WorldWideScience

Sample records for isolated limb injury

  1. Comorbid mild traumatic brain injury increases pain symptoms in patients suffering from an isolated limb fracture.

    Science.gov (United States)

    Jodoin, Marianne; Rouleau, Dominique M; Gosselin, Nadia; Benoit, Benoit; Leduc, Stéphane; Laflamme, Yves; Larson-Dupuis, Camille; De Beaumont, Louis

    2017-09-01

    This study seeks to evaluate the effects of a mild traumatic brain injury (mTBI) on pain in patients with an isolated limb fracture (ILF) when compared to a matched cohort group with no mTBI (control group). All subjects included in this observational study suffered from an ILF. Groups were matched according to the type of injury, sex, age, and time since the accident. Main outcome measurements were: Standardized semi-structured interviews at follow-up of a Level I Trauma Center, and a questionnaire on fracture-related pain symptoms. Factors susceptible to influence the perception of pain, such as age, sex, severity of post-concussive symptoms, and worker compensation were also assessed. A total of 68 subjects (36 females; 45 years old) with an ILF were selected, 34 with a comorbid mTBI and 34 without (24/34 with an upper limb fracture per group, 71% of total sample). Patients with mTBI and an ILF reported significantly higher pain scores at the time of assessment (mean: 49days, SD: 34.9), compared to the control group (p<0.0001; mean difference 2.8, 95% confidence interval 1.8-4.0). Correlational analyses show no significant association between the level of pain and factors such as age, sex, severity of post-concussive symptoms, and worker compensation. Results suggest that mTBI exacerbate perception of pain in the acute phase when occurring with an ILF, and were not explained by age, sex, post-concussive symptoms, or worker compensation. Rather, it appears possible that neurological sequelae induced by mTBI may interfere with the normal recovery of pain following trauma. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Lower limb landmine injuries.

    Science.gov (United States)

    Necmioglu, S; Subasi, M; Kayikci, C; Young, D B

    2004-04-01

    The medical records of 186 patients seeking treatment for landmine injuries in the authors' region between 1993 and 2001 were evaluated. Of these patients 13 died of accompanying complications. Ten (10) patients with general body trauma and upper limb trauma were excluded from the study. Of 163 patients with lower-limb injuries included in the study, 21 with traumatic amputation underwent surgical amputation at different levels. Patients without traumatic amputation were divided into 2 groups. There were 41 patients (29%) in Group I who were treated by limb salvage procedures. Treatments used in Group I including wound debridement, tendon repair, skin approximation, minimal osteosynthesis, external fixation of long bones and secondary wound coverage. In Group II, there were 101 patients (71%) with primary amputation. Trans-tibial amputation was performed in 52 cases (51.4%), ankle disarticulation in 24 (23.7%), trans-femoral amputation in 9 (8.9%), partial foot amputation in 8 (7.9%), knee disarticulation in 7 (6.9%) and hip disarticulation in 1 case. In Group I, there was infection in 21 patients (51.2%), revision in 27 (65.8%), and amputation in 15 (36.5%). In Group II, there was infection in 28 patients (27.7%), revision in 17 (16.8%), and amputation at a higher level in 8 (7%). In crush injuries such as those resulting from landmines, soft tissue, vascular, and neurological assessment must be performed with utmost care. Even so, the desired success in interventions intended to save a limb is complicated by a high infection rate, soft tissue complications, and high revision amputation rates. Therefore, a decision to amputate in the early term based on an accurate preoperative assessment is crucial.

  3. Management of Major Limb Injuries

    Science.gov (United States)

    Langer, Vijay

    2014-01-01

    Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries. PMID:24511296

  4. Management of Major Limb Injuries

    Directory of Open Access Journals (Sweden)

    Vijay Langer

    2014-01-01

    Full Text Available Management of major limb injuries is a daunting challenge, especially as many of these patients have severe associated injuries. In trying to save life, often the limb is sacrificed. The existing guidelines on managing such trauma are often confusing. There is scope to lay down such protocols along with the need for urgent transfer of such patients to a multispecialty center equipped to salvage life and limb for maximizing outcome. This review article comprehensively deals with the issue of managing such major injuries.

  5. Threatened limb from stingray injury.

    Science.gov (United States)

    Shiraev, Timothy P; Marucci, Damian; McMullin, Gabrielle

    2016-01-01

    We present the case of a 43-year-old female who suffered a stingray injury to her left ankle. The sting caused occlusion of the dorsalis pedis artery, causing dry gangrene of the medial forefoot. A below knee amputation was recommended but she was transferred for a second opinion. A Prostaglandin E1 infusion was commenced, resulting in alleviation of pain and improvement in perfusion. Amputation of great and second toes was performed, with the head of the first metatarsal preserved and covered via a cross-over skin flap raised from the contralateral leg. Achilles tendon lengthening was then performed to return the foot to a functional position. This case serves to highlight the utility of prostaglandin infusion, and the requirement for a multidisciplinary approach to critical limb ischemia in order to avoid major amputation.

  6. Percutaneous isolated limb perfusion with thrombolytics for severe limb ischemia.

    Science.gov (United States)

    Ali, Ahsan T; Kalapatapu, Venkat R; Bledsoe, Shelly; Moursi, Mohammed M; Eidt, John F

    2005-01-01

    Patients with severe tibioperoneal disease are poor candidates for a distal bypass. Absence of a distal target, lack of conduit, or multiple medical problems can make these patients a prohibitive risk for revascularization. Acute on chronic ischemia in this group poses a greater challenge. Thrombolytic therapy for acute ischemia can be prolonged and carries a significant risk of bleeding if continued beyond 24 hours. However, if the ischemic limbs can be isolated from the systemic circulation, a higher dose of the lytic agent can be given with lower risk. These are the initial results of a series of 10 patients who underwent percutaneous isolated limb perfusion with a high dose of thrombolytics for severe ischemia. Ten patients (lower extremity 8 and upper extremity 2) presented with severe limb-threatening ischemia. Mean ankle/brachial index (ABI) was 0.15 for the lower extremity, and there were no recordable digital pressures in patients with upper extremity ischemia. No distal target was visible on the initial arteriogram. These patients were then taken to the operating room, and under anesthesia, catheters were placed in an antegrade fashion via femoral approach in the popliteal artery and vein percutaneously. For upper extremity, the catheters were placed in the brachial artery and vein. A proximal tourniquet was then applied. This isolated the limb from the systemic circulation. Heparinized saline was infused through the arterial catheter while the venous catheter was left open. A closed loop or an isolated limb perfusion was confirmed when effluent became clear coming out of the venous port. A high dose of thrombolytic agent (urokinase 500,000 to 1,000,000 U) was infused into the isolated limb via the arterial catheter and drained out of the venous catheter. After 45 minutes, arterial flow was reestablished. In 4 patients, Reopro((R)) was used in addition to thrombolytics. Postprocedure angiograms showed minimal changes, but patients exhibited marked

  7. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb

    Science.gov (United States)

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A.

    2016-01-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation. PMID:27583121

  8. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb.

    Science.gov (United States)

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A; Danish, Qazi

    2016-09-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation.

  9. National trauma databank analysis of mortality and limb loss in isolated lower extremity vascular trauma.

    Science.gov (United States)

    Kauvar, David S; Sarfati, Mark R; Kraiss, Larry W

    2011-06-01

    Lower extremity injury is common in trauma patients; however, the influence of arterial injury on devastating patient and limb outcomes can be confounded by the presence and physiological derangement of concomitant head or thoracoabdominal injuries. We analyzed isolated lower extremity injuries with an arterial component. Our aim was to elucidate factors associated with mortality and limb loss in this selected population. We reviewed trauma incidents from the National Trauma Data Bank (2002-2006) containing isolated lower extremity injury codes and a specified infrainguinal arterial injury. Demographics, injury patterns, clinical characteristics, and adverse outcomes (death, amputation) during initial hospitalization were collected. Multivariate logistic regression was used to identify risk factors for limb loss. There were 651 isolated infrainguinal arterial injuries. Death (18) and early limb loss (42) were studied by mechanism (penetrating, n = 431; blunt, n = 220). Half of the deaths involved injury to the common femoral artery (CFA), and over 80% had injury to the CFA or superficial femoral artery (SFA). Death was three times as frequent in the CFA/SFA than in the popliteal/tibial injuries (P = .02). Penetrating injuries were present in almost 80% of deaths, and most of these were gunshot wounds. Patients who died had mean initial systolic blood pressure of 59.7 mm Hg, and almost 40% had no blood pressure on arrival. Mean initial Glasgow Coma Score was 4.5, and almost 80% arrived with a Glasgow Coma Score of 3 despite the absence of head injury. Twenty-seven above- and 15 below-the-knee amputations were performed. The popliteal artery was injured in half of the amputations, with injury isolated to the popliteal or tibial arteries in about three-quarters. Amputation was twice as frequent in popliteal/tibial than CFA/SFA injury (P = .03) and twice as frequent in blunt than penetrating injury (P = .05). Multiple arterial injuries (odds ratio, 5.2; 95% confidence

  10. 7 CFR 51.1220 - Leaf or limb rub injury.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 2 2010-01-01 2010-01-01 false Leaf or limb rub injury. 51.1220 Section 51.1220... MARKETING ACT OF 1946 FRESH FRUITS, VEGETABLES AND OTHER PRODUCTS 1,2 (INSPECTION, CERTIFICATION, AND STANDARDS) United States Standards for Grades of Peaches Definitions § 51.1220 Leaf or limb rub injury...

  11. MONITORING OF LOWER LIMB COMFORT AND INJURY IN ELITE FOOTBALL

    Directory of Open Access Journals (Sweden)

    Michael Kinchington

    2010-12-01

    Full Text Available The aim of the study was to examine the relation between lower limb comfort scores and injury and to measure the responsiveness of a lower limb comfort index (LLCI to changes over time, in a cohort of professional footballers. Lower limb comfort was recorded for each individual using a comfort index which assessed the comfort status of five anatomical segments and footwear. Specifically we tested the extent to which comfort zones as measured by the LLCI were related to injury measured as time loss events. The hypothesis for the study was that poor lower limb comfort is related to time loss events (training or match day. A total of 3524 player weeks of data was collected from 182 professional athletes encompassing three codes of football (Australian Rules, Rugby league, Rugby Union. The study was conducted during football competition periods for the respective football leagues and included a period of pre- season training. The results of regression indicated that poor lower limb comfort was highly correlated to injury (R2 =0.77 and accounted for 43.5 time loss events/ 1000hrs football exposure. While poor comfort was predictive of injury 47% of all time loss events it was not statistically relevant (R2 =0.18. The results indicate lower limb comfort can be used to assess the well-being of the lower limb; poor comfort is associated with injury, and the LLCI has good face validity and high criterion-related validity for the relationship between comfort and injury

  12. Musculoskeletal Lower Limb Injury Risk in Army Populations

    National Research Council Canada - National Science Library

    Andersen, Kimberley A; Grimshaw, Paul N; Kelso, Richard M; Bentley, David J

    2016-01-01

    .... In particular, the large loads borne by soldiers, the high intensity training programs and the influence of footwear have been identified as significant causative factors of lower limb injury in military populations...

  13. Long-term outcomes after upper limb arterial injuries

    NARCIS (Netherlands)

    vanderSluis, CK; Kucey, DS; Brenneman, FD; Hunter, GA; Maggisano, R; tenDuis, HJ

    OBJECTIVE: To assess long-term outcomes in multisystem trauma victims who have arterial injuries to upper limbs. DESIGN: A retrospective case series. SETTING: Tertiary care regional trauma centre in a university hospital. PATIENTS: All consecutive severely injured patients (Injury Severity Score

  14. Lower limb fractures associated with multiligament knee injury

    Science.gov (United States)

    Stagnaro, Joaquin; Yacuzzi, Carlos; Barla, Jorge; Zicaro, Juan Pablo; Costa-Paz, Matias

    2017-01-01

    Objectives: Knee ligament injuries related to lower limb fractures are common and frequently unnoticed. Management of acute polytrauma is usually focused in the bone lesion and a complete physical examination might be really difficult. The purpose of this study was to analyze a series of patients who suffered multiligament knee injuries associated to a lower limb fracture. Hypothesis: The use of magnetic resonance imaging (MRI) during the initial management can lead to an early diagnosis of ligament injuries. Methods: A retrospective search was conducted from our hospital´s electronic database. We evaluated the initial diagnosis and acute surgical treatment, and management and functional outcomes after the ligament lesion was diagnosed. Results: Seven patients who presented a knee multiligament injury associated with a lower limb fracture were evaluated. The average age was 29 years. Primary diagnoses were: four tibial plateau fractures; one open fracture-dislocation of the knee; one open leg fracture and ipsilateral hip dislocation; and one bifocal femur fracture. Only three patients had an MRI during the initial management of trauma. Six out of seven patients had to be operated on for the multiligament knee injury. The period between the resolution of the fracture and the ligamentous repair was from 3 to 24 months. Conclusion: Poor functional outcomes are reported in patients with multiligament knee injuries associated with high-energy lower limb fractures. We consider an MRI during the initial management can lead to better outcomes. A trauma surgeon working alongside an arthroscopic surgeon might optimize the results for these lesions.

  15. [Partial replantation following proximal limb injury].

    Science.gov (United States)

    Dubert, T; Malikov, S A; Dinh, A; Kupatadze, D D; Oberlin, C; Alnot, J Y; Nabokov, B B

    2000-11-01

    Proximal replantation is a technically feasible but life-threatening procedure. Indications must be restricted to patients in good condition with a good functional prognosis. The goal of replantation must be focused not only on reimplanting the amputated limb but also on achieving a good functional outcome. For the lower limb, simple terminalization remains the best choice in many cases. When a proximal amputation is not suitable for replantation, the main aim of the surgical procedure must be to reconstruct a stump long enough to permit fitting a prosthesis preserving the function of the adjacent joint. If the proximal stump beyond the last joint is very short, it may be possible to restore some length by partial replantation of spared tissues from the amputated part. We present here the results we obtained following this policy. This series included 16 cases of partial replantations, 14 involving the lower limb and 2 the upper limb. All were osteocutaneous microsurgical transfers. For the lower limb, all transfers recovered protective sensitivity following tibial nerve repair. The functional calcaeoplantar unit was used in 13 cases. The transfer of this specialized weight bearing tissue provided a stable distal surface making higher support unnecessary. In one case, we raised a 13-cm vascularized tibial segment covered with foot skin for additional length. For the upper limb, the osteocutaneous transfer, based on the radial artery, was not reinnervated, but this lack of sensitivity did not impair prosthesis fitting. One vascular failure was finally amputated. This was the only unsuccessful result. For all other patients, the surgical procedure facilitated prosthesis fitting and preserved the proximal joint function despite an initially very proximal amputation. The advantages of partial replantation are obvious compared with simple terminalization or secondary reconstruction. There is no secondary donor site and, because there is no major muscle mass in the

  16. NEURO-VASCULAR INJURIES ASSOCIATED WITH LIMB ...

    African Journals Online (AJOL)

    hi-tech

    2000-12-01

    Dec 1, 2000 ... infected end-to-end anastomosis of popliteal artery injury. The other was a case ... increased risk of delayed union and non-union(24). Some of the ... compromise and amputation after intramedullary nailing of a tibia fracture.

  17. Restorative surgery of combined injuries of neurovascular structures of limbs

    Directory of Open Access Journals (Sweden)

    I. V. Pertsov

    2015-02-01

    Full Text Available Combined damage of neurovascular structures is complicate pathology and require repeated surgical interventions and often lead to permanent disability. Aim. To define the features of restorative surgical treatment of traumatic injuries of limbs neurovascular structures and to study the effect of regional hemodynamics on the nerve function restore. Methods and results. In 98 patients with combined trauma of the neurovascular structures microcirculation indicators were established with laser Doppler flowmetry and determine the degree of restoration of nerve function. Conclusion. Strong direct correlation between the degree of restoration of nerve function and microcirculation was detected, the correlation coefficient was +0.72 at t = 3,16 p<0,05. Careful surgical restoration of blood flow helps to improve microcirculation in the limbs, makes positive impact on the recovery of limb function.

  18. Upper limb injury in rugby union football: results of a cohort study.

    Science.gov (United States)

    Usman, Juliana; McIntosh, Andrew Stuart

    2013-04-01

    There have been few in-depth studies of upper limb injury epidemiology in rugby union football, despite reports that they accounted for between 14% and 28% of all rugby injuries. To report on upper limb injury incidence, injury severity and to identify the risk factors associated with upper limb injuries, for example, level of play, season (years) and playing position. Prospective cohort study across five rugby seasons from 2004 to 2008. Formal rugby competitions-suburban, provincial and international. 1475 adult male rugby players in Colts, Grade and Elite competitions. An upper limb injury resulting in a missed game and its characteristics. A total of 61 598 athletic exposures (AE) and 606 upper limb injuries were recorded. About 66% of the injuries were to the shoulder. The overall upper limb injury incidence rate (IIR) was 9.84 injuries/1000 AE (95% CI 9.06 to 10.62). Statistically significant associations were found between upper limb injuries and level of play; and between shoulder injuries and playing position (p<0.05). No association was found between upper limb and shoulder injuries and study year. The overall upper limb IIR decreased as the level of play increased; 10.74 upper limb injuries/1000 AE (95% CI 9.93 to 11.56) in Colts to 6.07 upper limb injuries/1000 AE (95% CI 5.46 to 6.69) in Elite. The upper limb IIR decreased as the level of play increased indicating that age, level of skill and playing experience may be risk factors for upper limb injury.

  19. Bilateral lower limb amputations as a result of landmine injuries.

    Science.gov (United States)

    Atesalp, A S; Erler, K; Gür, E; Köseğlu, E; Kirdemir, V; Demiralp, B

    1999-04-01

    Landmine explosions cause most of the war injuries in the battlefield. Amputations resulting from severe injuries reveal serious problems despite the improvements in surgery. Bilateral lower limb amputations have more impact than unilateral on social life. Some 29 cases with lower limb amputations due to landmine injuries were treated in the Department of Orthopaedics and Traumatology, Gülhane Military Medical Academy between January 1992 and December 1996. Amputation levels were as follows: 1 case had hip disarticulation and a trans-femoral amputation, 6 had bilateral trans-femoral amputations, 6 had trans-femoral and trans-tibial amputations, 12 had bilateral trans-tibial amputations, 1 had trans-femoral and Chopart amputations and the remaining 3 cases had trans-tibial and Chopart amputations. The initial treatment was done for all cases in the first 6-8 hours after injury at the field hospitals. Aggressive debridement, excision and primary closure were performed. None of the stumps required reamputations and/or revision. No case had gas gangrene or tetanus. Postoperative, pre-prosthetic training programme which ranged between 30-120 days with an average 48 days; and prosthesis fitting and adequate post-prosthetic training programme which ranged 32-126 (average 94) days was applied. All the cases were followed-up with a mean of 38.5 months (14-72 months). Nine (9) cases (31%) returned to their previous occupation, while 20 (69%) cases had to change their jobs.

  20. Delivery of Placenta-Derived Mesenchymal Stem Cells Ameliorates Ischemia Induced Limb Injury by Immunomodulation

    Directory of Open Access Journals (Sweden)

    Bo Zhang

    2014-11-01

    Full Text Available Background: Peripheral artery disease (PAD is a major health burden in the world. Stem cell-based therapy has emerged as an attractive treatment option in regenerative medicine. In this study, we sought to test the hypothesis that stem cell-based therapy can ameliorate ischemia induced limb injury. Methods: We isolated mesenchymal stem cells derived from human placentas (PMSCs and intramuscularly transplanted them into injured hind limbs. Treatment with PMSCs reduced acute muscle fibers apoptosis induced by ischemia. Results: PMSC treatment significantly enhanced regeneration of the injured hind limb by reducing fibrosis and enhancing running capacity when the animals were subjected to treadmill training. Mechanistically, injected PMSCs can modulate acute inflammatory responses by reducing neutrophil and macrophage infiltration following limb ischemia. ELISA assays further confirmed that PMSC treatment can also reduce pro-inflammatory cytokines, TNF-α and IL-6, and enhance anti-inflammatory cytokine, IL-10 at the injury sites. Conclusion: Taken together, our results demonstrated that PMSCs can be a potential effective therapy for treatment of PAD via immunomodulation.

  1. Surgical treatment of infected arterial injuries of the major limb

    Institute of Scientific and Technical Information of China (English)

    GUO Qing-shan; WANG Ai-min; WANG Xiao-jun; SUN Hong-zhen; DU Quan-yin

    2005-01-01

    Objective: To analyze retrospectively the surgical treatment of 21 cases of infected arterial injuries of the major limb hospitalized from 1989 to 2003 in our department.Methods: After a radical debridement and drainage, an autologous vessel bypass reconstruction, simple vessel ligation or amputation were carried out respectively according to each patient's condition. In order to make a better milieu for the grafts, local musculo-cutaneous flaps were translocated to cover the wounds in 9 cases.Results : 1 case (4.8 % ) died during the treatment.5 cases ( 5/21, 23.8 %) underwent amputations. Blood supply reconstruction was successful in 15 cases (15/21,71.4 % ). 93.3 % ( 14/15 ) of the cases were successful in getting an unobstructed vessel at early stage. Thrombosis occurred in 1 case ( 1/15, 6.7 % ) and a sound result was obtained after a second operation.Conclusions: Radical debridement combined with bypass vessel reconstruction with autologous vein and with musculo-cutaneous flap translocation is an effective treatment for infective limb vascular injuries.

  2. The validity of the mangled extremity severity score in the assessment of upper limb injuries.

    Science.gov (United States)

    Togawa, S; Yamami, N; Nakayama, H; Mano, Y; Ikegami, K; Ozeki, S

    2005-11-01

    The Mangled Extremity Severity Score (MESS) may be used to decide whether to perform amputation in patients with injuries involving a limb. A score of 7 points or higher indicates the need for amputation. We have treated three patients with a MESS of 7 points or higher, in two of which the injured limb was salvaged. This scoring system was originally devised to assess injuries to the lower limb. However, a MESS of 7 points as a justification for amputation does not appear appropriate when assessing injuries to the major vessels in the upper limb.

  3. Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects.

    Science.gov (United States)

    Mattila, V M; Sillanpää, P J; Salo, T; Laine, H-J; Mäenpää, H; Pihlajamäki, H

    2011-12-01

    Lower limb overuse injuries are common among people who are exposed to physical stress. Orthotic shoe insoles are widely used to prevent lower limb overuse injuries. Here, we conducted a randomized-controlled study to examine whether the use of orthotic insoles prevents lower limb overuse injuries. Participants (n=228) were randomly assigned to use (n=73) or not to use (n=147) orthotic insoles. The insoles were molded to the shape of the foot to provide support during physical activity. The main outcome measure in the present study was the physician-diagnosed lower limb overuse injury. Thirty-four (46.6%) subjects in the insole group were diagnosed with a lower limb overuse injury compared with 56 (38.1%) in the control group (P=0.29) during the 6-month study period. When body mass index and the results of a 12-min running test and muscle strength were adjusted in a Cox's regression model, the hazard ratio for lower limb overuse injury in the insole group was 1.3 (95% confidence intervals: 0.8-2.1) compared with the control group. Use of orthotic insoles was not associated with a decrease in lower limb overuse injuries. Our findings suggest that routine use of orthotic insoles does not prevent physical-stress-related lower limb injuries in healthy young male adults.

  4. Examination of Interventions to Prevent Common Lower-Limb Injuries in the New Zealand Defense Force

    Science.gov (United States)

    2009-01-01

    below the level of the knee.’ Fractures to the foot/toes comprised 42% of these lower-limb fractures , tibia/ fibula fractures comprised 37%, and ankle...knee sprain (16%), indicating that priority should be given to addressing these injuries. Fractures , although comprising only 6% of lower-limb injuries...stability con- trol will be reduced. Fractures All 62 lower-limb fractures identified in the epidemiologi- cal study of NZDF personnel were sustained at or

  5. Isolated limb infusion with fotemustine after dacarbazine chemosensitisation for inoperable loco-regional melanoma recurrence.

    NARCIS (Netherlands)

    Bonenkamp, J.J.; Thompson, J.; Wilt, J.H.W. de; Doubrovsky, A.; Faria Lima, R. de; Kam, P.C.

    2004-01-01

    BACKGROUND: Isolated limb infusion (ILI) is a simple yet effective alternative to conventional isolated limb perfusion for the treatment of advanced melanoma of the extremities. PATIENTS AND METHODS: The study group comprised 13 patients with very advanced limb disease who had failed to achieve a sa

  6. Atypical supernumerary phantom limb and phantom limb pain in a patient with spinal cord injury: case report.

    Science.gov (United States)

    Choi, Ja Young; Kim, Hyo In; Lee, Kil Chan; Han, Zee-A

    2013-12-01

    Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

  7. Bilateral upper limb amputations in victims of high tension electrical injuries: Three case studies

    Directory of Open Access Journals (Sweden)

    Cajetan Nwadinigwe

    2015-02-01

    Full Text Available Bilateral upper limb amputations result in severe disability. High voltage electrical injury is a rare cause of such an outcome and injuries often occur as occupational hazards. We present three case reports of accidental high voltage injuries that occurred in a non-occupational setting. Victims were all initially managed at other centres before referral to our hospital and all subsequently had bilateral upper limb amputations. The high cost of treatment, importance of prevention, and need for rehabilitation are highlighted.

  8. Probability of Regenerating a Normal Limb After Bite Injury in the Mexican Axolotl (Ambystoma mexicanum).

    Science.gov (United States)

    Thompson, Sierra; Muzinic, Laura; Muzinic, Christopher; Niemiller, Matthew L; Voss, S Randal

    2014-06-01

    Multiple factors are thought to cause limb abnormalities in amphibian populations by altering processes of limb development and regeneration. We examined adult and juvenile axolotls (Ambystoma mexicanum) in the Ambystoma Genetic Stock Center (AGSC) for limb and digit abnormalities to investigate the probability of normal regeneration after bite injury. We observed that 80% of larval salamanders show evidence of bite injury at the time of transition from group housing to solitary housing. Among 717 adult axolotls that were surveyed, which included solitary-housed males and group-housed females, approximately half presented abnormalities, including examples of extra or missing digits and limbs, fused digits, and digits growing from atypical anatomical positions. Bite injury likely explains these limb defects, and not abnormal development, because limbs with normal anatomy regenerated after performing rostral amputations. We infer that only 43% of AGSC larvae will present four anatomically normal looking adult limbs after incurring a bite injury. Our results show regeneration of normal limb anatomy to be less than perfect after bite injury.

  9. Isolated limb perfusion of soft tissue sarcomas : A comprehensive review of literature

    NARCIS (Netherlands)

    Seinen, Jojanneke M.; Hoekstra, Harald J.

    2013-01-01

    Patients with primary irresectable, locally advanced soft tissue sarcomas of the limbs form a challenging group for the treating physician. Multimodality treatment is necessary to guarantee optimal limb salvage and survival rates. Since the introduction of isolated limb perfusion in the late fifties

  10. Early delayed amputation: a paradigm shift in the limb-salvage time line for patients with major upper-limb injury.

    Science.gov (United States)

    Burdette, Todd E; Long, Sarah A; Ho, Oscar; Demas, Chris; Bell, John-Erik; Rosen, Joseph M

    2009-01-01

    Patients with major injuries to the upper limbs sometimes fail to achieve successful limb salvage. During the attempt to fashion a functional limb, multiple painful procedures may be ventured. Despite the best efforts of surgeons and therapists, a nonfunctioning or painful upper limb may remain in place for many months or years before late delayed amputation and progression to productive rehabilitation occur. We present three patient cases that illustrate failed upper-limb salvage. In each case, patients expressed a desire for amputation at 6 months after their injury. To reduce the pain and suffering that patients with failed limb salvage endure, we propose a paradigm shift in the limb-salvage time line. We suggest that patients be evaluated for early delayed amputation 6 months after their injury.

  11. Upper limb joint muscle/tendon injury and anthropometric adaptations in French competitive tennis players.

    Science.gov (United States)

    Rogowski, Isabelle; Creveaux, Thomas; Genevois, Cyril; Klouche, Shahnaz; Rahme, Michel; Hardy, Philippe

    2016-01-01

    The purpose of this study was to examine the relationship between the upper limb anthropometric dimensions and a history of dominant upper limb injury in tennis players. Dominant and non-dominant wrist, forearm, elbow and arm circumferences, along with a history of dominant upper limb injuries, were assessed in 147 male and female players, assigned to four groups based on location of injury: wrist (n = 9), elbow (n = 25), shoulder (n = 14) and healthy players (n = 99). From anthropometric dimensions, bilateral differences in circumferences and in proportions were calculated. The wrist group presented a significant bilateral difference in arm circumference, and asymmetrical bilateral proportions between wrist and forearm, as well as between elbow and arm, compared to the healthy group (6.6 ± 3.1% vs. 4.9 ± 4.0%, P tennis injury and asymmetry in upper limb proportions using high-tech measurements in symptomatic tennis players.

  12. The Impact of Prophylactic Fasciotomy Following Porcine (Sus scrofa) Hind Limb Ischemia/Reperfusion Injury

    Science.gov (United States)

    2012-03-23

    ANSI Std. Z39.18 The Impact of Prophylactic Fasciotomy Following Porcine (Sus scrofa ) Hind Limb Ischemia/reperfusion Injury CAPT Thomas J...porcine model of hind limb ischemia. Method: Swine (Sus Scrofa ; 76 +/-6kg) were randomly assigned to no fasciotomy or prophylactic fasciotomy after...of ischemic intervals on neuromuscular recovery in a porcine (Sus scrofa ) survival model of extremity vascular injury. J Vasc Surg. 2011 Jan;53(1):165

  13. Golf and upper limb injuries: a summary and review of the literature

    Directory of Open Access Journals (Sweden)

    Pollard Henry P

    2005-05-01

    Full Text Available Abstract Background Golf is a popular past time that provides exercise with social interaction. However, as with all sports and activities, injury may occur. Many golf-related injuries occur in the upper limb, yet little research on the potential mechanisms of these injuries has been conducted. Objective To review the current literature on golf-related upper limb injuries and report on potential causes of injury as it relates to the golf swing. Discussion An overview of the golf swing is described in terms of its potential to cause the frequently noted injuries. Most injuries occur at impact when the golf club hits the ball. This paper concludes that more research into golf-related upper limb injuries is required to develop a thorough understanding of how injuries occur. Types of research include epidemiology studies, kinematic swing analysis and electromyographic studies of the upper limb during golf. By conducting such research, preventative measures maybe developed to reduce golf related injury.

  14. The relationship between postural stability and dancer's past and future lower-limb injuries.

    Science.gov (United States)

    Clark, Terry; Redding, Emma

    2012-12-01

    In an effort to address dance-related injuries, screening programs are typically employed to assess injury susceptibility. The aim of this study was to explore for potential links between postural stability and dancers' previous lower-limb injuries and susceptibility to future lower-limb injuries. Eighty-five contemporary dance students were recruited at a UK dance conservatoire. Information concerning previous injuries was collected by self-report survey. The participants completed two balance tasks, one static and one dynamic, performed on a RS Scan Footscan pressure pad to calculate postural sway. Injuries in the participant cohort were then tracked for a 10-month period to assess injury susceptibility. The participants exhibited significantly less postural sway when balancing on the left leg than their right, and the women exhibited less postural sway than the men. A one-way ANOVA revealed that participants who had experienced a lower-limb injury in the 12 months prior to testing exhibited more postural sway than participants who had not experienced a lower-limb injury, with some of the differences attaining significance (p dance and work to fully ascertain injury susceptibility.

  15. Spatiotemporal Gait Parameters as Predictors of Lower-Limb Overuse Injuries in Military Training

    Directory of Open Access Journals (Sweden)

    Shmuel Springer

    2016-01-01

    Full Text Available The study objective was to determine whether spatiotemporal gait parameters could predict lower-limb overuse injuries in cohort of combat soldiers during first year of military service. Newly recruited infantry soldiers walked on a treadmill at a 15° incline with a fixed speed of 1.67 m/sec while wearing a standard military vest with a 10 kg load. Stride time variability, stride length variability, step length asymmetry, and the duration of the loading response phase of the gait cycle were measured. Injury data on 76 soldiers who did not report musculoskeletal complaints at initial screening were collected one year after recruitment. Multiple logistic regression analyses were conducted to determine the predictive effect of the gait parameters on lower-limb injuries. Twenty-four soldiers (31.6% had overuse injuries during the first year after recruitment. Duration of the loading response was a significant predictor of general lower-limb injury (p<0.05, as well as of foot/ankle and knee injuries (p<0.05, p<0.01, resp.. A cutoff value of less than 12.15% for loading response duration predicted knee injuries with 83% sensitivity and 67% specificity. This study demonstrates the utility of spatiotemporal gait evaluation, a simple screening tool before military training, which may help to identify individuals at risk of lower-limb overuse injuries.

  16. Successful salvage of the upper limb after crush injury requiring nine operations: a case report.

    Science.gov (United States)

    Zeng, Qingmin; Cai, Guoping; Liu, Dechang; Wang, Kun; Zhang, Xinchao

    2015-03-01

    Emergency treatment of amputation is one of the most frequently used therapeutic methods for patients with severe upper limb crush injury with a mangled extremity severity score (MESS) of more than 7. With the development of advanced surgical repair techniques and reconstructive technology, cases that once required amputation can now be salvaged with appropriate management, and some limb functions may also be reserved. A patient with a severe upper limb crush injury with a MESS score of 10 was treated in our hospital. The limb was salvaged after 9 surgeries over 10 months. The follow-up visits over the next 18 months post-injury showed that the shoulder joint functions were rated as "excellent" (90) according to the Neer score, the Harris hip evaluation (HHS) for elbow joint functions was "good" (80), and the patient was very satisfied with the overall therapeutic outcome. We conclude from the successful outcome of this extreme injury that salvage attempts should be the first management choice for upper limbs with complex injuries to save as much function as possible. Amputation should only be adopted when the injury is life-threatening or no more function can be saved. The level of evidence was V.

  17. Arterial reconstruction after mangled extremity: injury severity scoring systems are not predictive of limb salvage.

    Science.gov (United States)

    Elsharawy, Mohamed Amin

    2005-01-01

    The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS ( 7, 91%; p = .22), and MESI ( 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

  18. Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    Directory of Open Access Journals (Sweden)

    Chang-zhi CHENG

    2011-06-01

    Full Text Available Objective To explore the risk factors of complication of acute renal failure(ARF in war injuries of limbs.Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed.The patients were divided into ARF group(n=9 and non-ARF group(n=343 according to the occurrence of ARF,and the case-control study was carried out.Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma,shock after injury,time of admission to hospital after injury,injured sites,combined trauma,number of surgical procedures,presence of foreign matters,features of fractures,amputation,and tourniquet time.Results Fifteen of the 352 patients died(4.3%,among them 7 patients(46.7% died of ARF,3(20.0% of pulmonary embolism,3(20.0% of gas gangrene,and 2(13.3% of multiple organ failure.Univariate analysis revealed that the shock,time before admitted to hospital,amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries,while the logistic regression analysis showed only amputation was the risk factor for ARF(P < 0.05.Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.

  19. Frequency upper limbs injuries in the emergency health service in Paranaiba, MS, Brazil

    Directory of Open Access Journals (Sweden)

    Eliane Cristina Coelho de Oliveira Correia

    2012-09-01

    Full Text Available To assess the frequency of upper limb injuries in the only emergency medical service inParanaiba, State of Mato Grosso do Sul. Methods: Retrospective study with data collection from medical recordsof patients assisted with upper limb injuries in “Santa Casa de Misericordia” Hospital, the only hospital in the cityto provide emergency care, in 2008. Variables of interest such as gender and type of injury were collected basedon the International Code of Diseases (ICD 10. Results: There were 314 cases of upper limb injury in 2008and men were the most affected with 211 cases (67.2%. The wrist was the most affected segment with 64 cases(20.4%, followed by the shoulder with 55 cases (17.5% and the hand with 50 cases (15.9%. Interventions andsurgeries involving bone portion were the most frequent - 225 (71.7%, followed by tendon - 19 (6.1% and neural - 16 (5.1%; 35 patients (11.1% underwent multiple operations. Osteosyntheses - 94 (29.9%, fractures- 48 (15.3%, and reduction - 46 (14.6% were the most frequent interventions, followed by 26 dislocations(8.3% and 14 tenorrhaphies (4.5%. Conclusion: The involvement of the upper limbs, especially bone lesions,is frequent. The segments most affected by injuries are men’s wrists and shoulders.

  20. Functional electrical stimulation for the upper limb in tetraplegic spinal cord injury: a systematic review.

    Science.gov (United States)

    Patil, Siddeshwar; Raza, Wajid A; Jamil, Firas; Caley, Richard; O'Connor, Rory J

    2014-01-01

    Technological advances have helped to improve functional ability in spinal cord injury survivors. The aim of this study is to systematically review the evidence for functional electrical stimulation (FES) on functional tasks involving the upper limb in people with spinal cord injuries. The authors systematically searched from September 2009 to September 2014 in relevant databases using a combination of keywords covering spinal cord injury and FES. Studies were selected using pre-determined criteria. The search yielded 144 studies. Only five studies met the inclusion criteria. All five reported improvements immediately and at follow-up in functional ability as a result of FES or FES combined with conventional therapy. There is some preliminary evidence that FES may reduce disability due to upper limb-related activity limitations in tetraplegic spinal cord injury. Further work needs to examine the role of FES in more detail and in combination with other treatments.

  1. A Neuromotor Device for Reducing Phantom Limb Pain in Individuals with Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Cui Lei

    2016-01-01

    Full Text Available Phantom Limb Pain is a disorder that can be experienced by individuals after amputation or spinal cord injury. In spinal cord injury the paralysis or paresis is often bilateral, thus limiting the application of apparent movement as a therapeutic model for phantom limb pain. This project aimed to develop a robotic rehabilitation device that replicated apparent movement to apply the same therapeutic principles with individuals with lower limb phantom pain that have bilateral paralysis of paresis. The proposed device achieved lower limb planar motion of the knee by a six-bar linkage of a single degree of freedom (DOF. It is driven by a linear actuator while the ankle motion is achieved by a gear motor, reaching an effective 70° range of motion for both joints. The system features closed loop control using feedback from surface electromyography sensors, limit switches and position sensors with an Arduino microcontroller as the control unit. This device will be used to further our understanding of the disorder and create opportunities for robot aided treatment for individuals with phantom limb pain as a result of spinal cord injury.

  2. Effectiveness of foot orthoses for treatment and prevention of lower limb injuries : a review.

    Science.gov (United States)

    Hume, Patria; Hopkins, Will; Rome, Keith; Maulder, Peter; Coyle, Greg; Nigg, Benno

    2008-01-01

    Healthcare professionals prescribe foot orthoses (FOs) for treatment and prevention of lower limb injuries, but previous reviews of the effectiveness of FOs have been inconclusive. We have therefore performed a review emphasizing the magnitude of treatment effects to evaluate the clinical effectiveness of FOs in the treatment and prevention of lower limb injuries.Qualifying studies were mainly controlled trials, but some uncontrolled clinical trials of patients with chronic injuries were analysed separately. Injuries included plantar fasciitis, tibial stress fractures and patellofemoral pain syndrome; these were included because of the large treatment costs for these frequent injuries in New Zealand. Outcomes were pain, comfort, function and injury status. Continuous measures were expressed as standardized differences using baseline between-subject standard deviations, and magnitudes were inferred from the intersection of 90% confidence intervals with thresholds of a modified Cohen scale. Effects based on frequencies were expressed as hazard ratios and their magnitudes were inferred from intersection of confidence intervals with a novel scale of thresholds.The effects of FOs for treatment of pain or injury prevention were mostly trivial. FOs were not effective in treating or preventing patellofemoral pain syndrome. Some studies showed moderate effects for treatment of plantar fasciitis. Only a few studies showed moderate or large beneficial effects of FOs in preventing injuries.Customized semi-rigid FOs have moderate to large beneficial effects in treating and preventing plantar fasciitis and posterior tibial stress fractures, and small to moderate effects in treating patellofemoral pain syndrome. Given the limited randomized controlled trials or clinical controlled trials available for the injuries of interest, it may be that more or less benefit can be derived from the use of FOs, but many studies did not provide enough information for the standardized effect

  3. 四肢脱套伤的处理%Management of degloving injuries of limbs

    Institute of Scientific and Technical Information of China (English)

    戴亚辉; 梅炯

    2015-01-01

    Degloving injuries of limbs occur relatively rarely but pose extreme challenges to surgeons, which are usually caused by trafifc accidents or industrial trauma. The key point that differentiates this kind of injury from others is that certain arteries will get damaged due to the separation of the skin and subcutaneous soft tissues from muscles, tendons and fascias, leading to the block of blood lfow. Loss of blood supply means the degloving skin and other soft tissues can hardly live. Mismanagement of such kind of injuries may result in delayed full-thickness necrosis of the avulsed skin lfap, higher complication rate, increased hospitalization and rehabilitation cost, even greater risk of amputation and death. By reviewing past scholars’ management of different types of degloving injuries, it is found that although there are many options available for the management, it is still disputed on how to choose effective treatment strategies and techniques. Some traditional methods are efficient and can be easily put into use in clinic. With the development of science and technology in recent years, new technologies and materials like microsurgical techniques and vaccum sealing drainage ( VSD )/vaccum assisted closure ( VAC ) can provide new options for these injuries, which could greatly reduce the heavy nursing care burden after surgery and decrease the postoperative infection rate. This article is introducing the classification of degloving injuries of limbs, storage methods of degloved skin and discussing the treatment strategies, surgical techniques and prognosis of this kind of injury, aiming to provide some recommendations to surgeons who will face these injuries.

  4. Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

    Science.gov (United States)

    Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa

    2015-05-01

    The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

  5. Serum EGF and NGF levels of patients with brain injury and limb fracture

    Institute of Scientific and Technical Information of China (English)

    Yan-Feng Zhuang; Jie Li

    2013-01-01

    Objective: To explore the expression and sign if icance of human epidermal growth factor (EGF) and nerve growth factor (NGF) in patients with knee osteoarthritis. Methods: RT-PCR and enzyme-linked immunosorbent assay were used to measure the serum EGF and NGF expression levels of patients with limb fracture and brain trauma injurry after 1 d, 3 d, 7 d, 14 d and the relationship between them was analyzed. The level was compared among the simple fracture group, traumatic brain injury group and the normal control group, with 40 cases in each group. Results: The serum NGF levels were significantly different among three groups. Serum NGF, EGF mRNA and protein levels gradually decreased with the increasing injury time in the limb fracture combined with brain injury group, traumatic brain injury group, the simple fracture group and the health control group (P<0.05). Conclusions: The serum of NGF, EGF levels significantly increased when limb fracture combined with brain injury, so EGF and NGF may be involved in the process of fracture healing.

  6. Pattern of rubber bullet injuries in the lower limbs: A report from Kashmir

    Institute of Scientific and Technical Information of China (English)

    Shabir Ahmed Dhar; Tahir Ahmed Dar; Sharief Ahmed Wani; Saheel Maajid; Jawed Ahmed Bhat; Naseer Ahmed Mir; Imtiyaz Hussain Dar

    2016-01-01

    Purpose:Rubber bullets are considered a non-lethal method of crowd control and are being used over the world.However the literature regarding the pattern and management of these injuries is scarce for the forensic pathologist as well as for the traumatologist.The objective of this report was to add our experience to the existing literature.Methods:From June 2008 to August 2010 the Government Hospital for Bone and Joint Surgery Barzulla and the Department of Orthopaedics,SKIMS Medical College/Hospital Bemina Srinagar received 28 patients for management of their orthopaedic injuries caused by rubber bullets.We documented all injuries and also recorded the management issues and complications that we encountered.Results:All patients were males with an age range of 11-32 years and were civilians who had been hit by rubber bullets fired by the police and the paramilitary forces.Among them,19 patients had injuries of the lower limbs and 9 patients had injuries of the upper limbs.All patients were received within 5 h of being shot.Conclusion:Our findings suggest that these weapons are capable of causing significant injuries including fractures and it is important for the surgeon to be well versed with the management of such injuries especially in areas of unrest.The report is also supportive of the opinion that these weapons are lethal and should hence be reclassified.

  7. Lower limb ischaemia and reperfusion injury in healthy volunteers measured by oxidative and inflammatory biomarkers

    DEFF Research Database (Denmark)

    Halladin, N. L.; Busch, Sarah Victoria Ekeløf; Alamili, M.

    2015-01-01

    exposed to 20 minutes of lower limb ischaemia. Muscle biopsies and blood samples were taken at baseline and 5, 15, 30, 60 and 90 minutes after tourniquet release and analysed for malondialdehyde (MDA), ascorbic acid, dehydroascorbic acid, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-1 receptor...... at any sampling time. CONCLUSION: Twenty minutes of lower limb ischaemia does not result in an ischaemia-reperfusion injury in healthy volunteers, measurable by oxidative and pro- and anti-inflammatory biomarkers in muscle biopsies and in the systemic circulation....

  8. Mucormycosis complicating lower limb crash injury in a multiple traumatised patient: an unusual case.

    Science.gov (United States)

    Stasiak, Mariusz; Samet, Alfred; Lasek, Jerzy; Wujtewicz, Maria; Witkowski, Zbigniew; Komarnicka, Jolanta; Golabek-Dropiewska, Katarzyna; Rybak, Bartosz; Gross, Marta; Marks, Wojciech

    2009-01-01

    Necrotising skin and soft tissues infections are most commonly bacterial in origin. However, saprophytic fungi of the class Zygomycetes, family Mucoraceae, can cause highly aggressive infections (mucormycoses) mainly in immunocompromised patients. Severe trauma is one of the major risk factors for mucormycosis. Fungal traumatic wound infection is an unusual complication associated with crash limb injury. This report describes a case of serious necrotising soft tissue infection caused by Mucor sp following primary fungal environmental wound contamination in a multiply injured patient. Despite undelayed diagnosis and proper treatment (surgical debridement and limb amputation, amphotericin B therapy) the patient presented a fatal outcome.

  9. Isolated limb perfusion with tumor necrosis factor and melphalan for limb salvage in 186 patients with locally advanced soft tissue extremity sarcomas. The cumulative multicenter European experience

    NARCIS (Netherlands)

    A.M.M. Eggermont (Alexander); P.M. Schlag; D. Lienard; A.N. van Geel (Albert); F.J. Lejeune; H.J. Hoekstra; I. Meller; J.C. Pector; O.E. Nieweg (Omgo); G. Ben-Ari; C. Kettelhack; H. Schraffordt Koops; J.M. Klausner; B.B. Kroon

    1996-01-01

    textabstractOBJECTIVE: The objective of the study was to achieve limb salvage in patients with locally advanced soft tissue sarcomas that can only be treated by amputation or functionally mutilating surgery by performing an isolated limb perfusion (ILP) with tumor necro

  10. Methods for axolotl blood collection, intravenous injection, and efficient leukocyte isolation from peripheral blood and the regenerating limb.

    Science.gov (United States)

    Debuque, Ryan J; Godwin, James W

    2015-01-01

    The vertebrate immune system comprises both adaptive and innate immune cells with distinct functions during the resolution of inflammation and wound healing after tissue injury. Recent evidence implicates a requirement for innate immune cells from the myeloid lineage during the early stages of limb regeneration in the Mexican axolotl. Understanding the functions of innate and adaptive immune cells in the axolotl has been hampered by a lack of approaches to isolate and analyze these cells. Here we describe a protocol to isolate myeloid cells from the regenerating axolotl limb that incorporates intravenous delivery of physiological labels. In addition we provide a protocol to enrich for leukocytes in the peripheral blood. These protocols produce single-cell suspensions that can be analyzed using flow cytometry or sorted into specific subsets using fluorescent-activated cell sorting (FACS). FACS is a routine approach to sort cells based on their physical characteristics as well as their cell surface antigen repertoire. Isolated cell populations can then be analyzed in a wide range of downstream assays to facilitate a greater understanding of leukocyte biology in the axolotl.

  11. From the battlefield to the laboratory: the use of clinical data analysis in developing models of lower limb blast injury.

    Science.gov (United States)

    Ramasamy, Arul; Newell, N; Masouros, S

    2014-06-01

    A key weapon in the insurgents' armamentarium against coalition and local security forces in Iraq and Afghanistan has been the use of anti-vehicle mines and improvised explosive devices (IEDs). Often directed against vehicle-borne troops, these devices, once detonated, transfer considerable amounts of energy through the vehicle to the occupants. This results in severe lower limb injuries that are frequently limb threatening. Fundamental to designing novel mitigation strategies is a requirement to understand the injury mechanism by developing appropriate injury modelling tools that are underpinned by the analysis of contemporary battlefield casualty data. This article aims to summarise our understanding of the clinical course of lower limb blast injuries from IEDs and its value in developing unique injury modelling test-beds to evaluate and produce the next generation of protective equipment for reducing the devastating effects of blast injury.

  12. Isolated limb perfusion of an irradiated foot with tumor necrosis factor, interferon, and melphalan

    NARCIS (Netherlands)

    vanGinkel, RJ; Hoekstra, HJ; Eggermont, AMM; Pras, E; Schraffordt Koops, H.

    1996-01-01

    A 57-year-old woman presented with the second recurrence of a high-grade malignant fibrous histiocytoma of the right foot, following previous local resection plus curative adjuvant radiotherapy. The first recurrence of the lesion was treated by isolated limb perfusion with cisplatin; the second recu

  13. Quality of life after hyperthermic isolated limb perfusion for locally advanced extremity soft tissue sarcoma

    NARCIS (Netherlands)

    Thijssens, KMJ; Hoekstra-Weebers, JEHM; van Ginkel, RJ; Hoekstra, HJ

    2006-01-01

    Background: Quality of life (QoL) and posttraumatic stress symptoms (PTSS) were studied in patients with soft tissue sarcoma (STS) of the extremities treated with isolated limb perfusion and delayed resection, with or without adjuvant irradiation. Methods: Forty-one patients received a questionnaire

  14. The use of negative pressure therapy and hyaluronic acid for the management of post-traumatic lower limb injury.

    Science.gov (United States)

    Cigna, Emanuele; Maruccia, Michele; Sorvillo, Valentina; Parisi, Paola; Palumbo, Francesca; Onesti, Maria Giuseppina

    2013-10-01

    Management of severe limb trauma continues to challenge surgeons. Suitable treatment should be individualised for each patient, taking into consideration not only the wound extremity but also the associated injuries, age and socioeconomic status of the patient with the goal to recover function and to improve patient quality of life. The aim of this report is to present a severe degloving multiplane lower limb injury case in which a conservative treatment of the wound was performed with negative pressure therapy and dermal substitute, avoiding amputation and restoring limb function.

  15. Fifty tumor necrosis factor-based isolated limb perfusions for limb salvage in patients older than 75 years with limb-threatening soft tissue sarcomas and other extremity tumors

    NARCIS (Netherlands)

    B. van Etten (Boudewijn); A.N. van Geel (Albert); J.H.W. de Wilt (Johannes); A.M.M. Eggermont (Alexander)

    2003-01-01

    textabstractBACKGROUND: Isolated limb perfusion (ILP) with tumor necrosis factor (TNF) and melphalan is highly effective in treating limb-threatening soft tissue sarcoma (STS) and other bulky tumors. Because of fear of TNF-associated toxicity, ILP with TNF is not offered to older p

  16. Hyperthermic isolated regional perfusion of the limb with carboplatin

    NARCIS (Netherlands)

    Daryanani, D; de Vries, EGE; Guchelaar, HJ; van Weerden, TW; Hoekstra, HJ

    2000-01-01

    Aims: To investigate the feasibility of hyperthermic isolated regional perfusion (HIRP) with carboplatin in the management of locally recurrent and/or intransit metastases of melanoma or locally advanced soft tissue sarcoma. Methods: Three patients, two with locally advanced melanoma and one with a

  17. Isolated limb infusion chemotherapy for melanoma: an overview of early experience at the Adelaide Melanoma Unit

    Directory of Open Access Journals (Sweden)

    Giles MH

    2013-08-01

    Full Text Available Mitchell H Giles,1 Brendon J Coventry2 1Adelaide Melanoma Unit, 2Discipline of Surgery, The University of Adelaide, Royal Adelaide Hospital Adelaide, SA, Australia Background: Isolated limb infusion (ILI using cytotoxic agents has been demonstrated to be an effective and less invasive alternative modality than isolated limb perfusion for the treatment of melanoma localized to a limb. Percutaneous catheters were inserted into the axial artery and vein of the affected limb while using a pneumatic cuff to restrict limb vascular flow proximally to "isolate" the limb from the body and enable delivery of high-dose intra-arterial chemotherapy selectively to the limb. The ILI technique was developed at the Sydney Melanoma Unit (now renamed the Melanoma Institute Australia, and only a few other centers have reported separate results. We report our early results using the ILI technique for management of locally recurrent surgically nonresectable melanoma. Methods and results: Twenty-eight ILI procedures were performed in 20 patients treated with one or more procedures between 1997 and 2007. Patient parameters and clinical responses were evaluated. The median follow-up duration was 15.9 months after the first ILI, with an overall response rate after one or more infusions of 70%, of which 35% were complete responders and 35% were partial responders, with a further 20% showing stable disease, giving a "clinically significant" response rate of 90%. After one ILI (n = 20, the overall response rate was 70%, with 20% complete responders and 50% partial responders, and 20% with stable disease. Low limb toxicities were generally observed, and no amputations were required. Conclusion: ILI chemotherapy is a useful technique, which can be readily repeated for control of melanoma in the limb. It is generally well tolerated, and is capable of achieving a cure, delayed progression, or effective palliation in selected cases. The longest survivors in this series were 8

  18. Predictors of secondary amputation in patients with grade IIIC lower limb injuries: A retrospective analysis of 35 patients.

    Science.gov (United States)

    Song, Wenhao; Zhou, DongSheng; Dong, Jinlei

    2017-06-01

    The aim of this study was to identify risk factors for failure of limb salvage surgery in grade IIIC lower extremity injuries.A single-institution, retrospective review was performed of all patients with grade IIIC lower limb injuries presenting from January 2009 to April 2014. We gathered the data on each patient who underwent limb salvage and analyzed the final outcome for these patients (limb salvage vs secondary amputation).Grade IIIC lower limb injuries were identified in 41 patients. Primary amputation was performed in 6 patients (15%) as the initial procedure. Thirty-five patients (85%) underwent vascular reconstruction and other surgical procedures to salvage the limb. Limb salvage was successful in 23 patients (66%); 12 patients (34%) ultimately underwent secondary amputation. The median time from injury to secondary amputation was 22.5 days (range 4-380 days). The mean Mangled Extremity Severity Score (MESS) was 7.2 ± 1.5 (range 5-10). The MESS was significantly higher in the secondary amputation group compared with the limb salvage group. Additionally, statistical testing revealed that the limb ischemia time, complex fractures, rate of fasciotomy, and number of vascular reconstruction were significantly higher in the secondary amputation group. Muscle necrosis and extensive soft tissue defect were the main reasons for secondary amputation.The findings indicate that MESS of 7 or greater, complex fractures, limb ischemia time equal to or greater than 6 hours, and osteofascial compartment syndrome were associated with an increased risk of delayed amputation. The MESS is highly prognostic but not perfect; decision-making in patients with an MESS of 7 or greater should be re-evaluated for clinical use.

  19. Apoptosis of the thick ascending limb results in acute kidney injury.

    Science.gov (United States)

    Srichai, Manakan B; Hao, Chuanming; Davis, Linda; Golovin, Anastasia; Zhao, Min; Moeckel, Gilbert; Dunn, Steve; Bulus, Nada; Harris, Raymond C; Zent, Roy; Breyer, Matthew D

    2008-08-01

    Ischemia- or toxin-induced acute kidney injury is generally thought to affect the cells of the proximal tubule, but it has been difficult to define the involvement of other tubular segments because of the widespread damage caused by ischemia/reperfusion or toxin-induced injury in experimental models. For evaluation of whether thick ascending limb (TAL)-specific epithelial injury results in acute kidney injury, a novel transgenic mouse model that expresses the herpes simplex virus 1 thymidine kinase gene under the direction of the TAL-specific Tamm-Horsfall protein promoter was generated. After administration of gancyclovir, these mice demonstrated apoptosis only in TAL cells, with little evidence of neutrophil infiltration. Compared with control mice, blood urea nitrogen and creatinine levels were at least five-fold higher in the transgenic mice, which also developed oliguria and impaired urinary concentrating ability. These findings suggest that acute injury targeted only to the TAL is sufficient to cause severe acute kidney injury in mice with features similar to those observed in humans.

  20. The Effectiveness of Physical Agents for Lower-Limb Soft Tissue Injuries: A Systematic Review.

    Science.gov (United States)

    Yu, Hainan; Randhawa, Kristi; Côté, Pierre; Optima Collaboration

    2016-07-01

    Study Design Systematic review. Background Soft tissue injuries to the lower limb bring a substantial health and economic burden to society. Physical agents are commonly used to treat these injuries. However, the effectiveness of many such physical agents is not clearly established in the literature. Objective To evaluate the effectiveness and safety of physical agents for soft tissue injuries of the lower limb. Methods We searched 5 databases from 1990 to 2015 for randomized controlled trials (RCTs), cohort studies, and case-control studies. Paired reviewers independently screened the retrieved literature and appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with a high risk of bias were excluded. We synthesized low-risk-of-bias studies according to principles of best-evidence synthesis. Results We screened 10261 articles. Of 43 RCTs identified, 20 had a high risk of bias and were excluded from the analysis, and 23 RCTs had a low risk of bias and were included in the analysis. The available higher-quality evidence suggests that patients with persistent plantar fasciitis may benefit from ultrasound or foot orthoses, while those with persistent midportion Achilles tendinopathy may benefit from shockwave therapy. However, the current evidence does not support the use of shockwave therapy for recent plantar fasciitis, low-Dye taping for persistent plantar fasciitis, low-level laser therapy for recent ankle sprains, or splints for persistent midportion Achilles tendinopathy. Finally, evidence on the effectiveness of the following interventions is not established in the current literature: (1) shockwave therapy for persistent plantar fasciitis, (2) cryotherapy or assistive devices for recent ankle sprains, (3) braces for persistent midportion Achilles tendinopathy, and (4) taping or electric muscle stimulation for patellofemoral pain syndrome. Conclusion Almost half the identified RCTs that evaluated the effectiveness of

  1. Rasch Analysis of the General Self-Efficacy Scale in Workers with Traumatic Limb Injuries.

    Science.gov (United States)

    Wu, Tzu-Yi; Yu, Wan-Hui; Huang, Chien-Yu; Hou, Wen-Hsuan; Hsieh, Ching-Lin

    2016-09-01

    Purpose The purpose of this study was to apply Rasch analysis to examine the unidimensionality and reliability of the General Self-Efficacy Scale (GSE) in workers with traumatic limb injuries. Furthermore, if the items of the GSE fitted the Rasch model's assumptions, we transformed the raw sum ordinal scores of the GSE into Rasch interval scores. Methods A total of 1076 participants completed the GSE at 1 month post injury. Rasch analysis was used to examine the unidimensionality and person reliability of the GSE. The unidimensionality of the GSE was verified by determining whether the items fit the Rasch model's assumptions: (1) item fit indices: infit and outfit mean square (MNSQ) ranged from 0.6 to 1.4; and (2) the eigenvalue of the first factor extracted from principal component analysis (PCA) for residuals was Rasch scores. Conclusions The results indicated that the items of GSE are unidimensional and have acceptable person reliability in workers with traumatic limb injuries. Additionally, the raw sum scores of the GSE can be transformed into Rasch interval scores for prospective users to quantify workers' levels of self-efficacy and to conduct further statistical analyses.

  2. Finite element simulation of lower limb injuries to the driver in minibus frontal collisions

    Institute of Scientific and Technical Information of China (English)

    Liang-Liang Shi; Chen Lei; Kui Li; Shuo-Zhen Fu; Zheng-Wei Wu; Zhi-Yong Yin

    2016-01-01

    Purpose:This study aims to explore the biomechanical mechanism of lower limb injuries to the driver by establishing a finite element (FE) simulation model of collisions.Methods:First a minibus FE model was integrated with a seat belt system.Then it was used to rebuild two collisions together with the total human model for safety (THUMS) provided by Toyota Motor Corporation:a rear-end collision between a minibus and a truck and a head-on collision of a minibus to a rigid wall.The impact velocities of both collisions were set at 56 km/h.The vehicle dynamic response,vehicle deceleration,and dashboard intrusion in the two collisions were compared.Results:In the minibus rear-end truck collision,the peak values of the von Mises equivalent stress at the tibia and the femur were 133 MPa and 126 MPa respectively;while in the minibus head-on rigid wall collision,the data were 139 MPa and 99 MPa.Compared with the minibus head-on rigid wall collision,the vehicle deceleration was smaller and the dashboard intrusion was larger in the minibus rear-end truck collision.Conclusion:The results illustrate that a longer dashboard incursion distance corresponds to a higher yon Mises equivalent stress at the femur.The simulation results are consistent with the driver's autopsy report on lower limbs injuries.These findings verify that FE simulation method is reliable and useful to analyze the mechanisms of lower limb injuries to the driver in minibus frontal collisions.

  3. Incidence and prophylaxis of deep venous thrombosis in outpatients with injury of the lower limb.

    Science.gov (United States)

    Kujath, P; Spannagel, U; Habscheid, W

    1993-03-01

    253 outpatients were included in a prospective randomized study. All patients had incidence of injuries of the lower limb immobilized by a plaster cast. 126 patients (group I) received a subcutaneous injection of Fraxiparin daily, and 127 patients (group II) received no thromboprophylaxis. Without prophylaxis 21 (16.5%) cases developed a thrombosis, and with prophylaxis a thrombosis could be proven in 6 (4.8%) patients only (p immobilized by a plaster cast, a thromboprophylaxis with a low-molecular-weight heparin is recommended.

  4. Injury rates in martial art athletes: anthropometric parameters and training volume, but not foot morphology indexes, are predictive risk factors for lower limb injuries.

    Science.gov (United States)

    Vitale, Jacopo A; Bassani, Tito; Galbusera, Fabio; Bianchi, Alberto; Martinelli, Nicolò

    2017-09-22

    Previous studies attempted to identify possible risk factors for acute and overuse injuries in several sports disciplines such as running, gymnastics or team sports. Given the lack of scientific works focused on risk factors for lower limb injuries in martial arts, the present study was aimed to investigate foot anatomy, anthropometric measures, and other background information as possible risk factors of injury in barefoot athletes practicing judo, karate, kung fu, thai boxe, or aikido. In addition, the injury rates were evaluated in relation with the different martial art styles. One group of 130 martial artists was retrospectively evaluated. Data of three foot morphological variables were collected: navicular height (NH), navicular drop (ND) and the rear foot (RF). In addition, each participant filled an interview questionnaire providing the following information: age, sex, body weight, height, BMI, hours of training per week, the kind of injury occurred to the lower limbs in the preceding year. Of 130 subjects, 70 (53.8%) did not sustain injuries, 35 (27.0%) suffered an acute injury and the remaining 25 (19.2%) reported an overuse injury. No significant differences were observed in the injury rates in relation to style and kind of martial art. Age, training volume and BMI were found as significant predictors of injury, while NH, ND and RF were not able to predict acute or overuse injury at lower limbs. The injury rates were similar in karate, judo, kung fu, aikido, and thai boxe. The foot morphology variables were not related with the presence or absence of acute and overuse injuries. Conversely, older and heavier martial artists, performing more hours of barefoot training, are at higher risk of acute and overuse injury. Athletic trainers should strongly take into account the present information in order to develop more accurate and specific injury prevention programs for martial artists.

  5. Isolated limb perfusion with TNF-alpha and melphalan in locally advanced soft tissue sarcomas of the extremities

    NARCIS (Netherlands)

    Grunhagen, D.J.; Wilt, J.H.W. de; Geel, A.N. van; Verhoef, C.; Eggermont, A.M.M.

    2009-01-01

    Limb-sparing surgery has become all the more important in soft tissue sarcoma (STS) of the extremities since we learned that amputation does not improve survival of these patients. In bulky tumours, however, preoperative strategies to reduce tumour size are then required. Isolated limb perfusion (IL

  6. Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism

    Directory of Open Access Journals (Sweden)

    Anuj Jain

    2014-10-01

    Full Text Available 【Abstract】Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths, usually from head injury. We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason. A child fell from a height of around 15 feet after toppling from a alcony. He developed multiple fractures involving the right femoral shaft, right distal femoral epiphysis (Salter Harris type 2, right distal metaphysis of the tibia and fi bula, and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia. There were no head, abdominal or spinal injuries. The patient was taken into emergency operation theatre after initial management which consisted of intravenous fl uids, blood transfusion, and splintage of both lower limbs. Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails. Distal femoral physeal injury required open eduction and fixation with K wires. Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs. All the fractures united in four weeks. At the last follow-up, the child had no disability and was able to perform daily ctivities comfortably. We also proposed the unique mechanism of injury in this report. Key words: Multiple bilateral lower limb fractures; Fall; Child

  7. Frequency of lower limb injuries and their Causes among motorcycle accident admitted into Imam Hossein hospital during one year

    Directory of Open Access Journals (Sweden)

    Ali Arhami Dolatabadi

    2013-01-01

    Full Text Available Abstract Background and Aim: Motor vehicle accidents are common cause of mortality, morbidity and disability. Human factors are principle cause for frequency of motor vehicle accident. In most studies, 52-40% lower limb injuries are trauma from a motorcycle accident. These accidents cause high financial cost and harm for society. Materials and Methods: In this study, patients with lower limb injuries referred to the hospital trauma ward of Imam Hussein were evaluated during one year. Questionnaire forms were designed and completed for patients then data of these forms was inserted in a database. The information was analyzed by statistical software SPSS 18. Results: from 766 patients with lower limb traumas which were examined and evaluated, 92 % were male and mean age of patients was 25± 12 years. 156 patients suffered from head and neck trauma and 134 persons had skin damage in addition to lower limb trauma. Injury to leg was most common injuries in lower leg and tibia shaft fracture was more frequent than lower bone fracture. Most injuries in pelvic trauma associated with fractures of the superior pubic ramus and coccyx bone. Seventy percent of related knee injuries included injury to patella and tibia plateau. The most observed injuries in ankle and foot were lateral malleolus fracture and lisferanc injuries. About 11 percent of patients were discharged from emergency room after primary management and other patients were admitted in hospital.Conclusion: Given the high incidence of lower extremity injuries, especially the leg, in the accident of motorcycle riders, procurement and construction of an efficient protective equipment, especially protective guard can be effective in reducing accidents.

  8. Ischemic post-conditioning attenuates the intestinal injury induced by limb ischemia/reperfusion in rats

    Directory of Open Access Journals (Sweden)

    Y.F. Leng

    2011-05-01

    Full Text Available The purpose of this study was to investigate the protective effects of ischemic post-conditioning on damage to the barrier function of the small intestine caused by limb ischemia-reperfusion injury. Male Wistar rats were randomly divided into 3 groups (N = 36 each: sham operated (group S, lower limb ischemia-reperfusion (group LIR, and post-conditioning (group PC. Each group was divided into subgroups (N = 6 according to reperfusion time: immediate (0 h; T1, 1 h (T2, 3 h (T3, 6 h (T4, 12 h (T5, and 24 h (T6. In the PC group, 3 cycles of reperfusion followed by ischemia (each lasting 30 s were applied immediately. At all reperfusion times (T1-T6, diamine oxidase (DAO, superoxide dismutase (SOD, and myeloperoxidase (MPO activity, malondialdehyde (MDA intestinal tissue concentrations, plasma endotoxin concentrations, and serum DAO, tumor necrosis factor-α (TNF-α, and interleukin-10 (IL-10 concentrations were measured in sacrificed rats. Chiu’s pathology scores for small intestinal mucosa were determined under a light microscope and showed that damage to the small intestinal mucosa was lower in group PC than in group LIR. In group PC, tissue DAO and SOD concentrations at T2 to T6, and IL-10 concentrations at T2 to T5 were higher than in group LIR (P < 0.05; however, tissue MPO and MDA concentrations, and serum DAO and plasma endotoxin concentrations at T2 to T6, as well as TNF-α at T2 and T4 decreased significantly (P < 0.05. These results show that ischemic post-conditioning attenuated the permeability of the small intestines after limb ischemia-reperfusion injury. The protective mechanism of ischemic post-conditioning may be related to inhibition of oxygen free radicals and inflammatory cytokines that cause organ damage.

  9. Isolated pancreatic injury following blunt abdominal trauma in a child

    Directory of Open Access Journals (Sweden)

    Jain Sandeep

    2007-01-01

    Full Text Available Pancreatic injury following blunt abdominal trauma is rare as compared to other visceral organs. Isolated injury to the pancreas is even more rare. The clinical presentation is subtle resulting in delayed treatment with high morbidity and mortality. A three-year-old female child presented with vomiting 18h following a motor vehicle accident. She was hemodynamically stable with no external signs of injury. Investigations revealed hyperamylasemia and isolated grade III pancreatic injury. Laparotomy with distal pancreatic resection and splenectomy was done. A high degree of clinical suspicion with due consideration to the mechanism of injury is the key to good outcome in these patients. Major ductal injury is the critical issue in the management and a number of therapeutic choices are available specific to the location of the insult.

  10. Lesões do membro superior no esporte Sports injuries of the upper limb

    Directory of Open Access Journals (Sweden)

    Rogerio Teixeira da Silva

    2010-01-01

    Full Text Available As lesões esportivas do membro superior são muito comuns da prática de atividades físicas e, por isso, devem ser estudadas detalhadamente, levando-se em consideração aspectos específicos da modalidades esportiva praticada. Especial atenção deve ser dada à dinâmica da articulação do ombro e toda cintura escapular, pois somente assim poderemos tratar de forma mais adequada os atletas, atuando também na prevenção das recidivas, que podem ocorrer em alguns casos devido ao fato de o atleta procurar sempre o retorno ao mesmo nível esportivo anterior à lesão. Este artigo vai focar principalmente o manejo das lesões tendíneas do membro superior, da fisiopatologia até os novos métodos de tratamento das lesões de maior prevalência na prática esportiva em nosso país.Sports injuries of the upper limbs are very common in physical activities, and need to be studied in detail, taking into consideration specific aspects of the types of sports practiced. Special attention should be paid to the dynamics of the shoulder girdle and scapular belt, as this will enable us to treat athletes more adequately, also helping prevent recurrences that can occur in some cases, due to the fact that the athlete always attempts to return to their pre-injury level of sport. This review focuses primarily on the management of upper limb tendon sports injuries, from the physiopathology through to the more common new methods of treatment in sports practice in our country.

  11. Isolated Gallbladder Injury in a Case of Blunt Abdominal Trauma

    OpenAIRE

    Birn, Jeffrey; Jung, Melissa; Dearing, Mark

    2012-01-01

    The diagnosis of blunt injury to the gallbladder may constitute a significant challenge to the diagnostician. There is often a delay in presentation with non-specific clinical symptoms. In the absence of reliable clinical symptoms, diagnostic imaging becomes an invaluable tool in the rapid identification of gallbladder injury. We present a case of isolated gallbladder injury following blunt abdominal trauma which was diagnosed by computed tomography and subsequently confirmed by cholecystectomy.

  12. Monitoring system for isolated limb perfusion based on a portable gamma camera

    Energy Technology Data Exchange (ETDEWEB)

    Orero, A.; Muxi, A.; Rubi, S.; Duch, J. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Vidal-Sicart, S.; Pons, F. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Inst. d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); Red Tematica de Investigacion Cooperativa en Cancer (RTICC), Barcelona (Spain); Roe, N. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); CIBER de Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain); Rull, R. [Servei de Cirurgia, Hospital Clinic, Barcelona (Spain); Pavon, N. [Inst. de Fisica Corpuscular, CSIC - UV, Valencia (Spain); Pavia, J. [Servei de Medicina Nuclear, Hospital Clinic, Barcelona (Spain); Inst. d' Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona (Spain); CIBER de Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain)

    2009-07-01

    Background: The treatment of malignant melanoma or sarcomas on a limb using extremity perfusion with tumour necrosis factor (TNF-{alpha}) and melphalan can result in a high degree of systemic toxicity if there is any leakage from the isolated blood territory of the limb into the systemic vascular territory. Leakage is currently controlled by using radiotracers and heavy external probes in a procedure that requires continuous manual calculations. The aim of this work was to develop a light, easily transportable system to monitor limb perfusion leakage by controlling systemic blood pool radioactivity with a portable gamma camera adapted for intraoperative use as an external probe, and to initiate its application in the treatment of MM patients. Methods: A special collimator was built for maximal sensitivity. Software for acquisition and data processing in real time was developed. After testing the adequacy of the system, it was used to monitor limb perfusion leakage in 16 patients with malignant melanoma to be treated with perfusion of TNF-{alpha} and melphalan. Results: The field of view of the detector system was 13.8 cm, which is appropriate for the monitoring, since the area to be controlled was the precordial zone. The sensitivity of the system was 257 cps/MBq. When the percentage of leakage reaches 10% the associated absolute error is {+-}1%. After a mean follow-up period of 12 months, no patients have shown any significant or lasting side-effects. Partial or complete remission of lesions was seen in 9 out of 16 patients (56%) after HILP with TNF-{alpha} and melphalan. Conclusion: The detector system together with specially developed software provides a suitable automatic continuous monitoring system of any leakage that may occur during limb perfusion. This technique has been successfully implemented in patients for whom perfusion with TNF-{alpha} and melphalan has been indicated. (orig.)

  13. Multiple bilateral lower limb fractures in a 2-year-old child: previously unreported injury with a unique mechanism

    Institute of Scientific and Technical Information of China (English)

    Basant Repswal; Anuj Jain; Sunil Gupta; Aditya Aggarwal; Tushar Kohli; Devendra Pathrot

    2014-01-01

    Fall from height is a common cause of unintentional injuries in children and accounts for 6% of all trauma-related childhood deaths,usually from head injury.We report a case of a 2-year-old child with multiple fractures of the bilateral lower limbs due to this reason.A child fell from a height of around 15 feet after toppling from a balcony.He developed multiple fractures involving the right femoral shaft,right distal femoral epiphysis (Salter Harris type 2),right distal metaphysis of the tibia and fibula,and undisplaced Salter Harris type 2 epiphyseal injury of the left distal tibia.There were no head,abdominal or spinal injuries.The patient was taken into emergency operation theatre after initial management which consisted of intravenous fluids,blood transfusion,and splintage of both lower limbs.Fracture of the femoral shaft was treated by closed reduction and fixation using two titanium elastic nails.Distal femoral physeal injury required open reduction and fixation with K wires.Distal tibia fractures were closely reduced and managed nonoperatively in both the lower limbs.All the fractures united in four weeks.At the last follow-up,the child had no disability and was able to perform daily activities comfortably.We also proposed the unique mechanism of injury in this report.

  14. Mechanism of the protective effects of noninvasive limbs preconditioning on myocardial ischemia-reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    CHEN Xiao-guang; WU Bin-yang; WANG Jun-ke; BAI Tao

    2005-01-01

    Background This study aimed at assessing the effect of noninvasive limb preconditioning on myocardial infarct size, and determining whether nitric oxide and neurogenic pathway play an important role in the mechanism of acute remote ischemic preconditioning (IPC).Methods Forty Wistar rats were randomly divided into four experimental groups. In Group Ⅰ, the rats underwent 30-minute occlusion of the left anterior descending coronary artery, and 120-minute reperfusion. In Group PL, the rats underwent four cycles of 5-minute occlusion and reperfusion of both hind limbs using a tourniquet before the experiment was continued as in Group Ⅰ. In Group PL-N and Group PL-H, we administered L-nitro-arginine methyl ester (L-NAME) 10 mg/kg or hexamethonium chloride 20 mg/kg intravenously, 10 minutes before IPC. Infarct size as a percentage of the area at risk was determined by triphenyltetrazolium chloride staining. Results There were no statistically significant differences in mean arterial pressure and heart rate among these groups at any time point during the experiment (P>0.05). The myocardial infarct size (IS) was decreased significantly in Group PL and Group PL-H compared with Group Ⅰ, and the IS/AAR was 34.5%±7.6%, 35.9%±8.6% and 58.5%±8.5%, respectively (P0.05).Conclusions Noninvasive limb IPC is effective in protecting the myocardium from ischemia reperfusion injury. Nitric oxide plays an important role in the mechanism of acute remote IPC, in which the neurogenic pathway is not involved.

  15. Isolated Ureter Injury After Abduction the Lower Back

    Directory of Open Access Journals (Sweden)

    Birdal Gullupinar

    2013-06-01

    Full Text Available Due to the anatomical structures the ureters are well protected and they%u2019re exposed to trauma rarely. The most common cause of ureteral injuries is iatrogenic. Early clinical diagnosis of ureteral injuries are quiet and clinical suspicion is often essential. Delayed diagnosis of ureteral injuries may cause mortality and morbidity. Contrast-enhanced computed tomography is used as a method of imaging. Treatment is done according to the localization of trauma. On our article we present a rare isolated ureter injury after abduction the lower back of a woman as a case report.

  16. Lower limb ischaemia and reperfusion injury in healthy volunteers measured by oxidative and inflammatory biomarkers

    DEFF Research Database (Denmark)

    Halladin, N. L.; Busch, Sarah Victoria Ekeløf; Alamili, M.;

    2015-01-01

    antagonist (IL-1Ra), IL-6, IL-10, TNF-receptor (TNF-R)I, TNF-RII and YKL-40. RESULTS: We found no significant increase in MDA in the muscle biopsies after reperfusion. Plasma levels of oxidative and pro- and anti-inflammatory parameters showed no significant differences between baseline and after reperfusion...... at any sampling time. CONCLUSION: Twenty minutes of lower limb ischaemia does not result in an ischaemia-reperfusion injury in healthy volunteers, measurable by oxidative and pro- and anti-inflammatory biomarkers in muscle biopsies and in the systemic circulation....... these interfering factors of surgery is, therefore, useful to test the potential of antioxidant and cytokine-modulatory treatments.The aim of this study was to characterize a human ischaemia-reperfusion model with respect to oxidative and inflammatory biomarkers. MATERIALS AND METHODS: Ten male volunteers were...

  17. [Thromboprophylaxis during immobilization of non-surgical traumatic injury in the lower limb. An outpatient perspective].

    Science.gov (United States)

    Garrastazu, R; Fernández-Fonfria, J R

    2012-09-01

    Thromboprophylaxis with low molecular weight heparin is efficient, effective and generates savings in health costs in hospitals. However, outside hospitals, there are situations of apparent risk of thrombosis, where there seems to be no such consensus. This occurs in traumatic lower limb injuries which are not undergoing surgery and need a period of immobilization. These are processes with multidisciplinary interventions (Emergency, Family Physicians and Traumatology), although during outpatient follow up it is not easy to find criteria for using thromboprophylaxis. We report a case of a pulmonary embolism, with unusual symptoms, in an ambulatory patient with a fractured fibula and metatarsal, who was being treated with Bemiparin. As we shall see, this is a rare complication, but it shows the importance of proper risk assessment of thromboembolic disease in these patients. We emphasize the accompanying tomographic images for their clarity and eloquence.

  18. Loss of independent limb control in childhood hemiparesis is related to time of brain injury onset.

    Science.gov (United States)

    Sukal-Moulton, Theresa; Murray, Theresa M; Dewald, Julius P A

    2013-03-01

    This study investigated the presence of inter-limb activity at the elbow joint in individuals with childhood-onset hemiparesis, including spontaneous mirror movements during unilateral tasks and the ability to suppress them during bilateral tasks. Eighteen individuals with hemiparesis were divided into three categories of injury timing: before birth (PRE-natal), around the time of birth (PERI-natal), and after 6 months of age (POST-natal). Individuals with hemiparesis, as well as 12 typically developing peers, participated in unilateral and bilateral elbow flexion and extension tasks completed at maximal and submaximal effort while muscle activity was monitored and motor output was quantified by two multiple degrees-of-freedom load cells. Significantly, higher levels of paretic elbow flexion were found only in the PRE- and PERI-natal groups during the flexion of the non-paretic limb, which was modulated by effort level in both unilateral and bilateral tasks. The bilateral activation of elbow flexors in the PRE-/PERI-natal groups indicates potential use of a common cortical command source to drive both upper extremities, while the POST-natal/typically developing groups' flexors appear to receive input from different supraspinal structures.

  19. 严重肢体损伤保肢与截肢的治疗选择%Options of limb salvage or amputation in severe limb injuries

    Institute of Scientific and Technical Information of China (English)

    战杰; 吴锦生; 孙鹏; 马俊伟; 申林; 邢长泰

    2015-01-01

    目的:通过回顾性总结我科5年来所治疗的严重肢体损伤病例,探讨严重肢体损伤保肢与截肢的治疗选择。方法以毁损肢体严重性( mangled extremity severity score,MESS )评分系统为基础,综合患者全身状况、肢体功能预估、患者及家属意愿等因素,对严重肢体损伤166例(169肢)分成三组进行保肢与截肢的回顾性分析,A 组:MESS 评分>9分64例(65肢)果断截肢。B 组:MESS 评分<7分的41例(41肢)保肢。C 组:7~9分的61例(63肢),其中59例(61肢)试行保肢。保肢手术多经历 I 期急诊血运重建手术、II 期骨及皮肤软组织功能重建手术,最长治疗时间2年6个月,最多经历手术8次。结果A 组64例(65肢)全部选择截肢。B 组选择保肢41例(41肢),3例(3肢)延迟性截肢,保肢成功38例(38肢),保肢成功率为92.6%,C 组选择保肢59例(61肢),1例因术后出现多器官功能衰竭死亡,17例延迟性截肢,保肢成功43肢,保肢成功率为68.3%。B,C 组共79例(81肢)保肢成功,77例患者满意,2例效果差。结论显微外科技术是保肢的技术保证;保肢与截肢的选择,首先要遵循生命第一、肢体第二的原则;其次,MESS 评分系统是目前比较客观、有效判断是否保肢的标准,要以此为基础再综合其它因素进行选择;7~9分的严重创伤肢体可试行保肢治疗。%Objective To investigate options ( limb salvage or amputation ) in the treatment of severe limb injury by analyzing patients collected within 5 years retrospectively. Methods Based on MESS scoring system, general condition, limb function prediction and will of patients and their families were collected to conduct analysis. One hundred and sixty-six patients ( 169 limbs ) were divided into 3 groups. Group A ( 64 patients, 65 limbs ): MESS score>9. Group B ( 41 patients, 41 limbs ): MESS score <7, had limb salvage. Group C ( 61 patients, 63 limbs ):

  20. Selective vulnerability of the medullary thick ascending limb to anoxia in the isolated perfused rat kidney.

    OpenAIRE

    Brezis, M; Rosen, S.; Silva, P.; Epstein, F H

    1984-01-01

    A specific anatomical lesion sharply localized to the cells of the medullary thick ascending limbs (mTAL) and characterized by mitochondrial swelling progressing to nuclear pyknosis and cell death is elicited reproducibly in isolated rat kidneys perfused for 15 or 90 min with cell-free albumin-Ringer's medium gassed with 5% CO2, 95% O2 (O2 content, 1.5 vol/100 ml). The lesion, involving about half of mTALs, appears first in mTALs removed from vascular bundles and near the inner medulla, areas...

  1. Tumour response after hyperthermic isolated limb perfusion for locally advanced melanoma

    DEFF Research Database (Denmark)

    Paulsen, Ida Felbo; Chakera, A H; Drejøe, Jennifer Berg

    2014-01-01

    INTRODUCTION: The aim was to describe tumour response, complications, recurrence and survival after hyperthermic isolated limb perfusion (ILP) with melphalan or melphalan in combination with tumour necrosis factor-alpha in patients with melanoma metastases confined to an extremity. MATERIAL......-transit melanoma metastases. RESULTS: The response rate after ILP was 85%; 42% had complete response (CR), 43% partial response (PR), 12% no change (NC) and 3% progression. Two- and five-year survival rates were 57% and 31%, respectively, and they were higher for patients with than without lymph node metastases...

  2. ISOLATED GUNSHOT URETERAL INJURY – CASE REPORT

    Directory of Open Access Journals (Sweden)

    Dejan Bratuš

    2004-04-01

    Full Text Available Background. In the article a case report of an eleven years old child who suffered an air rifle gunshot injury of his right ureter is presented.Methods. The child was admitted to the hospital without any subjective complaints while both ultrasound and CT scan showed a metallic alien body just below the hilus of his right kidney with no surrounding liquid collection. After the condition of the child had worsened with right lumbar and abdominal pain, the control CT scan showed a huge urinoma in his right retroperitoneum.Results. During a surgical exploration an ureteral injury was found with the pellet lying inside the right ureter just below the injury, causing an obstruction of the ureter. After the removal of the pellet and suturing of the ureter over a double J stent the child recovered without any sequels.Conclusions. The ureter is the least often injured genitourinary organ. The management of these injuries is usually straightforward and is primarily a problem of recognition at the initial presentation, especially of a patient with multiple injuries. The delayed presentation is principally responsible for the morbidity that is associated with a ureteral injury.

  3. Technique and outcomes of isolated limb infusion for locally advanced malignant melanoma - A radiological perspective

    Energy Technology Data Exchange (ETDEWEB)

    Chun, J.-Y., E-mail: drjyc78@gmail.com [Department of Radiology, St George' s Hospital, London (United Kingdom); Hussain, M.; Powell, B. [Plastic Surgery, St George' s Hospital, London (United Kingdom); Belli, A.-M. [Department of Radiology, St George' s Hospital, London (United Kingdom)

    2011-12-15

    Aim: Isolated limb infusion (ILI) is a novel, minimally invasive technique for delivering high-dose regional chemotherapy in patients with recurrent and in-transit melanoma. The aim of this study was to review our single-centre experience in treating eleven patients. We emphasize the role of radiologists in setting up this service, including pre-treatment workup and placement of vascular catheters. Materials and methods: A retrospective analysis of 11 patients who underwent 12 procedures between 2005 and 2009 was performed. Pre-procedural staging computed tomography (CT), CT angiography, and duplex studies were performed. All patients received a cytotoxic combination of melphalan and actinomycin-D via radiologically placed arterial and venous catheters in the affected limb under mild hyperthermic conditions. The outcome measures include response rates, limb toxicity, complications, and survival. Results: All patients were female with a mean age of 72 years. Three patients had American Joint Committee on Cancer (AJCC) stage IIIB melanoma, seven had stage IIIC melanoma, and one had a stage IIIB Merkel cell tumour. Complete response was seen in five patients (46%), partial response in four (36%), and progressive disease in two (18%). One patient developed grade 4 toxicity requiring a fasciotomy and another experienced systemic toxicity. Conclusion: These outcomes are comparable to previous studies and shows that ILI is effective in locoregional control of unresectable melanoma. It is a relatively safe procedure but not without risk. Our experience shows the importance of radiological input to ensure safe and effective delivery of services.

  4. MR imaging in the evaluation of isolated limb perfusion: a prospective study of 18 cases

    Energy Technology Data Exchange (ETDEWEB)

    Vanel, Daniel; Petrow, Peter; Dromain, Clarisse; Caillet, Hubert [Department of Radiology, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805, Villejuif Cedex (France); Bonvalot, Sylvie [Department of Surgery, Institut Gustave-Roussy, 39 rue Camille Desmoulins, 94805, Villejuif Cedex (France); Guinebretiere, Jean Marc [Department of Pathology, Centre Rene-Huguenin, 35 rue Dailly, 92210, Saint-Cloud (France)

    2004-03-01

    To prospectively evaluate the use of MRI with dynamic sequences during isolated limb perfusion (ILP) for soft tissue sarcomas, an aggressive local treatment using very high-dose chemotherapy and tumor necrosis factor aimed at avoiding limb amputation. Twenty-six patients were referred for ILP over one and a half years; eight were excluded as the lesions were either too proximal or suspicious inflammatory changes without tumor were found on the initial MRI, or the vascular status was poor. The indications for ILP were: vessel nerve involvement (13), multiple lesions (8), tumor size (4) or the presence of pulmonary metastases (2). MRI was performed 1 and 2 months after ILP, immediately prior to surgery and histological analysis. The MR examinations included T1-weighted SE and fast SE T2-weighted fat-saturated sequences, as well as dynamic sequences (T1-weighted SE repeated six times every 40 s), displaying the maximum intensity slope in each pixel. The tumor had disappeared in three patients. One patient still had histologically proven isolated widespread tumor cells without a mass. The tumor size had increased in two patients. In six patients, the size of the tumor had not changed but it had become completely necrotic, with a thin wall.In three patients, after an initially good result MRI demonstrated that the tumor wall had become thickened from 1 to 2 months after ILP. Dynamic MRI was mainly useful during the initial examination, demonstrating two patients with inflammatory changes without tumor. Three amputations and a second ILP were proposed based on poor results. Conservative limb-sparing surgery was successful in the other cases. MRI proved valuable in demonstrating the variable responses to ILP. (orig.)

  5. Artificial Limbs

    Science.gov (United States)

    ... diabetes. They may cause you to need an amputation. Traumatic injuries, including from traffic accidents and military combat Cancer Birth defects If you are missing an arm or leg, an artificial limb can sometimes replace it. The device, which is ...

  6. DISSOCIATION OF STRUCTURE AND FUNCTION AFTER ISCHAEMIA-REPERFUSION INJURY IN THE ISOLATED PERFUSED RAT KIDNEYS

    Directory of Open Access Journals (Sweden)

    M. Kadkhodaee

    1999-08-01

    Full Text Available Oxygen-derived free radical* (OFR involvement in ischacmia-rcpcrfusion (IR injury was investigated in a rat isolated kidney model, using 20 minutes iscliaemia followed by 15 or 60 minutes reperfusion. Two antioxidants, the xanthine oxidase inhibitor allopurinol and the hydroxyl radical scavenger dimcthylthiourca (DMTU, were uscit to try and prevent OFR-relatcd damage. Renal function was estimated from the inulin clearance, fractional soiiium excretion and renal vascular resistance, location and extent of tubular damage, and type of cell death (apoptosis vs necrosis were used as morphological parameters of IR-iiuluced change. Cell damage was most extensive in the nephron segments of the outer zone of the outer medulla (straight proximal tubule and thick ascending limb (TAL. I're-treatment with allopttrinol or DMTU did not Improve renal function. Less structural damage was observed in the TAL of allopuriol - or DMTU - treated kidneys compared with IR alone. In allopurinol - treated kidneys, luminal debris was less extensive than that seen in IR kidneys. Most cell death was necrotic in type and morphological features of apoptosis were seen infrequently. Tlic beneficial effects of allopurinol and DMTU on structural change did not correlate with functional improvement during the reperfusion period, litis may require longer repcrfusion or multiple treatments. Tlie results suggest that OFR ■ injury is of limited significance in this model of renal IR injury. Targeting OFR injury may only be useful after very brief periods of iscliaemia where necrosis is minimal ami the potential for recover}- is greater, Tiie results confirm the different susccptibilitcs of individual nephron segments to injury within the intact kidney. Understanding the molecular response to injury in each segment should facilitate development of methods to accelerate repair after [R injury.

  7. Cardiac allograft acceptance after localized bone marrow transplantation by isolated limb perfusion in nonmyeloablated recipients.

    Science.gov (United States)

    Askenasy, Nadir; Yolcu, Esma S; Shirwan, Haval; Wang, Zhiliang; Farkas, Daniel L; Yoleuk, Esma S

    2003-01-01

    Donor-specific tolerance to cardiac grafts may be induced by hematopoietic chimerism. This study evaluates the potential of localized bone marrow transplantation (BMT) performed by isolated limb (IL) perfusion to induce tolerance to secondary cardiac grafts without myeloablative conditioning. BALB/c recipients (H2d) preconditioned with lethal and sublethal doses of busulfan were injected i.v. and IL with 10(7) whole bone marrow cells (wBMCs) from B10 donors (H2(b)). Two hours after IL infusion of PKH-labeled wBMCs into myeloablated hosts, there were few labeled cells in the host peripheral blood (p < 0.001 versus i.v.) and femurs of the infused limb contained 57% +/- 7% PKH-labeled blasts (p < 0.001 versus 8% +/- 0.6% after i.v.). Femurs of the noninfused limbs contained 60-70 PKH-labeled blasts (p < 0.001 versus i.v.-BMT) after 2 days and 47% +/- 5% of 0.32 x 10(7) donor cells (p < 0.001 versus 78% +/- 4% of 1.2 x 10(7) donor cells in infused femurs) after 4 weeks. The survival rates of myeloablated hosts were 90% and 80% after i.v. and IL infusion, respectively, and the chimeras had 78%-84% donor peripheral blood cells. In recipients conditioned with 35 mg/g busulfan, the levels of donor chimerism in peripheral blood were 33% +/- 4% and 21% +/- 4% at 3 weeks after i.v.- and IL-BMT, respectively. Transplantation of donor-matched (H2(b)) secondary vascularized hearts in these chimeras after 3 weeks resulted in graft survival for periods exceeding 8 weeks, while third-party (H2(k)) allografts were acutely rejected (p < 0.001 versus H2(b)). These data indicate that IL perfusion is a reliable alternative procedure for establishment of hematopoietic chimerism and donor-specific tolerance without myeloablative conditioning.

  8. The relationship between the piriformis muscle, low back pain, lower limb injuries and motor control training among elite football players.

    Science.gov (United States)

    Leung, Felix T; Mendis, M Dilani; Stanton, Warren R; Hides, Julie A

    2015-07-01

    Australian Football League (AFL) players have a high incidence of back injuries. Motor control training to increase lumbopelvic neuromuscular control has been effective in reducing low back pain (LBP) and lower limb injuries in elite athletes. Control of pelvic and femoral alignment during functional activity involves the piriformis muscle. This study investigated (a) the effect of motor control training on piriformis muscle size in AFL players, with and without LBP, during the playing season, and (b) whether there is a relationship between lower limb injury and piriformis muscle size. Stepped-wedge intervention. 46 AFL players participated in a motor control training programme consisting of two 30min sessions per week over 7-8 weeks, delivered across the season as a randomised 3 group single-blinded stepped-wedge design. Assessment of piriformis muscle cross-sectional area (CSA) involved magnetic resonance imaging (MRI) at 3 time points during the season. Assessment of LBP consisted of player interview and physical examination. Injury data were obtained from club records. An interaction effect for Time, Intervention Group and LBP group (F=3.7, p=0.03) was found. Piriformis muscle CSA showed significant increases between Times 1 and 2 (F=4.24, p=0.046), and Times 2 and 3 (F=8.59, p=0.006). Players with a smaller increase in piriformis muscle CSA across the season had higher odds of sustaining an injury (OR=1.08). Piriformis muscle size increases across the season in elite AFL players and is affected by the presence of LBP and lower limb injury. Motor control training positively affects piriformis muscle size in players with LBP. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  9. Bilateral Lower Limb Amputations in a Nigerian Child Following High-Voltage Electrical Burns Injury: A Case Report

    OpenAIRE

    Dim, EM; Amanari, OC; Nottidge, TE; Inyang, UC; Nwashindi, A

    2013-01-01

    Abstract The human body conducts electricity very well. Direct contact with electric current can be lethal. The passage of electric current through the body is capable of producing a wide spectrum of injuries, including serious damage to the heart, brain, skin and muscles. Naked high-voltage electric cables negligently abandoned in residential, commercial and industrial areas are a recipe for disaster. This is a case report of a 5-year girl child who had bilateral lower limb gangrene followin...

  10. Tumour response after hyperthermic isolated limb perfusion for locally advanced melanoma

    DEFF Research Database (Denmark)

    Paulsen, Ida Felbo; Chakera, A H; Drejøe, Jennifer Berg

    2014-01-01

    INTRODUCTION: The aim was to describe tumour response, complications, recurrence and survival after hyperthermic isolated limb perfusion (ILP) with melphalan or melphalan in combination with tumour necrosis factor-alpha in patients with melanoma metastases confined to an extremity. MATERIAL......-transit melanoma metastases. RESULTS: The response rate after ILP was 85%; 42% had complete response (CR), 43% partial response (PR), 12% no change (NC) and 3% progression. Two- and five-year survival rates were 57% and 31%, respectively, and they were higher for patients with than without lymph node metastases...... toxicity. CONCLUSION: ILP induces tumour regression in the vast majority of patients. One patient, i.e. 1% of the group, died from surgical complications. Otherwise, ILP treatment had an acceptable morbidity in this group of very sick patients. We are convinced that the treatment should be offered...

  11. Changes in the inflammatory response to injury and its resolution during the loss of regenerative capacity in developing Xenopus limbs.

    Directory of Open Access Journals (Sweden)

    Anthony L Mescher

    Full Text Available Tissue and organ regeneration, unlike development, involves an injury that in postembryonic animals triggers inflammation followed by resolution. How inflammation affects epimorphic regeneration is largely uninvestigated. Here we examine inflammation and its resolution in Xenopus laevis hindlimb regeneration, which declines during larval development. During the first 5 days postamputation, both regeneration-competent stage 53 and regeneration-deficient stage 57 hindlimbs showed very rapid accumulation of leukocytes and cells expressing interleukin-1β and matrix metalloproteinase 9. Expression of genes for factors mediating inflammatory resolution appeared more persistent at stages 55 and 57 than at stage 53, suggesting changes in this process during development. FoxP3, a marker for regulatory T cells, was upregulated by amputation in limbs at all three stages but only persisted at stage 57, when it was also detected before amputation. Expression of genes for cellular reprogramming, such as SALL4, was upregulated in limbs at all 3 stages, but markers of limb patterning, such as Shh, were expressed later and less actively after amputation in regeneration-deficient limbs. Topical application of specific proinflammatory agents to freshly amputated limbs increased interleukin-1β expression locally. With aqueous solutions of the proinflammatory metal beryllium sulfate, this effect persisted through 7 days postamputation and was accompanied by inhibition of regeneration. In BeSO4-treated limbs expression of markers for both inflammation and resolution, including FoxP3, was prolonged, while genes for cellular reprogramming were relatively unaffected and those for limb patterning failed to be expressed normally. These data imply that in Xenopus hindlimbs postamputation inflammation and its resolution change during development, with little effect on cellular dedifferentiation or reprogramming, but potentially interfering with the expression of genes

  12. Changes in the inflammatory response to injury and its resolution during the loss of regenerative capacity in developing Xenopus limbs.

    Science.gov (United States)

    Mescher, Anthony L; Neff, Anton W; King, Michael W

    2013-01-01

    Tissue and organ regeneration, unlike development, involves an injury that in postembryonic animals triggers inflammation followed by resolution. How inflammation affects epimorphic regeneration is largely uninvestigated. Here we examine inflammation and its resolution in Xenopus laevis hindlimb regeneration, which declines during larval development. During the first 5 days postamputation, both regeneration-competent stage 53 and regeneration-deficient stage 57 hindlimbs showed very rapid accumulation of leukocytes and cells expressing interleukin-1β and matrix metalloproteinase 9. Expression of genes for factors mediating inflammatory resolution appeared more persistent at stages 55 and 57 than at stage 53, suggesting changes in this process during development. FoxP3, a marker for regulatory T cells, was upregulated by amputation in limbs at all three stages but only persisted at stage 57, when it was also detected before amputation. Expression of genes for cellular reprogramming, such as SALL4, was upregulated in limbs at all 3 stages, but markers of limb patterning, such as Shh, were expressed later and less actively after amputation in regeneration-deficient limbs. Topical application of specific proinflammatory agents to freshly amputated limbs increased interleukin-1β expression locally. With aqueous solutions of the proinflammatory metal beryllium sulfate, this effect persisted through 7 days postamputation and was accompanied by inhibition of regeneration. In BeSO4-treated limbs expression of markers for both inflammation and resolution, including FoxP3, was prolonged, while genes for cellular reprogramming were relatively unaffected and those for limb patterning failed to be expressed normally. These data imply that in Xenopus hindlimbs postamputation inflammation and its resolution change during development, with little effect on cellular dedifferentiation or reprogramming, but potentially interfering with the expression of genes required for blastema

  13. The design of a modified lower limb impactor to assess lower limb injury at typical blast loading rates

    CSIR Research Space (South Africa)

    Pandelani, T

    2014-01-01

    Full Text Available in either amputation or long term physical impairment [1]. The injury to the lower extremity is predominantly as a result of direct load transmission from the deforming vehicle floor which is subjected to the blast load [2]. To quantify the effect of high...

  14. Optimal Impact Isolation for Injury Prevention Evaluated by the Head Injury Criterion

    Directory of Open Access Journals (Sweden)

    D.V. Balandin

    2007-01-01

    Full Text Available The optimal control of the deceleration of a particle moving along a straight line after an impact against an isolated surface is considered. The force applied to the particle by the surface is treated as the control variable. The deceleration distance is minimized subject to a constraint on the Head Injury Criterion functional. This functional is an integral criterion that is utilized in engineering biomechanics to evaluate the expected severity of impact-induced head injury of a human being. The solution obtained provides characteristics of the limiting capabilities for the prevention of head injuries by means of an impact isolator, such as a coating of the surface against which the impacts occur. The head injuries can be due to impact occurrences, including traffic crashes, falling, and contacts with ballistic objects.

  15. FDG-PET to evaluate response to hyperthermic isolated limb perfusion for locally advanced soft-tissue sarcoma

    NARCIS (Netherlands)

    vanGinkel, RJ; Hoekstra, HJ; Pruim, J; Nieweg, OE; Molenaar, WM; Paans, AMJ; Willemsen, ATM; Vaalburg, W; Schraffordt Koops, H.

    1996-01-01

    We investigated FDG-PET in patients undergoing hyperthermic isolated limb perfusion (HILP) with rTNF-alpha, rIFN-gamma and melphalan for locally advanced soft-tissue sarcoma of the extremities. Methods: Twenty patients (11 women, 9 men; aged 18-80 yr, mean age 49 yr) were studied, FDG-PET studies we

  16. Isolated limb perfusion for local gene delivery: efficient and targeted adenovirus-mediated gene transfer into soft tissue sarcomas

    NARCIS (Netherlands)

    W.K. de Roos; J.H.W. de Wilt (Johannes); M.E. van der Kaaden; E.R. Manusama (Eric); M.W. de Vries; A. Bout; T.L.M. ten Hagen (Timo); D. Valerio (Dinko); A.M.M. Eggermont (Alexander)

    2000-01-01

    textabstractOBJECTIVE: To evaluate the potential of isolated limb perfusion (ILP) for efficient and tumor-specific adenovirus-mediated gene transfer in sarcoma-bearing rats. SUMMARY BACKGROUND DATA: A major concern in adenovirus-mediated gene therapy in cancer is the transfer of ge

  17. Isolated traumatic head injury in children: Analysis of 276 observations

    Directory of Open Access Journals (Sweden)

    Bahloul Mabrouk

    2011-01-01

    Full Text Available Background : To determine predictive factors of mortality among children after isolated traumatic brain injury. Materials and Methods : In this retrospective study, we included all consecutive children with isolated traumatic brain injury admitted to the 22-bed intensive care unit (ICU of Habib Bourguiba University Hospital (Sfax, Tunisia. Basic demographic, clinical, biochemical, and radiological data were recorded on admission and during ICU stay. Results : There were 276 patients with 196 boys (71% and 80 girls, with a mean age of 6.7 ± 3.8 years. The main cause of trauma was road traffic accident (58.3%. Mean Glasgow Coma Scale score was 8 ± 2, Mean Injury Severity Score (ISS was 23.3 ± 5.9, Mean Pediatric Trauma Score (PTS was 4.8 ± 2.3, and Mean Pediatric Risk of Mortality (PRISM was 10.8 ± 8. A total of 259 children required mechanical ventilation. Forty-eight children (17.4% died. Multivariate analysis showed that factors associated with a poor prognosis were PRISM > 24 (OR: 10.98, neurovegetative disorder (OR: 7.1, meningeal hemorrhage (OR: 2.74, and lesion type VI according to Marshall tomographic grading (OR: 13.26. Conclusion : In Tunisia, head injury is a frequent cause of hospital admission and is most often due to road traffic injuries. Short-term prognosis is influenced by demographic, clinical, radiological, and biochemical factors. The need to put preventive measures in place is underscored.

  18. Plasma iron levels appraised 15 days after spinal cord injury in a limb movement animal model.

    Science.gov (United States)

    Reis, F M; Esteves, A M; Tufik, S; de Mello, M T

    2011-03-01

    Experimental, controlled trial. The purpose of this study was to evaluate plasma iron and transferrin levels in a limb movement animal model with spinal cord injury (SCI). Universidade Federal de São Paulo, Departamento de Psicobiologia. In all, 72 male Wistar rats aged 90 days were divided into four groups: (1) acute SCI (1 day, SCI1), (2) 3 days post-SCI (SCI3), (3) 7 days post-SCI (SCI7) and (4) 15 days post-SCI (SCI15). Each of these groups had corresponding control (CTRL) and SHAM groups. Plasma iron and transferrin levels of the different groups were analyzed using a one-way analysis of variance (ANOVA) followed by Tukey's test. We found a significant reduction in iron plasma levels after SCI compared with the CTRL group: SCI1 (CTRL: 175±10.58 μg dl(-1); SCI: 108.28±11.7 μg dl(-1)), SCI3 (CTRL: 195.5±11.00 μg dl(-1); SCI: 127.88±12.63 μg dl(-1)), SCI7 (CTRL: 186±2.97 μg dl(-1); SCI: 89.2±15.39 μg dl(-1)) and SCI15 (CTRL: 163±5.48 μg dl(-1); SCI: 124.44±10.30 μg dl(-1)) (P<0.05; ANOVA). The SHAM1 group demonstrated a reduction in iron plasma after acute SCI (CTRL: 175±10.58 μg dl(-1); SHAM: 114.60±7.81 μg dl(-1)) (P<0.05; ANOVA). Reduced iron metabolism after SCI may be one of the mechanisms involved in the pathogenesis of sleep-related movement disorders.

  19. Isolated liver gunshot injuries: nonoperative management is feasible?

    Directory of Open Access Journals (Sweden)

    SIZENANDO VIEIRA STARLING

    2015-08-01

    Full Text Available ABSTRACTObjective:to evaluate the safety and effectiveness of non-operative management (NOM of liver injury, being the only abdominal injury, from gunshot wounds to the abdomen.Methods:patients who had liver damage diagnosed as single abdominal injury caused by PAF in the right thoracoabdominal region, hemodynamically stable were studied. All underwent examination with computed tomography. Were analyzed: age, gender, levels of trauma, hemodynamic condition and the abdominal examination on admission, the results of the CT scan, the extra-abdominal lesions found, the serum levels of hemoglobin, clinical course, complications, length of hospital stay, outpatient treatment and death.Results:during the study period 169 patients, treated non-operatively, presented liver gunshot wounds. Of these, only 28 patients (16.6% had liver injury as the only abdominal injury and consequently met the inclusion criteria for this study. The average age was 27.7 years and 25 patients (89.2% were male. The overall average of verified trauma scores were: RTS 7.45, ISS 10.9, and TRISS 98.7%. The most frequent injuries were grade II and grade III (85.7%. Complications occurred in only one patient who presented a progressive decline in hemoglobin. He underwent a CT scan which showed blush in the liver parenchyma. An arteriography was performed, which showed a successfully embolized arteriovenous fistula. There were no deaths in the patient sample. The average hospital stay was 5.3 days.Conclusion:isolated hepatic injury in gunshot abdominal trauma is uncommon. However, the NOM protocol for this type of injury is safe and has low morbidity. This approach should only be followed in institutions with adequate infrastructure, where an experienced and cohesive team is able to follow a specific protocol, with rigorous periodic evaluation of its results.

  20. Lower limb salvage surgery using Ilizarov circular external frame for a landmine injury about the knee.

    Science.gov (United States)

    Demiralp, Bahtiyar; Yıldırım, Cengiz; Yurttaş, Yüksel; Çiçek, Engin Ilker; Başbozkurt, Mustafa

    2013-01-01

    Limb salvage for severe trauma has been replaced amputation as the primary treatment in many trauma centers. However, the long-term outcomes after limb reconstruction or amputation have not been fully evaluated. In this report, we present the treatment results of limb salvage surgery using Ilizarov external circular frame in a male case who had a-22-cm bone loss on the left distal femur and left proximal tibia and large soft tissue defect around the knee due to stepping on a landmine with his knee. The decision to amputate a severely injured limb, being irreversible, is challenging and significantly affects the body image and the patient. Extremity salvage surgery should be considered initially when evaluating patients with high-energy injured limbs at high risk for amputation.

  1. Acute kidney injury and critical limb ischaemia associated with the use of the so called "legal high" 3-fluorophenmetrazine.

    Science.gov (United States)

    Fawzy, Michael; Wong-Morrow, Wei San; Beaumont, Anthony; Farmer, Chris K T

    2017-07-15

    Until the law in the United Kingdom (UK) changed in May 2016 so called "legal highs" or "new psychoactive substances" were freely available in high street shops across the UK. Following prohibition these drugs are still easily purchased illegally via the internet. We report a case of a patient who self-administered 3-fluorophenmetrazine intravenously with catastrophic consequences. Adverse effects were almost immediate with symptoms of malaise and tachycardia. Two days post administration he was transferred to the intensive therapy unit with acute kidney injury and irreversible four limb ischaemia. He required a period of renal replacement therapy and bilateral lower limb amputation. This case highlights the fact that new psychoactive substances have many unintended adverse effect which have not been previously described. Multiple routes of administration are used by people taking these agents including intravenously. Medical practitioners should always consider ingestion of new psychoactive substances in the differential diagnosis of acutely ill patients.

  2. Effect of picroside II on hind limb ischemia reperfusion injury in rats

    Directory of Open Access Journals (Sweden)

    Kılıç Y

    2017-06-01

    . Apoptosis was evaluated by TUNEL experiment.Results: TOS levels were significantly higher in I/R group than that of control and I/R + picroside II groups (P=0.014, P=0.005, respectively. TAS levels were significantly higher in I/R group than that of control and I/R + picroside II groups (P=0.007 P=0.005, respectively. TUNEL assay revealed that picroside II reduced cell necrosis.Conclusion: The results of this study demonstrated that picroside II plays a critical role to prevent I/R injury. Even though our results were found to be satisfactory, it should be encouraging to those who want to conduct future research on this topic. Keywords: ischemia reperfusion, picroside II, hind limb skeletal muscle, TOS, TAS

  3. Venous thromboembolic events in isolated severe traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahin Mohseni

    2012-01-01

    Full Text Available Objective: The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE in patients suffering from isolated severe traumatic brain injury (TBI. Materials and Methods: Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2 receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS, adverse effects of anticoagulation, and mortality. Results: After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002. The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001. No adverse outcomes were detected in the anticoagulated patients. Conclusion: Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.

  4. Isolated coronoid fracture: Assessment by magnetic resonance imaging for concomitant injuries

    Directory of Open Access Journals (Sweden)

    Aashay L Kekatpure

    2016-01-01

    Conclusion: LCL injury was consistent in all isolated coronoid fracture. The forces resulting in the injury appear similar to varus distraction forces acting in the knee leading to distraction injuries of the lateral structures of the knee joint. As concurrent osteochondral injuries and ligamentous injuries are not rare, magnetic resonance analysis serves as an excellent tool for analysis of the ligamentous injuries preoperatively and aids in surgical planning.

  5. Huayu capsule enhances limb-catching capability of rats with experimental open traumatic brain injury

    Institute of Scientific and Technical Information of China (English)

    Chunyang Zhou; Juan Zhang; Yong Wang; Haibing Qian; Li Gong; Guojun Huang

    2007-01-01

    BACKGROUND: It is hard to cure the open traumatic brain injury (TBI), especially for the brain functional recovery after brain injury. In this regard, traditional Chinese medicine (TCM) has a wide prospect.OBJECTIVE: To observe the effect of Huayu capsule on limb-catching capability of rat models of open TBI,and investigate its possible mechanism.DESIGN: Randomized and controlled study.SETTING: Grade 3 Pharmacological Laboratory of TCM, State Administration of TCM, Chengdu University of TCM.MATERIALS: This study was performed from October 2005 to January 2006. Fifty Sprague-Dawley rats of either gender, aged 3 months old, weighing from 190 to 220 g, were involved in this study. Huayu capsule was made and supplied by the Department of TCM Processing of Chengdu University of TCM, Lot No.050121; Xuefuzhuyu oral liquid was manufactured by Jilin Aodong Yanbian Pharmaceutical Industry Co.,Ltd., Lot No. 050406.METHODS: Open right parietal lobe TBI rat models were made as described in references. The involved rat models were randomized into 5 groups according to gender and body mass: model group, high-, middle-,low-dose Huayu capsule groups and Xuefuzhuyu oral liquid group, with 10 rats in each. Rats in the model group were administrated with distilled water of 5 mL/kg; Rats in the high-, middle- and low-dose Huayu capsule groups were administrated with 1.030, 0.515, 0.258 g/kg raw herbs; Rats in the Xuefuzhuyu oral liquid group were administrated with Xuefuzhuyu oral liquid of 5 mL/kg, intragastrically once a day for 7 days successively for all after recovering consciousness from anesthetization. ① One hour after administration on the 6th day, rats in each group were placed on a 100 cm fine straight iron wire paralleling to the ground and 20 cm above the operational table. The time of the rats keeping on the wire was counted and it indicated the nerve-muscle catching capability. The longer the remained time, the better the nerve-muscle catching capability.② Twenty

  6. Isolated fracture of the fibular shaft due to alpine skiing; a specific injury

    OpenAIRE

    Yıldız, Atıl Atilla, Ozkan Kose, Ferhat Guler, H

    2013-01-01

    Although musculoskeletal injuries of lower leg due to alpine skiing is well known and widely reported, an acute isolated fibula fracture as a specific ski injury has not been reported in the relevant literature. Herein, we present a case of isolated fibula fracture which is missed at initial admission, and discuss the mechanism of injury and relationship with alpine skiing equipment.

  7. Isolated limb perfusion with tumor necrosis factor alpha and melphalan for locally advanced soft tissue sarcoma : Three time periods at risk for amputation

    NARCIS (Netherlands)

    van Ginkel, Robert J.; Thijssens, Katja M. J.; Pras, Elisabeth; Van der Graaf, Winette T. A.; Suurmeijer, Albert J. H.; Hoekstra, Harald J.

    2007-01-01

    Background: The aim of this study was to investigate the long-term limb salvage rate and overall survival after isolated limb perfusion (ILP) with tumor necrosis factor alpha and melphalan for locally advanced soft tissue sarcoma (STS). Methods: From 1991 to 2003, 73 patients (36 men, 37 women, medi

  8. Determination of common pathogenic bacteria of blast injury to the limbs in plateau area and related research

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    Zheng-lei WANG

    2015-11-01

    Full Text Available Objective To investigate the common pathogenic bacteria and their drug susceptibility in the wounds in the limbs as a result of blast injury in plateau with a low temperature so as to provide a basis for prevention and treatment of war wound infection in such area. Methods The model of blast injury was reproduced to the hind legs of 800 rabbits in cold and dry plateau. 1, 3, 6, 12, 24, 48, 72 and 96h after injury, the general condition and vital signs of the wounded were observed, and bacterial culture, flora analysis and drug susceptibility test of excretion from wound tract, air, surface of snow, soil and animal fur were performed. Results Micrococciand Bacilliwere found in air and snow. Bacillus subtilis, Escherichia coliand Pseudomonas aeruginosawere found in soil, and Staphylococcus aureus, Acinetobacters, Pseudomonas aeruginosaand Escherichia coliin rabbit fur. The respiration and pulse became faster, and body temperature lowered after injury compared with that before injury. G+ bacteria were found in most wound tract secretions, and the frequency of the bacterial strains in descending order were Bacillus subtilis, coagulase-negative Staphylococci, E. coli, Pseudomonas aeruginosa, Stenotrophomonas maltophiliastrains. The sensitive antibiotics for these G+ bacteria were ofloxacin, ciprofloxacin, erythromycin. Susceptible G– bacteria were susceptible to ceftazidime, minocycline, sulfamethoxazole etc. Conclusions The growth of bacteria in the wounds as a result of blast injury grow slower in cold and dry alpine area. The time of debridement may be delayed for 2-3h. G+ bacteria were main susceptible flora to antibiotics, and it is related to the bacterial flora of the surrounding environment, thus it is suggested that a combination of different antibiotics (ofloxacin, ciprofloxacin or erythromycin alone combined with ceftazidime, minocycline or cotrimoxazole alone are needed to prevent infection after blast injury. DOI: 10.11855/j

  9. Factors predicting sensor y and motor recover y after the repair of upper limb peripheral nerve injuries

    Institute of Scientific and Technical Information of China (English)

    Bo He; Zhaowei Zhu; Qingtang Zhu; Xiang Zhou; Canbin Zheng; Pengliang Li; Shuang Zhu; Xiaolin Liu; Jiakai Zhu

    2014-01-01

    OBJECTIVE:To investigate the factors associated with sensory and motor recovery after the repair of upper limb peripheral nerve injuries. DATA SOURCES:The online PubMed database was searched for English articles describing outcomes after the repair of median, ulnar, radial, and digital nerve injuries in humans with a publication date between 1 January 1990 and 16 February 2011. STUDY SELECTION:The following types of article were selected:(1) clinical trials describ-ing the repair of median, ulnar, radial, and digital nerve injuries published in English;and (2) studies that reported sufifcient patient information, including age, mechanism of injury, nerve injured, injury location, defect length, repair time, repair method, and repair materials. SPSS 13.0 software was used to perform univariate and multivariate logistic regression analyses and to in-vestigate the patient and intervention factors associated with outcomes. MAIN OUTCOME MEASURES:Sensory function was assessed using the Mackinnon-Dellon scale and motor function was assessed using the manual muscle test. Satisfactory motor recovery was deifned as grade M4 or M5, and satisfactory sensory recovery was deifned as grade S3+or S4. RESULTS:Seventy-one articles were included in this study. Univariate and multivariate logistic regression analyses showed that repair time, repair materials, and nerve injured were inde-pendent predictors of outcome after the repair of nerve injuries (P CONCLUSION:Predictors of outcome after the repair of peripheral nerve injuries include age, gender, repair time, repair materials, nerve injured, defect length, and duration of follow-up.

  10. Feasibility and safety of ultrasound-guided nerve block for management of limb injuries by emergency care physicians

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    Sanjeev Bhoi

    2012-01-01

    Full Text Available Background: Patients require procedural sedation and analgesia (PSA for the treatment of acute traumatic injuries. PSA has complications. Ultrasound (US guided peripheral nerve block is a safe alternative. Aim: Ultrasound guided nerve blocks for management of traumatic limb emergencies in Emergency Department (ED. Setting and Design: Prospective observational study conducted in ED. Materials and Methods: Patients above five years requiring analgesia for management of limb emergencies were recruited. Emergency Physicians trained in US guided nerve blocks performed the procedure. Statistical analysis: Effectiveness of pain control, using visual analogue scale was assessed at baseline and at 15 and 60 minutes after the procedure. Paired t test was used for comparison. Results: Fifty US guided nerve blocks were sciatic- 4 (8%, femoral-7 (14%, brachial- 29 (58%, median -6 (12%, and radial 2 (4% nerves. No patients required rescue PSA. Initial median VAS score was 9 (Inter Quartile Range [IQR] 7-10 and at 1 hour was 2(IQR 0-4. Median reduction in VAS score was 7.44 (IQR 8-10(75%, 1-2(25% (P=0.0001. Median procedure time was 9 minutes (IQR 3, 12 minutes and median time to reduction of pain was 5 minutes (IQR 1,15 minutes. No immediate or late complications noticed at 3 months. Conclusion: Ultrasound-guided nerve blocks can be safely and effectively performed for upper and lower limb emergencies by emergency physicians with adequate training.

  11. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

    Science.gov (United States)

    McMaster, Jason; Desai, Pathik J.; Desai, Sapan S.; Kuy, SreyRam; Mata, Maggy; Cooper, Jamie

    2014-01-01

    The treatment of isolated sternal fractures (ISF) throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years) with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77) were admitted to hospital with 66% (58) of them discharged within 48 hours. Two (2%) patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63%) patients with only 2 (2%) having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7%) patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER. PMID:24653859

  12. The Association between Blunt Cardiac Injury and Isolated Sternal Fracture

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    Anahita Dua

    2014-01-01

    Full Text Available The treatment of isolated sternal fractures (ISF throughout the world is heterogeneous. This study aimed to identify the incidence, morbidity, and mortality associated with isolated fractures of the sternum and describe current practice for diagnosis and management of ISF and cardiac injury at a level I trauma center in the UK. A retrospective cohort study of adult patients (>16 years with ISF presenting from 2006 to 2010 was conducted. Eighty-eight patients with ISF were identified. Most patients (88%, 77 were admitted to hospital with 66% (58 of them discharged within 48 hours. Two (2% patients had an ER EKG with abnormality but both resolved to normal sinus rhythm within 6 hours of follow-up. Serum CEs were drawn from 55 (63% patients with only 2 (2% having a rise in serum troponin >0.04; however, in both of these patients troponin quickly normalized. Six (7% patients underwent echocardiograms without significant findings. In all 88 patients with ISF, no cases of clinically significant cardiac injury were identified. Patients presenting with an isolated sternal fracture with no changes on EKG or chest X-ray do not warrant an admission to hospital and may be discharged from the ER.

  13. Burden of Disease predicts response to isolated limb infusion with melphalan and actinomycin D in melanoma

    Science.gov (United States)

    Muilenburg, Diego J.; Beasley, Georgia M.; Thompson, Zachary J.; Lee, Ji-Hyun; Tyler, Douglas S.; Zager, Jonathan S.

    2015-01-01

    Background Isolated limb infusion (ILI) with melphalan is a minimally invasive, effective treatment for in transit melanoma. We hypothesized that burden of disease (BOD) would correlate to treatment response. Methods We retrospectively analyzed a prospectively collected database from two academic centers. BOD was stratified as high or low (less than 10 lesions, none > 2cm). Response rates were measured 3 months post-ILI. Multivariable analysis (MV) was used to evaluate the association between the response rate and BOD. Kaplan-Meier methods with log-rank tests and multivariable Cox proportional hazard models were used to analyze overall survival (OS) and progression free survival (PFS) Results Sixty (38%) patients had low and 100 (62%) high BOD. Patients with low BOD had an overall response rate (ORR) of 73%, and 50% CR; compared to an ORR of 47% and 24% CR in patients with high BOD (p= 0.002). MV analysis of preoperative, intraoperative, and postoperative parameters showed no significant impact on 3-month response. Patients with a CR at 3 months demonstrated improved PFS over the remainder of the cohort, but OS was equal. Low BOD patients had an increased median PFS of 6.9 vs 3.8 months (p= 0.047), and a non-statistically significantly increased median OS, 38.4 vs. 30.9 months (p=0.146). Conclusions Lower BOD is associated with an increased ORR and CR rate with statistically significantly improved PFS in patients undergoing ILI for in transit extremity melanoma. BOD provides useful prognostic information for patient counseling and serves as a marker to stratify patient risk groups. PMID:25192683

  14. The evaluation of function of the flail upper limb classification system: its application to unilateral brachial plexus injuries.

    Science.gov (United States)

    Eggers, I M; Mennen, U

    2001-01-01

    The evaluation of function of the flail upper limb (EFFUL) classification system measures in numerical terms the improvement achieved through hand surgery and hand therapy in patients with peripheral nerve injuries. To research the effectiveness of the EFFUL system a study was conducted that included 103 adult traumatic brachial plexus palsies. The measurement of upper limb function has 2 distinct phases: function without adaptation and function with adaptation. Patients will naturally adapt in order to cope whether we encourage them or not. This jump in gain of function by adaptation is a bonus that cannot be measured for comparison with other patients because each patient is different. Differences include factors such as each individual's personal pattern of adaptation with or without assistive devices, intelligence, dominant hand, and, in particular, motivation. Measurement of preoperative and postoperative function (with its associated hand therapy) therefore may not include adaptation. The EFFUL system is a method developed to measure unadapted function; it measures residual function of the flail upper arm using practical, everyday tasks performed by the shoulder, elbow, forearm, wrist, and hand, ie, all upper limb regions. It is a ranking system with a hierarchy of increasingly higher demands placed on function until normal function has been achieved. The execution of the tasks focuses on 2-handed coordination and hand dominance. The score is divided into no function, minimal nondominant arm function, supportive arm (nondominant side) function, minimal dominant arm function, useful arm function as done by the dominant arm, and normal arm function. These descriptive scores are subdivided into scores ranging from 0 to 10. Thus, the EFFUL classification system is an objective method of measuring residual function before and after treatment. The clinical examination and functional evaluation ought to have equal significance in the final report on outcome. This

  15. Factors Predicting the Effects of Hybrid Assistive Limb Robot Suit during the Acute Phase of Central Nervous System Injury.

    Science.gov (United States)

    Chihara, Hideo; Takagi, Yasushi; Nishino, Kazunari; Yoshida, Kazumichi; Arakawa, Yoshiki; Kikuchi, Takayuki; Takenobu, Yohei; Miyamoto, Susumu

    2016-01-01

    To improve the activities of daily living of patients with injury to the central nervous system, physical therapy starting from the acute phase of the injury is important. Recently, the efficacy of physical therapy using a hybrid assistive limb (HAL) robot suit was reported. However, individual differences exist in the effects of HAL. We investigated factors predicting the effects of HAL in 15 patients at our institution with central nervous system injury, primarily due to stroke, who underwent training using HAL during the acute phase. Patients were classified as either "with HAL suitability" or "without HAL suitability" based on scores from 10-m walking speed, gait, satisfaction, and pain. In both groups, Brunnstrom stage before HAL intervention, Fugl-Meyer assessment (FMA), stroke impairment assessment set (SIAS), and functional independence measure (FIM) were evaluated. Although motor function items did not differ significantly, FIM cognitive function items (P = 0.036), visuospatial perception items on SIAS (P = 0.0277), and pain items on SIAS (P = 0.0122) differed significantly between groups. These results indicated that training using HAL does not involve pain in patients with central nervous system injury during the acute phase, and exhibits positive effects in patients without pain and with high communication ability and visuospatial perception function. When conducting HAL intervention, incorporating functional assessment scores (FIM and SIAS), including peripheral items, may be useful to predict the suitability of HAL.

  16. Limb-kinetic apraxia due to injury of corticofugal tracts from secondary motor area in patients with corona radiata infarct.

    Science.gov (United States)

    Jang, Sung Ho; Seo, Jeong Pyo

    2016-12-01

    Limb-kinetic apraxia (LKA) is defined as an execution disorder of movements, resulting from injury of the corticofugal tract (CFT) from the secondary motor area. Diagnosis of LKA is difficult because it is made by clinical observation of movements. In this study, using diffusion tensor tractography (DTT), we attempted to investigate injury of the CFT from the secondary motor area in patients with corona radiata infarct. Twenty patients with corona radiata infarct were recruited. A probabilistic tractography method was used in fiber tracking for reconstruction of the corticospinal tract (CST) and CFT. Fractional anisotropy (FA), mean diffusivity, and tract volume of the CSTs and CFTs from the dorsal premotor cortex (dPMC) and supplementary motor area (SMA) were measured. In the affected hemisphere, FA values of the CST from the precentral hand knob and the CFT from the dPMC were significantly decreased compared with those of the unaffected hemisphere (p corona radiata infarct, using DTT. Our results suggest that LKA ascribed to injury of the CFTs from the secondary motor area could be accompanied by injury of the CST ascribed to the corona radiata infarct.

  17. Effect of seawater immersion on periosteal function of the soft tissue with open injury in rabbit limbs

    Institute of Scientific and Technical Information of China (English)

    WANG Chang-sheng; CHENG Xun-sheng; CHEN Xiao-song; SHAN Hong-wei; LIN Zhao-fen

    2012-01-01

    Objective To investigate the effect of seawater immersion on periosteal function of the soft tissue with open injury in rabbit limbs.Methods Forty-eight New Zealand rabbits were used in the experiment.The animal model of open soft tissue injury was developed by cutting open the hindlimbs,and then the animals were randomly divided into 3 groups:the simple injury group or the control group ( group A),the injury plus 30 min seawater immersion group (group B),and the injury plus 1 h seawater immersion group (group C).Rabbits were sacrificed following surgery on 0,1,3,7 days,and histopathology and expressions of TNF-α and TGF-β1 were observed and monitored from the collected periosteum.Results (1) Inflammatory response of periosteum resulting from limb surgery plus 30 min seawater immersion was more serious than that of the animals in the control group.The longer the immersion,the more serious the response.(2) Intramembranous bone formation delayed markedly,following 1 h seawater immersion,however,for the animals in group B,delay in intramembranous bone formation was insignificant. (3) Periosteal malpighian layer cells for the animals in group B increased significantly,following injury on 1,3,7 days.Marked differences could be seen,when comparisons were made with animals of group A and group C (P < 0.01 ).Though periosteal malpighian layer cells for the animals in group A increased,when compared with those of the animals in group C,no significant differences could be noted between them ( P > 0.05 ).(4) Expressions of TNF-α were all seen in periosteal osteoprogenitor cells and osteoblasts in the animals of the 3 groups.The expression reached peak on day 1 after surgery,then,decreased gradually,with the expression level increased with the extension of seawater immersion. (5)There were expressions of TGF-β1 in periosteal osteoprogenitor cells and osteoblasts in the animals of the 3 groups and persistent expression of TGF-β1 could be observed on day 0 to day 7,and

  18. Advanced insights in upper limb function of individuals with cervical spinal cord injury

    NARCIS (Netherlands)

    Velstra, Inge-Marie

    2015-01-01

    An important criterion for a clinical outcome measure, such as the Graded and Redefined Assessment of Strength, Sensibility and Prehension (GRASSP), is its sensitivity to detect changes in upper limb function over time. This facilitates the evaluation of recovery patterns and treatment efficacy of e

  19. Bone architecture adaptations after spinal cord injury: impact of long-term vibration of a constrained lower limb

    Science.gov (United States)

    Dudley-Javoroski, S.; Petrie, M. A.; McHenry, C. L.; Amelon, R. E.; Saha, P. K.

    2015-01-01

    Summary This study examined the effect of a controlled dose of vibration upon bone density and architecture in people with spinal cord injury (who eventually develop severe osteoporosis). Very sensitive computed tomography (CT) imaging revealed no effect of vibration after 12 months, but other doses of vibration may still be useful to test. Introduction The purposes of this report were to determine the effect of a controlled dose of vibratory mechanical input upon individual trabecular bone regions in people with chronic spinal cord injury (SCI) and to examine the longitudinal bone architecture changes in both the acute and chronic state of SCI. Methods Participants with SCI received unilateral vibration of the constrained lower limb segment while sitting in a wheelchair (0.6g, 30 Hz, 20 min, three times weekly). The opposite limb served as a control. Bone mineral density (BMD) and trabecular micro-architecture were measured with high-resolution multi-detector CT. For comparison, one participant was studied from the acute (0.14 year) to the chronic state (2.7 years). Results Twelve months of vibration training did not yield adaptations of BMD or trabecular micro-architecture for the distal tibia or the distal femur. BMD and trabecular network length continued to decline at several distal femur sub-regions, contrary to previous reports suggesting a “steady state” of bone in chronic SCI. In the participant followed from acute to chronic SCI, BMD and architecture decline varied systematically across different anatomical segments of the tibia and femur. Conclusions This study supports that vibration training, using this study’s dose parameters, is not an effective antiosteoporosis intervention for people with chronic SCI. Using a high-spatial-resolution CT methodology and segmental analysis, we illustrate novel longitudinal changes in bone that occur after spinal cord injury. PMID:26395887

  20. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

    Science.gov (United States)

    Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2012-04-01

    To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

  1. Jellyfish Envenomation Resulting In Vascular Insufficiency And Neurogenic Injury of Upper Limb

    Directory of Open Access Journals (Sweden)

    Choong CYL

    2015-11-01

    Full Text Available Following a week after a jellyfish sting, a young man presented with regional cyanosis and threat of distal gangrene secondary to vascular spasm in the forearm. The patient also suffered from transient paresis and numbness of the affected upper limb. Contrasted imaging revealed unopacified vessels in the distal forearm and worsening swelling warranted emergency surgical fasciotomy for impending compartment syndrome. This case highlights the occurrence of jellyfish envenomation and the need for early treatment.

  2. Relationship between structural brainstem and brain plasticity and lower-limb training in spinal cord injury: a longitudinal pilot study

    Directory of Open Access Journals (Sweden)

    Michael eVilliger

    2015-05-01

    Full Text Available Rehabilitative training has shown to improve significantly motor outcomes and functional walking capacity in patients with incomplete spinal cord injury (iSCI. However, whether performance improvements during rehabilitation relate to brain plasticity or whether it is based on functional adaptation of movement strategies remain uncertain. This study assessed training improvement-induced structural brain plasticity in chronic iSCI patients using longitudinal MRI.We used tensor-based morphometry (TBM to analyze longitudinal brain volume changes associated with intensive virtual reality (VR-augmented lower limb training in nine traumatic iSCI patients. The MRI data was acquired before and after a 4-week training period (16-20 training sessions. Before training, voxel-based morphometry (VBM and voxel-based cortical thickness (VBCT assessed baseline morphometric differences in nine iSCI patients compared to 14 healthy controls. The intense VR-augmented training of limb control improved significantly balance, walking speed, ambulation, and muscle strength in patients. Retention of clinical improvements was confirmed by the 3-4 months follow-up. In patients relative to controls, reductions in VBM of white matter volume within the brainstem and cerebellum and VBCT showed cortical thinning in the primary motor cortex. Over time, TBM revealed significant improvement-induced increases in the left middle temporal and occipital gyrus, left temporal pole and fusiform gyrus, both hippocampi, cerebellum, corpus callosum, and brainstem in iSCI patients. This study demonstrates structural plasticity at the cortical and brainstem level as a consequence of VR-augmented training in iSCI patients. These structural changes may serve as neuroimaging biomarkers of VR-augmented lower limb neurorehabilitation in addition to performance measures to detect improvements in rehabilitative training.

  3. Chondroitinase gene therapy improves upper limb function following cervical contusion injury

    NARCIS (Netherlands)

    James, Nicholas D; Shea, Jessie; Muir, Elizabeth M; Verhaagen, J.; Schneider, Bernard L; Bradbury, Elizabeth J

    2015-01-01

    Chondroitin sulphate proteoglycans (CSPGs) are known to be important contributors to the intensely inhibitory environment that prevents tissue repair and regeneration following spinal cord injury. The bacterial enzyme chondroitinase ABC (ChABC) degrades these inhibitory molecules and has repeatedly

  4. Seatbelt syndrome associated with an isolated rectal injury: case report.

    Science.gov (United States)

    Hefny, Ashraf F; Al-Ashaal, Yousef I; Bani-Hashem, Ahmed M; Abu-Zidan, Fikri M

    2010-02-04

    Seatbelt syndrome is defined as a seatbelt sign associated with a lumbar spine fracture and a bowel perforation. An isolated rectal perforation due to seatbelt syndrome is extremely rare. There is only one case reported in the Danish literature and non in the English literature. A 48-year old front seat restrained passenger was involved in a head-on collision. He had lower abdominal pain and back pain. Seatbelt mark was seen across the lower abdomen. Initial trauma CT scan was normal except for a burst fracture of L5 vertebra which was operated on by internal fixation on the same day. The patient continued to have abdominal pain. A repeated abdominal CT scan on the third day has shown free intraperitoneal air. Laparotomy has revealed a perforation of the proximal part of the rectum below the recto sigmoid junction. Hartmann's procedure was performed. The abdomen was left open. Gradual closure of the abdominal fascia over a period of two weeks was performed. Postoperatively, the patient had temporary urinary retention due to quada equina injury which resolved 10 months after surgery. The presence of a seatbelt sign and a lumbar fracture should raise the possibility of a bowel injury.

  5. Seatbelt syndrome associated with an isolated rectal injury: case report

    Directory of Open Access Journals (Sweden)

    Bani-Hashem Ahmed M

    2010-02-01

    Full Text Available Abstract Seatbelt syndrome is defined as a seatbelt sign associated with a lumbar spine fracture and a bowel perforation. An isolated rectal perforation due to seatbelt syndrome is extremely rare. There is only one case reported in the Danish literature and non in the English literature. A 48-year old front seat restrained passenger was involved in a head-on collision. He had lower abdominal pain and back pain. Seatbelt mark was seen across the lower abdomen. Initial trauma CT scan was normal except for a burst fracture of L5 vertebra which was operated on by internal fixation on the same day. The patient continued to have abdominal pain. A repeated abdominal CT scan on the third day has shown free intraperitoneal air. Laparotomy has revealed a perforation of the proximal part of the rectum below the recto sigmoid junction. Hartmann's procedure was performed. The abdomen was left open. Gradual closure of the abdominal fascia over a period of two weeks was performed. Postoperatively, the patient had temporary urinary retention due to quada equina injury which resolved 10 months after surgery. The presence of a seatbelt sign and a lumbar fracture should raise the possibility of a bowel injury.

  6. The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review

    Directory of Open Access Journals (Sweden)

    Herman Katherine

    2012-07-01

    Full Text Available Abstract Background Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens. In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective. Methods Seven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention. The quality of each included study was evaluated using a modified version of the van Tulder scale. Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy. Results Nine studies were identified including six randomized controlled trials (RCT and three controlled clinical trials (CCT. Heterogeneity in study design and warm-up strategies prevented pooling of results. Two studies investigated male and female participants, while the remaining seven investigated women only. Risk Ratio (RR statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 0.67, confidence interval (CI 0.54 to 0.84 and overuse (RR 0.45, CI 0.28 to 0.71 lower limb injuries as well as knee (RR 0.48, CI 0.32 to 0.72 injuries among young amateur female footballers. The 'Knee Injury Prevention Program' (KIPP significantly reduced the risk of noncontact lower limb (RR 0.5, CI 0.33 to 0.76 and overuse (RR 0.44, CI 0.22 to 0.86 injuries in young amateur female football and basketball players. The 'Prevent Injury and Enhance Performance' (PEP strategy reduces the incidence of anterior cruciate ligament (ACL injuries (RR 0.18, CI 0.08 to 0.42. The 'HarmoKnee' programme reduces the risk of knee injuries (RR 0.22, CI 0.06 to 0.76 in teenage female footballers. The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP significantly reduces the incidence of anterior

  7. Transepithelial water and urea permeabilities of isolated perfused Munich-Wistar rat inner medullary thin limbs of Henle's loop.

    Science.gov (United States)

    Nawata, C Michele; Evans, Kristen K; Dantzler, William H; Pannabecker, Thomas L

    2014-01-01

    To better understand the role that water and urea fluxes play in the urine concentrating mechanism, we determined transepithelial osmotic water permeability (Pf) and urea permeability (Purea) in isolated perfused Munich-Wistar rat long-loop descending thin limbs (DTLs) and ascending thin limbs (ATLs). Thin limbs were isolated either from 0.5 to 2.5 mm below the outer medulla (upper inner medulla) or from the terminal 2.5 mm of the inner medulla. Segment types were characterized on the basis of structural features and gene expression levels of the water channel aquaporin 1, which was high in the upper DTL (DTLupper), absent in the lower DTL (DTLlower), and absent in ATLs, and the Cl-(1) channel ClCK1, which was absent in DTLs and high in ATLs. DTLupper Pf was high (3,204.5 ± 450.3 μm/s), whereas DTLlower showed very little or no osmotic Pf (207.8 ± 241.3 μm/s). Munich-Wistar rat ATLs have previously been shown to exhibit no Pf. DTLupper Purea was 40.0 ± 7.3 × 10(-5) cm/s and much higher in DTLlower (203.8 ± 30.3 × 10(-5) cm/s), upper ATL (203.8 ± 35.7 × 10(-5) cm/s), and lower ATL (265.1 ± 49.8 × 10(-5) cm/s). Phloretin (0.25 mM) did not reduce DTLupper Purea, suggesting that Purea is not due to urea transporter UT-A2, which is expressed in short-loop DTLs and short portions of some inner medullary DTLs close to the outer medulla. In summary, Purea is similar in all segments having no osmotic Pf but is significantly lower in DTLupper, a segment having high osmotic Pf. These data are inconsistent with the passive mechanism as originally proposed.

  8. Shock-absorbing insoles reduce the incidence of lower limb overuse injuries sustained during Royal Marine training.

    Science.gov (United States)

    House, Carol; Reece, Allyson; Roiz de Sa, Dan

    2013-06-01

    This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1,416 recruits issued with standard Saran insoles and 1,338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI.

  9. Effect of a robotic rehabilitation device on upper limb function in a sub-acute cervical spinal cord injury population.

    Science.gov (United States)

    Zariffa, José; Kapadia, Naaz; Kramer, John L K; Taylor, Philippa; Alizadeh-Meghrazi, Milad; Zivanovic, Vera; Willms, Rhonda; Townson, Andrea; Curt, Armin; Popovic, Milos R; Steeves, John D

    2011-01-01

    Robotic rehabilitation devices have been suggested as a tool to increase the amount of rehabilitation delivered after a neurological injury. Clinical robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors. We present the results of a multi-center pilot study where an upper-limb robotic rehabilitation device (Armeo Spring®, Hocoma AG) was incorporated into the rehabilitation program of 12 subjects with sub-acute cervical spinal cord injury (motor level C4-C6, AIS A-D). Outcomes were measured using two tests of upper extremity function: ARAT and GRASSP. The change in scores for the arm receiving the Armeo training were not statistically significant when compared to the arm not receiving the Armeo training at discharge from therapy and over follow up assessments (8.7 +/- 2.9 compared to 7.4 +/- 2.5 for ARAT at discharge, p = 0.98, and 13.0 +/- 3.2 compared to 13.3 +/- 3.3 for GRASSP at discharge, p = 0.69). Nevertheless, subjects with some minimal (partial) hand function at baseline had a significantly larger increase in GRASSP scores than subjects with no minimal hand function preserved at baseline (19.3 +/- 2.4 compared to 6.6 +/- 4.7, p = 0.02). This suggests that the initial functional capabilities of patients can influence the benefits measured after robotic rehabilitation training and heterogeneous subject populations should be avoided in early phase studies. © 2011 IEEE

  10. Spasticity reduction using electrical stimulation in the lower limb of spinal cord injury patients

    NARCIS (Netherlands)

    van der Salm, Arjan

    2005-01-01

    The goal of this thesis was to investigate the influence of electrical stimulation on spasticity of leg muscles in spinal cord injury patients and its impact on gait. Both, the carry-over effect and the instant effect of electrical stimulation during gait were investigated.

  11. The influence of the training program on muscle activity of lower limb muscles in relation to the risk factors of hamstring injury at soccer players

    OpenAIRE

    Hnátová, Iva

    2013-01-01

    CHARLES UNIVERSITY IN PRAG Faculty of Physical Educational and Sport Department of Physiotherapy THE INFLUENCE OF THE TRAINING PROGRAM ON MUSCLE ACTIVITY OF LOWER LIMB MUSCLES IN RELATION TO THE RISK FACTORS OF HAMSTRING INJURY AT SOCCER PLAYERS Dissertation thesis Supervisor: Author: Doc. PaedDr. Dagmar Pavlů, CSc. Mgr. Iva Hnátová Consultant: PhDr. Aleš Kaplan, PhD. November 2012 SUMMARY Titel: The influence of the training program on muscle activity of lower limb muscles in relation to the...

  12. Isolated segmental, sectoral and right hepatic bile duct injuries

    Institute of Scientific and Technical Information of China (English)

    Radoje B Colovic

    2009-01-01

    The treatment of isolated segmental, sectoral and right hepatic bile duct injuries is controversial. Nineteen patients were treated over a 26-year period. Group one was comprised of 4 patients in whom the injury was primarily repaired during the original surgery;3 over a T-tube, 1 with a Roux-en-Y. These patients had an uneventful recovery. The second group consisted of 5 patients in whom the duct was ligated;4 developed infection, 3 of which required drainage and biliary repair. Two patients had good long-term outcomes;the third developed a late anastomotic stricture requiring further surgery. The fourth patient developed a small bile leak and pain which resolved spontaneously. The fifth patient developed complications from which he died. The third group was comprised of 4 patients referred with biliary peritonitis;all underwent drainage and lavage, and developed biliary fistulae, 3 of which resolved spontaneously, 1 required Roux-en-Y repair, with favorable outcomes. The fourth group consisted of 6 patients with biliary fistulae. Two patients, both with an 8-wk history of a fistula, underwent Roux-en-Y repair. Two others also underwent a Roux-en-Y repair, as their fistulae showed no signs of closure. The remaining 2 patients had spontaneous closure of their biliary fistulae. A primary repair is a reasonable alternative to ligature of injured duct. Patients with ligated ducts may develop complications. Infected ducts require further surgery. Patients with biliary peritonitis must be treated with drainage and lavage. There is a 50% chance that a biliary fistula will close spontaneously. In cases where the biliary fistula does not close within 6 to 8 wk, a Roux-en-Y anastomosis should be considered.

  13. AB296. SPR-23 Aberrant bladder reflexes can drive hind limb locomotor activity following complete suprasacral spinal cord injury

    Science.gov (United States)

    Inouye, Brian M.; Brooks, Jillene M.; Degoski, Danielle J.; Hughes, Francis M.; Purves, J. Todd; Fraser, Matthew O.

    2016-01-01

    Objective Many rats with chronic suprasacral spinal cord injury (SCI) demonstrate hind limb locomotor activity (HLLA) in response to external crede or high pressure contractions during cystometry. We propose that this aberrant, pressure-driven bladder reflex pathway may be harnessed to facilitate walking in SCI patients. As a first step in exploring this possibility, we examined the relationship between intravesical pressure (IVP) and HLLA in chronic suprasacral SCI rats. Methods Female rats (4 weeks post-SCI at T9-10, n=16) were anesthetized with isoflurane and fitted with transvesical catheters and right quadriceps EMG electrodes to monitor bladder and hind limb locomotor activities, respectively. The animals were mounted in Ballman restraint cages to which they had been previously acclimated. The catheter was connected to a pressure transducer, an infusion pump, and a saline-filled reservoir mounted on a metered vertical pole (pressure clamp). After 30 min of recovery from anesthesia, the bladder was filled at 0.1 mL/min with saline to verify bladder-to-bladder reflex activity for 30 min. IVP was then increased in an interrupted stepwise fashion from 0–120 cmH2O at 10 cmH2O increments. Each step consisted of five minutes: 3 minutes at the new pressure followed by 2 minutes at 0 cmH2O. IVP and the number of HLLA events (as defined by rhythmic EMG discharges of 3–10 cycles/event) were recorded for each pressure step. This process was repeated for two more trials for each rat to assess the durability of the reflex. Data were analyzed using ANOVA with repeated measures both within and across pressure escalation trials. P<0.05 was considered significant. Results ANOVA revealed that locomotor events increased with increasing IVP and decreased with the number of escalation trials (P<0.0001 for both effects). The increase in the number of locomotor events with increasing IVP appeared to plateau at ~50–60 cmH2O (P<0.05 for all). The average of the maximal number of

  14. Construction and validation of a microprocessor controlled extracorporal circuit in rats for the optimization of isolated limb perfusion.

    Science.gov (United States)

    Gürtler, Ulrich; Fuchs, Peter; Stangelmayer, Achim; Bernhardt, Günther; Buschauer, Armin; Spruss, Thilo

    2004-12-01

    Although a few experimental approaches to isolated limb perfusion (ILP) are described in the literature, none of these animal models mimics the clinical perfusion techniques adequately to improve the technique of ILP on the basis of valid preclinical data. Therefore, we developed an ILP setup in rats allowing online monitoring of essential perfusion parameters such as temperature (in perfusate, various tissues, and rectum), pH (perfusate), perfusion pressure, and O(2) concentration (in perfusate, tissue), by a tailor-made data acquisition system. This setup permits close supervision of vital parameters during ILP. Various interdependencies, concerning the flow rate and the pressure of perfusate as well as tissue oxygenation were registered. For the measurement of pO(2) values in the perfusate and in different regions of the perfused hind limb, a novel type of microoptode based on quenching of a fluorescent dye was devised. Stable normothermic (37 degrees C) perfusion conditions were maintained at a constant perfusion pressure in the range of 40-60 mm Hg by administration of the spasmo lytic moxaverine (0.5 mg/mL of perfusate as initial dose) at a perfusate flow rate of 0.5 mL/min for 60 min. At the end of an ILP, there were no signs of tissue damage, neither concerning laboratory data (K(+), myoglobin, creatine kinase, lactic dehydrogenase) nor histopathological criteria. The reported ILP model is not only well suited to investigate the effects of hyperthermia but also to assess the efficacy of new antineoplastic approaches, when nude rats, bearing human tumours in the hind limbs, are used.

  15. High-grade renal injuries are often isolated in sports-related trauma.

    Science.gov (United States)

    Patel, Darshan P; Redshaw, Jeffrey D; Breyer, Benjamin N; Smith, Thomas G; Erickson, Bradley A; Majercik, Sarah D; Gaither, Thomas W; Craig, James R; Gardner, Scott; Presson, Angela P; Zhang, Chong; Hotaling, James M; Brant, William O; Myers, Jeremy B

    2015-07-01

    Most high-grade renal injuries (American Association for Surgery of Trauma (AAST) grades III-V) result from motor vehicle collisions associated with numerous concomitant injuries. Sports-related blunt renal injury tends to have a different mechanism, a solitary blow to the flank. We hypothesized that high-grade renal injury is often isolated in sports-related renal trauma. We identified patients with AAST grades III-V blunt renal injuries from four level 1 trauma centres across the United States between 1/2005 and 1/2014. Patients were divided into "Sport" or "Non-sport" related groups. Outcomes included rates of hypotension (systolic blood pressure 110bpm), concomitant abdominal injury, and procedural/surgical intervention between sports and non-sports related injury. 320 patients met study criteria. 18% (59) were sports-related injuries with the most common mechanisms being skiing, snowboarding and contact sports (25%, 25%, and 24%, respectively). Median age was 24 years for sports and 30 years for non-sports related renal injuries (p=0.049). Males were more commonly involved in sports related injuries (85% vs. 72%, p=0.011). Median injury severity score was lower for sports related injuries (10 vs. 27, ptrauma was more likely to be isolated without other significant injury (69% vs. 39% (ptrauma is more likely to occur in isolation without other abdominal or thoracic injuries and clinicians must have a high suspicion of renal injury with significant blows to the flank during sports activities. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. [Long-term results of peripheral vascular injuries in patients' limbs following reconstructive surgical procedures and influence on the quality of life].

    Science.gov (United States)

    Deja, Włodzimierz; Wieczorek, Dariusz; Deja, Agata; Lasek, Jerzy; Kawecka, Aleksandra; Marks, Wojciech

    2006-01-01

    Major vascular injuries in extremities are rare and constitute problems for surgeons and their sequelae strongly influence remote future of the patients. The aim of study is to evaluate surgical treatment of vascular injuries in extremities and some aspects of quality of life. Since 1983 until 2002 sixty four patients with vascular limbs injuries were treated in the department. Remote evaluation has been performed in 33 persons. Severity of limb injuries was measured by Mangled Extremity Severity Score (MESS). In 20 patients (60.6%) very good and good recent results were obtained, satisfactory in 24.2% and bad results in 15.2% persons. Evaluation of functional status has been made by means of locomotion test and Jebsen-Taylor's test, social approval questionnaire, depression Beck's scale, the scale of hypochondria and by an original questionnaire to evaluate the quality of life. As considerable interdependence has been found between the functional status and the following factors: injury severity expressed in MESS (p < 0.01), clinic reception procedure (p < 0.001), ischemia time (p < 0.01), coincidence of other injuries (fractures and dislocations, muscle, tendon and nerve lesions) (p < 0.01), limb amputation (p < 0.01). Hand function significantly influences the quality of life. Patients who were in shock after trauma in the remote assessment showed susceptibility to the lowered mood and depression (p < 0.05). Quality of life is strongly connected with the features of personality, correlating mainly with the mood and tendencies of concentration upon somatic symptoms. Function of the hand influences strongly the quality of life. Amputated patients may in spite of their crippling limitations are able to adapt to everyday life.

  17. Effects of rehabilitation treatment after injury of lower limbs on function recovery%下肢外伤术后康复治疗促肢体功能恢复

    Institute of Scientific and Technical Information of China (English)

    陈长安; 吴海军; 徐平

    2003-01-01

    @@ BACKGROUND: With the development of medicine, rehabilitation treatment from early stage to later stage tends to systematization and specialization that are very important to function recovery of severe limb injury.

  18. Neuronal injury in the motor cortex after chronic stroke and lower limb motor impairment:a voxel-based lesion symptom mapping study

    Institute of Scientific and Technical Information of China (English)

    Alexandria M. Reynolds; Denise M. Peters; Jennifer M. C. Vendemia; Lenwood P. Smith; Raymond C. Sweet; Gordon C. Baylis; Debra Krotish; Stacy L Fritz

    2014-01-01

    Many studies have examined motor impairments using voxel-based lesion symptom mapping, but few are reported regarding the corresponding relationship between cerebral cortex injury and lower limb motor impairment analyzed using this technique. This study correlated neuro-nal injury in the cerebral cortex of 16 patients with chronic stroke based on a voxel-based lesion symptom mapping analysis. Neuronal injury in the corona radiata, caudate nucleus and putamen of patients with chronic stroke could predict walking speed. The behavioral measure scores were consistent with motor deifcits expected after damage to the cortical motor system due to stroke. These ifndings suggest that voxel-based lesion symptom mapping may provide a more accurate prognosis of motor recovery from chronic stroke according to neuronal injury in cerebral motor cortex.

  19. A matter of life or limb? A review of traumatic injury patterns and anesthesia techniques for disaster relief after major earthquakes.

    Science.gov (United States)

    Missair, Andres; Pretto, Ernesto A; Visan, Alexandru; Lobo, Laila; Paula, Frank; Castillo-Pedraza, Catalina; Cooper, Lebron; Gebhard, Ralf E

    2013-10-01

    All modalities of anesthetic care, including conscious sedation, general, and regional anesthesia, have been used to manage earthquake survivors who require urgent surgical intervention during the acute phase of medical relief. Consequently, we felt that a review of epidemiologic data from major earthquakes in the context of urgent intraoperative management was warranted to optimize anesthesia disaster preparedness for future medical relief operations. The primary outcome measure of this study was to identify the predominant preoperative injury pattern (anatomic location and pathology) of survivors presenting for surgical care immediately after major earthquakes during the acute phase of medical relief (0-15 days after disaster). The injury pattern is of significant relevance because it closely relates to the anesthetic techniques available for patient management. We discuss our findings in the context of evidence-based strategies for anesthetic management during the acute phase of medical relief after major earthquakes and the associated obstacles of devastated medical infrastructure. To identify reports on acute medical care in the aftermath of natural disasters, a query was conducted using MEDLINE/PubMed, Embase, CINAHL, as well as an online search engine (Google Scholar). The search terms were "disaster" and "earthquake" in combination with "injury," "trauma," "surgery," "anesthesia," and "wounds." Our investigation focused only on studies of acute traumatic injury that specified surgical intervention among survivors in the acute phase of medical relief. A total of 31 articles reporting on 15 major earthquakes (between 1980 and 2010) and the treatment of more than 33,410 patients met our specific inclusion criteria. The mean incidence of traumatic limb injury per major earthquake was 68.0%. The global incidence of traumatic limb injury was 54.3% (18,144/33,410 patients). The pooled estimate of the proportion of limb injuries was calculated to be 67.95%, with a

  20. The effect of virtual visual feedback on supernumerary phantom limb pain in a patient with high cervical cord injury: a single-case design study.

    Science.gov (United States)

    Katayama, Osamu; Iki, Hidemasa; Sawa, Shunji; Osumi, Michihiro; Morioka, Shu

    2015-01-01

    We characterized the effect of virtual visual feedback (VVF) on supernumerary phantom limb pain (SPLP) in a patient with high cervical cord injury. The subject was a 22-year-old man diagnosed with complete spinal cord injury (level C2) approximately 5 years ago. We applied the ABA'B' single-case design and set phases B and B' as intervention phases for comparison. SPLP significantly improved in comparison of phase A with phase B and phase A with phase B'. We suggest that VVF reduces SPLP and the effect lasts after VVF.

  1. Treating a patient with lower limb injury from shark attack – a case report

    Directory of Open Access Journals (Sweden)

    Uroš Ahčan

    2014-02-01

    Full Text Available Background: Every year a number of people are attacked by sharks worldwide; however, death as a consequence is quite unusual. In recent years, the number of reported shark attacks worldwide has been around 67 per year with fatalities averaging 5 persons annually. Shark attacks in the Adriatic Sea are very rare.Case report: In 2008, a great white shark attack happened in the Adriatic Sea, in which a man suffered a severe injury to his lower extremity and profuse bleeding that led to haemorrhagic shock.Conclusion: The expeditious intervention at the site of attack and the exemplary cooperation of medical teams in two centres in the neighbouring countries of Croatia and Slovenia has saved the life of the unusually injured patient and resulted in a satisfactory functional outcome.

  2. Lower Limb Voluntary Movement Improvement Following a Robot-Assisted Locomotor Training in Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Mirbagheri Mehdi

    2011-12-01

    Full Text Available Individuals with spinal cord injury (SCI suffer from severe impairments in voluntary movements. Literature reports a reduction in major kinematic and kinetic parameters of lower limbs’ joints. A body weight support treadmill training with robotic assistance has been widely used to improve lower-extremity function and locomotion in persons with SCI. Our objective was to explore the effects of 4-weeks robot-assisted locomotor training on voluntary movement of the ankle musculature in patients with incomplete SCI. In particular, we aimed to characterize the therapeutic effects of Lokomat training on kinematic measures (range of motion, velocity, smoothness during a dorsiflexion movement. We hypothesized that training would improve these measures. Preliminary results show an improvement of kinematic parameters during ankle dorsiflexion voluntary movement after a 4-weeks training in the major part of our participants. Complementary investigations are in progress to confirm these results and understand underlying mechanisms associated with the recovery.

  3. Value of continuous leakage monitoring with radioactive iodine-131-labeled human serum albumin during hyperthermic isolated limb perfusion with tumor necrosis factor-alpha and melphalan

    NARCIS (Netherlands)

    van Ginkel, RJ; Limburg, PC; Piers, DA; Hoekstra, HJ; Schraffordt Koops, H.

    Background: The aim of this study was to analyze the value of continuous leakage monitoring with radioactive iodine-131-labeled human serum albumin (RISA) in patients treated with hyperthermic isolated limb perfusion with tumor necrosis factor-alpha (TNFalpha) and melphalan. Methods: Forty-eight

  4. Role of nitric oxide in recombinant tumor necrosis factor-alpha-induced circulatory shock : A study in patients treated for cancer with isolated limb perfusion

    NARCIS (Netherlands)

    Zwaveling, JH; Maring, JK; Moshage, H; vanGinkel, RJ; Hoekstra, HJ; Donse, IF; Girbes, ARJ; Schraffordt Koops, H.

    1996-01-01

    Objectives: To analyze the mechanism of vasodilation and circulatory shock occurring in patients who are treated with isolated limb perfusion with melphalan and recombinant tumor necrosis factor (TNF)-alpha for locally advanced malignant tumors, To determine the role of nitric oxide, if any, by

  5. Isolated syndesmotic injury in acute ankle trauma: Comparison of plain film radiography with 3 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Schoennagel, B.P., E-mail: b.schoennagel@uke.uni-hamburg.de [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Karul, M.; Avanesov, M.; Bannas, P.; Gold, G. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Großterlinden, L.G. [Department of Trauma-, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany); Rupprecht, M. [Department of Pediatric Orthopedics, Children' s Hospital Hamburg-Altona, Bleickenallee 38, 22763 Hamburg (Germany); Adam, G.; Yamamura, J. [Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg (Germany)

    2014-10-15

    Highlights: • Isolated syndesmotic injury is a frequent finding after acute ankle trauma. • Cut-off values and accuracy of plain film radiograph measurements were determined. • The TFCS and the MCS have the potential to detect isolated syndesmotic injury. • Appropriate cut-off values allow detection of isolated syndesmotic injury. • Only MRI reveals severity of isolated syndesmotic injury and concomitant injuries. - Abstract: Objectives: To determine cut-off values and the accuracy of plain film measurements for the detection of isolated syndesmotic injury after acute ankle trauma and to investigate MRI findings of concomitant ankle injury. Methods: Eighty-four consecutive patients with absent fracture in plain film radiographs were prospectively evaluated for isolated syndesmotic injury after acute ankle trauma. The tibiofibular clear space (TFCS), the tibiofibular overlap (TFO), and the medial clear space (MCS) were independently assessed in plain radiographs by two readers. MRI performed at 3 T within 24 h served as the reference standard. MRI was evaluated for syndesmotic injury, using a four-scale grading system (0 = normal syndesmosis, 1a = periligamentous edema, 1b = intraligamentous edema, 2 = partial rupture, 3 = complete rupture), and for concomitant ankle injury. Inter-observer variability for x-ray measurements was assessed using Bland–Altman diagrams. ROC analyses were performed to determine cut-off values and sensitivity and specificity for TFCS, TFO, and MCS. Results: Eleven of 84 patients (13.1%) revealed syndesmotic injury (Grade 2 or 3) according to MRI. Between patients with and without syndesmotic injury significantly different measurements were obtained for TFCS (p = 0.003) and MCS (p = 0.04). ROC derived cut-off values were 5.3 mm for TFCS, 2.8 mm for TFO, and 2.8 mm for MCS. Sensitivity and specificity was 82% and 75% for TFCS, 36% and 78% for TFO, and 73% and 59% for MCS. The bias and limits of agreement were −0.04 mm and [−1

  6. Longitudinal evaluation of mouse hind limb bone loss after spinal cord injury using novel, in vivo, methodology.

    Science.gov (United States)

    McManus, Madonna M; Grill, Raymond J

    2011-12-07

    Spinal cord injury (SCI) is often accompanied by osteoporosis in the sublesional regions of the pelvis and lower extremities, leading to a higher frequency of fractures. As these fractures often occur in regions that have lost normal sensory function, the patient is at a greater risk of fracture-dependent pathologies, including death. SCI-dependent loss in both bone mineral density (BMD, grams/cm2) and bone mineral content (BMC, grams) has been attributed to mechanical disuse, aberrant neuronal signaling and hormonal changes. The use of rodent models of SCI-induced osteoporosis can provide invaluable information regarding the mechanisms underlying the development of osteoporosis following SCI as well as a test environment for the generation of new therapies. Mouse models of SCI are of great interest as they permit a reductionist approach to mechanism-based assessment through the use of null and transgenic mice. While such models have provided important data, there is still a need for minimally-invasive, reliable, reproducible, and quantifiable methods in determining the extent of bone loss following SCI, particularly over time and within the same cohort of experimental animals, to improve diagnosis, treatment methods, and/or prevention of SCI-induced osteoporosis. An ideal method for measuring bone density in rodents would allow multiple, sequential (over time) exposures to low-levels of X-ray radiation. This study describes the use of a new whole-animal scanner, the IVIS Lumina XR (Caliper Instruments) that can be used to provide low-energy (1-3 milligray (mGy)) high-resolution, high-magnification X-ray images of mouse hind limb bones over time following SCI. Significant bone density loss was seen in the tibiae of mice by 10 days post-spinal transection when compared to uninjured, age-matched control (naïve) mice (13% decrease, p analysis on mouse femurs post-mortem 30 days post-SCI (9). Our results suggest that the IVIS Lumina XR provides a novel, high

  7. An Adaptive Neuromuscular Controller for Assistive Lower-Limb Exoskeletons: A Preliminary Study on Subjects with Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Amy R. Wu

    2017-06-01

    Full Text Available Versatility is important for a wearable exoskeleton controller to be responsive to both the user and the environment. These characteristics are especially important for subjects with spinal cord injury (SCI, where active recruitment of their own neuromuscular system could promote motor recovery. Here we demonstrate the capability of a novel, biologically-inspired neuromuscular controller (NMC which uses dynamical models of lower limb muscles to assist the gait of SCI subjects. Advantages of this controller include robustness, modularity, and adaptability. The controller requires very few inputs (i.e., joint angles, stance, and swing detection, can be decomposed into relevant control modules (e.g., only knee or hip control, and can generate walking at different speeds and terrains in simulation. We performed a preliminary evaluation of this controller on a lower-limb knee and hip robotic gait trainer with seven subjects (N = 7, four with complete paraplegia, two incomplete, one healthy to determine if the NMC could enable normal-like walking. During the experiment, SCI subjects walked with body weight support on a treadmill and could use the handrails. With controller assistance, subjects were able to walk at fast walking speeds for ambulatory SCI subjects—from 0.6 to 1.4 m/s. Measured joint angles and NMC-provided joint torques agreed reasonably well with kinematics and biological joint torques of a healthy subject in shod walking. Some differences were found between the torques, such as the lack of knee flexion near mid-stance, but joint angle trajectories did not seem greatly affected. The NMC also adjusted its torque output to provide more joint work at faster speeds and thus greater joint angles and step length. We also found that the optimal speed-step length curve observed in healthy humans emerged for most of the subjects, albeit with relatively longer step length at faster speeds. Therefore, with very few sensors and no predefined

  8. Erognomic education on housework for women with upper limb repetitive strain injury (RSI): a conceptual representation of therapists' clinical reasoning.

    Science.gov (United States)

    Cheung, Therma W C; Clemson, Lindy; O' Loughlin, Kate; Shuttleworth, Russell

    2017-09-18

    Ergonomic education in housework that aims to facilitate behavior change is important for women with upper limb repetitive strain injury. Therapists usually conduct such programs based on implicit reasoning. Making this reasoning explicit is important in contributing to the profession's knowledge. To construct a conceptual representation of how occupational therapists make clinical decisions for such program. Based on a constructivist-grounded theory methodology, data were collected through in-depth interviewing with 14 occupational therapists from a major hospital in Singapore. Interviews were audiotaped and transcribed. Data was analyzed with line by line, focused and axial coding with constant data comparison throughout data collection. Therapists made clinical decisions based on their perceptions of their clients' behavior change in three stages: (i) listen; (ii) try; and (iii) persevere, bearing significant similarities to the transtheoretical theory of change. The study also showed that therapists may not have considered the full range of meanings that their clients attach to housework when interacting with them, a gap that needs to be addressed. The present study indicates the importance of therapists' understanding of the meanings that their clients attach to housework. Further research needs to address how to achieve this in a time-pressured clinical environment. Implications for Rehabilitation This study used qualitative research to demonstrate the process of translating therapists' tacit knowledge into an explicit form. It elucidates the following major implications for practice when therapists conduct ergonomic education to facilitate behavior change in housework for female homemakers with upper limb RSI:The conceptual framework of clinical reasoning constructed from the results can be used to increase therapists' awareness of how they make clinical decisions during an intervention. This framework can also be used for training new therapists. It is

  9. Hypofibrinogenemia in isolated traumatic brain injury in Indian patients

    Directory of Open Access Journals (Sweden)

    Chhabra Gaurav

    2010-12-01

    Full Text Available Coagulation abnormalities are common in patients with head injuries. However, the effect of brain injury on fibrinogen levels has not been well studied prospectively to assess coagulation abnormalities in patients with moderate and severe head injuries and correlate these abnormalities with the neurologic outcome. Consecutive patients with moderate (Glasgow Comma Scale (GCS,9-12 and severe (GCS≤8 head injuries were the subjects of this pilot study, All patients had coagulation parameters, including plasma fibrinogen levels measured. Clinical and computed tomography (CT scan findings and immediate clinical outcome were analyzed. Of the 100 patients enrolled, only seven (7% patients had hypofibrinogenemia (fibrinogen ≤200 mg/dL. The head injury was moderate in two patients and severe in five patients. Fibrinogen levels showed a progressively increasing trend in four patients (three with severe head injuries and one with moderate head injury. CT scan revealed subdural hematoma in five patients; extradural hematoma in one; and subarachnoid hemorrhage in another patient. Of the seven patients, two patients died during hospital. Large-scale prospective studies are needed to assess the fibrinogen level in patients with head injury and its impact on outcome.

  10. Predictors of mortality in patients with isolated severe traumatic brain injury.

    Science.gov (United States)

    Strnad, Matej; Borovnik Lesjak, Vesna; Vujanović, Vitka; Križmarić, Miljenko

    2017-02-01

    Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Many prognostic models predicting mortality in patients with TBI were developed, which also include patients with mild or moderate TBI and patients who suffered major extracranial injuries. From a prospective database, we conducted a retrospective medical chart review covering the period between January 2000 and December 2012 of patients with isolated severe TBI (Abbreviated Injury Score for head, AISH ≥ 3) without extracranial injuries, who were intubated in the field using the rapid sequence intubation method and were of age 16 or more. Prehospital vital signs, Injury Severity Score (ISS) and laboratory tests were compared in two study groups: survivors (n = 25) and non-survivors (n = 27). Selected variables identified during univariate analysis (p intubated patients with isolated severe TBI only ISS and mydriasis were found to be independent predictors of in-hospital mortality.

  11. Functional electrical stimulation cycling has no clear effect on urine output, lower limb swelling, and spasticity in people with spinal cord injury: a randomised cross-over trial.

    Science.gov (United States)

    Ralston, Keira E; Harvey, Lisa; Batty, Julia; Bonsan, Lee B; Ben, Marsha; Cusmiani, Rita; Bennett, Jacqueline

    2013-12-01

    Does functional electrical stimulation (FES) cycling increase urine output and decrease lower limb swelling and spasticity in people with recent spinal cord injury? Randomised cross-over trial. Fourteen participants with a recent motor complete spinal cord injury were consecutively recruited from two spinal cord injury units in Sydney. Participants were randomised to an experimental phase followed by a control phase or vice versa, with a 1-week washout period in between. The experimental phase involved FES cycling four times a week for two weeks and the control phase involved standard rehabilitation for two weeks. Assessments by a blinded assessor occurred at the beginning and end of each phase. Allocation was concealed and an intention-to-treat analysis was performed. The primary outcome was urine output (mL/hr) and the secondary outcomes were lower limb circumference, and spasticity using the Ashworth Scale, and the Patient Reported Impact of Spasticity Measure (PRISM). In addition, participants were asked open-ended questions to explore their perceptions about treatment effectiveness. All participants completed the study. The mean between-group difference (95% CI) for urine output was 82mL/hr (-35 to 199). The mean between-group differences (95% CI) for lower limb swelling, spasticity (Ashworth), and PRISM were -0.1cm (-1.5 to 1.2), -1.9 points (-4.9 to 1.2) and -5 points (-13 to 2), respectively. All point estimates of treatment effects favoured FES cycling. Participants reported many benefits from FES cycling. There were no clear effects of FES cycling on urine output, swelling and spasticity even though all point estimates of treatment effects favoured FES cycling and participants perceived therapeutic effects. ACTRN12611000923965. Copyright © 2013 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.

  12. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial

    OpenAIRE

    Pollard Henry; Hoskins Wayne

    2010-01-01

    Abstract Background Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. Methods Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and r...

  13. Traumatic pneumorrachis after isolated closed head injuries: An up-to-date review.

    Science.gov (United States)

    Hadjigeorgiou, Georgios F; Singh, Ranjodh; Stefanopoulos, Panagiotis; Petsanas, Adamantios; Hadjigeorgiou, Fivos G; Fountas, Kostas

    2016-12-01

    Pneumorrachis (PR) is characterized by the presence of air within the spinal canal. It can be classified descriptively into internal or intradural and external or epidural. The causes of PR can be divided as iatrogenic, nontraumatic and traumatic. In the present study, a comprehensive literature search was conducted to identify all previous cases of PR after an isolate head injury. Two additional cases were also reported. We concluded, that PR after isolated head injuries is a rare but likely an underdiagnosed entity. It is a marker of severe injury and the majority of such patients have a poor outcome. Although, PR is usually asymptomatic and reabsorbs spontaneously, prompt recognition and management of the underlying cause is essential. Therefore, clinicians should maintain a high level of suspicion for serious underlying injury in cases where initial radiological imaging reveals intraspinal air.

  14. A descriptive study of a manual therapy intervention within a randomised controlled trial for hamstring and lower limb injury prevention

    Directory of Open Access Journals (Sweden)

    Hoskins Wayne

    2010-08-01

    Full Text Available Abstract Background There is little literature describing the use of manual therapy performed on athletes. It was our purpose to document the usage of a sports chiropractic manual therapy intervention within a RCT by identifying the type, amount, frequency, location and reason for treatment provided. This information is useful for the uptake of the intervention into clinical settings and to allow clinicians to better understand a role that sports chiropractors offer. Methods All treatment rendered to 29 semi-elite Australian Rules footballers in the sports chiropractic intervention group of an 8 month RCT investigating hamstring and lower-limb injury prevention was recorded. Treatment was pragmatically and individually determined and could consist of high-velocity, low-amplitude (HVLA manipulation, mobilization and/or supporting soft tissue therapies. Descriptive statistics recorded the treatment rendered for symptomatic or asymptomatic benefit, delivered to joint or soft tissue structures and categorized into body regions. For the joint therapy, it was recorded whether treatment consisted of HVLA manipulation, HVLA manipulation and mobilization, or mobilization only. Breakdown of the HVLA technique was performed. Results A total of 487 treatments were provided (mean 16.8 consultations/player with 64% of treatment for asymptomatic benefit (73% joint therapies, 57% soft tissue therapies. Treatment was delivered to approximately 4 soft tissue and 4 joint regions each consultation. The most common asymptomatic regions treated with joint therapies were thoracic (22%, knee (20%, hip (19%, sacroiliac joint (13% and lumbar (11%. For soft tissue therapies it was gluteal (22%, hip flexor (14%, knee (12% and lumbar (11%. The most common symptomatic regions treated with joint therapies were lumbar (25%, thoracic (15% and hip (14%. For soft tissue therapies it was gluteal (22%, lumbar (15% and posterior thigh (8%. Of the joint therapy, 56% was HVLA

  15. Delayed diagnosis of an isolated posterolateral corner injury: a case report.

    Science.gov (United States)

    Welsh, Patrick; DeGraauw, Christopher; Whitty, David

    2016-12-01

    Isolated injuries to the posterolateral corner of the knee are a rare and commonly missed injury associated with athletic trauma, motor vehicle accidents, and falls. Delayed or missed diagnoses can negatively impact patient prognosis, contributing to residual instability, chronic pain, and failure of surgical repair to other ligaments. A 44-year-old male CrossFit athlete presented with a history of two non-contact hyperextension injuries to his left knee while walking on ice. The only positive finding was the Dial Test at 30 degrees of knee flexion, indicative of an isolated posterolateral corner injury. After a delay in diagnosis, the patient underwent a reconstruction of the posterolateral corner and subsequent rehabilitation. Early recognition of this injury is important as this can affect the prognosis and activities of daily living of the patient. This case will discuss the clinical presentation, diagnostic procedures, and management of an isolated posterolateral corner injury and highlight the importance of early recognition and referrals from primary contact healthcare practitioners.

  16. Compartment Syndrome following Open Femoral Fracture with an Isolated Femoral Vein Injury Treated with Acute Repair

    Directory of Open Access Journals (Sweden)

    David Walmsley

    2014-01-01

    Full Text Available Acute compartment syndrome is a surgical emergency and its diagnosis is more difficult in obtunded or insensate patients. We present the case of a 34-year-old woman who sustained a Gustilo-Anderson grade III open midshaft femur fracture with an isolated femoral vein injury treated with direct repair. She developed lower leg compartment syndrome at 48 hours postoperatively, necessitating fasciotomies. She was subsequently found to have a DVT in her femoral vein at the level of the repair and was started on therapeutic anticoagulation. This case highlights the importance of recognition of isolated venous injuries in a trauma setting as a risk factor for developing compartment syndrome.

  17. H2S Protecting against Lung Injury following Limb Ischemia-reperfusion by Alleviating Inflammation and Water Transport Abnormality in Rats

    Institute of Scientific and Technical Information of China (English)

    XIE Xiao Hua

    2014-01-01

    Objective To investigate the effect of H2S on lower limb ischemia-reperfusion (LIR) induced lung injury and explore the underlying mechanism. Methods Wistar rats were randomly divided into control group, IR group, IR+Sodium Hydrosulphide (NaHS) group and IR+DL-propargylglycine (PPG) group. IR group as lung injury model induced by LIR were given 4 h reperfusion following 4 h ischemia of bilateral hindlimbs with rubber bands. NaHS (0.78 mg/kg) as exogenous H2S donor and PPG (60 mg/kg) which can suppress endogenous H2S production were administrated before LIR, respectively. The lungs were removed for histologic analysis, the determination of wet-to-dry weight ratios and the measurement of mRNA and protein levels of aquaporin-1 (AQP1), aquaporin-5 (AQP5) as indexes of water transport abnormality, and mRNA and protein levels of Toll-like receptor 4 (TLR4), myeloid differentiation primary-response gene 88 (MyD88) and p-NF-κB as indexes of inflammation. Results LIR induced lung injury was accompanied with upregulation of TLR4-Myd88-NF-κB pathway and downregulation of AQP1/AQP5. NaHS pre-treatment reduced lung injury with increasing AQP1/AQP5 expression and inhibition of TLR4-Myd88-NF-κB pathway, but PPG adjusted AQP1/AQP5 and TLR4 pathway to the opposite side and exacerbated lung injury. Conclusion Endogenous H2S, TLR4-Myd88-NF-κB pathway and AQP1/AQP5 were involved in LIR induced lung injury. Increased H2S would alleviate lung injury and the effect is at least partially depend on the adjustment of TLR4-Myd88-NF-κB pathway and AQP1/AQP5 expression to reduce inflammatory reaction and lessen pulmonary edema.

  18. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  19. Relationship between clinical assessments of function and measurements from an upper-limb robotic rehabilitation device in cervical spinal cord injury.

    Science.gov (United States)

    Zariffa, José; Kapadia, Naaz; Kramer, John L K; Taylor, Philippa; Alizadeh-Meghrazi, Milad; Zivanovic, Vera; Albisser, Urs; Willms, Rhonda; Townson, Andrea; Curt, Armin; Popovic, Milos R; Steeves, John D

    2012-05-01

    Upper limb robotic rehabilitation devices can collect quantitative data about the user's movements. Identifying relationships between robotic sensor data and manual clinical assessment scores would enable more precise tracking of the time course of recovery after injury and reduce the need for time-consuming manual assessments by skilled personnel. This study used measurements from robotic rehabilitation sessions to predict clinical scores in a traumatic cervical spinal cord injury (SCI) population. A retrospective analysis was conducted on data collected from subjects using the Armeo Spring (Hocoma, AG) in three rehabilitation centers. Fourteen predictive variables were explored, relating to range-of-motion, movement smoothness, and grip ability. Regression models using up to four predictors were developed to describe the following clinical scores: the GRASSP (consisting of four sub-scores), the ARAT, and the SCIM. The resulting adjusted R(2) value was highest for the GRASSP "Quantitative Prehension" component (0.78), and lowest for the GRASSP "Sensibility" component (0.54). In contrast to comparable studies in stroke survivors, movement smoothness was least beneficial for predicting clinical scores in SCI. Prediction of upper-limb clinical scores in SCI is feasible using measurements from a robotic rehabilitation device, without the need for dedicated assessment procedures.

  20. Isolated limb infusion with melphalan and dactinomycin for regional melanoma and soft-tissue sarcoma of the extremity: final report of a phase II clinical trial.

    Science.gov (United States)

    Brady, Mary S; Brown, Karen; Patel, Ami; Fisher, Charles; Marx, Will

    2009-04-01

    Isolated limb infusion (ILI) is a minimally invasive technique of delivering regional chemotherapy in patients with advanced melanoma or soft-tissue sarcoma of the limb. We report the final results of the first clinical trial of ILI in North America (NCT00004250). Eligible patients had recurrent melanoma or unresectable soft-tissue sarcoma of the limb. Angiographic catheters were positioned just above the knee or elbow of the extremity. General anesthesia was performed, a proximal tourniquet inflated, and a normothermic, low flow, hypoxic infusion of melphalan and dactinomycin circulated through the involved limb for 20 min. Tumor response and morbidity were assessed using standard criteria. Thirty-seven patients were accrued to the trial and 44 ILIs were performed (eight patients had two ILIs); one patient was not treated. Of the 32 evaluable patients, 17 (53%) had a significant response at 3 months: 25% of patients had a complete response and 28% of patients had a partial response. The median duration of complete response was 1 year (5-32 months). Morbidity was acceptable, with peak erythema, edema, and pain experienced at 2 weeks and considered 'moderate' in most patients. No patients developed compartment syndrome or required amputation because of ILI. ILI is well tolerated. More than half of the treated patients experienced a complete or partial response.

  1. Intergrating injury screening with measurement and monitoring: a conceptual approach using a patient global assessment of the body and limbs scale

    Directory of Open Access Journals (Sweden)

    P. Gabel

    2006-02-01

    Full Text Available Purpose: To  develop a conceptual model for patients withmusculoskeletal injuries that relates Injury Screening to Measurement and Monitoring (ISMAM. Screening scores would predict quantifiable outcomes on a proposed Global Assessment of Body And Limbs (GABAL composite scale.  The scale would define status as a percentage of pre-injury capacity using quantitative and qualitative self report outcome measures combined with work and life status data. Background: Screening questionnaires use psychosocial yellow flags and activity limitation to identify potential chronic patients. Outcome measures provide clinical evidence by establishing patient status and assessing intervening change.  Independently developed,definitive statistical links between these established concepts are yet to be determined. Description: The ISMAM components are integrated using a graph of time versus score on the GABAL-scale with initial screening predicting recovery time to a designated pre-injury percentage level.  Actual status would be assessed through initial then subsequent sequential measurements with GABAL-scale scores enabling trendline analysis to  verify if the rate of actual recovery coincides with that predicted by screening. Observations: Face and content validity are apparent because validated screening tools are available and the requiredcomponents for the GABAL-scale would be existing validated outcome measures and quantifiable data.Conclusions: This model should provide a practical method of integrating screening and global measurement thatfacilitates communication across agencies and professions.  A clinical research trial to validate the ISMAM concepthas been initiated.

  2. Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit

    Directory of Open Access Journals (Sweden)

    Jose Chacko

    2012-01-01

    Full Text Available Background and Aims: Although smoke inhalation is well known to cause acute lung injury, there are few reports in literature that study the evolution, clinical course and outcomes of isolated inhalational lung injury in a modern intensive care setting. A major fire disaster provided us the opportunity to study victims of isolated inhalational injury admitted to our Multidisciplinary Intensive Care Unit (MICU. Materials and Methods: We studied the clinical course, ICU and hospital outcomes of 13 victims of a fire disaster who required mechanical ventilation for isolated inhalational lung injury. All patients were followed up at regular intervals, and their functional status was assessed at 8 months after hospital discharge. Results: The Lung Injury Scores (LIS worsened to reach a nadir on Day 3 of injury. There was a significant correlation between the LIS on Day 3 and duration of mechanical ventilation (r = 0.8; P = 0.003, ICU (r = 0.8; P = 0.002 and hospital (r = 0.6; P = 0.02 days. Late-onset airway complications were encountered in four patients. Three of them required long-term artificial airways - two with a tracheostomy while the third patient required surgical insertion of a "T" tube. Persistent problems with phonation occurred in two patients. At 8 months postdischarge, all patients were independent with activities of daily living; all were back to work, except for two who continued to need artificial airways. Conclusions: Inhalational lung injury progresses over the first few days and is worst after 72 h. Late-onset airway complications may manifest after several weeks and require repeated intervention.

  3. Isolated hand injuries on operational deployment: an examination of epidemiology and treatment strategy.

    Science.gov (United States)

    Penn-Barwell, Jowan G; Bennett, Philippa M; Powers, Dominic; Standley, David

    2011-12-01

    This study presents an analysis of 6 years of isolated hand injuries repatriated from Afghanistan or Iraq. Of a total of 6,337 medical cases evacuated back to the United Kingdom, 414 (6.5%) cases were identified as hand injuries; from these exclusions were: 207 who did not return to Royal Centre for Defence Medicine, 12 who were incorrectly coded, 1 was an old injury, and 41 whose notes were unavailable. The notes of the remaining 153 patients were reviewed: only 9% had battle injuries; nearly half involved fractures; overall, 73% required surgery, a total of 171 surgical episodes, a third of these operations occurred in deployed facilities. Patients with primary nerve or tendon repairs in deployed medical facilities had a trend toward significantly worse outcomes than those whose primary repair was delayed until repatriation. This study supports the current recommendation of delaying tendon and nerve repair until repatriation.

  4. Treatment Analysis of the Major Arterial Injuries in Limbs%四肢主干动脉损伤的治疗分析

    Institute of Scientific and Technical Information of China (English)

    潘力生; 方灿军; 聂宗杰; 刘会中

    2013-01-01

      目的:探讨四肢主干动脉损伤的有效治疗方法.方法:回顾性分析2007年1月~2012年1月47例四肢主干动脉损伤患者的治疗临床资料.外科手术42例,其中单纯动脉破裂修补术11例,直接吻合11例,大隐静脉移植术17例,人工血管移植术3例;另外5例行腔内治疗,其中覆膜支架植入3例,裸支架植入2例.结果:44例肢体成活,截肢3例.40例患者获门诊随访,为35例手术患者和5例腔内治疗病例,截肢患者均未随访.随访时间为3个月~3 a,平均随访时间15个月.在接受随访的35例手术患者中有5例吻合口处血管轻度狭窄,3例移植血管内重度狭窄,1例移植血管内闭塞;腔内治疗5例无明显异常发现.结论:外科手术及腔内治疗是四肢主干动脉损伤的有效治疗方法;选择合适的治疗方法,早期诊断和治疗,是保全肢体的关键.%Objective:To explore the effective therapeutic method of the major arterial injuries in limbs.Methods:The clinical data of 47 cases with the main arterial injuries in limbs treated in our department from January 2007 to January 2012 were retrospectively analyzed.42 cases were treated with surgery, including 11 cases with the simple artery rupture repair , 11 cases with artery direct anastomosis , 17 cases with great sa-phenous vein grafting and 3 cases with artificial blood vessels grafting , and the other 5 cases were treated with intracavitary therapy including stent implanted in 3 cases, and bare stent implantation in 2 cases.Results:44 limbs were survived, and 3 limbs were amputated.40 cases were followed up in our outpatient service , inclu-ding 35 cases surgical patients and 5 cases treated with intracavitary therapy , with the follow -up time for 3 months to 3 years;an average follow -up time was 15 months.Amputees were not followed up .Mild stenosis occurred in 5 operation cases, which happened at the site of anastomosis .Severe transplant intravascular artery stenosis

  5. Isolated cystic lesion of the callosal genu after traumatic brain injury.

    Science.gov (United States)

    Kato, Toru; Okumura, Akihisa; Tsuji, Takeshi; Emi, Misugi; Natsume, Jun

    2012-06-01

    We report the case of a 17-month-old infant who developed an isolated cystic lesion of the callosal genu as a unique lesion of traumatic axonal injury (TAI). Although one of the most common sites of TAI is the corpus callosum, there have been no reports describing the lesion seen in our patient. Brain computed tomography findings were normal on the day of the traffic accident. After 3 months, brain magnetic resonance imaging showed an isolated cystic lesion of the callosal genu that had the appearance of a cystic cavity. This lesion decreased in size 16 months later. The neuroimaging findings of this patient suggest that an isolated cystic lesion of the callosal genu could appear as a unique form of TAI in infants after traumatic brain injury (TBI), but it is nevertheless important to attend to such lesions in children with TBI.

  6. Botulinum toxin type A plus rehabilitative training for improving the motor function of the upper limbs and activities of daily life in patients with stroke and brain injury

    Institute of Scientific and Technical Information of China (English)

    Fei Guo; Wei Yue; Li Ren; Yumiao Zhang; Jing Yang

    2006-01-01

    BACKGROUND: Botulinum toxin type A (BTX-A) is mostly to be used to treat various diseases of motor disorders, whereas its effect on muscle spasm after stroke and brain injury needs further observation.OBJECTIVE : To observe the effect of BTX-A plus rehabilitative training on treating muscle spasm after stroke and brain injury.DESIGN: A randomized controlled observation.SETTINGS: Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University.PARTICIPANTS: Sixty inpatients with brain injury and stroke were selected from the Department of Rehabilitation, Department of Neurology and Department of Neurosurgery, the Second Hospital of Hebei Medical University from January 2001 to August 2006. They were all confirmed by CT and MRI, and had obvious increase of spastic muscle strength in upper limbs, their Ashworth grades were grade 2 or above. The patients were randomly divided into treatment group (n =30) and control group (n =30).METHODS: ① Patients in the treatment group undertook comprehensive rehabilitative trainings, and they were administrated with domestic BTX-A, which was provided by Lanzhou Institute of Biological Products, Ministry of Health (S10970037), and the muscles of flexion spasm were selected for upper limbs, 20-25 IU for each site.② Patients in the treatment group were assessed before injection and at 1 and 2 weeks, 1 and 3 months after injection respectively, and those in the control group were assessed at corresponding time points. The recovery of muscle spasm was assessed by modified Ashworth scale (MAS, grade 0-Ⅳ; Grade 0 for without increase of muscle strength; Grade Ⅳ for rigidity at passive flexion and extension); The recovery of motor function of the upper limbs was evaluated with Fugl-Meyer Assessment (FMA, total score was 226 points, including 100 for exercise, 14 for balance, 24 for sense, 44 for joint motion, 44 for pain and 66 for upper limb); The ADL were

  7. The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Pollard Henry

    2010-04-01

    Full Text Available Abstract Background Hamstring injuries are the most common injury in Australian Rules football. It was the aims to investigate whether a sports chiropractic manual therapy intervention protocol provided in addition to the current best practice management could prevent the occurrence of and weeks missed due to hamstring and other lower-limb injuries at the semi-elite level of Australian football. Methods Sixty male subjects were assessed for eligibility with 59 meeting entry requirements and randomly allocated to an intervention (n = 29 or control group (n = 30, being matched for age and hamstring injury history. Twenty-eight intervention and 29 control group participants completed the trial. Both groups received the current best practice medical and sports science management, which acted as the control. Additionally, the intervention group received a sports chiropractic intervention. Treatment for the intervention group was individually determined and could involve manipulation/mobilization and/or soft tissue therapies to the spine and extremity. Minimum scheduling was: 1 treatment per week for 6 weeks, 1 treatment per fortnight for 3 months, 1 treatment per month for the remainder of the season (3 months. The main outcome measure was an injury surveillance with a missed match injury definition. Results After 24 matches there was no statistical significant difference between the groups for the incidence of hamstring injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051 and primary non-contact knee injury (OR:0.116, 95% CI:0.013-1.019, p = 0.051. The difference for primary lower-limb muscle strains was significant (OR:0.097, 95%CI:0.011-0.839, p = 0.025. There was no significant difference for weeks missed due to hamstring injury (4 v14, χ2:1.12, p = 0.29 and lower-limb muscle strains (4 v 21, χ2:2.66, p = 0.10. A significant difference in weeks missed due to non-contact knee injury was noted (1 v 24, χ2:6.70, p = 0.01. Conclusions This study

  8. "When can I return to driving?": a review of the current literature on returning to driving after lower limb injury or arthroplasty.

    Science.gov (United States)

    MacLeod, K; Lingham, A; Chatha, H; Lewis, J; Parkes, A; Grange, S; Smitham, P J

    2013-03-01

    Clinicians are often asked by patients, "When can I drive again?" after lower limb injury or surgery. This question is difficult to answer in the absence of any guidelines. This review aims to collate the currently available evidence and discuss the factors that influence the decision to allow a patient to return to driving. Medline, Web of Science, Scopus, and EMBASE were searched using the following terms: 'brake reaction time', 'brake response time', 'braking force', 'brake pedal force', 'resume driving', 'rate of application of force', 'driving after injury', 'joint replacement and driving', and 'fracture and driving'. Of the relevant literature identified, most studies used the brake reaction time and total brake time as the outcome measures. Varying recovery periods were proposed based on the type and severity of injury or surgery. Surveys of the Driver and Vehicle Licensing Agency, the Police, insurance companies in the United Kingdom and Orthopaedic Surgeons offered a variety of opinions. There is currently insufficient evidence for any authoritative body to determine fitness to drive. The lack of guidance could result in patients being withheld from driving for longer than is necessary, or returning to driving while still unsafe.

  9. A modern-day solution to a 100-year-old problem: the use of a Bespoke Off-loading Brace in the rehabilitation of 'Deck-Slap' and other high-energy lower limb injuries.

    Science.gov (United States)

    Osborne, M A; Jarvis, H L; Bennett, N; Phillip, R D

    2014-01-01

    'Deck-Slap' is an injury pattern first described at the Battle of Jutland; it is still relevant today, with anti-vehicle mines a significant threat to Coalition troops. The effect of a device exploding beneath a vehicle produces a wave of high energy that is rapidly transmitted through the steel floor; this causes significant axial loading of lower limbs often resulting in severe fractures (notably of the calcaneum). Recent advancements in orthopaedic surgery have allowed for limbs that were destined for immediate amputation following significant trauma to be salvaged. However, despite intense rehabilitation, many of these salvaged limbs have subsequently gone on to delayed amputation, as functional outcomes are often poor. Technologically advanced prosthetic devices are available that afford good quality of life and allow for increased activity levels; these devices are, however, expensive to procure and maintain. This report describes a United Kingdom (UK) Armed Forces soldier who suffered a typical 'deck-slap' injury in Afghanistan with subsequent limb salvage. The use of the Bespoke Off-loading Brace (BOB) is discussed. The results presented here indicate that the biomechanical function of a patient with this type of injury improves when wearing the BOB. Further studies are needed to assess long-term clinical outcomes and the functional benefit of the device as a viable and cost-effective alternative to delayed limb amputation.

  10. Kinematic Metrics Based on the Virtual Reality System Toyra as an Assessment of the Upper Limb Rehabilitation in People with Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Fernando Trincado-Alonso

    2014-01-01

    Full Text Available The aim of this study was to develop new strategies based on virtual reality that can provide additional information to clinicians for the rehabilitation assessment. Virtual reality system Toyra has been used to record kinematic information of 15 patients with cervical spinal cord injury (SCI while performing evaluation sessions using the mentioned system. Positive correlation, with a moderate and very strong association, has been found between clinical scales and kinematic data, considering only the subscales more closely related to the upper limb function. A set of metrics was defined combining these kinematic data to obtain parameters of reaching amplitude, joint amplitude, agility, accuracy, and repeatability during the evaluation sessions of the virtual reality system Toyra. Strong and moderate correlations have been also found between the metrics reaching and joint amplitude and the clinical scales.

  11. Radiation exposure to surgical staff during hyperthermic isolated limb perfusion with 99m Technetium labeled red blood cells

    DEFF Research Database (Denmark)

    Kristoffersen, Ulrik Sloth; Straalman, Kristina; Schmidt, Grethe

    2009-01-01

    to the limb circuit. This has made HILP safe for the patient. However, the radiation exposure to the surgical staff has never been measured and could be a limiting factor for the use of HILP. The purpose of the present study was to measure and evaluate the radiation exposure to the surgical staff performing...

  12. Isolated hepatic artery injury in blunt abdominal trauma presenting as upper gastrointestinal bleeding: treatment with transcatheter embolisation.

    Science.gov (United States)

    Taslakian, Bedros; Ghaith, Ola; Al-Kutoubi, Aghiad

    2012-11-15

    Liver injury in blunt abdominal trauma is common. However, not often does blunt trauma cause injury to the anatomical structures of the porta hepatis. Isolated injury of the hepatic artery has been rarely reported in the literature. Such injury may be lethal and requires immediate diagnosis and management. This report describes an unusual case of blunt abdominal trauma resulting in hepatic and gastroduodenal artery dissection, with pseudoaneurysm formation complicated by active upper gastrointestinal bleeding. The injury was managed by transcatheter embolisation. Awareness of this diagnosis should facilitate management of similar trauma cases.

  13. Protective Effect of Liriodendrin Isolated from Kalopanax pictus against Gastric Injury

    OpenAIRE

    Sohn, Yoon Ah; Hwang, Seon A; Lee, Sun Yi; Hwang, In Young; Kim, Sun Whoe; Kim, So Yeon; Moon, Aree; Lee, Yong Soo; Kim, Young Ho; Kang, Keum Jee; Jeong, Choon Sik

    2015-01-01

    In this study, we investigated the inhibitory activities on gastritis and gastric ulcer using liriodendrin which is a constituent isolated from Kalopanax pictus. To elucidate its abilities to prevent gastric injury, we measured the quantity of prostaglandin E2 (PGE2) as the protective factor, and we assessed inhibition of activities related to excessive gastric acid be notorious for aggressive factor and inhibition of Helicobacter pylori (H. pylori) colonization known as a cause of chronic ga...

  14. Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers.

    Science.gov (United States)

    Foye, Patrick M; Sullivan, William J; Panagos, Andre; Zuhosky, Joseph P; Sable, Aaron W; Irwin, Robert W

    2007-03-01

    This self-directed study module focuses on the use of corticosteroids and other injections in the treatment of lateral epicondylitis, de Quervain's tenosynovitis, carpal tunnel syndrome, Achilles' tendinitis, and plantar fasciitis. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. To review the medical literature to help clinicians make treatment decisions regarding corticosteroid and other injections in the upper and lower limbs in injured workers.

  15. Plasma cytokine expression after lower-limb compression in rats

    Directory of Open Access Journals (Sweden)

    Mauricio Wanderley Moral Sgarbi

    2015-02-01

    Full Text Available OBJECTIVES: Muscle injury due to crushing (muscle compression injury is associated with systemic manifestations known as crush syndrome. A systemic inflammatory reaction may also be triggered by isolated muscle injury. The aim of this study was to investigate the plasma levels of interleukins (IL 1, 6 and 10 and tumor necrosis factor alpha (TNF-α, which are markers for possible systemic inflammatory reactions, after isolated muscle injury resulting from lower-limb compression in rats.METHODS: Male Wistar rats were subjected to 1 h of compression of their lower limbs by means of a rubber band. The plasma levels of IL 1, 6 and 10 and TNF-α were measured 1, 2 and 4 h after the rats were released from compression.RESULTS: The plasma levels of IL 10 decreased in relation to those of the other groups, with a statistically significant difference (p < 0.05. The method used did not detect the presence of IL 1, IL 6 or TNF-α.CONCLUSION: Our results demonstrated that the changes in plasma levels of IL 10 that were found may have been a sign of the presence of circulating interleukins in this model of lower-limb compression in rats.

  16. Reperfusion injury in skeletal muscle: a prospective study in patients with acute limb ischaemia and claudicants treated by revascularization.

    Science.gov (United States)

    Adiseshiah, M; Round, J M; Jones, D A

    1992-10-01

    A study was carried out to document the occurrence of rhabdomyolysis and renal complications in patients undergoing vascular reconstruction. Indices of muscle damage and renal function were monitored before, during and for up to 10 days after vascular reconstruction for a variety of conditions ranging from intermittent claudication to acute ischaemia. Seven patients with acute limb ischaemia (group 1) and nine with intermittent claudication (group 2) were studied prospectively. In group 1, median creatine kinase (CK) and myoglobin levels were markedly raised 24-48 h after surgery (CK, 29,370 units/l; myoglobin, 8.17 mg/l). Myoglobin reached its peak concentration and declined more quickly than CK, but both indices gave similar information about the extent of muscle damage. In contrast, patients undergoing elective surgery for claudication showed no significant departure from reference values for myoglobin or CK. All patients in group 1 underwent fasciotomy to relieve raised compartmental pressures and five were treated with alkali and mannitol to produce diuresis. Despite these measures, two patients suffered renal failure (peak creatinine levels 611 and 590 mumol/l) after successful revascularization and subsequently required haemodialysis; these patients did not have diuresis. One of these patients died following a stroke 8 days after surgery; the other survived and was discharged with a normal limb and restored renal function. There was no evidence of muscle damage or renal complications in group 2.(ABSTRACT TRUNCATED AT 250 WORDS)

  17. THE INCIDENCE OF NOSOCOMIAL INFECTIONS IN PATIENTS WITH ISOLATED SEVERE TRAUMATIC BRAIN INJURY

    Directory of Open Access Journals (Sweden)

    Valenčić Lara

    2015-12-01

    Full Text Available Introduction: Traumatic brain injury is the leading cause of death in children and adults in developed countries. Severe traumatic brain injury is classified with Glasgow Coma Scale score 8 and less. About 50% of patients with severe traumatic brain injury developes at least one infection as a complication of primary condition during hospitalization in the Intensive Care Unit, resulting with fatal outcome in 28% of patients. Ventilator associated pneumonia is the leading infection that affects patients with severe traumatic brain injury, with an incidence between 41% and 74%. Following are sepsis and urinary tract infections. The aim: To analyze the number of patients with nosocomial infection and isolated severe traumatic brain injury hospitalized in the Intensive Care Unit of the Clinical Hospital Centre Rijeka, Croatia, from 31st  January 2013 to 31st December 2014. Patients and methods: A two year retrospective study included 46 patients with isolated severe traumatic brain injury and nosocomial infection hospitalized in the Intensive Care Unit of the Clinical Hospital Centre Rijeka,Croatia, in the period from 31st January 2013 to 31st December 2014. All medical data was collected from the Division of Intensive Care Unit, Clinical Hospital Centre Rijeka, Croatia. Results: From 67 patients with isolated severe traumatic brain injury, 46 (68,65% of them developed nosocomial infection. There was statistically significant more male patients than female (p<0.05. The average age of infected patients was 57,8 years. The leading were the infections of the respiratory system. Gram negative bacteria Proteus mirabilis and Pseudomonas aerugnonsa were the leading pathogens. The average duration of the infection was 5,77 days. For 16 (34,78% of 46 patients the treatment outcome was lethal. Conclusion: Nosocomial infections are becoming a major public health problem. The emphasis must be set on the prevention which includes maintaining the hygiene and

  18. Prevention of reperfusion lung injury by lidocaine in isolated rat lung ventilated with higher oxygen levels.

    Directory of Open Access Journals (Sweden)

    Das K

    2003-01-01

    Full Text Available BACKGROUND: Lidocaine, an antiarrhythmic drug has been shown to be effective against post-ischaemic reperfusion injury in heart. However, its effect on pulmonary reperfusion injury has not been investigated. AIMS: We investigated the effects of lidocaine on a postischaemic reperfused rat lung model. MATERIALS AND METHODS: Lungs were isolated and perfused at constant flow with Krebs-Henseilet buffer containing 4% bovine serum albumin, and ventilated with 95% oxygen mixed with 5% CO2. Lungs were subjected to ischaemia by stopping perfusion for 60 minutes followed by reperfusion for 10 minutes. Ischaemia was induced in normothermic conditions. RESULTS: Postischaemic reperfusion caused significant (p < 0.0001 higher wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure compared to control lungs. Lidocaine, at a dose of 5mg/Kg b.w. was found to significantly (p < 0.0001 attenuate the increase in the wet-to-dry lung weight ratio, pulmonary arterial pressure and peak airway pressure observed in post-ischaemic lungs. CONCLUSION: Lidocaine is effective in preventing post-ischaemic reperfusion injury in isolated, perfused rat lung.

  19. [Isolated traumatic injuries of the axillary nerve. Radial nerve transfer in four cases and literatura review].

    Science.gov (United States)

    Domínguez-Páez, Miguel; Socolovsky, Mariano; Di Masi, Gilda; Arráez-Sánchez, Miguel Ángel

    2012-11-01

    To analyze the results of an initial series of four cases of traumatic injuries of the axillary nerve, treated by a nerve transfer from the triceps long branch of the radial nerve. An extensive analysis of the literature has also been made. Four patients aged between 21 and 42 years old presenting an isolated traumatic palsy of the axillary nerve were operated between January 2007 and June 2010. All cases were treated by nerve transfer six to eight months after the trauma. The results of these cases are analyzed, the same as the axillary nerve injuries series presented in the literature from 1982. One year after the surgery, all patients improved their abduction a mean of 70° (range 30 to 120°), showing a M4 in the British Medical Council Scale. No patient complained of triceps weakness after the procedure. These results are similar to those published employing primary grafting for the axillary nerve. Isolated injuries of the axillary nerve should be treated with surgery when spontaneous recovery is not verified 6 months after the trauma. Primary repair with grafts is the most popular surgical technique, with a rate of success of approximately 90%. The preliminary results of a nerve transfer employing the long triceps branch are similar, and a definite comparison of both techniques with a bigger number of cases should be done in the future. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  20. Hydrogen Gas Ameliorates Hepatic Reperfusion Injury After Prolonged Cold Preservation in Isolated Perfused Rat Liver.

    Science.gov (United States)

    Shimada, Shingo; Wakayama, Kenji; Fukai, Moto; Shimamura, Tsuyoshi; Ishikawa, Takahisa; Fukumori, Daisuke; Shibata, Maki; Yamashita, Kenichiro; Kimura, Taichi; Todo, Satoru; Ohsawa, Ikuroh; Taketomi, Akinobu

    2016-12-01

    Hydrogen gas reduces ischemia and reperfusion injury (IRI) in the liver and other organs. However, the precise mechanism remains elusive. We investigated whether hydrogen gas ameliorated hepatic I/R injury after cold preservation. Rat liver was subjected to 48-h cold storage in University of Wisconsin solution. The graft was reperfused with oxygenated buffer with or without hydrogen at 37° for 90 min on an isolated perfusion apparatus, comprising the H2 (+) and H2 (-) groups, respectively. In the control group (CT), grafts were reperfused immediately without preservation. Graft function, injury, and circulatory status were assessed throughout the perfusion. Tissue samples at the end of perfusion were collected to determine histopathology, oxidative stress, and apoptosis. In the H2 (-) group, IRI was indicated by a higher aspartate aminotransferase (AST), alanine aminotransferase (ALT) leakage, portal resistance, 8-hydroxy-2-deoxyguanosine-positive cell rate, apoptotic index, and endothelial endothelin-1 expression, together with reduced bile production, oxygen consumption, and GSH/GSSG ratio (vs. CT). In the H2 (+) group, these harmful changes were significantly suppressed [vs. H2 (-)]. Hydrogen gas reduced hepatic reperfusion injury after prolonged cold preservation via the maintenance of portal flow, by protecting mitochondrial function during the early phase of reperfusion, and via the suppression of oxidative stress and inflammatory cascades thereafter. Copyright © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  1. Morphology of Donor and Recipient Nerves Utilised in Nerve Transfers to Restore Upper Limb Function in Cervical Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Aurora Messina

    2016-09-01

    Full Text Available Loss of hand function after cervical spinal cord injury (SCI impacts heavily on independence. Multiple nerve transfer surgery has been applied successfully after cervical SCI to restore critical arm and hand functions, and the outcome depends on nerve integrity. Nerve integrity is assessed indirectly using muscle strength testing and intramuscular electromyography, but these measures cannot show the manifestation that SCI has on the peripheral nerves. We directly assessed the morphology of nerves biopsied at the time of surgery, from three patients within 18 months post injury. Our objective was to document their morphologic features. Donor nerves included teres minor, posterior axillary, brachialis, extensor carpi radialis brevis and supinator. Recipient nerves included triceps, posterior interosseus (PIN and anterior interosseus nerves (AIN. They were fixed in glutaraldehyde, processed and embedded in Araldite Epon for light microscopy. Eighty percent of nerves showed abnormalities. Most common were myelin thickening and folding, demyelination, inflammation and a reduction of large myelinated axon density. Others were a thickened perineurium, oedematous endoneurium and Renaut bodies. Significantly, very thinly myelinated axons and groups of unmyelinated axons were observed indicating regenerative efforts. Abnormalities exist in both donor and recipient nerves and they differ in appearance and aetiology. The abnormalities observed may be preventable or reversible.

  2. Upper limb joint kinetic analysis during tennis serve: Assessment of competitive level on efficiency and injury risks.

    Science.gov (United States)

    Martin, C; Bideau, B; Ropars, M; Delamarche, P; Kulpa, R

    2014-08-01

    The aim of this work was to compare the joint kinetics and stroke production efficiency for the shoulder, elbow, and wrist during the serve between professionals and advanced tennis players and to discuss their potential relationship with given overuse injuries. Eleven professional and seven advanced tennis players were studied with an optoelectronic motion analysis system while performing serves. Normalized peak kinetic values of the shoulder, elbow, and wrist joints were calculated using inverse dynamics. To measure serve efficiency, all normalized peak kinetic values were divided by ball velocity. t-tests were used to determine significant differences between the resultant joint kinetics and efficiency values in both groups (advanced vs professional). Shoulder inferior force, shoulder anterior force, shoulder horizontal abduction torque, and elbow medial force were significantly higher in advanced players. Professional players were more efficient than advanced players, as they maximize ball velocity with lower joint kinetics. Since advanced players are subjected to higher joint kinetics, the results suggest that they appeared more susceptible to high risk of shoulder and elbow injuries than professionals, especially during the cocking and deceleration phases of the serve.

  3. The prevalence of symptoms of Post-Traumatic Stress Disorder among soldiers with amputation of a limb or spinal injury: a report from a rehabilitation centre in Sri Lanka.

    Science.gov (United States)

    Abeyasinghe, N L; de Zoysa, P; Bandara, K M K C; Bartholameuz, N A; Bandara, J M U J

    2012-01-01

    Post-Traumatic Stress Disorder has been identified as one of the most commonly occurring mental illnesses in combatants. This study was conducted to determine the prevalence of Post-Traumatic Stress Disorder among soldiers who had undergone amputation of a lower or an upper limb or sustained a spinal cord injury in the battlefield, and to compare the prevalence among these categories. The research presented seeks to increase the awareness of this condition among those treating war casualties so that appropriate treatment choices could be made to address them. The study was carried out in 2009 at a rehabilitation centre for combatants of war. Data were collected from 96 male army veterans between the ages of 18-49 years using a pre-tested self-administered questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, the Impact of Event Scale and the PTSD symptom scale. Soldiers with injuries sustained at least four weeks prior to the study were selected by a convenience sampling technique. Soldiers with multiple injuries, head injuries or those diagnosed with psychiatric disorders were excluded. The results revealed that 41.7% of the study population was compatible with the diagnosis of Post-Traumatic Stress Disorder. Within the three groups, 42.5% of the lower limb amputees, 33.3% of the upper limb amputees and 45.7% of the participants with spinal cord injury had symptoms compatible with Post-Traumatic Stress Disorder. There was no difference between the prevalence among the different injury categories considered. This study highlights the need to pay more attention in providing psychological care as a part of the overall health management of injured combatants. Early preparation of soldiers for stressors of war and screening for and proper management of Post-Traumatic Stress Disorder will improve the overall outcome of rehabilitation.

  4. Effects of Lipoteichoic Acid induced Delayed Preconditioning on Ischemia-reperfusion Injury in Isolated Rat Hearts

    Institute of Scientific and Technical Information of China (English)

    马世玉; 向继洲; 吴基良; 胡本容

    2003-01-01

    To explore the potential of lipoteichoic acid (LTA) induced cardioprotection against is-chemia-reperfusion (I/R) injury in isolated rat hearts and whether endogenous nitric oxide (NO)participates-in the protection, the rats were pretreated with LTA (1 mg/kg, i. p. ) 24 h before theexperiment, and the isolated hearts were subjected to 30 min no-flow normothermic global ischemiaand 60 min reperfusion after a 20-min stabilization period by the langendorff method. Cardiac func-tions were evaluated at the end of stabilization, and at 30 min, 60 min of reperfusion. The amountsof MB isoenzyme of creatine kinase (CK-MB), lactate dehydrogenase(LDH) and total NO oxidationproducts in the coronary effluent were measured spectrophotometrically at the end of reperfusion. Itwas revealed that pretreatment with LTA could significantly improve the recovery of cardiac func-tion, reduce the release of CK-MB and LDH, and increase the concentrations of NO in coronary ef-fluent. The protective effects were abrogated by pretreatment of the rats with L-NAME. It wasconcluded that LTA could induce the delayed cardioprotection against I/R injury, and endogenousNO may be involved in the mechanisms.

  5. Sympathoadrenal Activation is Associated with Acute Traumatic Coagulopathy and Endotheliopathy in Isolated Brain Injury

    Science.gov (United States)

    Di Battista, Alex P.; Rizoli, Sandro B.; Lejnieks, Brandon; Min, Arimie; Shiu, Maria Y.; Peng, Henry T.; Baker, Andrew J.; Hutchison, Michael G.; Churchill, Nathan; Inaba, Kenji; Nascimento, Bartolomeu B.; de Oliveira Manoel, Airton Leonardo; Beckett, Andrew; Rhind, Shawn G.

    2016-01-01

    ABSTRACT Background: Acute coagulopathy after traumatic brain injury (TBI) involves a complex multifactorial hemostatic response that is poorly characterized. Objectives: To examine early posttraumatic alterations in coagulofibrinolytic, endothelial, and inflammatory blood biomarkers in relation to sympathetic nervous system (SNS) activation and 6-month patient outcomes, using multivariate partial least-squares (PLS) analysis. Patients and Methods: A multicenter observational study of 159 adult isolated TBI patients admitted to the emergency department at an urban level I trauma center, was performed. Plasma concentrations of 6 coagulofibrinolytic, 10 vascular endothelial, 19 inflammatory, and 2 catecholamine biomarkers were measured by immunoassay on admission and 24 h postinjury. Neurological outcome at 6 months was assessed using the Extended Glasgow Outcome Scale. PLS-discriminant analysis was used to identify salient biomarker contributions to unfavorable outcome, whereas PLS regression analysis was used to evaluate the covariance between SNS correlates (catecholamines) and biomarkers of coagulopathy, endotheliopathy, and inflammation. Results: Biomarker profiles in patients with an unfavorable outcome displayed procoagulation, hyperfibrinolysis, glycocalyx and endothelial damage, vasculature activation, and inflammation. A strong covariant relationship was evident between catecholamines and biomarkers of coagulopathy, endotheliopathy, and inflammation at both admission and 24 h postinjury. Conclusions: Biomarkers of coagulopathy and endotheliopathy are associated with poor outcome after TBI. Catecholamine levels were highly correlated with endotheliopathy and coagulopathy markers within the first 24 h after injury. Further research is warranted to characterize the pathogenic role of SNS-mediated hemostatic alterations in isolated TBI. PMID:27206278

  6. High plasma tumor necrosis factor (TNF)-alpha concentrations and a sepsis-like syndrome in patients undergoing hyperthermic isolated limb perfusion with recombinant TNF-alpha, interferon-gamma, and melphalan

    NARCIS (Netherlands)

    Zwaveling, JH; Maring, JK; Clarke, FL; vanGinkel, RJ; Limburg, PC; Hoekstra, HJ; Girbes, ARJ; Schraffordt Koops, H.

    1996-01-01

    Objectives: To describe the postoperative course of patients who underwent hyperthermic isolated limb perfusion with recombinant tumor necrosis factor (TNF)-alpha and melphalan after pretreat ment with recombinant interferon-gamma as treatment for recurrent melanoma, primary nonresectable soft-tissu

  7. Effect of valproic acid and injury on lesion size and endothelial glycocalyx shedding in a rodent model of isolated traumatic brain injury

    DEFF Research Database (Denmark)

    Jepsen, Cecilie Heerdegen; deMoya, Marc A; Perner, Anders;

    2014-01-01

    BACKGROUND: In isolated traumatic brain injury (TBI), little is known about the endothelial response and the effects of endothelial glycocalyx shedding. We have previously shown that treatment with valproic acid (VPA) improves outcomes following TBI and hemorrhagic shock.In this model, we...... hypothesized that severe isolated TBI would cause shedding of the endothelial glycocalyx, as measured by serum syndecan-1 (sSDC-1) levels. We further hypothesized that VPA treatment would reduce this response and reduce lesion size volume. METHODS: Forty Sprague-Dawley rats were allocated to TBI + VPA (n = 8......), TBI + saline vehicle control infusion (n = 8), sham + saline vehicle control infusion (n = 6), or sham + VPA (n = 8). TBI animals were subjected to severe controlled cortical impact and killed 6 hours after injury. VPA 300 mg/kg was given as an intravenous bolus 30 minutes after injury. Serum samples...

  8. Low Field Magnetic Resonance Imaging of Lower Limb Muscle Injury%下肢肌肉损伤的低场MRI表现

    Institute of Scientific and Technical Information of China (English)

    丁长青; 王文生; 丁爱兰; 崔智慧; 史志卫

    2012-01-01

    Objective To analyze the imaging of lower limb muscle injury in low field MRI. Methods The low-field MRI data of 45 patients with muscle damage confirmed by clinic were analysed retrospectively. Results Strain in 16 cases.which performed low T1WI high T2WI signal at the junction of tendon;contusion in 12 cases, which performed the form of direct injuries edema, muscle volume increase in T1 WI low signal of high T2WI signal; hematoma in 10 cases, which showed mass lesions within the muscle, due to different periods may have different signal performance; acute compartment syndrome in 4 cases, which performed T1 WI low T2WI high signal of affected muscle edema and blur compartment structure;chronic compartment syndrome in 3 cases, which performed T1WI low signal T2 WI high signal area of 2/3 above of skeletal muscle length in a specific compartment the signal of soluble liquid in the muscle could be seen; fascial hernia 1 case, which exhibited the muscle protruding through the fascial defect and was obvious in muscle contraction. Conclusion MRI has an important significance in the diagnosis of lower limb muscle injury.%目的 分析下肢肌肉损伤的低场MRI表现.方法 回顾性分析临床证实的45例肌肉损伤的患者的低场MRI资料.结果 拉伤1 6例,表现为肌腱交界处呈T1WI低信号T2WI高信号的线状或片状影;挫伤12例;表现为直接受伤部位水肿,肌肉体积增大呈T1WI低信号T2WI高信号;血肿1 0例,表现为肌肉内团块状病变,因时期不同可有不同的信号表现;急性骨筋膜室综合症4例,表现为受累肌肉高度水肿、肌间隔结构模糊,呈T1WI低信号T2WI高信号;慢性骨筋膜室综合征3例,表现为特定筋膜室间腔内累及骨骼肌全长2/3以上的T1WI低信号T2WI高信号区,内可见骨骼肌溶解液化信号.结论 MRI在下肢肌肉损伤中具有重要诊断意义.

  9. Effects of dexmedetomidine on renal tissue after lower limb ischemia reperfusion injury in streptozotocin induced diabetic rats

    Science.gov (United States)

    Erbatur, Meral Erdal; Sezen, Şaban Cem; Bayraktar, Aslıhan Cavunt; Arslan, Mustafa; Kavutçu, Mustafa; Aydın, Muhammed Enes

    2017-01-01

    ABSTRACT Aim: The aim of this study was to investigate whether dexmedetomidine – administered before ischemia – has protective effects against lower extremity ischemia reperfusion injury that induced by clamping and subsequent declamping of infra-renal abdominal aorta in streptozotocin-induced diabetic rats. Material and Methods: After obtaining ethical committee approval, four study groups each containing six rats were created (Control (Group C), diabetes-control (Group DM-C), diabetes I/R (Group DM-I/R), and diabetes-I/R-dexmedetomidine (Group DM-I/R-D). In diabetes groups, single-dose (55 mg/kg) streptozotocin was administered intraperitoneally. Rats with a blood glucose level above 250 mg/dl at the 72nd hour were accepted as diabetic. At the end of four weeks, laparotomy was performed in all rats. Nothing else was done in Group C and DM-C. In Group DM-I/R, ischemia reperfusion was produced via two-hour periods of clamping and subsequent declamping of infra-renal abdominal aorta. In Group DM-I/R-D, 100 μg/kg dexmedetomidine was administered intraperitoneally 30 minutes before ischemia period. At the end of reperfusion, period biochemical and histopathological evaluation of renal tissue specimen were performed. Results: Thiobarbituric acid reactive substance (TBARS), Superoxide dismutase (SOD), Nitric oxide synthase (NOS), Catalase (CAT) and Glutathion S transferase (GST) levels were found significantly higher in Group DM-I/R when compared with Group C and Group DM-C. In the dexmedetomidine-treated group, TBARS, NOS, CAT, and GST levels were significantly lower than those measured in the Group D-I/R. In histopathological evaluation, glomerular vacuolization (GV), tubular dilatation (TD), vascular vacuolization and hypertrophy (VVH), tubular cell degeneration and necrosis (TCDN), tubular hyaline cylinder (THC), leucocyte infiltration (LI), and tubular cell spillage (TCS) in Group DM-I/R were significantly increased when compared with the control group

  10. Niacinamide mitigated the acute lung injury induced by phorbol myristate acetate in isolated rat's lungs.

    Science.gov (United States)

    Lin, Chia-Chih; Hsieh, Nan-Kuang; Liou, Huey Ling; Chen, Hsing I

    2012-03-01

    Phorbol myristate acetate (PMA) is a strong neutrophil activator and has been used to induce acute lung injury (ALI). Niacinamide (NAC) is a compound of B complex. It exerts protective effects on the ALI caused by various challenges. The purpose was to evaluate the protective effects of niacinamide (NAC) on the PMA-induced ALI and associated changes. The rat's lungs were isolated in situ and perfused with constant flow. A total of 60 isolated lungs were randomized into 6 groups to received Vehicle (DMSO 100 μg/g), PMA 4 μg/g (lung weight), cotreated with NAC 0, 100, 200 and 400 mg/g (lung weight). There were 10 isolated lungs in each group. We measured the lung weight and parameters related to ALI. The pulmonary arterial pressure and capillary filtration coefficient (Kfc) were determined in isolated lungs. ATP (adenotriphosphate) and PARP [poly(adenosine diphophate-ribose) polymerase] contents in lung tissues were detected. Real-time PCR was employed to display the expression of inducible and endothelial NO synthases (iNOS and eNOS). The neutrophil-derived mediators in lung perfusate were determined. PMA caused increases in lung weight parameters. This agent produced pulmonary hypertension and increased microvascular permeability. It resulted in decrease in ATP and increase in PARP. The expression of iNOS and eNOS was upregulated following PMA. PMA increased the neutrophil-derived mediators. Pathological examination revealed lung edema and hemorrhage with inflammatory cell infiltration. Immunohistochemical stain disclosed the presence of iNOS-positive cells in macrophages and endothelial cells. These pathophysiological and biochemical changes were diminished by NAC treatment. The NAC effects were dose-dependent. Our results suggest that neutrophil activation and release of neutrophil-derived mediators by PMA cause ALI and associated changes. NO production through the iNOS-producing cells plays a detrimental role in the PMA-induced lung injury. ATP is beneficial

  11. Niacinamide mitigated the acute lung injury induced by phorbol myristate acetate in isolated rat's lungs

    Directory of Open Access Journals (Sweden)

    Lin Chia-Chih

    2012-03-01

    Full Text Available Abstract Background Phorbol myristate acetate (PMA is a strong neutrophil activator and has been used to induce acute lung injury (ALI. Niacinamide (NAC is a compound of B complex. It exerts protective effects on the ALI caused by various challenges. The purpose was to evaluate the protective effects of niacinamide (NAC on the PMA-induced ALI and associated changes. Methods The rat's lungs were isolated in situ and perfused with constant flow. A total of 60 isolated lungs were randomized into 6 groups to received Vehicle (DMSO 100 μg/g, PMA 4 μg/g (lung weight, cotreated with NAC 0, 100, 200 and 400 mg/g (lung weight. There were 10 isolated lungs in each group. We measured the lung weight and parameters related to ALI. The pulmonary arterial pressure and capillary filtration coefficient (Kfc were determined in isolated lungs. ATP (adenotriphosphate and PARP [poly(adenosine diphophate-ribose polymerase] contents in lung tissues were detected. Real-time PCR was employed to display the expression of inducible and endothelial NO synthases (iNOS and eNOS. The neutrophil-derived mediators in lung perfusate were determined. Results PMA caused increases in lung weight parameters. This agent produced pulmonary hypertension and increased microvascular permeability. It resulted in decrease in ATP and increase in PARP. The expression of iNOS and eNOS was upregulated following PMA. PMA increased the neutrophil-derived mediators. Pathological examination revealed lung edema and hemorrhage with inflammatory cell infiltration. Immunohistochemical stain disclosed the presence of iNOS-positive cells in macrophages and endothelial cells. These pathophysiological and biochemical changes were diminished by NAC treatment. The NAC effects were dose-dependent. Conclusions Our results suggest that neutrophil activation and release of neutrophil-derived mediators by PMA cause ALI and associated changes. NO production through the iNOS-producing cells plays a detrimental

  12. Comparison between dopaminergic agents and physical exercise as treatment for periodic limb movements in patients with spinal cord injury.

    Science.gov (United States)

    De Mello, M T; Esteves, A M; Tufik, S

    2004-04-01

    Randomized controlled trial of physical exercise and dopaminergic agonist in persons with spinal cord injury and periodic leg movement (PLM). The objective of the present study was to compare the effectiveness of physical exercise and of a dopaminergic agonist in reducing the frequency of PLM. Centro de Estudos em Psicobiologia e Exercício. Universidade Federal de São Paulo, Brazil. A total of 13 volunteers (mean age: 31.6+/-8.3 years) received L-DOPA (200 mg) and benserazide (50 mg) 1 h before sleeping time for 30 days and were then submitted to a physical exercise program on a manual bicycle ergometer for 45 days (3 times a week). Both L-DOPA administration (35.11-19.87 PLM/h, P<0.03) and physical exercise (35.11-18.53 PLM/h, P<0.012) significantly reduced PLM; however, no significant difference was observed between the two types of treatment. The two types of treatment were found to be effective in the reduction of PLM; however, physical exercise is indicated as the first treatment approach, while dopaminergic agonists or other drugs should only be recommended for patients who do not respond to this type of treatment.

  13. The isolated inferior glenohumeral labrum injury, anterior to posterior (the ILAP: A case series

    Directory of Open Access Journals (Sweden)

    Val Irion

    2015-01-01

    Full Text Available Introduction: We describe the presentation, exam findings, surgical repair techniques, and short-term outcomes in a series of patients with isolated inferior labral tears. Materials and Methods : A retrospective chart review was performed at a large academic medical center. Isolated inferior labral tears were defined as between the 4 o′clock and 8 o′clock position of the glenoid as determined by direct arthroscopic visualization. Tears that were smaller were also included but were required to cross the 6 o′clock point, having anterior and posterior components. Patients were excluded if they had any other pathology or treatment of the shoulder. 1-year follow-up was required. Results: Of the 17 patients who met inclusion criteria for review, 12 were available for a minimum 1-year follow-up. Average total follow-up for patients to complete the phone interview/Oxford Shoulder Instability Score (OSIS was an average of 37.7 months (range: 16-79 months. Postoperatively, all reported symptom improvement or resolution since surgery. The mean preoperative pain on a scale of 0-10 was 6.3 (range: 0-10. Mean postoperative pain on a scale of 0-10 was 2.25 (range: 0-5. Eleven of 12 patients (91.7% had returned to the level of activity desired. The mean OSIS was 41.4 (median: 43; range: 27-47. Eleven of 12 patients (91.7% had good or excellent scores. Ten of 12 patients (83.3% had a feeling of stability in the shoulder. All 12 patients reached were satisfied with the procedure and would undergo surgery again in a similar situation. Conclusions: We have presented our series of patients with isolated inferior labral injury, and have shown that when surgically treated, outcomes of this uncommon injury are good to excellent and a full return to sports can be expected.

  14. Systemic Inflammatory Response Syndrome (SIRS) Score Independently Predicts Poor Outcome in Isolated Traumatic Brain Injury.

    Science.gov (United States)

    Jacome, Tomas; Tatum, Danielle

    2017-05-25

    Systemic inflammatory response syndrome (SIRS) is frequently observed after various types of acute cerebral injury and has been linked to clinical deterioration in non-traumatic brain injury (TBI). SIRS scores have also been shown to be predictive of length of stay and mortality in trauma patients. We aimed to determine the prognostic utility of SIRS present at admission in trauma patients with isolated TBI. This was a 5-year retrospective cohort study of adults (≥18 years) with isolated TBI admitted to a Level II trauma center. The prognostic value of SIRS, total SIRS scores, and each SIRS criterion was examined by Χ (2) and logistic regression analyses. Of the 330 patients identified, 50 (15.2%) met SIRS criteria. SIRS was significantly associated with poor outcome (P SIRS score of 2 on admission (P = 0.007) and increased significantly to 6.5 times in patients with a SIRS score of 3 (P = 0.002). Logistic regression demonstrated SIRS and each criterion to be significant independent prognostic factors (SIRS, P = 0.030; body temperature, P = 0.006; tachypnea, P = 0.022, tachycardia P = 0.023). SIRS at admission is an independent predictor of poor outcome in isolated TBI patients. These data demonstrate SIRS to be an important clinical tool that may be used in facilitating prognostication, particularly in elderly trauma patients. Future prospective studies aimed at therapeutic interventions to mitigate SIRS in TBI patients are warranted. Prognostic, Level III.

  15. Upper limb rehabilitation after spinal cord injury: a treatment based on a data glove and an immersive virtual reality environment.

    Science.gov (United States)

    Dimbwadyo-Terrer, Iris; Trincado-Alonso, Fernando; de Los Reyes-Guzmán, Ana; Aznar, Miguel A; Alcubilla, Cesar; Pérez-Nombela, Soraya; Del Ama-Espinosa, Antonio; Polonio-López, Begoña; Gil-Agudo, Ángel

    2016-08-01

    Purpose state: The aim of this preliminary study was to test a data glove, CyberTouch™, combined with a virtual reality (VR) environment, for using in therapeutic training of reaching movements after spinal cord injury (SCI). Nine patients with thoracic SCI were selected to perform a pilot study by comparing two treatments: patients in the intervention group (IG) conducted a VR training based on the use of a data glove, CyberTouch™ for 2 weeks, while patients in the control group (CG) only underwent the traditional rehabilitation. Furthermore, two functional parameters were implemented in order to assess patient's performance of the sessions: normalized trajectory lengths and repeatability. Although no statistical significance was found, the data glove group seemed to obtain clinical changes in the muscle balance (MB) and functional parameters, and in the dexterity, coordination and fine grip tests. Moreover, every patient showed variations in at least one of the functional parameters, either along Y-axis trajectory or Z-axis trajectory. This study might be a step forward for the investigation of new uses of motion capture systems in neurorehabilitation, making it possible to train activities of daily living (ADLs) in motivational environments while measuring objectively the patient's functional evolution. Implications for Rehabilitation Key findings: A motion capture application based on a data glove is presented, for being used as a virtual reality tool for rehabilitation. This application has provided objective data about patient's functional performance. What the study has added: (1) This study allows to open new areas of research based on the use of different motion capture systems as rehabilitation tools, making it possible to train Activities of Daily Living in motivational environments. (2) Furthermore, this study could be a contribution for the development of clinical protocols to identify which types of patients will benefit most from the VR

  16. Resection of Residual Disease Following Isolated Limb Infusion (ILI) is Equivalent to a Complete Response Following ILI Alone in Advanced Extremity Melanoma

    Science.gov (United States)

    Wong, J; Chen, YA; Fisher, KJ; Beasley, GM; Tyler, DS; Zager, JS

    2015-01-01

    Introduction Isolated limb infusion (ILI) is a limb-preserving treatment for in-transit extremity melanoma. The benefit of resecting residual disease following ILI is unclear. Methods A multi-institutional experience was analyzed comparing patients who underwent ILI plus resection of residual disease (ILI+RES) versus ILI-alone. Results 176 patients were included: 154 ILI-alone and 22 ILI+RES. There were no differences between the groups with respect to gender, age, extremity affected, or time from diagnosis to ILI. All surgical resections were performed as an outpatient procedure, separate from the ILI. Within the ILI+RES group, fifteen (68%) had a partial response (PR), two (9%) stable disease (SD), and 5 (23%) progressive disease (PD). The ILI-alone group had 52 (34%) CR, 30 (19%) PR, 15 (10%) SD, and 46 (30%) PD. Eleven (7%) ILI-alone patients did not have 3-month response available for review. Evaluating overall survival (OS) from date of ILI, the ILI-alone group had a median OS of 30.9 months, whereas the ILI+RES group had not reached median OS, p=0.304. Although the ILI+RES group had a slightly longer disease free survival (DFS) compared to those with a CR after ILI-alone (12.4 vs. 9.6), this was not statistically significant, p=0.978. Within the ILI+RES group, those with an initial PR following ILI had improved DFS vs. those with SD or PD following ILI, pILI offers a DFS and OS similar to those who have a CR after ILI-alone, and may offer a treatment strategy that benefits more patients undergoing ILI. PMID:24162840

  17. Serum IL-6: a candidate biomarker for intracranial pressure elevation following isolated traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Ward Norman H

    2010-03-01

    Full Text Available Abstract Background Increased intracranial pressure (ICP is a serious, life-threatening, secondary event following traumatic brain injury (TBI. In many cases, ICP rises in a delayed fashion, reaching a maximal level 48-96 hours after the initial insult. While pressure catheters can be implanted to monitor ICP, there is no clinically proven method for determining a patient's risk for developing this pathology. Methods In the present study, we employed antibody array and Luminex-based screening methods to interrogate the levels of inflammatory cytokines in the serum of healthy volunteers and in severe TBI patients (GCS≤8 with or without incidence of elevated intracranial pressure (ICP. De-identified samples and ELISAs were used to confirm the sensitivity and specificity of IL-6 as a prognostic marker of elevated ICP in both isolated TBI patients, and polytrauma patients with TBI. Results Consistent with previous reports, we observed sustained increases in IL-6 levels in TBI patients irrespective of their ICP status. However, the group of patients who subsequently experienced ICP ≥ 25 mm Hg had significantly higher IL-6 levels within the first 17 hours of injury as compared to the patients whose ICP remained ≤20 mm Hg. When blinded samples (n = 22 were assessed, a serum IL-6 cut-off of 128 pg/ml correctly identified 85% of isolated TBI patients who subsequently developed elevated ICP, and values between these cut-off values correctly identified 75% of all patients whose ICP remained ≤20 mm Hg throughout the study period. In contrast, the marker had no prognostic value in predicting elevated ICP in polytrauma patients with TBI. When the levels of serum IL-6 were assessed in patients with orthopedic injury (n = 7 in the absence of TBI, a significant increase was found in these patients compared to healthy volunteers, albeit lower than that observed in TBI patients. Conclusions Our results suggest that serum IL-6 can be used for the

  18. The case of a prosthetic limb used to cause lethal intravaginal injuries: forensic medical aspects in a case of intimate partner violence.

    Science.gov (United States)

    Rancati, Alessandra; Crudele, Graziano Domenico Luigi; Gentile, Guendalina; Zoja, Riccardo

    2014-01-01

    A common form of violence against women is sexual coercion on the part of their husbands/partners, the uncontrollable effects of which can lead to extreme consequences, as in the case of uxoricide examined in this report. It involved a 59-year-old female alcoholic, under observation on the part of social services as the possible victim of abuse by her husband, an amputee with a transtibial prosthesis. The woman had never admitted to her social workers that her husband was abusing her. One night, she was admitted to hospital in a state of hemorrhagic shock due to massive vaginal bleeding, but despite treatment, she died 20 min after arrival. The anatomical-pathological examination conducted by the hospital revealed serious genital lesions which warranted reporting the case to the Judicial Authorities, who arranged for a forensic autopsy. The cause of death was identified as acute meta-hemorrhagic anemia in a cirrhotic woman, secondary to a large, irregular vaginal lesion involving both the vaginal wall and the soft perivaginal tissues as well as the medium and small urogenital vascular branches. To identify the foreign body used to inflict this injury, a scanning electron microscope and energy dispersive X-ray spectrometer (SEM-EDS) were used. This revealed tiny splinters of wood in the vaginal tissues examined. In addition to the genetic-forensic techniques used, this finding allowed the investigators to identify the husband's prosthetic limb as the instrument of sexual coercion. The report describes a particular case of marital rape that resulted in uxoricide, in which the overall concordance of the investigations carried out played a fundamental role in identifying the offending body and, consequently, the murderer.

  19. Limb anomalies

    DEFF Research Database (Denmark)

    Gurrieri, Fiorella; Kjær, Klaus Wilbrandt; Sangiorgi, Eugenio

    2002-01-01

    In this review we describe the developmental mechanisms involved in the making of a limb, by focusing on the nature and types of interactions of the molecules that play a part in the regulation of limb patterning and characterizing clinical conditions that are known to result from the abnormal...... function of these molecules. The latter subject is divided into sections dealing with syndromal and nonsyndromal deficiencies, polydactylies, and brachydactylies. Conditions caused by mutations in homeobox genes and fibroblast growth factors and their receptor genes are listed separately. Since the process...... of limb development has been conserved for more than 300 millions years, with all the necessary adaptive modifications occurring throughout evolution, we also take into consideration the evolutionary aspects of limb development in terms of genetic repertoire, molecular pathways, and morphogenetic events....

  20. Outcome following nerve repair of high isolated clean sharp injuries of the ulnar nerve.

    Directory of Open Access Journals (Sweden)

    René Post

    Full Text Available OBJECTIVE: The detailed outcome of surgical repair of high isolated clean sharp (HICS ulnar nerve lesions has become relevant in view of the recent development of distal nerve transfer. Our goal was to determine the outcome of HICS ulnar nerve repair in order to create a basis for the optimal management of these lesions. METHODS: High ulnar nerve lesions are defined as localized in the area ranging from the proximal forearm to the axilla just distal to the branching of the medial cord of the brachial plexus. A meta-analysis of the literature concerning high ulnar nerve injuries was performed. Additionally, a retrospective study of the outcome of nerve repair of HICS ulnar nerve injuries at our institution was performed. The Rotterdam Intrinsic Hand Myometer and the Rosén-Lundborg protocol were used. RESULTS: The literature review identified 46 papers. Many articles presented outcomes of mixed lesion groups consisting of combined ulnar and median nerves, or the outcome of high and low level injuries was pooled. In addition, outcome was expressed using different scoring systems. 40 patients with HICS ulnar nerve lesions were found with sufficient data for further analysis. In our institution, 15 patients had nerve repair with a median interval between trauma and reconstruction of 17 days (range 0-516. The mean score of the motor and sensory domain of the Rosen's Scale instrument was 58% and 38% of the unaffected arm, respectively. Two-point discrimination never reached less then 12 mm. CONCLUSION: From the literature, it was not possible to draw a definitive conclusion on outcome of surgical repair of HICS ulnar nerve lesions. Detailed neurological function assessment of our own patients showed that some ulnar nerve function returned. Intrinsic muscle strength recovery was generally poor. Based on this study, one might cautiously argue that repair strategies of HICS ulnar nerve lesions need to be improved.

  1. Comprehensive treatment for gas gangrene of the limbs in earthquakes.

    Science.gov (United States)

    Wang, Yue; Lu, Bo; Hao, Peng; Yan, Meng-ning; Dai, Ke-rong

    2013-10-01

    Mortality rates for patients with gas gangrene from trauma or surgery are as high as 25%, but they increase to 50%-80% for patients injured in natural hazards. Early diagnosis and treatment are essential for these patients. We retrospectively analyzed the clinical characteristics and therapeutic results of 19 patients with gas gangrene of the limbs, who were injured in the May 2008 earthquake in the Wenchuan district of China's Sichuan province and treated in our hospital, to seek how to best diagnose and treat earthquake-induced gas gangrene. Of 226 patients with limbs open injuries sustained during the earthquake, 53 patients underwent smear analysis of wound exudates and gas gangrene was diagnosed in 19 patients. The average elapsed time from injury to arrival at the hospital was 72 hours, from injury to definitive diagnosis was 4.3 days, and from diagnosis to conversion of negative findings on wound smear analysis to positive findings was 12.7 days. Anaerobic cultures were also obtained before wound closure. The average elapsed time from completion of surgery to recovery of normal vital signs was 6.3 days. Of the 19 patients, 16 were treated with open amputation, two with closed amputation, and 1 with successful limb salvage; 18 patients were successfully treated and one died. In earthquakes, rapid, accurate screening and isolation are essential to successful treatment of gas gangrene and helpful in preventing nosocomial diffusion. Early and thorough debridement, open amputation, and active supportive treatment can produce satisfactory therapeutic results.

  2. Chronic exposure to zinc oxide nanoparticles increases ischemic-reperfusion injuries in isolated rat hearts

    Science.gov (United States)

    Milivojević, Tamara; Drobne, Damjana; Romih, Tea; Mali, Lilijana Bizjak; Marin, Irena; Lunder, Mojca; Drevenšek, Gorazd

    2016-10-01

    The use of zinc oxide nanoparticles (ZnO NPs) in numerous products is increasing, although possible negative implications of their long-term consumption are not known yet. Our aim was to evaluate the chronic, 6-week oral exposure to two different concentrations of ZnO NPs on isolated rat hearts exposed to ischemic-reperfusion injury and on small intestine morphology. Wistar rats of both sexes ( n = 18) were randomly divided into three groups: (1) 4 mg/kg ZnO NPs, (2) 40 mg/kg ZnO NPs, and (3) control. After 6 weeks of treatment, the hearts were isolated, the left ventricular pressure (LVP), the coronary flow (CF), the duration of arrhythmias and the lactate dehydrogenase release rate (LDH) were measured. A histological investigation of the small intestine was performed. Chronic exposure to ZnO NPs acted cardiotoxic dose-dependently. ZnO NPs in dosage 40 mg/kg maximally decreased LVP (3.3-fold) and CF (2.5-fold) and increased the duration of ventricular tachycardia (all P < 0.01) compared to control, whereas ZnO NPs in dosage 4 mg/kg acted less cardiotoxic. Goblet cells in the small intestine epithelium of rats, treated with 40 mg ZnO NPs/kg, were enlarged, swollen and numerous, the intestinal epithelium width was increased. Unexpectedly, ZnO NPs in both dosages significantly decreased LDH. A 6-week oral exposure to ZnO NPs dose-dependently increased heart injuries and caused irritation of the intestinal mucosa. A prolonged exposure to ZnO NPs might cause functional damage to the heart even with exposures to the recommended daily doses, which should be tested in future studies.

  3. Limb salvage surgery

    Directory of Open Access Journals (Sweden)

    Dinesh Kadam

    2013-01-01

    Full Text Available The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

  4. Limb salvage surgery.

    Science.gov (United States)

    Kadam, Dinesh

    2013-05-01

    The threat of lower limb loss is seen commonly in severe crush injury, cancer ablation, diabetes, peripheral vascular disease and neuropathy. The primary goal of limb salvage is to restore and maintain stability and ambulation. Reconstructive strategies differ in each condition such as: Meticulous debridement and early coverage in trauma, replacing lost functional units in cancer ablation, improving vascularity in ischaemic leg and providing stable walking surface for trophic ulcer. The decision to salvage the critically injured limb is multifactorial and should be individualised along with laid down definitive indications. Early cover remains the standard of care, delayed wound coverage not necessarily affect the final outcome. Limb salvage is more cost-effective than amputations in a long run. Limb salvage is the choice of procedure over amputation in 95% of limb sarcoma without affecting the survival. Compound flaps with different tissue components, skeletal reconstruction; tendon transfer/reconstruction helps to restore function. Adjuvant radiation alters tissue characters and calls for modification in reconstructive plan. Neuropathic ulcers are wide and deep often complicated by osteomyelitis. Free flap reconstruction aids in faster healing and provides superior surface for offloading. Diabetic wounds are primarily due to neuropathy and leads to six-fold increase in ulcerations. Control of infections, aggressive debridement and vascular cover are the mainstay of management. Endovascular procedures are gaining importance and have reduced extent of surgery and increased amputation free survival period. Though the standard approach remains utilising best option in the reconstruction ladder, the recent trend shows running down the ladder of reconstruction with newer reliable local flaps and negative wound pressure therapy.

  5. Iron chelators do not reduce cold-induced cell injury in the isolated perfused rat kidney model.

    NARCIS (Netherlands)

    Bartels-Stringer, M.; Wetzels, J.F.M.; Wouterse, A.C.; Steenbergen, E.; Russel, F.G.M.; Kramers, C.

    2005-01-01

    BACKGROUND: In vitro, cold-induced injury is an important contributor to renal tubular cell damage. It is mediated by iron-dependent formation of reactive oxygen species and can be prevented by iron chelation. We studied whether iron chelators can prevent cold-induced damage in the isolated perfused

  6. Photodynamic injury of isolated crayfish neuron and surrounding glial cells: the role of p53

    Science.gov (United States)

    Sharifulina, S. A.; Uzdensky, A. B.

    2015-03-01

    The pro-apoptotic transcription factor p53 is involved in cell responses to injurious impacts. Using its inhibitor pifithrin- α and activators tenovin-1, RITA and WR-1065, we studied its potential participation in inactivation and death of isolated crayfish mechanoreceptor neuron and satellite glial cells induced by photodynamic treatment, a strong inducer of oxidative stress. In dark, p53 activation by tenovin-1 or WR-1065 shortened activity of isolated neurons. Tenovin-1 and WR-1065 induced apoptosis of glial cells, whereas pifithrin-α was anti-apoptotic. Therefore, p53 mediated glial apoptosis and suppression of neuronal activity after axotomy. Tenovin-1 but not other p53 modulators induced necrosis of axotomized neurons and surrounding glia, possibly, through p53-independent pathway. Under photodynamic treatment, p53 activators tenovin-1 and RITA enhanced glial apoptosis indicating the pro-apoptotic activity of p53. Photoinduced necrosis of neurons and glia was suppressed by tenovin-1 and, paradoxically, by pifithrin-α. Modulation of photoinduced changes in the neuronal activity and necrosis of neurons and glia was possibly p53-independent. The different effects of p53 modulators on neuronal and glial responses to axotomy and photodynamic impact were apparently associated with different signaling pathways in neurons and glial cells.

  7. The ethanolic extract of Kaempferia parviflora reduces ischaemic injury in rat isolated hearts.

    Science.gov (United States)

    Malakul, Wachirawadee; Ingkaninan, Kornkanok; Sawasdee, Pattara; Woodman, Owen L

    2011-09-01

    The ethanolic extract of Kaempferia parviflora (KPE) has been reported to contain a range of flavonoids and to enhance endothelial synthesis of NO. We investigated the vascular relaxant, antioxidant and cardioprotective activities of KPE. Vascular function was assessed in rat aortic rings and superoxide generation determined using lucigenin enhanced chemiluminescence. Ischaemia and reperfusion were induced in rat isolated, perfused hearts. KPE caused vasorelaxation (R(max) 102 ± 2%), which was partly inhibited by removal of the endothelium (R(max) 91 ± 1%) or by N(G)-nitro-l-arginine (L-NNA, R(max) 83 ± 3%) or 1H-[1,2,4] oxadiazolo[4,3-a]quinoxaline-1-one (ODQ, R(max) 80 ± 2%). In addition KPE caused concentration-dependent inhibition of the contractile response to exogenous Ca(2+). KPE (10(-3)M) also significantly inhibited superoxide radical generation induced by of xanthine/xanthine oxidase (2.3 ± 0.4% of control) to a similar extent to the xanthine oxidase inhibitor allopurinol (10(-4)M, 1.6 ± 0.5%) or by rat isolated aorta in the presence of NADPH (30.0 ± 6.3% of control) similarly to the NADPH oxidase inhibitor diphenyliodonium (5 × 10(-6)M, 23.1 ± 5.6%). In the presence of oxidant stress generated by pyrogallol endothelium-dependent relaxation of rat aortic rings was impaired (ACh R(max) control 99 ± 1%; pyrogallol 44 ± 5%), an effect that was significantly reduced by KPE (10(-4)M, ACh R(max) 82 ± 4%). In addition, KPE was found to attenuate the ventricular dysfunction caused by 20 min global ischaemia and 30 min reperfusion (I/R) in rat isolated hearts (dP/dt IR 1016 ± 242, IR+KPE 2238±233 mm Hg/s). KPE is an effective vasodilator and antioxidant that is able to prevent myocardial ischaemia-reperfusion injury. We suggest that KPE may be useful as an adjunct to thrombolytic therapy in the management of reperfusion injury. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  8. Comparison of mortality following hospitalisation for isolated head injury in England and Wales, and Victoria, Australia.

    Directory of Open Access Journals (Sweden)

    Belinda J Gabbe

    Full Text Available BACKGROUND: Traumatic brain injury (TBI remains a leading cause of death and disability. The National Institute for Health and Clinical Excellence (NICE guidelines recommend transfer of severe TBI cases to neurosurgical centres, irrespective of the need for neurosurgery. This observational study investigated the risk-adjusted mortality of isolated TBI admissions in England/Wales, and Victoria, Australia, and the impact of neurosurgical centre management on outcomes. METHODS: Isolated TBI admissions (>15 years, July 2005-June 2006 were extracted from the hospital discharge datasets for both jurisdictions. Severe isolated TBI (AIS severity >3 admissions were provided by the Trauma Audit and Research Network (TARN and Victorian State Trauma Registry (VSTR for England/Wales, and Victoria, respectively. Multivariable logistic regression was used to compare risk-adjusted mortality between jurisdictions. FINDINGS: Mortality was 12% (749/6256 in England/Wales and 9% (91/1048 in Victoria for isolated TBI admissions. Adjusted odds of death in England/Wales were higher compared to Victoria overall (OR 2.0, 95% CI: 1.6, 2.5, and for cases <65 years (OR 2.36, 95% CI: 1.51, 3.69. For severe TBI, mortality was 23% (133/575 for TARN and 20% (68/346 for VSTR, with 72% of TARN and 86% of VSTR cases managed at a neurosurgical centre. The adjusted mortality odds for severe TBI cases in TARN were higher compared to the VSTR (OR 1.45, 95% CI: 0.96, 2.19, but particularly for cases <65 years (OR 2.04, 95% CI: 1.07, 3.90. Neurosurgical centre management modified the effect overall (OR 1.12, 95% CI: 0.73, 1.74 and for cases <65 years (OR 1.53, 95% CI: 0.77, 3.03. CONCLUSION: The risk-adjusted odds of mortality for all isolated TBI admissions, and severe TBI cases, were higher in England/Wales when compared to Victoria. The lower percentage of cases managed at neurosurgical centres in England and Wales was an explanatory factor, supporting the changes made to the NICE

  9. 四肢战创伤并发急性肾衰竭危险因素的logistic回归分析%Logistic regression analysis of the risk factors of acute renal failure complicating limb war injuries

    Institute of Scientific and Technical Information of China (English)

    程昌志; 赵东海; 李全岳; 曲海燕; 陈伯成; 林舟丹

    2011-01-01

    Objective To explore the risk factors of complication of acute renal failure (ARF) in war injuries of limbs. Methods The clinical data of 352 patients with limb injuries admitted to 303 Hospital of PLA from 1968 to 2002 were retrospectively analyzed. The patients were divided into ARF group (n=9) and non-ARF group ( n=343) according to the occurrence of ARF, and the case-control study was carried out. Ten factors which might lead to death were analyzed by logistic regression to screen the risk factors for ARF,including causes of trauma, shock after injury, time of admission to hospital after injury, injured sites, combined trauma, number of surgical procedures, presence of foreign matters, features of fractures, amputation, and tourniquet time. Results Fifteen of the 352 patients died (4.3%) , among them 7 patients (46.7%) died of ARF, 3 (20.0%) of pulmonary embolism, 3 (20.0 %) of gas gangrene,and 2 (13.3%) of multiple organ failure. Univariate analysis revealed that the shock, time before admitted to hospital, amputation and tourniquet time were the risk factors for ARF in the wounded with limb injuries, while the logistic regression analysis showed only amputation was the risk factor for ARF ( P<0.05). Conclusion ARF is the primary cause-of-death in the wounded with limb injury.Prompt and accurate treatment and optimal time for amputation may be beneficial to decreasing the incidence and mortality of ARF in the wounded with severe limb injury and ischemic necrosis.%目的 探讨四肢战创伤并发急性肾衰竭(ARF)的危险因素.方法 回顾性分析1968-2002年收治的352例四肢战创伤患者,根据是否发生ARF将患者分为ARF组(9例)和非ARF组(343例)并进行病例对照研究,选择可能影响患者死亡的10个因素(致伤物、伤后是否休克、伤后入院时间、受伤部位、有无合并伤、手术次数、有否异物存留、骨折性质、是否截肢、止血带时间)进行logistic回归分析,筛

  10. Normalization of coagulopathy is associated with improved outcome after isolated traumatic brain injury.

    Science.gov (United States)

    Epstein, Daniel S; Mitra, Biswadev; Cameron, Peter A; Fitzgerald, Mark; Rosenfeld, Jeffrey V

    2016-07-01

    Acute traumatic coagulopathy (ATC) has been reported in the setting of isolated traumatic brain injury (iTBI) and is associated with poor outcomes. We aimed to evaluate the effectiveness of procoagulant agents administered to patients with ATC and iTBI during resuscitation, hypothesizing that timely normalization of coagulopathy may be associated with a decrease in mortality. A retrospective review of the Alfred Hospital trauma registry, Australia, was conducted and patients with iTBI (head Abbreviated Injury Score [AIS] ⩾3 and all other body AIS normalized ratio ⩾1.3) were selected for analysis. Data on procoagulant agents used (fresh frozen plasma, platelets, cryoprecipitate, prothrombin complex concentrates, tranexamic acid, vitamin K) were extracted. Among patients who had achieved normalization of INR or survived beyond 24hours and were not taking oral anticoagulants, the association of normalization of INR and death at hospital discharge was analyzed using multivariable logistic regression analysis. There were 157 patients with ATC of whom 68 (43.3%) received procoagulant products within 24hours of presentation. The median time to delivery of first products was 182.5 (interquartile range [IQR] 115-375) minutes, and following administration of coagulants, time to normalization of INR was 605 (IQR 274-1146) minutes. Normalization of INR was independently associated with significantly lower mortality (adjusted odds ratio 0.10; 95% confidence interval 0.03-0.38). Normalization of INR was associated with improved mortality in patients with ATC in the setting of iTBI. As there was a substantial time lag between delivery of products and eventual normalization of coagulation, specific management of coagulopathy should be implemented as early as possible.

  11. Saffron (Crocus sativus) pretreatment confers cardioprotection against ischemia-reperfusion injuries in isolated rabbit heart.

    Science.gov (United States)

    Nader, Moni; Chahine, Nathalie; Salem, Charelle; Chahine, Ramez

    2016-12-01

    Restoration of blood flow to the ischemic myocardium is imperative to avoid demise of cardiomyocytes, but is paradoxically associated with irreversible damage to cardiac tissues due to the excessive generation of reactive oxygen species (ROS). We have previously reported that saffron, a natural antioxidant, attenuated ischemia-reperfusion (IR) injuries in vitro; however, its role in a meaningful cardiac recovery remains unknown. Here, we show that saffron supplement (oral administration for 6 weeks) reduced myocardial damage and restored cardiac function in an IR model of rabbit hearts. This was evidenced by improved left ventricle pressure, heart rate and coronary flow, and left ventricle end diastolic pressure (LVEDP) in IR hearts (isolated from rabbits pre-exposed to saffron (S/IR)). Electrophysiological recordings revealed a significant decline in both premature ventricle contraction and ventricle tachycardia/fibrillation in S/IR compared to IR hearts. This was paralleled by increased expression of the contractile proteins α-actinin and Troponin C in the myocardium of S/IR hearts. Histological examination combined to biochemical analysis indicated that hearts pre-exposed to saffron exhibited reduced infarct size, lower lipid peroxidation, with increased glutathione peroxidase activity, and oxidation of nitro blue tetrazolium (by reactive oxygen species). Furthermore, in contrast with IR hearts, saffron pretreatment induced restoration of the phosphorylation level of the survival proteins Akt and 4EBP1 and reduced activity of p38. Collectively, our data demonstrate that the natural antioxidant saffron plays a pivotal role in halting IR-associated cardiac injuries and emerges as a novel preventive tool for ischemic heart disease.

  12. Admissions for isolated nonoperative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

    Science.gov (United States)

    Zhao, Ting; Mejaddam, Ali Y; Chang, Yuchiao; DeMoya, Marc A; King, David R; Yeh, Daniel D; Kaafarani, Haytham M A; Alam, Hasan B; Velmahos, George C

    2016-10-01

    Isolated nonoperative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge, and rehabilitation issues, which far exceed the acute component of their care. This study was aimed to compare the outcomes of patients with INOMHI admitted to three services: trauma surgery, neurosurgery, and neurology. Retrospective case series (January 1, 2009 to August 31, 2013) at an academic Level I trauma center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13 to 15 were admitted on a weekly rotational basis to trauma surgery, neurosurgery, and neurology. The three populations were compared, and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition. Four hundred eighty-eight INOMHI patients were admitted (trauma surgery, 172; neurosurgery, 131; neurology, 185). The mean age of the study population was 65.3 years, and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among the three groups. Patients who were admitted to trauma surgery, neurosurgery and neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (home, 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for Charlson Comorbidity Index CCI and Abbreviated Injury Scale head and neck scores, patients who were admitted to neurology or neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While the trauma group had the lowest proportion of repeats of brain computed tomography (61

  13. Reimplantes nas amputações por mecanismo de avulsão: táticas e técnicas para o sucesso Limb replantation after avulsion injuries: techniques and tactics for success

    Directory of Open Access Journals (Sweden)

    Renata Gregorio Paulos

    2012-01-01

    Full Text Available OBJETIVOS: Avaliação retrospectiva criteriosa de casos de reimplantes após amputação por avulsão. Avaliação de técnicas e táticas utilizadas que determinaram evolução satisfatória e bom resultado funcional. METÓDOS: Foram avaliados, retrospectivamente, prontuários de 43 pacientes que tiveram membros amputados por mecanismo de avulsão e reimplantados nos últimos 21 anos. RESULTADOS: A maior parte dos casos envolvia homens adultos jovens. A localização de amputação mais frequente foi do polegar. As técnicas e táticas cirúrgicas utilizadas isoladas ou conjuntamente incluem: enxertos de nervo, enxertos vasculares (veia ou artéria, transposição de feixe vascular digital, encurtamento do membro e reimplante heterotópico. A técnica mais frequentemente utilizada foi o emprego de enxertos venosos. A taxa de sobrevida dos reimplantes foi alta (93%, assim como a satisfação dos pacientes. CONCLUSÃO: Os reimplantes por mecanismo de avulsão dependem do correto diagnóstico de viabilidade anatômica e utilização de técnicas e táticas cirúrgicas apropriadas para cada caso. A experiência da equipe cirúrgica e estrutura hospitalar adequada são fundamentais para obtenção de bons resultados. Existem poucos relatos na literatura sobre indicação, tática, técnicas e resultados de procedimentos de reimplantes em amputações por avulsão. Acreditamos que a avaliação retrospectiva desta série de casos possa trazer novas informações e contribuições no atendimento desta situação de alta complexidade. Nível de evidência IV, Série de casos.OBJECTIVES: Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results. METHODS: Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries. RESULTS: The majority of the cases were young men. The

  14. Cardioprotection by polysaccharide sulfate against ischemia/reperfusion injury in isolated rat hearts

    Institute of Scientific and Technical Information of China (English)

    Ying YANG; Shen-jiang HU; Liang LI; Guo-ping CHEN

    2009-01-01

    Aim: Polysaccharide sulfate (PSS) is a new type of heparinoid synthesized with alginic acid as the basic material and then by chemical introduction of effective groups. Although PSS is successfully applied in ischemic cardio-cerebrovascular dis-ease, its effect on cardiac function after ischemia/reperfusion (I/R) injury has previously not been investigated. The aim of the present study was to investigate whether PSS can protect the heart from I/R injury and the underlying mechanism of protection. Methods: Isolated rat hearts were perfused (Langendorff) and subjected to 20 min global ischemia followed by 60 min rep-effusion with Kreb's Henseleit solution or PSS (0.3-100 mg/L). Myocardial contractile function was continuously recorded. Creatine kinase (CK) and lactate dehydrogenase (LDH) leakage were measured. Tumor necrosis factor-α (TNF-α) expres-sion in cardiomyocytes was investigated. Western blot analysis for extracellular regulated kinases (ERKs), c-jun amino-terminal kinase (INKs) and p38 mitogen-activated protein kinase (MAPK) activity was performed. Results: After I/R, cardiac contractility decreased, CK and LDH levels increased in the coronary effluent, and TNF-α expression increased in cardiomyocytes. PSS administration at concentrations of 1-30 mg/L improved cardiac contractility, reduced CK and LDH release and inhibited TNF-α production. Phosphorylated-p38MAPK (p-p38MAPK) and p-p54/p46-JNK increased in I/R rat hearts but diminished in PSS (1-30 mg/L) treated hearts. P-p44/p42-ERK levels were unchanged. In contrast, high concentrations of PSS (100 mg/L) had adverse effects that caused a worsening of heart function. Conclusion: PSS has dose-dependent cardioprotective effects on the rat heart after I/R injury. The beneficial effects may be mediated through normalization of the activity of p38 MAPK and JNK pathways as well as controlling the level of TNF-α expression.

  15. Identification and culture of neural stem cells isolated from adult rat subventricular zone following fluid percussion brain injury

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Objective To analyze proliferation and differentiation of glial fibrillary acid protein(GFAP)-and nestin-positive(GFAP+/nestin+)cells isolated from the subventricular zone following fluid percussion brain injury to determine whether GFAP+/nestin+ cells exhibit characteristics of neural stem cells.Methods Male Sprague-Dawley rats,aged 12 weeks and weighing 200-250 g,were randomly and evenly assigned to normal control group and model group.In the model group,a rat model of fluid percussion brain injury was es...

  16. The effect of short-duration sub-maximal cycling on balance in single-limb stance in patients with anterior cruciate ligament injury: a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Roberts David

    2004-11-01

    Full Text Available Abstract Background It has previously been shown that an anterior cruciate ligament (ACL injury may lead to impaired postural control, and that the ability to maintain postural control is decreased by fatigue in healthy subjects. To our knowledge, no studies have reported the effect of fatigue on postural control in subjects with ACL injury. This study was aimed at examining the effect of fatigue on balance in single-limb stance in subjects with ACL injury, and to compare the effects, and the ability to maintain balance, with that of a control group of uninjured subjects. Methods Thirty-six patients with unilateral, non-operated, non-acute ACL injury, and 24 uninjured subjects were examined with stabilometry before (pre-exercise and immediately after (post-exercise short-duration, sub-maximal cycling. In addition, the post-exercise measurements were compared, to evaluate the instantaneous ability to maintain balance and any possible recovery. The amplitude and average speed of center of pressure movements were registered in the frontal and sagittal planes. The paired t-test was used for the intra-group comparisons, and the independent t-test for the inter-group comparisons, with Bonferroni correction for multiple comparisons. Results No differences were found in the effects of exercise between the patients and the controls. Analysis of the post-exercise measurements revealed greater effects or a tendency towards greater effects on the injured leg than in the control group. The average speed was lower among the patients than in the control group. Conclusions The results of the present study showed no differences in the effects of exercise between the patients and the controls. However, the patients seemed to react differently regarding ability to maintain balance in single-limb stance directly after exercise than the control group. The lower average speed among the patients may be an expression of different neuromuscular adaptive strategies than

  17. Protective Effect of Liriodendrin Isolated from Kalopanax pictus against Gastric Injury.

    Science.gov (United States)

    Sohn, Yoon Ah; Hwang, Seon A; Lee, Sun Yi; Hwang, In Young; Kim, Sun Whoe; Kim, So Yeon; Moon, Aree; Lee, Yong Soo; Kim, Young Ho; Kang, Keum Jee; Jeong, Choon Sik

    2015-01-01

    In this study, we investigated the inhibitory activities on gastritis and gastric ulcer using liriodendrin which is a constituent isolated from Kalopanax pictus. To elucidate its abilities to prevent gastric injury, we measured the quantity of prostaglandin E2 (PGE2) as the protective factor, and we assessed inhibition of activities related to excessive gastric acid be notorious for aggressive factor and inhibition of Helicobacter pylori (H. pylori) colonization known as a cause of chronic gastritis, gastric ulcer, and gastric cancer. Liriodendrin exhibited higher PGE2 level than rebamipide used as a positive control group at the dose of 500 μM. It was also exhibited acid-neutralizing capacity (10.3%) and H(+)/K(+)-ATPase inhibition of 42.6% (500 μM). In pylorus-ligated rats, liriodendrin showed lower volume of gastric juice (4.38 ± 2.14 ml), slightly higher pH (1.53 ± 0.41), and smaller total acid output (0.47 ± 0.3 mEq/4 hrs) than the control group. Furthermore liriodendrin inhibited colonization of H. pylori effectively. In vivo test, liriodendrin significantly inhibited both of HCl/EtOH-induced gastritis (46.9 %) and indomethacin-induced gastric ulcer (46.1%). From these results, we suggest that liriodendrin could be utilized for the treatment and/or protection of gastritis and gastric ulcer.

  18. Prehospital Intubation in Patients with Isolated Severe Traumatic Brain Injury: A 4-Year Observational Study

    Directory of Open Access Journals (Sweden)

    Mazin Tuma

    2014-01-01

    Full Text Available Objectives. To study the effect of prehospital intubation (PHI on survival of patients with isolated severe traumatic brain injury (ISTBI. Method. Retrospective analyses of all intubated patients with ISTBI between 2008 and 2011 were studied. Comparison was made between those who were intubated in the PHI versus in the trauma resuscitation unit (TRU. Results. Among 1665 TBI patients, 160 met the inclusion criteria (105 underwent PHI, and 55 patients were intubated in TRU. PHI group was younger in age and had lower median scene motor GCS (P=0.001. Ventilator days and hospital length of stay (P=0.01 and 0.006, resp. were higher in TRUI group. Mean ISS, length of stay, initial blood pressure, pneumonia, and ARDS were comparable among the two groups. Mortality rate was higher in the PHI group (54% versus 31%, P=0.005. On multivariate regression analysis, scene motor GCS (OR 0.55; 95% CI 0.41–0.73 was an independent predictor for mortality. Conclusion. PHI did not offer survival benefit in our group of patients with ISTBI based on the head AIS and the scene motor GCS. However, more studies are warranted to prove this finding and identify patients who may benefit from this intervention.

  19. Epidemiological and Molecular Characterization of a Mexican Population Isolate with High Prevalence of Limb-Girdle Muscular Dystrophy Type 2A Due to a Novel Calpain-3 Mutation

    Science.gov (United States)

    Pantoja-Melendez, Carlos A.; Miranda-Duarte, Antonio; Roque-Ramirez, Bladimir; Zenteno, Juan C.

    2017-01-01

    Limb-Girdle Muscular Dystrophy type 2 (LGMD2) is a group of autosomally recessive inherited disorders defined by weakness and wasting of the shoulder and pelvic girdle muscles. In the past, several population isolates with high incidence of LGMD2 arising from founder mutation effects have been identified. The aim of this work is to describe the results of clinical, epidemiologic, and molecular studies performed in a Mexican village segregating numerous cases of LGMD2. A population census was conducted in the village to identify all LGMD affected patients. Molecular analysis included genome wide homozygosity mapping using a 250K SNP Affymetrix microarray followed by PCR amplification and direct nucleotide sequencing of the candidate gene. In addition, DNA from 401 randomly selected unaffected villagers was analyzed to establish the carrier frequency of the LGMD2 causal mutation. A total of 32 LGMD2 patients were identified in the village, rendering a disease prevalence of 4.3 (CI: 2.9–5.9) cases per 1,000 habitants (1 in 232). Genome wide homozygosity mapping revealed that affected individuals shared a 6.6 Mb region of homozygosity at chromosome 15q15. The identified homozygous interval contained CAPN3, the gene responsible for LGMD2 type A (LGMD2A). Direct sequencing of this gene revealed homozygosity for a novel c.348C>A mutation (p.Ala116Asp) in DNA from all 20 affected subjects available for genetic screening, except one which was heterozygous for the mutation. In such patient, a heterozygous c.2362AG>TCATCT deletion/insertion was recognized as the second CAPN3 mutation. Western blot and autocatalytic activity analyses in protein lysates from skeletal muscle biopsy obtained from a p.Ala116Asp homozygous patient suggested that this particular mutation increased the autocatalytic activity of CAPN3. Thirty eigth heterozygotes of the p.Ala116Asp mutation were identified among 401 genotyped unaffected villagers, yielding a population carrier frequency of 1 in 11

  20. Effect of early rehabilitation training on the hemiplegic limbs of the patients with severe head injury%早期康复训练对重型颅脑损伤患者偏瘫肢体的影响

    Institute of Scientific and Technical Information of China (English)

    万继平

    2011-01-01

    Objective: To investigate the rehabilitation effect of early rehabilitation training on the hemiplegic limbs of the patients with severe head injury. Methods: 62 hemiplegic patients induced by severe head injury were randomly divided into an observation group and a control group ( 31 cases for each group ). The prescription was almost the same in the two groups, and the patients in the observation group were provided the rehabilitation training of limb function at the early stage of the disease ( brain edema stage ) and in the stable period of the patient's condition based on routine treatment and nursing care; the patients in the control group received routine treatment and nursing care and had random functional exercise. Results: The muscle strength recovery progress of the patient's hemiplegic limbs was significantly faster in the observation group than the control group ( P < 0.01 ). Conclusions: The early rehabilitation training can obviously reduce the degree of disability of the patients with hemiplegic limbs induced by severe head injury and markedly improve their quality of life.%目的:探讨早期康复训练对重型颅脑损伤偏瘫肢体的康复效果.方法:将62例重型颅脑损伤偏瘫患者随机分为观察组和对照组各31例,两组药物治疗基本相同,观察组按常规治疗护理的同时,于病情早期(脑水肿期)及病情稳定期分阶段进行肢体功能康复训练,对照组进行常规护理并随意进行功能锻炼.结果:观察组患者偏瘫肢体肌力恢复进展明显优于对照组(P<0.01).结论:对重型颅脑损伤偏瘫肢体进行早期康复训练可明显减轻患者偏瘫肢体的致残程度,显著提高患者的生活质量.

  1. Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

    Science.gov (United States)

    Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

    2013-03-01

    Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

  2. Use of an arm weight-bearing combined with upper-limb reaching apparatus to facilitate motor paralysis recovery in an incomplete spinal cord injury patient: a single case report

    Science.gov (United States)

    Hoei, Takashi; Kawahira, Kazumi; Fukuda, Hidefumi; Sihgenobu, Keizo; Shimodozono, Megumi; Ogura, Tadashi

    2017-01-01

    [Purpose] Training using an arm weight-bearing device combined with upper-limb reaching apparatus to facilitate motor paralysis recovery, named the “Reaching Robot”, as well as Repetitive Facilitation Exercise were applied to a patient with severe impairment of the shoulder and elbow due to incomplete spinal cord injury and the effects were examined. [Subjects and Methods] A 66-year-old man with incomplete spinal cord injury participated in an upper extremity rehabilitation program involving a Reaching Robot. The program was comprised of active motor suspension, continuous low amplitude neuromuscular electrical stimulation and functional vibratory stimulation, as well as Repetitive Facilitation Exercise combined with continuous low amplitude neuromuscular electrical stimulation. This protocol used a crossover design following an A1-B1-A2-B2. “A” consisted of 2 weeks of Repetitive Facilitation Exercise, and “B” consisted of 2 weeks of Reaching Robot training. [Results] Improvements were observed after all sessions. Active range of motion for shoulder flexion improved after 2 weeks of Reaching Robot sessions only. There were no adverse events. [Conclusion] Reaching Robot training for severe paretic upper-extremity after incomplete spinal cord injury was a safe and effective treatment. Reaching Robot training may be useful for rehabilitation of paretic upper-extremity after incomplete spinal cord injury. PMID:28210068

  3. Protective Effects of Elaeagnus angustifolia Leaf Extract against Myocardial Ischemia/Reperfusion Injury in Isolated Rat Heart

    Directory of Open Access Journals (Sweden)

    Binsheng Wang

    2014-01-01

    Full Text Available The purpose of this study is to clarify the cardioprotective property of the aqueous extract of Elaeagnus angustifolia L. leaf (EA against myocardial ischemia/reperfusion injury in isolated rat heart. The myocardial ischemia/reperfusion (I/R injury model of isolated rat heart was set up by the use of improved Langendorff retrograde perfusion technology. Compared with the ischemia/reperfusion (I/R group, the aqueous extract of Elaeagnus angustifolia L. leaf (0.5 mg/mL, 1.0 mg/mL pretreatment markedly improved the coronary flow (CF and raised left ventricular developed pressure (LVDP and maximum rise/down velocity (±dp/dtmax. The infarct size of the EA-treated hearts was smaller than that of I/R group. After treatment with EA, the superoxide dismutase (SOD activity increased; malondialdehyde (MDA and protein carbonyl content reduced more obviously (P<0.01 than that of I/R injury myocardial tissue. Conclusion. Results from the present study showed that the aqueous extract of Elaeagnus angustifolia L. leaf has obvious protective effects on myocardial I/R injury, which may be related to the improvement of myocardial oxidative stress states.

  4. Epidemiology of isolated meniscal injury and its effect on performance in athletes from the National Basketball Association.

    Science.gov (United States)

    Yeh, Peter C; Starkey, Chad; Lombardo, Stephen; Vitti, Gary; Kharrazi, F Daniel

    2012-03-01

    The current incidence and outcomes of meniscal injury have not been quantified in professional athletes. To describe the incidence, risk, amount of time lost, and effect on performance for isolated meniscal injury in athletes from the National Basketball Association (NBA). Demographic factors predicting the risk of meniscal tears and the effect of injury in return to play were also investigated. Descriptive epidemiology study. A centralized database was queried to identify meniscal injuries occurring in the NBA over 21 seasons. The frequency of injury, time lost, game exposures, and incidence, rate, and risk were calculated. The preinjury and postinjury player efficiency rating (PER) was used to identify changes in player performance. We identified 129 isolated meniscal tears in NBA athletes during a 21-season span. From this number, 77 (59.7%) involved the lateral meniscus and 52 (40.3%) the medial meniscus. Injuries occurred more frequently in games. The lateral meniscus had a statistically significant higher injury rate. Both left and right knees were equally affected. The number of days missed for lateral meniscal tears and medial meniscal tears was 43.8 ± 35.7 days and 40.9 ± 29.7 days, respectively, and was not statistically different. There was a significant inverse relationship between age and rate of lateral meniscal tears, with lateral meniscal tears more likely to occur up to age 30 years; beyond that medial meniscal tears were more common. Players with a body mass index (BMI) greater than 25 had a significantly increased risk of meniscal tears compared with players with a BMI less than 25, specifically with an increased risk of lateral meniscal tears. Twenty-five players (19.4%) did not return to play. For those who did, upon returning to competition, there was no statistical change in PER from their preinjury status, and the mean number of seasons completed was 4.1 ± 3.7 seasons. The lateral meniscus is more frequently torn than the medial meniscus

  5. Lower Limb Ischaemia Complicating Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shiu-Wai Chan

    2012-06-01

    Full Text Available This article is about two patients having vascular injuries complicating total hip arthroplasty because of intraoperative indirect injuries. One patient had a delayed presentation of acute lower limb ischaemia, in which he required amputation of his left second toe because of ischaemic gangrene. The other patient had acute lower limb ischaemia leading to permanent muscle and nerve damage because of delayed recognition. Both patients had vascular interventions for the indirect vascular injuries. Preoperative workup for suspicious underlying peripheral vascular disease, intraoperative precautions, and perioperative period of vascular status monitoring are essential for prevention and early detection of such sinister events.

  6. Analysis on Risk Factors of Limb Ischemia Injury after Extracorporeal Membrane Oxygenation%体外膜肺氧合致下肢缺血损伤的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈妙莲; 李建伟; 徐雪影; 李云; 李斌飞; 叶红雨; 侯六生; 杨婷

    2016-01-01

    目的:总结体外膜肺氧合(ECMO)在成人心源性休克(CS)中的临床救治经验,探讨 ECMO 的临床应用价值及导致下肢缺血损伤的可能危险因素。方法:回顾性分析中山大学附属中山医院2009年7月至2014年7月因传统药物和(或)主动脉内球囊反搏(IABP)无效而行 ECMO 救治的成人 CS 患者的临床资料,将辅助前合并颅脑损伤及多器官功能衰竭的病例排除在外,根据患者是否合并下肢缺血将其分为缺血损伤组(n=9)与无缺血损伤组(n=49),通过组间单因素比较筛选出影响脱机的可能危险因素。结果:本研究入选的58例 ECMO 患者中,建立循环时间15-25 min,辅助时间132.5±89.2h,成功脱机35例(60.4%),康复出院26例(44.8%)。与无下肢缺血损伤组比较,患者平均年龄、糖尿病比例、心跳骤停比例、血乳酸水平以及 ECMO 辅助时间显著高于血运正常组(P<0.05),但心脏左室射血分数显著低于血运正常组(P<0.05)。组件插管口径、插管深度无统计学差异(P>0.05)。结论:ECMO 是救治成人心源性休克的较有效手段,肢体远端缺血损伤可直接影响疗效,尽早识别发生并发症的高危因素,并采取有效措施积极防治,是降低肢体远端缺血发生率,提高 ECMO 辅助成功的关键。%Objective:To summarize the clinical experience of treatment for adult cardiogenic shock (CS) with extracorporeal membrane oxygenation (ECMO) and analyze on risk factors of limb ischemia injury after ECMO. Methods:Patients with cardiogenic shock required veno-arterial ECMO after failure of conventional therapy and intra-aortic balloon pump counterpulsation therapy from July 2009 to July 2014 were retrospectively studied. Patients with traumatic brain injury and multiple organ failure were excluded. All patients were divided into limb ischemia injury group(n=9) and not

  7. Isolated bilateral transverse agenesis of the distal segments of the lower limbs at the level of the knee joint in a human fetus.

    Science.gov (United States)

    Christiaens, Antoine B; Deprez, Pierre M L; Amyere, Mustapha; Mendola, Antonella; Bernard, Pierre; Gillerot, Yves; Clapuyt, Philippe; Godfraind, Catherine; Lengelé, Benoît G; Vikkula, Miikka; Nyssen-Behets, Catherine

    2016-02-01

    Congenital limb anomalies occur in Europe with a prevalence of 3.81/1,000 births and can have a major impact on patients and their families. The present study concerned a female fetus aborted at 23 weeks of gestation because she was affected by non-syndromic bilateral absence of the zeugopod (leg) and autopod (foot). Autopsy of the aborted fetus, X-ray imaging, MRI, and histochemical analysis showed that the distal extremity of both femurs was continued by a cartilage-like mass, without joint cavitation. Karyotype was normal. Moreover, no damaging variant was detected by exome sequencing. The limb characteristics of the fetus, which to our knowledge have not yet been reported in humans, suggest a developmental arrest similar to anomalies described in chicks following surgical experiments on the apical ectodermal ridge of the lower limbs.

  8. The mangled limb: salvage versus amputation.

    Science.gov (United States)

    Wolinsky, Philip R; Webb, Lawrence X; Harvey, Edward J; Tejwani, Nirmal C

    2011-01-01

    A mangled extremity is defined as a limb with injury to three of four systems in the extremity. The decision to salvage or amputate the injured limb has generated much controversy in the literature, with studies to support advantages of each approach. Various scoring systems have proved unreliable in predicting the need for amputation or salvage; however, a recurring theme in the literature is that the key to limb viability seems to be the severity of the soft-tissue injury. Factors such as associated injuries, patient age, and comorbidities (such as diabetes) also should be considered. Attempted limb salvage should be considered only if a patient is hemodynamically stable enough to tolerate the necessary surgical procedures and blood loss associated with limb salvage. For persistently hemodynamically unstable patients and those in extremis, life comes before limb. Recently, the Lower Extremity Assessment Project study attempted to answer the question of whether amputation or limb salvage achieves a better outcome. The study also evaluated other factors, including return-to-work status, impact of the level of and bilaterality of the amputation, and economic cost. There appears to be no significant difference in return to work, functional outcomes, or the cost of treatment (including the prosthesis) between the two groups. A team approach with different specialties, including orthopaedics, plastic surgery, vascular surgery and trauma general surgery, is recommended for treating patients with a mangled extremity.

  9. Isolated Jejunal Perforation Following Bicycle Handlebar Injury in Adults: A Case Report

    Directory of Open Access Journals (Sweden)

    Kyriakos Neofytou

    2013-01-01

    Full Text Available The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults’ abdominal visceral injuries after flipping the bike’s handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.

  10. Isolated jejunal perforation following bicycle handlebar injury in adults: a case report.

    Science.gov (United States)

    Neofytou, Kyriakos; Michailidou, Maria; Petrou, Athanasios; Loizou, Sakis; Andreou, Charalampos; Pedonomou, Marios

    2013-01-01

    The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults' abdominal visceral injuries after flipping the bike's handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.

  11. Against the odds: what to expect in rehabilitation of chronic spinal cord injury with a neurologically controlled Hybrid Assistive Limb exoskeleton. A subgroup analysis of 55 patients according to age and lesion level.

    Science.gov (United States)

    Grasmücke, Dennis; Zieriacks, Amrei; Jansen, Oliver; Fisahn, Christian; Sczesny-Kaiser, Matthias; Wessling, Martin; Meindl, Renate C; Schildhauer, Thomas A; Aach, Mirko

    2017-05-01

    Objective Age and lesion level are believed to represent outcome predictors in rehabilitation of patients with chronic spinal cord injury (SCI). The Hybrid Assistive Limb (HAL) exoskeleton enables patients to perform a voluntary controlled gait pattern via an electromyography-triggered neuromuscular feedback system, and has been introduced as a temporary gait training tool in patients with SCI. The aim of this prospective pre- and postintervention study was to examine functional outcomes as a function of age and lesion level in patients with chronic incomplete SCI (iSCI) or chronic complete SCI (cSCI) with zones of partial preservation (ZPP) by using the HAL as a temporary training tool. Methods Fifty-five participants with chronic iSCI or cSCI (mean time since injury 6.85 ± 5.12 years) were classified according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and divided by age (exoskeleton. An improvement of approximately 50% in the 10MWTsss and in gait endurance (6MinWT) can be expected from such training. The influences of SCI lesion level and age on functional outcome were nonsignificant in the present study. Older age (≥ 50 years) may be associated with smaller improvements in the 10MWTsss. An iSCI in paraplegic patients with spastic motor behavior may be a nonsignificant negative predictor in gait endurance improvements. Clinical trial registration no.: DRKS00010250 ( https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_DE.do ).

  12. Hepatoprotective effects of polysaccharide isolated from Agaricus bisporus industrial wastewater against CCl₄-induced hepatic injury in mice.

    Science.gov (United States)

    Huang, Jiafu; Ou, Yixin; Yew, Tai Wai David; Liu, Jingna; Leng, Bo; Lin, Zhichao; Su, Yi; Zhuang, Yuanhong; Lin, Jiaofen; Li, Xiumin; Xue, Yu; Pan, Yutian

    2016-01-01

    During the industrial production of canned mushroom (Agaricus bisporus), a large quantity of wastewater is produced. In this study, the wastewater generated during the canning of mushroom was analyzed. From this wastewater, four polysaccharide components (Abnp1001, Abnp1002, Abap1001, and Abap1002) with hepatic-protective activity were isolated by ultrafiltration, DEAE cellulose-52 chromatography and Sephadex G-200 size-exclusion chromatography. Results of ultraviolet spectra analysis and molecular weight determination showed that Abnp1001, Abnp1002, Abap1001 and Abap1002 were uniform with average molecular weights of 336, 12.8, 330 and 15.8kDa, respectively. The monosaccharide composition analysis using gas chromatography (GC) showed that the four fractions were heteropolysaccharides and mainly composed of glucose. Fourier transform-infrared (FT-IR) analysis showed that the isolated fractions were all composed of β-glycoside linkages. Additionally, the potential hepatoprotective activities of these polysaccharides against CCl4-induced hepatic injury in mice were studied. Notably, Abnp1002 and Abap1002 could lower the alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations in serum in a dose dependent manner and reduce the hepatocellular degeneration and necrosis, as well as inflammatory infiltration. These results indicate that these two polysaccharides had protective effects on acute hepatic injury induced by CCl4 in mice and suggest that the polysaccharides extracted from A. bisporus industrial wastewater might have potential in therapeutics of acute hepatic injury.

  13. Low Frequency Electromagnetic Field Conditioning Protects against I/R Injury and Contractile Dysfunction in the Isolated Rat Heart.

    Science.gov (United States)

    Bialy, Dariusz; Wawrzynska, Magdalena; Bil-Lula, Iwona; Krzywonos-Zawadzka, Anna; Wozniak, Mieczyslaw; Cadete, Virgilio J J; Sawicki, Grzegorz

    2015-01-01

    Low frequency electromagnetic field (LF-EMF) decreases the formation of reactive oxygen species, which are key mediators of ischemia/reperfusion (I/R) injury. Therefore, we hypothesized that the LF-EMF protects contractility of hearts subjected to I/R injury. Isolated rat hearts were subjected to 20 min of global no-flow ischemia, followed by 30 min reperfusion, in the presence or absence of LF-EMF. Coronary flow, heart rate, left ventricular developed pressure (LVDP), and rate pressure product (RPP) were determined for evaluation of heart mechanical function. The activity of cardiac matrix metalloproteinase-2 (MMP-2) and the contents of coronary effluent troponin I (TnI) and interleukin-6 (IL-6) were measured as markers of heart injury. LF-EMF prevented decreased RPP in I/R hearts, while having no effect on coronary flow. In addition, hearts subjected to I/R exhibited significantly increased LVDP when subjected to LF-EMF. Although TnI and IL-6 levels were increased in I/R hearts, their levels returned to baseline aerobic levels in I/R hearts subjected to LF-EMF. The reduced activity of MMP-2 in I/R hearts was reversed in hearts subjected to LF-EMF. The data presented here indicate that acute exposure to LF-EMF protects mechanical function of I/R hearts and reduces I/R injury.

  14. Low Frequency Electromagnetic Field Conditioning Protects against I/R Injury and Contractile Dysfunction in the Isolated Rat Heart

    Directory of Open Access Journals (Sweden)

    Dariusz Bialy

    2015-01-01

    Full Text Available Low frequency electromagnetic field (LF-EMF decreases the formation of reactive oxygen species, which are key mediators of ischemia/reperfusion (I/R injury. Therefore, we hypothesized that the LF-EMF protects contractility of hearts subjected to I/R injury. Isolated rat hearts were subjected to 20 min of global no-flow ischemia, followed by 30 min reperfusion, in the presence or absence of LF-EMF. Coronary flow, heart rate, left ventricular developed pressure (LVDP, and rate pressure product (RPP were determined for evaluation of heart mechanical function. The activity of cardiac matrix metalloproteinase-2 (MMP-2 and the contents of coronary effluent troponin I (TnI and interleukin-6 (IL-6 were measured as markers of heart injury. LF-EMF prevented decreased RPP in I/R hearts, while having no effect on coronary flow. In addition, hearts subjected to I/R exhibited significantly increased LVDP when subjected to LF-EMF. Although TnI and IL-6 levels were increased in I/R hearts, their levels returned to baseline aerobic levels in I/R hearts subjected to LF-EMF. The reduced activity of MMP-2 in I/R hearts was reversed in hearts subjected to LF-EMF. The data presented here indicate that acute exposure to LF-EMF protects mechanical function of I/R hearts and reduces I/R injury.

  15. Sevoflurane postconditioning protects isolated rat hearts against ischemia-reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    YAO Yun-tai; FANG Neng-xin; SHI Chun-xia; LI Li-huan

    2010-01-01

    Background Studies suggested that anesthetics administered upon the early reperfusion or "anesthetic postconditioning" could protect post-ischemic hearts against myocardial ischemia reperfusion injury (MIRI).However, the mechanism responsible for such protection was not well-elucidated.We investigated the cardioprotection induced by sevoflurane postconditioning (SpostC) in rat hearts in vitro, and the respective role of phosphatidylinositol-3-kinase (PI3K), extracellular signal-regulated kinase 1 and 2 (ERK 1/2), mitochondrial KATP channels (mitoKATP) and mitochondrial permeability transition pore (mPTP), by selectively inhibiting PI3K, ERK 1/2, mitoKATP, with LY294002 (LY), PD98059 (PD), 5-hydroxydecanoate (5-HD) and by directly opening of mPTP with atractyloside (ATR), respectively.Methods Isolated rat hearts were randomly assigned to one of the 12 groups (n=15):Time control (continuous perfusion), ISCH (30 minutes of ischemia followed by 60 minutes of reperfusion alone), SpostC (3% sevoflurane postconditioning was administered during the first 15 minutes of reperfusion after 30 minutes of ischemia), ISCH+LY,ISCH+PD, ISCH+ATR, ISCH+5-HD and ISCH+ dimethyl sulfoxide (DMSO) groups (LY, PD, ATR, 5-HD and DMSO (the vehicle) was administered respectively during the first 15 minutes of reperfusion following test ischemia), SpostC+LY, SpostC+PD, SpostC+ATR and SpostC+5-HD groups (LY, PD, ATR and 5-HD was coadministered with 3% sevoflurane, respectively).Hemodynamics was compared within and between groups.Infarction size was determined at the end of experiments using triphenyltetrazolium chloride (TTC) staining.Lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB) and cardiac troponin I (cTnI) released from necrotic myocardium, were compared among TC, ISCH and SpostC groups.To investigate the relationships between RISK and mPTP implicated in SpostC, NAD+ content in myocardium, a marker of mPTP opening, was compared among some experimental groups (TC, ISCH, ISCH

  16. Whole-Genome Sequence of Multidrug-Resistant Pseudomonas aeruginosa Strain BAMCPA07-48, Isolated from a Combat Injury Wound.

    Science.gov (United States)

    Sanjar, Fatemeh; Karna, S L Rajasekhar; Chen, Tsute; Chen, Ping; Abercrombie, Johnathan J; Leung, Kai P

    2016-07-07

    We report here the complete genome sequence of Pseudomonas aeruginosa strain BAMCPA07-48, isolated from a combat injury wound. The closed genome sequence of this isolate is a valuable resource for pathogenome characterization of P. aeruginosa associated with wounds, which will aid in the development of a higher-resolution phylogenomic framework for molecular-guided pathogen-surveillance.

  17. [Limb apraxia].

    Science.gov (United States)

    Hödl, Anna K; Bonelli, Raphael M; Kapfhammer, Hans-Peter

    2006-01-15

    Apraxia is the disturbance of planning and of execution of motor activity. It is not caused by a lesion or a disturbance of the motor or sensory nervous system, it is elicited by a dysfunction of an area in the left cortex of the brain. This area in the left fronto-parietotemporal hemisphere is located right beside the area for speech. Therefore it is not unusual that patients with apraxia suffer from aphasia as well. The two different types of limb apraxia are ideomotor apraxia and ideational apraxia. Ideomotor apraxia is apraxia without tool use, it includes imitation of positions of hands and fingers, performance of gestures on demand, and pantomime of object use. Ideational apraxia is apraxia with tool use like cutting with a knife or utilizing a pencil.

  18. Transforming growth factor: beta signaling is essential for limb regeneration in axolotls.

    Directory of Open Access Journals (Sweden)

    Mathieu Lévesque

    Full Text Available Axolotls (urodele amphibians have the unique ability, among vertebrates, to perfectly regenerate many parts of their body including limbs, tail, jaw and spinal cord following injury or amputation. The axolotl limb is the most widely used structure as an experimental model to study tissue regeneration. The process is well characterized, requiring multiple cellular and molecular mechanisms. The preparation phase represents the first part of the regeneration process which includes wound healing, cellular migration, dedifferentiation and proliferation. The redevelopment phase represents the second part when dedifferentiated cells stop proliferating and redifferentiate to give rise to all missing structures. In the axolotl, when a limb is amputated, the missing or wounded part is regenerated perfectly without scar formation between the stump and the regenerated structure. Multiple authors have recently highlighted the similarities between the early phases of mammalian wound healing and urodele limb regeneration. In mammals, one very important family of growth factors implicated in the control of almost all aspects of wound healing is the transforming growth factor-beta family (TGF-beta. In the present study, the full length sequence of the axolotl TGF-beta1 cDNA was isolated. The spatio-temporal expression pattern of TGF-beta1 in regenerating limbs shows that this gene is up-regulated during the preparation phase of regeneration. Our results also demonstrate the presence of multiple components of the TGF-beta signaling machinery in axolotl cells. By using a specific pharmacological inhibitor of TGF-beta type I receptor, SB-431542, we show that TGF-beta signaling is required for axolotl limb regeneration. Treatment of regenerating limbs with SB-431542 reveals that cellular proliferation during limb regeneration as well as the expression of genes directly dependent on TGF-beta signaling are down-regulated. These data directly implicate TGF

  19. Clinical outcome and cost effectiveness of early tracheostomy in isolated severe head injury patients

    Directory of Open Access Journals (Sweden)

    Usman Tariq Siddiqui

    2015-01-01

    Conclusions: In patients with severe TBI, ET decreases total days of ventilation and ICU stay, and is associated with a decrease in the frequency of VAP. ET should be considered in severe head injury patients requiring prolong ventilatory support.

  20. Isolated acute non-cystic white matter injury in term infants presenting with neonatal encephalopathy.

    LENUS (Irish Health Repository)

    Barrett, Michael Joseph

    2013-03-01

    We discuss possible aetiological factors, MRI evolution of injury and neuro-developmental outcomes of neonatal encephalopathy (NE). Thirty-six consecutive infants diagnosed with NE were included. In this cohort, four infants (11%) were identified with injury predominantly in the deep white matter on MRI who were significantly of younger gestation, lower birthweight with higher Apgars at one and five minutes compared to controls. Placental high grade villitis of unknown aetiology (VUA) was identified in all four of these infants. Our hypothesis states VUA may induce white matter injury by causing a local inflammatory response and\\/or oxidative stress during the perinatal period. We underline the importance of continued close and systematic evaluation of all cases of NE, including examination of the placenta, in order to come to a better understanding of the clinical presentation, the patterns of brain injury and the underlying pathophysiological processes.

  1. MESS评分在肢体严重软组织损伤治疗中的应用评估%A Retrospective Assessment of the Application Value of MESS in the Treatment of Severe Limb Soft Tissue Injuries

    Institute of Scientific and Technical Information of China (English)

    何志; 李靖; 蒋立; 冯剑; 吕小星; 孙超峰; 李跃军; 李学拥; 黄辞

    2015-01-01

    Objective:To investigate the application value of MESS in the treatment of severe limb soft tissue injuries.Methods:The clinical data of 50 cases of patients with severe extremity soft tissue injuries who were treated in our division from August 2010 to May 2014 were retrospectively analyzed,including 34 males and 16 females,aged 23-53,with the average of 38.Each case was scored ac-cording to the protocol of MESS,and received debridement,limb salvage or amputation operation and repair operation according to his or her specific condition.The patients were followed up for 3 months to 3 years.All the cases were grouped according to their outcomes to limb-salvage group,first stage amputation group and secondary amputation group.The MESS score,hospital stay,operation times,incidence rate of complications and satisfaction rate were compared among the three groups.Results:32 patients in limb-salvage group had MESS score of 6-11 (8.63 ± 1.26).18 cases received amputation surgery had MESS score of 1 1-14,including 10 cases of first stage amputation group (MESS 12.60± 0.97) and 8 cases of secondary amputation group (12.88± 0.83).MESS score of limb-salvage group was significantly lower than that of the first stage amputation group (P<0.05) and the secondary amputation group (P<0.05).In addition,the satisfaction rate of limb-salvage group was higher than that of the first stage amputation group (P<0.05) and the secondary amputation group (P<0.05).The hospital stay,operation times and incidence rate of complications of first stage amputation group were all lower than those of the secondary amputation group.The patients' satisfaction rate of first stage amputation group was higher than that of the secondary amputation group (P<0.05).Conclusion:Severe limb soft tissue injuries patients with the MESS score<1 1 points got satisfactory results with the limb salvage operations.While for patients with the MESS score> 11 points,first stage amputation could have better

  2. Gait efficiency on an uneven surface is associated with falls and injury in older subjects with a spectrum of lower limb neuromuscular function: a prospective study

    Science.gov (United States)

    Zurales, Katie; DeMott, Trina K.; Kim, Hogene; Allet, Lara; Ashton-Miller, James A.; Richardson, James K.

    2015-01-01

    Objective To determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy (DPN). Design Twenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe DPN walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year. Results Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared to non-fallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL) and greater step-width-to-step-length ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-R2 = 0.65; p = .012) and remained so with inclusion of other relevant variables into the model. Post-hoc analysis comparing injured with non-injured fallers showed no difference in any gait parameter. Conclusion SW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces. PMID:26053187

  3. EFFECT OF LOCOMOTOR TRAINING WITH BODY WEIGHT SUPPORT ON GAIT AND LOWER LIMB STRENGTH IN INCOMPLETE SPINAL CORD INJURY-A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Parneet Kaur Bedi

    2016-08-01

    Full Text Available Background: Irrespective of the severity of the spinal injury, time after lesion and age at time of injury, the restoration of walking is given high priority by subjects with SCI. There is ample amount of literature with gait training methods for restoration of locomotion from other parts of the world. Rehabilitative training is currently one of the most thriving treatments to promote functional recovery following SCI. Many strategies exist to enhance locomotion, such as treadmill training with and without body weight support, robotic-assisted gait training, functional electrical stimulation, epidural stimulation and surface spinal stimulation. Pertaining to developing countries, this case study is an attempt to determine the effect of Locomotor Training with Body Weight Support on Gait and Muscle Strength in Incomplete Spinal Cord Injury. Methods: Single case design, Body weight support treadmill training for over a period of 12 months for an Individual with SCI (ASIA C in a private clinic set up for SCI rehabilitation. ASIA lower extremity muscle strength, Spinal Cord Injury Functional Ambulation Inventory and Walking Index for Spinal Cord Injury –II. Results: Significant change in lower extremity muscle strength, gait parameters and temporal parameters of SCI-FAI. Though, no change was observed in score of assistive devices and similarly WISCI-II scoring. Conclusion: Single participant case study provided us with vital evidence for locomotor training with Body weight support in incomplete SCI. Further research in to the field shall yield valuable clinical findings.

  4. Crossover replantation after bilateral traumatic lower limb amputations: a case report

    OpenAIRE

    Fang Jun; Li Huazhuang; Dou Honglei; Chen Jingchun; Xu Aiping; Liu Wenguo; Ding Gang

    2012-01-01

    Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replan...

  5. An Isolation Method for Assessment of Brain Mitochondria Function in Neonatal Mice with Hypoxic-Ischemic Brain Injury

    Science.gov (United States)

    Caspersen, Casper S.; Sosunov, Alexander; Utkina-Sosunova, Irina; Ratner, Veniamin I.; Starkov, Anatoly A.; Ten, Vadim S.

    2010-01-01

    This work was undertaken to develop a method for the isolation of mitochondria from a single cerebral hemisphere in neonatal mice. Mitochondria from the normal mouse brain hemisphere isolated by the proposed method exhibited a good respiratory control ratio of 6.39 ± 0.53 during glutamate-malate-induced phosphorylating respiration. Electron microscopy showed intact mitochondria. The applicability of this method was tested on mitochondria isolated from naïve mice and their littermates subjected to hypoxic-ischemic insult. Hypoxic-ischemic insult prior to reperfusion resulted in a significant (p < 0.01) inhibition of phosphorylating respiration compared to naïve littermates. This was associated with a profound depletion of the ATP content in the ischemic hemisphere. The expression for Mn superoxide dismutase and cytochrome C (markers for the integrity of the mitochondrial matrix and outer membrane) was determined by Western blot to control for mitochondrial integrity and quantity in the compared samples. Thus, we have developed a method for the isolation of the cerebral mitochondria from a single hemisphere adapted to neonatal mice. This method may serve as a valuable tool to study mitochondrial function in a mouse model of immature brain injury. In addition, the suggested method enables us to examine the mitochondrial functional phenotype in immature mice with a targeted genetic alteration. PMID:18349523

  6. Ocular and periocular injuries associated with an isolated orbital fracture depending on a blunt cranial trauma: anatomical and surgical aspects.

    Science.gov (United States)

    Karabekir, H Selim; Gocmen-Mas, Nuket; Emel, Erhan; Karacayli, Umit; Koymen, Ramazan; Atar, Elmas Kagnici; Ozkan, Nezih

    2012-10-01

    The anatomical location of fractures following blunt cranio-orbital trauma is important for neurosurgeons and maxillofacial surgeons. In this study, 588 cranio-orbital fractures following blunt trauma were evaluated retrospectively with regard to the anatomical site and surgical treatment. Orbital cranial nerve injuries and the outcomes of the medical and/or surgical treatment are described. Distribution of the zygomatic complex and orbital fractures were as follows: zygomatic complex fractures (n:304), isolated orbital fractures (n:58), complex comminuted fractures (n:226). In 58 cases, 69 orbit fractures were found (11 bilateral and 47 unilateral fractures). The lateral wall was the most frequent fracture (n:63). The least frequent fracture was the roof of the orbit (n:11). The accompanying lesions were as follows: 89.65% of cases were associated with periorbital haematoma (n:52), 13.79% of cases with retrobulbar haemorrhage (n:8), 96.55% cases with periorbital soft tissue oedema (n:56), 53.45% cases with pneumocephalus (n:31), 8.62% cases with intra-parenchymal contusion (n:5), 6.89% cases with enophthalmia (n:4), 5.17% of cases with rhinorrhoea (n: 3), 5.17% cases with optic bulb injury and adnexial trauma (n:3), 32.76% cases with intra-orbital emphysema (n:19), and 20.69% with vision dysfunctions (n:12), of whom 2 had no optic nerve injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Combined Isolated Laugier's Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Science.gov (United States)

    Osman, Walid; Alaya, Zeineb; Naouar, Nader; Ben Ayeche, Mohamed

    2016-01-01

    Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes. PMID:28070435

  8. Combined Isolated Laugier’s Fracture and Distal Radial Fracture: Management and Literature Review on the Mechanism of Injury

    Directory of Open Access Journals (Sweden)

    Walid Osman

    2016-01-01

    Full Text Available Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

  9. Cocaine-associated lower limb ischemia.

    LENUS (Irish Health Repository)

    Collins, Chris G

    2011-07-25

    Cocaine-associated thrombosis has been reported in the literature with reports of vascular injuries to cardiac, pulmonary, intestinal, placental, and musculoskeletal vessels; however, injury of the pedal vessels is rare. We report on a 31-year-old man who presented 2 months following a cocaine binge with limb-threatening ischemia without an otherwise identifiable embolic source. Angiography confirmed extensive occlusive disease of the tibioperoneal vessels. The patient improved following therapy with heparin and a prostacyclin analogue. Cocaine-induced thrombosis should be considered in patients presenting with acute arterial insufficiency in the lower limb without any other identifiable cause.

  10. Glutamate protects against Ca(2+) paradox-induced injury and inhibits calpain activity in isolated rat hearts.

    Science.gov (United States)

    Zhang, Jian-Ying; Kong, Ling-Heng; Lai, Dong; Jin, Zhen-Xiao; Gu, Xiao-Ming; Zhou, Jing-Jun

    2016-10-01

    This study determined the effects of glutamate on the Ca(2+) paradoxical heart, which is a model for Ca(2+) overload-induced injury during myocardial ischaemia and reperfusion, and evaluated its effect on a known mediator of injury, calpain. An isolated rat heart was retrogradely perfused in a Langendorff apparatus. Ca(2+) paradox was elicited via perfusion with a Ca(2+) -free Krebs-Henseleit (KH) solution for 3 minutes followed by Ca(2+) -containing normal KH solution for 30 minutes. The Ca(2+) paradoxical heart exhibited almost no viable tissue on triphenyltetrazolium chloride staining and markedly increased LDH release, caspase-3 activity, cytosolic cytochrome c content, and apoptotic index. These hearts also displayed significantly increased LVEDP and a disappearance of LVDP. Glutamate (5 and 20 mmol/L) significantly alleviated Ca(2+) paradox-induced injury. In contrast, 20 mmol/L mannitol had no effect on Ca(2+) paradox. Ca(2+) paradox significantly increased the extent of the translocation of μ-calpain to the sarcolemmal membrane and the proteolysis of α-fodrin, which suggests calpain activation. Glutamate also blocked these effects. A non-selective inhibitor of glutamate transporters, dl-TBOA (10 μmol/L), had no effect on control hearts, but it reversed glutamate-induced cardioprotection and reduction in calpain activity. Glutamate treatment significantly increased intracellular glutamate content in the Ca(2+) paradoxical heart, which was also blocked by dl-TBOA. We conclude that glutamate protects the heart against Ca(2+) overload-induced injury via glutamate transporters, and the inhibition of calpain activity is involved in this process. © 2016 John Wiley & Sons Australia, Ltd.

  11. MCT1 and MCT4 Expression During Myocardial Ischemic-Reperfusion Injury in the Isolated Rat Heart

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    Yi Zhu

    2013-09-01

    Full Text Available Background/Aims: Myocardium ischemia-reperfusion (I/R injury can be caused by imbalances in cellular metabolism. Lactate, transported by monocarboxylate transporters (MCTs, has been implicated as a mechanism in this process. The present study was designed to investigate the expression and functional role of MCTs in rat hearts during ischemia and reperfusion. Methods: Langendorff-perfused rat hearts were subjected to 20 minutes stabilization, 30 minutes of global ischemia and 60 minutes reperfusion. Hearts were collected serially for detecting expression changes in MCT1, MCT4 during myocardial I/R injury and lactate concentration was measured. Post-ischemic left ventricular function and infract size were determined at end-point, followed by the pretreatment of D-lactate, a competitive inhibitor of MCTs. Results: MCT4 was significantly increased following global ischemia and MCT1 expression was increased during the early stages of reperfusion in isolated rat hearts, while the expression of the ancillary protein CD147 was increased during I/R injury. We determined increases in AMPK phosphorylation status, which was significantly elevated following ischemia and early reperfusion. Blocking monocarboxylate transport by competitive inhibition with D-lactate caused decreased left ventricular performance and increased infarct size. Conclusion: Increased MCT4 expression facilitates lactate extrusion during the ischemic period, while increased MCT1 may facilitate lactate transport into and out of cells simultaneously during early reperfusion, with increases in AMPK phosphorylation status during the myocardial I/R period. Lactate transport by MCTs has a profound protective effect during myocardial ischemia reperfusion injury.

  12. Clinical, electrophysiological, and prognostic study of postinjection sciatic nerve injury: An avoidable cause of loss of limb in the peripheral medical service

    Directory of Open Access Journals (Sweden)

    Wani Maqbool

    2009-01-01

    Full Text Available Background: Post injection sciatic nerve injury is a common cause of sciatic nerve mononeuropathy in the developing world largely due to inadequate health care facilites in the rural regions. Objective: The study was conducted to analyse the pattern of this nerve lesion in clinical and electrophysiological parameters and also to study the outcome in a conservatively treated cohort. Materials and Methods: One hundred and six patients who underwent evaluation at our laboratory from 2000 to 2006 for post injection sciatic neuropathy formed the study population. Twenty two of these were followed up (mean 6.6 months for the outcome. Results: In the cases with full data, common peroneal division of the sciatic nerve was affected alone or predominantly. On follow up, 72% cases showed little or partial recovery. Thirty two percent patients had residual trophic changes and causalgia at their last visit. Conclusion: The majority of cases of postinjection sciatic nerve injury have poor prognosis on conservative treatment.

  13. Closed-suction drain placement at laparotomy in isolated solid organ injury is not associated with decreased risk of deep surgical site infection.

    Science.gov (United States)

    Mohseni, Shahin; Talving, Peep; Kobayashi, Leslie; Kim, Dennis; Inaba, Kenji; Lam, Lydia; Chan, Linda S; Coimbra, Raul; Demetriades, Demetrios

    2012-10-01

    The purpose of this study was to investigate the role of intra-abdominal closed-suction drainage after emergent trauma laparotomy for isolated solid organ injuries (iSOI) and to determine its association with deep surgical site infections (DSSI). All patients subjected to trauma laparotomy between January 2006 and December 2008 for an iSOI at two Level I urban trauma centers were identified. Patients with isolated hepatic, splenic, or renal injuries were included. Study variables extracted included demographics, clinical characteristics, intra-abdominal injuries, drain placement, DSSI, septic events, intensive care unit and hospital length of stay, and in-hospital mortality. Diagnosis of DSSI was based on abdominal computed tomography scan demonstrating an intra-abdominal collection combined with fever and elevated white blood cell count. For the analysis, patients were stratified based on injury severity. To identify an independent association between closed-suction drain placement and DSSI, stepwise logistic regression analysis was performed. Overall, 142 patients met the inclusion criteria with 80 per cent (n=114) having severe iSOI. In 47 per cent (n=53) of the patients with a severe injury, an intra-abdominal drain was placed. A drain was placed more often in patients with a blunt trauma with more severe injury defined by Injury Severity Score and abdominal Abbreviated Injury Scale Score and those who underwent splenectomy (Pdrain placement (odds ratio, 2.8; 95% confidence interval, 1.0 to 8.2; P=0.046). Subgroup analysis demonstrated those who sustained severe hepatic injury receiving a drain had a significantly increase risk of DSSI (P=0.02). There was no statistical difference in the rate of DSSI based on the presence or absence of an intra-abdominal drain after severe splenic injury (17 vs 18%, P=0.88). The use of intra-abdominal closed-suction drains after iSOI is not associated with decreased risk of DSSI.

  14. Isolated limb perfusion and external beam radiotherapy for soft tissue sarcomas of the extremity: long-term effects on normal tissue according to the LENT-SOMA scoring system.

    Science.gov (United States)

    Hoven-Gondrie, Miriam L; Thijssens, Katja M J; Geertzen, Jan H B; Pras, Elisabeth; van Ginkel, Robert J; Hoekstra, Harald J

    2008-05-01

    With the combined treatment procedure of isolated limb perfusion (ILP), delayed surgical resection and external beam radiotherapy (EBRT) for locally advanced soft tissue sarcomas (STS) of the extremities, limb salvage rates of more than 80% can be achieved. However, long-term damage to the healthy surrounding tissue cannot be prevented. We studied the late effects on the normal tissue using the LENT-SOMA scoring system. A total of 32 patients-median age 47 (range 14-71) years-were treated for a locally advanced STS with ILP, surgical resection and often adjuvant 60-70 Gy EBRT. After a median follow-up of 88 (range 17-159) months, the patients were scored, using the LENT-SOMA scales, for the following late tissue damage: muscle/soft tissue, peripheral nerves, skin/subcutaneous tissue and vessels. According to the individual SOM parameters of the LENT-SOMA scales, 20 patients (63%) scored grade-3 toxicity on one or more separate items, reflecting severe symptoms with a negative impact on daily activities. Of these patients, 3 (9%) even scored grade-4 toxicity on some of the parameters, denoting irreversible functional damage necessitating major therapeutic intervention. In evaluating long-term morbidity after a combined treatment procedure for STS of the extremity, using modified LENT-SOMA scores, two-thirds of patients were found to have experienced serious late toxic effects.

  15. Safety and efficacy of abobotulinumtoxinA for hemiparesis in adults with upper limb spasticity after stroke or traumatic brain injury: a double-blind randomised controlled trial.

    Science.gov (United States)

    Gracies, Jean-Michel; Brashear, Allison; Jech, Robert; McAllister, Peter; Banach, Marta; Valkovic, Peter; Walker, Heather; Marciniak, Christina; Deltombe, Thierry; Skoromets, Alexander; Khatkova, Svetlana; Edgley, Steven; Gul, Fatma; Catus, France; De Fer, Beatrice Bois; Vilain, Claire; Picaut, Philippe

    2015-10-01

    Resistance from antagonistic muscle groups might be a crucial factor reducing function in chronic hemiparesis. The resistance due to spastic co-contraction might be reduced by botulinum toxin injections. We assessed the effects of abobotulinumtoxinA injection in the upper limb muscles on muscle tone, spasticity, active movement, and function. In this randomised, placebo-controlled, double-blind study, we enrolled adults (aged 18-80 years) at least 6 months after stroke or brain trauma from 34 neurology or rehabilitation clinics in Europe and the USA. Eligible participants were randomly allocated in a 1:1:1 ratio with a computer-generated list to receive a single injection session of abobotulinumtoxinA 500 U or 1000 U or placebo into the most hypertonic muscle group among the elbow, wrist, or finger flexors (primary target muscle group [PTMG]), and into at least two additional muscle groups from the elbow, wrist, or finger flexors or shoulder extensors. Patients and investigators were masked to treatment allocation. The primary endpoint was the change in muscle tone (Modified Ashworth Scale [MAS]) in the PTMG from baseline to 4 weeks. Secondary endpoints were Physician Global Assessment (PGA) at week 4 and change from baseline to 4 weeks in the perceived function (Disability Assessment Scale [DAS]) in the principal target of treatment, selected by the patient together with physician from four functional domains (dressing, hygiene, limb position, and pain). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT01313299. 243 patients were randomly allocated to placebo (n=81), abobotulinumtoxinA 500 U (n=81), or abobotulinumtoxinA 1000 U (n=81). Mean change in MAS score from baseline at week 4 in the PTMG was -0·3 (SD 0·6) in the placebo group (n=79), -1·2 (1·0) in the abobotulinumtoxinA 500 U group (n=80; difference -0·9, 95% CI -1·2 to -0·6; phemiparesis. Future research into the treatment of spastic paresis with

  16. Pneumatic Feedback for Wearable Lower Limb Exoskeletons Further Explored

    NARCIS (Netherlands)

    Muijzer-Witteveen, Heidi; Guerra, Francisco; Sluiter, Victor; Kooij, van der Herman; Bello, Fernando; Kajimoto, Hiroyuki; Visell, Yon

    2016-01-01

    For optimal control of wearable lower limb exoskeletons the sensory information flow should also be (partly) restored, especially when the users are Spinal Cord Injury subjects. Several methods, like electrotactile or electromechanical vibrotactile stimulation, to provide artificial sensory feedback

  17. Pneumatic Feedback for Wearable Lower Limb Exoskeletons Further Explored

    NARCIS (Netherlands)

    Muijzer-Witteveen, Heintje Johanna Berendina; Guerra, Francisco; Sluiter, Victor IJzebrand; van der Kooij, Herman; Bello, Fernando; Kajimoto, Hiroyuki; Visell, Yon

    2016-01-01

    For optimal control of wearable lower limb exoskeletons the sensory information flow should also be (partly) restored, especially when the users are Spinal Cord Injury subjects. Several methods, like electrotactile or electromechanical vibrotactile stimulation, to provide artificial sensory feedback

  18. Low-Level Laser Therapy (904 nm) Counteracts Motor Deficit of Mice Hind Limb following Skeletal Muscle Injury Caused by Snakebite-Mimicking Intramuscular Venom Injection.

    Science.gov (United States)

    Vieira, Willians Fernando; Kenzo-Kagawa, Bruno; Cogo, José Carlos; Baranauskas, Vitor; Cruz-Höfling, Maria Alice da

    2016-01-01

    Myotoxins present in Bothrops venom disrupt the sarcolemma of muscle fibers leading to the release of sarcoplasmic proteins and loss of muscle homeostasis. Myonecrosis and tissue anoxia induced by vascularization impairment can lead to amputation or motor functional deficit. The objective of this study was to investigate the dynamic behavior of motor function in mice subjected to injection of Bothrops jararacussu venom (Bjssu) and exposed to low-level laser therapy (LLLT). Male Swiss mice received Bjssu injection (830 μg/kg) into the medial portion of the right gastrocnemius muscle. Three hours later the injected region was irradiated with diode semiconductor Gallium Arsenide (GaAs- 904 nm, 4 J/cm²) laser following by irradiation at 24, 48 and 72 hours. Saline injection (0.9% NaCl) was used as control. Gait analysis was performed 24 hours before Bjssu injection and at every period post-Bjssu using CatWalk method. Data from spatiotemporal parameters Stand, Maximum Intensity, Swing, Swing Speed, Stride Length and Step Cycle were considered. The period of 3 hours post venom-induced injury was considered critical for all parameters evaluated in the right hindlimb. Differences (plaser groups during the 3 hours post-injury period, in which the values of stand of most animals were null. After this period, the gait characteristics were re-established for all parameters. The venom + laser group kept the values at 3 hours post-Bjssu equal to that at 24 hours before Bjssu injection indicating that the GaAs laser therapy improved spatially and temporally gait parameters at the critical injury period caused by Bjssu. This is the first study to analyze with cutting edge technology the gait functional deficits caused by snake envenoming and gait gains produced by GaAs laser irradiation. In this sense, the study fills a gap on the field of motor function after laser treatment following snake envenoming.

  19. [Phantom limb pain].

    Science.gov (United States)

    Steffen, Peter

    2006-06-01

    Almost everyone who has amputated a limb will experience a phantom limb. They have the vivid impression, that the limb is still present. 60 to 70% of these amputees will suffer from phantom limb pain. The present paper gives an overview of the incidence and the characteristics of the so called "post amputation syndrome". Possible mechanism of this phenomena are presented, including peripheral, spinal, and central theories. Treatment of phantom limb pain is sometimes very difficult. It includes drug therapy, psychological therapy, physiotherapy as well as the prevention of phantom limb pain with regional analgesia techniques.

  20. 单一肢体损伤的功能评定%Assessment of Function of a Single Limb after Injury

    Institute of Scientific and Technical Information of China (English)

    孙会艳

    2015-01-01

    Objective To explore themethod for the objective evaluation of single lim b function after in-jury in forensic m edical practice. Methods The score of activities of daily living (ADL ) w ere graded for a single lim b function after injury from 47 cases.Allcases w ere sim ultaneously evaluated using the differentmethods including Fugl-M eyer m otor function assessm ent (FM A ), w eighting, look-up table (LUT). The correlation w ere com pared betw een ADL and the other threemethods. Results Injured part and the score using the threemethods w ere correlated w ith ADL score (P<0.05). The correlation coeffi-cient (|r| value) show ed highest using LUTmethod, and low est using FM Amethod. Conclusion The loss function of lim b is affected by the injuried parts. Themethods of FM A , w eighting and LUTshow a good accuracy for evaluating the lim b function after injury and the correlation presents higher using LUTmethod.%目的:探讨能客观反映单一肢体损伤功能评定的法医学评价方法。方法收集47例单一肢体损伤案件进行日常生活活动能力(activities of daily living,ADL)评分,获得单一肢体损伤的功能情况。每个案例均同时采用Fugl-Meyer运动功能评分分级法(简称FMA法)、加权法、查表法进行评估,比较ADL与三种评价方法的相关性。结果损伤部位、FMA法、加权法、查表法评分结果与ADL评分相关(P<0.05),就相关系数(|r|值)比较,查表法最高,FMA法最低。结论肢体损伤部位对功能丧失程度有影响。FMA法、加权法、查表法均能较准确地评定单一肢体损伤后的功能,但查表法与单一肢体损伤后功能丧失的相关性更高。

  1. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer.

    Science.gov (United States)

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan; Yoo, Heon Jong

    2017-03-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications.

  2. Lower limb compartment syndrome by reperfusion injury after treatment of arterial thrombosis post-laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer

    Science.gov (United States)

    Yeon, Jihee; Jung, Ye Won; Yang, Shin Seok; Kang, Byung Hun; Lee, Mina; Ko, Young Bok; Yang, Jung Bo; Lee, Ki Hwan

    2017-01-01

    Compartment syndrome is a clinical condition associated with decreased blood circulation that can lead to swelling of tissue in limited space. Several factors including lithotomy position, prolonged surgery, intermittent pneumatic compressor, and reperfusion after treatment of arterial thrombosis may contribute to compartment syndrome. However, compartment syndrome rarely occurs after gynecologic surgery. In this case, the patient was diagnosed as compartment syndrome due to reperfusion injury after treatment of arterial thrombosis, which occurred after laparoscopic radical hysterectomy and pelvic lymph node dissection for cervical cancer. Despite its rarity, prevention and identifying the risk factors of complication should be performed perioperatively; furthermore, gynecologist should be aware of the possibility of complications. PMID:28344966

  3. Lower thoracic spinal cord injury without radiographic abnormality in an amateur rugby player.

    Science.gov (United States)

    Smith, Hannah K; Durnford, Andrew J; Sherlala, Khaled; Merriam, William F

    2012-10-26

    A 37-year-old man, amateur rugby player sustained a hyperextension injury to his lower thoracic spine during a scrum collapse. The patient developed extreme hyperpathia in the T10-12 dermatome, and parasthesia from T12 to S1 in the left lower limb. Medical Research Council grade 5 power was regained rapidly within minutes of the accident, and the hyperpathia resolved within a week. MRI showed contusion of the spinal cord at T10 level but no associated osseoligamentous injury. Six months later, parasthesia and subjective weakness remained in the left lower limb. To our knowledge, this is the first description of a lower thoracic spinal cord injury without radiographic abnormality following an isolated low-energy injury in a skeletally mature patient.

  4. Suppressive effect of astaxanthin isolated from the Xanthophyllomyces dendrorhous mutant on ethanol-induced gastric mucosal injury in rats.

    Science.gov (United States)

    Kim, Jeong-Hwan; Choi, Seok-Keun; Choi, Sang-Yun; Kim, Han-Kyeom; Chang, Hyo-Ihl

    2005-07-01

    Ethanol has been found to induce ulcerative gastric lesion in humans. The present study investigated the in vivo protective effect of astaxanthin isolated from the Xanthophyllomyces dendrorhous mutant against ethanol-induced gastric mucosal injury in rats. The rats were treated with 80% ethanol for 3 d after pretreatment with two doses of astaxanthin (5 and 25 mg/kg of body weight respectively) for 3 d, while the control rats received only 80% ethanol for 3 d. The oral administration of astaxanthin (5 and 25 mg/kg of body weight) showed significant protection against ethanol-induced gastric lesion and inhibited elevation of the lipid peroxide level in gastric mucosa. In addition, pretreatment with astaxanthin resulted in a significant increase in the activities of radical scavenging enzymes such as superoxide dismutase, catalase, and glutathione peroxidase. A histologic examination clearly indicated that the acute gastric mucosal lesion induced by ethanol nearly disappeared after pretreatment with astaxanthin.

  5. Cardioprotective effect of aqueous extract of Chichorium intybus on ischemia-reperfusion injury in isolated rat heart.

    Science.gov (United States)

    Sadeghi, Najmeh; Dianat, Mahin; Badavi, Mohammad; Malekzadeh, Ahad

    2015-01-01

    Several studies have shown that Chichorium intybus (C. intybus) which possesses flavonoid compounds has an effective role in treatment of cardiovascular diseases. Contractile dysfunction mostly occurs after acute myocardial infarction, cardiac bypass surgery, heart transplantation and coronary angioplasty. The aim of the present study was to investigate the effect of aqueous extract of C. intybus on ischemia- reperfusion injury in isolated rat heart. The animals were divided into four groups (Sham, Control, 1 mg/ml and 3 mg/ml of extract) of 8 rats. The aorta was cannulated, and then the heart was mounted on a Langendorff apparatus. Next, a balloon was inserted into the left ventricle (LV) and peak positive value of time derivate of LV pressure (+dp/dt), coronary flow (CF), and left ventricular systolic pressure (LVSP) in pre-ischemia and reperfusion period were calculated by a Power Lab system. All groups underwent a 30-minute global ischemia followed by a 60-minute reperfusion. The results showed that heart rate (HR), coronary flow, and left ventricular developed pressure (LVDP) and rate of pressure product (RPP) significantly decreased in the control group during reperfusion, while these values in the groups receiving the extract (3mg/ml) improved significantly during reperfusion (p<0.001). It seems that flavonoid compounds of aqueous extract of C. intybus reduce ischemia - reperfusion injuries, suggesting its protective effect on heart function after ischemia.

  6. Phantom limb pain

    Science.gov (United States)

    Amputation - phantom limb ... Bang MS, Jung SH. Phantom limb pain. In: Frontera, WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation . 3rd ed. Philadelphia, PA: Elsevier ...

  7. Low-Level Laser Therapy (904 nm Counteracts Motor Deficit of Mice Hind Limb following Skeletal Muscle Injury Caused by Snakebite-Mimicking Intramuscular Venom Injection.

    Directory of Open Access Journals (Sweden)

    Willians Fernando Vieira

    Full Text Available Myotoxins present in Bothrops venom disrupt the sarcolemma of muscle fibers leading to the release of sarcoplasmic proteins and loss of muscle homeostasis. Myonecrosis and tissue anoxia induced by vascularization impairment can lead to amputation or motor functional deficit. The objective of this study was to investigate the dynamic behavior of motor function in mice subjected to injection of Bothrops jararacussu venom (Bjssu and exposed to low-level laser therapy (LLLT. Male Swiss mice received Bjssu injection (830 μg/kg into the medial portion of the right gastrocnemius muscle. Three hours later the injected region was irradiated with diode semiconductor Gallium Arsenide (GaAs- 904 nm, 4 J/cm² laser following by irradiation at 24, 48 and 72 hours. Saline injection (0.9% NaCl was used as control. Gait analysis was performed 24 hours before Bjssu injection and at every period post-Bjssu using CatWalk method. Data from spatiotemporal parameters Stand, Maximum Intensity, Swing, Swing Speed, Stride Length and Step Cycle were considered. The period of 3 hours post venom-induced injury was considered critical for all parameters evaluated in the right hindlimb. Differences (p<0.05 were concentrated in venom and venom + placebo laser groups during the 3 hours post-injury period, in which the values of stand of most animals were null. After this period, the gait characteristics were re-established for all parameters. The venom + laser group kept the values at 3 hours post-Bjssu equal to that at 24 hours before Bjssu injection indicating that the GaAs laser therapy improved spatially and temporally gait parameters at the critical injury period caused by Bjssu. This is the first study to analyze with cutting edge technology the gait functional deficits caused by snake envenoming and gait gains produced by GaAs laser irradiation. In this sense, the study fills a gap on the field of motor function after laser treatment following snake envenoming.

  8. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND

  9. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DAT

  10. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    NARCIS (Netherlands)

    Schotanus, M.; Middendorp, J.J. van; Hosman, A.J.F.

    2010-01-01

    STUDY DESIGN: Prospective single cohort study. OBJECTIVE: To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. SUMMARY OF BACKGROUND DAT

  11. Upper limb arterial thromboembolism

    DEFF Research Database (Denmark)

    Andersen, L V; Lip, Gregory Y.H.; Lindholt, J S;

    2013-01-01

    The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).......The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF)....

  12. Ratiometric imaging of calcium during ischemia-reperfusion injury in isolated mouse hearts using Fura-2

    Directory of Open Access Journals (Sweden)

    Venkataraman Raghav

    2012-07-01

    Full Text Available Abstract Background We present an easily implementable method for measuring Fura-2 fluorescence from isolated mouse hearts using a commercially available switching light source and CCD camera. After calibration, it provides a good estimate of intracellular [Ca2+] with both high spatial and temporal resolutions, permitting study of changes in dispersion of diastolic [Ca2+], Ca2+ transient dynamics, and conduction velocities in mouse hearts. In a proof-of-principle study, we imaged isolated Langendorff-perfused mouse hearts with reversible regional myocardial infarctions. Methods Isolated mouse hearts were perfused in the Landendorff-mode and loaded with Fura-2. Hearts were then paced rapidly and subjected to 15 minutes of regional ischemia by ligation of the left anterior descending coronary artery, following which the ligation was removed to allow reperfusion for 15 minutes. Fura-2 fluorescence was recorded at regular intervals using a high-speed CCD camera. The two wavelengths of excitation light were interleaved at a rate of 1 KHz with a computer controlled switching light source to illuminate the heart. Results Fura-2 produced consistent Ca2+ transients from different hearts. Ligating the coronary artery rapidly generated a well defined region with a dramatic rise in diastolic Ca2+ without a significant change in transient amplitude; Ca2+ handling normalized during reperfusion. Conduction velocity was reduced by around 50% during ischemia, and did not recover significantly when monitored for 15 minutes following reperfusion. Conclusions Our method of imaging Fura-2 from isolated whole hearts is capable of detecting pathological changes in intracellular Ca2+ levels in cardiac tissue. The persistent change in the conduction velocities indicates that changes to tissue connectivity rather than altered intracellular Ca2+ handling may be underlying the electrical instabilities commonly seen in patients following a myocardial infarction.

  13. Continuous inhibition of poly(ADP-ribose) polymerase does not reduce reperfusion injury in isolated rat heart.

    Science.gov (United States)

    Nishizawa, Kenya; Yanagida, Shigeki; Yamagishi, Tadashi; Takayama, Eiichi; Bessho, Motoaki; Kusuhara, Masatoshi; Adachi, Takeshi; Ohsuzu, Fumitaka

    2013-07-01

    Poly(ADP-ribose) polymerase (PARP), an enzyme that is important to the regulation of nuclear function, is activated by DNA strand breakage. In massive DNA damage, PARP is overactivated, exhausting nicotinamide adenine dinucleotide and leading to cell death. Recent studies have succeeded in reducing cellular damage in ischemia/reperfusion by inhibiting PARP. However, PARP plays an important part in the DNA repair system, and its inhibition may be hazardous in certain situations. We compared the short-time inhibition of PARP against continuous inhibition during ischemia/reperfusion using isolated rat hearts. The hearts were reperfused after 21 minutes of ischemia with a bolus injection of 3-aminobenzamide (3-AB) (10 mg/kg) followed by continuous 3-AB infusion (50 μM) for the whole reperfusion period or for the first 6 minutes or without 3-AB. At the end of reperfusion, contractile function, high-energy phosphate content, nicotinamide adenine dinucleotide content, and infarcted area were significantly preserved in the 3-AB 6-minute group. In the 3-AB continuous group, these advantages were not apparent. At the end of reperfusion, PARP cleavage had significantly proceeded in the 3-AB continuous group, indicating initiation of the apoptotic cascade. Thus, continuous PARP inhibition by 3-AB does not reduce reperfusion injury in the isolated rat heart, which may be because of acceleration of apoptosis.

  14. Cellular injuries of spray-dried Lactobacillus spp. isolated from kefir and their impact on probiotic properties.

    Science.gov (United States)

    Golowczyc, Marina A; Silva, Joana; Teixeira, Paula; De Antoni, Graciela L; Abraham, Analía G

    2011-01-05

    The injuries caused by spray drying (SD) of three potential probiotic lactobacilli isolated from kefir grains and the impact on some probiotic properties, were evaluated. Results demonstrated that Lactobacillus plantarum 83114 and L. kefir 8321 showed a slight reduction of viability (0.11 and 0.29 log CFU/ml respectively) after SD process, and L. kefir 8348 was found to be more sensitive to the process with a reduction in viability of 0.70 log CFU/ml. Neither membrane damage, evaluated by increased sensitivity to NaCl, lysozyme, bile salt and penicillin G, nor changes in acidifying activity in MRS and milk by lactobacilli were detected after SD. L. plantarum 83114 and L. kefir 8321 after SD did not lose their capacity to adhere to intestinal cells. Nevertheless, L. kefir 8348 showed a significant loss of adhesion capacity after SD. In addition, rehydrated spray-dried L. kefir 8321 retained the ability to protect against Salmonella invasion of intestinal cells. This effect was observed when L. kefir is co-incubated with Salmonella before invasion assay. This work shows that the membrane integrity evaluated by indirect methods and some probiotic properties of lactobacilli isolated from kefir did not change significantly after SD, and these powders could be used in functional foods applications. Copyright © 2010 Elsevier B.V. All rights reserved.

  15. Structured movement representations of a phantom limb associated with phantom limb pain.

    Science.gov (United States)

    Osumi, Michihiro; Sumitani, Masahiko; Wake, Naoki; Sano, Yuko; Ichinose, Akimichi; Kumagaya, Shin-Ichiro; Kuniyoshi, Yasuo; Morioka, Shu

    2015-09-25

    The relation between phantom limb pain (PLP) and the movement representation of a phantom limb remains controversial in several areas of neurorehabilitation, although there are a few studies in which the representation of phantom limb movement was precisely evaluated. We evaluated the structured movement representation of a phantom limb objectively using a bimanual circle-line coordination task. We then investigated the relation between PLP and the structured movement representation. Nine patients with a brachial plexus avulsion injury were enrolled who perceived a phantom limb and had neuropathic pain. While blindfolded, the participants repeatedly drew vertical lines using the intact hand and intended to draw circles using the phantom limb simultaneously. "Drawing of circles" by the phantom limb resulted in an oval transfiguration of the vertical lines ("bimanual coupling" effect). We used an arbitrary ovalization index (OI) to quantify the oval transfiguration. When the OI neared 100%, the trajectory changed toward becoming more circular. A significant negative correlation was observed between the intensity of PLP and the OI (r=-0.66, pphantom limb are necessary for alleviating PLP.

  16. 高频超声检查在上肢神经损伤中的临床应用%The clinical application of high resolution ultrasound in upper limb nerve injuries

    Institute of Scientific and Technical Information of China (English)

    檀臻炜; 钟刚; 岑石强; 张定伟; 项舟; 黄富国

    2010-01-01

    目的 探讨高频超声检查在上肢神经损伤中的应用价值.方法 对31例临床确诊为上肢单根神经损伤患者,根据超声检查分成保守治疗组和手术治疗组.手术组(19例)均行神经探查修复术,并以术中探查结果为准计算术前超声的诊断符合率;保守治疗组(12例)和手术组术后均予口服营养神经药物治疗,定期随访超声检查.结果 保守治疗组早期超声图像表现:神经走行弯曲,但神经外膜清晰可见,局部水肿.手术组术前超声图像表现:神经回声带连续性部分中断或完全中断,损伤区为无回声或低回声结构,神经近端直径增粗.手术组与超声诊断完全符合15例,符合率为78.9%;保守治疗组中10例神经功能恢复良好,2例保守治疗无效而行手术治疗.结论 高频超声检查对上肢周围神经损伤有很好的临床应用价值,并对临床治疗和随访有指导意义.%Objective To evaluate the diagnostic value of high resolution ultrasonography in upper limb nerve injuries. Methods Thirty-ong patients who were diagnosed with single nerve injury of the upper limb were divided into surgical treatment group and conservative treatment group according to the ultrasonographic findings. The surgical treatment group ( 19 cases) underwent radial nerve exploration and repair. Intraoperative findings were used to verify the accuracy of preoperative ultrasonographic diagnosis. Patients in the conservative treatment group (12 cases) and surgical treatment group postoperatively received oral administration of neurotrophic medicines and regular follow-up of with high resolution ultrasound examination. Results The ultrasonographic images of the conservative treatment group showed that the course of the nerve was curving,epineurial structure was still intact, and there was local edema. Preoperative ultrasonographic images of the surgical treatment group showed that the ultragenic signals of the nerve was completely or

  17. Paragliding injuries.

    Science.gov (United States)

    Krüger-Franke, M; Siebert, C H; Pförringer, W

    1991-06-01

    Regulations controlling the sport of paragliding were issued in April 1987 by the German Department of Transportation. The growing popularity of this sport has led to a steady increase in the number of associated injuries. This study presents the incidence, localization and degree of injuries associated with paragliding documented in Germany, Austria and Switzerland. The 283 injuries suffered by 218 paragliders were documented in the period 1987-1989: 181 occurred during landing, 28 during starting procedures and nine during flight. The mean patient age was 29.6 years. There were 34.9% spinal injuries, 13.4% upper extremity injuries and 41.3% lower limb injuries. Over half of these injuries were treated surgically and in 54 instances permanent disability remained. In paragliding the lower extremities are at greatest risk of injury during landing. Proper equipment, especially sturdy footwear, exact training in landing techniques as well as improved instruction in procedures during aborted or crash landings is required to reduce the frequency of these injuries.

  18. Detection and isolation of Listeria monocytogenes from food samples: implications of sublethal injury.

    Science.gov (United States)

    Donnelly, Catherine W

    2002-01-01

    Detection of L. monocytogenes is often limited by the performance of the enrichment media used to support bacterial growth to detectable levels. Because Listeria may exist at extremely low levels in foods, sample enrichment protocols must amplify these low initial populations to detectable limits. Listeria may also exist in an injured state in food products as a result of processing treatments such as heating, freezing, exposure to acids, or exposure to sanitizing compounds. Selective agents in enrichment media normally used for recovery of Listeria may inhibit repair and detection of sublethally injured Listeria, which may go on to repair, grow, and regain pathogenicity. Simple modifications to existing regulatory protocols, such as those that use more than one enrichment broth, raise sensitivity of detection to 90%. This review shows the efficacy of repair/enrichment strategies, which increase sensitivity of detection to 97.5-98.8% compared with 65-70% by standard regulatory protocols. Ribotype analysis of isolates obtained from meat samples reveals a complex microbial ecology, with striking differences in both number and distribution of distinct genetic types of Listeria, depending upon whether samples are enriched in selective or repair/enrichment media. In studies on enrichment of dairy environmental samples in University of Vermont medium and Listeria repair broth (UVM and LRB), combining these 2 primary enrichment media into a single tube of Fraser broth for dual secondary enrichment yielded a significantly higher percentage (p samples than did use of either LRB or UVM alone. Refinement of conventional Listeria recovery methods should consider the importance of the enrichment step, the nutritional needs of specific genetic types, and the physiological condition of Listeria isolates in foods.

  19. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

    OpenAIRE

    Kumar M; Badole C; Patond K

    2007-01-01

    Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS) in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: ...

  20. Hybrid brain-computer interfaces and hybrid neuroprostheses for restoration of upper limb functions in individuals with high-level spinal cord injury.

    Science.gov (United States)

    Rohm, Martin; Schneiders, Matthias; Müller, Constantin; Kreilinger, Alex; Kaiser, Vera; Müller-Putz, Gernot R; Rupp, Rüdiger

    2013-10-01

    The bilateral loss of the grasp function associated with a lesion of the cervical spinal cord severely limits the affected individuals' ability to live independently and return to gainful employment after sustaining a spinal cord injury (SCI). Any improvement in lost or limited grasp function is highly desirable. With current neuroprostheses, relevant improvements can be achieved in end users with preserved shoulder and elbow, but missing hand function. The aim of this single case study is to show that (1) with the support of hybrid neuroprostheses combining functional electrical stimulation (FES) with orthoses, restoration of hand, finger and elbow function is possible in users with high-level SCI and (2) shared control principles can be effectively used to allow for a brain-computer interface (BCI) control, even if only moderate BCI performance is achieved after extensive training. The individual in this study is a right-handed 41-year-old man who sustained a traumatic SCI in 2009 and has a complete motor and sensory lesion at the level of C4. He is unable to generate functionally relevant movements of the elbow, hand and fingers on either side. He underwent extensive FES training (30-45min, 2-3 times per week for 6 months) and motor imagery (MI) BCI training (415 runs in 43 sessions over 12 months). To meet individual needs, the system was designed in a modular fashion including an intelligent control approach encompassing two input modalities, namely an MI-BCI and shoulder movements. After one year of training, the end user's MI-BCI performance ranged from 50% to 93% (average: 70.5%). The performance of the hybrid system was evaluated with different functional assessments. The user was able to transfer objects of the grasp-and-release-test and he succeeded in eating a pretzel stick, signing a document and eating an ice cream cone, which he was unable to do without the system. This proof-of-concept study has demonstrated that with the support of hybrid FES

  1. The role of emergent arteriography in penetrating limb trauma.

    Science.gov (United States)

    Gahtan, V; Bramson, R T; Norman, J

    1994-02-01

    Routine arteriographic evaluation of patients with penetrating trauma in proximity to major limb arteries has been declining in popularity. Although some controversy still exists, management based on clinical examination alone has been advocated for those without overt signs of vascular injury. To better identify the need for invasive radiologic intervention, 453 limbs (394 patients) sustaining gunshot, shotgun, and stab wounds (331, 28, and 94, respectively) in proximity to a major artery underwent angiography from 1984 through 1990. An arterial injury was demonstrated in 37 (9.4%) of 394 limbs, with a normal vascular examination, but only eight (2.0%) were deemed to require operative intervention. By comparison, 45 (76%) of 59 patients with an abnormal vascular examination (diminished/absent peripheral pulses or decreased Doppler-derived limb blood pressures) had an arterial injury demonstrated by arteriography, with 33 (55.9%) undergoing operative repair. The presence of an associated long bone fracture increased the incidence of angiographically demonstrated vascular injury, but operative intervention was only increased for those with an abnormal vascular exam. A detailed physical examination including Doppler-derived limb blood pressures is essential. In the presence of a normal vascular exam, routine arteriography for proximity of injury is unnecessary. Arteriography should be reserved to identify those few patients with an abnormal vascular examination and an unclear injury who may require vascular repair.

  2. Isolation

    DEFF Research Database (Denmark)

    Agerholm, Frank Juul

    2011-01-01

    Næringsstoffet har i dette nummer sat fokus på ”velvære i vinterkulden”, ”indendørsaktiviteter” og ”fedtafgift”. I klummen vises det, at disse tre fokusområder, der for en umiddelbar betragtning måske nok synes noget uensartede, falder sammen i ét tema: Isolation!......Næringsstoffet har i dette nummer sat fokus på ”velvære i vinterkulden”, ”indendørsaktiviteter” og ”fedtafgift”. I klummen vises det, at disse tre fokusområder, der for en umiddelbar betragtning måske nok synes noget uensartede, falder sammen i ét tema: Isolation!...

  3. Isolation andin vivo hepatoprotective activity ofMelothria heterophylla (Lour.) Cogn. against chemically induced liver injuries in rats

    Institute of Scientific and Technical Information of China (English)

    Arijit Mondal; Tapan Kumar Maity; Dilipkumar Pal; Santanu Sannigrahi; Jagadish Singh

    2011-01-01

    Objective:To investigate hepatoprotective activity of ethanol extract of Melothria heterophylla Lour Cogn.(EEMH) againstCCl4-induced hepatic damage in rats.Methods:β-sitosterol was isolated by column chromatography and characterized spectroscopically. Two different doses (200 and400mg/kg bw) ofEEMHwere administered orally in alternate days. The hepatoprotective activity was studied in liver by measuring biochemical parameters such as serum aspartate amino transferase (AST), alanine amino transferase(ALT), alkaline phosphatase(ALP), total protein and total bilirubin. Lipid peroxidation product and different antioxidant enzyme activities were assessed in liver homogenate.Results:EEMH reduced all biochemical parameters and lipid peroxidation, as well as it increased the antioxidant enzyme activities in comparison with silymarin. The protective effect of the extract on CCl4 induced damage was confirmed by histopathological examination of the liver.Conclusions: This result strongly supports the protective effect ofEEMH against acute liver injury, and may be attributed to its antioxidative activity.

  4. Iridoid Glycosides Fraction Isolated from Veronica ciliata Fisch. Protects against Acetaminophen-Induced Liver Injury in Mice

    Directory of Open Access Journals (Sweden)

    Shancai Tan

    2017-01-01

    Full Text Available Veronica ciliata Fisch. has traditionally been used in Tibetan medicine for the treatment of hepatitis, cholecystitis, rheumatism, and urticaria. We analyzed the chemical composition of the iridoid glycosides fraction (IGF isolated from V. ciliata and evaluated the antioxidant and hepatoprotective properties. The IGF was separated by high-speed countercurrent chromatography (HSCCC and the main compounds were identified by ultra-performance liquid chromatography coupled to a photodiode array. We determined the in vitro antioxidant ability of the IGF through radical scavenging assays and assessed the in vivo hepatoprotective potential in an acetaminophen- (APAP- induced acute liver injury murine model. The IGF was separated by HSCCC and three major iridoid glycosides (verproside, catalposide, and amphicoside were identified as potent antioxidants and hepatoprotective compounds. Treatment with the IGF significantly suppressed the APAP-induced elevation in serum alanine aminotransferase, aspartate aminotransferase, and tumor necrosis factor-alpha (TNF-α; improved serum total antioxidant capacity; decreased malondialdehyde formation; elevated superoxide dismutase and glutathione activity; and decreased expression of proinflammatory factors (TNF-α, nuclear factor kappa B in the liver. Finally, we examined the histopathology of resected livers for evidence of hepatoprotection. The protection conferred by the IGF may be related to the reinforcement of antioxidant defense systems.

  5. Iridoid Glycosides Fraction Isolated from Veronica ciliata Fisch. Protects against Acetaminophen-Induced Liver Injury in Mice

    Science.gov (United States)

    Tan, Shancai; Lu, Qiuxia; Shu, Yueyue; Sun, Yiran

    2017-01-01

    Veronica ciliata Fisch. has traditionally been used in Tibetan medicine for the treatment of hepatitis, cholecystitis, rheumatism, and urticaria. We analyzed the chemical composition of the iridoid glycosides fraction (IGF) isolated from V. ciliata and evaluated the antioxidant and hepatoprotective properties. The IGF was separated by high-speed countercurrent chromatography (HSCCC) and the main compounds were identified by ultra-performance liquid chromatography coupled to a photodiode array. We determined the in vitro antioxidant ability of the IGF through radical scavenging assays and assessed the in vivo hepatoprotective potential in an acetaminophen- (APAP-) induced acute liver injury murine model. The IGF was separated by HSCCC and three major iridoid glycosides (verproside, catalposide, and amphicoside) were identified as potent antioxidants and hepatoprotective compounds. Treatment with the IGF significantly suppressed the APAP-induced elevation in serum alanine aminotransferase, aspartate aminotransferase, and tumor necrosis factor-alpha (TNF-α); improved serum total antioxidant capacity; decreased malondialdehyde formation; elevated superoxide dismutase and glutathione activity; and decreased expression of proinflammatory factors (TNF-α, nuclear factor kappa B) in the liver. Finally, we examined the histopathology of resected livers for evidence of hepatoprotection. The protection conferred by the IGF may be related to the reinforcement of antioxidant defense systems. PMID:28293265

  6. Cardioprotective effect of aqueous extract of Chichorium intybus L. on ischemia-reperfusion injury in isolated rat heart

    Directory of Open Access Journals (Sweden)

    Najmeh Sadeghi

    2015-10-01

    Full Text Available Objective: Several studies have shown that Chichorium intybus L. (C. intybus which possesses flavonoid compounds has an effective role in treatment of cardiovascular diseases. Contractile dysfunction mostly occurs after acute myocardial infarction, cardiac bypass surgery, heart transplantation and coronary angioplasty. The aim of the present study was to investigate the effect of aqueous extract of C. intybus on ischemia- reperfusion injury in isolated rat heart. Materials and Methods: The animals were divided into four groups (Sham, Control, 1 mg/ml and 3 mg/ml of extract of 8 rats. The aorta was cannulated, and then the heart was mounted on a Langendorff apparatus. Next, a balloon was inserted into the left ventricle (LV and peak positive value of time derivate of LV pressure (+dp/dt, coronary flow (CF, and left ventricular systolic pressure (LVSP in pre-ischemia and reperfusion period were calculated by a Power Lab system. All groups underwent a 30-minute global ischemia followed by a 60-minute reperfusion. Results: The results showed that heart rate (HR, coronary flow, and left ventricular developed pressure (LVDP and rate of pressure product (RPP significantly decreased in the control group during reperfusion, while these values in the groups receiving the extract (3mg/ml improved significantly during reperfusion (p

  7. LDTk: Limb Darkening Toolkit

    CERN Document Server

    Parviainen, Hannu

    2015-01-01

    We present a Python package LDTk that automates the calculation of custom stellar limb darkening (LD) profiles and model-specific limb darkening coefficients (LDC) using the library of PHOENIX-generated specific intensity spectra by Husser et al. (2013). The aim of the package is to facilitate analyses requiring custom generated limb darkening profiles, such as the studies of exoplanet transits--especially transmission spectroscopy, where the transit modelling is carried out for custom narrow passbands--eclipsing binaries (EBs), interferometry, and microlensing events. First, LDTk can be used to compute custom limb darkening profiles with uncertainties propagated from the uncertainties in the stellar parameter estimates. Second, LDTk can be used to estimate the limb-darkening-model specific coefficients with uncertainties for the most common limb-darkening models. Third, LDTk can be directly integrated into the log posterior computation of any pre-existing modelling code with minimal modifications. The last a...

  8. Initiation of limb regeneration: the critical steps for regenerative capacity.

    Science.gov (United States)

    Yokoyama, Hitoshi

    2008-01-01

    While urodele amphibians (newts and salamanders) can regenerate limbs as adults, other tetrapods (reptiles, birds and mammals) cannot and just undergo wound healing. In adult mammals such as mice and humans, the wound heals and a scar is formed after injury, while wound healing is completed without scarring in an embryonic mouse. Completion of regeneration and wound healing takes a long time in regenerative and non-regenerative limbs, respectively. However, it is the early steps that are critical for determining the extent of regenerative response after limb amputation, ranging from wound healing with scar formation, scar-free wound healing, hypomorphic limb regeneration to complete limb regeneration. In addition to the accumulation of information on gene expression during limb regeneration, functional analysis of signaling molecules has recently shown important roles of fibroblast growth factor (FGF), Wnt/beta-catenin and bone morphogenic protein (BMP)/Msx signaling. Here, the routine steps of wound healing/limb regeneration and signaling molecules specifically involved in limb regeneration are summarized. Regeneration of embryonic mouse digit tips and anuran amphibian (Xenopus) limbs shows intermediate regenerative responses between the two extremes, those of adult mammals (least regenerative) and urodele amphibians (more regenerative), providing a range of models to study the various abilities of limbs to regenerate.

  9. Cardioprotective Effect of Angiotensin Ⅱ Receptor Antagonist on Perfused Ischemic Reper-fusion Injury of Whole Isolated Rat Hearts

    Institute of Scientific and Technical Information of China (English)

    徐延敏; 黄体钢; 陈元禄; 李广平

    2003-01-01

    Objectives Investigated the cardioprotective and mechanisms of losartan onwhole isolated ischemic reperfused rat heart. Meth-ods Langendorff perfused systems was used to in-vestigate losartan effect on whole isolated rat hearts inCPK, LDH, MDA, SOD, ang Ⅱ and arrhythmia. Re-sults Losartan decreased incidence of arrhythmia,improved atrial ventricular block recovery in reperfu-sion period, during ischemic period, CPK and LDH inI/R group increased significantly compared with con-trol group, 51.33±27.02 vs 22.42±13.33, 31.80±4.56 vs 22.28 ± 15.96, respectively, but greatlydecreased in losartan group compared with I/R group,23.90±21.74 vs 51.33±27.02 and 11.50±13.20vs 31.80 ± 4. 56, respectively. During reperfusion pe-riod CPK, LDH increased significantly in I/R groupcompared with control group, 49.11 ± 20.63 vs 12.14±5.92 and 28.70±4.69 vs 23.10±21.38, re-spectively, but decreased greatly in losartan groupcompared with I/R group, 39.40 ± 9.60 vs 49.11 ±20.63 and 14.50±13.75 vs 28.70±4.69. Thecontent of MDA, ang Ⅱ in I/R group myocytes ishigher than control group's , 26. ±9. 25 vs 17.2 ±3.37 and 8.43±3.81 vs 4. 80±0.20. However thecontent of SOD in two groups has no significantlychange, 148. 20 ± 8. 72 vs 145.08±6.82. the con-tent of MDA in losartan group myocardial tissue ismuch lower than control group, 15.92±4.05 vs26.80± 9.25 and the content of ang Ⅱ in losartangroup myocardial tissue is much higher than I/Rgroup, 12.44 ± 6.09 vs 8.43 ± 3.21. The departmentof cardiology of second hospital of Tianjin medical u-niversity Tianjin 300211 However, SOD has nosignificant change in two groups, 143.47 ±7.91 vs145.08 ± 6.82. Conclusions Losartan against is-chemic-reperfusion injury of whole isolated rathearts, those beneficial effects are mediate primarily bythe inhibited of angiotensin Ⅱ binding with its receptorand inhibited oxygen free radical scavenging potential.

  10. Outbreak caused by Proteus mirabilis isolates producing weakly expressed TEM-derived extended-spectrum β-lactamase in spinal cord injury patients with recurrent bacteriuria.

    Science.gov (United States)

    Cremet, Lise; Bemer, Pascale; Rome, Joanna; Juvin, Marie-Emmanuelle; Navas, Dominique; Bourigault, Celine; Guillouzouic, Aurelie; Caroff, Nathalie; Lepelletier, Didier; Asseray, Nathalie; Perrouin-Verbe, Brigitte; Corvec, Stephane

    2011-12-01

    We performed a retrospective extended-spectrum β-lactamase (ESBL) molecular characterization of Proteus mirabilis isolates recovered from urine of spinal cord injury patients. A incorrectly detected TEM-24-producing clone and a new weakly expressed TEM-derived ESBL were discovered. In such patients, ESBL detection in daily practice should be improved by systematic use of a synergy test in strains of P. mirabilis resistant to penicillins.

  11. Sex Differences in Limb and Joint Stiffness in Recreational Runners

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan

    2015-09-01

    Full Text Available Purpose. Female runners are known to be at greater risk from chronic running injuries than age-matched males, although the exact mechanisms are often poorly understood. The aim of the current investigation was to determine if female recreational runners exhibit distinct limb and joint stiffness characteristics in relation to their male counterparts. Methods. Fourteen male and fourteen female runners ran over a force platform at 4.0 m · s-1. Lower limb kinematics were collected using an eight-camera optoelectric motion capture system operating at 250 Hz. Measures of limb and joint stiffness were calculated as a function of limb length and joint moments divided by the extent of limb and joint excursion. All stiffness and joint moment parameters were normalized to body mass. Sex differences in normalized limb and knee and ankle joint stiffness were examined statistically using independent samples t tests. Results. The results indicate that normalized limb (male = 0.18 ± 0.07, female = 0.37 ± 0.10 kN · kg · m-1 and knee stiffness (male = 5.59 ± 2.02, female = 7.34 ± 1.78 Nm · kg · rad-1 were significantly greater in female runners. Conclusions. On the basis that normalized knee and limb stiffness were shown to be significantly greater in female runners, the findings from the current investigation may provide further insight into the aetiology of the distinct injury patterns observed between sexes.

  12. Karate and karate injuries.

    OpenAIRE

    McLatchie, G

    1981-01-01

    The origins of karate and its evolution as a sport are described. Karate injuries tend to occur in three main areas: the head and neck, the viscera, and the limbs. Effective legislation controlling karate, which could help prevent injuries, is lacking at the moment and should be established. Recommendations for the prevention of injury include the introduction of weight classes, mandatory provision of protective equipment such as padded flooring, and the outlawing of certain uncontrollable m...

  13. In vitro and in vivo protective effects of proteoglycan isolated from mycelia of Ganoderma lucidum on carbon tetrachloride-induced liver injury

    Institute of Scientific and Technical Information of China (English)

    Xiao-Jun Yang; Jing Liu; Lin-Bai Ye; Fan Yang; Li Ye; Jin-Rong Gao; Zheng-Hui Wu

    2006-01-01

    AIM: To investigate the possible mechanism of the protective effects of a bioactive fraction, Ganoderma lucidum proteoglycan (GLPG) isolated from Ganoderma lucidum mycelia, against carbon tetrachloride-induced liver injury.METHODS: A liver injury model was induced by carbon tetrachloride. Cytotoxicity was measured by MTT assay.The activities of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined with an automatic multifunction-biochemical analyzer and the levels of superoxide dismutase (SOD) and TNF-α were determined following the instructions of SOD kit and TNF radioimmunoassay kit. Liver sections were stained with hematoxylin and eosin (H&E) for histological evaluation and examined under light microscope.RESULTS: We found that GLPG can alleviate the L-02liver cells injury induced by carbon tetrachloride (CCl4)through the measurements of ALT and AST activities and the administration of GLPG to L-02 cells did not display any toxicity. Furthermore, histological analysis of mice liver injury induced by CCl4 with or without GLPG pretreatment indicated that GLPG can significantly suppress the toxicity induced by CCl4 in mice liver. We also found that GLPG reduced TNF-α level induced by CCl4 in the plasma of mice, whereas increased SOD activity in the rat serum.CONCLUSION: GLPG has hepatic protective activity against CCl4-induced injury both in vitro and in vivo. The possible anti-hepatotoxic mechanisms may be related to the suppression of TNF-α level and the free radical scavenging activity.

  14. Isolated transverse process fractures of the subaxial cervical spine: a clinically insignificant injury or not?: a prospective, longitudinal analysis in a consecutive high-energy blunt trauma population.

    Science.gov (United States)

    Schotanus, Maaike; van Middendorp, Joost J; Hosman, Allard J F

    2010-09-01

    Prospective single cohort study. To analyze the incidence, associated injuries, treatment outcomes and associated adverse events of isolated transverse process fractures (TPFs) of the subaxial cervical spine in a high-energy blunt trauma population. Currently, TPFs of the subaxial cervical spine are considered to be clinically insignificant. However, this hypothesis is based on clinical experience and has never been supported by research previously. During a 32-month period, routine computed tomography scans of the spine were obtained in high-energy blunt trauma patients. Patients with isolated TPFs of the subaxial cervical spine were prospectively identified. For each enrolled patient, gender, age, mechanism of injury, trauma severity, neurologic deficit, injury levels, affected structures, treatment, radiographic follow-up, functional outcome (Cybex goniometer, neck disability index), and patient satisfaction (10 point visual analog scale) were recorded. Of 865 enrolled patients, 21 patients (2.4%) had 25 isolated TPFs of the subaxial cervical spine. The seventh vertebra was involved predominantly (76%). The initial treatment regimen was unrestricted movement in all patients. No associated adverse events were observed. A follow-up of 13 to 39 months was available in 14 patients. Follow-up showed a stable and intact subaxial cervical spine in all patients' radiographs, a patient satisfaction of 9.3 (SD 1.48), a Cybex measured range of motion in the sagittal plane of 109 degrees (SD 12.5, 95-129), the frontal plane of 70 (SD 17.8, 37-100) and the transverse plane of 144 (SD 12.5, 116-164), and a mean neck disability index score of 3.93 (SD 8.24). The incidence of isolated TPFs of the subaxial cervical spine was 2.4%. Unrestricted movement resulted in satisfying functional, anatomic, and neurologic outcomes without associated adverse events. This study confirms that isolated TPFs of the subaxial cervical spine can be considered as clinically insignificant and do not

  15. Trends in traumatic limb amputation in Allied Forces in Iraq and Afghanistan

    Directory of Open Access Journals (Sweden)

    Duncan Wallace

    2012-04-01

    Full Text Available Background: Limb amputation has been a common injury occurring in the conflicts in Iraq and Afghanistan. Compared to other injuries, less attention has been given to this serious, disabling wound. Purpose: The article describes the Allied military experience of traumatic limb amputation in Iraq and Afghanistan. It intends to inform health care personnel involved in the care of serving military personnel and veterans about the scale of these casualties. Methods: A literature search of both civilian and military academic databases was conducted. Results: Both the US and UK have incurred very significant numbers of casualties involving traumatic limb amputation, many of whom have suffered multiple limb loss. The rate of blast injuries causing traumatic limb amputation among US forces has increased since the surge of troops in Afghanistan. Dismounted Complex Blast Injury (DCBI consisting of multiple limb amputations with pelvic, abdominal or genito-urinary injuries has been reported as increasing in frequency among US troops in Afghanistan since 2010. Australian Defence Force casualties suffering traumatic limb amputation remain low. Conclusions: Significant casualties involving traumatic limb amputation are likely to continue among Allied troops while current counter-insurgency tactics are continued. Planned troop withdrawals should eventually result in fewer casualties, including reduced numbers of traumatic limb amputation.

  16. Upper Limb Exoskeleton

    NARCIS (Netherlands)

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace

  17. Upper Limb Exoskeleton

    NARCIS (Netherlands)

    Rusak, Z.; Luijten, J.; Kooijman, A.

    2015-01-01

    The present invention relates a wearable exoskeleton for a user having a torso with an upper limb to support motion of the said upper limb. The wearable exoskeleton comprises a first fixed frame mountable to the torso, an upper arm brace and a first group of actuators for moving the upper arm brace

  18. An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

    Directory of Open Access Journals (Sweden)

    Vipul Agarwal

    2016-05-01

    Results: Crush injury of leg with fracture of tibia and fibula was observed in 78% of injured limbs. The most common mechanism of injury was high-energy trauma. Road traffic accidents accounted for 72% of patients. Mean hospitalization for primary amputation was 19.3 (8-26 days and for delayed amputation limbs was 36.6 (15-62 days and for salvaged limbs was 45.5 (14-128 days. In the prospective study, out of 7 injured limbs with a MESS score of equal or more than 7, 6 limbs were amputated and 1 limb was salvaged. Out of the remaining 18 injured limbs with a MESS score of less than 7, 17 limbs were successfully salvaged and one limb was amputated. In the retrospective study, 10 injured limbs with a MESS score of equal or more than 7 were amputated (mean score 8.4 with range of 10-8 and the remaining 15 injured limbs with a MESS score of less than 7 were salvaged (mean score 4.57 with range of (4-6; suggesting a significant difference in the mean scores. Conclusions: MESS is a cost-effective, relatively simple and readily available scoring system, which assists the surgeon to identify variables that may ultimately influence the outcome of a severely traumatized extremity with arterial compromise due to high-energy injury. [Int J Res Med Sci 2016; 4(5.000: 1661-1665

  19. Protective effects of gomisin A isolated from Schisandra chinensis against CCl(4)-induced hepatic and renal injury.

    Science.gov (United States)

    Hwang, In Sik; Kim, Jee Eun; Lee, Yong Ju; Kwak, Moon Hwa; Choi, Young Hwan; Kang, Byeong Cheol; Hong, Jin Tae; Hwang, Dae Youn

    2013-04-01

    The aim of the present study was to investigate the protective effects of gomisin A, a lignan compound isolated from Schisandra chinensis, against liver and kidney damage induced by CCl(4) exposure. We assessed alterations in organ weights, levels of serum biochemical indicators, and activation of the caspase-3 and MAPK signaling pathways and carried out histological analysis of liver and kidney tissue in rats pretreated with gomisin A for four days. In the gomisin A/CCl(4)-treated group, only the liver experienced a significant increase in weight, whereas the other organs did not undergo any changes. Five biochemical indicators in serum indicated that liver and kidney toxicity dramatically decreased upon gomisin A pretreatment, although the decrease in ratios varied. Upon histological analysis, the gomisin A/CCl(4)-treated group showed less hepatocellular necrosis, a poorly dilated central vein in the liver section, decreased diameter of the glomerulus, a lower number of capillaries, and a convoluted tubule in the kidney section. Furthermore, the formation of active caspase-3 was inhibited by gomisin A pretreatment in the gomisin A/CCl(4)-treated group, whereas the expression level of Bax protein was slightly increased. Western blot analysis revealed that there were differences between the liver and kidney in terms of activation of the MAPK signaling pathway. In the liver, gomisin A pretreatment increased phosphorylation of three members of the MAPK pathway when compared to that in the vehicle pretreatment group. However, in the kidney, only the phosphorylation level of p38 was elevated upon gomisin A pretreatment, whereas levels of the other two members were decreased. These results suggest that gomisin A induces marked protective effects against hepatic and renal injury induced by CCl(4) exposure through differential regulation of the MAPK signal transduction pathway.

  20. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available INTRODUCTION: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  1. Special Considerations for Multiple Limb Amputation

    OpenAIRE

    Pasquina, Paul F.; Miller, Matthew; CARVALHO, A. J. de; Corcoran, Michael; Vandersea, James; Johnson, Elizabeth; Chen, Yin-Ting

    2014-01-01

    It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with sin...

  2. Epidemiology of Injury in Gaelic Handball.

    Science.gov (United States)

    O'Connor, S; Downey, M; Moran, K

    2016-03-10

    The initial step in developing injury prevention strategies is to establish the epidemiology of injury. However there has been no published research on injury in Gaelic handball. This study describes the epidemiology of injury in 75 Gaelic handball players utilising a retrospective questionnaire. 88% of participants reported one or more injuries. Injuries to the upper limb were prevalent (52.9%), followed by the lower limb (30.3%). The shoulder (17.6%), finger (10.5%) and ankle (9.8%) were the primary sites of injury. Injuries occurred most frequently in December (9.7%), January (9.7%), February (9.7%) and November (8.7%). Injuries predominantly occurred during games (82.4%). Injuries were primarily severe (54.7%), with 14.6% of participants admitted to hospital due to injury. Given that this is the only study on Gaelic handball to date, prospective epidemiological studies and further research on injury prevention strategies are necessary.

  3. Complications of extremity vascular injuries in conflict.

    Science.gov (United States)

    Brown, Kate V; Ramasamy, Arul; Tai, Nigel; MacLeod, Judith; Midwinter, Mark; Clasper, Jon C

    2009-04-01

    The extremities remain the most common sites of wounding in conflict, are associated with a significant incidence of vascular trauma, and have a high complication rate (infection, secondary amputation, and graft thrombosis). The purpose of this study was to study the complication rate after extremity vascular injury. In particular, the aim was to analyze whether this was influenced by the presence or absence of a bony injury. A prospectively maintained trauma registry was retrospectively reviewed for all UK military casualties with extremity injuries (Abbreviated Injury Score >1) December 8, 2003 to May 12, 2008. Demographics and the details of their vascular injuries, management, and outcome were documented using the trauma audit and medical notes. Thirty-four patients (34%)--37 limbs (30%)--had sustained a total of 38 vascular injuries. Twenty-eight limbs (22.6%) had an associated fracture, 9 (7.3%) did not. Twenty-nine limbs (23.4%) required immediate revascularization to preserve their limb: 16 limbs (13%) underwent an initial Damage Control procedure, and 13 limbs (10.5%) underwent Definitive Surgery. Overall, there were 25 limbs (20.2%) with complications. Twenty-two were in the 28 limbs with open fractures, 3 were in the 9 limbs without a fracture (p vascular trauma if there is an associated fracture, probably due to higher energy transfer and greater tissue damage.

  4. Isolation and characterization of two kinds of stem cells from the same human skin back sample with therapeutic potential in spinal cord injury.

    Directory of Open Access Journals (Sweden)

    Zhaowen Zong

    Full Text Available BACKGROUNDS AND OBJECTIVE: Spinal cord injury remains to be a challenge to clinicians and it is attractive to employ autologous adult stem cell transplantation in its treatment, however, how to harvest cells with therapeutic potential easily and how to get enough number of cells for transplantation are challenging issues. In the present study, we aimed to isolate skin-derived precursors (SKPs and dermal multipotent stem cells (dMSCs simultaneously from single human skin samples from patients with paraplegia. METHODS: Dissociated cells were initially generated from the dermal layer of skin samples from patients with paraplegia and cultured in SKPs proliferation medium. Four hours later, many cells adhered to the base of the flask. The suspended cells were then transferred to another flask for further culture as SKPs, while the adherent cells were cultured in dMSCs proliferation medium. Twenty-four hours later, the adherent cells were harvested and single-cell colonies were generated using serial dilution method. [(3H]thymidine incorporation assay, microchemotaxis Transwell chambers assay, RT-PCR and fluorescent immunocytochemistry were employed to examine the characterizations of the isolated cells. RESULTS: SKPs and dMSCs were isolated simultaneously from a single skin sample. SKPs and dMSCs differed in several respects, including in terms of intermediate protein expression, proliferation capacities, and differentiation tendencies towards mesodermal and neural progenies. However, both SKPs and dMSCs showed high rates of differentiation into neurons and Schwann cells under appropriate inducing conditions. dMSCs isolated by this method showed no overt differences from dMSCs isolated by routine methods. CONCLUSIONS: Two kinds of stem cells, namely SKPs and dMSCs, can be isolated simultaneously from individual human skin sample from paraplegia patients. Both of them show ability to differentiate into neural cells under proper inducing conditions

  5. Failure of P-selectin blockade alone to protect the liver from ischemia-reperfusion injury in the isolated blood-perfused rat liver

    Institute of Scientific and Technical Information of China (English)

    Samuel Wyllie; Neal R Barshes; Feng-Qin Gao; Saul J Karpen; John A Goss

    2008-01-01

    AIM: To determine if blockade of P-selectin in the isolated blood-perfused cold ex vivo rat liver model protects the liver from ischemia-reperfusion injury. METHODS: The effect of P-selectin blockade was assessed by employing an isolated blood-perfused cold ex vivo rat liver with or without P-selectin antibody treatment before and after 6 h of cold storage in University of Wisconsin solution.RESULTS: In our isolated blood-perfused rat liver model, pre-treatment with P-selectin antibody failed to protect the liver from ischemia-reperfusion injury, as judged by the elevated aspartate aminotransferase activity. In addition, P-selectin antibody treatment did not significantly reduced hepatic polymorphonuclear leukocyte accumulation after 120 min of perfusion. Histological evaluation of liver sections obtained at 120 min of perfusion showed significant oncotic necrosis in liver sections of both ischemic control and P-selectin antibody-treated groups. However, total bile production after 120 min of perfusion was significantly greater in P-selectin antibody-treated livers, compared to control livers. No significant difference in P-selectin and ICAM-1 mRNAs and proteins, GSH, GSSG, and nuclear NF-κB was found between control and P-selectin antibody-treated livers.CONCLUSION: In conclusion, we have shown that blockade of P-selectin alone failed to reduced polymorphonuclear leukocyte accumulation in the liver and protect hepatocytes from ischemia-reperfusion injury in the isolated blood-perfused cold-ex vivo rat liver model.

  6. Treatment of limb arterial in juries caused by traffic accidents

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Objective:To analyze the features,diagonosis and treatment of limb arterial injuries caused by traffic accidents.Methods:A total of 43 patients with limb arterial injury admitted in our department over the past 30years(about50%of them happened during the last10 years)were analyzed retrospectively in this article.The popliteal,femoral and brachial arteries were mainly involved,accounting for 432%,20.5%and20.5%respectively of all the involvements.There were 35cases of open injury and9of close injury,The involved vessels were transected in 43.2%of the cases and contused in 40.9%,All the patients had various complications,such as fractures,dislocations and severe soft tissue injuries.The injured vessels were repaired by means of end-to-end anastomosis in 10cases,autogenous vein graft in 23cases and intraluminal hydraulic dilatation in 4cases.Results:Successful limb salvage was achieved in 34cases initially,whereas10amputations were carried out due to injuries to popliteal arteries in7,femoral arteries in2and humeral artery in 1and severe soft tissue damages in9 cases.Twenty-nine patients were followed up for 1-156months,with the averageof48.8months.There was good circulation in 22 cases and certain ischemia in 5cases.Two amputations were carried out in the late stage because of popliteal artery thrombosis after repair in 2cases.There was no death in this series.Conclusions:The limb arterial injuries caused by traffic accidents are severe and complicated.It is proposed that particulatr attentions should be paid to the features in diagnosis and treatment for this type of injury and special efforts should be made for both life saving and limb salvage.

  7. Out on a Limb: Investigating the Anatomy of Tree Limbs

    Science.gov (United States)

    Shaw, Edward L.

    2008-01-01

    The author presents several upper elementary science activities involving tree limbs that were collected after severe weather conditions. The activities involved 3rd-grade students arranging tree limb pieces in the correct order from the trunk to the tip of the limb, measuring the pieces, determining the age of a tree limb by its rings,…

  8. Out on a Limb: Investigating the Anatomy of Tree Limbs

    Science.gov (United States)

    Shaw, Edward L.

    2008-01-01

    The author presents several upper elementary science activities involving tree limbs that were collected after severe weather conditions. The activities involved 3rd-grade students arranging tree limb pieces in the correct order from the trunk to the tip of the limb, measuring the pieces, determining the age of a tree limb by its rings,…

  9. The Hepatoprotection Provided by Taurine and Glycine against Antineoplastic Drugs Induced Liver Injury in an Ex Vivo Model of Normothermic Recirculating Isolated Perfused Rat Liver

    Directory of Open Access Journals (Sweden)

    Reza Heidari

    2016-03-01

    Full Text Available Taurine (2-aminoethane sulfonic acid is a non-protein amino acid found in high concentration in different tissues. Glycine (Amino acetic acid is the simplest amino acid incorporated in the structure of proteins. Several investigations indicate the hepatoprotective properties of these amino acids. On the other hand, antineoplastic agents-induced serum transaminase elevation and liver injury is a clinical complication. The current investigation was designed to screen the possible hepatoprotective properties of taurine and glycine against antineoplastic drugs-induced hepatic injury in an ex vivo model of isolated perfused rat liver. Rat liver was perfused with different concentration (10 μM, 100 μM and 1000 μM of antineoplastic drugs (Mitoxantrone, Cyclophosphamide, Cisplatin, 5 Fluorouracil, Doxorubicin and Dacarbazine via portal vein. Taurine and glycine were administered to drug-treated livers and liver perfusate samples were collected for biochemical measurements (ALT, LDH, AST, and K+. Markers of oxidative stress (reactive oxygen species formation, lipid peroxidation, total antioxidant capacity and glutathione were also assessed in liver tissue. Antineoplastic drugs caused significant pathological changes in perfusate biochemistry. Furthermore, markers of oxidative stress were significantly elevated in drug treated livers. It was found that taurine (5 and 10 mM and glycine (5 and 10 mM administration significantly mitigated the biomarkers of liver injury and attenuated drug induced oxidative stress. Our data indicate that taurine and glycine supplementation might help as potential therapeutic options to encounter anticancer drugs-induced liver injury.

  10. Effect of midazolam versus propofol sedation on markers of neurological injury and outcome after isolated severe head injury: a pilot study.

    LENUS (Irish Health Repository)

    Ghori, Kamran A

    2012-02-03

    BACKGROUND: Midazolam and propofol are sedative agents commonly administered to patients with brain injury. We compared plasma concentrations of glial cell S100beta protein and nitric oxide (NO) between patients who received midazolam and those who received propofol sedation after severe brain injury, and investigated the association between S100beta and NO concentrations and neurological outcome. DESIGN: 28 patients with severe head injury (Glasgow Coma Score <9) who required sedation and ventilation were randomly assigned to receive midazolam (n =15) or propofol (n = 13) based sedation. Blood samples were drawn daily for 5 days for estimation of S100beta and NO concentrations. Neurological outcome was assessed 3 months later as good (Glasgow Outcome Score [GOS], 4-5) or poor (GOS, 1-3). RESULTS: A good neurological outcome was observed in 8\\/15 patients (53%) in the midazolam group and 7\\/13 patients (54%) in the propofol group. Patients with a poor outcome had higher serum S100beta concentrations on ICU admission and on Days 1-4 in the ICU than those with a good outcome (mean [SD] on Day 1, 0.99 [0.81] v 0.41 [0.4] microg\\/L; Day 2, 0.80 [0.81] v 0.41 [0.24] microg\\/L; Day 3, 0.52 [0.55] v 0.24 [0.25] microg\\/L; and Day 4, 0.54 [0.43] v 0.24 [0.35] microg\\/L; P<0.05). There was no significant difference on Day 5. Plasma NO concentrations were not associated with outcome. In subgroup analysis, there was no difference in S100beta and NO concentrations between patients with a good outcome versus those with a poor outcome in either the midazolam or propofol group. CONCLUSIONS: Plasma concentrations of markers of neurological injury in patients with severe head injury were similar in those who received midazolam sedation and those who received propofol. Patients who had a poor neurological outcome at 3 months had consistently higher serum S100beta concentrations during the initial 4 days after injury than patients who had a good outcome.

  11. Ischemic Postconditioning Does Not Provide Cardioprotection from Long Term Ischemic Injury in Isolated Male or Female Rat Hearts

    Science.gov (United States)

    Lee, Daniel S.; Steinbaugh, Gregory E.; Quarrie, Ricardo; Yang, Fuchun; Talukder, Hassan; Zweier, Jay L.; Crestanello, Juan A.

    2010-01-01

    Background Ischemic postconditioning(PoC) is a cardio-protective strategy in which initial reperfusion is interrupted by episodes of ischemia. It is unclear whether PoC can be achieved in the Langendorff perfused rat heart model. We investigated 1) whether postconditioning occurs in Langendorff perfused rat heart and 2) whether there is a gender specific response to PoC. Materials and methods Male/female rat hearts(n=8/group) were subjected to 30 minutes of equilibration, 30 minutes of ischemia, and 120 minutes of reperfusion (CONTROL). PoC was induced by 6 cycles(PoC 6c10s), 3 cycles(PoC 3c10s), or 2 cycles(PoC 2c10s) of 10 second reperfusion/10 second ischemia. Rate pressure product(RPP) and infarct size were measured. Male rats(n=7/group) were subjected in vivo to 30 minute left coronary ligation followed by 24 hours of reperfusion(CONTROL) or PoC 6c10s and 24 hours of reperfusion. Results Recovery of RPP was 18±4% in male CONTROL vs. 17±2% for 6c10s, 16±1% for 3c10s, and 15±3% for 2c10s. Female CONTROL hearts recovered 25±3% of their RPP vs. 21±2% for 6c10s. Infarct size was 25±3% for male CONTROL vs. 26±3% for 6c10s, 30±2% for 3c10s, 28±1% for 2c10s; and 30±2% for female CONTROL vs. 29±2% in 6c10s. In vivo Infarct size for CONTROL and PoC 6c10s was 44±3% and 28±5%, respectively (p<0.05). Conclusions In the Langendorff perfused rat hearts, none of the PoC protocols improved myocardial tolerance to ischemia reperfusion injury nor decreased infarct size; however, in vivo postconditioning did confer protection. The lack of protection in the isolated hearts was not gender specific. PMID:20934717

  12. Hemodynamic instability after pulmonary veins isolation in a patient with dual chamber pacemaker: The phantom injury of the ventricular lead.

    Science.gov (United States)

    Kiuchi, Márcio Galindo; Lobato, Guilherme Miglioli; Chen, Shaojie

    2017-06-01

    The standard treatment of sinus node dysfunction (SND) is the pacemaker implantation, and the ideal methodology for the management of atrial fibrillation (AF) is rhythm control, but this is sometimes very hard to accomplish. For such actions, complete isolation of all pulmonary veins (PVI) is currently widely accepted as the best endpoint. In this case, we report a female patient, 81 years old, with controlled hypertension, without coronary artery disease, bearer of bilateral knee replacement, and dual chamber pacemaker implanted 1.5 years ago owing to sinus node disease, presenting the following symptoms: presyncope episodes associated with sustained irregular palpitation tachycardia. The evaluation of the pacemaker-recorded episodes of atrial fibrillation, the echocardiogram-presented normal systolic function and measurements, as well as the resting myocardial scintigraphy and with drug use did not demonstrate ischemia and/or fibrosis. The patient was in use of valsartan 320 mg daily, amlodipine 10 mg daily, sotalol hydrochloride 120 mg 2 times daily, and dabigatran 110 mg 2 times daily. At the end of the PVI, the patient presented hemodynamic instability, with a decrease in heart rate to 30 bpm and invasive arterial blood pressure to 60/30 mmHg. The pericardial puncture was quickly carried out with the possibility of cardiac tamponade as the first hypothesis, but no pericardial effusion was found. Next, we detected acute capture loss from the ventricular pacemaker lead, unvarying with high voltage and pulse width, even with stable impedance, sense and keeping the same position visualized by fluoroscopy. And there was soon afterwards induction of sustained ventricular tachycardia degenerating to spontaneous ventricular fibrillation. Electrical cardioversion-defibrillation was performed with 200J, and the sinus rhythm was reestablished, but there was a dead short, and the pacemaker generator was burned and disabled. So, we can speculate that

  13. Critical Limb Ischemia (CLI)

    Science.gov (United States)

    ... Buerger’s Disease Carotid Artery Disease Chronic Venous Insufficiency Congenital Vascular Malformation Critical Limb Ischemia (CLI) Deep Vein Thrombosis (DVT) Diabetes and Vascular Disease Fibromuscular Dysplasia High Blood Pressure and Vascular Disease Kidney Failure ...

  14. Workplace Safety and Health Topics: Diseases and Injuries

    Science.gov (United States)

    ... Effects Stress Tick-Borne Diseases Tobacco in the Workplace Traumatic Occupational Injuries Traumatic Incident Stress Upper Limb Musculoskeletal Disorder Consortium Tuberculosis Violence (Occupational) ( ...

  15. Limb regeneration: a new development?

    Science.gov (United States)

    Nacu, Eugen; Tanaka, Elly M

    2011-01-01

    Salamander limb regeneration is a classical model of tissue morphogenesis and patterning. Through recent advances in cell labeling and molecular analysis, a more precise, mechanistic understanding of this process has started to emerge. Long-standing questions include to what extent limb regeneration recapitulates the events observed in mammalian limb development and to what extent are adult- or salamander- specific aspects deployed. Historically, researchers studying limb development and limb regeneration have proposed different models of pattern formation. Here we discuss recent data on limb regeneration and limb development to argue that although patterning mechanisms are likely to be similar, cell plasticity and signaling from nerves play regeneration-specific roles.

  16. Gene expression patterns specific to the regenerating limb of the Mexican axolotl

    Directory of Open Access Journals (Sweden)

    James R. Monaghan

    2012-07-01

    Salamander limb regeneration is dependent upon tissue interactions that are local to the amputation site. Communication among limb epidermis, peripheral nerves, and mesenchyme coordinate cell migration, cell proliferation, and tissue patterning to generate a blastema, which will form missing limb structures. An outstanding question is how cross-talk between these tissues gives rise to the regeneration blastema. To identify genes associated with epidermis-nerve-mesenchymal interactions during limb regeneration, we examined histological and transcriptional changes during the first week following injury in the wound epidermis and subjacent cells between three injury types; 1 a flank wound on the side of the animal that will not regenerate a limb, 2 a denervated limb that will not regenerate a limb, and 3 an innervated limb that will regenerate a limb. Early, histological and transcriptional changes were similar between the injury types, presumably because a common wound-healing program is employed across anatomical locations. However, some transcripts were enriched in limbs compared to the flank and are associated with vertebrate limb development. Many of these genes were activated before blastema outgrowth and expressed in specific tissue types including the epidermis, peripheral nerve, and mesenchyme. We also identified a relatively small group of transcripts that were more highly expressed in innervated limbs versus denervated limbs. These transcripts encode for proteins involved in myelination of peripheral nerves, epidermal cell function, and proliferation of mesenchymal cells. Overall, our study identifies limb-specific and nerve-dependent genes that are upstream of regenerative growth, and thus promising candidates for the regulation of blastema formation.

  17. Special Considerations for Multiple Limb Amputation.

    Science.gov (United States)

    Pasquina, Paul F; Miller, Matthew; Carvalho, A J; Corcoran, Michael; Vandersea, James; Johnson, Elizabeth; Chen, Yin-Ting

    2014-01-01

    It has been estimated that more than 1.6 million individuals in the United States have undergone at least one amputation. The literature abounds with research of the classifications of such injuries, their etiologies, epidemiologies, treatment regimens, average age of onset (average age of amputation), and much more. The subpopulation that is often overlooked in these evaluations, however, is comprised of individuals who have suffered multiple limb loss. The challenges faced by those with single-limb loss are amplified for those with multiple limb loss. Pain, lifestyle adjustment, and quality of life return are just a few key areas of concern in this population. Along with amputations resulting from trauma, many individuals with multiple amputations have endured them as a result of dysvascular disease. Over recent years, amputations as a result of dysvascular disease have risen to comprise more than 80 % of new amputations occurring in the United States every year. This compares to just 54 % of total current prevalence. Those with diabetes comorbid with dysvascular disease make up 74 % of those with dysvascular amputations, and these individuals with diabetes comorbid with dysvascular disease have a 55 % chance of enduring an amputation of their contralateral limb within 2-3 years of their initial amputation. With the well-documented aging of the nation's population and the similarly skyrocketing prevalence of dysvascular disease and diabetes, it can be expected that the number of individuals with multiple limb loss will continue to increase in the United States. This article outlines the recommended measures of care for this particular subpopulation, including pain management, behavioral health considerations, strategies for rehabilitation for various levels and variations of multiple limb loss, and the assistive technology and adaptive equipment that might be available for these individuals to best enable them to continue healthy, fulfilling lives following

  18. Injury in rugby league.

    Science.gov (United States)

    Hoskins, W; Pollard, H; Hough, K; Tully, C

    2006-05-01

    It was the purpose of this review to document the range, incidence, location and mechanism of injury occurring in the sport of rugby league. Rugby league is a collision sport played in Europe and the Pacific regions including Australia. The sport is well established and has competitions ranging from junior to elite professional. Due to the contact nature of the game, injury is relatively common. The most common injuries are musculotendinous in nature and afflict the lower limb more frequently than elsewhere. Despite the high incidence of minor (sprains/strains) to moderate musculoskeletal injury (fracture, ligament and joint injury) and minor head injuries such as lacerations, nasal fractures and concussions, rare more serious spinal cord and other injuries causing death have also been recorded. The literature on rugby league injury is small but growing and suffers from a lack of consistent definition of what an injury is, thereby causing variability in the nature and incidence/prevalence of injury. Information is lacking on the injury profiles of different age groups. Importantly, there has been little attempt to establish a coordinated injury surveillance program in rugby league in the junior or professional levels. The implementation of such programs would require a universal definition of injury and a focus on important events and competitions. The implementation could provide important information in the identification and prevention of risk factors for injury.

  19. 负压封闭引流术治疗四肢软组织严重挤压伤的效果%Effect of vacuum sealing drainage on treating severe crush injury of limbs soft tissue

    Institute of Scientific and Technical Information of China (English)

    杨威; 刘杨; 赵鸣雁

    2015-01-01

    目的:观察负压封闭引流术(VSD)对四肢软组织严重挤压伤的治疗效果。方法选择哈尔滨医科大学附属第一医院2012年10月~2014年10月收治的62例GustiloⅢ型软组织挤压伤患者,根据清创术后选择VSD引流或常规换药治疗分为观察组(35例)和对照组(27例),观察组清创术后安装VSD装置,对照组根据伤口情况每日换药1~2次。术后对患者行积极的全身治疗,并于术后48 h检测患者血浆白细胞(WBC)计数,血清钾离子(K+)、肌酐(Scr)、尿素氮(BUN)水平以及尿蛋白情况。观察患者出现急性肾损伤(AKI)、全身炎症反应综合征(SIRS)、脓毒症、多器官功能障碍综合征(MODS)并发症的发生率,并统计患者病死率。在患者出院时统计患者伤口闭合时间、血液净化次数、住院时间及截肢率等预后指标。结果观察组WBC[(13.25±3.16)×109/L]、K+[(5.04±1.07)mmol/L]、Scr [(163.43±53.27)μmol/L]、BUN [(6.92±2.61)mmol/L]、尿蛋白评分[(2.09±0.83)分]均优于对照组[WBC:(18.63±4.58)×109/L,K+:(5.93±1.42)mmol/L,Scr:(334.56±109.82)μmol/L,BUN:(10.35±3.48)mmol/L,尿蛋白评分:(2.67±1.12)分],差异有统计学意义(P0.05)。结论 VSD技术能够有效降低软组织损伤后局部有害物质的吸收,减轻全身中毒症状,提高治疗效果。%Objective To observe the therapeutic effect of vacuum sealing drainage (VSD) on treating severe crush in-jury of limbs soft tissue. Methods From October 2012 to October 2014, in the First Affiliated Hospital of Harbin Med-ical University, 62 GustiloⅢ crush injured patients were chosen and divided into observed group (n =35)and control group (n = 27), according to using VSD or dressing change after debridement. After debridement, the observed group was installed VSD, the control group was used dressing change 1-2 times/d. With the positive therapy, all the patients were detected including white blood cell count (WBC

  20. Crossover replantation after bilateral traumatic lower limb amputations: a case report

    Directory of Open Access Journals (Sweden)

    Fang Jun

    2012-07-01

    Full Text Available Abstract Introduction Replantation of a limb to the contralateral stump after bilateral traumatic amputations is rare. To the best of our knowledge, there are only a few reports of crossover lower limb replantation in the literature. Case presentation We treated a 37-year-old Chinese woman with bilateral lower limb crush injuries sustained in a traffic accident. Her lower limb injuries were at different anatomic levels. We performed emergency bilateral amputations followed by crossover replantation. Five years later, the woman had recovered well, and had perfect movement and stability in her replanted leg. After reviewing the literature, we thought that presentation of our patient’s case might provide useful information for clinicians. Conclusions Crossover replantation should be considered when evaluating a patient with bilateral lower limb injuries, thus allowing the patient to touch the ground and stand using their own foot.

  1. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

    OpenAIRE

    2015-01-01

    Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surg...

  2. Use of Calcitonin in Recalcitrant Phantom Limb Pain Complicated by Heterotopic Ossification

    Directory of Open Access Journals (Sweden)

    Ricardo Viana

    2015-01-01

    Full Text Available A common complication following amputation is phantom sensation, which may include experiencing pain in the phantom limb. This study details the management of phantom limb pain in a 72-year-old man, in whom comorbid heterotopic ossification was present. In addition, the authors provide a review of the literature regarding phantom limb pain management, and summarize the current understanding of heterotopic ossification and its possible link to peripheral nerve injury.

  3. Punitive limb amputation.

    Science.gov (United States)

    Mavroforou, Anna; Malizos, Konstantinos; Karachalios, Theofilos; Chatzitheofilou, Konstantinos; Giannoukas, Athanasios D

    2014-10-01

    Limb amputation has been carried out through the ages as a punitive method in various parts of the world. This article highlights the historical and societal background associated with the use of punitive limb amputation. We performed an extensive electronic search of the pertinent literature augmented with a hand-search of additional sources. Evidence for punitive amputation is available as early as the court of the Babylonian Code of King Hammurabi (circa 1750 Before the Common Era [BCE]), which imposed punitive limb amputations on slaves who used force against free citizens. Other reports provided evidence that punitive amputation was used as early as the 4th century BCE in ancient Peru. Limb amputation restored law and order during the Roman and Byzantine periods. Amputation as a punitive instrument prevailed in Europe throughout the 17th century. During the Enlightenment, the intellectual movement in Europe approached criminal law from a humanistic perspective, incorporated it into societal practice, and promoted its preventive dimensions. Punitive limb amputation still exists in several Arab and African countries. Amputation as a punitive or correctional method has its roots in old civilizations. It has been used through the ages in various parts of the world. While it has been abandoned in modern western societies, punitive amputation is still used in several third-world countries.

  4. Effect of pumpkin seed (Cucurbita pepo) protein isolate on the activity levels of certain plasma enzymes in CCl4-induced liver injury in low-protein fed rats.

    Science.gov (United States)

    Nkosi, C Z; Opoku, A R; Terblanche, S E

    2005-04-01

    The effects of pumpkin seed (Cucurbita pepo) protein isolate on the activity levels of lactate dehydrogenase (LD), alanine transaminase (ALT), aspartate transaminase (AST) and alkaline phosphatase (ALP) against carbon tetrachloride (CCl4)-induced acute liver injury in low-protein fed rats were investigated. A group of male Sprague-Dawley rats maintained on a low-protein diet for 5 days were divided into three subgroups. Two subgroups were injected with carbon tetrachloride and the other group with an equivalent amount of olive oil. Two hours after CCl4 intoxication one of the two subgroups was administered with pumpkin seed protein isolate. All three subgroups of rats were maintained on the low-protein diet for the duration of the investigation. Groups of rats from the different subgroups were killed at 24, 48 and 72 h after their respective treatments. After 5 days on the low-protein diet the activity levels of all four enzymes were significantly higher than their counterparts on a normal balanced diet. CCl4 intoxication resulted in significant increases in the activity levels of all four enzymes investigated. The administration of pumpkin seed protein isolate after CCl4 intoxication resulted in significantly reduced activity levels of all four enzymes. It is concluded that pumpkin seed protein isolate administration was effective in alleviating the detrimental effects associated with protein malnutrition.

  5. Effect of Upper Limb PNF Training on Activity of Daily Living of Patients with Neck Incomplete Spinal Cord Injury%上肢PNF训练对颈部不完全性脊髓损伤患者日常生活能力的影响

    Institute of Scientific and Technical Information of China (English)

    曹永武; 姚加佳; 吴雪莹; 刘华卫; 陈斌; 唐恺; 秦佳维

    2015-01-01

    Objective:To observe the effect of upper extremity proprioceptive neuromuscular facilitation techniques (PNF) on activity of daily living of patients with neck incomplete spinal cord injury. Methods:40 cases of incomplete cervical cord injury were randomly divided into treatment group (20 cases) and control group (20 cases), all with physical, occupational and other conventional rehabilitation therapy, treatment group added upper limb PNF training, to observe the improvement of FIM, SCIM score between the two groups after 8 weeks. Results:The FIM, SCIM score of treat-ment group were higher than those of control group after treatment (P<0.05). Conclusion:Upper limb PNF training is helpful to improve the activity of daily living of patients with neck incomplete spinal cord injury.%目的:观察上肢本体神经肌肉促进技术(proprioceptive neuromusclar facilitation,PNF)对颈部不完全性脊髓损伤患者日常生活能力的影响。方法:将40例不完全性颈髓损伤患者随机分为治疗组(20例)和对照组(20例),均接受物理治疗、作业治疗等常规康复治疗,治疗组则在此基础上配合上肢PNF训练,观察训练8周后两组患者FIM、SCIM评分的改善情况。结果:治疗后,治疗组FIM评分、SCIM评分均高于对照组(P<0.05)。结论:上肢PNF训练有助于提高颈部不完全性脊髓损伤患者的日常生活能力。

  6. Evaluation of Chronic Physical and Psychological Stress Induction on Cardiac Ischemia / Reperfusion Injuries in Isolated Male Rat Heart: The Role of Sympathetic Nervous System.

    Science.gov (United States)

    Rakhshan, Kamran; Imani, Alireza; Faghihi, Mahdieh; Nabavizadeh, Fatemeh; Golnazari, Masoumeh; Karimian, SeyedMorteza

    2015-08-01

    Exposure to stress leads to physiological changes called "stress response" which are the result of the changes in the adrenomedullary hormone system, hypothalamus-pituitary-adrenal (HPA) and sympathetic nervous system (SNS) activity. In the present study, the effects of chronic physical and psychological stress and also the role of sympathetic system effects in stress on ischemia/reperfusion (I/R) injuries have been studied in isolated rat heart. Rat heart was isolated and subjected to 30 min regional ischemia and 120 min reperfusion. The daily stress was induced for one week prior to I/R induction. Sympathectomy was done chemically by injection of hydroxyl-dopamine prior to stress induction. There were no significant changes in heart rate and Coronary Flow between groups. Left ventricular developed pressure (LVDP) and rate product pressure (RPP) in both physical and psychological stress groups decreased significantly compared to those in control group (Pphysical and psychological stress groups. Infarct size significantly increased in both physical and psychological stress groups and control group(Pstress led to the elimination of the deleterious effects of stress as compared with stress groups (Presults show that induction of chronic physical and psychological stress prior to ischemia/reperfusion causes enhancement of myocardial injuries and it seems that increased sympathetic activity in response to stress is responsible for these adverse effects of stress on ischemic/reperfused heart.

  7. Cardioprotective Effects of Total Flavonoids Extracted from Xinjiang Sprig Rosa rugosa against Acute Ischemia/Reperfusion-Induced Myocardial Injury in Isolated Rat Heart.

    Science.gov (United States)

    Hou, Xuejiao; Han, Jichun; Yuan, Changsheng; Ren, Huanhuan; Zhang, Ya; Zhang, Tao; Xu, Lixia; Zheng, Qiusheng; Chen, Wen

    2016-01-01

    This study evaluated the antioxidative and cardioprotective effects of total flavonoids extracted from Xinjiang sprig Rosa rugosa on ischemia/reperfusion (I/R) injury using an isolated Langendorff rat heart model. The possible mechanism of Xinjiang sprig rose total flavonoid (XSRTF) against I/R injury was also studied. XSRTF (5, 10, and 20 µg/mL) dissolved in Krebs-Henseleit buffer was administered to isolated rat heart. The XSRTF showed remarkable scavenging effects against 1,1-diphenyl-2-picrylhydrazyl, hydroxyl, and superoxide anion radicals in vitro. XSRTF pretreatment improved the heart rate, increased LVDP, and decreased CK and LDH levels in coronary flow. This pretreatment also increased SOD activity and GSH/GSSG ratio but decreased MDA, TNF-α, and CRP levels and IL-8 and IL-6 activities. The infarct size and cell apoptosis in the hearts from the XSRTF-treated group were lower than those in the hearts from the I/R group. Therefore, the cardioprotective effects of XSRTF may be attributed to its antioxidant, antiapoptotic, and anti-inflammatory activities.

  8. Evaluation of Chronic Physical and Psychological Stress Induction on Cardiac Ischemia / Reperfusion Injuries in Isolated Male Rat Heart: The Role of Sympathetic Nervous System

    Directory of Open Access Journals (Sweden)

    Kamran Rakhshan

    2015-10-01

    Full Text Available Exposure to stress leads to physiological changes called “stress response” which are the result ofthe changes in the adrenomedullary hormone system, hypothalamus-pituitary-adrenal (HPA and sympatheticnervous system (SNS activity. In the present study, the effects of chronic physical and psychological stressand also the role of sympathetic system effects in stress on ischemia/reperfusion (I/R injuries have beenstudied in isolated rat heart. Rat heart was isolated and subjected to 30 min regional ischemia and 120 minreperfusion. The daily stress was induced for one week prior to I/R induction. Sympathectomy was donechemically by injection of hydroxyl-dopamine prior to stress induction. There were no significant changes inheart rate and Coronary Flow between groups. Left ventricular developed pressure (LVDP and rate productpressure (RPP in both physical and psychological stress groups decreased significantly compared to those incontrol group (Pgroups. Infarct size significantly increased in both physical and psychological stress groups and control group(Pas compared with stress groups (Ppsychological stress prior to ischemia/reperfusion causes enhancement of myocardial injuries and it seemsthat increased sympathetic activity in response to stress is responsible for these adverse effects of stress onischemic/reperfused heart.

  9. Prognostic relevance of {sup 18}F-FDG PET uptake in patients with locally advanced, extremity soft tissue sarcomas undergoing neoadjuvant isolated limb perfusion with TNF-α and melphalan

    Energy Technology Data Exchange (ETDEWEB)

    Andreou, Dimosthenis [Muenster University Hospital, Department of General Orthopedics and Tumor Orthopedics, Muenster (Germany); HELIOS Klinikum Berlin-Buch, Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Berlin (Germany); Boldt, Henrike [HELIOS Klinikum Berlin-Buch, Department of Nuclear Medicine, Berlin (Germany); Pink, Daniel [HELIOS Klinikum Bad Saarow, Department of Hematology, Oncology and Palliative Care, Sarcoma Center Berlin-Brandenburg, Bad Saarow (Germany); Jobke, Bjoern [HELIOS Klinikum Berlin-Buch, Department of Radiology, Berlin (Germany); Werner, Mathias [HELIOS Klinikum Emil von Behring, Department of Pathology, Sarcoma Center Berlin-Brandenburg, Berlin (Germany); Schuler, Markus [University Hospital Carl Gustav Carus Dresden, Department of Internal Medicine I, Dresden (Germany); Reichardt, Peter [HELIOS Klinikum Berlin-Buch, Department of Interdisciplinary Oncology, Sarcoma Center Berlin-Brandenburg, Berlin (Germany); Tunn, Per-Ulf [HELIOS Klinikum Berlin-Buch, Department of Orthopedic Oncology, Sarcoma Center Berlin-Brandenburg, Berlin (Germany)

    2014-06-15

    The objective of this study was to determine whether {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can adequately assess the risk of systemic disease progression in patients with primary, localized, high-grade soft tissue sarcomas of the extremities undergoing neoadjuvant isolated limb perfusion (ILP) with tumour necrosis factor and melphalan. This was a retrospective analysis of the files of 35 patients who underwent a PET or PET/CT scan prior to and after ILP followed by surgical resection with curative intent between 2006 and 2012. SUV{sub max1} was defined as the maximum standardized uptake value (SUV) at diagnosis, SUV{sub max2} as the maximum SUV after ILP and ΔSUV{sub max} as the percentage difference between SUV{sub max1} and SUV{sub max2}. The median follow-up was 40 months for all patients. The median SUV{sub max1} amounted to 7.6, while the median SUV{sub max2} was 4.7. The median ΔSUV{sub max} was -44 %. Overall survival (OS) probability at 2 and 5 years amounted to 78 and 70 %, respectively, while metastasis-free survival (MFS) probability at 2 and 5 years was 67 and 64 %, respectively. Receiver-operating characteristic (ROC) curve analysis showed that both SUV{sub max2} and ΔSUV{sub max} could predict systemic disease progression, while SUV{sub max1} could not adequately identify patients who went on to develop metastatic disease. The optimal cut-off value was 6.9 for SUV{sub max2} and -31 % for ΔSUV{sub max}. Patients with an SUV{sub max2} <6.9 had a 2-year MFS of 80 %, compared to 31 % for patients with an SUV{sub max2} ≥ 6.9 (p < 0.001). Patients with a ΔSUV{sub max} < -31 %, i.e. patients with a higher metabolic response, had an MFS of 76 % at 2 years, compared to 42 % for patients with a ΔSUV{sub max} ≥ -31 % (p = 0.050). SUV{sub max} after ILP for primary, locally advanced, non-metastatic high-grade soft tissue sarcomas of the extremities appears to be significantly correlated with prognosis. Whether patients

  10. A comparison of Gaelic football injuries in males and females in primary care.

    LENUS (Irish Health Repository)

    Crowley, J

    2011-10-01

    The Ladies Gaelic Football Association has a playing population of 150,000 of which 33% are adults. A number of studies have been published on rates of injury among male athletes but none on female athletes in Gaelic football. A retrospective review of insurance claims, submitted under the Gaelic Athletic Association Player Insurance Injury Scheme. 405 injuries were recorded, 248 [107 (70%) male, 141 (58%) female] to the lower limb, 91 [33 (21%) male, 58 (23%) female] to the upper limb. The majority of lower limb injuries [56 (52%) male, 56 (40%) female] were to muscle. Almost a third of upper limb injuries were fractures [10 (30.3%) male, 33 (57%) female]. injuries\\/1000 hours playing was 8.25 for men and 2.4 for women. The injury rate in ladies Gaelic football was found to be significantly lower than in men\\'s Gaelic football. Lower limb injuries accounted for the majority of injuries in both sports.

  11. Trends in traumatic limb amputation in Allied Forces in Iraq and Afghanistan

    OpenAIRE

    Duncan Wallace

    2012-01-01

    Background: Limb amputation has been a common injury occurring in the conflicts in Iraq and Afghanistan. Compared to other injuries, less attention has been given to this serious, disabling wound. Purpose: The article describes the Allied military experience of traumatic limb amputation in Iraq and Afghanistan. It intends to inform health care personnel involved in the care of serving military personnel and veterans about the scale of these casualties. Methods: A literature se...

  12. Limb girdle muscular dystrophies

    DEFF Research Database (Denmark)

    Vissing, John

    2016-01-01

    PURPOSE OF REVIEW: The aim of the study was to describe the clinical spectrum of limb girdle muscular dystrophies (LGMDs), the pitfalls of the current classification system for LGMDs, and emerging therapies for these conditions. RECENT FINDINGS: Close to half of all LGMD subtypes have been...

  13. Soccer injuries in children.

    Science.gov (United States)

    Paterson, Anne

    2009-12-01

    Soccer is the most popular sport in the world, with FIFA recognising more than 265 million amateur players. Despite the fact that soccer is a contact sport, it is perceived to be relatively safe to play, a factor that has contributed to its status as the fastest growing team sport in the USA. Acute and minor injuries predominate in the statistics, with contusions and abrasions being the most commonly recorded. As would be expected, the majority of soccer injuries are to the lower limbs, with serious truncal and spinal trauma being rare. This article examines the type and anatomic location of injuries sustained by children and adolescents who play soccer, and the main mechanisms whereby such injuries occur. The risk factors underpinning injury occurrence are considered, along with injury avoidance tactics.

  14. Soccer injuries in children

    Energy Technology Data Exchange (ETDEWEB)

    Paterson, Anne [Royal Belfast Hospital for Sick Children, Radiology Department, Belfast (United Kingdom)

    2009-12-15

    Soccer is the most popular sport in the world, with FIFA recognising more than 265 million amateur players. Despite the fact that soccer is a contact sport, it is perceived to be relatively safe to play, a factor that has contributed to its status as the fastest growing team sport in the USA. Acute and minor injuries predominate in the statistics, with contusions and abrasions being the most commonly recorded. As would be expected, the majority of soccer injuries are to the lower limbs, with serious truncal and spinal trauma being rare. This article examines the type and anatomic location of injuries sustained by children and adolescents who play soccer, and the main mechanisms whereby such injuries occur. The risk factors underpinning injury occurrence are considered, along with injury avoidance tactics. (orig.)

  15. Intramuscular Transplantation and Survival of Freshly Isolated Bone Marrow Cells following Skeletal Muscle Ischemia-reperfusion Injury

    Science.gov (United States)

    2013-01-01

    caused by explosivemunitions, can cause fractures , tissue loss, and vascular injury, all of which place skeletal muscle at risk of ischemia...Lineage-Depleted BMCs The tibiae and femurs of FVB-L2G85 transgenic mice were flushed, and BMC suspensions underwent MACS with lineage depletion. Cells...positioned at right angles. Sterilized needles were inserted through the skin for stimulation of the left common peroneal nerve. Stimulation voltage

  16. Changes in the concentrations of serum leptin at different phases in patients with brain injury accompanied by long tubular bone fracture in limbs%脑外伤合并四肢长管状骨骨折患者不同时间段血清瘦素浓度变化

    Institute of Scientific and Technical Information of China (English)

    杨华林; 史昌乾

    2011-01-01

    目的 观察脑外伤合并四肢长管状骨骨折患者不同时间段血清瘦素浓度变化.方法 连续选择21例脑外伤合并四肢长管状骨骨折患者(观察组)和26例单纯四肢长管状骨骨折患者(对照组),入选对象均在骨折后第1、3、7、14天接受了血清瘦素浓度测定,同时统计下床活动时间、骨折愈合时间和住院总时间等疗效指标.结果 两组患者骨折后第1天时检测血清瘦素浓度无明显区别(P>0.05);而第3、7、14天,观察组血清瘦素浓度均明显高于对照组(P均<0.05).观察组的骨折愈合时间明显短于对照组,而前者住院总时间明显多于对照组(P均<0.05).结论 脑外伤合并四肢长管状骨骨折患者病后第3、7、14天时间段血清瘦素浓度明显升高,骨折愈合时间较短.%objective To study the changes in the concentrations of serum leptin at different phases in patients with brain injury accompanied by long tubular bone fracture in limbs. Methods Twenty - one patients with brain injury accompanied by long tubular bone fracture in limbs (observed group) and 26 patients with simple long tubular bone fracture in limbs control group were successively selected, and the concentrations of serum lepfin were determined in all the enrolled subjects at days 1, 3, 7 and 14 after hospitalization. Meanwhile, the curative indexes including time of off - bed activity, time of fracture healing and total length of hospitalization were observed. Results There was no significant difference in changes of serum leptin concentration at day I after hospitalization botween the observed group and the control group (P >0.05). The concentrations of serum ieptin at days 3, 7 and 14 after hospitalization in the observed group were significantly higher than those in the control group at the same periods ( P < O. 05 ). The time of fracture healing in the observed group were significantly shorter than that in the control group, whereas the total length of

  17. Activation of Akt and cardioprotection against reperfusion injury are maximal with only five minutes of sevoflurane postconditioning in isolated rat hearts

    Institute of Scientific and Technical Information of China (English)

    Yuan-yuan YAO; Man-hua ZHU; Feng-jiang ZHANG; Chuan-yun WEN; Lei-lei MA; Wen-na WANG; Can-can WANG

    2013-01-01

    It had been proved that administration of sevoflurane for the first two minutes of reperfusion effectively protects the heart against reperfusion injury in rats in vivo.Our aim was to investigate the duration of effective sevoflurane administration and its underlying mechanism in isolated rat hearts exposed to global ischemia/reperfusion (I/R) injury.Adult male Sprague-Dawley rats were randomly divided into six groups (n=12):a sham-operation group,an I/R group,and four sevoflurane postconditioning groups (S2,S5,S10,and S15).In the S2,S5,S10,and S15 groups,the duration times of sevoflurane administration were 2,5,10,and 15 min after the onset of reperfusion,respectively.The isolated rat hearts were mounted on the Langendorff system,and after a period of equilibrium were subjected to 40 min global ischemia and 120 min reperfusion.Left ventricular (LV) hemodynamic parameters were monitored throughout each experiment and the data at 30 min of equilibrium and 30,60,90,and 120 min of reperfusion were analyzed.Myocardial infarct size at the end of reperfusion (n=7 in each group) and the expression of myocardial phosphorylated Akt (p-Akt) after 15-min reperfusion were determined in a duplicate set of six groups of rat hearts (n=5 in each group).Compared with the I/R group,the S5,S10,and S15 groups had significantly improved left ventricular end-diastolic pressure (LVEDP),left ventricular developed pressure (LVDP),and the maximal rate of rise or fall of the LV pressure (±dP/dtmax),and decreased myocardial infarct size (P<0.05),but not the S2 group.After 15 min of reperfusion,the expression of p-Akt was markedly up-regulated in the S5,S10,and S15 groups compared with that in the I/R group (P<0.05),but not in the S2 group.Sevoflurane postconditioning for 5 min was sufficient to activate Akt and exert maximal cardioprotection against I/R injury in isolated rat hearts.

  18. Change and role of heme oxygenase-1 in injured lungs following limb ischemia/reperfusion in rats

    Institute of Scientific and Technical Information of China (English)

    周君琳; 朱晓光; 林源; 凌亦凌; 邵新中; 张桂生

    2004-01-01

    Objective: To study the change and role of hemeoxygenase-1 (HO-1) in injured lungs following limbischemia/reperfusion in rats.Methods: A total of 96 healthy male Sprague-Dawley rats, weighing 250-300 g, were used in this study. Hind limb ischemia was made on 40 rats through clamping the infrarenal aorta for 2 hours with a microvascular clip, then limb reperfusion for 0, 4, 8,16 and 24 hours(n =8 in each time point)was performed, respectively. Other 8 rats undergoing full surgical operation including isolation of the infrarenal aorta without occlusion were taken as the sham operation group. Lung tissues were obtained from the 48animals and Northern blotting and Western blotting were employed to measure the changes of HO-1 mRNA and protein expression, respectively. Immunohistochemistry technique was used to determine the cell types responsible for HO-1 expression after limb ischemia/reperfusion. Then hind limb ischemia was made on other 12 rats through clamping the infrarenal aorta for 2 hours with a microvascular clip, among whom, 6 rats were given zinc protoporphyrin (ZnPP), an inhibitor of HO. Then limb reperfusion for 16 hours was performed on all the 12 rats.And other 12 rats underwent full surgical operation including isolation of the infrarenal aorta without occlusion,among whom, 6 rats were then given ZnPP. Then lung tissues were obtained from the 24 animals and lung injury markers, lung histology, polymorphonuclear leukocyte (PMN) count and malondialdehyde (MDA) content were detected, respectively. HO activity was determined through measuring the carboxyhemoglobin (COHb) level in artery blood with a CO-oximeter after limb ischemia/reperfusion.And the animal mortality was observed on the other 24rats.Results: Northern blotting analysis showed that HO-1mRNA increased significantly at 4 hours after reperfusion,peaked at 16 hours, and began to decrease at 24 hours. In contrast, no positive signal was observed in the sham and simple ischemia animals. Increased HO

  19. Perfusão isolada de membro com hipertermia na trataento das metástases em trânsito do melanoma cutâneo Hyperthermic isolated limb perfusion in the treatment of in-transit melanoma metastases

    Directory of Open Access Journals (Sweden)

    Victor Pavan Pasin

    2008-06-01

    Full Text Available OBJETIVO: Avaliar a casuística do Setor de Tumores Cutâneos da Disciplina de Cirurgia Plástica da Escola Paulista de Medicina/ Universidade Federal de São Paulo em relação à Perfusão Isolada de Membro (PIM para o tratamento das metástases em trânsito do melanoma cutâneo, bem como os resultados conseqüentes, comparando-os com a literatura internacional. MÉTODO: De maio de 1993 a abril de 2007, 41 pacientes portadores de metástases em trânsito do melanoma cutâneo submeteram-se a 44 PIM. Por meio da observação de seus prontuários, foram avaliados quanto à toxicidade regional e sistêmica, e resposta tumoral após a PIM. Após a coleta dos resultados, procedeu-se a comparação com a literatura internacional e as posteriores conclusões. RESULTADOS: Houve 43,2% de respostas completas, 36,4% de respostas parciais e 20,4% sem resposta ao tratamento proposto. A toxicidade regional aguda descrita foi, de modo geral, restrita a edema e eritema discretos, não havendo nenhum caso de complicação sistêmica grave. CONCLUSÃO: Os dados obtidos nessa casuística corroboram os descritos pela literatura internacional, demonstrando a importância e a possibilidade da PIM para o controle locoregional das metástases em trânsito do melanoma cutâneo também na realidade brasileira.BACKGROUND: To evaluate our cases at the Skin Tumors Sector of Plastic Surgery Division at Federal University of São Paulo in relation to Isolated Limb Perfusion (ILP for the treatment of in transit melanoma metastases, as well as the results, comparing them with international literature. METHODS: From May 1993 until April 2007, 41 patients with in transit metastases of skin melanoma were submitted to 44 ILP. Medical registry observations were evaluated in terms of regional and systemic toxicity and tumoral response after ILP. The obtained results were compared with international literature and posterior conclusions were done. RESULTS: We observed 43.2% of

  20. Combined subthreshold dose inhibition of myosin light chain phosphorylation and MMP-2 activity provides cardioprotection from ischaemic/reperfusion injury in isolated rat heart.

    Science.gov (United States)

    Cadete, Virgilio J J; Sawicka, Jolanta; Bekar, Lane K; Sawicki, Grzegorz

    2013-09-01

    Phosphorylation and degradation of myosin light chain 1 (MLC1) during myocardial ischaemia/reperfusion (I/R) injury is a well-established phenomenon. It has been established that MMP-2 is involved in MLC1 degradation and that this degradation is increased when MLC1 is phosphorylated. We hypothesized that simultaneous inhibition of MLC1 phosphorylation and MMP-2 activity will protect hearts from I/R injury. As phosphorylation of MLC1 and MMP-2 activity is important for normal heart function, we used a cocktail consisting combination of low (subthreshold for any protective effect alone) doses of MLC kinase, MMP-2 inhibitors and subthreshold dose of an MLC phosphatase activator. Isolated rat hearts were subjected to 20 min of global, no-flow ischaemia and 30 min reperfusion in the absence and presence of inhibitors of MLC1 phosphorylation and degradation. The recovery of cardiac function was improved in a concentration-dependent manner by the MLC kinase inhibitor, ML-7 (1-5 μM), the MLC phosphatase activator, Y-27632 (0.05-1 μM) or the MMP inhibitor, doxycycline (Doxy, 1-30 μM). Co-administration of subthreshold doses of ML-7 (1 μM) and Y-27632 (0.05 μM) showed a potential synergistic effect in protecting cardiac contractility and MLC1 levels in I/R hearts. Further combination with a subthreshold concentration of Doxy (1 μM) showed additional protection that resulted in full recovery to control levels. The results of this study exemplify a novel low-dose multidrug approach to pharmacological prevention of reperfusion injury that will enable a reduction of unwanted side effects and/or cytotoxicity associated with currently available MMP-2 and kinase inhibiting drugs. © 2013 The British Pharmacological Society.

  1. Isolated deafness following recovery from neurologic injury and adult respiratory distress syndrome. A sequela of intercurrent aminoglycoside and diuretic use.

    Science.gov (United States)

    Lynn, A M; Redding, G J; Morray, J P; Tyler, D C

    1985-05-01

    We report two children who survived neurologic injury (near-drowning and Reye's syndrome) and adult respiratory distress syndrome and who required prolonged ventilatory support. Follow-up examination in both children showed steady neurologic recovery, but five months following discharge from their acute illness, profound hearing loss was diagnosed in both children. A review of the literature is reported and the hypothesis that combined aminoglycoside antibiotic and loop diuretic therapy caused the hearing loss is presented. Recommendation is made for audiologic assessment within six months of recovery from critical illness of pediatric patients in whom therapy has included loop diuretic and aminoglycoside antibiotic therapy.

  2. Beneficial effect of medicinal plants on the contractility of post-hypoxic isolated guinea pig atria - Potential implications for the treatment of ischemic-reperfusion injury.

    Science.gov (United States)

    Bipat, Robbert; Toelsie, Jerry R; Magali, Indira; Soekhoe, Rubaina; Stender, Karin; Wangsawirana, Angelique; Oedairadjsingh, Krishan; Pawirodihardjo, Jennifer; Mans, Dennis R A

    2016-08-01

    Context Ischemic-reperfusion injury is accompanied by a decreased contractility of the myocardium. Positive-inotropic agents have proven useful for treating this condition but may exert serious side-effects. Objective In this study, aqueous preparations from Abelmoschus esculentus L. Moench (Malvaceae), Annona muricata L. (Annonaceae), Bixa orellana L. (Bixaceae), Cecropia peltata L. (Moraceae), Erythrina fusca Lour. (Fabaceae), Psidium guajava L. (Myrtaceae) and Terminalia catappa L. (Combretaceae) were evaluated for their ability to improve the decreased contractility of isolated guinea pig atria after hypoxic stress. Materials and methods Guinea pig atria isolated in Ringer-Locke buffer gassed with 100% O2 at 30 °C were exposed for 5 min to hypoxia, then allowed to recover in oxygenated buffer alone or containing a single plant extract (0.001-1 mg/mL). The contractility (g/s) and beating frequency (beats/min), as well as troponin C contents of the bathing solution (ng/mL), were determined and expressed as means ± SDs. Results The extracts of A. muricata, B. orellana, C. peltata and T. catappa caused an increase in the contractility compared to untreated atria of 340 ± 102%, 151 ± 13%, 141 ± 14% and 238 ± 44%, respectively. However, the latter two preparations increased the troponin C contents of the bathing solution to 36 ± 11 and 69 ± 33, compared to the value of 11 ± 3 ng/mL found with untreated atria. Conclusions Preparations from A. muricata and B. orellana may possess positive-inotropic properties which may improve the contractility of the post-hypoxic myocardium. Studies to assess their usefulness in ischemic-reperfusion injury are warranted.

  3. Delayed amputation in lower limb trauma: an analysis of factors leading to delayed amputation.

    Science.gov (United States)

    Thiagarajan, P

    1999-03-01

    An in-depth analysis of the course of events leading to 49 delayed amputation of the lower extremity in 47 patients with open lower limb fractures is presented. Seventeen amputations were performed within one month mainly for vascular reasons. Eleven were between one month and one year, due to persistent sepsis and 21 amputations were performed more than a year after the original injury for infected non-union. Below-knee amputation was done in 32 limbs, above-knee amputation in 13 limbs and Symes' amputation in 4 limbs. The delay in timing of the amputation was analysed with respect to the nature of the injury, the primary treatment and the Mangled Extremity Severity Score (MESS). The MESS score was computed for all injuries and a score of 7 or more predicted an early amputation. We suggest that in all severe lower limb injuries, particularly in Type III C fractures with associated neurological injury, the benefits of an early amputation be considered as an alternative to a limb salvage procedure.

  4. One stage reconstruction of limb injuries caused by high energy in 55 patients%55例高能量肢体伤的I期修复重建

    Institute of Scientific and Technical Information of China (English)

    肖茂明; 陈雪松; 王元山; 管力; 黄敢; 张黎明

    2008-01-01

    目的 总结I期修复重建高能量肢体损伤的经验体会,就相关问题进行探讨.方法 自2001年1月至2005年7月,对55例高能量肢体损伤实施I期修复重建,本组患者均存在伤部软组织广泛挫灭、严重的开放性骨折或肢体已接近毁损,包括GustiloⅢC型开放骨折16例,肢体损伤严重度评分(MESS)(6.25±2.53)分.全部进行游离或带蒂组织瓣移植,同时固定骨折,修复神经血管或进行肢体功能重建.结果 全部保肢成功,住院天数12~63 d,平均24 d,移植组织瓣全部成活.随访时间12~50个月,平均23个月.骨愈合率高,感染率低,肢体功能满意.结论 I期手术组织结构容易辨明,供、受区血管搭配及手术设计容易,治疗周期短,功能恢复好.吻合血管的组织瓣可主动改善局部循环,降低骨感染,利于骨愈合,使骨折坚强固定甚至早期植骨成为可能.%Objective To report the clinical results of one stage reconstruction of high-energyinjured limbs. Methods From January 2001 to July 2006,one stage reconstruction was done on 55patients suffered from massive limb trauma,severe open fractures or spoiled limbs caused by high energy.There included 16 patients with Gustilo Type-Ⅲ C fractures,with mangled extremity severity score (MESS)of(6.25 ±2.53)points.All patients were treated with transplantation of free flaps or pedicle skin flaps,fracture fixation,nerve reconstruction or functional reconstruction. Results All limbs were saved and all flaps were transplanted successfully.without protracted course to obtain soft tissue coverage.The hospitalization was mean 24 days(12-63 days)and follow-up ranged from 12 months to 50 months (averaged 23 months).Complications including wound infection,bone nonunion,necrosis and morbidity were significanfly less likely to appear than conventional ways and the ultimate functional results of the saved limbs were at least better than that of artificial ones. Conclusions In comparison with

  5. Antioxidative effects of pumpkin seed (Cucurbita pepo) protein isolate in CCl4-induced liver injury in low-protein fed rats.

    Science.gov (United States)

    Nkosi, C Z; Opoku, A R; Terblanche, S E

    2006-11-01

    The effects of pumpkin seed (Cucurbita pepo) protein isolate on the plasma activity levels of catalase (CA), superoxide dismutase (SOD), glutathione peroxidase (GSHpx) and total antioxidant capacity (TAC) as well as glucose-6-phosphatase (G6Pase) in liver homogenates and lipid peroxidation (LPO-malondialdehyde-MDA) levels in liver homogenates and liver microsomal fractions against carbon tetrachloride (CCl(4))-induced acute liver injury in low-protein fed Sprague-Dawley rats (Rattus norvegicus) were investigated. A group of male Sprague-Dawley rats maintained on a low-protein diet for 5 days were divided into three subgroups. Two subgroups were injected with carbon tetrachloride and the other group with an equivalent amount of olive oil. Two hours after CCl(4) intoxication one of the two subgroups was administered with pumpkin seed protein isolate and thereafter switched onto a 20% pumpkin seed protein isolate diet. The other two groups of rats were maintained on the low-protein diet for the duration of the investigation. Groups of rats from the different subgroups were killed at 24, 48 and 72 h after their respective treatments. After 5 days on the low-protein diet the activity levels of all the enzymes as well as antioxidant levels were significantly lower than their counterparts on a normal balanced diet. However, a low-protein diet resulted in significantly increased levels of lipid peroxidation. The CCl(4) intoxicated rats responded in a similar way, regarding all the variables investigated, to their counterparts on a low-protein diet. The administration of pumpkin seed protein isolate after CCl(4) intoxication resulted in significantly increased levels of all the variables investigated, with the exception of the lipid peroxidation levels which were significantly decreased. From the results of the present study it is concluded that pumpkin seed protein isolate administration was effective in alleviating the detrimental effects associated with protein

  6. Lower limb replantations: indications and a new scoring system.

    Science.gov (United States)

    Battiston, Bruno; Tos, Pierluigi; Pontini, Italo; Ferrero, Sebastiano

    2002-01-01

    The need for reconstruction of lower limb amputations is increasing, due to high-energy trauma in road accidents and work-related injuries. The indication for lower limb replantation is still controversial. Compared with upper limb replantations, indications are more select due to the frequent complications in lower limb salvage procedures, such as severe general complications or local complications such as necrosis, infections, nonunions, the need for secondary lengthening, or other reconstructive procedures. The satisfactory results given by artificial prosthesis, such as quicker recovery time and fewer secondary procedures, also contribute to the higher degree of selection for lower limb replantation candidates. Since 1993, we have replanted 14 amputations of the lower limb in 12 patients, including 2 bilateral cases. Although survival of the replanted segment was obtained in all patients, 5 cases were subsequently amputated for severe secondary complications. Of the remaining 9 cases, evaluated by means of Chen criteria, 7 had good results (3 Chen I and 4 Chen II), 1 sufficient (Chen III), and 1 poor (Chen IV). The best results were obtained in young patients. Our experience led us to examine the necessity for careful, objective patient selection. We developed a score evaluation system by modifying the international classifying method for severe limb traumas (mangled extremity severity score, or MESS system). This relatively simple system, based on the retrospective study of our cases, considers several parameters (patient's age, general conditions, level and type of lesion, time of injury, and associated lesions), giving each one a score. The total score gives the indication for replantation, predicts the functional outcome, and facilitates decision-making.

  7. Salamander limb regeneration involves the activation of a multipotent skeletal muscle satellite cell population.

    Science.gov (United States)

    Morrison, Jamie I; Lööf, Sara; He, Pingping; Simon, András

    2006-01-30

    In contrast to mammals, salamanders can regenerate complex structures after injury, including entire limbs. A central question is whether the generation of progenitor cells during limb regeneration and mammalian tissue repair occur via separate or overlapping mechanisms. Limb regeneration depends on the formation of a blastema, from which the new appendage develops. Dedifferentiation of stump tissues, such as skeletal muscle, precedes blastema formation, but it was not known whether dedifferentiation involves stem cell activation. We describe a multipotent Pax7+ satellite cell population located within the skeletal muscle of the salamander limb. We demonstrate that skeletal muscle dedifferentiation involves satellite cell activation and that these cells can contribute to new limb tissues. Activation of salamander satellite cells occurs in an analogous manner to how the mammalian myofiber mobilizes stem cells during skeletal muscle tissue repair. Thus, limb regeneration and mammalian tissue repair share common cellular and molecular programs. Our findings also identify satellite cells as potential targets in promoting mammalian blastema formation.

  8. A comparison between complete immobilisation and protected active mobilisation in sensory nerve recovery following isolated digital nerve injury.

    LENUS (Irish Health Repository)

    Henry, F P

    2012-06-01

    Post-operative immobilisation following isolated digital nerve repair remains a controversial issue amongst the microsurgical community. Protocols differ from unit to unit and even, as evidenced in our unit, may differ from consultant to consultant. We undertook a retrospective review of 46 patients who underwent isolated digital nerve repair over a 6-month period. Follow-up ranged from 6 to 18 months. Twenty-four were managed with protected active mobilisation over a 4-week period while 22 were immobilised over the same period. Outcomes such as return to work, cold intolerance, two-point discrimination and temperature differentiation were used as indicators of clinical recovery. Our results showed that there was no significant difference noted in either clinical assessment of recovery or return to work following either post-operative protocol, suggesting that either regime may be adopted, tailored to the patient\\'s needs and resources of the unit.

  9. Endoscopic release of limb constriction rings in utero.

    Science.gov (United States)

    Ronderos-Dumit, D; Briceño, F; Navarro, H; Sanchez, N

    2006-01-01

    Amniotic band syndrome is a sporadic condition that may result in constriction bands, amputation and multiple craniofacial, visceral and body wall defects. It occurs in 1/1,200 to 1/15,000 live births. Most cases present with multiple congenital anomalies that are incompatible with life. A small group of fetuses shows isolated limb constrictions that may cause severe limb dysfunction or limb amputation if left untreated. Successful in utero surgical lyses of constriction rings have been reported. We report a case of constriction amniotic bands involving both legs and compromising blood flow to the distal extremity. The constriction ring was successfully released by a minimally invasive endoscopic surgical technique avoiding severe limb dysfunction or foot amputation.

  10. A Novel Biopsy Method for Isolating Neural Stem Cells from the Subventricular Zone of the Adult Rat Brain for Autologous Transplantation in CNS Injuries.

    Science.gov (United States)

    Aligholi, Hadi; Hassanzadeh, Gholamreza; Gorji, Ali; Azari, Hassan

    2016-01-01

    Despite all attempts the problem of regeneration in damaged central nervous system (CNS) has remained challenging due to its cellular complexity and highly organized and sophisticated connections. In this regard, stem cell therapy might serve as a viable therapeutic approach aiming either to support the damaged tissue and hence to reduce the subsequent neurological dysfunctions and impairments or to replace the lost cells and re-establish damaged circuitries. Adult neural stem/progenitor cells (NS/PCs) are one of the outstanding cell sources that can be isolated from the subventricular zone (SVZ) of the lateral ventricles. These cells can differentiate into neurons, astrocytes, and oligodendrocytes. Implanting autologous NS/PCs will greatly benefit the patients by avoiding immune rejection after implantation, better survival, and integration with the host tissue. Developing safe and efficient methods in small animal models will provide us with the opportunity to optimize procedures required to achieve successful human autologous NS/PC transplantation in near future. In this chapter, a highly controlled and safe biopsy method for harvesting stem cell containing tissue from the SVZ of adult rat brain is introduced. Then, isolation and expansion of NS/PCs from harvested specimen as well as the techniques to verify proliferation and differentiation capacity of the resulting NS/PCs are discussed. Finally, a method for assessing the biopsy lesion volume in the brain is described. This safe biopsy method in rat provides a unique tool to study autologous NS/PC transplantation in different CNS injury models.

  11. Citrulline decreases hepatic endotoxin-induced injury in fructose-induced non-alcoholic liver disease: an ex vivo study in the isolated perfused rat liver.

    Science.gov (United States)

    Ouelaa, Wassila; Jegatheesan, Prasanthi; M'bouyou-Boungou, Japhète; Vicente, Christelle; Nakib, Samir; Nubret, Esther; De Bandt, Jean-Pascal

    2017-06-01

    Steatosis can sensitise the liver to various challenges and favour the development of non-alcoholic fatty liver disease (NAFLD). In this context, fructose feeding promotes endotoxin translocation from the gut, contributing to disease progression via an inflammatory process. Citrulline is protective against fructose-induced NAFLD; we hypothesised that this property might be related to its anti-inflammatory and antioxidative action against endotoxin-induced hepatic injuries. This hypothesis was evaluated in a model of perfused liver isolated from NAFLD rats. Male Sprague-Dawley rats (n 30) were fed either a standard rodent chow or a 60 % fructose diet alone, or supplemented with citrulline (1 g/kg per d) for 4 weeks. After an evaluation of their metabolic status, fasted rats received an intraperitoneal injection of lipopolysaccharide (LPS) (2·5 mg/kg). After 1 h, the livers were isolated and perfused for 1 h to study liver function and metabolism, inflammation and oxidative status. In vivo, citrulline significantly decreased dyslipidaemia induced by a high-fructose diet and insulin resistance. In the isolated perfused rat livers, endotoxaemia resulted in higher cytolysis (alanine aminotransferase release) and higher inflammation (Toll-like receptor 4) in livers of fructose-fed rats, and it was prevented by citrulline supplementation. Oxidative stress and antioxidative defences were similar in all three groups. Amino acid exchanges and metabolism (ammonia and urea release) were only slightly different between the three groups. In this context of mild steatosis, our results suggest that fructose-induced NAFLD leads to an increased hepatic sensitivity to LPS-induced inflammation. Citrulline-induced restriction of the inflammatory process may thus contribute to the prevention of NAFLD.

  12. [Therapy of phantom limb pain].

    Science.gov (United States)

    Schwarzer, Andreas; Zenz, Michael; Maier, Christoph

    2009-03-01

    About 80 % of all extremity amputations suffer from phantom limb pain following the operation. In this context, it is important to differentiate between painful phantom limb sensations, non-painful phantom limb sensations and residual limb pain. The pathophysiology of phantom limb pain is not fully understood. Current research findings ascribe a major pathophysiological role to cortical changes as well as a disturbed body perception. Peripheral and spinal mechanisms appear less relevant in the development of phantom limb pain. An essential part of the therapy is the pharmacological treatment with antidepressants, anticonvulsives and opioids. Another significant aspect of therapy is senso-motory training, important to mention here would be mirror therapy, lateralisation and motor imaging. In case of an elective amputation, an epidural or axiliar plexus catheter should be considered prior to the amputation. The perioperative treatment with ketamine is debated.

  13. Limb lengthening in achondroplasia

    Directory of Open Access Journals (Sweden)

    Sanjay K Chilbule

    2016-01-01

    Full Text Available Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%, 9.9 cm (52.8% and 9.6 cm (77.9%, respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3 rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment. Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length carries significant risk and should be undertaken only after due

  14. Single centre experience of the upper limb replantation and revascularisation.

    Science.gov (United States)

    Visnjic, Milan M; Kovacevic, Predrag T; Paunkovic, Ljiljana M; Milenkovic, Sasa S

    2004-01-01

    Replantation is defined as reattachment of the amputated limb using the neurovascular and musculoskeletal structures in order to obtain the recovery of the limb. Fortunately, injuries causing limb amputation are rare. Adequate treatment within the optimal time scale can provide successful rehabilitation of the shape and function of the replanted part. We report the experience of our Clinical Centre (regional replantation centre) in the replantation of five forearms/hands and revascularisation of six hands between 1997 and 2001. The most frequent site of injury was the distal part of the forearm, while the major cause of injuries was a wood processing machine. The surgical procedures were performed under general anaesthesia within 2-6 hours after injury. Vascular anastomoses, nerve repair and muscle repair were performed following the external bone fixation. All patients were given anticoagulation treatment postoperatively. Thrombosis in the anastomotic site developed as an early complication in two patients who underwent thrombectomy; one of these patients developed gangrene and underwent amputation. Late postoperative results were good in 10 patients. One patient developed acral epidermolysis. Postoperative results after revascularisation were good in all patients.

  15. INJURIES TO THE SPINE -MECHANICS , ANATOMICAL AND ORTHOPEDIC ASPECTS

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    Ashfaq ul Hassan

    2014-09-01

    Full Text Available Vertebral injuries can occur as isolated injuries or may be associated with other injuries. Recognition of the level of injury is important along with the mechanism of injury. The article describes the various types of injuries of the vertebral column along with the main mechanisms and the difference between the types of injuries in the vertebral column.

  16. Salvage versus amputation: Utility of mangled extremity severity score in severely injured lower limbs

    Directory of Open Access Journals (Sweden)

    Kumar M

    2007-01-01

    Full Text Available Background: The purpose of the present study was to evaluate the clinical utility of Mangled extremity severity score (MESS in severely injured lower limbs. Materials and Methods: Retrospectively 25 and prospectively 36 lower limbs in 58 patients with high-energy injuries were evaluated with the use of MESS, to assist in the decision-making process for the care of patients with such injuries. Difference between the mean MESS scores for amputated and salvaged limbs was analyzed. Results: In the retrospective study 4.65 (4.65 ± 1.32 was the mean score for the salvaged limbs and 8.80 (8.8 ± 1.4 for the amputated limbs. In the prospective study 4.53 (4.53 ± 2.44 was the mean score for the salvaged limbs and 8.83 (8.83 ± 2.34 for the amputated limbs. There was a significant difference in the mean scores for salvaged and amputated limbs. Retrospective 21 (84% and prospective 29 (80.5% limbs remained in the salvage pathway six months after the injury. Conclusion: MESS could predict amputation of severely injured lower limbs, having score of equal or more than 7 with 91% sensitivity and 98% specificity. There was a significant difference in the mean MESS scores in the prospective study (n=36, 4.53 (4.53 ± 2.44 in thirty salvaged limbs (83.33% and 8.83 (8.83 ± 2.34 in six amputated limbs (16.66% with a P -value 0.002 ( P -value < 0.01. Similarly there was a significant difference in the mean MESS score in the retrospective study (n=25, 4.65 (4.65 ± 1.32 in twenty salvaged limbs (80% and 8.80 (8.8 ± 1.4 in five amputated limbs (20% with a P -value 0.00005 ( P -value < 0.01. MESS is a simple and relatively easy and readily available scoring system which can help the surgeon to decide the fate of the lower extremity with a high-energy injury.

  17. The Flail and Pulseless Upper Limb: an Extreme Case of Traumatic Scapulo-thoracic Dissociation

    Directory of Open Access Journals (Sweden)

    Maria SW

    2015-07-01

    Full Text Available Scapulo-thoracic dissociation is an infrequent injury resulting from high energy trauma which is often associated with severe neurological and vascular injuries which may be unrecognised at the time of presentation. A 24 year-old female presented with bilateral rib fractures, pneumothorax, liver and kidney injuries following a road traffic accident. She also sustained fractures of her right scapula, odontoid, right transverse processes of the thoracic and lumbar vertebrae and a closed fracture of her right femur. Her right upper limb was later noted to be flail and pulseless, due to complete right brachial plexus injury, scapula-thoracic dissociation and subclavian artery avulsion. We managed the upper limb injuries non-operatively, and focused on resuscitation of the patient. Early exploration of the complete brachial plexus injury was not undertaken in spite of the possible associated poor functional outcome as there was no life-threatening indication.

  18. Limb salvage versus amputation. Preliminary results of the Mangled Extremity Severity Score.

    Science.gov (United States)

    Helfet, D L; Howey, T; Sanders, R; Johansen, K

    1990-07-01

    Objective criteria can predict amputation after lower-extremity trauma. The authors examined the hypothesis that objective data, available early in the evaluation of patients with severe skeletal/soft-tissue injuries of the lower extremity with vascular compromise, might discriminate the salvageable from the unsalvageable limbs. The Mangled Extremity Severity Score (MESS) was developed by reviewing 25 trauma victims with 26 severe lower-extremity open fractures with vascular compromise. The four significant criteria (with increasing points for worsening prognosis) were skeletal/soft-tissue injury, limb ischemia, shock, and patient age. (There was a significant difference in the mean MESS scores; 4.88 in 17 limbs salvaged and 9.11 in nine limbs amputated; p less than 0.01). This scoring system was then prospectively evaluated in 26 lower-extremity open fractures with vascular injury over a 12-month period at two trauma centers. Again, there was a significant difference in the mean MESS scores; 4.00 for the 14 salvaged limbs and 8.83 for the 12 amputated limbs (p less than 0.01). In both the prospective and retrospective studies, a MESS score of greater than or equal to 7 had a 100% predictable value for amputation. This relatively simple, readily available scoring system of objective criteria was highly accurate in acutely discriminating between limbs that were salvageable and those that were unsalvageable and better managed by primary amputation.

  19. Traumatic extremity arterial injury in children: Epidemiology, diagnostics, treatment and prognostic value of Mangled Extremity Severity Score

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    Lange Nadine

    2010-04-01

    Full Text Available Abstract Background Traumatic paediatric arterial injuries are a great challenge due to low incidence and specific characteristics of paediatric anatomy and physiology. The aim of the present study was to investigate their epidemiology, diagnostic and therapeutic options and complications. Furthermore, the prognostic value of the Mangled Extremity Severity Score (MESS was evaluated. Methods In a retrospective clinical study 44 children aged 9.0 ± 3.2 years treated for traumatic extremity arterial lesions in our Level I trauma center between 1971 and 2006 were enrolled. Exclusion criteria were age > 14, venous and iatrogenic vascular injury. Demographic data, mechanism of injury, severity of arterial lesions (by Vollmar and MESS, diagnostic and therapeutic management, complications and outcome were evaluated. Results The most commonly injured vessel was the femoral artery (25% followed by the brachial artery (22.7%. The mechanism of injury was penetrating (31.8%, isolated severe blunt extremity trauma (29.6%, multiple trauma (25% and humeral supracondylar fractures (13.6%. In 63.6% no specific vascular diagnostic procedure was performed in favour of emergency surgery. Surgical reconstructive strategies were preferred (68.2%. A MESS Conclusions Traumatic paediatric vascular injuries are very rare. The most common situations of vascular lesions in childhood were penetrating injuries and fractures of the extremities either as isolated injuries or in multiply injured patients. In paediatric patients, the MESS could serve as a basis for decision making for limb salvage or amputation.

  20. Regenerative Engineering and Bionic Limbs

    Science.gov (United States)

    James, Roshan; Laurencin, Cato T.

    2015-01-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been made in technological, material and in prosthesis integration where researchers are now exploring artificial prosthesis that integrate with the residual tissues and function based on signal impulses received from the residual nerves. Efforts are focused on challenging experts in different disciplines to integrate ideas and technologies to allow for the regeneration of injured tissues, recording on tissue signals and feed-back to facilitate responsive movements and gradations of muscle force. A fully functional replacement and regenerative or integrated prosthesis will rely on interface of biological process with robotic systems to allow individual control of movement such as at the elbow, forearm, digits and thumb in the upper extremity. Regenerative engineering focused on the regeneration of complex tissue and organ systems will be realized by the cross-fertilization of advances over the past thirty years in the fields of tissue engineering, nanotechnology, stem cell science, and developmental biology. The convergence of toolboxes crated within each discipline will allow interdisciplinary teams from engineering, science, and medicine to realize new strategies, mergers of disparate technologies, such as biophysics, smart bionics, and the healing power of the mind. Tackling the clinical challenges, interfacing the biological process with bionic technologies, engineering biological control of the electronic systems, and feed-back will be the important goals in regenerative engineering over the next

  1. Regenerative Engineering and Bionic Limbs.

    Science.gov (United States)

    James, Roshan; Laurencin, Cato T

    2015-03-01

    Amputations of the upper extremity are severely debilitating, current treatments support very basic limb movement, and patients undergo extensive physiotherapy and psychological counselling. There is no prosthesis that allows the amputees near-normal function. With increasing number of amputees due to injuries sustained in accidents, natural calamities and international conflicts, there is a growing requirement for novel strategies and new discoveries. Advances have been made in technological, material and in prosthesis integration where researchers are now exploring artificial prosthesis that integrate with the residual tissues and function based on signal impulses received from the residual nerves. Efforts are focused on challenging experts in different disciplines to integrate ideas and technologies to allow for the regeneration of injured tissues, recording on tissue signals and feed-back to facilitate responsive movements and gradations of muscle force. A fully functional replacement and regenerative or integrated prosthesis will rely on interface of biological process with robotic systems to allow individual control of movement such as at the elbow, forearm, digits and thumb in the upper extremity. Regenerative engineering focused on the regeneration of complex tissue and organ systems will be realized by the cross-fertilization of advances over the past thirty years in the fields of tissue engineering, nanotechnology, stem cell science, and developmental biology. The convergence of toolboxes crated within each discipline will allow interdisciplinary teams from engineering, science, and medicine to realize new strategies, mergers of disparate technologies, such as biophysics, smart bionics, and the healing power of the mind. Tackling the clinical challenges, interfacing the biological process with bionic technologies, engineering biological control of the electronic systems, and feed-back will be the important goals in regenerative engineering over the next

  2. Phantom limb pain after lower limb trauma: origins and treatments.

    Science.gov (United States)

    Foell, Jens; Bekrater-Bodmann, Robin; Flor, Herta; Cole, Jonathan

    2011-12-01

    Phantom sensations, that is, sensations perceived in a body part that has been lost, are a common consequence of accidental or clinical extremity amputations. Most amputation patients report a continuing presence of the limb, with some describing additional sensations such as numbness, tickling, or cramping of the phantom limb. The type, frequency, and stability of these phantom sensations can vary immensely. The phenomenon of painful phantom sensations, that is, phantom limb pain, presents a challenge for practitioners and researchers and is often detrimental to the patient's quality of life. In addition to the use of conventional therapies for chronic pain disorders, recent years have seen the development of novel treatments for phantom limb pain, based on an increasing body of research on neurophysiological changes after amputation. This article describes the current state of research in regard to the demographics, causal factors, and treatments of phantom limb pain.

  3. Lawnmower injuries in children.

    LENUS (Irish Health Repository)

    Nugent, Nora

    2012-02-03

    OBJECTIVE: Power lawnmowers can pose significant danger of injury to both the operator and the bystander, from direct contact with the rotary blades or missile injury. Our objective was to review our experience with paediatric lawnmower-associated trauma, and the safety recommendations available to operators of power lawnmowers. METHODS: The patient cohort comprised paediatric (<16 years of age) patients treated for lawnmower-associated trauma, by the plastic surgery service, between 1996 and 2003. These patients were identified retrospectively. Age at the time of injury, location and extent of bony and soft tissue injuries sustained, treatment instituted and clinical outcome were recorded. Brochures and instruction manuals of six lawnmower manufacturers were reviewed, and safety recommendations noted. RESULTS: Fifteen patients were identified. The majority of injuries occurred from direct contact with the rotary blades (93%); the remaining child sustained a burn injury. Fourteen children (93%) required operative intervention. Seven patients (46%) sustained injuries resulting in amputation, two of whom had major limb amputations. All children, except the burns patient, underwent wound debridement and received antibiotic therapy. Reconstructive methods ranged from primary closure to free tissue transfer. Many patients required multiple procedures. In all instruction manuals, instructions to keep children and pets indoors or out of the yard when mowing were found. CONCLUSIONS: Lawnmower injuries can be devastating, particularly in children. Many victims have lasting deformities as a result of their injuries. Awareness of and stringent adherence to safety precautions during use of power lawnmowers can prevent many of these accidents.

  4. 重复无创肢体缺血预适应对大鼠心肌缺血再灌注损伤的保护作用%Protective effects of repetition limb ischemic preconditioning on cardiac ischemia-reperfusion injury in rats

    Institute of Scientific and Technical Information of China (English)

    陈敏; 宋二飞; 张轩萍; 梁月琴; 张明升

    2012-01-01

    目的 研究重复多次无创肢体缺血预适应对大鼠心肌缺血再灌注损伤的保护作用.方法 SD大鼠24只随机分为对照组、单次无创肢体预适应(LPC)组、反复无创后肢缺血预适应(RLPC)组各8只,观察重复无创性肢体缺血预适应对大鼠心脏缺血再灌注损伤的作用.通过颈动脉插管法测定大鼠的平均动脉压(MAP),肢体Ⅱ导联记录心电图以分析心率、心律失常情况.实验结束后采血测定血清中的丙二醛(MDA)含量、超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-PX)的活性,留取心脏染色测定各组梗死面积.结果 与对照组相比,LPC组和RLPC组可以减小梗死面积,减轻心律失常情况,血清MDA浓度降低,SOD,GSH-PX的活性增加.但LPC组和RLPC组差异无统计学意义.结论 RLPC对大鼠缺血再灌注损伤的保护作用与LPC相似.%Objective To determine the protective effects of repetition limb ischemic preconditioning (RLPC) on cardiac ischemia-reperfusion injury. Methods Sprague-Dawley rats were randomly assigned to control group (group C), limb ischemic preconditioning group (group LPC) and repetition limb ischemic preconditioning group (group RLPC), respectively, thus allowing for determination of the protective effects of RLPC on cardiac ischemia-reperfusion injury. Mean arterial pressure (MAP) was measured via cervical catheterization, and incidence of cardiac arrhythmia was monitored based on lead II electrocardiogram and the heart rate. The levels of serum malondialdehyde (MDA) and superoxide dismutase (SOD) and activity of glutathione peroxidase (GSH-PX) were assayed at the end of study. Furthermore, the size of myocardial infarction was assessed by pathologic staining. Results Compared with control group, both LPC and RLPC resulted in reduced size of myocardial infarction, incidence of cardiac arrhythmia and serum MDA yet increased activity of SOD and GSH-PX. However, the difference in groups LPC and RLPC did not

  5. The intestinal tract as the major source of interleukin 6 production during abdominal aortic clamping and hind limb ischaemia-reperfusion injury O trato intestinal como a principal fonte na producao de interleucina 6 durante clampeamento da aorta abdominal e lesão de isquemia/rererfusão de membros inferiores

    Directory of Open Access Journals (Sweden)

    Márcio Benedito Palma Pimenta

    2007-01-01

    Full Text Available PURPOSE: The aim of this study was to investigate whether the hind limbs or intestinal tract is the most important initiator of the inflammatory response secondary aortic clamping and hind limb ischemia/reperfusion injury. METHODS: Blood samples of Wistar rats obtained from posterior cava vein, portal vein, and heart cavity during either laparotomy (control group, n=8 or laparotomy + 2 h of aortic clamping and bilateral hind limb ischemia (ischemia group, n=8, or 2 h after ischemia and 2 h of reperfusion (ischemia-reperfusion group, n=8 were assayed for interleukin 6 (IL-6 and C-reactive protein (CRP. RESULTS: Serum IL-6 at the heart (223.6±197.9 [10-832] pg/mL was higher (pOBJETIVO: Investigar qual o principal mediador da resposta inflamatória na lesao de isquemia/reperfusão após clampeamento da aorta abdominal e isquemia dos membros inferiores: o intestine ou as extremidades inferiores. MÉTODOS: amostra de sangue de ratos Wistar coletados da cava posterior, porta e cavidade cardíaca during tanto laparotomia (grupo controle n=8 ou laparotomia + 2 horas de clampeamento aórtico e isquemia bilateral de membros posteriores (grupo isquemia n=8, ou 2 h de isquemia seguido por 2 horas de reperfusão (grupo isquemia/reperfusão n=8, onde foram dosados interleucina 6 e proteína C-reativa. RESULTADOS: Il-6 no coração (223.6±197.9 [10-832] pg/mL foi maior (p<0.001 tanto na veia porta (133.08±108.52 [4-372] pg/mL quanto na veia cava posterior (127.58±109.15 [8-388] pg/mL. PCR não foi significativamente diferente entre os grupos. CONCLUSÃO: o trato intestinal foi responsável pela resposta inflamatória secundária a lesão de isquemia/reperfusão.

  6. Hydrogen sulfide postconditioning protects isolated rat hearts against ischemia and reperfusion injury mediated by the JAK2/STAT3 survival pathway

    Directory of Open Access Journals (Sweden)

    Heng-Fei Luan

    2012-10-01

    Full Text Available The JAK2/STAT3 signal pathway is an important component of survivor activating factor enhancement (SAFE pathway. The objective of the present study was to determine whether the JAK2/STAT3 signaling pathway participates in hydrogen sulfide (H2S postconditioning, protecting isolated rat hearts from ischemic-reperfusion injury. Male Sprague-Dawley rats (230-270 g were divided into 6 groups (N = 14 per group: time-matched perfusion (Sham group, ischemia/reperfusion (I/R group, NaHS postconditioning group, NaHS with AG-490 group, AG-490 (5 µM group, and dimethyl sulfoxide (DMSO; <0.2% group. Langendorff-perfused rat hearts, with the exception of the Sham group, were subjected to 30 min of ischemia followed by 90 min of reperfusion after 20 min of equilibrium. Heart rate, left ventricular developed pressure (LVDP, left ventricular end-diastolic pressure (LVEDP, and the maximum rate of increase or decrease of left ventricular pressure (± dp/dt max were recorded. Infarct size was determined using triphenyltetrazolium chloride (TTC staining. Myocardial TUNEL staining was used as the in situ cell death detection method and the percentage of TUNEL-positive nuclei to all nuclei counted was used as the apoptotic index. The expression of STAT3, bcl-2 and bax was determined by Western blotting. After reperfusion, compared to the I/R group, H2S significantly improved functional recovery and decreased infarct size (23.3 ± 3.8 vs 41.2 ± 4.7%, P < 0.05 and apoptotic index (22.1 ± 3.6 vs 43.0 ± 4.8%, P < 0.05. However, H2S-mediated protection was abolished by AG-490, the JAK2 inhibitor. In conclusion, H2S postconditioning effectively protects isolated I/R rat hearts via activation of the JAK2/STAT3 signaling pathway.

  7. The role of Hox genes during vertebrate limb development.

    Science.gov (United States)

    Zakany, Jozsef; Duboule, Denis

    2007-08-01

    The potential role of Hox genes during vertebrate limb development was brought into focus by gene expression analyses in mice (P Dolle, JC Izpisua-Belmonte, H Falkenstein, A Renucci, D Duboule, Nature 1989, 342:767-772), at a time when limb growth and patterning were thought to depend upon two distinct and rather independent systems of coordinates; one for the anterior-to-posterior axis and the other for the proximal-to-distal axis (see D Duboule, P Dolle, EMBO J 1989, 8:1497-1505). Over the past years, the function and regulation of these genes have been addressed using both gain-of-function and loss-of-function approaches in chick and mice. The use of multiple mutations either in cis-configuration in trans-configuration or in cis/trans configurations, has confirmed that Hox genes are essential for proper limb development, where they participate in both the growth and organization of the structures. Even though their molecular mechanisms of action remain somewhat elusive, the results of these extensive genetic analyses confirm that, during the development of the limbs, the various axes cannot be considered in isolation from each other and that a more holistic view of limb development should prevail over a simple cartesian, chess grid-like approach of these complex structures. With this in mind, the functional input of Hox genes during limb growth and development can now be re-assessed.

  8. The Hepatoprotective Effects of Corn Silk against Dose-induced Injury of Ecstasy (MDMA Using Isolated Rat Liver Perfusion System

    Directory of Open Access Journals (Sweden)

    Mohammad Karami

    2016-07-01

    Full Text Available Background: Corn silk (CS is widely used in Iranian traditional medicine. The aim of this study was to investigate hepatoprotective activity of CS by Isolated Rat Liver Perfusion System (IRLP. Methods: Hydro-alcoholic extract of corn silk (10, 20, 40, and 100 mg kg-1 was evaluated for its hepatoprotective activity by IRLP. Phenol and flavonoid contents of the extract were determined as gallic acid and quercetin equivalents from a calibration curve, respectively. IRLP system is ideal for studying biochemical alterations of chemicals with minimum neuro-hormonal effects. In this study, the liver was perfused with Kerbs-Henseleit buffer, containing different concentration of hydro-alcoholic extract of corn silk (10, 20, 40, 50,100mg/kg, added to the buffer, and perfused for 2 hours. During the perfusion, many factors, including amino-transferees activities and the level of GSH, were assessed as indicators of liver viability. Consequently, sections of liver tissues were examined for any histopathological changes. Results: Histopathological changes in liver tissues were related to hydro-alcoholic extract of corn silk concentrations in a dose-dependent manner. Also, 50 and 100mg/kg doses caused significant (P<0.05 histopathological changes. Level of GSH in samples perfused with hydro-alcoholic extract increased compared to the control group. Conclusion: Hepatoprotective effect of CS is due to decreased lipid peroxidation, although other mechanisms might also be involved.

  9. Evaluation of Limb-Girdle Muscular Dystrophy

    Science.gov (United States)

    2014-03-06

    Becker Muscular Dystrophy; Limb-Girdle Muscular Dystrophy, Type 2A (Calpain-3 Deficiency); Limb-Girdle Muscular Dystrophy, Type 2B (Miyoshi Myopathy, Dysferlin Deficiency); Limb-Girdle Muscular Dystrophy, Type 2I (FKRP-deficiency)

  10. 21 CFR 890.3475 - Limb orthosis.

    Science.gov (United States)

    2010-04-01

    ... PHYSICAL MEDICINE DEVICES Physical Medicine Prosthetic Devices § 890.3475 Limb orthosis. (a) Identification... improvement. Examples of limb orthoses include the following: A whole limb and joint brace, a hand splint,...

  11. Esthetic prostheses in minor and major upper limb amputations.

    Science.gov (United States)

    Leow, M E; Pho, R W; Pereira, B P

    2001-08-01

    In summary, the impact and value of esthetic prostheses on amputee rehabilitation and their long-term use were demonstrated in this study to have no correlation with the severity of injury and level of amputation. All patients with traumatic amputation should be given equal opportunity to receive prostheses if the service is readily available. Whether use of prostheses is temporary or long-term, they help patients cope with the traumatic life experience of limb loss.

  12. [Progress in surgery of limb's wounds during the Great War].

    Science.gov (United States)

    Chauvin, Frédéric; Fischer, Louis-Paul; Ferrandis, Jean-Jacques; Chauvin, Edouard; Gunepin, François-Xavier

    2002-01-01

    The prominent tenets of limb's wound surgery have been improved during the Great War. Before 1914, traditional treatment of war injuries was usually applied on the ground because injuries caused by firearms were supposedly trivial while the threatening infection refrained surgeons from acting. From the very start of 1914, gangrene and septicaemia were the terrible consequences of new types of injuries provoked by shrapnel, all the more dangerous that the wounded men were numerous and the injuries were nursed after a too important delay. New surgical facilities have been organised by the French Military Health Service which created the "Ambulances Chirurgicales Automobiles", improved the selection procedures and the mobilization of many surgeons. New surgical treatments such as lancing, continuous use irrigation, delayed suture of wounds allowed improvement of results and saved more than one soldier. Finally, the excision of dead and contaminated tissues is still nowadays the most important progress in war surgery.

  13. Injuries in classical ballet

    Directory of Open Access Journals (Sweden)

    Adriana Coutinho de Azevedo Guimarães

    2008-06-01

    Full Text Available This study aimed to elucidate what injuries are most likely to occur due to classical ballet practice. The research used national and international bibliography. The bibliography analysis indicated that technical and esthetical demands lead to a practice of non-anatomical movements, causing the ballet dancer to suffer from a number of associated lesions. Most of the injuries are caused by technical mistakes and wrong training. Troubles in children are usually due to trying to force external rotation at hip level and to undue use of point ballet slippers. The commonest lesions are in feet and ankles, followed by knees and hips. The rarest ones are in the upper limbs. These injuries are caused by exercise excess, by repetitions always in the same side and by wrong and early use of point slippers. The study reached the conclusion that incorrect application of classical ballet technique predisposes the dancers to characteristic injuries.

  14. Progressive thinning of visual motion area in lower limb amputees

    Directory of Open Access Journals (Sweden)

    Guangyao eJiang

    2016-03-01

    Full Text Available Accumulating evidence has indicated that amputation or deafferentation of a limb induces functional or structural reorganization in the visual areas. However, the extent of the visual areas involved after lower limb amputation remains uncertain. In this investigation, we studied 48 adult patients with unilateral lower limb amputation and 48 matched healthy controls using T1-weighted magnetic resonance imaging. Template-based regions of interest analysis was implemented to detect the changes of cortical thickness in the specific visual areas. Compared with normal controls, amputees exhibited significantly lower thickness in the V5/middle temporal (V5/MT+ visual area, as well as a trend of cortical thinning in the V3d. There was no significant difference in the other visual areas between the two groups. In addition, no significant difference of cortical thickness was found between patients with amputation at different levels. Across all amputees, correlation analyses revealed that the cortical thickness of the V5/MT+ was negatively correlated to the time since amputation. In conclusion, our findings indicate that the amputation of unilateral lower limb could induce changes in the motor-related visual cortex, and provide an update on the plasticity of the human brain after limb injury.

  15. The prevention method for an injury

    OpenAIRE

    2010-01-01

    Everybody hope the healthy life. But injured people have been increased in recent year. The reason of the injury is overwork, overweight and aging. In this review, research Anterior Cruciate Ligament (ACL) damage as the current state of the lower limbs injury in our country and the measures this introduction on the possibility of insole. ACL damage is one of the lower limbs injury. The reason of the ACL damage are stop-motion, cutting-motion and landing-motion . Prevention proglam of ACL dama...

  16. An evaluation of the clinical utility of mangled extremity severity score in severely injured lower limbs

    OpenAIRE

    Vipul Agarwal; Sarina Agarwal; Abhishek Singh; Setu Satani; Shewtank Goel; Pooja Goyal; Rohit Jhamnani

    2016-01-01

    Background: The management of severe lower limb injury is one of the most controversial subjects in the field of Orthopedic surgery. While the advancement of sophisticated microsurgical reconstruction technique has created the possibility of successful limb salvage in even the most extreme cases, it has become painfully obvious that the technical possibilities are double-edged swords. The aim of study was to analyze and ascertain the clinical utility of mangled extremity severity score (MESS)...

  17. Multiple traumatic limb loss: A comparison of Vietnam veterans to OIF/OEF servicemembers

    OpenAIRE

    Gayle E. Reiber, MPH, PhD; Donna Jo Blake, MD; Alberto Esquenazi, MD; Douglas G. Smith, MD; Paul J. Dougherty, MD; Lynne V. McFarland, PhD

    2010-01-01

    Multiple-limb loss due to war-theater injuries results in a unique group of servicemembers requiring intensiverehabilitation and diverse prosthetic devices. This article compares the Vietnam and the Operation Iraqi Freedom/OperationEnduring Freedom (OIF/OEF) groups with war-theater-associated multiple-limb loss to document significant changes in health status, prosthetic-device use, and long-term prognosis.During 2007 and 2008, a national survey queried 73 Vietnamveterans and 61 OIF/OEF servi...

  18. Relationship between intrinsic and extrinsic risk factors and the prevalence of lower limb injuries in basketball and volleyball athletes Relação entre fatores de risco intrínsecos e extrínsecos e a prevalência de lesões em membros inferiores em atletas de basquetebol e voleibol

    Directory of Open Access Journals (Sweden)

    Ivan Pacheco

    2009-08-01

    Full Text Available Introduction: Athletes are subjected to injuries in both training and competitions. These injuries are directly related to intrinsic and extrinsic predisposing factors and the absence of a preventive program. Objective: The objective of this study was, after identifying intrinsic and extrinsic risk factors, to relate them to the prevalence of lower limb injuries in volleyball and basketball athletes from a club. Material and Methods: The participants were 46 athletes, 23 from basketball (all male and 23 from volleyball (13 females and 10 males. The study considered some of the main intrinsic factors described in the literature, for instance, sex, age, weight and height, previous injury; and some extrinsic factors such as sport modality, practice time, frequency and duration of training and the use of protective material. Data regarding risk factors were given by the athletes through a questionnaire and data from previous injuries were obtained through the department of the medical and physical therapy records in the club. Results: In the results, the intrinsic factor previous injury (p=0,004 and the extrinsic factor time of practice in the sport (p=0,001, presented a significant influence. Conclusion: There is a need for further investigation evaluating risk factors in the literature, contributing to a better identification of the relationship between risk factors and the prevalence of injuries in athletes, in order to develop specific prevention programs to the identified factors.Introdução: Os atletas estão sujeitos a sofrerem lesões, tanto nos treinos como em competições. Estas lesões estão diretamente relacionadas a fatores predisponentes intrínsecos e extrínsecos e a ausência de um programa preventivo. Objetivo: O objetivo deste trabalho foi, após identificar fatores de risco intrínsecos e extrínsecos, relacioná-los com a prevalência de lesões em membros inferiores de atletas de voleibol e basquetebol de um clube na capital

  19. The utility of scores in the decision to salvage or amputation in severely injured limbs.

    Science.gov (United States)

    Shanmuganathan, Rajasekaran

    2008-10-01

    The decision to amputate or salvage a severely injured limb can be very challenging to the trauma surgeon. A misjudgment will result in either an unnecessary amputation of a valuable limb or a secondary amputation after failed salvage. Numerous scores have been proposed to provide guidelines to the treating surgeon, the notable of which are Mangled extremity severity score (MESS); the predictive salvage index (PSI); the Limb Salvage Index (LSI); the Nerve Injury, Ischemia, Soft tissue injury, Skeletal injury, Shock and Age of patient (NISSSA) score; and the Hannover fracture scale-97 (HFS-97). These scores have all been designed to evaluate limbs with combined orthopaedic and vascular injuries and have a poor sensitivity and specificity in evaluating IIIB injuries. Recently the Ganga Hospital Score (GHS) has been proposed which is specifically designed to evaluate a IIIB injury. Another notable feature of GHS is that it offers guidelines in the choice of the appropriate reconstruction protocol. The basis of the commonly used scores with their utility have been discussed in this paper.

  20. The utility of scores in the decision to salvage or amputation in severely injured limbs

    Directory of Open Access Journals (Sweden)

    Rajasekaran Shanmuganathan

    2008-01-01

    Full Text Available The decision to amputate or salvage a severely injured limb can be very challenging to the trauma surgeon. A misjudgment will result in either an unnecessary amputation of a valuable limb or a secondary amputation after failed salvage. Numerous scores have been proposed to provide guidelines to the treating surgeon, the notable of which are Mangled extremity severity score (MESS; the predictive salvage index (PSI; the Limb Salvage Index (LSI; the Nerve Injury, Ischemia, Soft tissue injury, Skeletal injury, Shock and Age of patient (NISSSA score; and the Hannover fracture scale-97 (HFS-97. These scores have all been designed to evaluate limbs with combined orthopaedic and vascular injuries and have a poor sensitivity and specificity in evaluating IIIB injuries. Recently the Ganga Hospital Score (GHS has been proposed which is specifically designed to evaluate a IIIB injury. Another notable feature of GHS is that it offers guidelines in the choice of the appropriate reconstruction protocol.The basis of the commonly used scores with their utility have been discussed in this paper.

  1. Simulation of Upper Limb Movements

    Science.gov (United States)

    Uherčík, Filip; Hučko, Branislav

    2011-12-01

    The paper deals with controlling an upper limb prosthesis based on the measurement of myoelectric signals (MES) while drinking. MES signals have been measured on healthy limbs to obtain the same response for the prosthesis. To simulate the drinking motion of a healthy upper limb, the program ADAMS was used, with all degrees of freedom and a hand after trans-radial amputation with an existing hand prosthesis. Modification of the simulation has the exact same logic of control, where the muscle does not have to be strenuous all the time, but it is the impulse of the muscle which drives the motor even though the impulse disappears and passed away.

  2. Norepinephrine stimulates mobilization of endothelial progenitor cells after limb ischemia.

    Directory of Open Access Journals (Sweden)

    Qijun Jiang

    Full Text Available OBJECTIVE: During several pathological processes such as cancer progression, thermal injury, wound healing and hindlimb ischemia, the mobilization of endothelial progenitor cells (EPCs mobilization was enhanced with an increase of sympathetic nerve activity and norepinephrine (NE secretion, yet the cellular and molecular mechanisms involved in the effects of NE on EPCs has less been investigated. METHODS AND RESULTS: EPCs from BMs, peripheral circulation and spleens, the VEGF concentration in BM, skeletal muscle, peripheral circulation and spleen and angiogenesis in ischemic gastrocnemius were quantified in mice with hindlimbs ischemia. Systemic treatment of NE significantly increased EPCs number in BM, peripheral circulation and spleen, VEGF concentration in BM and skeletal muscle and angiogenesis in ischemic gastrocnemius in mice with hind limb ischemia, but did not affair VEGF concentration in peripheral circulation and spleen. EPCs isolated from healthy adults were cultured with NE in vitro to evaluate proliferation potential, migration capacity and phosphorylations of Akt and eNOS signal moleculars. Treatment of NE induced a significant increase in number of EPCs in the S-phase in a dose-dependent manner, as well as migrative activity of EPCs in vitro (p<0.05. The co-treatment of Phentolamine, I127, LY294002 and L-NAME with NE blocked the effects of NE on EPCs proliferation and migration. Treatment with NE significantly increased phosphorylation of Akt and eNOS of EPCs. Addition of phentolamine and I127 attenuated the activation of Akt/eNOS pathway, but metoprolol could not. Pretreatment of mice with either Phentolamine or I127 significantly attenuated the effects of NE on EPCs in vivo, VEGF concentration in BM, skeletal muscle and angiogenesis in ischemic gastrocnemius, but Metoprolol did not. CONCLUSION: These results unravel that sympathetic nervous system regulate EPCs mobilization and their pro-angiogenic capacity via α adrenoceptor

  3. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…

  4. Prevalence and Characteristics of Phantom Limb Pain and Residual Limb Pain in the Long Term after Upper Limb Amputation

    Science.gov (United States)

    Desmond, Deirdre M.; MacLachlan, Malcolm

    2010-01-01

    This study aims to describe the prevalence and characteristics of phantom limb pain and residual limb pain after upper limb amputation. One-hundred and forty-one participants (139 males; mean age 74.8 years; mean time since amputation 50.1 years) completed a self-report questionnaire assessing residual and phantom limb pain experience. Prevalence…

  5. 肢体软组织损伤后继发创面出血止血方法的临床分析%Personalized hemostasis in secondary wound bleeding after limb soft tissue injury

    Institute of Scientific and Technical Information of China (English)

    窦晨浩; 刘月驹; 闫晓丽; 张英泽

    2015-01-01

    Background:Although secondary vessel rupture of wound is a severe complication after trauma, there are few systematic re-ports on specific methods of hemostasis. Objective:To explore emergency and surgical hemostasis for secondary bleeding after soft tissue injuries. Methods:A retrospective investigation of 45 patients with secondary wound surface bleeding resulting from severe open soft tissue injuries treated in our hospital from January 2006 to July 2013 was conducted in this study. There were 41 males and 4 females with an average age of (39.4±15.8) years (range, 11-76 years). The interval from injury to hospitalization was (1.4± 3.2) d on average (range, 1-13 d). The injury was caused by traffic accident in 27 cases, machine hurt in 7, crush of heavy ob-ject in 2, fall in 2, electrical injury in 2, and other injuries in 5. MESS score was used to evaluate the damage of soft tissues. Results:There were 32 cases with arterial bleeding (18 with lower extremity bleeding and 14 with upper extremity bleed-ing) and 13 cases with venous bleeding (9 with lower extremity bleeding and 4 with upper extremity bleeding). There were 37 cases with MESS score≥7 and the other 8 cases with MESS score Conclusions:Hemostasis for secondary wound bleeding should be based on the following three steps. The first step is imme-diate compression hemostasis for the wound. The second step is effective hemostasis according to features, position and MESS score of the bleeding. The third step is surgical treatment.%背景:继发性创面血管破裂为创伤后的严重并发症,但对其具体止血方法却鲜有系统性报道。  目的:探讨不同软组织损伤程度、不同部位及性质出血所采取的紧急止血方法及手术止血方法。  方法:回顾性分析2006年1月至2013年7月收治的开放性软组织损伤继发创面出血患者45例。其中男41例,女4例;年龄为11~76岁,平均(39.4±15.8)岁;伤后距入院时间1~13 d

  6. Limb Salvage After Bone Cancer

    Science.gov (United States)

    ... range-of-motion exercises are important in maintaining optimal limb function. If there is pain, swelling, redness, ... Say? What Help Is Available? Behaviors Overview Addressing Sleep Issues I Am Worried About My Child’s Behavior ...

  7. Endograft Limb Occlusion in EVAR

    DEFF Research Database (Denmark)

    Taudorf, M; Jensen, L P; Vogt, K C

    2014-01-01

    OBJECTIVE: To assess the incidence and outcome of graft limb occlusions after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) in a high volume single centre. To quantify iliac artery tortuosity in patients with AAA and correlate this with limb occlusion. DESIGN: Data were...... collected consecutively and prospectively, and analyzed retrospectively. MATERIALS: Patients treated with Zenith bifurcated stent grafts from January 2000 to December 2010 at a tertiary referral vascular unit were analyzed. Routine regular office follow-up with computed tomography angiography (CTA) and......, subsequently, duplex ultrasound imaging was performed. Patients with limb occlusions were identified. For each index patient, two controls were obtained, one immediately preceding and one following the index patient in the consecutive cohort of EVAR patients. METHODS: Demographics and CTA data on limb graft...

  8. Pattern, severity, and management of cranio-maxillofacial soft-tissue injuries in Port Harcourt, Nigeria

    Directory of Open Access Journals (Sweden)

    Akinbami Babatunde Olayemi

    2013-01-01

    Full Text Available Background: The pattern of craniofacial soft-tissue injuries occurring either in isolation or in association with fractures vary in different societies and is multiply influenced. The effects are enormous because of the prominence of the face; therefore, the purpose of this study was to document any changing pattern, severity and management of these craniofacial injuries in our center. Patients and Method: Cranio-maxillofacial region was classified into upper, middle and lower face. The cause, type, and site of the injuries were documented. Gunshot injuries were further categorized as penetrating, perforating or avulsions. Further, classification of injuries into mild, moderate, and severe was carried out based on multiple factors. Result: A total of 126 patients with soft-tissue injuries presented to our hospital out of which 85 (67.5% were males and 41 (32.5 were females. The age range of the patients was between 10 months and 90 years with a mean ± SD of 26.4 ± 15.5 years. Road traffic accident was the most common etiology of which vehicular accidents constituted 50 (54.9% and the motorcycle was 2 (2.2%. Assault contributed 16 (17.6% while cases due to gun shots were 13 (14.3%. A total of 19 (15.1% patients had associated head injuries, 11 (8.7% patients had craniofacial fractures involving any of the bones while 3 (2.4% patients had limb fractures and 2 (1.6% patients had rib fractures. There were 51 (41.8% cases classified as mild injuries, 37 (30.3% cases as moderate injuries and 24 (19.7% cases as severe injuries. Total of 126 cases managed, 121 (96.0% received primary closure of the wounds while 5 (4.0% received delayed closure under general anesthesia.

  9. Risk factors for amputation in extremity vascular injuries in Saudi Arabia.

    Science.gov (United States)

    Al Wahbi, Abdullah; Aldakhil, Salman; Al Turki, Saud; El Kayali, Abdulrahman; Al Kohlani, Hussein; Al Showmer, Abdulaziz

    2016-01-01

    Amputation is most closely associated with blunt, lower limb injuries associated with vascular trauma. These vascular injuries require a special attention to prevent life and limb loss. Patient outcomes can also be improved by organizing vascular trauma data into appropriate systems to facilitate future studies.

  10. 弥漫性轴索损伤患者并发下肢深静脉血栓的相关因素分析%Correlative factors analysis of diffuse axonal injury patients with deep veins thrombosis in lower limbs

    Institute of Scientific and Technical Information of China (English)

    刁正文; 周长清; 陈卉; 张德明; 李秋霖; 杨福兵

    2014-01-01

    目的 探讨弥漫性轴索损伤(DAI)患者并发下肢深静脉血栓(LDVT)的危险因素和预防策略.方法 对130例DAI患者进行双下肢血管超声检查,根据是否发生LDVT分为LDVT组22例和非LDVT组108例,对患者长期卧床、血浆纤维蛋白原、股静脉穿刺、静脉曲张、高血压、性别、吸烟、饮酒、糖尿病、肥胖、G CS评分等相关因素进行分析.结果 LDVT组与非LDVT组比较,患者长期卧床、高血压、吸烟、糖尿病、高血浆纤维蛋白原、GCS评分、年龄差异均有统计学意义(x2值分别为7.08、5.99、5.17、4.70、3.55、12.72,t =27.80;P均<0.05);而性别、饮酒、肥胖、静脉曲张因素比较差异均无统计学意义(P均>0.05).结论 DAI合并LDVT患者多见于年龄偏大、长期卧床、高血压、吸烟、糖尿病、GCS评分低、血浆纤维蛋白原较高者.%Objective To investigate the risk factors and preventive strategies of patients with diffuse axonal injury(DAI) with deep veins thrombosis in lower limbs (LDVT).Methods One hundred and thirty cases of diffuse axonal injury patients with lower limb vascular were divided into LDVT group(22 cases) and non LDVT group(108 cases) based on ultrasound.The information including long-term bed,plasma fibrinogen level,varicose veins,hypertention,sex,age,smoking,alcohol drinking,diabetes,obesity,Glasgow Coma Scale (GCS) were collected.Results There were significant different between LDVT and non-LDVT group in terms of longterm bed time,hypertension,smoking,diabetes,high plasma fibrinogen,age,low GCS score correlated with LDVT (x2 =7.08,5.99,5.17,4.70,3.55,12.72,t =27.80,P < 0.05).Gender,drinking,obesity,varicose vein factors had no correlation with LDVT(P > 0.05).Conclusion Diffuse axonal injury in patients with LDVT is more common in patients with older age,hypertension,low GCS score,the higher the plasma fibrinogen.

  11. The epidemiology of schoolboy rugby injuries.

    Science.gov (United States)

    Roux, C E; Goedeke, R; Visser, G R; van Zyl, W A; Noakes, T D

    1987-03-07

    During one 18-week season, in which players from 26 high schools played 3,350 rugby matches, 495 injuries prevented players from participating in rugby for at least 1 week; 71% occurred during matches and 29% during practices. Injury was more common during the first 4 weeks of the season and again in the same time period after the mid-season vacation. At all ages, A-team players suffered the greatest number of injuries. The safest playing positions were tight-forward and scrum-half; the most dangerous loose-forward and in the back-line excluding the scrum-half. Overall, eightmen were the most often injured players. Of all injuries 55% occurred while the player was tackling or being tackled and 18% during the loose scrum/maul. The lower limb (37%), the head and neck (29%) and the upper limb (20%) were most commonly injured, and fractures (27%), ligament/tendon injuries (25%) and muscle injuries (17%) were commonest. However, concussion injuries were underreported in 19 of the 26 schools. This study shows: that monitoring rugby injuries through correspondence results in underreporting of injuries; that rugby injuries show specific trends with age, team level, playing position, time of the season and phase of play; and that players in the different positions suffer specific injuries in predictable phases of the game. Speed of play may be the most important aetiological factor in the majority of rugby injuries.

  12. Positional information in axolotl and mouse limb extracellular matrix is mediated via heparan sulfate and fibroblast growth factor during limb regeneration in the axolotl (Ambystoma mexicanum).

    Science.gov (United States)

    Phan, Anne Q; Lee, Jangwoo; Oei, Michelle; Flath, Craig; Hwe, Caitlyn; Mariano, Rachele; Vu, Tiffany; Shu, Cynthia; Dinh, Andrew; Simkin, Jennifer; Muneoka, Ken; Bryant, Susan V; Gardiner, David M

    2015-08-01

    Urodele amphibians are unique among adult vertebrates in their ability to regenerate complex body structures after traumatic injury. In salamander regeneration, the cells maintain a memory of their original position and use this positional information to recreate the missing pattern. We used an in vivo gain-of-function assay to determine whether components of the extracellular matrix (ECM) have positional information required to induce formation of new limb pattern during regeneration. We discovered that salamander limb ECM has a position-specific ability to either inhibit regeneration or induce de novo limb structure, and that this difference is dependent on heparan sulfates that are associated with differential expression of heparan sulfate sulfotransferases. We also discovered that an artificial ECM containing only heparan sulfate was sufficient to induce de novo limb pattern in salamander limb regeneration. Finally, ECM from mouse limbs is capable of inducing limb pattern in axolotl blastemas in a position-specific, developmental-stage-specific, and heparan sulfate-dependent manner. This study demonstrates a mechanism for positional information in regeneration and establishes a crucial functional link between salamander regeneration and mammals.

  13. Large Geomagnetic Storms Associated with Limb Halo Coronal Mass Ejections

    CERN Document Server

    Gopalswamy, Nat; Xie, Hong; Akiyama, Sachiko; Makela, Pertti

    2009-01-01

    Solar cycle 23 witnessed the observation of hundreds of halo coronal mass ejections (CMEs), thanks to the high dynamic range and extended field of view of the Large Angle and Spectrometric Coronagraph (LASCO) on board the Solar and Heliospheric Observatory (SOHO) mission. More than two thirds of halo CMEs originating on the front side of the Sun have been found to be geoeffective (Dst = 45deg) have a 20% shorter delay time on the average. It was suggested that the geomagnetic storms due to limb halos must be due to the sheath portion of the interplanetary CMEs (ICMEs) so that the shorter delay time can be accounted for. We confirm this suggestion by examining the sheath and ejecta portions of ICMEs from Wind and ACE data that correspond to the limb halos. Detailed examination showed that three pairs of limb halos were interacting events. Geomagnetic storms following five limb halos were actually produced by other disk halos. The storms followed by four isolated limb halos and the ones associated with interact...

  14. Psychophysical correlates of phantom limb experience.

    OpenAIRE

    Katz, J

    1992-01-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intens...

  15. 无创远程肢体缺血联合处理对大鼠肾脏急性缺血再灌注损伤的保护作用%The protective effect of noninvasive remote ischemic limb perconditioning and postconditioning combined on acute renal ischemia-reperfusion injury

    Institute of Scientific and Technical Information of China (English)

    江海波; 陈仁富; 朱海涛; 薛松; 孙晓磊; 孙晓青

    2015-01-01

    Objectives To investigate the noninvasive remote ischemic limb perconditioning and postconditioning combined on acute renal ischemia-reperfusion injury and its mechanism in rats.Results 30 healthy male SD rats were randomly divided into three groups (n =10):A is sham operation group (Sham group),B is ischemia -reperfusion group (IR),C is noninvasive remote ischemic limb perconditioning and postconditioning combined treatment group (RIperC + RIpostC group).After 24h reperfusion,serum creatinine (Cr) and urea nitrogen (BUN) levels,kidney tissue myeloperoxidase (MPO) activity,malondialdehyde (MDA) content and superoxide dismutase (SOD) activity were measured and the light microscopy observed renal histological changes.Methods These indicators in group B Cr(429.52 ±29.08) μmol/L、BUN(39.05 ±2.23) mmol/L、MPO(7.31 ± 1.48) U/g、MDA (3.94± 0.48) nmol/mgprot were higher than group A Cr(103.91 ± 21.45) μ mol/L (P < 0.001)、BUN (12.20 ± 1.86) mmol/L(p <0.001)、MPO(2.25 ±0.89) U/g(P =0.009)、MDA(1.95 ±0.29) nmol/mgprot (p =0.003) while SOD(4.03 ±0.38) U/mgprut lower in group A SOD(6.819 ±0.68) U/mgprot(P =0.003) ; group C Cr(244.85 ± 40.30) μmol/L(p =0.002) 、BUN(23.48 ± 1.80) mmol/L(p <0.001) 、MPO(3.65 ±0.73) U/g(P =0.045)、MDA(2.19 ±0.31) nmol/mgprot(p =0.006) were lower than group B(P <0.05),while SOD SOD(5.71 ±0.30) U/mgprot(P =0.003) higher than in group B.Group A is normal morphology,group C is more significantly reduced than group B in morphological changes.Conclusions The noninvasive remote ischemic limb perconditioning and postconditioning combined on acute renal ischemia-reperfusion injury have significant protective effect.Through its protective effect may be transient limb ischemia-reperfusion stimulate e-ndogenous antioxidant capacity,so as to alleviate acute renal ischemia-reperfusion injury.%目的 探讨无创远程肢体缺血联合处理对大鼠肾脏急性缺血再灌注损伤的保护及作用机制.方法 30只健

  16. Histamine combined with melphalan in isolated limb perfusion for the treatment of locally advanced soft tissue sarcomas: preclinical studies in rats Histamina combinada ao melfalano na perfusão de membro isolado para o tratamento de sarcomas de partes moles localmente avançado: estudos pré-clínicos em ratos

    Directory of Open Access Journals (Sweden)

    Flavia Brunstein

    2005-08-01

    Full Text Available PURPOSE: To evaluate the potential benefit of histamine combined with melphalan in the isolated limb perfusion (ILP as an alternative to TNF-alfa and melphalan combination, for the treatment of irressectable soft tissue sarcomas of the limbs in Brown Norway (BN rats. METHODS: 20 BN rats had small fragments of syngeneic BN-175 fibosarcoma inserted on the right hind limb. In 7-10 days the tumor reached a median diameter of 12-15 mm and they were randomly divided in four groups (sham, melphalan, histamine and escalating doses of histamine combined to melphalan being submitted to experimental ILP for 30 minutes. Tumors were measured daily with a caliper and the volume was calculated. RESULTS: Response curves showed a significant effect of the combination of histamine 200 mg/mL with melphalan, with 66% overall response, including 33% complete responses (pOBJETIVO: Avaliar o potencial benéfico da histamina combinada ao melfalano, na perfusão de membro isolado (PMI, como alternativa à combinação TNF-alfa mais melfalano, no tratamento de sarcomas de partes moles irressecaveis em extremidades, em ratos de linhagem Brown Norway (BN. MÉTODOS: 20 ratos BN foram submetidos a implantação de fragmentos de fibrosarcoma singênico BN-175 na pata traseira direita. Em cerca de 7-10 dias o tumor atingiu um diâmetro médio de 12-15 mm e foram aleatóriamente divididos em quatro grupos (controle, melfalano, histamina em doses progessivas combinada ao melfalano e histamina sendo submetidos a PMI experimental por 30 minutos. Os tumores foram então medidos diariamente com o uso de paquímetro e o volume tumoral calculado. RESULTADOS: As curvas de resposta mostram um efeito significativo da combinação de Histamina na concentração de 200 mg/mL ao melfalano, com 66% de resposta global incluindo 33% de respostas completas (p < 0.01. Não houve efeitos colaterais sistêmicos e localmente apenas edema leve e transitório nos animais tratados com histamine

  17. F波在上运动神经元损伤后肢体痉挛治疗中的应用现状%Application status of F wave on the treatment of the limb spasm after upper motoneuron injury

    Institute of Scientific and Technical Information of China (English)

    张松东; 吴建贤

    2016-01-01

    痉挛是脑卒中、脊髓损伤等上运动神经元损伤后,由于脊髓与脑干反射亢进而导致的肌张力异常增高状态,也是上运动神经元损伤后残疾的主要原因,并且严重影响患者日常生活活动及融入社会,故改善痉挛对提高痉挛患者生活质量显得尤为重要。目前临床上针对痉挛的治疗方法繁多,如运动疗法,药物疗法,一般物理治疗中的温度疗法、电刺激疗法、磁疗、直接震动刺激,针刺疗法,局部注射及外科手术等,针对治疗前后痉挛变化情况的评估方法也多种多样,如采用量表及电生理诊断方法,近年来有学者应用肌电 F 波来评估痉挛并取得了显著的成效。本文收集近年来应用肌电图 F 波评估痉挛治疗的文献,总结 F 波各参数的变化情况及与痉挛的关系,为临床医师及康复治疗师评估痉挛治疗效果提供一种客观、可靠的检测方法。%Because of reflexes hyperfunction of the spinal cord and brainstem, spasticity is an abnormal state of muscular tension strengthen, which is the main cause of disability after upper motor neuron injury, such as stroke, spinal cord injury and so on, and affect the activities of daily living and integrating into society of patients seriously. So it is particularly important to improve the spasm to enhance the quality of life of patients with spasticity. There are many kinds of treatments aimed at spasticity at present, such as exercise therapy, drug, temperature therapy in general physical therapy, electrostimulation, direct vibration stimulation, acupuncture therapy, local injection, surgery, and so on. Evaluation method for spasticity changes before and after treatment are also diverse, such as the application of scale and electrophysiological diagnosis method. In recent years, some scholars have applied F wave of electromyogram to evaluated spasm and achieved remarkable results. This paper collected the

  18. On the Efficacy of Isolating Shoulder and Elbow Movements with a Soft, Portable, and Wearable Robotic Device

    Science.gov (United States)

    Kadivar, Zahra; Beck, Christopher E.; Rovekamp, Roger N.; O'Malley, Marcia K.; Joyce, Charles A.

    2016-01-01

    Treatment intensity has a profound effect on motor recovery following neurological injury. The use of robotics has potential to automate these labor-intensive therapy procedures that are typically performed by physical therapists. Further, the use of wearable robotics offers an aspect of portability that may allow for rehabilitation outside the clinic. The authors have developed a soft, portable, lightweight upper extremity wearable robotic device to provide motor rehabilitation of patients with affected upper limbs due to traumatic brain injury (TBI). A key feature of the device demonstrated in this paper is the isolation of shoulder and elbow movements necessary for effective rehabilitation interventions. Herein is presented a feasibility study with one subject and demonstration of the device's ability to provide safe, comfortable, and controlled upper extremity movements. Moreover, it is shown that by decoupling shoulder and elbow motions, desired isolated joint actuation can be achieved.

  19. Ex Situ Perfusion of Human Limb Allografts for 24 Hours.

    Science.gov (United States)

    Werner, Nicole L; Alghanem, Fares; Rakestraw, Stephanie L; Sarver, Dylan C; Nicely, Bruce; Pietroski, Richard E; Lange, Paul; Rudich, Steven M; Mendias, Christopher L; Rojas-Pena, Alvaro; Magee, John C; Bartlett, Robert H; Ozer, Kagan

    2017-03-01

    Vascularized composite allografts, particularly hand and forearm, have limited ischemic tolerance after procurement. In bilateral hand transplantations, this demands a 2 team approach and expedited transfer of the allograft, limiting the recovery to a small geographic area. Ex situ perfusion may be an alternative allograft preservation method to extend allograft survival time. This is a short report of 5 human limbs maintained for 24 hours with ex situ perfusion. Upper limbs were procured from brain-dead organ donors. Following recovery, the brachial artery was cannulated and flushed with 10 000 U of heparin. The limb was then attached to a custom-made, near-normothermic (30-33°C) ex situ perfusion system composed of a pump, reservoir, and oxygenator. Perfusate was plasma-based with a hemoglobin concentration of 4 to 6 g/dL. Average warm ischemia time was 76 minutes. Perfusion was maintained at an average systolic pressure of 93 ± 2 mm Hg, flow 310 ± 20 mL/min, and vascular resistance 153 ± 16 mm Hg/L per minute. Average oxygen consumption was 1.1 ± 0.2 mL/kg per minute. Neuromuscular electrical stimulation continually displayed contraction until the end of perfusion, and histology showed no myocyte injury. Human limb allografts appeared viable after 24 hours of near-normothermic ex situ perfusion. Although these results are early and need validation with transplantation, this technology has promise for extending allograft storage times.

  20. Lower limb pain in sympathetic-sensory coupling

    Institute of Scientific and Technical Information of China (English)

    Hongjun Yang; Kairun Peng; Sanjue Hu; Li Xuan

    2011-01-01

    Previous studies have shown that sympathetic nerves are related to certain types of pain, and this phenomenon is referred to as sympathetic-sensory coupling. Chronic pain resulting from nerve injury can be exacerbated by sympathetic stimulation or relieved by sympathetic inhibition. In the present study, the correlation between pain and sympathetic nerves was analyzed in patients with severe pain in lower limbs, as well as in a chronically compressed dorsal root ganglion (CCD) rat model (model of low back pain and sciatica). Patients with severe pain in the lower limbs underwent chemical lumbar sympathectomy (CLS), and the analgesic effects of CLS were compared with painkillers. Results demonstrated significantly relieved lower limb pain following CLS, and the analgesic effects of CLS were superior to those seen with painkillers. In the CCD rat model, dorsal root ganglion neuronal activity significantly increased as a result of electrical stimulation to the sympathetic nerves. These results suggest that sympathetic nerves are closely associated with pain and sympathetic-sensory coupling is likely in lower limb pain in both patients and rat models of CCD.

  1. Hindfoot injuries due to landmine blast accidents.

    Science.gov (United States)

    Khan, M Tahir; Husain, Faisal N; Ahmed, Aftab

    2002-03-01

    Landmines were initially developed as anti-tank weapons. They are still used indiscriminately and in a disorganised fashion, violating the United Nations Treaty on their use [United Nations (1980)]. The injury produced by these devices is variable depending upon the construction and strength of the landmine and body parts coming in contact with the landmine at the time of detonation. The purpose of the present study was to report the type of landmine-blast injuries of the lower limbs and the surgical options available to treat them. Twenty-eight patients, all with lower limb injuries were included in the present study. They had received injuries on the control line of the troubled Jammu and Kashmir regions in the north of Pakistan. All were male patients between the age of 13 and 55 years. A salvage procedure for the forefoot was possible on four patients only and all the rest had a below-knee amputation. Time lapsed between the injury and receiving medical help was the crucial determining factor as to the final outcome of the limb. We believe that the pattern of injury, amount of energy dissipation and part of body in contact with the landmine at the time of explosion are the main determining factors for the final outcome. If skin along with the underlying soft tissue and the neuro-vascular structures on the dorsum of the foot are spared then an attempt can be made at limb salvage.

  2. The phantom limb in dreams.

    Science.gov (United States)

    Brugger, Peter

    2008-12-01

    Mulder and colleagues [Mulder, T., Hochstenbach, J., Dijkstra, P. U., Geertzen, J. H. B. (2008). Born to adapt, but not in your dreams. Consciousness and Cognition, 17, 1266-1271.] report that a majority of amputees continue to experience a normally-limbed body during their night dreams. They interprete this observation as a failure of the body schema to adapt to the new body shape. The present note does not question this interpretation, but points to the already existing literature on the phenomenology of the phantom limb in dreams. A summary of published investigations is complemented by a note on phantom phenomena in the dreams of paraplegic patients and persons born without a limb. Integration of the available data allows the recommendation for prospective studies to consider dream content in more detail. For instance, "adaptation" to the loss of a limb can also manifest itself by seeing oneself surrounded by amputees. Such projective types of anosognosia ("transitivism") in nocturnal dreams should also be experimentally induced in normally-limbed individuals, and some relevant techniques are mentioned.

  3. Traumatic brain injury-induced sleep disorders

    Directory of Open Access Journals (Sweden)

    Viola-Saltzman M

    2016-02-01

    Full Text Available Mari Viola-Saltzman, Camelia Musleh Department of Neurology, NorthShore University HealthSystem, Evanston, IL, USA Abstract: Sleep disturbances are frequently identified following traumatic brain injury, affecting 30%–70% of persons, and often occur after mild head injury. Insomnia, fatigue, and sleepiness are the most frequent sleep complaints after traumatic brain injury. Sleep apnea, narcolepsy, periodic limb movement disorder, and parasomnias may also occur after a head injury. In addition, depression, anxiety, and pain are common brain injury comorbidities with significant influence on sleep quality. Two types of traumatic brain injury that may negatively impact sleep are acceleration/deceleration injuries causing generalized brain damage and contact injuries causing focal brain damage. Polysomnography, multiple sleep latency testing, and/or actigraphy may be utilized to diagnose sleep disorders after a head injury. Depending on the disorder, treatment may include the use of medications, positive airway pressure, and/or behavioral modifications. Unfortunately, the treatment of sleep disorders associated with traumatic brain injury may not improve neuropsychological function or sleepiness. Keywords: traumatic brain injury, insomnia, hypersomnia, sleep apnea, periodic limb movement disorder, fatigue

  4. BDNF基因修饰的NSCs移植对大鼠脊髓损伤后轴突再生及后肢运动功能的影响%Effects of neural stem cell modified by BDNF transplantation on the axonal regeneration and function of hind limbs in rats after spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    张国庆; 樊立华; 徐红梅; 孙奎兴

    2012-01-01

    Objective To investigate the effects of neural stem cell (NSC)modified by brain derived neurophic factor (BDNF) transplantation on the axonal regeneration and function of hind limbs in rats after spinal cord injury( SCI). Methods Total of 120 SCI rats were divided randomly into 4 groups with 30 in each,the Sham groupreceived laminotomy only, the 3 d after SCI group was given 5 μL normal saline by intraspinal injection, the NSC group was given 5 μL cell suspension of NSC(2 × 105/μL) , the NSC-BDNF group was given 5 μL cell suspension of NSC-BDNF. After 1,3,7,14,28 d, the BDNF and NF200 were detected by immunochemistry, hind limb function of the rats was evaluated using BBB open field locomotion rating score. Results The level of BDNF in NSC-BDNF group was significantly higher than that in the other three groups(P <0.05,0.01) in time-dependent manner. The level of NF200 in NSC -BDNF group was significantly higher than that in the other three groups (P < 0.05), and the BBB score was distinctly higher than that in the SCI and NSC group, was lower than that in Sham group ( P < 0.05,0.01) in time-dependent manner. Conclusion Transplantation of NSCs modified by BDNF can survive in the injured site of spinal cord, can promote the axonal reconstruction and recovery of the function of the hind limb in rats after SCI.%目的 探讨脑源性神经营养因子(BDNF)基因修饰的神经干细胞(NSC-BDNF)移植对脊髓损伤(SCI)的可行性及效果.方法 将120只SCI大鼠随机分为四组各30只,假手术组(Sham组)仅做椎板切开术,伤后3d损伤组(SCI组)脊髓内注射生理盐水溶液5μl,NSC组髓内注射移植细胞密度为2×105/μl的NSCs悬液5μl,NSC-BDNF组髓内注射NSC-BDNF悬液5μl.采用免疫组织化法检测1、3、7、14、28 d脊髓组织BDNF、神经丝蛋白(NF200)表达;行为学评分法判断后肢运动功能恢复情况.结果 NSC-BDNF组BDNF水平明显高于其他三组,且随着时间延长而增高(P<0.05或0.01)

  5. 姜黄素预处理对肢体缺血再灌注肺损伤大鼠肺内炎症反应的影响%Effects of curcumin pretreatment on pulmonary inflammatory response in lung injury induced by ischemia-reperfusion of hind limbs in rats

    Institute of Scientific and Technical Information of China (English)

    孙晓峰; 杨军; 赵宏

    2011-01-01

    目的 研究姜黄素预处理对肢体缺血再灌注肺损伤大鼠肺内炎症反应的影响.方法 选取成年♂ SD大鼠,建立大鼠肢体缺血2h再灌注3h肺损伤模型.随机分为5组(各12只):假手术组及模型组,分别给予等容量生理盐水;3个浓度姜黄素预处理组,分别于缺血前2h经腹腔注射姜黄素50,100,200 mg·kg-1.测定每组肺组织湿/干重比(W/D),髓过氧化物酶(MPO)活性、肿瘤坏死因子α(TNF-α)、白细胞介素-6(IL-6)含量以及核因子-кB p65(NF-кB p65)的蛋白表达.结果 与假手术组比较,模型组的肺组织W/D与MPO活性、TNF-α和IL-6含量并使NF-кB p65表达均明显升高;姜黄素预处理组可剂量依赖地降低肺组织W/D与MPO活性、TNF-o和IL-6含量并使NF-кB p65表达升高.结论 姜黄素预处理能减轻肢体缺血再灌注所致的大鼠肺内炎症反应,其机制可能与抑制NF-кB激活、从而减少TNF-α和IL-6介导的中性粒细胞聚集有关.%Objective To investigate the effects of curcumin pretreat-ment on pulmonary inflammatory response in lung injury induced by ischemia - reperfusion (I/R) of hind limbs in rats. Methods Sixty a-dult male SD rats were randomly divided into 5 groups (n = 12, each) ; sham group; model group; three contents curcumin pretreatment groups received curcumin 50, 100, 200 mg · kg-1 respectively via intraperitone-al injection 2 h before ischemia. I/R of hind limbs was produced by occlusion of bilateral femoral arteries for 2 h followed by 3 h reperfusion in model and curcumin pretreatment groups. The animals were killed at the end of 3 h reperfusion and their lungs were immediately removed for determination of wet/dry weight ( W/D ) ratio, myeloperoxidase ( MPO ) activity, tumor necrosis factor-a (TNF -a) and interleukin - 6 (IL -6 ) content The lung was also assessed for expression of nuclear factor -kB p6S (NF - kB p65) protein using Western blot analysis. Results Lung W/D ratio, MPO activity, TNF - a and

  6. Bilogy Machine Initiative: Developing Innovative Novel Methods to Improve Neuro-rehabilitation for Amputees and Treatment for Patients at Remote Sites with Acute Brain Injury

    Science.gov (United States)

    2010-09-01

    and easily deployed intervention for the prevention and treatment of phantom limb pain . Project 2 Deliverable: This project will provide new insight...related to brain plasticity into translational level information and technologies aimed at addressing issues in neurorehabilitation due to loss of limbs ...rehabilitation of injuries that directly (e.g., traumatic brain injury) or indirectly (e.g., spinal cord injury or limb amputation) affect the

  7. Angiotensin II stimulates superoxide production by nitric oxide synthase in thick ascending limbs.

    Science.gov (United States)

    Gonzalez-Vicente, Agustin; Saikumar, Jagannath H; Massey, Katherine J; Hong, Nancy J; Dominici, Fernando P; Carretero, Oscar A; Garvin, Jeffrey L

    2016-02-01

    Angiotensin II (Ang II) causes nitric oxide synthase (NOS) to become a source of superoxide (O2 (-)) via a protein kinase C (PKC)-dependent process in endothelial cells. Ang II stimulates both NO and O2 (-) production in thick ascending limbs. We hypothesized that Ang II causes O2 (-) production by NOS in thick ascending limbs via a PKC-dependent mechanism. NO production was measured in isolated rat thick ascending limbs using DAF-FM, whereas O2 (-) was measured in thick ascending limb suspensions using the lucigenin assay. Consistent stimulation of NO was observed with 1 nmol/L Ang II (P thick ascending limbs via a PKC- and NADPH oxidase-dependent process; and (2) the effect of Ang II is not due to limited substrate.

  8. [Pathomimia in upper limb].

    Science.gov (United States)

    Maalla, Riadh; Bensalma, Hichem; Hamdi, Lamia; Assel, Salem; Bahri, Hichem; Hamdi, Abdelaziz

    2005-03-01

    Pathomimia, or factitious disorders, are characterized by producing symptoms voluntarily with the intention of playing the role of the patient. Inspite of being considerd as a psychatric disorder, pathomimuia is often encountered in the daily professional life of doctors without being recognized or diagnosed. There are various clinical aspects of pathomimia. The items that decide the orientation of the diagnosis are essentially the uncommon and odd expression of the reported symptoms, A capricious evolution as well as the multiplicity of the past medical cases. We report a group of five patients who were followed and treated between the years 2000 and 2003. This group was composed of three men and two women with an average age of 30 years. In three cases, we found the notion of skin injury. In one case, we noted a median nerve lesion in the elbow and once in the right upper member. The evolution was performed towards recidives of the initial symptomatology with more or less long periods of improvements.

  9. Endothelial expression of human cytochrome P450 epoxygenase CYP2C8 increases susceptibility to ischemia-reperfusion injury in isolated mouse heart

    Science.gov (United States)

    Edin, Matthew L.; Wang, ZhongJing; Bradbury, J. Alyce; Graves, Joan P.; Lih, Fred B.; DeGraff, Laura M.; Foley, Julie F.; Torphy, Robert; Ronnekleiv, Oline K.; Tomer, Kenneth B.; Lee, Craig R.; Zeldin, Darryl C.

    2011-01-01

    Cytochrome P450 (CYP) epoxygenases CYP2C8 and CYP2J2 generate epoxyeicosatrienoic acids (EETs) from arachidonic acid. Mice with expression of CYP2J2 in cardiomyocytes (αMHC-CYP2J2 Tr) or treated with synthetic EETs have increased functional recovery after ischemia/reperfusion (I/R); however, no studies have examined the role of cardiomyocyte- vs. endothelial-derived EETs or compared the effects of different CYP epoxygenase isoforms in the ischemic heart. We generated transgenic mice with increased endothelial EET biosynthesis (Tie2-CYP2C8 Tr and Tie2-CYP2J2 Tr) or EET hydrolysis (Tie2-sEH Tr). Compared to wild-type (WT), αMHC-CYP2J2 Tr hearts showed increased recovery of left ventricular developed pressure (LVDP) and decreased infarct size after I/R. In contrast, LVDP recovery and infarct size were unchanged in Tie2-CYP2J2 Tr and Tie2-sEH Tr hearts. Surprisingly, compared to WT, Tie2-CYP2C8 Tr hearts had significantly reduced LVDP recovery (from 21 to 14%) and increased infarct size after I/R (from 51 to 61%). Tie2-CYP2C8 Tr hearts also exhibited increased reactive oxygen species (ROS) generation, dihydroxyoctadecenoic acid (DiHOME) formation, and coronary resistance after I/R. ROS scavengers and CYP2C8 inhibition reversed the detrimental effects of CYP2C8 expression in Tie2-CYP2C8 Tr hearts. Treatment of WT hearts with 250 nM 9,10-DiHOME decreased LVDP recovery compared to vehicle (16 vs. 31%, respectively) and increased coronary resistance after I/R. These data demonstrate that increased ROS generation and enhanced DiHOME synthesis by endothelial CYP2C8 impair functional recovery and mask the beneficial effects of increased EET production following I/R.—Edin, M. L., Wang, Z. J., Bradbury, J. A., Graves, J. P., Lih, F. B., DeGraff, L. M., Foley, J. F., Torphy, R., Ronnekleiv, O. K., Tomer, K. B., Lee, C. R., Zeldin, D. C. Endothelial expression of human cytochrome P450 epoxygenase CYP2C8 increases susceptibility to ischemia-reperfusion injury in isolated mouse

  10. Upper limb swelling following mastectomy: lymphedema or not?

    Science.gov (United States)

    Armer, Jane

    2007-04-01

    Having experienced an excisional biopsy, sentinel lymph node biopsy, and mastectomy, BH is at lifetime risk of developing post-breast cancer lymphedema in the arm on the side where her breast cancer was treated. She has two additional risk factors, among those documented in the literature: history of an infection (specifically a systemic infection, significant in that it required hospitalization for intravenous antibiotics) in the postsurgery period, and a moderate increase in bilateral limb volume and weight (body mass index) over the months and years following the breast cancer diagnosis. Further, the patient-reported transient hand swelling on the affected side and gradual weight increase are cues indicating a need for patient vigilance and careful monitoring by the health-care team. Preventing future infections, managing weight at an optimal level, and preventing trauma or injury to the affected arm and chest are important self-management precautions to reduce risk of chronic lymphedema development. BH needs continued support in reviewing evidence-based risk-reduction guidelines and understanding ways to apply them to her lifestyle. In the absence of preoperative baseline or contralateral limb measurements (with circumferences or perometry or water displacement), assessment of limb change at a level identified as diagnostic of lymphedema (commonly, 200-mL volume or 2-cm girth increase from baseline or as compared to the contralateral limb) is very challenging. Without bilateral preop limb measurements for baseline and contralateral limb comparisons, BH might have been diagnosed with lymphedema at postop or at 48 months, when both limbs increased symmetrically. Symptom assessment is also crucial, as symptom report of heaviness and swelling is found to be associated with limb volume changes indicative of lymphedema. Transient hand swelling may be evidence of latent lymphedema and cause for increased risk-reduction education and vigilance in assessment for

  11. Phantom limb syndrome: a review.

    Science.gov (United States)

    Chahine, Lama; Kanazi, Ghassan

    2007-06-01

    Phantom limb syndrome is a condition in which patients experience sensations, whether painful or otherwise, in a limb that does not exist. It has been reported to occur in 80-100% of amputees, and typically has a chronic course, often resistant to treatment. Risk factors include the presence of preoperative pain, traumatic amputation, and the type of anesthetic procedure used during amputation. Several pathophysiologic theories have been proposed, including spinal mechanisms, central sensitization, and somatosensory cortical rearrangements, and while recent studies have shed light on some interesting and significant data, a lot remains to be understood. Treatments include pharmacologic, mechanical, and behavioral modalities, but substantial efficacy in well-designed, randomized controlled trials has yet to be demonstrated. Phantom limb syndrome continues to be a difficult condition to both understand and treat.

  12. Superior limb reimplantation. Case presentation.

    Directory of Open Access Journals (Sweden)

    Yovanny Ferrer Lozano

    2009-07-01

    Full Text Available Reimplantation surgery is only performed in highly specialized medical institutions. Its success is associate to the development and improvement of microsurgical techniques and to the constant training of the medical team. We present the case of a white patient of 17 years of age, who, as a result of an accident at the working place, suffered the total detachment of his upper right limb in the shoulder area. He was admitted in the emergency unit presenting hypovolemic shock and was immediately stabilized to perform later the limb reimplantation. The postsurgical development was satisfactory, proving that reimplantation can be considered a safe and functional practice in complex wounds or amputation affecting limbs.

  13. Genetics Home Reference: isolated hyperCKemia

    Science.gov (United States)

    ... normal. While elevated creatine kinase often accompanies various muscle diseases, individuals with isolated hyperCKemia have no muscle weakness ... related distal myopathy , limb-girdle muscular dystrophy , rippling muscle disease , and a heart disorder called hypertrophic cardiomyopathy. Several ...

  14. Back Injuries

    Science.gov (United States)

    ... extending from your neck to your pelvis. Back injuries can result from sports injuries, work around the house or in the garden, ... back is the most common site of back injuries and back pain. Common back injuries include Sprains ...

  15. Electrical Injuries

    Science.gov (United States)

    ... it can pass through your body and cause injuries. These electrical injuries can be external or internal. You may have one or both types. External injuries are skin burns. Internal injuries include damage to ...

  16. Apparatus for determining changes in limb volume

    Science.gov (United States)

    Bhagat, P. K.; Wu, V. C. (Inventor)

    1981-01-01

    Measuring apparatus for determining changes in the volume of limbs or other boty extremities by determining the cross-sectional area of such limbs many comprise a transmitter including first and second transducers for positioning on the surface of the limb at a predetermined distance there between, and a receiver including a receiver crystal for positioning on the surface of the limb. The distance between the receiver crystal and the first and second transducers are represented by respective first and second chords of the cross-section of the limb and the predetermined distance between the first and second transducers is represented by a third chord of the limb cross section.

  17. Injuries in competitive boxing. A prospective study.

    Science.gov (United States)

    Siewe, J; Rudat, J; Zarghooni, K; Sobottke, R; Eysel, P; Herren, C; Knöll, P; Illgner, U; Michael, J

    2015-03-01

    Boxing remains a subject of controversy and is often classified as dangerous. But the discussion is based mostly on retrospective studies. This survey was conducted as a prospective study. From October 2012 to September 2013, 44 competitive boxers were asked to report their injuries once a month. The questionnaire collected general information (training, competition) and recorded the number of bouts fought, injuries and resulting lost days. A total of 192 injuries were recorded, 133 of which resulted in interruption of training or competition. Each boxer sustained 3 injuries per year on average. The injury rate was 12.8 injuries per 1 000 h of training. Boxers fighting more than 3 bouts per year sustain more injuries (p=0.0075). The injury rate does is not a function of age (age≤19 vs. > 19a, p=0.53). Injuries to the head and the upper limbs occur most frequently. The most common injuries are soft tissue lacerations and contusions. Head injuries with neurological symptoms rarely occur (4.2%). Boxing has a high injury rate that is comparable with other contact sports, but most injuries are minor. Injury frequency is not a function of whether the boxer competes in the junior or adult category. Athletes fighting many bouts per year have a greater risk of injury.

  18. Lengthening of replanted or revascularized lower limbs: is length discrepancy a contraindication for limb salvage?

    Science.gov (United States)

    Parmaksizoglu, Fatih; Beyzadeoglu, Tahsin

    2002-08-01

    Some replantation cases require substantial bone shortening for primary closure. Leg-length discrepancy can be restored by lengthening of the replanted or revascularized extremities. Between 1991 and 2000, four patients with four total and two subtotal below-knee amputations had replantation or revascularization for their severely damaged extremities. All of them had extensive debridement, vascular repair, bone shortening and nerve repair for sensibility of their soles. One of the replanted extremities failed and had to undergo below-knee amputation because of sepsis. No other infection or vascular complications were encountered following the replantations or revascularizations. After bony consolidation, four legs were lengthened; for elimination of length discrepancy in three cases, and for obtaining balanced body proportion in one case in which the other leg was also amputated. In all procedures, a unilateral dynamic axial external fixator was used. The lengthening was performed from the proximal tibial metaphysis, with a subperiosteal osteotomy. Evaluation of injury according to the Mangled Extremity Severity Score (MESS) would encourage the surgeon to avoid salvage surgery with a shortened extremity, because of the required debridement of soft tissue and bone. These authors think the amount of limb shortening is not a major criterion in evaluating a traumatic total or subtotal below-knee amputation for salvage replantation or revascularization. A knee that has stable joint motion and the possibility of preservation of sensibility of the sole broadens the scope of indications for limb salvage, even with deliberate shortening that can be restored by lengthening; length discrepancy is not a contraindication for limb salvage.

  19. The mangled extremity and attempt for limb salvage

    Directory of Open Access Journals (Sweden)

    Kontogeorgakos Vasileios A

    2009-02-01

    Full Text Available Abstract Background The decision, whether to amputate or reconstruct a mangled extremity remains the subject of extensive debate since multiple factors influence the decision. Methods Sixty three patients with high energy extremity trauma and attempts at limb salvage were retrospectively reviewed. We analyzed 10 cases of massive extremity trauma where there was made an attempt to salvage limbs, although there was a controversy between salvage and amputation. Results All of the patients except one had major vascular injury and ischemia requiring repair. Three patients died. All of the remaining patients were amputated within 15 days after the salvage procedure, mainly because of extremity sepsis. Seven patients required treatment at the intensive care unit. All patients had at least 2 reconstruction procedures and multiple surgical debridements. Conclusion The functional outcome should be considered realistically before a salvage decision making for extremities with indeterminate prognosis.

  20. An upper limb robot model of children limb for cerebral palsy neurorehabilitation.

    Science.gov (United States)

    Pathak, Yagna; Johnson, Michelle

    2012-01-01

    Robot therapy has emerged in the last few decades as a tool to help patients with neurological injuries relearn motor tasks and improve their quality of life. The main goal of this study was to develop a simple model of the human arm for children affected with cerebral palsy (CP). The Simulink based model presented here shows a comparison for children with and without disabilities (ages 6-15) with normal and reduced range of motion in the upper limb. The model incorporates kinematic and dynamic considerations required for activities of daily living. The simulation was conducted using Matlab/Simulink and will eventually be integrated with a robotic counterpart to develop a physical robot that will provide assistance in activities of daily life (ADLs) to children with CP while also aiming to improve motor recovery.

  1. Severely comminuted radius fracture presenting as a signature patterned injury.

    Science.gov (United States)

    Jain, Saurabh; Rajan, Sunil; Srivastava, Abhishek

    2016-01-01

    Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a "signature pattern injury" caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile.

  2. Isoflurane protects the isolated rat lungs against ischemia-reperfusion injury%异氟醚保护离体大鼠肺缺血再灌注损伤

    Institute of Scientific and Technical Information of China (English)

    陈志新; 曾因明; 方志源; 夏小萍

    2005-01-01

    Objective To study the effects of isoflurane on ischemia-reperfusion (IR)-induced injury in isolated rat lungs. Methods This study was performed on an isolated buffer-perfused rat lung model. There were four groups: CON group ( n = 6): perfusion for 60 min without ischemia; IR group (n = 6): after perfusion for 30 min, then interruption of perfusion and ventilation for 45 min followed by reperfusion for 30 min; ISO1 group (n = 6 ): 1.38% isoflurane was administered for 30 min before 45 min ischemia, then followed by 30 min reperfusion; ISO2 group (n= 6): 1.38% isoflurane was administered during the period of reperfusion. The Myeloperoxidase (MPO) activity of lung, neutrophils counts, tumor necrosis factor-α(TNF-α), superoxide dismutase (SOD) activity, malondialdehyde (MDA) in perfusate, and the Wet-to-Dry lung weight ratios were measured. Results IR caused significant increases in the wet-to-dry lung weight ratios, the activity of lung MPO, the contents of MDA and TNF-α in perfusate, but decreasess in the SOD activity and neutrophils counts. Administration of isoflurane (both ISO1 and ISO2 groups) significantly protected against IR-induced injury the via inhibiting increases of MPO activity and contents of MDA and TNF-α in perfusate. Isoflurane significantly increased the SOD activity and neutrophils counts in perfusate. No difference was found between ISO1 and ISO2 groups. Conclusion Our results suggest that isoflurane protects the lungs against IR-induced injury in isolated rat lung model.

  3. Multi-limb necrotizing fasciitis in a patient with rectal cancer

    Institute of Scientific and Technical Information of China (English)

    Shirley Yuk Wah Liu; Simon Siu Man Ng; Janet Fung Yee Lee

    2006-01-01

    Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors,including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases areattributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma.

  4. GATA6 is a crucial regulator of Shh in the limb bud.

    Directory of Open Access Journals (Sweden)

    Elena Kozhemyakina

    2014-01-01

    Full Text Available In the limb bud, patterning along the anterior-posterior (A-P axis is controlled by Sonic Hedgehog (Shh, a signaling molecule secreted by the "Zone of Polarizing Activity", an organizer tissue located in the posterior margin of the limb bud. We have found that the transcription factors GATA4 and GATA6, which are key regulators of cell identity, are expressed in an anterior to posterior gradient in the early limb bud, raising the possibility that GATA transcription factors may play an additional role in patterning this tissue. While both GATA4 and GATA6 are expressed in an A-P gradient in the forelimb buds, the hindlimb buds principally express GATA6 in an A-P gradient. Thus, to specifically examine the role of GATA6 in limb patterning we generated Prx1-Cre; GATA6(fl/fl mice, which conditionally delete GATA6 from their developing limb buds. We found that these animals display ectopic expression of both Shh and its transcriptional targets specifically in the anterior mesenchyme of the hindlimb buds. Loss of GATA6 in the developing limbs results in the formation of preaxial polydactyly in the hindlimbs. Conversely, forced expression of GATA6 throughout the limb bud represses expression of Shh and results in hypomorphic limbs. We have found that GATA6 can bind to chromatin (isolated from limb buds encoding either Shh or Gli1 regulatory elements that drive expression of these genes in this tissue, and demonstrated that GATA6 works synergistically with FOG co-factors to repress expression of luciferase reporters driven by these sequences. Most significantly, we have found that conditional loss of Shh in limb buds lacking GATA6 prevents development of hindlimb polydactyly in these compound mutant embryos, indicating that GATA6 expression in the anterior region of the limb bud blocks hindlimb polydactyly by repressing ectopic expression of Shh.

  5. GATA6 is a crucial regulator of Shh in the limb bud.

    Science.gov (United States)

    Kozhemyakina, Elena; Ionescu, Andreia; Lassar, Andrew B

    2014-01-01

    In the limb bud, patterning along the anterior-posterior (A-P) axis is controlled by Sonic Hedgehog (Shh), a signaling molecule secreted by the "Zone of Polarizing Activity", an organizer tissue located in the posterior margin of the limb bud. We have found that the transcription factors GATA4 and GATA6, which are key regulators of cell identity, are expressed in an anterior to posterior gradient in the early limb bud, raising the possibility that GATA transcription factors may play an additional role in patterning this tissue. While both GATA4 and GATA6 are expressed in an A-P gradient in the forelimb buds, the hindlimb buds principally express GATA6 in an A-P gradient. Thus, to specifically examine the role of GATA6 in limb patterning we generated Prx1-Cre; GATA6(fl/fl) mice, which conditionally delete GATA6 from their developing limb buds. We found that these animals display ectopic expression of both Shh and its transcriptional targets specifically in the anterior mesenchyme of the hindlimb buds. Loss of GATA6 in the developing limbs results in the formation of preaxial polydactyly in the hindlimbs. Conversely, forced expression of GATA6 throughout the limb bud represses expression of Shh and results in hypomorphic limbs. We have found that GATA6 can bind to chromatin (isolated from limb buds) encoding either Shh or Gli1 regulatory elements that drive expression of these genes in this tissue, and demonstrated that GATA6 works synergistically with FOG co-factors to repress expression of luciferase reporters driven by these sequences. Most significantly, we have found that conditional loss of Shh in limb buds lacking GATA6 prevents development of hindlimb polydactyly in these compound mutant embryos, indicating that GATA6 expression in the anterior region of the limb bud blocks hindlimb polydactyly by repressing ectopic expression of Shh.

  6. Risk factors of the upper limb disorders among cashiers in grocery retail industries: A review

    Science.gov (United States)

    Zuhaidi, Muhammad Fareez Ahmad; Nasrull Abdol Rahman, Mohd

    2017-08-01

    Cashiers have been appointed as one of top ten occupations in developing musculoskeletal disorders (MSDs) particularly on the upper limb. Many of the workers are still in high risk injury due to incorrect workstations and lack of employee education in basic biomechanical principles. Normally, cashiers are exposed in several risk factors such as awkward and static postures, repetition motion and forceful exertions. Thus, cashiers in supermarket are considered at risk from developing upper limb disorders (ULDs). This review evaluates selected papers that have studied risk factors of the upper limb disorders among cashiers in grocery retail industries. In addition, other studies from related industry were reviewed as applicable. In order to understand risk factors of the upper limb disorders among cashiers, it is recommended that future studies are needed in evaluating these risk factors among cashiers.

  7. Limb amputations in fixed dystonia: A form of body integrity identity disorder?

    NARCIS (Netherlands)

    Edwards, M.J.; Alonso-Canovas, A.; Schrag, A.; Bloem, B.R.; Thompson, P.D.; Bhatia, K.

    2011-01-01

    Fixed dystonia is a disabling disorder mainly affecting young women who develop fixed abnormal limb postures and pain after apparently minor peripheral injury. There is continued debate regarding its pathophysiology and management. We report 5 cases of fixed dystonia in patients who sought amputatio

  8. The biomechanical interaction between vertebral column and limbs in the horse: a kinematical study

    NARCIS (Netherlands)

    Gómez Álvarez, C.B.

    2007-01-01

    Nowadays, horses have to train and perform in high-level sportive and leisure activities. Injuries of the locomotor system with a decreased functionality or pain of the back are often seen in equine hospitals. In general, the relationship between limb and vertebral column function in mammals is comp

  9. The biomechanical interaction between vertebral column and limbs in the horse: a kinematical study

    NARCIS (Netherlands)

    Gómez Álvarez, C.B.

    2007-01-01

    Nowadays, horses have to train and perform in high-level sportive and leisure activities. Injuries of the locomotor system with a decreased functionality or pain of the back are often seen in equine hospitals. In general, the relationship between limb and vertebral column function in mammals is

  10. Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report.

    Science.gov (United States)

    Clement, Nicholas D; Goswami, Anukul

    2009-06-29

    We present a case of a Salter-Harris II injury to the proximal tibia associated with both vascular compromise and compartment syndrome. The potential complications of this injury are limb threatening and the neurovasular status of the limb should be continually monitored. Maintaining anatomic reduction is difficult and fixation may be needed to achieve optimal results.

  11. Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report

    OpenAIRE

    Clement Nicholas D; Goswami Anukul

    2009-01-01

    Abstract We present a case of a Salter-Harris II injury to the proximal tibia associated with both vascular compromise and compartment syndrome. The potential complications of this injury are limb threatening and the neurovasular status of the limb should be continually monitored. Maintaining anatomic reduction is difficult and fixation may be needed to achieve optimal results.

  12. Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Clement Nicholas D

    2009-06-01

    Full Text Available Abstract We present a case of a Salter-Harris II injury to the proximal tibia associated with both vascular compromise and compartment syndrome. The potential complications of this injury are limb threatening and the neurovasular status of the limb should be continually monitored. Maintaining anatomic reduction is difficult and fixation may be needed to achieve optimal results.

  13. Analysis of predictor factors of limb amputation in patients with high-voltage electrical burns

    Directory of Open Access Journals (Sweden)

    Guillermo García Álvarez

    2015-09-01

    Full Text Available Background: Limb amputation is considered one of the most devastating consequences of electrical injury. Any factors that correlate with the degree of muscle damage can be used to predict the necessity of limb amputation. The aim of this study was to determine the factors that can be used to predict limb amputation in high-voltage electrically injured patients. Methods: Eighty-two high-voltage electrically injured patients were admitted to the Department of Plastic and Reconstructive Surgery and Burns of National Arzobispo Loayza Hospital on a 5 year period. A retrospective analysis of the possible related risk factors between amputation and non-amputation patients was performed. Results: A total of 68 patients were enrolled for analysis. Thirteen patients underwent limb amputations. Multivariate analysis of the risk factors between amputation and non-amputation groups showed statistical significance for first 24 hour creatine kinase-isoenzyme MB (CKMB level. A serum CK-MB level above 14,955 U/L predicted high risk of limb amputation with high specificity (84% and sensitivity (77%. Only one patient with a remarkable decrease of creatine kinase (CPKt and CK-MB levels after fasciotomy avoided a major limb amputation. Conclusion: Our results suggest that CPK-MB level is an independent factor for prediction of limb amputation in patients with high-voltage electrical burns. We suggest that the addition of CPK-MB evaluation to clinical symptom screening may be a valuable method for early detection of muscle damage.

  14. Neuregulin-1 signaling is essential for nerve-dependent axolotl limb regeneration.

    Science.gov (United States)

    Farkas, Johanna E; Freitas, Polina D; Bryant, Donald M; Whited, Jessica L; Monaghan, James R

    2016-08-01

    The Mexican axolotl (Ambystoma mexicanum) is capable of fully regenerating amputated limbs, but denervation of the limb inhibits the formation of the post-injury proliferative mass called the blastema. The molecular basis behind this phenomenon remains poorly understood, but previous studies have suggested that nerves support regeneration via the secretion of essential growth-promoting factors. An essential nerve-derived factor must be found in the blastema, capable of rescuing regeneration in denervated limbs, and its inhibition must prevent regeneration. Here, we show that the neuronally secreted protein Neuregulin-1 (NRG1) fulfills all these criteria in the axolotl. Immunohistochemistry and in situ hybridization of NRG1 and its active receptor ErbB2 revealed that they are expressed in regenerating blastemas but lost upon denervation. NRG1 was localized to the wound epithelium prior to blastema formation and was later strongly expressed in proliferating blastemal cells. Supplementation by implantation of NRG1-soaked beads rescued regeneration to digits in denervated limbs, and pharmacological inhibition of NRG1 signaling reduced cell proliferation, blocked blastema formation and induced aberrant collagen deposition in fully innervated limbs. Taken together, our results show that nerve-dependent NRG1/ErbB2 signaling promotes blastemal proliferation in the regenerating limb and may play an essential role in blastema formation, thus providing insight into the longstanding question of why nerves are required for axolotl limb regeneration.

  15. Rat hair follicle stem cells differentiate and promote recovery following spinal cord injury

    Institute of Scientific and Technical Information of China (English)

    Nowruz Najafzadeh; Maliheh Nobakht; Bagher Pourheydar; Mohammad Ghasem Golmohammadi

    2013-01-01

    Emerging studies of treating spinal cord injury (SCI) with adult stem cells led us to evaluate the effects of transplantation of hair fol icle stem cells in rats with a compression-induced spinal cord lesion. Here, we proposed a hypothesis that rat hair fol icle stem celltransplantation can promote the recovery of injured spinal cord. Compression-induced spinal cord injury was induced in Wistar rats in this study. The bulge area of the rat vibrissa fol icles was isolated, cultivated and characterized with nestin as a stem cellmarker. 5-Bromo-2′-deoxyuridine (BrdU) labeled bulge stem cells were transplanted into rats with spinal cord injury. Immunohistochemical staining results showed that some of the grafted cells could survive and differentiate into oligodendrocytes (receptor-interacting protein positive cells) and neuronal-like cells (βIII-tubulin positive cells) at 3 weeks after transplantation. In addition, recovery of hind limb locomotor function in spinal cord injury rats at 8 weeks fol owing celltransplantation was assessed using the Basso, Beattie and Bresnahan (BBB) locomotor rating scale. The results demon-strate that the grafted hair fol icle stem cells can survive for a long time period in vivo and differentiate into neuronal- and glial-like cells. These results suggest that hair fol icle stem cells can promote the recovery of spinal cord injury.

  16. Focal skin defect, limb anomalies and microphthalmia.

    NARCIS (Netherlands)

    Jackson, K.E.; Andersson, H.C.

    2004-01-01

    We describe two unrelated female patients with congenital single focal skin defects, unilateral microphthalmia and limb anomalies. Growth and psychomotor development were normal and no brain malformation was detected. Although eye and limb anomalies are commonly associated, clinical anophthalmia and

  17. Congenital microgastria and hypoplastic upper limb anomalies.

    Science.gov (United States)

    Lueder, G T; Fitz-James, A; Dowton, S B

    1989-03-01

    Six cases of congenital microgastria associated with limb anomalies are reviewed. The microgastria-hypoplastic upper limb association may arise as a result of aberrant mesodermal development in the 5th embryonic week.

  18. The Military Extremity Trauma Amputation/Limb Salvage (METALS) study: outcomes of amputation versus limb salvage following major lower-extremity trauma.

    Science.gov (United States)

    Doukas, William C; Hayda, Roman A; Frisch, H Michael; Andersen, Romney C; Mazurek, Michael T; Ficke, James R; Keeling, John J; Pasquina, Paul F; Wain, Harold J; Carlini, Anthony R; MacKenzie, Ellen J

    2013-01-16

    The study was performed to examine the hypothesis that functional outcomes following major lower-extremity trauma sustained in the military would be similar between patients treated with amputation and those who underwent limb salvage. This is a retrospective cohort study of 324 service members deployed to Afghanistan or Iraq who sustained a lower-limb injury requiring either amputation or limb salvage involving revascularization, bone graft/bone transport, local/free flap coverage, repair of a major nerve injury, or a complete compartment injury/compartment syndrome. The Short Musculoskeletal Function Assessment (SMFA) questionnaire was used to measure overall function. Standard instruments were used to measure depression (the Center for Epidemiologic Studies Depression Scale), posttraumatic stress disorder (PTSD Checklist-military version), chronic pain (Chronic Pain Grade Scale), and engagement in sports and leisure activities (Paffenbarger Physical Activity Questionnaire). The outcomes of amputation and salvage were compared by using regression analysis with adjustment for age, time until the interview, military rank, upper-limb and bilateral injuries, social support, and intensity of combat experiences. Overall response rates were modest (59.2%) and significantly different between those who underwent amputation (64.5%) and those treated with limb salvage (55.4%) (p = 0.02). In all SMFA domains except arm/hand function, the patients scored significantly worse than population norms. Also, 38.3% screened positive for depressive symptoms and 17.9%, for posttraumatic stress disorder (PTSD). One-third (34.0%) were not working, on active duty, or in school. After adjustment for covariates, participants with an amputation had better scores in all SMFA domains compared with those whose limbs had been salvaged (p depressive symptoms, pain interfering with daily activities (pain interference), or work/school status. Major lower-limb trauma sustained in the military

  19. Learning about Vertebrate Limb Development

    Science.gov (United States)

    Liang, Jennifer O.; Noll, Matthew; Olsen, Shayna

    2014-01-01

    We have developed an upper-level undergraduate laboratory exercise that enables students to replicate a key experiment in developmental biology. In this exercise, students have the opportunity to observe live chick embryos and stain the apical ectodermal ridge, a key tissue required for development of the vertebrate limb. Impressively, every…

  20. Adolescent Neuroblastoma of Lower Limb

    Directory of Open Access Journals (Sweden)

    Rajeshwari K

    2013-04-01

    Full Text Available Neuroblastoma is an embryonic tumour of neural crest origin, commonly seen in children with upper abdomen involvement. Rarely neuroblastomas present in adolescents and adults involving lower limb. Histopathologically neuroblastoma of lower limb can be confused with other small round cell tumour especially with Ewing's sarcoma and rhabdomyosarcoma. A 16 year old male presented with 15x11cm swelling, pain and multiple discharging sinuses of right leg since 4 months. Routine haematological and biochemical analysis were within normal limits. Radiology of right leg showed large soft tissue swelling encompassing the pathological fracture of tibia and bowing of fibula. Fine needle aspiration of the swelling revealed malignant small round cell tumour. Histopathology revealed poorly differentiated neuroblastoma of lower limb. The immunohistochemistry of Synaptophysin and Chromogranin were positive and CD 99 was negative. Neuroblastoma diagnosed at unusual site with uncommon age has poor prognosis. Hence, one must keep in mind the differential diagnosis of neuroblastoma as one of the differential diagnosis in evaluating the soft tissue tumours of lower limb.

  1. Learning about Vertebrate Limb Development

    Science.gov (United States)

    Liang, Jennifer O.; Noll, Matthew; Olsen, Shayna

    2014-01-01

    We have developed an upper-level undergraduate laboratory exercise that enables students to replicate a key experiment in developmental biology. In this exercise, students have the opportunity to observe live chick embryos and stain the apical ectodermal ridge, a key tissue required for development of the vertebrate limb. Impressively, every…

  2. Lower-limb amputation and effect of posttraumatic stress disorder on Department of Veterans Affairs outpatient cost trends.

    Science.gov (United States)

    Bhatnagar, Vibha; Richard, Erin; Melcer, Ted; Walker, Jay; Galarneau, Michael

    2015-01-01

    Department of Veterans Affairs (VA) outpatient costs were analyzed for combat Veterans injured in Iraq and Afghanistan from 2001 to 2008. Patients had serious lower-limb injuries (n = 170) or unilateral (n = 460) or bilateral (n = 153) lower-limb amputation(s). Total costs over the follow-up period (2003 to 2012) and annual costs were analyzed. Unadjusted mean costs per year in 2012 U.S. dollars were $7,200, $14,700 and $18,700 for limb injuries and unilateral and bilateral lower-limb amputation(s), respectively (p amputation(s) (p Amputation status was associated with an adjusted 3.12-fold increase in mean prosthetic cost per year (p amputation status (p amputation. Finally, PTSD affected cost for multiple domains of health, highlighting the importance of accurate diagnosis, treatment, and support for PTSD.

  3. Psychophysical correlates of phantom limb experience.

    Science.gov (United States)

    Katz, J

    1992-09-01

    Phantom limb phenomena were correlated with psychophysiological measures of peripheral sympathetic nervous system activity measured at the amputation stump and contralateral limb. Amputees were assigned to one of three groups depending on whether they reported phantom limb pain, non-painful phantom limb sensations, or no phantom limb at all. Skin conductance and skin temperature were recorded continuously during two 30 minute sessions while subjects continuously monitored and rated the intensity of any phantom limb sensation or pain they experienced. The results from both sessions showed that mean skin temperature was significantly lower at the stump than the contralateral limb in the groups with phantom limb pain and non-painful phantom limb sensations, but not among subjects with no phantom limb at all. In addition, stump skin conductance responses correlated significantly with the intensity of non-painful phantom limb paresthesiae but not other qualities of sensation or pain. Between-limb measures of pressure sensitivity were not significantly different in any group. The results suggest that the presence of a phantom limb, whether painful or painless, is related to the sympathetic-efferent outflow of cutaneous vasoconstrictor fibres in the stump and stump neuromas. The hypothesis of a sympathetic-efferent somatic-afferent mechanism involving both sudomotor and vasoconstrictor fibres is proposed to explain the relationship between stump skin conductance responses and non-painful phantom limb paresthesiae. It is suggested that increases in the intensity of phantom limb paresthesiae follow bursts of sympathetic activity due to neurotransmitter release onto apposing sprouts of large diameter primary afferents located in stump neuromas, and decreases correspond to periods of relative sympathetic inactivity. The results of the study agree with recent suggestions that phantom limb pain is not a unitary syndrome, but a symptom class with each class subserved by

  4. Specific injuries induced by the practice of trampoline, tumbling and acrobatic gymnastics.

    Science.gov (United States)

    Grapton, Xavier; Lion, Alexis; Gauchard, Gérome C; Barrault, Denys; Perrin, Philippe P

    2013-02-01

    The recreational and competitive practice of acrobatic sports, that is, trampoline, tumbling and acrobatic gymnastics (ACRO), is growing rapidly around the world. Many studies described the injuries affecting young artistic gymnasts, but only few concerned acrobatic sports. During a 5-year period, 357 traumatic events were collected in young acrobats practicing trampoline, tumbling or ACRO. Accident characteristics, level of expertise and training, injury location (upper limb, spine and lower limb), type of tissue injured (bone, cartilage, muscle, ligament and tendon) and provoking factors (intrinsic/behavioural and extrinsic) were investigated. Acrobats of national and international levels were mostly injured. Injuries occurring in acrobatic sports concerned predominantly the lower limbs and concerned in this body part mainly damages to ligaments. Forearm and knee injuries were preferentially related to trampoline. Ankle injuries were preferentially related to tumbling. Wrist injuries were preferentially related to ACRO. Upper limb bone damage and upper limb tendon damage were preferentially related to trampoline and ACRO, respectively. Intrinsic/behavioural factors were the main injury determinant in the three acrobatic sports. The main injuries in acrobatic sports (i.e. lower limbs) are similar to those observed in artistic gymnastics. Specific injuries may result from falls and incomplete and/or erroneous figure's landing and may also depend to the type of the landing surface. II.

  5. 无创性延迟肢体缺血预适应保护糖尿病大鼠缺血/再灌注心肌%Cardiac protective effects of noninvasive delayed limb ischemic preconditioning against ischemia-reperfusion injury in diabetic rats

    Institute of Scientific and Technical Information of China (English)

    朱学慧; 娄建石; 李玉梅; 袁恒杰; 吴艳娜; 康毅; 焦建杰

    2009-01-01

    AIM: To study the effects of noninvasive delayed limb ischemic preconditioning (NDLIP) on myocardium ischemia-reperfusion injury in diabetic rats. METHODS: The acute diabetic rat models were induced by injecting streptozotocin (STZ) through vena caudalis. The diabetic rats were randomly divided into ischemia-reperfusion (I/R) group, cardiac ischemic preconditioning (CIP) group and NDLIP group. Rats in NDLIP group subjected to NDLIP left hind limb for 3 days, and at the fourth day, all rats were subjected to myocardial ischemia/reperfusion injury. Rats in CIP group were myocardial ischemic preconditioning before ischemia. Blood pressure and electrocardiogram were monitored continuously. The effects of myocardial electrophysiology function, myocardial infarction size and myocardial enzyme were observed in the diabetic rats with NDLIP after myocardium ischemia-reperfusion injury, and the superoxide dismutase(SOD), the activities of glutathion peroxidase(GSH-Px), the content of mal-onaldehyde in rats muscular tissues were detected. RESULTS: The levels of blood glucose were increased and the body weights were decreased in diabetic model rats(P < 0.01). Compared with I/R group, the elevation extent of ST segment in NDLIP and CIP group were degraded, the emergence time of ventricular premature contraction and ventricular tachycardia were delayed and the duration of both was shortened, and the incidence of ventricular arrhythmia was decreased (P < 0.05), the myocardial infarct size was reduced(P < 0.01), the releases of cadiocyte lactate dehydrogenase (LDH), creatine kinase (CK), and creatine kinase isozyme were decreased (P<0.05, P < 0.01), the activities of SOD and GSH-Px in rats muscular tissues were increased (P < 0.01) and the content of MDA was decreased in CIP and NDLIP groups(P < 0.05, P <0.01). CONCLUSION: NDLIP can relieve cadiocyte damage induced by I/R injury in the diabetic rats and the leakage of cardiac muscle enzyme is decreased, and the physiologic

  6. Homeomorphisms Between Limbs of the Mandelbrot Set

    DEFF Research Database (Denmark)

    Branner, Bodil; Fagella, Nuria

    1999-01-01

    Using a family of higher degree polynomials as a bridge, together with complex surgery techniques, we construct a homeomorphism between any two limbs of the Mandelbrot set of equal denominator. Induced by these homeomorphisms and complex conjugation, we obtain an involution between each limb...... of the limbs in the plane. As usual we plough in the dynamical planes and harvest in the parameter space....

  7. Advanced rehabilitation techniques for the multi-limb amputee.

    Science.gov (United States)

    Harvey, Zach T; Loomis, Gregory A; Mitsch, Sarah; Murphy, Ian C; Griffin, Sarah C; Potter, Benjamin K; Pasquina, Paul

    2012-01-01

    Advances in combat casualty care have contributed to unprecedented survival rates of battlefield injuries, challenging the field of rehabilitation to help injured service members achieve maximal functional recovery and independence. Nowhere is this better illustrated than in the care of the multiple-limb amputee. Specialized medical, surgical, and rehabilitative interventions are needed to optimize the care of this unique patient population. This article describes lessons learned at Walter Reed National Military Medical Center Bethesda in providing advanced therapy and prosthetics for combat casualties, but provides guidelines for all providers involved in the care of individuals with amputation.

  8. Modular externally-powered system for limb prostheses

    Energy Technology Data Exchange (ETDEWEB)

    Seamone, W.; Hoshall, C.H.; Schmeisser, G.

    Many upper limb amputees especially those who have sustained high level amputations of injury to remaining portions of the body, are unable to use conventional prosthetic devices effectively. In an effort to help the more severely handicapped amputees and those who may for other reasons require capabilities that standard prostheses cannot provide, the Applied Physics Laboratory, in conjunction with the Johns Hopkins Medical Institutions, has developed a prosthetic system which is powered by rechargeable batteries. The amputee need supply only a control signal. This article describes the concept which is now being evaluated with the aid of amputee subjects, and discusses results obtained to data in field tests.

  9. Imaging of peripheral nerve lesions in the lower limb.

    Science.gov (United States)

    Simmons, Donald Neil; Lisle, David A; Linklater, James M

    2010-02-01

    Lower limb peripheral neuropathy may have a variety of causes. This article focuses on focal neural lesions because of neural entrapment associated with static mechanical compression or dynamic compression/stretching. Mechanical compression may relate to direct blunt trauma, surgical injury, mass effect associated with adjacent mass lesions, and frictional effects associated with fibrous bands. Stretching neural injury may be associated with abnormalities in alignment such as plano-valgus hindfoot and hindfoot pronation. Recurrent inversion ankle injuries may also cause neural injury. Neural injury may be associated with denervation of the muscles supplied by the nerve. Electromyography (EMG) remains the gold standard for diagnosis of denervation. Diagnostic imaging plays a complementary role to EMG in difficult cases, the anticoagulated patient, and in clarifying the etiology of an EMG-demonstrated neuropathy. Magnetic resonance imaging and ultrasound can be used in peripheral nerve imaging to demonstrate extrinsic compressive lesions, focal neural lesions such as neural edema and swelling, focal neural scarring (posttraumatic neuroma in continuity) and intraneural ganglia. Imaging can also demonstrate the effects of muscle denervation. Focal areas of tenderness can be highlighted using skin markers for magnetic resonance imaging and by transducer palpation on ultrasound. Ultrasound can be particularly useful in assessing for intrinsic lesions in small peripheral nerves because of the superior spatial resolution of ultrasound in assessing superficial structures. Plain x-rays (and sometimes computed tomography scanning) may show significant bone changes and should be the initial imaging modality.

  10. Injuries in elite Taekwondo Poomsae athletes.

    Science.gov (United States)

    Kazemi, Mohsen; Ingar, Anas; Jaffery, Ali

    2016-12-01

    Poomsae is the only non-contact and no opponent form of Taekwondo. The purpose of this descriptive study was to determine the type and rate of injuries in elite Canadian Poomsae athletes. Strain and joint dysfunction were the most common types of injuries in Poomsae. Lower limb and back were the most common area of injury in females and males respectively. Females with a lower rank in experience level (DAN≤ 3) were more likely to suffer from chronic overuse injuries compared to their male counterparts, who reported more acute injuries. Athletes ≤40 years of age were more prone to acute injuries compared to athletes over 40. As result of reflection on this study a Poomsae Injury Report Form was developed.

  11. Injuries in elite Taekwondo Poomsae athletes

    Science.gov (United States)

    Kazemi, Mohsen; Ingar, Anas; Jaffery, Ali

    2016-01-01

    Poomsae is the only non-contact and no opponent form of Taekwondo. The purpose of this descriptive study was to determine the type and rate of injuries in elite Canadian Poomsae athletes. Strain and joint dysfunction were the most common types of injuries in Poomsae. Lower limb and back were the most common area of injury in females and males respectively. Females with a lower rank in experience level (DAN≤ 3) were more likely to suffer from chronic overuse injuries compared to their male counterparts, who reported more acute injuries. Athletes ≤40 years of age were more prone to acute injuries compared to athletes over 40. As result of reflection on this study a Poomsae Injury Report Form was developed. PMID:28065994

  12. The road to recovery and rehabilitation for injured service members with limb loss: a focus on Iraq and Afghanistan.

    Science.gov (United States)

    Isaacson, Brad M; Weeks, Sharon R; Pasquina, Paul F; Webster, Joseph B; Beck, James P; Bloebaum, Roy D

    2010-01-01

    Amputation of an extremity due to traumatic injury or a vascular occlusive disease is a life-altering event that occurs when limb salvage is not possible. While an amputation is viewed as a life saving procedure clinically, limb deficiency may result in an immediate loss in social, physical and financial well-being for the patient. Military personnel returning from Operation Enduring Freedom and Operation Iraqi Freedom face unique challenges due to short residual limbs, unplanned amputations, high incidences of multiple limb loss, and accustomed activity levels prior to an amputation. The primary rehabilitation goal for these individuals is to provide them with an expedited recovery and progressive reintroduction into the civilian or active duty population. It is the purpose of this review to discuss the most frequent rehabilitation hardships service members endure following combat related trauma and future of prosthetic limb technology.

  13. Manifestações sistêmicas adversas em medicina intensiva após realização de perfusão isolada de membro com melfalan e hipertermia: relato de caso Adverse systemic reactions in intensive care medicine after isolated limb perfusion with melphalan and hyperthermia: case report

    Directory of Open Access Journals (Sweden)

    Fernando Oetterer Arruda

    2006-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A presença de efeitos adversos, inerentes a todos os tratamentos, justifica a necessidade do profundo conhecimento pela equipe médica para prevenção e tratamento de eventuais disfunções orgânicas, reduzindo o seu impacto. O objetivo deste estudo foi relatar um caso de paciente que apresentou diversas manifestações sistêmicas, após a realização de perfusão isolada de membro com melfalan e hipertermia. RELATO DO CASO: Paciente do sexo feminino, 64 anos, branca, com diagnóstico de melanoma na região de maléolo medial do membro inferior esquerdo. Seis meses após a excisão da lesão, realizou-se perfusão isolada do membro, com melfalan e hipertermia para conter o processo em evolução de possível metástase. A admissão na UTI apresentou síndrome da resposta inflamatória sistêmica (SIRS com instabilidade hemodinâmica refratária à expansão volêmica. Durante a internação evoluiu com quadro de edema agudo de pulmão e disfunção miocárdica, revertidos com sucesso, depois de adequada intervenção terapêutica. CONCLUSÕES: A presença de efeitos adversos, inerentes a todos os tratamentos oncológicos, justifica a necessidade do conhecimento pela equipe da terapia intensiva para prevenção e tratamento de eventuais disfunções orgânicas, reduzindo o impacto de sua morbimortalidade.BACKGROUND AND OBJECTIVES: The presence of adverse reactions, inherent to all treatments, justifies the necessity of deep knowledge, by the medical team of the prevention and treatment of occasional organic dysfunctions, reducing its impact. The purpose of this paper is to report a case comprising the several systemic adverse reactions after perfusion of limb with melphalan and hyperthermia. CASE REPORT: A white female, 64-years old patient with diagnosis of melanoma in the medial malleoli region of the left lower limb. Six months after surgical removal of wound, an isolated perfusion of limb was carried out with

  14. Major vascular injury from high-pressure water jet.

    Science.gov (United States)

    Harvey, R L; Ashley, D A; Yates, L; Dalton, M L; Solis, M M

    1996-01-01

    High-pressure water jets are used in industry as a cleaning and cutting tool. Penetrating injuries by these devices can produce minimal external evidence of extensive internal damage. We report a literature review and the case of a limb-threatening injury to the lower extremity caused by such a device.

  15. The effect of eccentric exercise on position sense and joint reaction angle of the lower limbs.

    Science.gov (United States)

    Paschalis, V; Nikolaidis, M G; Giakas, G; Jamurtas, A Z; Pappas, A; Koutedakis, Y

    2007-04-01

    Impaired position sense and impaired joint reaction angle of the lower limbs after muscle-damaging activities is a serious functional limitation that may lead to an increased risk of injury, particularly in older populations. The purpose of the present study was to examine whether position sense and joint reaction angle to release can be affected by eccentric exercise-induced muscle damage. Twelve women underwent an isokinetic exercise session of the lower limb. Isometric peak torque, delayed-onset muscle soreness, serum creatine kinase, position sense, and knee joint reaction angle to release were examined before, immediately after, and 24, 48, and 72 h post-exercise. Due to the effect of eccentric exercise, subjects persistently placed their lower limb at a more extended position, representing a shorter knee extensor muscle. Eccentric exercise increased the knee reaction angle of the lower limb after release from 0 degrees and 15 degrees but not from 30 degrees and 45 degrees . Position sense and joint reaction to release were similarly affected by eccentric exercise and independently of visual feedback. Position sense was impaired only immediately post-exercise (probably due to muscle fatigue), whereas impairment of the reaction angle to release persisted up to 3 days post-exercise (probably due to muscle damage). Attenuation of position sense and joint reaction angle of the lower limbs after damaging activities is a serious functional limitation that may lead to an increase risk of injury, particularly in older populations.

  16. Effect of HEMADO on Level of CK-MB and LDH Enzymes after Ischemia/Reperfusion Injury in Isolated Rat Heart

    Directory of Open Access Journals (Sweden)

    Mohammad Amani

    2013-01-01

    Full Text Available Introduction: Ischemia/Reperfusion (IR injury mainly causes the increase of enzymes involved in myocytes injury including CK-MB (creatine kinase-MB isoenzyme and LDH (lactate dehydrogenase. Leakage of CK-MB isoenzyme and LDH from myocardial tissues to blood is indicator of acute myocardial infarction. The aim of this study was to assess the effect of HEMADO on IR injury and its relationship with mitochondrial ATP-sensitive K+ channels (mitoKATP in rat heart. Methods: Twenty eight male Wistar rats (250-300g were divided into four groups (seven members in each group: control (without ischemia, I/R (with ischemia+without HEMADO, ischemia received HEMADO (HEMADO, ischemia received HEMADO and 5-HD (5-hydroxydecanoate, specific mitoKATP channel blocker (HEMADO+5-HD. The animals were anesthetized and the hearts were quickly removed and mounted on Langendorff apparatus and perfused by Krebs-Henseleit solution under constant pressure and temperature of 37ºC. After 20 minutes of stabilization, ischemic groups were exposed to 40 minutes of global ischemia and consecutive 90 minutes of reperfusion. Results: IR injury increased the level of LDH and CK-MB in the collected coronary flow during 5 minutes since start of reperfusion. HEMADO reduced the enzymes’ levels and using 5-HD abolished the effect of HEMADO. Conclusion: Our findings indicated that HEMADO could protect the heart against ischemia-reperfusion injury by decreasing the CK-MB and LDH levels. The cardioprotective effect of HEMADO may be mediated in part by mitoKATP.

  17. Study of L-arginine-nitric oxide pathway in ischemia-reperfusion injured limbs in rats

    Institute of Scientific and Technical Information of China (English)

    朱立军; 黄耀添; 裴国献

    2002-01-01

    Objective: To observe the change of nitric oxide (NO) levels in the blood and the morphological change of the muscles in the limbs of rats during the (IR) injury and after being intervened by L-arginine (L-Arg) and L-nitroarginine (L-NNA).   Methods: Sixty-six male Sprague-Dawley (SD) rats were used and grouped into the normal controls, the sham injury controls, the IR injury group and the intervention groups (L-Arg group and L-NNA group). After 6 hours of ischemia, followed by reperfusion for 3, 12 or 24 hours, the samples in the IR injury group were obtained. The rats in the intervention groups were given L-Arg (100 mmol/L) and L-NNA (10 mmol/L), respectively, through the abdominal cavity. Then the anterior tibial muscle in the right limb was obtained for histological examination, the anterior tibial muscle in the left limb for ultrastructure observation and the blood for assay of NO in all the rats. NO was assayed by indirect measurement of NO2/NO3 with Griess method.   Results: There was no significant difference of NO between the normal controls and the sham injury controls (P>0.05). But NO significantly decreased in the IR injury group (P0.05). In the L-NNA group, NO decreased to the undetectable level (P<0.01). Histological examination and ultrastructure observation showed the muscles were normal in the control groups. After 6 hours of ischemia, the skeletal muscles displayed injuries, and they were most severely injured after 12 hours of reperfusion. In the L-Arg group, the skeletal muscles were less injured, while in the L-NNA group, the injury was similar to that in the IR injury group.   Conclusions: When the limbs of the rats sustain IR, NO in the blood decreases. Meanwhile, the muscles in the limbs are injured. When L-Arg is given, NO in the blood is restored and the muscles are protected. When L-NNA completely inhibits NO, no protection of the muscles is shown.

  18. Gremlin1 induces anterior-posterior limb bifurcations in developing Xenopus limbs but does not enhance limb regeneration.

    Science.gov (United States)

    Wang, Yi-Hsuan; Keenan, Samuel R; Lynn, Jeremy; McEwan, James C; Beck, Caroline W

    2015-11-01

    Gremlin1 (grem1) has been previously identified as being significantly up-regulated during regeneration of Xenopus laevis limbs. Grem1 is an antagonist of bone morphogenetic proteins (BMPs) with a known role in limb development in amniotes. It forms part of a self-regulating feedback loop linking epithelial (FGF) and mesenchymal (shh) signalling centres, thereby controlling outgrowth, anterior posterior and proximal distal patterning. Spatiotemporal regulation of the same genes in developing and regenerating Xenopus limb buds supports conservation of this mechanism. Using a heat shock inducible grem1 (G) transgene to created temperature regulated stable lines, we have shown that despite being upregulated in regeneration, grem1 overexpression does not enhance regeneration of tadpole hindlimbs. However, both the regenerating and contralateral, developing limb of G transgenics developed skeletal defects, suggesting that overexpressing grem1 negatively affects limb patterning. When grem1 expression was targeted earlier in limb bud development, we saw dramatic bifurcations of the limbs resulting in duplication of anterior posterior (AP) pattern, forming a phenotypic continuum ranging from duplications arising at the level of the femoral head to digit bifurcations, but never involving the pelvis. Intriguingly, the original limbs have AP pattern inversion due to de-restricted Shh signalling. We discuss a possible role for Grem1 regulation of limb BMPs in regulation of branching pattern in the limbs.

  19. The Urodele Limb Regeneration Blastema: The Cell Potential

    Directory of Open Access Journals (Sweden)

    Kenyon S. Tweedell

    2010-01-01

    Full Text Available The developmental potential of the limb regeneration blastema, a mass of mesenchymal cells of mixed origins, was once considered as being pluripotent, capable of forming all cell types. Now evidence asserts that the blastema is a heterogeneous mixture of progenitor cells derived from tissues of the amputation site, with limited developmental potential, plus various stem cells with multipotent abilities. Many specialized cells, bone, cartilage, muscle, and Schwann cells, at the injury site undergo dedifferentiation to a progenitor state and maintain their cell lineage as they redifferentiate in the regenerate. Muscle satellite reserve stem cells that are active in repair of injured muscle may also dedifferentiate and contribute new muscle cells to the limb blastema. Other cells from the dermis act as multipotent stem cells that replenish dermal fibroblasts and differentiate into cartilage. The blastema primordium is a self-organized, equipotential system, but at the cellular level can compensate for specific cell loss. It is able to induce dedifferentiation of introduced exogenous cells and such cells may be transformed into new cell types. Indigenous cells of the blastema associated with amputated tissues may also transform or possibly transdifferentiate into new cell types. The blastema is a microenvironment that enables dedifferentiation, redifferentiation, transdifferentiation, and stem cell activation, leading to progenitor cells of the limb regenerate.

  20. Avoidable birth injury complicated with limb gangrene: a reflection of ...

    African Journals Online (AJOL)

    2015-11-10

    Nov 10, 2015 ... ries to the newborn resulting from mechanical forces categorized as birth ... when traction is applied to extract the fetus.6, 7 Gangrene which refers to the ... tocrit reading of 21%, Total White Cell Count was. 9,400/mm³ with ...

  1. Transplantation of adult monkey neural stem cells into a contusion spinal cord injury model in rhesus macaque monkeys

    DEFF Research Database (Denmark)

    Nemati, Shiva Nemati; Jabbari, Reza; Hajinasrollah, Mostafa

    2014-01-01

    OBJECTIVE: Currently, cellular transplantation for spinal cord injuries (SCI) is the subject of numerous preclinical studies. Among the many cell types in the adult brain, there is a unique subpopulation of neural stem cells (NSC) that can self-renew and differentiate into neurons. The study aims......, therefore, to explore the efficacy of adult monkey NSC (mNSC) in a primate SCI model. MATERIALS AND METHODS: In this experimental study, isolated mNSCs were analyzed by flow cytometry, immunocytochemistry, and RT-PCR. Next, BrdU-labeled cells were transplanted into a SCI model. The SCI animal model...... was confirmed by magnetic resonance imaging (MRI) and histological analysis. Animals were clinically observed for 6 months. RESULTS: Analysis confirmed homing of mNSCs into the injury site. Transplanted cells expressed neuronal markers (TubIII). Hind limb performance improved in trans- planted animals based...

  2. Disorders of Upper Limb Movements in Ataxia-Telangiectasia.

    Directory of Open Access Journals (Sweden)

    Aasef G Shaikh

    Full Text Available Ataxia-telangiectasia is known for cerebellar degeneration, but clinical descriptions of abnormal tone, posture, and movements suggest involvement of the network between cerebellum and basal ganglia. We quantitatively assessed the nature of upper-limb movement disorders in ataxia-telangiectasia. We used a three-axis accelerometer to assess the natural history and severity of abnormal upper-limb movements in 80 ataxia-telangiectasia and 19 healthy subjects. Recordings were made during goal-directed movements of upper limb (kinetic task, while arms were outstretched (postural task, and at rest. Almost all ataxia-telangiectasia subjects (79/80 had abnormal involuntary movements, such as rhythmic oscillations (tremor, slow drifts (dystonia or athetosis, and isolated rapid movements (dystonic jerks or myoclonus. All patients with involuntary movements had both kinetic and postural tremor, while 48 (61% also had resting tremor. The tremor was present in transient episodes lasting several seconds during two-minute recording sessions of all three conditions. Percent time during which episodic tremor was present was greater for postural and kinetic tasks compared to rest. Resting tremor had higher frequency but smaller amplitude than postural and kinetic tremor. Rapid non-rhythmic movements were minimal during rest, but were triggered during sustained arm postures and goal directed arm movements suggesting they are best considered a form of dystonic jerks or action myoclonus. Advancing age did not correlate with the severity of involuntary limb movements. Abnormal upper-limb movements in ataxia-telangiectasia feature classic cerebellar impairment, but also suggest involvement of the network between the cerebellum and basal ganglia.

  3. Eye Injuries

    Science.gov (United States)

    The structure of your face helps protect your eyes from injury. Still, injuries can damage your eye, sometimes severely enough that you could lose your vision. Most eye injuries are preventable. If you play sports or ...

  4. Sports Injuries

    Science.gov (United States)

    ... sometimes you can injure yourself when you play sports or exercise. Accidents, poor training practices, or improper ... can also lead to injuries. The most common sports injuries are Sprains and strains Knee injuries Swollen ...

  5. Spastic paretic stiff-legged gait: biomechanics of the unaffected limb.

    Science.gov (United States)

    Kerrigan, D C; Frates, E P; Rogan, S; Riley, P O

    1999-01-01

    A concern for individuals with hemiparesis affecting their gait, which heretofore has never been studied, is the possibility that various compensations occurring in the unaffected limb may strain or fatigue the muscles or ligaments and/or predispose to joint injury in that limb. We studied the biomechanics of the unaffected limb during walking in 20 subjects with hemiparesis who had stiff-legged gait as a result of stroke. An optoelectronic motion analysis and force platform system was used to estimate torques in all three planes about the hip, knee, and ankle. Sagittal plane joint motion and power about the unaffected hip, knee, and ankle were also studied. Data were compared with control walking data collected from 20 able-bodied controls. On average, peak torques and powers were all either reduced or the same compared with controls, even though in some instances values were >2 standard deviations (SD) above the control means. Our findings suggest that on average the probability of excessive muscular-tendon effort and the risk for biomechanical injury in the unaffected limb are minimal compared with able-bodied, walking controls. However, given individual variability, we recommend routine clinical gait analysis for all people with stiff-legged gait to eliminate excessive values in certain biomechanical parameters, which could, if not addressed, predispose to muscle-tendon strain or joint or ligamentous injury.

  6. Severely comminuted radius fracture presenting as a signature patterned injury

    Directory of Open Access Journals (Sweden)

    Saurabh Jain

    2016-01-01

    Full Text Available Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a “signature pattern injury” caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile.

  7. GWOT Vascular Injury Study 2 Supplemental Project: Impact of Prophylactic Fasciotomy

    Science.gov (United States)

    2015-10-01

    injury characteristics, complications , other injures, and limb salvage information. Information regarding fasciotomy wound management and iatrogenic... complications of fasciotomy will be obtained from individual patient records. Information specific for return-to-duty and long-term disability will be...injury will be used to determine fasciotomy rates, wound management, and iatrogenic complications . The impact of injury and fasciotomy on the

  8. Reliability of an instrument to determine lower limb comfort in professional football

    Directory of Open Access Journals (Sweden)

    Michael Kinchington

    2010-06-01

    Full Text Available Michael Kinchington1, Kevin Ball1, Geraldine Naughton21School of Human Movement, Recreation and Performance, Victoria University, Melbourne, Australia; 2The Centre of Physical Activity Across the Lifespan (COPAAL, Australian Catholic University, Victoria, AustraliaAims and Objectives: This study extends previous work in the field of injury awareness using a novel lower limb comfort index (LLCI, which was developed to assess comfort in professional football. Participants rated comfort for designated anatomical segments of the lower limb utilizing a seven point Likert scale. The aims of the study were (i to assess the reliability of the LLCI in a competitive football environment (Australian Rules and Rugby League, and (ii to assess whether LLCI measurements were responsive to changes in lower limb comfort over time.Methods and Results: The reliability of the LLCI was observed in two professional football environments: Training Week (mean difference 0.1 point, intra-class correlation coefficient, ICC 0.99 for n = 41 participants; and Match Day (mean difference 0.2 points, ICC 0.97 for n = 22 players. Measurements of lower limb comfort were responsive to changes in comfort over time. Within-player differences were not significant for periods 0–8 hrs (P > 0.05 but, generally, significant for time periods 0–24 hrs (P < 0.05, and significant between 24–96 hrs (P < 0.01. The results indicate that the LLCI was reliable when tested for repeated measures and indicated how the index measures lower limb comfort changes over time.Conclusion: This study shows that the use of a lower limb comfort index, when used in a competitive football environment, is both reliable and responsive to change during both a training week and under match day conditions.Keywords: lower limb comfort, musculoskeletal, football, injury

  9. Injury Statistics

    Science.gov (United States)

    ... Certification Import Safety International Recall Guidance Civil and Criminal Penalties Federal Court Orders & Decisions Research & Statistics Research & Statistics Technical Reports Injury Statistics NEISS Injury ...

  10. Epidemiology of post-traumatic limb amputation: a National Trauma Databank analysis.

    Science.gov (United States)

    Barmparas, Galinos; Inaba, Kenji; Teixeira, Pedro G R; Dubose, Joseph J; Criscuoli, Michele; Talving, Peep; Plurad, David; Green, Donald; Demetriades, Demetrios

    2010-11-01

    The purpose of this study was to examine the epidemiology and outcomes of posttraumatic upper (UEA) and lower extremity amputations (LEA). The National Trauma Databank version 5 was used to identify all posttraumatic amputations. From 2000 to 2004 there were 8910 amputated patients (1.0% of all trauma patients). Of these, 6855 (76.9%) had digit and 2055 (23.1%) had limb amputation. Of those with limb amputation, 92.7 per cent (1904/2055) had a single limb amputation. LEA were more frequent than UEA among patients in the single limb amputation group (58.9% vs 41.1%). The mechanism of injury was blunt in 83 per cent; most commonly after motor vehicle collisions (51.0%), followed by machinery accidents (19.4%). Motor vehicle collision occupants had more UEA (54.5% vs 45.5%, P amputation is not uncommon after trauma in the civilian population and is associated with significant morbidity. Although single limb amputation did not impact mortality, the need for multiple limb amputation was an independent risk factor for death.

  11. A Study of Correlations within the Dimensions of Lower Limb Parts for Personal Identification in a Sudanese Population

    Directory of Open Access Journals (Sweden)

    Altayeb Abdalla Ahmed

    2014-01-01

    Full Text Available The presence of an isolated limb or limb parts from different individuals presents a major challenge for medicolegal investigators in establishing identification in cases of wars, mass disasters, and criminal assaults because different populations have different sizes and proportions. The measurement of lower limb dimensions showed a high success rate in establishing individual identity in terms of sex and stature in various populations. However, there is a paucity of data concerning the correlation within the lower limb parts. This study aims to assess the existence of relationships within lower limb parts and to develop regression formulae to reconstruct limb parts from one another. The tibial length, bimalleolar breadth, foot length, and foot breadth of 376 right-handed Sudanese adults were measured. The results showed that all variables were significantly larger in males than in females. A significant positive correlation (P<0.001 was found within the lower limb parts. Sex-specific linear equations and multiple regression equations were developed to reconstruct the lower limb parts in the presence of single dimension or multiple dimensions from the same limb. The use of multiple regression equations provided a better reconstruction than simple regression equations. These results are significant in forensics and orthopedic reconstructive surgery.

  12. Pattern of bony injuries among civilian gunshot victims at tertiary care hospital in Karachi, Pakistan

    Institute of Scientific and Technical Information of China (English)

    Ghulam Mustafa Kaim Khani; Syed Mujahid Humail; Kamran Hafeez; Naveed Ahmed

    2015-01-01

    Purpose:Firearm injuries impose a continuous economic burden on society and hospital resources.The aim of this study was to assess the pattern of bony injuries among victims of gunshots.Methods:A retrospective study was conducted in the Department of Orthopedics,Dow University of Health Sciences and Civil Hospital Karachi from January 2011 to December 2012.Patients with isolated bony injuries were included while patients with other systemic injuries were excluded.Results:There were 90 cases and the majority of them were male (84.4%).Mean age was (32,52 ± 10.27) years.Most of the patients (72.2%) belong to the younger age group.A low velocity weapon was used in 61 (67.8%) cases and a high velocity weapon was used in 29 (32.2%) cases.Armed robbery (64.4%) was the cause of conflict in more than half of the cases.Lower limb was involved in 72.2%.Fifty eight (64.4%) patients remained hospitalized for 15-20 days and others for more than 20 days.Internal fixation with intramedullary nailing was done in 35 patients while K-wire was used in 5 patients.Fifty patients were managed with external fixation,either uniplanar or multiplanar ilizarov.Deep wound infection and nonunion were observed more often in high velocity injuries.Conclusion:Armed robbery was the leading cause of gunshot bony injuries in our hospital.Young males were victimized in a majority of cases.High velocity injuries were associated with more complications.

  13. Lower-limb muscular strategies for increasing running speed.

    Science.gov (United States)

    Schache, Anthony G; Dorn, Tim W; Williams, Gavin P; Brown, Nicholas A T; Pandy, Marcus G

    2014-10-01

    This clinical commentary discusses the mechanisms used by the lower-limb musculature to achieve faster running speeds. A variety of methodological approaches have been taken to evaluate lower-limb muscle function during running, including direct recordings of muscle electromyographic signal, inverse dynamics-based analyses, and computational musculoskeletal modeling. Progressing running speed from jogging to sprinting is mostly dependent on ankle and hip muscle performance. For speeds up to approximately 7.0 m/s, the dominant strategy is to push on the ground forcefully to increase stride length, and the major ankle plantar flexors (soleus and gastrocnemius) have a particularly important role in this regard. At speeds beyond approximately 7.0 m/s, the force-generating capacity of these muscles becomes less effective. Therefore, as running speed is progressed toward sprinting, the dominant strategy shifts toward the goal of increasing stride frequency and pushing on the ground more frequently. This strategy is achieved by generating substantially more power at the hip joint, thereby increasing the biomechanical demand on proximal lower-limb muscles such as the iliopsoas, gluteus maximus, rectus femoris, and hamstrings. Basic science knowledge regarding lower-limb muscle function during running has implications for understanding why sprinting performance declines with age. It is also of great value to the clinician for designing rehabilitation programs to restore running ability in young, previously active adults who have sustained a traumatic brain injury and have severe impairments of muscle function (eg, weakness, spasticity, poor motor control) that limit their capacity to run at any speed.

  14. Positional information in axolotl and mouse limb extracellular matrix is mediated via heparan sulfate and fibroblast growth factor during limb regeneration in the axolotl (Ambystoma mexicanum)

    OpenAIRE

    Phan, Anne Q.; Lee, Jangwoo; Oei, Michelle; Flath, Craig; Hwe, Caitlyn; Mariano, Rachele; Vu, Tiffany; Shu,Cynthia; Dinh, Andrew; Simkin, Jennifer; Muneoka, Ken; Bryant, Susan V.; Gardiner, David M

    2015-01-01

    Abstract Urodele amphibians are unique among adult vertebrates in their ability to regenerate complex body structures after traumatic injury. In salamander regeneration, the cells maintain a memory of their original position and use this positional information to recreate the missing pattern. We used an in vivo gain‐of‐function assay to determine whether components of the extracellular matrix (ECM) have positional information required to induce formation of new limb pattern during regeneratio...

  15. Penetrating arterial trauma to the limbs: outcome of a modified protocol

    Science.gov (United States)

    2013-01-01

    Background Penetrating arterial injuries to the limbs are common injuries in high volume trauma centers. Their overall surgical results reported in the literature are satisfactory - apart of those of the popliteal artery that still may lead to a significant incidence in amputations. With the present study we assessed our outcome with penetrating arterial injuries to the limb as to see if the direct involvement of vascular surgeons in the management of popliteal artery injuries leads to an improved (lowered) amputation rate. Results were benchmarked with our published results from previous years. Methods All patients sustaining penetrating arterial injuries to the limbs admitted to the Chris Hani Baragwanath Academic Hospital during an 18- month period ending in September 2011 were included in this study. Axillary, brachial and femoral artery injuries were operated on by the trauma surgeons as in the past. All popliteal artery injuries were operated on by the vascular surgeons (new). Results There were a total of 113 patients with 116 injuries, as some patients had multiple vascular injuries: 10 axillary, 47 brachial, 34 femoral and 25 popliteal artery injuries. Outcome of axillary, brachial and femoral artery injury repair were excellent and not significantly different from our previous reported experience. Injury to the popliteal artery showed a diminished re-exploration rate from 34% down to 10% (p = 0,049) and a decrease of amputation rate from 16% to 11% which was statistically not significant (p = 0,8). Conclusion Penetrating arterial trauma to the axillary, brachial and femoral artery is followed by excellent results when operated by trauma surgeons. In the case of popliteal artery injury operated by the vascular surgeons, the results of this study do not show any statistically significant difference related to amputation rate from our previous reported studies when operated by trauma surgeons. Taking into consideration the diminished re

  16. Injury Rates in Iranian Taekwondo Athletes; a Prospective Study

    Directory of Open Access Journals (Sweden)

    Ziaee

    2010-03-01

    Full Text Available Purpose Taekwondo, as the most popular martial art among Iranian sportsmen, might lead to injury for the athletes of this sport during competitions. We decided to report the incidence rate of injuries sustained by the athletes of this sport during national competitions. Methods All competitions of Iran national championship taekwondo league in 2006-2007 with 204 athletes were observed prospectively to detect the occurrence of injuries. The severity of injuries was classified into four groups (mild, moderate, severe, and critical according to the involvement of medical care team in the contest, ability of the athletes to resume and duration of probable absence of injured athletes from future competitions and training sessions. Athlete-Exposure (A-E was defined as the number of competitions multiplied by two. On this base, the rate of injury incidence per 1000 A-Es, the rate of injuries per time unit and the rate of injury occurred for each 100 athletes were considered as the major outcomes of this study. Results Of totally 1,338 A-Es, 93 injuries were recorded during the competitions. The rate of injury incidence was found to be 69.5 injuries per 1000 A-Es and the rate of injuries per minute of competitions was 0.023 which corresponded to 23.3 injuries per 1000 minutes of competitions. 45.6 injuries were occurred for each 100 athletes during the course of competitions. The most frequent injuries were mild (68.8% and critical injuries (24.7%, followed by moderate and severe injuries; 4.3% and 2.1%, respectively. Conclusion The rate of injury we found was lower than that of western countries. In spite of finding the lower limbs as the most frequent place of injuries in other studies, we found the upper limbs as the most predisposed place of injuries which might be due to difference in the method of combat of Iranian athletes with other athletes.

  17. Intervention of limb ischemic postconditioning on myocardial ischemia-reperfusion injury in primary percutaneous coronary intervention%肢体缺血后处理对直接冠状动脉介入治疗心肌再灌注损伤的干预研究

    Institute of Scientific and Technical In