anatomical basis of the influence on micturition function after sacral tumor resection%骶骨肿瘤切刮治疗对排尿功能影响的解剖基础

    Institute of Scientific and Technical Information of China (English)

    王保仓; 赵刚

    2012-01-01

    According to the nature of the sacral tumor, it could lead to the extrusion, invasion and destruction of the sacral nerve. S4 and S5 nerve were usually cut off, when S4 and S5 were fouled by sacral tumors. The tumor tissues of the benign sacral tumor in S3 and above were always scraped within the lesion, so that we should protect the nerve root to save the motion of lower limbs and urination function. The author's experience: after keeping the nerve root of S1 and above, all the patients would be of the loss of urination function, and need to be catheterized in time. After keeping the nerve root of S3 and above, all patients could urinate. After keeping the nerve root of S2 and above, some of patients could urinate while others couldn't. In this paper the anatomical function of the sacral nerve was introduced.%@@ 骶骨肿瘤根据肿瘤性质对在肿瘤内走行的骶神经可以有挤压、侵袭和破坏.下部肿瘤(S4~S5)在切除游离中S4、S5神经通常被切断.位于S3以上的良性肿瘤常在病灶内搔刮肿瘤组织,同时注意保护在肿瘤内通过的骶神经,使之尽量保留双下肢的足踝运动和排尿功能.为此,本文对骶神经的功能解剖做如下介绍.

  10. 骶骨脊索瘤的手术治疗(附15例报告)%Surgical Management of Sacral Chordoma(A Review of Fifteen Cases)

    Institute of Scientific and Technical Information of China (English)

    李帅; 杨操; 杨述华; 邵增务; 郑启新

    2011-01-01

    Objective To evaluate the surgical treatment risks and effects of surgical treatment of sacral chordoma.Methods Fifteen patients with sacral chordoma were followed up. We reviewed the clinical data and analysis of the surgical methods,the causes and treatment measures of complications,and conduct the clinical and imageological evaluation preoperatively and postoperatively. Results The average follow-up time was 49 months. Five cases had died in 5 years postoperation,another one case had died in 2 hours postoperation. Six patients occurred recurrence in 3 years after operation.The dysfunction of bladder occurred in 4 patients whereas none has rectal injury.The symptom of 13 patients in 15 patients had been relieved or disappeared. Conclusion Primary sacral chordoma and recurrence with good general conditions are operative indications. Postoperative recurrenceis related to incomplete removal of tumor. As a whole,the surgical treatments are satisfied,they can prolong the lives of patients and improve the quality of life of patients,relieve pain and symptoms,and create conditions for other adjuvant treatments.%目的 评估骶骨脊索瘤的手术风险和效果.方法 回顾15例骶骨脊索瘤的临床资料,分析手术方式、引起并发症的原因及治疗措施,术前术后作临床及影像学评价.结果 平均随访49个月,术后5年内死亡共5例,另有1例术后2 h死亡.术后3年复发6例.术后发生膀胱功能异常4例,无直肠损伤病例.13例症状缓解或消失.结论 全身状况较好的原发骶骨脊索瘤及复发者均为手术适应证,术后复发与手术局部切除不彻底有关.手术治疗满意,可以延长患者的生命,改善生活质量,减轻痛苦和症状,并为其他辅助治疗创造条件.

  11. Treatment of microsurgery in symptomatic sacral canal cysts%症状性骶管囊肿的显微外科手术治疗

    Institute of Scientific and Technical Information of China (English)

    李家亮; 黄琦; 刘文祥; 李岩; 刘振栓; 李想

    2013-01-01

    Objective To investigate the microsurgical treatment in patients with symptomatic sacral canal cysts. Methods 15 cases of symptomatic sacral canal cyst patients in our hospital from January 2000 to April 2012 were selected, all the patients were treated with excision of the partial cyst wall and mended the communicating hole with a piece of lumbar back fascia and fibrin glue closely, therapecutic effect was observed. Results Cerebrospinal fluid leakage and infection were not found, the cysts were disappeared and found no recrudesce according to the review of lum-bosacral vertebrae MRI during the follow-up visit for 3 months to 5 years. 13 cases were found recovered completely and 2 cases were found recovered partly. All patients were found returned their daily work and life. Conclusion This method of finding the communicating hole carefully, removing the partial cyst wall and repairing the communicating hole with a piece of lumbar back fascia and fibrin glue closely under the microscope is a satisfying technique to treat symptomatic sacral canal cyst.%目的 探讨症状性骶管囊肿的手术治疗方法.方法 选择我院2000年1月~2012年4月收治的症状性骶管囊肿患者15例,采用在显微镜下切除部分囊壁,并用腰背筋膜及生物胶严密修补交通孔的手术方法,观察治疗效果.结果 术后无脑脊液漏及感染发生,经复查腰骶椎MRI示囊肿消失,术后随访3个月~5年,均未见囊肿复发,临床症状完全缓解13例,部分缓解2例,所有患者均恢复了正常工作和生活.结论 术中在显微镜下仔细寻找到交通孔、切除部分囊壁并用腰背筋膜及生物胶严密修补交通孔是治疗症状性骶管囊肿的一种理想方法.

  12. EFFECTIVENESS OF PERFORATOR FLAPS FOR ELDERLY PATIENTS WITH ISCHIA-SACRAL ULCERS%臀部穿支皮瓣治疗老年患者骶尾部褥疮的疗效

    Institute of Scientific and Technical Information of China (English)

    傅荣; 杜丽平; 游晓波

    2011-01-01

    Objective To investigate the operative technique and the effectiveness of perforator flaps for the treatment of elderly patients with ischia-sacral ulcers. Methods Between January 2005 and June 2010, 29 elderly patients with ischia-sacral ulcers were treated. There were 16 males and 13 females, aged from 61 to 75 years (mean, 68 years), including 11 cases of degree Ⅲ and 18 cases of degree Ⅳ according to the standard of the National Pressure Ulcer Advisory Panel (NPUAP). The disease duration was from 5 months to 10 years (median, 5.5 years). The size of ulcers ranged from 7 cm ×6 cm to 12 cm × 10 cm. Of them, 8 cases were companied by cerebral vascular disorders, 6 cases by Alzheimer disease, 11 cases by paraplegia, and 4 cases by others. The flap size ranged from 8 cm × 6 cm to 14 cm × 12 cm. The donor sites were sutured directly. Results Distal flap necrosis occurred in 3 cases (10.3%) 2 days after operation and healed after symptomatic treatment, and the remaining flaps survived and wound healed by first intention with first intention rate of 89.7%. The incisions of donor sites healed primarily. Two cases (6.9%) had infection 1 week after operation and 1 case (3.4%) had wound dehiscence 10 days after operation. Twenty-seven patients were followed up 6 months to 5 years (mean, 3 years). Two cases recurred at 1 and 3 years after operation, respectively. One died of infection, and the other healed by debridement and suture. The flaps of other patients had good texture, color, and elasticity. Conclusion As long as the indications are controlled strictly, good effectiveness can be achieved in the treatment of elderly patients with ischia-sacral ulcers by using perforator flaps.%目的 探讨应用臀部穿支皮瓣治疗老年患者骶尾部褥疮的临床效果.方法 2005年1月-2010年6月,收治29例老年骶尾部褥疮患者.男16例,女13例;年龄61~75岁,平均68岁.病程5个月~10年,中位病程5.5年.根据美国国家褥疮顾问小

  13. Disrafias vertebro-medulares caudais: formas intra-sacras Caudal spinal cord disraphism: intra-sacral forms. Report of 4 cases

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    Pedro M. Sampaio

    1975-03-01

    Full Text Available Os autores abordam a gênese das disrafias vértebro-medulares caudais, e se atêm aos divertículos meníngeos intra-sacros. Encontraram na literatura pertinente, descrição de 24 casos e acrescentaram 4 de sua experiência. A incontinencia urinaria foi sintoma proeminente e o resultado cirúrgico compensador. O diagnóstico foi firmado por mielografia.The mean theories of the sacral spinal dysraphisms are reviwed and 4 cases of "meningeal intrasacral diverticulum" are reported. The authors prefer this term to the more common "intrasacral occult meningocele". The proeminent symptom in their cases was late vesical incontinence, which disappeared after surgery. In the pertinent litterature 24 similar cases were described till now.

  14. Percutaneous cannulated screw fixation of sacral fractures and sacroiliac joint disruptions with CT-controlled guidewires performed by interventionalists: Single center experience in treating posterior pelvic instability

    International Nuclear Information System (INIS)

    Highlights: • Minimally invasive sacroiliac screw fixation can be performed under CT-imaging. • Guidewires help in precise placement of cannulated sacroiliac screw. • Only a diminishing rate of misplacements can be seen. • The method appears to be a safe and very accurate procedure. - Abstract: Objective: The purpose of our study was to evaluate minimally invasive sacroiliac screw fixation for treatment of posterior pelvic instability with the help of CT controlled guidewires, assess its accuracy, safety and effectiveness, and discuss potential pitfalls. Methods: 100 guidewires and hollow titan screws were inserted in 38 patients (49.6 ± 19.5 years) suffering from 35 sacral fractures and/or 16 sacroiliac joint disruptions due to 33 (poly-)traumatic, 2 osteoporotic and 1 post-infectious conditions. The guidewire and screw positions were analyzed in multiplanar reconstructions. Results: The mean minimal distance between guidewire and adjacent neural foramina was 4.5 ± 2.01 mm, with a distinctly higher precision in S1 than S2. Eight guidewires showed cortical contacts, resulting in a total of 2% mismatched screws with subsequent wall violation. The fracture gaps were reduced from 3.6 ± 0.53 mm to 1.2 ± 0.54 mm. During follow-up 3 cases of minor iatrogenic sacral impaction (<5 mm) due to the bolting and 2 cases of screw loosening were observed. Interventional time was 84.0 min with a mean of 2.63 screws per patient whilst acquiring a mean of 93.7 interventional CT-images (DLP 336.7 mGy cm). Conclusions: The treatment of posterior pelvic instability with a guidewire-based screw insertion technique under CT-imaging results in a very high accuracy and efficacy with a low complication rate. Careful attention should be drawn to radiation levels

  15. Peripheral injury of pelvic visceral sensory nerves alters GFRa (GDNF family receptor alpha localization in sensory and autonomic pathways of the sacral spinal cord

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    Shelley Lynne Forrest

    2015-04-01

    Full Text Available GDNF (glial cell line-derived neurotrophic factor, neurturin and artemin use their co-receptors (GFRα1, GFRα2 and GFRα3, respectively and the tyrosine kinase Ret for downstream signalling. In rodent dorsal root ganglia (DRG most of the unmyelinated and some myelinated sensory afferents express at least one GFRα. The adult function of these receptors is not completely elucidated but their activity after peripheral nerve injury can facilitate peripheral and central axonal regeneration, recovery of sensation, and sensory hypersensitivity that contributes to pain. Our previous immunohistochemical studies of spinal cord and sciatic nerve injuries in adult rodents have identified characteristic changes in GFRα1, GFRα2 or GFRα3 in central spinal cord axons of sensory neurons located in dorsal root ganglia. Here we extend and contrast this analysis by studying injuries of the pelvic and hypogastric nerves that contain the majority of sensory axons projecting to the pelvic viscera (e.g., bladder and lower bowel. At 7 d, we detected some effects of pelvic but not hypogastric nerve transection on the ipsilateral spinal cord. In sacral (L6-S1 cord ipsilateral to nerve injury, GFRα1-immunoreactivity (IR was increased in medial dorsal horn and CGRP-IR was decreased in lateral dorsal horn. Pelvic nerve injury also upregulated GFRα1- and GFRα3-IR terminals and GFRα1-IR neuronal cell bodies in the sacral parasympathetic nucleus that provides the spinal parasympathetic preganglionic output to the pelvic nerve. This evidence suggests peripheral axotomy has different effects on somatic and visceral sensory input to the spinal cord, and identifies sensory-autonomic interactions as a possible site of post-injury regulation.

  16. 先天性小儿腰骶管内畸胎瘤一例%Congenital Pediatric Teratoma in Sacral Canal: A Case Report

    Institute of Scientific and Technical Information of China (English)

    赵振国; 李传郡; 邹亮; 鲍同柱

    2012-01-01

    Teratoma is the most common germ cell tumors in children. It is mostly located in sacrococcygeal region and has high malignant potential. Teratoma can be divided into mature type, immature type and malignant teratoma. Teratoma in sacral canal accounts for 0. 15% of intraspinal tumor with unknown pathogenesis. This article reported a case of teratoma and the case has developed several fistulas with jelly-like secretions. The development of fistulas causes adhesion of surrounding blood vessels and nerves as well as fibrosis, making the operation very difficult to perform. Residual tumor will lead to relapse and possible cancerization. So in order to prevent the development of fistulas and improve the patient's prognosis, timely diagnosis and operation are the most effective methods for teratoma in sacral canal.%畸胎瘤是儿童最常见的生殖细胞肿瘤,好发于骶尾部,具有恶性、潜能高的特点.可分为成熟型、未成熟型和恶性畸胎瘤.其中腰骶管内畸胎瘤约占椎管内肿瘤的0.15%,其发病机制尚不清楚.本病例为畸胎瘤,随着病情的发展在骶尾部和下腹部形成多处窦道,并有胶胨样分泌物流出.窦道的形成造成周围血管、神经粘连及纤维化,增加了手术难度,如有残留瘤组织易复发并有癌变的可能.为了防止窦道形成及癌变,提高患者预后,及时确诊并实施手术是治疗骶管内畸胎瘤最有效的方法.

  17. [Chronicity, chronicization, systematization of delusions].

    Science.gov (United States)

    Trapet, P; Fernandez, C; Galtier, M C; Gisselmann, A

    1984-05-01

    Chronicity in psychopathology is indicative of a term, a decay. Chronicization only leads the way to this term. Here, chronicization is taken literally as an inscription in the time course of delusions. The mechanism of systematization seems to be a central mark in the approach to chronic delusions. It is not an alienation or an irreversible closing but an attempted accommodation with reality in the life of psychotic subjects, irrespective of the delusional structure. The role of therapy and drug treatment as a follow-up may in that case assume another meaning.

  18. Lumbopelvic reconstruction for treatment of unstable sacral fractures%腰骨盆重建术治疗不稳定骶骨骨折

    Institute of Scientific and Technical Information of China (English)

    王雷; 柳超; 田纪伟

    2013-01-01

    Objective To evaluate the clinical outcome of lumbopelvic reconstruction in treatment of unstable sacral fractures.Methods A retrospective study was performed on 17 cases (12 males and 5 females; at 23-55 years of age,mean 35.5 years) of unstable sacral fractures treated from January 2007 to June 2012.There were 11 cases of zone Ⅱ fracture and six zone Ⅲ fracture according to Denis classification and nine cases of type B fracture and eight type C fracture according to Tile classification.Sacral nerve injury assessed by Gibbons criteria was 3 points in seven cases and 4 points in 10 cases.Lumbar-pelvic ring stability of the patients was restored by posterior decompression and lumbar pedicle screw fixation combined with sacral pedicle screw or iliac screw fixation.Fracture reduction and healing were measured by X-ray film or CT scan; functional outcomes by Majeed scale; neurological outcome by Gibbons criteria.Results All the cases were followed up for mean 16 months (range,8-24 months).X-ray and CT follow-up revealed all fractures had bone union at average 6 months in the absence of remnant sacrum malformation,pseudarthrosis and fracture redisplacement.Iliac screw loosening not yet breakage happened to one case.In total,12 cases had full recovery of neurological function; four significant improvement,but experienced different degree of footdrop and hypoesthesia of lower extremities; one poor improvement and experienced not only lower extremity dysfunction but also bladder and bowel dysfunction.According to Majeed scale in the final follow-up,clinical functional outcome was excellent in 12 cases,good in three,fair in one and poor in one,with excellent-good rate of 88%.Gibbons score improved from preoperative (3.29 ±0.47) points to postoperative (1.53±0.94) points (t=12.94,P<0.01).Conclusion Posterior decompression plus lumbar pedicle screw fixation combined with sacral pedicle screw and/or iliac screw fixation is an effective method for treatment

  19. Blood pressure

    Science.gov (United States)

    ... the walls of the arteries is called blood pressure. Blood pressure is measured both as the heart contracts, which ... as it relaxes, which is called diastole. Normal blood pressure is considered to be a systolic blood pressure ...

  20. Biomechanical evaluation of connectible skills using iliac screw and lumbar-sacral spine pedicle screw in the fixation between lumbar-sacral spine and pelvis%髂骨钉与腰骶椎弓根钉连接技术在腰骶骨盆固定中的生物力学评价

    Institute of Scientific and Technical Information of China (English)

    苏汝堃; 刘兴漠; 邓颖辉; 李佛保; 潘滔

    2008-01-01

    BACKGROUND: There have been many methods of fixation between lumbar-sacral spine and pelvis. However, a safe, firm, and ideal method of internal fixation has not been found.OBJECTIVE: This study was designed to investigate the stability of the fixation between lumbar-sacral spine and pelvis with the connectible skills using iliac screw and lumbar-sacral spine pedicle screw.DESIGN, TIME AND SETTING: This study, a control experiment, was performed at the Institute of Biomechanics, Sun Yat-sen University, Guangzhou, Guangdong Province, China between January 2006 and December 2007.MATERIALS: The lumbar-sacral spine and pelvis specimens were collected from six freshly cryo-preserved male adult corpses caused by trauma. Iliac screw (8.5mm×100mm), L5 pedicle screw (6.5mm×45mm), and S1 pedicle screw (6.5mm×35mm) were provided by Sofamor Company, USA. MTS 858 Bionix Material Testing System (USA) was also used.METHODS: The lumbar and iliac vertebrae, pelvis from six fresh frozen cadaveric specimens were operated in three different ways of fixation respectively: iliac ala lag screw, L5-S1 pedicle screw rod system, iliac screw and L5 pedicle screw connecting system. Three ways of fixation as mentioned above were compared with the intact group in biomechanical stability.MAIN OUTCOME MEASURES: The mobility of whirl, lateral bending, proneness, and backward stretching among groups.RESULTS: Using iliac screw for the fixation between lumbar-sacral spine and pelvis turned out to be the best in stability. The range of motion (ROM) decreased obviously in each situation. The three-dimensional mobility in the 6.4Nm moment of force was (1.07±0.86)° for whirl, (0.95±0.47)° for lateral bending, (1.22±0.67)° for proneness, and (1.80±0.73)° for backward stretching. There was significant difference between the intact group and the group carried out by iliac screw and L5 pedicle screw for the fixation between lumbar-sacral spine and pelvis (P<0.01).CONCLUSION: The connectible skills

  1. Pulse pressure is not an independent predictor of outcome in type 2 diabetes patients with chronic kidney disease and anemia--the Trial to Reduce Cardiovascular Events with Aranesp Therapy (TREAT).

    Science.gov (United States)

    Theilade, S; Claggett, B; Hansen, T W; Skali, H; Lewis, E F; Solomon, S D; Parving, H-H; Pfeffer, M; McMurray, J J; Rossing, P

    2016-01-01

    Pulse pressure (PP) remains an elusive cardiovascular risk factor with inconsistent findings. We clarified the prognostic value in patients with type 2 diabetes, chronic kidney disease (CKD) and anemia in the Trial to Reduce cardiovascular Events with Aranesp (darbepoetin alfa) Therapy. In 4038 type 2 diabetes patients, darbepoetin alfa treatment did not affect the primary outcome. Risk related to PP at randomization was evaluated in a multivariable model including age, gender, kidney function, cardiovascular disease (CVD) and other conventional risk factors. End points were myocardial infarction (MI), stroke, end stage renal disease (ESRD) and the composite of cardiovascular death, MI or hospitalization for myocardial ischemia, heart failure or stroke (CVD composite). Median (interquartile range) age, gender, eGFR and PP was 68 (60-75) years, 57.3% women, 33 (27-42) ml min(-1) per 1.73 m2 and 60 (50-74) mm Hg. During 29.1 months (median) follow-up, the number of events for composite CVD, MI, stroke and ESRD was 1010, 253, 154 and 668. In unadjusted analyses, higher quartiles of PP were associated with higher rates per 100 years of follow-up of all end points (P⩽0.04), except stroke (P=0.52). Adjusted hazard ratios (95% confidence interval) per one quartile increase in PP were 1.06 (0.99-1.26) for MI, 0.96 (0.83-1.11) for stroke, 1.01 (0.94-1.09) for ESRD and 1.01 (0.96-1.07) for CVD composite. Results were similar in continuous analyses of PP (per 10 mm Hg). In patients with type 2 diabetes, CKD and anemia, PP did not independently predict cardiovascular events or ESRD. This may reflect confounding by aggressive antihypertensive treatment, or PP may be too rough a risk marker in these high-risk patients.

  2. 血尿酸浓度与慢性心力衰竭患者的血糖血脂血压相关性研究%Analysis on the relationships between serum uric acid concentration and blood -sugar, blood -lipid, and blood- pressure in patients with chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    宋健雄

    2011-01-01

    Objective To explore the relationships between serum uric acid(SUA) concentration and blood - sugar, blood lipid, and blood - pressure in patients with chronic heart failure. Methods Eighty -four patients suffering from chronic heart failure were used as the observation group and another 84 healthy people with normal heart function as the control group. The SUA, blood -pressure, fasting blood- glucose, blood- lipid including cholesterol, three acids glyceride, high -density lipo- protein, and low- density lipo- protein were determined in two groups. Results Compared with the control group, the patients with chronic heart failure have higher incidence in high SUA, high choles-terol, high blood - pressure, and abnormality in blood - sugar and blood - lipid. ( P < 0.05 ).Conclusions High SUA is relative to blood - sugar, blood - lipid, and blood - pressure in patients with chronic heart failure.%目的 探讨血尿酸浓度与慢性心力衰竭患者血糖、血脂、血压的关系.方法 选择84例慢性心力衰竭患者为观察组,另选84例心功能正常者为对照组,测定血尿酸、血压、空腹血糖、血脂,包括血浆总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白.结果 慢性心力衰竭组中高尿酸、高血压、血糖和血脂异常的发生率较高,与对照组比较差异有统计学意义(P<0.05).结论 高尿酸血症与慢性心力衰竭患者的血糖、血脂、血压水平密切相关.

  3. Chronic cholecystitis

    Science.gov (United States)

    ... foods may relieve symptoms in people. However, the benefit of a low-fat diet has not been proven. Alternative Names Cholecystitis - chronic Images Cholecystitis, CT scan Cholecystitis, cholangiogram Cholecystolithiasis Gallstones, cholangiogram Cholecystogram References Wang ...

  4. Chronic Meningitis

    Science.gov (United States)

    ... School Lunch Lines FDA Cracks Down on Antibacterial Soaps Health Tip: Schedule a Back-to-School Dental ... the Professional Version Meningitis Introduction to Meningitis Acute Bacterial Meningitis Viral Meningitis Noninfectious Meningitis Recurrent Meningitis Chronic ...

  5. Pressure ulcer prevention and treatment: use of prophylactic dressings

    Directory of Open Access Journals (Sweden)

    Reid K

    2016-10-01

    Full Text Available Kathleen Reid,1 Elizabeth A Ayello,2 Afsaneh Alavi,3 1Department of Nursing Practice and Education, Bridgepoint Active Healthcare, Toronto, Canada; 2School of Nursing, Excelsior College, Albany, NY, USA; 3Department of Medicine, University of Toronto, Toronto, Canada Abstract: The management of pressure ulcers is challenging for health care providers across disciplines. Pressure ulcers have significant impact on emotional and physical wellbeing, quality of life, and health care costs. The use of wound dressings could be an important and cost-effective strategy in preventing pressure ulcers. The main types of dressings that are examined for this purpose in the literature are foam, hydrocolloid, and films. Some small studies have shown a preventative role for sacral dressings with low-shear backings, though they raise concerns about over-hydration of the skin. Further research demonstrates the application of barrier films over bony prominences to have a prophylactic effect; however, adhesive dressings can also contribute to shearing forces on the skin. There is a vast body of research that examines the use of dressings to prevent pressure ulcers; however, there is limited high-level evidence, such as randomized control trials. A 2013 Cochrane review indicated that there is a paucity of high-level evidence to support the prophylactic use of dressings to prevent pressure ulcers; this paper will examine the emerging literature and consider its relevance to pressure ulcer prevention protocols. Keywords: quality of life, hydrocolloid dressing, topical agent

  6. Epidemiologia e tratamento das úlceras de pressão: experiência de 77 casos Epidemiological profile and treatment of pressure sores: experience with 77 cases

    Directory of Open Access Journals (Sweden)

    Márcio Paulino Costa

    2005-01-01

    crompression due to sitting, lying or wearing brace in a heathy person results in discomfort and pain due to local isquemia. The normal protective pahtways are interrupted, however, in paraplegics, quadriplegic or the signals are ignored in severely de hibilitade, eldery or chronic ill patients. The pressure sore develops in these patients. Few papers have been done in Brazil abour pressure sores, despite economic problem envolved with. The purpose of this paper is to evaluate the epidemiology, treatment and complications of pressure sores in the Hospital das Clínicas (University of São Paulo from February 1997 to March 1999 in the Orthopedics Institute. A prospective study has been done. Data were evaluated as to the sex, age, sites, classification, type of treatment employed, length of stay and complications. The treatment was evaluated by the success rate and recurrence rate . The average follow-up period was 1 year and a half, ranging from 6 month to 2 years. 77 pressure sores in 45 patients were apraised. 36 men and 9 women, age range 17-64, mean 34,78 years. Of the patients, 100% had severe spinal cord injuries, and most of them victims of gun shot (60%. 93,3% of the wound were chronic (present longer than 3 months. 77,92% were treated by surgical procedures, and most of them with myocutaneous flaps (45%. The success rate changed with the site of the lesion: 80% trochanter, 84% sacrum and 66,6% ischium. The recurrence rate was 25%. The complication rate also changed with the site of the lesion: 84% trocanter, 64% sacrum and 50% isquium.

  7. 骶骨脊索瘤术后复发的相关因素分析%Analysis of recurrent factors of sacral chordoma

    Institute of Scientific and Technical Information of China (English)

    陈康武; 杨惠林; 王根林; 陆俭; 季一鸣; 朱立帆; 莫建强

    2009-01-01

    [目的]探讨影响骶骨脊索瘤患者术后复发的相关因素.[方法]对1993~2008年间完成初次手术的28例骶骨脊索瘤病例进行随访,将患者术后CDFS期作为应变量,选取患者发病年龄、性别、肿瘤大小、部位、初次手术方式、有无局部浸润以及术后是否放疗等因素作为自变量,采用Kaplan-Meier法,Log-Rank法进行分析.[结果]28例患者随访时间平均为(76.2±47.2)个月,最后随访时共复发13例(46.4%),首次复发时间平均为(35.9±27.2)个月.Kaplan-Meier法单因素变量分析显示肿瘤部位、手术方式、有无局部浸润是影响骶骨脊索瘤患者术后复发的独立预测因素(P0.05).[结论]肿瘤部位高、手术切除不彻底和术前发生局部浸润患者复发率较高,术后CDFS期较短.扩大切除术有利于降低术后的复发率,延长术后CDFS期,术前仔细评估MRI有助于选择合理的手术方案.%[Objective] To retrospectively investigate recurrent factors of sacral chordoma after surgical treatment [Methods] This retrospective study included 28 patients with sacral chordoma who underwent primary operation from 1993 to 2008. The data on gender, age, tumor size, tumor location, invasion of the surrounding muscle, surgical type, and radiation therapy were reviewed. Continuous disease -free survival time (CDFS) was calculated according to the Kaplan - Meier method and statistical analysis was performed by using Log - Rank test [Results] The mean follow - up time was 76. 2 months. At the final follow - up, 13 of 28 patients (46.4%) developed local recurrences, and the average recurrence time was 35.9 months. Kaplan - Meier single factor analysis displayed that tumor location, invasion of the surrounding muscle, and surrgical type were the risk of the recurrence of sacral chordoma after surgical treatment ( P 0.05) . [ Conclusion] The higher level of tumor involvement, incomplete excision, and invasion into the surrounding muscles will probably

  8. Chronic myelogenous leukemia (CML)

    Science.gov (United States)

    CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... nuclear disaster. It takes many years to develop leukemia from radiation exposure. Most people treated for cancer ...

  9. Chronic obstructive pulmonary disease

    Science.gov (United States)

    ... airways disease; Chronic obstructive lung disease; Chronic bronchitis; Emphysema; Bronchitis - chronic ... a protein called alpha-1 antitrypsin can develop emphysema. Other risk factors for COPD are: Exposure to ...

  10. Lung Compliance and Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    D. Papandrinopoulou

    2012-01-01

    Full Text Available Chronic obstructive pulmonary disease, namely, pulmonary emphysema and chronic bronchitis, is a chronic inflammatory response of the airways to noxious particles or gases, with resulting pathological and pathophysiological changes in the lung. The main pathophysiological aspects of the disease are airflow obstruction and hyperinflation. The mechanical properties of the respiratory system and its component parts are studied by determining the corresponding volume-pressure (P-V relationships. The consequences of the inflammatory response on the lung structure and function are depicted on the volume-pressure relationships.

  11. 髂骨螺钉骨盆置钉方法的临床解剖研究%Clinical anatomic research of pelvic screw methods with sacral nails

    Institute of Scientific and Technical Information of China (English)

    聂海滨; 高晓群

    2014-01-01

    Objective To clarify the angle parameters of ilium after implantation screw nails way,and the feasibility of the ilium screw placement and security,in order to provide the reference of ilium nail.Methods Einhteen anticorrosion pelvic specimens were chosen,the soft tissue of peluic area carefully done.The measurement data were:①the S1 pedicle observation and measurement.②using sacral nailing with the nothod of this study for 18 pelvic ring posterior injury patients and follow-up its therapeutic effect.Results (1)the S1 pedicle measurement results:① The S1 pedicle height (20.2 ± 2.3) mm.②S1 pedicle width (27.7 ±2.0) mm.③S1 point to needle into the pedicle center distance (49.1 ±3.6) mm.④The needle point to S1 cortex of vertebral body before side range (86.5 ± 3.8) mm.⑤The needle point located at S1 under ahead after iliac mark(24.6 ±2.9) nun,above greater sciatic notch(41.8 ±3.4) mm.⑥Direction perpendicular to the needle for the lateral aspect of the ilium after wing,then end to tilt (7.1 ±2.3)°,back to tilt(7.7 ±3.8)°.(2)Clinical application evaluation:18 cases of sacral was placed for 19 sacral nail,and the X-ray films review showed sacral nail is normally located in S1 pedicle and vertebral body,and pelvic reset is also good.Conclusions ①The sl pedicle sacroiliac joint screws should choose long for 75 mm screws for appropriate.②The S1 pedicle level sacroiliac joint screws into the needle is located in the point of sciatic cut trace 40 mm above,after coming under the front was 25 mm.③The direction perpendicular to the needle for the lateral aspect of the ilium after wing,then end to tilt 5°-10°,back to tilt 5°-10°.%目的 明确经髂后上棘植入髂骨螺钉的角度参数,对髂骨螺钉置入的可行性以及安全性进行全方位的探讨,为研制适合国人的髂骨钉提供参考数据.方法 采用18具防腐骨盆标本,对骨盆周围软组织仔细剔除.测量的数据有:①Sl椎弓根观测与测量.②采用

  12. Pressure Ulcers Surveillance Report

    Directory of Open Access Journals (Sweden)

    Zehra Esin Gencer

    2015-04-01

    Full Text Available Objective: Pressure ulcer is a chronic wound. It reduces the quality of life of the elderly and individuals with restricted range of motion. It prolongs hospital stay and increases the risk of complications. The cost is quite high. Preventive actions for the prevention of pressure ulcers should be developed. Planning protocols and standards of care are among the main targets. Material and Method: Research was conducted in one-year period between 2012 May and 2013 May on patients who were followed up in Akdeniz University Hospital clinics and intensive care unit with pressure ulcers. The research population consisted of 569 patients. Patient data were recorded in SPSS 16 for Windows program. Statistical analyzes were performed with retrospective methods. The demographic characteristics of patients with pressure ulcers were analyzed as frequency and descriptive statistics. Prevalence and incidence of one year were calculated. Results: Of the patients, 58% were males, 42% were females. Of the patients, 36% were in the age range of 61-80 years, and their average length of stay was 42,9 days. Of the patients, 70% were at stage 2 and 3. In 15% of patients pressure ulcers occurred on the first day of hospitalization. Pressure ulcers were developed between days 2 and 10 in 59% of the patients. Prevalence rate was 2.5%, the incidence was 1.9%, the prevalence rate was 5.9% in the intensive care unit. Conclusion: It is easier to prevent pressure ulcers than treating.

  13. Influence of gross saponins from tribulus terrestris L on SOD activity and MDA content for chronic high intraocular pressure in rabbit%白蒺藜皂苷对慢性高眼压兔视网膜SOD活性和MDA含量的影响

    Institute of Scientific and Technical Information of China (English)

    李诺; 黄丽娜; 曾平

    2013-01-01

    AIM: To observe influence of gross saponins from tribulus terrestris L (GSTT) on SOD activity and MDA content for chronic high intraocular pressure in rabbit, and discusses the retina oxidative damage inhibition on chronic high intraocular pressure model of rabbit. METHODS: Totally 24 healthy New Zealand rabbits were randomly divided into 4 groups; normal control group (A group); high intraocular pressure model blank group (B group); high intraocular pressure model with GSTT treated group (C group); high intraocular pressure model with Erigeron brevicapas hand mass ( EBHM) treated group (D group). High intraocular pressure model was induced by 20g/L methylcellulose injection into the anterior chamber in B group, C group and D group. D group was injected 5 mg/kg GSTT and C group was injected 4. 5mg/kg EBHM and measured intraocular pressure with Schiotz tonometer every day for 4 weeks. The retina tissue superoxide dismutase (SOD) and maleic dialdehyde(MDA) content were detected 28 days later. RESULTS: After glaucoma model of rabbit eyes were established, the intraocular pressure during observation period was maintained in 32-39mmHg; High intraocular pressure model blank group and normal control group, EBHM treatment group, GSTT treatment group were compared, the differences of retina MDA, SOD content had statistical significance (P0. 05); EBHM treatment group, GSTT te atment group and normal o ntrol group were compared, the content of MDA in the retina was still slightly higher (P0.05),EBHM治疗组、GSTT组与正常对照组比较视网膜中MDA的含量仍略高(P<0.05),SOD的含量略降低(P<0.05).结论:白蒺藜皂苷能有效提高慢性高眼压下兔视网膜中SOD活性,降低MDA含量,从而对持续性高眼压视网膜氧化应激具有保护作用.

  14. Chronic pain - resources

    Science.gov (United States)

    Pain - resources; Resources - chronic pain ... The following organizations are good resources for information on chronic pain: American Chronic Pain Association -- www.theacpa.org National Fibromyalgia and Chronic Pain Association -- www.fmcpaware.org ...

  15. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... Low back pain is common. Almost everyone has back pain at some time in their life. Often, the exact cause ...

  16. Chronic motor tic disorder

    Science.gov (United States)

    Chronic vocal tic disorder; Tic - chronic motor tic disorder ... Chronic motor tic disorder is more common than Tourette syndrome . Chronic tics may be forms of Tourette syndrome. Tics usually start ...

  17. Chronic Pelvic Pain

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Chronic Pelvic Pain Home For Patients Search FAQs Chronic Pelvic Pain ... Pain FAQ099, August 2011 PDF Format Chronic Pelvic Pain Gynecologic Problems What is chronic pelvic pain? What ...

  18. Employees with Chronic Pain

    Science.gov (United States)

    ... Home | Accommodation and Compliance Series: Employees with Chronic Pain By Beth Loy, Ph.D. Preface Introduction Information ... at http://AskJAN.org/soar. Information about Chronic Pain How prevalent is chronic pain? Chronic pain has ...

  19. Chronic coughing

    International Nuclear Information System (INIS)

    Chronic coughing was acknowledged to result from pathological state of the respiratory organs. Cardiac diseases could be accompanied by coughing as well. It was recommended to perform x-ray examinations, including biomedical radiography of the chest, computerized tomography, scintiscanning with 67Ga-citrate, bronchi examination in order to exclude heart disease. The complex examination permitted to detect localization and type of the changes in the lungs and mediastinum, to distinguish benign tumor from malignant one

  20. Avaliação da circulação arterial pela medida do índice tornozelo/braço em doentes de úlcera venosa crônica Evaluation of arterial circulation using the ankle/brachial blood pressure index in patients with chronic venous ulcers

    Directory of Open Access Journals (Sweden)

    Fabiane Noronha Bergonse

    2006-03-01

    Full Text Available FUNDAMENTOS: As úlceras venosas dos membros inferiores são freqüentes e têm grande impacto na qualidade de vida e produtividade do indivíduo, além de alto custo para a saúde pública. OBJETIVOS: Detecção de alterações arteriais em pacientes de úlcera venosa crônica dos membros inferiores com emprego de método não invasivo, de modo a discriminar aqueles em que estaria contra-indicado o tratamento compressivo. MÉTODOS: Foram estudados 40 doentes portadores de úlcera venosa crônica, com o intuito de se avaliar a presença de doença arterial periférica pela medida do índice tornozelo/braço por doppler-ultra-som. RESULTADOS: O índice tornozelo/braço mostrou-se alterado (menor que 1 em 9/22 (40,9% doentes com úlcera venosa crônica e hipertensão arterial concomitante, e apenas em 1/13 (7,7% doentes de úlcera venosa crônica sem hipertensão arterial. CONCLUSÕES: Doentes de úlcera venosa crônica e hipertensão arterial concomitantes devem ser submetidos rotineiramente à medida do índice tornozelo/braço para detecção de possível insuficiência arterial periférica associada.BACKGROUND: Chronic venous ulcers are extremely frequent and have a significant impact on quality of life and work productivity of individuals, in addition to high costs to public health. OBJECTIVES: Detection of arterial circulation alterations in chronic venous ulcer legs using a non-invasive method to discriminate patients not indicated to have compressive treatment. METHODS: Forty patients with chronic venous ulcers were investigated for the presence of peripheral arterial disease with measurement of the ankle/brachial index by Doppler ultrasound. RESULTS: The resting ankle/brachial pressure index was abnormal (lower than 1 in 9/22 (40.9% patients with concomitant chronic venous ulcers and hypertension and only in one out of 13 (7.7% patients with chronic venous ulcers and no hypertension. CONCLUSIONS: Patients with concomitant chronic venous

  1. Peer Pressure

    Science.gov (United States)

    ... How Can I Help a Friend Who Cuts? Peer Pressure KidsHealth > For Teens > Peer Pressure Print A A A Text Size What's in ... She'd just had a big dose of peer pressure. Who Are Your Peers? When you were a ...

  2. Vital Signs - High Blood Pressure

    Centers for Disease Control (CDC) Podcasts

    2012-10-02

    In the U.S., nearly one third of the adult population have high blood pressure, the leading risk factor for heart disease and stroke - two of the nation's leading causes of death.  Created: 10/2/2012 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/17/2012.

  3. Estudio epidemiológico de las luxaciones sacroilíacas caninas y de su tratamiento - Epidemiological study about dog´s ilio-sacral luxations and their treatment

    Directory of Open Access Journals (Sweden)

    Casasola, A.

    2010-07-01

    Full Text Available ResumenSe ha realizado un estudio retrospectivo en 23 perros recibidos en laConsulta de Cirugía de la Facultad de Veterinaria de la Universidad deExtremadura a los que se les diagnosticó subluxación o luxación sacroilíaca unilateral o bilateral. El 1,06% de los perros con lesiones traumatológicas y/o ortopédicas tienen luxación sacroilíaca. El 39,13% de los casos de luxaciones sacroilíacas pesan menos de 10 kg. y el 73,9% son menores de 2 años. El 82,6% se deben a atropellos por vehículos de motor. El 20,7% (23/111 de las fracturas de pelvis en perros se acompañan de luxaciones sacroilíacas. A ninguno de los 16 casos remitidos por otro veterinario se le había diagnosticado la luxación sacroilíaca. Diagnóstico que no debe ser pasado por alto, porque, en nuestro estudio, el 28,6% de los casos se asociabacon déficits neurológicos. Un 86,25% de las luxaciones sacroilíacasestaban asociadas a otras lesiones, como fracturas de ilion, isquion,pubis, fémur, luxación lumbosacra o arrancamiento sacrococcígeo.La técnica quirúrgica se ha realizado con un abordaje dorsal y consistía, fundamentalmente, en la estabilización de la articulación con tornillos,agujas de Kirschner o combinaciones de ambos. En un 60% de los casos (6/10 se produjeron complicaciones intraoperatorias. En 4/6 por problemas en la colocación de implantes, bien inserciones repetidas o malposiciones. Las complicaciones postoperatorias acaecieron en el 30% (3/10, un caso por infección y dos por movilización de los implantes. En el 25% de los casos que llevaban agujas de Kirschner se produjeron migraciones de las mismas.SummaryA retrospective study in 23 dogs received in the Surgery Department ofthe Veterinary Faculty of Extremadura´s University whose diagnoseswere unilateral or bilateral ilio-sacral sub-luxation or luxation has been done. One point zero six percent of the dogs with traumatological and/or orthopedical injuries have ilio-sacral luxation. The

  4. 核素骨显像在骶骨肿瘤术前诊断中的应用%Bone scintigraphy used in the preoperative diagnosis of sacral tumor

    Institute of Scientific and Technical Information of China (English)

    李原; 赵亚妹; 王茜; 岳明纲; 李河北; 洪莲; 聂玉新; 王玉; 张彩群; 梁铁军

    2010-01-01

    目的 评价术前骨显像在骶骨肿瘤诊断中的临床价值.方法 103例骶骨肿瘤患者术前进行了99Tcm-亚甲基二膦酸盐(MDP)全身骨显像,其中39例加做了局部断层显像.全身显像用于观察有无多骨病变及骶骨肿瘤对显像剂的摄取;断层显像用于进一步观察骶骨肿瘤的核素摄取特征.结果 该组恶性肿瘤为65例,良性病变38例.骨显像在17.5%(18/103)的患者中检出了多发病灶,51.7%(12/21)的转移性骶骨瘤患者在骨显像上仅表现骶骨单发病变.骶骨肿瘤表现为放射性减低型者在平面显像中占46.6%(48/103),在断层显像中占84.6%(33/39).放射性浓聚型或伴局部浓聚的放射性减低型骶骨肿瘤多为恶性病变;而单纯的放射性减低型骶骨肿瘤在无多骨病变发生的情况下多为良性病变;呈现"炸面圈"征的骶骨肿瘤则多为骨巨细胞瘤.结论 骶骨肿瘤术前骨显像有助于全身多发病变的筛查,但对于单发的转移性肿瘤其诊断价值有限;观察肿瘤对显像剂的摄取特征,可为其鉴别诊断提供帮助.%Objective To evaluate the clinical significance of bone scintigraphy in the preoperative diagnosis of sacral tumor. Methods Preoperative 99Tcm-methylene diphosphonate (MDP) whole body bone scintigraphy was performed in total of 103 patients with sacral tumor for whole body survey and radionuclide uptake in the sacral tumor. Of these 103 patients,39 had SPECT. According to the osteoblastic reaction in bone SPECT studies,patterns of tumor with a "hot" lesion was defined as type Ⅰ,a "cold" lesion accompanied with partial uptake was defined as type Ⅱ,a purely "cold" lesion was defined as type Ⅲ,and a "cold" lesion with marginal uptake which produced "doughnut sign" was defined as type Ⅳ. Imaging interpretation was correlated with the final pathologic diagnosis. Results Of the 103 patients,18 ( 17.5% ) had polyostotic involvement. About 46.6% (48/103 ) in planar and 84.6% ( 33/39 ) in

  5. Total sacrectomy via posterior approach for malignant sacral tumors%单纯后路全骶骨切除治疗骶骨恶性肿瘤

    Institute of Scientific and Technical Information of China (English)

    孙伟; 陈泉池; 马小军; 华莹奇; 蔡郑东

    2014-01-01

    目的 探讨累及高位(S1、S2)原发骶骨恶性肿瘤行单纯后路全骶骨切除术的手术指征、手术入路、手术切除方式及手术并发症.方法 回顾性分析2010年3月至2011年3月,采用单纯后路全骶骨切除髂腰重建手术治疗5例原发骶骨恶性肿瘤患者资料,男3例,女2例;年龄32~ 55岁,平均41岁.影像学检查均显示溶骨性破坏,4例伴有明显的软组织肿块,1例有明显的骶孔扩张伴骨破坏.MRI示肿瘤位于S1~S51例,S1.21例,S1~S33例.肿瘤体积最小者为9.2 cm×7.6 cm×4.1 cm,最大者为22.0 cm×19.0 cm×16.0 cm.5例患者术前均行穿刺活检,病理诊断为脊索瘤2例,恶性神经鞘瘤1例,软骨肉瘤1例,血管内皮细胞肉瘤1例.5例患者术前均有腰骶部疼痛或腰腿痛,视觉模拟评分(visual analogue scale,VAS)2例2分,2例6分,1例8分.5例均采用脊柱椎弓根钉棒系统行髂腰稳定性重建.结果 5例患者平均手术时间6.5 h(范围,4.5~11.0 h),术中出血量平均3 700 ml(范围,2 000~7 200 ml),围手术期无一例患者死亡.术后平均随访17个月(范围,9~23个月).术中1例出现直肠损伤,遂行结肠造瘘,术后12周给予造瘘口还纳.术后2例出现伤口并发症,给予清创后冲洗引流,二期愈合,未发生深部感染;4例出现双下肢坐骨神经症状,足跖屈运动障碍,给予踝关节支具固定行走;术后5例患者均出现括约肌功能丧失.术后9个月1例出现局部复发,因无再次手术指征,故给予局部放疗,现随访13个月,带瘤生存.结论 单纯后路全骶骨切除是治疗原发高位骶骨恶性肿瘤的有效手段,通过良好的外科切除边界,可获得良好的肿瘤学预后.单纯后路全骶骨切除术后并发症发生率较高,对患者的术后神经功能影响较大.%Objective To investigate the surgical indication,approach,resection methods and complications of total sacrectomy via posterior approach for primary malignant sacral tumors involving

  6. Application of lavation and drainage with continuous negative pressure in repairing chronic infectious wounds on axial-pattern flap%持续负压灌洗引流技术在轴型皮瓣修复慢性感染创面中的应用

    Institute of Scientific and Technical Information of China (English)

    郭志谦; 江碧川; 张新合; 杨新蕾; 雷磊; 孟红阳; 米增法

    2012-01-01

    Objective To evaluate the repair of chronic infectious wounds on axial-pattern flap by using lavation and drainage under continuous negative pressure. Metheods Twenty-five patiens suffering chronic infectious wound were involved.After the axial-pattern flap overcastted.wounds of pations were lavaged and drained for 7-14 days under continuous negative pressure through a detained tube.Suction under negative pressure continued for 3~5days after lavation,and then grainage tube was removed.The conditions of the wounds were observed. Results All flaps survived with infection controlled and wounds cicatrized. Conclution Lavation and drainage under continuous negative pressure can help control infection,increase flaps survival and wound plerosis.%目的:总结持续负压灌洗引流技术应用于轴型皮瓣修复慢性感染创面中的临床经验.方法:慢性感染创面共25例,实施轴型皮瓣修复,皮瓣下留置负压引流管进行持续负压灌洗引流7~14天,停止灌洗后维持负压吸引3~5天,拔除引流管,观察创面愈合情况.结果:所有皮瓣均存活,感染控制,创面及时修复.结论:持续负压灌洗引流有利于控制感染,促进皮瓣存活及创面修复.

  7. Chronic Insomnia

    OpenAIRE

    Buysse, Daniel J.

    2008-01-01

    Ms. F, a 42-year-old divorced woman, presents for evaluation of chronic insomnia. She complains of difficulty falling asleep, often 30 minutes or longer, and difficulty maintaining sleep during the night, with frequent awakenings that often last 30 minutes or longer. These symptoms occur nearly every night, with only one or two “good” nights per month. She typically goes to bed around 10:00 p.m. to give herself adequate time for sleep, and she gets out of bed around 7:00 a.m. on work days and...

  8. ORANGE JUICE AND BLOOD PRESSURE

    Directory of Open Access Journals (Sweden)

    M. F. VALIM

    2009-01-01

    Full Text Available

    Blood pressure is the force of blood against artery walls. It is measured in millimeters of mercury (mm Hg and recorded as two numbers: systolic pressure (as the heart contracts over diastolic pressure (as the heart relaxes between beats. High blood pressure (hypertension is defined as chronically elevated high blood pressure, with systolic blood pressure (SBP of 140 mm Hg or greater, and diastolic blood pressure (DBP of 90 mm Hg or greater. High blood pressure (HBP, smoking, abnormal blood lipid levels, obesity and diabetes are risk factors for coronary heart disease, the leading cause of death in the US. Lifestyle modifications such as engaging in regular physical activity, quitting smoking and eating a healthy diet (limiting intake of saturated fat and sodium and increasing consumption of fiber, fruits and vegetables are advocated for the prevention, treatment, and control of HBP. As multiple factors influence blood pressure, the effects of each factor are typically modest, particularly in normotensive subjects, yet the combined effects can be substantial. Nutrition plays an important role in influencing blood pressure. Orange juice should be included as part of any low sodium diet and/or any blood pressure reducing eating plan, as it is sodium free, fat-free and can help meet recommended levels of potassium intake that may contribute to lower BP.

  9. Sindrome de currarino associada ao Tailgut Cyst: ressecção abdômino-sacral The Tailgut Cyst is na embryological remnant of the retrorectal (Presacral) space that can be a part of the currarino syndrome

    OpenAIRE

    Cristiane Koizimi Martos Fernandes; Fábio Lopes; Luiz Felipe Campos Lobato; Leonardo Silluzio Ferreira; Ramon T. Silveira; Vera Coelho Teixeira; Bráulio Fortes Mesquita; Antônio Lacerda-Filho

    2007-01-01

    O Tailgut Cyst é um remanescente embriológico do intestino posterior, que pode fazer parte da Síndrome de Currarino. Relato do caso: Paciente feminino, 43 anos com lombalgia, retenção urinária e massa retrorretal. História pregressa de ânus ectópico, constipação associada a megacólon congênito. Exames de imagem evidenciando cisto retrorretal comprimindo o sacro, rechaçando as estruturas pélvicas anteriormente e deformidade sacral congênita. Realizada ressecção em bloco da lesão retrorretal, r...

  10. Chronic kidney disease

    Science.gov (United States)

    Kidney failure - chronic; Renal failure - chronic; Chronic renal insufficiency; Chronic kidney failure; Chronic renal failure ... 2012_CKD_GL.pdf . McCullough PA. Interface between renal disease ... patients with kidney failure. N Engl J Med . 2010;362(14):1312- ...

  11. Pressure Sore at an Unusual Site- the Bilateral Popliteal Fossa: A Case report

    Directory of Open Access Journals (Sweden)

    Kamal Kataria

    2012-05-01

    Full Text Available Pressure sore is tissue ulceration due to unrelieved pressure, altered sensory perception, and exposure to moisture. Geriatric patients with organic problems and patients with spinal cord injuries are the high-risk groups. Soft tissues over bony prominences are the common sites for ulcer development. About 95% of pressure ulcers occur in the lower part of the body. Ischial tuberosity, greater trochanter, sacrum and heel are common sites. In addition to these, pressure sores at unusual sites like nasal alae, malar eminences, cervical region and medial side of knee have also been described. Only 1.6% of the patients present with sores in areas outside the pelvis and lower extremity. In a paraplegic patient, pressure sores are usually over extensor surface of knee and heel but pressure ulcer over popliteal fossa are extremely rare. We herein report a case of a 36-years-old diabetic and paraplegic male, who presented with multiple bed sores involving the sacral area, heels and bilateral popliteal fossa. Popliteal fossa is an unusual site for pressure sores. Only one similar case has been previously reported in the literature.

  12. Influence of negative pressure wound therapy on granulation tissue formation and interleukin-6 variation in chronic wound%负压创面疗法对慢性创面肉芽组织生长及白细胞介素-6的影响

    Institute of Scientific and Technical Information of China (English)

    李虎山; 雷晋; 郝振明

    2011-01-01

    Objective To investigate the influence of negative pressure wound therapy ( NPWT ) on vascular endothelial cells, proliferating cells and interleukin-6 variation in chronic wound. Methods Forty patients with chronic wound were divided into negative pressure wound therapy treatment group and conventional treatment group randomly. The granulation tissue formation was observed, and specimens were obtained from wound bed at 1, 4, 7, 14 days after treatment. The specimens were pathologically studied with hematoxylin-eosin staining to assess the wound healing process of the two groups. Furthermore, immunohistochemistry was done to estimate the number of vascular endothelial cells ( factor vm related antigen being used as marker ) and proliferating cells ( mouse anti-Ki-67 nuclear antigen being used as marker). Exudates of chronic wound were collected at 1, 4, 7, 14 days after negative pressure wound therapy treatment, interleukin-6 contents were determined and comparisons were made between them based on enzyme linked Immunosorbnent assay.Results The wounds of patients in negative pressure wound therapy treatment group were cured rapidly. The granulation tissue formation was promoted in negative pressure wound therapy treatment group. The number of vascular endothelial cells and proliferating cells in negative pressure wound therapy treatment group was larger than that of conventional treatment group ( P <0. 05 ). Interleukin-6 contents were decreased with time going after negative pressure wound therapy with significant variations between 1 ,4, 7 days ( P <0. 05 ), and levels of interleukin-6 were got close to normal at 7, 14days. Conclusion Compared with conventional treatment, negative pressure wound therapy could initiate granulation tissue formation more promptly, accelerate endothelial cell cytopoiesis, stimulate cell proliferation and decrease interleukin-6 contents.%目的 研究负压创面疗法对慢性创面血管内皮细胞、增

  13. Atypical Chronic Myelogenous Leukemia

    Science.gov (United States)

    ... myeloproliferative neoplasms, leukemia , and other conditions . Chronic Myelomonocytic Leukemia Key Points Chronic myelomonocytic leukemia is a disease ... chance of recovery) and treatment options. Chronic myelomonocytic leukemia is a disease in which too many myelocytes ...

  14. 3D打印技术辅助手术治疗骶骨骨折伴骶丛神经损伤%Surgical treatment of sacral fractures accompanied with lumbosacral plexus avulsion assisted by 3D printing

    Institute of Scientific and Technical Information of China (English)

    杨鹏; 叶添文; 张帆; 杨迪; 朱磊; 何翔; 陈爱民

    2015-01-01

    Objective To report the preliminary results of using 3D printing technology to assist surgical treatment of sacral fractures accompanied with lumbosacral plexus avulsion.Methods From May 2013 to August 2014,11 hospitalized patients with sacral fracture accompanied with lumbosacral plexus avulsion were enrolled in the present study.They were 6 males and 5 females,28 to 57 years of age (mean,42.3 years).Seven fractures were fresh and 4 obsolete.According to the Denis classification,3 fractures were type Ⅱ and 8 type Ⅲ.All the cases experienced a decrease or loss in skin sensation in the saddle area or in the area innervated by the sacral plexus at the lower extremity.Ten cases reported radiating pain and dysfunction of the lower extremity,and 5 had dysfunction of bladder sphincter,anal sphincter,or sexual performance.Their average Injury Severity Score was 21.5.All patients underwent 3D reconstruction of CT scans.Their fracture models were manufactured by 3D printing before operation.A bundle of wire 3 mm in diameter was used to stimulate the course of sacral plexus by which we evaluated the distribution and compression of the nerves.After surgical stimulation on the 3D printing models,operations were performed on the patients.Lumbo-sacral internal fixation,sacral plexus exploration and decompression were taken as the standard surgical pattern.The postoperative sensory and motor function was evaluated according to the criteria proposed by the British Medical Research Council.Results The mean surgical time was 3.2 hours and the mean intraoperative bleeding was 1 845 mL for the 11 patients.All the patients were followed up from 6 to 15 months (average,8.2 months).Their sacral fractures obtained stable fixation and bone healing after 13.5 weeks.Their recovery of motor function increased 2.5 levels and their sensory recovery increased 2.6 levels compared to the preoperation.Radiating pain at the lower limb was alleviated in 10 cases and disappeared in 3.Conclusion 3D

  15. Negative pressure wound therapy: clinical utility

    OpenAIRE

    Sandoz H

    2015-01-01

    Heidi Sandoz Accelerate CIC, Mile End Hospital, London, UK Abstract: Negative pressure wound therapy (NPWT), also known as topical negative pressure therapy, has been increasingly used in health care for the management of a wide variety of wounds over the last 2–3 decades. It is an advanced therapy that can be helpful to accelerate wound healing in both acute and chronic wounds by delivering negative pressure (suction) to the wound bed. More recent advancements in the application o...

  16. Chronic mucus hypersecretion

    DEFF Research Database (Denmark)

    Harmsen, L; Thomsen, S F; Sylvan Ingebrigtsen, Truls;

    2010-01-01

    Chronic mucus hypersecretion (CMH) is a common condition in patients with chronic respiratory diseases. Little is known about the incidence, prevalence and determinants of CMH in younger individuals....

  17. 脊柱全长X线片对非矩形化腰椎骶化的诊断价值%The value of whole spine plain radiograph for the diagnosis of non-squaring lumbar-sacralized vertebra

    Institute of Scientific and Technical Information of China (English)

    崔洪鹏; 侯黎升; 阮狄克; 白雪东; 何勍; 史丽静; 李海峰; 赵程

    2011-01-01

    目的:探讨脊柱全长X线片对非矩形化腰椎骶化的诊断价值.方法:2008年8月~2009年7月共153例腰腿痛并颈部或胸背部不适的患者接受脊柱全长X线片检查,男84例,女69例,年龄14-82岁,平均47.9±13.7岁.观察其脊柱全长X线片,明确是否有腰椎X线平片难辨出的腰椎骶化.结果:共发现7例腰椎X线平片难辨出的非矩形化完全型腰椎骶化,男5例,女2例,年龄21~60岁,平均39.7±13.7岁.所有骶化的椎体均为正常S1椎体矩形化表现,下方椎间隙为正常S1/2椎间融合表现.合并颈肋2例,第12肋骨缺如4例.结论:脊柱全长X线片能确诊单纯腰椎X线平片难以明确的非矩形化腰椎骶化.%objective: To investigate the value of whole spine plain radiograph for the diagnosis of non-squaring lumbar-sacralized vertebra. Method: Between August 2008 and July 2009,153 consecutive cases who took whole spine plain radiograph due to low back pain and sciatica combined with cervical scapula discomfort were enrolled in the study. There were 84 males and 69 females with an average age of 47.9±13.7 years (range,14 to 82 years).Everyone's whole spine plain radiograph were reviewed to verify whether sacralized vertebra were ignored. Result:7 cases with non-squaring sacralized vertebra were missed as normal lumbosacral structure under lumbar plain radiographs alone. Among them, there were 5 males and 2 female with an average age of 39.7±13.7 years(range,21 to 60 years).All sacralized vertebra exhibited normal S1 vertebra shape with its lower disc exhibiting normal fused S1/2 intervertebral disc appearance.2 were complicated with cervical ribs of the 7th cervical vertebra while 4 had the 12th ribs absence. These pitfalls could only be identified and corrected under whole spine radiograph. Conclusion: Non-squaring sacralized vertebra may be missed as normal lumbosacral structure under lumbar plain radiographs alone. Whole spine plain radiograph is recommended.

  18. Profile of patients with spinal cord injuries and occurrence of pressure ulcer at a university hospital.

    Science.gov (United States)

    Nogueira, Paula Cristina; Caliri, Maria Helena Larcher; Haas, Vanderlei José

    2006-01-01

    Patients with traumatic spinal cord injury (TSCI) have an increased risk of developing pressure ulcers (PU). It is a retrospective study done by review of records in order to identify the characteristics of patients who were assisted at a tertiary hospital as well as the occurrence of PU. Most patients were male, white and 36,2% between 21 and 30 years. The most common causes of TSCI were wound by fire weapons followed by vehicle crash/overturn. There was a predominance of injury at the toracic level followed by cervical. The PU occurred in 20 pacientes (42,5%). The most frequent regions of occurrence were the sacral and heels. Only 25% of the records had PU's dimensions charted, 80% stated the aspect, and 52.1% did not state the stage. There is a need for better documentation of PU so that interventions used for treatment can be evaluated. PMID:16926993

  19. Prophylactic use of dressings for pressure ulcer prevention in the critical care unit.

    Science.gov (United States)

    Thorpe, Elaine

    2016-06-23

    Multiple comorbidities and intensive therapy increase the risk of pressure ulcer (PU) development in critical care unit (CCU) patients. Given the high number of risk factors that CCU patients present with, it is important to acknowledge that not all PUs are entirely preventable, and incidence is thought to be between 14% and 42%. The consequences of acquiring a PU in critical care include increased mortality, morbidity and longer length of stay. Implementing prevention strategies as soon as the patient enters the unit can significantly reduce incidence. By adopting a proactive versus reactive mind-set, one CCU abandoned traditional PU risk assessment and implemented a number of intensive interventions, including the use of a prophylactic sacral dressing as an adjunct. As a result, PU incidence fell from 19.9 per 1000 patient population to 0.84 per 1000 patient population in 2014. In addition, 310 PU-free days were achieved. PMID:27345087

  20. Chronic urticaria

    Directory of Open Access Journals (Sweden)

    Sandeep Sachdeva

    2011-01-01

    Full Text Available Chronic urticaria (CU is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the ′idiopathic′ forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented.

  1. Pressure sensor

    Energy Technology Data Exchange (ETDEWEB)

    Mee, David K.; Ripley, Edward B.; Nienstedt, Zachary C.; Nienstedt, Alex W.; Howell, Jr., Layton N.

    2015-09-29

    Disclosed is a passive, in-situ pressure sensor. The sensor includes a sensing element having a ferromagnetic metal and a tension inducing mechanism coupled to the ferromagnetic metal. The tension inducing mechanism is operable to change a tensile stress upon the ferromagnetic metal based on a change in pressure in the sensing element. Changes in pressure are detected based on changes in the magnetic switching characteristics of the ferromagnetic metal when subjected to an alternating magnetic field caused by the change in the tensile stress. The sensing element is embeddable in a closed system for detecting pressure changes without the need for any penetrations of the system for power or data acquisition by detecting changes in the magnetic switching characteristics of the ferromagnetic metal caused by the tensile stress.

  2. Neuromodulation of chronic headaches

    DEFF Research Database (Denmark)

    Martelletti, Paolo; Jensen, Rigmor H; Antal, Andrea;

    2013-01-01

    The medical treatment of patients with chronic primary headache syndromes (chronic migraine, chronic tension-type headache, chronic cluster headache, hemicrania continua) is challenging as serious side effects frequently complicate the course of medical treatment and some patients may be even...

  3. Untying chronic pain

    OpenAIRE

    Häuser, Winfried; Wolfe, Frederik; Henningsen, Peter; Schmutzer, Gabriele; Brähler, Elmar; Hinz, Andreas

    2014-01-01

    Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic ...

  4. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B.; Nikolajsen, L.; Kehlet, H.;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies Udgivelsesdato: 2008/3...

  5. Chronic pain after hysterectomy

    DEFF Research Database (Denmark)

    Brandsborg, B; Nikolajsen, L; Kehlet, Henrik;

    2008-01-01

    BACKGROUND: Chronic pain is a well-known adverse effect of surgery, but the risk of chronic pain after gynaecological surgery is less established. METHOD: This review summarizes studies on chronic pain following hysterectomy. The underlying mechanisms and risk factors for the development of chronic...... post-hysterectomy pain are discussed. RESULTS AND CONCLUSION: Chronic pain is reported by 5-32% of women after hysterectomy. A guideline is proposed for future prospective studies. Udgivelsesdato: 2008-Mar...

  6. Stiffness and thickness of fascia do not explain chronic exertional compartment syndrome

    DEFF Research Database (Denmark)

    Dahl, Morten; Hansen, Philip; Stål, Per;

    2011-01-01

    Chronic exertional compartment syndrome is diagnosed based on symptoms and elevated intramuscular pressure and often is treated with fasciotomy. However, what contributes to the increased intramuscular pressure remains unknown....

  7. [Sacral block: indications and effectiveness].

    Science.gov (United States)

    Grob, D; Dvorak, J

    1998-02-25

    It has been shown that during injection of 17 to 20 ml local anesthetics combined with a corticosteroid via the hiatus canalis sacralis that the solution is distributed up to the level of the thoraco-lumbar junction. The indication for therapeutical peridural injection are radicular symptoms as a result of disc herniation, foraminal stenosis as well as neurogenic claudicatio. Contraindications are anticoagulation, local infection as well as suspicion of systemic inflammatory disease of the peripheral nervous system. With proper technique and adequate desinfection, complications and side effects are very rare.

  8. Analysis of the body pressure/weight ratio distribution of the pressure sores suscep-tible parts at different lying position%不同卧位时压疮易患部位的人体压力/重力比值分布分析

    Institute of Scientific and Technical Information of China (English)

    唐玉超; 翁晨曦; 杨霞; 曹伟; 孙艳; 姜丽萍

    2015-01-01

    目的 通过测量三种不同卧位时压疮好发部位的压力/重力比值分布状况,探讨人体压力分布与局部组织受压的特征,为压疮防治提供依据. 方法 200名健康志愿者分别采取平卧位、侧卧位或半坐卧位,运用自制简易测压装置测量局部体表压力,计算压力/重力比值,运用SPSS 17. 0对其差异进行统计分析. 结果 局部压力与人体重力比值以及局部压力分布在性别方面差异具有统计学意义( P<0. 01 ). 不同卧位时体表相同受压部位的压力与人体重力比值差异具有统计学意义( P<0. 01 ). 男性骶尾部平卧位与半坐卧位压力与其重力比值分别为56. 46%,56. 81%;女性骶尾部平卧位与半坐卧位压力与人其重力比值分别为64. 38%,67. 00%.结论 人体体重与局部压力/重力比值分布有一定差异,不同卧位时,身体压力/重力比值分布女性均高于男性,尤其以骶尾部相差最大,足跟部相差最小;身体不同部位以骶尾部所占压力比值最大.%Objective To explore the characteristic of the pressure distribution and the local tissue compres-sion of human body by measuring the pressure/weight ratio distribution of the prone pressure sores parts for the three dif-ferent recumbent positions, thus to provide the foundation for prevention and cure of pressure sores. Methods The 200 healthy volunteers took the supine position, lateral poosition or semi-recumbent position respectively, the interface pressure was measured and recorded by simple pressure measuring device, the SPSS 17. 0 was used to do statistical a-nalysis. Results The partial pressure of the human body gravity ratio and the partial pressure in the same local pressed part in the aspect of gender among three positions had statistical significance ( P<0. 01 ) and the male sacral area pres-sure of their body gravity ratio in supine position and semi-recumbent position were 56. 46%, 56. 81% ; the female sa-cral area pressure of their

  9. Electroacupuncture treatment of chronic insomniacs

    Institute of Scientific and Technical Information of China (English)

    RUAN Jing-wen; WANG Chu-huai; LIAO Xin-xue; YAN Ying-shuo; HU Yue-hua; RAO Zhong-dong; WEN Ming; ZENG Xiao-xiang; LAI Xin-sheng

    2009-01-01

    Background Due to the quick rhythm of life and work pressure, more and more people suffer from sleep quality problems. In this study, we investigated the effect of electroacupuncture on sleep quality of chronic insomniacs and the safety of electroacupuncture therapy.Methods Four courses of electroacupuncture treatment were applied to 47 patients. With pre-treatment and post-treatment self-control statistical method, Pittsburgh sleep quality index (PSQI) scores were used for evaluating sleep quality. Polysomnogram was used for detecting insomniacs' changes in sleep architecture. The safety of electroacupuncture was evaluated by monitoring the self-designed adverse events and side effects during treatment and post-treatment.Results Electroacupuncture considerably improved insomniacs' sleep quality and social function during the daytime.Electroacupuncture had certain repairing effect on the disruption in sleep architecture. At the same time,electroacupuncture prolonged slow wave sleep (SWS) time and relatively rapid eye movement sleep (REM sleep) time.There was no hangover, addiction or decrements in vigilance during the daytime (incidence rate was 0). However,insomnia rebound rate was about 23% within one month.Conclusions These results suggest that electroacupuncture has beneficial effect on sleep quality improvement in the patients with chronic insomnia, which may be associated with repairing sleep architecture, reconstructing sleep continuity,as well as prolonging SWS time and REM sleep time. Electroacupuncture treatment for chronic insomnia is safe.Therefore, electroacupuncture therapy could be a promising avenue of treatment for chronic insomnia.

  10. 无创气道正压通气联合生脉注射液治疗心力衰竭的临床研究%Clinical research of non-invasive positive airway pressure ventilation combined with Shengmai injection ;in the treatment of chronic heart failure

    Institute of Scientific and Technical Information of China (English)

    林能波; 郑炜华; 张妙华

    2015-01-01

    目的:探讨无创气道正压通气联合生脉注射液对慢性心力衰竭(CHF)患者心功能以及心率的影响。方法80例慢性心力衰竭患者随机分为治疗组和对照组,各40例。对照组采用常规治疗,治疗组在对照组治疗基础上,给予无创气道正压通气联合生脉注射液治疗,记录治疗前后患者的症状、心脏功能指标[左室射血分数(LVEF)、心输出量(CO)、心搏出量(SV)]、血气指标[血氧饱和度(SaO2)、氧分压(PO2)、二氧化碳分压(PCO2)]情况。结果两组患者治疗后临床症状和SaO2、PO2、PCO2均有所改善, CO、SV、LVEF均明显增高,且治疗组的效果明显优于对照组(P<0.05)。结论与传统治疗相比,无创气道正压通气联合生脉注射液治疗且能明显改善慢性心力衰竭患者心功能及心率。%Objective To investigate influence of non-invasive positive airway pressure ventilation combined with Shengmai injection on cardiac function and heart rate in chronic heart failure (CHF) patients. Methods A total of 80 chronic heart failure patients were randomly divided into treatment group and control group, with 40 cases in each group. The control group received conventional treatment, and the treatment group received additional non-invasive positive airway pressure ventilation combined with Shengmai injection. Records were made on symptoms, cardiac function indexes [left ventricular ejection fraction (LVEF), cardiac output (CO), stroke volume (SV)], and blood gas indexes [oxyhemoglobin saturation (SaO2), partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2)] before and after treatment. Results Both groups had improved clinical symptoms, SaO2, PO2, and PCO2, and their CO, SV, and LVEF were all obviously increased. The treatment group had much better effects than the control group (P<0.05). Conclusion Compared with traditional treatment, non-invasive positive airway pressure ventilation combined with

  11. 慢性阻塞性肺疾病患者采用压力支持通气模式撤机时调节压力上升时间对呼吸形态的影响%Effect of different inspiratory rise time during pressure support ventilation in patients recovering from acute exacerbations of chronic obstructive pulmonary disease

    Institute of Scientific and Technical Information of China (English)

    王艳茹; 潘文森; 许晓岚; 张鲁涛

    2011-01-01

    Objective To explore the effects of different inspiratory rise time in patients recovering from acute exacerbation of chronic obstructive pulmonary disease. Methods 23 patients of acute exacerbation of chronic obstructive pulmonary disease were ventilated with pressure support ventilation at two different inspiratory rise time in turn. The parameters in two conditions of respiration, the vital signs and scales of dyspnea were monitored and compared. Results From the shorter to the longer inspiratory rise time, the tidal volume became bigger,inspiratory time extended,the inspiratory peak flow decreased,airway occlusion pressure increased, the visual analogue score and Borg score of dyspnea exacerbated ( P < 0.05 or < 0.01 ). The visual analogue score and Borg score of dyspnea positively correlated with airway occlusion pressure. The coefficients of correlation were 0. 510 and 0. 640 respectively (both P < 0.05). Conclusion To patients recovering from acute exacerbations of chronic obstructive pulmonary disease,ventilation with pressure support ventilation at the shorter inspiratory rise time decreases the effort of breathing and the scales of dyspnea. Airway occlusion pressure, the visual analogue score and Borg score of dyspnea may be helpful to select appropriate inspiratory rise time.%目的 探讨不同压力上升时间设定对采用压力支持通气模式(PSV)撤机的慢性阻塞性肺疾病(COPD)患者的影响.方法 对23例因呼吸衰竭已经气管插管机械通气并至恢复期的COPD患者进行压力支持通气,采用自身前后对照方法,先后给予较短压力上升时间和较长压力上升时间两种设定,观察患者呼吸形态、生命体征和呼吸困难情况.结果 从较短压力上升时间至较长压力上升时间潮气量增加(0.45±0.08)L vs(0.49±0.10)L、吸气时间延长(0.92±0.13)秒vs(0.49±0.10)秒、吸气峰值流速减小(53.92±8.33)L/min vs(41.69±7.53)L/min、气道闭合压增大(1.88±0.08)mmHg vs

  12. 无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效%Effect of noninvasive positive pressure ventilation in the treatment of chronic obstructive pulmonary disease with respiratory failure

    Institute of Scientific and Technical Information of China (English)

    傅万颖; 陈菱菱

    2014-01-01

    目的:探讨无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果。方法将我院2010~2013年112例慢性阻塞性肺疾病合并呼吸衰竭患者随机分为对照组和实验组,每组各56例,其中对照组采用常规治疗,而实验组采用无创正压通气治疗。比较两组患者的住院时间、插管率、病死率以及治疗前后血气分析的指标(氧分压、二氧化碳分压、pH)。结果对照组住院时间、插管率和病死率均明显高于实验组,差异有统计学意义(P<0.05)。两组患者在治疗前氧分压、二氧化碳分压、pH间比较差异无统计学意义(P>0.05),但治疗后对照组氧分压低于实验组,二氧化碳分压高于实验组,差异有统计学意义(P<0.05)。对照组中插管率为15.00%,而实验组插管率为3.57%,差异有统计学意义(P<0.05)。结论无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭效果较好,改善预后,降低并发症发生率,值得临床推广。%Objective To explore the effect of noninvasive positive pressure ventilation on chronic obstructive pulmonary disease complicated with respiratory failure. Methods A total of 112 chronic obstructive pulmonary disease patients with complication of respiratory failure admitted from 2010 to 2013 were selected, and randomly divided into control group and experimental group by half in which the control group using conventional treatment, while the experimental group using noninvasive positive pressure ventilation treatment. Then comparing hospitalization, intubation rate, mortality and indicators of blood gas analysis before and after treatment (for example partial pressure of oxygen, carbon dioxide partial pressure, pH). Results Hospitalization, intubation and mortality rates were compared between two groups, the indicators for control group were significantly higher than the experimental group, the difference was

  13. Neural stimulation for chronic voiding dysfunctions.

    Science.gov (United States)

    Elabbady, A A; Hassouna, M M; Elhilali, M M

    1994-12-01

    Neural stimulation of the sacral nerve roots could become an acceptable and promising modality in controlling variable forms of difficult voiding dysfunctions. A total of 50 patients who presented with various forms of voiding dysfunction underwent initial screening by percutaneous nerve evaluation of the S3 nerve root guided by movements of the levator ani and toes. Only 17 patients demonstrated a satisfactory response to percutaneous nerve evaluation and subsequent subchronic wire testing for 4 to 5 days, and they were eligible to enter the study. The studied patients (13 women and 4 men) were classified into 2 groups according to presentation. Group 1 included 8 patients who presented mainly with nonobstructive chronic urinary retention. All 8 patients were on intermittent self-catheterization except 1 with a suprapubic tube. The 9 patients in group 2 mainly presented with other forms of voiding dysfunctions, including pain (suprapubic and perineal), frequency and/or urgency. All patients were neurologically free, and had failed pharmacological and surgical attempts to correct the problems. In both groups radiological and ultrasound evaluations of the urinary tract as well as cystourethroscopy were within normal limits. Urodynamic studies were performed preoperatively and postoperatively. Unilateral S3 foramen implantation was performed on the selected side in all patients. Followup ranged from 3 to 52 months. All patients were followed preoperatively and postoperatively by voiding and itemized symptom score diary as well as a quality of life questionnaire. Each symptom and question were given certain grades that reflect the severity or importance to the patient. The symptom scores and the quality of life questionnaires were analyzed preoperatively and postoperatively. In group 1 voided volume (expressed as a percentage of total bladder capacity) was significantly increased at 6 months (23 +/- 7.5% preoperatively versus 81.9 +/- 7.7% postoperatively, p compared

  14. Pressure challenge test and histopathological inspections for 17 Japanese cases with clinically diagnosed delayed pressure urticaria

    OpenAIRE

    Morioke, Satoshi; Takahagi, Shunsuke; Iwamoto, Kazumasa; Shindo, Hajime; Mihara, Shoji; Kameyoshi, Yoshikazu; Hide, Michihiro

    2010-01-01

    Delayed pressure urticaria (DPU) is characterized by deep dermal wheals that appear in response to a local continuous pressure. Although it has been reported to complicate as many as 40% of cases of Caucasian patients with chronic urticaria, no definitive cases of Asian/Japanese patients have been reported in English literature. Here, we identified 17 cases of DPU, among 540 Japanese patients with urticaria (3.1%), based on careful history taking, pressure challenge test and, ideally, skin bi...

  15. EFFECTIVENESS OF KATIVASTHI AND EXERCISE IN CHRONIC LOW BACK PAIN: A RANDOMIZED CONTROL STUDY

    Directory of Open Access Journals (Sweden)

    Panda Ashok Kumar

    2011-02-01

    Full Text Available Chronic low back pain is very common and comprises of 2 .21% in US population and 15% in working groups over the age of 30. In this study there were two groups, one was Kativasthi therapy group and another was Exercise therapy group. Both groups were continued for 10 days. Kativasthi is process specially prepared warm medicated oil kept over low back area with Masa churna (Black gram powder paste boundary over a period of 45 minutes. An open prospective study was conducted to evaluate the effectiveness of Kativasthi (warm oil stagnation procedure in patients of chronic low back pain. Mahanarayan taila is used in Kativasthi for 10 days after Sarvanga Snehana with Mahanarayan taila (oil massage and Sarvanga Baspa Svedana (steam bath. 40 patients, aged 40±10.4 years were divided into two groups by a computer generated random number table. X ray of lumbo-sacral spine (antero-posterior & lateral view was reviewed. Differences of lumbar and ridiculer pains on an analog visual scale, Modified Oswestry Disability score and distance finger ground test were assessed at 0-day & 10th -day. There is significant improvement in all above parameters on 10th day. It was found that Kativasthi was more effective than the conventional exercise practices.

  16. 骶神经电刺激治疗顽固性排尿功能障碍疗效%Effect of sacral nerve electrostimulation on the management of refractory voiding dysfunction

    Institute of Scientific and Technical Information of China (English)

    沈国球; 刘志敏; 潘铁军; 文瀚东; 郭骏; 钱卫红

    2003-01-01

    目的探讨骶神经电刺激(Sacral nerve stimulation, SNS)治疗顽固性排尿功能障碍的临床效果.方法对1例确诊为顽固性排尿功能障碍患者行骶3孔神经电刺激治疗.结果电刺激治疗8 d后及拔除电极后第1、4、8周,B超测定剩余尿量完全消失,尿失禁、尿频、尿急、每次排尿量等临床症状均明显改善或正常.结论骶神经电刺激能有效地治疗顽固性排尿功能障碍.

  17. Oral-facial-digital syndrome with mesoaxial polysyndactyly, common AV canal, hirschsprung disease and sacral dysgenesis: Probably a transitional type between II, VI, variant of type VI or a new type

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2014-07-01

    Full Text Available We report a 4 month old male infant, the first in order of birth of healthy first cousin consanguineous parents who has many typical features of oral-facial-digital syndrome type VI (OFDS VI including hypertelorism, bilateral convergent squint, depressed nasal bridge, and wide upturned nares, low set posteriorly rotated ears, long philtrum, gum hyperplasia with notches of the alveolar borders, high arched palate, and hyperplastic oral frenula. He has mesoaxial and postaxial, polysyndactyly which is the specific feature of OFDS VI, however the cerebellum is normal on MRI brain. He has also some rare congenital anomalies including common atrioventricular canal, hirschsprung disease, and sacral dysgenesis. This patient may have a transitional type between II and VI, a variant of type VI or a new type.

  18. Chemical pressure

    OpenAIRE

    Hauser, Andreas; Amstutz, Nahid; Delahaye, Sandra; Sadki, Asmaâ; Schenker, Sabine; Sieber, Regula; Zerara, Mohamed

    2002-01-01

    The physical and photophysical properties of three classic transition metal complexes, namely [Fe(bpy)3]2+, [Ru(bpy)3]2+, and [Co(bpy)3]2+, can be tuned by doping them into a variety of inert crystalline host lattices. The underlying guest-host interactions are discussed in terms of a chemical pressure.

  19. Clinical application of negative pressure wound therapy with hypertonic saline dressing in the treatment of cancer patients chronic wounds%高渗盐敷料结合负压创面治疗技术治疗肿瘤患者慢性伤口的临床研究

    Institute of Scientific and Technical Information of China (English)

    张玲玲; 袁艺

    2012-01-01

    Objective Observe and study the application and the therapeutic effect of negative pressure wound therapy (NPWT) using hypertonic saline dressing in cancer patients'chronically moderate-sized superficial wounds. Method Sixty cancer patients who had chronically superficial wounds of moderate size were randomly divided into an experimental group (negative pressure treatment group) and a control group (conventional dressing group). The former was treated with a modified NPWT, which is using hypertonic saline dressing as filling material and disposable silicone gastric tube as the drainage tube to cooperate with clinical negative pressure suction device. The latter was strictly applied conventional dressing method. Noticeable-findings were observed and compared in terms of the wounds'healing time, frequency and costs of dressing changes. Result The healing period(P<0. 05), the frequency and the costs of dressing changes in the experimental group were significantly reduced comparing to the control group(P<0. 05). Conclusion The modified negative pressure wound therapy is likely to improve the wound closure rate of cancer patients with certain chronic wounds, reduce costs and shorten hospitalization for the patients; and lower related workload of nurses'.%目的 探讨高渗盐敷料结合负压创面治疗技术在肿瘤患者慢性、中小型、表浅伤口的运用和疗效.方法 将60例有慢性、中小型、表浅伤口的肿瘤患者随机分为实验组(负压治疗组)和对照组(常规换药组).实验组采用高渗盐敷料为伤口填充材料,以一次性使用胃导管为引流管,利用病房的负压吸引系统为患者进行负压创面引流治疗;对照组采用湿性愈合原理常规换药.观察比较两组患者伤口愈合时间、换药次数、换药费用.结果 实验组的伤口愈合时间、换药次数、换药费用都较对照组明显减少,P<0.05,差异具有显著意义.结论 高渗盐敷料结合负压创面治疗技术,

  20. Referred pain patterns provoked on intra-pelvic structures among women with and without chronic pelvic pain: a descriptive study.

    Directory of Open Access Journals (Sweden)

    Thomas Torstensson

    Full Text Available To describe referred pain patterns provoked from intra-pelvic structures in women with chronic pelvic pain (CPP persisting after childbirth with the purpose to improve diagnostics and give implications for treatment.In this descriptive and comparative study 36 parous women with CPP were recruited from a physiotherapy department waiting list and by advertisements in newspapers. A control group of 29 parous women without CPP was consecutively assessed for eligibility from a midwifery surgery. Inclusion criterion for CPP was: moderate pain in the sacral region persisting at least six months after childbirth confirmed by pelvic pain provocation tests. Exclusion criteria in groups with and without CPP were: persistent back or pelvic pain with onset prior to pregnancy, previous back surgery and positive neurological signs. Pain was provoked by palpation of 13 predetermined intra-pelvic anatomical landmarks. The referred pain distribution was expressed in pain drawings and described in pain maps and calculated referred pain areas.Pain provoked by palpation of the posterior intra-pelvic landmarks was mostly referred to the sacral region and pain provoked by palpation of the ischial and pubic bones was mostly referred to the groin and pubic regions, with or without pain referred down the ipsilateral leg. The average pain distribution area provoked by palpation of all 13 anatomical landmarks was 30.3 mm² (19.2 to 53.7 in women with CPP as compared to 3.2 mm² (1.0 to 5.1 in women without CPP, p< 0.0001.Referred pain patterns provoked from intra-pelvic landmarks in women with CPP are consistent with sclerotomal sensory innervation. Magnification of referred pain patterns indicates allodynia and central sensitization. The results suggest that pain mapping can be used to evaluate and confirm the pain experience among women with CPP and contribute to diagnosis.

  1. Efectos crónicos de un programa regular de natación. Sobre la tensión arterial de adultos hipertensos. Swimming chronic effects on the blood pressure. In hypertensive adults.

    Directory of Open Access Journals (Sweden)

    Natali , Antônio José

    2006-07-01

    Full Text Available ResumenEl propósito de este trabajo fue verificar los efectos crónicos de un programa regular de natación sobre la tensión arterial de adultos hipertensos. La muestra ha sido compuesta por 28 personas con hipertensión leve y moderada separados en dos grupos: Grupo Experimental (GE 11 mujeres y 3 hombres y Grupo Control (GC 8 hombres y 6 mujeres con edades 42,29 ± 8,72, y 42,15 ± 9,72 años respectivamente. Aquellos pertenecientes al grupo experimental, participaron de un programa regular de natación durante 10 semanas, mientras el grupo control permaneció sin practicar actividad física en ese período. El procedimiento estadístico utilizado fue el Teste-t de Student, para verificar las diferencias entre los promedios antes y después de diez semanas del programa regular de natación. El estudio admitió el nivel de p AbstractThe purpose of this work was to verify the chronic effects of a regular swimming program on hypertensive adults’ pressoric levels. The sample was constituted of 28 individuals that presented light and moderated hypertension, who were divided into two groups: Experimental (11 women and 3 men and Control (8 men and 6 women, with 42,29 ± 8,72 and 42.15 ± 9.72 years old, respectively. The subjects of Experimental group have engaged into a regular swimming program for 10 weeks, while the Control group did not practice any physical activity for the period. It was used the Student t-Test as statistical procedure, in order to analyze the differences between the average indexes recorded before and after the 10-weeks regular swimming program. The study admitted a level of p

  2. Chronic mucus hypersecretion

    DEFF Research Database (Denmark)

    Ulrik, Charlotte Suppli; von Linstow, Marie-Louise; Nepper-Christensen, Steen;

    2005-01-01

    To investigate if chronic mucus hypersecretion (CMH) can be used as a marker of asthma in young adults.......To investigate if chronic mucus hypersecretion (CMH) can be used as a marker of asthma in young adults....

  3. Chronic Diarrhea in Children

    Science.gov (United States)

    ... can include cramping abdominal pain nausea or vomiting fever chills bloody stools Children with chronic diarrhea who have ... can include cramping, abdominal pain, nausea or vomiting, fever, chills, or bloody stools. Children with chronic diarrhea who ...

  4. Chronic inflammatory demyelinating polyneuropathy

    Science.gov (United States)

    Polyneuropathy - chronic inflammatory; CIDP; Chronic inflammatory polyneuropathy; Guillain-Barré - CIDP ... CIDP is one cause of damage to nerves outside the brain or spinal cord ( peripheral neuropathy ). Polyneuropathy ...

  5. Chronic fatigue syndrome

    Science.gov (United States)

    Bennett RM. Fibromyalgia, chronic fatigue syndrome, and myofascial pain. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 274. Engleberg NC. Chronic ...

  6. "Chronic Lyme Disease"

    Science.gov (United States)

    ... Content Marketing Share this: Main Content Area "Chronic Lyme Disease" What is "chronic Lyme disease?" Lyme disease is an infection caused by ... J Med 357:1422-30, 2008). How is Lyme disease treated? For early Lyme disease, a short ...

  7. Prostaglandins and chronic inflammation

    OpenAIRE

    Aoki, Tomohiro; Narumiya, Shuh

    2012-01-01

    Chronic inflammation is the basis of various chronic illnesses including cancer and vascular diseases. However, much has yet to be learned how inflammation becomes chronic. Prostaglandins (PGs) are well established as mediators of acute inflammation, and recent studies in experimental animals have provided evidence that they also function in transition to and maintenance of chronic inflammation. One role PGs play in such processes is amplification of cytokine signaling. As such, PGs can facil...

  8. Pressurized hopper

    International Nuclear Information System (INIS)

    A Secure Automated Fuel Fabrication Line is being developed to reduce personnel exposure and to improve safeguards. Fertile and fissile fuel powders are blended in the line for making fuel pellets. A pressurized hopper was developed for use not only as a blender, but also as a storage and feeding device. It works with or without injection tubes to produce a well-blended powder with reduced agglomerate population. Results of blending experiments using dry Kaolin clay and Tempra pigment are given

  9. Complications of Diabetes: Chronic Kidney Disease (CKD and Diabetic Nephropathy

    Directory of Open Access Journals (Sweden)

    iyabet Dunyagoz Hospitals G

    2014-09-01

    Full Text Available Today, almost half of the patients who are on chronic kidney replacement therapy have diabetes. The enormous worldwide rise in these cases pose potential economic burden for every country and therefore monitoring kidney function should be a practice provided in outpatient settings. Poorly controlled diabetes will not only result in chronic renal failure, but also patients with chronic renal disease will have some metabolic abnormalities that will increase both morbidity and mortality of the patients. While hypertension may associate with most of the diabetic cases, those people with diabetes who have no rise in blood pressure will eventually develop hypertension at later stage of the chronic kidney disease.

  10. 慢性肾脏疾病患者的血脂异常和血压变异性的相关性分析%Correlative analysis of lipid abnormality and blood pressure variability of patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    李杰峰; 吴光付; 陈小玲

    2015-01-01

    目的:探讨慢性肾脏疾病(CKD)患者血脂代谢异常与血压变异性的相关性。方法将适合标准的86例慢性肾脏疾病的患者纳入本研究,血脂正常的46例患者为对照组,而血脂异常的40例患者设为试验组。测量空腹时血清高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、尿酸、肌酐及24h尿蛋白定量。对所有患者行24h动态血压监测,对两组24h、日间、夜间收缩压标准差及变异系数和24h、日间、夜间舒张压标准差及变异系数进行对比分析,并检验与分析血压变异系数与血脂值的相关性。结果试验组24h、日间、夜间收缩压标准差及其对应的变异系数明显高于对照组,差异有统计学意义(P<0.05)。而两组的24h、日间、夜间舒张压标准差及其对应的变异系数差异无统计学意义(P>0.05)。试验组24h、日间及夜间收缩压变异系数均与TC呈正相关(r=0.24,P=0.032;r=0.18,P=0.044)。而对照组血压变异性指标与血脂无相关性(P>0.05)。结论 CKD合并高脂血症患者血压变异性与TC呈正相关,为了降低CKD患者血压变异性,减少心血管事件的发生,患者除了应尽早使血压达标外,还需尽早干预脂代谢使其恢复正常。%ObjectiveTo explore correlation of lipid abnormality and blood pressure variability of patients with chronic kidney disease (CKD).Methods 86 qualified patients with chronic kidney disease were selected in the research. 46 patients with lipid normality were set as the control group and 40 patients with lipid abnormality were set as the experiment group. Serum high density lipoprotein cholesterol, low density lipoprotein cholesterol, total cholesterol, triglyceride, uric acid, creatinine and 24h urinary protein were detected on an empty stomach. All patients were received ambulatory blood pressure monitoring. Systolic blood pressure standard deviation

  11. Analysis on relationship between stiffness of large artery and variability of blood pressure in patients with chronic kidney disease without dialysis%非透析慢性肾脏病合并血压变异患者大动脉僵硬度分析

    Institute of Scientific and Technical Information of China (English)

    陈灿

    2015-01-01

    目的:探讨非透析慢性肾脏病(CKD)患者血压变异性与大动脉僵硬度的关系。方法选取2010年4月至2014年4月诊断为 CKD 3~5期非透析患者,检测24 h 动态血压,根据患者是否患有高血压以及血压变异性进行分组,分析各组各项指标的差异以及血压变异性与大动脉僵硬度的关系。结果共收集 CKD 合并高血压患者368例, CKD 血压正常患者64例。直线相关分析发现 CKD 合并高血压患者血压变异性与脉搏波传导速度(PWV)呈显著的负相关( r =-0.583,P ﹤0.05)。CKD 血压正常患者血压变异性与 PWV 呈显著的负相关( r =-0.844,P ﹤0.05)。多元线性回归分析患者各项观察指标与患者 PWV 的关系发现,CKD 合并高血压患者收缩压、舒张压、脉压、血压变异性、CKD 分期与患者 PWV 显著相关;CKD 血压正常患者血压变异性和 CKD 分期与患者 PWV 显著相关。结论 CKD 患者是否合并高血压,其血压的昼夜异常变化与患者大动脉僵硬度关系密切。%Objective To explore the relationship between variability of blood pressure and stiffness of large artery in patients with chronic kidney disease(CKD)without dialysis. Methods Patients with CKD at phase 3 ~ 5 without dialysis admitted in the department of internal medi-cine in this hospital during April 2010 to April 2014 were allocated in this study. Twenty four hours dynamic blood pressure had been examined, and patients were grouped according to whether they suffered from high blood pressure and variability of blood pressure. The difference in each in-dex of each group and the relationship between variability of blood pressure and stiffness of large artery had been analyzed. Results There were 368 patients with CKD and hypertension and 64 patients with CKD were allocated for this study. There was significant negative correlation between variability of blood pressure and PWV in patients with CKD and

  12. Chronic Inflammatory Demyelinating Polyneuropathy

    OpenAIRE

    Dimachkie, Mazen M.; Barohn, Richard J.

    2013-01-01

    Chronic Inflammatory polyneuropathies are an important group of neuromuscular disorders that present chronically and progress over more than 8 weeks, being referred to as chronic inflammatory demyelinating polyneuropathy (CIDP). Despite tremendous progress in elucidating disease pathogenesis, the exact triggering event remains unknown. Our knowledge regarding diagnosis and management of CIDP and its variants continues to expand, resulting in improved opportunities for identification and treat...

  13. 穴位埋线对慢性心力衰竭大鼠血压与心功能的影响%Influence of Acupoint-catgut-implantation on Blood Pressure and Cardiac Function in Chronic Congestive Heart Failure Rats

    Institute of Scientific and Technical Information of China (English)

    邓元江; 梁伟雄; 程淑意

    2011-01-01

    Objective To observe the effect of acupoint-catgut-implantation on blood pressure and cardiac function in chronic heart failure (CHF) rats. Methods A total of 60 SD female rats were randomly divided into shem-operation group (sham), CHF model group, catgut-implantation group, Captopril group. CHF model was established by suprarenal abdominal artery constriction. Surgical catgut (No. 3-0, 2-3 mm length piece) was implanted into bilateral “Neiguan” (PC 6), “Xinshu” (BL 15) and “Zusanli” (ST 36) twice for 7 weeks. Rats of the Captopril group were treated with intragastric infusion of Captopril from the 50th day on after the operation, once daily for 7 weeks. Blood pressure (BP) including the systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP), heart rate (HR) and the left ventricular ejection fraction (LVEF)were detected respectively by cardiac sonography. Results On the 14th week after modeling, in comparison with the sham group, the SBP, DBP, MBP and HR in rats of the model group were increased significantly (P<0.01, P<0.05), while LVEF of the model group was decreased considerably (P<0.01). Compared with the model group, the SBP, DBP, MBP and HR after 7 weeks' treatment in rats of the catgut-implantation and Captopril groups were decreased considerably (P<0.01), while the LVEF of the catgut-implantation group was increased evidently (P<0.05). No significant differences were found between the catgut-implantation and Captopril groups in the SBP, DBP, MBP and HR levels, and between the model and Captopril groups in LVEF values (P>0.05). Conclusion Acupoint-catgut-implantation can down-regulate BP and HR, and increase LVEF in chronic congestive heart failure rats, which may contribute to its effect in ameliorating the cardiac function.%目的:探讨穴位理线对慢性心力衰竭大鼠血压与心功能的干预作用.方法:将雌性SD大鼠随机分为假手术组、心衰模型组、穴位埋线组

  14. CT-based three-dimensional reconstruction navigation technique assisted pedicle screw placement in lumbar and sacral bone%腰骶骨椎弓根螺钉置入内固定:CT三维重建虚拟导航的辅助

    Institute of Scientific and Technical Information of China (English)

    陈晓明; 陈前芬; 肖增明; 宗少晖

    2015-01-01

      结果与结论:共置入腰骶椎椎弓根螺钉1088枚,其中1068枚螺钉位置为Ⅰ级,置钉准确率达98.2%。152例获得随访,随访时间12个月,无内固定物移位、断裂等并发症。术前CT三维重建虚拟导航技术能为腰骶骨椎弓根螺钉内固定提供三维立体的解剖信息,制定最优置钉计划,使置钉更加精确安全,从而提高整体的修复质量。%BACKGROUND:Pedicle screw fixation techniques have been widely used in the treatment of lumbar and sacral disease, such as trauma, deformity, tumor and degeneration. How to improve the accuracy of screw placement is a hot topic. CT-based three-dimensional reconstruction navigation technique provides real-time, multi-perspective, three-dimensional visualization of lumbar and sacral anatomy, and surgeons can perform the pedicle screw insertion procedures confidently with increase of accuracy and safety. OBJECTIVE:To study the clinical value of CT-based three-dimensional reconstruction navigation technique in the application of lumbar and sacral pedicle screw placement. METHODS:A total of 203 patients with lumbar and sacral diseases, including lumbar fracture, lumbar spondylolysis and lumbar spinal stenosis, were recruited from Department of Spine&Osteopathy, the First Affiliated Hospital of Guangxi Medical University between July 2008 and November 2014. Patients received pedicle screw placement in lumbar and sacral bone under the guidance of CT-based three-dimensional reconstruction navigation. Postoperative X-ray films and three-dimensional CT scan of lumbar bone were routinely examined in each patient. The accuracy of pedicle screw insertion was evaluated with postoperative CT scan according to Andrew classification. RESULTS AND CONCLUSION:A total of 1 088 screws were inserted in the lumbar and sacral bone. The accuracy of pedicle screw insertion was rated as grade I in 1 068 screws (98.2%) according to postoperative CT scan. 152 cases were fol owed

  15. [Chronic illness and contraception].

    Science.gov (United States)

    Saarikoski, S

    1987-01-01

    In recent years sterilization that can cause problems of the psyche and marital life has been recommended much less frequently with respect to chronic diseases. As regards heart and hypertensive diseases pregnancy is always contraindicated in case of 3rd and 4th disease categories and sterilization is recommended according to the New York Heart Association. As far as 1st and 2nd category patients are concerned if the load carrying capacity is normal pregnancy could be undertaken. Combination pills are not recommended for contraception because they can cause fluid retention or increase the risk of thrombosis. If the patient has a higher-than-normal risk of developing thrombosis or infection, for instance, those who wear pacemakers only tablets containing progesterone or subdermal capsule implants can be used. In those with blood pressure problems the additional use of the IUD is also advised. Among diseases of neurological and psychic origin the effect of hormonal contraceptives is weakened by antiepileptics, but even in such cases older combination pills of larger doses of active ingredients can be employed. Migraine is exacerbated in 1/3 of patients; here IUDs can be used. Even the contraceptive tablets themselves can induce depression. In psychosis methods requiring regular attention can be easily forgotten, therefore the IUD is the most suitable device. In diabetes progesterone and other progestogens reduce insulin response, harm carbohydrate metabolism; therefore in young people the IUD is preferred an in older women with children even sterilization can be employed. Hormonal tablets must not be used in hyperlipidemia and liver diseases. Caution must be exercised in hyperthyroidism and in endocrine disorders (e.g., Cushing's syndrome); if it is accompanied by blood pressure disorders appropriate treatment is required. In kidney diseases pregnancy is contraindicated if it is accompanied by blood pressure increase or a higher level of creatine. On the other hand

  16. The effect of a trunk release maneuver on Peak Pressure Index, trunk displacement and perceived discomfort in older adults seated in a high Fowler’s position: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Best Krista L

    2012-11-01

    Full Text Available Abstract Background Pressure ulcers pose significant negative individual consequences and financial burden on the healthcare system. Prolonged sitting in High Fowler’s position (HF is common clinical practice for older adults who spend extended periods of time in bed. While HF aids in digestion and respiration, being placed in a HF may increase perceived discomfort and risk of pressure ulcers due to increased pressure magnitude at the sacral and gluteal regions. It is likely that shearing forces could also contribute to risk of pressure ulcers in HF. The purpose of this study was to evaluate the effect of a low-tech and time-efficient Trunk Release Manuever (TRM on sacral and gluteal pressure, trunk displacement and perceived discomfort in ambulatory older adults. Method A randomized controlled trial was used. We recruited community-living adults who were 60 years of age and older using posters, newspaper advertisements and word-of-mouth. Participants were randomly allocated to either the intervention or control group. The intervention group (n = 59 received the TRM, while the control group (n = 58 maintained the standard HF position. Results The TRM group had significantly lower mean (SD PPI values post-intervention compared to the control group, 59.6 (30.7 mmHg and 79.9 (36.5 mmHg respectively (p = 0.002. There was also a significant difference in trunk displacement between the TRM and control groups, +3.2 mm and −5.8 mm respectively (p = 0.005. There were no significant differences in perceived discomfort between the groups. Conclusion The TRM was effective for reducing pressure in the sacral and gluteal regions and for releasing the trunk at the point of contact between the skin and the support surface, but did not have an effect on perceived discomfort. The TRM is a simple method of repositioning which may have important clinical application for the prevention of pressure ulcers that may occur as a result of HF.

  17. Blood pressure measurement

    Science.gov (United States)

    Diastolic blood pressure; Systolic blood pressure; Blood pressure reading; Measuring blood pressure ... or your health care provider will wrap the blood pressure cuff snugly around your upper arm. The ...

  18. Blood Pressure Quiz

    Science.gov (United States)

    ... page please turn Javascript on. Feature: High Blood Pressure Blood Pressure Quiz Past Issues / Fall 2011 Table of Contents ... About High Blood Pressure / Treatment: Types of Blood Pressure Medications / Blood Pressure Quiz Fall 2011 Issue: Volume 6 Number ...

  19. Hypertension (High Blood Pressure)

    Science.gov (United States)

    ... right away. continue How Do Doctors Measure Blood Pressure? Blood pressure readings are fast and painless. Blood pressure ... same age, height, and gender have lower blood pressure. Blood pressure between 90% and 95% of the normal ...

  20. THROMBOENDARTERECTOMY FOR CHRONIC PULMONARY THROMBOEMBOLISM

    Institute of Scientific and Technical Information of China (English)

    Hua Ren; Pi-xiong Su; Chao-ji Zhang; Song Gu; Heng Zhang; Chen Wang

    2005-01-01

    Objective To evaluate the improving reliability and safety of thromboendarterectomy and perioperative management for chronic pulmonary thromboembolism. Methods The clinical data of 12 cases with chronic pulmonary thromboembolism, who underwent thromboendarterec tomy assisted by low flow or circulation arrest with deep hypothermia, were reviewed retrospectively. Results Pulmonary artery pressure decreased 20 to 40 mmHg immediately after surgical procedures in 9 cases. The postoperative pulmonary edema at various degrees happened in 12 cases, among them, 1 died of severe lung infection and pulmonary re-embolism at 19 days postoperation. Computed tomography pulmonary angiography and angiography of 11 cases indicated that the original obstruction of pulmonary artery disappeared. During the follow-up period of 2 months to 5 years, the clinical symptoms and activity was improved. Conclusion Thromboendarterectomy is an effective treatment for chronic pulmonary thromboembolism. The outcome of the surgical procedure needs to be further investigated and followed up regularly according to an evaluative system, because it might be influenced by multiple factors.

  1. Outcomes of Noninvasive Ventilation for Acute Exacerbations of Chronic Obstructive Pulmonary Disease in the United States, 1998–2008

    OpenAIRE

    Chandra, Divay; Stamm, Jason A.; Taylor, Brian; Ramos, Rose Mary; Satterwhite, Lewis; Krishnan, Jerry A.; Mannino, David; Sciurba, Frank C.; Holguín, Fernando

    2012-01-01

    Rationale: The patterns and outcomes of noninvasive, positive-pressure ventilation (NIPPV) use in patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (COPD) nationwide are unknown.

  2. Recent advances on the association of apoptosis in chronic non healing diabetic wound

    OpenAIRE

    Arya, Awadhesh K; Tripathi, Richik; Kumar, Santosh; Tripathi, Kamlakar

    2014-01-01

    Generally, wounds are of two categories, such as chronic and acute. Chronic wounds takes time to heal when compared to the acute wounds. Chronic wounds include vasculitis, non healing ulcer, pyoderma gangrenosum, and diseases that cause ischemia. Chronic wounds are rapidly increasing among the elderly population with dysfunctional valves in their lower extremity deep veins, ulcer, neuropathic foot and pressure ulcers. The process of the healing of wounds has several steps with the involvement...

  3. Chronic granulomatous disease associated with chronic glomerulonephritis

    DEFF Research Database (Denmark)

    Frifelt, J J; Schønheyder, Henrik Carl; Valerius, Niels Henrik;

    1985-01-01

    A boy with chronic granulomatous disease (CGD) developed glomerulonephritis at the age of 12 years. The glomerulonephritis progressed to terminal uraemia at age 15 when maintenance haemodialysis was started. The clinical course was complicated by pulmonary aspergillosis and Pseudomonas septicaemia...

  4. 无创正压通气对慢性阻塞性肺疾病肺动脉高压及脑钠肽的影响%Effect of Noninvasive Positive Pressure Ventilation on Chronic Obstructive Pulmonary Disease Pulmonary Hypertension and Brain Natriuretic Peptide

    Institute of Scientific and Technical Information of China (English)

    彭慧群; 林伟革; 刘龙英

    2014-01-01

    Objective To study the noninvasive positive pressure ventilation (NIPPV) in patients with chronic obstructive pulmonary disease (COPD) in pulmonary arterial hypertension (AP) and brain natriuretic peptide (BNP) effect. Methods 30 cases of COPD complicated with AP in our hospital from 2008 January to 2013 January were treated patients as the research object, using non-invasive positive pressure ventilator mask to patients on ventilation for 7 days, al of the patients receiving noninvasive positive pressure ventilation ventilation before and after PaCO2 (mmHg), PaO2 (mmHg), AP (mmHg), BNP (pg/ml) were observed, compared. Results All patients in this study, 17 patients in after 7 days of treatment, in which PaCO2, PaO2, AP, BNP levels before and after treatment has obvious dif erence, with statistical significance, <0.05. 5 patients in the course of treatment for invasive ventilation in the treatment of transit. Conclusion NIPPV on noninvasive positive pressure ventilation in both on chronic obstructive pulmonary disease pulmonary hypertension and brain natriuretic peptide significantly improved.%目的:本文探讨无创正压通气(NIPPV)慢性阻塞性肺疾病(COPD)肺动脉高压(AP)及脑钠肽(BNP)的影响。方法选择我院2008年1月~2013年1月所收治的30例COPD合并AP的患者作为研究对象,采用无创正压呼吸机面罩来对患者进行辅助通气治疗7d,对所有患者在接受无创正压通气前以及通气后PaCO2(mmHg)、PaO2(mmHg)、 AP(mmHg)、BNP(pg/ml)变化进行观察、比较。结果本研究所有患者中,有17例患者在经过7d的治疗后,其体内的PaCO2、PaO2、AP、BNP水平与治疗前存在明显差异,具有统计学意义,P<0.05。5例患者在治疗的过程中转为有创通气治疗。结论 NIPPV对无创正压通气对慢性阻塞性肺疾病肺动脉高压及脑钠肽都有明显改善。

  5. Nitric oxide and chronic colitis

    Directory of Open Access Journals (Sweden)

    Matthew B Grisham

    1996-01-01

    Full Text Available Nitric oxide (NO is thought to play an important role in modulating the inflammatory response by virtue of its ability to affect bloodflow, leukocyte function and cell viability. The objective of this study was to assess the role that NO may play in mediating the mucosal injury and inflammation in a model of chronic granulomatous colitis using two pharmacologically different inhibitors of nitric oxide synthase (NOS. Chronic granulomatous colitis with liver and spleen inflammation was induced in female Lewis rats via the subserosal (intramural injection of peptidoglycan/polysaccharide (PG/PS derived from group A streptococci. Chronic NOS inhibition by oral administration of NG-nitro-L-arginine methyl ester (L-NAME (15 µmol/kg/day or amino-guanidine (AG (15 µmol/ kg/day was found to attenuate the PG/PS-induced increases in macroscopic colonic inflammation scores and colonic myeloperoxidase activity. Only AG -- not L-NAME – attenuated the PG/PS-induced increases in colon dry weight. Both L-NAME and AG significantly attenuated the PG/PS-induced increases in spleen weight whereas neither was effective at significantly attenuating the PG/PS-induced increases in liver weight. Although both L-NAME and AG inhibited NO production in vivo, as measured by decreases in plasma nitrite and nitrate levels, only AG produced significantly lower values (38±3 versus 83±8 µM, respectively, P<0.05. Finally, L-NAME, but not AG, administration significantly increased mean arterial pressure from 83 mmHg in colitic animals to 105 mmHg in the PG/PS+ L-NAME-treated animals (P<0.05. It is concluded that NO may play an important role in mediating some of the pathophysiology associated with this model of chronic granulomatous colitis.

  6. The relationship between pathological type and blood pressure level or its circadian rhythm in patients with chronic kidney disease%慢性肾脏病患者病理类型与血压水平及昼夜节律变化的关系

    Institute of Scientific and Technical Information of China (English)

    方曙波; 王国政; 王方芳; 王军

    2014-01-01

    Objective To investigate the relationship between pathological type and blood pressure level or its circadian rhythm,as well as the relationship between the latter and the lesion degree of renal arterioles in patients with chronic kidney disease.Methods Data of 1746 cases with chronic kidney disease were collected form our hospitals who underwent renal biopsies and 24-hour ambulatory blood pressure monitoring from 2008-2013,and were analyzed according to the 2013 European Society of Hypertension Practice Guidelines.24 h average blood pressure ≥ 130/80 mmHg was referred to as hypertension. Nocturnal blood pressure decline rate =[(daytime blood pressure-nocturnal blood pressure)/daytime blood pressure]×100%.Nocturnal blood pressure decline >20% was referred to as extreme dippers rhythm, 10%-20% as dippers rhythm,<10% as nondipper rhythm,and <0% as risers rhythm.Both the extreme dippers rhythm and the dippers rhythm were defined as normal circadian rhythm,while the nondipper and risers rhythms defined as the abnormal blood pressure rhythm.The pathological diagnosis and typing were in reference to the 1995 WHO Glomerular Diseases Histological Type Amendments and the domestic 2001 Renal Biopsy Pathological Diagnosis Standard Guidance.Renal arteriole injury score standard was in reference to the IgA nephropathy Oxford typing score system.Results (1 )Age range of the 1746 cases was 47.4 ± 24.9 years,including 929 male cases (53.2%).The 24 h average blood pressure was≥130/80 mmHg in 560 cases (32.1%),the daytime average blood pressure ≥ 135/85 mmHg in 474 cases (27.1%),and the nocturnal average blood pressure ≥ 120/70 mmHg in 762 cases (43.6%).Extreme dippers blood pressure was in 38 cases (2.2%),dippers blood pressure in 647 cases (37.1%),nondipper blood pressure in 908 cases (52%),and risers blood pressure in 155 cases (8.9%).(2)The incidence of hypertension in patients with different pathological types of CKD was 75 .5% (74 cases ) in diabetic nephropathy,41

  7. A novel, non-invasive diagnostic clinical procedure for the determination of an oxygenation status of chronic lower leg ulcers using peri-ulceral transcutaneous oxygen partial pressure measurements: Results of its application in chronic venous insufficiency (CVI [Ein neues, nicht-invasives, klinisch-diagnostisches Verfahren zur Ermittlung eines Sauerstoff-Status chronischer Unterschenkelgeschwüre mit peri-ulzeralen transkutanen Sauerstoffpartialdruck-Messungen: Ergebnisse der Anwendungen bei chronisch-venöser Insuffizienz (CVI

    Directory of Open Access Journals (Sweden)

    Barnikol, Wolfgang K. R.

    2012-06-01

    Full Text Available [english]
    The basis for the new procedure is the simultaneous transcutaneous measurement of the peri-ulceral oxygen partial pressure (tcPO, using a minimum of 4 electrodes which are placed as close to the wound margin as possible, additionally, as a challenge the patient inhales pure oxygen for approximately 15 minutes. In order to evaluate the measurement data and to characterise the wounds, two new oxygen parameters were defined: (1 the oxygen characteristic (K-PO, and (2 the oxygen inhomogeneity (I-PO of a chronic wound. The first of these is the arithmetic mean of the two lowest tcPO measurement values, and the second is the variation coefficient of the four measurement values. Using the K-PO parameter, a grading of wound hypoxia can be obtained. To begin with, the physiologically regulated (and still compensated hypoxia with K-PO values of between 35 and 40 mmHg is distinguished from the pathological decompensated hypoxia with K-PO values of between 0 and 35 mmHg; the first of these still stimulates self-healing (within the limits of the oxygen balance. The decompensated hypoxia can be (arbitrarily divided into “simple” hypoxia (Grade I, intense hypoxia (Grade II and extreme hypoxia (Grade III, with the possibility of intermediate grades (I/II and II/III.Measurements were carried out using the new procedure on the skin of the right inner ankle of 21 healthy volunteers of various ages, and in 17 CVI (chronic venous insufficiency wounds. Sixteen of the 17 CVI wounds (i.e., 94% were found to be pathologically hypoxic, a state which was not found in any of the healthy volunteers. The oxygen inhomogeneity (I-PO of the individual chronic wounds increased exponentially as a function of the hypoxia grading (K-PO, with a 10-fold increase with extreme hypoxia in contrast to a constant value of approximately 14% in the healthy volunteers. This pronounced oxygen inhomogeneity explains inhomogeneous wound healings, resulting in the so

  8. Chronic prostatitis treated with perfused ozonated water through urethra with prostatic constant pressure location%三氧水溶液经尿道前列腺恒压定位灌注治疗慢性前列腺炎的临床研究

    Institute of Scientific and Technical Information of China (English)

    王均友; 相建峰; 柳青; 尉希超; 王月卿; 马国华; 龙园园; 张永

    2012-01-01

    目的 研究三氧水经尿道前列腺恒压定位灌注治疗慢性前列腺炎(CP)的临床价值.方法 将符合诊断标准的238例CP患者随机分为三氧组和对照组,各119例.三氧组使用前列腺恒压定位灌注装置(专利号03271223.5)进行前列腺灌注治疗,灌注液为浓度42.5%三氧水溶液40ml,每周2次,3~6次为一疗程;对照组进行常规治疗.通过对比病人治疗前后NIH-CPSI评分、症状评分及EPS常规镜检结果来观察临床价值.结果 三氧组总有效率100%,对照组总有效率73%,三氧组治愈、显效、总有效率均高于对照组(P<0.05).结论 在前列腺恒压定位灌注治疗前列腺炎的基础上,应用自制三氧水溶液作为灌注液治疗CP,其临床疗效优于对照组,能迅速改善症状,适用于各类CP,且长期应用无耐药之虞,无毒副作用.%Objective To evaluate the clinical effect in the treatment of chronic prostatitis.with perfused ozonated water through the urethra with prostatic constant pressure location. Methods In total 238 patients with chronic prostatitis were randomly divided into the treatment group (119 cases) and control group, (119 cases). Ozonated water (42.5mg/L 40ml) was perfused into patient's prostate using a device of constant pressure location (Patent No. 03271223.5), twice a week. Three-six times completed a course of treatment. The patients in the control group received routine drug treatment. The NIH-CPSf score, symptom score and the results of EPS conventional microscopic observation before and after treatment were comparartively analyzed. Results The total effective rate was 100% in the treatment group, and 73% in the control group. The curative rate, marked effective rate and total efficiency rate of the treatment group were higher than those of the control group (P<0.05). Conclusion Appropriate concentration of ozoned water perfused can rapidly relieve the symptoms of chronic prostatitis. It has no risk of drug resistance

  9. Efficacy and complications of preoperative arterial embolization in the treatment of high sacral tumors%术前动脉栓塞在高位骶骨肿瘤手术中的疗效及并发症

    Institute of Scientific and Technical Information of China (English)

    齐典文; 扈文海; 张国川; 胡彤宇; 郭昶志; 陈燕; 赵家宁

    2013-01-01

    Objective To investigate the efifcacy and complications of preoperative arterial embolization in the surgical treatment of high sacral tumors. Methods The data of 37 patients with high sacral tumors who underwent surgical resection in our hospital between January 2006 and December 2011 were retrospectively analyzed. Preoperative arterial embolization were performed in all the patients and surgery were performed within the following 24 hours. The data of surgical time, blood loss, transfusion volume, and the postoperative complications were collected by reviewing the arterial embolization record, image, operation record, progress notes, nursing records and etc. Results Angiography clearly demonstrated the blood supply of the tumor and the dimension of the lesion. The tumor stain was markedly reduced after selective embolization in angiography. The volume of the tumor was decreased, the margin of the tumor became clear, and blood loss during the exposure was reduced. The surgical time was ( 147.97±38.99 ) min, blood loss was ( 1932.35±1293.27 ) ml, transfusion volume was ( 1296.00±938.00 ) ml. No serious embolization-associated complications were observed in all the patients. The incidence of delayed wound healing was 18/37 ( 49%), and the incidence of wound infection was 8/37 ( 22%). Conclusions Preoperative arterial embolization is an effective supplementary means for the surgery of high sacral tumor, which can shorten the surgical time, reduce the blood loss and the transfusion volume. Meanwhile, it could increase the possibility of delayed wound healing and wound infection.%目的:探讨术前动脉栓塞在高位骶骨肿瘤手术中的应用价值。方法回顾性分析37例于2006年1月至2011年12月,我院行手术治疗的高位骶骨肿瘤患者的病历资料。所有患者术前均行选择性动脉栓塞,后实施手术。通过回顾其介入操作记录、影像资料、手术记录、术后病程及护理记录单等,统计手术时间

  10. 水平方向骶髂关节螺钉固定治疗骶骨纵形骨折的安全性评价%The safety of transverse iliosacral screw fixation of longitudinal sacral fracture

    Institute of Scientific and Technical Information of China (English)

    孙旭; 李宇能; 杨明辉; 吴新宝; 赵春鹏; 王满宜

    2011-01-01

    ObjectiveTo evaluate the safety of transverse iliosacral screw fixation of longitudinal sacral fracture.MethodsWe obtained CT scan data of the pelvis from 100 adults without any bony problems from September to December 2009. They were 52 males and 48 females, aged from 15 to 91 years (average, 43. 1 years) . We then reconstructed virtual three-dimensional models of the pelvis. The three-dimensional models were re-segmented through the sacral horizontal axis to obtain standard sagittal planes of the sacrum. To identify the safe zone for transverse screw fixation, we marked off the sacral margin on each sagittal plane. In simulation of the transverse screw ipsilateral fixation and transfixation, one single virtual cylindrical implant was inserted into the safe zone. The maximum diameter of the virtual cylindrical implant was measured.ResultsA 20. 0% rate of sacral variation was observed (80 normal versus 20 deformed morphological sacrums). In ipsilateral fixation, the average screw diameter of variant S2 (14. 92 ± 2.57 mm) >normal S2 ( 12. 37 ± 1.84 mm) ( P =0. 000) > normal S1 ( 11.87 ± 3.92 mm) ( P =0. 319 ) > variant S3 (9. 30 ± 2. 00 mm) ( P =0. 000). In transfixation, the average screw diameter of variant S2 ( 13.63 ± 2. 68 mm) > normalS2 (11.48 ±1.92mm) (P=0. 002) > normal S1(10. 40 ±4.05 mm) (P=0.033) >variant S3 (7.95 ± 2. 26 mm) ( P =0. 001 ) . The maximum screw diameter of normal S2 showed a slightly negative correlation with that of normal S1, but there was no correlation between the maximum screw diameter for each sacral vertebra and the acetabulum diameter. The normal male S2 was significantly larger than the female one ( P < 0.05), but there was no significant difference in S1 between genders ( P > 0.05) .ConclusionsIn most Chinese people, the posterior pelvic ring could be fixed with 2 iliosacral screws of 6. 5 mm in diameter simultaneously in horizontal direction, but care should be taken because the safety zone is quite

  11. 高压喷射氧雾化吸入沐舒坦对慢性阻塞性肺疾病急性加重期痰液性状的影响%The Effects of Ambroxol Mucosolvan Inhalated by High-pressure Jet Oxygen Atomization to Sputum Properties in Patients with Chronic Obstructive Pulmonary Disease During Acute Aggravating Period

    Institute of Scientific and Technical Information of China (English)

    杨玉平; 周向东

    2014-01-01

    Objective To observe the effects of Ambroxol mucosolvan inhalated by High-pressure jet oxygen atomization to the physical and chemical properties of sputum in patients with chronic obstructive pulmonary disease during acute aggravating period. Method 72 cases of COPD patients with acute aggravating period to give an easy high-pressure jet oxygen atomization inhalation,bathing separately col ected before detect atomization,1 hours after atomization sputum volume,wet/dry weight and viscosity. Results After oxygen atomization,oxygen atomization before amount of sputum,sputum viscosity,sputum dry/wet weight had significant dif erence (p<0.05), and inflammatory biomarkers of neutrophil (PMN) combined with elastic enzyme membrane(HLE) has no obvious change. Conclusion High-pressure jet oxygen atomization inhalation of Ambroxol mucosolvan with dilute sputum and increased sputum volume effect,so as to ease of airway obstruction caused by high mucus secretion,relieve the patient's clinical symptoms,but the inhibition effect of the inflammatory response in the airways of has yet to be further research.%目的:观察高压喷射氧雾化吸入沐舒坦对慢性阻塞性肺疾病(COPD)急性加重期患者痰液理化性质的作用。方法72例COPD急性加重期患者给予沐舒坦高压喷射氧雾化吸入,分别收集检测雾化前、雾化后1h痰液量、干/湿重及黏度。结果氧雾化前与雾化后的痰液量、痰液黏度、痰液干/湿重均有明显差异(P<0.05)。而炎症指标中性粒细胞(PMN)膜结合弹力酶(HLE)无明显改变。结论高压喷射氧雾化吸入沐舒坦有稀释痰液、增加排痰量的作用。从而缓解黏液高分泌所致的气道阻塞、减轻患者的临床症状,但抑制气道炎症反应的作用尚无明确证据。

  12. Chronic penile strangulation

    OpenAIRE

    Lopes, Roberto I.; Silvia I Lopes; Roberto N. Lopes

    2003-01-01

    Chronic penile strangulation is exceedingly rare with only 5 cases previously reported. We report an additional case of progressive penile lymphedema due to chronic intermittent strangulation caused by a rubber band applied to the penile base for 6 years. A 49-year-old man presented incapacity to exteriorize the glans penis. For erotic purposes, he had been using a rubber-enlarging band placed in the penile base for 6 years. With chronic use, he noticed that his penis swelled. Physical examin...

  13. Chronic obstructive pulmonary disease

    OpenAIRE

    NR Anthonisen

    2007-01-01

    The global prevalence of physiologically defined chronic obstructive pulmonary disease (COPD) in adults aged >40 yr is approximately 9-10 per cent. Recently, the Indian Study on Epidemiology of Asthma, Respiratory Symptoms and Chronic Bronchitis in Adults had shown that the overall prevalence of chronic bronchitis in adults >35 yr is 3.49 per cent. The development of COPD is multifactorial and the risk factors of COPD include genetic and environmental factors. Pathological changes in COPD are...

  14. High Blood Pressure (Hypertension)

    Science.gov (United States)

    ... your doctor prescribes it, medicine. What Is Blood Pressure? Blood pressure is the force of blood flow inside ... Will I Know if I Have High Blood Pressure? High blood pressure is a silent problem — you won't ...

  15. Understanding Blood Pressure Readings

    Science.gov (United States)

    ... What is the AHA recommendation for healthy blood pressure? This blood pressure chart reflects categories defined by the American ... unusually low blood pressure readings. How is high blood pressure diagnosed? Your healthcare providers will want to get ...

  16. High Blood Pressure

    Science.gov (United States)

    ... pressure and should be taken seriously. Over time, consistently high blood pressure weakens and damages ... of landmark NIH blood pressure study confirm that lower blood pressure target can reduce ...

  17. Chronic Heart Failure: Contemporary Diagnosis and Management

    OpenAIRE

    Ramani, Gautam V.; Uber, Patricia A.; Mehra, Mandeep R.

    2010-01-01

    Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF...

  18. 无创正压通气治疗2例慢性充血性心力衰竭合并陈-施呼吸患者经验总结及分析%Clinical experiences and analysis of non-invasive positive pressure ventilation in treating patients of chronic congestive heart failure with complications of Cheyne-Stoke respiration

    Institute of Scientific and Technical Information of China (English)

    肖高辉; 顾蕾; 席新蕊; 单晓宇; 黄席珍

    2009-01-01

    目的 比较两种无创呼吸机治疗慢性充血性心力衰竭合并陈-施呼吸(cheyne-stoke respiration,CSR)患者效果.方法 选取北京市公安医院2例慢性充血性心力衰竭合并CSR患者,针对患者病情给予患者常规治疗,并在常规治疗的基础上分别采用压力支持自动伺服通气(Autoset CS)以及双水平无创正压通气(Bilevel PAP)进行治疗.比较治疗前后的呼吸频率、心率、血气变化情况(pH、PaO2、PaCO2、SaO2)、收缩压、舒张压、左室射血分数等情况.同时注意观察患者接受治疗后的不良反应,例如:局部皮肤损伤、鼻炎、明显腹胀、气压伤、误吸、低血压等.结果 采用Autoset CS治疗CSR显示出不仅有睡眠质量的提高、白天嗜睡的减轻及认知度的改善,而且心力衰竭患者的左室射血分数及心功能都有明显改善.另外采用BilevelPAP经鼻无创通气治疗CSR其参数设定吸气压通常为10.0 cm H2O;呼气压通常为6~8 cm H2O即可.吸气时间较治疗慢性阻塞性肺疾病的参数有所延长,通常为0.5~0.6 s;呼气时间较治疗慢性阻塞性肺疾病的参数有所减少,通常为0.3 S.结论 Autoset CS治疗CSR采用自动调节的伺服通气运算,提供一种全新的无创正压通气治疗形式,更及时完全地控制CSR.BilevelPAP经鼻无创通气治疗CSR其参数设定与治疗慢性阻塞性肺疾病的参数设定显著的不同.%Objective To compare the effect of two non-invasive positive pressure ventilations in treating patients of chronic congestive heart failure with complications of Cheyne-Stoke respiration(CSR). Methods Two patients of chronic congestive heart failure with complications of CSR were given conventional treatment plus adaptive-service ventilation(Autoset CS) or Bilevel PAP respectively. Parameters including respiratory rate, heart rate, pH, PaO2, PaCO2, SaO2, SBP, DBP, left ventricular ejection factor (LVEF) were measured and compared for two patients before

  19. Study of bi-level positive airway pressure in patients with chronic heart failure combined with sleep aprea hypopnea syndrome%双水平气道正压通气治疗合并睡眠呼吸暂停综合征的慢性心力衰竭患者的疗效研究

    Institute of Scientific and Technical Information of China (English)

    陈青; 许建新; 朱伟年

    2011-01-01

    Objective Observe the effect of bi-level positive airway pressure (BiPAP) in patients with chronic heart failure combined with sleep apnea hypopnea syndrome(SAHS). Methods 60 patients were randomly assigned to routine drug therapy group(group A) and routine drug therapy combined with BiPAP group(group B),30 patients in each group. After 2-year fellow up, apnea hypopnea index(AHI),nocturnal oximetry,left ventricular ejection fraction, brain natriuretic peptide,6-minute walk test, NYHA difference indicators of heart failure between the two groups were improved in varying degrees, group B AHI, nocturnal oximetry were markedly improved in group B, but the two both were deterioration in group A. Conclusions The effect of BiPAP was evident and can improve the prognosis obviously in patients with chronic heart failure combined with SAHS.%目的 观察双水平气道正压通气(BiPAP)对合并睡眠呼吸暂停综合征的慢性心力衰竭患者的治疗效果.方法 将符合标准的入选病例随机分为常规药物治疗组(A组)30例及常规药物+BiPAP治疗组(B组)30例.所有受试者随访2年并在试验前后分别榆测睡眠呼吸暂停低通气指数(AHI)、夜间血氧饱合度、左室射血分数、脑钠肽、6分钟步行距离及评定心功能分级.结果 试验结束时①B组患者无论是主要终点事件还是次要终点事件均明显少于A组(P<0.05).②两组患者主要心力衰竭差数指标均有不同程度改善,但B组改善程度明显优于A组(P<0.01).③B组患者AHI、夜间血氧饱合度较治疗前均明显改善(P<0.05),而A组患者两者均有恶化趋势.结论 BiPAP对合并睡眠呼吸暂停综合征的慢性心力衰竭患者的治疗效果明确并能改善预后.

  20. Chronic diseases in adolescence

    Directory of Open Access Journals (Sweden)

    Rončević Nevenka

    2006-01-01

    Full Text Available Introduction. The prevalence of chronic diseases in adolescence is constantly increasing, especially in the last two decades. Adolescence is a period of important changes: body growth and development, sexual development, development of cognitive abilities, change in family relations and between peers, formation of personal identity and personal system of values, making decisions on future occupation etc. Chronic diseases in adolescence. Chronic disorders affect all development issues and represent an additional burden for adolescents. The interaction between chronic disorders and various development issues is complex and two-way: the disease may affect development, and development may affect the disease. Developmental, psychosocial and family factors are of great importance in the treatment of adolescents with chronic disorders. Chronic disorders affect all aspects of adolescent life, including relations with peers, school, nutrition, learning, traveling, entertainment, choice of occupation, plans for the future. Physicians should keep in mind that chronic diseases and their treatment represent only one aspect of person's life. Adolescents with chronic diseases have other needs as well, personal priorities, social roles and they expect these needs to be recognized and respected. Adolescent health care should be adjusted to the life style of adolescents.

  1. Managing your chronic pain

    Science.gov (United States)

    ... your chronic back pain To use the sharing features on this page, please enable JavaScript. Managing chronic pain means finding ways to make your back pain tolerable so you can live your life. You may not be able to ...

  2. Phenotypes selected during chronic lung infection in cystic fibrosis patients

    DEFF Research Database (Denmark)

    Ciofu, Oana; Mandsberg, Lotte F; Wang, Hengzhuang;

    2012-01-01

    During chronic lung infection of patients with cystic fibrosis, Pseudomonas aeruginosa can survive for long periods of time under the challenging selective pressure imposed by the immune system and antibiotic treatment as a result of its biofilm mode of growth and adaptive evolution mediated...... the importance of biofilm prevention strategies by early aggressive antibiotic prophylaxis or therapy before phenotypic diversification during chronic lung infection of patients with cystic fibrosis....

  3. Hypertrophy signaling pathways in experimental chronic aortic regurgitation

    DEFF Research Database (Denmark)

    Olsen, Niels Thue; Dimaano, Veronica L; Fritz-Hansen, Thomas;

    2013-01-01

    The development of left ventricular hypertrophy and dysfunction in aortic regurgitation (AR) has only been sparsely studied experimentally. In a new model of chronic AR in rats, we examined activation of molecular pathways involved in myocardial hypertrophy. Chronic AR was produced by damaging on...... of activation of intracellular pathways different from that seen with pathological hypertrophy in pressure overload, and more similar to that associated with benign physiological hypertrophy....

  4. Microcirculation of the juvenile knee in chronic arthritis

    DEFF Research Database (Denmark)

    Bünger, Cody; Bülow, J; Tøndevold, E;

    1986-01-01

    In order to investigate pathogenetic factors in growth abnormalities of the knee in hemophilic arthropathy and juvenile rheumatoid arthritis, the hemodynamic changes of the knee following chronic synovial inflammation and elevated joint pressure were studied in puppies. Unilateral arthritis....... The growth plates formed borders for the extension of these changes. The increased permeability and surface area between blood and bone in arthritis may accelerate the resorption and subsequent destruction of subchondral bone in chronic arthropathies of the juvenile knee....

  5. Chronic gastritis - an update.

    Science.gov (United States)

    Varbanova, Mariya; Frauenschläger, Katrin; Malfertheiner, Peter

    2014-12-01

    Helicobacter pylori is the main aetiologic factor for chronic gastritis worldwide. The degree of inflammation and the evolution of this form of chronic gastritis can vary largely depending on bacterial virulence factors, host susceptibility factors and environmental conditions. Autoimmune gastritis is another cause of chronic inflammation in the stomach, which can occur in all age groups. This disease presents typically with vitamin B12 deficiency and pernicious anaemia. The presence of anti-parietal cell antibodies is highly specific for the diagnosis. The role of H. pylori as a trigger for autoimmune gastritis remains uncertain. Other rare conditions for chronic gastritis are chronic inflammatory conditions such as Crohn's disease or on the background of lymphocytic or collagenous gastroenteropathies. PMID:25439069

  6. [Chronic migraine: treatment].

    Science.gov (United States)

    Pascual, Julio

    2012-04-10

    We define chronic migraine as that clinical situation in which migraine attacks appear 15 or more days per month. Until recently, and in spite of its negative impact, patients with chronic migraine were excluded of the clinical trials. This manuscript revises the current treatment of chronic migraine. The first step should include the avoidance of potential precipitating/aggravating factors for chronic migraine, mainly analgesic overuse and the treatment of comorbid disorders, such as anxiety and depression. The symptomatic treatment should be based on the use of nonsteroidal anti-inflammatory agents and triptans (in this case ergotamine-containing medications. Preventive treatment includes a 'transitional' treatment with nonsteroidal anti-inflammatory agents or steroids, while preventive treatment exerts its actions. Even though those medications efficacious in episodic migraine prevention are used, the only drugs with demonstrated efficacy in the preventive treatment of chronic migraine are topiramate and pericranial infiltrations of Onabotulinumtoxin A. PMID:22532241

  7. The effects of lumbar stabilization exercise with thoracic extension exercise on lumbosacral alignment and the low back pain disability index in patients with chronic low back pain.

    Science.gov (United States)

    Woo, Seong-Dae; Kim, Tae-Ho

    2016-01-01

    [Purpose] To determine the effects of lumbar stabilization exercise with thoracic extension exercise on chronic low back pain patients. [Subjects and Methods] Thirty patients with chronic low back pain were randomly divided into a lumbar stabilization exercise group (group A) and a lumbar stabilization exercise with thoracic extension exercise group (group B). Group B did 15 min of lumbar stabilization exercises and 15 min of thoracic extension exercises, while group A did 30 min of lumbar stabilization exercises five times a week for 4 weeks. For assessing lumbosacral alignment, the lordotic angle, lumbosacral angle, and sacral angle were evaluated. The Oswestry disability index was used for assessment of disability due to low back pain. [Results] Both groups showed improvement in lumbosacral alignment and in the disability index. Group B showed greater changes in the lordotic angle and in the Oswestry disability index than group A, although the differences were not statistically significant. [Conclusion] Lumbar stabilization exercise with thoracic extension exercise can be recommended for improvement of chronic low back pain, although the improvements seen in lumbosacral alignment and low back pain disability index in this study did not achieve statistical significance.

  8. Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)

    Science.gov (United States)

    ... People About NINDS NINDS Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Information Page Table of Contents (click to jump ... en Español What is Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)? Chronic inflammatory demyelinating polyneuropathy (CIDP) is a neurological ...

  9. Stages of Chronic Myelogenous Leukemia

    Science.gov (United States)

    ... ALL Treatment Childhood AML Treatment Research Chronic Myelogenous Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Myelogenous Leukemia Go to Health Professional Version Key Points Chronic ...

  10. Stages of Chronic Lymphocytic Leukemia

    Science.gov (United States)

    ... ALL Treatment Childhood AML Treatment Research Chronic Lymphocytic Leukemia Treatment (PDQ®)–Patient Version General Information About Chronic Lymphocytic Leukemia Go to Health Professional Version Key Points Chronic ...

  11. Chronic Rhinosinusitis with Nasal Polyps.

    Science.gov (United States)

    Stevens, Whitney W; Schleimer, Robert P; Kern, Robert C

    2016-01-01

    Chronic rhinosinusitis with nasal polyps (CRSwNP) is an important clinical entity diagnosed by the presence of both subjective and objective evidence of chronic sinonasal inflammation. Symptoms include anterior or posterior rhinorrhea, nasal congestion, hyposmia, and/or facial pressure or pain that last for a duration of more than 12 weeks. Nasal polyps are inflammatory lesions that project into the nasal airway, are typically bilateral, and originate from the ethmoid sinus. Males are more likely to be affected than females, but no specific genetic or environmental factors have been strongly linked to the development of this disorder to date. CRSwNP is frequently associated with asthma and allergic rhinitis, but the cellular and molecular mechanisms that contribute to the clinical symptoms are not fully understood. Defects in the sinonasal epithelial cell barrier, increased exposure to pathogenic and colonized bacteria, and dysregulation of the host immune system are all thought to play prominent roles in disease pathogenesis. Additional studies are needed to further explore the clinical and pathophysiological features of CRSwNP so that biomarkers can be identified and novel advances can be made to improve the treatment and management of this disease. PMID:27393770

  12. RELATIONSHIP BETWEEN BLOOD-PRESSURE DURING HEMODIALYSIS AND AMBULATORY BLOOD-PRESSURE IN BETWEEN DIALYSES

    NARCIS (Netherlands)

    HUISMAN, RM; DEBRUIN, C; KLONT, D; SMIT, AJ

    1995-01-01

    Background. Ambulatory blood pressure measurements in haemodialysis patients are relevant in view of the high cardiovascular morbidity and mortality in chronic haemodialysis patients. Methods. Twelve normotensive patients were studied from the beginning of one dialysis until the end of the next (mea

  13. AECOPD呼吸衰竭患者无创正压通气治疗效果的相关因素分析%Analysis on relevant factors of the result of noninvasive positive pressure ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease and respiratory failure

    Institute of Scientific and Technical Information of China (English)

    徐丽娜; 曹洁; 陈宝元

    2010-01-01

    Objective To investigate the factors related to the failure of noninvasive positive pressure ventilation(NIPPV) in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and typeⅡ respiratory failure. Methods One hundred and seventy six AECOPD patients with hypercapnia respiratory failure treated by BiPAP ventilation were enrolled and were divided into effective group and failure group according to the curative effect ,clinical and physiological parameters were analyzed comparatively between two groups, multi-variable logistic regression analysis was used to find the predictive factors of the failure in noninvasive ventilation. Results In stable phase, FEV1%predicted was higher,PaCO2 values was lower significantly in patients in NIPPV failure group who also had a lower GCS, lower albumin and BMI, higher APACHE Ⅱ on admission compared with NIPPV success group. Multi-variable logistic analysis suggests statistical significance in GCS and APACHE Ⅱ on admission. Conclusions The failure of NIPPV in patients with AECOPD and type Ⅱ respiratory faliure was influenced by GCS and APACHEⅡ on admission.%目的 探讨应用无创正压通气(noninvasive positive pressure ventilation,NIPPV)救治慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)并Ⅱ型呼吸衰竭失败的相关因素.方法 选取176例AECOPD并Ⅱ型呼吸衰竭的患者接受无创双水平气道内正压呼吸机治疗.按照治疗效果分为成功组和失败组,比较两组患者各项指标及变化,进行Logistic回归分析,寻找无创通气失败的相关因素.结果 NIPPV失败组患者稳定期FEV1%预计值较高,PaCO2值较低,治疗之前GCS评分较低,白蛋白及体质量指数较低,急性生理学和慢性健康状况评分Ⅱ(APACHEⅡ)较高,与NIPPV成功组比较差异有显著性意义.Logistic回归分析提示,治疗前格拉斯哥昏迷评分(GCS)及APACHE Ⅱ评分对NIPPV后期

  14. Application of noninvasive positive pressure ventilation for weaning in patients with chronic obstructive pulmonary disease undergoing mechanical ventilation%无创正压通气在慢性阻塞性肺疾病患者机械通气撤机中的应用

    Institute of Scientific and Technical Information of China (English)

    王建中; 李坚; 魏建军; 徐君美

    2011-01-01

    目的 评价无创正压通气(NPPV)作为慢性阻塞性肺疾病急性加重(AECOPD)有创通气患者撤机方式的应用效果.方法 74例AECOPD有创通气患者随机选择NPPV(拔管后立即应用NPPV过渡撤机)或常规低水平压力支持通气方式撤机.比较两组动脉血气变化、呼吸机相关性肺炎(VAP)的发生率、机械通气时间、住院时间、再插管率和病死率.结果 两组患者总的机械通气时间、住院时间和再插管率相似.但NPPV撤机组有刨通气时间明显缩短(P<0.01),VAP发生率和病死率均低于常规撤机组(P<0.05).结论 NPPV用作AECOPD并呼吸衰竭患者的撤机方式,可明显缩短有创通气时间,降低VAP发生病和病死率,改善患者预后.%Objective To study the efficacy of noninvasive positive pressure ventilation(NPPV) for weaning in patients with chronic obstructive pulmonary disease( AECOPD) undergoing mechanical ventilation. Methods A total of 74 AECOPD patients undergoing mechanical ventilation was randomly divided into two groups of A(36 cases,given NPPV soon after extubation for weaning) and B(38 cases, given conventional weaning by lower level pressure support ventilation). Arterial blood gase was analyzed. The incidence of ventilator-associated pneumonia (VAP), duration of mechanical ventilation,hospital stay and outcomes were compared. Results There were no significant differences in total duration of mechanical ventilation, hospital stay and reintubation rate between two groups. However, the duration of invasive ventilation during weaning was significantly shorter in group A than that in group B(P<0. 01). The rates of VAP and mortality were markedly lower in group A than those in group B(P<0. 05). Conclusion Compared to conventional weaning technique, use of NPPV for weaning has the advantages of shorter duration of invasive ventilation and less incidence of VAP and mortality in AECOPD patients undergoing mechanical ventilation.

  15. 无创正压机械通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭的研究%Clinical study of noninvasive positive pressure ventilation in the treatment of acute exacerbation of chronic ob-structive pulmonary disease combined with type Ⅱ respiratory failure

    Institute of Scientific and Technical Information of China (English)

    林飞克; 陈丰

    2015-01-01

    Objective To investigate the curative effect of noninvasive positive pressure ventilation (NIPPV) on treating patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with type Ⅱ respiratory failure. Methods A total of 86 cases of AECOPD combined with type Ⅱ respiratory failure were randomly divided into the NIPPV group and the control group according to whether accept NIPPV therapy or not. The curative effect,the parame-ters of PaO2, PaCO2 and RR and HR before and after treatment were compared between the two groups. The average length of stay,expenses for medicine, examination fee and the total of hospitalization costs were also compared between the two groups. Results The total effective rate of NIPPV group was significantly higher than that of the control group (χ2=5.94, P0.05). The average length of stay of NIPPV groups was shorter than that of control group(t=5.23,P0.05). NIPPV组平均住院天数短与对照组,药费、检查费及住院总费用低于对照组,差异均有统计学意义(t分别=5.23、16.42、2.64、11.36,P均<0.05). 结论 NIPPV在治疗AECOPD合并呼吸衰竭患者有十分明显的治疗效果,并且可以减低患者住院天数、药费、检查费及总住院费用.

  16. Effects of non-invasive bi-level positive airway pressure ventilation on chronic obstructive pulmonary disease complicating with type II respiratpry failure%无创双水平气道正压通气治疗慢性阻塞性肺疾病并发Ⅱ型呼吸衰竭疗效观察

    Institute of Scientific and Technical Information of China (English)

    魏庆娟; 李传文

    2011-01-01

    目的:探讨经面罩双水平气道正压通气(bi-leve positive airway pressure,BiPAP)呼吸机治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)并发Ⅱ型呼吸衰竭的疗效.方法:66例COPD并发Ⅱ型呼吸衰竭患者随机分为治疗组及对照组,两组均给予抗感染、解痉平喘、祛痰、支持对症等常规治疗,对照组加低浓度吸氧,治疗组加面罩BiPAP呼吸机治疗.结果:治疗组和对照组相比,治疗后24h动脉血氧饱和度、动脉血氧分压明显上升,心率、呼吸频率、动脉血二氧化碳分压、pH值明显下降,住院时间缩短,差异均有统计学意义(P<0.01).治疗组总有效率84.8%(28/33)与对照组66.7%(22/33)相比差异有统计学意义(P<0.05).结论:COPD并发Ⅱ型呼吸衰竭患者早期使用BiPAP呼吸机治疗,对低氧血症和CO2潴留的改善疗效显著.

  17. COMPARACIÓN DE ESTRATEGIAS TERAPÉUTICAS PARA EL CONTROL DE LA TENSIÓN ARTERIAL Y LA ANGINA DE PECHO EN PACIENTES CON HIPERTENSIÓN ARTERIAL Y CARDIOPATÍA ISQUÉMICA CRÓNICA EN LA PROVINCIA DE VILLA CLARA. APÉNDICE DEL ESTUDIO INVEST / Comparison of therapeutic strategies for the control of blood pressure and angina in patients with hypertension and chronic ischemic heart disease in the province of Villa Clara. Appendix of INVEST study

    Directory of Open Access Journals (Sweden)

    Omaida J. López Bernal

    2011-06-01

    Full Text Available Background and Objectives: The treatment of hypertension and its complications are a worldwide problem. In our country nearly 25 % of the population over 15 years old is hypertensive, and this figure nearly doubles in those over 60. This research aims to compare two treatment strategies for controlling hypertension in outpatients with chronic coronary ischemic syndrome. Method: A total of 150 patients was included, 73 were randomized to receive calcium antagonist and non-calcium antagonist respectively, as 4 patients were subsequently excluded. Each was asked to sign consent, underwent clinical examination and a 12-lead, conventional electrocardiogram. Blood pressure and episodes of angina were evaluated at 6 months and one year. All variables were entered into a database and statistical analysis was performed using Student's t and Chi square. Results: The mean age was 61,5 years. Women and white skin color were predominant. At 12 months of treatment, blood pressure normalized in more than 80 % of patients without significant differences between the two treatment strategies. Over 75 % of patients in both groups controlled the angina episodes and more than 85 % said the quality of life was good. Conclusions: Control of blood pressure and angina was achieved and there were no significant differences between the two treatment strategies.

  18. Chronicity and control

    DEFF Research Database (Denmark)

    Whyte, Susan Reynolds

    2012-01-01

    This paper proposes a way of framing the study of ‘noncommunicable diseases’ within the more general area of chronic conditions. Focusing on Africa, it takes as points of departure the situation in Uganda, and the approach to health issues developed by a group of European and African colleagues...... over the years. It suggests a pragmatic analysis that places people's perceptions and practices within a field of possibilities shaped by policy, health care systems, and life conditions. In this field, the dimensions of chronicity and control are the distinctive analytical issues. They lead...... on to consideration of patterns of sociality related to chronic conditions and their treatment....

  19. Medications and Blood Pressure

    Science.gov (United States)

    ... Blood Pressure Tools & Resources Stroke More Medications and Blood Pressure Updated:Jul 6,2016 When your blood pressure ... was last reviewed on 08/04/2014. High Blood Pressure • Home • About High Blood Pressure (HBP) • Why HBP ...

  20. CPAP in chronic heart failure

    Directory of Open Access Journals (Sweden)

    F. Lari

    2013-05-01

    Full Text Available BACKGROUND Chronic Heart Failure (CHF represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

  1. Chronic Condition Data Warehouse

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Chronic Condition Data Warehouse (CCW) provides researchers with Medicare and Medicaid beneficiary, claims, and assessment data linked by beneficiary across...

  2. Sleep and Chronic Disease

    Science.gov (United States)

    ... message, please visit this page: About CDC.gov . Sleep About Us About Sleep Key Sleep Disorders Sleep ... Sheets Data & Statistics Projects and Partners Resources Events Sleep and Chronic Disease Recommend on Facebook Tweet Share ...

  3. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Contact Us Shop FAQs The Art of Pain Management Resources Going to the ER Glossary Surveys What We Have Learned Communication Tools Videos Pain Management Programs Resource Guide to Chronic Pain Treatments Pain ...

  4. What Is Chronic Pain?

    Medline Plus

    Full Text Available Already a member? Log In or Sign Up Home About Us Support the ACPA Contact Us Shop ... for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is Chronic Pain? ...

  5. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... chronic pain there may be no apparent physical injury or illness to explain it. The physician and ... expected period of healing for an illness or injury. You can experience pain even if you are ...

  6. Chronic rhinosinusitis pathogenesis.

    Science.gov (United States)

    Stevens, Whitney W; Lee, Robert J; Schleimer, Robert P; Cohen, Noam A

    2015-12-01

    There are a variety of medical conditions associated with chronic sinonasal inflammation, including chronic rhinosinusitis (CRS) and cystic fibrosis. In particular, CRS can be divided into 2 major subgroups based on whether nasal polyps are present or absent. Unfortunately, clinical treatment strategies for patients with chronic sinonasal inflammation are limited, in part because the underlying mechanisms contributing to disease pathology are heterogeneous and not entirely known. It is hypothesized that alterations in mucociliary clearance, abnormalities in the sinonasal epithelial cell barrier, and tissue remodeling all contribute to the chronic inflammatory and tissue-deforming processes characteristic of CRS. Additionally, the host innate and adaptive immune responses are also significantly activated and might be involved in pathogenesis. Recent advancements in the understanding of CRS pathogenesis are highlighted in this review, with special focus placed on the roles of epithelial cells and the host immune response in patients with cystic fibrosis, CRS without nasal polyps, or CRS with nasal polyps. PMID:26654193

  7. Chronic penile strangulation

    Directory of Open Access Journals (Sweden)

    Lopes Roberto I

    2003-01-01

    Full Text Available Chronic penile strangulation is exceedingly rare with only 5 cases previously reported. We report an additional case of progressive penile lymphedema due to chronic intermittent strangulation caused by a rubber band applied to the penile base for 6 years. A 49-year-old man presented incapacity to exteriorize the glans penis. For erotic purposes, he had been using a rubber-enlarging band placed in the penile base for 6 years. With chronic use, he noticed that his penis swelled. Physical examination revealed lymphedema of the penis, phimosis and a stricture in the penile base. The patient was submitted to circumcision and the lymphedema remained stable 10 months postoperatively. Chronic penile incarceration usually causes penile lymphedema and urinary disturbance. Treatment consists of removal of foreign devices and surgical treatment of lymphedema.

  8. Chronic Conditions Dashboard

    Data.gov (United States)

    U.S. Department of Health & Human Services — The CMS Chronic Conditions Dashboard presents statistical views of information on the prevalence, utilization and Medicare spending for Medicare beneficiaries with...

  9. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... after a period of time the spinal cord has changed, after a period of time there are ... absence of an apparent cause. But chronic pain has a physiological or neurological basis even when we ...

  10. Chronic Conditions Chartbook

    Data.gov (United States)

    U.S. Department of Health & Human Services — Chronic Conditions among Medicare Beneficiaries is a chartbook prepared by the Centers for Medicare and Medicaid Services and created to provide an overview of...

  11. What Is Chronic Pain?

    Medline Plus

    Full Text Available ... Programs Resource Guide to Chronic Pain Treatments Pain Awareness Toolkits Partners for Understanding Pain September is Pain Awareness Month Home Pain Management Tools Videos What Is ...

  12. Chronic Fatigue Syndrome

    Science.gov (United States)

    Chronic fatigue syndrome (CFS) is a disorder that causes extreme fatigue. This fatigue is not the kind of tired feeling that ... activities. The main symptom of CFS is severe fatigue that lasts for 6 months or more. You ...

  13. Chronic dysimmune neuropathies: Beyond chronic demyelinating polyradiculoneuropathy

    Directory of Open Access Journals (Sweden)

    Khadilkar Satish

    2011-01-01

    Full Text Available The spectrum of chronic dysimmune neuropathies has widened well beyond chronic demyelinating polyradiculoneuropathy (CIDP. Pure motor (multifocal motor neuropathy, sensorimotor with asymmetrical involvement (multifocal acquired demylinating sensory and motor neuropathy, exclusively distal sensory (distal acquired demyelinating sensory neuropathy and very proximal sensory (chronic immune sensory polyradiculopathy constitute the variants of CIDP. Correct diagnosis of these entities is of importance in terms of initiation of appropriate therapy as well as prognostication of these patients. The rates of detection of immune-mediated neuropathies with monoclonal cell proliferation (monoclonal gammopathy of unknown significance, multiple myeloma, etc. have been facilitated as better diagnostic tools such as serum immunofixation electrophoresis are being used more often. Immune neuropathies associated with malignancies and systemic vasculitic disorders are being defined further and treated early with better understanding of the disease processes. As this field of dysimmune neuropathies will evolve in the future, some of the curious aspects of the clinical presentations and response patterns to different immunosuppressants or immunomodulators will be further elucidated. This review also discusses representative case studies.

  14. Idiopathic chronic eosinophilic pneumonia

    OpenAIRE

    Cordier Jean-François; Marchand Eric

    2006-01-01

    Abstract Idiopathic chronic eosinophilic pneumonia (ICEP) is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or blood eosinophilia, and peripheral pulmonary infiltrates on chest imaging. Eosinophilia is present in most cases, usually in excess of 1000/mm3. In absence of significant blood eosinophilia, a diagnosis of ICEP is supported by the demonstration of bronchoalveolar lavage eosinophilia. ICEP is typically associated with eosinophil counts higher than ...

  15. Experimental chronic periodontitis morphogenesis

    OpenAIRE

    Schneider S.A.

    2011-01-01

    Morphogenesis of periodontium tissue in a model of chronic periodontitis was studied. Adult Wistar rats wereused in a model; chronic periodontitis was developed through mastication-related loading decrease. Histological assessmentof periodontium tissue was conducted at Days 7, 14, 21 and 30. It was demonstrated that dystrophic tissue changes prevailover the inflammatory one in this particular experimental model. The structural elements of periodontium were involved intothe pathologic process ...

  16. New pharmacological approaches against chronic bowel and bladder problems in paralytics.

    Science.gov (United States)

    Guertin, Pierre A

    2016-02-01

    Spinal cord injury (SCI) leads generally to an irreversible loss of sensory functions and voluntary motor control below injury level. Cures that could repair SCI and/or restore voluntary walking have not been yet developed nor commercialized. Beyond the well-known loss of walking capabilities, most SCI patients experience also a plethora of motor problems and health concerns including specific bladder and bowel dysfunctions. Indeed, chronic constipation and urinary retention, two significant life-threatening complications, are typically found in patients suffering of traumatic (e.g., falls or car accidents) or non-traumatic SCI (e.g., multiple sclerosis, spinal tumors). Secondary health concerns associated with these dysfunctions include hemorrhoids, abdominal distention, altered visceral sensitivity, hydronephrosis, kidney failure, urinary tract infections, sepsis and, in some cases, cardiac arrest. Consequently, individuals with chronic SCI are forced to regularly seek emergency and critical care treatments when some of these conditions occur or become intolerable. Increasing evidence supports the existence of a novel experimental approach that may be capable of preventing the occurrence or severity of bladder and bowel problems. Indeed, recent findings in animal models of SCI have revealed that, despite paraplegia or tetraplegia, it remains possible to elicit episodes of micturition and defecation by acting pharmacologically or electrically upon specialized lumbosacral neuronal networks, namely the spinal or sacral micturition center (SMC) and lumbosacral defecation center (LDC). Daily activation of SMC and LDC neurons could potentially become, new classes of minimally invasive treatments (i.e., if orally active) against these dysfunctions and their many life-threatening complications. PMID:26855887

  17. Hypertension in Chronic Glomerulonephritis.

    Science.gov (United States)

    Ihm, Chun-Gyoo

    2015-12-01

    Chronic glomerulonephritis (GN), which includes focal segmental glomerulosclerosis and proliferative forms of GN such as IgA nephropathy, increases the risk of hypertension. Hypertension in chronic GN is primarily volume dependent, and this increase in blood volume is not related to the deterioration of renal function. Patients with chronic GN become salt sensitive as renal damage including arteriolosclerosis progresses and the consequent renal ischemia causes the stimulation of the intrarenal renin-angiotensin-aldosterone system(RAAS). Overactivity of the sympathetic nervous system also contributes to hypertension in chronic GN. According to the KDIGO guideline, the available evidence indicates that the target BP should be ≤140mmHg systolic and ≤90mmHg diastolic in chronic kidney disease patients without albuminuria. In most patients with an albumin excretion rate of ≥30mg/24 h (i.e., those with both micro-and macroalbuminuria), a lower target of ≤130mmHg systolic and ≤80mmHg diastolic is suggested. The use of agents that block the RAAS system is recommended or suggested in all patients with an albumin excretion rate of ≥30mg/ 24 h. The combination of a RAAS blockade with a calcium channel blocker and a diuretic may be effective in attaining the target BP, and in reducing the amount of urinary protein excretion in patients with chronic GN. PMID:26848302

  18. High Blood Pressure

    Science.gov (United States)

    ... normal blood pressure 140/90 or higher is high blood pressure Between 120 and 139 for the top number, ... prehypertension. Prehypertension means you may end up with high blood pressure, unless you take steps to prevent it. High ...

  19. High blood pressure - infants

    Science.gov (United States)

    National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics . ...

  20. High Blood Pressure Facts

    Science.gov (United States)

    ... Heart Disease Cholesterol Salt Million Hearts® WISEWOMAN High Blood Pressure Facts Recommend on Facebook Tweet Share Compartir ... facts about high blood pressure [PDF-255K] . High Blood Pressure in the United States About 70 million ...

  1. Increased blood pressure can reduce fatigue of thenar muscles paralyzed after spinal cord injury

    NARCIS (Netherlands)

    Butler, JE; Ribot-Ciscar, E; Zijdewind, Inge; Thomas, CK

    2004-01-01

    The aim of this study was to evaluate whether increases in blood pressure, and presumably muscle perfusion pressure, improve the endurance of thenar muscles paralyzed chronically by cervical spinal cord injury (SCI). Resting mean arterial pressure (MAP) was low in all eight subjects (64 +/- 2 mmHg).

  2. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, Wietske H W; Schoonhoven, Lisette; Schuurmans, Marieke J.; Veugelers, Rebekka; Leenen, Luke P H

    2015-01-01

    Introduction: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk fo

  3. Pressure ulcer education improves interrater reliability, identification, and classification skills by emergency nurses and physicians

    NARCIS (Netherlands)

    Ham, W.H.; Schoonhoven, L.; Schuurmans, M.J.; Veugelers, R.; Leenen, L.P.

    2015-01-01

    INTRODUCTION: Pressure ulcers (PUs) are a serious health complication that develop as a result of pressure alone or pressure in combination with shearing forces. Although PUs are typically associated with older adults and chronic illness, acutely injured trauma patients may have a particular risk fo

  4. Preventing Pressure Sores

    Medline Plus

    Full Text Available ... Preventing Pressure Sores Preventing Pressure Sores Transition from Hospital to Home Transition from Hospital to Home Spasticity, Physical Therapy-Lokomat Spasticity, Physical ...

  5. Preventing Pressure Sores

    Medline Plus

    Full Text Available ... Injury 101 The Basics of Spinal Cord Injury Rehabilitation The Basics of Spinal Cord Injury Rehabilitation Preventing Pressure Sores Preventing Pressure Sores Transition from ...

  6. Risk factors of infection caused by sacral canal blocking and preventive measures%骶管封闭治疗并发感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    徐仲阳

    2016-01-01

    Objective:To analyze risk factors of lumbar infection caused by sacral canal blocking,and find corresponding preventive measures. Methods:Review cases from Jan. 2006 to Jan. 2014, according to analysis of rate, single factor analysis, sites, types and bacteria species,screen risk factors for lumbar infection. Results:Infection rate was 8. 6%(18 in 210),among the related risk factors, the cases that over the age of 40,with diabetes mellitus,with spina bifida occulta,with cerebrospinal fluid leakage caused by puncture, and combined with more than 4 kinds of drugs injection,whose infection rates were higher than cases that below the age of 40,without diabetes mellitus,without spina bifida occulta,without cerebrospinal fluid leakage caused by puncture,and combined with less than 4 kinds of drugs injection(P <0. 05 to P <0. 01). The infection site located mainly in L5 ~S1 and posterior lumbar soft tissue,the infection types mainly were intervertebral infection and posterior lumbar soft tissue infection,bacteria species mainly were gram-positive cocci. Conclusions:According to analysis of risk factors of infection caused by sacral canal blocking,we can take preventive measures, to avoid infection.%目的::分析骶管封闭并发腰椎感染的危险因素,并提出针对性的预防措施。方法:回顾性分析2006年1月至2014年1月行骶管封闭患者210例,通过感染率、单因素分析、感染部位、感染形式及感染菌种的分析,筛选腰椎感染的危险因素。结果:210例患者中并发感染18例,感染率8.6%。感染危险因素分析中,年龄≥40岁、合并糖尿病、合并隐形脊柱裂、穿刺致脑脊液漏和联合4种以上药物注入腰椎患者感染率均高于年龄<40岁、无合并糖尿病、无合并隐形脊柱裂、无穿刺致脑脊液漏和无联合4种以上药物注入者(P<0.05~P<0.01)。感染部位主要发生在腰5至骶1节段及腰后部软组织,感染形式主要为椎间隙感染及

  7. Risk factors of infection caused by sacral canal blocking and preventive measures%骶管封闭治疗并发感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    徐仲阳

    2016-01-01

    目的::分析骶管封闭并发腰椎感染的危险因素,并提出针对性的预防措施。方法:回顾性分析2006年1月至2014年1月行骶管封闭患者210例,通过感染率、单因素分析、感染部位、感染形式及感染菌种的分析,筛选腰椎感染的危险因素。结果:210例患者中并发感染18例,感染率8.6%。感染危险因素分析中,年龄≥40岁、合并糖尿病、合并隐形脊柱裂、穿刺致脑脊液漏和联合4种以上药物注入腰椎患者感染率均高于年龄<40岁、无合并糖尿病、无合并隐形脊柱裂、无穿刺致脑脊液漏和无联合4种以上药物注入者(P<0.05~P<0.01)。感染部位主要发生在腰5至骶1节段及腰后部软组织,感染形式主要为椎间隙感染及腰后部软组织感染,感染的菌种主要为革兰阳性球菌。结论:通过分析骶管封闭引发感染的危险因素,可采取针对性预防措施,规避感染风险。%Objective:To analyze risk factors of lumbar infection caused by sacral canal blocking,and find corresponding preventive measures. Methods:Review cases from Jan. 2006 to Jan. 2014, according to analysis of rate, single factor analysis, sites, types and bacteria species,screen risk factors for lumbar infection. Results:Infection rate was 8. 6%(18 in 210),among the related risk factors, the cases that over the age of 40,with diabetes mellitus,with spina bifida occulta,with cerebrospinal fluid leakage caused by puncture, and combined with more than 4 kinds of drugs injection,whose infection rates were higher than cases that below the age of 40,without diabetes mellitus,without spina bifida occulta,without cerebrospinal fluid leakage caused by puncture,and combined with less than 4 kinds of drugs injection(P <0. 05 to P <0. 01). The infection site located mainly in L5 ~S1 and posterior lumbar soft tissue,the infection types mainly were intervertebral infection and posterior lumbar soft tissue infection

  8. Smoking, Chronic Wound Healing, and Implications for Evidence-Based Practice

    OpenAIRE

    McDaniel, Jodi C.; Browning, Kristine K.

    2014-01-01

    Chronic wounds are rising in prevalence and creating significant socioeconomic burdens for patients and healthcare systems worldwide. Therefore, it is now more important than ever that clinicians follow evidence-based guidelines for wound care when developing personalized treatment plans for their patients with chronic wounds. Evidence-based guidelines for treating venous leg ulcers, diabetic foot ulcers, and pressure ulcers, the 3 main categories of chronic wounds, focus primarily on biologi...

  9. Determinants of Chronic Carbon Dioxide Retention and Its Correction in Humans

    OpenAIRE

    Skatrud, James B.; Dempsey, Jerome A; Bhansali, Praful; Irvin, Charles

    1980-01-01

    17 patients with chronic ventilatory failure (including 14 with chronic obstructive pulmonary disease) were studied to determine the causes of carbon dioxide retention and the chronic effect of medroxyprogesterone acetate on ventilatory drive and acid-base status. Carbon dioxide retention in patients with high mechanical loads occurred concomitantly with a higher than normal inspiratory effort (mouth occlusion pressure) and normal minute ventilation to carbon dioxide production ratio (V̇e/V̇c...

  10. Hereditary chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Mössner Joachim

    2007-01-01

    Full Text Available Abstract Hereditary chronic pancreatitis (HCP is a very rare form of early onset chronic pancreatitis. With the exception of the young age at diagnosis and a slower progression, the clinical course, morphological features and laboratory findings of HCP do not differ from those of patients with alcoholic chronic pancreatitis. As well, diagnostic criteria and treatment of HCP resemble that of chronic pancreatitis of other causes. The clinical presentation is highly variable and includes chronic abdominal pain, impairment of endocrine and exocrine pancreatic function, nausea and vomiting, maldigestion, diabetes, pseudocysts, bile duct and duodenal obstruction, and rarely pancreatic cancer. Fortunately, most patients have a mild disease. Mutations in the PRSS1 gene, encoding cationic trypsinogen, play a causative role in chronic pancreatitis. It has been shown that the PRSS1 mutations increase autocatalytic conversion of trypsinogen to active trypsin, and thus probably cause premature, intrapancreatic trypsinogen activation disturbing the intrapancreatic balance of proteases and their inhibitors. Other genes, such as the anionic trypsinogen (PRSS2, the serine protease inhibitor, Kazal type 1 (SPINK1 and the cystic fibrosis transmembrane conductance regulator (CFTR have been found to be associated with chronic pancreatitis (idiopathic and hereditary as well. Genetic testing should only be performed in carefully selected patients by direct DNA sequencing and antenatal diagnosis should not be encouraged. Treatment focuses on enzyme and nutritional supplementation, pain management, pancreatic diabetes, and local organ complications, such as pseudocysts, bile duct or duodenal obstruction. The disease course and prognosis of patients with HCP is unpredictable. Pancreatic cancer risk is elevated. Therefore, HCP patients should strongly avoid environmental risk factors for pancreatic cancer.

  11. Application of Bi-level Positive Airway Pressure Ventilation in Elderly Do-not-intubate Patients with Acute Exacerbation Chronic Obstructive Pulmonary Disease and Respiratory Failure%双水平正压通气在拒绝插管的老年慢性阻塞性肺病急性加重呼吸衰竭病人的应用

    Institute of Scientific and Technical Information of China (English)

    王长捷

    2012-01-01

    Objective To determine the effect of bi- level positive airway pressure ventilation (Bi- PAP) in elderly do- not- intubate patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure. Methods 65 elderly patients who were admitted to intensive care unit from September 2006 to December 2010 with acute exacerbation chronic obstructive pulmonary disease (AECOPD) and respiratory failure were randomly divided into 2 groups standard group (re =32) and Bi-PAP group (re =33) . The changes of consciousness, physiological parameters, hospital mortality and adverse events in patients were compared between the two groups. Results The baseline characters of patients were similar in both the Bi- PAP and standard therapy groups. After 2 hour of treatment, GCS scores of patients in Bi-PAP group (P<0.01) and median (5th-95th percentile) PaO2/FIO2 ratios were significantly higher [182 (77-384) vs 165 (70-358), P<0.0l] , and PaCO2 was lower than standard group [55 (31~86) mmHg vs 82 (47 - 107) mmHg, P<0.0l]. Treatment with Bi-PAP successfully reduced the hospital mortality [11 (33%) vs 24 (75%), P< 0.01]. It looked similar with adverse events occurred both Bi-PAP and standard treatment. Conclusion For elderly do-not-intubate patients with AECOPD and respiratory failure, treatment with Bi- PAP not only can improve the patient's physiological parameters, but also improve the patient's outcomes.%目的 观察双水平正压通气(Bi-PAP)在拒绝插管(Do-not-intubate)的老年慢件阻塞性肺病急性加重(AECOPD)呼吸衰竭病人的疗效.方法 2006年9月至2010年12月65名入住重症监护病房的老年慢性阻塞性肺病急性加重呼吸衰竭病人纳入研究.将病人随机分为普通治疗组(n=32)和Bi-PAP(n=33)组.比较2组病人研究期间的意识变化、生理学参数的变化、院内死亡率及不良事件发生率.结果 老年慢性阻塞性肺病急性加重呼吸衰竭无创通气组与普通治疗

  12. The study of aortic stiffness in different hypertension subtypes in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    布海霞

    2014-01-01

    Objective To investigate whether there is any difference in aortic stiffness among different hypertension subtypes in patients with chronic kidney disease.Methods Six hundred and twenty-six patients with chronic kidney disease were included in the present analysis.They were classified into four groups:normotension(n=391)with systolic blood pressure(SBP)<140 mmHg and diastolic

  13. Telemedical Wearable Sensing Platform for Management of Chronic Venous Disorder.

    Science.gov (United States)

    Li, Ruya; Nie, Baoqing; Zhai, Chengwei; Cao, Jennifer; Pan, Jian; Chi, Yung-Wei; Pan, Tingrui

    2016-07-01

    Enabled by emerging wearable sensors, telemedicine can potentially offer personalized medical services to long-term home care or remote clinics in the future, which can be particularly helpful in the management of chronic diseases. The wireless wearable pressure sensing system reported in this article provides an excellent example of such an innovation, whereby periodic or continuous monitoring of interface pressure can be obtained to guide routine compression therapy, the cornerstone of chronic venous disorder management. By applying a novel capacitive, iontronic sensing technology, a flexible, ultrathin, and highly sensitive pressure sensing array is seamlessly incorporated into compression garments for the monitoring of interface pressure. The linear pressure sensing array assesses pressure distribution along the limb in a real-time manner (up to a scanning rate of 5 kHz), and the measurement data can be processed and displayed on a mobile device locally, as well as transmitted through a Bluetooth communication module to a remote clinical service. The proposed interface pressure measuring system provides real-time interface pressure distribution data and can be utilized for both clinical and self-management of compression therapy, where both treatment efficacy and quality assurance can be ascertained. PMID:26530542

  14. A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity pain [ISRCTN 16558617

    Directory of Open Access Journals (Sweden)

    McManus Carla D

    2005-07-01

    Full Text Available Abstract Background Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. Methods A prospective, randomized, double-blind trial was conducted to determine the outcome of spinal endoscopic adhesiolysis to reduce pain and improve function and psychological status in patients with chronic refractory low back and lower extremity pain. A total of 83 patients were evaluated, with 33 patients in Group I and 50 patients in Group II. Group I served as the control, with endoscopy into the sacral level without adhesiolysis, followed by injection of local anesthetic and steroid. Group II received spinal endoscopic adhesiolysis, followed by injection of local anesthetic and steroid. Results Among the 50 patients in the treatment group receiving spinal endoscopic adhesiolysis, significant improvement without adverse effects was shown in 80% at 3 months, 56% at 6 months, and 48% at 12 months. The control group showed improvement in 33% of the patients at one month and none thereafter. Based on the definition that less than 6 months of relief is considered short-term and longer than 6 months of relief is considered long-term, a significant number of patients obtained long-term relief with improvement in pain, functional status, and psychological status. Conclusion Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.

  15. Management of chronic paronychia

    Directory of Open Access Journals (Sweden)

    Vineet Relhan

    2014-01-01

    Full Text Available Chronic paronychia is an inflammatory disorder of the nail folds of a toe or finger presenting as redness, tenderness, and swelling. It is recalcitrant dermatoses seen commonly in housewives and housemaids. It is a multifactorial inflammatory reaction of the proximal nail fold to irritants and allergens. Repeated bouts of inflammation lead to fibrosis of proximal nail fold with poor generation of cuticle, which in turn exposes the nail further to irritants and allergens. Thus, general preventive measures form cornerstone of the therapy. Though previously anti-fungals were the mainstay of therapy, topical steroid creams have been found to be more effective in the treatment of chronic paronychia. In recalcitrant cases, surgical treatment may be resorted to, which includes en bloc excision of the proximal nail fold or an eponychial marsupialization, with or without nail plate removal. Newer therapies and surgical modalities are being employed in the management of chronic paronychia. In this overview, we review recent epidemiological studies, present current thinking on the pathophysiology leading to chronic paronychia, discuss the challenges chronic paronychia presents, and recommend a commonsense approach to management.

  16. Autoantibodies in chronic pancreatitis

    DEFF Research Database (Denmark)

    Rumessen, J J; Marner, B; Pedersen, N T;

    1985-01-01

    In 60 consecutive patients clinically suspected of having chronic pancreatitis the serum concentration of the immunoglobulins (IgA, IgG, IgM), the IgG- and IgA-type non-organ-specific autoantibodies against nuclear material (ANA), smooth and striated muscle, mitochondria, basal membrane, and reti......In 60 consecutive patients clinically suspected of having chronic pancreatitis the serum concentration of the immunoglobulins (IgA, IgG, IgM), the IgG- and IgA-type non-organ-specific autoantibodies against nuclear material (ANA), smooth and striated muscle, mitochondria, basal membrane......, and reticulin, and the IgG- and IgA-type pancreas-specific antibodies against islet cells, acinus cells, and ductal cells (DA) were estimated blindly. In 23 of the patients chronic pancreatitis was verified, whereas chronic pancreatitis was rejected in 37 patients (control group). IgG and IgA were found...... in significantly higher concentrations in the patients with chronic pancreatitis than in the control group but within the normal range. ANA and DA occurred very frequently in both groups but with no statistical difference. Other autoantibodies only occurred sporadically. The findings of this study do not support...

  17. Chronic daily headaches

    Directory of Open Access Journals (Sweden)

    Fayyaz Ahmed

    2012-01-01

    Full Text Available Chronic Daily Headache is a descriptive term that includes disorders with headaches on more days than not and affects 4% of the general population. The condition has a debilitating effect on individuals and society through direct cost to healthcare and indirectly to the economy in general. To successfully manage chronic daily headache syndromes it is important to exclude secondary causes with comprehensive history and relevant investigations; identify risk factors that predict its development and recognise its sub-types to appropriately manage the condition. Chronic migraine, chronic tension-type headache, new daily persistent headache and medication overuse headache accounts for the vast majority of chronic daily headaches. The scope of this article is to review the primary headache disorders. Secondary headaches are not discussed except medication overuse headache that often accompanies primary headache disorders. The article critically reviews the literature on the current understanding of daily headache disorders focusing in particular on recent developments in the treatment of frequent headaches.

  18. Chronic nerve root entrapment: compression and degeneration

    Science.gov (United States)

    Vanhoestenberghe, A.

    2013-02-01

    Electrode mounts are being developed to improve electrical stimulation and recording. Some are tight-fitting, or even re-shape the nervous structure they interact with, for a more selective, fascicular, access. If these are to be successfully used chronically with human nerve roots, we need to know more about the possible damage caused by the long-term entrapment and possible compression of the roots following electrode implantation. As there are, to date, no such data published, this paper presents a review of the relevant literature on alternative causes of nerve root compression, and a discussion of the degeneration mechanisms observed. A chronic compression below 40 mmHg would not compromise the functionality of the root as far as electrical stimulation and recording applications are concerned. Additionally, any temporary increase in pressure, due for example to post-operative swelling, should be limited to 20 mmHg below the patient’s mean arterial pressure, with a maximum of 100 mmHg. Connective tissue growth may cause a slower, but sustained, pressure increase. Therefore, mounts large enough to accommodate the root initially without compressing it, or compliant, elastic, mounts, that may stretch to free a larger cross-sectional area in the weeks after implantation, are recommended.

  19. Arterial hypertension and chronic liver disease

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S

    2005-01-01

    , calcitonin gene-related peptide, nitric oxide, and other vasodilators, and is most pronounced in the splanchnic area. This provides an effective (although relative) counterbalance to raised arterial blood pressure. Subjects with arterial hypertension (essential, secondary) may become normotensive during......This review looks at the alterations in the systemic haemodynamics of patients with chronic liver disease (cirrhosis) in relation to essential hypertension and arterial hypertension of renal origin. Characteristic findings in patients with cirrhosis are vasodilatation with low overall systemic...... the development of chronic liver disease, and arterial hypertension is rarely manifested in patients with cirrhosis, even in those with renovascular disease and high circulating renin activity. There is much dispute as to the understanding of homoeostatic regulation in cirrhotic patients with manifest arterial...

  20. An undiagnosed cause of chronic cough

    Science.gov (United States)

    Malvi, Ketan; Padmanabhan, Arjun; Hari, T. A.

    2015-01-01

    Tracheomalacia (TM) refers to loss of tracheal rigidity and resulting susceptibility to collapse. It is usually an incidental finding during investigations of other illness. The main symptoms are dyspnoea, cough, sputum production and hemoptysis. Most cases are considered as respiratory infection and are treated symptomatically. Acquired TM results from damage to trachea due to various conditions such as inflammation, chronic pressure, or medical/surgical procedures. The diagnosis is done by end-expiratory dynamic tracheal imaging, which demonstrates typical crescentric narrowing of trachea and reduced antero-posterior diameter <50% of normal. Management include conservative measures like cough suppressants or surgical measures like tracheoplasty, stenting or surgical repair. We are reporting a case of chronic cough, which was subsequently diagnosed as TM. PMID:26985425

  1. 磷酸肌酸钠联合高压氧治疗一氧化碳中毒迟发性脑病疗效观察%Curative effect observation of creatine phosphate sodium combined with high pressure oxygen in the treatment of chronic encephalopathy of carbon monoxide poisoning

    Institute of Scientific and Technical Information of China (English)

    李伟; 台立稳

    2016-01-01

    Objective:To explore the curative effect of creatine phosphate sodium combined with high pressure oxygen in the treatment of chronic encephalopathy of carbon monoxide poisoning(DEACMP).Methods:43 patients with DEACMP were selected. They were randomly divided into the treatment group and the control group.Patients in the control group were given conventional treatment.Patients in the treatment group were given injection creatine phosphate sodium treatment on the basis of the control group.The curative effects of two groups were observed.Results:The cure rate and effective rate of the treatment group were significantly higher than those of the control group,and the differences were statistically significant(P<0.05).Conclusion:The creatine phosphate sodium can improve the cell energy supply of DEACMP patients,protect the brain function,improve the hypoxia tolerance of brain cells,improve the life quality of DEACMP patients.%目的:探讨磷酸肌酸钠联合高压氧治疗一氧化碳中毒迟发性脑病(DEACMP)的疗效。方法:收治DEACMP患者43例,随机分为治疗组和对照组。对照组给予常规治疗,治疗组则在对照组的基础上加注射用磷酸肌酸钠治疗。观察两组患者的疗效。结果:治疗组治愈率及有效率均明显高于对照组,差异有统计学意义(P<0.05)。结论:磷酸肌酸钠可以改善DEACMP患者的细胞能量供应,保护脑功能,提高脑细胞对缺氧的耐受性,提高DEACMP患者的生活质量。

  2. Effect of Bi-level positive airway pressure combined with vibration spu-tum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation complicated with respiratory failure%BiPAP联合振动排痰治疗AECOPD合并呼吸衰竭的效果评价

    Institute of Scientific and Technical Information of China (English)

    李海泉; 赵杰; 王海清; 徐俊马; 杜永亮; 李慧婷

    2014-01-01

    目的:探讨无创双水平气道正压通气联合振动排痰治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果。方法将40例患者随机分为A组与B组各20例。 A组患者采用无创双水平正压通气联合振动排痰进行治疗,B组患者仅使用无创双水平正压通气治疗,观察两组的治疗效果。结果 A组患者的PaCO2较B组下降快(P<0.05),呼吸支持时间及住院时间亦明显缩短(P<0.05),气管插管率较B组低(P<0.05)。结论无创正压通气联合振动排痰对治疗慢性阻塞性肺疾病合并呼衰的患者具有明显优势,值得临床推广。%Objective To evaluate the efficacy of Bi-level positive airway pressure (BiPAP) combined with vibration sputum elimination in the treatment of chronic obstructive pulmonary disease with acute exacerbation (AECOPD) com-plicated with respiratory failure. Methods 40 cases of patients with respiratory failure were randomly divided into group A (20 cases) and group B (20 cases).The patients in group A were received noninvasive BiPAP ventilation and vibration sputum elimination.The patients in group B were treated with BiPAP ventilation only.Clinical effect in two groups were observed. Results After treatment,PaCO2 changed more significantly in group A than that in group B .The patients in group A had a significantly shorter duration of respiratory support than group B (P<0.05).The respiratory support time and hospital stay of group A was shorter than that of group B (P<0.05).The rate of endotracheal intubation of group A was lower than that of group B (P<0.05). Conclusion BiPAP combined with vibration sputum elimination in treatment of AECOPD complicated with respiratory failure has good curative effect and it is worth promoting.

  3. Why chronic wounds will not heal: a novel hypothesis

    DEFF Research Database (Denmark)

    Bjarnsholt, Thomas; Kirketerp-Moller, K.; Jensen, P.O.;

    2008-01-01

    The present paper presents a hypothesis aimed at explaining why venous leg ulcers, pressure ulcers, and diabetic foot ulcers develop into a chronic state. We propose that the lack of proper wound healing is at least in part caused by inefficient eradication of infecting, opportunistic pathogens...

  4. Heliox in the treatment of chronic obstructive pulmonary disease

    OpenAIRE

    Andrews, R.; Lynch, M

    2004-01-01

    Objective: To determine if breathing helium oxygen mixtures in addition to conventional therapy in non-intubated adult chronic obstructive airways disease (COPD) patients reduces the arterial partial pressure of carbon dioxide (PaCO2) more than conventional treatment alone, and confers an advantage in terms of the odds of intubation in the acute setting.

  5. Sliding and pressure evaluation on conventional and V-shaped seats of reclining wheelchairs for stroke patients with flaccid hemiplegia: a crossover trial

    Directory of Open Access Journals (Sweden)

    Chen Chi-Myn

    2011-07-01

    Full Text Available Abstract Background Reclining wheelchairs are commonly used to transport elderly stroke patients in Taiwan. However, there is concern that the patient's body in the wheelchair often slides forward when they return to a seated position, increasing the sitting pressure. Therefore, a novel reclining wheelchair with an ergonomic "V-Seat" was designed to prevent forward sliding and pressure sores. The use of these reclining chairs by stroke patients has not yet been studied. Thus, we investigated the effects of V-shaped and conventional seats in reclining wheelchairs on the extent of forward sliding and on the sitting pressure of stroke patients with flaccid hemiplegia and of able-bodied elders. Methods We recruited 13 able-bodied elders and 11 stroke patients with flaccid hemiplegia and performed 5 reclining cycles in both types of wheelchair. The amount of sliding along the backrest (BS plane and the seat (SS plane, the mean sitting pressure (MP, and the sacral peak pressure (SPP of the subjects were recorded. We used the Wilcoxon signed-rank test to compare the BS, SS, MP, and SPP in wheelchairs with conventional and V-shaped seats, and we used the Wilcoxon rank sum test to compare the differences in BS and SS between stroke patients and able-bodied elders in both types of reclining wheelchair. Results The BS, SS, and SPP of stroke patients were significantly lower in the wheelchairs with V-shaped seats than in conventional wheelchairs in most comparisons; however, the BS of able-bodied elders was higher in V-shaped seats than in conventional seats. The SS and SPP of stroke patients were significantly higher than those of able-bodied elders in both types of reclining wheelchair, and the BS of stroke patients was significantly higher than that of able-bodied elders only in conventional reclining wheelchairs. Conclusions The use of V-shaped seats in reclining wheelchairs can help reduce the forward sliding and sacral peak pressure of stroke patients

  6. Avaliação das pressões respiratórias máximas em pacientes renais crônicos nos momentos pré e pós-hemodiálise Evaluation of maximum respiratory pressures in chronic renal paients at the pre and post hemodialysis moment

    Directory of Open Access Journals (Sweden)

    Carmélia Bomfim Jacó Rocha

    2010-03-01

    Full Text Available INTRODUÇÃO E OBJETIVO: Medidas da pressão inspiratória máxima (PImáx e da pressão expiratória máxima (PEmáx são utilizadas para avaliar a integridade da musculatura respiratória medindo sua força. O objetivo do estudo foi avaliar a influência imediata da hemodiálise (HD na força desses músculos pelas mensurações de PImáx e PEmáx, investigando a integridade desta musculatura e/ou a presença de fraqueza muscular. MÉTODO: Realizou-se um estudo prospectivo, transversal, numa amostra de conveniência, no qual foram avaliados 35 indivíduos renais crônicos (26 homens e 9 mulheres, com idade média de 51,7 ± 14,7 anos, no serviço de hemodiálise do Hospital Universitário Alzira Vellano (HUAV, em Alfenas-MG. Foram determinadas as medidas das PImáx e PEmáx, na posição sentada (90º, utilizando um manovacuômetro digital (MVD 300® acoplado a um microcomputador para a leitura e armazenamento dos dados obtidos, antes e após a HD. RESULTADOS: Tanto a PImáx como a PEmáx foram menores que as preditas nos momentos pré e pós-hemodiálise (p INTRODUCTION AND OBJECTIVE: Maximal inspiratory and expiratory pressures (PImax and PEmax are used to assess the integrity of respiratory muscles by measuring their strength. The aim of this study was to assess the immediate influence of hemodialysis (HD on respiratory muscle strength by measuring PImax and PEmax, investigating the integrity of that musculature and/or the presence of muscular weakness. METHOD: A prospective, crosssectional study was carried out on a convenience sample of 35 patients with chronic kidney disease (26 men and 9 women; mean age, 51.7 ± 14.7 years at the Nephrology Division of the Hospital Universitário Alzira Vellano, in the city of Alfenas, in the state of Minas Gerais, Brazil. Patients had their PImax and PEmax taken in the seated position (at 90° by using a digital manovacuometer (MVD 300® attached to a notebook for reading and recording data obtained

  7. Omalizumab for chronic urticaria

    DEFF Research Database (Denmark)

    Ivyanskiy, Ilya; Sand, Carsten; Thomsen, Simon Francis

    2012-01-01

    urticaria. We present a case series of 19 patients with chronic urticaria treated in a university department with omalizumab and give an overview of the existing literature comprising an additional 59 cases as well as a total of 139 patients enrolled in two randomized controlled trials comparing omalizumab...... with placebo. The collective evidence points to omalizumab as a safe and effective treatment option for patients with chronic urticaria who do not sufficiently respond to standard therapy as recommended by existing guidelines.......Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic...

  8. Chronic urticaria: recent advances.

    Science.gov (United States)

    Greaves, Malcolm W; Tan, Kian Teo

    2007-10-01

    Chronic urticaria is an umbrella term, which encompasses physical urticarias, chronic "idiopathic" urticaria and urticarial vasculitis. It is important to recognize patients with physical urticarias as the investigation and treatment differs in important ways from patients with idiopathic chronic urticaria or urticarial vasculitis. Although relatively uncommon, urticarial vasculitis is an important diagnosis to make and requires histological confirmation by biopsy. Underlying systemic disease and systemic involvement, especially of the kidneys, should be sought. It is now recognized that chronic "idiopathic" urticaria includes a subset with an autoimmune basis caused by circulating autoantibodies against the high affinity IgE receptor (FceR1) and less commonly against IgE. Although the autologous serum skin test has been proven useful in prompting search for and characterization of circulating wheal-producing factors in chronic urticaria, its specificity as a screening test for presence of functional anti-FceR1 is low, and confirmation by demonstration of histamine-releasing activity in the patient's serum must be the benchmark test in establishing this diagnosis. Improved screening tests are being sought; for example, ability of the chronic urticaria patient's serum to evoke expression of CD 203c on donor human basophils is showing some promise. The strong association between autoimmune thyroid disease and autoimmune urticaria is also an area of ongoing research. Drug treatment continues to be centered on the H1 antihistamines, and the newer second-generation compounds appear to be safe and effective even in off-label dosage. Use of systemic steroids should be confined to special circumstances such as tapering regimens for acute flare-ups. Use of leukotriene antagonists is becoming popular, but the evidence for efficacy is conflicting. Cyclosporin is also effective and can be used in selected cases of autoimmune urticaria, and it is also effective in non

  9. Chronic lead poisoning

    Energy Technology Data Exchange (ETDEWEB)

    Hess, K.; Straub, P.W.

    1974-02-19

    A detailed description is given of the complex pathological picture observed in the case of a worker with 30 years' occupational exposure to lead in an accumulator factory (evolution of the disease, clinical findings, autopsy). In spite of a typical clinical picture, lead is not held responsible for the terminal encephalopathy, in view of the fact that Alzheimer's syndrome was discovered at autopsy. However, the neurovegetative asthenia and progressive kidney disease without hypertonia, but with uraemia, which preceded the encephalopathy are in all probability due to chronic lead poisoning. The article discusses the diagnosis and symptomatology of chronic lead poisoning, encephalopathy and kidney disease.

  10. Omalizumab for chronic urticaria

    DEFF Research Database (Denmark)

    Ivyanskiy, Ilya; Sand, Carsten; Thomsen, Simon Francis

    2012-01-01

    urticaria. We present a case series of 19 patients with chronic urticaria treated in a university department with omalizumab and give an overview of the existing literature comprising an additional 59 cases as well as a total of 139 patients enrolled in two randomized controlled trials comparing omalizumab......Omalizumab is a recombinant humanized monoclonal antibody that blocks the high-affinity Fc receptor of IgE. Omalizumab has been approved for the treatment of moderate to severe asthma; however, there is currently more and more data showing promising results in the management also of chronic...

  11. Chronic unilateral vestibular loss.

    Science.gov (United States)

    Kerber, K A

    2016-01-01

    Chronic unilateral vestibular loss is a condition defined by the presence of reduced function of the peripheral vestibular system on one side, which has generally persisted for 3 or more months. The deficit is demonstrated by a reduction of the vestibular-ocular reflex either at the bedside or on laboratory testing. Though some patients with chronic vestibular loss have disabling symptoms, others are asymptomatic. Causes include a viral/postviral disorder, Menière's disease, structural lesions, ischemia, and trauma. Any other systemic or genetic disorder would be expected to involve both sides at some point. PMID:27638074

  12. [Histaminergic angioedema and chronic urticaria].

    Science.gov (United States)

    Hacard, Florence; Nosbaum, Audrey; Bensaid, Benoit; Nicolas, Jean-François; Augey, Frédéric; Goujon, Catherine; Bérard, Frédéric

    2015-01-01

    Most angioedemas are histaminergic and correspond to deep urticarial swelling. Recurrent histaminergic angioedema led to the diagnosis of chronic urticaria, even when there are no superficial associated hives. Chronic urticaria is a benign disease, and autoimmune in 40 % of cases. The occurrence of angioedema in chronic urticaria is not a sign of severity. The occurrence of angioedema in chronic urticaria is associated with a longer duration of urticarial disease. NSAIDs and/or systemic corticotherapy are classic triggers of angioedema in chronic urticaria. In the absence of clinical endpoints, there is no need to make further assessment in chronic urticaria good responders to antihistamines.

  13. Analysis of the Effect of Non-invasive Positive Pressure Ventilation in the Treatment of Acute StrokeComplicated with Respiratory Failure Due to Chronic Obstructive Pulmonary Disease%无创正压通气治疗急性脑卒中合并慢性阻塞性肺疾病呼吸衰竭的疗效

    Institute of Scientific and Technical Information of China (English)

    刘梅; 蔡振林; 邓星奇; 李响; 凌美蓉; 周健

    2012-01-01

    Aim: To study the effect of non-invasive positive pressure ventilation (NIPPV) in the treatment of acute stroke complicated with respiratory failure due to chronic obstructive pulmonary disease(COPD). Methods: Analysis of 67 patients with acute stroke complicated with respiratory failure due to chronic obstructive pulmonary disease(COPD) (acute stroke+COPDRF group), 59 patients with acute stroke complicated with central respiratory failure(acute stroke+CRF group), 65 patients with COPD complicated with respiratory failure (control group) were treated by BiPAP. During six hours before and after the treatment, the changes of vital signs and arterial blood gas, mortality rate, average effective ventilation time, and average mechanical ventilation time of dead or survivor in the three groups were analyzed statistically. Results: The therapeutic efficiency of acute stroke+COPDRF group, acute stroke+CRF group and the control group was 71.64%, 30.50%, 72.30%, respectively. There was no statistical significance between the acute stroke+COPDRF group and the control group (P>0.05). There were statistical significances between the acute stroke+CRF group and the other two groups(F0.05). There were statistical significances between the acute stroke+CRF group and the other two groups(p<0.01). There were statistical significances between the acute stroke+COPDRF group and the control group in average effective ventilation time, and between the acute stroke +CRF group and the other two groups(p<0.05). There were statistical significances between the average mechanical ventilation time of dead or survivor with acute stroke+COPDRF group and the control group and the other two groups(p<0.05). Conclusion: It was confirmed that non-invasive positive pressure ventilation on acute stroke complicated with respiratory failure due to COPD had clinical effect.%目的:观察无创正压通气(NIPPV)治疗急性脑卒中合并慢性阻塞性肺疾病(COPD)呼吸衰

  14. Activated protein C to heal pressure ulcers.

    Science.gov (United States)

    Wijewardena, Aruna; Lajevardi, Sepehr S; Vandervord, Elle; Vandervord, John; Lang, Thomas C; Fulcher, Gregory; Jackson, Christopher J

    2016-10-01

    Pressure ulcers present a major clinical challenge, are physically debilitating and place the patient at risk of serious comorbidities such as septic shock. Recombinant human activated protein C (APC) is an anticoagulant with anti-inflammatory, cytoprotective and angiogenic effects that promote rapid wound healing. Topical negative pressure wound therapy (TNP) has become widely used as a treatment modality in wounds although its efficacy has not been proven through randomised controlled trials. The aim of this study was to determine the preliminary efficacy and safety of treatment with APC for severe chronic pressure sores with and without TNP. This case presentation describes the history, management and outcome of two patients each with a severe chronic non-healing pressure ulcer that had failed to respond to conventional therapy. TNP was added to conservative management of both ulcers with no improvement seen. Then local application of small doses of APC was added to TNP and with conservative management, resulted in significant clinical improvement and rapid healing of both ulcers, displaying rapid growth of vascular granulation tissue with subsequent epithelialisation. Patients tolerated the treatment well and improvements suggested by long-term follow-up were provided. Randomised placebo-controlled double blind trials are needed to quantify the efficacy, safety, cost-effectiveness, optimal dose and quality of life changes seen from treatment with APC.

  15. A Study of Anorectal Manometry in Patients with Chronic Idiopathic Constipation

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To study the changes of anorectal motility in patients with chronic idiopathic constipation, anorectal motility was investigated by water-perfused manometric system in 30 patients with chronic idiopathic constipation and 18 healthy subjects. Our results showed that there was no significant difference between the constipation group and the control group in anal sphincteric resting pressure and anal maximal squeezing pressure. The minimum relaxation volume, the rectal defecatory threshold, the rectal maximal tolerable volume and the rectal compliance in the patients were significantly higher than those in the controls (P< 0. 01 or P< 0. 05). It is concluded that patients with chronic idiopathic constipation have anorectal motility disturbances.

  16. Guanfacine in essential hypertension: Effect on blood pressure, plasma noradrenaline concentration and plasma renin activity

    OpenAIRE

    Schoeppe, W; Brecht, H. M.

    1980-01-01

    1 The acute and chronic effects of guanfacine on blood pressure, plasma noradrenaline concentration and plasma renin activity were investigated in 23 patients (15 males, 8 females) with essential hypertension (WHO grade I-II).

  17. The Chronic Responsibility

    DEFF Research Database (Denmark)

    Ravn, Iben M; Frederiksen, Kirsten; Beedholm, Kirsten

    2016-01-01

    behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already...

  18. Chronic fatigue syndrome.

    NARCIS (Netherlands)

    Prins, J.B.; Meer, J.W.M. van der; Bleijenberg, G.

    2006-01-01

    During the past two decades, there has been heated debate about chronic fatigue syndrome (CFS) among researchers, practitioners, and patients. Few illnesses have been discussed so extensively. The existence of the disorder has been questioned, its underlying pathophysiology debated, and an effective

  19. Chronic Myeloproliferative Neoplasms Treatment

    Science.gov (United States)

    ... Cancers by Body Location Childhood Cancers Adolescent & Young Adult Cancers Metastatic Cancer Recurrent Cancer Research NCI’s Role in ... on the hands and feet. Muscle pain. Itching. Diarrhea . Stages of Chronic Myeloproliferative Neoplasms Key Points There is no standard staging system ...

  20. CHRONIC PROBLEM FAMILIES.

    Science.gov (United States)

    STONE, EDWARD

    THE REPORT POINTS OUT THAT, IN GENERAL, CHRONIC PROBLEM PARENTS GREW UP IN ENVIRONMENTS OF EMOTIONAL IMPOVERISHMENT, INCONSISTENCY, CONFUSION, AND DISORDER, OFTEN WITH DEPRIVATION OF FOOD, CLOTHING, AND SHELTER. THESE PARENTS CATEGORIZE PEOPLE AS THOSE WHO GIVE AND THOSE WHO TAKE. THEY BLAME THEIR PROBLEMS ON EXTERNAL CIRCUMSTANCES NOT UNDER THEIR…